ABSTRACT
BACKGROUND: The ideal time to operate on pectus excavatum (PE) using the Nuss procedure (NP) is between 12 and 18 years of age, because it is more difficult to bend the sternum of older patients and they have more pain and complications. The authors present a prospective study of adult patients with PE operated on by NP, analyzing technical improvements, new tricks, bar modifications, and preliminary outcomes. MATERIALS AND METHODS: From May 2003 to September 2009, 19 patients presenting PE (group 1), aged 20-27 years, underwent NP. A modified operation was performed in 10 patients using the scope at the axilla; the bar needed hyperconvex modeling in the middle and extended internal curving of its extremities before rotation at the thorax. A new and more resistant bar was designed and was used in the last 5 patients. Two stabilizers were implanted in 11 cases. Group 1 patients were compared with a group of 26 teenagers operated on before 20 years of age (group 2) during the same period. RESULTS: All operations could be performed despite the more intense rigidity of the anterior thoracic wall in group 1. It was easier in the last patients who received thicker bars. After the third postoperative day, the operations were more painful in group 1, requiring more potent analgesic drugs. However, the adults were more tolerant and complained less than most patients of group 2. There were no differences between the two groups in operative times, complications, or hospitalization. CONCLUSIONS: Patients with PE can be operated on during the third decade of life by the NP, facilitated by compensating bending of the bar, a stronger bar, and the use of potent analgesics, leading to outcomes similar to those in younger patients.
Subject(s)
Funnel Chest/surgery , Prostheses and Implants , Adolescent , Adult , Analgesics/administration & dosage , Female , Humans , Male , Treatment OutcomeABSTRACT
BACKGROUND: Esophageal replacement (ER) is indicated for long gap esophageal atresia (LGEA) when anastomosisis not possible, especially in cases without fistula or when elongation techniques have failed. The authors show their techniques and analyze preliminary results of the laparoscopic gastric pull-up (LGPU) for ERin LGEA. METHODS: Four children with LGEA admitted for ER (three type A, one type C) underwent LGPU. Using three ports, including the gastrostomy site, surgical steps included releasing the stomach while preserving the right gastric and gastroepiploic arteries, pyloromyoplasty, and retromediastinal blunt dissection through a laparoscopic view. The esophagostomy was freed and the superior mediastinum was dissected, the stomach was pulled up for cervical anastomosis to the distal esophagus in two cases and to the gastric fundus in another two, adding thoracoscopy in two. RESULTS: All operations were performed without major surgical complications, conversion, death, or reoperation.There were no abdominal complications. Two children presented atelectasis and one case evolved to pneumonia.A girl had a cervical fistula close spontaneously. Transanastomotic tube feeding began after 2-4 days,oral feeding after 8-12 days. Mild anastomotic stenosis (2) was resolved with endoscopic dilatations. After a follow-up of 9-26 months all children have functional grafts and satisfactory oral feeding. One child has duodeno-gastric reflux. Cosmetics have been excellent. The children have the same scars they had before (umbilicus,gastrostomy, and esophagostomy) plus a tiny 3 mm scar on the right flank. CONCLUSIONS: Video-assisted esophageal replacement with the stomach for LGEA can be safely performed in children and infants, even after a previous mediastinal operation; however, larger comparative series are required in the future.
