Tratamiento actual de la acalasia, reporte de un caso y revisión de la literatura / Current treatment of achalasia. A case report and literature review

Resumen: Presentamos el caso de una joven de 16 años con síntomas digestivos, principalmente disfagia y dolor retroesternal. Luego de ser diagnosticada de acalasia (sintomatología compatible), que se confirma por manometría de alta resolución, se indica tratamiento quirúrgico (miotomía de Heller + funduplicatura de Toupet), con cirugía mínimamente invasiva (laparoscopia), La evolución fue muy favorable: desaparecieron los síntomas digestivos y fue notable la pronta recuperación. Se revisa la literatura de las distintas opciones terapéuticas y sus principales indicaciones. Palabras claves: acalasia, manometría de alta resolución, miotomía de Heller, funduplicatura de Toupet

Abstract: We report the case of 15 year old female with digestive symptoms, mainly dysphagia and chest pain. After being diagnosed with possible achalasia (compatible clinical), is confirmed by high-resolution manometry, surgical treatment is indicated (myotomy heller + fundoplication toupet), with minimally invasive surgery (laparoscopy), with a very favorable evolution, disappearing digestive symptoms and produced a remarkable recovery in a short time. We do a literature review of therapeutic options available and their main indications. Key words: achalasia, high-resolution manometry, Heller myotomy, Toupet fundoplication

Trauma raquimedular penetrante a nivel torácico por arma blanca sin déficit neurológico / Raquimedular trauma penetrating thoracic stab without neurological deficit

Resumen: El trauma penetrante de médula espinal es una patología poco frecuente y corresponde a la tercera causa más común de lesión de médula espinal. Presentamos el caso de un paciente con trauma medular penetrante, causado por un cuchillo que permaneció 12 horas incrustado en su columna dorsal y que no presentó déficit neurológico. Según nuestro conocimiento, existe un solo caso reportado de lesión penetrante de médula espinal sin compromiso neurológico. Es controvertido el manejo de estas lesiones, por ello comentaremos nuestra experiencia con el presente caso. Palabras claves: : trauma penetrante de médula espinal, lesión de médula espinal, arma blanca, cirugía, tratamiento, manejo.

Abstract: The penetrating spinal trauma is a very uncommon pathology, corresponds to the third most frequent of spinal medular lesion. We present a case of a patient with penetrating spinal trauma causes by a knife that remained twelve hours embedded at the spinal cord and this patient did not present neurological deficit. For our knowledge, there is only one case reported of a penetrating spinal trauma without a neurological compromise. There are controversies about the management of these lesions and that is why we will to present this case as our experience. Key words: penetrating spinal cord trauma, spinal cord injury, knife, surgery, treatment, management.

Comparative study of Laparoscopic Nissen fundoplication Vs Posterior fundoplication in Gastroesophageal reflux disease

Background: Gastroesophageal reflux Disease is a highly prevalent gastrointestinal (GI) disorder and is one of the most common GI illnesses encountered in clinical practice. Gastroesophageal reflux disease (GERD) is one of the most common conditions presenting to primary care physicians and gastroenterologists. It refers to the abnormal exposure of the oesophageal mucosa to refluxed gastric contents, including acid and pepsin, resulting in symptoms and/or tissue damage. Our aim was to compare the result of nissen and toupet procedures and to determine which procedure is better in terms of symptomatic improvement symptom recurrence and post-operative complications. Materials and methods: This was the both prospective and retrospective study included 29 patients with GERD who were operated upon by Laproscopic Nissen Fundoplication and Laproscopic Posterior Fundoplication. Demographic and clinical profiles of all patients were recorded. All patients were subjected to thorough clinical evaluation, upper GI endoscopy done in all patients, esophageal Manometry and 24 ph study done in selected patients. All preoperative data compared with the postoperative data. Results: In our series 68.9% of the patients were below 50 years. 31.03% was above 50 years. The average age of occurrence was being 41.4 years. In our series Sex distribution were 75.8% of Males and 24.1% of Females. Wound (port site) infection 5 (17.2%) was treated with antibiotics and drainage, chest infection (atelectasis) 7 (24%) treated with IV antibiotics, Pleural effusion 2 (6.8%) was treated with physiotherapy settled down 2-3 days, mild surgical emphysema 2 (6.8%) may be due to good hiatal dissection and proper esophagus mobilization, it settled down in 2 days, urinary tract Patel Y, Baria B, Gohil K, Parmar H. Comparative study of Laparoscopic Nissen fundoplication Vs Posterior fundoplication in Gastroesophageal reflux disease. IAIM, 2016; 3(9): 189-193. Page 190 infection 3 (10.3%) was treated with antibiotics, port site hematoma 3 (10.3%) was managed conservatively. Conclusion: Both Laparoscopic Nissen fundoplication and Laparoscopic posterior fundoplication provides excellent results for GERD in terms of postoperative morbidity and complications.

