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Revista Espanola de Enfermedades Digestivas, 2011

Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

The laparoscopic treatment of eventrations and ventral hernias has been little used, although the... more The laparoscopic treatment of eventrations and ventral hernias has been little used, although these hernias are well suited to a laparoscopic approach. The objective of this study was to investigate the usefulness of a laparoscopic approach in the surgical treatment of ventral hernias. Between January 1994 and July 1998, a series of 100 patients suffering from major abdominal wall defects were operated on by means of laparoscopic techniques, with a mean postoperative follow-up of 30 months. The mean number of defects was 2.7 per patient, the wall defect was 93 cm2 on average. There were 10 minor hernias (<5 cm), 52 medium-size hernias (5-10 cm), and 38 large hernia (>10 cm). The origin of the wall defect was primary in 21 cases and postsurgical in 79. Three access ports were used, and the defects were covered with PTFE Dual Mesh measuring 19 x 15 cm in 54 cases, 10 x 15 cm in 36 cases, and 12 x 8 cm in 10 cases. An additional mesh had to be added in 21 cases. In the last 30 ca...

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of... more Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of the biliary or vascular tree. Being difficult to diagnose during routine preoperative studies, these anomalies can provide surgeons with an unusual surprise during laparoscopic surgery. The presence of any congenital anomaly or the mere suspicion of its existence demands that we exercise surgical prudence, limit the use of electrocoagulation, and ensure that no structure be divided until a clear picture of the bile ducts and blood vessels is obtained. If necessary, perform intraoperative cholangiography to further define the biliary system. However, if the case remains unclear, or if laparoscopy does not provide enough information, open surgery should be considered before undesirable complications occur.

Revista Española de Enfermedades Digestivas, 2011

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is the treat... more Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is the treatment of choice for common bile duct (CBD) stones. The complication rate is 5-10% with a mortality rate between 0.5-1.0%. Post-ERCP complications are usually apparent within three days of the procedure, and rarely present after the 12 th day. Pancreatitis and bleeding are the most common complication. Gallstone ileus after ERCP with CBD removal is exceedingly rare. CASE REPORT A 66 years old male was admitted for cholangitis with obstructive jaundice. Transabdominal US showed cholelithiasis with a 20 mm CBD compatible with choledocholithiasis. He had a history of bilateral inguinal hernia repair, appendectomy and pyloroplasty. At ERCP a prior small sphincterotomy was enlarged, the papilla was balloon dilated, and all 12 stones found (largest diameter, 25 mm) were removed from the CBD. After ERCP the patient had bilious vomiting with dilated small bowel loops on abdominal X ray and aerobilia (Figs. 1 and 2). Abdominal CT on day 10 showed a dilated stomach and jejunal loops, with a stone lodged inside the lumen at the terminal ileum (Fig. 3). Emergent laparoscopic surgery was undertaken, where adhesions were found in the left inguinal area, with dilated and torqued small bowel loops. The adhesions were cut, freeing the bowel loop, and cholecystectomy was carried out. DISCUSSION Prolonged ERCP with insufflation estimated at over 6 liters of room air in the setting of prior adhesions, triggered in this case small bowel obstruction. This unusual complication has not been reported before. Use of carbon dioxide instead of room air, as it is done in laparoscopy, may prevent this complication in the future.

Surgery Today, 2007

To determine the short-term results of abdominal surgery in nonagenarians. Retrospective analyses... more To determine the short-term results of abdominal surgery in nonagenarians. Retrospective analyses of 193 patients aged 90 and older operated on for abdominal complaints during a 15-year period (1990-2004) in a 500-bed tertiary care institutional hospital and 100-bed rural institutional hospital in Spain. The factors analyzed included the following: perioperative risk, diagnosis, operative procedures, timing of operation (elective or emergency), morbidity, mortality, and length of hospital stay. The most common diagnoses were hernia in 69 cases, colorectal cancer in 39, and biliary lithiasis in 24. One hundred and thirty-seven patients (71%) were operated on on an emergency basis. Forty-seven patients died (24%), with mortality rates of 9% (5/56) and 31% (42/137) respectively, for elective and emergency surgery. None of the 15 patients classified as grade I according to the criteria of the American Society of Anesthesiologists (ASA) died and only 3 out of 63 (5%) died who were ASA grade II. Eighty patients (41%) had postoperative complications. Local morbidity was 16% (n = 30), and systemic morbidity was 30% (n = 58). Our results support the notion that elective and acute abdominal surgery in nonagenarians can be performed with acceptable rates of mortality and morbidity. Mortality for surgery in nonagenarians is strongly related to the perianesthetic risk (ASA grade), emergency operation, and seriousness of the disease in question.

