The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases.

BACKGROUND: The outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) depends on the extent of peritoneal metastases (PM) and the completeness of cytoreduction (CCR). The role of preoperative assessment of PM is to identify potential candidates for CRS/HIPEC and to prevent unwarranted laparotomy for those who are not. Laparoscopy has been utilized for that purpose but with concerns related to technical difficulties and risk of trocar site metastases. Single-incision laparoscopic peritoneal exploration (SILPE) has not yet been evaluated in this setting. METHODS: This single-center retrospective study examined patients from January 2011 to December 2015 who underwent SILPE for diagnosis and staging of PM. Preoperative, intraoperative, and postoperative data were collected. For the patients who underwent subsequent laparotomy, a comparison between SILPE and laparotomy findings was made. RESULTS: A total of 183 SILPE were performed. Primary sites were mostly colorectal in 72 cases (39.3%) and gastric in 47 (25.7%). Overall, 157 patients (85.8%) had at least one prior abdominal surgery and 48 (26.2%) had 3 or more. SILPE was successfully achieved in 90.2% of the cases. Two (1.2%) intraoperative complications and five (3%) postoperative complications were observed. Eighty-one patients had laparotomy, with a median of 27 days between SILPE and laparotomy (4-162 days). The peritoneal carcinomatosis index PCI was 9.7 ± 7.5 at SILPE, and 13.5 ± 9.6 at laparotomy. The positive predictive value of SILPE to predict CCR was 79.5%. SILPE sensitivity was 75% and specificity 97%. The lowest sensitivity was in regions 9-12 ranging from 44 to 53%. CONCLUSION: SILPE can be safely incorporated in the management of patients with PM. It is a safe and feasible staging tool, allowing for preventing unwarranted laparotomy for patients not deemed candidate for CRS/HIPEC. Even though it may underestimate PCI, SILPE accurately predicts the possibility of CCR.

Specific computed virtual chromoendoscopy for detection of peritoneal carcinomatosis: an animal study.

BACKGROUND: Detection of an incipient Peritoneal Carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. The aim of this study was to create a murine model of incipient PC and to explore the PC with Fujinon Intelligent Chromo Endoscopy (FICE) in order to determine the wavelengths of the white light (WL) spectre that offer the highest contrast between PC nodules and surrounding peritoneum. METHODS: Eighteen BALB/c mice had intraperitoneal injection of murine colonic cancer CT26 cells. Peritoneal exploration with FICE was performed at different times. For each PC nodule, 1 WL and 10 FICE images were recorded. Each image was then divided into its elementary red, green and blue band images. Depending on the FICE channel, each elementary image corresponds to a specific wavelength of the WL spectre. Through numerical analysis of these images, the value of the nodule and the background peritoneum were obtained, and the contrast value was calculated. Contrast values obtained with the different wavelengths were then compared. RESULTS: PC grew in all the mice. The number as well as the size of PC nodules was increasingly high depending on the day of exploration. Mean PCI was 1.6 ± 1.2 at day 5, 7.7 ± 2.6 at day 8 and 15.0 ± 7.3 at day 10. A total number of 1805 elementary images of PC nodules were analysed. The wavelength that offered the best contrast between PC nodules and background peritoneum was 460 nm with a mean contrast value of 0.240 ± 0.151 (p < 0.0001). CONCLUSION: This murine model of incipient PC is effective, reliable and reproducible. A monochromatic light with a wavelength at 460 nm offers the highest contrast between PC nodules and background peritoneum, allowing a better detection of PC.

A feasibility study of the use of computed virtual chromoendoscopy for laparoscopic evaluation of peritoneal metastases.

