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J S Azagra

Publications and source records attributed to J S Azagra.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: results of a 2-year follow-up study.

BACKGROUND: The world's epidemic of obesity is responsible for the development of bariatric surgery in recent decades. The number of gastrointestinal surgeries performed annually for severe obesity (BMI > 40 kg/m2) in the United States has increased from about 16,000 in the early 1990s to about 103,000 in 2003. The surgical techniques can be classified as restrictive, malabsorptive, or mixed procedures. This article presents the results for 2 years of bariatric surgery in the authors' minimally invasive center and analyzes the results of the most used surgical techniques with regard to eating habits. METHODS: Between January 2002 and January 2004, the authors attempted operations for morbid obesity in 110 consecutive patients adequately selected by a multidisciplinary obesity unit. This represented 43% of all consultations for morbidly obese patients. The patients were classified as sweet eaters or non-sweet eaters. All sweet eaters underwent gastric bypass. The procedures included 70 Roux-en-Y gastric bypasses, 39 Mason's vertical banded gastroplasties, and 1 combination of vertical gastroplasty with an antireflux procedure. Revision procedures were excluded. RESULTS: The mean age of the patients was 41.36 years (range, 23-67 years), and 72.3% were female. The mean preoperative body mass index was 44.78 kg/m2 (range, 34.75-70.16 kg/m2). The mean operating time was longer for gastric bypass than for the Mason procedure. Three patients required conversion to an open procedure (2.7%). The two operative techniques had the same efficacy in weight reduction. Early complications developed in 11 patients (10%), and late complications occurred in 9 patients (8.1%). The postoperative length of hospital stay averaged 4.4 days (range, 1-47 days; median, 4 days), and was longer in the gastric bypass group. The mortality rate was zero. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used. CONCLUSION: With zero mortality and low morbidity, bariatric surgery performed for adequately selected patients is the most effective therapeutic intervention for weight loss and subsequent amelioration or resolution of comorbidities. The patient's eating habits before surgery play an important role in the choice of the operative technique used.

Adult↗
PubMed2006

Present state of the Mini-Invasive Surgery (MIS) in esophageal and gastric cancer.

The purpose of this review is to stress the role of the Mini-Invasive Surgery (MIS) in the treatment of the esophagogastric malignant illnesses, supporting ourselves on the most relevant publications of the literature as well as on our own experience in this subject. In short, although no randomised prospective study has proven the MIS advantages in relation to the traditional surgery in the esophagectomy due to cancer, some authors preferently indicate this approach to selected and informed enough patients, who present the following: - High grade dysplasia, preferently choosing from laparoscopic transhiatal esophagectomy (LTE). - Carcinoma in situ, preferently choosing the LTE vs thoracoscopy. - Esophageal tumour locally advanced, in resectable patients with contraindication for a thoracotomy or, in initially non-resectable patients with tumoral reduction after neo-adjuvant chemo-radiotherapy. The arguments given by the authors are the postoperative spectacular improvement in relation to the comfort and quality of life and, the absence of oncological negative effects in the long-term followup. Concerning gastric cancer, the MIS, as exeresis surgical tool in the so-called < > gastric forms, is such a definite and oncological approach as the traditional approach, and superior to this as far as quality of life is concerned. When the MIS is used for treating locally advanced forms of gastric cancer, it is as safe as the laparotomic way and it seems to obtain the same oncological outcomes in the long-term.

Esophageal Neoplasms↗
PubMed2006

Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results.

BACKGROUND: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy. PATIENTS AND METHODS: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years). RESULTS: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

Adenocarcinoma↗
PubMed2005

[Laparoscopic surgery of gastric cancer].

