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1.
Eur J Cancer ; 206: 114128, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38805957

RESUMO

Duodenal adenocarcinoma is a rare digestive cancer, often diagnosed at a late stage and harbours a poor prognosis. The arrival of immunotherapy has changed the prognosis of many neoplasia, including digestive adenocarcinomas with MSI-H status. Hereby, we describe three cases of MSI-H locally advanced duodenal adenocarcinoma who received neoadjuvant treatment with a PD1 inhibitor, pembrolizumab. A partial metabolic and endoscopic response was observed in all patients after 2 cycles. Duodenopancreatectomy was performed at the end of treatment (4-6 cycles), and anatomopathological analysis demonstrated pathological complete response in all patients. Our case series paves the way for prospectively exploring neoadjuvant immunotherapy in duodenal MSI-H adenocarcinoma and raises the question of organ sparing surgery in case of complete clinical response as observed in gastric and colo-rectal adenocarcinomas.


Assuntos
Adenocarcinoma , Anticorpos Monoclonais Humanizados , Neoplasias Duodenais , Instabilidade de Microssatélites , Terapia Neoadjuvante , Humanos , Adenocarcinoma/genética , Adenocarcinoma/terapia , Adenocarcinoma/patologia , Neoplasias Duodenais/genética , Neoplasias Duodenais/patologia , Neoplasias Duodenais/terapia , Terapia Neoadjuvante/métodos , Masculino , Idoso , Pessoa de Meia-Idade , Feminino , Anticorpos Monoclonais Humanizados/uso terapêutico , Imunoterapia/métodos , Inibidores de Checkpoint Imunológico/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Resultado do Tratamento
2.
Acta Chir Belg ; 119(5): 309-315, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30354853

RESUMO

Background: The optimal timing for cholecystectomy in patients with acute cholecystitis remains controversial. The aim of this study is to assess prospectively the impact of the duration of symptoms on outcomes in early laparoscopic cholecystectomy (ELC) for acute cholecystitis. Methods: The series consisted of 276 consecutive patients who underwent ELC for acute cholecystitis in 2016. The patients were divided into three groups according to the timing of surgery: within the first 3 days (group 1), between 4 and 7 days (group 2) and beyond 7 days (group 3) from the onset of symptoms. Results: The percentage of surgical procedure rated as difficult was respectively: 12% in G1, 18% in G2 and 38% in G3 (p < .001). Accordingly, we observed an increased mean operative time within groups but no significant difference in the conversion rate. We noted a different overall postoperative complication rate within groups, respectively: 9% in G1, 14% in G2 and 24% in G3 (p < .04). The median hospital stay was also different within groups, respectively: 3 in G1, 4 in G2 and 6 days in G3 (p < .001). On univariate analysis, age ≥60, male gender, ASA 3, WBC ≥13.000/µL, CRP ≥100 mg/l and delay between onset of symptoms and surgery were factors statistically associated with increased morbidity rate. On multivariate analysis, the delay was the only independent predictive factor of postoperative morbidity (OR: 1,08, 95% CI: 1.01-1.61, p < .031). Conclusion: Our study confirms that it is ideal to perform ELC within 3 days of symptoms onset and reasonable between 4 to 7 days. We do not recommend performing ELC beyond 7 days because of more difficult procedure and significantly increased risk of post-operative complications.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Tempo para o Tratamento , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Acta Chir Belg ; 118(2): 94-98, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28927340

RESUMO

OBJECTIVES: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient's outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications. METHODS: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications. RESULTS: Mean age and body mass index were respectively 39 years and 41.5kg/m2. Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p = .0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p = .0129). CONCLUSIONS: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.


Assuntos
Gastroplastia/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Bélgica/epidemiologia , Feminino , Gastroplastia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Adulto Jovem
4.
Acta Chir Belg ; 115: 81-2, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26021797

RESUMO

The aim of this case report is to outline the challenge and the feasibility of laparoscopic gastric bypass in a patient with situs inversus totalis. Situs inversus totalis does not seem to be a contraindication for laparoscopic surgery.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Situs Inversus/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Radiografia , Situs Inversus/diagnóstico por imagem , Situs Inversus/cirurgia
5.
Acta Chir Belg ; 115(1): 81-2, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27384902

RESUMO

The aim of this case report is to outline the challenge and the feasibility of laparoscopic gastric bypass in a patient with situs inversus totalis. Situs inversus totalis does not seem to be a contraindication for laparoscopic surgery.


