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Gil PJ, Ruiz-Manzanera JJ, Ruiz de Angulo D, Munitiz V, Ferreras D, López V, Conesa A, Ortiz Á, Martínez de Haro LF, Ramírez P. Learning Curve for Laparoscopic Sleeve Gastrectomy: a Cumulative Summation (CUSUM) Analysis. Obes Surg 2022; 32:2598-2604. [PMID: 35687255 DOI: 10.1007/s11695-022-06145-2] [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: 01/31/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. OBJECTIVE to analyze the learning curve for LSG. MATERIALS AND METHODS We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared. RESULTS According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss. CONCLUSION According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.
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Affiliation(s)
- Pedro J Gil
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Juan José Ruiz-Manzanera
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain.
| | - David Ruiz de Angulo
- Bariatric Surgery Unit and Upper Gastrointestinal Surgical, General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Vicente Munitiz
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - David Ferreras
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Víctor López
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Ana Conesa
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Ángeles Ortiz
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Luisa F Martínez de Haro
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain.,Instituto Murciano De Investigación Biosanitaria (IMIB), 30120, El Palmar, Murcia, Spain
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Ruiz de Angulo D, Balaguer Román A, Munitiz Ruiz V, Gil Vázquez PJ, Ruiz Merino G, Ortiz Escandell MÁ, Martínez de Haro LF, Parrilla Paricio P. Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy. Cir Esp 2021; 99:428-432. [PMID: 34130814 PMCID: PMC8114763 DOI: 10.1016/j.cireng.2021.05.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022]
Abstract
Introduction COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. Methods Case–control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. Results The mean %EWL in group 1 is 47.37 ± 18.59 and in group 2 is 51.13 ± 17.59, being P=.438. Meanwhile, the mean %TWL in group 1 is 21.14 ± 8.17 and in group 2 is 24.67 ± 8.01, with P=.115. Conclusions Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions.
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Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - Andrés Balaguer Román
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Vicente Munitiz Ruiz
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pedro José Gil Vázquez
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Guadalupe Ruiz Merino
- Unidad de Bioestadística, Instituto Murciano de Investigación Biosanitaria (IMIB), Spain
| | - M Ángeles Ortiz Escandell
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luisa F Martínez de Haro
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pascual Parrilla Paricio
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Lopez-Lopez V, Ruiz-Manzanera JJ, Eshmuminov D, Lehmann K, Schneider M, von der Groeben M, de Angulo DR, Gajownik U, Pons JA, Sánchez-Bueno F, Robles-Campos R, Ramírez-Romero P. Are We Ready for Bariatric Surgery in a Liver Transplant Program? A Meta-Analysis. Obes Surg 2020; 31:1214-1222. [PMID: 33225408 DOI: 10.1007/s11695-020-05118-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/25/2020] [Revised: 10/30/2020] [Accepted: 11/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity-related non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are two main causes of end-stage liver disease requiring a liver transplantation. Studies exploring bariatric surgery in the liver transplantation setting have increased in recent years; however, a systematic analysis of the topic is lacking to date. This meta-analysis was conducted to explore the perioperative and long-term outcomes of bariatric surgery in obese patients undergoing liver transplantation. METHODS Electronic databases were systematically searched for studies reporting bariatric surgery in patients undergoing liver transplantation. The primary outcomes were postoperative complications and mortality. We also extracted data about excess weight loss, body mass index, and improvement of comorbidities after bariatric surgery. RESULTS A total of 96 patients from 8 articles were included. Bariatric surgery-related morbidity and mortality rates were 37% (95% CI 0.27-0.47) and 0.6% (95% CI 0.02-0.13), respectively. Body mass index at 24 months was 31.02 (95% CI 25.96-36.09) with a percentage excess weight loss at 12 and 24 months of 44.08 (95% CI 27.90-60.26) and 49.2 (95% CI 31.89-66.66), respectively. After bariatric surgery, rates of improvement of arterial hypertension and diabetes mellitus were 61% (95% CI 0.45-0.75) and 45% (95% CI 0.25-0.66), respectively. In most patients, bariatric surgery was performed after liver transplant and the most frequent technique was sleeve gastrectomy. CONCLUSIONS Bariatric surgery can be performed safely in the setting of liver transplantation resulting in improvement of obesity-related comorbidities. The optimal timing and technique require further studies.
