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Cruz Cidoncha A, Rúiz-Tovar J, Robín A, San Miguel C, Pérez-Flecha M, Galván A, Minaya A, Aguilera Velardo A, López-Quindós P, Moreno A, Jiménez C, González E, Medina Pedrique M, García-Ureña MA. Is Surgery for Hepatic Echinococcosis Appropriate in a Low-Volume Center? Surg Infect (Larchmt) 2021; 22:1081-1085. [PMID: 34449274 DOI: 10.1089/sur.2021.088] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Cystic echinococcosis is a parasitic disease that develops in endemic areas due to the transmission of Echinococcus granulosus. The liver is the organ most affected. The most frequent symptoms include pain, palpable mass, jaundice, and fever. Diagnosis is based on epidemiologic history, examination, imaging, and serologic tests. Patients and Methods: We conducted a retrospective study of patients with hepatic echinococcosis diagnosed in our center. We collected data from our patients regarding personal history, cyst characteristics, surgery performed, and post-operative complications. Results: Sixteen patients were diagnosed with hepatic echinococcosis, 11 of whom underwent surgery. We found multiple cysts in six patients (37.5%) and a single cyst in 10 (62.5%). In 14 patients the cysts were found only in the right hepatic lobe (87.5%) and in two patients they were found in both lobes (12.5%). Segment 4 was affected in seven cases. The sizes ranged from 2.7 to 20 cm. Endoscopic retrograde cholangiopancreatography was prior to surgery in five patients. The interventions performed were partial cyst-pericystectomies in eight patients, a total cyst-pericystectomy in one case, and drains were placed in two cases of rupture. Post-operative fistulas were evident in five patients, four of which were closed. The fifth, which occurred after emergency surgery for rupture of the cyst, has maintained suppuration. The mean follow-up was 3.5 years. There was no post-operative mortality or recurrence to date. Conclusions: We can state that center without highly specialized hepato-biliary surgery units can assume the surgery of hydatid liver cysts excluding those with well-defined characteristics. The establishment of recommendations for the referral of patients with complex hydatid cysts may help in the optimal management of this pathology.
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Affiliation(s)
- Arturo Cruz Cidoncha
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Jaime Rúiz-Tovar
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Alvaro Robín
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Carlos San Miguel
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Marina Pérez-Flecha
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Armando Galván
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Ana Minaya
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Asunción Aguilera Velardo
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Patricia López-Quindós
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Almudena Moreno
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Carmen Jiménez
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Enrique González
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Manuel Medina Pedrique
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
| | - Miguel A García-Ureña
- General and Digestive Surgery Department, Hospital Universitario del Henares, Coslada, Madrid, Spain
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Calcerrada Alises E, San Miguel Méndez C, Cruz Cidoncha A, Minaya Bravo A, Pérez-Flecha González M, Garcia-Urena MA. The small bites technique for closure of abdominal midline incisions - a video vignette. Colorectal Dis 2021; 23:765. [PMID: 33319425 DOI: 10.1111/codi.15492] [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: 11/03/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Enrique Calcerrada Alises
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Carlos San Miguel Méndez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Arturo Cruz Cidoncha
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ana Minaya Bravo
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Marina Pérez-Flecha González
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
| | - Miguel Angel Garcia-Urena
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Madrid, Spain
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Robin-Lersundi A, Abella Alvarez A, San Miguel Mendez C, Moreno Elalo-Olaso A, Cruz Cidoncha A, Aguilera Velardo A, Gordo Vidal F, García-Ureña MA. Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital. World J Surg 2019; 43:2994-3002. [PMID: 31440777 DOI: 10.1007/s00268-019-05114-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality. METHODS We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis. RESULTS Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%. CONCLUSION Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.
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Affiliation(s)
- Alvaro Robin-Lersundi
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain.
| | - Ana Abella Alvarez
- Department of Intensive Care Medicine, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Carlos San Miguel Mendez
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Almudena Moreno Elalo-Olaso
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Arturo Cruz Cidoncha
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Asunción Aguilera Velardo
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
| | - Federico Gordo Vidal
- Department of Intensive Care Medicine, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Miguel-Angel García-Ureña
- Department of Surgery, Hospital Universitario del Henares, Avda. Marie Curie, s/n, 28822, Coslada, Madrid, Spain
- Grupo de Investigación en Pared Abdominal, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
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García-Ureña MÁ, López-Monclús J, Cuccurullo D, Blázquez Hernando LA, García-Pastor P, Reggio S, Jiménez Cubedo E, San Miguel Méndez C, Cruz Cidoncha A, Robin Valle de Lersundi A. Abdominal Wall Reconstruction Utilizing the Combination of Absorbable and Permanent Mesh in a Retromuscular Position: A Multicenter Prospective Study. World J Surg 2018; 43:149-158. [DOI: 10.1007/s00268-018-4765-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cruz Cidoncha A, Garcia del Salto L, González González E, García-Ureña MÁ. Jejuno-gastric invagination after Billroth II gastrectomy. Cir Esp 2014; 93:194. [PMID: 25530532 DOI: 10.1016/j.ciresp.2014.11.002] [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] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 10/30/2014] [Accepted: 11/10/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Arturo Cruz Cidoncha
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Coslada, Madrid, España.
| | | | - Enrique González González
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Coslada, Madrid, España
| | - Miguel Ángel García-Ureña
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Henares, Coslada, Madrid, España
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Barriga Sánchez R, Cruz Cidoncha A, González E, García Ureña MA. [Management of incidental gallbladder carcinoma]. Cir Esp 2010; 87:265; author reply 266. [PMID: 20080231 DOI: 10.1016/j.ciresp.2009.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 11/08/2009] [Indexed: 11/29/2022]
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