Subject(s)
Esophageal Atresia/surgery , Laparoscopy , Digestive System Surgical Procedures/methods , Female , Follow-Up Studies , Humans , Infant , Male , Postoperative ComplicationsABSTRACT
A atresia é a má-formação congênita mais comum do esôfago. A evolução é o sucesso na correção cirúrgica da atresia de esõfago constitui o principal marco para o reconhecimento e estabecimento da cirúrgia pediátrica como especialidade.Desde a sua primeira descrição por Durston,em 1670, a atresia de esôfago experimentou um avanço significativo em seu tratamento, passando de uma mortalidade de 100% para uma sobrevida atual de 60 a 90% nos centros de referência.Os bons resultados em seu tratamento decorrem da tecnica da equipe cirúrgica e infra-estrutura hospitar adequada.Em Juiz de Fora e região não há , até a presente data, relato de estudos de pacientes conduzidos e operados de atresia de esôfago parametrando os resultados e comparando-os com os referenciais da literatura.O objetivo deste estudo retrospectivo é apresentar a casuítica de 28 pacientes portadores de atresia de esôfago, operados no período de fevereiro/1994 a outubro /2001.Para tanto,dividimos a casuítica em 2 fases iguais,contendo,cada uma ,14 pacientes e duração de 4 anos.Analisando a sobrevida obtida em cada fase, obtivemos indices de 28,5% na fase inicial e de 85,7% na fase subquente.Tal ocorrência reflete a melhoria na assistência prestada,operação mais precoce,bem como o aprimoramento técnico-profissional e institucional, ocorrido na 2ª fase.
Atresia is the most common congenital malformation of the esophageal. Sucess and evolution in the surgical correction of esophageal atresia is considerd to be the main hallmark to the acknowledgement of pediatric surgery as a speciality. since its firts description by Durston, in 1670,esophageal atresia treatment has experienced substantial advance, rising from a mortartaly rate of 100% to a survival rate of 60 a 90% in the best treatment centers.Good results in its treatment are obtained from harmonious relationships among early diagnosis, technical ability of the surgical team and adequate infrastructure in hospitals. Until the present date, there is not any registered study of operated patients with esophageal atresia in Juiz de Fora and surroundings analyzing and comparing results with references in the current literature. The aim of this retrospective study is to present our experience involving 28 patients we have o perated on between February/1994 and October/2001.To do so, we have divided our patients into 2 equal groups, each containing 14 patients and lasting 4years.By analyzing the survival rate obtained in each group,we have come to the following result:28.5% in the first group and 85.7% in the second.Such a fact shows improvement in the assistance we have provided, earlier surgery, as well as technical mastering and institutional development, which took place in the second analysed period.
Subject(s)
Humans , Male , Female , Infant, Newborn , Esophageal Atresia , Esophageal Fistula , Esophageal Atresia/surgery , Esophagus/abnormalities , Esophagus/surgeryABSTRACT
Os autores relatam um caso de dilataçäo cística congênita do colédoco em uma paciente de 7 anos, com história de dor abdominal do tipo cólica, cuja propedêutica laboratorial, assim como a radiografia simples de abdome, encontrava-se normal. A ultra-sonografia de abdome inicial evidenciava apenas colelitíase. Após tratamento da crise persistiu com a mesma sintomatologia por 9 meses, realizando mais 4 ultra-sonografias abdominais, que evidenciaram dilataçäo das vias biliares intra e extra hepáticas, sem colelitíase. A mesma foi submetida a laparotomia, que confirmou a presença de um grande cisto de colédoco, sendo o mesmo retirado e realizada uma anastomose bilio-digestiva, com boa evoluçäo no pós-operatório. Säo também revisados aspectos da sintomatologia, incidência e terapêutica.
Subject(s)
Humans , Female , Child , Choledochal Cyst/surgery , Abdominal Pain , Anastomosis, Surgical , Choledochal Cyst/diagnosis , Dilatation, Pathologic/surgery , Bile Ducts, Extrahepatic/abnormalities , Gallstones , Bile Ducts, Intrahepatic/abnormalitiesABSTRACT
Nessa revisäo, os autores abordam um tema que é extremamente complexo: as glomerulonefrites. Apresenta-se uma classificaçäo morfológica das lesöes glomerulares que, embora simples, tem-se mostrado extremamente útil na orientaçäo terapêutica dos pacientes. Também se discute as diferentes formas de apresentaçäo clínica das glomerulonefrites e as modalidades de tratamento de que se dispöe no momento no manuseio clínico destes nefropatas.