Assuntos
Derivação Gástrica/métodos , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Situs Inversus/complicações , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Medição de Risco , Situs Inversus/diagnóstico , Resultado do Tratamento , Redução de Peso
6.
Acta Chir Belg ; 113(4): 254-7, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24224433

RESUMO

OBJECTIVES: Sleeve gastrectomy (SG) has been used as the first step of a staged malabsorptive procedure for high-risk patients. More recently SG was proposed as an stand alone procedure in the treatment of morbidly obese patients. The aim of this study is to analyze perioperative outcome of morbid obese patients after SG. METHODS: 301 patients, 201 women and 100 men, undergoing SG were retrospectively analyzed. SG was performed by 17 surgeons all member of the Club Coelio. The mean BMI was 44.7kg/m2 (27.4-70.3 kg/m2). 34 patients (11.3%) of our series had SG as revisional surgery. These revisional procedures consisted of 32 conversions from gastric banding, 1 conversion from vertical gastroplasty (VBG) and 1 from transoral endoscopic gastroplasty. Among the 32 patients that had revisional SG after a gastric banding, 13 bands were removed at least 3 months before the revisional SG and 19 bands were removed during the SG procedure. Endpoints were perioperative morbidity and mortality and potential risk factors for complications, mainly per or postoperative bleeding or leakage. RESULTS: Overall mortality was 0% and morbidity was 10.3%. Perioperative bleeding occurred in 10 patients (3.3%), leakage in 12 patients (4%) patients and stenosis in 3 patients (1%). The risk of leakage was significantly higher after revisional bariatric surgery and in case of gastric perforation during surgery (p = 0.0001). Previous gastric banding is also associated with a higher risk of postoperative bleeding (p = 0.0006). CONCLUSIONS: SG can be safely performed but patients and surgeons must be aware of a higher risk of postoperative complications when SG is proposed as a revisional surgery.


Assuntos
Gastroplastia/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/epidemiologia , Medição de Risco/métodos , Adulto , Idoso , Bélgica/epidemiologia , Índice de Massa Corporal , Feminino , Seguimentos , Gastroplastia/métodos , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento , Resultado do Tratamento , Adulto Jovem
7.
Ann Oncol ; 23(9): 2327-2335, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22377565

RESUMO

BACKGROUND: Prognosis of patients with pancreatic adenocarcinoma is poor. Many prognostic biomarkers have been tested, but most studies included heterogeneous patients. We aimed to investigate the prognostic and/or predictive values of four relevant biomarkers in a multicentric cohort of patients. PATIENTS AND METHODS: A total of 471 patients who had resected pancreatic adenocarcinoma were included. Using tissue microarray, we assessed the relationship of biomarker expressions with the overall survival: Smad4, type II TGF-ß receptor, CXCR4, and LKB1. RESULTS: High CXCR4 expression was found to be the only independent negative prognostic biomarker [hazard ratio (HR) = 1.74; P < 0.0001]. In addition, it was significantly associated with a distant relapse pattern (HR = 2.19; P < 0.0001) and was the strongest prognostic factor compared with clinicopathological factors. In patients who did not received adjuvant treatment, there was a trend toward decrease in the overall survival for negative Smad4 expression. Loss of Smad4 expression was not correlated with recurrence pattern but was shown to be predictive for adjuvant chemotherapy (CT) benefit (HR = 0.59; P = 0.002). CONCLUSIONS: CXCR4 is a strong independent prognostic biomarker associated with distant metastatic recurrence and appears as an attractive target to be evaluated in pancreatic adenocarcinoma. Negative SMAD4 expression should be considered as a potential predictor of adjuvant CT benefit.


Assuntos
Adenocarcinoma/metabolismo , Biomarcadores Tumorais/metabolismo , Neoplasias Pancreáticas/metabolismo , Receptores CXCR4/metabolismo , Proteína Smad4/metabolismo , Adenocarcinoma/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Progressão da Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Resultado do Tratamento
9.
Rev Med Brux ; 31(5): 459-62, 2010.
Artigo em Francês | MEDLINE | ID: mdl-21174648

