Educação permanente em saúde sobre estomias intestinais com enfermeiros de São Bento do Sul (SC): relato de experiência / Permanent health education on intestinal ostomy with nurses from São Bento do Sul (SC): Experience report / Educación permanente en salud sobre estomales intestinales con enfermeros de São Bento do Sul (SC): Informe de experiencia

Introdução:No Brasil a pessoa estomizadaé contemplada com diretrizes e políticas públicas, além de ser entendida como uma deficiência, sendo necessário assim um cuidado integral, exigindo do profissional que presta a assistência e/ou orientação educação permanente. Objetivo:Relatar uma experiência sobre cuidados de enfermagem com estomias intestinais aos enfermeiros atuantes na Secretaria Municipal de São Bento do Sul/Santa Catarina Metodologia: Trata-se deum estudo descritivo qualitativo do tipo relato de experiência, que se deu através de capacitação realizada em Junho de 2022, com os enfermeiros que atuam na secretaria municipal de saúde de São Bento do Sul, o qual conta com 44 enfermeiros atuantes em 21 unidades básicas de saúde , com a temática cuidados de enfermagem com estomia de eliminação', tendo o mesmo sido ministrado por enfermeira estomaterapeuta no formato presencial com discussão teórica e prática.Resultados e discussão: O Ministério da Saúde vem incentivando práticas formativas aos profissionais inseridos nos serviços, amparadasna Política Nacional de Educação Permanente. Uma vez que a formação de enfermeiros no Brasil é generalista, os cursos e capacitação se tornam uma ferramenta fundamental para uma atuação reflexiva. Dos 44 enfermeiros atuantes no município, participaram do treinamento 21 (47,72%), atendendo ao critério de ao menos um profissional por UBS, podendo este ser um multiplicador de conhecimento, estratégia importante da educação permanente em saúde. Ao final do curso, foram desenvolvidos fluxos de atendimento com os participantes, buscando a descentralização do cuidado para as unidades básicas de cada enfermeiro, favorecendo a criação de vínculo dos pacientes com a equipe. Conclusões:Umprofissional orientado e seguro em sua prática implica diretamente na segurança do paciente, nesse sentido a realização de atividades como cursos, capacitações e eventos, principalmente quando se trata de pacientes estomizados se tornam importantes ferramentas de aprimoramento profissional (AU).

Introduction:In Brazil, people with a stoma are covered by guidelines and public policies, in addition to being understood as a disability, thus requiring comprehensive care, requiring permanent education from the professional who provides assistance and/or guidance. Objective:To report an experience on nursing care with intestinal ostomies to nurses working at the Municipal Secretariat of São Bento do Sul/Santa Catarina. Methodology:This is a qualitative descriptive study of the experience report type, which took place through training carried out in June 2022, with nurses who work at the municipal health department of São Bento do Sul, which has 44 nurses working in 21 basic health units, with the theme of nursing care with elimination stoma', with the same being taught by a stoma therapy nurse in a face-to-face format with theoretical and practical discussion. Results and discussion:The Ministry of Health has been encouraging training practices for professionals working in services, supported by the National Permanent Education Policy. Since the training of nurses in Brazil is generalist, courses and training become a fundamental tool for reflective action. Of the 44 nurses working in the city, 21 (47.72%) participated in the training, meeting the criteria of at least one professional per UBS, which could be a knowledge multiplier, an important strategy for continuing health education. At the end of the course, care flows were developed with the participants, seeking to decentralize care to each nurse's basic units, favoring the creation of a bond between patients and the team.Conclusion: A professional who is oriented and confident in his practice directly implies patient safety, in this sense, carrying out activities such as courses, training and events, especially when dealing with stoma patients, become important tools for professional improvement (AU).

Introducción:En Brasil, las personas ostomizadasestán cubiertas por directrices y políticas públicas, y entendidas como una discapacidad, por lo que requieren atención integral y profesionales que brinden asistencia y/o orientación en educación continua. Objetivo:Relatar la experiencia como enfermerostrabajando en la Secretaría Municipal de São Bento do Sul/Santa Catarina en la atención de ostomías intestinales. Metodología:Estudio cualitativo descriptivo, del tipo relato de experiencia, realizado a través de una capacitación realizada en junio de 2022, con cuarenta y cuatro enfermeros que actúan en la Secretaría Municipal de Salud de São Bento do Sul, con el tema "Asistencia de enfermería a la eliminación del estoma". Impartido por una enfermera estomatóloga en formato presencial con discusión teórica y práctica. Resultados y discusión:El Ministerio de Salud viene incentivando prácticas de formación de profesionales que actúan en los servicios, apoyados en la Política Nacional de Educación Permanente. Dado que la formación de enfermeros en Brasil es generalista, los cursos y capacitaciones se convierten en una herramienta fundamental para la acción reflexiva. De los 44 enfermeros que actúan en la ciudad, 21 (47,72%) participaron de la capacitación, cumpliendo con el criterio de al menos un profesionalpor UBS, lo que podría ser un multiplicador de conocimientos, una estrategia importante para la educación continua en salud. Al final del curso, se desarrollaron flujos de atención con los participantes, buscando descentralizar la atención hacia las unidades básicas de cada enfermero, favoreciendo la creación de vínculo entre los pacientes y el equipo. Conclusiones:Un profesional orientado y confiado en su práctica implica directamente la seguridad del paciente, en este sentido, la realización de actividades como cursos, capacitaciones y eventos, especialmente cuando se trata de pacientes estomáticos se convierten en importantes herramientas de superación profesional (AU).

Progress in the study of intragastric occupancy device for weight reduction / 中南大学学报(医学版)

Obesity is a global public health problem that imposes a heavy economic burden on society. The current main strategies for treating obesity include lifestyle interventions, pharmacological treatments, endoscopic treatments and metabolic surgery. With the development of medical technology, weight reduction by intragastric occupancy devices represented by intragastric balloons and intragastric capsules are gradually emerging. Intragastric balloons are used to reduce weight by occupying the volume of the stomach with balloons filled with different volumes of gas or liquid, among which ReShape, Orbera, Obalon, Elipse and Spatz balloons are gradually used in patients with mild to moderate obesity due to their non-invasive, high safety and reusable advantages. Intragastric capsules are recommended in overweight and obese patients for weight loss through hydrogels with transient superabsorbent swelling properties and completely noninvasive. Both approaches achieve weight loss by limiting gastric volume, increasing satiety and reducing food intake. Despite the presence of adverse gastrointestinal events associated with nausea, vomiting, and abdominal distention, they offer new ideas for the non-invasive clinical treatment of obesity.

