IntroductionA introdução da técnica laparoscópica em 1985 foi um fator importante na colecistectomia por representar técnica menos invasiva, resultado estético melhor e menor risco cirúrgico comparado ao procedimento laparotômico.AimTo compare laparoscopic and minilaparotomy cholecystectomy in the treatment of cholelithiasis.MethodsA systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) was performed. The keywords used were "Cholecystectomy", "Cholecystectomy, Laparoscopic" and "Laparotomy". The methodological quality of primary studies was assessed by the Grade system.ResultsTen randomized controlled trials were included, totaling 2043 patients, 1020 in Laparoscopy group and 1023 in Minilaparotomy group. Laparoscopic cholecystectomy dispensed shorter length of hospital stay (p<0.00001) and return to work activities (p<0.00001) compared to minilaparotomy, and the minilaparotomy shorter operative time (p<0.00001) compared to laparoscopy. Laparoscopy decrease the risk of postoperative pain (NNT=7) and infectious complications (NNT=50). There was no statistical difference between the two groups regarding conversion (p=0,06) and surgical reinterventions (p=0,27), gall bladder's perforation (p=0,98), incidence of common bile duct injury (p=1.00), surgical site infection (p=0,52) and paralytic ileus (p=0,22).ConclusionIn cholelithiasis, laparoscopic cholecystectomy is associated with a lower incidence of postoperative pain and infectious complications, as well as shorter length of hospital stay and time to return to work activities compared to minilaparotomy cholecystectomy.

-Objective -To compare the laparotomy and laparoscopy techniques for correction of ventral hernia when related to perioperative complications, length of hospitalization, surgical time, and recurrence of hernia. Methods -This was a systematic review of randomized controlled trials, which included studies retrieved from four databases (MEDLINE, Embase, Cochrane and LILACS), using a combination of the terms (Hernia, Ventral) and (Laparoscopy) and (Laparotomy). Results -Six randomized trials were included, totaling 566 patients, 283 in the Laparoscopy group and 283 in the Laparotomy group. Laparoscopy reduced the risk of infection of the surgical wound (NNT = 5) and seroma formation (NNT = 13) and less length hospitalization (P = 0.02) compared to laparotomy in the correction of ventral hernias. Furthermore, laparoscopy increased the incidence of enterotomy (NNH = 25) and post operative pain (NNH = 8) and longer surgical time (P = 0.0009) when compared with laparotomy. There was no difference related to abscess (P = 0.79), hematoma (P = 0.43) and recurrency of ventral hernias (P = 0.25). Conclusion -In the correction of ventral hernias, the use of laparoscopic technique is effective to reduce infections of the surgical wound and seroma formation, as well as, decrease the length hospitalization. HEADINGS -Ventral hernia. Laparoscopy. Laparotomy. Review.

Introduction:Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion.Objective:This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis.Evidence Acquisition:An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus.Evidence Synthesis:Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3).Conclusion:Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain.Patient Summary:This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

IntroductionPostoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis.AimTo compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and surgical time.MethodsA systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) using the combination of descriptors (anastomosis, surgical) and (esophagectomy) was performed.ResultsThirteen randomized trials were included, totaling 1778 patients, 889 in the hand-sewn group and 889 in the stapler group. The stapler reduced bleeding (p <0.03) and operating time (p<0.00001) when compared to hand-sewn after esophageal resection. However, stapler increased the risk of anastomotic stricture (NNH=33), pulmonary complications (NNH=12) and mortality (NNH=33). There was no significant difference in relation to anastomotic leak (p=0.76) and cardiac complications (p=0.96).ConclusionAfter resection of esophageal cancer, the use of stapler shown to reduce blood loss and surgical time, but increased the incidence of anastomotic stricture, pulmonary complications and mortality.

