RESUMO
BACKGROUND: Gastric pull-up is a useful method for reconstruction of the upper digestive tract, with considerable morbidity/mortality, especially in esophageal cancers (EC). OBJECTIVE: To analyze the experience of a multidisciplinary team with a laparoscopic gastric pull-up (LGPU) method, with or without thoracoscopy, in a series of 120 patients with EC. STUDY DESIGN: Retrospective. PATIENTS AND METHODS: From 1992 to 2004, 120 EC [cervical/cervicothoracic (3.0%), middle third (15.0%), and inferior third (82.0%)]. Most were squamous cell carcinomas (47.0%) and adenocarcinomas (34.0%). Stomach was dissected and mobilized exclusively by laparoscopy. Occasionally, laparoscopic approach was extended cranially, until connecting with cervical dissection. In other cases, dissection of thoracic esophagus was accomplished through a thoracoscopic approach. RESULTS: Eighty-one patients (68.0%) had LGPU; 39 (32.0%) needed thoracoscopy. Mortality was 5.9%. Complications were fistula (10.0%) and pneumonia (10.0%). All fistulae closed spontaneously; 89.2% of patients could swallow a normal oral diet. CONCLUSION: Low morbidity/mortality of LGPU for EC compared favorably with conventional techniques.
Assuntos
Neoplasias Esofágicas/cirurgia , Laparoscopia , Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Esofagoplastia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Faringe/cirurgia , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Estômago/cirurgia , Toracoscopia , Resultado do TratamentoRESUMO
O objetivo deste trabalho é o desenvolvimento de uma prótese em silicone para ser utilizada em toracostomia, à Eloesser modificado no tratamento dos empiemas crônicos, sobretudo nos empiemas pós-pneumectomia. Esse sistema deixa um aspecto estético bastante desagradável ao paciente, além de representar um ato cirúrgico relativamente complexo para a função a que se propõe. A proposição consiste de um tubo de silicone de 25 mm de diâmetro, corrugado, e com anteparo interno e externo, para evitar migrações que pode ser colocada através de uma incisão de 30 a 40 mm e ressecção segmentar de apenas uma costela, diminuindo o trauma cirúrgico, como também as seqüelas estéticas na parede torácica, enquanto mantém adequada e contínua drenagem do espaço pleural. Até a presente data, 13 pacientes foram submetidos à toracostomia utilizando a prótese desenvolvida, com tempo de acompanhamento entre 14 a 305 dias. Os resultados são satisfatórios e sugerem que a utilização da prótese apresenta vantagens quando comparadas aos métodos tradicionais.
Abstract - This paper presents the design and construction of a toracostomy silicone prosthesis. Its main utilization is in Clagett's and modified Eloesser toracostomies and for the treatment of chronic and post-pneúmonectomy empyemas. The new prosthesis designed consists of a silicone tube (25 mm diameter) corrugated and with one internal and one externa! flange to avoid migration. It can be placed through a 30 to 40 mm incision and resection of a segment of solely one rib, minimizing surgical trauma and resulting in a esthetically improved aspect, while maintaining adequate and continuous draining of the pleural space. Hitherto, the prosthesis was utilized in 13 patients subjected to toracostomy with a follow up period of 14 to 305 days. The results obtained suggest that its utilization presents many advantages in comparison to the traditional method utilized
