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1. Compendio de las clasificaciones anatómicas de las hernias de pared abdominal y validez actual de las mismas

Author

Romero Vargas, E., Álamo Juzgado, C. del, Herrera Gutiérrez, L., Roldán-Aviña, Juan Pastor, Muñoz Pozo, F., Palacios, E., Romero Vargas, E., Álamo Juzgado, C. del, Herrera Gutiérrez, L., Roldán-Aviña, Juan Pastor, Muñoz Pozo, F., and Palacios, E.

Abstract

The correct classification of abdominal wall hernias is a key point to subsequently perform the best surgical approach. In recent years we have seen many types of classifications. Currently the European Hernia Society described a classification accepted worldwide and that is the most used in our surgical services in Andalusia., La correcta clasificación de las hernias de pared abdominal es un punto clave para realizar posteriormente el mejor abordaje quirúrgico. en los últimos años hemos visto mucho tipos de clasificaciones. Actualmente la European Hernia Society describió una clasificación aceptada mundialmente y que es la más usada en nuestros servicios de cirugía de Andalucía.

Published
2018

2. Laparoscopic treatment of cholelithiasis in cirrhotic patients

Author

Flores Cortés, M., Obispo Entrenas, A., Docobo Durántez, F., Romero Vargas, E., Legupín Tubío, D., and Valera García, Z.

Subjects
Laparoscopic cholecystectomy, Cirrhosis, Colecistectomía, Cholecystectomy, Cirrosis, Colecistectomía laparoscópica
Abstract

Objective: to assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child´s Class A and Class B cirrhosis. Study design: descriptive and retrospective study. Patients: we studied 14 patients (mean age 60 yrs) with Child´s Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. Results: eight patients were women (57.14%) and 6 were men (42.85%). Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28%) in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%), 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back). Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. Conclusions: LC (laparoscopic cholecystectomy) is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short. Objetivo: evaluar la seguridad y eficacia del uso de la laparoscopia en pacientes cirróticos en estadio A y B de Child-Pugh con colelitiasis sintomática. Diseño del estudio: estudio descriptivo, retrospectivo. Pacientes: catorce pacientes con una edad media de 60 años diagnosticados de cirrosis hepática en estadios A y B que se les practicó colecistectomía laparoscópica. Se estudia la aparición de complicaciones intraoperatorias y postoperatorias tras la intervención Resultados: ocho (57,14%) casos eran mujeres y 6 ( 42,85%) varones. De los 14 pacientes, 8 presentaban un estadio Child-Pugh B y 6 un Child-Pugh A. Todos los pacientes se intervienen de colelitiasis de forma programada. El tiempo operatorio medio fue de 77 min. Dos (14,28%) de los pacientes presentaron complicaciones intraoperatorias, sangrado del lecho quirúrgico. Tres (21,42%) pacientes presentaron complicaciones postoperatorias: dos (14,28%) presentaron ascitis con empeoramiento del Child-Pugh en uno de ellos y el otro presentó un cuadro anginoso. La estancia media de estos pacientes es de 3 días. No hubo ninguna muerte tras la intervención y no hubo ninguna reconversión. Conclusiones: la CL es una alternativa segura y efectiva en el tratamiento de colelitiasis sintomáticas en pacientes con cirrosis en estadio A y B compensada. Ofrece una baja morbimortalidad postoperatoria con una escasa pérdida de sangre, un tiempo operatorio corto y una reducida estancia hospitalaria.

Published
2005

3. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

Author

Martínez Vieira, A., Docobo Durántez, F., Mena Robles, J., Durán Ferreras, I., Vázquez Monchul, J., López Bernal, F., and Romero Vargas, E.

