Injerto autólogo de vaina posterior de músculo recto del abdomen para la reconstrucción vascular del confluente espleno-mesentérico-portal en cirugía pancreática

La cirugía es el único tratamiento potencialmente curativo del adenocarcinoma de páncreas. Sin embargo, sólo el 15-20% de los pacientes son tributarios a tratamiento quirúrgico en el momento del diagnóstico. Los resultados del mismo dependen de varios factores, entre ellos, del tamaño tumoral, la afectación vascular, la enfermedad extrapancreática y la afectación de los márgenes de resección. La invasión vascular es un hallazgo común durante el diagnóstico de tumores de cabeza y cuerpo de páncreas, y es actualmente indicación de tratamiento neoadyuvante. Tras éste, puede estar indicada una cirugía con resección vascular para obtener unos márgenes microscópicos negativos a nivel oncológico.

Presentamos dos casos clínicos con resección venosa del confluente espleno-mesentérico-portal seguido de una reconstrucción vascular mediante injerto antólogo de peritoneo y vaina posterior de músculo recto del abdomen.

Doctors who have participated

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dra. Sentí

Consultant in Hepatobiliopancreatic Surgery

Dr. Sara Sentí i Farrarons (Barcelona, 1992) is a Digestive  surgeon developing her clinical practice in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Minimally invasive versus open central pancreatectomy: Systematic review and meta-analysis

Sara Sentí, Eduard A. van Bodegraven, Alain Sauvanet, Mohammed Abu Hilal, Marc G. Besselink, Safi Dokmak

This systematic review and meta-analysis aimed to give an overview on the postoperative outcome after a minimally invasive (ie, laparoscopic and robot-assisted) central pancreatectomy and open central pancreatectomy with a specific emphasis on the postoperative pancreatic fistula. For benign and low-grade malignant lesions in the pancreatic neck and body, central pancreatectomy may be an alternative to distal pancreatectomy. Exocrine and endocrine insufficiency occur less often after central pancreatectomy, but the rate of postoperative pancreatic fistula is higher.

Overall, 41 studies were included involving 1,004 patients, consisting of 158 laparoscopic minimally invasive central pancreatectomies, 80 robot-assisted minimally invasive central pancreatectomies, and 766 open central pancreatectomies. The overall rate of postoperative pancreatic fistula was 14%, major morbidity 14%, and 30-day mortality 1%. The rates of postoperative pancreatic fistula (17% vs 24%, P = .194), major morbidity (17% vs 14%, P = .672), and new-onset diabetes (3% vs 6%, P = .353) did not differ significantly between minimally invasive central pancreatectomy and open central pancreatectomy, respectively. Minimally invasive central pancreatectomy was associated with significantly fewer blood transfusions, less exocrine pancreatic insufficiency, and fewer readmissions compared with open central pancreatectomy.

Doctors who have participated

Dra. Sentí

Consultant in Hepatobiliopancreatic Surgery

Dr. Sara Sentí i Farrarons (Barcelona, 1992) is a Digestive  surgeon developing her clinical practice in hepatobiliopancreatic surgery and pancreatic transplantation.

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Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study

A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality.

No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.

Doctors who have participated

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Challenge and future of liver and pancreatic robotic surgery. Analysis of 64 cases in a specialized unit

The results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality.

Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery.

Doctors who have participated

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

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Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Telemedicine to follow patients in a general surgery department. A randomized controlled trial

A prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction.

Telemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.

Doctors who have participated

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

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Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Detection of the sentinel node in pancreatic cancer by fluorescence imaging.

Carlota Matallana, Fernando Pardo, Francisco Espin, Manel Cremades, Esteban Cugat.

El uso de la imagen fluorescente ha aumentado significativamente su uso en la cirugía hepatobiliar y pancreática, pero no hay estudios comparativos que definan su aplicabilidad intraoperatoria en el abordaje linfático. La complejidad de las vías de diseminación linfática del adenocarcinoma de páncreas hace que sea un terreno difícil de definir y en el cual el avance tecnológico puede tener un papel fundamental ayudándonos a esclarecer estas rutas linfáticas.

En esta línea, creemos que el uso de Verde de Indocianina intraoperatorio para la detección del ganglio centinela mediante la imagen de fluorescencia puede ayudarnos a delimitar el territorio ganglionar afectado y lograr así linfadenectomías más dirigidas.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Outflow Control of the Right Hepatic Vein During Laparoscopic Right Hepatectomy.

