[Show abstract][Hide abstract]ABSTRACT: Introduction
In the last decade dramatic changes have taken place in hernia repair with the introduction of mesh techniques under the concept of tension- free hernioplasty, both open and laparoscopic. The aim of this study was to compare the results obtained in patients with bilateral inguinal hernia in order to determine whether totally extraperitoneal (TEP) laparoscopic hernia repair presents advantages over open tension-free hernioplasty through an anterior approach.
Patients and methods
Since 1996, 216 patients underwent bilateral inguinal hernia repair, 83 of them in an ambulatory setting. Eighty-eight patients underwent bilateral TEP laparoscopic hernia repair and 128 underwent open tension-free hernioplasty through an anterior approach. Data were collected prospectively. Clinical, anesthetic, surgical and follow-up variables were assessed.
Seven patients in the TEP group required conversion to open hernioplasty. Postoperative complications were similar except for wound hematoma and urinary retention, which were more frequent in the open group. Operating time was higher in the open group (72.9 versus 64.9 min, p < 0.01). Postoperative pain was less intense in the TEP group (p < 0.001). Five patients in the TEP group (7.9%) and four in the open group (20%) required hospitalization. The substitution rate at the present time is 56% in the open group and 85.7% in the TEP group. Recurrence rates were 0.41% in the open group and 2.41% in the TEP group.
Laparoscopic treatment of bilateral inguinal hernias could be a viable alternative to open tension-free hernioplasty, since it can be performed effectively and safely. It reduces operating time, postoperative pain, and wound morbidity and can be performed in an ambulatory setting.
[Show abstract][Hide abstract]ABSTRACT: Introduction
In our environment, the surgical treatment of unilateral inguinal hernia is widely incorporated in major ambulatory surgery units, unlike bilateral hernias, which are usually treated on an inpatient basis. The aim of this study was to assess the feasibility of treating bilateral inguinal hernias, using the open or laparoscopic approaches, in our day surgery unit.
Patients and method
Since January 1998, 82 patients underwent repair of bilateral inguinal hernias in an ambulatory setting. Fifty-seven patients underwent bilateral totally extraperitoneal laparoscopic repair (TEP) and 25 underwent open hernioplasty, using the Lichtenstein or Gilbert procedures. Data were collected prospectively. Clinical, anesthetic and surgical parameters, admissions, degree of patient satisfaction, and recurrences were assessed.
General anesthesia was used in 48 patients and spinal anesthesia in 34. Two patients in the TEP group required conversion to open hernioplasty. Eleven patients (13.4%) required hospitalization: 5 in the TEP group (8.8%) and 6 in the open group (24%). The substitution rate at the present time is 52.9% in the open group and 90.1% in the TEP group. Followup: there has been one early bilateral recurrence in a patient in the TEP group. The degree of patient satis- faction was excellent or satisfactory in 94.7% of the patients in the TEP group and in 88% in the open group.
Surgical treatment of bilateral inguinal hernias, whether laparoscopic or open, can be performed safely, effectively, efficiently and with excellent patient acceptance within an major ambulatory surgery program.
[Show abstract][Hide abstract]ABSTRACT: Morgagni hernia is an uncommon type of diaphragmatic hernia, which usually presents in adulthood. Its treatment is mainly surgical.We present the case of a 65-year-old man with a giant Morgagni hernia with a 12 × 7 diaphragmatic defect. The hernia was repaired laparoscopically using an intra-abdominal bilaminar mesh. We review the present-day treatment of Morgagni hernia, in which laparoscopy is beginning to occupy a predominant position.
No preview · Article · Dec 2002 · Cirugía Española
[Show abstract][Hide abstract]ABSTRACT: The authors present a case of extensive Verneuil’s disease requiring flaps and skin grafts to cover the wide defect left by excision. The favorable results obtained suggest the advisability of this type of treatment over healing by secondary intention. We discuss the characteristics of grafts and flaps as well as the necessary pre- and postoperative care.
