ABSTRACT
AIM: To analyze the indications, efficacy and safety of sphincteroplasty in our centre. METHODS: A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure. RESULTS: The indications included intradiverticular papilla in 26 patients (49%), stenosis of a previous sphincterotomy in 19 patients (35.8%), small size of the papilla in 4 patients (7.5%), Billroth II gastrectomy in 3 patients (5.6%), and coagulopathy in one patient (1.9%). The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients (39.6%) had calculi with a diameter equal to or greater than 10 mm. Seven patients (13.2%) presented complications: haemorrhage in 1 patient (1.9%) and mild pancreatitis in 6 patients (11.3%). The mean hospital stay in case of complications was of 3 +/- 0.63 d. CONCLUSION: Sphincteroplasty is highly effective, with a complication rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy.
Subject(s)
Ampulla of Vater/abnormalities , Gallstones/surgery , Sphincterotomy, Transduodenal/methods , Aged , Aged, 80 and over , Ampulla of Vater/surgery , Bile Ducts/abnormalities , Bile Ducts/surgery , Catheterization , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Sphincter of Oddi/abnormalities , Sphincter of Oddi/surgery , Sphincterotomy, Transduodenal/adverse effects , Sphincterotomy, Transduodenal/instrumentationABSTRACT
La osteotomía deslizante del mentón es una operación de gran utilidad, que permite resolver problemas del balance estético facial, y se utiliza no sólo en las deficiencias del tamaño o simetría del mentón, sino como complemento a otras cirugías de la cara. Se hace una descripción de la técnica operatoria en donde se destaca la simplificación y sistematización de los pasos a seguir. Y se presentan casos representativos que demuestran la utilidad de la cirugía. La osteotomía deslizante del mentón es la piedra angular en el tratamiento de trastornos del esqueleto facial y tiene gran utilidad como complemento de la cirugía ortognática. Se describe también su utilidad en el manejo del perfil, acompañando a la rinoplastia estética. En la cirugía de rejuvenecimiento del cuello puede jugar también un papel importante, lo mismo que en la corrección de los estigmas del síndrome de Down, de las secuelas de traumatismos y en el crecimiento facial asimétrico. Con la simplificación y sistematización de la técnica de mentoplastia deslizante se dispone de un elemento terapéutico muy útil para todo cirujano plástico. Se recomienda tener en cuenta esta técnica, y sensibilizarse no sólo también con la gran variedad de indicaciones posibles que presenta, lo que se verá reflejado en buenos resultados de manera consistente (AU)
Sliding genioplasty is a very useful surgery to solve aesthetic problems of the facial skeleton. It is used not only in the treatment of chin deficiencies or asymmetries, but also as a complement to other facial aesthetic surgeries. This article is a description of the surgical technique, with emphasis on simplicity and systematization of operative steps. Representative cases demonstrating surgery usefulness are illustrated. Chin osteotomy is the corner stone of facial skeleton surgery, and it is a natural complement in orthognatic surgery. Its benefits as accompanying procedure in rhinoplasty, and rythidectomy are described. Downs syndrome stigmata, growth defects by excess, deficiency or asymmetry as well as traumatic defects, can also be corrected with this versatile procedure. Simplification and systematization of sliding genioplasty offer to plastic surgeons a powerful tool. Recommendation for plastic surgeons to place chin osteotomy in a high rank into their surgical armamentarium is encouraged. Plastic surgeons sensibilization to technical aspects as well as the wide variety of indications can be reflected in good results consistently (AU)