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1.
Article in Chinese | WPRIM | ID: wpr-928845

ABSTRACT

In the standardized diagnosis and treatment process of advanced gastric cancer, there is a unappreciated key link between standard radical surgery and accurate pathological reports. That is, the process of dissection, fixation, sampling and recording of the specimen by the surgeons, starting from specimen isolation to the management of the pathologist. Standardizing this process can not only accurately reflect the detailed distribution and exact number of lymph nodes, but also clarify the pathological stage of gastric cancer, so as to make adjuvant treatment plans. Moreover, it can also reflect the scope of intraoperative lymph node dissection to ensure the standardized implementation of surgery, including the overall dissection principle (en bloc resection), and therefore can provide a solid foundation for later related researches. So far, there is still a lack of complete and unified standard for the surgical management of specimens after radical gastrectomy in China. On the basis of the relevant researches and clinical practice about specimen management at home and abroad, the Chinese Journal of Gastrointestinal Surgery, in the name of the Gastric Cancer Professional Committee, Chinese Anticancer Association, as well as the Oncogastroenterology Professional Committee, Chinese Anticancer Association, organized dozens of experts to formulate a consensus on the standardized surgical management of specimens after repeated discussions and revisions for two years. This consensus is aimed to standardize the preparations, basic requirements and sample processing procedures before the surgical treatment of postoperative specimens after a radical surgery for gastric cancer patients, including the processing time of specimens, the processing and data archiving of gastric specimens, and lymph node grouping, sorting and fine sorting records, etc and with the purpose of standardizing the surgical treatment of postoperative specimens on the basis of standardized diagnosis and treatment of gastric cancer, in order to further promote the high-quality development of gastric cancer surgery in China.


Subject(s)
Consensus , Gastrectomy/methods , Humans , Lymph Node Excision/methods , Lymph Nodes/pathology , Stomach Neoplasms/surgery
2.
Rev. cuba. cir ; 59(4): e1032, oct.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1149848

ABSTRACT

RESUMEN Introducción: El cáncer de estómago representa la segunda causa más frecuente de muerte relacionada con neoplasias en el mundo, es responsable del 8 al 10 por ciento de todas las muertes por cáncer. Objetivo: Determinar la morbilidad y la mortalidad por cáncer gástrico en el servicio de cirugía del Hospital Universitario "General Calixto García". Métodos: Se realizó un estudio observacional descriptivo, transversal. El universo estuvo conformado por 145 pacientes que cumplieron con los criterios de inclusión. Se utilizaron métodos estadísticos descriptivos y cálculos con valores porcentuales. Resultados: El 67,6 por ciento de los pacientes pertenecían al sexo masculino, mientras que 87 se ubicaron en los grupos de edades entre 60 y 79 años. El 37,2 por ciento de los pacientes presentaron lesión ulcerada infiltrante de acuerdo a la clasificación endoscópica de Borrmann. El adenocarcinoma gástrico fue el tipo histológico más encontrado. La técnica quirúrgica más empleada fue la gastrectomía subtotal, y la gastroyeyunostomía. La complicación postoperatoria más frecuente la constituyó la bronconeumonía con 35 pacientes. La mayoría de los pacientes egresaron vivos. Conclusiones: La investigación sugiere que el diagnóstico precoz y la cirugía en la actualidad es la única modalidad con potencial curativo y puede elevar la calidad de vida y mejorar los índices de morbimortalidad en la población(AU)


ABSTRACT Introduction: Stomach cancer is the second leading cause of death related to neoplasms worldwide. It is responsible for 8-10 percent of all cancer-related deaths. Objective: To determine the morbidity and mortality for gastric cancer in the surgery service of General Calixto García University Hospital. Methods: A descriptive, cross-sectional and observational study was carried out. The universe consisted of 145 patients who met the inclusion criteria. Descriptive statistical methods and calculations with percentage values were used. Results: 67.6 percent of the patients belonged to the male sex, while 87 were located in the age groups between 60 and 79 years. 37.2 percent of the patients presented an infiltrating ulcerated lesion according to Borrmann endoscopic classification. Gastric adenocarcinoma was the most common histological type. The most used surgical technique was subtotal gastrectomy, followed by gastrojejunostomy. The most frequent postoperative complication was bronchopneumonia, accounting for 35 patients. Most of the patients were discharged alive. Conclusions: Research suggests that early diagnosis and surgery are currently the only modality with curative potential and can raise the quality of life as well as improve morbidity and mortality rates among the population(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Stomach Neoplasms/mortality , Adenocarcinoma/surgery , Indicators of Morbidity and Mortality , Gastrectomy/methods , Quality of Life , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
3.
Int. j. morphol ; 38(5): 1479-1484, oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134465

ABSTRACT

SUMMARY: Gastric cancer (CG) is the second leading cause of cancer deaths. The best treatment option for patients with advanced GC (AGC) is still surgery, which involves performing a gastrectomy and D2 lymphadenectomy (D2L). The aim of this study was to determine postoperative morbidity (POM) and 5-year OS in patients resected by AGC without neoadjuvant. Case series with follow-up of patients with AGC undergoing total or subtotal gastrectomies and D2L, consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2019. The outcome variables were POM and 5-year OS. Other variables of interest were surgical time, number of resected lymph nodes, hospital stay, and recurrence. Descriptive statistics was used, and Kaplan-Meier curves were calculated. In this analysis 38 patients (71.1 % men), with a median age of 65 years, were operated. The most frequent location was subcardial (50.0 %). The most frequent type of resection was total gastrectomy (60.5 %). The median of surgical time, number of resected lymph nodes and hospital stay; was 190 min, 32 and 6 days respectively. MPO was 18.4 %. With a median follow-up of 28 months, a recurrence of 44.7 % was verified; and 5-year OS for stages IIIA, IIIB and IV were 53.3 %, 46.1 % and 20.0 % respectively (p= 0,007). The results achieved, in terms of POM and OS series were similar to national and international series in which neoadjuvant therapies have not been applied.


