Short esophagus: selection of patients for surgery and long-term results.

BACKGROUND: After improvements in antireflux surgery (ARS), a percentage of reherniations still has cause of failure attributed to a reopening of the hiatal closure or to an untreated short esophagus. However, the existence of short esophagus and its treatment results still are matters of debate. METHODS: The consecutive medical records containing prospective collective data for patients with gastroesophageal reflux disease (GERD) during the period 2001-2009 were analyzed retrospectively. Every patient considered to be a candidate for ARS was studied with a dynamic contrast radiologic study (DCRxS) in which the esophageal length was evaluated. The choice of surgical technique takes into account the motility status of the esophagus and its estimated length. In the postoperative period, every patient had a DCRxS and an endoscopy 1 year after surgery and then after 3 years. Satisfaction with the procedure was surveyed. RESULTS: The consecutive medical records of 437 GERD patients showed that 171 underwent ARS. During the preoperative DCRxS, a short esophagus was suspected in 26 patients. A short esophagus was confirmed for 11 patients (6.4% of the surgically treated patients), and a Collis procedure plus a funduplication was performed. At the preoperative endoscopy, two patients had a normal mucosa, four patients had esophagitis, and five patients had Barrett's esophagus (BE). In the postoperative period, seven patients presented with a healthy mucosa, one BE had disappeared, and the remaining four BEs remained unchanged. During an average follow-up period of 43 months, no reherniations occurred. The 11 patients achieved good symptoms control and would choose surgery again. CONCLUSIONS: Short esophagus can be suspected during preoperative studies, and in this series, it was confirmed in 6.4% of the patients who had surgery. A Collis fundoplication procedure seems to be an adequate operation to control reflux symptoms and to avoid reherniation over the long-term follow-up period.

Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study.

Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. The incidence of esophageal perforation reported is about 5%-10%. Robotically assisted Heller myotomy (RAHM) is emerging as a safe alternative to LHM. Data comparing the two approaches are scant. The aim of this study was to compare RAHM with LHM in terms of efficacy and safety for treatment of achalasia. A total of 121 patients underwent surgical treatment of achalasia at three institutions. A retrospective review of prospectively collected perioperative data was performed. Patients were divided into two groups: group A (RAHM), 59 patients, and group B (LHM), 62 patients. All the operations were completed using minimally invasive techniques. There were 63 women and 58 men, with a mean age of 45 +/- 19 years (14-82 years). Fifty-one percent of patients in group A and 95% of patients in group B reported weight loss. Duration of symptoms was equal for both groups. Dysphagia was the main complaint in both groups (P = NS). There was no difference in preoperative endoscopic treatment in both groups (44% versus 27%, P = NS). Operative time was significantly shorter for LHM in the first half of the experience (141 +/- 49 versus 122 +/- 44 minutes, P < .05). However, in the last 30 cases there was no difference in operative time between the groups (P = NS). Intraoperative complications (esophageal perforation) were more frequent in group B (16% versus 0%). The incidence of postoperative heartburn did not differ by group. There were no deaths. At 18 and 22 months, 92% and 90% of patients had relief of their dysphagia. This study suggests that RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups

Leiomioma duodenal. Tratamiento quirúrgico de urgencia por perforación post-ecoendoscopía / Duodenal leiomyoma: emergency surgical management after endoscopic ultrasonography

Duodenal leiomyomas are unfrequent gastrointestinal submucosal tumors. Endoscopic ultrasonography is an important procedure for the differential diagnosis of these type of tumors of the digestive system. A female patient presenting a duodenal submucosal tumor is presented. She was submitted to emergency surgical management because of a perforation following a duodenal endoscopic ultrasonography. The surgical procedure performed is detailed and the result is commented.

Tiroidectomía total: análisis de las complicaciones postoperatorias / Postoperative complication rate of total thyroidectomy

Antecedentes: el porcentaje de complicaciones postoperatorias de la tiroidectomía total es altamente variable en diferentes series. Objetivo: determinar el porcentaje y tipo de complicaciones postoperatorias de la tidoidectomía total y evaluar la correlación con variables clínicas y quirúrgicas. Lugar de aplicación: hospital con residentes. Diseño: estudio observacional retrospectivo. Población: 100 pacientes consecutivos a los que se les realizó tiroidectomía total por patología benigna (n = 45) o maligna (n = 55). El cirujano fue un residente ayudado por un cirujano de planta en 89 casos y un cirujano de planta en los restantes 11. Método: revisión de historias clínicas; las variables fueron registradas en Statistic 3.5; se usaron las pruebas del chi cuadrado y de Fisher. Resultados: el porcentaje de complicaciones fue 35 por ciento: 23 casos de hipocalcemia (21 fueron transitorios y 2 definitivos), 7 de lesión recurrencial (5 transitorios y 2 definitivos), 5 infecciones de herida y un hematoma. No hubo correlación estadísticamente significativa con las variables analizadas, incluyendo el tipo de cirujano. Conclusiones: la tiroidectomía total pudo ser realizada por residentes y cirujanos de planta con un porcentaje de complicaciones similar al publicado por otros autores, y no pudieron ser correlacionadas con las variables analizadas