Search

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.

Background Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastro esophageal reflux disease (GERD), with esophagitis and Barrett's esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling. Goal To study the incidence of reflux symptoms, esophagitis, BE, hiatal hernia and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain. Setting Public and private hospitals with bariatric surgery units. Patients and method Prospective, multicenter, non-randomized study involving 13 Spanish hospitals with a cumulative experience of 4500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry and manometry studies were carried out, and the data analyzed statistically. The study has been authorized by the official Spanish ethics committee "CEI/CEIm Hospital Universitario Gran Canaria Dr Negrin", with the code 2019-216-1. Results 105 patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years and 70.5% were women. The mean characteristics of the SG procedure were a 37.2 French probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien Dindo> 3) or deaths. The average preoperative Body Mass Index (BMI) was 46.3 kg/m2, the minimum reached was 20.6 kg/m2, while the average after 5 years was of 34.5 kg/m2. The presence of GER, hiatal hernia and esophagitis symptoms went from 17.1%, 28.6% and 5.7%, respectively, before the SG to 76%, 30,5% and 31,4% respectively, 5 years after the procedure. Symptoms persisted over the years in 37,1% of cases and presented de novo in 52,8% of cases. 53% of manometries (n=27, total 51) and 64% of pH-metries (n=32, total 53) (DeMeester average score was 65) were pathological 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30,5% of total) and esophagitis in 32 patients (31,4% of total). 80 patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatics. Only one patient (0,9%) developed BE. Conclusion Our study has confirmed a high rate of both “persistent” and “de novo” esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors (PPIs) necessary in these cases, regardless of symptoms. We recommend a control gastroscopy should be performed in all cases, regardless of symptoms, 5 years after SG. Further studies are needed to validate these recommendations.

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.

Cytoreductive surgery (CRS) provides a survival benefit when achieved without residual disease. As diaphragm is frequently affected in peritoneal malignancies, complete cytoreduction often requires surgical techniques over the diaphragm. The purpose of the study was to assess diaphragmatic resection impact on cytoreduction completeness, morbidity and mortality compared to less aggressive diaphragmatic peritonectomy in CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) settings.Patients with peritoneal carcinomatosis and supramesocolic disease undergoing CRS/HIPEC from 2011 to 2019 were included in a prospectively collected database. We compared patients who underwent full-thickness diaphragmatic resection (DR) and diaphragmatic peritonectomy (DP). Epidemiological and clinical data, morbidity, and mortality within 90 days of surgery were documented.232 patients were initially selected. Inclusion criteria were met by 88 procedures. DR was performed on 32 patients and DP on 56. Number of resected organs was 5.21 in the DR cohort vs. 3.57 in the DP cohort (p0.0001). Rate of Peritoneal Cancer Index (PCI) score14 was higher in the DR group (75%) than in the DP group (50.9%) (p=0.027). Tumor invasion of diaphragmatic muscle after DR was confirmed in 89.3% patients. Postoperative pleural effusion was observed in 28 patients (50%) in the DP group and in 17 (53.1%) in the DR group.CRS/HIPEC requires specific surgical techniques over the diaphragm to achieve complete cytoreduction. As diaphragmatic muscle invasion is frequent, full-thickness resection may allow a cytoreduction completeness increase without an increased morbidity. Pleural drains are not systematically required as these procedures show low incidence of major respiratory complications.

Introduction We distributed a survey in order to determine the current indications for the use of colonic stents to treat colonic obstruction in Spain and its compliance with international guidelines. Methods Descriptive study of a survey distributed by the Spanish Association of Surgeons (Asociacion Espanola de Cirujanos), the Catalan Society of Surgery (Societat Catalana de Cirurgia) and the Spanish Society of Digestive Endoscopy (Sociedad Espanola de Endoscopia Digestiva). Results 340 valid responses were received: 25% from gastrointestinal specialists, and 75% from general surgeons. During the last year, 44.4% of respondents assessed between 10 and 20 COC. Of these, 52.2% indicated less than 5 stents/year, 75% of which were indicated as a prior step to preferential surgery and only 25% were performed with palliative intent. 55.3% of the participants reported knowing the official guidelines, and 64% of respondents would use the stent as a step prior to surgery in elderly patients with localized disease. 75.9% would place stents as palliative therapy in young patients with carcinomatosis, and 61.8% would use them in stage IV malignancies under treatment with chemotherapy. Only 18.1% knew of the risk of colon perforation after stent placement in patients undergoing treatment with antiangiogenics. Conclusions In Spain, the indication for colonic stents is reserved for selected cases and varies according to the specialty and the years of experience of the respondent. The compliance with international guidelines of most respondents is moderate. It is important to insist on the high risk of perforation after angiogenics, which is unknown to most surgeons.

