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Article in Chinese | WPRIM | ID: wpr-878733


Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.

Celiac Artery/surgery , Constriction, Pathologic/surgery , Decompression, Surgical , Humans , Laparoscopy , Ligaments/surgery , Median Arcuate Ligament Syndrome/surgery
Int. braz. j. urol ; 44(4): 838-839, July-Aug. 2018.
Article in English | LILACS | ID: biblio-1040041


ABSTRACT Objectives: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. Materials and Methods: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. Results: No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s. Conclusion: The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient's stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures.

Humans , Male , Penile Diseases/surgery , Urethral Stricture/surgery , Skin Transplantation/methods , Mouth Mucosa/transplantation , Urologic Surgical Procedures, Male/methods , Surgical Flaps/transplantation , Reproducibility of Results , Treatment Outcome , Constriction, Pathologic/surgery , Middle Aged
Int. braz. j. urol ; 44(3): 624-628, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-954045


ABSTRACT Objective: To present our technique of ureteroileal bypass to treat uretero-enteric stric- tures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral im- plantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by "ureteroileal bypass", one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diag- nosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ure-terohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.

Humans , Aged , Postoperative Complications/surgery , Ureter/surgery , Ureteral Obstruction/surgery , Urinary Diversion/adverse effects , Urinary Bladder/surgery , Ileum/surgery , Urinary Diversion/methods , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Urinary Catheterization/methods , Cystectomy/methods , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Constriction, Pathologic/surgery , Operative Time , Urinary Catheters , Length of Stay , Medical Illustration
Rev. AMRIGS ; 60(4): 377-380, out.-dez. 2016. ilus
Article in Portuguese | LILACS | ID: biblio-847866


Introdução: A atresia de coana (AC) é a anomalia nasal congênita mais comum. Estima-se a incidência de 1 caso para cada 8000-10000 nascidos vivos. Relato do caso: Paciente feminina, 9 anos, com obstrução nasal em fossa nasal direita (FND) desde o nascimento. Apresentava roncos e apneia em vigência de infecção de via aérea superior. À rinoscopia anterior direita, secreção hialina abundante. À videonasoendoscopia flexível não foi possível visualizar cavum pela FND, observando-se estase de secreção em região posterior; à esquerda cavum livre, sem lesão expansiva. Tomografia de nariz e seios paranasais evidenciou atresia de coana mista à direita. Foi realizada cirurgia para correção da malformação. Após 30 dias, observou-se reestenose do cavum. Na reintervenção, a coana foi ampliada com remoção do osso palatino e do septo posterior, realizada dilatação com balão e posicionado molde de silicone. Realizada aplicação de Mitomicina. A remoção do molde foi feita em bloco cirúrgico após 42 dias, com permeabilidade coanal preservada. Nasofibroendoscopia após 6 meses mostrou fossas nasais pérvias. Discussão: Ainda há controvérsias na literatura quanto à efetividade das diferentes técnicas cirúrgicas e ao uso de stents e de agentes antineoplásicos no pós-operatório. Neste relato, a dilatação com balão pode ter contribuído para o sucesso da cirurgia, porém o molde foi fundamental para evitar a reestenose. Considerações finais: O uso do molde mostrou um excelente resultado nesta reintervenção de correção de atresia de coana. A baixa reação inflamatória e o sucesso do pós-operatório mostraram que esta é uma opção a ser utilizada para evitar a reestenose (AU)

Introduction: Choanal atresia (CA) is the most common congenital nasal anomaly. Its incidence is estimated as 1 case for every 8,000-10,000 live births. Case report: Female patient, 9 years old, with obstruction in the right nasal cavity (RNC) since birth. She presented snoring and apnea in the presence of upper airway infection. At right anterior rhinoscopy, abundant hyaline secretion. Flexible videonasoendoscopy failed to visualize cavum through RNC, with secretion stasis in posterior region; left cavum free, without expansive lesion. Tomography of the nose and paranasal sinuses revealed mixed choanal atresia on the right. Surgery was performed to correct the malformation. Thirty days later, restenosis of the cavum was observed. At reoperation the choana was enlarged with removal of the palatine bone and posterior septum, balloon dilatation was performed and a silicone cast was positioned. Mitomycin application was performed. Removal of the cast was done in surgical ward after 42 days, with preserved choanal permeability. Nasofibroscopy at 6 months postoperatively showed permeable nasal cavities. Discussion: There is still controversy in the literature regarding the effectiveness of different surgical techniques and the use of stents and anti-neoplastic agents in the postoperative period. In this report, balloon dilatation may have contributed to the success of the surgery, but the cast was crucial to avoid restenosis. Final considerations: The use of the cast had an excellent outcome in this re-intervention of choanal atresia correction. The low inflammatory reaction and postoperative success have shown that this is an effective option to be used to avoid restenosis (AU)

