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1.
repert. med. cir ; 31(1): 84-88, 2022. ilus.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1367081

ABSTRACT

Presentación del caso: se reporta un paciente pediátrico con diagnóstico de hiperglicinemia no cetósica (HNC), enfermedad neurometabólica poco frecuente ocasionada por una deficiencia en el sistema de segmentación de la glicina, codificada por los genes GLDC, GCSH, AMT y GCSL que conduce a niveles elevados de glicina en la sinapsis generando un efecto agonista prolongado en los receptores N-metil-D-aspartato (NMDA). Discusión y conclusiones: se asocia con hipotonía, convulsiones y trastornos de la deglución, los cuales dependerán de la edad de presentación. Se revisa la literatura actual para el abordaje perioperatorio.


Case presentation: we report a child with a diagnosis of non-ketotic hyperglycinemia (NKGH), a rare neurometabolic disease caused by a defect in the glycine cleavage system, encoded by the GLDC, GCSH, AMT and GCSL genes resulting in elevated synaptic glycine levels generating a prolonged agonist effect on N-methyl-D-aspartate (NMDA) receptors. Discussion and conclusions: it is associated with hypotonia, seizures and swallowing disorders, which will depend on the age at presentation. A literature review was conducted to tailor perioperative approach.


Subject(s)
Humans , Male , Infant , Hyperglycinemia, Nonketotic , Propionic Acidemia , Perioperative Period , Deglutition Disorders , Fundoplication , Muscle Hypotonia
3.
Rev. colomb. gastroenterol ; 35(4): 542-544, dic. 2020. graf
Article in Spanish | LILACS | ID: biblio-1156338

ABSTRACT

Resumen El hipo crónico es un síntoma que puede provocar una invalidez significativa y a menudo revela una enfermedad subyacente. A continuación, se presenta el caso de un varón de 68 años que ingresó con hipo de más de 3 meses de duración que se asociaba con epigastralgia, vómitos posprandiales y pérdida ponderal. Había sido intervenido en 2 ocasiones debido a una enfermedad por reflujo gastroesofágico y hernia hiatal, una primera en la que se realizó una fundoplicatura y, posteriormente, una reintervención consistente en el cierre de los pilares diafragmáticos y re-Nissen laparoscópico. La clínica se debía a una obstrucción hiatal por acodamiento de la fundoplicatura previa y fue resuelta mediante la reposición hiatal a los parámetros anatómicos y desmontaje del Nissen previo.


Abstract Chronic hiccups is a rare symptom that can lead to significant disability and often reveals an underlying disease. The following is the case of a 68-year-old man who was admitted due to hiccups that had lasted more than 3 months associated with epigastric pain, postprandial vomiting, and weight loss. He had undergone surgery twice due to gastroesophageal reflux disease and hiatal hernia. During the first procedure, a fundoplication was performed, and then, he underwent a reoperation consisting of diaphragmatic pillars closure and laparoscopic Nissen. The symptoms were caused by a hiatal obstruction due to the kinking of the previous fundoplication and were resolved by repositioning the hiatus to anatomical parameters and dismantling the previous Nissen.


Subject(s)
Humans , Male , Aged , Hiccup , Gastroesophageal Reflux , Fundoplication , Hernia, Hiatal
4.
ABCD arq. bras. cir. dig ; 33(1): e1488, 2020. tab
Article in English | LILACS | ID: biblio-1130511

ABSTRACT

ABSTRACT Background: Gastroesophageal reflux disease is defined by the abnormal presence of gastric content in the esophagus, with 10% incidence in the Western population, being fundoplication one treatment option. Aim: To evaluate the early (six months) and late (15 years) effectiveness of laparoscopic fundoplication, the long term postoperative weight changes, as well as the impact of weight gain in symptoms control. Methods: Prospective study of 40 subjects who underwent laparoscopic Nissen's fundoplication. Preoperatively and early postoperatively, clinical, endoscopic, radiologic, manometric and pHmetric evaluations were carried out. After 15 years, clinical and endoscopic assessments were carried out and the results compared with the early ones. The presence or absence of obesity was stratified in both early and late phases, and its influence in the long-term results of fundoplication was studied, measuring quality of life according to the Visick criteria. Results: The mean preoperative ages, weight, and body mass index were respectively, 51 years, 69.67 kg and 25.68 kg/m2. The intraoperative and postoperative complications rates were 12.5% and 15%, without mortality. In the early postoperative period the symptoms were well controlled, hernias and esophagitis disappeared, the lower esophageal sphincter had functional improvement, and pHmetry parameters normalized. In the late follow-up 29 subjects were assessed. During this period there was adequate clinical control of reflux regardless of weight gain. In both time periods Visick criteria improved. Conclusion: Fundoplication was safe and effective in early and late periods. There was late weight gain, which did not influence effective symptoms control.