RESUMEN: El cáncer gástrico (CG) es la segunda causa de muerte por cáncer. La mejor opción terapéutica para pacientes con CG avanzado (CGA), sigue siendo la cirugía, que supone la realización de gastrectomía asociada a linfadenectomía D2 (LD2). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia (SV) en pacientes resecados por CGA sin neoadyuvancia. Serie de casos con seguimiento, de pacientes con CGA sometidos a gastrectomía total o subtotal con LD2, de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2008 y 2019. Las variables resultado fueron MPO y SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria y recurrencia. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 38 pacientes (71,1 % hombres), con una mediana de edad de 65 años. La localización más frecuente fue subcardial (50,0 %); el tipo de resección más frecuente fue gastrectomía total (60,5 %). Las medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fue 190 min, 32 y 6 días respectivamente. La MPO fue 18,4 %. Con una mediana de seguimiento de 28 meses, se verificó recurrencia de 44,7 %; y SVAG a 5 años para estadios IIIA, IIIB y IV de 53,3%, 46,1 % y 20,0 % respectivamente (p=0,007). Los resultados obtenidos, en términos de MPO, mortalidad y SVAG, fueron similares a series de centros de derivación nacionales e internacionales en los que no se ha aplicado terapias neoadyuvantes.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stomach Neoplasms/surgery , Gastrectomy/methods , Lymph Node Excision/methods , Postoperative Complications , Recurrence , Survival Analysis , Follow-Up Studies , Operative Time , Length of Stay
4.
Rev. cir. (Impr.) ; 72(3): 257-261, jun. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1115552

ABSTRACT

Resumen El cáncer gástrico es una patología de alta incidencia en Chile. Afortunadamente es baja la incidencia de márgenes R1 cuando se realiza una cirugía con intención curativa. Al tener un tumor subcardial o cardial es perentorio realizar una biopsia rápida (intraoperatoria), en caso que ésta resulte positiva, es difícil tomar una decisión sobre qué realizar a continuación, ya que el realizar una esofagoyeyunoanastomosis intratorácica aumenta el riesgo quirúrgico. Para esto, es de suma importancia tener la información de las características histopatológicas del tumor, el riesgo de filtración, la recurrencia, la sobrevida, las terapias adyuvantes y la realidad país. Se realizó una revisión de la literatura con el fin de poder guiar la toma de decisiones.


Gastric cancer is a pathology with a high incidence in Chile, fortunately, the incidence of R1 margins is low when performing surgery with curative intent. When having a sub cardial or cardial tumor, it is essential to perform a rapid (intraoperative) biopsy, if this is positive when cutting the esophagus just under the pillars, it is difficult to make the decision of what to do next, since performing an inthrathoracic esophagojejunostomy increases the surgical risk. For this, it is very important to have information about the histopathological characteristics of the tumor, the leakage risk, there currence, the survival, the adjuvant therapies and the reality of the country. A review of the literature was done in order to guide the decisions.


Subject(s)
Humans , Stomach Neoplasms/surgery , Biopsy/methods , Margins of Excision , Recurrence , Digestive System Surgical Procedures/methods , Gastrectomy/methods , Intraoperative Period
5.
ABCD arq. bras. cir. dig ; 33(4): e1552, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152635

ABSTRACT

ABSTRACT Background: The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease´s stage, or the extent of the surgery performed. Aim: Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. Methods: From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. Results: Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. Conclusion: Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.


RESUMO Racional: A população octogenária está expandindo mundialmente e é esperado que a demanda por gastrectomia devido a câncer gástrico nessa faixa também aumente. Entretanto, os resultados da operação curativa nessa população são pobremente reportados e não está claro o que mais importa no resultado: idade, status clínico, estágio da doença, ou a extensão da operação. Objetivos: Avaliar os resultados cirúrgicos da gastrectomia em octogenários e verificar os fatores relacionados com a sobrevida. Métodos: Através de revisão de banco de dados prospectivo, pacientes com 80 anos ou mais de idade e adenocarcinoma gástrico comprovado histologicamente e submetidos a gastrectomia com intuito curativo foram analisados. Fatores relacionados a complicações pós-operatórias e sobrevida foram estudadas. Resultados: Cinquenta e um pacientes preencheram os critérios de inclusão. A gastrectomia subtotal foi realizada em 70,5% dos casos e a linfadenectomia D1 em 72,5% dos pacientes. Complicações ocorreram em 25 pacientes (49%), sendo que em 11 elas foram graves (sete foram complicações clínicas). Pacientes com complicações tiveram maior duração da internação hospitalar (8,5 vs. 17,8 dias, p=0,002) e sobrevida global mais curta (mediana de 1,4 vs. 20,5 meses, p=0,009). Linfadenectomia D2 e a presença de complicações foram fatores independentes de pior sobrevida global. Conclusão: Os octogenários submetidos à gastrectomia com intenção curativa apresentam alto risco de complicações clínicas no pós-operatório. A linfadenectomia D1 deve ser o padrão de atendimento nesses pacientes.


