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Hinojosa-Gonzalez DE, Salgado-Garza G, Tellez-Garcia E, Escarcega-Bordagaray JA, Bueno-Gutierrez LC, Madrazo-Aguirre K, Muñoz-Hibert MI, Diaz-Garza KG, Ramirez-Mulhern I, Alvarez de la Reguera-Babb R, Flores-Villalba E, Rodarte-Shade M, Gonzalez-Urquijo M. Blood salvage and autotransfusion during orthotopic liver transplantation for hepatocellular carcinoma: A systematic review and meta-analysis. Clin Transplant 2024; 38:e15222. [PMID: 38064310 DOI: 10.1111/ctr.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/12/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a significant cause of oncologic mortality worldwide. Liver transplantation represents a curative option for patients with significant liver dysfunction and absence of metastases. However, this therapeutic option is associated with significant blood loss and frequently requires various transfusions and intraoperative blood salvage for autotransfusion (IBS-AT) with or without a leukocyte reduction filter. This study aimed to analyze available evidence on long-term oncologic outcomes of patients undergoing liver transplantation for HCC with and without IBS-AT. METHODS Per PRISMA guidelines, a systematic review of keywords "Blood Salvage," "Auto-transfusion," "Hepatocellular carcinoma," and "Liver-transplant" was conducted in PubMed, EMBASE, and SCOPUS. Studies comparing operative and postoperative outcomes were screened and analyzed for review. RESULTS Twelve studies totaling 1704 participants were included for analysis. Length of stay, recurrence rates, and overall survival were not different between IBS-AT group and non IBS-AT group. CONCLUSION IBS-AT use is not associated with increased risk of recurrence in liver transplant for HCC even without leukocyte filtration. Both operative and postoperative outcomes are similar between groups. Comparison of analyzed studies suggest that IBS-AT is safe for use during liver transplant for HCC.
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Affiliation(s)
| | | | | | | | | | | | | | - Karla G Diaz-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | | | | | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
- Tecnologico de Monterrey, School of Engineering and Sciences, Monterrey, Mexico
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
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2
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Gonzalez-Urquijo M, Romero-Davila A, Mendoza-Silva M, Treviño ANH, Rodarte-Shade M, Gil-Galindo G. A fecalith mimicking a bladder calculus secondary to an appendicovesical fistula: a case report. Ann Coloproctol 2023; 39:362-365. [PMID: 34284561 PMCID: PMC10475804 DOI: 10.3393/ac.2020.00311.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/17/2020] [Accepted: 05/16/2021] [Indexed: 10/20/2022] Open
Abstract
An appendicovesical fistula is defined as an abnormal communication between the appendix and the urinary bladder, with only a few cases reported in the literature. It is very challenging to make an early diagnosis, due to the inability of conventional imaging modalities to detect this unique pathology. The symptoms are often mild, and there are not any specific signs or symptoms that might suggest this type of anomalous communication. We report a case of a 27-year-old male patient who presented difficulty for initiating urination, dysuria, and persistent urinary tract infections. An abdominal x-ray showed a large calculus inside the bladder. A cystoscopy was performed, where the tip of the appendix was seen protruding inside the bladder with a large fecalith adhered to the bladder wall. An appendectomy and partial cystectomy with primary repair were auspiciously achieved. A review of the literature is also presented.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Department of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Department of Surgery, Hospital Metropolitano “Dr. Bernando Sepúlveda”, San Nicolás de los Garza, México
| | - Andrea Romero-Davila
- Department of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - MaryCarmen Mendoza-Silva
- Department of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Department of Surgery, Hospital Metropolitano “Dr. Bernando Sepúlveda”, San Nicolás de los Garza, México
| | - Antonio Nassim Halun Treviño
- Department of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Department of Surgery, Hospital Metropolitano “Dr. Bernando Sepúlveda”, San Nicolás de los Garza, México
| | - Mario Rodarte-Shade
- Department of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Department of Surgery, Hospital Metropolitano “Dr. Bernando Sepúlveda”, San Nicolás de los Garza, México
| | - Gerardo Gil-Galindo
- Department of Surgery, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
- Department of Surgery, Hospital Metropolitano “Dr. Bernando Sepúlveda”, San Nicolás de los Garza, México
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3
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Quevedo-Fernandez E, Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Morales-Flores LF, Morales-Morales CA, Zambrano-Lara M, Guajardo-Nieto D, Rodarte-Shade M. Analysis of deferral times in patients diagnosed with acute appendicitis. Asian J Surg 2023; 46:1187-1192. [PMID: 36041893 DOI: 10.1016/j.asjsur.2022.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There are still controversies regarding the time of surgical management for acute appendicitis (AA). The main objective of this study was to recognize the surgical deferral time in patients with acute appendicitis and its relationship with the severity of presentation. MATERIALS AND METHODS We performed a retrospective review of prospectively collected data of all patients with acute appendicitis undergoing appendectomy from August 2018 to August 2020 in an academic, public hospital. Elapsed time from arrival to the emergency room to skin incision was determined. Patients were divided into three groups based on the elapsed time: less than 6 h, between 6 and 12 h, and more than 12 h. RESULTS A total of 782 patients were included. Of them, 443 (56.6%) patients had a surgical deferral time of less than 6 h, 238 (30.4%) patients between 6 and 12 h, and 101 (13%) patients of more than 12 h. Patients with more than 12 h of surgical deferral time had a more complicated clinical presentation (P = 0.013), a higher frequency of abscess formation (P = 0.022), higher requirement for the use of surgical drainage (P = 0.018), and longer length of hospital stay (P = <0.001). CONCLUSION Surgical deferral >12 h was associated with a higher incidence of complicated appendicitis, intra-abdominal abscesses, and overall hospital stay. However, in the multivariate analysis, only total evolution time, from the first symptom to surgery, was a significant independent predictor of complicated appendicitis.