INTRODUCTION: The present state of minimally invasive surgery in gastric cancer is reviewed and its technical aspects are detailed. PATIENTS AND METHOD: The authors provide their personal experience in a non-randomized prospective study, in two different settings (the CHU Charleroi, Belgium and the Hospital of Zumárraga, the Basque Country, Spain) carried out between June 1993 and January 2004. In this study involving 101 patients with gastric adenocarcinoma, the mini-invasive laparoscopic approach was employed as a surgical tool with the "aim of treatment by laparoscopy". The average age of the patients was 67 years (37-83). RESULTS: Postoperativemortality after 60 days was 5 patients; 87 patients were subjected to an oncological follow-up averaging 41 months (7-129). The average of survival observed in the 10 non-resected patients was 4.5 months. The average of survival observed in the 10 patients subjected to a palliative resection was 7.1 months. The actuarial survival after 5 years observed following type RO exeresis was 34%. The 5-years actuarial survival of the resected patients was 29%. CONCLUSIONS: Laparoscopic gastrectomy associated with any type of lymphadenectomy is a significant but safe intervention, with acceptable rates of morbidity and mortality in patients with advanced gastric cancer, who frequently present a bad general status. The long term oncological results are similar to those obtained via laparotomy. More prospective studies are needed that evaluate the results of this approach, both its short-term benefits and the long range oncological result.

Actuarial Analysis↗
PubMed2002

Laparoscopic liver resection of benign liver tumors.

OBJECTIVE: The objective of this study was to assess the feasibility, safety, and outcome of laparoscopic liver resection for benign liver tumors in a multicenter setting. BACKGROUND: Despite restrictive, tailored indications for resection in benign liver tumors, an increasing number of articles have been published concerning laparoscopic liver resection of these tumors. METHODS: A retrospective study was performed in 18 surgical centres in Europe regarding their experience with laparoscopic resection of benign liver tumors. Detailed standardized questionnaires were used that focused on patient's characteristics, clinical data, type and characteristics of the tumor, technical details of the operation, and early and late clinical outcome. RESULTS: From March 1992 to September 2000, 87 patients suffering from benign liver tumor were included in this study: 48 patients with focal nodular hyperplasia (55%), 17 patients with liver cell adenoma (21%), 13 patients with hemangioma (15%), 3 patients with hamartoma (3%), 3 patients with hydatid liver cysts (3%), 2 patients with adult polycystic liver disease (APLD) (2%), and 1 patient with liver cystadenoma (1%). The mean size of the tumor was 6 cm, and 95% of the tumors were located in the left liver lobe or in the anterior segments of the right liver. Liver procedures included 38 wedge resections, 25 segmentectomies, 21 bisegmentectomies (including 20 left lateral segmentectomies), and 3 major hepatectomies. There were 9 conversions to an open approach (10%) due to bleeding in 45% of the patients. Five patients (6%) received autologous blood transfusion. There was no postoperative mortality, and the postoperative complication rate was low (5%). The mean postoperative hospital stay was 5 days (range, 2-13 days). At a mean follow-up of 13 months (median, 10 months; range, 2-58 months), all patients are alive without disease recurrence, except for the 2 patients with APLD. CONCLUSIONS: Laparoscopic resection of benign liver tumors is feasible and safe for selected patients with small tumors located in the left lateral segments or in the anterior segments of the right liver. Despite the use of a laparoscopic approach, selective indications for resection of benign liver tumors should remain unchanged. When performed by expert liver and laparoscopic surgeons in selected patients and tumors, laparoscopic resection of benign liver tumor is a promising technique.

Adolescent↗
PubMed2001

Is there a place for laparoscopy in management of postcholecystectomy biliary injuries?

