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Objective A cost-effective analysis of the laparoscopic total extraperitoneal (TEP) repair and laparoscopic trans- abdominal preperitoneal (TAPP) laparoscopic versus open inguinal hernia repair is still not well addressed. The aim of this study is to compare the clinical and cost-effective outcomes of TEP repair and TAPP repair for unilateral inguinal hernia. Methods This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital. Cases of primary, reducible unilaterl inguinal hernia were included and randomized using a simple randomization program. The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio. Results Between January 2020 and January 2023, 60 patients were enrolled in this study (30 of them underwent TEP and 30 TAPP). The TEP procedure had less early postoperative pain (p=0.035). The operative time was higher in the TAPP group with respecto to the TEP group (p =0.05). The overall cost of TAPP procedure was higher compared with the TEP cost but without statically significance (883.93s vs 780 p>0,05). The mean QALYs at 1 year for TEP (0.7094) was higher than that associated with TAPP (0.541) (p=0,038). At a willingness-to-pay threshold of 20,000 s and 30,000 s, there was a 85.28% and 91.44% probability that TEP was more cost-effective relative to TAPP. Conclusions The TEP procedure for unilateral and bilateral inguinal hernia appears to be more cost-effective compared with TAPP.

In the last years 3D printing has progressively gained widespread interest for its several applications in many medical fields. Among the most common diagnostic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) allow only two-dimensional images to obtain information on different pathologies. This requires excellent visualization skills from not specialized medical doctors. The 3D printing has been developed to overcome the current disadvantages of conventional imaging techniques. The 3D models are created from the diagnostic studies of the patient (MRI, CT, PET or a combination of those) with a process that fuse advanced medical imaging algorithms and medical image processing, which are supervised by specialized radiologists. Hereby we describe the cases of two patients with giant incisional hernias. The patients underwent 3D study before botulinum toxin treatment and another 3D model a months after the botulin toxin. With the 3D model we calculated the abdominal cavity volume before and after the treatment with botulinum toxin. Six weeks after the toxin we planned the surgery. The operation time was 180 min and 150 min respectively. The patient's diet was resumed on the first day postsurgery, and the postoperative hospital stay was five days. Our experience gives an overview of the current use of 3D-techniques, more specifically in the field of abdominal wall defect.

Giant inguinoscrotal (GIS) hernias are rarely encountered in clinical settings and are oftenassociated with mental neglect for many years. This type of hernia is defined as “giant” if it descends belowthe mid-point of the inner thigh of a patient in an upright position. The laparoscopic repair approach of aGIS hernia is technically challenging. It has been claimed that laparoscopic surgery has several advantagesover the open surgical approach, with less pain and an earlier recovery. The aim of this video is to evaluatethe efficacy of TAPP (laparoscopic transabdominal preperitoneal) in order to treat a GIS hernia. A 65-year-old male without a relevant past medical history was admitted to theemergency service with abdominal pain, belching and nausea. He denied any other symptoms, and noprevious surgical operations were recorded. Physical examination showed a large mass in the left scrotumbelow the mid-point of the inner thigh of the patient in an upright position. A CT scan confirmed thediagnosis of a GIS. A laparoscopic TAPP procedure was decided upon as the best course of treatment. Results The patient underwent a successful repair procedure. The operation time was 150 min. Nointraoperative blood transfusion was necessary. The patient's diet was resumed on the first day postsurgery, and the postoperative hospital stay was three days. Laparoscopic TAPP repair is a safe and feasible method for surgically managing GIS hernias.