Resultados de la cirugía de sustitución esofágica con tubo gástrico invertido vía ascenso retroesternal en dos hospitales pediátricos / Results of esophageal substitution surgery with inverted gastric tube via retrosternal lift

Resumen Objetivo: Describir resultados de la cirugía de sustitución esofágica con tubo gástrico invertido, vía ascenso retroesternal en dos hospitales pediátricos durante el período marzo 2015 a marzo 2018. Materiales y Método: Un estudio observacional, transversal, con recolección de datos retrospectivo, donde se incluyeron todos los expedientes de pacientes que presentaban patología del esófago por causa adquirida o congénita que fueron operados de sustitución esofágica con tubo gástrico invertido en dos hospitales pediátricos durante 3 años. Resultados: Encontramos 29 niños sometidos a sustitución esofágica, de los cuales 27 cumplieron criterios de inclusión. La edad comprendida entre 2 y 17 años. El 63% corresponde al sexo femenino. La causa más frecuente de sustitución esofágica es por estenosis esofágica por ingesta caustica (92,59%). El 70% presentó algún tipo de complicación luego de la cirugía. La fístula esofagocutánea es la complicación principal con 33,33%. La permanencia en la unidad de cuidados intensivos es menor de 24 horas en un 74% de los niños. Se inicia la vía oral en casi la mitad de casos entre los 10-12 días de posquirúrgico, la estancia hospitalaria es en promedio 18,5 días. La mortalidad es 3,7%. Conclusión: La sustitución esofágica por tubo gástrico invertido vía ascenso retroesternal, es una técnica comparable en resultados a la interposición de colón. Para los autores, el estómago es un órgano ideal para realizar la reconstrucción esofágica, y sus complicaciones son manejables.

Aim: To describe the results of esophageal replacement surgery with an inverted gastric tube via retrosternal ascent in two pediatric hospitals during the period March 2015 to March 2018. Materials and Method: an observational, cross-sectional study with retrospective data collection that included all the records of patients with esophageal discontinuity due to acquired or congenital causes who underwent esophageal replacement surgery with an inverted gastric tube in two pediatric hospitals for 3 years. Results: We found 29 children undergoing esophageal replacement, of which 27 met inclusion criteria. The age between 2 to 17 years. 63% corresponds to the female sex. The most frequent cause of esophageal replacement is esophageal stricture due to caustic ingestion (92.59%). 70% presented some type of complication after surgery. The esophagocutaneous fistula is the main complication with 33.33%. The stay in the intensive care unit is less than 24 hours in 74% of children. The oral route is started in almost half of cases between 10-12 days after surgery; the hospital stay is on average 18.5 days. Mortality is 3.70%. Conclusión: The esophageal substitution by inverted gastric tube via retrosternal ascent is a technique comparable in results to the interposition of the colon. For the authors, the stomach is an ideal organ to perform esophageal reconstruction, and its complications are manageable.

Conducta actual frente la hemorragia digestiva alta: desde el diagnóstico al tratamiento / Current behavior against Upper Digestive Hemorrhage: from diagnosis to treatment

Resumen La hemorragia digestiva alta (HDA) es una emergencia médico-quirúrgica común que debe ser tratada precozmente por su alta morbimortalidad. Corresponde a sangrado del esófago, estómago o del duodeno proximal, y se divide en etiología no variceal y variceal. Dentro de las no variceales destaca la úlcera péptica como la más frecuente, siendo esta producida por un desbalance entre factores protectores y agresivos. Por otro lado, en las hemorragias variceales destacan las várices gastroduodenales, las cuales son consecuencia del aumento de la presión portal. La incidencia de la HDA a nivel mundial varía entre 37 a 172 casos por cada 100.000 habitantes por año y la mortalidad entre un 5 y un 14% según diferentes estudios. Lamentablemente, no existen cifras nacionales fidedignas de incidencia y prevalencia. El médico debe conocer bien la presentación clínica y la fisiopatología para ser asertivo en la sospecha, diagnóstico y manejo de esta patología. En cuanto al tratamiento, el enfrentamiento se divide en el manejo de urgencias y luego endoscópico, puesto que la resucitación temprana intensiva puede reducir la morbimortalidad en pacientes con HDA. A continuación se hará una revisión actualizada enfocada en los aspectos más relevantes del manejo de esta patología. Se obtuvieron los datos de Pubmed y Scielo, específicamente la búsqueda de artículos originales y de revisiones sistemáticas con las palabras "hemorragia digestiva alta", "úlcera péptica", "várices esofágicas" y otras relacionadas. Los criterios usados fueron artículos preferentemente menores a 5 años de publicación en revistas científicas de alto índice de impacto.

Upper gastrointestinal bleeding (UHD) is a common medical-surgical emergency that must be treated early due to its high morbidity and mortality. It corresponds to bleeding from the esophagus, stomach, or proximal duodenum, and is divided into non-variceal and variceal etiology. Among the non-variceal, the peptic ulcer stands out as the most frequent, being this produced by an imbalance between protective and aggressive factors. On the other hand, in variceal hemorrhages gastroduodenal varices stand out, are a consequence of increased portal pressure. The incidence of HDA worldwide varies between 37 to 172 cases per 100,000 inhabitants per year and mortality between 5 to 14% according to different studies. Unfortunately, there are no reliable national statistics of incidence and prevalence. The physician must have a good understanding of the clinical presentation and pathophysiology to be assertive in the suspicion, diagnosis, and management of this pathology. Regarding treatment, the confrontation is divided into emergency management and then endoscopic, because early intensive resuscitation can reduce morbidity and mortality in patients with UHD. This is an updated review which will be focused on the most relevant aspects of the management of this pathology. Data were obtained from Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "upper gastrointestinal bleeding", "peptic ulcer", "esophageal varices" and other related words. The criteria used were articles preferably less than 5 years old in scientific journals with a high impact index.