Despite its minimal invasiveness, laparoscopic cholecystectomy (LC) carries unquestionably higher morbidity and mortality rates when compared with the open counterpart (OC). Among the iatrogenic injuries, biliary tract lesions are the most clinically relevant because of their potential for patient's disability and long-term sequelae. No universal agreement exists for classifying these lesions, but numerous authors have advocated a distinction between bile leaks and bile injuries. Even if not entirely correct, bile leaks refer to fistulas from minor ducts in continuity with the major ductal system or from accessory ducts (as the duct of Luschka). Biliary injuries are major complications consisting of leaks, strictures, transection, or ligation of major bile ducts. While bile leaks are typically treated by percutaneous and/or endoscopic drainage and stenting, biliary injuries often require a combined radiology-assisted and endoscopic approach or even conventional surgery. The role of laparoscopy in the management algorithm of biliary lesions is still anecdotal. To date, a total of 25 cases of laparoscopic drainage of post-cholecystectomy bilomas have been reported in the literature, whereas there is no mention of laparoscopic primary repair of biliary injuries detected at or after cholecystectomy. The main reasons depend on the excellent results achieved by the ancillary techniques; the emergency settings that accompany more complex biliary lesions; the technical challenges posed by the presence of inflammation, collections, and obscured anatomy; and the potential for malpractice litigation. However, a sound laparoscopic technique and a strict adherence to basic surgical tenets are crucial in order to avoid the incidence of iatrogenic biliary injuries and reduce their still unknown impact on long-term patient disability.

Bile Ducts↗
PubMed1999

Minimally invasive surgery for gastric cancer.

BACKGROUND: The use of laparoscopic surgery in the treatment of gastric cancer has not yet met with widespread acceptance; thus, it should be regarded as still in the developmental phase. Nevertheless, the laparoscopic approach appears to have some valuable advantages for the management of gastric cancer patients, and it can be expected to have a dramatic impact on public health expenditures. Herein we present the results of our experience with laparoscopic and laparoscopy-assisted gastrectomies for cancer, and we discuss the role of these procedures in current surgical practice. METHODS: Between June 1993 and November 1997, we performed a total of 13 laparoscopic procedures on 13 patients affected with gastric carcinoma. There were eight male and five female patients with a mean age of 65.4 years (range, 42-78). All patients were staged preoperatively with US and CT scan and required to sign a formal consent. RESULTS: Altogether we performed nine D1 laparoscopic total gastrectomies, seven of which were done with a laparoscopy-assisted approach; three D2 laparoscopy-assisted total gastrectomies, associated in one case with a distal pancreasectomy; and one laparoscopy-assisted distal gastrectomy performed on a morbid obese patient. The preliminary laparoscopic staging allowed for a better definition of tumor extension and identification of undetected hepatic metastases in two patients. The mean duration of the intervention was 240 min. Blood losses were as high as 300 cc on average. We recorded one major intraoperative complication, consisting of an inadvertent injury to the proper hepatic artery, which was successfully repaired by the same laparoscopic route. The postoperative course was uneventful in all patients but one, who died of acute hepatic failure on day 6. At a mean follow-up of 27.5 months, 11 patients are still alive. Two of them have hepatic metastases and nine are disease-free. CONCLUSIONS: Although they remain challenging procedures, laparoscopic gastrectomies appear to be oncologically adequate. We believe that a pure laparoscopic approach should be reserved for low-stage lesions (N0, up to T2), while a combined approach is preferable for locally advanced cancer (N1 or higher, T3 or higher). Much work still needs to be done to establish the optimal strategy in both open and laparoscopic surgery, but laparoscopy can be a valuable tool in the decision-making process for patients affected with gastric malignancies.

Adenocarcinoma↗
PubMed1999

Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs open vertical banded gastroplasty.

BACKGROUND: The purpose of the current study was to present the preliminary results of a randomized prospective trial comparing laparoscopic and open vertical banded gastroplasty (Mason's procedure). METHODS: From April 1995 to April 1996, 68 patients (9 men and 59 women, mean age, 36 years; ranges, 17-60 years) affected from morbid obesity (mean body weight, 123 kg; range, 89-188 kg; mean body mass index (BMI), 43 kg/m2; range, 37-66 kg/m2) were enrolled in a prospective trial and randomly assigned to a laparoscopic (group A) or open (group B) Mason's gastroplasty. There was no statistically significant difference between the two groups in terms of patient epidemiologic data. The significance level among the data was assessed by means of Fisher's exact test. RESULTS: The success of laparoscopic gastroplasty was 88.2% (30/34). The intervention was significantly longer in the laparoscopic group (150 min vs. 60 min; p = 0.001). No mortality was recorded in the overall population. Intraoperative complications included only one case of gastric bleeding in group A (2.9% vs. 0%; p value not significant [NS]). Early major complications ranged as high as 6.6% and 7.8%, respectively, in groups A and B (p = NS), and included one case of peritonitis and one case of pneumonia in group A, and two cases of peritonitis and one pulmonary embolism in group B. Early minor postoperative complications consisted of wound infections only, observed in one group A patient (3.3%) and four group B patients (10. 8%, p = 0.04). At longer follow-up, incisional hernias occurred in 15.8% (6/38) of patients surgically treated with a conventional approach compared with none among those successfully surgically treated with laparoscopic access (p = 0.04). No statistically significant difference was observed between the two groups regarding the efficacy of the procedure, in terms of decrease in percentage of excess body weight, mean body weight, or mean BMI. CONCLUSIONS: The preliminary results of current study show that the laparoscopic Mason procedure is a time-consuming and technically demanding operation, as effective as its traditional counterpart, but carrying a statistically significant decrease in the incidence of wound infections and incisional hernias.

