Current status of laparoscopic surgery in Chile 

Laparoskopska kirurgija v Èilu 
Marcelo A. Beltran 

Department of Surgery, Hospital de Ovalle, Chile 

Avtor za dopisovanje (correspondence to): 
Marcelo A. Beltran, m. d., Hospital de Ovalle, Department of Surgery, Plazuela Baquedano 240, P.O. 
Box 308, Ovalle – IV Region, Chile – Sud America, e-mail: beltran_01@yahoo.com 


Prispelo/Received: 10.1.2006 

Abstract 
Background. Laparoscopic surgery was introduced in Chile in 1991; the first operation performed 
by a minimally invasive approach was laparoscopic cholecystectomy. The technique has been widely 
adopted and has become the most commonly performed procedure in the country. 
Material and Methods. An overview of all reports on laparoscopic surgery published in the Chilean 
medical journals Revista Chilena de Cirugía and Revista Médica de Chile in the past five years. 
Results. Currently, many gastric and oesophageal operations are performed by a minimally invasive 
approach, the most common among them being bariatric and antireflux procedures. Laparoscopic 
cholecystectomy is used in elective and acute settings, in elderly patients and as an outpatient day-
case procedure. It is associated with intraoperative cholangiography and biliary tree exploration. 
Colonic surgery, which has evolved over the past 12 years, is mostly used for the treatment of 
colorectal cancer and diverticular disease. Laparoscopic splenectomy was introduced in Chile in 
1999, and has become a firmly established procedure. Laparoscopic urologic surgery has been 
successfully used since 1994. In selected cases, the laparoscopic approach has been employed for the 
exploration and repair of diaphragmatic lesions and for treating appendicitis and abdominal trauma. 
Inguinal and incisional hernioplasties are routinely performed in many centres. 
Conclusions This review shows that the current status of laparoscopic surgery in Chile is 
comparable to the status of minimally invasive surgery in most countries in the world at the 
beginning of the 21st century. 
Key words. Laparoscopy, surgery, Chile. 
Izvleèek 
Izhodišèa. Laparoskopska kirurgija se je v Èilu zaèela leta 1991; prva laparoskopska operacija je 
bila holecistektomija. V kratkem èasu je to metodo prevzela veèina kirurgov in je sedaj najpogosteje 
izvajana operacija v državi. 
Endoscopic Rev, Vol. 11, No. 25, April 2006 