Subject(s)
Humans , Male , Female , Aged, 80 and over , Stomach Neoplasms/surgery , Adenocarcinoma/surgery , Gastrectomy/methods , Postoperative Complications/epidemiology , Retrospective Studies , Length of Stay , Lymph Node Excision
6.
ABCD arq. bras. cir. dig ; 33(4): e1553, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152628

ABSTRACT

ABSTRACT Background: Gastroesophageal reflux (GER) is one of the most common indications for conversion of sleeve gastrectomy (LSG) to laparoscopic Roux-en-Y gastric bypass (LRYGBP). Objective evaluations are necessary in order to choose the best definitive treatment for these patients. Aim: To present and describe the findings of the objective studies for gastroesophageal reflux disease performed before LSG conversion to LRYGBP in order to support the indication for surgery. Method: Thirty-nine non-responder patients to proton pump inhibitors treatment after LSG were included in this prospective study. They did not present GER symptoms, esophagitis or hiatal hernia before LSG. Endoscopy, radiology, manometry, 24 h pH monitoring were performed. Results: The mean time of appearance of reflux symptoms was 26.8+24.08 months (8-71). Erosive esophagitis was found in 33/39 symptomatic patients (84.6%) and Barrett´s esophagus in five. (12.8%). Manometry and acid reflux test were performed in 38/39 patients. Defective lower esophageal sphincter function was observed independent the grade of esophagitis or Barrett´s esophagus. Pathologic acid reflux with elevated DeMeester´s scores and % of time pH<4 was detected in all these patients. more significant in those with severe esophagitis and Barrett´s esophagus. Radiologic sleeve abnormalities were observed in 35 patients, mainly cardia dilatation (n=18) and hiatal hernia (n=11). Middle gastric stricture was observed in only six patients. Conclusion: Patients with reflux symptoms and esophagitis or Barrett´s esophagus after SG present defective lower esophageal sphincter function and increased acid reflux. These conditions support the indication of conversion to LRYGBP.


RESUMO Racional: O refluxo gastroesofágico é uma das indicações mais comuns para a conversão da gastrectomia vertical (SG) em gastroplastia laparoscópica em Y-de-Roux (LRYGBP). Avaliações objetivas são necessárias para escolher o melhor tratamento definitivo para esses pacientes. Objetivo: Apresentar e descrever os achados objetivos da doença do refluxo gastroesofágico realizados antes da conversão do SG para o LRYGBP, a fim de apoiar a indicação cirúrgica. Método: Trinta e nove pacientes não respondedores ao tratamento com inibidores da bomba de prótons após SG foram incluídos neste estudo prospectivo. Eles não apresentavam sintomas de refluxo gastroesofágico, esofagite ou hérnia hiatal antes da SG. Endoscopia, radiologia, manometria, monitoramento de pH 24 horas foram realizados. Resultados: O tempo médio de aparecimento dos sintomas de refluxo foi de 26,8+24,08 meses (8-71). Esofagite erosiva foi encontrada em 33/39 pacientes sintomáticos (84,6%) e esôfago de Barrett em cinco (12,8%). A manometria e o teste de refluxo ácido foram realizados em 38/39 pacientes. A função alterada do esfíncter inferior do esôfago foi observada independentemente do grau de esofagite ou esôfago de Barrett. Em todos esses pacientes, foi detectado refluxo ácido patológico com escores elevados de DeMeester e % de tempo pH<4, mais significativo nos com esofagite grave e esôfago de Barrett. Anormalidades radiológicas SG foram observadas em 35 pacientes, principalmente dilatação da cárdia (n=18) e hérnia hiatal (n=11). Estenose gástrica foi observada em apenas seis pacientes . Conclusão: Pacientes com sintomas de refluxo e esofagite ou esôfago de Barrett após SG apresentam função do esfíncter esofágico inferior defeituosa e aumento do refluxo ácido. Esses sintomas e estudos objetivos apoiam a indicação de conversão para LRYGBP.


Subject(s)
Humans , Female , Adult , Middle Aged , Obesity, Morbid/surgery , Gastric Bypass/adverse effects , Gastroesophageal Reflux/etiology , Laparoscopy/adverse effects , Gastrectomy/adverse effects , Gastroesophageal Reflux/surgery , Prospective Studies , Gastrectomy/methods
7.
ABCD arq. bras. cir. dig ; 33(2): e1513, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130520

ABSTRACT

ABSTRACT Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.