RESUMO Racional: A doença do refluxo gastroesofágico é definida pela presença anormal do conteúdo gástrico no esôfago com incidência de 10% na população ocidental, sendo a fundoplicatura uma das opções de tratamento. Objetivo: Avaliar a efetividade precoce (seis meses) e tardia (15 anos) da fundoplicatura laparoscópica, bem como a evolução ponderal pós-operatória em longo prazo, e o impacto do ganho de peso no controle tardio dos sintomas. Métodos: Estudo prospectivo com 40 indivíduos submetidos à fundoplicatura laparoscópica pela técnica de Nissen. No pré e pós-operatório precoce, foram realizadas avaliações clínica, endoscópica, radiológica, manométrica e pHmétrica. Após 15 anos, realizaram-se avaliações clínica e endoscópica, comparando-se os resultados com os da fase precoce. Estratificou-se a presença ou ausência de obesidade nestas fases e estudou-se sua influência nos resultados em longo prazo, mensurando-se a qualidade de vida pelos critérios de Visick. Resultados: As médias de idade, peso e do índice de massa corporal pré-operatórias foram 51 anos, 69.67 kg e 25,68 kg/m2. O índice de complicações intra e pós-operatórias foram 12,5% e 15%, sem mortalidade. No pós-operatório precoce houve controle dos sintomas, remissão das hérnias e esofagites, melhora funcional do esfíncter esofágico inferior e normalização dos parâmetros pHmétricos. No seguimento tardio, 29 indivíduos foram acompanhados. Nesta fase, houve adequado controle clínico do refluxo, independente do ganho de peso. Em ambas as fases houve melhora nos critérios de Visick. Conclusão: A fundoplicatura foi segura e efetiva, precoce e tardiamente. Houve ganho de peso tardio, o que não influenciou no controle efetivo dos sintomas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Weight Gain/physiology , Gastroesophageal Reflux/surgery , Laparoscopy/methods , Fundoplication/methods , Postoperative Period , Prospective Studies , Follow-Up Studies , Fundoplication/adverse effects , Bariatric Surgery , Preoperative Period , Manometry , Obesity/surgery
5.
ABCD arq. bras. cir. dig ; 33(3): e1543, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152622

ABSTRACT

ABSTRACT Background: Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. Aim: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. Method: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). Results: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). Conclusion: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.


RESUMO Racional: A endoscopia digestiva alta é importante ferramenta para a avaliação de pacientes submetidos à fundoplicatura, principalmente para elucidar os sintomas pós-operatórios. Entretanto, a avaliação endoscópica da sua anatomia e complicações é atualmente pouco padronizada entre os endoscopistas, o que leva à disparidade de laudos e condutas. Objetivo: Avaliar a frequência de anormalidades pós-operatórias da fundoplicatura através de uma classificação endoscópica e correlacionar os achados endoscópicos com os sintomas clínicos. Método: Este é estudo observacional prospectivo, realizado em um único centro. Os pacientes foram submetidos a um questionário para coleta de dados. A avaliação endoscópica da fundoplicatura foi realizada de acordo com a classificação em estudo, que considerou quatro parâmetros anatômicos, incluindo a posição da junção gastroesofágica em vista frontal (acima ou no nível da zona de pressão); posição da válvula na visão retroflexa (intra-abdominal ou migrada); conformação valvar (total, parcial, desgarrada ou torcida) e hérnia paraesofágica (presente ou ausente). Resultados: Foram avaliados 100 pacientes submetidos à fundoplicatura, 51% homens (idade média: 55,6 anos). Quarenta e três por cento relataram sintomas pós-operatórios. Anormalidades endoscópicas da anatomia da fundoplicatura foram relatadas em 46% dos pacientes. Junção gastroesofágica acima da zona de pressão (fundoplicatura deslizada) e fundoplicatura migrada foram significativamente correlacionadas com a ocorrência de sintomas pós-operatórios. Não houve correlação entre sintomas e conformação da fundoplicatura (total, parcial ou torcida). Conclusão: Essa classificação endoscópica modificada proposta para avaliar a anatomia da fundoplicatura é reprodutível e parece correlacionar-se com a sintomatologia. As anormalidades mais frequentes observadas foram fundoplicaturas migradas e deslizadas, e ambas se correlacionaram com a presença de sintomas.