Journal of the American Geriatrics Society, 2004

To the Editor: It is well known that insulin-like growth factor (IGF)-1 levels decrease with age,... more To the Editor: It is well known that insulin-like growth factor (IGF)-1 levels decrease with age, but in the absence of a true deficiency, it is not clear why so much variability exists in circulating levels of serum IGF-1 nor what contributes to this variability, aside from growth hormone levels. Cross-sectional studies are inconsistent regarding the associations between serum IGF-1 and lean tissue mass and bone mineral density (BMD) in the elderly, and there are few longitudinal studies addressing this issue in healthier older adults. Serum levels of IGF-1 in a well-functioning cohort of black and white men and women from the Memphis and Pittsburgh areas, aged 70 to 79 at baseline, were examined. A random sample (n5 625) of participants was selected from the Health, Aging, and Body Composition Study, and IGF-1 in serum that had been frozen at 801C after a fasting blood draw was measured. IGF-1 was separated from its binding proteins using acid-ethanol cryoprecipitation and measured using an IGF-binding protein-blocked radioimmunoassay (ALPCO, Windham, NH). The mean intra-assay coefficient of variation (CV) for the 20 batches run was 2.3% (range50.43–5.87%), and the interassay CV was 3.2%. Total lean and fat mass and regional BMD were measured using dual-energy x-ray absorptiometry (DXA) at baseline and again 2 years later. Abdominal visceral fat and thigh muscle and fat areas were measured using computed tomography (CT) scanning. Thigh intermuscular fat was calculated using the deep fascial plane and muscle areas as guidelines. Thigh muscle density, as an indicator of fatty infiltration into muscle, was calculated using mean attenuation values in Hounsfield Units excluding intermuscular fat. Participants were divided into sex-specific groups by 25th and 75th percentile cutpoints for IGF1. Those cutpoints were 94 ng/L and 148 ng/L for men and 77 ng/L and 127 ng/L for women, respectively. Analysis of covariance was used to examine the cross-sectional relationship between various body composition components and IGF-1 levels in 609 participants with valid IGF-1, CT, and BMD measurements (Table 1). Linear regression was then used to examine the association between baseline IGF-1 (log-transformed) and the prospective 2-year change in total lean body mass (n5514), total fat mass (n5528), and total hip BMD (n5526) from DXA with adjustment for age, sex, race, study site, thigh length (from CT), and baseline levels of lean body mass, total fat mass, and hip BMD for the respective analyses. IGF-1 was not associated with change in lean body mass (P5.12), fat mass (P5.27), or hip BMD (P5.56). Further adjustment for smoking, alcohol consumption, exercise level, or prevalent diseases at baseline did not affect these results, nor did further modeling using the 25th and 75th percentile cutpoints for IGF-1. With the exception of higher indices of thigh muscle mass and muscle density, variations in IGF-1 were not

Frontiers in Surgery

BackgroundThe studies which address the impact of costs of robotic vs. laparoscopic approach on q... more BackgroundThe studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery.MethodsThe Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure).DiscussionThe results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes.

Revista de otorrinolaringología y cirugía de cabeza y cuello

Los autores declaran no tener conflictos de interés.

Obesity surgery, 2005

Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divid... more Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a ...

