Publications (8)11.72 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Introduction The laparoscopic approach has been demonstrated to be a safe and effective procedure in the treatment of hematological diseases requiring splenectomy, especially in those in which the spleen is of normal size (idiopathic thrombocytopenic purpura). However, although the immediate results are promising, insufficient information is available on long-term outcomes. Objective To evaluate the long-term results in a prospective series of 257 patients who underwent laparoscopic splenectomy (LS) according to hematological indication. Material and methods From February 1993 to October 2003, 257 LS were performed in 100 men and 157 women with a mean age of 45 ± 19 years. Clinical information was prospectively gathered in a database. Indications for splenectomy included the following diagnoses: idiopathic thrombocytopenic purpura (ITP) (n = 115), ITP associated with HIV (n = 9), Evans’ syndrome (n = 6), autoimmune hemolytic anemia (AHA) (n = 13), hereditary spherocytosis (HS) (n = 19), malignant hematological disease (n = 66), thrombotic thrombocytopenia purpura (TTP) (n = 1) and others (n = 26). The immediate results (operating time, conversion, morbidity, and length of hospital stay) as well as long-term follow-up (laboratory results, clinical course reported by the referring hematologist, telephone interviews with both the patient and the referring hematologist). Results Immediate postoperative period: the mean operating time was 137 ± 56 minutes with a conversion rate of 6.7%, postoperative mortality of 0.8% and mean length of hospital stay of 5 days. Long-term follow- up was performed in 188 patients (75%) for a mean period of 35 months. ITP: follow-up of 87 patients (76%) with remission in 89%; ITP-HIV: follow-up of six patients (86%) with complete remission in 83%; Evans’ syndrome: follow up of four patients (67%) with complete remission in 100%; TTP: the only patient with this diagnosis was monitored during follow-up and showed complete remission; AHA: follow-up of nine patients (82%) with complete remission in 67%; HS: follow-up of 13 patients (76%) with complete remission in 100%; malignant hematological disease: follow-up of 47 patients (73%) with a mortality rate of 22%; others: follow-up of 18 patients (78%) with no mortality. During the follow-up, there have been no cases of sepsis related to splenectomy. Conclusions LS can be performed in all the hematological indications for splenectomy with satisfactory long-term results.
- [Show abstract] [Hide abstract] ABSTRACT: Situs inversus (SI) is a rare autosomal recessive congenital defect in which the position of abdominal and/or thoracic organs is a "mirror image" of the normal one, in the sagittal plain. In 25% of these cases, SI is part of the Kartagener syndrome, together with bronchiectasis and chronic sinusitis. We present a case of a patient with Kartagener syndrome and complete SI that was laparoscopically operated on for diverticulitis. We also review the published English information available on this rare condition. A review of the literature revealed another single case of laparoscopic sigmoidectomy and 27 cases of other laparoscopic interventions in the presence of SI. Those laparoscopic procedures included basic procedures such as explorations and cholecystectomies, as well as advanced procedures such as gastrectomy and gastric bypass. The laparoscopic approach is feasible in cases of SI, although technically more complicated because of the different position of the organs and the different laparoscopic view of the anatomy.
- [Show abstract] [Hide abstract] ABSTRACT: Initial experience with the laparoscopic repair of paraesophageal and type III mixed hiatal hernias showed that it is safe and feasible, with excellent immediate and short-term results. However, after a longer follow-up, a recurrence rate of < or =40% has been demonstrated. Data related to the outcome of paraesophageal hernia repair and the recurrence rate are still lacking. Quality-of-life scores may offer a better means of assessing the impact of surgical treatment on the overall health status of patients. Therefore, we performed prospective evaluation of anatomic and/or symptomatic recurrences after paraesophageal or large hiatal hernia repair. In addition, we investigated the correlation between recurrence and the patient's quality of life. All patients after who had undergone repair of paraesophageal of mixed hiatal hernia were identified prospectively from a database consisting of all patients who had had laparoscopic operations for gastroesophageal pathology at our hospital between February 1998 and December 2002. The preoperative symptoms were taken from patients' clinical files. In March 2003, all patients with > or =6 months of follow-up had a barium swallow and were examined for radiological and clinical signs of recurrence. Thereafter, the patients' quality of life after surgery was evaluated using three standard questionnaires (Short Form 36 [SF-36], Glasgow Dyspepsia Severity Score [GDSS], and Gastrointestinal Quality of Life Index [GIQLI]. During the study period, 46 patients had been operated on. The mean age was 63 years (range, 28-93). Thirty seven of them had a follow-up of > or =6 months. Eight patients (21%) had postoperative gastrointestinal symptoms. Barium swallow was performed in 30 patients (81%) and showed a recurrence in six of them (20%). According to SF-36 and GDSS, the patients' postoperative quality of life reached normal values and did not differ significantly from the standard values for the Spanish population of similar age and with similar comorbidities. Successfully operated patients reached a GIQLI value comparable to the standard population. However, symptomatic patients had significantly lower GIQLI scores than the asymptomatic or the Rx-recurrent group. The laparoscopic treatment of large paraesophageal and mixed hiatal hernias is not only feasible and safe but also offers a good quality of life on a midterm basis. However, the anatomic and functional recurrence rate is high. The next step is to identify the subset of patients who are at risk of failure and to establish technical alternatives that would ensure the durability of the repair.
