RESUMO
The optimal surgical procedure for Siewert II oesophagogastric junction cancer is still debated. The minimally invasive Ivor Lewis technique can be considered the most adequate intervention from the oncological perspective but it is still contested owing to its technical difficulties. To allow an easier thoracoscopic stage during the procedure, we performed it with laparoscopic trans-hiatal oesophageal transection and transabdominal extraction. An 80-year-old man with stage 3 Siewert II oesophagogastric junction adenocarcinoma not suitable for neoadjuvant therapy underwent minimally invasive Ivor Lewis oesophagectomy with two-field lymphadenectomy, using a laparoscopic and thoracoscopic approach in prone position. The trans-hiatal oesophageal resection permitted easy extraction of a transabdominal specimen and frozen section examination. The prone position, together with the absence of the specimen in the operative field, allowed easier mediastinal node dissection and oesophagogastric anastomosis with better visualisation. The postoperative course was uneventful. Pathology showed a G3-pT3, N2 adenocarcinoma with 6/30 metastatic lymph nodes.
Assuntos
Adenocarcinoma , Neoplasias Esofágicas , Laparoscopia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/diagnóstico , Esofagectomia/métodos , Junção Esofagogástrica/patologia , Junção Esofagogástrica/cirurgia , Humanos , Laparoscopia/métodos , Masculino , Estudos RetrospectivosRESUMO
In the past few years, minimally invasive oesophagectomy has become an increasingly popular approach for oesophagectomy showing advantages in terms of fewer postoperative complications, shorter hospital stay and faster recovery. We present the case of a 60-year-old man with a lesion of the distal third of the oesophagus and solid pulmonary nodule who underwent McKeown subtotal oesophagectomy by laparoscopic and thoracoscopic approach in prone position with concomitant thoracoscopic pulmonary wedge resection. The postoperative course was smooth, and the patient was discharged on postoperative day 10. The procedure is feasible and safe, and combines better respiratory postoperative outcomes even when associated with other diagnostic or therapeutic lung procedures.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Laparoscopia/métodos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Toracoscopia/métodos , Biópsia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/patologia , Esofagectomia/efeitos adversos , Esôfago/diagnóstico por imagem , Esôfago/patologia , Esôfago/cirurgia , Estudos de Viabilidade , Humanos , Laparoscopia/efeitos adversos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente/efeitos adversos , Posicionamento do Paciente/métodos , Pneumonectomia/efeitos adversos , Decúbito Ventral , Toracoscopia/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. The patient started oral intake on postoperative day one and was discharged on postoperative day three. Postoperative computed tomography at six months showed no signs of recurrence. In the setting of a symptomatic hiatus hernia post-minimally invasive oesophagectomy, we suggest an initial laparoscopic approach, because of its countless advantages.
Assuntos
Esofagectomia/efeitos adversos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Toracoscopia/efeitos adversos , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia Adjuvante , Colo Transverso/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Neoplasias Esofágicas/terapia , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/etiologia , Herniorrafia/instrumentação , Humanos , Intestino Delgado/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Terapia Neoadjuvante , Readmissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The incidence of biliary lithiasis after gastric surgery seems to be higher than in the general population. Endoscopic retrograde cholangiopancreatography (ERCP) allows several biliary and pancreatic pathologies to be dealt with; however, in patients with an altered anatomy of the upper and mid gastrointestinal tract, this endoscopic manoeuvre can be extremely challenging. We report a case of a 79-year-old woman with previous subtotal gastrectomy and Roux-en-Y reconstruction, admitted with a diagnosis of cholecystitis and choledocolithiasis. She was successfully treated with transjejunal laparoscopic-assisted ERCP and laparoscopic cholecystectomy, which appears to be a safe and useful procedure for choledocolithiasis treatment in patients with surgically altered anatomy.
