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Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

PURPOSE: Evaluate short results after fundoplication procedure, concerning the division of short gastric vessels. METHODS: A prospective randomization of 90 patients with indication for hiatoplasty and total fundoplication with fundus mobilization was performed. They were divided into two groups: no SGV division (group A, n= 46) and with SGV division (Group B, n=44), although in both groups the gastric fundus was mobilized to perform a floppy valve. Early outcome with clinical follow up (1 year) was observed. RESULTS: Both groups were similar regarding preoperative parameters and severity of gastroesophageal reflux disease (GERD). No difference in morbidity was observed during hospital stay. Nevertheless, the median operating time was 80,2 minutes in group A and 94,1 minutes (p=0,021) in Group B. Transitory dysphagia during the first year was significantly lower in group B (46,6% versus 23,2%, p=0,012). However, in 12 months clinical outcome was similar in both groups (clinical symptoms of GERD, persistent dysphagia and reoperations). CONCLUSION: There was no improvement in routine division of SGV in total fundoplication procedure when the gastric fundus was mobilized.

-Context -The occurrence of severe dysphagia after laparoscopic total fundoplication is currently an important factor associated with loss of quality of life in patients undergoing this modality of treatment for gastroesophageal reflux disease. Objective -Compare the incidence and evaluate the causes of severe postoperative dysphagia in patients undergoing laparoscopic total fundoplication (LTF) without short gastric vessels division, using the anterior gastric wall (Rossetti LTF) or anterior and posterior gastric walls (Nissen LTF). Methods -Analysis of the data of 289 patients submitted to LTF without short gastric vessels division from January 2004 to January 2012, with a minimum follow-up of 6 months. Patients were divided in Group 1 (Rossetti LTF -n = 160) and Group 2 (Nissen LTF -n = 129). Results -The overall incidence of severe postoperative dysphagia was 3.11% (4.37% in group 1 and 1.55% in group 2; P = 0.169). The need for surgical treatment of dysphagia was 2.5% in group 1 and 0.78% in group 2 (P = 0.264). Distortions of the fundoplication were identified as possible causes of the dysphagia in all patients taken to redo fundoplication after Rossetti LTF. No wrap distortion was seen in redo fundoplication after Nissen LTF. Conclusion -The overall incidence of severe postoperative dysphagia did not differ on the reported techniques. Only Rossetti LTF was associated with structural distortion of the fundoplication that could justify the dysphagia.

RESUMO -Racional -A exenteração pélvica tem sido a melhor opção terapêutica radical para o tratamento dos tumores de reto T4. No entanto, essa operação ainda permanece com mortalidade significante e alta morbidade. exenteração infra-elevadora (n = 6), exenteração supra-elevadora (n = 4), exenteração posterior (n = 3) e exenteração posterior com cistectomia e ureterectomia parciais (n = 2). Resultados -A média de tempo cirúrgico foi de 403 minutos (280-485). A média de sangramento foi de 1620 mL (300-4800). A mortalidade pós-operatória foi de 6,66% (n = 1). A morbidade pós-operatória foi de 53,3% (n = 8). Os exames histológicos evidenciaram que todas as ressecções foram R0. Envolvimento linfonodal foi observado em quatro pacientes (26,66 %) sendo que todos faleceram em decorrência da neoplasia. A sobrevida global em cinco anos foi de 35,7%. Conclusão -A exenteração pélvica ainda apresenta alta morbidade, no entanto permanece justificada, pois pode conferir maior controle do câncer de reto T4 em longo prazo. DESCRITORES -Exenteração pélvica. Neoplasias retais. INTRODUÇÃOA primeira exenteração pélvica foi reportada por Brunschwig no ano de 1948. Coube a esse autor a descrição da técnica que consistia na remoção de todos os órgãos pélvicos, tanto do aparelho reprodutor quanto do aparelho urinário, além do cólon sigmóide e reto com a realização de ureterosigmoidostomia (3) . BRICKER et al.(1) melhoraram esse procedimento por meio do uso de um segmento ileal para confecção da derivação urinária, assim a ureteroileostomia cutânea era posicionada no lado direito do abdome, enquanto a colostomia permanecia à esquerda (1,2,8) . Enquanto a exenteração supra-elevadora preserva o assoalho pélvico, a exenteração infra-elevadora, por sua vez, envolve a ressecção da porção inferior da vagina, vulva ou períneo, incluindo o ânus e uretra. A exenteração supra-elevadora tem sua maior indicação para os tumores pélvicos que não envolvam o aparelho esfincteriano, podendo desta forma, estar associada a maiores índices de conservação esfincteriana. Em contrapartida, a exenteração infra-elevadora é habitualmente reservada para os casos em que ocorra o envolvimento dessas estruturas ou para casos de tumores pélvicos volumosos que impossibilitem uma abordagem exclusivamente por via abdominal (11) .As exenterações pélvicas têm sido indicadas para o tratamento de diferentes neoplasias pélvicas, tanto primárias quanto residuais ou ainda mais raramente recurrentes. Embora historicamente tenham sido descritas para o tratamento do câncer de colo uterino avançado, essas operações têm sido preconizadas para o tratamento de tumores localmente avançados de reto, endométrio, vagina, vulva ou mesmo bexiga urinária. Em situações especiais, pode ser indicada ainda para o tratamento do câncer recurrente de ovário ou, excepcionalmente, para correção de fístulas complexas pós-radioterapia (7) . Estima-se que até 5% dos tumores primários do reto apresentem aderências que envolvam a bexiga urinária, a próstata, os anexos ou a vagina. Em contrapartida, a próp...

