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1.
Rev. chil. cir ; 67(1): 21-28, feb. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-734734

ABSTRACT

Background: Minimally invasive surgery reduced the incidence of postoperative complications. Many benign or malignant esophageal diseases can be treated with this technique. Aim: To report our experience with the technique in the treatment of esophageal tumors. Material and Methods: Analysis of a cohort of 85 patients with esophageal tumors aged 28 to 82 years (59 males). Sixty seven had esophageal cancer, 14 had leiomyomas or esophageal stromal tumors and four had duplication cysts. All were subjected to minimally invasive surgery. Short and long term results were recorded. Results: Forty three percent of patients with cancer had complications and 2.9 percent died. No complications were recorded among patients with stromal tumors or duplication cysts. Conclusions: Minimally invasive surgery is a feasible and safe therapeutic approach for patients with esophageal tumors.


Introducción: En las últimas dos décadas, la implementación de técnicas quirúrgicas mínimamente invasivas ha colaborado en la reducción de las complicaciones intra y postoperatorias. Un amplio espectro de enfermedades del esófago, benignas o malignas, pueden ser tratadas por medio de estas técnicas. Objetivo: Se presenta nuestra experiencia en el tratamiento quirúrgico de la patología tumoral esofágica y se hace una revisión de las indicaciones y resultados publicados en la literatura internacional. Material y Método: Se trata de 85 pacientes operados desde 1993 a la fecha, 67 corresponden a cáncer esofágico, 14 casos operados por leiomomas o tumores estromales esofágicos y 4 pacientes con quistes de duplicación. Todos fueron sometidos a cirugía mini invasiva de acuerdo a técnicas descritas previamente. Se analizan y discuten los resultados a corto y largo plazo y se discuten los resultados a la luz de los datos de la literatura internacional. Resultados: En los pacientes sometidos a esofagectomía por cáncer, las complicaciones ocurrieron en 43 por ciento y la mortalidad actual es de un 2,9 por ciento. En pacientes operados por tumores estromales o quistes de duplicación no hubo complicaciones postoperatorias ni mortalidad. En las otras patologías hubo mínima morbilidad y no hubo mortalidad, resultados que son comparables a la literatura consultada. Conclusión: Las técnicas de cirugía mínimamente invasiva diseñadas para el abordaje de los diversos tipos de patologías que afectan al esófago, resultan por lo general, altamente factibles de realizar, con buenos resultados en cuanto a complicaciones y mortalidad postoperatoria.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Esophagectomy/methods , Esophageal Neoplasms/surgery , Minimally Invasive Surgical Procedures/methods , Esophageal Neoplasms/mortality , Postoperative Complications
3.
Rev. chil. cir ; 65(2): 128-138, abr. 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-671265

ABSTRACT

Background: Minimally invasive surgical techniques are increasingly used for the treatment of benign esophageal diseases. Aim: To report the results of minimally invasive surgical techniques among patients with benign esophageal diseases. Material and Methods: Four hundred eighty three patients aged 37 to 81 years (184 males), were studied. Of these, 278 had a Barret esophagus, 125 had a hiatal hernia, 75 had achalasia and five had esophageal diverticula. All patients were studied using standard protocols, operated using minimally invasive techniques and followed, registering postoperative complications and recurrence of symptoms. Results: Among patients with esophageal reflux, 85 percent had successful results on the long term. Among patients with hiatal hernia and subjected to laparoscopic surgery, 12 percent had complications and 12 percent had recurrence of symptoms which increased to 17 percent if a mesh was not used. The recurrence rate among patients with achalasia is less than 5 percent. There was no recurrence among patients with esophageal diverticula. Conclusions: Minimally invasive surgery for esophageal diseases has good success rates, with a lower incidence of complications than open surgery.


