Comparative study of pain in women submitted to conventional laparoscopic cholecystectomy versus single-port laparoscopic cholecystectomy.

PURPOSE:: To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. METHODS:: Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p<0.05. RESULTS:: Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. CONCLUSION:: This study found no significant difference in postoperative pain between the two groups.

Comparative study of pain in women submitted to conventional laparoscopic cholecystectomy versus single-port laparoscopic cholecystectomy

Abstract Purpose: To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. Methods: Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p<0.05. Results: Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. Conclusion: This study found no significant difference in postoperative pain between the two groups.

Effectiveness of Spiritist Passe (Spiritual Healing) on the Psychophysiological Parameters in Hospitalized Patients.

Context • The coexistence of affective disorders, especially anxiety and depression, with medical illness is a topic of considerable clinical and research interest. Complementary biofield modalities are therapies that involve touch or placement of the hands in or through biofields. Spiritual healing, or Spiritist passe (SP), is a kind of laying on of hands (LOH), and therefore is a biofield therapy. Objective • The current study intended to evaluate the effects of SP on psychological parameters such as anxiety and depression and on the perceptions of muscle tension and wellness as well as physiological parameters, such as pain intensity, heart rate (HR), and oxygen saturation (SpO2). Design • This study was a randomized, controlled trial. Setting • The study took place at the medical clinic of the clinical hospital of the Federal University of Triângulo Mineiro (HC/UFTM) in Uberaba, Brazil. Participants • The participants were patients aged ≥18 y who had been hospitalized in the clinic between August 2014 and June 2015. Intervention • Participants in the no-SP and SP groups were instructed to direct their thoughts to Jesus with wishes to heal during the intervention. In the SP group, the patients underwent application of the SP, and in the no-SP group, workers, students, or volunteers at the Clinical Hospital of Uberaba practiced a kind of LOH in a nonspiritual therapy with intention to healing emitting sincere wishes of improvement to the patients by thought. All procedures in those groups were carried out during a 10-min period on 3 consecutive days. In the control group, the patients lay for 10 min during the same periods on the 3 days, with no intervention occurring. Outcome Measures • The study evaluated depression and anxiety using the Hospital Anxiety and Depression (HAD) scale as well as patients' pain using a visual analog scale (VAS). The study also measured their perceptions of muscle tension and wellness and their physiological parameters: HR and SpO2. Results • Seventy-two patients consented to participate in the study. The SP group showed statistically significant reductions in anxiety (P < .001) and depression (P = .008) between baseline and postintervention, with perceptions of muscle tension significantly decreasing on day 1 (D1) and day 3 (D3) of the study (both < .001) after the interventions and wellness significantly increasing between baseline and postintervention (P = .001) and when compared with the control and no-SP groups, with P = .001. The SP group presented the smallest numbers for HR after the interventions, but no significant differences were found between groups for HR, SpO2, and pain on the VAS. Conclusions • The current research team has concluded that the SP was effective in promoting a state of muscle relaxation, reducing anxiety and depression, decreasing muscle tension, and, consequently, raising the perceptions of wellness in hospitalized patients.

COMPARATIVE ANALYSIS OF IMMUNOLOGICAL PROFILES IN WOMEN UNDERGOING CONVENTIONAL AND SINGLE-PORT LAPAROSCOPIC CHOLECYSTECTOMY.

Background: Surgical trauma triggers an important postoperative stress response characterized by significantly elevated levels of cytokines, an event that can favor the emergence of immune disorders which lead to disturbances in the patient's body defense. The magnitude of postoperative stress is related to the degree of surgical trauma. Aim: To evaluate the expression of pro-inflammatory (TNF-α, IFN-γ, IL-1ß, and IL-17) and anti-inflammatory (IL-4) cytokines in patients submitted to conventional and single-port laparoscopic cholecystectomy before and 24 h after surgery. Methods: Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 submitted to conventional laparoscopic cholecystectomy and 19 to single-port laparoscopic cholecystectomy. Results: Evaluation of the immune response showed no significant difference in IFN-γ and IL-1ß levels between the groups or time points analyzed. With respect to TNF-α and IL-4, serum levels below the detection limit (10 pg/ml) were observed in the two groups and at the time points analyzed. Significantly higher postoperative expression of IL-17A was detected in patients submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels (p=0.0094). Conclusions: Significant postoperative expression of IL-17 was observed in the group submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels, indicating that surgical stress in this group was higher compared to the conventional laparoscopic cholecystectomy.

