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

Herbella, Fernando A. M.; Grande, José Carlos Del; Lourenço, Laércio Gomes; Mansur, Nacime Salomão Barbachan; Haddad, Chibly Michel

doi:10.1590/s0104-42301999000400006

Cited by 28 publications

(27 citation statements)

References 9 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 .…”

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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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 untreated advanced megaesophagus is characterized by the absence of adequate contractility of the esophageal body.Thus, more conservative procedures such as myotomy do not provide good results in relief of dysphagia, although this aspect in the recurrence becomes even more evident due to the presence of scarring of previous surgery 2,7,9,15 . These factors have encouraged the standardization of procedures for improve drainage of the esophagus with larger diameter, especially in cases of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…This becomes evident in the non advanced megaesophagus without prior treatment, in which the myotomy with fundoplication -conservative and not complex operation -provides better results compared to other techniques 7,9,15 . In the advanced megaesophagus without prior treatment, the therapy of choice has been esophagectomy without thoracotomy or esophageal mucosal resection with preservation of the muscular layer, with the replacement of esophagus performed by gastric transposition to the neck 5,8,17 .…”

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confidence: 99%

Análise das complicações da esofagectomia transmediastinal no tratamento cirurgico do megaesôfago recidivado

Aquino¹,

Said²,

Leandro‐Merhi³

et al. 2011

ABCD, arq. bras. cir. dig.

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headings -Esophagectomy. Esophageal ahalasia.abstRact -Background -The best option for the treatment of patients with achalasia and recurrent symptoms after previous treatment, has always been very controversial. In literature review, there is no surgical technique considered the best to deal with this condition. The idea to use a more selective treatment with transmediastinal esophagectomy without thoracotomy in patients with advanced megaesophagus in relapsed cases after prior cardiomyotomy can be considered. Aim -To evaluate the results of transmediastinal esophagectomy in recurrent megaesophagus regarding local and systemic complications. Methods -Thrity two patients were treated with recurrent symptoms after previous surgery to achalasia and indication for esophagectomy with gastric transmediastinal transposition through the posterior mediastinum for grade IV megaesophagus. They were 25 men (78.1%) and seven women (21.9%), aged from 34 to 72 years. All underwent previous myotomy varying from five to 39 years to the day of transmediastinal esophagectomy. Results -Some patients had complications. Among these, eight had pulmonary infection (25.0%) resulting in good outcome to the specific clinical treatment; two died due to hemodynamic effect caused by injury to the azygos vein and the other due to trachea injury; nine (28.1% ) had cervical esophagogastric anastomotic dehiscence doing well with conservative treatment. Of the 21 patients in whom monitoring was carried out in the long term -six months to 14 years -, 17 reported good swallowing solids and pastes, four (19.0%) had gastroesophageal reflux with clinical improvement with specific medical treatment. Conclusions -Transmediastinal esophagectomy, although providing adequate swallowing in most cases, is a procedure of high morbidity. This technique should not be recommended as first treatment option for relapsed megaesophagus.Resumo -Racional -A melhor opção para o tratamento dos pacientes com megaesôfago e recidiva de sintomas após tratamento prévio sempre foi muito controversa. Em resultados de trabalhos analisados, não há seleção da técnica cirúrgica mais adequada para a doença. Assim, surge a ideia de se realizar um estudo mais seletivo com esofagectomia transmediastinal sem toracotomia em pacientes com megaesôfago avançado recidivado após cardiomiotomia prévia. Objetivo -Avaliar os resultados da esofagectomia transmediastinal no megaesôfago recidivado quanto às complicações sistêmicas e locais. Método -Trinta e dois pacientes foram atendidos todos com recidiva de sintomas após operação prévia e indicação para esofagectomia transmediastinal com transposição gástrica pelo mediastino posterior por apresentarem megaesôfago grau IV.

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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%

“…It is estimated that about 10 million Brazilians are affected by Chagas disease and 5% of these have megaesophagus 12 . The disease is insidious and presents as main symptoms dysphagia, regurgitation and weight loss, interfering significantly with the feeding habits and nutritional status 9,11 . In the diagnosis of megaesophagus contrast radiography of the esophagus and endoscopy are needed.…”

Section: Introductionmentioning

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

Cited by 28 publications

References 9 publications

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

Análise das complicações da esofagectomia transmediastinal no tratamento cirurgico do megaesôfago recidivado

Cardiomiotomia com fundoplicatura videolaparoscópica no tratamento do megaesôfago não avançado

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