Revista Espanola de Enfermedades Digestivas, 2011

Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

The laparoscopic treatment of eventrations and ventral hernias has been little used, although the... more The laparoscopic treatment of eventrations and ventral hernias has been little used, although these hernias are well suited to a laparoscopic approach. The objective of this study was to investigate the usefulness of a laparoscopic approach in the surgical treatment of ventral hernias. Between January 1994 and July 1998, a series of 100 patients suffering from major abdominal wall defects were operated on by means of laparoscopic techniques, with a mean postoperative follow-up of 30 months. The mean number of defects was 2.7 per patient, the wall defect was 93 cm2 on average. There were 10 minor hernias (<5 cm), 52 medium-size hernias (5-10 cm), and 38 large hernia (>10 cm). The origin of the wall defect was primary in 21 cases and postsurgical in 79. Three access ports were used, and the defects were covered with PTFE Dual Mesh measuring 19 x 15 cm in 54 cases, 10 x 15 cm in 36 cases, and 12 x 8 cm in 10 cases. An additional mesh had to be added in 21 cases. In the last 30 ca...

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of... more Congenital anomalies of the gallbladder are rare and can be accompanied by other malformations of the biliary or vascular tree. Being difficult to diagnose during routine preoperative studies, these anomalies can provide surgeons with an unusual surprise during laparoscopic surgery. The presence of any congenital anomaly or the mere suspicion of its existence demands that we exercise surgical prudence, limit the use of electrocoagulation, and ensure that no structure be divided until a clear picture of the bile ducts and blood vessels is obtained. If necessary, perform intraoperative cholangiography to further define the biliary system. However, if the case remains unclear, or if laparoscopy does not provide enough information, open surgery should be considered before undesirable complications occur.

Revista Española de Enfermedades Digestivas, 2011

Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is the treat... more Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy is the treatment of choice for common bile duct (CBD) stones. The complication rate is 5-10% with a mortality rate between 0.5-1.0%. Post-ERCP complications are usually apparent within three days of the procedure, and rarely present after the 12 th day. Pancreatitis and bleeding are the most common complication. Gallstone ileus after ERCP with CBD removal is exceedingly rare. CASE REPORT A 66 years old male was admitted for cholangitis with obstructive jaundice. Transabdominal US showed cholelithiasis with a 20 mm CBD compatible with choledocholithiasis. He had a history of bilateral inguinal hernia repair, appendectomy and pyloroplasty. At ERCP a prior small sphincterotomy was enlarged, the papilla was balloon dilated, and all 12 stones found (largest diameter, 25 mm) were removed from the CBD. After ERCP the patient had bilious vomiting with dilated small bowel loops on abdominal X ray and aerobilia (Figs. 1 and 2). Abdominal CT on day 10 showed a dilated stomach and jejunal loops, with a stone lodged inside the lumen at the terminal ileum (Fig. 3). Emergent laparoscopic surgery was undertaken, where adhesions were found in the left inguinal area, with dilated and torqued small bowel loops. The adhesions were cut, freeing the bowel loop, and cholecystectomy was carried out. DISCUSSION Prolonged ERCP with insufflation estimated at over 6 liters of room air in the setting of prior adhesions, triggered in this case small bowel obstruction. This unusual complication has not been reported before. Use of carbon dioxide instead of room air, as it is done in laparoscopy, may prevent this complication in the future.

Surgery Today, 2007

To determine the short-term results of abdominal surgery in nonagenarians. Retrospective analyses... more To determine the short-term results of abdominal surgery in nonagenarians. Retrospective analyses of 193 patients aged 90 and older operated on for abdominal complaints during a 15-year period (1990-2004) in a 500-bed tertiary care institutional hospital and 100-bed rural institutional hospital in Spain. The factors analyzed included the following: perioperative risk, diagnosis, operative procedures, timing of operation (elective or emergency), morbidity, mortality, and length of hospital stay. The most common diagnoses were hernia in 69 cases, colorectal cancer in 39, and biliary lithiasis in 24. One hundred and thirty-seven patients (71%) were operated on on an emergency basis. Forty-seven patients died (24%), with mortality rates of 9% (5/56) and 31% (42/137) respectively, for elective and emergency surgery. None of the 15 patients classified as grade I according to the criteria of the American Society of Anesthesiologists (ASA) died and only 3 out of 63 (5%) died who were ASA grade II. Eighty patients (41%) had postoperative complications. Local morbidity was 16% (n = 30), and systemic morbidity was 30% (n = 58). Our results support the notion that elective and acute abdominal surgery in nonagenarians can be performed with acceptable rates of mortality and morbidity. Mortality for surgery in nonagenarians is strongly related to the perianesthetic risk (ASA grade), emergency operation, and seriousness of the disease in question.

