216 research outputs found
Trasplante hepático
Liver transplantation is an efficient therapeutic
option for terminal hepatic diseases. The principal
indications of liver transplantation are hepatic cirrhosis,
hepatic tumours (mainly, hepotocellular carcinoma)
and acute liver failure. Over the years, the
absolute contraindications for a transplant have lessened.
Surgical techniques have also undergone
changes. The results of liver transplant have improved
so that survival one year after the transplant is close to
90% and after five years some 80% of transplanted
patients continue to live
Laparoscopic limited liver resection decreases morbidity irrespective of the hepatic segment resected
AbstractObjectivesThe laparoscopic approach is widely used in abdominal surgery. However, the benefits of laparoscopy in liver surgery have hitherto been insufficiently established. This study sought to investigate these benefits and, in particular, to establish whether or not the laparoscopic approach is beneficial in patients with lesions involving the posterosuperior segments of the liver.MethodsOutcomes in a cohort of patients undergoing mostly minor hepatectomy (50 laparoscopic and 52 open surgery procedures) between January 2000 and December 2010 at the University Clinic of Navarra were analysed. The two groups displayed similar clinical characteristics.ResultsPatients submitted to laparoscopic liver resection (LLR) had a lower risk for complications [odds ratio (OR) = 0.24, 95% confidence interval (CI) 0.07–0.74; P = 0.013] and shorter hospital stay (OR = 0.08, 95% CI 0.02–0.27; P < 0.001) independently of the presence of classical risk factors for complications. In the cohort of patients with lesions involving posterosuperior liver segments (20 laparoscopic, 21 open procedures), LLR was associated with significantly fewer complications (OR = 0.16, 95% CI 0.04–0.71) and a lower risk for a long hospital stay (OR = 0.1, 95% CI 0.02–0.43).ConclusionsThis study confirms that the laparoscopic approach to hepatic resection decreases the risk for post-surgical complications and lengthy hospitalization in patients undergoing minor liver resections. This beneficial effect is observed even in patients with lesions located in segments that require technically difficult resections
Trasplante pancreático
Diabetes mellitus is a health concern of the first order, given the high level of
associated morbidity and mortality. The objective, in order to slow down the
advance of its complications before they become irreversible, is based on correct
metabolic control. The high rate of morbidity associated with the surgery of the
vascularized pancreas transplant and the high index of rejection have for three
decades formed an obstacle to this being considered a valid alternative in the
treatment of these patients. Nowadays the pancreas transplant has come to occupy
a key position, thanks to the new regimes of immunosuppression and to the
perfection of surgical techniques. In this article we review the evolution of the
pancreas transplant from its beginnings to its present state
Cirugía laparoscópica hepática y pancreática
The development of laparoscopic surgery also
includes the more complex procedures of abdominal
surgery such as those that affect the liver and the
pancreas. From diagnostic laparoscopy, accompanied
by laparoscopic echography, to major hepatic or
pancreatic resections, the laparoscopic approach has
spread and today encompasses practically all of the
surgical procedures in hepatopancreatic pathology.
Without forgetting that the aim of minimally invasive
surgery is not a better aesthetic result but the
reduction of postoperative complications, it is
undeniable that the laparoscopic approach has
brought great benefits for the patient in every type of
surgery except, for the time being, in the case of big
resections such as left or right hepatectomy or
resections of segments VII and VIII.
Pancreatic surgery has undergone a great
development with laparoscopy, especially in the field
of distal pancreatectomy due to cystic and
neuroendocrine tumours where the approach of choice
is laparoscopic. Laparoscopy similarly plays an
important role, together with echolaparoscopy, in
staging pancreatic tumours, prior to open surgery or
for indicating suitable treatment.
In coming years, it is to be hoped that it will
continue to undergo an exponential development and,
together with the advances in robotics, it will be
possible to witness a greater impact of the
laparoscopic approach on the field of hepatic and
pancreatic surgery
Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID)
Iterative surgery; Metastases; Renal cell carcinomaCirurgia iterativa; Metàstasis; Carcinoma de cèl·lules renalsCirugía iterativa; Metástasis; Carcinoma de células renalesBackground and objectives
Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival.
Methods
Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected.
Results
The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2–56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895).
Conclusion
Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection
Portal Revascularization in the Setting of Cavernous Transformation Through a Paracholedocal Vein: A Case Report
Diffuse thrombosis of the entire portal system (PVT) and cavernomatous
transformation of the portal vein (CTPV) represents a demanding challenge in
liver transplantation. We present the case of a patient with nodular regenerative
hyperplasia and recurrent episodes of type B hepatic encephalopathy concomitant
with PVT as well as CTPV, successfully treated with orthotopic liver
transplantation. The portal inflow to the graft was carried out through the
confluence of 2 thin paracholedochal varicose veins, obtaining good early graft
function and recovery of the encephalopatic episodes. This alternative should be
kept in mind as an option to assure hepatopetal splanchnic flow in those cases of
diffuse thrombosis and cavernomatous transformation of portal vein.
