[show abstract][hide abstract] ABSTRACT: Chylous ascites is an uncommon finding which is due to the presence of thoracic or intestinal lymph in the abdominal cavity. It is usually caused by a chronic disruption of the lymphatic system. The present report is one of the rare cases in the literature of chylous ascites secondary to idiopathic acute pancreatitis, which showed a complete resolution with a combination of low fat enteral nutrition with MCT and somatostatin analogs.
Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 02/2012; 27(1):314-8. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Laparoscopic surgery has become the elective approach for the surgical treatment of gastroesophageal reflux disease in the last decade. Outcome data beyond 10 years are available for open fundoplication, with good-to-excellent results, but few studies report long-term follow-up after laparoscopic fundoplication. We performed a retrospective study of all the patients that underwent laparoscopic Nissen and Toupet fundoplications as antireflux surgery between 1995 and 1998 in our institution. To evaluate the long-term results, a face-to-face interview was performed in 2009. One hundred and six patients were included in the study. Surgical techniques performed were Nissen fundoplication (NF) in 56 patients and Toupet (TF) in 50. Complication rate was 4 per cent in both groups (nonsignificant [NS]). Two patients (4%) of NF required reoperation because of dysphagia. After 10 years, 10 per cent of the patients remain symptomatic in both groups. Fifteen per cent of NF take daily inhibitors of the proton pump versus 14 per cent of TF (NS). Twenty per cent of NF refer dysphagia, all of them without evidence of stenosis at endoscopy or contrasted studies. The satisfaction rate of the patients was 96 per cent in NF and 98 per cent in TF. Laparoscopic Toupet fundoplication seems to be as safe and long-term effective as Nissen, but with a lower incidence of postoperative dysphagia. In our experience Toupet fundoplication should be the elective approach for the surgical treatment of gastroesophageal reflux disease.
The American surgeon 12/2010; 76(12):1408-11. · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study is to analyze the clinical outcome of gastrointestinal stromal tumors (GISTs) and to determine new prognostic factors. We perform a retrospective study of all the patients diagnosed with GIST in any location and operated on between 2000 and 2008 at our institution. We analyzed 35 patients, 16 males (45.7%) and 19 females (54.3%), with a mean age of 64 +/- 13.8 years. The tumors were located in the stomach in 22 patients (62.9%), in the small bowel in 10 (28.6%), and the retroperitoneum in three (8.6%). Referring to gastric GIST, endoscopy revealed an ulceration in the mucosa in five cases, suggesting an epithelial neoplasm. In all these cases, pathology of the biopsy specimen was nonconclusive. Survival rate at 1 and 5 years was 94.3 and 88.6 per cent, respectively. Disease-free survival at 1 and 2 years was 91.4 and 88.6 per cent, respectively. Analyzing prognostic factors, a lower disease-free survival was observed among patients with constitutional syndrome at diagnosis (P = 0.000), small bowel GIST (P = 0.037), and tumors not expressing actin (P = 0.015). A lower global survival was observed among men (P = 0,036), patients with an abdominal mass (P = 0.033) or with constitutional syndrome (P = 0.007) at diagnosis and tumors at a retroperitoneal location (P = 0.0002). Gastric GIST may be confused with epithelial neoplasms, modifying the surgery. In our patients, masculine gender, constitutional syndrome and abdominal mass at diagnosis, small bowel and retroperitoneal location, and actin negative tumors are bad prognostic factors.
The American surgeon 11/2010; 76(11):1244-50. · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: The volvulus of the small bowel is a surgical emergency, causing small bowel obstruction. We performed a retrospective study of all the patients diagnosed and treated with small bowel volvulus between 1977 and 2007 at our institution. One hundred twenty-nine patients were analyzed. Thirty-nine patients presented primary volvulus and 90 secondary ones. The most frequent symptom was sudden abdominal pain. CT scan was the best diagnostic method with an accuracy of 83 per cent. Necrotic small bowel loops appeared in 46.5 per cent of the patients. Eighteen patients had postoperative complications (14%). Mortality rate was 9.3 per cent. A higher mortality is observed among patients with previous abdominal surgeries and cardiopathies. Necrotic loops are associated with higher mortality and incidence of surgical complications; patients with diabetes are associated with a higher incidence of necrotic loops. Cardiopathies are associated with more frequent medical and surgical complications. Recurrence rate was 3.9 per cent associated with simple devolvulation. Primary volvulus are more frequent among males and patients with diabetes. Jejunal location is associated with primary volvulus and these correlate with a higher incidence of necrotic loops. Primary volvulus presents a higher incidence of surgical complications. A bowel obstruction with sudden abdominal pain must be suspicious of small bowel volvulus. The main aim is to achieve an early diagnosis to prevent a necrotic small bowel. CT scan is the imaging test with the best diagnostic accuracy. Primary volvulus, the presence of necrotic loops, and patients with cardiopathies, diabetes mellitus, and with previous abdominal surgery are associated with a worse outcome.
