ABSTRACT
BACKGROUND: Repair of hernias with loss of domain in obese patients can lead to acute respiratory failure. OBJECTIVES: The objective of this study was to analyze preoperative progressive pneumoperitoneum (PPP) in increasing abdominal cavity volume and its impact on respiratory function. SETTING: The study was conducted at the University Hospital, State University of Londrina, Brazil, which is a referral center for the treatment of obesity. The patients were hospitalized for the duration of the study. METHODS: Sixteen obese patients were evaluated. Computed tomography was used to determine hernia sac volume (HSV) and abdominal cavity volume (ACV). Respiratory function was evaluated by measuring vital capacity and forced expiratory volume in the first second (FEV-1). All data were obtained before PPP, on the day before surgery, and on the second postoperative day. PPP was performed daily with insufflation of CO2. RESULTS: The number of insufflations was 12. The average of total volume inflated was 5.7 L. The HSV was 2953 cm3 before PPP and 1935 cm3 after PPP. The average ACV increased from 8898 to 11,317 cm3 after PPP. The relationship between HSV and ACV was 38.2% before and 16.3% after PPP. There was a favorable improvement in respiratory function with an increase in vital capacity from 1875 to 2760 mL and an increase in FEV-1 from 1060 to 1670 mL after PPP. Respiratory function tests after surgery showed values of 2600 and 1560 mL, respectively, for cavity volume and FEV-1. There were no postoperative respiratory complications. CONCLUSIONS: This technique can be used safely in the surgical preparation of obese patients with hernias with loss of domain, reducing the relation between HSV and ACV and avoiding pulmonary complications.
Subject(s)
Hernia, Abdominal/diagnostic imaging , Hernia, Abdominal/surgery , Herniorrhaphy/methods , Obesity, Morbid/diagnosis , Pneumoperitoneum, Artificial/methods , Respiratory Insufficiency/etiology , Adult , Brazil , Cohort Studies , Female , Herniorrhaphy/adverse effects , Hospitals, University , Humans , Male , Middle Aged , Multivariate Analysis , Pneumoperitoneum, Artificial/adverse effects , Postoperative Complications/epidemiology , Postoperative Complications/physiopathology , Preoperative Care/methods , Prognosis , Respiratory Function Tests , Respiratory Insufficiency/prevention & control , Retrospective Studies , Risk Assessment , Statistics, Nonparametric , Surgical Mesh/statistics & numerical data , Treatment OutcomeABSTRACT
BACKGROUND: Sleeve gastrectomy may alter esophageal motility and lower esophageal sphincter pressure. AIM: To detect manometric changings in the esophagus and lower esophageal sphincter before and after sleeve gastrectomy in order to select patients who could develop postoperative esophageal motilitity disorders and lower esophageal sphincter pressure modifications. METHODS: Seventy-three patients were selected. All were submitted to manometry before the operation and one year after. The variables analyzed were: resting pressure of the lower esophageal sphincter, contraction wave amplitude, duration of contraction waves, and esophageal peristalsis. Data were compared before and after surgery and to the healthy and non-obese control group. Exclusion criteria were: previous gastric surgery, reflux symptoms or endoscopic findings of reflux or hiatal hernia, diabetes and use of medications that could affect esophageal or lower esophageal sphincter motility. RESULTS: 49% of the patients presented preoperative manometric alterations: lower esophageal sphincter hypertonia in 47%, lower esophageal sphincter hypotonia in 22% and increase in contraction wave amplitude in 31%. One year after surgery, manometry was altered in 85% of patients: lower esophageal sphincter hypertonia in 11%, lower esophageal sphincter hypotonia in 52%, increase in contraction wave amplitude in 27% and 10% with alteration in esophageal peristalsis. Comparing the results between the preoperative and postoperative periods, was found statistical significance for the variables of the lower esophageal sphincter, amplitude of contraction waves and peristalsis. CONCLUSION: Manometry in the preoperative period of sleeve gastrectomy is not an exam to select candidates to this technique.
Subject(s)
Gastroplasty/methods , Manometry , Obesity, Morbid/surgery , Patient Selection , Adult , Female , Humans , Male , Middle Aged , Postoperative Period , Prospective Studies , Young AdultABSTRACT
ABSTRACT Background: Sleeve gastrectomy may alter esophageal motility and lower esophageal sphincter pressure. Aim: To detect manometric changings in the esophagus and lower esophageal sphincter before and after sleeve gastrectomy in order to select patients who could develop postoperative esophageal motilitity disorders and lower esophageal sphincter pressure modifications. Methods: Seventy-three patients were selected. All were submitted to manometry before the operation and one year after. The variables analyzed were: resting pressure of the lower esophageal sphincter, contraction wave amplitude, duration of contraction waves, and esophageal peristalsis. Data were compared before and after surgery and to the healthy and non-obese control group. Exclusion criteria were: previous gastric surgery, reflux symptoms or endoscopic findings of reflux or hiatal hernia, diabetes and use of medications that could affect esophageal or lower esophageal sphincter motility. Results: 49% of the patients presented preoperative manometric alterations: lower esophageal sphincter hypertonia in 47%, lower esophageal sphincter hypotonia in 22% and increase in contraction wave amplitude in 31%. One year after surgery, manometry was altered in 85% of patients: lower esophageal sphincter hypertonia in 11%, lower esophageal sphincter hypotonia in 52%, increase in contraction wave amplitude in 27% and 10% with alteration in esophageal peristalsis. Comparing the results between the preoperative and postoperative periods, was found statistical significance for the variables of the lower esophageal sphincter, amplitude of contraction waves and peristalsis. Conclusion: Manometry in the preoperative period of sleeve gastrectomy is not an exam to select candidates to this technique.
