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Search Results: 1 - 10 of 1452 matches for " Ramon Vilallonga "
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Single port access sleeve gastrectomy: Is it reasonable?
Vilallonga Ramon,Rius Josep,Fort José,Armengol Manuel
Journal of Minimal Access Surgery , 2011,
Abstract: This short letter is in response to the article published in your publication about single-incision laparoscopic bariatric surgery, by Chih-Kun Huang. We want to focus on the technical aspects.
Right-sided diaphragmatic rupture after blunt trauma. An unusual entity
Ramon Vilallonga, Vicente Pastor, Laura Alvarez, Ramon Charco, Manel Armengol, Salvador Navarro
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-3
Abstract: Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery. Sennertus, in 1541, performed an autopsy in one patient who had died from herniation and strangulation of the colon through a diaphragmatic gap secondary to a gunshot wound received seven months earlier [1]. However, these cases remain rare, and difficult to diagnose and care for. This has highlighted some of the aspects related to these lesions, especially when they are caused by blunt trauma and injuries of the right diaphragm [1,2].We report the case of a man of 36 years of age, thrown from a height of 12 meters and was referred to our centre. The patient arrived conscious and oriented, and we began manoeuvring the management of the patient with multiple injuries according to the guidelines of the ATLS (Advanced Trauma Life Support) recommended by the American College of Surgeons. The patient had an unstable pelvic fracture (type B2) with hemodynamic instability and respiratory failure. Patient's Injury Severity Score (ISS) was 38. Pelvis and chest X-rays were performed which confirmed the pelvic fracture and pathological elevation of the right hemidiaphragm was observed (Figure 1). We proceeded to stabilise the pelvic fracture and replace fluids, improving hemodynamic status. The patient continued with respiratory failure. For this reason, a chest tube was placed and Computerised Tomography (CT) was performed (Figure 2), showing a ruptured right hemidiaphragm, including chest drain in the right hepatic lobe and occupation of the lesser sac by blood. The patient underwent surgery, finding a right hemidiaphragm transverse rupture with a hepatothorax and an intrahepatic thoracic tube. We performed the suture of the diaphragm and liver packing, moved the patient to the intensive care unit, and after 48 hours, the liver packing was removed without problems. The patient evolved favourably.Currently, traumatic injuries of the diaph
Management of Patients with Hernia or Incisional Hernia Undergoing Surgery for Morbid Obesity
Ramon Vilallonga,José Manuel Fort,Oscar Gonzalez,Juan Antonio Baena,Albert Lecube,Manuel Armengol
Journal of Obesity , 2011, DOI: 10.1155/2011/860942
Abstract: Morbidly obese patients (MOPs) are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or splits of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair.
Postthyroidectomy Horner’s Syndrome
Ramon Vilallonga,José Manuel Fort,Alejandro Mazarro,Oscar Gonzalez,Enric Caubet,Giancarlo Romero,Manel Armengol
Case Reports in Medicine , 2012, DOI: 10.1155/2012/316984
Abstract: Horner’s syndrome (HSd) results from an injury along the cervical sympathetic chain, producing ipsilateral miosis, ptosis, enophthalmos, and facial anhydrosis. Although more commonly associated to malignant tumors affecting the preganglionar segment of the sympathetic chain (especially in the lung apex), HSd has been described as a rare complication of thyroid surgery. We herein report a case of HSd after completing total thyroidectomy.
A Giant Euthyroid Endemic Multinodular Goiter with No Obstructive or Compressive Symptoms
Ahmed Nada,Ashraf Mohamed Ahmed,Ramon Vilallonga,Manuel Armengol,Ibrahim Moustafa
Case Reports in Medicine , 2011, DOI: 10.1155/2011/620480
Abstract: Diffusely enlarged thyroid glands (goitres) are becoming increasingly infrequent. However, in some geographical areas they are still relatively common and can cause compressive symptoms involving the trachea, oesophagus, and recurrent laryngeal nerve. Surgical treatment of diffusely enlarged thyroid glands requires a high level of expertise and may lead to severe complications. Here we present a case report of surgical treatment of an extremely enlarged thyroid gland, found in a 61-year-old female patient. The patient underwent surgery, and a thyroidectomy was performed. The resulting specimen weighed 4.7 kg (10.4 lbs). Histopathological examination revealed a multinodular goitre with multiple cysts and areas of haemorrhage and necrosis. Surgical excision can immediately resolve local symptoms and is often recommended when substernal extension is evident. To the best of our knowledge, this is the largest thyroid gland ever reported in the literature. Only experienced surgeons should treat large thyroid goitres. Ideally, large thyroid goitres should be treated before they reach a substernal component, otherwise any sudden growth in gland size could seriously compromise respiration.