Metode. Pregledani so bili vsi prispevki (publikacije, objave) o laparoskopski kirurgiji, objavljeni v 
zadnjih petih letih v dveh èilenskih medicinskih revijah: Revista Chilena de Cirugía in Revista 
Médica de Chile. 
Rezultati. Številne operacije želodca in požiralnika se izvajajo z minimalno invazivno kirurgijo; naj-
pogostejši med njimi so bariatrièna kirurgija in antirefluksne operacije. Laparoskopska holecistekto-
mija se izvaja v elektivnih (programskih) in akutnih primerih, pri starejših bolnikih in kot dnevna 
ambulantna kirurgija; s holecistektomijo povezana postopka sta medoperativna holangiografiija in 
pregled žolènih izvodil. Kirurgija širokega èrevesa se v Èilu izvaja zadnjih 12 let; veèina operacij na 
širokem èrevesu je zaradi kolorektalnega raka in divertikulitisa. Prva laparoskopska splenektomija je 
bila v Èilu opravljena leta 1997 in je danes splošno uveljavljen operativni poseg. Laparoskopija se 
uspešno uporablja pri uroloških operacijah od leta 1994. Laparoskopija v izbranih primerih se upo-
rablja za pregled in rekonstrukcijo poškodb prepone, diagnostiko apendicitisa in poškodb trebuha. 
Ingvinalne in pooperativne hernioplastike se rutinsko izvajajo v številnih centrih. 
Zakljuèki. Pregled laparoskopske kirurgije v Èilu kaže, da je trenutno stanje minimalno invazivne 
kirurgije v Èilu primerljivo s stanjem v veèini držav v svetu v zaèetku XXI. stoletja. 
Kljuène besede. Laparoskopija, kirurgija, Èile. 
Metode. Pregledani so bili vsi prispevki (publikacije, objave) o laparoskopski kirurgiji, objavljeni v 
zadnjih petih letih v dveh èilenskih medicinskih revijah: Revista Chilena de Cirugía in Revista 
Médica de Chile. 
Rezultati. Številne operacije želodca in požiralnika se izvajajo z minimalno invazivno kirurgijo; naj-
pogostejši med njimi so bariatrièna kirurgija in antirefluksne operacije. Laparoskopska holecistekto-
mija se izvaja v elektivnih (programskih) in akutnih primerih, pri starejših bolnikih in kot dnevna 
ambulantna kirurgija; s holecistektomijo povezana postopka sta medoperativna holangiografiija in 
pregled žolènih izvodil. Kirurgija širokega èrevesa se v Èilu izvaja zadnjih 12 let; veèina operacij na 
širokem èrevesu je zaradi kolorektalnega raka in divertikulitisa. Prva laparoskopska splenektomija je 
bila v Èilu opravljena leta 1997 in je danes splošno uveljavljen operativni poseg. Laparoskopija se 
uspešno uporablja pri uroloških operacijah od leta 1994. Laparoskopija v izbranih primerih se upo-
rablja za pregled in rekonstrukcijo poškodb prepone, diagnostiko apendicitisa in poškodb trebuha. 
Ingvinalne in pooperativne hernioplastike se rutinsko izvajajo v številnih centrih. 
Zakljuèki. Pregled laparoskopske kirurgije v Èilu kaže, da je trenutno stanje minimalno invazivne 
kirurgije v Èilu primerljivo s stanjem v veèini držav v svetu v zaèetku XXI. stoletja. 
Kljuène besede. Laparoskopija, kirurgija, Èile. 
Introduction 

Chile is one of ten South American countries; it 
runs along 3,000 kilometers of the coast facing 
the Pacific Ocean, and has a population of 
15,000,000. Together with Brazil, Argentina and 
Colombia, Chile has attained high general health 
care standards, particularly in surgery. Laparoscopic 
surgery was introduced in Chile in 1991; 
laparoscopic cholecystectomy was the first 
operation performed by a minimally invasive 
approach. Soon, it was widely adopted by 
surgeons and has become the most common 
procedure in Chile, performed in approximately 
10,000 cases per year. 

Material and methods 

This review is based on all reports on laparoscopic 
surgery published in the past five years in two 
most important Chilean medical journals: Revista 
Chilena de Cirugía (Chilean Surgical Journal) 
and Revista Médica de Chile (Chilean Medical 
Journal), and on some articles by Chilean authors 
appearing in international journals. 

Oesophageal and gastric surgery 

The contributions of Professor Attila Csendes to 
the development of oesophageal surgery are 
recognized worldwide. The Hospital Clínico de 
la Universidad de Chile, where he works, is one 

of the leading medical schools in Chile, and has 
pioneered numerous laparoscopic esophageal and 
gastric surgical procedures (1-6). Minimally 
invasive techniques are currently used in many 
gastric operations; most commonly in bariatric 
surgery for morbid obesity (7-10) (Table 1). 

Biliary tract surgery 

Since it was introduced in Chile laparoscopic 
cholecystectomy has been used in thousands of 
patients every year, with minimal complication 
and conversion to open surgery rates (11-14). 
Laparoscopic cholecystectomy has been performed 
in elective and acute settings, in elderly patients 
and as a day-case outpatient procedure (15-17). 
Other procedures done during cholecystectomy 
include intraoperative cholangiography and 
instrumental exploration of the biliary tree 
(18,19) (Table 2). 

