The relationship between bariatric surgery and gastric cancer is conjectural. We present a 52-year-old woman with BMI 45 operated initially by a Lap-Band procedure complicated by gastric wall erosion of the band 9 months later. She was re-operated and the band was removed. She subsequently underwent a Roux-en-Y gastric bypass. 5 years after, gastric carcinoma was discovered in the gastric pouch. Because of varied symptoms following bariatric surgery, patients may not present promptly with symptoms related to a gastric carcinoma.

Background and Objectives: The aim of this study is to evaluate the usefulness of Magnetic Resonance Imaging (MRI) for planning surgery and postoperative control of complex cases of abdominal wall hernia. Methods: Included in a prospective data base with more than 350 patients treated in two centers, a prospective study over ten patients with complex incisional hernias was designed. In all cases, preoperative diagnosis study and postoperative imaging control by MR Imaging were established. In the early and late follow-up controls, local and general complications were specifically noted and studied by MRI in each case. Results: The preoperative MRI was effective method for an adequate understanding of the defects and hernia sack content. In the postoperative control, the MRI was useful in the follow-up of the mesh integration, detection of complications and diagnosis of the relapsing. Conclusion: In our experience the MRI test is specially recommended in the preoperative workup of complex cases of incisional hernia.

Background:The laparoscopic approach for colorectal pathologies is becoming more widely used, and surgeons have had to learn how to perform this new technique. The purpose of this work is to study the indicators of the learning curve for laparoscopic colectomy in a community hospital and to find when the group begins to improve.Methodology:From January 1 2005 to December 31 2012, 313 consecutive laparoscopic colorectal surgeries were performed (105 rectal and 208 colonic) by at least 60% of the same surgical team (6 members) in each operation. We evaluate the learning curve by moving averages and cumulative sums (CUSUM) for different variables related to the surgery outcomes.Results:Moving average curves for postoperative stay, fasting, and second step analgesia show a stabilizing trend toward improvement as we get more experience. However, intensive care unit stay, number of lymph nodes achieved, and operating time did not show a clear decreasing tendency. CUSUM curves of conversion, specimens <12 lymph nodes, and complications all show a clear turning point marked on all the charts around the procedure 60, accumulating a positive trend toward improvement. The CUSUM curve of the “learning variable” shows this improvement point at procedure 70.Conclusions:The laparoscopic colectomy learning curve accelerates with a collective team involvement in each procedure. The CUSUM and moving average curves are useful for initial and ongoing monitoring of new surgical procedures. The markers of the learning curve evidenced in our study are the conversion rate, postoperative surgical morbidity, and the number of patients with a lymph node count <12.What is new in this paper?The significance of this study is the evaluation of the learning curve, in laparoscopic colorectal surgery, of a surgical team in a community hospital, using moving average and CUSUM curves. This study demonstrated that the number of patients needed to achieve skilful practice decreased when there is collective team involvement in each procedure.

Resumen Las lesiones yatrógenas de la vía biliar representan un problema importante con una incidencia en la colecistectomía laparoscópica del 0,4-0,6%. Se han postulado muchas medidas para evitarla y entre ellas la más importante es la correcta identificación de la anatomía biliar extrahepática utilizando la técnica quirúrgica de la visión crítica de seguridad. El uso de la colangiografía clásica de manera rutinaria no está consensuado pero en los últimos años, la aparición de la colangiografía por fluorescencia con verde de indocianina parece ser una herramienta muy eficaz en la correcta identificación del conducto cístico y vía biliar principal y por lo tanto una medida de apoyo para evitar lesiones biliares. Se han publicado numerosas experiencia en cirugía laparoscópica y robótica con muy buenos resultados. El problema fundamental es definir la dosis de verde de indocianina a administrar y con qué antelación al momento de la cirugía para conseguir una mejor definición de la imagen. Por otro lado, la penetración de las fuentes de luz actuales es de 5-10 mm y por ello se puede ver dificultada la visualización de las estructuras biliares cuando los tejidos están engrosados como en obesidad, colecistitis aguda, etc. A pesar de todo ello, es una técnica fácil, barata y muy bien acogida entre los cirujanos, que puede ser usada para disminuir la incidencia de lesiones biliares durante procedimientos de colecistectomía por abordaje mínimamente invasivo.

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