Humans , Female , Child , Choanal Atresia/surgery , Choanal Atresia/diagnosis , Constriction, Pathologic/surgery , Surgical Procedures, Operative/methods
Int. braz. j. urol ; 42(1): 154-159, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-777325


ABSTRACT Aim To assess if calibration of the ureteropelvic junction (UPJ) using a high-pressure balloon inflated at the UPJ level in patients with suspected crossing vessels (CV) could differentiate between intrinsic and extrinsic stenosis prior to laparoscopic vascular hitch (VH). Materials and Methods We reviewed patients with UPJO diagnosed at childhood or adolescence without previous evidence of antenatal or infant hydronephrosis (10 patients). By cystoscopy, a high-pressure balloon is sited at the UPJ and the balloon inflated to 8-12 atm under radiological screening. We considered intrinsic PUJO to be present where a ‘waist’ was observed at the PUJ on inflation of the balloon and a laparoscopic dismembered pyeloplasty is performed When no ‘waist’ is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. Patients with absence of intrinsic PUJ stenosis documented with this method are included for the study. Results Six patients presented pure extrinsic stenosis. The mean age at presentation was 10.8 years. Mean duration of surgery was 99 min and mean hospital stay was 24 hours in all cases. We found no intraoperative or postoperative complications. All children remain symptoms free at a mean follow up of 14 months. Ultrasound and renogram improved in all cases. Conclusion When no ‘waist’ is observed we considered this to represent extrinsic stenosis and a laparoscopic VH was performed. In these patients, laparoscopic transposition of lower pole crossing vessels (‘vascular hitch’) may be a safe and reliable surgical technique.

Humans , Male , Female , Child , Adolescent , Ureteral Obstruction/surgery , Laparoscopy/methods , Angioplasty, Balloon/methods , Kidney Pelvis/surgery , Kidney Pelvis/blood supply , Pressure , Calibration , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Angioplasty, Balloon/instrumentation , Constriction, Pathologic/surgery , Hydronephrosis/surgery
Braz. j. med. biol. res ; 49(9): e5182, 2016. tab, graf
Article in English | LILACS | ID: lil-788942


We used a computational fluid dynamics (CFD) model to study the inspiratory airflow profiles of patients with anterior nasal cavity stenosis who underwent curative surgery, by comparing pre- and postoperative airflow characteristics. Twenty patients with severe anterior nasal cavity stenosis, including one case of bilateral stenosis, underwent computed tomography (CT) scans for CFD modelling. The pre- and postoperative airflow characteristics of the nasal cavity were simulated and analyzed. The narrowest area of the nasal cavity in all 20 patients was located within the nasal valve area, and the mean cross-sectional area increased from 0.39 cm2 preoperative to 0.78 cm2 postoperative (P<0.01). Meanwhile, the mean airflow velocity in the nasal valve area decreased from 6.19 m/s to 2.88 m/s (P<0.01). Surgical restoration of the nasal symmetry in the bilateral nasal cavity reduced nasal resistance in the narrow sides from 0.24 Pa.s/mL to 0.11 Pa.s/mL (P<0.01). Numerical simulation of the nasal cavity in patients with anterior nasal cavity stenosis revealed structural changes and the resultant patterns of nasal airflow. Surgery achieved balanced bilateral nasal ventilation and decreased nasal resistance in the narrow region of the nasal cavity. The correction of nasal valve stenosis is not only indispensable for reducing nasal resistance, but also the key to obtain satisfactory curative effect.