Subject(s)
Humans , Male , Female , Middle Aged , Gastroesophageal Reflux/surgery , Endoscopy, Digestive System/methods , Laparoscopy , Fundoplication/adverse effects , Hernia, Hiatal/surgery , Postoperative Complications , Prospective Studies , Treatment Outcome
6.
Rev. Col. Bras. Cir ; 47: e20202637, 2020. tab
Article in English | LILACS | ID: biblio-1143689

ABSTRACT

ABSTRACT Objective: to evaluate esophageal dysmotility (ED) and the extent of Barrett's esophagus (BE) before and after laparoscopic Nissen fundoplication (LNF) in patients previously diagnosed with BE and ED. Methods: twenty-two patients with BE diagnosed by upper gastrointestinal (GI) endoscopy with biopsies and ED diagnosed by conventional esophageal manometry (CEM) were submitted to a LNF, and followed up with clinical evaluations, upper GI endoscopy with biopsies and CEM, for a minimum of 12 months after the surgical procedure. Results : sixteen patients were male (72.7%) and six were females (27.3%). The mean age was 55.14 (± 15.52) years old. and the mean postoperative follow-up was 26.2 months. The upper GI endoscopy showed that the mean length of BE was 4.09 cm preoperatively and 3.91cm postoperatively (p=0.042). The evaluation of esophageal dysmotility through conventional manometry showed that: the preoperative median of the lower esophageal sphincter resting pressure (LESRP) was 9.15 mmHg and 13.2 mmHg postoperatively (p=0.006). The preoperative median of the esophageal contraction amplitude was 47.85 mmHg, and 57.50 mmHg postoperatively (p=0.408). Preoperative evaluation of esophageal peristalsis showed that 13.6% of the sample presented diffuse esophageal spasm and 9.1% ineffective esophageal motility. In the postoperative, 4.5% of patients had diffuse esophageal spasm, 13.6% of aperistalsis and 22.7% of ineffective motor activity (p=0.133). Conclusion: LNF decreased the BE extension, increased the LES resting pressure, and increased the amplitude of the distal esophageal contraction; however, it was unable to improve ED.


RESUMO Objetivo: avaliar a dismotilidade esofágica (DE) e a extensão do esôfago de Barrett (EB) antes e depois da fundoplicatura laparoscópica a Nissen (FLN) em pacientes previamente diagnosticados com EB e DE. Método: vinte e dois pacientes com EB diagnosticada por endoscopia digestiva alta (EDA) com biópsias e DE diagnosticada por manometria esofágica convencional (MEC) foram submetidos a FLN, e acompanhados por avaliações clínicas, endoscopia digestiva alta com biópsias e MEC, por no mínimo 12 meses após o procedimento cirúrgico. Resultados: dezesseis pacientes eram do sexo masculino (72,7%) e seis do feminino (27,3%). A média de idade foi de 55,14 (± 15,52) anos e o seguimento pós-operatório médio foi de 26,2 meses. A endoscopia digestiva alta mostrou que o comprimento médio do EB foi de 4,09 cm no pré-operatório e 3,91 cm no pós-operatório (p = 0,042). A avaliação da dismotilidade esofágica por meio da manometria convencional mostrou que a mediana pré-operatória da pressão de repouso do esfíncter esofágico inferior (PREEI) foi de 9,15 mmHg, e de 13,2 mmHg no pós-operatório (p = 0,006). A mediana pré-operatória da amplitude de contração esofágica foi de 47,85 mmHg, e de 57,50 mmHg no pós-operatório (p = 0,408). A avaliação pré-operatória do peristaltismo esofágico mostrou que 13,6% da amostra apresentava espasmo esofágico difuso e 9,1%, motilidade esofágica ineficaz. No pós-operatório, 4,5% dos pacientes apresentaram espasmo esofágico difuso, 13,6% de aperistalse e 22,7% de atividade motora ineficaz (p = 0,133). Conclusões: a FLN diminuiu a extensão do EB, aumentou a pressão de repouso do EEI e aumentou a amplitude da contração esofágica distal; no entanto, não foi capaz de melhorar a DE.


Subject(s)
Humans , Male , Female , Adult , Aged , Barrett Esophagus/surgery , Esophageal Motility Disorders/surgery , Laparoscopy , Fundoplication/adverse effects , Esophageal Spasm, Diffuse , Treatment Outcome , Fundoplication/methods , Middle Aged
7.
San Salvador; s.n; 2020. 21 p.
Thesis in Spanish | LILACS, BISSAL | ID: biblio-1128347

ABSTRACT

La enfermedad por reflujo gastroesofágico (ERGE) fue reconocida como problema clínico importante y se identificó como causa de esofagitis, su prevalencia ha sido estimada en base a la presencia de síntomas típicos y atípicos. La cirugía antirreflujo (CAR), asociada a la introducción de la técnica laparoscópica y sus ventajas han permitido la expansión de la fundiplicatura laparoscópica estableciéndose como el estándar de oro en el manejo quirúrgico de ERGE. Se proponen actividades de promoción, prevención, detección, diagnóstico y tratamiento para pacientes con diagnóstico de ERGE con la finalidad de identificar aquellos candidatos para CAR. El protocolo de seguimiento para pacientes con ERGE tiene como objetivo evaluar la calidad de vida posterior a la realización de CAR en todos los pacientes intervenidos en el Instituto Salvadoreño del Seguro Social.