BACKGROUND: Detection of an incipient peritoneal carcinomatosis (PC) is still challenging, and there is a crucial need for technological improvements in order to diagnose and to treat early this condition. Fujinon Intelligent Chromo Endoscopy (FICE) is a spectral image processing technology that enhances the contrast of the target tissue. The aim of this study is to investigate the usefulness of FICE system during peritoneal endoscopy and to establish the optimal FICE preset(s) for peritoneal exploration and PC detection. METHODS: A total of 561 images corresponding to 51 different areas of PC nodules and normal peritoneum were recorded during peritoneal endoscopies (For each area, one white light endoscopy (WLE) image and 10 FICE images). Three groups of 5 evaluators each: senior surgeons, surgical residents and medical students assessed these images. In a first questionnaire, the evaluators gave a score ranging from 1 to 10 to each image, and the three best FICE channels were determined. In a second questionnaire, five criteria were studied specifically: contrast, brightness, vascular architecture, differentiation between organs and detection of PC. The evaluators ranked the WLE and the three best FICE channel images according to these criteria. RESULTS: The three best FICE channels were channels 6, 2 and 9 with mean scores of 6.21 ± 1.59, 6.17 ± 1.48 and 6.06 ± 1.52, respectively. FICE Channel 2 was superior to WLE and other FICE channels, in terms of contrast (p < 10-4), visualization of vascular architecture (p < 10-4), differentiation between organs (p < 10-4) and detection of PC (p < 10-4); and ranked first in 38.8, 41.5, 31 and 46.9 % of the cases, respectively. CONCLUSION: FICE system provides adequate illumination of the abdominal cavity and a unique contrast that enhances the vascular architecture. FICE Channel 2 is the optimal channel for peritoneal exploration and could be a useful tool for the diagnosis of PC during peritoneal explorations.

Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis.

OBJECTIVE: To show the feasibility and the safety of peritoneal carcinomatosis (PC) evaluation by single-incision flexible endoscopy (SIFE) and to compare it to single-incision rigid endoscopy (SIRE). BACKGROUND: Direct peritoneal visualization, either by laparotomy or laparoscopy, continues to be the gold standard in diagnosing PC. We reported, in animal study, that combining single-incision laparoscopic surgery and flexible endoscopy improved evaluation of the peritoneal cavity in a live porcine model and in four human cadavers. METHODS: Patients, undergoing surgical exploration for diagnosis and staging of PC, were included in a prospective study. Using a superiority design a sample size of 47 patients was determined. Through a single incision, a standardized peritoneoscopy was conducted with rigid (SIRE) and with flexible endoscope (SIFE). Primary outcome was the access success rates for the 13 regions of the Peritoneal Carcinomatosis Index (PCI). RESULTS: Overall access to the 13 regions of PCI was successful in 83 % of the cases with SIRE and in 91.1 % with SIFE (p < 10(-10)). SIFE access rates were superior to SIREs' in the regions: R1 (87.2 vs. 61.7 %, p = 0.002), R2 (87.2 vs. 66 %, p = 0.004), R3 (85.1 vs. 59.6 %, p = 0.001) and R6 (80.9 vs. 61.7 %, p = 0.008). The mean PCI was higher (p < 10(4)) with SIFE 12.77 (±11.97) than with SIRE 11.77 (±11.63). CONCLUSION: This prospective, comparative study shows that SIFE was significantly superior to SIRE in the exploration of some difficult-to-access peritoneal areas, located in regions 1, 2, 3 and 6. These two minimally invasive staging procedures are safe, feasible and have to be seen as complementary rather than competing.

Transcolonic peritoneoscopy by using submucosal endoscopy with mucosal flap for the detection of peritoneal bead targeting in the porcine survival model: a feasibility and effectiveness study.