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Affiliation(s)
- Enrique Quevedo-Fernandez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - David E Hinojosa-Gonzalez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - Luis Fernando Morales-Flores
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - Carlos Antonio Morales-Morales
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - Mario Zambrano-Lara
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - Diego Guajardo-Nieto
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Monterrey, Nuevo León, 64710, Mexico.
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Pérez-Macías J, Rodarte-Shade M, Garza-García C, Tueme-De la Peña D, Rodríguez-Guerra M. Granulomatosis with polyangiitis (Wegener’s granulomatosis) with gastrointestinal involvement: A case report. Revista de Gastroenterología de México (English Edition) 2022; 87:392-394. [DOI: 10.1016/j.rgmxen.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Padilla-Armendariz DP, Saldaña-Rodriguez JA, Leyva-Alvizo A, Rodarte-Shade M, Rojas-Mendez J. Esophageal Duplication Cysts in 97 Adult Patients: A Systematic Review. World J Surg 2021; 46:154-162. [PMID: 34628532 DOI: 10.1007/s00268-021-06325-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Esophageal duplication cysts are a rare congenital cystic malformation from faulty intrauterine recanalization of the esophagus during the 4-8th weeks of development. They account for 20% of all gastrointestinal duplication cysts and commonly involve the distal esophagus. Presenting symptoms may be related to size and location. MATERIALS AND METHODS Following the PRISMA guidelines, a systematic review was performed by searching published literature in various databases. Data from 97 reported case reports were pooled to present a descriptive and statistical analysis. RESULTS Patient population was composed of 51(52.5%) males and 46 (47.5%) females, and mean ages was 42.3 years (18-77). Distal cysts were the most prevalent. Seventy-nine (81.4%) patients were symptomatic; common symptoms included dysphagia, chest pain, cough and weight loss. Fifteen (15.5%) patients were treated conservatively and 75 (84.5%) by surgical treatment, among them thoracotomy in 30 (30.9%) patients and VATS in 17 (17.5%) patients. Mean length of hospital stay was 8.6 days (range: 1-26 days). One fatality was registered. Location, unlike size, was not found to influence presenting symptoms or treatment employed. Frequency of conservative treatment was not significantly different between symptomatic and asymptomatic patients. Open approaches were associated with longer stays than their minimally invasive counterparts. CONCLUSION Esophageal duplication cysts remain rare in adults and are frequently located in the distal esophagus. Larger cysts are more likely to cause symptoms. Various surgical techniques may successfully be employed in the treatment of this pathology. Minimally invasive procedures have a shorter hospital stay.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México.
| | - David Eugenio Hinojosa-Gonzalez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México
| | - Diana Paola Padilla-Armendariz
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México
| | - Jorge Alberto Saldaña-Rodriguez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México
| | - Adolfo Leyva-Alvizo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México
| | - Javier Rojas-Mendez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, Nuevo León, 64710, Monterrey, México
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Estevez-Cerda SC, Saldaña-Rodríguez JA, Alam-Gidi AG, Riojas-Garza A, Rodarte-Shade M, Velazco-de la Garza J, Leyva-Alvizo A, Gonzalez-Ruvalcaba R, Martinez-Resendez MF, Ortiz de Elguea-Lizarraga JI. [Severe bowel complications in SARS-CoV-2 patients receiving protocolized care]. Rev Gastroenterol Mex 2021; 86:378-386. [PMID: 38620671 PMCID: PMC8249684 DOI: 10.1016/j.rgmx.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/05/2021] [Indexed: 11/25/2022]
Abstract
Introduction and aims A case series of ten patients that received protocolized care for SARS-CoV-2 infection and developed severe gastrointestinal complications, is presented. The aim of our study was to contribute to the ongoing discussion regarding gastrointestinal complications related to SARS-CoV-2 infection. After reviewing the current literature, ours appears to be the first detailed case series on the topic. Materials and methods A retrospective filtered search of all patients admitted to our hospital for SARS-CoV-2 infection, who developed severe gastrointestinal complications, was performed. All relevant data on hospital patient management, before and after surgery, were collected from the medical records. Results Of the 905 patients admitted to our hospital due to SARS-CoV-2 infection, as of August 26, 2020, ten of them developed severe gastrointestinal complications. Seven of those patients were men. There were four cases of perforation of the proximal jejunum, three cases of perforations of the ascending colon, one case of concomitant perforation of the sigmoid colon and terminal ileum, one case of massive intestinal necrosis, and one preoperative death. Three right colectomies, four intestinal resections, one Hartmann's procedure with bowel resection, and one primary repair of the small bowel were performed. The mortality rate of the patients analyzed was 50%. Conclusion Spontaneous bowel perforations and acute mesenteric ischemia are emerging as severe, life-threatening complications in hospitalized SARS-CoV-2 patients. More evidence is needed to identify risk factors, establish preventive measures, and analyze possible adverse effects of the current treatment protocols.