- [Show abstract] [Hide abstract] ABSTRACT: Obstruction of the left colon may be the first manifestation of colorectal cancer. Resection of the colonic segment involved and the construction of an end colostomy (Hartman's procedure) is the most frequent treatment. Alternatives to the placement of a stoma are subtotal colectomy or intraoperative lavage of the colon and primary anastomosis, but their application depends on intraoperative findings and the availability of a skilled surgeon. The use of an expandable stent (SEMS) can enhance the feasibility of laparoscopic colectomy, avoiding the need for a colostomy and offering the advantages of a combination of two minimally invasive procedures. Between 1997 and 2004, an SEMS was placed in 11 cases of left colonic obstruction due to cancer, the obstruction being successfully resolved in each case. Seven patients were approached by laparoscopy to attempt the definitive colectomy. We evaluated the location and pathological characteristics of the tumor, effectiveness and complications of SEMS insertion, time interval between the insertion of SEMS and laparoscopic surgery, and postoperative data. The tumors were situated in the recto-sigma (1 case), sigma (3 cases) and descending colon (3 cases). Immediate relief of the obstruction was achieved in all cases after SEMS insertion of the stent, and oral diet was started at 24 h. The 7 patients were operated on an average of 8 days (range 6-14) after insertion of the stent. Conversion to open surgery was necessary in one case for reasons not related to the stent. Preliminary results of the combination of SEMS and elective laparoscopic surgery demonstrate that the procedure is feasible and that it presents all the clinical advantages of a minimally invasive approach. The procedure is a valid alternative to traditional major urgent surgery.
- [Show abstract] [Hide abstract] ABSTRACT: The term intussusception refers to a spontaneous invagination of a portion of the intestine into another bowel loop. Its incidence is higher in children, but in adults it causes 1% to 5% of intestinal obstructions. The diagnosis of intussusception in the adult is difficult due to the variability of the symptoms. The condition may be chronic, intermittent, or acute. Surgical intervention is necessary in all cases and in up to 90% of cases an organic lesion inside the invaginated part of the bowel is found to be the lead point. The laparoscopic approach offers both a diagnostic and therapeutic option. Laparoscopy may be used as the final diagnostic or therapeutic tool for intussusception in the adult.
- [Show abstract] [Hide abstract] ABSTRACT: El tratamiento de la oclusión por cáncer más ampliamente utilizado consiste en la resección del segmento cólico y la realización de una colostomía terminal (operación de Hartmann). Las alternativas técnicas para evitar la realización de un estoma son la colectomía subtotal o colectomía segmentaria con lavado intraoperatorio pero, aunque existen muchos argumentos a favor de la cirugía en un tiempo, ésta es posible en menos del 70% de los casos. Otra opción técnica a esta intervención consiste en la colocación de una endoprótesis autoexpandible, con finalidad paliativa definitiva, o como paso previo a la colectomía electiva convencional. Ello permite obviar la realización de una colostomía. Por otra parte, la posibilidad de efectuar la colectomía laparoscópica permite asociar un abordaje mínimamente invasivo, con las consecuentes ventajas de bienestar para el paciente.
- [Show abstract] [Hide abstract] ABSTRACT: Situs inversus is a rare autosomal-recessive congenital defect characterized by lateral transposition of the viscera of the thorax and/or abdomen. We present the case of a female patient with Kartagener syndrome and complete situs inversus who developed acute recurrent diverticulitis and underwent laparoscopic sigmoidectomy. A literature review yielded one other single case of laparoscopic sigmoidectomy in patients with situs inversus and 27 cases who underwent surgery for other diseases. The procedures used include basic laparoscopic techniques (exploratory laparoscopy, cholecystectomy) and advanced techniques (gastrectomy and gastric by-pass). The laparoscopic approach is feasible in cases of situs inversus, despite the increased technical difficulty posed by the reversed anatomical position.
- [Show abstract] [Hide abstract] ABSTRACT: The terms intussusception or invagination are used to describe the spontaneous telescoping of one segment of the intestine into another segment. Invagination is more frequent in children and in adults it accounts for 1% of bowel obstructions. Diagnosis of invagination is difficult in adults. Surgery is always required and in 90% of cases an organic lesion is found within the invagination. The laparoscopic approach provides a diagnostic and therapeutic option. Objective We present two cases of adult intussusception that were satisfactorily treated using the laparoscopic approach. Case I: A 52-year-old man was admitted to hospital for melena. Enteroscopy revealed ulcerated tumor of the jejunum. Laparoscopy was performed, revealing invagination of the small intestine in the area of the tumor. Diagnosis was tumor of the gastrointestinal stroma of low malignant potential. Case II: A 72-year old woman was admitted to hospital for intestinal subocclusion. Computerized axial tomography revealed a pelvic mass in an intestinal loop compatible with invagination of the mass into an ileal loop. The invaginated mass, a low nuclear grade mesenchymal tumor, was resected laparoscopically. Conclusion Laparoscopic approach can be useful in the diagnosis and treatment of adult intussusception.
Autonomous University of Barcelona
Cerdanyola del Vallès, Catalonia, Spain
- Department of Surgery