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Papers by Pablo Merchán del Hierro

Revista Médica del Hospital José Carrasco Arteaga, 2015

et al.; licencia Rev Med HJCA. Este es un artículo de acceso abierto distribuido bajo los término... more et al.; licencia Rev Med HJCA. Este es un artículo de acceso abierto distribuido bajo los términos de "Creative Commons Attribution License" (http://creativecommons. org/licenses/by/2.0), el cual permite el uso no restringido, distribución y reproducción por cualquier medio, dando el crédito al propietario del trabajo original. El dominio público de transferencia de propiedad (http:// creativecommons.org/publicdomain/zero/1.0/) aplica a los datos recolectados y disponibles en este artículo, a no ser que exista otra disposición personal del autor.

Revista Argentina de Cirugía, 2021

Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is ass... more Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule. Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones. Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020. Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation. Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive app...

Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells i... more Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells is a rare, aggressive variety of gallbladder cancer, with symptoms mimicking cholecystitis. Survival and prognosis are worse that other types of gallbladder cancer despite surgery and chemotherapy. The aim of this article is to describe a case of a rare gallbladder cancer with specific histology and the treatment performed.

Background:The advances in perioperative care and immunosuppressive treatment resulted in a signi... more Background:The advances in perioperative care and immunosuppressive treatment resulted in a significant increase in survival of transplant patients; as a result, cholelithiasis is more common in transplant patients.Objective: The aim of this study is to analyze and describe the results obtained in cholecystectomies in heart transplant patients.Material and methods: We selected patients by cross-referencing the databases of heart transplantation and scheduled biliary surgeries, and collected information on their medical history, clinical parameters and laboratory tests, among other data.Results: Between January 1994 and December 2017, 154 heart transplant procedures were performed; mean age was 40 years; 16 underwent laparoscopic cholecystectomy after heart transplantation and were included in this study. There were no complications, readmissions or deaths.Conclusion: Laparoscopic cholecystectomy is safe and is the method of choice for heart transplant patients with cholelithiasis. I...

Revista Médica del Hospital José Carrasco Arteaga, 2021

BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small ston... more BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small stones to the duodenum. However, asymptomatic migration of stones larger than 1cm (macrolithiasis) is atypical. We present a case of migration of a macrocalculus located in the middle of the common bile duct. CASE REPORTS: We present the case of a 27-years-old man, who consulted for postprandial epigastric pain, that started 4 months ago. Abdominal ultrasound showed biliary sludge and common bile duct macrocalculus, with Cholangio-MRI the diagnosis was confirmed. A laparoscopic cholecystectomy with intraoperative cholangiography was performed. EVOLUTION: During the laparoscopic cholecystectomy, no stones were evidenced in the intraoperative cholangiograpy. Due to the disagreement between the preoperative IOC images, transcystic instrumentation with a Dormia basket was performed, without stone extraction. The patient had a favorably evolution, without complications due to the stone migration....

Cirugía Española (English Edition), 2020

Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is al... more Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers.

Revista Médica del Hospital José Carrasco Arteaga, 2016

Revista Médica del Hospital José Carrasco Arteaga, 2016

INTRODUCCION: La prevalencia de trombosis de la vena cava inferior en la poblacion general oscila... more INTRODUCCION: La prevalencia de trombosis de la vena cava inferior en la poblacion general oscila entre 4% y15%, mientras que la prevalencia de trombosis en la vena ovarica varia entre el 0.15% y 0.18%, presentandose tambien esta patologia en mujeres embarazadas. CASO CLINICO: Se presenta el caso de una paciente de 32 anos, a quien se le realizo una cesarea por compromiso del bienestar fetal a las 36 semanas de gestacion. 24 horas despues presento dolor en fosa iliaca izquierda y edema de extremidades inferiores. Es diagnosticada de trombosis de vena cava inferior junto con una trombosis de la vena ovarica derecha de manera incidental por ecografia. EVOLUCION: Para el manejo inicial de la trombosis se utilizo heparina de bajo peso molecular y posteriormente se realizo una trombectomia farmaco-mecanica con Angio-jet ®. La falla renal aguda y el manejo del dolor se corrigieron mediante fluidos intravenosos, paracetamol y opioides. La paciente evoluciono sin complicaciones y fue dada de alta con tratamiento a base de heparina de bajo peso molecular por seis meses. CONCLUSION: Las terapias invasivas para la trombosis ofrecen un alivio rapido y prevencion para el sindrome postrombotico. La evidencia de estas terapias esta en aumento, sobre todo con el uso de la trombectomia farmaco-mecanica, que muestra un fuerte potencial de beneficios clinicos.

Revista Argentina de Cirugía, 2021

Background: The prevalence of common bile duct stones associated with cholelithiasis increases wi... more Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithias...

