RESUMO
Resumen La fundoplicatura de Nissen laparoscópica (FNL) es el gold standard del tratamiento quirúrgico de pacientes con reflujo gastroesofágico patológico (RGE), con perfil de seguridad y resultados a largo plazo satisfactorios en un 80%. En la última década, se ha propuesto el uso de un dispositivo de potenciación del esfínter esofágico inferior (MSA) comercializado como LINX® (de Ethicon, Johnson & Johnson), como alternativa a la cirugía antirreflujo. El dispositivo consiste en una cadena expansible de cuentas de titanio con un núcleo magnético diseñadas para aumentar el tono del esfínter esofágico inferior (EEI) y evitar su relajación inadecuada. Los resultados preliminares han sido alentadores, sin embargo, no está exento de complicaciones. Las indicaciones más aceptadas son: RGE con motilidad esofágica normal y sin esofagitis erosiva, hernia hiatal < 3 cm, IMC <35 kg/m2 y pacientes sin cirugías gastroesofágicas previas. Se instala por vía laparoscópica. Los efectos adversos más importantes son: disfagia con necesidad de dilataciones endoscópicas, y, retiro del dispositivo, entre 1% y 7% a los 2,5 años. La mayoría de los estudios tienen limitaciones metodológicas, conflictos de interés, falta de resultados objetivos y seguimientos a largo plazo, impidiendo llegar a conclusiones extrapolables respecto a la eficacia del MSA.
Laparoscopic Nissen Fundoplication (LNF) is the gold standard of surgical treatment for patients with Gastroesophageal Reflux Disease (GER), with safety profile and long term results satisfactory in 80%. In the last decade, the use of a Lower Esophageal Sphincter Enhancement Device (LESD), marketed as LINX® (from Ethicon, Johnson & Johnson), has been proposed as an alternative to Anti-Reflux Surgery. The device consists of an expandable chain of titanium beads with a magnetic core designed to increase the tone of the lower esophageal sphincter (LES) and prevent its improper relaxation. Preliminary results have been encouraging; however, it is not without complications. The most accepted indications are: GER with normal esophageal motility and without erosive esophagitis, hiatal hernia < 3 cm, BMI <35 kg/m2, and patients without previous gastroesophageal surgeries. It is installed by laparoscopy. The most important adverse effects are: dysphagia with the need for endoscopic dilations, and, removal of the device, between 1 and 7% at 2.5 years. Most of the studies have methodological limitations, conflicts of interest, lack of objective results and long-term follow-up, preventing the reaching of extrapolable conclusions regarding the efficacy of MSA.
Assuntos
Humanos , Fundoplicatura/métodos , Implantação de Prótese/métodos , Desenho de Prótese , Refluxo Gastroesofágico/cirurgia , Implantação de Prótese/efeitos adversos , Pesquisa Comparativa da EfetividadeRESUMO
Background: The worldwide incidence of acute pancreatitis (AP) is increasing. Aim: To determine the national incidence of AP between 2013 and 2018. Material and Methods: Analysis of hospital discharge records available at the web page of the Statistical and Information Service of the Chilean Ministry of Health. We recorded the number of patients discharged with a diagnosis of AP, excluding chronic pancreatitis and pancreatic cancer, between 2013 and 2018. We also recorded length of hospital stay, age, etiology, and lethality. Rates of raw and age-adjusted incidence were calculated. Results: During the study period, 46,420 patients with AP were discharged, with an incidence rate ranging between 39 and 43.7/100,000 inhabitants, and a non-significant increase along time of 8.6%. There are important differences between the average adjusted rates of Northern (Arica to Metropolitan) and Southern regions (O'Higgins to Magallanes), with rates of 36.9 and 53.6/100,000 inhabitants respectively (p < 0.01). The average hospital stay was 11 days. Two thirds of cases were aged between 20 and 64 years. The case fatality was 4.2%, with no decrease between 2013 and 2018. The mortality rate was 1.6/100,000 inhabitants. Conclusions: The annual incidence of AP is 42.6/100,000 inhabitants, with geographical differences from North to South, which can be associated with the high frequency of biliary tract disease in aboriginal ethnic groups. The age distribution and length hospital stay were stable over time.