Colonic surgery 

Colonic surgery has evolved in Chile in the past 
12 years. It has reached excellent standards, 
comparable to those in most published series in 
the world literature. The reported median perioperative 
complications and mortality rates were 
10.5% (8% to 15%) and 0.8% (0.5% to 1.2%; the 
median conversion rate was 9.5% (7% to 14%). 
Most colonic procedures are performed for colorectal 
cancer (25% to 37%) and diverticular 

Endoscopic Rev, Vol. 11, No. 25, April 2006 


disease (30.4% to 35%); other indications include: 
megacolon secondary to Hirschprung’s disease 
(5%) and Chagas disease (7%), familiar adenomatous 
polyposis (4%), colorectal trauma 
(6.5%), transit reconstitution after Hartmann’s 
operation (26% to 34%), prolapsed rectum (12% 
to 13.6%), intestinal inflammatory diseases (4% 
to 6%) and colon inertia (5%) (20-25) A broad 
range of procedures have been performed: from 
simple hemicolectomy to complex Miles abdominoperineal 
resection (Table 3). 

Small bowel surgery 

Laparoscopic intestinal resection is infrequently 
performed in Chile and most reports on this 
operation are anecdotic. The main indications 
included Crohn’s disease, gastrointestinal stromal 
tumors and gallstone ileus. The procedures used 
included ileostomy and small bowel resection 
(26,27). 

Spleen surgery 

The first laparoscopic splenectomy in Chile was 
reported in 1997. Since then this procedure has 
evolved and has become firmly established (2832). 
Laparoscopic splenectomy is a safe procedure, 
with the reported perioperative complication 
rates of 0% to 9%, mean conversion rate of 5.8% 
(0% to 14.3%), and with no associated mortality. 
Main indications for this procedure included 
haematologic diseases, principally idiopathic 
thrombocytopenic purpura (Table 4). 

Urologic surgery 

Laparoscopy has been successfully applied to 
operative treatment of urologic diseases. Many 
reports on laparoscopic renal and prostatic 
surgery have been published since 1994 (33-36). 
The most frequently described operations include 
laparoscopic radical prostatectomy, hand-assisted 
laparoscopic renal operation and retroperitoneal 
laparoscopic renal surgery. These procedures are 
indicated for the treatment of prostatic adenoma 
and carcinoma, renal cysts, renal tumors, ureterolithotomy 
and live donor nephrectomy. The 
reported conversion rates range from 0% to 0.5% 
and perioperative complication rates from 0% to 
21.4%, with no associated mortality. Nephrectomy 

was the most frequently performed procedure 
(Table 5). 

Trauma and emergency surgery 

Laparoscopy has been used for the exploration 
and repair of diaphragmatic lesions in selected 
cases (37). Also some cases of gallstone ileus 
resolved by laparoscopic surgery have been 
reported (27). Most reports refer to the laparoscopic 
management of selected cases of acute 
appendicitis and abdominal trauma (38,39). 

Other procedures: inguinal and 
incisional hernioplasty, 
reconstructive surgery, adrenal 
gland surgery, and oncological 
procedures 

Inguinal and incisional hernioplasty are routinely 
performed in many centres, however no series 
have been described in the Chilean surgical 
literature to date. Reports on these operations, 
mostly with expected outcomes, have been 
presented mainly at surgical congresses and 
meetings. Videoscopy is being used, but the 
technique for flap harvesting in plastic and 
reconstructive surgery is still under development. 
It has been applied to harvesting the gracilis, 
latissimus and rectus abdominis flaps (40). The 
main indication for adrenal gland laparoscopic 
surgery is adrenal pheochromocytoma; the 
technique has been used in a small number of 
patients. The published series reported no conversions 
to open surgery and no perioperative 
complications except in one patient who succumbed 
to uncontrollable intraoperative hypertensive 
crisis (41). In oncological patients, laparoscopy is 
employed for staging and for preoperative frozen-
section biopsy and ultrasonography. It is well-
established and its value has been proven (42). 

Conclusions 

This brief review of laparoscopic surgery in 
Chile shows that its current status is comparable 
to the status reported by most countries in the 
world at the beginning of the 21st century. 