A novel classification and strategy choice of digestive tract reconstruction procedures after function-preserving gastrectomy for early gastric caner / 中华胃肠外科杂志

Function-preserving gastrectomy (FPG) can be regarded as a concrete embodiment of precise treatment for early gastric cancer. Digestive tract reconstruction plays an important role in FPG. The aims of reconstruction mainly include the preservation of normal digestive tract and digestive function, the reconstruction of pivotal anatomical structure, and the consequent improvement of postoperative quality of life. We establish a new classification of digestive tract reconstruction based on the different role of digestive tract reconstructions in FPG for early gastric cancer, meanwhile we briefly summarize current progress and elucidate surgical indications. We hope that it can provide theoretical reference for surgeons to choose the appropriate procedure of digestive tract reconstruction after FPG.

Safety and feasibility of laparoscopic double-flap technique in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction tumors larger than 5 cm / 中华胃肠外科杂志

Objective: To investigate the safety and feasibility of laparoscopic double-flap technique (Kamikawa) in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction (EGJ) leiomyoma and gastrointestinal stromal tumor (GIST) with the maximum diameter >5 cm. Methods: A descriptive case-series study was used to retrospectively analyze the data of patients with EGJ leiomyoma and GIST undergoing laparoscopic-assisted proximal gastrectomy and double-flap technique (Kamikawa) at the Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from September 2017 to March 2019. All the tumors invaded the cardia dentate line, and the maximum diameter was >5 cm. After the exclusion of patients requiring emergency surgery and complicating with severe cardiopulmonary diseases, a total of 4 patients, including 3 males and 1 female with age of 29-49 years, were included in this study. After laparoscopic-assisted proximal gastrectomy, the residual stomach was pulled out of the abdominal cavity and marked with methylene blue at the proximal end 3~4 cm from the anterior wall of the residual stomach in the shape of "H". The gastric wall plasma muscular layer was cut along the "H" shape, and the space between the submucosa and the muscular layer was separated to both sides along the longitudinal incision line to make the seromuscular flap. The residual stomach was put back into the abdominal cavity. Under laparoscopy, 4 stitches were intermittently sutured at the upside of "H" shape and 4-5 cm from the posterior wall of the esophageal stump. The stump of the esophagus was cut open, and the submucosa and mucosa were cut under the "H" shape to enter the gastric cavity. The posterior wall of the esophageal stump was sutured continuously with the gastric stump mucosa and submucosa under laparoscopy. The anterior wall of the esophageal stump was sutured continuously with the whole layer of the residual stomach. The anterior wall of the stomach was sutured to cover the esophagus. The anterior gastric muscle flap was sutured and embedded in the esophagus to complete the reconstruction of digestive tract. The morbidity of intraoperative complications and postoperative reflux esophagitis and anastomosis-related complications were observed. Results: All the 4 patients completed the operation successfully, and there was no conversion to laparotomy. The median operative time was 239 (192-261) minutes, the median Kamikawa anastomosis time was 149 (102-163) minutes, and the median intraoperative blood loss was 35 (20-200) ml. The abdominal drainage tube and gastric tube were removed, and the fluid diet was resumed on the first day after surgery in all the 4 patients. The median postoperative hospitalization time was 6 (6-8) days. Postoperative pathology revealed 3 leiomyomas and 1 GIST. There were no postoperative complications such as anastomotic leakage or stenosis, and no reflux symptoms were observed. The median follow-up time was 22 (11-29) months after the operation, and no reflux esophagitis occurred in any of the 4 patients by gastroscopy. Conclusion: For >5 cm EGJ leiomyoma or GIST, double-flap technique (Kamikawa) used for digestive tract reconstruction after proximal gastrectomy is safe and feasible.

Shorten preoperative fasting and introducing early eating assistance in recovery after gastrojejunal bypass? / Abreviar jejum pré-operatório e introduzir alimentação precoce auxiliam na recuperação após bypass gastrojejunal?

ABSTRACT Rational: The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation. Aim: To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass. Methods: Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated. Results: There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups. Conclusions: The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient's recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.

RESUMO Racional: A resposta metabólica ao trauma cirúrgico é potencializada pelo jejum pré-operatório prolongado que contribui para o aumento da resistência à insulina. Esta manifestação é mais intensa no 1º e 2º dias de pós-operatório e é diretamente proporcional ao porte da operação. Objetivo: Comparar se a abreviação do jejum pré-operatório e a realimentação precoce no pós-operatório associado à restrição hídrica no trans e pós-operatório interferem na evolução dos pacientes submetidos ao bypass gastrojejunal. Métodos: Foram recrutados 80 pacientes indicados ao bypass gastrojejunal em Y-de-Roux. Eles foram distribuídos randomicamente em dois grupos: ringer lactato (RL) que fizeram jejum de 6 h para sólidos, administrando 50 g de maltodextrina em 100 ml de água mineral 2 h antes do início da anestesia e de soro fisiológico (SF) que fizeram jejum de 12 h para sólidos e líquidos. A anestesia foi padronizada para os dois grupos. Durante o procedimento operatório no RL foi administrado 1500 ml solução de ringer lactato e no SF 2500 ml de soro fisiológico (0,9% de cloreto de sódio). Em ambos os grupos foram analisados durante a intubação a ocorrência ou não de bronco-aspiração e mensurado o volume gástrico residual após abertura da cavidade abdominal. No pós-operatório do Grupo RL, os pacientes iniciaram dieta liquida após 24 h do término do procedimento operatório; no Grupo SF foi mantido jejum nas primeiras 24 h, prescrição de 2000 ml de soro fisiológico e início da dieta líquida restrita com 36 h. Cada paciente realizou no pós-operatório imediato, ainda na sala de cirurgia, a dosagem de CPK, insulina, sódio, potássio, ureia, creatinina, PaCO2, pH e bicarbonato e em 48 h repetiu-se a coleta destes exames. Resultados: Não houve episódios de broncoaspiração e fístulas gastrojejunais em ambos os grupos. Na análise do volume residual gástrico dos grupos SF e RL, as médias de volume foram respectivamente 16,5 e 8,8 apresentando significância estatística entre os grupos. Nos exames laboratoriais não houve diferença entre os grupos no sódio; nível sérico de potássio no SF foi maior (p=0,029); ureia e creatinina maiores no RL; CPK não apresentou diferenças; insulina no grupo SF foram maiores; pH foi maior no SF; bicarbonato de sódio evidenciou diferença significativa em todos o momentos; PaCO2 no RL foi maior. Na análise de incidência de náusea e flatos não foram observados significância estatística entre os grupos. Conclusões: A abreviação do jejum pré-operatório e a realimentação precoce no pós-operatório de bypass gastrojejunal em Y-de-Roux com a aplicação de programas como ERAS ou Projeto Acerto aceleram a recuperação do paciente, diminuindo o volume gástrico residual e o nível de insulina, e não predispõem complicações.