RESUMO

OBJECTIVES: Bariatric surgery is considered as the most effective therapy for morbid obesity. But, each procedure carries both short-and long-term complications. And, it remains unclear if the late occurrence of gastric adenocarcinoma could be linked to bariatric surgery. We described a case of a female who developed a gastric adenocarcinoma after a silastic ring vertical gastroplasty (SRVG). METHODS: A 54-year-old female presented with postprandial vomiting, poor appetite, dysphagia and weight loss 10 year after a SRVG. A gastroscopy with biopsy disclosed a juxta-pyloric adenocarcinoma. No distant metastasis was found. After 3 cycles of neoadjuvant chemotherapy, a subtotal gastrectomy with Roux-en-Y anastomosis was performed. RESULTS: After the surgery, a minor anastomotic leak was treated conservatively and a parietal abscess was drained. The pathological studies demonstrated a T2bN1 adenocarcinoma with negative margins. Adjuvant chemotherapy was administered. At the last work up, the patient is disease-free. CONCLUSION: The association between a gastric adenocarcinoma and a bariatric procedure such as a SRVG is difficult to assess without a case-control or a cross-sectional study. Nevertheless, when new upper digestive tract complaints occur in any patient with an otherwise unremarkable bariatric surgery follow-up, the diagnosis of gastric cancer should be bear in mind.


Assuntos
Adenocarcinoma/etiologia , Gastroplastia/efeitos adversos , Neoplasias Gástricas/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
10.
Br J Cancer ; 100(9): 1444-51, 2009 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-19352387

RESUMO

Chemokines and their receptors are involved in tumourigenicity and clinicopathological significance of chemokines receptor expression in pancreatic adenocarcinoma (PA) is not fully understood. This study was conducted to determine patients' outcome according to the expressions of CXCR4, CXCR7 and HIF-1alpha after resection of PA. Immunohistochemistry for CXCR4, CXCR7 and HIF-1alpha expressions as well as cell proliferative index (Ki-67) was conducted in 71 resected (R0) PA and their 48 related lymph nodes (LN) using tissue microarray. CXCR4 and CXCR7 expressions were positively correlated to HIF-1alpha suggesting a potential role of HIF-1alpha in CXCR4 and CXCR7 transcription activation. Patients with CXCR4(high) tumour expression had shorter OS than those with low expression (median survival: 9.7 vs 43.2 months, P=0.0006), a higher risk of LN metastases and liver recurrence. In multivariate analysis, high CXCR4 expression, LN metastases and poorly differentiated tumour are independent negative prognosis factors. In a combining analysis, patients with a CXCR7(high)/CXCR4(high) [corrected] tumour had a significantly shorter DFS and OS than patients with a CXCR4(low)/CXCR7(low) [corrected] tumour. CXCR4 in resected PA may represent a valuable prognostic factor as well as an attractive target for therapeutic purpose.


Assuntos
Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Regulação Neoplásica da Expressão Gênica , Pancreatectomia/estatística & dados numéricos , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/cirurgia , Receptores CXCR4/genética , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Análise de Sequência com Séries de Oligonucleotídeos , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Prognóstico , Receptores CXCR/genética , Estudos Retrospectivos , Análise de Sobrevida , Sobreviventes
11.
Endoscopy ; 40(5): 406-13, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18459077

RESUMO

BACKGROUND AND STUDY AIMS: Bariatric surgical treatments have been proven to induce long-term weight loss in morbidly obese patients, but complications are relatively frequent. We recently reported a first human multicenter trial assessing the safety, feasibility, and weight loss results of the Transoral Gastroplasty (TOGA) system (Satiety Inc., Palo Alto, CA) at 6 months. Here we report the 6-month results of the second phase of the pilot trial with the TOGA system, with technical improvements to the device. PATIENTS AND METHODS: Patients met established criteria for bariatric surgery. The TOGA system, a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curvature of the stomach. Follow-up was at 1 week and at 1, 3, and 6 months. At 3 months, re-treatment consisting in additional distal restrictions was allowed if necessary. RESULTS: Data were available for 11 patients in our center (7 female, mean age 44.2 years, mean body mass index 41.6). The procedure was completed safely in all patients. There were no serious adverse events. Mean excess weight loss was 19.2 %, 33.7 %, and 46.0 % at 1, 3, and 6 months, respectively. Average body mass index decreased from 41.6 before treatment to 33.1 at 6 months. Absolute mean weight loss was 9.9 kg, 17.5 kg, and 24.0 kg at 1, 3, and 6 months, respectively. A dramatic improvement in quality-of-life measures was observed in all patients. CONCLUSIONS: This second pilot trial confirmed the feasibility and safety of transoral gastroplasty. The early results and technical improvements reported in the present study are encouraging in terms of safety, early weight loss, and quality of life, and clearly allowed multicenter trials, which are planned to start soon.