Racional: O trauma cirúrgico induz resposta de estresse pós-operatório significativo, evidenciado pelos níveis elevados de citocinas, podendo favorecer o surgimento de distúrbios imunológicos. A magnitude de estresse está relacionada ao grau do trauma cirúrgico. Objetivos: Avaliar a expressão das citocinas pró-inflamatórias (TNF-α, IFN-γ, IL-1ß, IL-17) e da anti-inflamatória (IL-4) no pré e pós-operatório de pacientes submetidas à colecistectomia laparoscópica por dois métodos: convencional e por portal único. Métodos: Quarenta mulheres com colecistolitíase sintomática foram operadas, sendo 21 por procedimento laparoscópico convencional e 19 por portal único. As citocinas TNF-α, IFN-γ, IL-1ß, IL-4, e IL-17 presentes no plasma foram quantificadas pelo método de ELISA em dois momentos: no pré-operatório e após 24 h da operação. Resultados: A avaliação da resposta imune não mostrou diferença estatisticamente significante das citocinas IFN-γ e IL-1ß na comparação entre os grupos e tempos analisados. Em relação às citocinas TNF-α e IL-4 os níveis séricos estavam abaixo dos níveis de detecção (10 pg/ml) em ambos os grupos e tempos analisados. Observou-se que as operadas por portal único apresentaram expressão significativa da IL-17A do período pré para o pós-operatório (p=0,0094). Conclusões: A expressão aumentada da IL-17A no pós-operatório do grupo de portal único pode indicar que o estresse cirúrgico foi maior em comparação ao da colecistectomia laparoscópica convencional.

Comparative analysis of immunological profiles in women undergoing conventional and single-port laparoscopic cholecystectomy / Perfil imunológico de mulheres submetidas à colecistectomia laparoscópica convencional e por portal único

ABSTRACT Background: Surgical trauma triggers an important postoperative stress response characterized by significantly elevated levels of cytokines, an event that can favor the emergence of immune disorders which lead to disturbances in the patient's body defense. The magnitude of postoperative stress is related to the degree of surgical trauma. Aim: To evaluate the expression of pro-inflammatory (TNF-α, IFN-γ, IL-1β, and IL-17) and anti-inflammatory (IL-4) cytokines in patients submitted to conventional and single-port laparoscopic cholecystectomy before and 24 h after surgery. Methods: Forty women with symptomatic cholelithiasis, ranging in age from 18 to 70 years, participated in the study. The patients were divided into two groups: 21 submitted to conventional laparoscopic cholecystectomy and 19 to single-port laparoscopic cholecystectomy. Results: Evaluation of the immune response showed no significant difference in IFN-γ and IL-1β levels between the groups or time points analyzed. With respect to TNF-α and IL-4, serum levels below the detection limit (10 pg/ml) were observed in the two groups and at the time points analyzed. Significantly higher postoperative expression of IL-17A was detected in patients submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels (p=0.0094). Conclusions: Significant postoperative expression of IL-17 was observed in the group submitted to single-port laparoscopic cholecystectomy when compared to preoperative levels, indicating that surgical stress in this group was higher compared to the conventional laparoscopic cholecystectomy.