Subjects
Outpatient laparoscopic cholecystectomy, Day surgery unit, Cirugía mayor ambulatoria, Calidad percibida, Perceived quality, Colecistectomía laparoscópica ambulatoria
Abstract

Objective: analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Patients and method: eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service) from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Results: group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017), inability to tolerate oral diet (p = 0.002), and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003). Conclusions: outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results. Objetivo: analizar los factores clínicos y quirúrgicos que en una serie de pacientes sometidos a colecistectomía laparoscópica ambulatoria influyeron en la decisión del momento del alta y cuál fue la aceptación de los pacientes al alta. Pacientes y método: en este estudio fueron incluidos 81 pacientes consecutivos procedentes de la lista de espera quirúrgica en quienes se realizó una colecistectomía laparoscópica electiva a lo largo del año 2002. Es un estudio retrospectivo y comparativo que incluye dos grupos de pacientes: los del grupo A fueron dados de alta entre 24 a 48 horas tras la intervención; los del grupo B lo fueron en menos de 24 horas. Analizamos las características clínicas, quirúrgicas y evolución postoperatoria de ambos grupos de pacientes Resultados: el grupo A estaba compuesto por 53 pacientes. El Grupo B por 28 pacientes. Los factores con significación estadística que determinaron que el alta se prolongara más de 24 horas fueron: las incidencias o complicaciones postquirúrgicas precoces (p=0,017), la no tolerancia oral de alimentos (p=0,002) y las dudas o inseguridad de los pacientes ante el alta determinada por la tradición cultural (62,3%; p=0,0003). Conclusiones: la colecistectomía laparoscópica ambulatoria es un procedimiento seguro y realizable, con un elevado porcentaje de aceptación y escasas complicaciones. Quizás se deba cambiar la tradición cultural para obtener mejores resultados.

Published
2004

4. Laparoscopic treatment of cholelithiasis in cirrhotic patients

Author

Universidad de Sevilla. Departamento de Cirugía, Legupín Tubio, D., Docobo Durántez, Fernando, Obispo Entrenas, Ana, Flores Cortés, Mercedes, Valera García, Z., Romero Vargas, E., Universidad de Sevilla. Departamento de Cirugía, Legupín Tubio, D., Docobo Durántez, Fernando, Obispo Entrenas, Ana, Flores Cortés, Mercedes, Valera García, Z., and Romero Vargas, E.

Published
2005

7. Laparoscopic treatment of cholelithiasis in cirrhotic patients | Experiencia en el tratamiento laparoscópico de la colelitiasis del cirrótico

Author

Flores Cortés, M., Ana Obispo Entrenas, Docobo Durántez, F., Romero Vargas, E., Legupín Tubío, D., and Valera García, Z.

Subjects
Laparoscopic cholecystectomy, Cirrhosis, Colecistectomía, Cholecystectomy, lcsh:Diseases of the digestive system. Gastroenterology, lcsh:RC799-869, Cirrosis, Colecistectomía laparoscópica
Abstract

Objective: to assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child´s Class A and Class B cirrhosis. Study design: descriptive and retrospective study. Patients: we studied 14 patients (mean age 60 yrs) with Child´s Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. Results: eight patients were women (57.14%) and 6 were men (42.85%). Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28%) in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%), 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back). Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. Conclusions: LC (laparoscopic cholecystectomy) is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short.Objetivo: evaluar la seguridad y eficacia del uso de la laparoscopia en pacientes cirróticos en estadio A y B de Child-Pugh con colelitiasis sintomática. Diseño del estudio: estudio descriptivo, retrospectivo. Pacientes: catorce pacientes con una edad media de 60 años diagnosticados de cirrosis hepática en estadios A y B que se les practicó colecistectomía laparoscópica. Se estudia la aparición de complicaciones intraoperatorias y postoperatorias tras la intervención Resultados: ocho (57,14%) casos eran mujeres y 6 ( 42,85%) varones. De los 14 pacientes, 8 presentaban un estadio Child-Pugh B y 6 un Child-Pugh A. Todos los pacientes se intervienen de colelitiasis de forma programada. El tiempo operatorio medio fue de 77 min. Dos (14,28%) de los pacientes presentaron complicaciones intraoperatorias, sangrado del lecho quirúrgico. Tres (21,42%) pacientes presentaron complicaciones postoperatorias: dos (14,28%) presentaron ascitis con empeoramiento del Child-Pugh en uno de ellos y el otro presentó un cuadro anginoso. La estancia media de estos pacientes es de 3 días. No hubo ninguna muerte tras la intervención y no hubo ninguna reconversión. Conclusiones: la CL es una alternativa segura y efectiva en el tratamiento de colelitiasis sintomáticas en pacientes con cirrosis en estadio A y B compensada. Ofrece una baja morbimortalidad postoperatoria con una escasa pérdida de sangre, un tiempo operatorio corto y una reducida estancia hospitalaria.