Subject(s)
Gastroesophageal Reflux , Fundoplication , General Surgery
8.
Rev. argent. cir ; 111(2): 95-98, jun. 2019.
Article in English, Spanish | LILACS | ID: biblio-1013351

ABSTRACT

El bypass gástrico en Y-de-Roux (RYGB) trata eficazmente la obesidad y a la vez la enfermedad por reflujo gastroesofágico (ERGE). Desafortunadamente, algunos pacientes que finalmente se presentan para cirugía bariátrica han sido previamente sometidos a una funduplicatura de Nissen por ERGE. La conversión a RYGB después de esta funduplicatura ha demostrado ser segura y eficaz, pero con una mayor morbilidad, tiempo operatorio más prolongado y mayor estancia hospitalaria. Se presenta una paciente de 50 años, con IMC 40,4 kg/m², evaluada para cirugía bariátrica. Había sido sometida a funduplicatura de Nissen laparoscópica siete años atrás. Informamos un caso de eliminación laparoscópica de funduplicatura de Nissen y conversión a RYGB. La funduplicatura previa no es una contraindicación para LRYGB. Estos procedimientos deben ser llevados a cabo por cirujanos experimentados, y el abordaje laparoscópico debe ser el método de elección.


Roux-en-Y gastric bypass (RYGB) effectively treats both obesity and gastroesophageal reflux disease (GERD). Unfortunately, some patients finally present for bariatric surgery have previously undergone Nissen fundoplication due to GERD. Conversion to EYGB after Nissen fundoplication is safe and effective, but is associated with greater morbidity and longer operative time and hospital stay. A 50-year-old female patient with a body mass index (BMI) of 40.4 kg/m² was evaluated for bariatric surgery. She had a history laparoscopic Nissen fundoplication seven years before. We report a case of laparoscopic take-down of Nissen fundoplication and conversion to RYGB. A previous fundoplication is not a contraindication for laparoscopic RYGB. These procedures should be performed by well-trained surgeons and laparoscopic approach should be the method of choice.


Subject(s)
Gastric Bypass/methods , Laparoscopy/methods , Fundoplication/adverse effects , Obesity, Morbid/complications , Gastroesophageal Reflux/surgery , Bariatric Surgery/methods , Contraindications, Procedure
9.
Rev. cuba. cir ; 58(1): e781, ene.-mar. 2019. tab
Article in Spanish | LILACS | ID: biblio-1093145

ABSTRACT

RESUMEN Introducción: En la actualidad, la fundoplicatura laparoscópica se considera el tratamiento de elección para la enfermedad por reflujo gastroesofágico con resultados excelentes en más del 90 por ciento de los pacientes. Sin embargo, a pesar de estos resultados, el 30 % de los pacientes presentan persistencia de los síntomas y del 3 por ciento al 10 por ciento requieren reintervención por fallo de la cirugía antirreflujo. Objetivo: Describir las causas del fracaso de la cirugía antirreflujo y las técnicas realizadas en la reintervención. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, de una serie de pacientes a los cuales se les realizo cirugía antirreflujo en el Centro Nacional de Cirugía de Mínimo Acceso desde enero de 1994 hasta diciembre de 2016. Las variables analizadas fueron: reintervenciones y sus causas, tratamiento quirúrgico, morbilidad y el índice de conversión. Resultados: De un total de 1 550 pacientes operados, 37 (2,3 por ciento) fueron reintervenidos. Las causas más frecuentes de reintervención fueron la recidiva de los síntomas y la presencia de disfagia. La herniación de la fundoplicatura fue el hallazgo transoperatorio más frecuente. El índice de conversión fue bajo y no hubo fallecidos en las reintervenciones. La morbilidad triplicó la del total de la serie, así como la estadía hospitalaria. Conclusiones: Las reintervenciones por fallo de la cirugía antirreflujo resultan de gran complejidad pues aumentan considerablemente la morbilidad y la estadía hospitalaria. Debe realizarse en centros que acumulen una alta experiencia en estas técnicas(AU)


ABSTRACT Introduction: Nowadays, laparoscopic fundoplication is considered the treatment of choice for gastroesophageal reflux disease, showing excellent results in more than 90 percent of patients. However, despite these results, 30 percent of patients present with persistent symptoms, while 3 percent to 10 percent require reintervention for failed antireflux surgery. Objective: To describe the causes of failed antireflux surgery and the techniques performed in the reintervention. Method: A descriptive, retrospective and longitudinal study was conducted with a series of patients who underwent antireflux surgery at the National Center for Minimally Access Surgery, from January 1994 to December 2016. The variables analyzed were reinterventions and their causes, surgical treatment, morbidity and the conversion rate. Results: From among 1550 patients operated on, 37 (2.3 percent) were reintervened. The most frequent causes of reintervention were the recurrence of symptoms and the occurrence of dysphagia. The fundoplication herniation was the most frequent transoperative finding. The conversion rate was low and there were no deaths in the reinterventions. The morbidity tripled that of the total of the series, as well as hospital stay. Conclusions: Reinterventions for failed antireflux surgery are very complex, since they increase morbidity and hospital stay considerably. It must be performed in centers that accumulate a high experience in these techniques(AU)


Subject(s)
Humans , Reoperation/adverse effects , Gastroesophageal Reflux/epidemiology , Fundoplication/methods , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies
10.
Article in English | WPRIM | ID: wpr-787182

ABSTRACT

The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.