BACKGROUND: Staging peritoneoscopy is typically done by laparoscopy in the operating room. Natural orifice transluminal endoscopic surgery peritoneoscopy is an appealing alternative to the current approach. Transcolonic submucosal endoscopy with mucosal flap (SEMF) may provide natural orifice transluminal endoscopic surgery peritoneoscopy. OBJECTIVE: The aim was to verify the feasibility and safety of transcolonic peritoneoscopy with SEMF (TCPS) in a porcine survival model. DESIGN: Survival study. SETTING: Animal research unit. INTERVENTION: Seven target beads were placed in the peritoneal cavity by laparoscopy in each of 6 animals, and TCPS was performed to identify and touch beads to simulate biopsy. Animals were euthanized after 1 week, at which time, laparotomy was performed and the SEMF site was resected for histological analysis. MAIN OUTCOME MEASUREMENTS: The number of beads identified and touched during peritoneoscopy, rate of successful completion of TCPS, procedure time, mortality equivalent 1 week after TCPS, adverse event rate, histological assessment of SEMF site. RESULTS: All 7 beads in all 6 pigs were identified and touched during TCPS. The success rate of TCP was 100%. No major adverse events occurred during the procedure. The median procedure times for the creation of a submucosal tunnel, peritoneoscopy, closure of mucosal incision, and entire procedure were 19.5, 17, 9.5, and 45 minutes, respectively. All pigs survived until euthanasia, and there was no evidence of peritonitis or severe infection. LIMITATIONS: Animal study, single endoscopist, small sample size. CONCLUSION: Results of this study indicate that TCPS is feasible and safe in a porcine survival model.

Natural orifice transluminal endoscopic surgery (NOTES) for clinical management of intra-abdominal diseases.

Clinical research on natural orifice transluminal endoscopic surgery (NOTES) has been increasingly reported over the past 5 years and more than 1200 patients have received various NOTES procedures. The present article reviews the clinical practice of NOTES for the treatment of intra-abdominal diseases, and was carried out through systematic search with specific keywords in major databases for NOTES-related clinical literature. The last date of the search was 15 August, 2012. Transvaginal cholecystectomy is the commonest NOTES procedure reported, and its clinical feasibility and safety was established through prospective case series and randomized trials. There is a regional difference in NOTES development with the majority of NOTES fromCaucasian countries being transvaginal cholecystectomy and most reports from Asian countries being NOTES-related procedures. Safe closure of gastrointestinal access remains challenging, and novel endoscopic instruments are essential to enhance future development of NOTES.

A Single-Center Experience: The Diagnostic Role of Peritoneoscopy in Patients with Exudative Ascites.

BACKGROUND AND AIM: The causes of exudative and transudative ascites can be detected through noninvasive methods nowadays. In selected cases, peritoneoscopy could be necessary for definitive diagnosis. In this retrospective study, we aimed to present the peritoneal biopsy results of patients who had exudative ascites with unclear etiology. MATERIALS AND METHODS: A retrospective analysis was performed in 86 patients who had exudative ascites of unclear etiology. All the patients showed abnormalities of the peritoneum or greater omentum as determined by abdominal ultrasonography and underwent peritoneoscopy between January 2012 and December 2015. Patient data were obtained from hospital records. RESULTS: Eighty-six patients (male: 22; 25.6%, mean age ± standard deviation: 57.97 ± 15.97) who had exudative ascites of unclear etiology were included to the study. The success rate of the procedures was 100% (86/86). A specific histopathological diagnosis was made in all patients, with an overall diagnostic accuracy of 100%. Among the 86 diagnosed patients, 43 (50%) were peritonitis carcinomatosa, 21 (24.4%) were tuberculous peritonitis, 14 (16.3%) were mesothelioma, 4 (4.7%) were chronical inflammation, and 1 (1.2%) was lymphoma. Three (3.5%) patients had normal peritoneal biopsy findings. DISCUSSION: Peritoneoscopy is a safe and efficient alternative method due to its high diagnostic capacity in selected patients who have exudative ascites of unclear etiology.

Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification.

Introduction: Peritoneal tuberculosis is a common type of abdominal tuberculosis. The most commonly used classification divides peritoneal tuberculosis into wet-ascitic type, dry-plastic type, and fixed-fibrotic type. Areas covered: We performed a systematic literature search on the definitions of existing classification of peritoneal tuberculosis. The literature search identified confusion in the classification of peritoneal tuberculosis. The classification system also fails to classify some patterns of peritoneal tuberculosis like an abdominal cocoon and a substantial overlap in various categories was found. The impact of the present classification on clinical management is unclear. Lack of prospective studies and the presence of heterogeneity in reporting add to the confusion. Expert opinion: We suggest that a uniform system which better classifies peritoneal tuberculosis and helps in clinical management should be used in future studies. We propose a simple, clinico-radiological classification of peritoneal tuberculosis into two types: distension-dominant and/or pain-obstruction dominant based on the clinical presentation. This approach will be relevant to clinicians as patients with the pain-obstruction dominant presentation are more likely to receive surgical interventions and may benefit from additional measures aimed to reduce fibrosis-like addition of steroids to ATT. Future studies should aim to validate the proposed clinico-radiological classification in patients with peritoneal tuberculosis.

Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management.

Minimally invasive surgery during abdominal, thoracic and urological procedures has become the standard management of many surgical interventions in adults. Recent development of smaller devices has allowed the management of many paediatric surgeries using these minimally invasive techniques. However, the lack of knowledge of (a) adequate management of haemodynamic and respiratory alterations occurring during those procedures and (b) postoperative advantages of these techniques over open surgeries, still impairs their development. The current review aimed to clarify mechanisms of those haemodynamic and respiratory alterations, propose easy rules in order to overcome them and shed the light on potential postoperative advantages of minimally invasive surgery in paediatrics.

Outcomes of dialysis catheters placed by the Y-TEC peritoneoscopic technique: a single-center surgical experience.

BACKGROUND: In the last few years, peritoneal dialysis (PD) catheter placement techniques and outcomes have become important because of the growing population of PD patients. Although there are a growing number of catheters placed by the minimally invasive Y-TEC peritoneoscopic technique, there are still limited data on outcomes for these catheters, especially those placed by a surgeon. We aimed to conduct a retrospective study of our experience with PD catheters placed by the Y-TEC peritoneoscopic technique in our institution. METHODS: We reviewed patients with peritoneoscopic PD catheter insertion over the last decade and described their complications and outcomes. In a secondary analysis, we compared the outcomes and complications of these catheters with those with open placement placed by the same surgeon. RESULTS: We had complete data on 62 patients with peritoneoscopic catheter placement during the study period. The mean age was 55 years, 48.4% were females and the most common cause of end-stage renal disease was diabetes mellitus (33%). Surgical complications were seen in only 6/62 (9.6%) and peritonitis in 16/62 (26%) of peritoneoscopic catheters. Most catheters were used after 2 months of placement, while 12.3% were used within 2 months. When compared with 93 patients with open placement of catheters as a secondary analysis, peritoneoscopic catheters were found to have a higher 2-year survival. CONCLUSION: Our large series of peritoneoscopically placed catheters by a surgeon demonstrate low surgical complications and peritonitis rates as well as superior 2-year survival compared with open placement of catheters.

Prevalencia de hernia inguinal contralateral diagnosticada por peritoneoscopía con factores de riesgo, en niños y niñas menores de 5 años del 1 de marzo de 2015 al 31 de marzo de 2018 / Prevalence of contralateral inguinal hernia diagnosed by peritoneoscopy with risk factors, in boys and girls under 5 years of age from March 1, 2015 to March 31, 2018

Las hernias inguinales son las anomalías más comunes en pediatría que requieren de tratamiento quirúrgico. El 70% desarrolla una hernia inguinal unilateral y el 30% restante desarrolla hernia inguinal contralateral. La finalidad de llevar a cabo una exploración contralateral es disminuir el riesgo de recurrencia de hernias metacrónicas en pacientes de riesgo que tienen persistencia del processus vaginalis, así como evitar el daño a estructuras subyacentes por llevar a cabo una exploración abierta1,2. El objetivo fue determinar la prevalencia de hernias inguinales contralaterales en niños y niñas menores de 5 años con factores de riesgo, identificadas a través de peritoneoscopía del 1 de marzo de 2015 al 31 de marzo del 2018 en el Hospital Roosevelt. El diseño de este estudio fue descriptivo y transversal. Se realizó en el departamento de Cirugía Pediátrica del Hospital Roosevelt en la ciudad de Guatemala. Los materiales y métodos empleados consistieron en un estudio realizado a través de la revisión de 128 expedientes de menores de 5 años del Departamento de Cirugía Pediátrica del Hospital Roosevelt que hayan presentado una hernia inguinal entre el período indicado y a quiénes se les practicó peritoneoscopía. Como resultado se comprobó que la prevalencia de hernia inguinal contralateral diagnosticada por peritoneoscopía fue del 59% IC(44,72), 26 casos, en cuyos casos se efectuó cirugía correctiva bilateral, sin recurrencia. Esto permitió concluir que la prevalencia de hernias inguinales se da con mayor frecuencia en niños y niñas menores. (AU)

