Tratamiento quirúrgico de la acalasia esofágica: experiencia en 328 pacientes / Surgical treatment of achalasia: experience in 328 patients

Background: Patients with achalasia may require surgical treatment. Aim: To assess postoperative evolution, complications and mortality after surgical treatment of achalasia. Material and Methods: Analysis of 328 patients aged 13 to 80 years (51 percent females) with achalasia, operated in a period of 40 years. Open surgery was used in 165 patients and a laparoscopic modality (starting in 1994) in 163. Results: Patients subjected to open or laparoscopic surgery had similar demographic and manometric features. Mucosal injury during myotomy occurred in 20 (12 percent) and 10 (6 percent) of patients subjected to open or laparoscopic surgery, respectively (p < 0.05). Four patients operated using a laparoscopic approach had to be converted to open surgery. Two patients operated using an open approach had a postoperative leak. One patient had an abscess and one a hemoperitoneum. Conclusions: The surgical approach of choice for achalasia is laparoscopic, with a low incidence of complications.

Objetivos: Evaluar la evolución postoperatoria inmediata y morbimortalidad en 328 pacientes con acalasia sometidos a tratamiento quirúrgico en un período de 40 años. Material y Método: Se analizan 328 pacientes con acalasia, sometidos a abordaje laparotómico en 165 pacientes y laparoscópico en 163 pacientes, evaluando la morbilidad y mortalidad postoperatoria exclusivamente. Se aplicó el mismo protocolo quirúrgico en ambos grupos, variando sólo en la vía de acceso abdominal. Resultados: Ambos grupos son enteramente comparables tanto en edad, distribución por género, síntomas, duración de síntomas y estudio manométrico. Hubo significativamente más apertura de la mucosa esofágica durante cirugía laparoscópica comparada con la vía laparotómica. Hubo 2 pacientes con filtración postoperatoria con cirugía laparotómica y 1 hemoperitoneo después de abordaje laparoscópico. No hubo mortalidad operatoria. Conclusión: El abordaje laparoscópico es la técnica de elección en la actualidad en pacientes con acalasia, con una muy baja morbilidad.

O perfil dos portadores de doença de Chagas, com ênfase na forma digestiva, em hospital terciário de Ribeirão Preto, SP / Features of Chagas' disease patients with emphasis on digestive form, in a tertiary hospital of Ribeirão Preto, SP

Para caracterizar o perfil clínico e demográfico dos portadores da forma digestiva da doença de Chagas atualmente atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, foram revistos 377 prontuários de pacientes com resultado positivo para reação sorológica para a doença de Chagas atendidos entre janeiro de 2002 a março de 2003. A idade mediana dos pacientes era de 67 anos e 210 (56 por cento) eram mulheres. Megaesôfago e/ou megacólon chagásicos estavam presentes em 135 pacientes, dos quais, 59 por cento apresentavam cardiopatia. Para 49 por cento dos pacientes com doença digestiva, havia prescrição de pelo menos dois medicamentos para tratamento de doença cardiovascular. Em 66 pacientes, foram detectadas comorbidades crônicas. A população de portadores da forma digestiva da doença de Chagas do HCFMRP é majoritariamente geriátrica e apresenta freqüência elevada de doenças cardiovasculares, o que sugere risco elevado das modalidades de tratamento cirúrgico do megaesôfago e megacólon.

Management of patients with esophageal artesia with or without tracheoesophageal fistula, a 7 years experience

To see the short term outcome in patients treated for esophageal artesia with or without tracheo-esophageal fistula in our setup. Descriptive and retrospective. Department of Paediatric Surgery and Department of Cardiothoracic Surgery, Postgraduate Medical Institute, Lady Reading Hospital Peshawar from January 1998 to December 2004 with duration of 7 years. After diagnosis, patients were put on broad-spectrum intravenous antibiotics, intravenous fluids, vitamin K injection and throat suction in a normothermic environment. Diagnosis was established mainly on clinical grounds and supported by passing a big size nasogastric suction tube [size 10 Fr] through the mouth into the esophagus and taking a plain X-ray chest of the patient. After adequate preparation, through a right thoracotomy in 5th intercostals space, fistula repair and esophageal anastomosis was performed extrapleurally in patients with tracheoesophageal fistula while gastrostomy and ce rvical esophagostomy was performed in patients with pure esophageal atresia. Transanastomotic tube was passed as a nasogastric tube size 10 to act as a stent and later on used for tube feeding. A total of 60 patients with esophageal artesia with or without tracheoesophageal fist ula were admitted. There were 40 males and 20 females. Age ranged from 1-7 days. Weight of the newborn patients was in the range of 2 - 3Kg. Four patients had cyanotic congenital heart disease, two were with imperforate anus and two with spina bifida. All patients had some form of bronchopneumonia due to aspiration of upper pouch contents out of whom 30 patients had severe pneumonia. Six patients left the hospital against medical advice and 6 patients died before operation. Forty-eight patients were operated. Esophagostomy and astrostomy was performed for pure esophageal atresia [10 Patients], while in 38 patients, a right thoracotomy in the 5" inter costal space with fistula ligation and esophageal anastomosis was performed. Three out of ten patients with pure esophageal atresia died, while eighteen patients with tracheoesophageal fistula died after surgery. Twenty-seven out of total 48 patients survived and were discharged to home after an average hospital stay of 7 days after surgery. Eleven patients were s een in follow up and treated accordingly. This study shows that majority of these patients presented late because of improper referral system. Delay in diagnosis and management led to various complications such as aspiration pneumonia, dehydration and septicemia with great mortality which is further increased due to nonavailability of the neonatal intensive care facility in our setup. Survival of these patients can be improved by early and proper referral system, specialized medical and surgical team, specialized anesthesia with personnel trained in neonatal anesthesia

Percutaneous endoscopic gastrostomy in Trinidad and Tobago

Percutaneous endoscopic gastrostomy tube placement is rapidly becoming the preferred method of gastrostomy tube placement. We describe our experience with this procedure in nine patients. The main complications were minor and due to local infection. This report demonstrates the simplicity and safety of this technique

Causas básicas de morte em chagásicos idosos / Basic causes of death in elderly chagasic patients

Determinaram-se, ocm bases em dados clínicos e necroscópicos, as causas básicas de morte de 100 chagásicos idosos (grupo A), 100 idosos näo chagásicos (grupo B) e 100 chagásicos näo idosos (grupo C). Em relaçäo a B, o grupo A teve um número significativamente maior de mortes por cardiopatica hagásica crôn e "mega" digestivos e menor de neoplasias malignas. Quando comparado a C, o grupo A teve, em grua significativo, mortalidade maior por enfisema pulmonar e neoplasias malignas e menor por cardiopatia chagásica crônica. Esta causou 26 óbitos súbitos inesperados entre os näo idosos, mas nenhum entre os idosos