Type 2 myocardial infarction resulted from the left thoracic stomach

Abstract The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.

Síndrome de Rapunzel gigante con complicación atípica: Reporte de un caso / Giant Rapunzel syndrome with atypical complication: Report of a case

El síndrome de Rapunzel es una forma inusual y rara de tricobezoar gástrico que se extiende al intestino delgado. La formación es debida a la ingestión continua de cabello la cual lleva a la impactación del mismo junto con moco y alimento, pero es infrecuente que se produzca perforación gástrica. Reportamos el caso de una paciente de sexo femenino de 16 años de edad admitida en nuestra institución con antecedentes de depresión y cuadro clínico caracterizado por náuseas, epigastralgia severa y pérdida patológica de peso. Al examen físico se evidenció un abdomen tenso con reacción peritoneal, la tomografía de abdomen contrastada evidenció un estomago distendido con contenido heterogéneo que se extiende hacia el duodeno, hidroneumoperitoneo y líquido en fondo de saco de Douglas, por lo que se le decidió realizar una laparotomía exploratoria que evidenció perforación en cara anterior de estómago que es una complicación infrecuente, por lo que se procedió a la extracción del tricobezoar gigante con extensión duodenal; evolucionando de forma favorable remitiéndose la paciente a controles ambulatorios con psiquiatría; finalmente se le realizó una endoscopía alta a los 6 meses que evidenció la cicatriz del procedimiento quirúrgico.

Rapunzel syndrome is an unusual and rare form of gastric trichobezoar that extends into the small intestine. The formation is due to the continuous ingestion of hair which leads to the impaction of the hair along with mucus and food, but it is rare that gastric perforation occurs. We report the case of a female patient of 16 years of age admitted to our institution with a history of depression and clinical symptoms characterized by nausea, severe epigastralgia and pathological loss of weight. The physical examination showed a tense abdomen with a peritoneal reaction. Contrast-enhanced tomography showed a distended stomach with a heterogeneous content that extended to the duodenum, hydro pneumoperitoneum, Douglas sack bottom liquid, and it was decided to perform an exploratory laparotomy. Showed perforation in the anterior face of the stomach which is infrequent, so we proceeded to the extraction of giant trichobezoar with duodenal extension; Evolving favorably, the patient being referred to outpatient controls with psychiatry; Finally, a high endoscopy was performed at 6 months, which evidenced the scar of the surgical procedure.

Ursodeoxycholic acid in the prevention of gallstones in patients subjected to Roux-en-Y gastric bypass

Abstract Purpose: To evaluate the contribution of ursodeoxycholic acid (UDCA) in the first 12 months after Roux-en-Y gastric bypass in the prevention of gallstone formation. Methods: A community-based clinical trial was conducted. A total of 137 patients were included in the study; 69 were treated with UDCA, starting 30 days after the surgery, at a dose of 150 mg twice daily (300 mg/day) over a period of 5 consecutive months (GROUP A), and 68 were control patients (GROUP B). The patients were followed-up, and ultrasonography was performed to determine the presence of gallstones at various times during follow-up. Demographic, anthropometric and comorbid indicators were obtained. The data were subjected to normality tests and evaluated using appropriate tests. Results: Patients did not differ in their baseline characteristics. Of the 69 patients who used UDCA, only one patient developed cholelithiasis (1%), whereas 18 controls (26%) formed gallstones (OR = 24.4, p <0.001). Also, other factors were found not to influence the formation of calculi, such as pre-operative or postoperative hepatic steatosis or diabetes (p = 0.759, 0.468, 0.956). Conclusion: The results demonstrated that patients who did not use UDCA showed a 24.4-fold greater probability of developing cholelithiasis.

Pharyngo-ileo-colo-anastomosis with micro-vascular blood supply augmentation for esophago-gastric replacement due to esophago-gastric necrosis after caustic ingestion / Faringo-íleo-colo-anastomose com suprimento sanguíneo microvascular para substituição esofagogástrica por necrose esofagogástrica após ingestão cáustica

ABSTRACT Background : Complete esophago-gastric necrosis after caustic ingestion is a challenging surgical scenario for reconstruction of the upper digestive transit. Aim : To present a surgical technique for reconstruction of the upper digestive tract after total esophagectomy and gastrectomy due to esophageal and gastric necrosis Method: The transit was re-established by means of a pharyngo-ileo-colic interposition with microsurgical arterial and venous anastomosis for augmentation of blood supply. Colo-duodeno-anastomosis and ileo-transverse colic anastomosis were performed for complete digestive transit reconstruction. Result: This procedure was applied in a case of 41 years male attempted suicide by ingesting alkali caustic liquid (concentrated sodium hydroxide). Total necrosis of the esophagus and stomach occurred, which required initially total esophago-gastrectomy, closure at the level of the crico-pharyngeal sphincter and jejunostomy for enteral feeding with a highly deteriorated quality of life . The procedure was performed later and there were no major early and late postoperative complications and normal nutritional conditions were re-stablished. Conclusion: The procedure is feasible and must be managed by multidisciplinary team in order to re-establish a normal quality of life.

