Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch.

BACKGROUND: The purpose of this research is to compare the wound healing of the laparoscopic esophagomyotomy with and without a gastric patch. METHODS: Twelve male pigs were distributed into two groups of six animals. Esophagomyotomy was performed in group A. A gastric patch was associated to the myotomy in group B. On the 21st postoperative day, lumen molding was accomplished to determine the index of stenosis (IS) at the area of myotomy (AM). Macroscopic and microscopic aspects of wound healing were also studied at AM. Three microscopic morphologic patterns were defined for morphometric evaluation: leukocytes (constituted by polymorphonuclear and mononuclear cells), new endothelial cells, and collagen fibers. RESULTS: There was a longer operative duration in group B (93.6 min) than in group A (45 min). At AM, IS was negative (lumen increased) and equivalent in both groups: -11.1% in group A and -12.7% in group B. Mesotelial epithelium covering RM was observed in group A. Inflammatory reaction was greater in group B in comparison with group A (leuCocytes: 22 cells versus 8.6; fibrosis: 25.5 fibers versus 15.6; granulation tissue: 18.7 vessels versus 9.7). CONCLUSION: Esophagomyotomy followed by gastric patch does not heal adequately and is worsened by the presence of foreign body granulomas around stitches. Myotomy without gastric patch is faster and causes lower inflammation. Myotomy alone or with gastric patch does not lead to esophageal stenosis at RM and does not lead to restoration of the esophageal musculature continuity.

Colecistectomia e exploracao das vias biliares na cirrose hepatica. / Cholecystectomy and exploration of bile ducts in hepatic cirrhosis

Operaram-se 10 pacientes portadores de cirrose hepatica e calculose biliar. No pos-operatorio nao se observou mortalidade dade e as complicacoes mais frequentes incluiram: vazamento de ascite pelo orificio de drenagem, eventracao e confusao mental transitoria. Houve mortalidade tardia em um paciente, por evolucao de hepatoma no 4o. mes de seguimento, e em outro, por peritonite bacteriana espontanea no 7o.mes. Sugere-se uma serie de cuidados que devem ser tomados para aprimorar os resultados: diagnostico precoce da patologia por ultra-som, controle pre-operatorio da ascite, anestesia peridural continua, incisao transversa alta, hemostasia rigorosa do leito vesicular, evitar o uso de drenos na cavidade ou na via biliar e restricao de sodio, com administracao liberal de coloides no pos-operatorio