Aspectos técnicos da esofagocardiomiotomia com divulsão para o tratamento cirúrgico do megaesôfago chagásico não avançado

Pilon, Benedito; Teixeira, Fábio Vieira; Terrazas, J.P.I.; Moreira, E.P.; Pillon, E.Y.

doi:10.1590/s0104-42301998000300004

Cited by 5 publications

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“…Oliveira Oliveira Oliveira Oliveira Oliveira Tratamento cirúrgico do megaesôfago no Hospital de Clínicas da UNICAMP -fatores associados a melhores ou a piores resultados DISCUSSÃO DISCUSSÃO DISCUSSÃO DISCUSSÃO DISCUSSÃO Com enfoque nos fatores associados a melhores ou piores resultados após cirurgia para tratamento das diversas formas de apresentação do megaesôfago, quer seja de etiologia chagásica ou não, pode-se observar que a cardiomiotomia é a de melhor resultado e segurança, no quesito presença de complicações, pelo baixo índice de complicações, apesar de a maior parte acontecer no intraoperatório, devidamente resolvidas no momento cirúrgico, o que reforça o bom resultado e a segurança da cardiomiotomia, já encontrado em outros trabalhos nesta década e em anteriores [10][11][12][13][14][15][16][17] . Valezi et al, encontraram complicações mais freqüentes, como perfuração de mucosa gástrica ou esofágica em 25% de pacientes operados por via laparoscópica 18 .…”

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

Oliveira

Lopes

Andreollo

et al. 2009

Rev. Col. Bras. Cir.

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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.

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Section: Resultados Resultados Resultados Resultados Resultadosunclassified

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

Oliveira

Lopes

Andreollo

et al. 2009

Rev. Col. Bras. Cir.

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“…The tecnique that presents the best results and safety, with a lower rate of complications, is cardiomyotomy 11,16 . The laparoscopic treatment of achalasia has been adopted since 1991.…”

Section: Discussionmentioning

confidence: 99%

Cardiomiotomia com fundoplicatura videolaparoscópica no tratamento do megaesôfago não avançado

Silva¹,

Souza²,

Cruz³

et al. 2011

ABCD, arq. bras. cir. dig.

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-Background -The chagasic megaesophagus is progressive esophageal motility dysfunction. Its main symptoms are dysphagia, regurgitation and weight loss. Cardiomyotomy associated with fundoplication is used as treatment for advanced megaesophagus since decades ago. Aim -To evaluate the results obtained with cardiomyotomy associated with laparoscopic fundoplication for the treatment of non-advanced megaesophagus. Method -A retrospective study with analysis of the results obtained with this operation for the treatment of megaesophagus grade I and II was done. Were evaluated the weight loss, time and intensity of symptoms, operative time, conversion rate, complication rate, length of hospitalization. Results -Were operated 68 patients, 34 men. The majority (42%) had severe symptoms. The average length of symptoms was 9.27 years. The mean weight loss was 5.1 kg. Chagas serology was positive in 88.13%. The average operation time was 190 minutes. There was one conversion to laparotomy. The median length of hospital stay was three days. The complication rate was 4.4%. The improvement in symptoms was observed in 92% of patients. Conclusion -The laparoscopic treatment of nonadvanced megaesophagus by cadiomiotomy associated with fundoplication was found to be safe and effective method. Has a low complication rate and good results in short follow-up. ABCDDV/792RESUMO -Racional -O megaesôfago chagásico é disfunção da motilidade esofágica de caráter progressivo. Seus principais sintomas são disfagia, regurgitação e perda de peso. A cardiomiotomia associada à fundoplicatura é usada como tratamento para o megaesôfago não avançado há algumas décadas. Objetivo -Avaliar os resultados obtidos com a cardiomiotomia associada à fundoplicatura por videolaparoscopia para o tratamento do megaesôfago não avançado. Método -Estudo retrospectivo com análise dos resultados obtidos com essa operação para tratamento do megaesôfago graus I e II. Avaliou-se perda ponderal, tempo e intensidade dos sintomas, tempo operatório, taxa de conversão, índice de complicações, tempo de internação. Resultados -Foram operados 68 pacientes, sendo 34 homens. A maioria (42%) apresentava sintomas intensos. O tempo médio de sintomas foi de 9,27 anos. A perda ponderal média foi de 5,1 kg. Sorologia para Chagas foi positiva em 88,13%. O tempo médio de operação foi de 190 minutos. Houve uma conversão para laparotomia. A mediana do tempo de internação foi de três dias. A taxa de complicações foi de 4,4%. A melhora dos sintomas foi observada em 92% dos pacientes. Conclusão -O tratamento videolaparoscópico do megaesôfago não-avançado pela cadiomiotomia associada à fundoplicatura mostrou-se método seguro e eficaz. Apresenta baixo índice de complicações e bons resultados no seguimento a curto prazo.

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“…Esophageal achalasia is an uncommon motility disorder of the esophagus, with an incidence of between 0.03 to 1 per 100,000 individuals 5 with no preference in terms of age or gender 14 . This condition can be classified as idiopathic, chagasic, pseudoachalasia or linked to syndromic contexts 2 , 19 . It is secondary to an irreversible degeneration of Auerbach’s myenteric plexus of the esophagus, causing aperistalsis and the absence of lower esophageal sphincter relaxation 9 , 10 , 13 , 18 , 22 , 23 .…”

Section: Introductionmentioning

confidence: 99%

Late Evaluation of Dysphagia After Heller Esophageal Myotomy With Dor Fundoplication for Achalasia

Câmara

Madureira

et al. 2017

ABCD, arq. bras. cir. dig.

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Background: All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. Aim:To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. Methods:A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied. The evaluation protocol with dysphagia scores compared preoperative, immediate (up to three months) postoperative and late (over one year) postoperative scores to estimate quality of life. Results:The surgical procedure was Heller-Dor in 100% of cases, with 84 cases performed laparoscopically. The percent reduction in pre- and immediate postoperative lower esophageal sphincter pressurewas 60.35% in the success group and 32.49% in the failure group. Regarding the late postoperative period, the mean percent decrease was 60.15% in the success group and 31.4% in the failure group. The mean overall drop in dysphagia score between the pre- and immediate postoperative periods was 7.33 points, which represents a decrease of 81.17%. Conclusions:Reduction greater than 60% percent in lower esophageal sphincter pressurebetween the pre- and postoperative periods suggests that this metric is a predictor of good prognosis for surgical response. Surgical treatment was able to have a good affect in quality of life and drastically changed dysphagia over time.

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Aspectos técnicos da esofagocardiomiotomia com divulsão para o tratamento cirúrgico do megaesôfago chagásico não avançado

Abstract: RESUMO -OBJETIVO. Os autores descrevem uma 11Enfatizamos os excelentes resultados obtidos em 50 pacientes, analisando parâmetros clínicos, cirúrgicos, radiológicos e endoscópicos.

Cited by 5 publications

References 1 publication

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

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

Cardiomiotomia com fundoplicatura videolaparoscópica no tratamento do megaesôfago não avançado

Late Evaluation of Dysphagia After Heller Esophageal Myotomy With Dor Fundoplication for Achalasia

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