Subject(s)
Classification , Deglutition , Esophageal Achalasia , Esophagogastric Junction , Esophagus , Female , Fundoplication , Hernia, Hiatal , Humans , Hypertrophy , Laparoscopy , Manometry , Middle Aged , Peristalsis , Protestantism , Relaxation , Tomography, X-Ray Computed
11.
Article in English | WPRIM | ID: wpr-742334

ABSTRACT

Epiphrenic diverticula are known to cause a series of complications. We report the case of a 54-year-old woman who was diagnosed with an epiphrenic diverticulum at a regular checkup in November 2006. Ten years later, she presented with massive hematemesis. Imaging studies revealed an epiphrenic diverticulum measuring 7.8 cm in diameter and a large amount of bleeding inside the diverticulum. Computed tomography showed fistula formation between the diverticulum and the left lower lobe of the lung, leading to the development of a pulmonary abscess. Diverticulectomy and 180° posterior partial fundoplication were performed transabdominally. The pulmonary abscess was treated with antibiotics alone. She was discharged 16 days after the operation without any complications over 7 months of follow-up.


Subject(s)
Anti-Bacterial Agents , Diverticulum , Diverticulum, Esophageal , Female , Fistula , Follow-Up Studies , Fundoplication , Hematemesis , Hemorrhage , Humans , Lung , Lung Abscess , Middle Aged
12.
ABCD arq. bras. cir. dig ; 32(4): e1482, 2019. graf
Article in English | LILACS | ID: biblio-1054593

ABSTRACT

ABSTRACT Background: Obesity represents a growing threat to population health all over the world. Laparoscopic sleeve gastrectomy induces alteration of the esophagogastric angle due to surgery itself, hypotony of the lower esophageal sphincter after division of muscular sling fibers, decrease of the gastric volume and, consequently, increase of intragastric pressure; that's why some patients have reflux after sleeve. Aim: To describe a technique and preliminary results of sleeve gastrectomy with a Nissen fundoplication, in order to decrease reflux after sleeve. Method: In the current article we describe the technique step by step mostly focused on the creation of the wrap and it care. Results: This procedure was applied in a case of 45 BMI female of 53 years old, with GERD. An endoscopy was done demonstrating a hiatal hernia, and five benign polyps. A Nissen sleeve was performed due to its GERD, hiatal hernia and multiple polyps on the stomach. She tolerated well the procedure and was discharged home uneventfully 48 h after. Conclusion: N-sleeve is a feasible and safe alternative in obese patients with reflux and hiatal hernia when Roux-en-Y gastric bypass it is not indicated.


RESUMO Racional: A obesidade representa ameaça crescente à saúde da população em todo o mundo. A gastrectomia por laparoscopia induz alteração do ângulo esofagogástrico devido à própria técnica, hipotonia do esfíncter esofágico inferior após secção de fibras musculares da junção, diminuição do volume gástrico e, consequentemente, aumento da pressão intragástrica; é por isso que alguns pacientes têm refluxo após a gastrectomia vertical. Objetivo: Descrever uma técnica e resultados preliminares da gastrectomia vertical com fundoplicatura a Nissen, a fim de diminuir o refluxo após ela. Método: No artigo atual, descrevemos a técnica passo a passo, principalmente focada na criação da válvula e seu cuidado. Resultados: Este procedimento foi aplicado em um caso de mulher com IMC 45 de 53 anos com DRGE. Foi realizada endoscopia demonstrando hérnia hiatal e cinco pólipos benignos. A gastrectomia vertical com Nissen foi realizada devido à DRGE, à hérnia hiatal e aos múltiplos pólipos no estômago. Ela tolerou bem o procedimento e recebeu alta sem intercorrências 48 h depois. Conclusão: A N-gastrectomia vertical (N-sleeve) é alternativa viável e segura em pacientes obesos com refluxo e hérnia hiatal quando não é indicado o desvio gástrico em Y-de-Roux.