[Show abstract][Hide abstract]ABSTRACT: Hepatic hemangiomas are controversial tumors, especially as far as treatment is concerned. This paper analyses a series of 26 cavernous hemangiomas of the liver diagnosed between 1982 and 1993. MATERIALS and
A descriptive study is made of cases, their treatment and subsequent follow-up averaging 5 years.
A preoperative diagnosis was made in 18 patients. Fifteen of the 26 patients underwent operation, and no deaths occurred. One patient with Kasabach-Merritt syndrome (3.8%) had complications due to rupture of the hemangioma. Postoperative complications were limited to two abscesses (13%). There were no recurrences in the follow-up (average 4.4 years). Three of the 15 surgery patients revealed residual hemangiomas. There were no complications in the 11 non-surgery patients (five of which had giant hemangiomas) during a follow-up averaging 5.9 years. One patient initially without pain and with a hemangioma of 7.4 cm became symptomatic, and the hemangioma grew to 9.6 cm; another patient with pain became asymptomatic, with no change in hemangioma size.
Most hemangiomas can be managed conservatively. Indication for surgery should be assessed in units with experience in liver surgery, where low morbidity and mortality rates can justify the intervention.
No preview · Article · Mar 1996 · Hepato-gastroenterology
[Show abstract][Hide abstract]ABSTRACT: Thymomas are uncommon tumours. This study analyses the prognostic value of certain clinical variables and of two different histological classifications. Thirty cases were analysed; 24 were women and six men, with a mean age of 50 years (range 22-69). The pre-operative study included: clinical data (Masaoka's and Osserman's clinical classification); chest radiography; and computed axial tomography. Surgery was divided into three categories: total tumour resection, partial resection and biopsy alone. For the pathological study we followed Salyer-Eggleston and Marino-Müller classifications. Follow-up averaged 5.5 years (range: 2-11). As a statistical method we used Kaplan-Meier's survival curves and Cox's regression model. Eleven of the patients had associated myasthenia gravis, this being the most common clinical type. Age, sex, association with myasthenia gravis, surgical technique and Salyer-Eggleston's classification showed no prognostic value; conversely, clinical staging and Marino-Müller's classification had a high prognostic value. The first treatment that should be considered is surgery, with an attempt to perform total tumour resection. Myasthenia gravis did not modify the prognosis of the disease. The factors of greatest prognostic significance were clinical staging and Marino-Müller's histological classification.
No preview · Article · Nov 1995 · European Journal of Surgical Oncology
[Show abstract][Hide abstract]ABSTRACT: We reviewed 50 patients with benign tumors of small intestine treated over a period of 15 years. Mean age was 58 years, and 54% of the patients were female. The most frequent location of the tumors was the jejunum (54%). The commonest histological variety was leiomyoma (56%), followed by fibroma (14%). Average size of tumor was 4.8 cm. With regard to clinical data, 20% of the patients were asymptomatic; in the remaining 80% of the patients, abdominal pain, gastrointestinal hemorrhage and abdominal distension were the most frequent symptoms. The mean symptom-diagnosis interval was 2 months. Barium studies, duodenal endoscopy and selective angiography were the most useful diagnostic tools. However, only in 30% of cases the correct diagnosis was reached preoperatively. All patients underwent surgical treatment. The more frequent surgical technique was segmental resection of small bowel (84%). Operative mortality was 4% and morbidity was 10%. Actuarial 5-year survival for all patients was 96%.
No preview · Article · Apr 1994 · Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva
[Show abstract][Hide abstract]ABSTRACT: A new variant of papillary carcinoma of the thyroid is analysed, known as 'diffuse sclerosing'. This lesion is characterized by a papillary cancer with a marked lymphocytic infiltration, intense fibrosis and a large number of psammoma bodies. Of a population of 158 differentiated thyroid carcinomas, we found four cases of this rare variant. The clinicopathological characteristics were studied together with the importance of an accurate diagnosis and prognosis, and the data obtained were compared with those of a 'well-differentiated or classical' papillary cancer, which yielded the following outstanding features: (a) younger age of presentation; (b) greater affinity for males; (c) greater frequency of extrathyroid extension; and (d) greater frequency of recurrences. The clinical importance of recognizing this variant is based on the need to apply a more aggressive treatment and a more exhaustive follow-up to such patients.