The American surgeon 12/2009; 75(12):1179-82. · 0.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: Laparoscopic surgery has become the elective approach for the surgical treatment of gastroesophageal reflux disease (GERD) in the last decade. Outcome data beyond 10 years are available for open fundoplication, but few studies report long-term follow-up after laparoscopic fundoplication and comparison between laparoscopic and open approaches.
In this study, we performed a retrospective study of all the patients undergoing Nissen fundoplication (open and laparoscopic) for antireflux surgery between 1996 and 1998 at our institution.
In total, 166 patients were included: 88 underwent open Nissen fundoplication and 78 the laparoscopic approach. Complication rate was 5% for both groups. Conversion rate for the laparoscopic approach was was 4%. Median postoperative hospital stay was 9.5 days for open surgery and 3 days for laparoscopic 1 (P < 0.001). During the follow-up, 3 patients required reoperation, 1 after laparoscopic Nissen and 2 after open surgery, all of them due to dysphagia, though complementary tests showed normal features. After 10 years, 24% of the patients of the open surgery group (OS) remain symptomatic, and in the laparoscopic group (LS) 11% (P < 0.05). Overall, 16% of OS take dialy proton-pump inhibitors and 7% of LS (P < 0.05). Three patients have undergone an open Nissen fundoplication and 2 a laparoscopic referring mild dysphagia (NS). The satisfaction rate of the patients was 96% for OS and 97% for LS (NS).
Laparoscopic Nissen fundoplication appears to be at least as safe and long term in effectiveness for GERD as the open approach, with the associated postoperative advantages of a minimally invasive access.
[show abstract][hide abstract] ABSTRACT: Radiation enteritis is a complication of radiation therapy for pelvic tumours. It appears after a variable period of time and is often progressive.
We analyse our experience of 77 cases (52 females and 25 males) diagnosed with radiation enteritis or proctitis between 1986 and 2006.
The most frequent location of radiation injury is ileum (55 patients, 71%), followed by rectum (22 patients, 28%). Twenty-eight patients (36%) were medically managed and 49 (64%) required surgical treatment. In 41 (53%) of the patients the affected region was resected, in 5 (7%) a by-pass was performed and in 3 (4%) a terminal colostomy. Surgical mortality was 4% (3 cases) and the complication rate 9% (7 cases). Twelve patients (16%) presented recurrence of radiation-related illness. Excluding those cases deceased because of tumoral progression, 5-year survival rate was 90% and 10-year survival rate 83%.
Radiation enteritis must be initially conservatively managed, but in those cases without response, surgery is indicated. Surgical treatment should not be delayed fearing postoperative complications, which are more susceptible to appear in deteriorated patients. If technically possible, the affected region should be resected, because complications may appear later at this damaged location.
Clinical and Translational Oncology 09/2009; 11(8):539-43. · 1.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: Primary small bowel adenocarcinoma is an uncommon tumour, with non-specific symptoms that cause a delay in the diagnosis and consequently a worse outcome for the patient. We analyse our experience in the management of this disease.
We performed a retrospective study of our experience with 17 patients diagnosed with primary small bowel adenocarcinoma, excluding all the cases suggesting secondary involvement of the small bowel from an adenocarcinoma in other locations.
We analysed 9 females (53%) and 8 males (47%) with a mean age of 61.8 years. Tumour location was duodenum (8 cases), jejunum (5) and ileum (4). Those with duodenal tumours underwent 4 pancreaticoduodenectomies, 3 gastroenterostomies and 1 diagnostic biopsy; 6 bowel resections with lymphadenectomy, 2 en-bloc resections and 1 by-pass were performed on those with jejuno-ileal tumours. There were complications in 3 patients (18%). General survival was 18 months; in duodenal and jejunal tumours it was 15 months vs. 58 in ileal ones (p = 0.048). Survival was 48 months in the absence of lymph node metastases vs. 11 in those with (p = 0.067). In those tumours infiltrating the retroperitoneum, survival was 15 months compared to 23 when not affected (p = 0.09).
Curative treatment consists of small bowel resection. Retroperitoneal infiltration was a non-resectability criterion in our series. Ileal location is associated with a better outcome. Advanced stages, lymph node metastases, non-resected cases and retroperitoneal infiltration tended to be associated with a poor prognosis in our group.
