RESUMO
Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure in patients with obesity and gastroesophageal reflux (GERD), but in patients with preoperative hiatal hernia (HH) or GERD, who are unfit for RYGB, there are no clear guidelines. Ligamentum teres cardiopexy (LTC) has been proposed as an effective alternative. The purpose of this study was to analyze medium-term results of LTC procedure associated with laparoscopic sleeve gastrectomy (LSG) in patients with GERD or HH, according to the absence of pathologic acid reflux in esophageal 24 h pH monitoring test, symptom release, or PPI reduction. Five patients underwent LSG-LTC between March 2018 and October 2019. In one patient, the effectiveness of LTC as an anti-reflux procedure could not be assessed because of conversion to RYGB was required. After a follow-up period of 30 [24-42] months and excessive BMI loss of 62.74 ± 18.18%, GERD recurrence was observed in 75% of patients. The study was discontinued due to unsatisfactory preliminary results with LTC. Our results suggest that LTC might not prevent GERD after LSG in patients with preoperative GERD or HH.
Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Obesidade Mórbida , Ligamentos Redondos , Humanos , Obesidade Mórbida/cirurgia , Refluxo Gastroesofágico/prevenção & controle , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/complicações , Hérnia Hiatal/complicações , Derivação Gástrica/métodos , Gastrectomia/métodos , Ligamentos Redondos/cirurgia , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Esophageal cancer represents the eighth neoplasm worldwide. The therapeutic approach is interdisciplinary, with surgery being the most effective option. Several techniques have been proposed to perform esophagogastrostomy after esophagectomy, among them mechanical triangular esophagogastrostomy (MT), with a little experience published in the Western literature on the latter. The objective of this study is to describe the technical aspects and initial results of MT anastomosis. METHODS: A retrospective review of the patients who underwent esophagectomy according to the McKeown technique was performed, those in which MT anastomosis was implemented, between October 2017 and March 2020 in our hospital. RESULTS: 14 patients were included, with a mean age of 63 years. The mean operative time was 436 min (360-581), being diagnosed of anastomotic leak (AL) 3 of the 14 patients (21.4%), as well as 3 patients presented anastomotic stenosis (AS). The median stay was 20 days, without any death in the series. DISCUSSION: Multiple publications suggest the superiority in terms of AL and AS of the mechanical triangular anastomosis, which was also observed in our series, in which despite the small sample, a rapid improvement was observed in the indicators after the first cases. Therefore, this type of anastomosis may be a safe option for performing esophagogastric anastomosis after esophagectomy, being necessary more definitive conclusive studies.
Assuntos
Neoplasias Esofágicas , Esofagoplastia , Anastomose Cirúrgica/métodos , Fístula Anastomótica/cirurgia , Constrição Patológica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Humanos , Pessoa de Meia-IdadeRESUMO
IntroducciónEl cáncer de esófago representa la octava neoplasia a nivel mundial. El abordaje terapéutico es interdisciplinar y la cirugía es la opción más eficaz. Se han planteado varias técnicas para la realización de la esofagogastrostomía posterior a la esofagectomía, entre ellas, la esofagogastrostomía triangular mecánica, con muy poca experiencia publicada en la literatura occidental. El objetivo de este estudio es describir los aspectos técnicos y los resultados iniciales de la instauración de anastomosis triangular mecánica.MétodosSe realizó una revisión retrospectiva de los pacientes tratados mediante esofaguectomía según la técnica de McKeown, en los cuales se realizó anastomosis triangular mecánica entre octubre de 2017 y marzo de 2020 en nuestro hospital.ResultadosFueron incluidos 14 pacientes, con una media de edad de 63 años. El tiempo operatorio promedio fue de 436 min (360-581); fueron diagnosticados de fuga anastomótica 3 de los 14 pacientes (21,4%) y otros 3 pacientes presentaron estenosis anastomótica. La mediana de estancia fue de 20 días, sin ningún fallecimiento en la serie.ConclusionesMúltiples publicaciones señalan la superioridad en términos de fuga anastomótica y estenosis anastomótica de la anastomosis triangular mecánica. Esto también se observa en nuestra serie, en la cual, a pesar de lo reducido de la muestra, se observó una rápida mejoría en los indicadores posterior a los primeros casos, por lo que este tipo de anastomosis puede ser una opción segura para la confección de la anastomosis esofagogástrica posterior a la esofaguectomía. Son necesarios más estudios para alcanzar conclusiones definitivas (AU)
IntroductionEsophageal cancer represents the eighth neoplasm worldwide. The therapeutic approach is interdisciplinary, with surgery being the most effective option. Several techniques have been proposed to perform esophagogastrostomy after esophagectomy, among them mechanical triangular esophagogastrostomy, with a little experience published in the Western literature on the latter. The objective of this study is to describe the technical aspects and initial results of triangular esophagogastrostomy anastomosis.MethodsA retrospective review of the patients who underwent esophagectomy according to the McKeown technique was performed, those in which triangular esophagogastrostomy anastomosis was implemented, between October 2017 and March 2020 in our hospital.ResultsA total of 14 patients were included, with a mean age of 63 years. The mean operative time