Introducción. El carcinoma de células renales corresponde al 3 % de todos los tumores sólidos y, de ellos, cerca del 10 % tiene compromiso de la vena cava inferior. La nefrectomía con trombectomía es la mejor alternativa con intención curativa. La mortalidad perioperatoria se encuentra entre el 2 y el 11 %. El objetivo del presente estudio fue presentar una serie de casos de carcinomas renales con trombos de tipo III según la clasificación de Neves-Zincke, en los cuales se usaron con éxito técnicas del trasplante hepático para su extracción.Materiales y métodos. Se presenta una serie de cinco casos, de pacientes sometidos a nefrectomía radical y que presentaban trombo de la vena cava inferior, atendidos en el periodo comprendido entre enero de 2012 y septiembre de 2018.Resultados. De 26 pacientes encontrados con cáncer de células renales, se seleccionaron cinco con trombos de tipo Neves III, cuatro de ellos de tipo IIIa y uno de tipo IIIc.El promedio de edad fue de 63,2 años, cuatro mujeres y un hombre. El promedio de tiempo operatorio fue de 274 minutos y el de pinzamiento de la vena cava inferior fue de 13,6 minutos. El tiempo promedio de estancia en la unidad de cuidados intensivos fue de 2,8 días y el de estancia hospitalaria fue de 9,6 días. Un paciente no presentó ninguna complicación, y los cuatro restantes presentaron complicaciones quirúrgicas menores, I y II de la clasificación de Clavien-Dindo.Conclusión. El uso de maniobras técnicas del trasplante hepático para extraer trombos de la vena cava inferior que no comprometen la aurícula derecha en pacientes con tumores renales, es una alternativa segura con baja morbimortalidad perioperatoria y que puede llegar a garantizar el control de la enfermedad a largo plazo.
Methods: Case series with follow-up with measures of central tendency and dispersion. Results: At that period, 12 patients with cholangiohydatidosis were diagnosticated. With mean of age of 51.3 AE 15 years, 66.6% were men, 25% (n = 3) had surgical history of liver hydatidic disease. Mean of ultrasound of cysts was 1.16 AE 0.43. Mean of diameter of 10.7 AE 5.4 cm, 83.3% of patients with largest cystic localized at right hepatic lobe. Regarding surgery, in all patients was performed subtotal cystectomy and open exploration of bile ducts with choledocostomy. One patient required further left hepatectomy. Intraoperatory findings: 1 cyst in hepatothoracic transit, 1 liver abscess of hydatid origin and 1 rupture at abdominal cavity (anaphylactic shock). One patient died at 48 hours post-surgery. Mean of follow-up of 5.6 AE 7.3 months. No recurrence at follow-up period. Mean of hospitalization of 14.9 AE 12.2 days. Conclusion: Subtotal cystectomy with choledocostomy was the most used surgical technique for hepatic hydatid disease. Morbidity and mortality rates are comparable with respect to national and international literature.
postoperative patients who underwent Pancreaticoduodenectomy in PGIMER over a period of 18 months. Complications were compared in the two groups. 59 patients were enrolled. Among them, 21 had PBD while 38 didn't have. Primary outcome was any clinically significant complication within 30 days. Results: The two groups were comparable in terms of age, sex distribution, BMI, pre-operative albumin and haemoglobin. Clinically significant post-operative morbidity was present in 54% of patients. PBD group had higher overall morbidity (61% vs 50%, p = 0.273), pancreatic fistula (33% vs 21%, p = 0.357), Surgical site infection (33% vs 28%, p = 8.76), operative time (314 mins vs 308 mins, p = 0.240) compared to patients without PBD. However, patients without PBD had lower Delayed Gastric Emptying (61% vs 63%, p = 0.924) and intraoperative blood loss (261 mins vs 305 mins, p = 0.196) than patients with PBD. Conclusion: Pre-operative Biliary Drainage had no significant influence in post-operative complications in patients undergoing Pancreaticoduodenectomy. PBD can be safely opted when clinically indicated.
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