Can inflammatory biomarkers help in the diagnosis and prognosis of gangrenous acute cholecystitis? A prospective study.

The diagnosis of gangrenous acute cholecystitis represents a diagnostic challenge for the physician and is rarely identified preoperatively. We report a longitudinal prospective study in 180 patients who underwent cholecystectomy for acute cholecystitis. A ROC curve was obtained to determine the preoperative cut-off for various biomarkers (neutrophil to lymphocyte ratio [NLR], C-reactive protein [CRP], platelet to lymphocyte ratio [PLR], lactate and procalcitonin) and their association with both preoperative and postoperative findings.

Gastric syphilis and its importance for a differential diagnosis in HIV patients.

A 41-year-old male, with history of HIV presented to emergency department with two months of abdominal pain and a weight loss. Radiological and endoscopic examinations where suggestive of gastric cancer. However, biopsies ruled out malignancy.

[The first experiences with colorectal laparoscopic surgery in Spain. Valencia, November 1991].

The development of laparoscopic colon surgery in Spain has spread quickly since its beginnings at the end of 1991. Colorectal Minimally Invasive Surgery is widely implemented and has changed the way we treat our patients, specially due to the short-term advantages such as lower morbidity with a better quality of life with the same oncological outcomes in the long term. A huge number of Spanish surgeons have contributed to the implementation of techniques and spreading the knowledge of these concepts by means of courses, controlled randomized studies, scientific papers, and books, and have obtained international recognition.

[Ambulatory laparoscopic cholecystectomy by minilaparoscopy versus traditional multiport ambulatory laparoscopic cholecystectomy. Prospective randomized trial].

Objective: Difference analysis of ambulatorization rate, pain, analgesic requirements and daily activities recovery in patients undergoing laparoscopic cholecystectomy with standard multiport access (CLMP) versus a minilaparoscopic, 3mm size, technique.

Methods: Prospective randomized trial of 40 consecutive patients undergoing laparoscopic cholecystectomy. Comparison criteria included predictive ultrasound factors of difficult cholecystectomy, previous history of complicated biliary disease and demographics.

Biliary Pancreatitis. Liver Function Tests and Common Biliopancreatic Channel Kinetics--Biliopancreatic Reflux.

Objective: To determine the prevalence of biliopancreatic reflux (BPR) in patients with biliary pancreatitis (BP) undergoing elective cholecystectomy with intraoperative cholangiography (IOC) in comparison with a control group of symptomatic cholelithiasis (CG).

Patients And Methods: Retrospective review of 107 consecutive BP cases. BPR was determined by IOC and liver function tests (LFT) were recorded at admission (A), 48hours, and preoperative examination (P).

[Ambulatory laparoscopic cholecystectomy. A cohort study of 1,600 consecutive cases].

Objective: A descriptive analysis of day-case laparoscopic cholecystectomy (ALC) in a cohort of 1,600 consecutive patients performed in Instituto de Cirugía y Aparato Digestivo (ICAD), Clínica Quirón de Valencia in the period 1997-2010.

Patients And Methods: Prospective observational study of 1,601 consecutive patients undergoing elective laparoscopic cholecystectomy (LC) provided by the regional health service and private health companies.

Main Measures: Conversion rate, non-planned admissions, readmissions, surgery duration and demographics.

[Evaluation of the gastrointestinal quality of life index as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy].

Introduction: We prospectively evaluated health-related quality of life (HRQoL) through the gastrointestinal quality of life index (GIQLI) as a system to prioritize patients on the waiting list for laparoscopic cholecystectomy (LC) and its correlation with a linear prioritization system developed in the General and Gastrointestinal Surgery Institute of Clínica Quirón in Valencia.

Material And Methods: There were 100 consecutive patients who underwent elective outpatient LC. The main outcome measures consisted of: 1) assessment of the impact of the disease, measured through the GIQLI; 2) evaluation of an objective system based on technical scientific criteria; 3) evaluation of the utility of LC in improving HRQoL through the GIQLI by analyzing expected and obtained utility through the change ratio, and 4) analysis of the correlation between the objective linear system, HRQoL and utility.

[Pain, analgesic consumption and daily life activities recovery in patients undergoing ambulatory totally extra-peritoneal laparoscopic inguinal hernioplasty versus ambulatory Lichtenstein hernioplasty].

Introduction: Although the unique comparison standard of primary inguinal hernia repair is the Lichtenstein technique (LICH), totally extra-peritoneal (TEP) laparoscopic inguinal hernioplasty shows, although not systematically demonstrated, clear advantages as regards, perceived pain, analgesic use, and recovery of daily life activities.

Objective: To demonstrate the differences in perceived pain, analgesic use, and recovery of daily life activities between Lichtenstein hernioplasty and TEP laparoscopy.

Material And Methods: A prospective, non-randomised observational study was conducted on 169 consecutive patients subjected to LICH vs TEP.

[Surgical Complexity Classification Index (SCCI): a new patient classification system for clinical management of laparoscopic cholecystectomy].

Objective: To devise a classification system of patients subjected to elective laparoscopic cholecystectomy (LC) which will enable the degree of surgical difficulty and possible time in surgery to be correlated with clinical, ultrasound, associated comorbidity and age group variables.

Material And Method: A prospective observational study of 110 patients subjected to LC in which the SCCI (Surgical Complexity Classification Index) had been calculated. The SCCI was worked out from previous studies published on patient classification systems and complication predictive factors in patients subjected to LC.

[Intraoperative factors predictive of failure of the ambulatory regimen after laparoscopic cholecystectomy].

Objectives: To determine which intraoperative factors during ambulatory laparoscopic cholecystectomy predict postoperative admission.

Material And Method: Between January 1999 and August 2003, we attempted 410 consecutive laparoscopic cholecystectomies. Intraoperative variables were analyzed using univariate and multivariate methods.

Laparoscopic repair of vaginal evisceration: a case report.

Vaginal evisceration, although rare, is usually present in postmenopausal women with a history of vaginal surgery and high-grade pelvic floor dysfunction. Operative management is directed toward resecting any compromised bowel, repairing vaginal defect, and correcting the defect in the pelvic floor, which is associated with most cases, either in the same intervention or in a second procedure. Laparoscopy allows for assessment of the viability of the compromised bowel and the vaginal defect suture with advantages common to minimally invasive techniques.

The learning curve in ambulatory laparoscopic cholecystectomy.

Whether laparoscopic cholecystectomy (LC) should be performed as an outpatient procedure is still under discussion. The aim of this study was to evaluate the influence of surgeon's experience in ambulatory management of LC. Three hundred eighty-one consecutive elective LCs were planned as outpatient procedures.