Humans , Male , Female , Nasal Cavity/surgery , Nasal Obstruction/surgery , Respiratory Mechanics/physiology , Computer Simulation , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/physiopathology , Constriction, Pathologic/surgery , Hydrodynamics , Imaging, Three-Dimensional , Nasal Cavity/diagnostic imaging , Nasal Cavity/physiopathology , Nasal Obstruction/diagnostic imaging , Nasal Obstruction/physiopathology
Int. braz. j. urol ; 41(4): 796-803, July-Aug. 2015. graf
Article in English | LILACS | ID: lil-763063


ABSTRACTBackground:Uretero-ileal anastomotic stricture (UIAS) is a urological complication after ileal neobladder, the initial management being endourological intervention. If this fails or stricture recurs, surgical intervention will be indicated.Design and Participants:From 1994 to 2013, 129 patients were treated for UIAS after unsuccessful endourological intervention. Unilateral UIAS was present in 101 patients, and bilateral in 28 patients; total procedures were 157. The previous ileal neobladder techniques were Hautmann neobladder, detubularized U shape, or spherical shape neobladder.Surgical procedures:Dipping technique was performed in 74 UIAS. Detour technique was done in 60 renal units. Ileal Bladder flap was indicated in 23 renal units. Each procedure ended with insertion of double J, abdominal drain, and indwelling catheter.Results:Follow-up was done for 12 to 36 months. Patency of the anastomosis was found in 91.7 % of cases. Thirteen patients (8.3%) underwent antegrade dilatation and insertion of double J.Conclusion:After endourological treatment for uretero-ileal anastomotic failure, basically three techniques may be indicated: dipping technique, detour technique, and ileal bladder flap. The indications are dependent on the length of the stenotic/dilated ureteral segment. Better results for long length of stenotic ureter are obtained with detour technique; for short length stenotic ureter dipping technique; when the stenotic segment is 5 cm or more with a short ureter, the ileal tube flap is indicated. The use of double J stent is mandatory in the majority of cases. Early intervention is the rule for protecting renal units from progressive loss of function.

Female , Humans , Male , Ileal Diseases/surgery , Ureteral Obstruction/surgery , Ureterostomy/methods , Urologic Surgical Procedures/methods , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Constriction, Pathologic/surgery , Cystectomy/adverse effects , Dilatation , Follow-Up Studies , Ileal Diseases/etiology , Postoperative Care , Surgical Flaps/surgery , Ureteral Obstruction/etiology , Urinary Bladder/surgery
Medicina (B.Aires) ; 75(3): 169-172, June 2015. ilus
Article in Spanish | LILACS | ID: lil-757099


El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.

Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.

Aged , Female , Humans , Celiac Artery/abnormalities , Constriction, Pathologic/diagnosis , Celiac Artery/surgery , Constriction, Pathologic/surgery , Laparoscopy
Rev. chil. cir ; 67(3): 306-308, jun. 2015. ilus
Article in Spanish | LILACS | ID: lil-747506


Background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. Case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved.

Introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. Caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.

Humans , Male , Middle Aged , Celiac Artery/surgery , Celiac Artery/pathology , Constriction, Pathologic/surgery , Constriction, Pathologic/etiology , Ligaments/surgery , Ligaments/pathology , Angiography , Tomography, X-Ray Computed
Gut and Liver ; : 251-252, 2015.
Article in English | WPRIM | ID: wpr-190723


A 72-year-old man with jaundice by ampullary adenocarcinoma was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the common bile duct (CBD) and improving cholangitis. This is the first report of a unique use of a double-pigtail plastic stent to correct CBD kinking. The placement of a double-pigtail plastic stent can correct CBD kinking, without requiring replacement or addition of a FCSEMS, and can lead to cost savings.

Aged , Common Bile Duct/injuries , Constriction, Pathologic/surgery , Decompression, Surgical/instrumentation , Humans , Male , Self Expandable Metallic Stents/adverse effects , Stents , Torsion Abnormality/surgery
Rev. chil. pediatr ; 85(5): 594-598, oct. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-731648


Introduction: The most common congenital malformations of the bile duct are biliary atresia and choledochal cyst. In addition, the most common liver anatomical variation is the right hepatic artery aberration. The goal of this study is to characterize a patient with this disease and propose the hepatoduodenal anastomosis as surgical treatment. Case report: One-month-old patient with suspected congenital biliary atresia due to progressive jaundice and acholia since birth. Liver tests consistent with a cholestatic pattern and brain MRI scan consistent with biliary atresia. Periods of decreased bilirubin and sporadic slight pigmentation of depositions were described. The surgical finding was a bile duct stricture due to a vascular ring caused by aberrant right hepatic artery. Resection of bile duct and hepatic-duodenal bypass were performed. The patient evolved satisfactorily from this condition. Conclusion: There are few reports of biliary obstruction due to vascular malformations. It is important to keep in mind that not all neonatal jaundice episodes are caused by biliary atresia or choledo-chal cyst. The clinical course, laboratory tests and imaging should be considered and in the case of suspicion, further exploration should take place.