BACKGROUND: Pancreatectomy plus celiac axis resection (CAR) is performed in patients with locally advanced pancreatic cancer. The morbidity rates are high, and no survival benefit has been confirmed. It is not known at present whether it is the type of pancreatectomy, or CAR itself, that is the reason for the high complication rates.; METHODS: Observational retrospective multicenter study.; INCLUSION CRITERIA: patient undergoing TP, PD or DP plus CAR for a pancreatic cancer.; RESULTS: Sixty-two patients who had undergone pancreatic cancer surgery (PD,TP or DP) plus CAR were studied. Group 1: 17 patients who underwent PD/TP-CAR (13TP/4PD); group 2: 45 patients who underwent DP-CAR. Groups were mostly homogeneous. Operating time was longer in the PD/TP group, while operative complications did not differ statistically in the two groups. The number of lymph nodes removed was higher in the PD/TP group (26.5 vs 17.3), and this group also had a higher positive node ratio (17.9% vs 7.6%). There were no statistical differences in total or disease-free survival between the two groups.; CONCLUSION: It seems that CAR, and not the type of pancreatectomy, influences morbidity and mortality in this type of surgery. International multicenter studies with larger numbers of patients are now needed to validate the data presented here.

Purpose The aim of this case series is to describe our ongoing experience of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using Tisseel fibrin glue for the fixation of the mesh and peritoneum closure. Materials and methods From October 2018, patients who underwent laparoscopic TAPP for unilateral inguinal hernia repair using Tisseel fibrin glue to secure the mesh and the peritoneum, with a minimum of 1 year of follow-up, have been included. Patient demographics, main operative findings, and main postoperative outcomes were analyzed prospectively using a visual analgesic scale (VAS) and a modified short-form 36 (SF-36) questionnaire. Results A total of 26 patients have been included and none have been lost during the follow-up. The mean operative time was 92.1 minutes and there was no conversion. The median hospital stay was 1.03 day (range, 1 to 2). The mean follow-up duration was 19.3 months (range, 12 to 26 mo) and none had a recurrence. The postoperative VAS score at 1, 7, 30 days, and 6 months from surgery was 3.18, 1.52, 0, and 0, respectively. The mean SF-36 score at 1, 6, and 12 months from surgery was 90.09, 94.8, and 05.1, respectively. Conclusions The use of fibrin glue for TAPP inguinal hernia repair is a safe and feasible technique with favorable results. Larger comparative randomized studies are needed to confirm these early results.

Previous studies have sought to improve the way of classifying upper limb motor involvement in patients with alterations or pathologies in the central nervous system, so it has become of great importance to find an objective way of measuring and classifying the degree of movement capacity. This work uses the artificial neural network method to quantify the motor skils at five levels of the SSULF scale proposed to have a better assessment of the degree of upper limb motor functionality in patients diagnosed with cerebral hemiparesis.

The hand has a complex structure that allows us to perform daily living activities. When the hand is lost, hand prosthesis is used to restore the lost functions, usually, a hook is used and, in some cases, a mechanical hand. In the last few years, there has been a growth in 3D prosthetic designs since it has many benefits. We propose a method to test both the functionality and kinematic performance of a prosthesis and his/her user respectively. All types of activities performed with the hook were above 4 points on average, while depending on the type of activity the average score for the mechanical and 3D printed hand varied. The overall performance was 100\(\%\) for the hook, while for the mechanical 69\(\%\) and 3D printed hand was below 60\(\%\).

BRCA gene mutations are found in up to 10% of pancreatic adenocarcinoma cases. We present a description of 4 cases along with a review of the current literature regarding pathogenesis, target treatment, response and survival rates in these types of malignancies. We describe four cases of pancreatic adenocarcinoma, in three of which the BRCA2 mutation was identified, in one - BRCA1 gene alteration. Two patients underwent surgery following the neoadjuvant treatment with Folfirinox and radiotherapy; in the first case, a distal pancreatectomy with splenectomy was performed and in the second one - the Whipple's procedure. In both cases, a complete pathological response was reported. Other 2 patients were treated with Folfirinox after BRCA mutation identification and acceptable life expectancy was obtained. The association of pathologic complete response (PCR) with lower rates of local recurrence and better survival in patients with various types of adenocarcinomas is well known. Identification of such patients carrying BRCA mutations could provide an application of better personalized treatment. In some patients with pancreatic cancer, especially when there is clinical or demographic reason to suspect a genetic predisposition, a confirmation of the presence of BRCA mutations could provide an opportunity to use target treatment with beneficial outcomes regarding survival.