Cirugía Española 05/2009; 85(6):354-9. · 0.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: Mesenteric panniculitis: Predictor of a neoplasm Introduction: Mesenteric panniculitis is a rare disorder characterized by chronic, non-specific inflammation involving the adipose tissue of the bowel mesentery of unknown aetiology. It has been associated with different processes, including digestive and urothelial malignancies. Case report: A 44- years-old man came to the Emergency Department complaining of mesogastric pain for the last 24 hours. CT scan showed an increased density of the mesenteric adipoid tissue. Mesenteric paniculitis was diagnosed and antibiotic treatment was instaured. The patient recovered uneventfully. Two months later the patient was diagnosed of an infiltrating urothelial carcinoma. Conclusions: Mesenteric panniculitis may be associated with malignancies and other pathologies. It is advisable to perform tests to dismiss the coexistence of these disorders. In those cases, in which associated diseases could not be demonstrated, a frequent follow-up would be advisable to achieve an early diagnosis if these appear.
[show abstract][hide abstract] ABSTRACT: IntroductionPrimary small bowel adenocarcinoma is an uncommon tumour, with non-specific symptoms that cause a delay in the diagnosis and consequently a worse outcome for the patient. We analyse our experience in the management of this disease.
[show abstract][hide abstract] ABSTRACT: Pancreatic neuroendocrine tumours (PNT) are infrequent epithelial neoplasms associated with a better outcome than pancreatic adenocarcinoma.
We analysed our 22 years of experience in managing PNT. Forty-nine patients (27 women and 22 men) with a mean age of 49 years were studied. There were 28 insulinomas, eight glucagonomas, three gastrinomas, one VIPoma and one carcinoid. Eight patients presented with nonfunctional tumours. Enucleation was performed in 20 patients, distal pancreatectomy in 16, middle pancreatic resection in four, cephalic pancreatoduodenectomy in two and total pancreatoduodenectomy in one. In six patients, the tumour was not resected.
Postoperative complication rate was 22%: six pancreatic fistulas, three intra-abdominal collections, one remnant pancreatitis and one pancreatic pseudocyst. There was no mortality. 39 cases showed benign histologic features and ten malignant ones. Symptomatic palliation was achieved in 94% of the cases. Five patients presented recurrences: three liver metastases and two pancreatic recurrences. Actuarial mean survival was 163 months and was longer in insulinomas, in those tumours completely resected and in tumours with benign histological features.
Conservative surgery of the pancreas is preferred, but aggressive surgery is indicated when the primary tumour can be controlled. Despite of minimising pancreatic resection, there is a high complication rate, mainly pancreatic fistulas, though they can often be conservatively managed. Insulinomas are the PNT with better outcome; those completely resected also associate a better prognosis.
Clinical and Translational Oncology 09/2008; 10(8):493-7. · 1.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: Nd-YAG laser coagulation is a therapeutic method for the treatment of refractory superficial bladder cancer. Complications resulting from its use are uncommon. We report a case of jejunal and bladder perforation 24 h after Nd-YAG bladder irradiation of a recurrent bladder tumour.
[show abstract][hide abstract] ABSTRACT: Visceral artery aneurysms are an infrequent entity. Most of them are asymptomatic, but when they present as a rupture, a high mortality is associated.
We review our experience of 18 cases between 1988 and 2006.
9 males and 9 females with a mean age of 66,5 years are analyzed. Aneurysms were located in splenic artery (9), hepatic artery (2), superior mesenteric artery (2), celiac trunk (3), inferior mesenteric artery (1) and gastroduodenal artery (1). Three of them were associated with abdominal aorta aneurysms. Fourteen patients were asymptomatic, three presented abdominal pain and one case presented with rupture and intraperitoneal bleeding. Surgical treatment was performed in thirteen of the patients and endovascular in five. Two cases of endovascular treatment failed and surgery was necessary. Postsurgical mortality was 0 and complications appeared in 2 patients. Mean hospital stay after surgical treatment was 11 days and 3 days after endovascular one. None of the patients presented recurrences, and one has chronic mesenteric ischemia as sequelae of surgical treatment of a superior mesenteric artery aneurysm.
Visceral artery aneurysms must be treated if it is feasible, due to the potential risk of rupture. Endovascular treatment associates lower morbimortality rates and shorter hospital stay than surgical one, but nowadays many aneurysms are not suitable for this management. Endovascular treatment is a technically difficult approach, that requires a specific training and the first cases represent a learning curve.