Introducción: Las malformaciones congénitas de la vía biliar más frecuentes son la atresia de vías biliares y quiste de colédoco. Por otro lado, la variante anatómica hepática más común es la aberración de la arteria hepática derecha. El objetivo es caracterizar un paciente portador de esta patología y plantear la hepato-duodeno anastomosis como tratamiento quirúrgico. Caso clínico: Paciente de 1 mes de edad, con sospecha de Atresia de Vía Biliar congénita por ictericia progresiva y acolia desde recién nacido. Pruebas hepáticas concordantes con un patrón colestásico y resonancia magnética compatible con atresia de vías biliares. Evolucionó con períodos de descenso de bilirrubina y leve pigmentación, esporádica, de deposiciones. El hallazgo quirúrgico fue una estenosis crítica de vía biliar a nivel del conducto hepático común debido a un anillo vascular por una arteria hepática derecha aberrante. Se realizó una sección de vía biliar y una derivación hepato-duodenal. Evolucionó con una resolución completa de su patología. Conclusión: Existen pocos reportes de obstrucción de vía biliar por malformaciones vasculares. Es importante tener presente que no todas las ictericias neonatales son por atresia de vías biliares o quiste de colédoco. Se debe considerar la evolución clínica, laboratorio e imágenes, y si existen sospechas, explorar.

Female , Humans , Infant , Common Bile Duct Diseases/diagnosis , Constriction, Pathologic/diagnosis , Hepatic Artery/abnormalities , Vascular Diseases/diagnosis , Biliary Atresia/diagnosis , Common Bile Duct Diseases/etiology , Common Bile Duct Diseases/surgery , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Hepatic Artery/surgery , Treatment Outcome , Vascular Diseases/complications , Vascular Diseases/surgery
Arq. gastroenterol ; 51(3): 240-249, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-723861


Context Biliary strictures after liver transplantation are recognized as its Achilles’ heel. The strictures are classified in anastomotic and ischemic or non-anastomotic biliary strictures, and they figure among the most common complications after liver transplantation. There are some treatment options including balloon dilation, the placement of multiple plastic stents and the placement of self-expandable metal stents and all of them seem to have good results. Objectives The aim of this study was to systematically review the literature concerning the results of the endoscopic treatment of anastomotic biliary strictures after liver transplantation. Methods A systematic review of the literature was performed on the management of anastomotic biliary strictures post- orthotopic liver transplantation. The Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were electronically searched from January 1966 to April 2013. Results No well-designed randomized controlled trial was found. Most studies were retrospective or prospective comparisons in design. One study (86 patients) compared the endoscopic and the percutaneous accesses. The sustained clinical success rates were similar but the treatment duration was longer in the percutaneous group access. Two studies (56 patients) compared balloon dilation with balloon dilation and multiple plastic stents. There were no differences concerning sustained clinical success and complication rates. Conclusions Balloon dilation is as effective as balloon dilation plus multiple plastic stenting for the resolution of the anastomotic biliary strictures. Well-designed randomized trials are still needed to compare balloon dilation versus multiple plastic stenting versus metallic stenting. .

Contexto A estenose biliar figura como uma das complicações mais frequentes pós-transplante hepático. São classificadas em anastomóticas e não anastomóticas, sendo estas últimas geralmente isquêmicas. Dentre as várias opções de tratamento, destacam-se a dilatação balonada, a colocação de próteses plásticas e a colocação de próteses metálicas autoexpansíveis, que podem ser realizadas tanto por via endoscópica, como por via percutânea. Não há consenso quanto ao melhor tratamento para a estenose da anastomose biliar. Objetivos O objetivo deste estudo foi realizar revisão sistemática da literatura sobre o resultado do tratamento endoscópico da estenose da anastomose biliar após transplante hepático. Métodos Revisão sistemática da literatura foi realizada sobre o tratamento da estenose da anastomose biliar pós transplante hepático, através do acesso aos bancos de dados pesquisados eletronicamente: Medline - PubMed, EMBASE, Scielo- Lilacs, Cochrane de janeiro de 1966 a abril de 2013. Resultados Não foi encontrado estudo clinico controlado e randomizado. A maioria dos estudos são comparativos retrospectivos ou prospectivos. Um estudo (86 pacientes) avaliou o acesso endoscópico e percutâneo. As taxas de sucesso clínico sustentados foram semelhantes, mas a duração do tratamento foi maior no grupo de acesso percutâneo. Dois estudos (56 pacientes) compararam a dilatação por balão com dilatação por balão e múltiplas próteses plásticas. Não houve diferenças em relação as taxas de sucesso e de complicações clínicas sustentadas. Conclusões A dilatação com balão é tão eficaz quanto a dilatação ...