RESUMO Racional: A gastrectomia vertical ampliada é uma variação da técnica da gastrectomia vertical, necessitando de estudos a fim de elucidar a segurança em relação ao refluxo gastroesofágico. Objetivo: Analisar comparativamente gastrectomia vertical (GV) e gastrectomia vertical ampliada (GVA) em ratos com obesidade induzida por dieta cafeteria em relação à presença de esofagite de refluxo, perda de peso e alterações macroscópicas relacionadas aos procedimentos. Método: Trinta ratos Wistar foram randomizados em três grupos, e após período de indução de obesidade por meio de dieta cafeteria de 28 dias, foram submetidos a operação simulada (grupo controle GC), gastrectomia vertical (grupo GV) e gastrectomia vertical ampliada (grupo GVA). Os animais foram acompanhados por 28 dias no pós-operatório e, após a eutanásia, foi realizada a pesquisa de esofagite de refluxo através de avaliação histopatológica. Peso e avaliação macroscópica foram as outras variáveis de estudo, sendo o peso aferido semanalmente e a avaliação macroscópica no momento da eutanásia. Resultados: Todos os animais apresentaram algum grau de inflamação e a presença de ao menos um critério de inflamação, porém, não houve diferença estatisticamente significante na análise entre os grupos. Em relação à perda de peso, os animais do GC apresentaram aumento gradativo durante todo experimento evoluindo para super-obesidade ao término do estudo, enquanto os dos grupos GV e GVA tiveram reganho de peso após a primeira semana do pós-operatório, porém, reganho menos acentuado se comparável ao GC, tanto para GV quanto para GVA. Conclusões: Não há diferença em relação à esofagite de refluxo entre GV e GVA, bem como em relação às alterações macroscópicas. Ambas as técnicas têm capacidade de controlar a evolução do peso no pós-operatório em relação ao grupo controle.


Subject(s)
Humans , Animals , Rats , Gastroesophageal Reflux/etiology , Laparoscopy/adverse effects , Gastrectomy/methods , Obesity/surgery , Random Allocation , Rats, Wistar , Gastrectomy/adverse effects
8.
Rev. venez. cir ; 73(1): 10-13, 2020. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1283939

ABSTRACT

La gastrectomía vertical laparoscópica es actualmente la cirugía bariátrica más empleada a nivel mundial. Aunque es un procedimiento seguro y efectivo pueden ocurrir complicaciones mayores. En el presente trabajo reportamos el caso de un infarto y absceso esplénico como una rara complicación de esta técnica, que requirió finalmente de esplenectomía como tratamiento definitivo. Caso clínico: Mujer de 22 años con obesidad grado I, a quien se le practicó gastrectomía vertical laparoscópica con buena evolución intrahospitalaria y egreso a las 48 horas. Al 4to día posoperatorio consultó por fiebre, dolor abdominal, taquipnea y taquicardia. Mediante tomografía computada de abdomen se diagnosticó infarto esplénico parcial. Recibió tratamiento médico con remisión inicial de los síntomas, los cuales reaparecieron a la 3era semana. Se reinició el tratamiento médico, esta vez sin respuesta, y con evolución al absceso esplénico. Se decidió esplenectomía como tratamiento definitivo logrando la recuperación completa de la paciente. Conclusión: El infarto esplénico es una complicación infrecuente de la gastrectomía vertical. Su tratamiento inicial es médico, reservando la esplenectomía para los casos que no responden(AU)


Laparoscopic sleeve gastrectomy is currently the most performed bariatric surgery worldwide. Although it is an effective and safe procedure major complications can occur. In the present manuscript we report a case of splenic infarct and abscess as a rare complication of laparoscopic sleeve gastrectomy, finally requiring a splenectomy as a definitive treatment. Case report: A 22 years old woman with grade I obesity underwent laparoscopic sleeve gastrectomy with good hospital evolution and 48 hours discharge. On the 4th postoperative day she return because fever, abdominal pain, tachypnea and tachycardia. By means of a computed tomography a splenic infarct was diagnosed. She received medical treatment with initial remission of symptoms, which reappear at the third week. Medical treatment was restarted, this time without success, and with progression to splenic abscess. We decided a splenectomy as definitive treatment achieving a complete patient recovery. Conclusion: Splenic infarction is a rare complication after sleeve gastrectomy. The treatment is non surgical, reserving the splenectomy for the non responded cases(AU)


Subject(s)
Humans , Female , Adult , Young Adult , Splenic Infarction/etiology , Laparoscopy/adverse effects , Bariatric Surgery/adverse effects , Gastrectomy/adverse effects , Splenectomy , Splenic Infarction/surgery , Splenic Infarction/diagnosis , Laparoscopy/methods , Bariatric Surgery/methods , Gastrectomy/methods , Obesity/surgery
9.
Rev. chil. cir ; 71(1): 29-34, feb. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-985375

ABSTRACT

Resumen Introducción: La gastrectomía vertical (GV) y el by-pass gástrico (BPG) son los procedimientos más utilizados en el tratamiento de la obesidad. El objetivo de este trabajo es comparar ambas técnicas tanto en pérdida ponderal como en mejoría de las comorbilidades asociadas. Materiales y Método: Estudio observacional ambispectivo de los pacientes sometidos a BPG y GV desde enero de 2011 hasta diciembre de 2013. Se ha analizado la pérdida de peso y de IMC, la tasa de éxito, la reganancia de peso, el impacto en las comorbilidades asociadas y la morbimortalidad de ambas técnicas. Resultados: 172 pacientes fueron intervenidos (92 BPG y 80 GV). El BPG presenta mejores resultados en cuanto a pérdida de peso y mejoría de las comorbilidades. El grupo GV presenta mayor reganancia de peso. Ambos procedimientos presentan resultados similares en cuanto a morbimortalidad.