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Affiliation(s)
- S C Estevez-Cerda
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - J A Saldaña-Rodríguez
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - A G Alam-Gidi
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - A Riojas-Garza
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - M Rodarte-Shade
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - J Velazco-de la Garza
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - A Leyva-Alvizo
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - R Gonzalez-Ruvalcaba
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - M F Martinez-Resendez
- Departamento de Enfermedades Infecciosas, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - J I Ortiz de Elguea-Lizarraga
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
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7
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Estevez-Cerda SC, Saldaña-Rodríguez JA, Alam-Gidi AG, Riojas-Garza A, Rodarte-Shade M, Velazco-de la Garza J, Leyva-Alvizo A, Gonzalez-Ruvalcaba R, Martinez-Resendez MF, Ortiz de Elguea-Lizarraga JI. Severe bowel complications in SARS-CoV-2 patients receiving protocolized care. Rev Gastroenterol Mex (Engl Ed) 2021; 86:378-386. [PMID: 34400118 PMCID: PMC8346336 DOI: 10.1016/j.rgmxen.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/05/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND AIMS A case series of ten patients that received protocolized care for SARS-CoV-2 infection and developed severe gastrointestinal complications, is presented. The aim of our study was to contribute to the ongoing discussion regarding gastrointestinal complications related to SARS-CoV-2 infection. After reviewing the current literature, ours appears to be the first detailed case series on the topic. MATERIALS AND METHODS A retrospective filtered search of all patients admitted to our hospital for SARS-CoV-2 infection, who developed severe gastrointestinal complications, was performed. All relevant data on hospital patient management, before and after surgery, were collected from the medical records. RESULTS Of the 905 patients admitted to our hospital due to SARS-CoV-2 infection, as of August 26, 2020, ten of them developed severe gastrointestinal complications. Seven of those patients were men. There were four cases of perforation of the proximal jejunum, three cases of perforations of the ascending colon, one case of concomitant perforation of the sigmoid colon and terminal ileum, one case of massive intestinal necrosis, and one preoperative death. Three right colectomies, four intestinal resections, one Hartmann's procedure with bowel resection, and one primary repair of the small bowel were performed. The mortality rate of the patients analyzed was 50%. CONCLUSION Spontaneous bowel perforations and acute mesenteric ischemia are emerging as severe, life-threatening complications in hospitalized SARS-CoV-2 patients. More evidence is needed to identify risk factors, establish preventive measures, and analyze possible adverse effects of the current treatment protocols.
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Affiliation(s)
- S C Estevez-Cerda
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - J A Saldaña-Rodríguez
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - A G Alam-Gidi
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - A Riojas-Garza
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - M Rodarte-Shade
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - J Velazco-de la Garza
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - A Leyva-Alvizo
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - R Gonzalez-Ruvalcaba
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - M F Martinez-Resendez
- Departamento de Enfermedades Infecciosas, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - J I Ortiz de Elguea-Lizarraga
- Departamento de Cirugía General, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico.
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8
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Gonzalez-Urquijo M, Hinojosa-Gonzalez DE, Rodarte-Shade M, Gil-Galindo G, Flores-Villalba E, Rojas-Mendez J. Use of the self-reported critical view of safety in laparoscopic cholecystectomy during residency. Surg Endosc 2021; 36:3110-3115. [PMID: 34159462 DOI: 10.1007/s00464-021-08612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Even though the goal of safely performing cholecystectomy is already a priority in general surgical training programs, we aimed to study how many residents and attendings reached the critical view of safety (CVS) in laparoscopic cholecystectomy. MATERIALS AND METHODS Retrospective review of prospectively collected data of all patients with biliary surgical conditions, which underwent laparoscopic cholecystectomy and their corresponding postoperative notes with self-reported CVS from May 2019 to May 2020 in an academic hospital. Comparisons of operative variables between postgraduate year and attendings were made. RESULTS Laparoscopic cholecystectomy was performed in 126 elective cases (62.6%) and 75 (37.3%) emergency cases. On 105 (83.3%) of the elective cases and on 54 (66.7%) emergency cases, a CVS was successfully performed. PGY3 and PGY5 had higher odds of achieving CVS compared to attendings OR 6.09 (95% CI 2.05 to 8.07) and 4.51 (95% CI 1.0 to 10.20), respectively. Overall, attendings had decreased odds ratio of achieving CVS of 0.488 when compared to all residents. Elective procedures had increased odds ratios of achieving CVS of 3.44 (95% CI 1.52 to 7.74). On elective cases, attendings performed significantly faster procedures when compared to PGY2-4, but not PGY5. No differences were seen between operative speeds between PGY. Third-year residents were identified as having the highest frequency of CVS; however, these differences were not statistically significant. In emergency cases, blood loss, operative time, CVS, and bile duct injuries revealed non-significant differences between operators. CONCLUSION CVS was reached significantly more often in elective than in emergency surgeries. There is still a lack of residents and attending surgeons who still failed to complete CVS during LC, highlighting the need for further education. Future studies should be attempted to repeat this study with a larger sample size and multiple coaching sessions to determine long-term efficacy.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, NL, México.
| | - David E Hinojosa-Gonzalez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, NL, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, NL, México
| | - Gerardo Gil-Galindo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, NL, México
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, School of Engineering and Science, Av. Eugenio Garza Sada 2501 Sur, Tecnológico, 64849, Monterrey, NL, Mexico
| | - Javier Rojas-Mendez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, NL, México
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9
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Zambrano-Lara M, Gonzalez-Urquijo M, Lozano-Balderas G, Rodarte-Shade M, Fabiani M. Median arcuate ligament syndrome as a rare cause of chronic abdominal pain. Revista de Gastroenterología de México (English Edition) 2021. [DOI: 10.1016/j.rgmxen.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Zambrano-Lara M, Gonzalez-Urquijo M, Lozano-Balderas G, Rodarte-Shade M, Fabiani MA. Median arcuate ligament syndrome as a rare cause of chronic abdominal pain. Rev Gastroenterol Mex (Engl Ed) 2021; 86:199-201. [PMID: 32680594 DOI: 10.1016/j.rgmx.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Affiliation(s)
- M Zambrano-Lara
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
| | - M Gonzalez-Urquijo
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
| | - G Lozano-Balderas
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
| | - M Rodarte-Shade
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
| | - M A Fabiani
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México.
