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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.

Indocyanine green (ICG) near-infrared fluorescence cholangiography (NIRF-C) is widely used to visualize the biliary tract during laparoscopic cholecystectomy (LC). However, the ICG dose and its dosing time vary in the literature so there is not a standard ICG protocol. The objectives of this descriptive prospective study were to demonstrate that NIRF-C at a very low dose of ICG provides good visualization of the extrahepatic biliary tree while avoiding hepatic hyperluminescence and to assess the surgeon-perceived benefit. Furthermore, another additional aim was quantifying the amount of ICG dye in the liver tissue and biliary tract through a green colour intensity (GCI) analysis according to red green blue (RGB) color model and correlating it to surgeon-perceived benefit.Forty-four patients were scheduled for LC. We recorded demographics, surgical indication, intraoperative details, adverse reactions to ICG, hepatic hyperluminescence, visualization of the cystic duct (CD), the common bile duct (CBD) and the cystic duct-bile duct junction (CDBDJ) before and after dissection of Calot's triangle, operation time, surgical complications and subjective surgeon data. For all procedures, a unique dose of 0.25 mg of ICG was administered intravenously during the anaesthetic induction. ICG NIRF-C was performed using the overlay mode of the VISERA ELITE II Surgical Endoscope in all surgeries. Video recordings of all 44 LC were reviewed. Using a color analysis software, the GCI of CBD versus adjacent liver tissue was calculated using RGB color model.ICG NIRF-C was performed in all 44 cases. The mean operation time was 45 ± 15 min. There were no bile duct injuries (BDIs) or allergic reactions to ICG. The postoperative course was uneventful in all of cases. The mean postoperative hospital stay was 28 ± 4 h. ICG NIRF-C identified the CBD in 100% of the patients, the CD in 71% and the CDBDJ in 84%, with a surgeon satisfaction of 4/5 or 5/5 in almost 90% of surgeries based on a visual analogue scale (VAS). No statistically significant differences were found in the visualization of the biliary structures after the dissection of Calot's triangle in obese patients or with gallbladder inflammation. Furthermore, 25% of patients with a BMI ≥ 30, 27% of patients with a Nassar grade ≥ 3 and 21% of patients with gallbladder inflammation had a VAS score 5/5 compared to 6% of patients with a BMI 30 (p = 0.215), 6% of patients with a Nassar grade 3 (p = 0.083) and none of the patients without gallbladder inflammation (p = 0.037). Measured pixel GCI of CBD was higher than adjacent hepatic tissue for all cases regardless of the degree of gallbladder inflammation, the Nassar scale grades or the patient's BMI (p 0.0001). In addition, a significant correlation was observed between surgeon-perceived benefit and the amount of ICG dye into the CBD according the RGB color model (p 0.0001).ICG NIRF-C at a very low dose of ICG (0.25 mg of ICG 20 min before surgery) enables the real-time identification of biliary ducts, thereby avoiding the hepatic hyperluminescence even in cases of obese patients or those with gallbladder inflammation.

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.

Introducción: La isquemia mesentérica aguda presenta una elevada morbi-mortalidad y constituye un reto intraoperatorio en el manejo de las áreas isquémicas. En este contexto, analizamos el uso de la fluorescencia con verde de indocianina para valorar la vascularización intestinal a través de 3 casos clínicos. Presentación de los casos: presentamos 3 casos clínicos intervenidos por isquemia mesentérica aguda. Se realiza valoración de la viabilidad intestinal bajo luz infrarroja tras la infusión endovenosa de 25 mg de verde de indocianina. El caso 1 es un varón de 42 años con múltiples antecedentes de enfermedad vascular grave, que presenta una isquemia mesentérica aguda masiva con afecación parchaeada de múltiples segmentos intestinales. La fluorescencia permite la realización de dos resecciones intestinales ajustadas con doble anastomosis intestinal. El caso 2 es una mujer de 74 años con antecedentes de fibrilación auricular no anticoagulada a la que se le decide realizar una cirugía urgente al objetivarse una neumatosis esofágica, gástrica y en sistema porta, como signos indirectos de isquemia, en la TAC urgente. Durante el acto quirúrgico se halla una isquemia de ileon terminal y colon derecho sin claros signos de afectación a nivel esófago-gástrico. La valoración tras administración de ICG discrimina la clara afectación isquémica desde ileon terminal a colon ascendente y parcheada en colon transverso e izquierdo, sin afectación esofágica ni gástrica. El caso 3 es una mujer de 49 años con enfermedad de Takayasu aortoilíaca y visceral y cirugía de revascularización del tronco celíaco. Ante el aumento del dolor abdominal, una nueva TAC evidencia neumatosis colónica. La laparotomía urgente muestra necrosis a nivel del colon izquierdo e hipoperfusión del ciego. La administración de ICG halla una falta de captación de todo el colon. Se realiza una colectomía subtotal con ileostomía y fístula mucosa. Conclusiones: La fluorescencia con ICG aporta una mejor visualización de la vascularización intestinal en la IMA, y permite determinar los límites del tejido afecto para realizar resecciones ajustadas.

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.

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.

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.

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.