ABSTRACT
Surgical myotomy is the gold standard in therapy for achalasia, but treatment failures occur and require revisional surgery. A MEDLINE search of peer-reviewed articles published in English from 1970 to December 2008 was performed using the following terms: esophageal achalasia, Heller myotomy, and revisional surgery. Thirty-three articles satisfied our inclusion criteria. A total of 12,727 patients, with mean age of 43.3 years (males 46% and females 50%), underwent Heller myotomy (open 94.8% and laparoscopic 5.2%). Revisional surgery was performed in 6.19%. Procedures performed included revision of the original myotomy or creation of a new myotomy with or without an antireflux procedure or esophagectomy. Reasons for reoperation were incomplete myotomy (51.8%), onset of reflux (34%), megaesophagus (16.2%), and esophageal carcinoma (3.04%). Systematic review of the literature for revisional surgery following Heller myotomy revealed a 6.19% rate of reoperation with a low mortality rate.
ABSTRACT
Endoscopic Ultrasound is an emerging diagnostic tool in the field of Gastrointestinal Surgery. Our review article focuses on role of EUS in staging cancers (esophageal, gastric, biliary and rectal), detection of bilio-pancreatic calculi and diagnosis of chronic pancreatitis. Potential for performing EUS based therapeutic interventions are been explored and looks promising from the initial reports.
ABSTRACT
CONTEXT: Choledochal cysts, rarely present with chronic calcific pancreatitis. We report two patients with choledochal cysts who had concomitant chronic pancreatitis. CASE REPORT #1: A 27-year-old female with a history of recurrent abdominal pain, fever and jaundice presented with a type I choledochal cyst with calcifications in the uncinate process of the pancreas on CT scan. Her magnetic resonance cholangiopancreatogram (MRCP) revealed calcifications in the region of the uncinate process of the pancreas, the presence of a type I choledochal cyst with dilatation of the right and left hepatic ducts at their confluence suggesting an anomalous pancreaticobiliary ductal junction. She underwent choledochal cyst excision with a Roux-en-Y hepaticojejunostomy. CASE REPORT #2: A 35-year-old male with colicky abdominal pain of four months duration whose CT scan was suggestive of an atrophic pancreas with a 1 cm dilatation of the pancreatic duct and a calculus in the pancreatic duct near the ampulla. MRCP showed significant atrophy of the pancreas with an isointense filling defect seen in the pancreatic duct at its distal end near the ampulla. A diagnosis of chronic calcific pancreatitis with type I choledochal cyst was made. He underwent choledochal cyst excision with a cholecystectomy, hepaticojejunostomy (end-to-side) and side-to-side pancreaticojejunostomy. CONCLUSION: Chronic calcific pancreatitis is a rare occurrence in patients with choledochal cysts and only six cases have been reported in the literature. Our two patients with choledochal cysts associated with chronic pancreatitis were treated surgically.
Subject(s)
Choledochal Cyst/complications , Pancreatitis, Chronic/complications , Adult , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Choledochal Cyst/diagnostic imaging , Female , Humans , Male , Pancreatitis, Chronic/diagnostic imagingABSTRACT
BACKGROUND: Pulmonary embolism (PE) remains a leading cause of death after Roux-en-Y gastric bypass. Currently, various regimens of low-molecular-weight heparin (LMWH) are used for perioperative deep vein thrombosis (DVT) prophylaxis. Anti-factor Xa (AFXa) has been suggested as a potential marker of LMWH activity. We have developed a perioperative prophylactic DVT regimen for our bariatric patients in which the dosage of LMWH they receive is based on their body mass index (BMI). We looked at whether AFXa levels correlated with bleeding risk. METHODS: A retrospective, single institution review of 102 patients undergoing a gastric bypass from November 2003 to April 2004 was performed. Twelve patients received transfusions. AFXa levels were present for 7 of 12 patients requiring transfusions and 74 of 90 patients not requiring transfusions. The average AFXa level for each group was compared. RESULTS: The transfusion rate for the group was 11.7%, with an average of 2.6 units of blood given (SD 1.2). There was no statistical difference between the average AFXa value for transfused and nontransfused patients (0.13 +/- 0.08 vs. 0.16 +/- 0.19, P = .7). CONCLUSION: AFXa levels do not appear to correlate with bleeding risk in patients receiving LMWH prophylaxis following gastric bypass. Determining such risk seems to require another marker.
Subject(s)
Factor Xa Inhibitors , Gastric Bypass/adverse effects , Gastrointestinal Hemorrhage/epidemiology , Heparin, Low-Molecular-Weight/therapeutic use , Pulmonary Embolism/epidemiology , Pulmonary Embolism/prevention & control , Adult , Anastomosis, Roux-en-Y/adverse effects , Blood Transfusion/statistics & numerical data , Female , Gastrointestinal Hemorrhage/etiology , Humans , Male , Retrospective StudiesSubject(s)
Bariatrics/methods , Obesity, Morbid/surgery , Postoperative Complications/prevention & control , Pulmonary Embolism/prevention & control , Venous Thrombosis/prevention & control , Body Mass Index , Female , Gastric Bypass/adverse effects , Gastric Bypass/methods , Gastroplasty/adverse effects , Gastroplasty/methods , Humans , Male , Obesity, Morbid/diagnosis , Primary Prevention/methods , Prognosis , Pulmonary Embolism/mortality , Risk Assessment , Severity of Illness Index , Survival Rate , Venous Thrombosis/mortalityABSTRACT
The thiazolidinediones are the insulin sensitizers used in the management of Type 2 diabetes mellitus. These drugs can potentially decrease the risk of cardiovascular disease by correcting the different components of the insulin resistance syndrome.