Subject(s)
Humans , Female , Middle Aged , Obesity, Morbid/surgery , Gastroesophageal Reflux/surgery , Gastrectomy/methods , Hernia, Hiatal/surgery , Obesity, Morbid/complications , Gastroesophageal Reflux/etiology , Tomography, X-Ray Computed , Treatment Outcome , Fundoplication , Hernia, Hiatal/etiology
13.
ABCD arq. bras. cir. dig ; 32(2): e1440, 2019. tab
Article in English | LILACS | ID: biblio-1019241

ABSTRACT

ABSTRACT Background: Re-fundoplication is the most often procedure performed after failed fundoplication, but re-failure is even higher. Aim: The objectives are: a) to discuss the results of fundoplication and re-fundoplication in these cases, and b) to analyze in which clinical situation there is a room for gastrectomy after failed fundoplication. Method: This experience includes 104 patients submitted to re-fundoplication after failure of the initial operation, 50 cases of long segment Barrett´s esophagus and 60 patients with morbid obesity, comparing the postoperative outcome in terms of clinical, endoscopic, manometric and 24h pH monitoring results. Results: In patients with failure after initial fundoplication, redo-fundoplication shows the worst clinical results (symptoms, endoscopic esophagitis, manometry and 24 h pH monitoring). In patients with long segment Barrett´s esophagus, better results were observed after fundoplication plus Roux-en-Y distal gastrectomy and in obese patients similar results regarding symptoms, endoscopic esophagitis and 24h pH monitoring were observed after both fundoplication plus distal gastrectomy or laparoscopic resectional gastric bypass, while regarding manometry, normal LES pressure was observed only after fundoplication plus distal gastrectomy. Conclusion: Distal gastrectomy is recommended for patients with failure after initial fundoplication, patients with long segment Barrett´s esophagus and obese patients with gastroesophageal reflux disease and Barrett´s esophagus. Despite its higher morbidity, this procedure represents an important addition to the surgical armamentarium.


RESUMO Racional: Re-fundoplicatura é o procedimento mais frequentemente realizado após falha na fundoplicatura, mas neste caso a falha é ainda maior. Objetivo: a) discutir os resultados da fundoplicatura e re-fundoplicatura nesses casos; e b) analisar em que situação clínica há espaço para gastrectomia após falha na fundoplicatura. Método: Esta experiência inclui 104 pacientes submetidos à re-fundoplicatura após falha da operação inicial, sendo 50 casos de esôfago de Barrett de segmento longo e 60 pacientes com obesidade mórbida, comparando-se o resultado pós-operatório em termos de pH clínico, endoscópico, manométrico de 24 h de monitoramento. Resultados: Em pacientes com falha após a fundoplicatura inicial, a re-fundoplicatura mostra os piores resultados clínicos (sintomas, esofagite endoscópica, manometria e pHmetria 24 h). Em pacientes com esôfago de Barrett de segmento longo, melhores resultados foram observados após fundoplicatura com gastrectomia distal em Y-de-Roux e em pacientes obesos resultados semelhantes em relação aos sintomas, esofagite endoscópica e monitoramento de pH 24 h foram observados após fundoplicatura com gastrectomia distal ou ressecção com bypass gástrico laparoscópico, enquanto que em relação à manometria, a pressão normal do EEI só foi observada após a fundoplicatura e gastrectomia distal. Conclusão: A gastrectomia distal é recomendada para pacientes com falha após a fundoplicatura inicial, pacientes com esôfago de Barrett de segmento longo e obesos com doença do refluxo gastroesofágico e esôfago de Barrett. Apesar de sua maior morbidade, esse procedimento representa um importante acréscimo ao arsenal cirúrgico.


Subject(s)
Humans , Barrett Esophagus/surgery , Obesity, Morbid/surgery , Fundoplication/adverse effects , Gastrectomy/methods , Reoperation , Anastomosis, Roux-en-Y , Treatment Failure , Esophageal pH Monitoring , Manometry
14.
Article in English | WPRIM | ID: wpr-765954

ABSTRACT

BACKGROUNDS/AIMS: This multicenter study aims to evaluate the effect and feasibility of anti-reflux surgery compared with medical treatment for gastroesophageal reflux disease (GERD). METHODS: Patients with GERD who were undergoing medical treatment with proton pump inhibitors for more than 8 weeks and those who were scheduled to undergo anti-reflux surgery were enrolled. Efficacy of pre-operative medical treatment was evaluated retrospectively and effect of anti-reflux surgery was prospectively evaluated at 1 week and 3 months after surgery. Quality of life (QOL) was also investigated before and after surgery. RESULTS: Between February and October 2018, 51 patients underwent laparoscopic Nissen fundoplication for treating GERD at 5 hospitals in Korea. Thirty-four patients (66.7%) showed poor proton pump inhibitor response. At 3 months after surgery, heartburn was completely resolved in 87.9% patients and partially improved in 9.1%. Acid regurgitation was completely resolved in 82.9% and partially improved in 11.4%. Atypical extraesophageal symptoms were completely controlled in 45.5% and partially controlled in 36.4%. GERD-related QOL scores at 1 week after surgery significantly improved compared with pre-operative scores. There was no difference in GERD-related QOL scores between 1 week and 3 months after surgery. General QOL measured with European QOL-5 dimensions and health-related QOL instrument with 8 items significantly improved after anti-reflux surgery. Satisfaction with treatment was significantly higher after surgery than before surgery (72.5% vs 11.8%, P < 0.001). CONCLUSION: Anti-reflux surgery improved GERD symptoms and QOL in patients. Anti-reflux surgery is an effective treatment option compared with medical treatment for GERD patients selected for surgical treatment.