Scandinavian journal of surgery: SJS: official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 02/2007; 96(4):308-13. · 1.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: This is a retrospective review of our experience on surgical treatment of gastric adenocarcinoma between 1990 and 1995 in
our hospital, where 129 patients received a gastrectomy (58% subtotal).
We divided the patients in three groups: group 1=D1 lymphadenectomy group 2=D2 lymphadenectomy, and group 3=D3 lymphadenectomy.
There were no statistical differences (p<0.01) between the three groups with respect to 5-years overall survival or postoperative
Significative differences on 5 years overall survival were found between pN0 cases versus pN+ (p<0.001).
Presentamos nuestra experiencia con el tratamiento quirúrgico del adenocarcinoma gástrico en nuestro centro desde el año 1990
a 1995 valorada retrospectivamente donde a 129 pacientes se les realizó una gastrectomía (58% subtotal). Dividimos los casos
en tres grupos según se les haya realizado una linfadenectomía D1, D2 o D3, denominándolos grupos 1, 2 y 3 respectivamente.
La mortalidad global en el postoperatorio inmediato fue del 8,5%. No encontramos diferencias significativas ni en la supervivencia
a 5 años ni en la mortalidad postoperatoria entre los tres grupos (p<0,001). Supervivencia actuarial a los 5 años en el grupo
1 del 56% (IC 95% 44,3; 70,7); en el grupo 2 del 47% (IC 95% 34,3; 60), y en el grupo 3 del 43% (IC 95% 23,4; 62,6).
Analizada también la supervivencia a los 5 años entre los pN0 frente a los pN+ sí existe diferencia estadísticamente significativas
entre los dos grupos (p<0,001).
Clinical and Translational Oncology 05/2003; 5(5):286-290. · 1.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: The preperitoneal approach to inguinal hernia permits direct access to the innermost aponeuroticofascial layer of the abdominal wall without disturbing the structures in and around the inguinal canal. It is also of exceptional value in the treatment of difficult hernias, specially recurrent hernia. We present here our experience with this approach in the treatment of recurrent hernia. 31 patients were operated for recurrent hernia. A preperitoneal approach with the use of a prosthesis was used in all of them. The mean surgical time was 45 min. The postoperative course was uneventful in 27 patients, 3 patients had urinary retention and one patient (under anticoagulant therapy) had a scrotal hematoma. No infections or mesh rejections were detected. At follow up (from 6 months to 4 years) no recurrence has been found.
[show abstract][hide abstract] ABSTRACT: IntroductionRadiation enteritis is a complication of radiation therapy for pelvic tumours. It appears after a variable period of time
and is often progressive.
Material and methodsWe analyse our experience of 77 cases (52 females and 25 males) diagnosed with radiation enteritis or proctitis between 1986
ResultsThe most frequent location of radiation injury is ileum (55 patients, 71%), followed by rectum (22 patients, 28%). Twenty-eight
patients (36%) were medically managed and 49 (64%) required surgical treatment. In 41 (53%) of the patients the affected region
was resected, in 5 (7%) a by-pass was performed and in 3 (4%) a terminal colostomy. Surgical mortality was 4% (3 cases) and
the complication rate 9% (7 cases). Twelve patients (16%) presented recurrence of radiation-related illness. Excluding those
cases deceased because of tumoral progression, 5-year survival rate was 90% and 10-year survival rate 83%.
ConclusionRadiation enteritis must be initially conservatively managed, but in those cases without response, surgery is indicated. Surgical
treatment should not be delayed fearing postoperative complications, which are more susceptible to appear in deteriorated
patients. If technically possible, the affected region should be resected, because complications may appear later at this
Clinical and Translational Oncology 11(8):539-543. · 1.28 Impact Factor
[show abstract][hide abstract] ABSTRACT: Meckel's diverticulitis is an infrequent disease that must be considered in the differential diagnosis of acute abdominal pain.
We present 10 cases of Meckel's diverticulitis diagnosed at Hospital Ramón y Cajal (Madrid) between 1985 and 2007. There were eight males and two females with a mean age of 27.5 years. Nine cases presented as a pain in the right lower quadrant suspicious of acute appendicitis, and one case presented as bowel obstruction. Appendectomy + diverticulectomy were performed in those cases with preoperative diagnosis of appendicitis, and diverticulectomy and adhesion release in the patient diagnosed with bowel obstruction.
Meckel's diverticulitis is a rare pathology. Intraoperatively, when the appendix is macroscopically normal, the abdominal compartment must be explored in order to exclude other inflammatory processes such as Meckel's diverticulitis.
Cirugia y cirujanos 77(2):141-4. · 0.32 Impact Factor