Endoscopic Rev, Vol. 11, No. 25, April 2006 


Table 1 

Minimally invasive oesophageal and gastric surgery in Chile 

• 
Heller myotomy plus Dor partial fundoplication for achalasia 
• 
Nissen fundoplication for pathological gastro-oesophageal reflux 
• 
Roux-en-Y long limb diversion for patients with Barrett’s oesophagus 
• 
Repair of hiatal hernia with and without prosthesis 
• 
Combined laparoscopic and thoracoscopic oesophagectomy and gastric pull-up for 
oesophageal cancer and benign diseases requiring oesophagectomy 
• 
Selective vagotomy for peptic ulcer 
• 
Adjustable gastric band for morbid obesity 
• 
Gastric bypass with or without resection of the excluded distal gastric segment for morbid 
obesity 
• 
Distal and total gastrectomy for gastric cancer 
Table 2 

Biliary surgery: Characteristics and the associated procedures 

% 
Complications 1.8 – 15.8 
Conversion to open surgery 3 – 5.2 
Biliary tree -minor lesions 0.2 – 1 
Biliary tree -major lesions 0.1 – 0.3 
Intraoperative cholangiography 9.1 – 12 
Laparoscopic exploration of the biliary tree 3 – 4.5 
Residual choledocholithiasis 0.1 – 0.5 

Table 3 

Colorectal laparoscopic operations 

Procedure % 
Sigmoidectomy 17.4 – 38.1 
Left colectomy 13 – 28.2 
Right colectomy 9 – 13 
Total colectomy 2.1 – 9 
Proctocolectomy 1 – 4 
Abdominoperineal resection (Miles) 0.5 – 3 
Transit reconstitution after Hartmann’s operation 26 – 34 

Endoscopic Rev, Vol. 11, No. 25, April 2006 


Table 4 

Indications for laparoscopic splenectomy 

Indication % 
Idiopathic thrombocytopenic purpura 71 – 100 
Splenic benign cyst 28.6 
Autoimmune haemolytic anemia 11.7 – 18.2 
Lymphoma 11.7 
Systemic erythematous lupus 5.8 

Table 5 

Urologic laparoscopic procedures 

Renal procedures % 
Simple nephrectomy 9 – 13.5 
Radical nephrectomy 35.6 – 42.3 
Partial nephrectomy 33 – 40.1 
Radical nephroureterotomy 1.5 – 3.8 
Prostatic procedures 
Radical prostatectomy 100 

Literature 

1. 
Braghetto I, Csendes A, Burdiles P, Korn O. 
Antireflux surgery, highly selective vagotomy, 
and duodenal switch procedure: Postoperative 
evaluation in patients with complicated and non-
complicated Barrett’s esophagus. Dis Esoph 
2000; 13: 12-17 
2. 
Korn O, Braghetto I, Burdiles P, Csendes A. 
Cardiomyotomy in Achalasia: Which fibers do 
we cut? Dis Esoph 2000; 13: 104-7 
3. 
Csendes A, Burdiles P, Díaz JC, Rojas J. 
Resultados de la cirugía laparoscópica antireflujo 
en 108 pacientes. Rev Chil Cir 2001; 53: 20-6 
4. 
Csendes A, Braghetto I, Burdiles P, Korn O. 
Roux-en-Y long limb diversion as the first option 
for patients who have Barrett’s esophagus. Chest 
Surg Clin N Am 2002; 12: 157-84 
5. 
Braghetto I, Korn O, Burdiles P, Debandi A, 
Valladares H, Brunett L. Hernias hiatales 
verdaderas: Tratamiento quirúrgico por vía 
laparoscópica. Rev Chil Cir 2002; 54: 
628-38 
6. 
Csendes A, Burdiles P, Korn O. Laparoscopic 
Nissen fundoplication: The “right posterior” 
approach. J Gastrointest Surg 2005; 9: 985-91 
7. 
Hamilton JS. Resultados a 20 meses de la banda 
gástrica ajustable en el tratamiento de la obesidad 
mórbida. Rev Chil Cir 2004; 56: 307-16 
8. 
Pérez GB, Escalona AP, Boza CW, Ibánez LA, 
Guzmán SB. Bypass gástrico laparoscópico 
versus abierto: Estudio de casos y controles. Rev 
Chil Cir 2004; 56: 545-9 
9. 
Pérez GB. Bypass gástrico laparoscópico: 
Desarrollo de la técnica y resultados precoces en 
151 pacientes consecutivos. Rev Chil Cir 2005; 
57: 131-7 
10. Csendes A, Burdiles P, Papapietro K, Diaz JC, 
Maluenda F, Burgos A, Rojas J. Results of 
gastric Bypass plus resection of the distal 
excluded gastric segment in patients with morbid 
obesity. J Gastrointest Surg 2005; 9: 121-31 
11. Cárcamo C, Venturelli AL, Kuschel CH, Murúa 
AB, Díaz JB, Banse CE, Avendano RH, 
Barrientos CS, Navarrete EU, Twele LM. 
Colecistectomía laparoscópica: Experiencia del 
Hospital Clínico Regional Valdivia. Rev Chil Cir 
2002; 54: 153-8 
12. Samaniego C, Negri N, Marín J, Saguier G. 
Lesión quirúrgica de la vía biliar principal 
durante la colecistectomía laparoscópica. Rev 
Chil Cir 2002; 54: 479-84 
Endoscopic Rev, Vol. 11, No. 25, April 2006 