Introducción: En este artículo se presenta la experiencia de nuestro grupo de trabajo de los resultados obtenidos en el tratamiento quirúrgico con técnicas mínimamente invasivas en patología esofágica benigna. Material y Método: Se analizan los resultados en pacientes sometidos a cirugía antirreflujo por enfermedad por reflujo gastroesofágico, esófago de Barrett, tratamiento de las hernias hiatales, acalasia esofágica y diver-tículos esofágicos. Resultados: Los resultados obtenidos por nuestro grupo son comparables a los que señala la literatura internacional, con mínima morbilidad y sin mortalidad. En pacientes con reflujo gastroesofágico, los resultados a largo plazo presentan una tasa de éxito en el 85 por ciento de los casos. En pacientes con hernia hiatal operados por vía laparoscópica las complicaciones son cercanas al 12 por ciento y la recurrencia es de un 12 por ciento en promedio, pero se eleva al 17 por ciento cuando no se usa malla. En Acalasia por otro lado, la tasa de recurrencia es menor a un 5 por ciento. Los pacientes operados por divertículos esofágicos no presentan recidiva. Conclusiones: Las técnicas de cirugía mínimamente invasiva diseñadas para el abordaje de los diversos tipos de patologías que afectan al esófago, resultan por lo general, altamente factibles de realizar por cuanto reproducen los resultados de la cirugía abierta pero con menor tasa de complicaciones.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Esophageal Diseases/surgery , Laparoscopy/methods , Minimally Invasive Surgical Procedures , Esophageal Achalasia/surgery , Diverticulum, Esophageal/surgery , Barrett Esophagus/surgery , Hernia, Hiatal/surgery , Gastroesophageal Reflux/surgery , Treatment Outcome
4.
Rev. méd. Chile ; 140(6): 703-712, jun. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-649839

ABSTRACT

Background: Minimally invasive surgery has the advantage of a lower rate of complications and can be used for benign esophageal diseases. Aim: To report a single surgeon experience with laparoscopic surgery for benign esophageal diseases. Material and Methods: Prospective analysis of 421 patients (160 males) with benign esophageal disease, who were subjected to laparoscopic surgery by a single surgeon. Immediate mortality, surgical complications and long term results in terms of symptoms recurrence, were analyzed. Results: The underlying diagnoses of the operated patients were Barrett's esophagus or esophagitis in 257, hiatal hernia in 91, achalasia in 68 and esophageal diverticula in five. Surgery obtained successful results in 90% of patients with Barrett's esophagus. Among patients with hiatal hernia, there was a 12% rate of complications and a 30% recurrence, when a mesh was not used. Among patients with achalasia the recurrence rate was less than 5%. Conclusions: Laparoscopic surgery has a fair success rate in benign esophageal diseases, with a lower rate of complications.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Esophageal Diseases/surgery , Laparoscopy/methods , Barrett Esophagus/surgery , Esophagitis/surgery , Gastroesophageal Reflux/surgery , Hernia, Hiatal/surgery , Laparoscopy/adverse effects , Prospective Studies , Treatment Outcome
5.
Rev. chil. cir ; 64(1): 40-45, feb. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-627076

ABSTRACT

The pedicle transverse rectus abdominus myocutaneous flap (TRAM) is widely used for breast reconstruction, however is not exempt from complications. Between 2004 and 2010 the authors performed breast reconstruction after total mastectomy in 52 patients with pedicled TRAM flaps. Purpose: To describe the demography, outcomes and complications in patients operated for breast cancer and reconstructed with TRAM flap. To assess the influence of smoking, the laterality and timing of reconstruction. Material and Method: Retrospective, observational and comparative. We reviewed the medical records of 52 patients operated by the authors between 2004 and 2010. Four cases were excluded due to incomplete data. Results: In the 48 patients studied were 50 TRAM flaps. The most frequent comorbidity was smoking (27 percent). Regarding the timing of reconstruction, 74 percent (37) was performed immediately post-mastectomy and 26 percent (13) was deferred. Was used by 78 percent (39) ipsilateral TRAM, 18 percent (9) contralateral and 4 percent (2) bilateral. Only minor complications were observed and the cosmetic result evaluated by the surgeon's satisfaction was very good or excellent in 62 percent (31). Smoking, timing of reconstruction and laterality did not affect in complications or cosmetic outcome (p > 0.05). Conclusions: The pedicled TRAM flap is an excellent alternative for reconstruction in breast cancer patients. It is not exempt from complications, with a tendency to get better cosmetic results in the non-smoker group.


