Tratamento cirúrgico das complicações da anastomose esôfago-visceral cervical / Surgical treatment of the complications of the cervical esophago visceral anastomosis

A anastomose esôfago-visceral cervical apresenta como complicações a fístula e a estenose, que podem necessitar de reintervenção cirúrgica para sua correção. Com o objetivo de avaliar as táticas para abordagem operatória dessas complicações e seus resultados, os autores estudaram retrospectivamente nove pacientes, que demandaram esta conduta, num período de 17 anos. Foram operadas duas fístulas e sete estenoses da anastomose esôfago-visceral cervical, sendo a via de acesso inicial a cervicotomia em todos ospacientes. Em quatro casos, houve necessidade de ampliação para esternotomia mediana total, que facilitousignificativamente a reconstrução, porém com mortalidade de 75%. As táticas adotadas foram a reanastomoseem cinco casos, a sutura do orifício da fístula em um caso e a plastia em três casos. A ressutura teve mau resultado. As plastias evoluíram satisfatoriamente, e os doentes submetidos a reanastomose sem ésternotomiatambém evoluíram satisfatoriamente. A plastia da anastomose demonstrou ser uma boa tática para o tratamento da estenose cervical, enquanto a reanastomose parece ter a melhor indicação nas fístulas, devendo-se evitar a esternotomia total mediana.

The esophago-visceral cervical anastomosis presents complications such as fistula and stenosis that mayneed surgical reintervention for it’s correction. The authors, with the objective of evaluating proceduresfor surgical approach and the results of these complications, have studied retrospectively 9 patients whom demanded this conduct in a 17-year period. Two fistulas and seven esophago-visceral cervical anastomosisstenosis were performed, being cervicotomy the initial access in all patients. In four cases there was a needto enlarge the access, achieved with a total median sternotomy, which made the reconstruction significantly easier, therefore there was 75% mortality. The tactics adopted were reanastomosis in 5 cases, suture of the fistula’s orifice in one case, and plasty in three. Ressuturing obtained bad results. The patients subbmited to plasties evoluted satisfactorily and patients submitted to reanastomosis without total median sternotomy also evoluted satisfactorily. Anastomosis plasty proved to be a good tactic for the treatment of cervicalstenosis, while reanastomosis seems to be a better indication for treatment of fistulas, being that total median sternotomy is avoided.

Clinical and laboratorial correlation of postoperative hypocalcemia after extensive thyroidectomy

The medical records of 84 patients submitted to extensive thyroidectomy from January 1991 to April 1995 were reviewed and the data there was analyzed in order to verified a correlation between postoperative laboratories results and physical findings suggestive of hypocalcemia. It was verifed that was hypocalcemia in 51.2 percent of the patients, of which only 18.6 percent presented symptoms. It was concluded that asymptomatic hypocalcemia is frequent in extensive thyroidectomy and a routine screening for serum calcium in the postoperative period following thyroidectomy and calcium reposition must be systematic.