Laparoscopic repair of incisional hernias. Experience in 21 patientsBackground: Ventral hernias are one of the most common complications of open abdominal surgery and can be repaired laparoscopically. Aim: To assess the feasibility, safety and efficacy of the laparoscopic repair of incisional hernias. Patients and Methods: Retrospective study of the patients undergoing laparoscopic ventral hernia repair from march 2006 to october 2008 at a surgical department of a clinical hospital. We analyzed patient's characteristics, surgical variables, perioperative results, complications and short term follow up. Results: Twenty-one patients aged 54 ± 14 years (16 females) underwent laparoscopic ventral hernia repair during this period. Their mean body mass index was 32.2 ± 6.5 kg/m 2 . One patient was converted to open surgery. The mean hernia ring diameter was 8.4 ± 3.9 cm (range 3-17). Median operative time was 92 minutes (range 45-300). Mean hospital stay was 3.0 ± 1.6 days. During the procedure, two patients were simultaneously subjected to a sleeve gastrectomy and cholecystectomy, respectively. A pulmonary atelectasis and a seroma occurred in two patients (10%) as early minor complications. As late complications, two patients (10%) experienced continuing pain in the area in both operations. No patient died. Follow up was 100% with a mean of 14 months (range 4-36), without hernia recurrence during this period. Conclusions: Laparoscopic incisional hernia repair is a feasible technique to perform, without serious complications.
Mesenteric lymphangioma causing volvulus. Report of one caseLymphangiomas are rare benign lesions, most commonly seen in children and adolescents. Their intra-abdominal presentation is uncommon. We report a 19 years old male, presenting to the emergency room with abdominal pain associated with fever, vomiting and abdominal distension. There was a history of multiple previous consultations for abdominal pain. A plain abdominal X-ray examination suggested a bowel obstruction. At surgery a volvulus and dilation of the small bowel in relation to a vascular malformation was found, excising 40 cm of jejunum with an end-to-end intestinal anastomosis. The pathology report showed a Mesenteric Multicystic Lymphangioma. Presently, the patient is in good conditions. Key words: Volvulus, bowel obstruction, lymphangioma. ResumenLos linfangiomas son lesiones benignas, de baja incidencia, más comunes en niños y adolescentes. Con muy baja frecuencia son intraabdominales y poseen presentación clínica variable, yendo desde el hallazgo clínico hasta pacientes con riesgo vital por abdomen agudo. Presentamos el caso de un paciente de 19 años, sin antecedentes mórbidos que acude a urgencias por dolor abdominal asociado a fiebre, vómitos y distensión abdominal; la radiografía simple es sugerente de obstrucción intestinal. En laparotomía exploradora se encuentra un vólvulo y dilatación del intestino delgado en relación a una malformación vascular y lesiones multilobuladas en mesenterio. Se resecan 40 cm de yeyuno y realiza anastomosis término-terminal. La histología reveló un Linfangioma Multiquístico Mesentérico. El paciente evoluciona en buenas condiciones generales y se mantiene control clínico e imagenológico seriado. Aunque infrecuente, es uno de los diagnósticos diferenciales de abdomen agudo. A pesar de su naturaleza benigna puede llegar a comprometer el pronóstico vital del paciente.Palabras clave: Linfangioma, mesenterio, linfangioma quístico, vólvulo.
Omphalopagus conjoined twins with a twin-twin transfusion syndrome. Result of a multidisciplinary and successful separation in Chile
Surgical excision of non colorectal liver metastases Background: The benefits of hepatic resections for colorectal liver metastases are well known. This is not the case for excisions in the treatment of non-colorectal, non neuroendocrine liver metastases. Aim: To assess the results of liver resection in the treatment of patients with non-colorectal, non neuroendocrine liver metastases. Material and Methods: Electronic database analysis of patients with noncolorectal non-endocrine liver metastases undergoing to hepatectomy between 2000-2009. Results: Seventeen patients aged 22 to 78 years, nine women, were operated. The most common primary tumors were stomach, liver, adrenal glands and uterus. In two cases, a synchronic primary tumor and metastasis excision was performed. Anatomic segmentectomy was performed in 10 cases (58.8%) and a mayor surgical resection in 7 patients (41.2%). In 15 cases (88.2%) the tumor margins were negative. Three patients presented postoperative complications and three patients had hepatic tumor recurrence. No patient died in the peri-operative period. One, two and three years survival were 85, 51 and 51% respectively, after a follow-up ranging from 9 to 56 months. Conclusions: The surgical treatment of patients with non-colorectal non-endocrine liver metastases is safe and beneficial in selected patients, with a low rate of complications and good survival rates.
Surgical treatment in hepatocellular carcinoma. Preliminary experience Background: The hepatocellular carcinoma (HCC) is the main primary liver tumour and is a major health problem worldwide, it is the fifth most common cancer in the world, as only 10% to 20% are resectable and the natural progression of the disease presents an ominous prognosis with lower overall survival of less than nine months. The aim of this paper is to analyze the results of the surgical alternatives of HCC in our center. Patients and Methods: Analysis of the prospective database of all patients with HCC undergoing surgical treatment between 2003 and 2008 in terms of surgical technique (liver transplantation, liver resection and radiofrequency ablation surgery), surgical margins, complications, tumour recurrence and survival. Results: The series was 38 patients, 23 women, median age 65 years (41-82 years), were early and late complications in six patients (15.8%) respectively. The cumulative survival of all patients undergoing to surgical treatment was 86%, 76% and 65% for year 1, 2, 3 postoperative respectively. According technique: 14 patients underwent liver transplantation, liver resection in eight patients, 15 patients with radiofrequency ablation and a patient with resection and surgical radiofrequency. Discussion: The surgical treatment of HCC in our series presented promising results in terms of survival globally and for each surgical option used. Thus the surgical treatment of HCC is beneficial in selected patients in terms of surgical complications and survival.
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