was 436minutes (360-581), being diagnosed of anastomotic leak 3 of the 14 patients (21.4%), as well as 3 patients presented anastomotic stenosis. The median stay was 20 days, without any death in the series.ConclusionsMultiple publications suggest the superiority in terms of anastomotic leak and anastomotic stenosis of the mechanical triangular anastomosis, which was also observed in our series, in which despite the small sample, a rapid improvement was observed in the indicators after the first cases. Therefore, this type of anastomosis may be a safe option for performing esophagogastric anastomosis after esophagectomy, being necessary more definitive conclusive studies (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias Esofágicas/cirurgia , Esofagoplastia , Anastomose Cirúrgica/métodos , Constrição Patológica/cirurgia , Esofagectomia/métodos , Estudos Retrospectivos , Fístula AnastomóticaRESUMO
INTRODUCTION: Esophageal cancer represents the eighth neoplasm worldwide. The therapeutic approach is interdisciplinary, with surgery being the most effective option. Several techniques have been proposed to perform esophagogastrostomy after esophagectomy, among them mechanical triangular esophagogastrostomy, with a little experience published in the Western literature on the latter. The objective of this study is to describe the technical aspects and initial results of triangular esophagogastrostomy anastomosis. METHODS: A retrospective review of the patients who underwent esophagectomy according to the McKeown technique was performed, those in which triangular esophagogastrostomy anastomosis was implemented, between October 2017 and March 2020 in our hospital. RESULTS: A total of 14 patients were included, with a mean age of 63 years. The mean operative time was 436minutes (360-581), being diagnosed of anastomotic leak 3 of the 14 patients (21.4%), as well as 3 patients presented anastomotic stenosis. The median stay was 20 days, without any death in the series. CONCLUSIONS: Multiple publications suggest the superiority in terms of anastomotic leak and anastomotic stenosis of the mechanical triangular anastomosis, which was also observed in our series, in which despite the small sample, a rapid improvement was observed in the indicators after the first cases. Therefore, this type of anastomosis may be a safe option for performing esophagogastric anastomosis after esophagectomy, being necessary more definitive conclusive studies.
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Assuntos
Humanos , Feminino , Idoso , Pneumoperitônio/terapia , Gastrostomia/métodos , Esclerose Lateral Amiotrófica/complicações , Tratamentos com Preservação do Órgão , Conduta Expectante , Ventilação não InvasivaRESUMO
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Assuntos
Humanos , Feminino , Idoso , Doença de Hirschsprung/diagnóstico , Tireoidectomia , Proteínas Proto-Oncogênicas c-ret/análise , Mutação , Neoplasias da Glândula Tireoide/patologia , Carcinoma Medular/patologiaAssuntos
Carcinoma Medular/genética , Doença de Hirschsprung/genética , Neoplasia Endócrina Múltipla Tipo 2a/genética , Mutação , Proteínas Proto-Oncogênicas c-ret/genética , Neoplasias da Glândula Tireoide/genética , Tireoidectomia , Idoso , Biomarcadores Tumorais/sangue , Calcitonina/sangue , Antígeno Carcinoembrionário/análise , Carcinoma Medular/metabolismo , Carcinoma Medular/cirurgia , Cistos Coloides/genética , Cistos Coloides/patologia , Éxons/genética , Feminino , Humanos , Metanefrina/urina , Proto-Oncogene Mas , Doenças da Glândula Tireoide/genética , Doenças da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/metabolismo , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
Fundamento: En 1998 se detectaron en la Comunidad de Madrid concentraciones de arsénico mayores de 50mµg/l en algunos abastecimientos de agua de consumo de origen subterráneo, concentración máxima admisible en el agua de bebida en España. El objetivo de este trabajo fue determinar la concentración de arsénico en el agua procedente de abastecimientos subterráneos en la Comunidad de Madrid. Métodos: Se presentan los resultados de los dos primeros muestreos realizados en el plan de seguimiento de niveles de arsénico establecido. En la primera fase se analizaron muestras de agua de los 353 abastecimientos censados por la Dirección General de Salud Pública de la Comunidad de Madrid. Con estos primeros resultados se realizó una clasificación de riesgo de los abastecimientos. En una segunda fase, seis meses después, se repitieron los análisis en los 35 abastecimientos que se consideró podían suponer un riesgo para la salud pública. Resultados: El 74 por ciento de los abastecimientos estudiados en la primera fase presentaron una concentración de arsénico menor de 10mµg/l.; el 22,6 por ciento contenía niveles entre 10 y 50µg/l.; y en el 3,7 por ciento eran superiores a 50m µg/l.. La mayoría de los abastecimientos con niveles de arsénico superiores a 10m µg/l. se encuentran situados en la misma zona geográfica. En el segundo muestreo (6 meses después) se incluyeron los 35 abastecimientos clasificados de riesgo. De ellos, 26 presentaron el mismo nivel de arsénico (10-50µg/l.) y 9 cambiaron de categoría: 6 pasaron a tener menos de 10m µg/l. y 3 más de 50m µg/l.. Conclusiones: La vigilancia periódica de la calidad del agua realizada por la Dirección General de Salud Pública ha permitido detectar la presencia de 16 abastecimientos de agua de consumo de origen subterráneo con más de 50m µg/l. de arsénico, nivel máximo admisible según la legislación vigente en nuestro país. Se han adoptado medidas para evitar el consumo de agua en estos abastecimientos (AU)
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