El colgajo de recto abdominal con isla transversal de piel infraumbilical (TRAM) pediculado es ampliamente utilizado para la reconstrucción mamaria, sin embargo, no está exento de complicaciones. Entre los años 2004 y 2010 los autores realizaron reconstrucción mamaria post-mastectomía total en 52 pacientes con colgajos TRAM pediculados. Objetivo: Describir la demografía, resultados y complicaciones de las pacientes operadas por cáncer de mama y reconstruidas con colgajo TRAM. Evaluar la influencia del tabaquismo, la lateralidad y el momento de la reconstrucción en dichos resultados. Material y Método: Diseño retrospectivo, observacional y comparativo. Se revisaron las historias clínicas de las 52 pacientes operadas por los autores entre los años 2004-2010. Se excluyeron 4 casos por datos incompletos. Resultados: En las 48 pacientes estudiadas se realizaron 50 colgajos TRAM. La comorbilidad más frecuente fue el tabaquismo (27 por ciento). La reconstrucción se realizó en un 74 por ciento (37) de manera inmediata postmastectomía y en un 26 por ciento (13) fue diferido. Se utilizó en un 78 por ciento (39) TRAM ipsilateral, 18 por ciento (9) contralateral y 4 por ciento (2) bilateral. Sólo se observaron complicaciones menores; el resultado estético evaluado por la satisfacción del cirujano fue muy bueno o excelente en un 62 por ciento (31). El tabaquismo, momento de la reconstrucción y la lateralidad no influyeron en las complicaciones ni en el resultado estético (p > 0,05). Conclusiones: El colgajo TRAM pediculado es una excelente alternativa de reconstrucción en pacientes mastectomizadas. No está exento de complicaciones, con una tendencia a obtener mejores resultados estéticos en el grupo no fumador.


Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/surgery , Reconstructive Surgical Procedures/methods , Surgical Flaps , Comorbidity , Esthetics , Smoking/adverse effects , Smoking/epidemiology , Mastectomy , Breast Neoplasms/epidemiology , Postoperative Complications , Retrospective Studies , Risk Factors , Rectus Abdominis/transplantation , Treatment Outcome
6.
Rev. Hosp. Clin. Univ. Chile ; 22(3): 187-194, 2011. tab
Article in Spanish | LILACS | ID: lil-647603

ABSTRACT

Negative effect of post-mastectomy radiotherapy in transverse rectus abdominus myocutaneous (TRAM) flap breast reconstruction remains unclear. The immediate post-mastectomy TRAM has shown better cosmetic results than delayed reconstruction, making it necessary to define the effects of radiation on this type of reconstruction. The aim of this study is to compare the effect of radiotherapy on immediate and delayed reconstruction with TRAM, analyzing aesthetic results and complications. We reviewed medical records of 23 patients undergoing mastectomy with TRAM reconstruction and radiation therapy between 2004-2009, distributed in those undergoing immediate reconstruction (n=12) and delayed post-radiotherapy (n=11). Cosmetic results and complications were compared between the groups. There were no differences in age, prevalence of comorbidities or clinical stage. Regarding the aesthetic result of immediate TRAM, 50 percent were classified as excellent, 20 percent very well, 20 percent good and 10 percent regular, while in delayed reconstructions, 64 percent was excellent, 18 percent very good and 18 percent good, no differences between both groups (p=0.51). There were no differences in local complications. Although the study population is insufficient to draw conclusions comparable, our results are comparable to those of other studies showing no deleterious effect of radiotherapy on immediate TRAM reconstructions. Additional studies are needed to recommend the treatment of choice.


Subject(s)
Humans , Adult , Female , Middle Aged , Mammaplasty/methods , Mammaplasty/trends , Breast Neoplasms/surgery , Breast Neoplasms/radiotherapy , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/trends
7.
Rev. chil. dermatol ; 26(4): 404-411, 2010. ilus, tab
Article in Spanish | LILACS | ID: lil-721804

ABSTRACT

Las metástasis cutáneas son infrecuentes, reportándose en la literatura rangos entre 0,6 por ciento y 10 por ciento. El cáncer de mama es la neoplasia más común en las mujeres con metástasis cutáneas. La presencia de éstas constituye un signo de enfermedad avanzada y es indicadora de mal pronóstico. Las lesiones pueden tener distintos patrones clínicos: tipo nodular, erisipeloide, alopecia y carcinoma telangiectásico. En el presente artículo se realiza un análisis retrospectivo de tres casos clínicos atendidos en nuestro centro y una revisión de la literatura.


Cutaneous metastases are unusual; their frequency in the literature ranges from 0.6 percent to 10 percent. Breast cancer is the most common cancer in women with cutaneous metastases. They are perceived as a sign of advanced disease and are regarded as a serious prognostic indicator. The lesions may present in distinct clinical forms: nodular pattern, erysipelas like presentations, alopecia and carcinoma telangiectaticum. In this article we analyzed three clinical cases that were seen in our center and a review of the literature.


Subject(s)
Humans , Female , Middle Aged , Adenocarcinoma/secondary , Skin Neoplasms/secondary , Skin Neoplasms/therapy , Breast Neoplasms/pathology , Breast Neoplasms/therapy
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