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Preoperative calculation of angles of vision and working area in laparoscopic surgery to treat a giant hiatal hernia

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1638-1650页

作者： Francisco javier perez Lara Rogelio Zubizarreta Jimenez Francisco javier Moya Donoso Jose Manuel Hernández Gonzalez Tatiana Prieto-Puga arjona Arturo del Rey Moreno Maria Pitarch Martinez Surgery Service Antequera HospitalRincón de la Victoria 29730MálagaSpain DOXA Microfluidics Rincon de la Victoria 29738MálagaSpain

BACKGROUND Giant hiatal hernias still pose a major challenge to digestive surgeons,and their repair is sometimes a highly complex *** is usually performed by laparoscopy,while the role of the thoracoscopic approach has yet to be clearly *** To preoperatively detect patients with a giant hiatal hernia in whom it would not be safe to perform laparoscopic surgery and who,therefore,would be candidates for a thoracoscopic *** In the present study,using imaging test we preoperatively simulate the field of vision of the camera and the working area(instrumental access)that can be obtained in each patient when the laparoscopic approach is *** From data obtained,we can calculate the access angles that will be obtained in a preoperative computerised axial tomography coronal section,according to the location of the *** also provide the formula for performing the angle calculations If the trocars are placed in loss common situations,thus enabling us to determine the visibility and manoeuvrability for any position of the *** The working area determines the cases in which we can operate safely and those in which certain areas of the hernia cannot be accessed,which is when the thoracoscopic approach would be safer.

关键词： Hiatal hernia Angles Approach Laparoscopy Thoracoscopy

Back-table surgery pancreas allograft for transplantation:Implications in complications

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World Journal of Transplantation 2021年第1期11卷 1-6页

作者： javier Briceño Juan Manuel Sánchez-Hidalgo Alvaro arjona-Sanchez Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain

To describe the main aspects of back-table surgery in pancreatic graft and the problems arising from poor ***-table surgery for pancreatic graft is a complex,meticulous and laborious technique on which the success of implant surgery and perioperative results *** technique can be described in the following steps:Preparation of the sterile table,ex-situ inspection of the pancreasspleen block,management of the duodenum,identification of the bile duct,preparation of the portal vein,preparation of the own graft arteries and anastomosis to the arterial graft,spleen management and graft preservation prior to implantation in the recipient.A careful inspection of the pancreas-spleen block should be *** is important to identify the stump of the main bile duct,the portal vein cuff,and the arrangement of the superior mesenteric artery and splenic *** redundant duodenum must be *** availability of a good venous cuff facilitates the portal vein anastomosis and the positioning of the graft,two key points to prevent *** section line of the arteries must be clean,without atherosclerosis,to prevent arterial *** superior and splenic mesenteric arteries are generally separated by dense fibrolymphatic *** artery can be reconstructed by interposing a"Y"graft from the donor iliac artery;or with an end-to-end anastomosis between the splenic artery and the superior mesenteric *** exquisite technique of bench work helps to prevent the most feared complications of pancreas transplantation:Thrombosis and graft pancreatitis.

关键词： Pancreas transplantation Back-bench work Pancreas thrombosis Graft pancreatitis Arterial reconstruction Pancreas allograft

Review of incomplete macroscopic resections(R2)in rectal cancer:Treatment,prognosis and future perspectives

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World Journal of Gastrointestinal Oncology 2021年第9期13卷 1062-1072页

作者： Francisco javier Pérez Lara Maria Luisa Hebrero Jimenez Francisco javier Moya Donoso Jose Manuel Hernández Gonzalez Maria Pitarch Martinez Tatiana Prieto-Puga arjona Department of Surgery Antequera HospitalMálaga 29200Spain Department of Oncologic Radiotherapy Hopital Regional de MálagaMálaga 29010Spain

Colorectal cancer is one of the most prevalent tumours,but with improved treatment and early detection,its prognosis has greatly improved in recent ***,when the tumour is locally advanced at diagnosis or if there is local recurrence,it is more difficult to perform a complete tumour resection,and there may be a residual macroscopic *** this paper,we review the literature on residual macroscopic tumour resections,concerning both locally advanced primary tumours and recurrences,evaluating the main problems encountered,the treatments applied,the prognosis and future perspectives in this field.

关键词： Rectal cancer Surgery Treatment Incomplete resection Local recurrence

Management of hepatitis B virus infection after liver transplantation

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World Journal of Gastroenterology 2015年第42期21卷 12083-12090页

作者： Miguel Jiménez-Pérez Rocío González-Grande José Mostazo Torres Carolina González arjona Francisco javier Rando-Mu?oz Liver Transplantation and Hepatology Unit UGC de Aparato Digestivo Hospital Regional Universitario Department of Abdominals Diseases Hospital Nij Smellinghe Ziekenhuis

Chronic hepatitis B virus(HBV) infection is responsible for up to 30% of cases of liver cirrhosis and up to 53% of cases of hepatocellular carcinoma. Liver transplantation(LT) is the best therapeutic option for patients with end-stage liver failure caused by HBV. The success of transplantation, though, depends on receiving prophylactic treatment against post-transplant viral reactivation. In the absence of prophylaxis, liver transplantation due to chronic hepatitis B(CHB) is associated with high rates of viral recurrence and poor survival. The introduction of treatment with hepatitis B immunoglobulins(HBIG) during the 1990 s and later the incorporation of oral antiviral drugs have improved the prognosis of these patients. Thus, LT for CHB is now a universally accepted option, with an estimated 5 years survival of around 85% vs the 45% survival seen prior to the introduction of HBIG. The combination of lamivudine plus HBIG has for many years been the most widely used prophylactic regimen. However, with the appearance of new more potent oral antiviral agents associated with less resistance(e.g., entecavir and tenofovir) for the treatment of CHB, new prophylactic strategies are being designed, either in combination with HBIG or alone as a monotherapy. These advances have allowed for more personalized prophylaxis based on the individual risk profile of a given patient. In addition, the small pool of donors has required the use of anti-HBc-positive donors(with the resulting possibility of transmitting HBV from these organs), which has been made possible by suitable prophylactic regimens.