Journal of the American Geriatrics Society, 2004

To the Editor: It is well known that insulin-like growth factor (IGF)-1 levels decrease with age,... more To the Editor: It is well known that insulin-like growth factor (IGF)-1 levels decrease with age, but in the absence of a true deficiency, it is not clear why so much variability exists in circulating levels of serum IGF-1 nor what contributes to this variability, aside from growth hormone levels. Cross-sectional studies are inconsistent regarding the associations between serum IGF-1 and lean tissue mass and bone mineral density (BMD) in the elderly, and there are few longitudinal studies addressing this issue in healthier older adults. Serum levels of IGF-1 in a well-functioning cohort of black and white men and women from the Memphis and Pittsburgh areas, aged 70 to 79 at baseline, were examined. A random sample (n5 625) of participants was selected from the Health, Aging, and Body Composition Study, and IGF-1 in serum that had been frozen at 801C after a fasting blood draw was measured. IGF-1 was separated from its binding proteins using acid-ethanol cryoprecipitation and measured using an IGF-binding protein-blocked radioimmunoassay (ALPCO, Windham, NH). The mean intra-assay coefficient of variation (CV) for the 20 batches run was 2.3% (range50.43–5.87%), and the interassay CV was 3.2%. Total lean and fat mass and regional BMD were measured using dual-energy x-ray absorptiometry (DXA) at baseline and again 2 years later. Abdominal visceral fat and thigh muscle and fat areas were measured using computed tomography (CT) scanning. Thigh intermuscular fat was calculated using the deep fascial plane and muscle areas as guidelines. Thigh muscle density, as an indicator of fatty infiltration into muscle, was calculated using mean attenuation values in Hounsfield Units excluding intermuscular fat. Participants were divided into sex-specific groups by 25th and 75th percentile cutpoints for IGF1. Those cutpoints were 94 ng/L and 148 ng/L for men and 77 ng/L and 127 ng/L for women, respectively. Analysis of covariance was used to examine the cross-sectional relationship between various body composition components and IGF-1 levels in 609 participants with valid IGF-1, CT, and BMD measurements (Table 1). Linear regression was then used to examine the association between baseline IGF-1 (log-transformed) and the prospective 2-year change in total lean body mass (n5514), total fat mass (n5528), and total hip BMD (n5526) from DXA with adjustment for age, sex, race, study site, thigh length (from CT), and baseline levels of lean body mass, total fat mass, and hip BMD for the respective analyses. IGF-1 was not associated with change in lean body mass (P5.12), fat mass (P5.27), or hip BMD (P5.56). Further adjustment for smoking, alcohol consumption, exercise level, or prevalent diseases at baseline did not affect these results, nor did further modeling using the 25th and 75th percentile cutpoints for IGF-1. With the exception of higher indices of thigh muscle mass and muscle density, variations in IGF-1 were not

Frontiers in Surgery

BackgroundThe studies which address the impact of costs of robotic vs. laparoscopic approach on q... more BackgroundThe studies which address the impact of costs of robotic vs. laparoscopic approach on quality of life (cost-effectiveness studies) are scares in general surgery.MethodsThe Spanish national study on cost-effectiveness differences among robotic and laparoscopic surgery (ROBOCOSTES) is designed as a prospective, multicentre, national, observational study. The aim is to determine in which procedures robotic surgery is more cost-effective than laparoscopic surgery. Several surgical operations and patient populations will be evaluated (distal pancreatectomy, gastrectomy, sleeve gastrectomy, inguinal hernioplasty, rectal resection for cancer, Heller cardiomiotomy and Nissen procedure).DiscussionThe results of this study will demonstrate which treatment (laparoscopic or robotic) and in which population is more cost-effective. This study will also assess the impact of previous surgical experience on main outcomes.

Revista de otorrinolaringología y cirugía de cabeza y cuello

Los autores declaran no tener conflictos de interés.

Obesity surgery, 2005

Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divid... more Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a ...