Highlights Systemic scleroderma in severe cases, such as gastroesophageal reflux disease, a lung transplant cannot be performed. Although gastroesophageal reflux disease can be medically treated, a poor response will warrant an anti-reflux surgery. We propose an open gastrectomy with roux-en-Y anastomosis as an alternative to the Nissen fundoplication. The decision to provide a surgical intervention must be individualized.

RESUMEN Objetivo: comparar los resultados de los abordajes abiertos y laparoscópicos en esplenectomía de pacientes con patología esplénica de origen hematológico. Métodos: se realizó un estudio observacional de corte transversal, teniendo como fuente de datos el registro institucional de las esplenectomías abiertas y laparoscópicas realizadas en la Fundación Cardioinfantil-Instituto de Cardiología entre 1996 y 2016. Se evaluaron variables preoperatorias, intraoperatorias y posoperatorias; se compararon la tasa de complicaciones, tiempo quirúrgico, estancia hospitalaria y la necesidad de re-intervención entre los dos abordajes.

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Objective: Present a giant adrenal cyst (AC) case treated with minimally invasive resection and to perform a narrative literature review available. Material and Methods: A 54 year-old male presents with a left retroperitoneal slow growing mass, no symptoms, with a complex AC evidenced by previous images and mass biopsy, with suspected renal infiltration. A transabdominal laparoscopic resection is indicated. Results: A complex hemorrhagic 9 cm diameter AC was found, with adhesions to left Gerota's fascia. Complete resection of the AC was achieved through minimally invasive approach. The patient had an uneventful clinical recovery and was discharged on the second postoperative day. On 19th month of follow-up is completely asymptomatic. Even though the AC are benign lesions, the symptomatic giant AC, with fast growing ratio, and/or hemorrhagic conversion could be resected though laparoscopic adrenalectomy, with no increased morbidity or mortality. Discussion: The laparoscopic approach for giant non-functional AC should be considered as the standard of care. More evidence is required in terms of surgical approach outcomes to define clear recommendations. Conclusion: This report adds to the actual evidence in terms of minimally invasive approach for hemorrhagic giant AC.