Adult↗
PubMed1999

[Multiple cholesterol emboli syndrome: beneficial effects of early heparin therapy. A case report].

The multiple cholesterol emboli syndrome (MCES) is a rare, multi-organ disease than can occur spontaneously or after arterial or cardiac catheterization, arteriography, angioplasty, cardiovascular surgery, oral or intravenous anticoagulation, systemic fibrinolysis and cardiorespiratory resuscitation, predominantly in male subjects with disseminated atherosclerosis over the age of 60 years. Clinical signs of MCES vary considerably depending on the organs involved, but the signs most frequently encountered are renal failure, skin lesions (livedo reticularis, purple toc, ulcers, etc) and transient eosinophilia. Optimal treatment of this syndrome is controversial and is often symptomatic. However, the most effective measure remains prevention based on identification of high-risk patients, treatment with platelet antiaggregants and careful handling of catheters. This syndrome has a serious prognosis in the majority of cases. In this article, the authors describe a case of MCES. After thoracic aortography, this 73-years-old patient presented typical clinical sign of MCES (angina, cerebrovascular accident, bilateral blindness, transient renal failure and splenic infarction). The clinical course was favourable in response to heparin therapy and splenectomy and caudal pancreatectomy. Histology confirmed the presence of cholesterol emboli in the lumen of splenic arterioles. Except in the case of severe bleeding diathesis, the authors recommend early heparin therapy for MCES caused by catheterization, angioplasty or cardiovascular surgery. However, complementary studies must be performed to more clearly define the effects of heparin on MCES.

Aged↗
PubMed1996

Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects.

Laparoscopic liver surgery is a tremendous challenge. The authors report a left liver lobectomy and removal by a total laparoscopic approach. Anatomical left lateral laparoscopic segmentectomy was performed on a woman who had a symptomatic hepatic adenoma. The patient was discharged after an uncomplicated postoperative recovery; the hospital stay and convalescence period were very short. The cosmetic result was good.

Adenoma, Liver Cell↗
PubMed1990

[Value of echography for measuring the volume of the thyroid and its lesions].

The sizes of thyroid lobes and lesions estimated by ultrasonography have been compared to surgical specimens in 92 cases of thyroid pathology. Volumes can be calculated with a reasonable accuracy for parenchymatous and cystic lesions from measurements of their diameters when considered as ellipsoids. This easy method, currently used by ultrasonographers, is however unsatisfactory for estimation of the volumes of thyroid lobes. More reliable results are obtained by computation of volumes from planimetry of cross-sections through the gland.

Humans↗
PubMed1990

[Peri-colostomy hemorrhage due to portal hypertension secondary to hepatic metastasis of a rectal adenocarcinoma. Apropos of a case report. Literature review].

The authors present a case report of recurrent peristomal variceal bleeding resulting from portal hypertension induced by hepatic metastases of a rectal cancer. They propose mucocutaneous disconnection as a simple and effective palliative surgery in order to prevent new bleeding. Discussion is based on a review of the literature and illustrates the different therapeutic options for this complication.

Adenocarcinoma↗