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11
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Gonzalez-Urquijo M, Zambrano-Lara M, Patiño-Gallegos JA, Rodarte-Shade M, Leyva-Alvizo A, Rojas-Mendez J. Pregnant patients with internal hernia after gastric bypass: a single-center experience. Surg Obes Relat Dis 2021; 17:1344-1348. [PMID: 33858785 DOI: 10.1016/j.soard.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/28/2021] [Accepted: 02/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bariatric surgery has been a popular way for many women to reach a healthy body mass index, and as a consequence, a decreased body mass, which causes a greater chance of fertility, with improved pregnancy and better maternal outcomes. OBJECTIVE Describe a single-center experience of pregnancies complicated by internal hernias after gastric bypass. SETTING Academic Medical Center. METHODS During 2011 and 2019 a series of patients were treated for internal hernia after gastric bypass at our teaching hospital. The hospital records were retrospectively reviewed. RESULTS Seven women were treated. Median age was 33 years (range: 24-39 yr). Median gestational age was 25.6 weeks (range: 5-33 wk). Median time from Roux-en-Y gastric bypass to pregnancy was 4 years (range: 1-7 yr). Median body mass index was 24 kg/m2 (range: 24-31 kg/m2). Five (71.4%) patients underwent an exploratory laparotomy, and 2 (28.5%) patients a diagnostic laparoscopy. In all patients, an internal hernia of the small bowel in the Petersen space was encountered. Median length of pregnancy was 38 weeks (range: 33.6-39.6 wk). Six (85.7%) patients underwent C-section, and 1 (14.2%) patient gave birth by vaginal delivery. There was only 1 maternal postoperative complication and no fetal postoperative complications. Median follow-up was 9 months (range: 2-20 mo). CONCLUSION The rapid growth in bariatric surgery on obese women of fertile age could result in more cases of internal herniation during pregnancy in the future. An internal hernia should be suspected when encountering a postgastric bypass pregnant patient with abdominal pain, nausea, and vomiting.
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Affiliation(s)
| | - Mario Zambrano-Lara
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | | | - Mario Rodarte-Shade
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | - Adolfo Leyva-Alvizo
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México
| | - Javier Rojas-Mendez
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, México.
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Salgado-Garza G, Hernandez-Arriaga P, Gonzalez-Urquijo M, Díaz-Elizondo JA, Flores-Villalba E, Rojas-Méndez J, Rodarte-Shade M. Single-operator cholangioscopy and electrohydraulic lithotripsy for the treatment of Mirizzi syndrome. Ann Med Surg (Lond) 2021; 62:274-277. [PMID: 33537142 PMCID: PMC7841223 DOI: 10.1016/j.amsu.2021.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Mirizzi syndrome is an infrequent complication of long-standing cholelithiasis. Extrinsic compression of the common hepatic duct is usually caused by an impacted stone in Hartmann's pouch or cystic duct resulting in the development of cholecystobiliary fistula. This syndrome is classified based on the presence and severity of cholecystobiliary fistula. Mirizzi syndrome is challenging to diagnose preoperatively and may require complex biliary surgical procedures for resolution. RESULTS We present three patients with Mirizzi syndrome with different clinical presentations. All were successfully treated by cholangioscopy with electrohydraulic lithotripsy. Endoscopic treatment is a safe alternative with a high success rate. Single-operator cholangioscopy combined with lithotripsy has been shown to have a 90-100% success rate in the treatment of biliary stones. CONCLUSION Herein, we present our experience treating Mirizzi syndrome with single-operator cholangioscopy guided electrohydraulic lithotripsy. Difficult management of Mirizzi syndrome has led to research of new treatment options to minimize the risk of high-rate complications. Single-operator cholangioscopy in combination with laser lithotripsy is an adequate and safe alternative for the treatment of this condition.
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Affiliation(s)
- Gustavo Salgado-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
| | - Pamela Hernandez-Arriaga
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
| | - Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
| | - José Antonio Díaz-Elizondo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
- Tecnologico de Monterrey, Escuela Nacional de Ingeniería, Departamento de Ciencias Clinicas, Hospital Zambrano Hellion, Batallon de San Patricio, 112. Col. Real de San Agustin, Monterrey, 66278, Mexico
| | - Javier Rojas-Méndez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto, O 3000, 64710, Monterrey, Nuevo Leon, Mexico
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Gonzalez-Urquijo M, Gil-Galindo G, Rodarte-Shade M. Mirizzi syndrome from type I to Vb: a single center experience. Turk J Surg 2020; 36:399-404. [PMID: 33778400 PMCID: PMC7963310 DOI: 10.47717/turkjsurg.2020.4676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study describes a cohort of patients diagnosed with Mirizzi syndrome from type I to Vb, over a period of four years. It aimed to identify diagnostic and management pitfalls of Mirizzi syndrome, as well as their concomitant cholecystobiliary or cholecystoenteric fistulas. MATERIAL AND METHODS We retrospectively reviewed all electronic medical records of patients who underwent surgery for Mirizzi syndrome at a single institution. RESULTS Twenty-two patients (0.6%) were diagnosed with Mirizzi syndrome. Most of the patients were females (n=19, 86.3%). Mean age was 43.8 years (range: 21-71 years). Ultrasound was performed in all (100%) patients. Six (27.2%) patients had a CT scan and six (27.2%) patients had endoscopic retrograde cholangiopancreatography. Overall preoperative diagnosis was achieved on 36.6% (n=8) of the patients. There were the same total and partial cholecystectomies, accounting for ten (45.5%) cases each, one hepaticojejunostomy with cholecystectomy (4.5%), and one enterolithotomy (4.5%). Laparoscopic cholecystectomy was attempted in 15 (68.1%) patients, with conversion to open surgery in 93.3% (n=14) of the patients. An open approach was made in five (22.7%) cases. Four (18.1%) patients were reported as MS type I, both types II and III each account for 22.7% (n=5) of the cases, there was only one (4.5%) patient with type IV, and seven (31.8%) patients with type V. CONCLUSION There are limited studies of patients with Mirizzi syndrome, including type V classification, and when this syndrome is suspected, a preoperative diagnosis should be made to avoid bile duct injuries or lesions to adjacent organs.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Department of Surgery, Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | | | - Mario Rodarte-Shade