Objective: To analyze quality of life and observe the prevalence of musculoskeletal pain in patients submitted to bariatric surgery. Methods: A prospective, observational and comparative study with 26 individuals aged 18 to 60 years, 25 women, which included two evaluations, one preoperative and the other approximately 42 months after surgery. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and the Human Body Diagram with Visual Analogue Scale were employed. Results: The individual samples showed grade III obesity, with a predominance of postoperative overweight, hypertension and diabetes in 65.4% and 42.3% of the samples, with remission of hypertension in 50% and of diabetes mellitus in 38.5% (p<0.001). The SF-36 demonstrated improved quality of life, especially in aspects related to motricity; vitality and mental health showed no significant changes. Osteoarticular pain was reported and identified in various sites by the subjects; however, 87.5% of patients in the preoperative period and 88.5% in the postoperative period reported not having any physical therapy orientation, while 65.4% reported being engaged in some type of regular physical activity after surgery (p<0.001). Conclusion: Morbidly obese individuals have a high probability of suffering from clinical, psychic, and musculoskeletal alterations, compromising their quality of life and showing improvement after bariatric surgery; on the other hand, the psycho-emotional manifestations did not progress in the same way.Keywords: Pain, postoperative/etiology; Arthralgia/etiology; Obesity; Bariatric surgery; Quality of life RESUMO Objetivo: Analisar a qualidade de vida e observar a prevalência de dor musculoesquelética em pacientes submetidos à cirurgia bariátrica.Métodos: Estudo prospectivo, observacional e comparativo, incluindo 26 amostras, idade entre 18 e 60 anos, sendo 25 mulheres e compreendendo duas avaliações, uma pré-operatória e outra cerca de 42 meses após a cirurgia, com aplicação do Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) e do Diagrama do Corpo Humano com Escala Visual Analógica. Resultado: As amostras apresentaram obesidade grau III, com predomínio de sobrepeso após cirurgia, hipertensão e diabetes presentes em 65,4% e 42,3% das amostras, com remissão da hipertensão em 50% e da diabete mellitus em 38,5% (p<0,001). O SF-36 evidenciou melhora da qualidade de vida, sobretudo nos aspectos relacionados à motricidade; vitalidade e saúde mental não apresentaram mudanças significativas. A dor osteoarticular esteve presente e foi apontada em diversos pontos pelos sujeitos da amostra; contudo, 87,5% dos pacientes no pré e 88,5% no pós-operatório relataram não ter realizado nenhum acompanhamento fisioterápico, enquanto 65,4% relataram fazer algum tipo de atividade física regularmente após a cirurgia (p<0,001). Conclusão: Obesos mórbidos apresentam alta probabilidade de sofrer com as alterações clínicas, psíquicas e musculoesqueléticas, comprometendo sua qualidade de vida e apresentando melhora após a ci...

the division of the short gastric vessels is not required routinely, but male gender and grade IV-V esophagitis are independent predictors of the need for section of these vessels.

The manometric pattern of either diffuse esophageal spasm (DES), nutcracker esophagus (NE), or hypertensive lower esophageal sphincter (HLES) in the presence of gastroesophageal reflux disease (GERD) is considered a secondary finding and treatment should be directed toward GERD. This study aims to evaluate the outcomes of laparoscopic Nissen fundoplication (LNF) in patients with manometric patterns of esophageal motility disorders. Patients with GERD confirmed by pH monitoring and manometric pattern of DES (simultaneous contractions 20 to 90% of wet swallows), NE (increased mean distal amplitude greater than 180 mmHg), or HLES (lower esophageal sphincter pressure greater than 45 mmHg) who underwent LNF were studied. A group of 50 consecutive patients with normal esophageal motility who underwent LNF were used as control subjects. Groups were comparable to control subjects for age, gender, preoperative symptoms, hiatal hernia, and Barrett's esophagus, except for NE that had younger individuals and a lower rate of hiatal hernia. Symptomatic outcome was similar when groups were compared with control subjects. Transient dysphagia was present in the postoperative period in 33, 7, 0, and 20 per cent of the patients with HLES, DES, NE, and control subjects, respectively. LNF is an adequate treatment for patients with GERD and manometric patterns of esophageal motility disorders.