Hernia de Amyand: comunicación de dos casos reparados con técnica de Rutkow-Robbins

ResumenIntroducciónLa hernia de Amyand es una entidad poco frecuente, definida como aquella hernia inguinal que contiene en su saco el apéndice cecal de características normales o con signos de inflamación aguda. Constituye menos del 1% del total de hernioplastias en el adulto. Su tratamiento estándar se discute aún.Material y métodosSe informa de 2 casos de hernia de Amyand sin apendicitis aguda que fueron reparados exitosamente, de forma urgente, con la técnica protésica de Rutkow-Robbin.ResultadosAmbos casos no presentaron morbilidad a corto plazo ni recidiva a los 3 y 4 años de seguimiento, respectivamente.ConclusiónEn nuestra experiencia, la hernia de Amyand sin signos de apendicitis puede resolverse con éxito mediante la colocación de una malla protésica.AbstractIntroductionAmyand hernia is a rare entity that is defined as an inguinal hernia where a cecal appendix—either normal or with signs of acute inflammation—is included in the hernial sac. It is reported in less than 1% of adult hernioplasties. The standard treatment is still debated.Material and methodsWe report 2 cases of Amyand hernia without acute appendicitis that were successfully repaired with the prosthetic Rutkow-Robbin technique.ResultsImmediate positive evolution. No recurrence at 3 and 4 years respectively after surgery.ConclusionAmyand hernia without signs of appendicitis, in our experience, can be successfully repaired with prosthetic mesh placement

Long-term relationship between tobacco use and weight loss after sleeve gastrectomy

8 p.Fil: Signorini, Franco José. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Polero, Virginia. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Viscido, Germán. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Navarro, Luciano. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Obeide, Lucio. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Moser, Federico. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.BACKGROUND: Smoking cessation had been typically associated with weight gain. We have reported that there is no relationship between tobacco use and weight loss after bariatric surgery in the short term. The objective of this study was to establish the relationship between weight loss and the smoking habit in patients undergoing bariatric surgery and to analyze weight loss on severe smokers and on those patients who stopped smoking during the long-term postoperative period. METHODS: One hundred eighty-four patients included in our previous study were contacted by phone at 7 years after sleeve gastrectomy. They were again divided into three groups: (A) smokers, (B) ex-smokers, and (C) non-smokers. Demographics and weight loss at 6, 12, 24, and 7 years were analyzed. Smokers were subdivided for further analysis into the following: group A1: heavy smokers, group A2: non-heavy smokers, group A3: active smokers after surgery, and group A4: quitters after surgery. Student test was used for statistics. RESULTS: One hundred two patients were included. The follow-up was 80.74 ± 7.25 month. Group A: 29 patients, group B: 34 patients, and group C: 39 patients. Mean BMI was 34.35 ± 8.44 kg/m2 and the %EWL was 56.95 ± 27. The subgroup analysis showed the following composition: group A1: 6 patients, group A2: 23 patients, group A3: 23 patients, and group A4: 6 patients. Weight loss difference among groups and subgroups was statistically non-significant. CONCLUSIONS: This study reaffirms the hypothesis that weight loss among bariatric patients is independent from smoking habit even at long-term follow-up and regardless from cessation.http://link.springer.com/10.1007/s11695-018-3217-9info:eu-repo/semantics/publishedVersionFil: Signorini, Franco José. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Polero, Virginia. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Viscido, Germán. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Navarro, Luciano. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Obeide, Lucio. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Fil: Moser, Federico. Hospital Privado Universitario de Córdoba. Departamento de Cirugía General. Programa de Cirugía Bariátrica; Argentina.Cirugí

Laparoscopic hepaticojejunostomy for the treatment of bile duct injuries in difficult scenarios (with video)

Open Roux-en-Y hepaticojejunostomy (RYHJ) is the treatment of choice for bile duct injuries (BDI) sustained during laparoscopic cholecystectomy. Although in recent years the mini-invasive approach has been explored at expert centers, laparoscopic RYHJ for challenging surgical scenarios has rarely been attempted. We herein report two cases of RYHJ for BDI in highly complex surgical scenarios, such as right posterior BDI or failure of previous repairs, with special emphasis on the technical aspects through the embedded videos. The first was an intraoperative repair in a 55-year-old female who suffered a Strasberg type C (transection of the aberrant right hepatic duct) thermal lesion. The second was an iterative repair in a 54-year-old female with a history of a Strasberg type E1 lesion (injury of the main hepatic duct more than 2 cm from the confluence) that had been repaired intraoperatively with an end-to-end anastomosis over a T-tube nine months before referral. Both patients had an uneventful recovery and were discharged four and five days after surgery. After 2.5 and 4 years of follow-up, both patients are asymptomatic and have normal imaging and laboratory tests. To our knowledge, there is no other report in the literature regarding intraoperative laparoscopic right posterior RYHJ for BDI. Laparoscopic RYHJ for BDI repair in the hands of expert laparoscopic biliary surgeons is feasible and safe, even in very challenging surgical scenarios, as herein reported, offering the benefits of mini-invasive surgery. Future high-quality and long-term comparative studies are necessary to elucidate its potential superiority against the standard open approach

Laparoscopic repair of acute traumatic diaphragmatic hernia with mesh reinforcement: A case report

Introduction and importance: Traumatic diaphragmatic injuries are rare and usually occur after thoracoabdominal trauma. Most patients will have other potentially life-threatening injuries. High index of suspicion is the most important attribute. Unfortunately, it is incorrectly diagnosed in up to 33% of cases. If left untreated, the onset of complications carries mortality rates between 25 and 80%. Case presentation: We report a case of an acute diaphragmatic laceration in a 29-year-old male with thoracoabdominal trauma due to a road traffic accident. Physical examination revealed an absence of normal breath sounds in the left hemithorax. CT-scan confirmed a voluminous left diaphragmatic hernia with omental, gastric, and transverse colon content, so surgical intervention was advised. During laparoscopy, a 15 cm long and 5 cm wide diaphragmatic defect was identified. The hernia was reduced laparoscopically, and the defect repaired with interrupted non-absorbable sutures. As a reinforcement, a visceral contact prosthesis was placed. The patient had an uneventful recovery and after 12-month follow-up he has no evidence of recurrence. Clinical discussion: Diaphragmatic injuries do not close spontaneously. An abdominal approach is recommended as it allows for evaluation of the entire abdomen and treatment of any associated injury. Watertight closure with nonabsorbable suture and in case of large defects, the placement of a mesh on the peritoneal side of the diaphragm is recommended to reinforce the primary repair. Conclusion: Laparoscopic emergency surgery has proved to be effective and safe in selected patients with hemodynamic stability. Patients can expect the benefits of minimal invasive surgery with recurrence rate like the open approach.Fil: Gielis, Manuel. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Department of General Surgery; ArgentinaFil: Bruera, Nicolás. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Department of General Surgery; ArgentinaFil: Pinsak, Agustín. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Department of General Surgery; ArgentinaFil: Olmedo, Ignacio. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Department of Thoracic Surgery. Department of Thoracic Surgery; ArgentinaFil: Fabián, Paez Walter. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Department of Thoracic Surgery. Department of Thoracic Surgery; ArgentinaFil: Viscido, German. Universidad Católica de Córdoba. Clínica Universitaria Reina Fabiola. Department of General Surgery; Argentin