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Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
| | - Juan José Ruiz-Manzanera
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | - Kuno Lehmann
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | - Marcel Schneider
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Zurich, Switzerland
| | | | - David Ruiz de Angulo
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ursula Gajownik
- Department of Hepatology, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Jose Antonio Pons
- Department of Hepatology, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Francisco Sánchez-Bueno
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Pablo Ramírez-Romero
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
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Iglesias Jorquera E, Egea Valenzuela J, Serrano Jiménez A, Carrilero Zaragoza G, Ortega Sabater A, Sánchez Velasco E, Ruiz de Angulo D, Munitiz V, Parrilla P, Alberca de Las Parras F. Endoscopic treatment of postoperative esophagogastric leaks with fully covered self-expanding metal stents. Rev Esp Enferm Dig 2020; 113:14-22. [PMID: 33118355 DOI: 10.17235/reed.2020.6821/2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the management of postoperative esophageal leaks is a huge therapeutic challenge. Thanks to the advances in endoscopy, treatment with esophageal stents has been proposed as a valid option. AIMS the main objective of the study was to evaluate the effectiveness and safety of the use of fully covered esophageal metal stents in the treatment of postoperative esophageal leaks. METHODS a retrospective observational study was performed in patients with postoperative esophageal leaks, treated with fully covered self-expandable metal stents between June 2011 and May 2018. RESULTS twenty-five patients were evaluated and 34 stents were placed. The closure of the leak was observed in 21 patients after removal of the stent, with an overall technical success rate of 84 %. The mean time with a stent placed for closure of the fistula was 55.7 ± 27.11 days/patient (mean of 39 ± 24.30 days/stent). The most frequent complication was a partial distal stent migration (7/34 stents), followed by five cases of complete migration into the stomach. CONCLUSIONS endoscopic treatment with fully covered self-expandable metal stents seems to be an effective and safe first-line treatment for postoperative esophageal leaks, according to the experience in our center.
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Affiliation(s)
| | - Juan Egea Valenzuela
- Aparato Digestivo , Hospital Clínico Universitario Virgen de la Arrixaca, España
| | | | | | | | | | | | - Vicente Munitiz
- Cirugía, Hospital Clinico Universitario Virgen de la Arrixaca
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Ruiz de Angulo D, Jimeno Griño P, Ortiz Escandell MÁ, Munitiz Ruiz V, Gil Vázquez PJ, Pérez Flores D, Martínez de Haro LF, Miguel Hernández A, Parrilla Paricio P. Evolution of gastroesophageal reflux after laparoscopic vertical gastrectomy. A radiographic, manometric and pH-metric study. Rev Esp Enferm Dig 2020; 111:662-666. [PMID: 31257899 DOI: 10.17235/reed.2019.5972/2018] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION the relationship between laparoscopic vertical gastrectomy (LVG) and gastroesophageal reflux (GER) is still controversial. Therefore, its study is of great interest in order to obtain definitive conclusions. The goal of the study was to establish whether LVG modifies pH-metric GER in obese patients and to analyze the associated factors. PATIENTS AND METHODS the first 26 patients who underwent LVG in our institution were enrolled in the study. A barium swallow, 24-hour ambulatory pH-metry and four-channel intraluminal esophageal manometry (IEM) were all performed before and one year after surgery. RESULTS among the pH-metric data, there was a significant increase in the DeMeester index after the procedure (p = 0.028), while other parameters remained unchanged. Furthermore, 50% of patients with preoperative pH-metric GER had normal values at one year after surgery. IEM showed a decrease in lower esophageal sphincter (LES) pressure and in the mean wave amplitude at the distal third of the esophagus (p = 0.007 and p = 0.025, respectively). The rate of newly-developed hiatal hernias in the radiographic study was 36.4%. CONCLUSION LVG mildly increases GER, which is likely related to the development of hiatal hernias and a decrease in LES pressure and esophageal sweep. However, LVG should not be contraindicated for patients with preoperative pH-metric GER, as this may clear after the procedure.
