Juan Ramón Hernández Hernández

Hospital Nuestra Señora del Rosario, Madrid, Madrid, Spain

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Publications (15)14.21 Total impact

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    ABSTRACT: Malabsorptive techniques such as biliopancreatic diversion described by Scopinaro can cause disabling steatorrhea affecting patients’ quality of life. While it usually improves over time, a reduced group of patients can require treatment.Objective Assess the effects of bismuth subgallate on the quality of life (QoL) of patients undergoing Scopinaro's biliopancreatic diversion (SBPD) for morbid obesity. Setting: Hospital Insular de Gran Canaria, Spain; Public hospital.Patients and methodsA prospective, observational study in clinical practice to ascertain the effects of bismuth subgallate on QoL in a group of patients undergoing SBPD who reported disabling diarrhea and related odor. Patients received treatment with two courses of oral bismuth subgallate, 200 mg every 8 hours for 12 weeks, with a 4-week rest period. A pre-treatment and post-treatment survey was performed. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used, which evaluates symptoms, physical status, emotional status, social performance, and treatment effects.ResultsSixty patients - 90% women - with a mean age of 45.6 years were included in the study, 65% of which had super obesity. GIQLI scores obtained at treatment completion were significantly higher - both overall and in the various domains - than those obtained before treatment onset (p <0.01). When the morbid obesity and super obesity groups were analyzed separately, a significant increase in the scores for both patient groups was also observed (p <0.01).Conclusions In clinical practice, treatment with bismuth subgallate resulted in a short-term improvement of QoL for patients undergoing SBPD.
    Surgery for Obesity and Related Diseases 11/2014; · 4.12 Impact Factor
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    ABSTRACT: Abstract Biliopancreatic diversion (BPD) has excellent results, with the average patient losing 60% to 80% of the excess weight in the first 2 years. However, the BPD works by malabsorption and malabsorptive problems may be experienced with the operation. Therefore, monitoring is necessary for life. In the recent literature there is some debate over the possibility that this technique can increase the risk of colon cancer secondary to the action of the unabsorbed food and bile acid on colonic mucosa. We report the case of a 42-year-old patient with a previous bariatric surgery (BPD with 50 cm common channel; 300 cm alimentary limb) who developed a very aggressive right colon cancer 6 years after the operation. We also review our series of 330 patients operated on during a 14-year period to try to answer if there is any relationship between BPD and colon cancer.
    International surgery. 07/2014; 99(4):354-358.
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    ABSTRACT: Intestinal malrotation and situs inversus can have important repercussions if acute abdominal pain develops. Intraabdominal structures can have inverted position and thus may easily mislead the surgeon during physical examination. Fortunately, radiological exams have improved the preoperative diagnosis of these patients. However, in difficult cases when an underlying surgical disease is suspected, laparoscopy remains the gold standard in order to diagnose and treat if possible the suspected disorder. We present a case of acute left-side appendicitis in a child with unknown congenital intestinal malrotation. In addition, this case stressed the value of laparoscopy in daily practice to evaluate patients with atypical abdominal pain.
    Acta gastroenterologica Latinoamericana 03/2014; 44(1):62-6.
  • Cirugía Española 09/2013; · 0.87 Impact Factor
  • Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva 06/2013; 105(6):368-369. · 1.65 Impact Factor
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    ABSTRACT: Gastrointestinal stromal tumors (GIST) can represent a source of substantial gastrointestinal hemorrhage. Bleeding is described as a frequent cause of clinical presentation and commonly patients received surgical treatment on an urgent basis to drain the hematoma. However, a literature review has shown that perforation with peritonitis is very uncommon and rarely reported. These tumors are usually located in the stomach, and primary ileal and Meckel's localization is rare, occurring in less than 10% of cases in many series. In the English literature, we have found seven well-reported cases of GIST in a Meckel's diverticulum that presented with perforation and peritonitis; these case were found through a MEDLINE search of the terms: "perforated" GISTs in "Meckel's" GISTs. Herein, we describe a rare case of a perforated GIST in Meckel's diverticulum that caused severe peritonitis and that was treated with minimally invasive surgery.
    Asian Journal of Endoscopic Surgery 05/2013; 6(2):126-9.
  • Álvaro Larrad Jiménez, Juan Ramón Hernández Hernández
    Endocrinología y Nutrición 04/2013; 60(4):161–163.
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    ABSTRACT: Background We have developed a new vasovasostomy surgical procedure called the “simple biplane” technique, which aims to simplify vasectomy reversal. The effectiveness of this technique, depending on the obstructive interval, can be tested by the presence of sperm in semen as well as pregnancy rates obtained. Methods This study prospectively evaluated 68 microsurgical vasovasostomies, using the simple biplane technique, in patients with different periods of obstruction. Results After vasectomy reversal average rates of 85% for sperm presence and 51% for pregnancy were observed. Our results do not seem to be influenced by the duration of the obstructive interval. With this technique, excellent results for sperm count and pregnancy rates could be achieved in patients with long-term obstructive intervals. Conclusions With results similar to those described in the literature, the simple biplane technique offers an easy, safe and low-cost procedure. More studies are necessary to compare, in terms of pregnancy rates, simple biplane with more complex techniques for the longest obstructive intervals.
    American journal of men's health 03/2013; · 1.15 Impact Factor
  • Alvaro Larrad Jiménez, Juan Ramón Hernández Hernández
    Endocrinología y Nutrición 02/2013;