Mesenteric fibromatosis is a benign locally-aggressive mesenchymal neoplasm that lacks the potential for metastasis. It is related to Gardner's Syndrome, previous trauma, abdominal surgery, and prolonged intake of oestrogen. Differentially diagnosing this from similar tumours is crucial in order for establishing the appropriate treatment and only immunohistochemical features can be used for a definitive diagnosis. Although medical therapies play a role in the treatment of mesenteric fibromatosis, surgical resection is the gold-standard procedure.Our case study is a 40-year-old male with a concomitant diagnosis of non-Hodgkin lymphoma and mesenteric fibromatosis, not associated with any of the risk factors mentioned above. We performed CT and PET scans and observed a vascularised and well-defined mesenteric centre-abdominal hypermetabolic solid mass in contact with the gastric body, duodenum, body and tail of the pancreas, transverse colon, and spleen. An ultrasound-guided tru-cut biopsy revealed features suggestive of mesenteric fibromatosis.An elective laparotomy was carried out and a giant mass, arising from mesentery, was excised, including a partial gastrectomy and segmental resection of the transverse colon. Distal pancreatectomy, small bowel resection and successive splenectomy were performed due to a large hypertensive component. The postoperative period was uneventful. The histopathology of the surgical pieces was compatible with intra-abdominal desmoid fibromatosis.As far as we know from the literature, this is the largest mesenteric fibromatosis tumour ever to be excised. We also noticed that this is the first reported case of the concomitant presence of mesenteric fibromatosis and non-Hodgkin lymphoma that is not related to any of the described risk factors. Further research is needed to establish what type of association this presentation may indicate.

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 %).

Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and the lungs. It is usually asymptomatic, hence it often represents an incidental finding. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests but immunodiagnostics are available that may complement its study, with antibody detection being the modality of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding both characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (10 cm), and cysts at risk of rupture and/or complicated cysts. The laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because of its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.

Intermittent intraoperative neuromonitoring of the recurrent laryngeal nerve is the ideal complement in thyroid surgeries, decreasing thyroid injuries.To analyze the prevalence of recurrent laryngeal nerve injuries with the use and without the use of neuromonitoring in thyroid surgery.Observational, descriptive and retrospective study, in which a total of 571 patients were included between the years 2012-2018. Of which 180 neuromonitoring was used and 391 were not used.Of the 180 patients who underwent total thyroidectomy with the use of neuromonitoring, we had a total of 8 (4.4%) transient paralysis and 2 (1.1%) definitive. Without the use of neuromonitoring we obtain 12 (3%) transient paralysis and 7 (1.85%) definitive.We believe that the use of neuromonitoring complementary to surgery should be used routinely to the usual technique. And we also obtain significant results regarding the reduction of recurrent laryngeal nerve injuries with the use of intraoperative neuromonitoring.La neuromonitorización intraoperatoria intermitente del nervio laríngeo recurrente es el complemento ideal en las cirugías tiroideas, ya que disminuye las lesiones.Analizar la prevalencia de lesiones del nervio laríngeo recurrente con y sin el uso de neuromonitorización en cirugía de tiroides.Estudio observacional, descriptivo y retrospectivo, en el que se incluyeron 571 pacientes entre los años 2012 y 2018. De ellos, en 180 se utilizó neuromonitorización y en 391 no.De los 180 pacientes que se sometieron a tiroidectomía total con neuromonitorización hubo 8 (4.4%) parálisis transitorias y 2 (1.1%) parálisis definitivas. Sin el uso de neuromonitorización hubo 12 (3%) parálisis transitorias y 7 (1.85%) definitivas.Creemos que la neuromonitorización debe usarse sistemáticamente con la técnica habitual. Obtenemos resultados significativos con respecto a la reducción de las lesiones del nervio laríngeo recurrente con el uso de neuromonitorización intraoperatoria.

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.

Rectal adenocarcinoma usually metastasizes to the liver and lungs and when it has bone spread, it more frequently involves the vertebrae and pelvis. Thus, aberrant metastasis from a rectal adenocarcinoma to upper extremities with preservation of intra-abdominal organs is very uncommon. We present the case of an 80-year-old male patient with a diagnosis of adenocarcinoma of the rectum T4N1M1 with non-axial single bone metastases and with preservation of visceral organs. Anterior resection of rectum after neoadjuvant chemotherapy and radiotherapy were made. The bone metastasis received palliative radiotherapy and was not resected. The patient died 10 months after diagnosis. This clinical situation generally has a poor prognosis. When the patient complains of unusual bone pain it is necessary to suspect a malignant disease and even if extraordinarily rare, rectal cancer must be considered as a possible cause.

