Tratamento cirúrgico do megaesôfago no Hospital de Clínicas da UNICAMP - fatores associados a melhores ou a piores resultados

Abstract

ABSTRACT ABSTRACT ABSTRACTObjectives: Objectives: Objectives: Objectives: Objectives: To verify some possible factors, which would be associated with better or worse results for surgical treatment of megaesophagus. Methods Methods Methods Methods Methods: There were 417 patients operated on for megaesophagus, but only 390 medical charts were analyzed between 1989 and 2005. The presence of intraoperative and postoperative complications and the maintenance of severe dysphagia complaints were evaluated in a directed questionnaire, studying association with: the surgical approach chosen, megaesophagus degree, etiology and presence of other digestive alterations. Results Results ResultsResults Results: There were 360 cardiomiotomies, 20 esophagectomies and 11 mucosectomies. The results indicate that the cardiomiotomy is the safest surgery and the esophagectomy has more complications. The degree of megaesophagus is directed related with the results; more advanced megaesophagus has the worse results. The presence of digestive alterations has also a direct influence with worse results. Conclusion Conclusion Conclusion Conclusion Conclusion: The most important factor considering the results is the surgery chosen, and the best one were seen with cardiomiotomy. The degree of megaesophagus has also influenced the results. The etiology suggests better results with Chagas disease patients, maybe for the chronic course of this disease. The presence of digestive alteration is a factor which causes worse results, especially if associated with gastritis, esophagitis, megacolon and others.

Challenges and perspectives of Chagas disease: a review

“…According to Oliveira et al [54], there are an estimated 300,000 individuals with megacolon, the main symptoms of which are constipation and fecal impaction. Silva et al [55], reported alterations in intestinal secretion, absorption and motility in these patients, which culminate in mega-syndromes (dilated area upstream from the achalasic segment).…”

Physiotherapy in the surgical treatment of Chagasic Megaesophagus

“…There is no definite treatment for CME since the functional changes are permanent and progressive. Treatment includes a clinical approach, with a change in Physiotherapy in the surgical treatment of Chagasic Megaesophagus Vento DA, et al eating habits and medication, and, in more advanced cases or cases presenting greater clinical repercussions, surgery [9][10][11] .…”

Esophageal mucosal resection versus esophagectomy: a comparative study of surgical results in patients with advanced megaesophagus

“…Dysphagia is the manifestation that leads the patient to seek medical advice, and is generally progressive 12 , 14 . Megaesophagus is classified according to the transverse diameter of its body, ranging from 1 to 4 (Mascarenhas' score).…”

“…Megaesophagus is classified according to the transverse diameter of its body, ranging from 1 to 4 (Mascarenhas' score). The treatment is surgical and this classification assists the choice of surgery 8 , 12 , 14 .…”

“…The team of the Digestive System Diseases Service at the Clinic Hospital of Unicamp, in about 15 years, has treated some cases of megaesophagus with esophageal mucosectomy 12 , 14 . However, subtotal esophagectomy has not been abandoned and their results have not yet been directly compared to the esophageal mucosectomy.…”