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Affiliation(s)
- David Ruiz de Angulo
- Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, ESPAÑA
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Brusadin R, López-López V, de Angulo DR, López-Conesa A, Navarro-Barrios Á, Caballero-Planes A, Parrilla-Paricio P, Robles-Campos R. Case report of Tourniquet ALPPS and simultaneous sleeve gastrectomy: A valuable association to achieve an adequate future liver remnant in obese patients. Medicine (Baltimore) 2020; 99:e20748. [PMID: 32846750 PMCID: PMC7447475 DOI: 10.1097/md.0000000000020748] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Obesity represents a risk factor in case of major hepatectomy, because the future liver remnant (FLR) must be proportional with body weight. To avoid post-hepatectomy liver failure, and further increase the ratio between FLR and body weight, we performed a bariatric procedure in the first stage of the ALPPS technique. PATIENT CONCERNS Fifty-four-year-old woman, with morbid obesity (BMI 58.5) and type II diabetes mellitus, was scheduled for a major hepatectomy due to multiple colorectal liver metastases DIAGNOSIS:: Six months before, the patient was diagnosed with colorectal cancer and synchronous liver metastases. She was initially treated with sigmoidectomy and chemotherapy. After partial response of the liver metastases, we considered a liver resection but the FLR was very low, especially in relation to her BMI. INTERVENTION We planned a novel approach and, for the first time, we performed a sleeve gastrectomy during the first stage of Tourniquet ALPPS (T-ALPPS). After achieving an adequate FLR, we successfully completed the major hepatectomy during the second stage of T-ALPPS. OUTCOME The association between sleeve gastrectomy and T-ALPPS produced an increase of FLR/body weight ratio up to 0.8 that allowed completing a right trisectionectomy in the second stage of ALPPS. The major hepatectomy was performed without severe complications, and several months after surgery the patient is still alive without any recurrence Conclusion: Despite obesity represents a risk factor involved in the carcinogenesis, the role of the bariatric surgery in the oncological setting is not well established. In this clinical case, we benefited from the weight loss produced by bariatric surgery combined with an effective hypertrophy technique and chemotherapy. These findings suggest that bariatric surgery could be useful for obese patients with liver malignancy and need for extended hepatectomy.
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Affiliation(s)
| | | | | | | | | | - Albert Caballero-Planes
- Department of Pathology, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
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Ruiz de Angulo D, Balaguer Román A, Munitiz Ruiz V, Gil Vázquez PJ, Ruiz Merino G, Ortiz Escandell MÁ, Martínez de Haro LF, Parrilla Paricio P. Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy. Cir Esp 2020; 99:428-432. [PMID: 34629481 PMCID: PMC7428729 DOI: 10.1016/j.ciresp.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022]
Abstract
Introducción La pandemia por COVID-19 ha obligado al confinamiento de la población en muchos países. En España, el estado de alarma se estableció desde el 15 de marzo al 20 de junio del 2020. Este hecho, por lo general, disminuyó la movilidad y la actividad física de las personas, además de producir o exacerbar alteraciones psicológicas. Nuestro objetivo es analizar la influencia que esta situación ha ejercido sobre los resultados ponderales a corto plazo de los pacientes tratados mediante una gastrectomía vertical laparoscópica entre mayo del 2019 y mayo del 2020. Métodos Estudio de casos y controles donde se compararon el porcentaje de exceso de peso perdido (%EWL) y el porcentaje de peso total perdido (%TWL) de los pacientes intervenidos en el último año y a los que ha afectado el confinamiento durante el mes de abril y parte de marzo del 2020 (grupo 1; n = 20), con el de un grupo control (grupo 2; n = 40) de nuestra casuística previa. Resultados El %EWL medio en el grupo 1 es de 47,37 ± 18,59 y en el grupo 2 es de 51,13 ± 17,59, siendo la p = 0,438. Por su parte, el %TWL medio en el grupo 1 es de 21,14 ± 8,17 mientras que en el grupo 2 es de 24,67 ± 8,01, resultando la p = 0,115. Conclusiones El confinamiento de la población por COVID-19 no empeoró los resultados ponderales a corto plazo de la gastrectomía vertical. Son necesarios más estudios con un mayor número de pacientes para obtener conclusiones más sólidas.
