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Introduction The present work is an observational study of a series of variables regarding overall survival and disease-free survival in patients diagnosed with primary liposarcoma. Methods The study is prospective with retrolective data collection that includes all patients with primary liposarcoma referred to Hospital Son Espases University Hospital, Palma de Mallorca, Spain from January 1990 to December 2019. Results The study includes 50 patients and the compartment surgery was performed in 18 patients (36%) of cases. The mean overall survival of the sample was 15.57 years (95% CI: 12.02–19.12) and the mean disease-free survival was 6.70 years (95% CI: 4.50–8.86). Conclusion Compartment surgery has not shown benefits in terms of overall survival and disease-free survival. The ASA classification (≥3) predicts a poor prognosis in both overall survival and disease-free survival. Resection with free margins, described on the pathological results and defined in this work as R0, show better disease-free survival.

Resumen Introduccion La cirugia y la quimioterapia han aumentado la supervivencia de los pacientes con neoplasias pancreaticas. La disminucion de la morbimortalidad postoperatoria y el aumento de la esperanza de vida han ampliado las indicaciones de la duodenopancreatectomia cefalica (DPC), aunque sigue siendo controvertida en la poblacion geriatrica. Metodos Estudio observacional retrospectivo sobre una base de datos prospectiva, de pacientes con adenocarcinoma ductal de pancreas sometidos a una DPC entre 2007-2018. El objetivo principal fue analizar la morbimortalidad y supervivencia asociada a la DPC en pacientes ≥ 75 anos (ancianos). Resultados Se incluyeron 79 pacientes, 21 de ellos mayores de 75 anos (27%); dentro de este grupo el 23,9% tenian mas de 80 anos. El ASA de ambos grupos fue similar. Los pacientes ≥ 75anos requirieron mas transfusiones. No se observaron diferencias en el tiempo operatorio, aunque en los ancianos se realizaron mas resecciones vasculares (26 vs. 8,7%; p = 0,037). La morbilidad fue mayor en los ancianos (61,9 vs. 46,6%), aunque sin diferencias. Los ≥ 75anos presentaron mas complicaciones no quirurgicas (33,3%; p = 0,050) siendo la neumonia la mas frecuente. La mortalidad postoperatoria fue superior en los ≥ 75anos (9 vs. 0%; p = 0,017), constituyendo la reseccion venosa un factor de riesgo (p = 0,01). La supervivencia global y la supervivencia libre de enfermedad no mostraron diferencias significativas en ambos grupos. Conclusiones Los pacientes ancianos presentaron una mayor mortalidad postoperatoria y mas complicaciones no quirurgicas. La supervivencia no mostro diferencias, por lo que, con una adecuada seleccion de pacientes, la edad no debe constituirse por si misma como una contraindicacion para la DPC.

The incidence of anal cancer has increased in recent years, making screening and early detection of anal intraepithelial neoplasia (AIN) a necessity in patients at risk.A descriptive observational study of homosexual patients (MSM) or women with CIN III, with human immunodeficiency virus (HIV) infection included in an AIN detection screening program was carried out between March 2016 and September 2019.We have performed 695 anal smears, 156 with results of LSIL (low-grade lesion) or HSIL (high-grade lesion) (22.4%), 116 high resolution anoscopy (HRA) 75.3% of patients with altered cytology. We have 403 biopsies being 84% pathological, 197 biopsies of AIN 1 (49%), 96 AIN II and III (24%), 44 were condylomas (11%) and the rest, 16%, normal mucosa.The high prevalence of premalignant lesions and the improvement in the staging of lesions after treatment recommend this protocol.

To the EditorBody packing (BP) is a method of drug trafficking in which smugglers ingest drug-filled packages before travelling, usually crossing international boundaries [1]. Drug packets usually ...

espanolEl tratamiento del cancer de esofago ha experimentado un cambio con el avance de la cirugia minimamente invasiva. Se reducen las tasas de morbi-mortalidad y complicaciones de los pacientes quienes son sometidos a esofagectomia minimamente invasiva. Presentamos el caso de un paciente de 60 anos con adenocarcinoma de esofago distal a quien se le realizo esofaguectomia total minimamente invasiva. https://www.youtube.com/watch?v=NYKf4vZk2UU EnglishThe treatment of oesophageal cancer has undergone a change with the progress of minimally invasive surgery. The morbidity and mortality rates of patients who undergo minimally invasive esophagectomy are dropping. We present the case of a 60-year-old patient with distal oesophageal adenocarcinoma who underwent minimally invasive total esophagectomy. Full video

Gastrointestinal melanoma metastases are not uncommon, with the jejunum and ileum being the most common locations (58 %), followed by the stomach (26 %), colon (22 %), duodenum (12 %), and rectum (5 %).

