RESUMEN
INTRODUCTION: Total resection of the gastric tube with lymphadenectomy for advanced gastric tube cancer is highly invasive and associated with severe complications. Other surgical option, partial gastrectomy or wedge resection, is insufficient if lymph node metastasis is suspected. Therefore, a technique balancing invasiveness and curability is required. MATERIALS AND SURGICAL TECHNIQUE: First, we laparoscopically peeled off adhesions of the gastric tube, gastric mesentery (including the right gastroepiploic artery/vein), pericardial membrane, and aorta, up to the planned resection line. Subsequently, we cut the infrapyloric and right gastric arteries at their roots and dissected No. 5 and No. 6 lymph nodes. We taped and spared the right gastroepiploic artery and vein and dissected the tissues including No. 4d lymph nodes. Finally, the gastric tube was cut using a linear stapler, and the remaining gastric tube was anastomosed to the jejunum with a circular stapler. The mean operative time for the three cases treated using this intervention was 729 min. The patients were discharged on postoperative day 8 or 9 without any complications. They all remained alive and recurrence-free. DISCUSSION: This novel approach balances invasiveness and curability by leveraging the advantages of laparoscopy. The procedure was performed safely and reproducibly in three consecutive cases, providing another viable option for the treatment of gastric tube cancer.
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Esofagectomía , Gastrectomía , Arteria Gastroepiploica , Laparoscopía , Escisión del Ganglio Linfático , Neoplasias Gástricas , Humanos , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Gastrectomía/métodos , Masculino , Esofagectomía/métodos , Persona de Mediana Edad , Anciano , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , FemeninoRESUMEN
BACKGROUND: Coronary artery bypass grafting (CABG) using the right gastroepiploic artery (RGEA) is a well-established, safe procedure. However, problems with RGEA grafts in subsequent abdominal surgeries can lead to fatal complications. This report presents the first case of right hepatectomy for hepatocellular carcinoma after CABG using the RGEA. CASE PRESENTATION: We describe a case in which a right hepatectomy for an 81-year-old male patient with hepatocellular carcinoma was safely performed after CABG using a RGEA graft. Preoperatively, three-dimensional computed tomography (3D- CT) images were constructed to confirm the run of the RGEA graft. The operation was conducted with the standby of a cardiovascular surgeon if there was a problem with the RGEA graft. The RGEA graft had formed adhesions with the hepatic falciform ligament, necessitating meticulous dissection. After the right hepatectomy, the left hepatic lobe descended into the vacated space, exerting traction on the RGEA. However, this traction was mitigated by suturing the hepatic falciform ligament to the abdominal wall, ensuring stability of the RGEA. There were no intraoperative or postoperative complications. CONCLUSION: It is crucial to confirm the functionality and anatomy of the RGEA graft preoperatively, handle it gently intraoperatively, and collaborate with cardiovascular surgeons.
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Carcinoma Hepatocelular , Puente de Arteria Coronaria , Arteria Gastroepiploica , Hepatectomía , Neoplasias Hepáticas , Humanos , Masculino , Arteria Gastroepiploica/cirugía , Hepatectomía/métodos , Anciano de 80 o más Años , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/patología , Carcinoma Hepatocelular/cirugía , Carcinoma Hepatocelular/patología , Puente de Arteria Coronaria/métodos , Tomografía Computarizada por Rayos X , Pronóstico , Imagenología Tridimensional , Complicaciones Posoperatorias/cirugíaRESUMEN
Los pseudoaneurismas arteriales viscerales son patologías infrecuentes y raras veces son de hallazgo casual, ya que normalmente debutan con un sangrado. Las lesiones vasculares de la gastroduodenal y de la omental derecha son bastante infrecuentes dentro de este grupo de patologías y debido a su ubicación por frecuencia son asociadas a la pancreatitis y durante el curso de esta enfermedad se las podría hallar de manera casual. Los sangrados de estos aneurismas tienen un índice de mortalidad alto, debido a la inespecificidad de sus síntomas no son de primera línea de diagnóstico y por lo tanto se retrasan en su tratamiento. Idealmente y si son accesibles deben de ser tratados de manera endovascular siempre que la hemodinamia del paciente lo permita, pero un enfoque quirúrgico ya sea abierto o laparoscópica puede resolver la mayoría de los aneurismas complicados de nuestros pacientes
Visceral arterial pseudoaneurysms are rare pathologies and are rarely found by chance, since they normally begin with bleeding. Vascular lesions of the gastroduodenal and right omental are quite uncommon within this group of pathologies and due to their frequent location, they are associated with pancreatitis and during the course of this disease they could be found by chance. Bleeding from these aneurysms has a high mortality rate, due to the non-specificity of their symptoms, they are not first line of diagnosis and therefore their treatment is delayed. Ideally, if they are accessible, they should be treated endovascularly as long as the patient's hemodynamics allow it, but an open or laparoscopic surgical approach can resolve the majority of complicated aneurysms in our patients.
