Cardiomiectomia com fundoplicatura parcial videolaparoscópica no tratamento do megaesôfago não avançado: estudo de 50 casos

Abstract

Foram estudados prospectivamente cinqüenta pacientes com megaesôfago não avançado tratados por cardiomiectomia com fundoplicatura parcial por via laparoscópica, avaliados sob o ponto de vista clínico e funcional. Houve 12% de complicações intra-operatórias, duas complicações pós-operatórias imediatas e um óbito. Não houve conversões ou complicações tardias. Os resultados ótimos e bons somaram 97,9% dos casos. Houve tendência à diminuição radiológica do calibre do esôfago e desaparecimento da esofagite à endoscopia. A eletromanometria mostrou diminuição significativa da pressão média do esfíncter inferior do esôfago após a operação; a pHmetria de 24 horas constatou diminuição da estase esofágica e ausência de refluxo gastro-esofágico no pós-operatório. Não houve diferença entre os resultados do tratamento de pacientes com megaesôfago chagásico e não chagásico. Os pacientes tiveram o benefício da cirurgia laparoscópica de menor dor, rápida realimentação, alta precoce e breve retorno às atividades habituais.

Resultados tardios da operação de Heller associada à fundoplicatura no tratamento do megaesôfago: análise de 83 casos

“…Por outro lado, deve-se, também, lembrar que com o advento da via de acesso por vídeo-laparoscopia, e os bons resultados obtidos por esse método 2 , aumenta o interesse dos estudos comparativos a longo prazo entre essas duas vias de acesso.…”

Results of the surgical treatment of non-advanced megaesophagus using Heller–Pinotti's surgery: Laparotomy vs. Laparoscopy

“…Intraoperative complication rates are low with both types of surgery, mucosal perforation being found in 15% of cases, bleeding in 0.5%, visceral perforation in 0.5%, pneumothorax in 1% and conversion to open surgery in 2–6% of cases. 14 , 28 – 32 These complications do not, however, alter the final outcome of surgery.…”

Laparoscopic Treatment of Traumatic Diaphragmatic Hernia

“…The most probable course of action that leads to TDH in blunt trauma is the outward transmission of increased abdominal pressure in a radial direction leading to rupture at the weakest point, and thoracic negative pressure leads to herniation of abdominal viscera. [2][3][4][5][6][7][8][9][10][11][12] Herniation of gastrointestinal contents can later lead to obstruction and necrosis,4 thus elevating morbidity and mortality (20%).6'12 Organs that are most frequently herniated on the left side include stomach (80%), spleen (60%), omentum (50%), colon (45%), liver (15%), the small bowel (10%), and kidney (5%); on the right side are liver and the small bowel.13 In this patient the stomach, spleen, portion of the small intestine, and colon were herniated. Surgical indication in the present case was mandatory because of the risk of obstruction and ischemia; the patient had herniated gastric volvulus and colon migration, with the possibility of late occurrence of acute complications and the necessity of ressective operation and consequent morbidity and mortality.14 Traditionally, TDH has been repaired either by laparotomy or thoracotomy, depending on location of associated injuries, and whether it is chronic or acute due to the presence of adhesions.…”

“…Surgical indication in the present case was mandatory because of the risk of obstruction and ischemia; the patient had herniated gastric volvulus and colon migration, with the possibility of late occurrence of acute complications and the necessity of ressective operation and consequent morbidity and mortality.14 Traditionally, TDH has been repaired either by laparotomy or thoracotomy, depending on location of associated injuries, and whether it is chronic or acute due to the presence of adhesions. 5,9 Laparoscopy and thoracoscopy have proved to be of extreme importance for diagnosis and even for treatment.15'16 However, thoracoscopy has proven to be more effective in acute trauma cases within 24 hours, after which inadvertent injuries due to adhesions may occur. 815 Diagnostic laparoscopy has been useful for evaluating such injuries when preoperative diagnosis is doubtful,3 and even allows their correction by suture17 or mesh placement.8…”