La combinación de anestesia general con analgesia epidural se considera como el gold-estándar para la cirugía abdominal por vía laparotómica. Ante la aparición de síntomas neurológicos en el postoperatorio inmediato de pacientes portadores de catéter epidural es preciso sospechar de complicaciones relacionadas con el mismo.En caso de presentar un hematoma epidural, es fundamental un diagnóstico precoz con prueba de imagen y la realización de una cirugía descompresiva urgente.

Surgery and chemotherapy have increased the survival of pancreatic cancer. The decrease in postoperative morbidity and mortality and increase in life expectancy, has expanded the indications por cephalic pancreaticoduodenectomy (PDC), although it remains controversial in the geriatric population.Retrospective study on a prospective database of patients with ductal adenocarcinoma of pancreas who underwent PDC between 2007-2018. The main objective was to analyse the morbidity-mortality and survival associated with PDC in patients ≥75 years (elderly).79 patients were included, 21 of them older than 75 years (27%); within this group, 23'9% were over 80 years old. The ASA of both groups was similar. Patients ≥75 years required more transfusions. No differences in operating time were observed, although more vascular resection were performed in the elderly (26 vs. 8.7%; P = .037). Morbidity was higher in the elderly (61.9% vs. 46.6%), although without differences. Patients aged ≥75 years had more non-surgical complications (33.3%, P = .050), being pneumonia the most frequent. Postoperative mortality was higher in the ≥75 years (9 vs. 0%; P = .017). The overall survival and disease-free survival did not show significant differences in both groups.Elderly patients had higher postoperative mortality and more non-surgical complications. Survival did not show differences, so with an adequate selection of patients, age should not be considered itself as a contraindication for PDC.

To date, bariatric surgery has been proposed as the most effective treatment to resolve morbid obesity, a multifactorial chronic disease with an epidemic and increasing tendency. The purpose of this study was to determinate the impact of the laparoscopy on weight loss parameters in morbid obese patients who underwent surgery according to Scopinaro’s biliopancreatic diversion (BPD) and evaluate early and late complications related to the open and laparoscopic approach of this technique. This is a longitudinal retrospective study in consecutive patients undergoing BPD due to morbid obesity between 1999 and 2015. From 2006 the laparoscopic technique was introduced in our group for obesity surgery. In both approaches, open and laparoscopic surgery, the procedure performed consists of a proximal gastric section with a long Roux-en-Y reconstruction. The following variables were assessed in the two groups: intervention duration (min), estimated blood loss (mL), conversions to open approach (%), preoperative stay, postoperative and global stay (days). Complications were divided into early and late postoperative complications. The early surgical complications were catalogued according to the Clavien–Dindo classification. Two hundred seventy-seven patients were consecutively enrolled and divided in two groups: open BPD and laparoscopic BPD. There were no significant differences in the comparison of the two groups and the mean age was 43.9 years (19–60) with a mean BMI of 52.5 kg/m2. A statistically significant reduction was observed in favor of the laparoscopic group with respect to the reduction in hospital stay and in the incidence of incisional hernia as a late complication. No statistically significant difference were found with respect to early postoperative complications. Laparoscopic BPD is a safe technique that allows a shorter hospital stay compared to open surgery and that allows a drastic reduction in the incidence of incisional hernias.

Resumen El uso de la fluorescencia en cirugia se ha ampliado y difundido en los ultimos anos, lo que ha constituido un autentico fenomeno tecnologico ligado a la aparicion de dispositivos adaptados a su utilizacion en los abordajes laparoscopicos y roboticos. La cirugia guiada por fluorescencia en el campo de la cirugia endocrina esta igualmente en auge. Cada vez son mas los articulos que describen su uso en la cirugia de las glandulas tiroides, paratiroides y suprarrenal, aunque con series aun modestas y con protocolos diversos no estandarizados. Existen actualmente diversas areas de desarrollo de la aplicacion de la fluorescencia en cirugia endocrina. Cabe destacar el uso de la fluorescencia con verde de indocianina en cirugia suprarrenal, la identificacion y prediccion de la perfusion paratiroidea con verde de indocianina, y la autofluorescencia de las glandulas paratiroides. El objetivo de este articulo es revisar las actuales aplicaciones de la fluorescencia en cirugia endocrina.

