RESUMO
OBJECTIVE: To assess the feasibility of laparoscopic gastroenteric and cholecystenteric bypass procedures for palliation of inoperable cancer of the pancreas. DESIGN: Prospective study. SETTING: Teaching hospital, Italy. SUBJECTS: 6 patients (4 men and 2 women, range 53-72 years, median 64) who presented between July 1995 and April 1997 with inoperable pancreatic cancer. INTERVENTIONS: Laparoscopic gastroenterostomy for duodenal obstruction. Four patients had already had endoscopic biliary decompression. 2 patients also had laparoscopic cholecystojejunostomy for biliary obstruction at the time of the laparoscopic gastroenterostomy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The procedure was completed laparoscopically in all patients. There was no perioperative mortality and morbidity was low (1 bleeding from the drain and 1 paralytic ileus). The median postoperative stay was 4.5 days (range 4-6). CONCLUSIONS: Laparoscopic gastroenterostomy, together with cholecystojejunostomy in selected patients with inoperable pancreatic cancer, offers a less invasive alternative to open surgery with a short hospital stay and rapid return to normal activity.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia , Cuidados Paliativos/métodos , Neoplasias Pancreáticas/cirurgia , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Estudos de Viabilidade , Feminino , Gastroenterostomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicaçõesRESUMO
The aim of this study was to assess the feasibility of laparoscopic gastroenteric and cholecystenteric bypass procedures for palliation of inoperable cancer of the pancreas. Between July 1994 and January 1996, five patients underwent laparoscopic gastroenterostomy for duodenal obstruction due to pancreatic cancer. There were four men and one woman, ranging in age from 53 to 72 years (median 63). Four patients already had endoscopic biliary decompression. One patient underwent laparoscopic cholecystojejunostomy for biliary obstruction at the time of the laparoscopic gastroenterostomy. The procedure was completed laparoscopically in all patients. There was no perioperative mortality, and the morbidity was low. The median post-operative stay was 4 days (range, 4-6). Laparoscopic gastroenterostomy associated with cholecystojejunostomy in selected cases offers a less invasive alternative than open surgery, with a shorter hospital stay and more rapid return to normal activity.
Assuntos
Gastrostomia/métodos , Jejunostomia/métodos , Laparoscopia , Cuidados Paliativos , Neoplasias Pancreáticas/cirurgia , Idoso , Obstrução Duodenal/etiologia , Obstrução Duodenal/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/complicações , Resultado do TratamentoRESUMO
The authors consider the causes of bowel infarction and report the up-to-date diagnostic tools for optional treatment. They verify management and outcome of 97 cases treated during the last decade.
Assuntos
Infarto/diagnóstico , Intestinos/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolia/complicações , Emergências , Feminino , Humanos , Infarto/complicações , Infarto/epidemiologia , Infarto/etiologia , Infarto/cirurgia , Itália/epidemiologia , Masculino , Artéria Mesentérica Superior , Oclusão Vascular Mesentérica/complicações , Veias Mesentéricas , Pessoa de Meia-Idade , Prognóstico , Trombose/complicaçõesRESUMO
Esophageal sutures require the same general criteria applied for the realization of an intestinal suture. The lack of a serous membrane and the particular vascularization of the organ, though, make this portion of the gastroenteric tract very prone to serious complications. Undoubtedly, the introduction of new systems of suture renders easier, faster and more efficacious the work of the surgeon. In particular, the Authors stress the advantages that staplers can offer for the treatment of achalasic megaesophagus.