The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon’s Experience While Introducing the Robotic Technology in a Bariatric Surgery Department
Ramon Vilallonga,José Manuel Fort,Oscar Gonzalez,Enric Caubet,Angeles Boleko,Karl John Neff,Manel Armengol
Minimally Invasive Surgery , 2012, DOI: 10.1155/2012/347131
Abstract: Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases. 1. Introduction The sleeve gastrectomy (SG) is the first part of the duodenal switch operation and leaves a lesser curvature tube after excising the fundus and greater curvature portion of the stomach. This surgery has become more and more popular as the first stage in the treatment of obesity [1, 2]. Minimally invasive surgery is being incorporated into general surgical practice. During the last decade, the advent of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has enabled many complex procedures to be performed with minimally invasive techniques in bariatric surgery [3]. Roux en Y gastric bypass remains one of the most challenging procedures performed by bariatric and general surgeons [4]. Sleeve gastrectomies are a less technically demanding procedure, and for this reason, we used them to gain dissection and suturing experience using the da Vinci system. This initial experience was used to determine the learning curve in performing the robot-assisted sleeve gastrectomy. 2. Materials and Methods Between February 2010 and April 2011, a trained surgeon in advanced laparoscopic surgery (RV and JMF) performed 32 consecutive robotic sleeve gastrectomies (RSGs) for the treatment of morbid obesity. Patients
Management of Patients with Hernia or Incisional Hernia Undergoing Surgery for Morbid Obesity
Ramon Vilallonga,José Manuel Fort,Oscar Gonzalez,Juan Antonio Baena,Albert Lecube,Manuel Armengol
Journal of Obesity , 2011, DOI: 10.1155/2011/860942
Abstract: Morbidly obese patients (MOPs) are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or splits of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair. 1. Introduction Morbidly obese patients (MOPs) are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity [1]. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery [2]. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or split of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair [3]. 2. Methods Medical records of consecutive morbidly obese patients who underwent open or laparoscopic Roux-en-Y (ORYGBP-LRYGBP) gastric bypass with a secondary diagnosis of ventral hernia were reviewed. Only patients who were beyond 12 months of followup were included. In this study, all details of consecutive patients who underwent ORYGBP or LRYGBP at the University Hospital Vall d’Hebron, from May 2001 to February 2010 were entered into an electronic database. The medical charts of these patients were reviewed. The data that was obtained included demographics, body mass index (BMI), and hernia characteristics such as status of natural history (reduced versus incarcerated). Operative details included the hernia management. Short-and long-term followup data consisted of length of hospital stay, the incidence of early and late complications, length of followup, and the frequency of recurrence by clinical examination. The BMI, a standard index for classifying obesity, was calculated as (kg)/height 2(m). Data are presented as mean and range. 3. Results The study population was 398 patients, 41 of who had ventral hernias or incisional hernias (Table 1). There were six groups of patients according
Postthyroidectomy Horner’s Syndrome
Ramon Vilallonga,José Manuel Fort,Alejandro Mazarro,Oscar Gonzalez,Enric Caubet,Giancarlo Romero,Manel Armengol
Case Reports in Medicine , 2012, DOI: 10.1155/2012/316984
Abstract: Horner’s syndrome (HSd) results from an injury along the cervical sympathetic chain, producing ipsilateral miosis, ptosis, enophthalmos, and facial anhydrosis. Although more commonly associated to malignant tumors affecting the preganglionar segment of the sympathetic chain (especially in the lung apex), HSd has been described as a rare complication of thyroid surgery. We herein report a case of HSd after completing total thyroidectomy. 1. Introduction Described by Bernard (1853) and Horner (1869), Horner’s syndrome (HSd) consists of a tetrad defined by unilateral miosis, ptosis, enophtalmos, and facial anhydrosis. It results from an injury along the ipsilateral cervical sympathetic chain, usually in the preganglionic portion. The most frequent cause of HSd is neoplasms, being the malignant ones more common than the benign ones. However, when secondary to thyroid pathology, and against the general belief, HSd is more often due to benign thyroid pathology [1]. 2. Case Presentation A 79-year-old woman presented with a right cervical mass. She had undergone a subtotal thyroidectomy in 1986 for multinodular goiter, and the results of the histopathological studies revealed no malignancy. Twenty-four years after surgery, the patient complained about mass, pain, and swallowing difficulty. The only biochemical remaining sequela was subclinical hypothyroidism. Imaging studies that were performed (ultrasound—Figure 1—and CT scan—Figure 2) revealed an enlarged right thyroid lobe and a right paratracheal mass displacing (but not invading) the carotid artery, the esophagus, and the trachea. A fine needle aspiration cytology (FNAC) was performed but no conclusion could be given according to the cytology found. Figure 1: Hypoechogenic and avascular mass compatible with thyroidal remains. Figure 2: CT scan showing the mass pushing the trachea and occluding its lumen. Surgery was performed, finding a thyroid gland strongly adhered to the carotid sheath and invading the posterolateral side of the esophagus. The recurrent laryngeal nerve was identified and respected. During the surgery, the patient suffered from bradycardia secondary to carotid manipulation, being reverted with atropine. The first postoperative day, the physical exploration revealed right ptosis and miosis, being diagnosed with Horner’s syndrome. Hematoma and seroma were ruled out as a cause after a careful exploration, and HSd was attributed to damage to the communication between the cervical sympathetic chain and the recurrent laryngeal nerve, associated to palsy of the right vocal cord (Figure 2).