The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.

In the multidisciplinary therapeutic approach to obesity, bariatric surgery is considered the most effective treatment in weight reduction and the decrease in associated comorbidities. The objective of this work is to describe the long-term clinical and metabolic results in obese patients undergoing biliopancreatic diversion (BPD) according to Scopinaro’s technique. Patients undergoing surgery were followed by the same multidisciplinary team in a study period of 15 years (1999–2015). A retrospective study based on a prospective database was designed, where data on the evolution of obesity-related diseases and nutritional parameters were studied. Two hundred seventy-seven patients were collected; 75.5% were women. The preoperative body mass index (BMI) decreased from 52.5 kg/m2 to 34.9 kg/m2 10 years after surgery. A resolution or improvement of diabetes has been observed in 85.38% of the patients; a decrease in arterial hypertension and obstructive sleep apnea syndrome were in 65.61% and 89.14%, respectively. Throughout the monitoring of the sample, protein malnutrition increased, from 1.8% after the first year of surgery to 4.5% 10 years after the operation. Even if Scopinaro’s technique is beginning to be replaced by other malabsorptive techniques, it can still be considered as an effective surgical procedure in terms of weight loss, quality of life, and evolution of obesity-related diseases. In order to avoid nutritional deficiencies, the operated patients need a strict follow-up and a supplementation adjusted to the technique.

Background The liver is the most injured organ following abdominal trauma. Uncontrolled bleeding remains the main cause of early liver injury-related death, with a mortality rate of 50-54% in the first 24 h after admission and with 80% of operative deaths. Packing and reoperation account for the increased survival in severe liver trauma, and they are recommended for severe liver injuries (grades IV-V). Perihepatic packing can lead to several potential complications. An excessive packing can cause complications due to abdominal compartment syndrome, while a soft packing may be ineffective, and thus, bleeding can continue inadvertently with the consequent hypovolemic shock and potentially death. Methods We designed a new vacuum-based device to perform perihepatic packing without the negative side-effects of the classic technique. We conducted a prospective pilot feasibility study in a porcine model. We compared the traditional perihepatic packing (PHP) (n = 2) with the new VacBagPack device (VBP) (n = 2). Results Both pigs survived with the new device and showed an equivalent outcome to the one that survived in the traditional technique group. Blood tests were similar too. This suggests that VBP could be at least as effective as traditional PHP. Conclusions We establish a first step towards the development of a new packing device. A new study with a bigger sample size still in pigs will be conducted. Also, an industrial model of the device is currently in production., Private funding was received and used to buy the swine model and pay for the theater hours. Authors and researchers received no money. This research has received funding from local authorities (IbSalut), as a research scholarship, and from Swan Medical. Acknowledgment to IDISBA for contributing to its publication in Open Access.

Objective To evaluate the prognosis of anatomical resection (AR) and non-anatomical resection (NAR) of hepatocellular carcinoma. Method We carried-out a retrospective study on a prospective database between May 2002 and December 2016. A propensity score matching (PSM) was performed to compare the outcomes between the groups to avoid possible confusion biases, because of non-random assignment. Results We included 86 patients, divided into two groups: 39 in the AR group and 47 in the NAR group. After PSM, 17 were selected into each group. There were no differences in any of the demographic and tumor variables. Overall survival (OS) after PSM was 93.9 and 55.9% at 1 and 5 years, and overall disease-free survival (DFS) was 91 and 45.7%, respectively. There were no differences in OS and DFS between groups (p = 0.47 and p = 0.31). The regression analysis did not observe differences between the groups in OS (p = 0.47), nor in DFS (p = 0.31). No differences were observed between the groups in recurrences. NAR was tended to recurrence before and after PSM. The time of recurrence was similar between the groups. Conclusions The resection method does not influence in the long-term outcomes nor the recurrence.