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.

Introduction Cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy (HIPEC) has recently been established as the treatment of choice for selected patients with peritoneal carcinomatosis of colonic origin. Until recently, the simultaneous presence of peritoneal and hepatic dissemination has been considered a contraindication for surgery. The aim of this paper is to analyze the morbidity, mortality and survival of patients with simultaneous peritoneal and hepatic resection with HIPEC for peritoneal carcinomatosis secondary to colon cancer. Methods Between January 2010 and January 2015, 61 patients were operated on, 16 had simultaneous peritoneal and hepatic dissemination (group RH+), and 45 presented only peritoneal dissemination (group RH−). Results There were no differences between the groups in terms of demographic data, length of surgery and extension of peritoneal disease. Postoperative grade III–V complications were significantly higher in the RH+ group (56.3 vs 26.6%; P =0.032). For the whole group, mortality rate was 3.2% (two patients in group RH−, and none in group RH+). Patients with liver resection had a longer postoperative stay (14.4 vs 23.1 days) ( P =.027). Median overall survival was 33 months for RH−, and 36 for RH+ group. Median disease-free survival was 16 months for RH−, and 24 months for RH+ group. Conclusions Simultaneous peritoneal cytoreduction and hepatic resection resulted in a significantly higher Clavien grade III–V morbidity and a longer hospital stay, although the results are similar to other major abdominal interventions. The application of multimodal oncological and surgical treatment may obtain similar long-term survival results in both groups.

Resumen Introduccion La citorreduccion con quimioterapia intraperitoneal hipertermica (HIPEC) se ha postulado como tratamiento de eleccion en pacientes seleccionados con carcinomatosis peritoneal por cancer de colon. La presencia simultanea de diseminacion peritoneal y hepatica ha sido considerada una contraindicacion para esta cirugia. El objetivo del presente estudio es analizar la morbimortalidad y supervivencia de los pacientes con carcinomatosis peritoneal por cancer de colon, intervenidos mediante una citorreduccion peritoneal y reseccion hepatica simultanea con HIPEC. Metodos Entre enero de 2010 y enero de 2015 se intervinieron 61 pacientes, 45 pacientes con carcinomatosis peritoneal (grupo RH−) y 16 con carcinomatosis peritoneal y metastasis hepaticas (grupo RH+). Resultados No hubo diferencias significativas entre los 2 grupos en los datos demograficos, ASA, duracion de la intervencion, ni extension de la enfermedad peritoneal. Las complicaciones postoperatorias Clavien III-V fueron significativamente superiores en el grupo RH+ (56,3 vs. 26,6%; p = 0,03). La mortalidad global de la serie fue del 3,2% (2 pacientes en el grupo RH− y ninguno en el grupo RH+). Los pacientes con reseccion hepatica presentaron una estancia hospitalaria significativamente mas larga (14,4 vs. 23,1 dias; p = 0,027). La mediana estimada de supervivencia global fue de 33 meses para RH− y de 36 meses para RH+, y la de supervivencia libre de enfermedad fue de 16 meses para RH− y de 24 para RH+. Conclusiones La citorreduccion peritoneal con reseccion hepatica simultanea presenta una morbilidad postoperatoria y una estancia hospitalaria significativamente mayores, aunque las cifras son similares a las de otras cirugias abdominales mayores. La aplicacion de un tratamiento oncologico y quirurgico multimodal permite obtener resultados de supervivencia similares en ambos grupos.

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.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an effective but complex treatment for peritoneal metastasis (PM). Our objective was to identify risk factors for postoperative morbidity and mortality following CRS-HIPEC. Retrospective study of prospectively collected data of patients undergoing CRS-HIPEC for PM arises from colorectal cancer between January 2008 and December 2017. Perioperative variables were correlated with morbidity outcomes using a logistic regression model. Sixty-seven patients underwent CRS-HIPEC, and overall morbidity and mortality were 31.3% and 4.5% respectively. Major morbidity rate was 19.4%; 7.5% of patients were re-operated. Intraoperative blood transfusion (p = 0.01), liver resection (p

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.