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Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - Andrés Balaguer Román
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, España
| | - Vicente Munitiz Ruiz
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Pedro José Gil Vázquez
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Ángeles Ortiz Escandell
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Luisa F Martínez de Haro
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Pascual Parrilla Paricio
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Ferreras D, Ruiz de Angulo D, Sánchez Bueno F. Gastrointestinal bleeding in a pancreatic arteriovenous malformation successfully treated by transarterial embolization. Rev Esp Enferm Dig 2020; 112:505-506. [PMID: 32379477 DOI: 10.17235/reed.2020.6518/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pancreatic arteriovenous malformation (PAVM) is a rare case of upper gastrointestinal bleeding (UGIB), but it must be recognized in clinical practice, as it may be a potentially lethal condition in case of rupture and haemorrhage. This anatomic alteration is extremely rare as less than a hundred cases are reported in the scientific literature. The aim of this work is to report a case of PAVM presented as upper gastrointestinal bleeding (UGIB) and successfully treated by transarterial embolization.
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Affiliation(s)
- David Ferreras
- Cirugía General y del Aparato Dige, Hospital Universitario Virgen de la Arrixaca
| | - David Ruiz de Angulo
- Cirugía General y del Aparato Dige, Hospital Clinico Universitario Virgen de la Arrixaca, ESPAÑA
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Munitiz Ruiz V, Jimeno P, Ruiz de Angulo D, Ortiz Á, Martínez de Haro LF, Marín M, Cascales P, Ruiz García G, Ortiz Ruiz E, Parrilla P. Is prophylactic gastrectomy indicated for healthy carriers of CDH1 gene mutations associated with hereditary diffuse gastric cancer? Rev Esp Enferm Dig 2020; 111:189-192. [PMID: 30466290 DOI: 10.17235/reed.2018.5831/2018] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION hereditary diffuse gastric cancer (HDGC) is a recently reported hereditary cancer syndrome. Patients with suspected HDGC must be under surveillance via endoscopy and multiple biopsies. As an alternative, some studies suggest prophylactic gastrectomy (PG) for disease carriers. The goal of this article was to report our experience with a CDH1 mutation positive family who underwent PG. PATIENTS AND METHODS the index case was a 34-year-old female diagnosed with diffuse gastric adenocarcinoma and massive carcinomatosis. There was a family history of gastric adenocarcinoma in seven family members. A genetic study identified the c.1577G>A mutation, in exon 11 of the CDH1 gene via sequencing analysis. RESULTS this mutation was also present in other six family members, who subsequently underwent prophylactic gastrectomy. The pathology study of resected gastric segments revealed multiple microscopic foci of adenocarcinoma in five of these individuals. These foci were not detected in the multiple endoscopies performed before surgery. CONCLUSIONS we recommend prophylactic gastrectomy for CDH1 mutation carriers even in the absence of lesions during endoscopic screening.