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Humanos , Femenino , Persona de Mediana Edad , Angiografía , Aneurisma Falso , Arteria Gastroepiploica/patologíaRESUMEN
BACKGROUND: Vascularized gastroepiploic lymph node transfer (VGLNT) is a well-accepted surgical treatment for restoring physiological function in chronic lymphedema. However, the inclusion of substantial lymph nodes (LNs) in the flap remains uncertain. This study aimed to identify the anatomical basis for reliable flap harvest for VGLNT. PATIENTS AND METHODS: The anatomy of perigastric station 4d LNs was studied in healthy cadavers (n = 15) and patients with early gastric cancer (EGC) (n = 27). The omentum was divided into three segments: proximal, middle, and distal from the origin of the right gastroepiploic vessels. The flap dimension, number, location, size of LNs, and caliber of the vessels were reviewed. Eight patients underwent VGLNT for upper/lower limb lymphedema. RESULTS: The mean numbers of LNs in the proximal, middle, and distal segment were 2.5, 1.4, 0.5 in the cadavers, and 4.9, 2.7, 0.7 in the gastrectomy specimens, respectively. The proximal third included a significantly greater number of LNs than the distal third in the cadaveric (p = 0.024) and ECG (p = 0.016) specimens. A total of 95% of the LNs were located within proximal two-thirds of the flap from the vessel origin both in the cadavers (21.0 × 5.0 cm) and in the gastrectomy specimens (20 × 3.5 cm). In VGLNT, the transferred flap was 25.5 ± 6.9 × 4.1 + 0.7 cm in dimension, containing a mean number of 6.5 ± 1.9 LNs. At postoperative 6 months, the volumetric difference was significantly reduced by 22.8 ± 9.2% (p < 0.001). CONCLUSIONS: This study provides a distinct distribution pattern of station 4d LNs. Inclusion of the proximal two-thirds of the flap, which carries majority of the LNs, is recommended for VGLNT.
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Cadáver , Gastrectomía , Ganglios Linfáticos , Linfedema , Neoplasias Gástricas , Colgajos Quirúrgicos , Humanos , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Masculino , Femenino , Persona de Mediana Edad , Gastrectomía/métodos , Linfedema/cirugía , Anciano , Arteria Gastroepiploica/cirugía , Adulto , Pronóstico , Estudios de Casos y Controles , Estudios de SeguimientoRESUMEN
BACKGROUND: This prospective cohort study, conducted at a high-volume esophageal cancer center from July 2019 to July 2022, aimed to investigate the link between the right gastroepiploic artery (RGEA) length and anastomotic leakage (AL) rates following minimally invasive esophagectomy (MIE). Real-world data on stomach blood supply in the Chinese population were examined. MATERIALS AND METHODS: A total of 516 cases were enrolled, categorized into two groups based on the Youden index-determined optimal cut-off value for the relative length of RGEA (length of RGEA/length of gastric conduit, 64.69%) through ROC analysis: Group SR (short RGEA) and Group LR (long RGEA). The primary observation parameter was the relationship between AL incidence and the ratio of direct blood supply from RGEA. Secondary parameters included the mean length of the right gastroepiploic artery, greater curvature, and the connection type between right and left gastroepiploic vessels. Patient data were prospectively recorded in electronic case report forms. RESULTS: The study revealed median lengths of 43.60 cm for greater curvature, 43.16 cm for the gastric conduit, and 26.75 cm for RGEA. AL, the most common postoperative complication, showed a significant difference between groups (16.88 vs. 8.84%, P =0.01). Multivariable binary logistic regression identified Group SR and LR (odds ratio: 2.651, 95% CI: 1.124-6.250, P =0.03) and Neoadjuvant therapy (odds ratio: 2.479, 95% CI: 1.374-4.473, P =0.00) as independent predictors of AL. CONCLUSIONS: The study emphasizes the crucial role of RGEA length in determining AL incidence in MIE for esophageal cancer. Preserving RGEA and fostering capillary arches between RGEA and LGEA are recommended strategies to mitigate AL risk.
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Fuga Anastomótica , Neoplasias Esofágicas , Esofagectomía , Arteria Gastroepiploica , Humanos , Esofagectomía/efectos adversos , Neoplasias Esofágicas/cirugía , Fuga Anastomótica/etiología , Fuga Anastomótica/epidemiología , Masculino , Estudios Prospectivos , Femenino , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , China/epidemiologíaRESUMEN
ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. Case Report: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.