- Department of Surgery, Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
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14
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Abstract
BACKGROUND The present study aims to present a case series of patients who underwent splenectomy for splenic primary solid tumors without preoperative histopathologic diagnosis. METHODS From 2013 to 2019, 12 patients underwent splenectomy for solid primary splenic tumors at 3 different academic medical centers. All electronic medical records were retrospectively reviewed. RESULTS Seven (58.3%) patients were women, and 5 (41.6%) were male. The median age was 48 years (range: 25-72 years). In 8 (66.6%) patients, a conventional approach was performed. In 2 (16.6%), a hand-assisted laparoscopic surgery procedure was completed, and in other 2 (16.6%) patients, a laparoscopic approach was auspiciously achieved. Median operative time was 135 minutes (range: 60-210 minutes), and median blood loss was 500 mL (range: 200-1500 mL). Procedure-related morbidity was found in 2 (16.6%) patients, and the mortality rate was 0%. The final histopathologic diagnosis was lymphoma in 5 (41.6%) patients, lymphangioma in 3 (25%) patients, hamartoma in 2 (16.6%) patients, angiosarcoma, and sclerosing angiomatoid nodular transformation (SANT) in 1 (8.3%) case each. CONCLUSION Splenectomy should be the treatment of choice when encountering a primary splenic tumor without the need for preoperative fine-needle aspiration biopsy, avoiding the complications this technique entails.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernando Sepúlveda". Adolfo López Mateos, San Nicolás de los Garza, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernando Sepúlveda". Adolfo López Mateos, San Nicolás de los Garza, México
| | - Gerardo Gil-Galindo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernando Sepúlveda". Adolfo López Mateos, San Nicolás de los Garza, México
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15
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Morales-Morales CA, Gonzalez-Urquijo M, Rumbaut-Díaz RA, Guajardo-Pérez HJ, Rodarte-Shade M. Ileal bezoar causing bowel obstruction mimicking an internal hernia in a patient with Roux-en-Y gastric bypass. Clin J Gastroenterol 2020; 13:1111-1115. [PMID: 32651871 DOI: 10.1007/s12328-020-01183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
We presented a case of a 64-year-old female patient with a history of gastric bypass that presented with bowel obstruction due to a bezoar. She arrived at the emergency department, referring to severe abdominal pain, nausea, and vomiting. Abdominal X-ray reported gastric distention and hydro-air levels. CT scan reported swirling of the mesentery vessels and a collapsed intestinal loop, mimicking an internal hernia. Laparotomy was accomplished, which shows obstruction at 60 cm from the ileocecal valve. An enterolithotomy was performed, and a 6 × 6 cm phytobezoar was extracted. The patient had a satisfactory postoperative outcome, discharging her home on the fourth postoperative day. On a 12 month-follow up, the patient is doing well with no further complications. Gastric bypass continues to be one of the most performed bariatric procedures with low complication rates. It is important to note that not all intestinal obstructions in postoperative bariatric surgeries are due to internal hernias or adhesions. The differential diagnosis of intestinal obstruction due to bezoar must be present in patients who underwent bariatric surgery. Nutritional counseling is essential for the follow-up of patients, emphasizing fluid intake and slow chewing, as well as the use of absorbable materials for suture during the surgery.
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Affiliation(s)
- Carlos Antonio Morales-Morales
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico
| | - Mauricio Gonzalez-Urquijo
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico.
| | - Roberto Agustín Rumbaut-Díaz
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico.,Especialidades Bariátricas, Avenida de la Industria 300, Torre C, Oficina 8, Punto Central, 66279, San Pedro Garza García, Mexico
| | - Horacio Javier Guajardo-Pérez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico.,Especialidades Bariátricas, Avenida de la Industria 300, Torre C, Oficina 8, Punto Central, 66279, San Pedro Garza García, Mexico
| | - Mario Rodarte-Shade
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Mexico
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16
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Gonzalez-Urquijo M, Estrada-Cortinas OJ, Rodarte-Shade M, Bermea-Mendoza JH, Gil-Galindo G. Preoperative progressive pneumoperitoneum: The answer for treating giant inguinal hernias while avoiding morbidities? Hernia 2020; 24:781-786. [PMID: 32157504 DOI: 10.1007/s10029-020-02155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Preoperative progressive pneumoperitoneum (PPP) is mostly used for giant abdominal incisional hernias, and only a few isolated or paired cases that used PPP in the treatment of giant inguinal hernias (GIH) have been reported. The main objective of this study is to describe our technique in the use of PPP in the treatment of GIH in a series of patients who presented with this challenging condition. METHODS We retrospectively reviewed the medical records of a series of patients treated with PPP for GIH during a 6-year period (2012-2018) at a single institution. The demographics, preoperative, and surgical characteristics were analyzed. RESULTS In total, 7 patients were treated for GIH with PPP. The median age was 64 (range 30-89) years. The median history time with the inguinal hernia was 8 (range 2-20) years. The median time of PPP was 22 (range 15-30) days. All patients underwent the Lichtenstein technique. The median follow-up time was 12 (range 3-84) months. Three (42.8%) of the patients had preoperative complications. Two patients developed mild dyspnea during PPP, and another patient had subcutaneous emphysema during the insertion of the catheter. Two (28.5%) patients had postoperative complications. One of them developed a right scrotal abscess, and another patient developed bilateral grade III hydrocele. CONCLUSION With our limited experience, it is too early to tell if this should be the gold standard for the treatment of GIH. To see if there is superiority among different procedures, more studies that compare the morbidity of PPP with that of other trans operative techniques are needed. Nevertheless, the procedure we propose has provided satisfactory results.