Inguinal hernias are the most common anomalies in pediatrics that require surgical treatment. 70% develop a unilateral inguinal hernia and the remaining 30% develop a contralateral metachronous inguinal hernia. The purpose of performing a contralateral examination is to decrease the risk of recurrence of metachronoushernias in risk patients who have persisten tprocessus vaginalis, as well as to avoid damage to underlying structures by conducting an open exploration1,2. The objective was to determine the prevalence of contralateral inguinal hernias in boys and girls under 5 years of age with risk factors, identified through peritoneoscopy from March 1, 2015 to March 31, 2018 at Roosevelt Hospital. The design of this study was descriptive and transversal. It was performed in the Pediatric Surgery department of the Roosevelt Hospital in Guatemala City. The materials and methods used consisted of a study conducted through the review of 128 records of children under 5 years of the Department of Pediatric Surgery at Roosevelt Hospital who presented an inguinal between the indicated period and who underwent peritoneoscopy. As a result, it was found that the prevalence of contralateral inguinal hernia diagnosed by peritoneoscopy was 59% IC(44,72) 26 cases, in which cases bilateral corrective surgery was performed, without recurrence. This allowed us to conclude that the prevalence of inguinal hernias occurs more frequently in boys and girl. (AU)

Endoscopic ultrasound-assisted direct peritoneal visualization with a small-caliber scope: A proof of concept study in a swine model.

BACKGROUND: Laparoscopic and natural orifice transluminal endoscopic surgery techniques can diagnose peritoneal findings that suggest tumor cell dissemination. However, they have not been incorporated into routine practice, mainly owing to their complexity. To develop a minimally invasive endoscopic technique for the diagnosis of peritoneal findings, we conducted feasibility study using an acute swine model. MATERIALS AND METHODS: This study involved six domestic pigs. Trans-gastric access to the peritoneal cavity was performed utilizing an endoscopic ultrasound fine needle aspiration (EUS-FNA) technique. After dilation of the needle hole with a biliary dilatation catheter and balloon, a small-caliber scope was inserted into the peritoneal cavity. Peritoneal images were obtained with the scope and a high-resolution microendoscope (HRME). Main outcome measurements were technical feasibility and time needed to access the peritoneal cavity. RESULTS: Direct visualization of the peritoneum was successful in all six pigs and gained access to the gross appearance of the peritoneal cavity. HRME imaging with topical contrast agent also obtained reasonable quality images representing nuclei of the peritoneal mesothelium. Average operation time from the initiation of EUS-FNA to acquiring peritoneal images was 26.5 min (range 15-40 min). Autopsy found no damage to the adjacent organs, and stomach wall defects were tightly closed with hemostasis clips. CONCLUSION: EUS-assisted direct peritoneal visualization with small-caliber scope is technically feasible. HRME may assist in the diagnosis of findings on the peritoneum.

Forward-viewing endoscopic ultrasound-guided NOTES interventions: a study on peritoneoscopic potential.

AIM: To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS). METHODS: This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications. RESULTS: In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study. CONCLUSION: Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES.

Role of ascites adenosine deaminase in differentiating between tuberculous peritonitis and peritoneal carcinomatosis.