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Humanos , Femenino , Persona de Mediana Edad , Choque Hemorrágico/etiología , Aneurisma Roto/complicaciones , Arteria Gastroepiploica/cirugía , Arteria Gastroepiploica/diagnóstico por imagen , Rotura Espontánea/cirugía , Rotura Espontánea/complicaciones , Rotura Espontánea/diagnóstico por imagen , Choque Hemorrágico/cirugía , Tomografía Computarizada por Rayos X/métodos , Dolor Abdominal/etiología , Aneurisma Roto/cirugía , Aneurisma Roto/diagnóstico por imagen , Laparotomía/métodosRESUMEN
OBJECTIVES: This study aimed to evaluate the role of multidetector computed tomography angiography in diagnosing patients with pulmonary sequestration. METHODS: We retrospectively analyzed the computed tomography studies and clinical materials of 43 patients who had undergone preoperative multidetector computed tomography angiography in our hospital and had pathologically proven pulmonary sequestration. Each examination of pulmonary sequestration was reviewed for type, location, parenchymal changes, arterial supply and venous drainage on two-dimensional and three-dimensional computed tomography images. RESULTS: Multidetector computed tomography successfully detected all pulmonary sequestrations in the 43 patients (100%). This included 40 patients (93.0%) with intralobar sequestration and 3 patients (7.0%) with extralobar sequestration. The locations of pulmonary sequestration were left lower lobe (28 cases, 70% of intralobar sequestrations), right lower lobe (12 cases, 30% of intralobar sequestrations) and costodiaphragmatic sulcus (3 cases). Cases of sequestered lung presented as mass lesions (37.2%), cystic lesions (32.6%), pneumonic lesions (16.3%), cavitary lesions (9.3%) and bronchiectasis (4.6%). The angioarchitecture of pulmonary sequestration, including feeding arteries from the thoracic aorta (86.1%), celiac truck (9.3%), abdominal aorta (2.3%) and left gastric artery (2.3%) and venous drainage into inferior pulmonary veins (86.0%) and the azygos vein system (14.0%), was visualized on multidetector computed tomography. Finally, the multidetector computed tomography angiography results of the sequestered lungs and angioarchitectures were surgically confirmed in all the patients. CONCLUSIONS: As a noninvasive modality, multidetector computed tomography angiography is helpful for making diagnostic decisions regarding pulmonary sequestration with high confidence and for visualizing the related parenchymal characteristics, arterial supply, and venous drainage features to help plan surgical strategies.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Secuestro Broncopulmonar/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Tomografía Computarizada Multidetector/métodos , Aorta Abdominal/anomalías , Aorta Abdominal/diagnóstico por imagen , Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Secuestro Broncopulmonar/patología , Arteria Celíaca/anomalías , Arteria Celíaca/diagnóstico por imagen , Arteria Gastroepiploica/anomalías , Arteria Gastroepiploica/diagnóstico por imagen , Imagenología Tridimensional , Pulmón/irrigación sanguínea , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJETIVO: Avaliar os resultados a longo prazo da cirurgia de revascularização do miocárdio com o uso exclusivo de enxertos arteriais em pacientes com doença coronariana triarterial. MÉTODOS: Avaliamos 136 pacientes submetidos a cirurgia de revascularização do miocárdio isolada, no período janeiro de 1995 e dezembro de 1997. Utilizaram-se 353 enxertos para revascularizar 449 artérias (média: 3,30 por paciente). Foram utilizadas a artéria torácica interna esquerda (99,2 por cento), artéria torácica interna direita (56,6 por cento), artéria radial (87,5 por cento), artéria gastroepiplóica direita (20,5 por cento) e uma artéria epigástrica inferior. Setenta e seis (55,8 por cento) pacientes receberam enxertos compostos (em "Y") e 66 (48,5 por cento) receberam anastomoses seqüenciais. RESULTADOS: A mortalidade hospitalar foi de 4,4 por cento. No seguimento a longo prazo, (9,5 a 12,8 anos), 82,1 por cento dos pacientes não apresentaram nenhum evento cardíaco. Vinte (17,9 por cento) pacientes necessitaram de reinternação por eventos cardiovasculares; 15 com angina e cinco com infarto agudo do miocárdio, sendo que três apresentaram insuficiência cardíaca associada. Oito (7,1 por cento) pacientes necessitaram de reintervenção por doença coronariana, sendo um reoperado e os demais submetidos a angioplastia com stent. A probabilidade estimada livre de eventos cardíacos foi de 98,2 por cento, 95,4 por cento e 84,2 por cento em 1, 5 e 10 anos, respectivamente. Ocorreram 16 (14,2 por cento) óbitos tardios, sendo quatro deles (3,6 por cento) de causa cardíaca. Sobrevida actuarial em 12,8 anos por todas as causas foi de 85 por cento neste grupo. CONCLUSÃO: Revascularização do miocárdio com o uso exclusivo de enxertos arteriais em pacientes com doença coronariana triarterial é um procedimento seguro, com bons resultados a longo prazo.