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    ABSTRACT: This article features the case study of a 32‐year‐old female patient who had undergone surgery to remove a cervical spine tumor and who later developed cervical esophagus necrosis secondary to the erosion caused by an osteosynthesis 13 years after her prosthetic cervical surgery.Barium swallow did not show anything abnormal, but after an emergency spiral computerized axial tomography (CAT) scan, a paravertebral abscess was found, along with displacement of the fixation plate and the disappearance of the esophageal silhouette on coronal sections. The patient underwent surgery to drain the abscess, extract the osteosynthesis materials and the stabilization plates, and to perform a temporary esophageal exclusion.Two months after this surgery the esophagus was reconstructed by performing a retrosternal pharyngogastrostomy without resection of the remaining cervicothoracic esophagus due to severe fibrosis and the absence of local recurrence.During the immediate post operatory period the patient developed a cervical fistula and after a month of conservative treatment, severe dysphagia was observed. Imaging tests showed a spontaneous fistula from the pharynx to the native esophagus, which prompted extraordinary treatment. Therefore, a jejunal loop was taken to the esophagus in the hiatus with a Roux‐en‐Y anastomosis to resolve this condition.
    Thoracic Cancer 01/2013; 4(1). · 0.65 Impact Factor
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    ABSTRACT: The authors report the case of a 50-year-old woman with a benign intermuscular lipoma of the gluteus compressing the sciatic nerve in its course through the sciatic notch. This benign soft-tissue tumor extended into the pelvis, displacing the rectum laterally. Resection was necessary to alleviate symptoms and prevent irreversible damage of the nerve. Wide exposure of the piriformis muscle and sciatic nerve via a transgluteal approach allowed safe lesion removal, and thus avoiding a laparotomy to resect the intrapelvic extension of the tumor. This report features a curious case of soft-tissue tumor growth across the sciatic foramen forming an inverted sciatic hernia. The authors' proposed approach was simple and safe and avoided a laparotomy.
    Journal of Neurosurgery 08/2012; 117(4):795-9. · 3.15 Impact Factor
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    ABSTRACT: To assess morbidity, mortality and quality of life after oesophageal reconstruction in patients with oesophageal exclusion for benign diseases. From 2002 to 2011, 20 of 24 patients with esophageal exclusion due to benign disease underwent a delayed reconstruction. We analyzed morbidity, mortality and health-related quality of life using the SF-36 questionnaire, before and after reconstruction. Twenty patients were operated (16 men and 4 women) with an average age of 54.5 ± 10.5 years. Main causes of oesophageal disconnection were: 10 cases of caustics ingestion, 3 iatrogenic perforations, 4 anastomotic leaks and 3 cases with Boerhaave syndrome. Fourteen (60%) coloplasties and 6 (25%) gastric interpositions were performed with an average time of 212,2 ± 23.5 days after oesophageal exclusion. Pulmonary complications were the most common postoperative complications (55% patients) and according to the modified Clavien classification were divided into: grade 1 (10%), grade 2 (15%), grade 3a (40%), grade 3b (10%), and grade 4a (10%). The 30-day mortality (grade 5) of the series was 10%. Quality of life after reconstruction improved significantly in all analyzed domains of the SF-36 questionnaire. Deferred oesophageal reconstruction is associated with a high morbidity and a mortality rate of 10%. After reconstruction, the quality of life improved in all the parameters evaluated.
    Cirugía Española 05/2012; 90(6):363-8. · 0.87 Impact Factor
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    ABSTRACT: Objectives To assess morbidity, mortality and quality of life after oesophageal reconstruction in patients with oesophageal exclusion for benign diseases.Patients and methodsFrom 2002 to 2011, 20 of 24 patients with esophageal exclusion due to benign disease underwent a delayed reconstruction. We analyzed morbidity, mortality and health-related quality of life using the SF-36 questionnaire, before and after reconstruction.ResultsTwenty patients were operated (16 men and 4 women) with an average age of 54.5 ± 10.5 years. Main causes of oesophageal disconnection were: 10 cases of caustics ingestion, 3 iatrogenic perforations, 4 anastomotic leaks and 3 cases with Boerhaave syndrome. Fourteen (60%) coloplasties and 6 (25%) gastric interpositions were performed with an average time of 212,2 ± 23.5 days after oesophageal exclusion. Pulmonary complications were the most common postoperative complications (55% patients) and according to the modified Clavien classification were divided into: grade 1 (10%), grade 2 (15%), grade 3a (40%), grade 3b (10%), and grade 4a (10%). The 30-day mortality (grade 5) of the series was 10%. Quality of life after reconstruction improved significantly in all analyzed domains of the SF-36 questionnaire.Conclusions Deferred oesophageal reconstruction is associated with a high morbidity and a mortality rate of 10%. After reconstruction, the quality of life improved in all the parameters evaluated.
    Cirugía Española 01/2012; 90(6):363–368. · 0.87 Impact Factor
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    ABSTRACT: Background We present our initial experience with the laparoscopic BPD technique for super-obese patients. Recommended tips on the technique are summarized.
    Cirugia Espanola - CIR ESPAN. 01/2011; 89(6):362-369.
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    ABSTRACT: We present our initial experience with the laparoscopic BPD technique for super-obese patients. Recommended tips on the technique are summarized. A total of 35 super-obese patients were submitted to BPD by laparoscopy in November 2009 and June 2010 for the treatment of morbid obesity. All operations were performed by laparoscopy with no need to convert to laparotomy. No mayor complications and mortality related to surgery were observed. The Scopinaro technique can be safely performed in super-obese patients by surgeons with special dedication for bariatric surgery and advanced skills in intracorporeal suturing and knot-tying.
    Cirugía Española 01/2011; 89(6):362-9. · 0.87 Impact Factor