RESUMEN
Caecal volvulus is an uncommon cause of intestinal obstruction, with a high associated morbidity and mortality. Caecal volvulus is a very rare complication following retroperitoneal surgery. As such, a high degree of clinical suspicion is warranted post operatively to minimise delay in definitively investigating and managing this condition. We present a case of an 80-year-old Caucasian woman who was admitted for an elective left-sided laparoscopic retroperitoneal nephroureterectomy for transitional cell carcinoma of the left upper pole renal calyx. Postoperatively, the patient developed intestinal obstruction, secondary to caecal volvulus. The patient underwent an emergency laparotomy and limited right-sided colonic resection with primary anastomosis.
Asunto(s)
Enfermedades del Ciego/etiología , Vólvulo Intestinal/etiología , Laparoscopía/efectos adversos , Nefroureterectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Anciano de 80 o más Años , Enfermedades del Ciego/cirugía , Femenino , Humanos , Vólvulo Intestinal/cirugía , Laparoscopía/métodos , Nefroureterectomía/métodos , Complicaciones Posoperatorias/cirugíaRESUMEN
PURPOSE: The aims of this paper were to evaluate the clinical features of patients with primary duodenal adenocarcinoma and to address the prognostic relevance of different surgical and pathological variables after potentially curative pancreaticoduodenectomy. METHODS: Patients with primary duodenal adenocarcinoma observed from 2000 through 2009 were identified from a single-institution electronic database. Univariate and multivariate analyses were performed to identify factors associated with survival. RESULTS: The study population consisted of 37 patients. Of these, 25 underwent pancreaticoduodenectomy, while the remaining 12 were not amenable to resection and underwent bypass operations or were given best supportive care. Overall survival after radical resection (R0) was significantly longer than after palliative surgery (180 versus 35 months, p = 0.013). On multivariate analysis, tumor grade (hazard ratio (HR) = 1.345, 95% CI = 1.28-1.91, p = 0.03) and the occurrence of postoperative or abdominal complications (HR = 1.781, 95% CI = 1.10-2.89, p = 0.037; HR = 1.878, 95% CI = 1.21-3.08, p = 0.029) were found to be significant prognostic factors for survival in patients undergoing potentially curative resection. In particular, median survival was 180 months in patients with an uneventful postoperative course and 52 months in those with abdominal complications. The 5-year overall survival rates were 100 and 60 %, respectively. CONCLUSIONS: According to the present findings, the development of postoperative complications may be an additional prognostic factor after potentially curative pancreaticoduodenectomy for primary duodenal adenocarcinoma. This emphasizes the need for centralization to high-volume centers where an appropriate postoperative care can be delivered.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias Duodenales/cirugía , Pancreaticoduodenectomía , Complicaciones Posoperatorias/epidemiología , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Duodenales/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Estadísticas no Paramétricas , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Reinforcement of inguinal hernia repair with prosthetic mesh is standard practice but can cause considerable pain and stiffness around the groin and affect physical functioning. This has led to various types of mesh being engineered, with a growing interest in lighter-weight mesh. Minimally invasive approaches have also significantly reduced postoperative recovery from inguinal hernia repair. The aim of this systematic review was to compare the outcomes after laparoscopic inguinal repair using new lightweight or traditional heavyweight mesh in published randomised controlled trials. METHODS: Medline, Embase, trial registries, conference proceedings, and reference lists were searched for controlled trials of heavyweight versus lightweight mesh for laparoscopic repair of inguinal hernias. The primary outcomes were recurrence and chronic pain. Secondary outcomes were visual analogue pain score at 7 days postoperatively, seroma formation, and time to return to work. Risk differences were calculated for categorical outcomes and standardised mean differences for continuous outcomes. RESULTS: Eight trials were included in the analysis of 1,667 hernias in 1,592 patients. Mean study follow-up was between 2 and 60 months. There was no effect on recurrence [pooled analysis risk difference 0.00 (95% CI -0.01 to 0.01), p = 0.86] or chronic pain [pooled analysis risk difference -0.02 (95% CI -0.04 to 0.00); p = 0.1]. Lightweight and heavyweight mesh repair had similar outcomes with regard to postoperative pain, seroma development, and time to return to work. CONCLUSION: Both mesh options appear to result in similar long- and short-term postoperative outcomes. Further long-term analysis may guide surgeon selection of mesh weight for laparoscopic inguinal hernia repair.
Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Mallas Quirúrgicas , Dolor Crónico/etiología , Humanos , Dimensión del Dolor , Dolor Postoperatorio/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función , Recurrencia , Seroma/etiología , Resultado del TratamientoRESUMEN
Acute pancreatitis is an acute inflammatory disease of the pancreas which can lead to a systemic inflammatory response syndrome with significant morbidity and mortality in 20% of patients. Gallstones and alcohol consumption are the most frequent causes of pancreatitis in adults. The treatment of mild acute pancreatitis is conservative and supportive; however severe episodes characterized by necrosis of the pancreatic tissue may require surgical intervention. Advanced understanding of the pathology, and increased interest in assessment of disease severity are the cornerstones of future management strategies of this complex and heterogeneous disease in the 21st century.