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R García Espinosa

Publications and source records attributed to R García Espinosa.

15 recordsLinked to original sources
PubMed2006

Outpatient laparoscopic cholecystectomy: a new gold standard for cholecystectomy.

OBJECTIVE: To contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC). PATIENTS: Between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. RESULTS: The ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%), most of them for "social" causes. Five patients required admission (between 24 and 48 hours) for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications). Six patients (1.1%) were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. CONCLUSIONS: Outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.

Adult↗
PubMed2004

Quality of life (GIQLI) and laparoscopic cholecystectomy usefulness in patients with gallbladder dysfunction or chronic non-lithiasic biliary pain (chronic acalculous cholecystitis).

OBJECTIVE: The aim of this study was to evaluate the incidence, clinical features and role of laparoscopic cholecystectomy (LC) in patients with chronic acalculous cholecystitis (CAC) in comparison with a control group of patients who underwent cholecystectomy for chronic calculous cholecystitis (CCC). MATERIAL AND METHODS: Prospective evaluation of 34 patients with CAC in contrast with 297 patients with CCC. OUTCOME MEASURES: Clinical presentation, quality of life using the Gastrointestinal Quality of Life Index (GIQLI), usefulness derived from the therapeutic procedure as measured in quality of life units by GIQLI, and clinical efficacy at one year of follow-up. RESULTS: The incidence of complicated biliary disease was higher in CAC (27%), in comparison with CCC (13.8%). The histological study of the excised gallbladder revealed a higher incidence of cholesterolosis associated with chronic cholecystitis in the CAC group (64.9%). GIQLI showed significant differences between preoperative and postoperative measurements in both groups. The associated usefulness of LC was similar in both groups (73 versus 67.3 percent), confirming an important increase in quality of life for both categories. CONCLUSIONS: The incidence of CAC is 11 per cent with a high association with cholesterolosis. Quality of life and LC usefulness are similar to those of patients with CCC. Due to the fact that cholecistogammagraphy is a technique not available in daily clinical practice, and that oral cholecystography and dynamic ultrasound are reliable when a positive result is obtained, extended clinical evaluation is still the most reliable indicator for cholecystectomy.

Adult↗
PubMed2002

Prospective analysis of marlex mesh repair for symptomatic rectocele with obstructive defecation.

OBJECTIVE: Evaluation of perineoplasty with marlex mesh in symptomatic rectocele with obstructive defecation and evaluation of the incidence of postobstetric perineal tear in patients with symptomatic rectocele. DESIGN: Prospective analysis of 11 consecutive patients undergoing elective rectocele repair. Prospective analysis of sphicnter postobstetric tears in patients with rectocele. RESULTS: Incidence of postobstetric perineal tears in 100 per cent of patients. Absence of obstructive defecation symptoms in 100 per cent of patients. Mesh displacement in 5/8 cases. CONCLUSIONS: Endoanal ultrasound secreening in patients with symptomatic rectocele is mandatory. Prosthetic repair eliminates obstructive defecation symptoms in 100 per cent of patients. Mesh is well tolerated although it has to be fixed in the suprasphincteric area and with non reabsorbable stitches.

Adult↗
PubMed2002

Total quality management in laparoscopic cholecystectomy. Quality of care and quality perception in ambulatory laparoscopic cholecystectomy.

OBJECTIVE: Analysis of acceptance and perception of quality in patients undergoing ambulatory laparoscopic cholecystectomy. PATIENTS: 84 consecutive patients undergoing elective laparoscopic cholecystectomy within SVS (Servei Valencia de Salut) through a special plan for waiting lists. METHODS: A prospective analysis of related variables with quality perception evaluated by a specialized nurse with no interaction with the surgical team. RESULTS: Ambulatory acceptance, 80 percent; return to work or daily activities at 72 hours after surgery, 40 percent. Extra need of medical attention was as follows: emergency general practitioner 2.7 percent, emergency room attention in 1.3 percent, extra telephone interview with the surgeon 6.0 percent. Global estimation of the procedure was very good or good by 94.7 percent. CONCLUSIONS: High acceptance rate, high quality perception. Up to 20 percent of patients would change from ambulatory to traditional surgery, possibly due to cultural factors.

Ambulatory Surgical Procedures↗
PubMed2002

[Course of postoperative pain in laparoscopic cholecystectomy under multimodal anesthesia-analgesia in ambulatory care].