8. The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?

Author

De Simone B, Abu-Zidan FM, Chouillard E, Di Saverio S, Sartelli M, Podda M, Gomes CA, Moore EE, Moug SJ, Ansaloni L, Kluger Y, Coccolini F, Landaluce-Olavarria A, Estraviz-Mateos B, Uriguen-Etxeberria A, Giordano A, Luna AP, Amín LAH, Hernández AMP, Shabana A, Dzulkarnaen ZA, Othman MA, Sani MI, Balla A, Scaramuzzo R, Lepiane P, Bottari A, Staderini F, Cianchi F, Cavallaro A, Zanghì A, Cappellani A, Campagnacci R, Maurizi A, Martinotti M, Ruggieri A, Jusoh AC, Rahman KA, Zulkifli ASM, Petronio B, Matías-García B, Quiroga-Valcárcel A, Mendoza-Moreno F, Atanasov B, Campanile FC, Vecchioni I, Cardinali L, Travaglini G, Sebastiani E, Chooklin S, Chuklin S, Cianci P, Restini E, Capuzzolo S, Currò G, Filippo R, Rispoli M, Aparicio-Sánchez D, Muñóz-Cruzado VD, Barbeito SD, Delibegovic S, Kesetovic A, Sasia D, Borghi F, Giraudo G, Visconti D, Doria E, Santarelli M, Luppi D, Bonilauri S, Grossi U, Zanus G, Sartori A, Piatto G, De Luca M, Vita D, Conti L, Capelli P, Cattaneo GM, Marinis A, Vederaki SA, Bayrak M, Altıntas Y, Uzunoglu MY, Demirbas IE, Altinel Y, Meric S, Aktimur YE, Uymaz DS, Omarov N, Azamat I, Lostoridis E, Nagorni EA, Pujante A, Anania G, Bombardini C, Bagolini F, Gonullu E, Mantoglu B, Capoglu R, Cappato S, Muzio E, Colak E, Polat S, Koylu ZA, Altintoprak F, Bayhan Z, Akin E, Andolfi E, Rezart S, Kim JI, Jung SW, Shin YC, Enciu O, Toma EA, Medas F, Canu GL, Cappellacci F, D'Acapito F, Ercolani G, Solaini L, Roscio F, Clerici F, Gelmini R, Serra F, Rossi EG, Fleres F, Clarizia G, Spolini A, Ferrara F, Nita G, Sarnari J, Gachabayov M, Abdullaev A, Poillucci G, Palini GM, Veneroni S, Garulli G, Piccoli M, Pattacini GC, Pecchini F, Argenio G, Armellino MF, Brisinda G, Tedesco S, Fransvea P, Ietto G, Franchi C, Carcano G, Martines G, Trigiante G, Negro G, Vega GM, González AR, Ojeda L, Piccolo G, Bondurri A, Maffioli A, Guerci C, Sin BH, Zuhdi Z, Azman A, Mousa H, Al Bahri S, Augustin G, Romic I, Moric T, Nikolopoulos I, Andreuccetti J, Pignata G, D'Alessio R, Kenig J, Skorus U, Fraga GP, Hirano ES, de Lima Bertuol JV, Isik A, Kurnaz E, Asghar MS, Afzal A, Akbar A, Nikolouzakis TK, Lasithiotakis K, Chrysos E, Das K, Özer N, Seker A, Ibrahim M, Hamid HKS, Babiker A, Bouliaris K, Koukoulis G, Kolla CC, Lucchi A, Agostinelli L, Taddei A, Fortuna L, Agostini C, Licari L, Viola S, Callari C, Laface L, Abate E, Casati M, Anastasi A, Canonico G, Gabellini L, Tosi L, Guariniello A, Zanzi F, Bains L, Sydorchuk