Breve historia de la cirugía del estómago / Brief history of gastric surgery

En este artículo se reseñan los principales hitos en la historia de la cirugía gástrica, en la úlcera péptica y el cáncer gástrico en el mundo y en Chile. Se mencionan los principales protagonistas, su aporte y se establecen líneas de tiempo. Como resumen no es posible detallar contextos ni completar historias, pero se busca dar una visión panorámica del desarrollo de esta cirugía.

This article reviews the main milestones in the history of gastric surgery, in peptic ulcer and gastric cancer in the world and in Chile. The main protagonists are mentioned, their contribution and set time lines. As a summary it is not possible to detail contexts or complete stories, but it seeks to give a panoramic view of the development of this surgery.

Utilidad de las escalas Rockall y Baylor modificado en hemorragia digestiva alta por úlcera péptica / Usefulness of the Modified Rockall and Baylor Scores in Gastrointestinal Hemorrhage due to Peptic Ulcer

Introducción: la hemorragia digestiva alta constituye un problema de salud frecuente en todo el mundo y es una de las urgencias que determina gran número de ingresos en los servicios de Cirugía General en nuestro medio, por lo que reviste gran importancia clínica y sanitaria. Objetivo: determinar la utilidad de las escalas de Rockall y Baylor modificado para pronosticar resangrado en pacientes con hemorragia digestiva alta. Método: se realizó un estudio observacional descriptivo prospectivo, incluyendo a los pacientes ingresados por hemorragia digestiva alta por úlcera péptica en el Hospital Enrique Cabrera, desde el 1ro. de enero del 2012 hasta el 30 de septiembre del 2015. Resultados: de 300 pacientes ingresados por hemorragia digestiva alta por úlcera péptica, se tomó una muestra de 71 enfermos. El tratamiento endoscópico se realizó a todos los pacientes, y el tratamiento quirúrgico en 8,4 por ciento. Nueve pacientes presentaron resangrado (12,7 por ciento). Las escalas de Rockall y Baylor modificado presentaron una especificidad de 82 por ciento y 86 por ciento, respectivamente con baja sensibilidad en ambos casos a pesar de esto la escala de Rockall es la de mayor sensibilidad. Conclusiones: las dos escalas fueron altamente específicas, pero la de Rockall fue más sensible para identificar los pacientes con riesgo alto de resangrado(AU)

Introduction: Upper gastrointestinal hemorrhage is a common health problem worldwide and one of the emergencies determining a huge number of admissions into general surgery services in our scenario, it is therefore of great clinical and sanitary importance. Objective: To determine the usefulness of the modified Rockall and Baylor scores in predicting rebleeding in patients with upper gastrointestinal hemorrhage. Method: A prospective, descriptive, observational study was carried out, including patients admitted for upper gastrointestinal hemorrhage due to peptic ulcer in Enrique Cabrera, from January 1st, 2015 to September 30, 2015. Results: Among the 300 patients admitted for upper digestive hemorrhage due to peptic ulcer, we took a sample of 71 patients. All patients were performed endoscopic treatment, while 8.4 percent were performed surgical treatment. Nine patients presented with rebleeding (12.7 percent). The modified Rockall and Baylor scores showed a specificity of 82 percent and 86 percent, respectively, with low sensitivity in both cases. Despite this, the Rockall score is the one with the highest sensitivity. Conclusions: The two score were highly specific, but the Rockall score was more sensitive for identifying patients at high risk of rebleeding(AU)

Surgical outcomes for perforated peptic ulcer: a prospective case series at an academic hospital in Monrovia, Liberia

Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant; and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes.Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia; Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality.Results Median age was 33 years and 85 were males. A majority of the patients (70) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5 days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35. Median length of stay among survivors was 16 days; and death occurred at median 1 day after admission. Long symptom duration and age 30 years of age were significantly associated with in-hospital mortality on univariate (? = 2.60 [0.18-5.03]; p = 0.035) and multivariate testing (? = 2.95 [0.02-5.88]; p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series; surgical treatment for perforated peptic ulcer disease carried a high mortality; and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries

Rebleeding after Initial Endoscopic Hemostasis in Peptic Ulcer Disease

Endoscopic hemostasis is the first-line treatment for upper gastrointestinal bleeding (UGIB). Although several factors are known to be risk factors for rebleeding, little is known about the use of antithrombotics. We tried to verify whether the use of antithrombotics affects rebleeding rate after a successful endoscopic hemostasis for peptic ulcer disease (PUD). UGIB patients who underwent successful endoscopic hemostasis were included. Rebleeding was diagnosed when the previously treated lesion bled again within 30 days of the initial episode. Of 522 UGIB patients with PUD, rebleeding occurred in 93 patients (17.8%). The rate of rebleeding was higher with aspirin medication (P=0.006) and after a long endoscopic hemostasis (P<0.001). Of all significant variables, procedure time longer than 13.5 min was related to the rate of rebleeding (OR, 2.899; 95% CI, 1.768-4.754; P<0.001) on the logistic regression analysis. The rate of rebleeding after endoscopic hemostasis for PUD is higher in the patients after a long endoscopic hemostasis. Endoscopic hemostasis longer than 13.5 min is related to rebleeding after a successful endoscopic hemostasis for PUD.

Helicobacter pylori infection in India from a western perspective.

Helicobacter pylori is a common bacterial infectious disease whose manifestations predominately affect the gastrointestinal tract. India is the prototypical developing country as far as H. pylori infection is concerned and more than 20 million Indians are estimated to suffer from peptic ulcer disease. Considering the high level of medical research and of the pharmaceutical industry, one would expect that India would be the source of much needed information regarding new therapies and approaches that remain effective in the presence of antimicrobial resistance, new methods to reliably prevent reinfection, and the development of therapeutic and preventive vaccines. Here we discuss H. pylori as a problem in India with an emphasis on H. pylori infection as a serious transmissible infectious disease. We discuss the pros and cons of eradication of H. pylori from the entire population and come down on the side of eradication. The available data from India regarding antimicrobial use and resistance as well as the effectiveness of various treatments are discussed. Rigorous ongoing studies to provide current regional antibiotic resistance patterns coupled with data concerning the success rate with different treatment regimens are needed to guide therapy. A systematic approach to identify reliably effective (e.g., 90% or greater treatment success) cost-effective regimens is suggested as well as details of regimens likely to be effective in India. H. pylori is just one of the health care problems faced in India, but one where all the resources are on hand to understand and solve it.

Evolução histórica da úlcera péptica: da etiologia ao tratamento / History of peptic ulcer: from etiology to treatment

Objetivos: revisar os principais aspectos históricos da progressão do conhecimento sobre a etiologia da úlcera péptica e das terapêuticas clínicas e cirúrgicas empregadas no tratamento desta enfermidade.Fonte de dados: revisão bibliográfica através do PubMed. Foram analisados artigos selecionados sobre a história da úlcera péptica.Síntese dos dados: durante décadas, cirurgiões acreditaram que a doença da úlcera péptica era causada pelo excesso de ácido. O aforisma ?sem ácido, sem úlcera? foi enraizado em todos os residentes de cirurgia, e todos os esforços foram concentrados em eliminar o ácido através de uma operação. Com o advento da terapêutica farmacológica, houve melhora no sucesso do tratamento clínico e o número de casos cirúrgicos diminuiu. Com a descoberta do Helicobacter pylori, ainda mais pacientes foram tratados clinicamente e o número de casos cirúrgicos diminuiu novamente, persistindo apenas para casos refratários, hemorragia ou perfuração.Conclusões: úlcera péptica é uma doença reconhecida desde a antiguidade. A compreensão da evolução gradual das várias formas de seu tratamento serve de alerta e ensinamento de como evolui o conhecimento científico, onde as certezas efinitivas podem ser alteradas por inovações e resultados de pesquisas metodologicamente bem delineadas e realizadas, bem como elucidar a difícil trajetória que tem sido percorrida para poder solucionar o sofrimento dos pacientes que possuem essa enfermidade.

Aims: To review the main aspects of the historical progression of knowledge about the etiology of peptic ulcer and the clinical and surgical treatment used in the treatment of this disease.Source of data: A search was carried out at PubMed. Selected papers about the history of the peptic ulcer were reviewed.Summary of findings: For decades, surgeons were taught and believed that peptic ulcer disease was caused by acid.The dictum ?no acid, no ulcer? was engrained into every resident of surgery, and all efforts were focused on eliminating acid through operation. With the advent of pharmacological therapy, more ulcers were successfully treated medically and the number of surgical cases decreased. With the discovery of Helicobacter pylori, even more patients were successfully treated medically and the number of surgical cases decreased again, usually only to include refractory cases, hemorrhage or perforation.Conclusions: Peptic ulcer is a disease recognized since ancient times. The understanding of the gradual evolution of several forms of treatment serves as a warning and teaching of how scientific knowledge evolves, where the final certainties can be changed by innovations and research findings methodologically well designed and executed, and to clarify the difficult path that has been traversed in order to solve the suffering of patients who have this disease.

Helicobacter pylori infection in India from a western perspective.

Helicobacter pylori is a common bacterial infectious disease whose manifestations predominately affect the gastrointestinal tract. India is the prototypical developing country as far as H. pylori infection is concerned and more than 20 million Indians are estimated to suffer from peptic ulcer disease. Considering the high level of Medicine and of the pharmaceutical industry, one would expect that India would be the source of much needed information regarding new therapies and approaches that remain effective in the presence of antimicrobial resistance, new methods to reliably prevent reinfection, and the development of therapeutic and preventive vaccines. Here, we discuss H. pylori as an Indian problem with an emphasis on H. pylori infection as a serious transmissible infectious disease. We discuss the pros and cons of eradication of H. pylori from the entire population and come down on the side of eradication. The available data from India regarding antimicrobial use and resistance as well as the effectiveness of various treatments is discussed. Rigorous ongoing studies to provide current regional antibiotic resistance patterns coupled with data concerning the success rate with different treatment regimens are needed to guide therapy. A systematic approach to identify reliably effective (e.g., 90% or greater treatment success) cost-effective regimens is suggested as well as details of regimens likely to be effective in India. H. pylori is just one of the health care problems faced in India, but one where all the resources are on hand to understand and solve it.

Sangrado digestivo alto: consideraciones actuales acerca de su diagnóstico y tratamiento / Upper digestive bleeding: current considerations about its diagnosis and treatment

Introducción: El sangrado digestivo alto es una emergencia medicoquirúrgica frecuente, que suele ser diagnosticado mediante la endoscopia por vía oral y la radiografía de esófago, estómago y duodeno. Objetivo: Describir los resultados diagnósticos y terapéuticos en los pacientes ingresados por esa causa en el Servicio de Cirugía General del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba durante el bienio 2007-2008. Métodos: Se hizo un estudio descriptivo, transversal y retrospectivo de 88 pacientes hospitalizados con esa afección, tomando en cuenta variables seleccionadas. Resultados: La endoscopia por vía oral se efectuó a 56,8 por ciento de la serie y reveló que tanto la úlcera duodenal como las gastritis agudas y crónicas fueron las gastropatías predominantes según clasificación de Forrest III; en la radiografía de esófago, estómago y duodeno se observaron más comúnmente los pliegues engrosados. Excepto 6 pacientes (6,8 por ciento) que fallecieron, los restantes mejoraron con el tratamiento durante una corta estadía. Conclusiones: A pesar de la efectividad de la prueba endoscópica, aún no puede realizarse a todas las personas con sangrado digestivo alto.

ntroduction: The upper digestive bleeding is a frequent medical surgical emergency that is usually diagnosed by means of oral endoscopy and the esophagus, stomach and duodenum x-ray. Objective: To describe the diagnostic and therapeutic results in the patients admitted by that cause in the General Surgery Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba during the biennium 2007-2008. Methods: A descriptive, cross-sectional and retrospective study of 88 patients hospitalized with that affection was carried out, taking into account selected variables. Results: The oral endoscopy was made to 56,8 per cent of patients of the series and revealed that both duodenal ulcer and acute and chronic gastritis were the predominant gastropathies according to classification of Forrest III. In the esophagus, stomach and duodenum x-ray thickened folds were the most commonly observed. Except for 6 patients (6,8 per cent) who died, the rest of them improved with the treatment during a short stay. Conclusions: In spite of the effectiveness of the endoscopic test, it cannot still be made to all the people with upper digestive bleeding.

Cirugía exerética en la úlcera péptica complicada: ¿procedimiento extemporáneo? / Exeretic surgery in complicated peptic ulcer: An inopportune procedure?

INTRODUCCIÓN. El objetivo del presente estudio fue analizar los resultados del tratamiento quirúrgico en la enfermedad ulceropéptica crónica gástrica o duodenal complicada, durante un período de 15 años. MÉTODOS. Se realizó un estudio descriptivo y retrospectivo de los pacientes con enfermedad ulceropéptica complicada tratados mediante exéresis. Los pacientes (45 en total) fueron atendidos por alguno de los autores, en el Hospital Provincial Clinicoquirúrgico Amalia Simoni, en Camagüey, entre enero de l989 y diciembre del 2004. RESULTADOS. La enfermedad se presentó con mayor frecuencia en el sexo masculino (82,22 por ciento) y en las edades comprendidas entre 36 y 50 años (46,67 por ciento). El 95,56 por ciento de los pacientes tratados padecían úlcera duodenal, y la principal indicación para la cirugía fue la intratabilidad (62,22 por ciento). La endoscopia (84,44 por ciento) resultó ser muy útil para el diagnóstico de esta afección. A todos los operados se le realizó vagotomía con antrectomía; en el 68,89 por ciento la anastomosis fue de Billroth II, y en el resto de los pacientes (31,11 por ciento) fue del tipo Billroth I. Se observó igual cantidad de complicaciones precoces en las técnicas realizadas, y entre ellas prevalecieron el sangrado de la anastomosis y el retardo de la evacuación. Se detectaron más complicaciones tardías en la anastomosis de tipo Billroth II que en la de Billroth I. Los resultados quirúrgicos fueron excelentes y muy buenos en el 89 por ciento de los casos. La variante antecólica registró el mayor porcentaje de resultados no satisfactorios (9,09 por ciento). Solo en dos pacientes se obtuvieron resultados malos, aunque no hubo mortalidad operatoria. CONCLUSIONES. Este tipo de cirugía tiene indicación solo en casos de úlcera péptica complicada. No es el método de elección en pacientes ulcerosos, pero su uso requiere conocer las diferentes técnicas y saber utilizarlas. No es por tanto un procedimiento que deba olvidarse(AU)

INTRODUCTION: The aim of present study was to analyze the surgical treatment results in the complicated duodenal or gastric chronic peptic ulcer over 15 years. METHODS: A retrospective and descriptive study was conducted in patients presenting with complicated peptic ulcer by exeresis. Patients (n=45) were seen by some of us in the Amalia Simoni Clinical Surgical of Camaguey province from January, 1989 to December, 2004. RESULTS: Disease was more frequent in male sex (82,22 percent) and in ages from 36 to 50 years (46,67 percent). The 95,56 percent of patients treated suffered from duodenal ulcer and the main criterion for surgery was its unmanageable condition (62,22 percent). Endoscopy was very useful for diagnosis of this entity. All operated on underwent vagotomy with antrectomy; in the 68,89 percent we performed a Billroth's II anastomosis and in remainder (31,11 percent it was of Billroth I type. There was a similar figure of early complications related to techniques used and among them prevails the anastomosis bleeding and delay evacuation. There were more late complications in type Billroth II anastomosis than in the Billroth I. Surgical results were excellent and very good in the 89 percent of cases. The enterocolitis variant has the great percentage of non-satisfactory results (9,09 percent). Only two patients had poor results, although there wasn't operative mortality. CONCLUSIONS: This kind of surgery is indicated only in cases of complicated peptic ulcer. It is not the choice method in ulcer patients, but in its use it is necessary to know about different techniques and its use. Thus, we must to know a lot about this procedure(AU)

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients / Estudo comparativo quanto à recidiva ulcerosa do tratamento cirúrgico de úlcera péptica perfurada entre pacientes H. Pylori positivos, após erradicação, e negativos

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done.AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori.METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months.RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients.CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.

RACIONAL: O tratamento cirúrgico da úlcera péptica perfurada é assunto discutível. Os cirurgiões, por muitos anos, fizeram suas opções entre procedimentos de redução ácida, somente fechamento da perfuração - porém com maior chance de recidiva ulcerosa. Desde a comprovada vinculação da úlcera péptica e suas complicações à infecção gastroduodenal causada pelo Helicobacter pylori, houve recomendação para mudança na atitude dos cirurgiões na volta à operação mais simples com erradicação da bactéria.OBJETIVO: Analisar a recidiva ulcerosa em pacientes com úlcera perfurada H. pylori positiva que foram submetidos à simples sutura da lesão e omentopexia com erradicação da bactéria e compará-la com H. pylori negativo submetido ao mesmo tratamento cirúrgico.MÉTODOS: Cento e quatorze pacientes com úlceras pré-pilóricas, pilóricas e duodenais perfuradas foram atendidos com fechamento simples. Trinta dias após a operação submeteram-se à endoscopia digestiva alta com biópsias para testes da urease e histopatológicos. Foram divididos em dois grupos de acordo com o resultado dos testes: positivo e negativo.Os positivos foram erradicados e, junto com o grupo negativo, foram seguidos com endoscopias semestrais e testes de detecção para H. pylori procurando por recidiva ulcerosa e reinfecção no grupo erradicado.RESULTADOS: O grupo positivo foi formado por 25 pacientes, dos quais dois foram considerados não erradicáveis segundo os critérios do protocolo. Os demais foram seguidos por período médio de 38,21 meses e detectadas recidivas em quatro pacientes (17,39%), metade deles (8,69%) foram reinfectados. O grupo negativo foi formado por 26 pacientes, seguido por período médio de 38,28 meses e oito (30,76%) apresentaram recidiva ulcerosa. Não foi evidenciada diferença estatisticamente significativa entre os grupos...

Guidelines of Treatment for Bleeding Peptic Ulcer Disease / 대한소화기학회지

Peptic ulcer (PU) bleeding is the main cause of non-variceal gastrointestinal bleeding. Negative outcomes include re-bleeding and death, and many of the deaths are associated with decompensation of coexisting medical conditions precipitated by acute bleeding event. Accurate analysis of risk for clinical features can help physician to decide treatment modality. Endoscopy can detect bleeding stigmata and perform therapeutic hemostasis. Proton pump inhibitor (PPI) compared with placebo or H2RA reduces mortality following PU bleeding among patients with high-risk endoscopic findings, and reduces re-bleeding rates and surgical intervention. PPI treatment initiated prior to endoscopy in upper gastrointestinal (UGI) bleeding significantly reduces the proportion of patients with stigmata of recent hemorrhage (SRH) at index endoscopy but does not reduce mortality, re-bleeding or the need for surgery. The strategy of giving oral PPI before and after endoscopy, with endoscopic hemostasis for those with major SRH, is likely to be the most cost-effective. The treatment of H. pyori infection was found to be more effective than anti-secretory therapy in preventing recurrent bleeding from PU. H. pyori eradication alone and eradication followed by misoprostol (with switch to PPI, if misoprostol is not tolerated) are the two most cost-effective strategies to prevent ulcer bleeding among H. pyori-infected NSAID users, although the data cannot exclude PPIs also being cost-effective treatment. This review focuses specifically on the current treatment of patients with acute bleeding from a peptic ulcer.

Incidence, types and complications of chronic gastric ulcer [a change in the indications of surgery]

Peptic ulcers are defects in the gastrointestinal mucosa that extend through the muscularis mucosae. They persist as a function of the acid or peptic activity in gastric juice. The natural history of peptic ulcer ranges from resolution without intervention to the development of complications with the potential for significant morbidity and mortality, such as bleeding and perforation. Reviewing the incidence, types, complications and surgical indications for chronic gastric ulcer in Iraq and comparing it with other world reports. Retrospective study of the data base for 5166 patients with chronic peptic ulcer disease operated upon between 1965-2000. The incidence of chronic gastric ulcer, their age, sex, race, clinical presentation, diagnosis, types, size of ulcers and the indications of surgery during the period 1965-1980 [Group A] and 1981-2000 [Group B] were reviewed. Among the 5166 patients with peptic ulcer disease, 111 [2.15%] had chronic gastric ulcer.86 [77.5%] were male and 25 [22.5%] were females. 97 [87%] were Arabs and 14 [12.6%] were Kurds, a ratio: 8.1/1. Age ranges [mean] 19-79 [53.9] years. Duration of illness ranges [mean] 6 months to 9 years [4.2 years]. 68.5% of patients were among the low socioeconomic classes. 77.9% of males were smokers. Barium study showed the ulcer in the 89 patients examined. Malignancy was excluded by endoscopy and biopsy in 91 and frozen section biopsy during surgery in 49 patients. Types of ulcer were; Type I: 47 [42.3%], Type II: 44 [39.6%], Type III: 14 [12.6%] and Type IV 6 [5.4%] patients. The Size of ulcers was; < 2 cm 23 [20.7%], 2-4 cm 57 [51.4%] and > 4 cm 31 [27.9%] patients. Indications for surgery in Group A [67 patients] versus Group B [44 patients] were; dyspepsia 51 [67.1%] v 11 [25%], gastric outlet obstruction 9 [13.4%] v 18 [40.9%], bleeding 6 [9%] v 13 [29.5%] and perforation one [1.5%] v 2 [4.5%] patients. Surgical procedures were; vagotomy and drainage in 77 [69.4%] and B-I partial gastrectomy in 34 [30.6%] patients. 2 [1.8%] died post-operatively, 11 lost to follow after 6-9 months and 98 patients were followed for 5-32 years. Evidence of recurrent stomal ulcer in one patient. The incidence of chronic gastric ulcer in Iraq is low compared to chronic DU a ratio 1/45.5. Mean age 53.9 years. Male/female: 3.4/1 .Arabs/Kurds: 6.9/1. Coexistence of chronic duodenal ulcer with chronic gastric ulcer was 39.6%. The indications for surgery during the period 1965-1980 versus the period 1981-2000 were; elective in 51 [76%] v 11 [25%] and urgent or emergency in 16 [24%] v 33 [75%] patients. Operations were; vagotomy and drainage in 69.4% and resection in 30.6% of patients

Reparación videolaparoscópica con parche de epiplón en pacientes con úlceras gastroduodenales perforadas: primera experiencia en el Hospital Universitario de Caracas / Laparoscopic repair with omental patch in patients with perforated gastroduodenal ulcers: first experience at the Hospital Universitario de Caracas

El objetivo de este trabajo consistió en aplicar por primera vez en nuestro hospital la técnica laparoscópica de reparación de úlcera gastroduodenal perforada con cierre primario y colocación de parche de epiplón mediante la confección de nudos intracorpóreos a 8 pacientes masculinos, con edades comprendidas entre los 28 y los 74 años, que consultaron a la emergencia del Hospital Universitario de Caracas, con cuadro clínico de abdomen agudo sugestivo de perforación gastroduodenal, en el período comprendido entre noviembre de 2003 y septiembre de 2004. La edad promedio fue 48 años. El tiempo de evolución clínica osciló entre 6 y 48 horas, con un promedio de 11,31 horas. El tiempo operatorio promedio fue 160 minutos. En promedio el dolor posoperatorio fue de 2/10 según EVA (escala visualanalógica para dolor). El promedio de hospitalización fue de 7,85 días. El reintegro a las actividades cotidianas fue en promedio de 13 días. No hubo necesidad de conversión a técnica abierta en ningún caso. Se presentaron complicaciones en 2 pacientes, uno de ellos por reapertura del cierre primario y otro quien presentó colección intrabdominal, ambos fueron reintervenidos de forma abierta, sin complicaciones ulteriores. No hubo mortalidad. La reparación videolaparoscópica constituye un método seguro y efectivo, con excelente resultado estético y menor dolor posoperatorio, por lo que se recomienda ampliamente para el tratamiento de emergencia de los cuadros de úlcera gastroduodenal perforada.

The objective of this work consist to apply for first time in our hospital the laparoscopic repair technique for perforated gastroduodenal ulcers with primary closure and ommental patch using intracorporeal knots. Eight male patients were consults to emergency room of Hospital Universitario de Caracas with ages between 28 and 74 years old, presents clinical syndrome of acute abdomen suggest of perforated gastroduodenal ulcer within period of 2003 November to 2004 September. The mean age was 48 years old. The clinical evolution time before surgery was oscillate between 6 and 48 hours with mean of 11.31 hours. Mean surgery time was 160 minutes. Postoperative pain was 2/10 according to VAS (visual-analog scale for pain). Mean hospitalization days was 7.85 days. Reintegration to daily activities was in mean 13 days. There was not need to conversion to open technique in any case. There were complications in two patients, one of them with reopened of repair site and the other with intrabdominal collection, both were operated in open way without posterior complications. No mortality was occurs. Laparoscopic repair method is secure and effective with excellent cosmetic results and less postoperative pain so we recommended for emergency treatment of perforated gastroduodenal ulcer.