Cirugía anti-reflujo laparoscópica para el tratamiento de la enfermedad por reflujo gastro-esofágico: experiencia en 125 casos / Laparoscopic anti-reflux surgery for the treatment of disease gastroesophageal reflux: experience in 125 cases

Evaluar la cirugía anti-reflujo laparoscòpica para el tratamiento de la enfermedad por reflujo gastro-esofágico. Se realizaron 125 operaciones anti-reflujo en igual número de pacientes, 62 (49,6 por ciento correspondieron al sexo masculino y 63 (50,4 por ciento) al sexo femenino. Edad promedio de 46,63 años ± 7,25 años. Los síntomas más frecuentes fueron pirosis (98,4 por ciento) y regurgitación (97,6 por ciento). La mayoría de los pacientes 85 (68 por ciento), tenían 10 años o más de tratamiento médico. Se realizó la operación de Nissen modificada "Floppy Nissen" en 76 pacientes (60,8 por ciento), en 23 pacientes (18,4 por ciento) se realizó la técnica de Toupet y en 4 pacientes (3,2 por ciento) la técnica de Dor. Las patologías asociadas (29 en total) estuvieron presentes en 28 pacientes (22,4 por ciento). Todas estas patologías fueron resueltas en el mismo acto operatorio. Las complicaciones fueron leves en su mayoría (infecciones locales, seromas, etc). Hubo una perforación de la unión gastro-esofágica que ameritó conversión. Un paciente (0,8 por ciento), ameritó reintervención por disfagia severa. No hubo mortalidad post-operatoria. Centro Médico "Dr. Rafael Guerra Méndez", Valencia-Venezuela. Tasa de éxito del 91,2 por ciento para la desaparición de los síntomas. La cirugía anti-reflujo es el método más eficaz para el tratameito de la enfermedad por reflujo gastro-esofágico de curso progresivo y con respuesta deficiente al tratamiento médico. Es necesario establecer con exactitud el defecto funcional del esófago a fin de seleccionar la técnica más adecuada. La estancia hospitalaria, los costos, la morbilidad y la mortalidad se reducen con el abordaje laparoscópico.

Laparoscopic Repair of Esophageal Hiatal Hernia / 中国微创外科杂志

Objective To investigate the clinical effects of laparoscopic repair of esophageal hiatal hernia using Bard CruraSoft PTFE/ePTFE Mesh combined with Toupet partial fundoplication.Methods From August 2006 to April 2007,13 patients with esophageal hiatal hernia(typeⅠin 6 and type Ⅲ in 7)were treated by laparoscopy in our hospital.Under a laparoscope,esophageal hiatal hernia was separated by ultrasonic scalpel,and then repaired using Bard CruraSoft PTFE/ePTFE Mesh with Ethicon Endopath Multifieed Stapler.Afterwards,Toupet partial fundoplication was performed.Results The operation was completed in all the cases without converting to open surgery.The mean operation time was 142 min(115-185 min);mean intraoperative blood loss was 75 ml(25-120 ml);mean time to the first flatus and oral feeding was 32 h(26-37 h);and mean postoperative hospital stay was 4 d(3-6 d).The patients were followed up for 4-11 mon(mean 6.5 mon).The symptoms disappeared in 1 month.Three months after the operation,barium examination found no recurrence of the hernia in the 13 cases.Conclusions Laparoscopic repair of esophageal hiatal hernia with mesh combined with Toupet partial fundoplication is a safe and minimally invasive operation.The method is worth being widely used.