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Affiliation(s)
- M Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico.,Department of Surgery, Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - O J Estrada-Cortinas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico.,Department of Surgery, Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - M Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico.,Department of Surgery, Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - J H Bermea-Mendoza
- Department of Radiology, Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - G Gil-Galindo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico. .,Department of Surgery, Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico.
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Abstract
Purpose Colonic volvulus constitutes a significant cause of large bowel obstruction in adults. Most studies of colonic volvulus come from high endemic zones and are limited by the small number of patients. In our region, there is a shortage of studies concerning this disorder, and treatment of colonic volvulus remains controversial. Methods This is a retrospective study of 34 patients who presented with colonic volvulus at a single academic institution in a 4-year period and their respective treatment and outcomes. Results A total of 34 patients, 17 males (50%) and 17 females (50%), with a mean age of 55 ± 23.9 years underwent treatment for colonic volvulus. Twelve patients (35.3%) underwent initial decompression, followed by a Hartman procedure in 4 patients (11.7%) and sigmoid resection with primary anastomosis in 3 patients (8.8%), with 3 fatalities (8.8%) following initial decompression. Two patients (5.8%) were lost to follow-up. Twenty-two patients (64.7%) underwent emergency surgery, of whom 16 (47%) underwent a Hartman procedure, with colorectal anastomosis in 9 patients (26.4%), with 3 fatalities (8.8%) immediately after the first procedure. Four patients (11.7%) were lost to follow up after the Hartman procedure. Of the 6 remaining patients (17.6%), of the emergency surgical group, 3 patients (8.8%) had an initial sigmoidectomy and primary anastomosis, and the remaining 3 patients (8.8%) had a cecal volvulus with a right hemicolectomy performed with primary anastomosis in 2 patients (5.8%) and with a fatality in the remaining patient, on whom a terminal ileostomy was performed for damage control. The mean hospital stay was 5.7 days, with an overall mortality rate of 23.5%. Conclusion Acute colonic volvulus in our region is not as uncommon as in other parts of the world. This disorder must be suspected when a patient presents with abdominal pain, abdominal distension, and bean sign on plain X-rays and/or a whirl sign on computed tomography scan.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México.,Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
| | - Gerardo Gil-Galindo
- Hospital Metropolitano "Dr. Bernardo Sepúlveda," Secretaria de Salud de Nuevo León, San Nicolás de los Garza, México
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18
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Gonzalez-Urquijo M, Rodarte-Shade M, Lozano-Balderas G, Gil-Galindo G. Cholecystoenteric fistula with and without gallstone ileus: A case series. Hepatobiliary Pancreat Dis Int 2020; 19:36-40. [PMID: 31919039 DOI: 10.1016/j.hbpd.2019.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/17/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND A cholecystoenteric fistula (CEF) is an uncommon complication of gallstone disease. The aim of this study was to present our experience of a series of patients with CEF, presenting with or without gallstone ileus, along with their surgical outcomes. METHODS From 2015 to 2018, 3245 consecutive patients underwent cholecystectomy for gallbladder disease at our institution, of which 15 were diagnosed with a CEF. All electronic medical records were retrospectively reviewed. RESULTS Fifteen patients presented with CEF. Ten patients presented cholecystoduodenal fistula, four patients cholecystocolonic, and one patient cholecystogastric counterparts. Twelve patients were female. The median patient age was 61 years (range 33-86 years). Five patients presented with gallstone ileus treated by laparotomy and enterolithotomy. In ten patients, a laparoscopic approach was attempted, but conversion to open surgery was necessary for eight of them. The median operative time was 140 min (range 60-240 min), and the median operative blood loss was 50 mL (range 10-600 mL). The procedure-related morbidity and mortality rates were 13.3% and 6.7%, respectively. CONCLUSIONS There is no consensus on the best treatment modality for a CEF, as the treatment outcome is mostly dependent on the surgeon's expertise and the patient's condition. Not all CEFs are accompanied by gallstone ileus. For such case, the main purpose is to resolve the intestinal obstruction and, unless necessary, avoidance of the gallbladder area.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México; Department of Surgery, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Secretaria de Salud de Nuevo León, Adolfo López Mateos No. 4600, San Nicolás de los Garza 66400, México.