RESUMO Racional: A necrose esofagogástrica completa após ingestão cáustica é um cenário cirúrgico desafiador para a reconstrução do trânsito digestivo alto. Objetivo: Apresentar uma técnica cirúrgica para reconstrução do trato digestivo superior após esofagectomia total e gastrectomia por necrose esofágica e gástrica. Método: O trânsito foi restabelecido por interposição faringo-íleo-cólica com anastomose arterial e venosa microcirúrgica com aumento do suprimento sanguíneo. Adicionalmente, anastomose colo-duodeno-anastomótica e íleo-transversa foram realizadas para reconstrução completa do trânsito digestivo. Resultado: Este procedimento foi aplicado em um homem de 41 anos com tentativa de suicídio pela ingestão de líquido cáustico alcalino (hidróxido de sódio concentrado). Ocorreu necrose total do esôfago e do estômago, o que exigiu inicialmente esofagogastrectomia total, fechamento ao nível do esfíncter cricofaríngeo e jejunostomia para alimentação enteral produzindo qualidade de vida altamente deteriorada. O procedimento foi realizado mais tardiamente e não houve maiores complicações pós-operatórias precoces e tardias e condições nutricionais normais foram restabelecidas. Conclusão: O procedimento é viável e deve ser manejado por equipe multidisciplinar a fim de restabelecer a qualidade de vida normal.

Rotinas e condutas em cirurgias para as doenças malignas e benignas do esôfago, estômago e duodeno / Preoperative care in surgeries for the malignant and benign diseases of oesophagus, stomach and duodenum

Resumo: As doenças que acometem o trato digestivo alto, mais precisamente o esôfago, estômago e duodeno revestem-se de grande importância não só devido à relevância epidemiológica (com incidências elevadas e crescentes), mas também pela intensidade dos sintomas e a gravidade das complicações, comprometendo de forma significativa a qualidade de vida dos seus portadores. Nas últimas décadas, os avanços nos cuidados a pacientes portadores de doenças benignas e malignas do aparelho digestivo superior se manifestaram por meio da introdução de novos métodos de diagnóstico e estadiamento, mudanças no paradigma das estratégias perioperatórias e desenvolvimento de novos procedimentos, técnicas e vias de acesso cirúrgicos; ampliando ainda mais o espectro de opções diagnósticas e terapêuticas. Diante do amplo acesso a uma quantidade imensa de informações provida pela medicina atual, o desenvolvimento de protocolos de cuidados pré- e pós-operatórios baseados em evidências, resulta em auxílio na tomada de decisão e certamente também contribui para melhoria dos resultados cirúrgicos. Pela complexidade associada, é imperativo que o seguimento destes pacientes seja realizado em serviços terciários, muitos dos quais também se constituem em hospitais de ensino, com participação contínua de profissionais em treinamento e aprendizado. O presente projeto objetiva à elaboração de manual de rotinas e condutas específicas para o tratamento cirúrgico das doenças malignas e benignas do esôfago, estômago e duodeno; fundamentado em evidências clínicas e com aplicação em hospital de nível terciário. No contexto de hospitais universitários, de ensino e de referência ¿ que contem com equipes médicas, de enfermagem e multidisciplinares, além do envolvimento de alunos e médicos residentes em treinamento ¿ a implementação de protocolos de assistência possui relevância ainda maior, visto que não apenas diferencia e favorece melhores resultados operatórios, menor morbimortalidade e maior sobrevida em geral, mas também uniformiza condutas facilitando o processo de aprendizagem(AU)

Abstract: The diseases that affect the upper digestive tract, the esophagus, stomach and duodenum, are of great importance not only due to the epidemiological relevance (with high and increasing incidence), but also the intensity of the symptoms and the severity of the complications, compromising patients quality of life. Lately, the advances in patients care with benign and malignant diseases of the upper digestive system have consisted in the introduction of new diagnostic methods, changes in the paradigm of perioperative strategies and the development of new procedures, techniques and surgical access; expanding the spectrum of diagnostic and therapeutic options. Given the broad access to a vast amount of information provided by current medicine, the development of pre-and post-operative guidelines based on evidence, results in better decision making and certainly also contributes to improved surgical outcomes. Because of the associated complexity, it is imperative that the follow-up of these patients be performed in tertiary services, many of which also constitute teaching hospitals, with continuous participation of professionals in training and learning. The present project aims the elaboration of a guideline of specific routines and procedures for the surgical treatment of malignant and benign diseases of the esophagus, stomach and duodenum; based on clinical evidence. In the context of university, teaching and reference hospitals - which includes medical, nursing and multidisciplinary teams, as well as the involvement of students and physicians in training - the implementation of assistance protocols will have even greater influence, since it not only favors better overall survival, but also facilitates the learning process(AU)

Pre and postoperative ph monitoring and weight loss analysis in patients undergoing gastric plication in association with fundoplication / Comparação da phmetria pré e pós-operatória e análise da perda de peso em pacientes submetidos à plicatura gástrica associada à fundoplicatura

ABSTRACT Background : Obese patients with gastroesophageal reflux disease with pathological pH monitoring result may benefit from surgical treatment which is based on the fundoplication technique in association with laparoscopic gastric plication. The Nissen surgery is the gold standard for surgical treatment of gastroesophageal reflux disease, whereas laparoscopic gastric plication is a restrictive surgery that consists of the invagination of the greater curvature, resulting in weight loss. Aim: To compare pre and postoperative pHmetry results and to evaluate weight loss in patients submitted to gastroplasty with fundoplication. Method: Sixteen patients with class I body mass index with symptoms of gastroesophageal reflux with changes of stomach pH and/or erosive esophagitis seen in endoscopy were selected The evaluation of the weight and 24-h pH monitoring was performed preoperatively and postoperatively. The weight, body mass index, percentage of excess weight loss and DeMeester score of patients that underwent the surgery were evaluated pre and postoperatively. Results: Regarding pH monitoring, the average preoperative DeMeester index was 28.7, which was followed by a significant postoperative average reduction to 2.8 (p<0,001). Regarding the weight reduction, the average of weight loss was 13.6 kg and body mass index of 5.3 kg/m2 (p<0.001). Furthermore, the average percentage of excess weight loss was 53.9% (standard deviation=26.2). Conclusion: The combination of Nissen surgery and gastric plication is a viable procedure and appears to be an acceptable option for the treatment of gastroesophageal reflux disease in obese patients, especially patients with obesity class I.