Endoscopic retrograde cholangiopancreatography may be difficult in patients that have undergone Roux-en-Y gastric bypass. Due to the fact that prevalence of morbid obesity is increasing, and laparoscopic procedures for its treatment have increased, the incidence of biliary tract problems in patients of altered anatomy is also growing. We describe a laparoscopic technique to access the biliary tree by endoscope, through the excluded stomach.

This paper presents a new methodology to pre-diagnose the state of post-surgical abdominal wounds based on visual information. The process consist of four major phases: a) building dense 3D reconstruction of the abdominal area around the wound, b) selecting an area close to the wound to fit a plane, c) calculating the distance from each point of the 3D model to the plane, d) analyzing this map of distances to infer if the wound is inflamed or not. This method needs to be wrapped in an application to be used by patients in order to save unnecessary visits to the medical center. Ministerio de Economía y Competitividad TIN2014-58662-R Ministerio de Economía y Competitividad DPI2014-57746-C3-2-R

Background: Laparoscopic sleeve gastrectomy (LSG) is a procedure frequently used to treat morbid obesity, due to its simplicity compared to other bariatric techniques. However, LSG can lead to serious complications, such as gastric leakage and bleeding from the staple line. To reduce these complications, seroserosal reinforcement of the mechanical suture line after gastrectomy is generally recommended. In recent decades, studies have focused on the safety of anastomosis with staples, especially compared to manual sewing techniques. Since studies on the improvement of stapling technology are limited, this study arises to compare the clinical results of staple line oversewing versus stapling technology with triple-row and enhanced staple configurations in laparoscopic sleeve gastrectomy.Methods: A retrospective review from a prospectively maintained database of 124 laparoscopic vertical gastrectomies performed at single centre between March 2010 and December 2016. Patients were divided into two groups, with comparable anthropometric parameters and inclusion criteria. Seroserosal reinforcement was used in the first group, and stapling technology with triple-row and enhanced staple configurations in the second. Rates of anastomotic leakage, bleeding, reoperation, and 30-day mortality were compared.Results: In Group 1 the average surgical time was 125 min, whereas in Group 2 it was 87 min. No differences were found between the two groups regarding leakage or bleeding of the staple line.Conclusions: The use of triple-row stapling devices during laparoscopic vertical gastrectomy enables surgical time to be reduced. Further high-quality studies to evaluate the efficacy and effectiveness of stapling technology with triple-row and enhanced staple configurations are needed.

Highlights • Closed abdominal traumatisms occurring at typical popular horse-riding festivals in our region constitute a high risk of pancreatic traumatism. • We describe our experience in the diagnosis and treatment of pancreatic lesion secondary to closed abdominal traumatism. • Facing a complete traumatic pancreatic section in the neck the most extended surgical procedure is the resection of pancreatic body, tail, and spleen. • A safer option may be the distal pancreatic preservation with pancreaticogastric anastomosis in grade III lesions with healthy pancreatic tissue., Introduction Pancreatic lesions are very infrequent after closed abdominal trauma (5% of cases) with a complication rate that affects 30–40% of patients, and a mortality rate that can reach 39%. In our experience, closed abdominal traumatisms occurring at typical popular horse-riding festivals in our region constitute a high risk of pancreatic trauma. The purpose of the present paper is to raise awareness about our experience in the diagnosis and treatment of pancreatic lesions secondary to closed abdominal traumatism. Presentation of case We present the clinical cases of two young patients who, after suffering blunt abdominal trauma secondary to the impact of a horse during the celebration of typical horse-riding festival, were diagnosed with pancreatic trauma type III. The treatment was surgical in both cases and consisted in performing a pancreaticogastric anastomosis with preservation of the distal pancreas and spleen. The postoperative period was uneventful and, at present, both patients are asymptomatic. Discussion Signs and symptoms caused by pancreatic lesion are unspecific and difficult to objectify. With some limitations CT is the imaging test of choice for diagnosis and staging in the acute phase. The Wirsung section is indication for surgical treatment. The most extended surgical procedure in these cases is the resection of pancreatic body, tail, and spleen. Conclusion The identification of a pancreatic injury after closed abdominal trauma requires a high suspicion based on the injury mechanism. A safer option may be the distal pancreatic preservation with pancreaticogastric anastomosis in grade III lesions with healthy pancreatic tissue.