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México; Department of Surgery, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Secretaria de Salud de Nuevo León, Adolfo López Mateos No. 4600, San Nicolás de los Garza 66400, México
| | - Gerardo Lozano-Balderas
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México
| | - Gerardo Gil-Galindo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey 64710, México; Department of Surgery, Hospital Metropolitano "Dr. Bernardo Sepúlveda", Secretaria de Salud de Nuevo León, Adolfo López Mateos No. 4600, San Nicolás de los Garza 66400, México
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Gonzalez-Urquijo M, Baca-Arzaga AA, Flores-Villalba E, Rodarte-Shade M. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography for choledocholithiasis after Roux-en-Y gastric bypass: A case report. Ann Med Surg (Lond) 2019; 44:46-50. [PMID: 31312443 PMCID: PMC6610664 DOI: 10.1016/j.amsu.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 12/27/2022] Open
Abstract
Background Exclusion of the stomach after Roux-en-Y gastric bypass (RYGB) makes access to the biliary tree very challenging for the surgeon or the endoscopist. Different techniques have been described to overcome this downside, including laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP), which is an outstanding method to access the remnant stomach in order to reach the duodenal papilla. The use of this technique is associated with a high success rate. Presentation of case Here we present the case of a 57-year-old patient with altered RYGB anatomy. The patient underwent laparoscopic cholecystectomy. Intraoperative cholangiography revealed the presence of a stone in the common bile duct. A laparoscopy-assisted transgastric ERCP was performed successfully. During the procedure, the duodenoscope was introduced through a gastrostomy, obviating the need for an intragastric trocar. The patient evolved favorably and was discharged on second postoperative day without any complications. Discussion Transgastric laparoscopy-assisted ERCP represents an effective approach for the management of biliary complications after RYGB, even if there is a long interval between the two interventions, as occurred in the present case. Other methods described for accessing the biliary tree in patients with altered RYGB anatomy are double-balloon ERCP and endoscopic ultrasound-directed transgastric ERCP. We elected to perform the laparoscopy-assisted approach because choledocholithiasis was diagnosed transoperatively, thus, avoiding the need for secondary procedures or interventions. Conclusion Transgastric laparoscopy-assisted ERCP is a feasible procedure with low complication rates and is used in treating patients with altered RYGB anatomy who present with biliary tract disorders. The use of transgastric laparoscopy-assisted ERCP allows endoscopic treatment and cholecystectomy to be performed in a single setting. Case report of a patient with altered RYGB anatomy, which presented choledocholithiasis. There are several ways to treat this disorder on patients with this condition. Laparoscopic Assisted Trans-gastric ERCP is a feasible and secure option.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico
| | - Adrian A Baca-Arzaga
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey. Escuela Nacional de Ingeniería. Departamento de Ciencias Clinicas. Hospital Zambrano Hellion, Batallon de San Patricio 112, Col. Real de San Agustin, Monterrey, 66278, Mexico
| | - Mario Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, Monterrey, 64710, Mexico
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Gonzalez-Urquijo M, Mayagoitia-Gonzalez JC, Rodarte-Shade M, Bermea-Mendoza JH, Gil-Galindo G. Large inguinal bladder hernias: can a preoperative diagnosis be made? Hernia 2019; 23:1221-1227. [PMID: 31055706 DOI: 10.1007/s10029-019-01955-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Bladder hernias are asymptomatic in most cases and are found incidentally during exploration for inguinal hernia repair. The treatment of inguinal bladder hernia is either reduction or resection of the herniated bladder, followed by herniorrhaphy. We present a case series with preoperative diagnoses, along with their surgical outcomes. METHODS We retrospectively reviewed the medical records from a single institution over a 5-year period (2012-2017) of five patients with diagnosis of large bladder inguinal hernia. Demographics, clinical status, medical history, anatomical structure of the hernia, and surgical outcomes were all analyzed. RESULTS Patients' median age was 51 years (range 45-81 years). The median size of the hernial sac was 13 cm (range 8-20 cm). The diagnosis was made with computed tomography in three patients and with ultrasonography and cystography in two patients. Median length of hospital stay was 2 days (range 1-6 days), and median length of follow-up was 28 months (range 18-72 months). All patients continue to be alive and well, without hernia recurrence. The five cases are described separately along with their surgical managements. CONCLUSION The main objectives in treatment of inguinal bladder hernia are to preserve the voiding function and to avoid bladder injuries in a tension-free hernia repair. To our knowledge, this is the first series of cases in which all inguinal bladder hernias were diagnosed preoperatively.
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Affiliation(s)
- M Gonzalez-Urquijo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico.,Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - J C Mayagoitia-Gonzalez
- Centro Especializado en el Tratamiento de Hernias, Hospital Médica Campestre y Unidad Médica de Atención Ambulatoria 55 (UMAA 55) del Instituto Mexicano del Seguro Social (IMSS), Guanajuato, Mexico
| | - M Rodarte-Shade
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico.,Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - J H Bermea-Mendoza
- Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico
| | - G Gil-Galindo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Dr. Ignacio Morones Prieto O 3000, 64710, Monterrey, Nuevo León, Mexico. .,Hospital Metropolitano "Dr. Bernando Sepúlveda", Adolfo López Mateos No. 4600, 66400, San Nicolás de los Garza, Nuevo León, Mexico.
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González-Urquijo M, Kettenhofen SE, Rodarte-Shade M. Colonic intussusception by a giant colon lipoma: A case report. International Journal of Surgery Open 2017. [DOI: 10.1016/j.ijso.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alonso-Lárraga J, de la Mora Levy J, Hernández Guerrero A, Rodarte-Shade M, Ramírez-Solís M. Fully covered metal stents for the treatment of leaks after esophagogastric oncologic surgery. Revista de Gastroenterología de México (English Edition) 2017. [DOI: 10.1016/j.rgmxen.2016.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Alonso-Lárraga JO, de la Mora Levy JG, Hernández Guerrero A, Rodarte-Shade M, Ramírez-Solís ME. Fully covered metal stents for the treatment of leaks after esophagogastric oncologic surgery. Rev Gastroenterol Mex 2016; 82:100-102. [PMID: 27161793 DOI: 10.1016/j.rgmx.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/05/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J O Alonso-Lárraga
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México.