Humans , Biliary Tract Diseases/etiology , Biliary Tract Diseases/surgery , Endoscopy, Digestive System/methods , Liver Transplantation/adverse effects , Constriction, Pathologic/surgery
Rev. chil. cir ; 66(1): 15-21, feb. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-705547


Introducción: La cirugía bariátrica revisional se realiza para modificar o reparar alguno de los tipos de cirugía para perder peso, entre ellos la gastrectomía vertical laparoscópica (GVL). La revisión de procedimientos bariátricos se hace necesaria entre el 10 al 25 por ciento de los pacientes, ya sea por baja de peso insuficiente o por complicaciones, siendo la estenosis una de ellas. Posterior a una GVL, el bypass gástrico en Y de Roux (BPG) es la intervención quirúrgica más requerida para la conversión. El objetivo de este estudio fue describir una serie de 5 pacientes que tuvieron cirugía revisional por estenosis posterior a una GVL. Material y Métodos: Entre enero de 2006 y marzo de 2013, en 770 pacientes consecutivos se realizó GVL. Los pacientes fueron incluidos en un protocolo prospectivo. Cinco pacientes tuvieron cirugía revisional con conversión a BPG por estenosis posterior a la GVL. Tres pacientes fueron operados de GVL en nuestro hospital, los otros 2 provenían de otros centros hospitalarios. Resultados: En los 5 pacientes con cirugía revisional la edad promedio fue 39,8 +/- 15,7 años. Cuatro pacientes fueron mujeres (80 por ciento). El promedio IMC antes de GVL fue 37,0 +/- 2,1 kg/m² y del IMC antes del BPG fue 29,4 +/- 5,4 kg/m². El BPG fue laparoscópico en 3 casos y abierto en 2. No hubo complicaciones, ni mortalidad. Conclusiones: La conversión a bypass gástrico en Y de Roux es un tratamiento efectivo para la estenosis posterior a una GVL.

Introduction: Revisional bariatric surgery is performed to alter or repair one of the many types of weight loss surgery, including laparoscopic sleeve gastrectomy (LSG). The revision of bariatric procedures is required between 10 to 25% of patients operated, either by insufficient weight loss or complications, including stenosis. After a LSG, the Roux- en- Y gastric bypass (RYGBP) is the most requested surgery for conversion. The aim of this study was to describe a series of 5 patients who had revisional surgery for stenosis following LSG. Material and Method: Between January 2006 and March 2013, in 770 consecutive patients was performed LSG. Patients were included in a prospective protocol. Five patients had revisional surgery with conversion to RYGBP for stenosis following LSG. In three patients the initial LSG was performed in our hospital, the other 2 were from other hospitals. Results: In the 5 patients with revisional surgery mean age was 39.8 ± 15.7 years. Four patients were women (80%). The average BMI before LSG was 37.0 ± 2.1 kg/m2 and BMI before RYGBP was 29.4 ± 5.4 kg/m2. The RYGBP was laparoscopic in 3 cases and opened in two. There were no complications, and no mortality. Conclusions: Conversion to RYGBP is an effective treatment for stenosis following a LSG.

Humans , Male , Adult , Female , Aged , Constriction, Pathologic/surgery , Constriction, Pathologic/etiology , Gastrectomy/adverse effects , Laparoscopy , Bariatric Surgery/adverse effects , Gastrectomy/methods , Obesity, Morbid/surgery , Reoperation
Int. braz. j. urol ; 39(2): 195-202, Mar-Apr/2013. tab, graf
Article in English | LILACS | ID: lil-676269