The aim of this study is to evaluate the cost-effectiveness of different modifications of the trans-abdominal pre-peritoneal (TAPP) repair of groin hernia. Data were collected prospectively for all consecutive patients who underwent TAPP unilateral inguinal hernia repair between November 2017 and March 2019, and who completed a minimum of 1 year of follow-up. Costs and quality adjusted life year (QALY) gained were collected. Three TAPP variations were assessed: mesh fixation and peritoneal closure with staples (group 1); mesh fixation with fibrin glue and peritoneal closure with sutures (group 2); and mesh fixation and peritoneal closure with fibrin glue (group 3). A matched group of open repairs was established. The incremental cost-effectiveness ratio (ICER) and main intra-operative and post-operative outcomes were assessed. Overall 120 patients were included (group 1 n = 31; group 2 n = 27; group 3 n = 33; open group: 29). Operative time was shorter for groups 2 and 3, and the main post-operative outcomes were similar. The overall mean total cost of the open group (1185.95€) was lower compared with the laparoscopic group (group 1: 1682.39; group 2: 1538.54€; group 3: 1510.1€) (p = 0.026). However, the mean ICERs of groups 2 and 3 were significantly higher compared with group 1 (p = 0.021) and the open group (p = 0.032). At simulations analysis, the probability of cost-effectiveness was 33.32%, 36.26%, and 36.7% in TAPP groups 1, 2, and 3. In the long term, laparoscopic repair of groin hernia is cost-effective compared with open surgery. The use of fibrin glue for mesh fixation and/or for closing the peritoneum is the most cost-effective option and shortens operative times.

Objective The aim of this study is to compare the clinical and cost-effective outcomes of the open Lichtenstein repair (OL) and laparoscopic trans-abdominal preperitoneal (TAPP) repair for bilateral inguinal hernias. Summary background data A cost-effective analysis of laparoscopic versus open inguinal hernia repair is still not well addressed, especially regarding bilateral hernia. Methods This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital.Cases of primary, reducible bilateral inguinal hernia were included and randomized using a simple randomization program.The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio. Results Between March 2013 and January 2017, 165 patients were enrolled in this study (81 of them underwent TAPP and 84 OL).The TAPP procedure had less early postoperative pain (P = 0.037), a shorter length of stay (P = 0.001), and fewer postoperative complications (P = 0.002) when compared with the OL approach. The overall cost of TAPP procedure was higher compared with the OL cost (1,683.93O vs 1192.83O, P = 0.027). The mean QALYs at 1 year for TAPP (0.8094) was higher than that associated with OL (0.6765) (P = 0.018). At a willingness-to-pay threshold of 20,000 O and 30,000 O, there was a 95.38% and 97.96% probability that TAPP was more cost-effective relative to OL. Conclusions The TAPP procedure for bilateral inguinal hernia appears to be more cost-effective compared with OL.

The percutaneous isolated hepatic perfusion utilizes a venovenous bypass to administer high-dose chemotherapy exclusively in the liver, getting depurated through a hemofilter before returning to the systemic circulation. The hepatic perfusion is managed under general anesthesia and invasive monitoring as a result of very abrupt changes in venous return and vascular resistances because of the isolation of the hepatic territory and absorption of circulating catecholamines by the hemofilter. We report a case in which we describe the technique, physiologic implications, anesthetic, and goal-directed hemodynamic management for this procedure.