Patients undergoing abdominal operations have to perform a post-operative follow-up during long periods of time after surgery. These face-to-face consultations have an economic cost and affect patients’ quality of life. To simplify the follow-up of these patients, a smartphone application could be used. Based on an image of their surgical wound, post-operative complications may be detected. There are two cues to detect wound infection: inflammation and reddening. In this work, we aim at detecting and segmenting the wound. The first step of this process consists of locating and deleting the staples that maintain the wound closed because they distort the overall color of the image. To do this, we applied the discrete fuzzy morphological dilation operation to the whole image. Next, we applied an inpainting algorithm to restore the regions detected as staples. Finally, using fuzzy sets we determine if there are areas of the wound that present a deviation with respect to the red color, and study if the wound is reddening.

espanolResumen: Introduccion: Los adenomas en la region anogenital son infrecuentes y el origen de este tipo de lesion ha creado confu- sion. En el pasado estas lesiones se han considerado como tejidos ectopicos mamarios o como glandulas apocrina cutanea. Mas recientemente han sido definidas como glandulas anogenital de tipo mamario. Presentacion del caso: Este caso presenta una masa anogenital de origen ectopico en una mujer de 47 anos de edad. Las secciones de tejido microscopico mostraron un patron morfologico similar al de un fibroadenomas mamario, y la inmuno- tincion demostro la presencia de receptores de estrogenos y receptores de progesterona. El diagnostico definitivo fue un adenoma apocrino tubulo-papilar sin signos de malignidad. Conclusion: Cuando se encuentra un tumor del margen anal de origen desconocido, es oportuno considerar, aunque muy raros, los adenomas que imitan los tejidos mamarios. EnglishAbstract: Background: Adenomas in the anogenital region are uncommon and the origin of this kind of lesion has created confusion. In the past these lesions have been considered as ectopic breast tissues or as cutaneous apocrine glands. More recently they have been defined as mammary-type anogenital glands. Methods: This case reports an anogenital mass in a 47-year-old woman that was removed and subsequently studied through a pathological and immunostaining study. Results: Microscopic tissue sections showed a morphologic pattern similar to that of a mammary fibroadenomas, and immunostaining demonstrated the presence of oestrogen receptors and progesterone receptors. The definitive diagnosis was an apocrine adenoma tubulo-papillary without signs of malignancy. Conclusion: When a tumour of the anal margin of unknown origin is found, it is opportune to consider, although very rare, the adenomas that mimic the mammary tissues

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

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.

Background Enhanced recovery after surgery (ERAS) has demonstrated in colorectal surgery a reduction in morbidity and length of stay without compromising security. Experience with ERAS programmes in pancreatoduodenectomy (PD) is still limited. The aims of this study were first to evaluate the applicability of an ERAS programme for PD patients in our hospital, and second to analyse the postoperative results. Methods A retrospective study using a prospectively maintained database identified 41 consecutive PD included in an ERAS programme. Key elements studied were early removal of tubes and drainages, early oral feeding and early mobilisation. Variables studied were mortality, morbidity, perioperative data, length of stay, re-interventions and inpatient readmission. This group of patients was compared with an historic control group of 44 PD patients with a standard postoperative management. Results A total of 85 pancreatoduodenectomies were analysed (41 patients in the ERAS group, and 44 patients in the control group. General mortality was 2.4% (2 patients) belonging to the control group. There were no statistical differences in mortality, length of stay in intensive care, reoperations, and readmissions. ERAS group had a lower morbidity rate than the control group (32% vs. 48%; P =.072), as well as a lower length of stay (14.2 vs. 18.7 days). All the key ERAS proposed elements were achieved. Conclusions ERAS programmes may be implemented safely in pancreaticoduodenectomy. They may reduce the length of stay, unifying perioperative care and diminishing clinical variability and hospital costs.

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.

Mujer de 42 anos con antecedente de hepatopatia cronica alcoholica y malformacion hepatica congenita (shunt portocava parcial). Consulta, tras reinicio de ingesta alcoholica, por coluria, acolia e hiporexia. La exploracion fisica evidencia ictericia franca. El analisis sanguineo muestra colestasis y elevada citolisis. La TC en fase venosa objetiva imagen tipica de malformacion de Abernethy con comunicacion (flecha) entre venas porta (estrella) y cava (triangulo) asi como area isquemica hepatica derecha. Con diagnostico de fallo hepatico agudo de etiologia enolica e isquemica (por progresion del shunt portocava) se instaura tratamiento con pentoxifilina y suplementos nutricionales, apreciandose mejoria clinica (fig. 1).