13. Hernández FF, Rodríguez CT, Matus FC, Cerda 
SR, Leiva PL, Montalva NS, Adauy A. Lesión 
mayor de la vía biliar en colecistectomía 
laparoscópica. Rev Chil Cir 2004; 56: 16-20 
14. Yarmuch J, Csendes A, Schutte H. Lesiones de la 
vía biliar en 10,791 colecistectomías 
laparoscópicas. Rev Chil Cir 2005; 58: 127-30 
15. Silva VO, Arístides GF, Pulgar US, Rivero GM, 
Rodríguez AN, Pizarro CS, Ordenes MV, 
Bozinovic FA, Cabezas JM, Freitte XB, Ibacache 
MS, Córdoba R, Díaz E. Tratamiento laparoscópico 
de la colecistitis aguda: Variables que inciden en 
el alta. Rev Chil Cir 2003; 55: 165-70 
16. Montalva NS, Flisfisch FH, Caglevic C, Leiva 
PL, Cerda SR, Hernández FF, Matus FC, Rioseco 
M, Tabilo CP, Tolentino MD. Colecistectomía 
videolaparoscópica en el paciente geriátrico. Rev 
Chil Cir 2004; 56: 337-40 
17. Patillo JC, Kusanovic RB, Salas PV, Reyes JR, 
García-Huidobro IH, Sanhueza MG, Palma AD, 
Báez SB, Vinuela EF, Friant OP, Galaz IE, 
Silberman MG, Arrese MJ, Martínez JC. 
Colecistectomía laparoscópica ambulatoria: Una 
experiencia factible en un hospital público 
chileno. Rev Med Chil 2004; 132: 429-36 
18. Pérez GB, Pimentel FM, Ibánez LA. Exploración 
de la vía biliar por coledocotomía laparoscópica. 
Rev Chil Cir 2002; 54: 251-5 
19. Pérez GB, Jarufe NC, Escalona AP, Solís MM, 
Mondaca JV, Ramírez EW. Exploración 
laparoscópica de la vía biliar en colédocolitiasis 
residual. Rev Chil Cir 2003; 55: 179-81 
20. Marín AG, Vergara JB, Espíndola JS, Sepúlveda 
RD, Urbano NG. Cirugía colorectal por 
videolaparoscopía en el Hospital Militar de 
Santiago. Rev Chil Cir 2002; 54: 595-9 
21. López KF, Soto GD, Pinedo GM, Martínez C, 
Sáenz R. Colectomía total por vía laparoscópica 
en poliposis adenomatosa familiar. Rev Chil Cir 
2003; 55: 385-8 
22. Melkonian ET, Wainstein CG, Díaz HB, Villar 
VM, Campana GV, Parada HL. Cirugía 
laparoscópica colorectal. Rev Chil Cir 2004; 56: 
107-11 
23. López KF, Cirugía laparoscópica colorectal: 
Análisis de 85 pacientes consecutivos. Rev Chil 
Cir 2004; 56: 255-62 
24. López KF, Fullerton DM, Pinedo GM, Molina 
MP. Proctocolectomía laparoscópica y reservorio 
íleo-anal en poliposis adenomatosa familiar. Rev 
Chil Cir 2004; 56: 598-603 
25. López KF, Soto GD, León FG, García-Huidobro 
MA. Resección anterior ultrabaja laparoscópica 
por cáncer del tercio inferior del recto. Rev Chil 
Cir 2005; 57: 345-9 