RESUMO Racional: Pacientes que apresentam obesidade e doença do refluxo gastroesofágico comprovada com pHmetria, podem se beneficiar do tratamento cirúrgico que se baseia na união da técnica da fundoplicatura e gastroplicatura laparoscópicas. A operação de Nissen é o padrão-ouro para o tratamento cirúrgico; já a gastroplicatura laparoscópica é operação restritiva, cuja técnica é a invaginação intraluminar da parede da grande curvatura, o que resulta na perda de peso. Objetivo: Comparar os resultados da pHmetria pré e pós-operatórias e avaliar a perda de peso em pacientes submetidos à gastroplicatura com fundoplicatura. Método: Foram selecionados 16 pacientes com IMC em obesidade grau I, associado aos sintomas de doença do refluxo gastroesofágico, e com pHmetria alterada e/ou esofagite erosiva na endocopia digestiva alta. A avaliação do peso e da pHmetria de 24 h foi realizada no pré e pós-operatório. As variáveis foram: peso pré e pós-operatório, IMC, percentual da perda do excesso de peso e escore de DeMeester. Resultados: Dos 16 pacientes em relação à pHmetria a média pré-operatória do índice de DeMeester foi de 28,7, verificando-se na sequência redução significativa para média pós-operatória de 2,8 (p<0,001). Em relação ao peso, a média da redução foi de 13,6 kg e do índice de massa corporal de 5,3 kg/m2 (p<0,001). A média do percentual da perda do excesso de peso foi de 53,9%26,2±. Conclusão: A associação da operação de Nissen com a gastroplicatura é procedimento viável e opção aceitável para o tratamento de doença do refluxo gastroesofágico em pacientes com obesidade grau I.

ASSESSMENT OF THE GASTRO-JEJUNO-DUODENAL TRANSIT AFTER JEJUNAL POUCH INTERPOSITION / AVALIAÇÃO DO TRÂNSITO GASTROJEJUNODUODENAL APÓS INTERPOSIÇÃO DE ALÇA JEJUNAL

Background : The jejunal pouch interposition between the gastric body and the duodenum after the gastrectomy, although not frequent in the surgical practice today, has been successfully employed for the prevention and treatment of the postgastrectomy syndromes. In the latter, it is included the dumping syndrome, which affects 13-58% of the patients who undergo gastrectomy. Aim : Retrospective assessment of the results of this procedure for the prevention of the dumping syndrome. Methods : Fourty patients were selected and treatetd surgically for peptic ulcer, between 1965 and 1970. Of these, 29 underwent vagotomy, antrectomy, gastrojejunalduodenostomy at the lesser curvature level, and the 11 remaining were submitted to vagotomy, antrectomy, gastrojejunal-duodenostomy at the greater curvature level. The gastro-jejuno-duodenal transit was assessed in the immediate or late postoperative with the contrasted study of the esophagus, stomach and duodenum. The clinical evolution was assessed according to the Visick grade. Results : Of the 40 patients, 28 were followed with the contrast evaluation in the late postoperative. Among those who were followed until the first month (n=22), 20 (90%) had slow gastro-jejuno-duodenal transit and in two (10%) the transit was normal. Among those who were followed after the first month (n=16), three (19%) and 13 (81%) had slow and normal gastric emptying, respectively. None had the contrasted exam compatible with the dumping syndrome. Among the 40 patients, 22 underwent postoperative clinical evaluation. Of these, 19 (86,5%) had excellent and good results (Visick 1 and 2, respectively). Conclusions : The jejunal pouch interposition showed to be a very effective surgical procedure for the prevention of the dumping syndrome in gastrectomized patients.

Racional : A interposição de alça jejunal entre o corpo gástrico e o duodeno após a antrectomia, apesar de pouco frequente na prática cirúrgica atual, tem sido empregada com sucesso na prevenção e tratamento das síndromes pós-gastrectomias. Entre estas se inclui a síndrome de dumping, que acomete 13-58% dos pacientes gastrectomizados. Objetivo : Avaliação retrospectiva dos resultados desse procedimento na prevenção da síndrome de dumping. Métodos : Foram selecionados 40 pacientes todos encaminhados para tratamento cirúrgico de úlcera cloridropéptica entre 1965 e 1970. Destes, 29 foram submetidos à vagotomia, antrectomia, gastrojejunoduodenostomia no nível da pequena curvatura, e os 11 restantes à vagotomia, antrectomia, gastrojejunoduodenostomia no nível da grande curvatura. O trânsito gastrojejunoduodenal foi avaliado no pós-operatório imediato ou tardio por meio do estudo contrastado de esôfago, estômago e duodeno. A evolução clínica no pós-operatório foi avaliada segundo a classificação de Visick. Resultados : Dos 40 pacientes, 28 foram acompanhados com o estudo contrastado no pós-operatório tardio. Entre aqueles de até o 1º mês de pós-operatório (n=22), 20 (90%) apresentaram o trânsito gastrojejunoduodenal lento e dois (10%) tiveram o trânsito normal. Entre os que puderam ser acompanhados após o 1º mês (n=16), três (19%) e 13 (81%) mostraram o esvaziamento gástrico lento e normal, respectivamente. Nenhum apresentou o estudo contrastado compatível com a síndrome de dumping. Entre os 40 doentes, 22 foram submetidos à avaliação clínica pós-operatória. Destes, 19 (86,5%) apresentaram excelentes e bons resultados (Visick 1 e 2, respectivamente). Conclusões : A interposição de alça jejunal mostrou-se procedimento cirúrgico bastante eficaz na prevenção da síndrome de dumping em pacientes gastrectomizados.