RESUMO Racional: A gastrectomia vertical pode determinar alterações na motilidade esofágica e no esfíncter inferior do esôfago. Objetivo: Estudar as alterações manométricas do esfíncter inferior do esôfago e do esôfago antes e depois da operação a fim de selecionar pacientes que pudessem desenvolver alterações pós-operatórias. Métodos: Setenta e três pacientes foram selecionados. Todos foram submetidos à manometria antes da operação e um ano após. As variáveis analisadas foram: pressão do esfíncter inferior do esôfago, amplitude e duração das ondas de contração e peristaltismo esofágico. Os dados foram comparados entre si antes e depois da operação e também com grupo controle saudável e não obeso. Critérios de exclusão foram: operação gástrica prévia, história de refluxo ou achado endoscópico de esofagite de refluxo ou de hérnia de hiato, diabete e uso de medicamentos que pudessem afetar a motilidade do esôfago ou do esfíncter esofágico inferior. Resultados: 49% dos pacientes apresentaram alterações no pré-operatório: hipertonia do esfíncter em 47%, hipotonia do esfíncter em 22% e aumento na amplitude das ondas de contração em 31%. Um ano após, a manometria encontrou-se alterada em 85% dos pacientes: hipertonia do esfíncter em 11%, hipotonia do esfíncter em 52%, aumento na amplitude das ondas de contração em 27% e 10% com alteração no peristaltismo esofágico. Comparando-se os resultados entre o pré e pós-operatório encontrou-se significância estatística para a pressão do esfíncter inferior do esôfago, amplitude das ondas de contração e peristaltismo. Conclusão: A manometria no pré-operatório da gastrectomia vertical não é fator de seleção dos candidatos a essa técnica.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Obesity, Morbid/surgery , Gastroplasty/methods , Patient Selection , Manometry , Postoperative Period , Prospective StudiesABSTRACT
Objetivos: O objetivo deste estudo foi analisar a eficácia do método laparoscópico em casos de abdome agudo inflamatório de difícil avaliação, quanto à acurácia, sensibilidade, especificidade e valores preditivos positivo e negativo. Método: Foram examinados, prospectivamente, 29 doentes com suspeita clínica de abdome agudo inflamatório, que após exames clínico e complementares não esclarecedores, foram submetidos à laparoscopia diagnóstica e/ou terapêutica. Resultados: A precisão diagnóstica do exame foi de 96,5%. Com relação à terapêutica, 58,6 % dos doentes foram tratados por laparoscopia, 34,4% clinicamente e 6,8 % por laparotomia. A taxa de complicação foi de 10,3%, com ausência de mortalidade nesta série. Os doentes submetidos ao tratamento laparoscópico, tiveram alta hospitalar em média 36 horas após o procedimento. Conclusões: A laparoscopia mostrou-se um método de elevada acurácia diagnóstica, que permitiu manejo terapêutico satisfatório, associado à baixa morbidez e à recuperação pósoperatória precoce.
Objective: The aim of this study is to analize the efficacy of laparoscopy in cases of acute inflamatory abdomen of difficult diagnosis, according to accuracy, sensitivity, specificity and negative and positive predictive values. Methods: The authors studied, prospectively, 29 patients with clinical suspicion of inflamatory acute abdomen, that, after inconclusive clinical and complemental investigations were submitted to diagnostic and / or therapeutic laparoscopy. Results: In 96,5 % of the patients the procedure confirmed the diagnosis; 58,6 % of the patients were treated by laparoscopy, 6,8% by laparotomy and 34,4% received clinical treatment. The complication rate was 10,3 %, with no mortality in this study. Patients treated by laparoscopy were discharged from hospital in 36 hours after the procedure. Conclusions: Laparoscopy proved to be a good diagnostic and therapeutic method in acute inflamatory diseases of the abdomen and is associated with lower hospitalization time and lower rate of complications.
ABSTRACT
Os autores analisam um grupo de 30 pacientes com lesöes por extravasamento de drogas antineoplásicas. Para determinar as características dessas lesöes, uma ficha de controle foi elaborada contendo os dados específicos. Isso permitirá a avaliaçäo dos fatores predisponentes e resultados do tratamento com o objetivo de diminuir a freqüência e a morbidade desse tipo de acidentes