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Affiliation(s)
| | - Pilar Jimeno
- Hospital Clínico Universitario Virgen de la Arrixaca
| | | | - Ángeles Ortiz
- Hospital Clínico Universitario Virgen de la Arrixaca
| | | | - Miguel Marín
- Hospital Clínico Universitario Virgen de la Arrixaca
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Munitiz Ruiz V, Martienz de Haro LF, Ortiz Á, Ruiz de Angulo D, Parrilla P. Barrett's esophagus: "All diseases are divine and all are human". Rev Esp Enferm Dig 2019; 111:789-794. [PMID: 31566411 DOI: 10.17235/reed.2019.6261/2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different.
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Affiliation(s)
| | | | - Ángeles Ortiz
- Hospital Clínico Universitario Virgen de la Arrixaca
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11
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Ruiz de Angulo D, Ortiz MÁ, Munitiz V, Martínez de Haro LF, Alberca F, Serrano A, Egea J, Parrilla P. Role of self-expanding stents in the treatment of intrathoracic dehiscence after Ivor Lewis esophagectomy. Cir Esp 2018; 96:555-559. [PMID: 29934256 DOI: 10.1016/j.ciresp.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/14/2018] [Revised: 04/13/2018] [Accepted: 05/06/2018] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The role that self-expanding stents play in the treatment of dehiscence after transthoracic esophagectomy is not well defined and controversial. Our aim is to describe the experience in a tertiary care hospital using these devices for treating dehiscence after Ivor Lewis esophagectomy. METHODS Descriptive observational study of patients who suffered anastomotic dehiscence after a transthoracic esophagectomy, and especially those treated with stents, in the period between 2011-2016 at our hospital. RESULTS Ten patients (11.8%) presented anastomotic dehiscence. Eight patients received stents, one of them died due to causes unrelated to the device. Stent migration was observed in one case, and the devices were maintained an average of 47.3 days. The stent was not effective only in one patient who suffered early dehiscence due to acute ischemia of the stomach. The two patients who did not receive stents died after reoperation. CONCLUSIONS Stents are safe and effective devices that did not associate mortality in our series. They are especially indicated in intermediate or late-onset dehiscence and in fragile patients. The use of stents, together with mediastinal and pleural drainage, avoid reoperations with morbidity and mortality. Therefore, stents should be part of the usual therapeutic arsenal for the resolution of most suture dehiscences after Ivor Lewis esophagectomy. Randomized prospective studies would help to more precisely determine the role played by these devices in the treatment of dehiscence after transthoracic esophagectomy.
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Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - María Ángeles Ortiz
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Vicente Munitiz
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Luisa Fernanda Martínez de Haro
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Fernando Alberca
- Unidad de Endoscopias, Servicio de Medicina Interna del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Andrés Serrano
- Unidad de Endoscopias, Servicio de Medicina Interna del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Juan Egea
- Unidad de Endoscopias, Servicio de Medicina Interna del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Pascual Parrilla
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Garcia-Perez R, Munitiz V, Martinez-Caceres CM, Ruiz de Angulo D, Ortiz A, F Martinez de Haro L, Navas D, Parrilla P. Histopathological and Immunohistochemical Analysis of the Use of Collagen Dressing as a Reinforcement of Esophagic Anastomosis in a Rat Experimental Model. Cir Esp 2017; 95:588-593. [PMID: 29117903 DOI: 10.1016/j.ciresp.2017.08.008] [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: 04/23/2017] [Revised: 08/11/2017] [Accepted: 08/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION One of the most severe complications after esophaguectomy is anastomotic dehiscence. The use of collagen sponges could be an effective way to resolve this complication. Our objective was to perform an experimental model of esophageal anastomosis in rats to study these mechanisms. METHODS A total of 50 Sprague-Dawley rats were used divided into 2 groups, Tachosil® group (n=25) and control group (n=25). After the section of the abdominal esophagus a single-layer esophago-gastric anastomosis was performed reinforced with 1cm of Tachosil® wrapping the anastomosis in group 1. A functional study was performed using manometry as well as histopathological and immunohistochemical studies for angiogenic, fibrogenic and growth factors. RESULTS The mortality in our series was 8% in the collagen dressing group, compared to 36% in the control group. When esophageal manometry was performed, the dehiscence pressure was higher in the reinforced anastomosis, On microscopical analysis, in the collagen dressing group a profuse inflammatory reaction with abundant neutrophils and macrophages surrounded by a connective matrix with fibroblasts and blood vessels was observed, The expression of VEGF, FGF1 and FGF2 was noticeably higher in the collagen dressing group. CONCLUSIONS These results show that the application of collagen dressing facilitates tissue reparation phenomena, and therefore could be very useful as a reinforcement of esophago-gastric anastomosis to prevent dehiscence.
