Fisioterapia respiratória e motora no pós-operatório imediato de gastroplastia - relato de caso / Practice physiotherapeutic in the immediate postoperative period of gastroplasty - a case study

O objetivo deste trabalho foi relatar a atuação fisioterapêutica no pós-operatório imediato de gastroplastia de Fobi-Capella. Para isso, foram realizadas duas avaliações, uma antes e outra após o tratamento. As avaliações englobaram: anamnese, exame físico geral, cirtometria e o teste da distância percorrida durante seis minutos. A conduta fisioterapêutica foi realizada em quatro sessões e baseou-se em manobras de higienização brônquica, reexpansão pulmonar, exercícios respiratórios, treino de padrão respiratório diafragmático e fisioterapia motora. A paciente relatada evoluiu de forma satisfatória no pós-operatório, evidenciando-se a importância da Fisioterapia para a recuperação motora e respiratória. Essa evolução foi principalmente constatada por meio da melhora da expansibilidade torácica ? aumento de três centímetros na expansibilidade diafragmática e de dois centímetros na altura do processo xifóide; do padrão respiratório, o qual passou de uma predominância apical para um padrão misto e por intermédio da capacidade física geral, verificada por meio do aumento expressivo da distância percorrida no teste de caminhada de 6 minutos (111,25 metros para 262,15 metros). Considera-se, portanto, a fisioterapia importante no pós-operatório de pacientes submetidos a gastroplastia, propiciando, junto a uma equipe multidiscplinar, uma melhor recuperação desses pacientes.

This study aimed to report the physiotherapeutic intervention in the immediate postoperative period of gastroplasty by Fobi-Capella. In order to do this, there were two evaluations, one before and one after treatment. Evaluations included: history, general physical examination, cirtometry and the six minutes walk test. There were four sessions of physiotherapeutic intervention which were based on maneuvers for the removal of respiratory secretion, re-lung, breathing exercises, training of diaphragmatic breathing pattern and physiotherapy needs. The patient reported growing satisfactorily in the postoperative period, which highlights the importance of physiotherapy to restore motor and breathing capacities. This was demonstrated in this study mainly by the chest expansion improvement (a three centimeter rise in diaphragmatic mobility and a two centimeter rise in mobility at the xiphoid process level), the breathing pattern (which changed from an apical breathing pattern to a pattern characterized mainly by the diaphragmatic expansion) and also demonstrated by the general physical capacity progress which was verified through the expressive increase in the distance walked during the six-minute-walk-test (111,25 meters to 262,15 meters). Therefore, it is concluded that the physiotherapeutic intervention is important in the gastroplasty immediate post-operative period, as it can provide, with a multidisciplinary group, a better recovery for these patients.

Effect of band ligation on portal hypertensive gastropathy and development of fundal varices.

BACKGROUND: Use of endoscopic therapies for esophageal varices has resulted in increased prevalence of fundal varices and severe portal hypertensive gastropathy. This study was meant to compare the effect of band ligation and sclerotherapy on development of fundal varices and portal hypertensive gastropathy. METHODS: Patients with esophageal varices presenting in the endoscopy unit of Shiakh Zayed Hospital, with at least one previous endoscopy were included. Patient's past record was reviewed for findings and type of treatment given for varices during first endoscopy, number of endoscopies till date, number of esophageal varices band ligation (EVBL) or sclerotherapy sessions. All patients underwent upper GI endoscopy and findings were recorded. Type of treatment patient rendered during first endoscopy either EVBL or sclerotherapy was correlated to the presence of fundal varices and severity of portal hypertensive gastropathy observed on present endoscopy, using Chi square test (chi2). RESULTS: Eighty one patients were included. Mean age of patients was 48.70 +/- 12.63. Esophageal varices band ligation was carried out during first endoscopy in 49 (60.5%) patients and sclerotherapy in 31 (38.2%) patients. On fresh endoscopy, fundal varices were seen in 25 (30.8%) patients. Severe portal hypertensive gastropathy was found in 26 (32.1%) and mild in 54 (66.7%) patients. Severity of portal hypertensive gastropathy and presence of fundal varices in recent endoscopy was significantly more in patients with EVBL in first endoscopy. CONCLUSION: Band ligation of esophageal varices is associated with more frequent development of fundal varices and worsening of portal hypertensive gastropathy compared to sclerotherapy.

Complications after vertical gastroplasty with artificial pseudopylorus in the treatment of morbid obesity: a 7-year experience.

BACKGROUND: Vertical gastroplasty with artificial pseudopylorus (VGAP) was designed to reduce the complication rate of other forms of gastroplasty. The purpose of this study was to analyze the complications of this approach for 7 years of surgical practice. METHODS: A total of 156 morbidly obese patients (BMI 41-81 kg/m2) who underwent VGAP were analyzed retrospectively in terms of early and late complications and gastroplasty failure. RESULTS: The early complication rate, operative and systemic, was 6.40% (10 patients) and the late complication rate was 12.16% (19 patients). Early complications: We observed two gastric leaks and subphrenic abscess formation with one gastrocutaneous fistula, one severe intraabdominal hemorrhage, one evisceration, two serious wound hematomas, one lobar pneumonia, one massive pulmonary embolism and two nodular erythemas. Late complications: There were two prepyloric ulcers, one pseudopyloric ulcer with stoma stenosis, seven wound hernias, four pseudopyloric dilatations with suture rejection and gastroplasty failure, and five staple-line dehiscences with endostomach channel formation and gastroplasty failure. One patient (0.64%) died from massive pulmonary embolism. CONCLUSIONS: The early and late complication rate was acceptable in this series. The applied technique of VGAP is simple, safe, and helps avoid many complications caused by the other forms of gastroplasty.