Introduction: Sleeve gastrectomy (SG) and gastric bypass (GBP) are the most commonly used procedures in the treatment of obesity. The objective of this paper is to compare these two techniques in regard to weight loss and improvement of the associated comorbidities. Material and Method: An ambispective observational study of patients undergoing GBP and SG from January 2011 to December 2013. Weight loss, BMI, success rate, weight regain, impact on associated comorbidities and morbimortality of both techniques were analysed. Results: 172 patients underwent operations (92 GBP and 80 SG). GBP had better results in regard to weight loss and improvement of comorbidities. The SG group had greater weight regain. The two procedures had similar results in regard to morbimortality.


Subject(s)
Humans , Male , Female , Gastric Bypass/adverse effects , Gastric Bypass/methods , Gastric Bypass/mortality , Gastrectomy/adverse effects , Gastrectomy/methods , Gastrectomy/mortality , Obesity, Morbid/surgery , Anastomosis, Roux-en-Y/methods , Weight Loss , Treatment Outcome , Perioperative Care
10.
J. health med. sci. (Print) ; 5(1): 15-20, Ene-Mar. 2019. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1151831

ABSTRACT

El cáncer gástrico (CG), representa el cuarto lugar de enfermedades oncológicas en mujeres y el primero en hombres. La mejor opción de tratamiento para pacientes con CG avanzado (CGA), sigue siendo la cirugía, lo que supone la realización de una gastrectomía total o subtotal, asociado a linfadenectomía D2 (LD2 ). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia (SV) en pacientes resecados por CGA sin neoadyuvancia. La metodología usada fue serie de casos en retrospectiva de pacientes con CGA sometidos a gastrectomía total o subtotal con LD2 , de forma consecutiva, en Clínica RedSalud Mayor Temuco, entre 2008 y 2017. La variable resultado fue SV actuarial global (SVAG) a 5 años. Otras variables de interés fueron: tiempo quirúrgico, número de linfonodos resecados, estancia hospitalaria, MPO, y recurrencia. Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier y long Rank test. Se intervinieron 29 pacientes (72,4 % hombres), con una mediana de edad de 63 años. La localización más frecuente fue subcardial (51,7 %); el tipo de resección más frecuente fue gastrectomía total (51,7 %). La medianas del tiempo quirúrgico, del número de linfonodos resecados y de estancia hospitalaria; fue de 185 min, 32 y 6 días respectivamente. La MPO fue 17,2 %. Con una mediana de seguimiento de 26 meses, se verificó recurrencia de 37,9 %; y SVAG a 5 años para estadios IIIA, IIIB y IV fue de 47,6 %, 34,3 % y 15,4 % respectivamente (p < 0,05). Los resultados obtenidos, en términos de MPO, mortalidad y SVAG, fueron similares a series de centros de derivación nacionales e internacionales en los que no se ha aplicado terapias neoadyuvantes.


Gastric cancer (CG) represents the fourth place of oncological diseases in women and the first in men. The best treatment option for patients with advanced CG (ACG) is still surgery, which involves making total or subtotal gastrectomies and D2 lymphadenectomy (D2L). The aim of this study is to determine postoperative morbidity (POM) and overall survival (OS) in patients resected by CGA without neoadjuvant therapy. The methodology used was a series of cases in retrospective of patients with CGA undergoing total or subtotal gastrectomies and D2L, consecutively at RedSalud Mayor Temuco Clinic, between 2008 and 2017. The outcome variable was OS at 5 years. Other variables of interest were: surgical time, number of resected lymph nodes, hospital stay, POM, and recurrence. Patients were followed clinically. Descriptive statistics was used, and OS analysis was applied using long Rank test. Twenty-nine patients (72.4% men), with a median age of 63 years, were operated. The most frequent location was subcardinal (51.7%). The most frequent type of resection was total gastrectomy (51.7%). The median of surgical time, number of resected lymph nodes and hospital stay; was 185 min, 32 and 6 days respectively. MPO was 17.2%. With a median follow-up of 26 months, a recurrence of 37.9% was verified; and 5-year OS for stages IIIA, IIIB and IV were 47.6%, 34.3% and 15.4% respectively (p <0.05). The results achieved, in terms of POM and OS series were similar to national and international series in which neoadjuvant therapies have not been applied.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stomach Neoplasms/surgery , Lymph Node Excision/methods , Recurrence , Sex , Stomach Neoplasms/mortality , Survival Analysis , Chile , Death Certificates , Medical Records , Data Interpretation, Statistical , Follow-Up Studies , Age Factors , Survivorship , Gastrectomy/methods , Informed Consent
11.
Medwave ; 19(8): e7692, 2019.
Article in English, Spanish | LILACS | ID: biblio-1021438