RESUMO Racional: O trauma cirúrgico induz resposta de estresse pós-operatório significativo, evidenciado pelos níveis elevados de citocinas, podendo favorecer o surgimento de distúrbios imunológicos. A magnitude de estresse está relacionada ao grau do trauma cirúrgico. Objetivos: Avaliar a expressão das citocinas pró-inflamatórias (TNF-α, IFN-γ, IL-1β, IL-17) e da anti-inflamatória (IL-4) no pré e pós-operatório de pacientes submetidas à colecistectomia laparoscópica por dois métodos: convencional e por portal único. Métodos: Quarenta mulheres com colecistolitíase sintomática foram operadas, sendo 21 por procedimento laparoscópico convencional e 19 por portal único. As citocinas TNF-α, IFN-γ, IL-1β, IL-4, e IL-17 presentes no plasma foram quantificadas pelo método de ELISA em dois momentos: no pré-operatório e após 24 h da operação. Resultados: A avaliação da resposta imune não mostrou diferença estatisticamente significante das citocinas IFN-γ e IL-1β na comparação entre os grupos e tempos analisados. Em relação às citocinas TNF-α e IL-4 os níveis séricos estavam abaixo dos níveis de detecção (10 pg/ml) em ambos os grupos e tempos analisados. Observou-se que as operadas por portal único apresentaram expressão significativa da IL-17A do período pré para o pós-operatório (p=0,0094). Conclusões: A expressão aumentada da IL-17A no pós-operatório do grupo de portal único pode indicar que o estresse cirúrgico foi maior em comparação ao da colecistectomia laparoscópica convencional.

Effects of Isha Hatha Yoga on Core Stability and Standing Balance.

Context • The coexistence of affective disorders, especially anxiety and depression, with medical illness is a topic of considerable clinical and research interest. Complementary biofield modalities are therapies that involve touch or placement of the hands in or through biofields. Spiritual healing, or Spiritist passe (SP), is a kind of laying on of hands (LOH), and therefore is a biofield therapy. Objective • The current study intended to evaluate the effects of SP on psychological parameters such as anxiety and depression and on the perceptions of muscle tension and wellness as well as physiological parameters, such as pain intensity, heart rate (HR), and oxygen saturation (SpO2). Design • This study was a randomized, controlled trial. Setting • The study took place at the medical clinic of the clinical hospital of the Federal University of Triângulo Mineiro (HC/UFTM) in Uberaba, Brazil. Participants • The participants were patients aged ≥18 y who had been hospitalized in the clinic between August 2014 and June 2015. Intervention • Participants in the no-SP and SP groups were instructed to direct their thoughts to Jesus with wishes to heal during the intervention. In the SP group, the patients underwent application of the SP, and in the no-SP group, workers, students, or volunteers at the Clinical Hospital of Uberaba practiced a kind of LOH in a nonspiritual therapy with intention to healing emitting sincere wishes of improvement to the patients by thought. All procedures in those groups were carried out during a 10-min period on 3 consecutive days. In the control group, the patients lay for 10 min during the same periods on the 3 days, with no intervention occurring. Outcome Measures • The study evaluated depression and anxiety using the Hospital Anxiety and Depression (HAD) scale as well as patients' pain using a visual analog scale (VAS). The study also measured their perceptions of muscle tension and wellness and their physiological parameters: HR and SpO2. Results • Seventy-two patients consented to participate in the study. The SP group showed statistically significant reductions in anxiety (P < .001) and depression (P = .008) between baseline and postintervention, with perceptions of muscle tension significantly decreasing on day 1 (D1) and day 3 (D3) of the study (both < .001) after the interventions and wellness significantly increasing between baseline and postintervention (P = .001) and when compared with the control and no-SP groups, with P = .001. The SP group presented the smallest numbers for HR after the interventions, but no significant differences were found between groups for HR, SpO2, and pain on the VAS. Conclusions • The current research team has concluded that the SP was effective in promoting a state of muscle relaxation, reducing anxiety and depression, decreasing muscle tension, and, consequently, raising the perceptions of wellness in hospitalized patients.

IMMUNOLOGICAL EVALUATION OF PATIENTS WITH TYPE 2 DIABETES MELLITUS SUBMITTED TO METABOLIC SURGERY / AVALIAÇÃO IMUNOLÓGICA DE PACIENTES COM DIABETE MELITO TIPO 2 SUBMETIDOS À CIRURGIA METABÓLICA

Background: Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus. Aim: To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells. Methods: Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient. Results: No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients. Conclusion: These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.

