Revista Argentina de Cirugía

The research question as the backbone of a scientific project

Pablo E. Huespe — 2024-02-26

When reading a scientific manuscript, it is common to notice a lack of a core idea throughout the work. This means that the manuscript is composed of different parts that have little relationship with each other, creating a true chimera (a mythological animal made up of parts of different animals).

Editorial on “Pancreatic resections for metastases in the pancreas: analysis of surgical and oncologic outcomes”

Lucio S. Uranga — 2024-02-26

Metastases to the pancreas represent less than 2% of all pancreatic resections; the most common primary malignancy found in this organ is clear renal cell carcinoma. Isolated pancreatic metastases from other organs are exceptional and anecdotal, as evidenced by the published series. Therefore, I will limit my comments to this topic.

Improvement on quality of life after bile duct injury repair using the SF-36 Health Survey

Lenz Virreira Marcelo E. — 2024-02-26

Background: Different publications have examined the pathophysiology of bile duct injury (BDI), bur few studies have investigated the effects of BDIs and their subsequent repair on psychosocial and health-related quality of life
Objective: The aim of this study was to compare the quality of life of patients before and after definitive BDI repair.
Material and methods: The SF-36 Health Survey was used as an instrument to assess health-related quality of life (HRQL) in a series of patients operated on between December 2015 and June 2019 for BDI repair.
Results: Of 48 patients who underwent BDI repair, 22 (46%) responded to the survey. The SF-36 items, which includes different domains (physical functioning, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, mental health, and health transition) were compared. All domains demonstrated statistically significant improvement (p < 0.001) following repair. On univariate analysis, mental health was affected by the presence of a complex injury (p = 0.019), and physical and emotional role functioning before BDI repair were associated with the type of injury of the Strasberg classification (p = 0.001 and p = 0.032, respectively). An associated vascular injury had a negative correlation with physical functioning (p = 0.019), vitality (p = 0.033), mental health (p = 0.005), and pain (p = 0.026) prior to repair.
Conclusion: The definitive resolution of BDIs at a center specialized in hepatobiliary and pancreatic surgery resulted in a significant improvement of patients’ quality of life.

Algorithm to select chest wall perforator flaps in immediate conservative breast surgery reconstruction

Alberto Rancati — 2024-02-26

Background: Chest wall perforator flaps are a good option for immediate breast reconstruction after conservative surgery.
Objective: The aim of this study was to describe the clinical results of an algorithm for using chest wall perforator flaps for breast reconstruction after breast-conserving surgery for breast cancer.
Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from the medical records of the patients diagnosed with breast cancer who underwent breast-conserving surgery and required reconstruction using chest wall perforator flaps between January 2020 and March 2022. The indications included volume deficit, contour defect and asymmetry.
The vascular pedicle of the flap was evaluated by color Doppler ultrasound in all cases, which allowed us to follow an algorithm for selecting the best flap option.
Results: Twenty flaps were made in 19 patients. Mean age: 52 years ± 11 (range 30-76). There were no intraoperative complications. One patient required reoperation due to a hematoma with compression of the vascular pedicle of the flap with partial flap loss, and another flap presented superficial epidermolysis. There were no cases of complete flap loss. All the patients underwent postoperative
radiation therapy without loss of volume or retractions. Mean follow-up was 15 months. At 6 months, patients rated the results as excellent, good, and fair in 7, 11, and 2 cases, respectively.
Conclusion: The selection of local perforator flaps to correct breast defects after conservative surgery, using preoperative color Doppler ultrasound to identify the vascular pedicle and a specific algorithm...