L, Iftoda O, Sydorchuk A, Malerba M, Costanzo F, Galleano R, Monteleone M, Costanzi A, Riva C, Walędziak M, Kwiatkowski A, Czyżykowski Ł, Major P, Strzałka M, Matyja M, Natkaniec M, Valenti MR, Di Vita MDP, Sotiropoulou M, Kapiris S, Massalou D, Veroux M, Volpicelli A, Gioco R, Uccelli M, Bonaldi M, Olmi S, Nardi M, Livadoti G, Mesina C, Dumitrescu TV, Ciorbagiu MC, Ammendola M, Ammerata G, Romano R, Slavchev M, Misiakos EP, Pikoulis E, Papaconstantinou D, Elbahnasawy M, Abdel-Elsalam S, Felsenreich DM, Jedamzik J, Michalopoulos NV, Sidiropoulos TA, Papadoliopoulou M, Cillara N, Deserra A, Cannavera A, Negoi I, Schizas D, Syllaios A, Vagios I, Gourgiotis S, Dai N, Gurung R, Norrey M, Pesce A, Feo CV, Fabbri N, Machairas N, Dorovinis P, Keramida MD, Mulita F, Verras GI, Vailas M, Yalkin O, Iflazoglu N, Yigit D, Baraket O, Ayed K, Ghalloussi MH, Patias P, Ntokos G, Rahim R, Bala M, Kedar A, Sawyer RG, Trinh A, Miller K, Sydorchuk R, Knut R, Plehutsa O, Liman RK, Ozkan Z, Kader SA, Gupta S, Gureh M, Saeidi S, Aliakbarian M, Dalili A, Shoko T, Kojima M, Nakamoto R, Atici SD, Tuncer GK, Kaya T, Delis SG, Rossi S, Picardi B, Del Monte SR, Triantafyllou T, Theodorou D, Pintar T, Salobir J, Manatakis DK, Tasis N, Acheimastos V, Ioannidis O, Loutzidou L, Symeonidis S, de Sá TC, Rocha M, Guagni T, Pantalone D, Maltinti G, Khokha V, Abdel-Elsalam W, Ghoneim B, López-Ruiz JA, Kara Y, Zainudin S, Hayati F, Azizan N, Khei VTP, Yi RCX, Sellappan H, Demetrashvili Z, Lekiashvili N, Tvaladze A, Froiio C, Bernardi D, Bonavina L, Gil-Olarte A, Grassia S, Romero-Vargas E, Bianco F, Gumbs AA, Dogjani A, Agresta F, Litvin A, Balogh ZJ, Gendrikson G, Martino C, Damaskos D, Pararas N, Kirkpatrick A, Kurtenkov M, Gomes FC, Pisanu A, Nardello O, Gambarini F, Aref H, Angelis ND, Agnoletti V, Biondi A, Vacante M, Griggio G, Tutino R, Massani M, Bisetto G, Occhionorelli S, Andreotti D, Lacavalla D, Biffl WL, and Catena F

Subjects
Male, Humans, Middle Aged, Female, Pandemics, SARS-CoV-2, Postoperative Complications epidemiology, COVID-19 epidemiology, Cholecystitis epidemiology, Cholecystitis surgery, Cholecystitis, Acute epidemiology, Cholecystitis, Acute surgery, Sepsis
Abstract

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not., Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not., Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]., Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands., (© 2022. The Author(s).)

Published
2022
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