Racional: Mecanismos imunológicos e inflamatórios desempenham papel-chave no desenvolvimento e progressão do diabete melito tipo 2. Objetivo: Levantar a hipótese de que alterações nos parâmetros imunológicos ocorrem após operação duodenojejunal combinada com interposição ileal sem gastrectomia, e influenciam o metabolismo da insulina das células beta. Métodos: Dezessete pacientes com diabete melito tipo 2 sob manejo clínico foram submetidos à cirurgia e amostras de sangue foram coletadas antes e seis meses após para avaliação do perfil de sorológico de citocinas pró-inflamatórias (IFN-γ, TNF-α, IL-17A) e anti-inflamatórias(IL-4, IL-10). Além disso, parâmetros antropométricos, glicemia e uso de insulina foram avaliados em cada paciente. Resultados: Não ocorreram alterações no padrão de expressão de citocinas pró-inflamatórias observadas antes e depois da operação. Em contraste, houve diminuição significativa na expressão de IL-10, que coincide com redução da dose diária de insulina, com o controle glicêmico e redução do IMC dos pacientes. Apresentação precoce de alimentos para o íleo pode ter induzido a produção das incretinas tais como GLP-1 e PYY, que, juntamente com o controle da glicemia, contribuíram para a perda de peso, remissão do diabete e o bom prognóstico consequente cirúrgico. Além disso, o controle de síndrome metabólica foi responsável pela redução da expressão de IL-10 nestes doentes. Conclusão: Baixo grau de inflamação estava presente nesses pacientes no pós-operatório, certamente pelo adequado controle glicêmico e ausência de obesidade, o que contribuiu para bom resultado cirúrgico.

IMMUNOLOGICAL EVALUATION OF PATIENTS WITH TYPE 2 DIABETES MELLITUS SUBMITTED TO METABOLIC SURGERY.

BACKGROUND: Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus. AIM: To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells. METHODS: Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient. RESULTS: No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients. CONCLUSION: These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.

Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery.

BACKGROUND: Incretins are hormones produced by the intestine and can stimulate the secretion of insulin, helping to diminish the post-prandial glycemia. The administration of an emulsion of palm oil can help in the maintenance of the weight, and can increase circulating incretins levels. Glutamine increases the concentration of incretins in diabetic people. Both can help in metabolic syndrome. AIM: To analyze the effects of ingestion of palm oil and glutamine in glycemia and in incretins in patients with diabetes submitted to surgical duodenojejunal exclusion with ileal interposition without gastrectomy. METHODS: Eleven diabetic type 2 patients were included and were operated. They were called to laboratory follow-up without eating anything between eight and 12 hours. They had there blood collected after the stimulus of the palm oil and glutamine taken in different days. For the hormonal doses were used ELISA kits. RESULTS: The glycemia showed a meaningful fall between the fast and two hours after the stimulus of the palm oil (p=0,018). With the glutamine the GLP-1 showed an increase between the fast and one hour (p=0,32), the PYY showed an important increase between the fast and one hour after the stimulus (p=0,06), the glycemia showed a meaningful fall after two hours of the administration of the stimulus (p=0,03). CONCLUSION: Palm oil and glutamine can influence intestinal peptides and glucose.

Effect of the ingestion of the palm oil and glutamine in serum levels of GLP-1, PYY and glycemia in diabetes mellitus type 2 patients submitted to metabolic surgery / Efeito do óleo de palma e da glutamina nos níveis séricos de GLP-1, PYY e da glicemia em portadores de diabete melito tipo 2 submetidos à cirurgia metabólica