The differences between the costs of robotic rectal resection and of the laparoscopic approach are still not well known. The aim of this study was to evaluate the cost-effectiveness of robotic versus laparoscopic surgery. We conducted an observational, comparative, prospective, non-randomized study on patients having laparoscopic and robotic rectal resection between February 2014 and March 2018 at the Sanchinarro University Hospital, Madrid. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). The primary endpoint was to compare cost effectiveness in the robotic and laparoscopic surgery groups. A willingness-to-pay of 20,000€ and 30,000€ per QALY was used as a threshold to determine the most cost-effective treatment. A total of 81 RRR and 104 LRR were included. The mean operative costs were higher for RRR (4307.09€ versus 3834.58€; p = 0.04), although mean overall costs were similar (7272.03€ for RRR and 6968.63€ for the LLR; p = 0.44). Mean QALYs at 1 year for the RRR group (0.8482) was higher than that associated with LRR (0.6532) (p = 0.018). At a willingness-to-pay threshold of 20,000€ and 30,000€ there was a 95.54% and 97.18% probability, respectively, that RRR was more cost-effective than LRR. Our data regarding the cost-effectiveness of RRR versus LRR shows a benefit for RRR.

In the last decade, there have clearly been important changes in the surgical approach of gastric cancer treatment due to an increased interest in the minimally invasive surgical approach (MIS). The higher cost of robotic surgery procedures remains an important issue of debate. The objective of the study is to compare the main operative and clinical outcomes and to assess the incremental cost-effectiveness ratios (ICERs) of the two techniques. This is a prospective cost-effectiveness and clinical study when comparing the robotic gastrectomy (RG) technique with open gastrectomy (OG) in gastric cancer. Outcome parameters included surgical and post-operative costs, quality-adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). The incremental utility was 0.038 QALYs and the estimated ICER for patients was dominated by robotic approach. The probability that the robotic approach was cost effective was 94.04% and 94.20%, respectively, at a WTP threshold of 20,000€ and 30,000€ per QALY gained. RG for gastric cancer represents a cost-effective procedure compared with the standard OG.

Background F-flurodeoxyglucose positron emission tomography (FDG-PET) have been claimed to be an important prognostic tool in different malignancies. However, its predictive prognostic value on pancreatic neuroendocrine tumors (PNETs) is still under investigation. Aim We study the prognostic impact of FDG-PET scan in neuroendocrine pancreatic tumors. Methodology Between 2007 and 2012, 26 patients with no metastastatic histologically confirmed PNETs (mean age: 57 years) were examined with FDG-PET. We studied its captation in relation with the well established hystopathological prognostic markers assessed in the tumoral resected specimen according to the WHO 2004 and ENETS/WHO 2010 classification. Results FDG-PET captation was positive in 17 cases (65.4%). The median follow-up period was 34.4 months and recurrences occurred in 4 cases (15.4%). We found a significant correlation between this captation and Ki 67 index (p = 0.032), mitotic index (p = 0.002), tumor grade (p = 0.017) and tumor size (p = 0.01). Conclusions FDG-PET provides a good prognostic value for PNETs. Present results must be further validated with larger sample studies.

La inflación es el aumento sostenido y generalizado de los precios de bienes y servicios, por lo que consideramos un tema de interés para todos los mexicanos. Este trabajo es el resultado de colaboración de alumnos de bachillerato del primer semestre quienes decidieron participar en el concurso que el Banco de México realiza año con año. Donde se realiza una investigación sobre el tema de la inflación en México, los aspectos que intervienen, los factores que se afectan y como se calcula. También se enlistan los productos que forman parte de la canasta básica siendo estos productos los que deben mantener sus precios para evitar que se encarezcan y sea difícil el poderlos adquirir. Se realiza una propuesta sobre cómo medir la inflación en México a través de las distintas zonas en las que se divide nuestro país ya que la producción de esos productos de la canasta básica la mayoría de ellos se realiza en el centro del país.

