Totally laparoscopic pancreaticoduodenectomy: Surgical technique and initial experienceIntroduction: Nowadays the utility of laparoscopic pancreatic surgery is accepted for a wide variety of indications. However pancreaticoduodenectomy has been considered beyond the possibilities of laparoscopy by the majority of surgeons. The objective of this report is to show our surgical technique and initial experience with totally laparoscopic pancreaticoduodenectomy. Material and Methods: Between november of 2007 and june of 2008, a laparoscopic technique was offered to patients with indication of pancreaticoduodenectomy for different pathologies. We describe the surgical technique, perioperative care, intraoperative complications, need for conversion to open technique, mortality, and early postoperative complications. Results: A total of three patients were subjected to laparoscopic pancreaticoduodenectomy. The surgical indication was an ampullar adenocarcinoma in a 52 years old woman, a pseudopapilar tumor of the pancreatic head in a 17 years old woman, and a duodenal gastrointestinal stromal tumor in a 63 years old man. There was no need for conversion to open technique. There was no mortality. The operative time ranged from 300 to 360 min. The first patient presented an upper gastrointestinal bleeding, from pancreatic anastomoses requiring surgical hemostasis. The last patient developed a self-limited biliary fistula, managed successfully with drains. The hospital stay varied from 8 to 25 days. Discussion: Totally laparoscopic pancreaticoduodenectomy is a feasible procedure, replicating the same steps of open surgery in a reasonable operative time, and with surgical results comparable with open technique.

Background: Gastric cancer has a direct relation with chronic atrophic gastritis (AG) and intestinal metaplasia (IM), considered as preneoplastic lesions. Determination of serum pepsinogen I levels (PGI) and pepsinogen I / pepsinogen II ratio (PGI/PGII) can detect this conditions; achieving 70-90% of gastric cancer detection in early stages. Aim: To determine the cutoff values for serum PGI and PGI/PGII in chilean subjects, for the detection of gastric preneoplastic lesions, establishing their sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. Patients and Methods: Prospective study of patients subjected to upper gastrointestinal endoscopy and determination of serum pepsinogen levels. The presence and severity of preneoplastic lesions were compared with serum levels of PGI and PGI/PGII. Results: A total of 56 men and 44 women were studied, with a mean age of 43 (14-77) years. There was a significant association (p <0.

Simplifi ed transumbilical sleeve gastrectomy. Technique and surgical results in 100 patientsBackground: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplifi ed sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS ® or GelPoint ® multiport, and a 5mm metallic accessory trocar laterally in the left fl ank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confi rming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m 2 . Mean operative time was 56.4 ± 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 ± 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left fl ank simplifi es the procedure, allowing the use of rigid instruments.