ABSTRACT

OBJETIVO Describir las características clínicas, los patrones de tratamiento y los costos asociados en pacientes con cáncer gástrico localmente avanzado o metastásico en Argentina, en los sectores público y privado. MÉTODOS Una cohorte histórica de pacientes que recibieron tratamiento de quimioterapia de primera línea (análogo de platino y/o una fluoropirimidina) y fueron seguidos durante al menos tres meses después de la última administración de un agente citotóxico de primera línea fueron elegibles. Se extrajeron los datos a través de un cuestionario estructurado a partir de los registros médicos de cuatro hospitales argentinos. Las estimaciones de los costos de tratamiento también se calcularon utilizando los costos unitarios de los hospitales participantes. RESULTADOS Entre los 101 pacientes, más de tres cuartas partes (79,2%) eran hombres, 41,6% fueron diagnosticados con enfermedad metastásica en estadio IV, la edad media fue de 57,7 años y el 27,7% tenían antecedentes de tabaquismo. Antes del diagnóstico de cáncer gástrico metastásico, el 42,4% de los pacientes habían recibido gastrectomía total. El 97% de los pacientes recibió una terapia doble o triplete, de los cuales el tratamiento más frecuente fue la epirubicina en combinación con oxaliplatino y capecitabina (38%), seguida de capecitabina + oxaliplatino (29%). Alrededor del 36% de los pacientes respondieron al tratamiento de primera línea (respuesta completa y parcial). Del 76,2% de los pacientes que siguieron un tratamiento de segunda línea, al 37,7% todavía se les administró un análogo de platino y/o fluoropirimidina. Durante el período de seguimiento, el 50% de los pacientes progresó y el 32,8% tenía enfermedad estable. La terapia de apoyo consistió principalmente en visitas ambulatorias después de la última línea de quimioterapia (16,8%), radioterapia paliativa (16,8%) y cirugía (30,7%). Se observaron diferencias significativas entre los costos de los hospitales públicos y privado. CONCLUSIONES Comprender los patrones de tratamiento en pacientes con cáncer gástrico localmente avanzado o metastásico puede ayudar a abordar las necesidades médicas no satisfechas para un mejor manejo del paciente y la mejora de sus resultados clínicos en Argentina.


AIM To assess patient and disease characteristics, treatment patterns and associated costs in patients with locally advanced or metastatic gastric cancer in Argentina, in the public and private sectors. METHODS A historic cohort of patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed-up for at least three months after the last administration of a first-line cytotoxic agent were eligible. Case-report forms were prepared based on medical records from four Argentinian hospitals. Estimates of treatment costs were also calculated using the unit costs of the participating hospitals. RESULTS Of 101 patients, more than three quarters (79.2%) were male, 41.6% were diagnosed with metastatic stage IV disease (mean age, 57.7years), and 27.7 % had a smoking history. Before locally advanced or metastatic gastric cancer diagnosis, 42.4% of the patients had received total gastrectomy. Ninety-seven percent of the patients received a doublet or triplet therapy, of which epirubicin in combination with oxaliplatin and capecitabine was the most common treatment (38%), followed by capecitabine plus oxaliplatin (29%). Around 36% of the patients responded to first-line treatment (complete and partial response). Out of the 76.2% of the patients who followed a second-line treatment, 37.7% were still administered a platinum analog and/or fluoropyrimidine. During the reported follow-up period, 50% of the patients progressed, and 32.8% had stable disease. The best supportive care consisted mostly of outpatient visits after last-line therapy (16.8%), palliative radiotherapy (16.8%), and surgery (30.7%). We observed significant differences between public and private hospital costs. CONCLUSIONS Understanding treatment patterns in patients with locally advanced or metastatic gastric cancer may help address unmet medical needs for better patient management and improvement of their clinical outcome in Argentina.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Stomach Neoplasms/epidemiology , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Gastrectomy/methods , Argentina , Stomach Neoplasms/pathology , Stomach Neoplasms/therapy , Retrospective Studies , Cohort Studies , Follow-Up Studies , Hospital Costs/statistics & numerical data , Neoplasm Metastasis , Neoplasm Staging
12.
Rev. Col. Bras. Cir ; 46(6): e20192314, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057187

ABSTRACT

RESUMO Objetivo: avaliar se a laparoscopia com lavado peritoneal é superior à tomografia computadorizada para o estadiamento do adenocarcinoma gástrico e se pode modificar a conduta cirúrgica do paciente. Métodos: estudo retrospectivo de 46 pacientes portadores de adenocarcinoma gástrico tratados pela equipe de cirurgia digestiva do Hospital de Clínicas de Passo Fundo (RS), de janeiro de 2015 a dezembro de 2018, e submetidos à laparoscopia com lavado peritoneal pré-operatório. Todos os pacientes foram submetidos ao estadiamento clínico pré-operatório com tomografia computadorizada. Resultados: dos 46 pacientes analisados, a maioria apresentava tumores localizados na cárdia (34,8%), pouco diferenciados (69,6%) e do subtipo células em anel de sinete (65,2%). Em 91,3% deles a tomografia computadorizada não identificou carcinomatose peritoneal ou metástases à distância. Entre estes pacientes com tomografia computadorizada negativa para doença à distância, 21,8% apresentaram lavado peritoneal positivo para células neoplásicas e tiveram suas condutas terapêuticas modificadas. Conclusão: a laparoscopia e o lavado peritoneal alteraram a decisão cirúrgica em 21,8% dos pacientes, proporcionando um estadiamento pré-operatório mais fidedigno no adenocarcinoma gástrico.