BACKGROUND: Incretins are hormones produced by the intestine and can stimulate the secretion of insulin, helping to diminish the post-prandial glycemia. The administration of an emulsion of palm oil can help in the maintenance of the weight, and can increase circulating incretins levels. Glutamine increases the concentration of incretins in diabetic people. Both can help in metabolic syndrome. AIM: To analyze the effects of ingestion of palm oil and glutamine in glycemia and in incretins in patients with diabetes submitted to surgical duodenojejunal exclusion with ileal interposition without gastrectomy. METHODS: Eleven diabetic type 2 patients were included and were operated. They were called to laboratory follow-up without eating anything between eight and 12 hours. They had there blood collected after the stimulus of the palm oil and glutamine taken in different days. For the hormonal doses were used ELISA kits. RESULTS: The glycemia showed a meaningful fall between the fast and two hours after the stimulus of the palm oil (p=0,018). With the glutamine the GLP-1 showed an increase between the fast and one hour (p=0,32), the PYY showed an important increase between the fast and one hour after the stimulus (p=0,06), the glycemia showed a meaningful fall after two hours of the administration of the stimulus (p=0,03). CONCLUSION: Palm oil and glutamine can influence intestinal peptides and glucose .

RACIONAL: A administração de óleo de palma auxilia na manutenção do peso e aumenta níveis de incretinas circulantes. A glutamina aumenta a concentração de incretinas em indivíduos diabéticos. Assim, eles podem influenciar no tratamento da síndrome metabólica. OBJETIVO: Analisar os efeitos da ingestão de óleo de palma e glutamina na glicemia e incretinas em pacientes diabéticos que foram submetidos à operação de exclusão duodenojejunal com interposição ileal sem gastrectomia. MÉTODOS: Participaram 11 pacientes, portadores de diabete melito tipo 2, que foram operados com exclusão duodenojejunal com interposição ileal sem gastrectomia. Foram convocados para comparecer ao laboratório em jejum de oito a 12 horas e submetidos ao procedimento de coleta de sangue após os estímulos de óleo de palma e glutamina via oral em dias distintos. Para as dosagens hormonais foram utilizados kits de ELISA. RESULTADOS: A glicemia apresentou queda significativa entre o jejum e duas horas após o estímulo de óleo de palma (p=0,018). Com a glutamina, o GLP-1 apresentou aumento entre o jejum e uma hora (p=0,32); o PYY apresentou aumento entre o jejum e uma hora após o estímulo (p=0,06); a glicemia apresentou queda significativa após duas horas da administração do estímulo (p=0,03). CONCLUSÃO: O óleo de palma e a glutamina podem influenciar os peptídeos intestinais e na glicemia .

Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery.

PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.

Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery

PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.

Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy.

PURPOSE: Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS: Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy, were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS: It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS: The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.

Evaluation of anatomical and functional changes esophageal stump of patients with advanced megaesophagus submitted to subtotal laparoscopic esophagectomy / Avaliação das alterações anatômicas e funcionais do coto esofágico de pacientes portadores de megaesôfago avançado submetidos à esofagectomia subtotal laparoscópica

PURPOSE: Evaluate anatomical and functional changes of the esophageal stump and gastric fundus of patients with advanced megaesophagus, submitted to laparoscopic subtotal esophagectomy. METHODS: Twenty patients with advanced megaesophagus, previously submitted to a videolaparoscopic subtotal esophagectomy , were evaluated. Were conducted: radiological evaluation of the stump esophagus with transposed stomach, electromanometric, endoscopic examination and histopathology of the esophageal stump and gastric fundus, without making gastric tube or pyloroplasty. RESULTS: It was observed that the average height and pressure of the anastomosis, in the electromanometric evaluation, were 23.45cm (±1.84cm) and 7.55mmHg (±5.65mmHg). In patients with megaesophagus III, the pressure of the anastomosis was 10.91mmHg (±6.33mmHg), and pressure from the UES, 31.89mmHg (±14.64mm Hg), were significantly higher than those in grade IV. The pathological evaluation detected mild esophagitis in 35% of patients, moderate in 20% and acanthosis glicogenica in 45%. The examination of the gastric fundus showed that 50% of patients were infected with Helicobacter pylori. Chronic gastritis occurred in 95% of the patients. CONCLUSIONS: The laparoscopic esophagectomy shown to be effective in the treatment of advanced achalasia. The cervical level anastomosis protects the esophageal stump from the aggression resulted from gastric reflux after the esophagectomy.