Subject(s)
Fundoplication , Gastroesophageal Reflux , Heartburn , Humans , Korea , Laparoscopy , Prospective Studies , Proton Pump Inhibitors , Proton Pumps , Quality of Life , Retrospective Studies
15.
Article in English | WPRIM | ID: wpr-761534

ABSTRACT

The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.


Subject(s)
Classification , Deglutition , Esophageal Achalasia , Esophagogastric Junction , Esophagus , Female , Fundoplication , Hernia, Hiatal , Humans , Hypertrophy , Laparoscopy , Manometry , Middle Aged , Peristalsis , Protestantism , Relaxation , Tomography, X-Ray Computed
16.
Article in Chinese | WPRIM | ID: wpr-691325

ABSTRACT

Hiatal hernia is a common disease, which is always complicated with gastro-esophageal reflux. However, owing to restriction of diagnosis ability, the finding of hiatal hernia is still at low level in China. How to increase the finding or diagnosis of this disease and improve the life quality of patients, is an important task of radiologists and hernial surgeons. Surgery has been integrated into the therapy of hiatal hernia for a long time, but most surgeons still need to improve their recognition about its essence and the anti-reflux mechanism of lower esophagus. The purpose of surgery of hiatal hernia is not only to repair the defect, but to recover the anatomic structure and function of lower esophagus, as well as to rebuild anti-reflux barrier in stomach at the mean time. The key principle of surgery is to recover structure of GEJ, location of LES and the length of lower esophagus through fundoplication and firm fixation, which prevent it from dislocating to thoracic cavity. By adhering to the principle of this, we can combine the anatomy and function in repair of hiatal hernia, and recover and keep the anti-reflux function of LES utmost. MDT, specialized precision program and standardization will play more and more important roles in hiatal hernia therapy in the future. In this article, we made a review about the diagnosis and therapy history of hiatal hernia, as well as prospected the progress in the near future.


Subject(s)
China , Esophagus , Fundoplication , Gastroesophageal Reflux , Hernia, Hiatal , Diagnosis , General Surgery , Humans
17.
Article in English | WPRIM | ID: wpr-715548

ABSTRACT

PURPOSE: Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. METHODS: The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. RESULTS: Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication. CONCLUSION: Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.


Subject(s)
Deglutition Disorders , Diagnosis , Eructation , Flatulence , Fundoplication , Gastroesophageal Reflux , Humans , Korea
18.
Journal of Gastric Cancer ; : 313-327, 2018.
Article in English | WPRIM | ID: wpr-719101

ABSTRACT

The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea, and physicians, including surgeons, have been focusing on its treatment. Indeed, in Korea, medical treatment using a proton pump inhibitor is the mainstream treatment for GERD, while awareness of surgical treatment is limited. Accordingly, to promote the understanding of surgical treatment for GERD, the Korean Anti-Reflux Surgery Study Group published the Evidence-Based Practice Guideline for the Surgical Treatment of GERD. The guideline consists of 2 sections: fundamental information such as the definition, symptoms, and diagnostic tools of GERD and a recommendation statement about its surgical treatment. The recommendations presented 5 debates regarding fundoplication: 1) comparison of the effectiveness of medical and surgical treatments, 2) effectiveness of surgical treatment in cases of refractory GERD, 3) effectiveness of surgical treatment of extraesophageal symptoms, 4) comparison of effectiveness between total and partial fundoplication, and 5) effectiveness of fundoplication in cases of hiatal hernia. The present guideline is the first to demonstrate the efficacy of the surgical treatment GERD in Korea.


Subject(s)
Evidence-Based Practice , Fundoplication , Gastroesophageal Reflux , Hernia, Hiatal , Korea , Prevalence , Proton Pumps , Surgeons
19.
Article in English | WPRIM | ID: wpr-716295

ABSTRACT

PURPOSE: Although nonerosive and erosive gastroesophageal reflux disease (GERD) have similar symptom severity, nonerosive reflux disease (NERD) is considered a milder type of GERD and gastroenterologists have hesitated to refer these patients for antireflux surgery. The aim of this study was to compare surgical outcomes of antireflux surgery between patients with NERD and erosive reflux disease (ERD). METHODS: Seventy patients met the inclusion criteria of this study among a total of 117 patients who underwent antireflux surgery from November 2012 to October 2017. According to preoperative endoscopy, patients were classified into NERD group (minimal changes or no esophagitis) and ERD group. Clinical characteristics and surgical outcomes were compared between NERD and ERD. RESULTS: There were 26 patients in NERD group and 44 patients in ERD group. The male:female ratio was higher in the ERD group than in the NERD group (P = 0.044). Preoperative symptoms, response to acid suppressive medication, acid exposure on pH monitoring study, and esophageal manometry results were similar in the 2 groups. Reflux on barium esophagography was more frequently observed in ERD (77.3%) than in NERD (50.0%, P = 0.019). At 6 months after surgery, complete resolution and partial improvement of GERD symptoms were similar in the 2 groups (80.8% and 15.4%, respectively, in NERD vs. 88.6% and 2.3%, respectively, in ERD; P = 0.363). CONCLUSION: Laparoscopic Nissen fundoplication is equally beneficial to patients with NERD and ERD. Antireflux surgery should not be avoided for GERD patients without mucosal breaks on endoscopy as the evidence of erosive esophagitis.