| | - J G de la Mora Levy
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - A Hernández Guerrero
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - M Rodarte-Shade
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
| | - M E Ramírez-Solís
- Servicio de Endoscopia Gastrointestinal, Instituto Nacional de Cancerología, SSA, Ciudad de México, México
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Corona-García R, Farell J, Marín-Dominguez R, Landero-Jimenez N, Maldonado Pintado DG, Campos Pérez FJ, Santos-Gonzalez E, Rodarte-Shade M, Romero G, Macias Valadez LZ. Gastrointestinal Symptoms Comparison Between Roux en y Gastric Bypass Versus Sleeve Gastrectomy in a Mexico City Public Bariatric Center. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodarte-Shade M, Kahaleh M. Stent placement as a bridge to surgery in malignant biliary obstruction (pancreatic cancer, distal bile duct cancer, and hilar tumors). Gastrointestinal Intervention 2015. [DOI: 10.1016/j.gii.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Karia K, Tyberg A, Rodarte-Shade M, Zerbo S, Sharaiha RZ, Kahaleh M. Successful decompression of a massively dilated bile duct by use of a through-the-scope esophageal stent. Gastrointest Endosc 2015; 81:999. [PMID: 25805466 DOI: 10.1016/j.gie.2014.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/21/2014] [Indexed: 12/11/2022]
Affiliation(s)
- Kunal Karia
- Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, New York, New York, USA
| | - Amy Tyberg
- Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, New York, New York, USA
| | - Mario Rodarte-Shade
- Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, New York, New York, USA
| | - Steven Zerbo
- Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, New York, New York, USA
| | - Michel Kahaleh
- Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University, New York, New York, USA
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Abstract
A hybrid technique of laparoscopy and endoscopy can be successful in removal of eroded gastric bands. Background: Intragastric migration is a late and rare postsurgical complication in patients with gastric band placement. Gastric band erosion rate has previously been described to be 1.46%. In this report, we present the case of a 43-y-old male with gastric band erosion undergoing a laparoendoscopic retrieval of the gastric band, due to intragastric migration. Method: A hybrid procedure was performed to retrieve the gastric band. A laparoscopic approach was initially used to extract the connecting tube. Endoscopy was then performed to cut the gastric band with a specific cutter system and was subsequently extracted transorally. Results: The postoperative course was uneventful. Clear liquids were started on day 1, and the patient was discharged on day 2. Discussion: The purpose of this study was to describe a hybrid technique for the removal of an eroded gastric band, as a safe and feasible option in patients with band erosions. Conclusion: The laparoscopic approach enables safe extraction of the connecting tube, while endoscopy allows extraction of the band without creating a large incision in the stomach.
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Affiliation(s)
- Mario Rodarte-Shade
- Department of Surgery, Instituto Tecnologico y de Estudios Superiores de Monterrey, Mexico.
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Affiliation(s)
- Mario Rodarte-Shade
- Department of Surgery, Escuela de Medicina del TEC de Monterrey, Instituto Tecnologico y de Estudios Superiores de Monterrey, Nuevo Leon, Mexico.
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Riquelme M, Aranda A, Rodarte-Shade M, Rodriguez-Gomez J, Torres-Riquelme J. A new surgical stabilizing instrument for hypospadias repair. Eur J Pediatr Surg 2013; 23:148-9. [PMID: 22926693 DOI: 10.1055/s-0032-1322543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mario Riquelme
- Department of Pediatric Surgery, Christus-Muguerza Hospital, Monterrey, Nuevo Leon, Mexico.
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Riquelme M, Lopez M, Landa S, Mejia F, Aranda A, Rodarte-Shade M, Rodriguez-Gomez J, Torres-Riquelme J. Laparoscopic extravesical ureteral reimplantation (LEVUR): a multicenter experience with 95 cases. Eur J Pediatr Surg 2013; 23:143-7. [PMID: 23165518 DOI: 10.1055/s-0032-1329708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Minimally invasive techniques have been used to treat vesicoureteral reflux (VUR) on pediatric patients. The aim of this study is to review the experience of the laparoscopic approach for VUR by the laparoscopic extravesical ureteral reimplantation (LEVUR) Lich-Gregoir technique. MATERIALS AND METHODS We performed a multicentric retrospective study. From 2001 to 2009, 81 pediatric patients with VUR constituting 95 ureteral units underwent LEVUR. Reflux was grade II in 32%, grade III in 55%, and grade IV in 8%. RESULTS LEVUR was performed successfully on the 81 patients with 95 ureteral units. Mean operative time was 105 minutes for left-sided reimplants, 70 minutes for right sided, and 180 minutes for bilateral reimplants. Mean hospital stay was 1.6 days. Urinary catheter was kept in place for a mean time of 0.5 days. Follow-up was achieved for at least 1 year with regular clinic visits, urinalysis, ultrasound, and voiding cystourethrogram. Four patients (4.2%) had evidence of recurrent VUR in a follow-up of 6 to 36 months after antireflux surgery. CONCLUSIONS Although new endoscopic techniques have been widely available for VUR, they have a lower success rate and might require multiple attempts before success. We report that LEVUR has an acceptable success rate (95.8%) and durability compared with open and endoscopic procedures.
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Affiliation(s)
- Mario Riquelme
- Department of Pediatric Surgery, Christus-Muguerza Hospital, Monterrey, Mexico.
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Riquelme M, Aranda A, Rodarte-Shade M, Rodriguez-Gomez J, Torres-Riquelme J. Totally Laparoscopic Approach for Failed Conventional Orchiopexy. J Laparoendosc Adv Surg Tech A 2012; 22:514-7. [DOI: 10.1089/lap.2012.0038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mario Riquelme
- Department of Pediatric Surgery, Christus Muguerza Hospital, Monterrey, Nuevo Leon, Mexico
| | - Arturo Aranda
- Department of Pediatric Surgery, Christus Muguerza Hospital, Monterrey, Nuevo Leon, Mexico
| | - Mario Rodarte-Shade
- Monterrey Institute of Technology and Higher Education (ITESM), Monterrey, Nuevo Leon, Mexico
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