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Affiliation(s)
- Rocio Garcia-Perez
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Vicente Munitiz
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España.
| | - Carlos Manuel Martinez-Caceres
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - David Ruiz de Angulo
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Angeles Ortiz
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Luisa F Martinez de Haro
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Diana Navas
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
| | - Pascual Parrilla
- Servicio de Cirugía General y Experimental, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, España; CIBERehd, Barcelona, España
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Ruiz de Angulo D, Parrilla P. Surgical treatment for esophageal cancer: Are the questions finished or are the surgeons who are finished by the questions? Cir Esp 2017; 96:182-183. [PMID: 28918965 DOI: 10.1016/j.ciresp.2017.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - Pascual Parrilla
- Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Ruiz de Angulo D, Munitiz V, Ortiz MÁ, Martínez de Haro LF, Frutos MD, Hernández A, Parrilla P. Communication between the obese patient and bariatric surgeon. Cir Esp 2015; 93:492-5. [PMID: 25912163 DOI: 10.1016/j.ciresp.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/10/2014] [Revised: 12/18/2014] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important.
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Affiliation(s)
- David Ruiz de Angulo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - Vicente Munitiz
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - M Ángeles Ortiz
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Luisa F Martínez de Haro
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - M Dolores Frutos
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Antonio Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Pascual Parrilla
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Ruiz de Angulo D, Ortiz MÁ, Martínez de Haro LF. Efectos secundarios de los inhibidores de la bomba de protones, ¿una razón más para indicar la cirugía antirreflujo en el esófago de Barrett? Cir Esp 2014; 92:303-4. [DOI: 10.1016/j.ciresp.2014.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/17/2014] [Indexed: 11/16/2022]
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Ruiz de Angulo D, Martínez de Haro LF, Ortiz MÁ, Munitiz V, Navas D, Abrisqueta J, Parrilla P. Valoración del resultado estético percibido por los pacientes apendicectomizados vía laparoscópica mediante tres incisiones. Cir Esp 2011; 89:317-20. [DOI: 10.1016/j.ciresp.2011.01.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/30/2022]
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Martínez de Haro LF, Munitiz V, Ortiz A, Ruiz de Angulo D, Navarro MD, Parrilla P. [Outpatient monitoring of oesophageal pH with a catheter-free pH-meter (Bravo System). A Study of tolerance, safety and efficacy]. Cir Esp 2008; 84:201-9. [PMID: 18928770 DOI: 10.1016/s0009-739x(08)72620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE A new catheter-free outpatient oesophageal pH-meter system (Bravo) has recently been developed. The objective of this study is to test the tolerance, safety and efficacy of the system in the measurement of gastric-oesophageal reflux by comparing it with a conventional pH system. PATIENTS AND METHOD The study was performed on a control group consisting of 10 healthy volunteers (group 1) and in a group of 40 patients with symptoms of gastric-oesophageal reflux disease (groups 2 and 3). An upper digestive system endoscopy, oesophageal manometry and oesophageal pH measurements with a conventional system and/or with the Bravo catheter-free system, was performed on all patients. All patients who had both tests done (groups 1 and 2) filled in a questionnaire on any physical problems and changes in their daily activity. RESULTS The test tolerance was higher with the Bravo system in the 9 parameters studied. In the group of healthy volunteers (group 1), the median (range) of the total percentage of pH < 4 was 1.1% (0.5-3.1) with the conventional pH and 1.7% (0-3.4) with the Bravo. When comparing the patients with symptoms of gastric-oesophageal reflux disease (group 2) with those who had only one type of pH measurement made, the acid reflux was significantly higher in patients with Barrett's oesophagus than in the rest of the groups, with conventional pH as well as with the Bravo. If we analyse the patient group with disease due to gastric-oesophageal reflux with those on whom both techniques were used (group 3), 7 of the 10 patients had a pathological reflux that only showed up on measuring pH with the Bravo system. CONCLUSIONS Catheter-free pH measurements (Bravo) is better tolerated and with better satisfaction for the healthy volunteers and patients than with conventional PH, even, on occasions being more efficient for studying acid reflux due to the lower incidence of negative results.