INTRODUÇÃOA Doença Diverticular é uma doença benigna, de boa resposta ao tratamento clínico, instituído na mudança de hábitos alimentares, maior consumo de fibras, antibioticoterapia potente nos processos inflamatórios mais simples e uso da radiologia intervencionista nos abscessos. A indicação cirúrgica fica restrita ao insucesso da terapêutica clínica e às formas mais graves da doença, como estenoses, abscessos e perfurações.A diverticulite aguda do cólon é a complicação mais freqüente da doença diverticular e ocorre em 30% dos pacientes, dentro dos próximos 20 anos após seu diagnóstico (1,2).A laparoscopia surgiu como técnica segura e ideal para a cirurgia do sigmóide por diminuir o tempo de internação hospitalar, e melhor resultado cosmético.Por outro lado, o método apresenta várias limitações (3,4,5,6,7,8), como a ausência da sensação tátil, alguma dificuldade no controle hemorrágico, trauma na manipulação e afastamento dos órgãos. Existe,

Ao meu pai e à minha mãe, Pelo exemplo de família que souberam construir; por se amarem tanto e pelos valores que me ensinaram. À Elisa e ao Pedro,Por serem meus irmãos amados, exemplos de vida, amor e carinho. Aos meus amigos,Parte fundamental da minha vida, pela paciência nas horas difíceis. AGRADECIMENTOSAo Prof. Dr. Fábio Pinatel Lopasso, orientador desta tese, pelo incansável auxílio na elaboração e melhor condução deste estudo, bem como por sua atenção, compreensão e amizade.Ao Prof. Kiyoshi Irya pelo carinho, disponibilidade, atenção e auxílio nas decisões importantes sobre a metodologia deste estudo. Ao Sr. Edson Pereira da Costa, pelo auxílio incansável em todos os procedimentos realizados nesta tese.À Sra. Vicência Mara Rodrigues de Lima, pela colaboração nos procedimentos cirúrgicos. À Dra. Adriana Bruscato Bortoluzzo, pela acessibilidade e competência na análise estatística desta tese.As Sra. Angélica Belem de Souza e Rose Cler Ferreira pela atenção oferecida durante todo o período de pós-graduação.As Sras. Suely Kinimi Kuebo Ariga e Fátima Abatepaulo pela atenção e auxílio na leitura das lâminas da HSP70.À Maria Nilce Pereira, pela carinhosa colaboração na redação final do texto. À Edileuza da Silva Cunha e Rosely Domingues Barboza pelaformação deste trabalho."Cada pessoa que passa em nossa vida, passa sozinha, é porque cada pessoa é única e nenhuma substitui a outra. Cada pessoa que passa em nossa vida passa sozinha, e não nos deixa só, porque deixa um pouco de si e leva um pouquinho de nós. Essa é a mais bela responsabilidade da vida e a prova de que as pessoas não se encontram por acaso". INTRODUCTION: The anastomotic leakage remains a serious complication in surgery of large bowel. The influence about the molecular mechanisms involved at this process is barely known, but its well known that collagen synthesis is essential for good healing. The Heat Shock Proteins (HSP) are expressed at stress situations, such as hypovolemia, also they are involved at the process of collagen synthesis. Besides, there are a few information about HSP70 expression at the healing process. OBJECTIVES: To determine the HSP70 expression at large bowel and intestinal anastomoses in normal and hypovolemic rats, as well as the amount of collagen and the quality of the inflammatory cells involved at this process, and correlate them. METHODS: It was used fourty Wistar rats divided into six groups. Twenty-four rats were submitted to catheterization of carotida artery followed by withdraw of 20% of their blood volume; eight of them were underwent just to hypovolemia and the others sixteen to hypovolemia followed by colectomy (right and left). The remaining sixteen rats were divided into two groups: eight of them were underwent to right colectomy and eight to the left. The specimens were analyzed at the seventh and fourteenth postoperative (PO) days. The inflammatory cells were assessed by Hematoxilin-eosin, the amount of collagen was stained by red Picrossirius and the HSP70 expression was determined by immunohistochemical stu...