ABSTRACT Objective: to assess whether laparoscopy with peritoneal lavage is superior to computed tomography for staging gastric adenocarcinoma and whether it can modify the surgical approach. Methods: we conducted a retrospective study of 46 patients with gastric adenocarcinoma treated by the digestive surgery team of the Passo Fundo Clinics Hospital (RS), from January 2015 to December 2018, and submitted to laparoscopy with preoperative peritoneal lavage. All patients underwent preoperative clinical staging with computed tomography. Results: of the 46 patients analyzed, the majority had tumors located in the cardia (34.8%), poorly differentiated (69.6%), and subtype signet ring cells (65.2%). In 91.3%, the computed tomography scan did not identify peritoneal carcinomatosis or distant metastasis. Among these patients with negative computed tomography for distant disease, 21.8% had positive peritoneal lavage for neoplastic cells and had their therapeutic approaches modified. Conclusion: laparoscopy and peritoneal lavage altered the surgical decision in 21.8% of patients, providing a more reliable preoperative staging in gastric adenocarcinoma.


Subject(s)
Humans , Male , Female , Aged , Stomach Neoplasms/surgery , Digestive System Surgical Procedures/methods , Peritoneal Lavage/methods , Adenocarcinoma/surgery , Laparoscopy/methods , Stomach Neoplasms/pathology , Preoperative Care , Adenocarcinoma/pathology , Tomography, X-Ray Computed , Retrospective Studies , Gastrectomy/methods , Middle Aged , Neoplasm Staging
13.
Rev. Col. Bras. Cir ; 46(6): e20192351, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1057184

ABSTRACT

RESUMO Objetivo: analisar as características clínicas e epidemiológicas, as complicações pós-operatórias e a perda de peso em pacientes submetidos à gastrectomia vertical por via convencional, em uma instituição de saúde do Sistema Único de Saúde (SUS). Métodos: estudo transversal, longitudinal, retrospectivo realizado a partir da coleta de dados de prontuários para análise de variáveis em pacientes submetidos à gastrectomia vertical aberta, no SUS, no período de julho de 2013 a janeiro de 2017. Resultados: foram analisados 296 pacientes operados no período do estudo, dos quais 54% eram do sexo masculino; a média de idade foi de 39,9 anos ±11,4; o índice de massa corporal (IMC) médio no pré-operatório foi de 43,5kg/m² e no pós-operatório, de 30,3kg/m²; a perda de excesso de peso foi de 73,6%; 83,24% apresentaram uma perda de excesso de peso maior do que 50%; o IMC pré-operatório foi maior no grupo com perda de peso menor do que 50%. Observou-se uma taxa de complicações precoces com necessidade de internamento de 5,4% e um índice de mortalidade de 1%. Conclusão: a gastrectomia vertical aberta é uma técnica segura e eficaz para a perda de peso e que pode ser mais realizada no SUS. Dentre as variáveis avaliadas, o IMC prévio foi a única relacionada com o sucesso pós-operatório.


ABSTRACT Objective: to analyse clinical and epidemiological characteristics, postoperative complications, and weight loss in patients undergoing conventional vertical gastrectomy in a hospital under Brazil's Public Health System (SUS). Methods: cross-sectional longitudinal retrospective study based on data collection from medical records for variable analysis in patients undergoing open vertical gastrectomy in SUS, from July 2013 to January 2017. Results: we analysed 296 patients operated on during the study period, of which 54% were male. The average age was of 39.9 years ±11.4; the average body mass index (BMI) was of 43.5kg/m² in the preoperative period and of 30.3kg/m² in the postoperative period; and the excess weight loss was of 73.6% (83.24% had an excess weight loss greater than 50%). Preoperative BMI was higher in the group with weight loss below 50%. We observed a 5.4% rate of early complications requiring hospitalization and a 1% mortality rate. Conclusion: open vertical gastrectomy is a safe and effective weight loss technique, which can be more performed in SUS. Among the variables evaluated in our work, the previous BMI was the only one related to the postoperative success.


Subject(s)
Humans , Male , Adolescent , Adult , Aged , Young Adult , Obesity, Morbid/surgery , Gastrectomy/methods , Postoperative Complications/etiology , Brazil , Body Mass Index , Cross-Sectional Studies , Retrospective Studies , Longitudinal Studies , Treatment Outcome , Laparoscopy/methods , Middle Aged , National Health Programs
14.
Rev. Col. Bras. Cir ; 46(5): e20192264, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057173