OBJETIVO: Avaliar as alterações anatômicas e funcionais do coto esofágico e fundo gástrico de pacientes com megaesôfago avançado, submetidos à esofagectomia subtotal laparoscópica. MÉTODOS: Vinte pacientes com megaesôfago avançado, previamente submetidos à esofagectomia subtotal videolaparoscópica, foram avaliados. Foram realizados: avaliação radiológica do coto esofágico com o estômago transposto, eletromanometria endoscopia e exame histopatológico do coto esofágico e fundo gástrico,sem fazer tubo gástrico ou piloroplastia. RESULTADOS: Observou-se que a altura média e pressão da anastomose, na avaliação eletromanométrica, foram: 23,45cm (± 1,84cm) e 7,55mmHg (± 5,65mmHg), Em pacientes com megaesôfago III, a pressão da anastomose foi de 10,91mmHg (± 6,33mmHg), e a pressão do ESE, 31,89mmHg (±14,64mmHg) foram significativamente mais elevados do que aqueles em grau IV. A avaliação patológica detectou esofagite leve em 35% dos pacientes, moderada em 20% e acantose glicogênica em 45%. O exame do fundo gástrico mostrou que 50% dos pacientes foram infectados com Helicobacter pylori. Gastrite crônica ocorreu em 95% dos pacientes. CONCLUSÕES: A esofagectomia laparoscópica mostrou-se eficaz no tratamento de acalasia avançada. A anastomose em nível cervical tem um papel protetor para o coto esofágico ao evitar a agressão resultante de refluxo gástrico após a esofagectomia.

Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines.

PURPOSE: To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS: Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS: The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION: Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.

Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines / Estudo comparativo entre ligadura com fio ou clampeamento metálico por videolaparoscopia para obstrução biliar experimental em suínos

PURPOSE: To induce a total extra-hepatic obstructive jaundice in swines, by ligation of the common bile duct by laparoscopic surgery. METHODS: Eight swines of the Landrace race, 36-day-old, originated from the same matrix, distributed in two groups. Group A: was used titanium metal clip to the common bile duct ligation in three animals; group B: were ligated with 2-0 cotton thread in five animals. RESULTS: The ligation of the biliary ducts was performed successfully in all animals, with easy identification of the common bile duct by laparoscopy. There weren't difficulties in the procedures, mainly due to the increased surgical field provided by the excellent quality of light and image of the appliance. The clinical signs of jaundice were evident in the animals in seven days. In group A, two animals showed bile duct perforation near the clip, probably due to ischemic necrosis, progressing to peritonitis and death. In group B, five animals showed obstructive jaundice without any amendment. CONCLUSION: Under the conditions of this study, we therefore recommend the use of unabsorbed wires to experimental biliary obstruction, in order to avoid complications, such as ischemia and necrosis, followed by perforation of the wall of the bile ducts.

OBJETIVO: Induzir um quadro de icterícia obstrutiva extrahepática total em suínos, através da ligadura no ducto colédoco por meio de cirurgia videolaparoscópica. MÉTODOS: Oito suínos da raça Landrace, com 36 dias de idade, originários da mesma matriz, foram distribuídos em dois grupos. Grupo A: utilizou-se clipe metálico de titânio para ligadura do ducto colédoco em três animais; grupo B: foi feita a ligadura com fio de algodão 2-0 em cinco animais. RESULTADOS: A ligadura da via biliar principal foi realizada com sucesso em todos os animais, com fácil identificação do colédoco por videolaparoscopia. Não houve dificuldades nos procedimentos, principalmente devido ao aumento do campo cirúrgico proporcionado pela qualidade de luz e imagem do aparelho. Os sinais clínicos indicativos de icterícia foram evidentes nos animais em sete dias. No grupo A, dois animais apresentaram perfuração coledociana junto ao clipe por provável isquemia e necrose, evoluindo com coleperitônio e óbito. No grupo B, os cinco animais apresentaram quadro de icterícia obstrutiva sem qualquer alteração. CONCLUSÃO: Nas condições desse estudo, recomenda-se a utilização de fios inabsorvíveis para obstrução experimental das vias biliares, a fim de evitar complicações, como isquemia e necrose, seguida de perfuração da parede das vias biliares.