LATE RESULTS OF ESOPHAGOGASTRIC DEVASCULARIZATION AND SPLENECTOMY ASSOCIATED WITH ENDOSCOPIC TREATMENT IN PATIENTS WITH SCHISTOSOMIASIS / RESULTADOS TARDIOS DA DESCONEXÃO ÁZIGO-PORTAL E ESPLENECTOMIA ASSOCIADOS AO TRATAMENTO ENDOSCÓPICO PÓS-OPERATÓRIO EM PACIENTES ESQUISTOSSOMÓTICOS

Background:Schistosomiasis is endemic problem in Brazil affecting about three to four million people, and digestive hemorrhage caused by esophageal varices rupture is the main complication of the disease. Surgical treatment has become a therapeutic option, especially for secondary prophylaxis after at least one episode of bleeding. The surgical technique used by the vast majority of surgeons for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Although with good postoperative results, rebleeding rate is significant, showing the need to follow-up endoscopy in all patients.Aim:To evaluate long-term results of patients submitted to esophagogastric devascularization and splenectomy and postoperative endoscopic treatment regarding esophageal varices caliber and rebleeding rates.Methods:A retrospective study of 12 patients underwent esophagogastric devascularization and splenectomy followed for more than five years.Results: All patients showed varices size reduction, and no patient had postoperative bleeding recurrence.Conclusion:Esophagogastric devascularization and splenectomy decreased significantly the esophageal variceal size when associated with endoscopic follow-up, being effective for bleeding recurrence prophylaxis.

Racional:A esquistossomose acomete três a quatro milhões de pessoas no Brasil, sendo a hemorragia digestiva por ruptura das varizes esofágicas a principal complicação da doença. O tratamento cirúrgico é empregado como profilaxia secundária em pacientes com história de hemorragia prévia. A cirurgia mais utilizada é a desconexão ázigo-portal mais esplenectomia, técnica com bons resultados, porém com índice de recidiva hemorrágica considerável, fazendo necessário o seguimento endoscópico destes pacientes.Objetivo:Analisar a evolução tardia dos pacientes no que se refere à recidiva hemorrágica e ao comportamento das varizes esofágicas quando submetidos à desconexão ázigo-portal mais esplenectomia e tratamento endoscópico pós-operatório.Método:Foram avaliados retrospectivamente 12 pacientes submetidos à desconexão ázigo-portal mais esplenectomia com acompanhamento endoscópico pós-operatório maior de cinco anos.Resultados:Todos tiveram redução significativa do calibre das varizes e nenhum paciente apresentou sangramento pós-operatório.Conclusão:A desconexão ázigo-portal mais esplenectomia diminuiu significativamente o calibre das varizes esofágicas quando associada ao tratamento endoscópico pós-operatório. Este tratamento foi efetivo para a profilaxia da recidiva hemorrágica.

Effects of inferior splenic lobe pole fixation and gastrosplenic peritoneal membrane section on the vitality of the remanent of subtotal splenectomy in rats

PURPOSE: To investigate the vitality of the spleen lower pole after subtotal splenectomy with suture to the stomach and after posterior peritoneal gastro-splenic membrane section, using macro and microscopic evaluations. METHODS: Sixty Wistar rats were used in this study and were randomly distributed in the three groups: Group 1: (n=20), subtotal splenectomy with lower pole preservation, Group 2: (n=20) subtotal splenectomy with lower pole preservation and suture to the stomach, Group 3: subtotal splenectomy with lower pole preservation and posterior peritoneal gastrosplenic ligament section. The animals were sacrificed 45 days after the surgery and the spleen lower poles were removed for macroscopic and microscopic examination. RESULTS: All animals in this series survived. No macroscopic differences were encountered between the groups. Microscopic evaluation observed statistic difference concerning fibrosis between group 1 and 3 (p≤0.05), but the analysis for necrosis and inflammation presented no differences. CONCLUSION: Vitality of the spleen lower pole after subtotal splenectomy is minimally modified when it is fixed to the stomach or when the posterior peritoneal gastrosplenic ligament is resected. .

Celiotomy by plastrotomy in a yellow-footed tortoise (geochelone denticulata)

One herein reports a successful case of celiotomy by plastrotomy for removal of foreign bodies in yellow-footed tortoise (Geochelone denticulata). The animal was treated at the Veterinary Hospital of the Federal University of Piaui, with appetite loss, regurgitation, constipation, lethargy, reluctance to walk and slightly reddish ocular mucous membranes. Radiographic examination was performed, confirming the presence of foreign bodies in the stomach. The tortoise underwent celiotomy by plastrotomy for the removal of the foreign bodies. The opening of the plastron was performed through the abdominal shields, with the aid of a circular mini grinding saw. One performed an incision in the midline between the two abdominal veins to access the abdominal cavity. A gastrotomy for removal of the foreign bodies (nails, toothpicks, stones, pieces of plastic, glass and crockery pieces) was performed after the location of the stomach. The surgery was successful and confirmed with radiographic evaluation in the immediate postoperative period. The celiotomy by plastrotomy for removal of foreign bodies in that animal proved to be a viable, very important and safe technique to the survival of chelonians.

Neste relato descreve-se um caso bem sucedido de celiotomia por plastrotomia para remoção de corpos estranhos em uma jabuti-tinga (Geochelone denticulata). O animal foi atendido no Hospital Veterinário da Universidade Federal do Piauí apresentando falta de apetite, regurgitação, constipação, letargia, relutância em andar e mucosas oculares hiperêmicas. Foi realizado exame radiográfico, o qual confirmou presença de corpos estranhos no estômago. O animal foi submetido à celiotomia por plastrotomia para remoção dos corpos estranhos. A abertura do plastrão foi realizada através dos escudos abdominais, com o auxílio de uma mini-serra circular de retífica. Foi feita uma incisão na linha média entre as duas veias abdominais para se acessar a cavidade abdominal e, uma vez exposto, o estômago foi incisado para remoção dos corpos estranhos (grampos, palitos de dente, pedras, peças de plástico, fragmentos de louças e vidros). A cirurgia foi bem sucedida e a remoção total dos corpos estranhos foi confirmada por radiografia realizada no pós-operatório imediato. A celiotomia por plastrotomia para remoção de corpos estranhos neste animal demonstrou ser uma técnica muito importante, segura e viável para a sobrevivência de quelônios.