OBJECTIVE: To evaluate the long-term results of the coronary artery bypass grafting with exclusive use of arterial grafts for patients with triple vessel disease. METHODS: We evaluated 136 patients who underwent isolated coronary artery bypass grafting between January 1995 and December 1997. 353 grafts were used for revascularization of 449 arteries (mean: 3.30 per patient). Grafts used were left internal thoracic artery (99.2 percent), right internal thoracic artery (56.6 percent), radial artery (87.5 percent), right gastroepiploic artery (20.5 percent) and one inferior epigastric artery. 76 (55.8 percent) patients received composite grafts ("Y" shape) and 66 (48.5 percent) patients received sequential anastomoses. RESULTS: Hospital mortality was 4.4 percent. In the long-term follow-up (9.5 to 12.8 years), 82.1 percent of the patients were free of cardiac events. 20 (17.9 percent) patients had hospital readmission due to cardiac events: 15 presented angina and five presented acute myocardial infarction, and three of them presented associated heart failure. Eigth (7.1 percent) patients needed coronary reintervention: one of them underwent coronary bypass reoperation and the others underwent coronary angioplasty with stent. Estimated probability of cardiac event-free was 98.2 percent, 95.4 percent e 84.2 percent at 1, 5 and 10 years follow-up respectively. There were 16 (14.2 percent) late deaths and four of them (3.6 percent) were cardiac-related. Actuarial 12.8-year-survival of all deaths was 85 percent in this group. CONCLUSION: Coronary artery bypass grafting with exclusive use of arterial grafts is a safe procedure for patients with triple vessel coronary disease with good long-term results.
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Arteria Gastroepiploica/trasplante , Arterias Mamarias/trasplante , Arteria Radial/trasplante , Angina de Pecho/epidemiología , Angina de Pecho/etiología , Brasil/epidemiología , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Estudios de Seguimiento , Mortalidad Hospitalaria , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Reoperación/estadística & datos numéricos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Vasos responsáveis pelo suprimento sangüíneo do estômago originam-se da artéria celíaca, primeiro ramo da aorta abdominal, localizada na região do hiato aórtico. Assim, dirigem-se à superfície do estômago as artérias gástricas esquerda e direita, as artérias gastroepilóicas esquerda e direita e as artérias gástricas curtas. Apesar de bem conhecidas as origens destes vasos, informações a respeito do comportamento dos mesmos ao atingirem a superfície do estômago ainda são escassas. O fluxo sangüíneo na parede do estômago exerce importante papel nos mecanismos de defesa da mucosa gástrica. Eqüinos em treinamento intensivo apresentam alta freqüência de ocorrência de lesões ulcerativas na mucosa do estômago, tornando as pesquisas sobre vascularização sangüínea deste órgão com grande significado prático na compreensão dos mecanismos relacionados à proteção da mucosa gástrica. O objetivo deste trabalho foi avaliar alguns aspectos relacionados à distribuição arterial na superfície do estômago de eqüinos adultos, sem raça definida e destinados a abate. Utilizaram-se estômagos oriundos de 15 machos e 15 fêmeas. A área superficial do estômago foi mensurada com software de análise de imagens e os dados correlacionados ao número de ramos avaliados. Observou-se reduzida participação da artéria gástrica esquerda na irrigação da curvatura menor do estômago. Estes achados justificam estudos relacionados à particularidades anatômicas da região da curvatura menor do estômago de eqüinos, em trabalhos futuros.
Vessels responsible for stomach blood supply have their origin in the celyac artery, abdominal aorta first branch, in the aortic hiatus region. Thus, the stomach surface receives the left and right gastric arteries, the left and right gastroepiploic arteries and the breves gastric arteries. Origins of these vessels are well-known, but information about stomach surface arterial distribution are still unknown. Stomach surface blood supply has an important role on gastric mucosa defense mechanisms. Equines submitted to intensive training show high frequency of the ulcerative lesions in the gastric mucosa, with is a promising of applicability for researches on vascularization. The aim of this study was to analyze some aspects of the stomach surface arterial distribution, of the mixed breed adults equines destined to slaughter. Equine stomachs of 15 male and 15 female were analyzed. The stomach surface area was measured with images analysis software and the data correlation with number of vessels branch accounted. A low contribution of the left gastric artery to the stomach minor curvature irrigation was observed. These results justify studies related to anatomic particularities of the region of equine stomach minor curvature, in future researches.