AIM: To investigate the usefulness of tumor markers and adenosine deaminase in differentiating between tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC). METHODS: A retrospective analysis of data was performed on consecutive patients who underwent peritoneoscopic and abdominal computed tomography (CT) evaluations. Among 75 patients at the Seoul National University Hospital from January 2000 to June 2010 who underwent both tests, 27 patients (36.0%) and 25 patients (33.3%) were diagnosed with TBP and PC, respectively. Diagnosis was confirmed by peritoneoscopic biopsy. RESULTS: Serum c-reactive protein (7.88 ± 6.62 mg/dL vs 3.12 ± 2.69 mg/dL, P = 0.01), ascites adenosine deaminase (66.76 ± 32.09 IU/L vs 13.89 ± 8.95 IU/L, P < 0.01), ascites lymphocyte proportion (67.77 ± 23.41% vs 48.36 ± 18.78%, P < 0.01), and serum-ascites albumin gradient (0.72 ± 0.49 g/dL vs 1.05 ± 0.50 g/dL, P = 0.03) were significantly different between the two groups. Among tumor markers, serum and ascites carcinoembryonic antigen, serum carbohydrate antigen 19-9 showed significant difference between two groups. Abdominal CT examinations showed that smooth involvement of the parietal peritoneum was more common in the TBP group (77.8% vs 40.7%) whereas nodular involvement was more common in the PC group (14.8% vs 40.7%, P = 0.04). From receiver operating characteristic (ROC) curves ascites adenosines deaminase (ADA) showed better discriminative capability than tumor markers. An ADA cut-off level of 21 IU/L was found to yield the best results of differential diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value were 92.0%, 85.0%, 88.5% and 89.5%, respectively. CONCLUSION: Besides clinical and radiologic findings, ascitic fluid ADA measurement is helpful in the differential diagnosis of TBP and PC.

Determinación de la factibilidad técnica y seguridad de un abordaje endoscópico transgástrico a la cavidad peritoneal en un modelo porcino / Determination of the technical feasibility and safety of transgastric peritoneal approach in a pig model

La viabilidad de un abordaje transgástrico para realizar peritoneoscopia y biopsia hepática ha sido demostrada en estudios previos en animales. Objetivo. Nuestro objetivo fue determinar la viabilidad y seguridad de un abordaje transgástrico peritoneal en una experiencia local. Resultados. El abordaje transgástrico con modelo similar a PEG (gastrostomía endoscópica percutánea) se realizó en 3 cerdos de la especie suis scrofa domesticus; el tiempo promedio del procedimiento fue de 102 minutos, no hubo complicaciones relacionadas con el acceso, y la necropsia no evidenció ningún daño de órganos adyacentes al estómago, aunque el cierre de la pared gástrica no fue exitoso en 2 cerdos. Conclusiones. Este estudio reporta la experiencia local con un abordaje transgástrico peroral a la cavidad peritoneal, técnicamente viable. El abordaje similar a PEG es simple y seguro, el cierre de la pared gástrica requiere destreza y mejor tecnología

Background. The feasibility of peroral transgastric peritoneoscopy and liver biopsy has been demonstrated in prior animal studies.Objective. Our purpose was to determine the feasibility and safety of transgastric peritoneal approach in local experience. Designs. Animal experimental feasibility study. Results. The peritoneal transgastric approach with PEG- like model was used in 3 pigs suis scrofa domesticus specie. The average procedure was 102 minutes, it did no have complications related to the access, and the necropsy did not reveal any damage to organs adjacent to the stomach. Nevertheless the gastric wall close was not successful in 2 pigs. Conclusions. This study report the local experience with peroral transgastric approach to peritoneal cavity, it’s technically feasible, a PEG- like transgastric model is simple and safe, the close of gastric wall requires skill and best technology.

Nuestra experiencia en esplenectomía laparoscópica versus convencional / Our experience in laparoscopic splenectomy versus conventional splenectomy