Conversion therapy in gastric cancer: experience at Instituto Nacional de Cancerología de Colombia

Clara Briceño Morales — 2024-02-26

Background: Gastric cancer (GC) represents a public health problem in Colombia and worldwide. Since most patients are at advanced stages at the time of diagnosis, it is necessary to develop management strategies as conversion therapy (CT).
Objective: The aim of this study was to estimate the results of CT for treating patients with advanced and GC at Instituto Nacional de Cancerología de Colombia (INC).
Material and methods: We included patients with incurable gastric cancer who underwent induction chemotherapy and intended curative surgery between 2010 and 2021. The clinical and pathological data and survival of the patients included were retrospectively reviewed. Overall survival (OS) was calculated from the time of initiation of chemotherapy until the date of death. Survival functions were estimated using the life table and Kaplan-Meier methods, and survival curves at 3 and 5 years were constructed.
Results: 23 patients were analyzed; mean age was 56 years, and 17 (74%) were men. The most common criterion indicating unresectability was a T4b tumor in 13 cases (56.5%). All the patients underwent CT. Median follow-up was 28 months. Eleven patients developed disease recurrence (52%). Median survival was 41.2 months, and 3- and 5-year OS was 57.7% and 38.5%, respectively.
Conclusions: CT provided an acceptable OS rate for selected patients with incurable advanced GC. This strategy requires an adequate selection of patients and multidisciplinary management in reference oncology centers

Pancreatic resections for metastases in the pancreas: analysis of surgical and oncologic outcomes. A retrospective cohort study

Oscar D. Brosutti — 2024-02-26

Background: Pancreatic metastases are rare but are likely to be diagnosed more frequently in the future due to the increase in oncology surveillance programs.
Objective: The aim of this study was to describe the surgical and oncologic outcomes of a series of patients undergoing surgery for pancreatic metastases.
Materials and methods: We conducted a retrospective, descriptive, and multicenter cohort study on patients who underwent pancreatic resections for metastases in the pancreas by the same surgical group between January 2016 and December 2022 in three healthcare providers.
Results: A total of 19 patients were operated on, mean age was 59 years, and 11 were women with good performance status and no other evidence of oncologic disease. Clear cell renal cell carcinoma was the primary tumor in 14 cases (7 diagnosed during surveillance), and the remaining primary tumors were one case of breast ductal carcinoma, one testicular cancer, one colorectal cancer, one melanoma and one cervical cancer. The surgical techniques used were pancreatectomies and splenectomies in 7 patients , 4 enucleations (3 conventional procedures and 1 laparoscopic surgery), 3 conventional cephalic pancreaticoduodenectomies, 2 conventional central pancreatectomies and one spleen-preserving distal pancreatectomy. No deaths were reported within 90 days of surgery, and overall survival and disease-free survival were 58 and 53 months, respectively.
Conclusion: Resection of pancreatic metastases is safe and provides good oncologic outcomes and overall survival when performed with a multidisciplinary approach in centers with a high volume of hepatobiliary and pancreatic surgeries and in selected cases.

Non-invasive conservative treatment of splenic trauma

Alexis. A. Acosta — 2024-02-26

Background: Non-invasive conservative treatment of splenic trauma reduces the rate of unnecessary surgical interventions and depends on the type of healthcare center involved.
Objective: The aim of this study is to describe the outcomes of non-invasive conservative treatment in patients with blunt abdominal trauma and splenic injury and their correlation with the preoperative variables.
Material and methods: We conducted a retrospective and observational study of patients admitted with blunt abdominal trauma and splenic injury between 2012 and 2022. The variables analyzed were kinematics of trauma, lesion severity on computed tomography images, amount of hemoperitoneum, type of unit of hospitalization and results of non-invasive conservative treatment.
Results: Among 102 patients, the most common kinematics of trauma was motorcycle-to-car collisions (47.1%); the success rate of non-invasive conservative treatment was 66.6%, and was associated with lesion severity on computed tomography images (p < 0.001), amount of hemoperitoneum (p < 0.001), presence of other injuries (p < 0.001), severe trauma brain injury (p < 0.009), and type of unit of hospitalization (p < 0.002).
Conclusion: Despite the absence of recommended human and technological resources, the results of non-invasive conservative treatment in this series were comparable to those obtained in high complexity centers.

