PURPOSE: To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy.
METHODS:We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach.
RESULTS:Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation.
CONCLUSION:Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy. Key words: Esophagus. Esophagectomy. Constriction, Pathologic. Anastomotic Leak, Gastroplasty.
RESUMOOBJETIVO: Avaliar a incidência de fístula e estenose da anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago após esofagectomia subtotal.
MÉTODOS:Foram estudados 54 pacientes submetidos à esofagectomia subtotal, 45 (83,3%) com carcinoma e nove (16,6%) com megaesôfago chagásico avançado. Em todos os casos, a anastomose esofagogástrica cervical foi realizada com invaginação do coto esofágico proximal no interior do estômago.
RESULTADOS:Três (5,5%) pacientes apresentaram fístula, dois deles com saída mínima de ar e saliva pela incisão cervical que evoluíram com rápida cicatrização; o terceiro apresentou fístula de pequeno débito que drenou para o espaço pleural causando empiema que teve boa evolução após drenagem. Treze (24%) doentes apresentaram estenose fibrótica e foram tratados com sucesso com dilatação endoscópica.
CONCLUSÃO:A anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago apresentou baixa incidência de fístula e estenose tornando-se opção atraente para a reconstrução do trânsito alimentar após esofagectomia subtotal.
ABSTRACT ABSTRACTThis article reports the case of a patient whit a diagnosis of diarrhea and weight loss. Subsidiary exams showed ulcerovegetant lesion in the second duodenal portion and duodenocolic fistula. An exploratory laparotomy was performed and a neoplasic lesion in the hepatic angle of the colon was observed invading the second duodenal portion. The patient then underwent a cephalic gastroduodenopancreatectomy associated with en bloc right hemicolectomy and improved well in the postoperative period. Currently, 48 months after the surgery, he does not present any signs of the disease dissemination or recurrence. The consulted literature recommends that multivisceral resection must be considered if the patient is clinically able to undergo major surgery and does not present any signs of neoplasic dissemination, since the postoperative survival time is considerably longer in the resected group and some of these patients even achieve cure.
Ménétrier’s disease (MD) is a rare condition. Its incidence remains undetermined.
MD is frequently associated with
infection, hypergastrinemia and hypoalbuminaemia.
The gastric mucosal usually presents giant rugal folds with polypoid appearance on upper endoscopy.
Clinical, laboratory, endoscopic and histopathological findings are paramount for reaching the diagnosis of MD.
MD should be suspected in all cases of upper gastrointestinal symptoms and hypertrophied gastric mucosa.
Introdução: O pseudocisto pancreático pode ocorrer, em geral, por complicações da pancreatite aguda. Geralmente se desenvolve entre quatro a seis semanas após o início da pancreatite e ocorre entre 16 a 50% dos casos de pancreatite aguda e 20-40% na crônica. Em aproximadamente apenas 0,4% dos casos de pancreatite pode ocorrer comunicação com a cavidade pleural, formando uma fístula pancreatopleural, complicação rara e pouco descrita na literatura. O diagnóstico muitas vezes é difícil por conta de sua apresentação clínica atípica. Em relação ao tratamento, não existe um consenso definido. Em geral, pode-se realizar tratamento clínico. Aproximadamente 40% dos casos respondem à terapia clínica. Em casos refratários, ou com rotura de pseudocistos, opta-se pela conduta cirúrgica. Relato do caso: Nesse estudo, será relatado um caso raro de fístula pancreatopleural por um pseudocisto traumático, com tratamento cirúrgico efetivo. Conclusão: O relato em questão ilustra um caso incomum na literatura, com relevância na prática cirúrgica.
cholecystectomy require further examination of the reduced clinic referrals and elective surgery wait times, considering the well-known delays for procedures in our vulnerable patient population. Table Characteristics of Cholecystectomy Operations Pre-SIP (n¼88) Post-SIP (n¼84) P-value Female gender (n [%]) 64 (72.7%) 60 (71.4%) 0.85 Age (y, mean +/-SD) 47.1 +/-15.246.1 +/-17.10.35 Emergent surgery (n [%]) 61 (69.3%) 61 (72.6%) 0.60 Wait time for elective surgery (months, mean +/-SD) 4.8 +/-2.5 5.1 +/-4.2 0.76 Wait time for emergent surgery (days, mean +/-SD) 3.2 +/-3.4 2.7 +/-2.0 0.30 Length of hospital stay (days, mean +/-SD) 4.
INTRODUCTION:The outcomes and indications for vein resection during pancreatoduodenectomy remains unclear. This review aimed to evaluate the risks and survival of pancreatoduodenectomy associated with venous resection (VRPD) compared with standard pancreatoduodenectomy (PD).METHODS: A systematic review and meta-analysis of studies comparing VRPD and PD were performed.RESULTS: A total of 2986 individuals were included after the study selection. VRPD was associated with a higher risk for postoperative mortality (RD: -0.01; 95% CI -0.02 to -0.00) and complications (RD: -0.05; 95% CI -0.09 to -0.01) than PD. The length of hospital stay was not different between the groups (MD: -0.65; 95% CI -2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: -69.09; 95% CI -88.4 to -49.78), with a higher blood loss rate (MD: -314.04; 95% ). The positive margins rate was higher in the VRPD group (RD: -0.06; 95% CI -0.1 to -0.02). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (HR: 1.13; 95% CI 1.03 to 1.23).CONCLUSION: Venous resection in pancreatoduodenectomy is associated with a higher risk of short-term complications and mortality and a lower probability of survival than standard pancreatoduodenectomy.
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