关键词： Hepatitis B virus Liver tra nsplantation Recurrence Prophylaxis Hepatitis B immunoglobulin

Novel suturing technique,based on physical principles,achieves a breaking point double that obtained by conventional techniques

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World Journal of Gastrointestinal Surgery 2021年第9期13卷 1039-1049页

作者： Francisco javier Pérez Lara Rogelio Zubizarreta Jimenez Francisco javier Moya Donoso Jose Manuel Hernández Gonzalez Tatiana Prieto-Puga arjona Ricardo Marín Moya Maria Pitarch Martinez Department of Surgery Hopital de AntequeraMalaga 29200Spain DOXA Malaga 29730Spain

BACKGROUND Sutures have been used to repair wounds since ancient ***,the basic suture technique has not significantly *** Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break *** To determine whether these theoretical levels of resistance were met by the new type of *** An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was *** tension produced by this traction was *** following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break *** study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all *** The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).

关键词： Suture Technique Physical principles Tension

Gastrointestinal stromal tumors:a multidisciplinary challenge

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World Journal of Gastroenterology 2018年第18期24卷 1925-1941页

作者： Juan Manuel Sanchez-Hidalgo Manuel Duran-Martinez Rafael Molero-Payan Sebastian Rufian-Pena Alvaro arjona-Sanchez Angela Casado-Adam Antonio Cosano-Alvarez javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Department of Intern Medicine Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Lipids and Atherosclerosis Research Unit IMIBIC/Hospital Universitario Reina Sofía/Universidad de CórdobaCordoba 14004Spain

Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs(> 95%) are positive for the KIT protein(CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis(the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvantImatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

关键词： Gastrointestinal stromal tumors Surgery Oncology Radiology Endoscopy Nuclear medicine Pathology Disease management Tyrosine kinase inhibitors Gastroenterology

Peritoneal metastases of colorectal origin treated by cytoreduction and HIPEC: An overview

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World Journal of Gastrointestinal Oncology 2014年第10期6卷 407-412页

作者： Alvaro arjona-Sánchez Francisco javier Medina-Fernández Francisco Cristobal Mu?oz-Casares Angela Casado-Adam Juan Manuel Sánchez-Hidalgo Sebastián Rufián-Pe?a Unit of Oncological and Pancreatic Surgery Department of General and Digestive Surgery University Hospital Reina Sofia 14004 Cordoba Spain

Colorectal peritoneal carcinomatosis was considered a terminal condition with a merely palliative treatment that included only supportive care, palliative surgery and the best systemic chemotherapy. Since the birth of a new approach, cytoreductive surgery with peritonectomy procedures together with hyperthermic intraperitoneal chemotherapy and/or early postoperative intraperitoneal chemotherapy to treat peritoneal carcinomatosis, many research groups contributed with promising results using this procedure being up to date this strategy the only one that has shown curative benefits on colorectal peritoneal carcinomatosis achieving reported overall survival rates up to 64 mo and fiveyear survival rates up to 51%. The aim of this paper is to expose an updated overview of the therapeutic possibilities of these procedures in colorectal peritoneal metastases in the same way that our Unit of Oncologic Surgery has performed since 1997 with more than four hundred procedures.

关键词： Carcinomatosis peritoneal Colon cancer Intraperitoneal chemotherapy Cytoreduction Perito-nectomy

Colorectal peritoneal metastases:Optimal management review

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World Journal of Gastroenterology 2019年第27期25卷 3484-3502页

作者： Juan Manuel Sánchez-Hidalgo Lidia Rodríguez-Ortiz Alvaro arjona-Sánchez Sebastián Rufián-Pena Angela Casado-Adam Antonio Cosano-Alvarez javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

关键词： Peritoneal metastases Colorectal cancer Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Peritoneal carcinomatosis

Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2739-2746页

作者： Francisco javier Pérez Lara Rogelio Zubizarreta Jimenez Tatiana Prieto-Puga arjona Pilar Gutierrez Delgado Juan Manuel Hernández Carmona Jose Manuel Hernández Gonzalez Maria Pitarch Martinez Department of Surgery Hopital de AntequeraAntequera 29200Spain DOXA MicrofluidicsRincon de la Victoria 29730Spain Department of Surgery HRU Carlos HayaUnidad Cirugia Hepatobiliopancreat&TrasplantesMalaga 29200Spain

BACKGROUND Giant hernias present a significant challenge for digestive *** approach taken(laparoscopic vs thoracoscopic)depends largely on the preferences and skills of each surgeon,although in most cases today the laparoscopic approach is *** To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem,in order to assess the need for a thoracoscopic *** For the retrospective series of patients treated in our hospital for hiatal hernia(n=112),we calculated the laparoscopic field of view and the working area accessible to surgical instruments,by means of preoperative imaging tests,to assess the likely outcome for cases inaccessible to *** Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was *** difference was statistically ***,the insertion of mesh did not improve results for the non-accessible *** For patients with giant hiatal hernias,it is essential to conduct a preoperative evaluation of the angle of vision and the working area for *** parts of the intrathoracic sac are inaccessible laparoscopically,the thoracoscopic approach should be considered.

关键词： Hiatal hernia Abdominal surgery Laparoscopy Thoracoscopy surgery