Gastrointestinal bleeding due to ulcerated intussuscepted jejunal lipoma

Sonia Matthiess — 2024-02-26

Jejunal lipomas are rare benign mesenchymal tumors made up of adipocytes confined to the submucosa layer. They are usually asymptomatic and are incidentally found during imaging or endoscopic tests. Those measuring > 2 cm may become symptomatic as a result of complications as intestinal intussusception, obstruction and bleeding.
We herein report a rare case of intussusception of an ulcerated jejunal lipoma in an adult patient, that was diagnosticated in the setting of an intestinal hemorrhage.

Splenectomy for sclerosing extramedullary hematopoietic tumor of the spleen

Carolina Perdomo — 2024-02-26

Extramedullary hematopoietic tumors are rare and characterized by the presence of hematopoietic elements at various stages of maturity, atypical megakaryocytes, and fibroblastic proliferation. We report the case of a patient with sclerosing extramedullary hematopoietic tumor of the spleen.The patient was 71-year-old man with a history of hypertension, diabetes, and hepatitis C virus infection. Multiple spleen lesions were identified in imaging tests during workup due to abdominal discomfort. Although a vascular tumor was suspected, laparoscopic splenectomy was decided after considering other possible causes. The pathology examination revealed a sclerosing extramedullary hematopoietic tumor of the spleen, which was confirmed by immunohistochemical tests. These tumors are usually single or, less frequently, multiple lesions affecting different organs and are associated with chronic myeloproliferative syndromes. The histologic confirmation is mandatory due to their similarity to malignant tumors. Extramedullary hematopoietic tumors are rare, and there is little scientific clinical evidence regarding their diagnosis and management. The histological confirmation is mandatory due to their similarity to malignant tumors.

Urgent right hepatectomy for infected hepatic necrosis secondary to endoscopic cholangiography

Patricio Vanerio — 2024-02-26

Hepatic subcapsular hematoma is a rare but potentially lethal complication of endoscopic retrograde cholangiography. On the other hand, complications derived from the hematoma can be its rupture with the consequent massive bleeding, and/or portal thrombosis due to compression that evolves towards necrosis, which is susceptible to generally serious infections that require more aggressive management.
We present the case of a patient treated in our department who underwent retrograde endoscopic cholangiography as treatment for her acute cholangitis, presenting in the evolution a subcapsular hematoma that progressed to hepatic necrosis due to compression of the portal pedicle and later an infection of that necrosis. requiring an emergency right hepatectomy as surgical treatment.

Late intestinal obstruction secondary to polypropylene mesh migration

Roberto de Y Botello-Arredondo — 2024-02-26

The use of meshes for abdominal wall repair has been widely accepted worldwide; however, serious complications may occur, such as foreign body reaction, mesh migration, penetration into the peritoneal cavity and even migration into the preperitoneal space mimicking colorectal cancer. The aim of this paper is to report a case of intestinal obstruction secondary to mesh migration into the peritoneal cavity in a previously asymptomatic patient who underwent left inguinal hernia repair 10 years prior to admission.

ALPPS in synchronous colorectal cancer in times of COVID-19

Mateo Poupard — 2024-02-26

During the SARS-CoV-2 pandemic, we observed an increase in morbidity and mortality secondary to surgical procedures. The mortality rate for elective surgery is estimated at 19.1% and is 26% for emergency procedures. Additionally, approximately half of patients who undergo surgery while infected with SARS-CoV-2 experience postoperative pulmonary complications. Due to limitations caused by the health emergency, cancer treatments in our country have been affected in terms of hospitalization capabilities and implementation of chemotherapy treatments. We report the first ALPPS (associating liver partition with portal vein ligation for staged hepatectomy) procedure performed in northeastern Argentina on a patient with multiple colorectal metastases during the SARS-CoV-2 pandemic, with successful outcomes.