No preview · Article · Mar 1994 · European Journal of Surgical Oncology
[Show abstract][Hide abstract]ABSTRACT: The authors analyse the adhesion forming capacity of various forms of treating a peritoneal lesion. There were four groups each of 10 rats, all receiving the same peritoneal lesion. The control group did not receive any treatment for this injury; in the remaining three, the peritoneal lesion was treated with electrocoagulation, mechanical suture or manual suture. The animals were killed after 30 days, and adhesions quantified using an original method of the authors, which evaluates number, thickness, tenacity, vascularisation and site. Electrocoagulation significantly generated the smallest number of adhesions. The application of suture stimulated the formation of adhesions to a larger extent, manual suture more so than the mechanical method.
No preview · Article · Feb 1994 · Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica
[Show abstract][Hide abstract]ABSTRACT: We analyse a new variety of papillary carcinoma of the thyroid, known as the tall cell variant. The lesion is characterized by a papillary cancer (PCT) in which more than 30% of the tumour is made up of a population of tall columnar cells over twice as tall as their width. Of a population of 158 differentiated thyroid carcinomas we found five cases of this rare variant. We studied their clinico-pathological features, the importance of an early diagnosis and their prognostic implications. The data were compared with those of Well-Differentiated or Classical PCT (WDPC), the most important features of which were: (a) later age of appearance; (b) greater predilection for males; (c) greater frequency of extrathyroid tumor extensions; (d) greater frequency of recurrences; and (e) a shorter survival or disease-free interval. The prognostic importance involved in recognizing this variant is based on the need to give patients a more aggressive treatment and more exhaustive follow-up.
No preview · Article · Jan 1994 · European Journal of Surgical Oncology
[Show abstract][Hide abstract]ABSTRACT: The creation of intestinal neomucosa on grafts or materials implanted in the intestinal wall is one of the therapeutic procedures that has been tested in the short bowel syndrome. This paper presents the results obtained after intestinal implanting lyophilised dural patches in an experimental model of massive intestinal resection in rats. Data were contrasted with those of a control group subjected to massive resection without patches. The findings reveal: 1) high mortality related to the surgical technique; 2) slight improvement in the ponderal curve; 3) slowing down of intestinal transit; 4) neomucosa on the patch, with histological characteristic similar to normal. We conclude that although the creation of neomucosa on dural patches is feasible and conditions a slight improvement in the animal's nutritive status, application of the procedure is not practical in treatment for the short bowel syndrome due to the high mortality rate.
No preview · Article · Aug 1993 · Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica
[Show abstract][Hide abstract]ABSTRACT: The influence of certain surgical manoeuvres and incidents on the formation of postoperative peritoneal adhesions was analysed in an experimental study on 80 rats. The control group was made up of 10 animals receiving laparotomy and immediate closure. The remaining animals, also laparotomised, were divided into the following groups according to manoeuvre: simple exposure of the abdominal cavity; haemoperitoneum; intraperitoneal lavage; manipulation of the bowel loops, and foreign body. Peritoneal adhesions were quantified 30 days after laparotomy using an original method of the authors. All the groups presented a statistically significant increase in the rate of adhesions with respect to the controls (adhesion rate 3.00 ± 3.29). The increase was more marked in the foreign body (adhesion rate 14.5 ± 1.23), intestinal manipulation (adhesion rate 11.02 ± 1.68), and intraperitoneal lavage (adhesion rate 8.14 ± 1.56) groups.
No preview · Article · Jan 1993 · Digestive surgery