Se realizó un estudio comparativo transversal de 28 pacientes con enfermedades hematológicas a los cuales se les realizó esplenectomía, 14 por la vía convencional y 14 por cirugía de mínimo acceso, con el objetivo de realizar una comparación entre ambas técnicas quirúrgicas, en el Servicio de Cirugía del Hospital Universitario Abel Santamaría, en el período comprendido desde Mayo de1996 hasta Mayo del 2002. Se aplicó una encuesta tomando como fuente las historias clínicas que se encuentran en el archivo del hospital, donde se analizó la edad, diagnóstico preoperatorio, tiempo quirúrgico, complicaciones, estadía hospitalaria, y a los resultados les fue aplicado el método estadístico de Chi cuadrado. Los principales resultados encontrados en nuestro trabajo fueron: en el grupo de esplenectomía laparoscópica 12 pacientes se fueron de alta en las primeras 96 horas, se operaron 8 pacientes entre 180 y 240 minutos y este grupo presentó costos hospitalarios menores. En el grupo de Esplenectomía convencional 11 pacientes se fueron de alta entre los 7 y 20 días, 12 pacientes se operaron entre 60 y 180 minutos y presentaron sepsis de la herida quirúrgica 6 casos.

A comparative cross ? sectional study is performed in 28 patients suffering from blood disorders who underwent a splecnectomy (14 using the conventional approach and 14, the minimal access procedures) aimed at performing a comparison between both surgical procedures by Surgical Department at Abel Santamaría University Hospital during May 1996 ? May 2002. A survey was being carried out taking the clinical records from the hospital archive and age, preoperative diagnosis, surgery time, complications, hospital stay were analyzed and it was used the chi ? square statistical method. The main results found in out study were: 12 patients were discharged from the hospital after 96 hours (laparoscopic splenectomy group), the surgery time in patients ranged between 180 and 240 minutes and this group presented the lower hospital cost. In the conventional splenectomy group, 11 patients were discharged ranged between 60 and 180 minutes and presented wound sepsis (6 cases).

A Case of Tuberculous Peritonitis Confirmed by Peritoneoscopy

Tuberculous peritonitis is mainly transmitted via hematogenous spreading of tuberculous bacilli. But sometimes this disease is occured, as the abdominal lymph node infected by the localized tuberculous enteritis was ruptured We pressent the report and the brief review of related literatures, who experienced a case of tuberculous peritonitis confirmed by paracentiesis and peritoneoscopic examination in a 9 years old male patient who was suspected toa malignant tumor because of the recent unexplained abdominal distension.

Retroperitoneal laparoscopic adrenalectomy (report of 52 cases) / 中华泌尿外科杂志

Objective To evaluate retroperitoneal laparoscopic adrenalectomy. Methods From June of 1999 to January of 2001, retroperitoneal laparoscopic adrenalectomy was performed on 52 patients with adrenal diseases, including 34 cases of aldosterone-preducing adenoma,3 nodular hyperplasia bilateral in 1, 5 Cushing's syndrom,1 Cushing's disease, 3 adrenal pheochromacytoma (bila- teral in 1), 4 nonfunctional adrenal adenoma, 1 myelolipoma and 1 metastasis carcinoma. Results 54 sessions of retroperitoneal adrenalectomy have been carried out for 52 patients (2 on both sides) with success in 51 procedures. The procedure was converted to open operation in 3 occasions because of bleeding or adhesion. The mean operation time was 135 minutes (40～270 min), and the estimated blood loss 45 ml (5～150 ml) with no need of transfusion. The postoperative hospital stay was 6 d (3～14 d) and the mean analgesia consumed 8.5 mg (0～50 mg) of morphine equivalents with no need of any analgesic at all in 17 patients. Conclusions Retroperitoneal laparoscopic adrenalectomy was less traumatic to the patients, with less postoperative discomfort and quicker recovery. The procedure should be considered as the first choice of therapy for benign adrenal diseases.

Primary idiopathic chylopericardium: report of a case and review of the literature

Primary or isolated chylopericardium of unknown etiology is considered a rare cause of pericardial effusion. Its etiology is obscure but certain communication between the lymphatic system and pericardial sac was suggested. Up to 1991, there was only one case report that successfully showed the direct communication by a lymphangiogram. We report a case of chylopericardium occurring in a nearly asymptomatic 22-year-old man with no apparent history of trauma, infection or mediastinal neoplasm, in which we succeeded in visualizing the communication between the thoracic duct and pericardial sac by lymphangiography and computed tomography of the chest. A review of the previous cases is described also.