Subject(s)
Barium , Endoscopy , Esophagitis , Fundoplication , Gastroesophageal Reflux , Humans , Hydrogen-Ion Concentration , Manometry
20.
ABCD arq. bras. cir. dig ; 30(4): 279-282, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-885752

ABSTRACT

ABSTRACT Introduction : Obesity is related with higher incidence of gastroesophageal reflux disease. Antireflux surgery has inadequate results when associated with obesity, due to migration and/or subsequent disruption of antireflux wrap. Gastric bypass, meanwhile, provides good control of gastroesophageal reflux. Objective: To evaluate the technical difficulty in performing gastric bypass in patients previously submitted to antireflux surgery, and its effectiveness in controlling gastroesophageal reflux. Methods: Literature review was conducted between July to October 2016 in Medline database, using the following search strategy: ("Gastric bypass" OR "Roux-en-Y") AND ("Fundoplication" OR "Nissen ') AND ("Reoperation" OR "Reoperative" OR "Revisional" OR "Revision" OR "Complications"). Results: Were initially classified 102 articles; from them at the end only six were selected by exclusion criteria. A total of 121 patients were included, 68 women. The mean preoperative body mass index was 37.17 kg/m² and age of 52.60 years. Laparoscopic Nissen fundoplication was the main prior antireflux surgery (70.58%). The most common findings on esophagogastroduodenoscopy were esophagitis (n=7) and Barrett's esophagus (n=6); the most common early complication was gastric perforation (n=7), and most common late complication was stricture of gastrojejunostomy (n=9). Laparoscopic gastric bypass was performed in 99 patients, with an average time of 331 min. Most patients had complete remission of symptoms and efficient excess weight loss. Conclusion: Although technically more difficult, with higher incidence of complications, gastric bypass is a safe and effective option for controlling gastroesophageal reflux in obese patients previously submitted to antireflux surgery, with the added benefit of excess weight loss.


RESUMO Introdução: Obesidade está relacionada à maior incidência de doença do refluxo gastroesofágico. Cirurgia antirrefluxo apresenta resultados inadequados quando associada à obesidade, devido à migração e/ou ruptura posterior da válvula antirrefluxo. Bypass gástrico enquanto isso determina bom controle de refluxo gastroesofágico. Objetivo: Avaliar a dificuldade técnica na realização de bypass gástrico em pacientes previamente submetidos à cirurgia antirrefluxo, e sua eficácia no controle do refluxo gastroesofágico. Método: Revisão de literatura foi realizada entre os meses de julho a outubro de 2016, na base de dados Medline, com a seguinte estratégia de busca: ("Gastric Bypass" OR "Roux-en-Y") AND ("Fundoplication" OR "Nissen") AND ("Reoperation" OR "Reoperative" OR "Revisional" OR "Revision" OR "Complications"). Resultados: Foram inicialmente classificados 102 artigos selecionando-se, por critérios de exclusão, apenas seis ao final. Foram incluídos 121 pacientes, sendo 68 mulheres. A média de índice de massa corporal pré-operatório foi 37,17 kg/m² e idade de 52,60 anos. Fundoplicatura de Nissen laparoscópica foi a principal operação antirrefluxo prévia (70,58%). Os achados mais comuns na endoscopia digestiva alta foram esofagite (n=7) e esôfago de Barrett (n=6); a complicação precoce mais comum foi perfuração gástrica (n=7), e tardia, estenose de anastomose gastrojejunal (n=9). Bypass laparoscópico foi realizado em 99 pacientes, com tempo médio de 331 min. A grande maioria dos pacientes apresentou completa remissão dos sintomas e perda eficiente do excesso de peso. Conclusão: Apesar de tecnicamente mais difícil, com maior incidência de complicações, o bypass gástrico é opção segura e efetiva no controle do refluxo gastroesofágico em pacientes obesos previamente submetidos à operação antirrefluxo, com a vantagem adicional da perda do excesso de peso.


Subject(s)
Gastric Bypass , Gastroesophageal Reflux/surgery , Fundoplication , Obesity/surgery , Reoperation , Gastroesophageal Reflux/complications , Obesity/complications
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