Background and Purpose Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ) obstruction. Advanced minimally invasive surgical (MIS) reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported. We herein report our experience with these techniques in the largest series to date. Materials and Methods We performed a retrospective chart review of nine patients with UPJ obstruction in horseshoe kidneys who underwent MIS repair at our institution between March 2000 and January 2012. Four underwent laparoscopic, two robotic, and one laparoendoscopic single-site (LESS) dismembered pyeloplasty. An additional two pediatric patients underwent robotic Hellstrom repair. Perioperative outcomes and treatment success were evaluated. Results Median patient age was 18 years (range 2.5-62 years). Median operative time was 136 minutes (range 109-230 min.) and there were no perioperative complications. After a median follow-up of 11 months, clinical (symptomatic) success was 100%, while radiographic success based on MAG-3 renogram was 78%. The two failures were defined by prolonged t1/2 drainage, but neither patient has required salvage therapy as they remain asymptomatic with stable differential renal function. Conclusions MIS repair of UPJ obstruction in horseshoe kidneys is feasible and safe. Although excellent short-term clinical success is achieved, radiographic success may be lower than MIS pyeloplasty in heterotopic kidneys, possibly due to inherent differences in anatomy. Larger studies are needed to evaluate MIS pyeloplasty in this population. .

Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Kidney/abnormalities , Kidney/surgery , Laparoscopy/methods , Ureteral Obstruction/surgery , Body Mass Index , Constriction, Pathologic/surgery , Kidney Pelvis/abnormalities , Kidney Pelvis/surgery , Operative Time , Robotics , Treatment Outcome
RMJ-Rawal Medical Journal. 2013; 38 (1): 18-21
in English | IMEMR | ID: emr-146847


To evaluate the efficacy of esophageal guide wire dilatation of stricture after surgical treatment of esophageal atresia. This prospective and descriptive study was carried out at Department of Pediatric Surgery, The children's hospital, Pakistan Institute of Medical Sciences [PIMS], Islamabad from January 2008 to December 2011. It included 23 patients, 15 males and 8 females, aged one month to 3 years with esophageal stricture secondary to esophageal atresia who underwent guide wire esophageal dilatation with savary Gilliard Dilators. All procedures were performed under general anesthesia. Associated gastroesophageal reflux [GER]. was noted in 13 patients. Dilatation relieved the stricture in all patients over a follow-up period varying from 3 months to 3 years. Only two patients developed esophageal perforation, which was treated conservatively. Guide wire dilatation is a safe and effective method of treatment in the management of strictures secondary to surgical repair of esophageal atresia

Humans , Male , Female , Anastomosis, Surgical/complications , Constriction, Pathologic/therapy , Constriction, Pathologic/surgery , Prospective Studies
ABCD arq. bras. cir. dig ; 25(4): 283-289, out.-dez. 2012. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-665749


INTRODUÇÃO: Bypass gástrico em Y-de-Roux pode resultar em estenose de anastomose gastrojejunal. Não há protocolo de tratamento bem definido para essa complicação. OBJETIVO: Analisar os resultados da dilatação endoscópica em pacientes com estenose, através de revisão sistemática, incluindo complicações e taxa de sucesso. MÉTODOS: Foi realizada busca dos estudos relevantes publicados de 1988 a 2010 na base de dados do PubMed, sendo identificados 23 estudos para análise. Apenas os que descreviam o tratamento de estenose de anastomose após bypass gástrico em Y-de-Roux foram incluídos e relatos de caso que apresentavam menos de três pacientes foram excluídos. RESULTADOS: A idade média da população foi de 42,3 anos e o índice de massa corpórea pré-operatório médio foi de 48,8 kg/m². No total, 760 pacientes (81% feminino) foram submetidos a 1298 procedimentos, sendo realizadas 1,7 dilatações por paciente. Balões Through-the-scope foram utilizados em 16 estudos (69,5%) e dilatador de Savary-Gilliard em quatro. Apenas 2% dos pacientes necessitaram revisão cirúrgica após a dilatação; a taxa de complicações reportada foi de 2,5% (n=19). A taxa de sucesso anual foi maior que 98% nos anos 1992 a 2010, exceto por uma de 73% em 2004. Sete estudos relataram complicações, sendo perfuração a mais comum, relatada em 14 pacientes (1,82%), necessitando operação imediata em dois pacientes. Outras complicações foram também relatadas: um hematoma esofágico, uma lesão de Mallory-Weiss, um caso grave de náusea e vômito, e dois casos de dor abdominal importante. CONCLUSÃO: Tratamento endoscópico de estenose é seguro e eficaz; entretanto, mais estudos controlados randomizados devem ser realizados a fim de confirmar esses achados.

INTRODUCTION: Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication. AIM: Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates. METHODS: The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded. RESULTS: The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain. CONCLUSION: Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings.

Humans , Gastric Bypass , Jejunum/surgery , Postoperative Complications/surgery , Stomach/surgery , Anastomosis, Surgical , Constriction, Pathologic/surgery , Endoscopy, Gastrointestinal