Revista Médica del Hospital José Carrasco Arteaga, 2015

et al.; licencia Rev Med HJCA. Este es un artículo de acceso abierto distribuido bajo los término... more et al.; licencia Rev Med HJCA. Este es un artículo de acceso abierto distribuido bajo los términos de "Creative Commons Attribution License" (http://creativecommons. org/licenses/by/2.0), el cual permite el uso no restringido, distribución y reproducción por cualquier medio, dando el crédito al propietario del trabajo original. El dominio público de transferencia de propiedad (http:// creativecommons.org/publicdomain/zero/1.0/) aplica a los datos recolectados y disponibles en este artículo, a no ser que exista otra disposición personal del autor.

Revista Argentina de Cirugía, 2021

Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is ass... more Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule. Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones. Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020. Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation. Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive app...

Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells i... more Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells is a rare, aggressive variety of gallbladder cancer, with symptoms mimicking cholecystitis. Survival and prognosis are worse that other types of gallbladder cancer despite surgery and chemotherapy. The aim of this article is to describe a case of a rare gallbladder cancer with specific histology and the treatment performed.

Background:The advances in perioperative care and immunosuppressive treatment resulted in a signi... more Background:The advances in perioperative care and immunosuppressive treatment resulted in a significant increase in survival of transplant patients; as a result, cholelithiasis is more common in transplant patients.Objective: The aim of this study is to analyze and describe the results obtained in cholecystectomies in heart transplant patients.Material and methods: We selected patients by cross-referencing the databases of heart transplantation and scheduled biliary surgeries, and collected information on their medical history, clinical parameters and laboratory tests, among other data.Results: Between January 1994 and December 2017, 154 heart transplant procedures were performed; mean age was 40 years; 16 underwent laparoscopic cholecystectomy after heart transplantation and were included in this study. There were no complications, readmissions or deaths.Conclusion: Laparoscopic cholecystectomy is safe and is the method of choice for heart transplant patients with cholelithiasis. I...

Revista Médica del Hospital José Carrasco Arteaga, 2021

BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small ston... more BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small stones to the duodenum. However, asymptomatic migration of stones larger than 1cm (macrolithiasis) is atypical. We present a case of migration of a macrocalculus located in the middle of the common bile duct. CASE REPORTS: We present the case of a 27-years-old man, who consulted for postprandial epigastric pain, that started 4 months ago. Abdominal ultrasound showed biliary sludge and common bile duct macrocalculus, with Cholangio-MRI the diagnosis was confirmed. A laparoscopic cholecystectomy with intraoperative cholangiography was performed. EVOLUTION: During the laparoscopic cholecystectomy, no stones were evidenced in the intraoperative cholangiograpy. Due to the disagreement between the preoperative IOC images, transcystic instrumentation with a Dormia basket was performed, without stone extraction. The patient had a favorably evolution, without complications due to the stone migration....

Cirugía Española (English Edition), 2020

Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is al... more Laparoscopic surgery is the gold standard treatment of symptomatic gallstones. For some, it is also the treatment of choice for choledocholithiasis. Certain special and rare circumstances regarding the number, size and location of bile duct stones or altered bile duct anatomy (embryonic or acquired), can be challenging to resolve with usual laparoscopic techniques. For these situations, we describe 10 surgical strategies that are relatively simple and inexpensive to apply, making them appropriate to be used in most surgical centers.

Revista Médica del Hospital José Carrasco Arteaga, 2016

Revista Médica del Hospital José Carrasco Arteaga, 2016

INTRODUCCION: La prevalencia de trombosis de la vena cava inferior en la poblacion general oscila... more INTRODUCCION: La prevalencia de trombosis de la vena cava inferior en la poblacion general oscila entre 4% y15%, mientras que la prevalencia de trombosis en la vena ovarica varia entre el 0.15% y 0.18%, presentandose tambien esta patologia en mujeres embarazadas. CASO CLINICO: Se presenta el caso de una paciente de 32 anos, a quien se le realizo una cesarea por compromiso del bienestar fetal a las 36 semanas de gestacion. 24 horas despues presento dolor en fosa iliaca izquierda y edema de extremidades inferiores. Es diagnosticada de trombosis de vena cava inferior junto con una trombosis de la vena ovarica derecha de manera incidental por ecografia. EVOLUCION: Para el manejo inicial de la trombosis se utilizo heparina de bajo peso molecular y posteriormente se realizo una trombectomia farmaco-mecanica con Angio-jet ®. La falla renal aguda y el manejo del dolor se corrigieron mediante fluidos intravenosos, paracetamol y opioides. La paciente evoluciono sin complicaciones y fue dada de alta con tratamiento a base de heparina de bajo peso molecular por seis meses. CONCLUSION: Las terapias invasivas para la trombosis ofrecen un alivio rapido y prevencion para el sindrome postrombotico. La evidencia de estas terapias esta en aumento, sobre todo con el uso de la trombectomia farmaco-mecanica, que muestra un fuerte potencial de beneficios clinicos.

Revista Argentina de Cirugía, 2021

Background: The prevalence of common bile duct stones associated with cholelithiasis increases wi... more Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithias...