ABSTRACT
La yeyunostomía implica el abocamiento del yeyuno a la piel y se utiliza como vía de nutrición enteral en pacientes con imposibilidad de alimentarse por vía oral; en quienes la gastrostomía no es una opción adecuada. La misma puede realizarse por vía mínimamente invasiva, como percutánea y laparoscópica
Subject(s)
Humans , Female , Middle Aged , Stomach Neoplasms/pathology , Jejunostomy/methods , Laparoscopy/methods , Audiovisual Aids , Video-Audio MediaABSTRACT
Introducción: Las perforaciones del esófago cervical por traumas externos son lesiones raras asociadas con una morbilidad significativa. Los mecanismos primarios son los traumatismos penetrantes por heridas de bala, cerca del 80 por ciento de los casos, seguidas de las heridas con armas cortopunzantes en el 15 al 20 por ciento. Objetivo: Describir los criterios actuales sobre la conducta y enfoque terapéutico ante el trauma penetrante de esófago cervical. Métodos: Se realizó revisión descriptiva narrativa, de fuentes primarias y secundarias que abordaron el tema durante el primer semestre del año 2021. Los criterios de selección de los artículos a examinar fueron determinados, entre otros, por el objetivo de la actual revisión. Desarrollo: El estándar diagnóstico para estas lesiones, en ausencia de inestabilidad hemodinámica, se basó en estudios como el esofagograma, la endoscopia y la tomografía. La reparación primaria con o sin reforzamiento fue la opción más utilizada, aunque las condiciones locales y tipo de lesión en esófago cervical marcan en gran medida el proceder a realizar. Conclusiones: Las lesiones traumáticas del esófago cervical son raras pero muy mórbidas. El tratamiento depende de la ubicación de la perforación y cualquier lesión concurrente. La mayoría de los casos son susceptibles de reparación primaria con refuerzo de colgajo. Otros principios del tratamiento incluyen el drenaje adecuado alrededor de la reparación, la descompresión del esófago y el estómago (mediante sonda nasogástrica o sonda de gastrostomía) y nutrición enteral distal (yeyunostomía de alimentación). El cirujano ha de ser incisivo en los esfuerzos por descubrir la lesión de forma temprana y manejarla adecuadamente(AU)
Introduction: Cervical esophageal perforations for external trauma are rare injuries associated with a significant morbidity. The primary mechanisms are penetrating trauma for gunshot wounds, accounting for about 80 percent of cases, followed by sharp weapon injuries, accounting for 15 percent to 20 percent. Objective: To describe the current criteria on the behavior and therapeutic approach to cervical esophageal penetrating trauma. Methods: A descriptive narrative review was carried out of primary and secondary sources that addressed the subject during the first semester of the year 2021. The selection criteria of the articles to be examined were determined, among others, by the objective of the current review. Development: The standard diagnosis for these lesions, in the absence of hemodynamic instability, was based on studies such as esophagogram, endoscopy and tomography. Primary repair with or without reinforcement was the most commonly used option, although local conditions and type of lesion in cervical esophagus largely mark the procedure to be performed. Conclusions: Traumatic cervical esophageal injuries are rare but very morbid. Their treatment depends on the location of the perforation and any concurrent injury. Most cases are amenable to primary repair with flap reinforcement. Other principles of treatment include adequate drainage around the repair, decompression of the esophagus and stomach (by nasogastric tube or gastrostomy tube), as well as distal enteral nutrition (feeding jejunostomy). The surgeon must be incisive in efforts to discover the injury early and manage it appropriately(AU)
Subject(s)
Humans , Male , Wounds, Penetrating/etiology , Jejunostomy/methods , Esophageal Perforation , Esophagus/injuries , Epidemiology, Descriptive , Endoscopy/methodsABSTRACT
ABSTRACT Background: In high-income countries, morbid obesity is a growing health problem that has already reached epidemic proportions. When performing a laparoscopic gastric bypass several operative methods exist. Aim: To describe the institutional experience using a knotless unidirectional barbed suture (V-Loc 180/Covidien, Mansfield, MA) to create a hand-sewn gastrojejunostomy (GJ) and jejunojejunostomy (JJ) during bariatric surgery. Methods: Evaluation of a case series of 87 morbidly obese patients who underwent laparoscopic gastric bypass with a hand-sewn gastrojejunostomy (GJA) and jejunojejunostomy (JJA) between 01/2015 and 06/2017. The patients were divided into two groups: in group I, GJA und JJA sutures were performed using the knotless unidirectional barbed suture; in group II, GJA and JJA were sutured with resorbable multifilament thread (Vicryl® 3/0 Ethicon, Livingstone, UK). The recorded data on gender, age, BMI, ASA score, operative time, postoperative morbidity, length of hospital stay, and reoperation, were analyzed and compared. Results: All procedures were completed laparoscopically with no mortality. The mean operative time was 123.23 (±30.631) in group I and 127.57 (±42.772) in group II (p<0.05). The postoperative complications did not differ significantly between the two groups. Early complications were observed for two patients (0.9%) in the barbed suture group and for one patient (0.42%) in the multifilament suture group (p<0.05). In group I two patients (0.9%) required reoperation: on the basis of jejunojejunal stenosis in one patient, and local abscess near the gastrojejunostomy, without a leakage, in the other. In group II one patient (0.42%) required reoperation due to stenosis of the GJA. The duration of hospital admission was similar for both groups: 3.36 (±0.743) days in group I vs. 3.38 (±1.058) days in group II (p<0.05). Conclusion: The novel anastomotic technique is a safe and effective method and can be applied to gastrojejunal anastomosis and jejunojejunal anastomosis in laparoscopic gastric bypass.
RESUMO Racional : Em países de alta renda, a obesidade mórbida é um problema crescente de saúde que já atingiu proporções epidêmicas. Ao realizar um bypass gástrico laparoscópico, existem vários métodos operatórios. Objetivo: Descrever a experiência institucional utilizando uma sutura farpada unidirecional sem nós (V-Loc 180/Covidien, Mansfield, MA) para criar gastrojejunostomia (JJ) e jejunojejunostomia (JJ) costuradas à mão durante a cirurgia bariátrica. Métodos: Avaliação de uma série de casos com 87 pacientes obesos mórbidos submetidos ao bypass gástrico por videolaparoscopia com gastrojejunostomia (JJA) e jejunojejunostomia (JJA) suturados à mão entre 01/2015 e 06/2017. Os pacientes foram divididos em dois grupos; no grupo I, GJA e JJA as suturas foram realizadas com a sutura farpada unidirecional sem nós e, no grupo II, com sutura multifilamentar reabsorvível (Vicryl® 3/0 Ethicon, Livingstone, UK). Foram analisados e comparados os dados registrados sobre gênero, idade, IMC, escore ASA, tempo operatório, morbidade pós-operatória, tempo de internação hospitalar e reoperação. Resultados: Todos os procedimentos foram concluídos por laparoscopia sem mortalidade. O tempo cirúrgico médio foi 123,23 (±30,631) no grupo I e 127,57 (±42,772) no grupo II (p<0,05). As complicações pós-operatórias não diferiram significativamente entre os dois grupos. Complicações precoces foram observadas em dois pacientes (0,9%) no grupo de sutura farpada e um (0,42%) no de sutura multifilamentar (p<0,05). No grupo I, dois pacientes (0,9%) necessitaram de reoperação; um devido à estenose jejunojejunal e abscesso local próximo à gastrojejunostomia, sem vazamento, no outro. No grupo II, um paciente (0,42%) necessitou de reoperação por estenose da GJA. O tempo de internação hospitalar foi semelhante nos dois grupos: 3,36 (±0,743) dias no grupo I vs. 3,38 (±1,058) dias no grupo II (p<0,05). Conclusão: A nova técnica de anastomose é método seguro e eficaz e pode ser aplicado nas anastomoses gastrojejunal e jejunojejunal no bypass gástrico laparoscópico.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Obesity, Morbid/surgery , Suture Techniques/instrumentation , Equipment Safety/instrumentation , Bariatric Surgery/instrumentation , Polyglactin 910 , Anastomosis, Surgical/instrumentation , Anastomosis, Surgical/methods , Jejunostomy/instrumentation , Jejunostomy/methods , Gastric Bypass/instrumentation , Gastric Bypass/methods , Prospective Studies , Treatment Outcome , Bariatric Surgery/methods , Jejunum/surgery , Length of StayABSTRACT
El absceso hepático piógeno es una enfermedad secundaria a un foco primario cuyas vías básicas de infección son: vía biliar y el sistema portal. Se presenta el caso de un paciente de 23 años que presenta dolor a nivel de hemiabdomen superior que refiere haber ingerido un alambre en forma de gancho. Sobre la base de los antecedentes y exámenes complementarios se interpreta la posibilidad de un absceso hepático secundario a un cuerpo extraño. Se realizó drenaje del absceso y yeyunotomía para extracción del cuerpo extraño endoluminal. Actualmente, el paciente se encuentra totalmente recuperado(AU)
Pyogenic hepatic abscess is a disease secondary to a primary focus whose basic pathways of infection are the bile duct and the portal system. The case is presented of a 23-year-old patient with pain at the level of the upper hemiabdomen and who reported having ingested a wire in the shape of a hook. Upon the basis of the antecedents and complementary examinations the possibility is interpreted for a hepatic abscess secondary to a foreign body. Drainage of the abscess and jejunostomy were performed to remove the foreign body from the endoluminal system. Currently, the patient is fully recovered(AU)
Subject(s)
Humans , Male , Adult , Foreign Bodies/diagnostic imaging , Infections/surgery , Liver Abscess, Pyogenic/diagnostic imaging , Jejunostomy/methodsABSTRACT
Los quistes del colédoco son dilataciones congénitas de la vía biliar que afectan fundamentalmente a la población pediátrica, de ellas, el tipo 1 es el más frecuente. Pueden producir graves complicaciones y el tratamiento quirúrgico de elección es la resección total de la lesión seguida de hepaticoenterostomía. Actualmente, este proceder se realiza por vía laparoscópica con buenos resultados. El objetivo del trabajo es reportar el tratamiento laparoscópico de un quiste de colédoco tipo 1 en un paciente de 5 años. No hubo complicaciones posoperatorias y los resultados estéticos y funcionales al año de seguimiento son excelentes. Se concluye que la resección laparoscópica en quistes de colédoco tipo 1 es posible y se sugiere continuar con su implementación(AU)
Choledochal cysts are congenital dilatation of the bile ducts that typically affect the pediatric population. Cases of its type 1 are the more frequent. Serious complications may occur and the surgical treatment of election is the lesions' total resection followed by hepaticoenterostomy. Today this procedure is carried out by laparoscopic way with good outcomes. The objective of this paper is to report a choledochal cyst type 1´s laparoscopic treatment in a 5-year-old patient. There were not postoperative complications and the aesthetic and functional results after one-year follow-up are excellent. The choledochal cysts´ laparoscopic resection is concluded to be possible and its implementation is suggested to follow(AU)
Subject(s)
Humans , Child, Preschool , Cholecystectomy, Laparoscopic/methods , Choledochal Cyst/surgery , Jejunostomy/methodsABSTRACT
Objectives: The choledochal cyst has an incidence of 1 in 100.000-150.000. The purpose of this study was to analyze the variables introduced for the optimization in the diagnosis and treatment of choledochal cyst. Material and Methods: Retrospective study of patients treated in our center by hepatic-jejunostomy and Roux-Y, from September 1988 to November 2012. We analyzed 40 variables including age, symptoms, type of cysts, diagnostic tests, changes in surgical technique, complications and outcomes. Results: Eighteen patients (66.6 percent female) were grouped according to the age of presentation: Prenatal (< 1 month), Early (124), Delayed (> 24 months). The most common symptoms were jaundice and abdominal pain (for early-onset and late-onset respectively). The 83.3 percent presented choledochal cysts type I, the ultrasound was sufficient for diagnosis in 94.4 percent. Since 2004 we modified the surgical technique, performing laparoscopic dissection of the bile duct and cyst, adding a mini-laparotomy (3-5 cm) for hepatic-jejunostomy with 40 cm intestinal loop using polypropylene suture. One complication was observed since 2004, one case of partial dehiscence of the anastomosis resolved with conservative treatment and a cholangitis in 1 patient with hepatic and renal polycystic. In 2012, 83.3 percent are asymptomatic. Conclusions: The diagnostic have been simplified, in more than 90 percent of cases was done by ultrasound; advances in minimally invasive surgery and creation of descending loop of 40 cm, have helped to improve the prognosis of choledochal cyst.
Objetivos: El quiste de colédoco presenta una incidencia de 1 en 100.000-150.000. El propósito de este estudio fue analizar las variables introducidas para la optimización en el diagnóstico y tratamiento del quiste de colédoco. Material y Métodos: Estudio retrospectivo de pacientes intervenidos en nuestro centro de quiste de colédoco mediante hepático-yeyunostomía en Y de Roux, desde septiembre de 1988 a noviembre de 2012. Se analizan 40 variables incluyendo edad, sintomatología, tipo de quiste, pruebas diagnósticas, cambios en la técnica quirúrgica, complicaciones y evolución. Resultados: 18 pacientes (66,6 por ciento mujeres) fueron agrupados de acuerdo a la edad de presentación: Prenatal (< 1 mes); Precoz (1-24 meses); Tardía (> 24 meses). Los síntomas más frecuentes fueron ictericia y dolor abdominal (para los de inicio precoz y tardío respectivamente). El 83,3 por ciento presentaban quistes de colédoco tipo I; siendo suficiente la ecografía para el diagnóstico en el 94,4 por ciento. A partir de 2004 modificamos la técnica quirúrgica, realizando por vía laparoscópica la disección de la vía biliar y mediante laparotomía mínima (3-5 cm) hepático-yeyunostomía con asa descendente de 40 cm, empleando sutura de polipropileno, observando desde el 2004, sólo 1 dehiscencia parcial de la anastomosis, resuelta con tratamiento conservador y 1 colangitis en paciente con poliquistosis hepática y renal. En el año 2012 el 83,3 por ciento están asintomáticos. Conclusiones: El diagnóstico se ha simplificado, en más de 90 por ciento de los casos se realiza sólo con ecografía; los avances en cirugía mínimamente invasiva y la creación de asa descendente de 40 cm, han logrado optimizar el pronóstico del quiste de colédoco.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Infant , Child, Preschool , Child , Young Adult , Middle Aged , Choledochal Cyst/surgery , Choledochal Cyst/diagnosis , Jejunostomy/methods , Age of Onset , Anastomosis, Roux-en-Y , Clinical Evolution , Postoperative Complications , Retrospective StudiesABSTRACT
OBJECTIVE: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. MATERIALS AND METHODS: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. RESULTS: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). CONCLUSION: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Analysis of Variance , Feasibility Studies , Gastrectomy/methods , Gastric Stump , Gastrostomy/instrumentation , Jejunostomy/methods , Operative Time , Punctures/methods , Radiography, Interventional , Retrospective Studies , Suture Anchors , Treatment OutcomeABSTRACT
La iatrogenia biliar cobra una importancia particular en nuestros tiempos, pues después de la era laparoscópica su incidencia no solo se mantiene en altos índices, sino que la envergadura de las lesiones tiende a ser mayor. Se presentan pacientes con complicaciones más complejas que demandan de esfuerzos extraordinarios y de un enfoque multidisciplinario. Se presenta un paciente con una lesión iatrogénica de la vía biliar, complicado con una cirrosis biliar, un absceso hepático con fístula biliopleural y se explica su manejo, con buenos resultados. Con este trabajo se pretende comunicar un caso singularmente complejo que fue enviado a nosotros después de múltiples intentos de reparación y estenosis de una lesión iatrogénica de la vía biliar(AU)
Biliary iatrogeny gains particular importance in our times, since its incidence after laparoscopic era is not only high but the significance of the lesions tends to be greater. More patients with more complex complications demanding extraordinary efforts and multidisciplinary approach appear. Here is a patient suffering iatrogenic lesion of the bile duct, complicated with biliary cirrhosis, a hepatic abscess with biliary pleural fistula was presented, along with the management of the patient with good results. This paper was intended to show a particularly complex case that was referred to our service after a lot of repair attempts and the stenosis of iatrogenic lesion of the bile duct(AU)
Subject(s)
Humans , Female , Adult , Bile Ducts/injuries , Cholecystectomy, Laparoscopic/methods , Iatrogenic Disease/epidemiology , Jejunostomy/methods , Liver Cirrhosis, Biliary/pathologyABSTRACT
Las lesiones iatrogénicas de las vías biliares se han convertido en una verdadera preocupación de la comunidad de cirujanos a nivel mundial dado su significativo aumento después del advenimiento de la cirugía laparoscópica, pues se reportan anualmente miles de casos. Presentamos a un paciente víctima de una lesión iatrogénica compleja, que requirió 5 intervenciones para su solución. Consecuentemente, el propósito de este trabajo es recomendar que siempre, esta cirugía de gran complejidad técnica, debe ser realizada solamente en centros de referencia y con personal de experiencia(AU)
Iatrogenic lesions of the bile ducts has become a real concern for the surgeons worldwide, given the marked rise of this health problem after the emergence of laparoscopic surgery, since thousands of cases are annually reported. Here is the case of a male patient suffering complex iatrogenic lesion, who required 5 surgeries to solve the problem. The objective of this paper was to recommend that this highly complex surgery be always performed by experienced medical staff in reference centers(AU)
Subject(s)
Humans , Male , Middle Aged , Bile Ducts/injuries , Cholangiography/methods , Urinary Bladder Calculi/surgery , Cholecystectomy, Laparoscopic/methods , Iatrogenic Disease/epidemiology , Jejunostomy/methods , Medical Errors/adverse effectsABSTRACT
Se presenta a un paciente de 37 años de edad que acude a nuestro Cuerpo de Guardia politraumatizado, con lesiones torácicas y abdominales, con síntomas y signos sugestivos de fracturas costales múltiples, con hemotórax derecho y hemoperitoneo, corroborado imaginológicamente y en la punción abdominal. Se realiza pleurostomía mínima intermedia y laparotomía exploratoria. Se le encuentran lesiones hepáticas de los segmentos VI, V, VIII y IV, con una profundidad mayor de 3 cm, además, deserosamientos en las asas delgadas intestinales y colon. Se realiza hepatorrafia y empaquetamiento hepático. Posteriormente van apareciendo complicaciones, por lo que tiene que ser reintervenido en máqs de 60 ocasiones. Entre ellas, la aparición de una fístula de alto gasto, que lo llevó a la desnutrición y a la permanencia con el abdomen expuesto durante 7 meses hasta el egreso. Se revisa la literatura correspondiente a estas entidades(AU)
A 37 years-old multi-traumatized male patient went to our emergency service. He had many injures in the thorax and the abdomen, together with symptoms and signs suggestive of multiple costal fractures, with right hemothorax and hemoperitoneum, all of which was confirmed by imaging techniques and by abdominal puncture. Minimal intermediate pleurostomy and exploratory laparoscopy were performed. We found hepatic lesions in the 6th, 5th, 8th and 4th segments, over 3 cm deep; additionally, the loss of serosa from the intestinal ansae and from the colon. Hepatorrhaphy and hepatic packing were also performed. Later on, more complications appeared, so he had to be re-operated more than 60 times. The occurrence of a high output fistula led him to malnutrition and his abdomen remained exposed for 7 months until he was finally discharged from hospital. This paper also presented a literature review on this topic(AU)
Subject(s)
Humans , Male , Adult , Thoracic Injuries/diagnostic imaging , Cholecystostomy/methods , Intestinal Fistula/surgery , Jejunostomy/methods , Cholangiography/methodsABSTRACT
OBJECTIVE: The aim of this study was to evaluate the frequency of postoperative biliary stricture and its risk factors in patients undergoing surgery for type I choledochal cyst. MATERIALS AND METHODS: A total of 35 patients with type I choledochal cyst underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy between August 2004 and August 2011. Their medical records and radiologic images (including endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, pancreatobiliary computed tomography, or ultrasound) were retrospectively analyzed to evaluate the frequency of postoperative biliary stricture and its risk factors. RESULTS: Postoperative biliary stricture was found in 10 (28.6%) of 35 patients. It developed more frequently in patients with type Ia choledochal cyst (53.8%, 7 of 13 patients) than in patients with type Ic choledochal cyst (13.6%, 3 of 22 patients), which was statistically significant (p = 0.011). There were no significant associations between other factors and postoperative biliary stricture. CONCLUSION: Type Ia is a risk factor of postoperative anastomotic stricture. Therefore, preoperative radiologic subclassification of type Ia and Ic may be useful in predicting postoperative outcomes of choledochal cysts.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Anastomosis, Roux-en-Y , Biliary Tract Surgical Procedures/methods , Chi-Square Distribution , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Choledochal Cyst/pathology , Jejunostomy/methods , Laparoscopy/methods , Postoperative Complications/diagnosis , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography/methodsABSTRACT
OBJECTIVE: The aim of this study was to evaluate the frequency of postoperative biliary stricture and its risk factors in patients undergoing surgery for type I choledochal cyst. MATERIALS AND METHODS: A total of 35 patients with type I choledochal cyst underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy between August 2004 and August 2011. Their medical records and radiologic images (including endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, pancreatobiliary computed tomography, or ultrasound) were retrospectively analyzed to evaluate the frequency of postoperative biliary stricture and its risk factors. RESULTS: Postoperative biliary stricture was found in 10 (28.6%) of 35 patients. It developed more frequently in patients with type Ia choledochal cyst (53.8%, 7 of 13 patients) than in patients with type Ic choledochal cyst (13.6%, 3 of 22 patients), which was statistically significant (p = 0.011). There were no significant associations between other factors and postoperative biliary stricture. CONCLUSION: Type Ia is a risk factor of postoperative anastomotic stricture. Therefore, preoperative radiologic subclassification of type Ia and Ic may be useful in predicting postoperative outcomes of choledochal cysts.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Anastomosis, Roux-en-Y , Biliary Tract Surgical Procedures/methods , Chi-Square Distribution , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Choledochal Cyst/pathology , Jejunostomy/methods , Laparoscopy/methods , Postoperative Complications/diagnosis , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography/methodsABSTRACT
Antecedentes: el uso de un asa en omega excluida, es de utilidad para preservar el órgano anastomosado y es de ejecución sencilla. Objetivo: mostrar una experiencia personal con esta técnica. Lugar de Aplicación: Hospital Público y práctica privada Diseño: observacional retrospectivo Población: 26 pacientes que requirieron anastomosis entre el hepático, el estómago, el esófago o pseudoquistes de páncreas con un asa yeyunal. Método: Los pacientes, recibieron anastomosis con asa larga en omega, con Braun al pie y exclusión a lo Hivet-Warren-Praderi, entre Junio de 1997 y Junio de 2005. Resultados: la edad media fue 53,85 años; en un 73 por fueron mujeres. Se realizaron 14 hepático, 3 esófago, 7 gastro y 2 cisto yeyuno anastomosis. Fallecieron 3 pacientes en el perioperatorio, es decir el 11,54 por ciento. Se reoperó un paciente por sangrado del muñón pancreático. No se registraron dehiscencias anastomóticas. Conclusiones: las anastomosis con asa en omega y exclusión del asa aferente son técnicamente reproducibles y ofrecen buenos resultados.
Background: the use of a excluded omega loop is useful to preserve the anastomosed organ and it is of simple execution. Objectives: to show a personal experience with this technique. Application place: public hospital and private practice. Design: retrospective observation. Population: 26 patients that required anastomosis among the hepatic duct, stomach, esophagus or pseudocysts of pancreas with a yeyunal loop. Method: the patients received anastomosis with large loop in omega with Braun side to side anastomosis and exclusion as Hivet-Warren-Praderi, between June 1997 and June 2005. Results: the average was 53,85 years; 73 per cent were women. There were made 14 hepatic, 7 gastric, 3 esophagus and 2 cysts yeyuno anastomosis. Two patients died in the per-operation, that is to say an 11.54 per cent. A patient was reoperated because of pancreatic stump bleeding. There was not anastomotic dehiscence. Conclusion: the anastomosis with omega loop and exclusion of the afferent loop are technically reproducible and they offer good results.
Subject(s)
Humans , Male , Female , Young Adult , Middle Aged , Anastomosis, Surgical/methods , Anastomosis, Roux-en-Y , Cholecystectomy/methods , Postoperative Complications , Gastrectomy/methods , Digestive System Surgical Procedures/mortality , Digestive System Surgical Procedures/methods , Jejunostomy/methodsABSTRACT
To investigate the safety and efficacy of percutaneous endoscopic gastrostomy/jejunostomy [PEG/PEJ] combined with percutaneous transhepatic biliary drainage [PTCD] in treating malignant biliary obstruction. Nine patients [6 males and 3 females, average age 71.3 +/- 5.5 years] with complete obstruction of the biliary tract were treated with PEG/PEJ after PTCD. The PEG/PEJ and PTCD tubes were linked outside of the abdominal wall to direct the externally drained bile back to the jejunum through the PEG/PEJ intestinal tube. Clinical symptoms and liver function were assessed following the treatment. The operations were successfully completed in the 9 patients within 40 min [average 35 +/- 2.9 min]. Clinical symptoms such as jaundice, abdominal distension, stomachache and diarrhea appeared but improved within 7 days of the operation. Serum levels of bilirubin, aspartate aminotransferase and alanine aminotransferase were reduced [p < 0.01] 4 weeks following the treatment. There were no procedural complications. Combined PEG/PEJ and PTCD appeared to be safe and effective in the management of malignant biliary obstruction. Further, larger-scale studies will be needed to verify findings of this report
Subject(s)
Humans , Male , Female , Jaundice, Obstructive/therapy , Bile Ducts, Intrahepatic/surgery , Endoscopy, Gastrointestinal , Gastrostomy/methods , Jejunostomy/methods , Cholangiocarcinoma/surgery , Radiography, Interventional , Liver Neoplasms , Pancreatic Neoplasms , Liver Function Tests , Treatment OutcomeSubject(s)
Humans , Female , Gastrostomy/methods , Jejunostomy/methods , Laparoscopy , Endoscopy , DrainageSubject(s)
Humans , Child , Adult , Enteral Nutrition , Gastrostomy , Jejunostomy , Gastrostomy/methods , Jejunostomy/methods , LaparotomyABSTRACT
Se presenta la experiencia del autor en diferentes técnicas quirúrgicas de colangioyeyunostomías y resecciones hepáticas asociadas a nivel del tercio proximal de la convergencia biliar entre 1988 y el 2004. Análisis de datos obtenidos de la experiencia personal llevada prospectivamente por el autor, en colangioyeyunostomías realizadas a nivel del tercio proximal del hepático común y en la convergencia, entre 1988 y el 2004, referidos al mismo a cuatro diferentes Instituciones: Servicio de Cirugía II del Hospital Ildemaro Salas (IVSS), Servicio de Cirugía Digestiva del Hospital Oncológico "Padre Machado", Servicio de Cirugía III del Hospital "Domingo Luciani" (IVSS) y al Instituto de Clínicas y Urología Tamanaco. Se excluyeron pacientes con estenosis bajas. Se analizaron 164 casos. 64,4 por ciento de las cirugías se hicieron por lesiones intraoperatorias ocurridas durante colecistectomías. El 33,3 por ciento se debieron a enfermedad maligna. 154 (93.9 por ciento) fueron centrales o hiliares y 10 (6,09 por ciento) fueron periféricas. Se efectuaron 32 resecciones hépáticas, 23 (71,7 por ciento) fueron resecciones menores y 9 (28,13 por ciento) fueron mayores. Se realizaron 95 (57,9 por ciento) reintervenciones de las vías biliares: 90 (94.4 por ciento) por patología benigna y 5 (5.2 por ciento) por patología maligna. La morbilidad fue de 21,9 por ciento y la mortalidad fue de 7,9 por ciento (61,5 por ciento sepsis). 88.68 por ciento de los pacientes con lesión de la vía biliar, presentaron buena evolución. Los pacientes con estenosis biliares tratadas con las diferentes técnicas quirúrgicas descritas en el presente estudio mejoraron su calidad de vida en comparación con las condiciones preoperatorias de dichos pacientes.