Single-Port Transumbilical Laparoscopic Appendectomy: A Preliminary Multicentric Comparative Study in 87 Patients with Acute Appendicitis
Ramon Vilallonga,Umut Barbaros,Ahmed Nada,Aziz Sümer,Tu?rul Demirel,José Manuel Fort,Oscar González,Manuel Armengol
Minimally Invasive Surgery , 2012, DOI: 10.1155/2012/492409
Abstract: Introduction. Laparoscopic appendectomy (LA) has been performed in many approaches such as open, laparoscopic and recently Single Port Access (SPAA). In order to elucidate its potential advantages, we compared the two laparoscopic approaches. Methods. 87 patients were included in a multicentric study for suspected appendicitis in order to perform (SPAA) appendectomy or laparoscopic appendectomy (LA). All outcomes, including blood loss, operative time, complications, and length of stay and pain were recorded prospectively. Results. There were 46 patients in the SPAA group and 41 in the LAG with a mean operative time of 40,4 minutes in the SPAA group and 35,0 minutes in the LA group. Only one patient was converted to an open approach. We described only 2 complications. Pain was graded 2,8 in the SPAA group and 2,9 in the LA group, according to the AVS after 24 hours. Patients in the SPAA Group were more satisfied (7,5 versus 6,9) ( ). Same results were found for the cosmetic result (8,6 versus 7,4) ( ). Conclusion. Using the single port approach feasible and safe. The true benefit of the technique should be assessed by new randomised controlled trials. 1. Introduction Nowadays, minimally invasive surgery has increased in its use [1]. A new era has been opened with recent innovations that have pioneered the use of single-incision laparoscopic surgery (SILS) or Single Port Access (SPA). This novel technique or approach may be placed between the pure NOTES surgery, the hybrid NOTES surgery, and the standard laparoscopic surgery [2–5]. Appendectomy is the most common abdominal emergency operation performed in the western world. Some reasons have made that more and more appendectomies are currently performed laparoscopically such as advantages to patients in terms of more accurate diagnosis, diminished wound infections, possibility to treat obese patients, and a more rapid recovery [6]. First report of single-puncture laparoscopic appendectomy technique was performed in 1992 and showed the new approach as a safe, inexpensive, and effective alternative to the currently used multiple-puncture method [7]. The new transumbilical approach seems to reduce the trauma of surgical access with its improvement of the postoperative pain and patient cosmesis compared to standard laparoscopic approach. However, other important issues must be critically analysed such as time consumed complications, and difficulties to perform this novel technique. This new technique has been introduced to the surgical community, and we have concentrated on knowing about the feasibility,
Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)
Ramon Vilallonga,José Manuel Fort,Oscar Gonzalez,Juan Antonio Baena,Albert Lecube,Josè Salord,Manel Armengol Carrasco,Josep Ramon Armengol-Miró
Diagnostic and Therapeutic Endoscopy , 2010, DOI: 10.1155/2010/891345
Abstract: Background. Drain inclusion inside the gastric pouch is rare and can represent an important source of morbidity and mortality associated with laparocopic Roux-en-Y gastric bypass (LRYGBP). These leaks can become chronic and challenging. Surgical options are often unsuccessful. We present the endoscopic management of four patients with drain inclusion. Patients. All four obese morbidly patients underwent LRYGBP and presented a gastro-jejunal fistula after acute anastomotic leakage. During follow-up endoscopy the drain was found inside the gastric pouch. It was moved into the abdominal cavity. Fistula debit reduced significantly and closed. Results. Gastric leak closure in less than 24 hours was achieved in all, with complete resolution of symptoms. These patients benefited exclusively from endoscopic treatment. Conclusions. Endoscopy is useful and technically feasible in chronic fistulas. This procedure is a less invasive alternative to traditional surgical revision. Other therapeutic strategies can be used such as clips and fibrin glue. Drains should not be placed in contact with the anastomosis or stapled lines. Drain inclusion must be suspected when fistula debit suddenly arises. If so, endoscopy is indicated for diagnostic accuracy. Under endoscopy vision, the drain is gently removed from the gastric reservoir leading to sudden and complete resolution of the fistula. 1. Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is one of the most frequently performed bariatric procedures worldwide and complications such as postoperative gastrocutaneous fistula (GCF) are infrequent and difficult to treat [1]. Leaks can occur in 0.5% to 4.4% of patients who undergo LRYGBP operations, resulting in significant morbidity with peritonitis, abscess formation, sepsis, multiorgan failure, and eventual death [2–5]. Early detection of leaks is necessary and is proven to reduce morbidity and mortality. Leaks may appear in the gastric remanent either in staple line or in the gastrojejunal anastomosis itself. Some surgeons feel that most leaks can be managed conservatively with total parenteral nutrition and broad-spectrum intravenous antibiotics as long as adequate drainage has been achieved. Operative intervention with large-drain placement and/or surgical repair is, however, necessary when sepsis and/or symptoms of sepsis developed. Though, spontaneous closure of GCF occurs in 90% of cases within 2 weeks, but the mortality rate can reach 85% among patients presenting with sepsis [6]. Because of the surgical difficulty, however, successful primary surgical
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