ABSTRACT

RESUMO Objetivo: o duodenal switch é um procedimento disabsortivo complexo, associado aos melhores resultados de perda de peso e controle metabólico. A cirurgia em etapas, com gastrectomia vertical como primeiro passo, é uma opção para reduzir complicações em pacientes superobesos. No entanto, alguns problemas persistem, como fígados grandes, que dificultam a abordagem cirúrgica, e complicações, como fístulas graves. A bipartição do trânsito intestinal é um modelo modificado e simplificado de desvio biliopancreático que complementa a gastrectomia vertical. É semelhante ao duodenal switch com menores complexidade e consequências nutricionais. Este estudo avaliou a viabilidade e a segurança da bipartição de trânsito isolada como o procedimento inicial para tratar a superobesidade. Métodos: foram incluídos 41 pacientes superobesos, com IMC médio de 54,5±3,5kg/m2. Uma bipartição de trânsito isolada laparoscópica foi realizada como o primeiro procedimento em uma nova abordagem em duas etapas. Perda de peso e complicações foram analisadas durante um ano de acompanhamento. Resultados: todos os procedimentos foram completados por laparoscopia. Após seis meses, a perda média de excesso de peso percentual foi de 28%, permanecendo estável até o final do estudo. Não houve dificuldades intraoperatórias. Metade dos pacientes apresentou diarreia precoce e três tiveram úlceras marginais. Não houve complicações cirúrgicas maiores ou mortes. Conclusão: a bipartição de trânsito isolada laparoscópica é uma nova opção para uma abordagem em estágios na superobesidade, que pode permitir um segundo procedimento mais seguro após a perda de peso ao longo de seis meses. Pode ser útil, particularmente, para pacientes com obesidade grave.


ABSTRACT Objective: biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. Methods: this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. Results: we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. Conclusion: isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Obesity, Morbid/surgery , Biliopancreatic Diversion/methods , Duodenum/surgery , Gastrectomy/methods , Weight Loss , Prospective Studies , Follow-Up Studies , Treatment Outcome , Length of Stay , Middle Aged
15.
Acta cir. bras ; 34(8): e201900801, 2019. tab, graf
Article in English | LILACS | ID: biblio-1038129

ABSTRACT

Abstract Purpose To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy. Methods Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared. Results The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536). Conclusion Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy.


Subject(s)
Animals , Male , Rats , Surgical Wound Dehiscence/prevention & control , Fibrin Tissue Adhesive/pharmacology , Surgical Stapling/adverse effects , Gastrectomy/methods , Pressure , Random Allocation , Suture Techniques , Rats, Wistar , Disease Models, Animal
17.
ABCD arq. bras. cir. dig ; 32(4): e1464, 2019. tab, graf
Article in English | LILACS | ID: biblio-1054598

ABSTRACT

ABSTRACT Background: The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. Aim: To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. Methods: Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. Results: The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. Conclusion: Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.


RESUMO Racional: O tratamento do câncer gástrico avançado com intenção curativa é essencialmente cirúrgico e a quimiorradioterapia está indicada como neo ou adjuvância para controlar a doença e prolongar a sobrevida. Objetivos: Avaliar a sobrevida dos doentes submetidos à gastrectomia subtotal ou total com linfadenectomia D2 seguidos de quimiorradioterapia adjuvante. Métodos: Foram analisados retrospectivamente 87 gastrectomizados portadores de adenocarcinoma gástrico avançado considerandos estádios IB até IIIC e submetidos à quimiorradioterapia adjuvante (protocolo INT 0116). Foram excluídos os tumores da transição esofagogástrica, com implantes peritoneais, metástases à distância e os que após a operação apresentaram margem cirúrgica comprometida ou óbito precoce. Foram separados quanto à extensão da gastrectomia e analisados em relação ao local e histopatologia do tumor, invasão linfonodal, estadiamento, morbidade e sobrevida. Resultados: O número de doentes que conseguiu completar o esquema adjuvante na sua totalidade foi de 45 (51,7%). Os que iniciaram o tratamento e interromperam por toxicidade, piora relacionada ao tumor, ou perda de seguimento foram 10 (11,5%) e relacionados como adjuvância incompleta. O número de doentes que recusou ou não iniciou o tratamento adjuvante foi de 33 (48,3%). A gastrectomia subtotal foi indicada em 60 (68,9%) e a total em 27 (31,1%) e esta apresentou menor sobrevida. A média de linfonodos ressecados foi de 30,8. O estadiamento e o número de linfonodos acometidos foram preditores de pior sobrevida e quanto mais avançado foi o tumor. Os pacientes submetidos à terapia adjuvante com quimiorradioterapia completa mostraram sobrevida maior quando comparados àqueles que a fizeram de forma incompleta ou submetidos à operação exclusiva. Por outro lado, comparando-se os doentes estádios T4b (IIIB + IIIC) que tiveram adjuvância completa com os submetidos à operação exclusiva ou que não completaram a adjuvância, houve significativa diferença na sobrevida. Conclusão - A quimiorradioterapia adjuvante apresenta ganho de sobrevida para doentes em estádio T4b submetidos ao tratamento cirúrgico com intenção curativa.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Stomach Neoplasms/therapy , Chemoradiotherapy, Adjuvant , Gastrectomy/methods , Retrospective Studies , Disease-Free Survival , Lymph Node Excision , Neoplasm Staging
18.
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
19.
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
20.
ABCD arq. bras. cir. dig ; 32(1): e1413, 2019. tab, graf
Article in English | LILACS | ID: biblio-973378

ABSTRACT

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.


RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Laparoscopy/methods , Laparoscopy/mortality , Gastrectomy/methods , Gastrectomy/mortality , Postoperative Complications , Stomach Neoplasms/pathology , Time Factors , Chile , Survival Rate , Retrospective Studies , Treatment Outcome , Laparoscopy/adverse effects , Statistics, Nonparametric , Kaplan-Meier Estimate , Early Detection of Cancer , Perioperative Period , Gastrectomy/adverse effects , Lymph Node Excision/mortality , Neoplasm Staging
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