Subject(s)
Humans , Female , Middle Aged , Anastomosis, Surgical/methods , Cholecystectomy/methods , Bile Ducts, Intrahepatic/surgery , Bile Ducts, Intrahepatic/injuries , Cholangiography/methods , Bile Ducts/injuries , Gastroenterology , Jejunostomy/methodsABSTRACT
Introducción: El cáncer gástrico, es la principal causa de mortalidad masculina por cáncer en Chile. Su tratamiento, la gastrectomía total radical, se ha visto revolucionada por la introducción de la sutura mecánica, que supone disminuye la morbimortalidad y tiempo operatorio. Material y método: Estudio descriptivo. Se revisaron todas las gastrectomías totales por cáncer gástrico con sutura mecánica, realizadas en el Hospital Regional de Valdivia y se compararon con igual número realizadas con sutura manual, mediante análisis estadístico por software STATA 10.0. Resultados: Se recolectaron 45 casos, 21 con sutura manual y 24 con sutura mecánica. La edad promedio fue de 61 años para cada grupo. El sexo predominante fue el masculino. La frecuencia de fístulas de la anastomosis esofagoyeyunal fue igual en ambos grupos. Tanto el tiempo operatorio como la estadía postoperatoria también fueron similares. Conclusión: La introducción de la sutura mecánica en la anastomosis esofagoyeyunal, no ha producido un impacto importante en el descenso de la morbilidad, incluyendo la fistula anastomótica; como tampoco en la mortalidad ni en el tiempo operatorio.
Subject(s)
Humans , Male , Female , Middle Aged , Anastomosis, Roux-en-Y/methods , Esophagostomy/methods , Gastrectomy/methods , Stomach Neoplasms/surgery , Surgical Stapling , Jejunostomy/methods , Chile/epidemiology , Surgical Wound Dehiscence/epidemiology , Epidemiology, Descriptive , Esophageal Fistula/epidemiology , Esophageal Fistula/etiology , Intestinal Fistula/epidemiology , Intestinal Fistula/etiology , Length of Stay , Reoperation , Suture Techniques , Time FactorsABSTRACT
Introdução: O Colangiocarcinoma hilar (CCH) constitui-se em doença desafidora para seu diagnóstico e tratamento. Apesar dos avanços tecnológicos alcançados na Medicina e dos conhecimentos fisiopatológicos atuais, o CCH ainda apresenta modestos índices de ressecabilidade e de sobrevida, com índices consideráveis de morbi-mortalidade quando do seu tratamento cirúrgico radical. A coloangiojejunostomia em segmento III tem se tornado cirurgia paliativa atraente para os pacientes portadores de CCH, pois propicia sobrevida confortável sem os inconvenientes do prurido e da icterícia, melhorando o metabolismo hépático. Relato de caso: Paciente com CCH irressecável que referia icterícia, prurido intenso e ascite moderada, submetido a tratamento cirúrgico através da colangiojejunostomia em segmento III, teve boa evolução pós-operatória com a diminuição da icterícia e desaparecimento do prurido sendo a ascite contolada com diuréticos e paracenteses. Considerações finais: Os autores crêem que a colangiojejunostomia em segmento III é tratamento cirúrgico eficaz em casos selecionados oferecendo ao doente um final de vida sereno