Interest in robotic pancreatectomy has been greatly increasing over the last decade. However, evidence supporting the benefits of robotic over open pancreatectomy is still outstanding. This study aims to assess the safety and efficacy of robotic pancreatectomy compared with the conventional open surgical approach. Propensity score-matched (1:1) was used to balance age, sex, BMI, ASA, tumor size, and malignancy of 17 robotic pancreaticoduodenectomies (PD), 12 pancreatic enucleations (PE), and 28 distal pancreatectomies (DP); and was compared with the open standard approach. Robotic PD was associated with longer operative time (594 vs. 413 min; p = 0.03) and decreased blood loss (190 vs. 394 ml; p = 0.001). Robotic PE showed a lower mean length of hospital stay (8.4 vs. 12.8 days; p = 0.04) and, in addition, robotic DP showed less blood loss (175 vs. 375 ml; p = 0.01), less severe morbidities (7.14 vs. 17.9%; p = 0.02), and a reduced mean length of hospital stay (8.9 vs. 15.1; p = 0.001). Overall, conversion rate was 4 (7%). Robotic pancreatectomy is as safe and effective as the standard open surgical approach with reduced blood loss in PD and DP, length of hospital stay in PE and DP, and severe morbidity in DP.

Background The robotic surgery cost presents a critical issue which has not been well addressed yet. This study aims to compare the clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods Data were abstracted prospectively from 2011 to 2017. An independent company performed the financial analysis. Results A total of 28 RDP and 26 LDP were included. The mean operative time was significantly lower in the LDP (294 vs 241 min; p = 0.02). The main intra and post-operative data were similar, except for the conversion rate (RDP: 3.6% vs LDP: 19.2%; p = 0.04) and hospital stay (RDP: 8.9 vs LDP 13.1 days; p = 0.04). The mean total costs were similar in both groups (RDP: 9198.64 € vs LDP: 9399.74 €; p > 0.5). Conclusions RDP showed lower conversion rate and shorter hospital stay than LDP at the price of longer operative time. RDP is financially comparable to LDP.

Background In literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia. Methods Patients were prospectively randomized between March 2013 and March 2015. Outcome parameters included hospital stay, operation time, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life. Results Sixty-one patients underwent TAPP repair and 73 underwent OLR. TAPP procedure had less early post-operative pain up to 7 days from surgery (p = 0.003), a shorter length of hospital stay (p = 0.001), less postoperative complications (p = 0.012) and less chronic pain (0.04) when compared with the OLR approach. Conclusions TAPP procedure for bilateral inguinal hernia effectively reduces early postoperative pain, hospital stay and postoperative complications.

Leiomyosarcomas present high postoperative morbidity and poor prognosis [1]. In the literature, only few cases of localized small leiomyosarcoma have been described [2, 3]. These cases might benefit from a minimally invasive approach. Robotic surgery has been claimed to have several advantages over laparoscopy such as enhanced vision and instruments movements which might make more feasible the execution of this type of surgery where partial renal resection is required. A 53-year-old female with a medical history of myeloid leukemia and with chronic renal failure (creatinine: 2.6) was referred to our hospital for an incidental finding of right perirenal tumor of almost 3 cm compatible with leiomyosarcoma arising from the right renal vein. The operation was performed using a Da Vinci Robotic Surgical System model Si (Intuitive Surgical, Sunnyvale, CA, USA).Robotic ports were placed in a standard configuration for minimally invasive right nephrectomy. The dissection started with the partial mobilization of the right liver and Kocher maneuver. After the identification of the inferior vena cava the tumor was finally localized and dissected. Resection ended with a partial right vein resection and suture. Pathological final exam confirmed the diagnosis with margins free from tumor. In selected cases, robotic resection of leiomyosarcoma might be a safe and feasible procedure in experienced hands.