Study of the clinical and histopathological repercussions of the "omental band" in dogs' stomach

PURPOSE: To evaluate the efficacy of the "omental band" as a bariatric surgical technique. METHODS: A sample of 35 dogs was studied. The Test Group was composed by 20 dogs. Of these, six were observed by 10 days, six were observed by 20 days and eight were observed by 30 days of post-operatory. The Control Group was composed by 15 dogs. Of these, five were observed by 10 days, five were observed by 20 days and five were observed by 30 days of post-operatory. The weight loose was the variable utilized to the evaluation of the efficacy of the surgical technique described in this study, once all of the dogs were weighted in precision balance before the surgical act and at the end of the post-operatory observation period. RESULTS: At the end of the study it was observed that the weight loose of the dogs submitted to the "omental band's" surgical technique was meaningfully higher in comparison with the dogs of the Control Group at the end of the post-operatory observation period. CONCLUSION: The surgical technique of the "omental band" showed effective in dogs, once has proposed a meaningfully weight loose. .

Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: sistematic review and meta-analysis / Anastomose esofagogástrica manual versus mecânica pós-ressecção esofágica: revisão sistemática e metanálise

INTRODUCTION: Postoperative anastomotic leak and stricture are dramatic events that cause increased morbidity and mortality, for this reason it's important to evaluate which is the best way to perform the anastomosis. AIM: To compare the techniques of manual (hand-sewn) and mechanic (stapler) esophagogastric anastomosis after resection of malignant neoplasm of esophagus, as the occurrence of anastomotic leak, anastomotic stricture, blood loss, cardiac and pulmonary complications, mortality and surgical time. METHODS: A systematic review of randomized clinical trials, which included studies from four databases (Medline, Embase, Cochrane and Lilacs) using the combination of descriptors (anastomosis, surgical) and (esophagectomy) was performed. RESULTS: Thirteen randomized trials were included, totaling 1778 patients, 889 in the hand-sewn group and 889 in the stapler group. The stapler reduced bleeding (p <0.03) and operating time (p<0.00001) when compared to hand-sewn after esophageal resection. However, stapler increased the risk of anastomotic stricture (NNH=33), pulmonary complications (NNH=12) and mortality (NNH=33). There was no significant difference in relation to anastomotic leak (p=0.76) and cardiac complications (p=0.96). CONCLUSION: After resection of esophageal cancer, the use of stapler shown to reduce blood loss and surgical time, but increased the incidence of anastomotic stricture, pulmonary complications and mortality. .

INTRODUÇÃO: Deiscências e estenoses anastomóticas pós-operatórias são eventos dramáticos que causam aumento da morbimortalidade; por esta razão é sempre importante avaliar qual é o melhor meio de se fazer as anastomoses. OBJETIVO: Comparar as técnicas de anastomose esofagogástrica manual e mecânica, após ressecção de neoplasia maligna de esôfago, quanto à ocorrência de fístula, estenose, sangramento, complicações cardíacas e pulmonares, mortalidade e tempo cirúrgico. MÉTODOS: Foi realizada uma revisão sistemática de ensaios clínicos randomizados, que incluiu estudos de quatro bases de dados (Medline, Embase, Cochrane e Lilacs) usando a combinação dos descritores (anastomosis, surgical) and (esophagectomy). RESULTADOS: Treze ensaios clínicos randomizados foram incluídos, totalizando 1778 pacientes, sendo 889 no grupo da anastomose manual e 889 no grupo da anastomose mecânica. A anastomose mecânica reduziu o sangramento (p<0,03) e o tempo cirúrgico (p<0,00001) quando comparado à anastomose manual pós ressecção esofágica. No entanto, a anastomose mecânica aumentou o risco de estenose (NNH=33), complicações pulmonares (NNH=12) e mortalidade (NNH=33). Não houve diferença significativa em relação à formação de fístulas (p=0,76) e complicações cardíacas (p=0,96). CONCLUSÃO: Após ressecção de neoplasia esofágica, o uso da anastomose mecânica demonstrou reduzir o sangramento e o tempo cirúrgico, porém aumentou a incidência de estenose, complicações pulmonares e mortalidade. .

Morphometric study in stomach of rabbits / Estudio morfométrico del estómago en conejos

Thirty three healthy, New Zealand rabbits, underwent a total gastrectomy via laparotomy and subsequent evaluation of gastric dimensions. Were measured the lengths of the lesser and greater gastric curvature, in addition to the largest diameters of the organ. They presented average overall length of the lesser and greater curvature, respectively 6.7 cm and 27.3 cm. In addition, open surgical specimen presented a total area of 172.6 cm2. The sample was divided into two groups by age to perform comparisons between weight and stomach measures. Group 1 consisted of animals with age equal or less than 138 days and group 2 those with more than 138 days. No significant differences were found between the groups. This may suggest the use of younger animals to perform experiments related to surgical training involving the stomach, without dimensional prejudice of organ or generation of technical difficulties. Finally, it was noted also the predominance of the left gastric artery in the irrigation of the gastric wall and the presence of a transparent film between the liver and stomach in all animals.

Treinta y tres conejos, neozelandeses, sanos, se sometieron a una gastrectomía total por laparotomía y posterior evaluación de las dimensiones gástricas. Se midió la longitud de las curvaturas gástricas menor y mayor y el diámetro mayor del órgano. La longitud total promedio de las curvaturas menor y mayor fue de 6,7 cm y 27,3 cm, respectivamente. La zona quirúrgica abierta presentada 172,6 cm2. Según la edad y para hacer comparaciones entre el peso y las medidas gástricas la muestra se dividió en dos grupos. Grupo 1 animales con menos de 138 días y grupo 2 animales que tenían más de 138 días. No se encontraron diferencias significativas entre los grupos. Esto puede sugerir que para el entrenamiento quirúrgico el uso de animales más jóvenes puede ser llevado a cabo en los protocolos. Finalmente, se observó en todos los animales predominio de la arteria gástrica izquierda en la irrigación de la pared gástrica y la presencia de una fina capa peritoneal transparente entre el hígado y el estómago.