RESUMO
Laparoscopic anterior cardiomyotomy in addition to anterior Dor's fundoplication is the procedure of choice for achalasia of the esophagus with approximately 95% success rate. Redo cardiomyotomy is complicated and associated with rerecurrence of dysphagia. Twelve patients with failed redo myotomy were clinically evaluated with radiology, endoscopy, and manometry in whom achalasia type III or IV was confirmed. We propose as treatment for these selected cases an inversed Y cardioplasty + truncal vagotomy, a partial distal gastrectomy and Roux-en-Y gastrojejunostomy in order to facilitate esophageal emptying and avoid the appearance of postoperative gastroesophageal reflux as a side effect of this procedure. One patient was reoperated on in order to enlarge the cardioplasty. Disappearance of dysphagia was confirmed in all patients. Three patients presented reflux symptoms and were treated with 20 mg of Omeprazole 20 twice/day. No food retention, erosive esophagitis, or Barrett's esophagus were observed. The mean resting pressure decreased from 24.9 +/- 8.5 mm Hg to 7.5 +/- 2.5 mm Hg (P = 0.0001). Furthermore, esophageal diameter decreased significantly after a 5-year follow-up. This procedure could be an option for treating patients in which repeated Heller operations have failed.
Assuntos
Acalasia Esofágica/cirurgia , Estenose Esofágica/cirurgia , Junção Esofagogástrica , Derivação Gástrica/métodos , Gastroplastia/métodos , Vagotomia Troncular , Adulto , Idoso , Idoso de 80 Anos ou mais , Cárdia/cirurgia , Estudos de Coortes , Acalasia Esofágica/complicações , Acalasia Esofágica/patologia , Estenose Esofágica/etiologia , Estenose Esofágica/patologia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Prevenção Secundária , Adulto JovemRESUMO
Oral ulcers are a frequent problem in transplant medicine. It is important to consider infectious etiologies, exacerbated by the immunosuppressive treatment, but other etiologies are also possible, like adverse drug reactions. Mycophenolate mofetil (MMF) is an immunosuppressive medication that has been used in combination with calcineurin inhibitors and steroids. Reports of renal transplant patients with oral ulcers related to MMF have appeared lately and herein we have described 2 cases in liver transplant patients. Their oral ulcers resolved quickly after suspension of the medication. Our 2 cases in liver transplant patients represented a unique setting for this type of complication.
Assuntos
Imunossupressores/efeitos adversos , Transplante de Fígado/imunologia , Ácido Micofenólico/análogos & derivados , Úlceras Orais/induzido quimicamente , Adulto , Antibacterianos/uso terapêutico , Ciclosporina/uso terapêutico , Feminino , Humanos , Resistência a Meticilina , Pessoa de Meia-Idade , Ácido Micofenólico/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Resultado do TratamentoRESUMO
BACKGROUND: Surgical treatment of esophageal cancer is associated with a high rate of morbidity and mortality even in specialized centers. Minimally invasive surgery has been proposed to decrease these complications. METHODS: The authors present their results regarding postoperative complications and the survival rate at 3 years, comparing the classic open procedures (transthoracic or transhiatal esophagectomy) with minimally invasive surgery. Surgical procedures were performed according to procedures published elsewhere. RESULTS: The study enrolled 166 patients who underwent surgery between 1990 and 2003. Open transthoracic surgery was performed for 60 patients. In this group of patients, postoperative mortality was observed in 11% of the cases. Major, minor, and late complications were observed in 61.6% of the patients, and the 3-year survival rate was 30% for this group. Open transhiatal surgery was performed for 59 patients. The morbidity, mortality, and 3-year rate were almost the same as for the transthoracic surgery group. For the 47 patients submitted to minimally invasive procedures (thoracoscopic and laparoscopic), the complications and mortality rates were significantly reduced (38.2% and 6.4%, respectively). For the patients submitted to minimally invasive surgery, the 3-year survival rate was 45.4%. It is important to clarify that the patients submitted to minimally invasive surgery manifested early stages of the diseases, and that this the reason why the morbimortality and survival rates were better. CONCLUSIONS: The transthoracic and transhiatal open approaches have similar early and late results. Minimally invasive surgery is an option for patients with esophageal carcinoma, with reported results similar to those for open surgery. This approach is indicated mainly for selected patients with early stages of the disease.
Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagectomia/mortalidade , Esofagectomia/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Análise de Sobrevida , Cirurgia Torácica VídeoassistidaRESUMO
BACKGROUND: Esophageal carcinoma has a dismal prognosis. Several authors have reported a very low survival in Chile. AIM: To report the survival of patients with esophageal carcinoma, subjected to esophageal resection. MATERIAL AND METHODS: Analysis of 108 patients subjected to thoracic esophageal resection between 1985 and 1996. Patients were classified according to the location of the tumor and its staging. RESULTS: Eleven patients died in the immediate postoperative period and 90 patients were followed. In 53 the exact cause of death was determined. Global five years survival was 29% and median survival was 18 months. Survival was 100% in stage I tumors. Adjuvant therapy resulted in a better survival of stage III tumors. Survival of stage IV tumors was worst than stage I to III tumors. There was no survival difference between squamous carcinoma or adenocarcinoma. Tumors located in the superior third of the esophagus had a worst prognosis. Causes of death were mediastinic metastases, local recidivism, pleural or pulmonary metastases and less frequently, brain, bronchial or bone metastases. CONCLUSIONS: The survival of these, patients with esophageal carcinoma did not differ from the figures reported abroad.
Assuntos
Adenocarcinoma/mortalidade , Carcinoma de Células Escamosas/mortalidade , Neoplasias Esofágicas/mortalidade , Esofagectomia/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Seguimentos , Humanos , Recidiva Local de Neoplasia/mortalidade , Estadiamento de Neoplasias , Período Pós-Operatório , Análise de SobrevidaRESUMO
BACKGROUND: Laparoscopic adrenal approach was introduced in 1992 and is becoming the surgical method of choice for several adrenal diseases. AIM: To report the initial Chilean experience in laparoscopic adrenalectomy. MATERIAL AND METHODS: A retrospective review of 17 patients subjected to the surgical procedure by the authors. RESULTS: The preoperative diagnosis were adenomas (8 patients), pheochromocytoma (3), cystic lesions (2), adrenal metastases (2), hyperaldosteronism (1) and a pituitary Cushing (1). The average lesion size was 5.4 cm, the operative time 2.5 hours and the hospital stay 2.5 days. Eight patients were discharged in less than 48 hours. Pain was managed with non steroidal antiinflammatory drugs in 14 patients. One subject required conversion to open surgery. Transfusions were required in complex cases with a diaphragmatic hamartoma, Cushing disease and in a combined adrenal and renal resection. One patient had to be re admitted due to a pancreatic pseudo cyst that was drained percutaneously. There have been no recurrences after a mean follow up of 2 years. CONCLUSIONS: This early experience with laparoscopic adrenalectomy shows good results. A good patient selection and experience with advanced laparoscopic surgery are requisites for a successful use of this surgical technique.