Cerebral Palsy (CP) is a group of permanent pre, post and perinatal disorders of the motor and posture development due to non-progressive alterations in brain’s natural development caused by injuries in the Central Nervous System. Due to the importance of the daily use of the upper limb members, it’s important to consider more efficient ways to evaluate the performance in patients diagnosed with CP. One way to obtain an evaluation of the performance of the thoracic member is recording defined movements and calculating the smoothness, using an instrumented sorting block box. Our objective is to create a protocol of valuation for the upper member that is objective, efficient and that gives a quantitative feedback of the grade of the motor affectation of child with PC in a clinical environment.

A high throughput screening for anticancer activity of FDA approved drugs identified mycophenolic acid (MPA), an inhibitor of inositol monophosphate dehydrogenase (IMPDH) as an active agent with an antiangiogenesis mode of action. Exposure of pancreatic cancer cell lines to MPA resulted in growth inhibition and reduced the expression of VEGF that was reversed by supplementing the media with guanosine supporting and IMPDH-dependant mechanism. In preclinical in vivo study, MPA showed a moderate inhibition of tumor growth in a panel of 6 human derived pancreatic cancer xenografts but reduced the expression of VEGF. To investigate the effects of MPA in human pancreatic cancer, a total of 12 patients with resectable pancreatic cancer (PDA) received increasing doses of mycophenolate mofetil (MMF) in cohorts of 6 patients each from 5-15 days prior to surgical resection. Treatment was well tolerated with one episode of grade 1 muscle pain, one episode of grade 2 lymphopenia (2 gr/day dose) and one episode of grade 2 elevantion in LFT (all in the 2 gr./day dose). Patients recovered from surgery uneventfully with no increased post-operative complications. Assessment of CD31, VEGF, and TUNEL in resected specimens compared to a non treated control of 6 patients showed no significant variations in any of the study endpoints. In conclusion, this study shows the feasibility of translating a preclinical observation to the clinical setting and to explore a drug mechanism of action in patients. MPA, however, did not show any hints of antiangiogenesis of anticancer clinical activity questioning if this agent should be further developed in PDA.

Background Pancreatectomy for locally advanced adenocarcinoma affecting the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) is still under discussion [1]. However, in selected cases, in light of the advancement of recent neoadjuvant treatments, it must be taken into account [2,3]. This video demonstrates some of the technical aspects of SMA and SMV resection as well as some tips of vascular reconstruction. Methods A 48-year-old man with a large adenocarcinoma of the uncinated process affecting the SMA and SMV underwent 3 cycles of gemcitabine and nab-paclitaxel neoadjuvancy. Post chemotherapy studies showed no disease progression with a normalization of CA 19.9 and SUV of FDG PET CT scan and a downsizing of the tumor, as well. Therefore, an en bloc total spleno-pancreato-duodenectomy with resection of SMA and SMV was planned. Results Through a bilateral subcostal incision, an "arterial first approach" [3] was performed. Considering the large length of the vascular resection, the replacement of the resected SMA and SMV was performed using two PTFE grafts, as showed in the video. Postoperative pathology showed margins free from disease with an important pathological response (grade 2 of Ryan classification adapted from rectal cancer) [4]. The post-operative course was uneventful and the patient is still free from disease at 31 months from surgery. Conclusions This case is part of a large experience our group have acquired since we started neoadjuvancy in 2010. In our experience, we gathered 25 cases of locally advanced pancreatic tumors, of which 12 underwent to pancreatic resection after good response to the neoadjuvant treatment. In 5 of them concomitant SMA and SMV resection was required and post-operative mortality occurred in 1 of them. Morbidities and mortalities are higher compared with standard pancreatectomies, specially related to the vascular reconstruction (bleeding, graft thrombosis) [5]. However, in some circumstances like young age, great radiological and biological response to neoadjuvancy (such as the case herein presented), surgery might be considered the best option of care providing the only possibility to increase survival for these types of locally advanced tumors. However, further studies are needed to know which patients might benefit from this approach. En bloc total spleno-pancreato-duodenectomy with resection of SMA and SMV might be considered as an effective procedure in selected cases of pancreatic adenocarcinoma with good response to preoperative treatment.