OBJECTIVE: To evaluate the evolution of postoperative pain and convalescence in a group of patients undergoing elective laparoscopic cholecystectomy under a multimodal anesthesia-analgesia treatment protocol. MATERIAL AND METHOD: Eighty-four consecutive patients undergoing elective laparoscopic cholecystectomy were given intramuscular ketoprofen during induction, anesthesia, with minimal use of opioids, and intraperitoneal irrigation with bupivacaine. We assessed the rate of conversion to hospitalization, hospital stay in hours, duration of the pain-free interval, oral analgesics per day at home, and intensity of postoperative pain and physical activity daily on a visual analog scale. RESULTS: The procedures were carried out on an outpatient basis in 90.5% of the cases, and the mean postoperative hospital stay was 7.2 +/- 0.9 hours. Eight patients required an overnight stay. No postoperative analgesics were required by 27.3% of the patients. Patients requiring analgesics had pain-free intervals lasting 17.3 +/- 11.8 hours after discharge. On the third day after surgery 80% had used no analgesics and over 75% had no pain or only minor pain. On the fourth postoperative day 50% were able to perform activities of daily living without help, and 50% returned to work on the eleventh day after surgery. CONCLUSIONS: The multimodal analgesia-anesthesia treatment proposed allows a high percentage of laparoscopic cholecystectomies to be performed on an outpatients basis. The protocol provides good control of postoperative pain and nausea and rapid return to habitual activity.

Ambulatory Surgical Procedures↗
PubMed1990

[Synchronous or metachronous extragastric neoplasms associated with gastric neoplasia. Common pathogenesis of gastric intestinal and colonic carcinoma?].

Coexistence of syncronous or metacronous extragastric carcinomas, particularly of the colon and small bowel may favour the hypothesis of a common origin with gastric carcinoma. Three cases of colonic carcinoma coexisting with early gastric cancer, are presented. The etiopathogenesis of intestinal-type gastric cancer and colonic cancer are discussed in the light of a possible common mechanism.

Aged↗
PubMed1990

[Adenocarcinoma at the site of colostomy. Is it local recurrence or subsequent cancer?].

This paper presents on case of adenocarcinoma at the site of colostomy in a patient treated by abdominoperineal amputation five years earlier due to rectal cancer. The case raised the doubt as to whether the carcinoma represented a late, local recurrence or a second metachronic neoplasia. The most frequent location and pathogenesis of each were analyzed. The role of follow-up of these patients in detecting cases such as the one presented here are discussed.

Adenocarcinoma↗
PubMed1990

[Colonic perforation in patients with kidney transplant].

Of a total of 320 renal transplants performed at our center in the last 8 years, two patients presented colonic perforation (0.62%). We emphasize the clinical manifestations, which were masked by the antiinflammatory properties of the steroids; for this reason, careful and repeated physical exams should be made out in the case of any episode of abdominal pain in these patients, as well as ancillary studies for early diagnosis. Surgical measures, which consist of exclusion of the septic focus in the peritoneal cavity, do not differ from those carried out in the general population with the same colonic pathology, although they require more cautious maneuvers and meticulous lavage of the peritoneal cavity. Alternatively, when exclusion is not possible, proximal colostomy and adequate drainage must be performed.

Adult↗
PubMed1990

[Neoplasms of the Meckel diverticulum. Apropos of 2 new cases].

We present two new cases of cancer in a Meckel's diverticulum, representing 3.3% of the complicated Meckel's diverticula encountered in our department. The first case was a carcinoid tumor encountered in a pathology study of an inflamed Meckel's diverticulum, and the second case was a leiomyosarcoma on a Meckel's diverticulum that presented as diverticular perforation. We emphasize the advanced age of the two patients and review the cases reported in Spain and in the Western literature.

Aged↗
PubMed1990

[Significance of peroperative cholangiography in elective geriatric surgery of the bile ducts].

We present a retrospective study on the value of peroperative cholangiography (POC) in geriatric patients submitted to elective surgery of the biliary tract. We analyze the results of the present series and compare them with a previous study of 200 cases of cholelithiasis in the general population. Our conclusion is that in geriatric patients, POC should be a routine practice in order to avoid an unnecessary choledochotomy and/or residual lithiasis post-cholecystectomy.

Aged↗
PubMed1989

[Gastric leiomyosarcoma].

We present a case of gastric leiomyosarcoma of special characteristics, given its clinical and pathologic divergence the existence of antecedents of sarcomatous neoplasm previously excised in the same patient. We emphasize the association of these tumors with the appearance of malignant neoplasms in other sites previously, synchronically or metachronically, and the necessary preoperative staging, based fundamentally on CAT and endoscopy, to establish the therapeutic approach according to the predicted behavior of these tumors.

Aged↗