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Affiliation(s)
- Luisa F Martínez de Haro
- Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
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Munítiz V, Martínez de Haro LF, Ortiz MA, Ruiz de Angulo D, Molina J, Bermejo J, Serrano A, Parrilla P. [Surgical treatment of high-grade dysplasia in Barrett's esophagus]. Cir Esp 2008; 82:214-8. [PMID: 17942046 DOI: 10.1016/s0009-739x(07)71709-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/04/2023]
Abstract
INTRODUCTION Barrett's esophagus undergoes malignant transformation in 0.5-1% of patients per year following the sequence of low-grade dysplasia, high-grade dysplasia and adenocarcinoma. The aim of the present study was to present our experience in the surgical treatment of Barrett's esophagus with high-grade dysplasia. PATIENTS AND METHOD Of a group of 128 patients with a diagnosis of Barrett's esophagus, 8 (6.2%) developed high-grade dysplasia during a median follow-up of 7 years (2-25). A further 5 patients with high-grade dysplaing out side the study were referred for evaluation and surgical treatment. Eight patients were under medical treatment with omeprazole (40 mg daily) while the remaining 5 patients had undergone open Nissen fundoplication, with a diagnosis of high-grade dysplasia at a median of 5 years (1-16) after treatment initiation. After confirmation of the diagnosis by a second pathologist and tumoral staging, transthoracic esophagectomy with anastomosis at the apex of the thorax was performed in all patients. RESULTS Postoperative mortality was nil. Morbidity was 36% (5 patients). Definitive histological analysis of the surgical specimen revealed high-grade dysplasia in 7 patients (54%) and adenocarcinoma in 6 (46%). All patients remain alive after a median follow-up of 4.7 years (1-14). CONCLUSIONS In patients with Barrett's esophagus with high-grade dysplasia, the best therapeutic option is surgical resection, which can be performed with nil mortality in experienced centers. In almost half of surgical patients, the surgical specimen shows adenocarcinoma. Five-year survival is higher than 90%.
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Affiliation(s)
- Vicente Munítiz
- Unidad de Patología Esofágica, Servicio de Cirugía General I, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Munítiz V, Ortiz-Escandell Á, Martínez de Haro LF, Antonio García-Marcilla J, Molina J, Ruiz de Angulo D, Carlos Navalón J, Parrilla P. Resultados del cáncer de esófago resecado. Estudio comparativo entre el adenocarcinoma y el carcinoma epidermoide. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72367-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Munítiz Ruiz V, Martínez de Haro LF, Ortiz Escandell Á, Serrano Jiménez A, Ruiz de Angulo D, Parrilla Paricio P. El esófago de Barrett no incrementa la tasa de fallos de la fundoplicatura de Nissen. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72128-9] [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: 10/27/2022]
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