Fernando Pardo, Francisco Espin, Jordi Navinés, Esteban Cugat

El control de la vena suprahepática derecha es una de las maniobras más demandantes durante la hepatectomía derecha laparoscópica. En este vídeo se muestran tres formas diferentes de controlarla. Los dos primeros pacientes fueron diagnosticados de metástasis hepáticas de origen colorrectal y el tercer paciente de metástasis hepática de un tumor estromal gastrointestinal (GIST) ileal. En el primer vídeo se realiza el control de la vena de abajo a arriba, previo a la transección hepática; en el segundo vídeo, también previo a la transección, se controla la vena de arriba abajo, y en el tercer vídeo se controla tras realizar la transección hepática.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

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Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

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Fluorescent cholangiography with direct injection of indocyanine green (ICG) into the gallbladder: a safety method to outline biliary anatomy.

Clara Gené, Fernando Pardo, Francisco Espin, Manel Cremades, Jordi Navinés, Alba Zarate y Esteban Cugat.

A case-controlled study comparing 20 patients undergoing laparoscopic cholecystectomies with Near Infrared Cholangiography (NIRC) with direct injection of ICG into the gallbladder to 20 consecutive standard cholecystectomies. NIRC with direct injection of ICG into the gallbladder is a feasible method that is not time-consuming; it does not require a different learning curve from standard laparoscopic cholecystectomies and has no major complications described so far.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

View profile

Dr. Espín

Consultant in Hepatobiliopancreatic Surgery

Dr. Francisco Espín is a  Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (Germans Trias Teaching Unit).

View profile

Dr. Navinés

Consultant in Hepatobiliopancreatic Surgery

Surgeon Specialist in General and Digestive System Surgery and Doctor of Surgery from the Universitat Autònoma de Barcelona.

View profile

Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

View profile

Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

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Pancreas anastomosis after laparoscopic and robotic pancreatoduodenectomy.

Fernando Pardo, Esteban Cugat, Manel Cremades, Alba Zárate.

A pesar de que a día de hoy la duodenopancreatectomía cefálica laparoscópica y robótica no se realiza en la mayoría de unidades de cirugía hepatobiliopancreática, se trata de una técnica en proyección y que en los próximos años su implementación en determinados casos será incuestionable. La reconstrucción pancreática es una de las partes más demandantes de esta cirugía, y en concreto la anastomosis pancreática. El vídeo muestra la anastomosis pancreático-yeyunal y la anastomosis pancreático-gástrica tanto por laparoscopia como por cirugía robótica. La sistematización del procedimiento permite realizarla de manera segura.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dr. Cugat

Clinical Head of the Hepatobiliopancreatic Surgery Team

Dr. Esteban Cugat (Barcelona, 1960) is a medical specialist in General and Digestive System Surgery. Specialized in Hepatobiliopancreatic Surgery. Clinical Associate Professor at the Faculty of Medicine of the Autonomous University of Barcelona. 

View profile

Dr. Cremades

Consultant in Hepatobiliopancreatic Surgery

Dr. Manel Cremades is a Medical specialist in hepatobiliopancreatic (HPB) surgery and pancreatic transplantation. He is also an Associate Professor at the Faculty of Medicine at the Autonomous University of Barcelona (UAB – Germans Trias Teaching Unit), collaborates on management committees for the implementation of hospital transformation projects, and is the co-founder of two startups in the health sector.

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Dra. Zárate

Consultant in Hepatobiliopancreatic Surgery

Dr. Alba Zárate (Barcelona, 1989) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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Dose and administration time of indocyanine green in near-infrared fluorescence cholangiography during laparoscopic cholecystectomy (DOTIG): study protocol for a randomised clinical trial.

Jaime López-Sánchez, Sonsoles Garrosa-Muñoz, Fernando Pardo et al. DOTIG Collaborative Group.

This is a randomised, multicentre, per-protocol analysis, open clinical trial with four arms. The estimated duration of the trial is 12 months. The aim of the study is to analyse whether there are differences between the dose and administration ICG intervals to obtain good-quality near-infrared fluorescence cholangiography with indocyanine green (NIRFC) during laparoscopic cholecystectomy (LC). The primary outcome is the degree of identification of critical biliary structures during LC. In addition, different factors will be analysed that may have an influence on the results of this technique.

This trial was approved by the local institutional Ethics Committee and the AEMPs. The results of the study will be presented to the scientific community through publications, conferences or other means.

Doctors who have participated

Dr. Pardo

Consultant in Hepatobiliopancreatic Surgery

Dr. Fernando Pardo (Madrid, 1986) is a Digestive surgeon specializing in hepatobiliopancreatic surgery and pancreatic transplantation.

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