Avaliação tardia de doentes gastrectomizados por úlcera péptica: aspectos clínicos, endoscópicos e histopatológicos / Late follow-up of gastrectomized patients for peptic ulcer: clinical, endoscopic and histopathological aspects

RACIONAL: Atualmente são raras as vezes em que é necessária a realização de uma gastrectomia, já que os inibidores da bomba de prótons associados aos esquemas antibióticos usados para erradicar o Helicobacter pylori, mudaram o enfoque do tratamento da úlcera péptica. OBJETIVOS: Avaliar tardiamente os doentes submetidos a gastrectomia parcial no tratamento da úlcera péptica, em época em que o Helicobacter pylori ainda não era erradicado de forma intencional, incluindo os sintomas pós-operatórios em comparação com os pré-operatórios e a incidência de síndromes pós-gastrectomias; avaliação endoscópica, incluindo o tipo de cirurgia realizada e os achados macroscópicos da mucosa do coto gástrico, duodeno ou jejuno, dependendo do tipo de reconstrução; avaliação histopatológica, incluindo a pesquisa da bactéria por dois métodos: histológico e teste de urease; e sua possível associação presente no estômago remanescente com as avaliações clínica, endoscópica e histopatológica pós-operatórias. CASUíSTICAS E MÉTODOS: Cinqüenta e nove doentes gastrectomizados por úlcera péptica entre os anos de 1985 e 1993 foram avaliados, sendo que 44 (74,6 por cento) eram do sexo masculino e tinham idade média de 55 anos, com variação de 31 a 77 anos, passaram por entrevista clínica e por exame endoscópico. O Helicobacter pylori foi pesquisado nas peças cirúrgicas ressecadas, para constatação da sua presença ou não no pré-operatório. RESULTADOS: A avaliação clínica no pós-operatório tardio mostrou que 96 por cento dos doentes apresentaram excelentes e bons resultados (Visick I e II). Os sintomas pós-operatórios mais comuns foram dispepsia leve e outras queixas, como diarréia, anemia e dumping, que ocorreram, respectivamente, em 11 (18,6 por cento), 2 (3,4 por cento) e 2 (3,4 por cento) casos. A reconstrução tipo Billroth I trouxe melhores resultados clínicos tardios, quando comparada com as reconstruções tipo Billroth II e Y-de-Roux. Na avaliação endoscópica, a maioria dos doentes (52,5 por cento) apresentou exame normal, enquanto que os demais apresentaram gastrites enantematosa (37,3 por cento) e erosiva (8,5 por cento). Recidiva ulcerosa ocorreu em dois doentes (3,4 por cento). Na análise histopatológica, foi observada incidência elevada de gastrite crônica (98,3 por cento). A presença de Helicobacter pylori ocorreu em 86 por cento dos doentes antes da cirurgia e em 89,8 por cento no pós-operatório tardio...

Operaciones conservadoras de órganos en la úlcera péptica duodenal / Conserving-organ operations in duodenal peptic ulcer

Se realizó un estudio descriptivo de los resultados obtenidos del tratamiento quirúrgico electivo de la úlcera péptica duodenal en 107 pacientes durante el periodo de 1985 a 1995. Se utilizaron como procederes quirúrgicos la vagotomía altamente selectiva en 56 pacientes y la vagotomía altamente selectiva anterior con vagotomía troncular posterior en 51 pacientes. La indicación quirúrgica más frecuente fue la no respuesta al tratamiento médico en el 90,7 por ciento de los casos. De ambas técnicas, la vagotomía altamente selectiva anterior con vagotomía troncular posterior fue la de menor tiempo quirúrgico y menor estadía posoperatoria. El 32,7 por ciento de los pacientes tuvieron complicaciones posoperatorias. La disfagia (14 por ciento) y las diarreas (17 por ciento) fueron las más frecuentes. Hubo recidivas en el 4,6 por ciento de los casos. Se obtuvieron buenos resultados, según la clasificación de Visick, en el 92,6 por ciento de los pacientes y no hubo mortalidad posoperatoria