26. López KF, Soto GD, Zárate AC, Pinedo GM, 
Pérez GB, Avendano R, García-Huidobro I, 
Ibánez LA. Protocolo de cirugía laparoscópica 
intestinal. Rev Chil Cir 2003; 55: 225-31 
27. Berger FD, Rojas CD, Iniguez JS, Santamaría 
PH. Íleo biliar resuelto por laparoscopia. Rev 
Chil Cir 2005; 57: 511-4 
28. Vallejos CO, Torres F, Gonzáles G. Esplenectomía 
laparoscópica. Rev Chil Cir 1997; 49: 705-7 
29. Contreras JEP, Justiniano JCP, Venegas MC, 
Álvarez AP. Tratamiento laparoscópico de las 
enfermedades del bazo. Rev Chil Cir 2002; 54: 
384-91 
30. Pérez GB, Escalona AP, López KF, Pérez MB, 
Crovari FE, Boza CW, Ibánez LA. 
Esplenectomía laparoscópica en pacientes con 
púrpura trombocitopénico idiopático. Rev Chil 
Cir 2002; 54: 639-43 
31. Maluenda FG, Burdiles PP, Braghetto IM, 
Csendes AJ. Esplenectomía laparoscópica en 
enfermedades hematológicas. Rev Med Chil 
2004; 132: 189-94 
32. Vallejos CO. Esplenectomía laparoscópica: 
Experiencia del Hospital Regional de Coyhaique. 
Rev Chil Cir 2004; 56: 440-2 
33. Hidalgo FC, Castillo O, Kerkebe M. Nefrectomía 
laparoscópica mano-asistida en donante para 
transplante. Rev Chil Cir 2003; 55: 635-9 
34. Castillo O, Portalier P. Cirugía renal 
laparoscópica con asistencia manual. Rev Chil 
Cir 2004; 56: 332-6 
35. Castillo O, Portalier P. Abordaje laparoscópico 
retroperitoneal o lumboscópico: Una vía alternativa 
para cirugía renal. Rev Chil Cir 2004; 56: 466-9 
36. Castillo O, Cabello R. Prostactectomía radical 
laparoscópica transperitoneal. Rev Chil Cir 2004; 
56: 572-9 
37. Pacheco AF, Reyes IM, Soto RL, Bravo IY, 
Palacios RR. Laparoscopia en la detección de 
lesiones ocultas de diafragma. Rev Chil Cir 
2003; 55: 445-8 
38. Rivera CA. Apendicectomía laparoscópica en 
apendicitis aguda. Rev Chil Cir 1998; 50: 208-15 
39. Larrachea PH. Laparoscopia diagnóstica en la 
sospecha de apendicitis aguda. Rev Chil Cir 
2000; 52: 227-34 
40. Sepúlveda S, Sciaraffia C, Mora C, Wisnia C. 
Asistencia videoscópica en levantamiento de 
colgajos libres. Rev Chil Cir 2004; 56: 46-50 
41. Castillo O, Díaz MC, Bravo J, Henríquez R, Díaz 
MM. Cirugía laparoscópica del feocromocitoma. 
Rev Chil Cir 2004; 56: 463-5 
42. Jarufe NC, Ibánez LA, Pérez GB, Guzmán SB. 
Laparoscopia y ultrasonografía laparoscópica en 
cáncer digestivo. Rev Chil Cir 2002; 54: 64-71 
Endoscopic Rev, Vol. 11, No. 25, April 2006