CI - Copyright (c) 2010 Elsevier Inc. All rights reserved
Surgery and radioembolization of liver tumors
Surgical resection is considered the curative treatment par excellence for patients with primary or
metastatic liver tumors. However, less than 40% of them are candidates for surgery, either due to nonmodifiable factors (comorbidities, age, liver dysfunction. . .), or to the invasion or proximity of the tumor
to the main vascular requirements, the lack of a future liver remnant (FLR) adequate to maintain postoperative liver function, or criteria oftumor size and number. In these lastfactors, hepatic radioembolization
has been shown to play a role as a presurgical tool, either by hypertrophy of the FLR or by reducing tumor
size that manages to reduce tumor staging (term known as downstaging ¨ ¨
). To these is added a third factor,
which is its ability to apply the test oftime, which makes it possible to identify those patients who present
progression of the disease in a short period of time (both locally and at distance), avoiding a unnecessary
surgery. This paper aims to review RE as a tool to facilitate liver surgery, both through the experience of
our center and the available scientific evidence.La resección quirúrgica se considera eltratamiento curativo por excelencia para los pacientes con tumores
hepáticos primarios o metastásicos. Sin embargo, menos del 40% de ellos son candidatos a cirugía, ya
sea por factores no modificables (comorbilidades, edad, disfunción hepática. . .), como por la invasión o
proximidad del tumor a los principales pedículos vasculares, la falta de un futuro remanente hepático
(FRH) adecuado para mantener una función hepática postoperatoria, o criterios de tamano˜ y numero
tumoral. En estos últimos factores, la radioembolización hepática ha mostrado tener un papel como
herramienta prequirúrgica, ya sea mediante la hipertrofia del FRH o mediante la reducción del tamano˜
tumoral que consigue disminuir la estadificación tumoral (término conocido como “downstaging”). A
estos se suma un tercer factor, que es su capacidad de aplicar el test del tiempo, que permite identificar
aquellos pacientes que presenten en un plazo corto de tiempo progresión de la enfermedad (tanto a
nivel local como a distancia), evitándoles una cirugía innecesaria. En este trabajo se pretende hacer una
revisión de la RE como herramienta facilitadora de la cirugía hepática, tanto a través de la experiencia de
nuestro centro como de la evidencia científica disponible
Totally Laparoscopic Roux-en-Y Duct-to-Mucosa Pancreaticojejunostomy After Middle Pancreatectomy A Consecutive Nine-case Series at a Single Institution
To present the results of a series of laparoscopic middle
pancreatectomies with roux-en-Y duct-to-mucosa pancreaticojejunostomy. SUMMARY OF
BACKGROUND DATA: Middle pancreatectomy makes it possible to preserve pancreatic
parenchyma in the resection of lesions that traditionally have been treated by
distal splenopancreatectomy or cephalic duodenopancreatectomy. The laparoscopic
approach could minimize the invasiveness of the procedure and enhance the
benefits of middle pancreatectomy. METHODS: From March 2005 to October 2007, 9
consecutive patients with benign or low malignant potential lesions in the
pancreatic neck or body underwent surgery. Laparoscopic middle pancreatectomy
with a roux-en-Y duct-to-mucosa pancreaticojejunostomy was planned on all of
them. In the first 2 patients, the pancreas was transected by endostapler; in the
last 7, the staple line was reinforced with absorbable polymer membrane. RESULTS:
The intervention was concluded laparoscopically in every case except 1
(laparoscopic-assisted) in which pancreaticojejunostomy was performed by means of
minilaparotomy. Mortality was 0% and perioperative morbidity was 33%, (fistula of
the cephalic stump in the first 2 patients (22%)). The pancreaticojejunostomy
fistula rate was 0%. The median postoperative hospital stay was 5 days (range,
3-41). In the last 7 patients, in which pancreas was transected with staple line
reinforcement material there were no stump fistulas; morbidity decreased to 14%
and the median hospital stay was 4 days (range, 3-30). CONCLUSIONS: Laparoscopic
middle pancreatectomy is feasible and safe. Duct-to-mucosa pancreaticojejunostomy
can be performed safely using this approach. The method of pancreatic transection
seems to be decisive in the incidence of cephalic stump fistulas
Conversion From Calcineurin Inhibitors to Mycophenolate Mofetil in Liver Transplant Recipients With Diabetes Mellitus
Diabetes mellitus, a frequent metabolic complication in liver transplant
recipients, may be produced by the diabetogenic effect of calcineurin inhibitors
cyclosporine and tacrolimus. The aim of this study was to investigate the safety
and metabolic effects of a gradual switch from cyclosporine or tacrolimus to
mycophenolate mofetil among 12 diabetic liver transplant recipients. One patient
was withdrawn from the study due to gastrointestinal side effects. Of the 11
remaining patients, cyclosporine or tacrolimus was completely withdrawn in five
patients. Two patients developed suspected acute rejection episodes that were
controlled by increasing the tacrolimus dosage. Glycosylated hemoglobin A1C and
C-peptide levels were significantly lower at 3 and 6 months after the initiation
of mycophenolate mofetil (P<.03 in all cases). Furthermore, urea and uric acid
levels were significantly reduced after the change of treatment. In conclusion, a
switch from cyclosporine/tacrolimus to mycophenolate mofetil may produce
beneficial metabolic effects in diabetic liver transplant recipients, but poses a
risk of graft rejection
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