Assuntos
Endoscopia do Sistema Digestório , Gastroplastia/métodos , Obesidade Mórbida/cirurgia , Grampeamento Cirúrgico/métodos , Redução de Peso , Adulto , Anti-Inflamatórios/administração & dosagem , Estudos de Viabilidade , Feminino , Seguimentos , Gastroplastia/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
12.
Surg Endosc ; 22(3): 589-98, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17973163

RESUMO

OBJECTIVE: To evaluate the safety and feasibility in human subjects of a new transoral restrictive procedure for the treatment of obesity. METHODS: The protocol was approved by the institutional review boards (IRBs) of both centers involved, and all patients gave informed consent. Patients met established inclusion criteria for bariatric surgery. The TOGa system (Satiety Inc., Palo Alto, CA), a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curve of the stomach. Patients were hospitalized overnight for observation and underwent barium upper gastrointestinal (UGI) the next morning. Post procedure, all patients were placed on a liquid diet for 1 month and asked to begin an exercise program. Follow-up was carried out at 1 week and 1, 3, 4, 5, and 6 months. RESULTS: Twenty one patients were enrolled [17 female, age 43.7 (22-57) years, BMI 43.3 (35-53) kg/m(2)]. Device introduction was completed safely in all patients. There were no serious adverse events (AEs). The most commonly reported procedure or device related adverse events were vomiting, pain, nausea, and transient dysphagia. At 6 month endoscopy, all patients had persistent full or partial stapled sleeves. Gaps in the staple line were evident in 13 patients. Patients lost an average 17.6 pounds at 1 month, 24.5 pounds at three months, and 26.5 pounds at 6 months post-treatment [excess weight loss (EWL) of 16.2%, 22.6%, and 24.4%, respectively]. CONCLUSIONS: There is great interest in new procedures for morbid obesity that could offer lower morbidity than current options. Early experience with the TOGa procedure indicates that this transoral approach may be safe and feasible. Further experience with the device and technique should improve anatomic and functional outcomes in the future. Additional studies are underway.


Assuntos
Gastroplastia/métodos , Gastroscopia/métodos , Obesidade Mórbida/cirurgia , Qualidade de Vida , Adulto , Índice de Massa Corporal , Endoscopia/efeitos adversos , Endoscopia/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Gastroscopia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Obesidade Mórbida/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Medição de Risco , Gestão da Segurança , Método Simples-Cego , Resultado do Tratamento , Redução de Peso
13.
Rev Med Brux ; 28(4): 254-6, 2007 Sep.
Artigo em Francês | MEDLINE | ID: mdl-17958017

RESUMO

Bariatric surgery remains the only durable option for weight loss in the morbidly obese patient. The aim of this article is to present the different types of surgical procedures. This multidisciplinary approach try to define which type of surgery would be the more indicated for which patient.


Assuntos
Cirurgia Bariátrica/métodos , Obesidade Mórbida/cirurgia , Seleção de Pacientes , Gastroplastia/métodos , Humanos
14.
Surg Endosc ; 21(11): 1985-90, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17704884

RESUMO

BACKGROUND: Laparoscopic Toupet fundoplication (TF) is reported to be as effective as Nissen (NF), but to be associated with fewer unfavorable postoperative side-effects. This study evaluates the one- and three-year clinical outcome of 140 randomized patients after a laparoscopic NF or TF. PATIENTS AND METHODS: Inclusion criteria included patients over 16 years old with complications of gastro-oesophageal reflux disease (GORD) and persistence or recurrence of symptoms after three months of treatment. Subjects with a previous history of gastric surgery or repeated fundoplication, brachy-oesophagus or severe abnormal manometry results were excluded. Seventy-seven NF and 63 TF were performed. The severity of symptoms was assessed before and after the procedure. RESULTS: One hundred and twenty-one of the 140 patients after one year, and 118 after three years, were evaluated and no statistically significant clinical difference was observed. The level of satisfaction concerning the outcome of the operation remained high after one or three years regardless of the type of fundoplication performed. CONCLUSIONS: Functional complications after NF are not avoided with TF.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Transtornos de Deglutição/etiologia , Eructação , Feminino , Flatulência/etiologia , Seguimentos , Fundoplicatura/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Satisfação do Paciente , Pneumotórax/etiologia , Hemorragia Pós-Operatória/etiologia , Resultado do Tratamento
15.
Obes Surg ; 14(9): 1233-6, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15527640

RESUMO

BACKGROUND: Among the different techniques of surgical treatment for morbid obesity, silastic ring vertical gastroplasty (SRVG) is an alternative, effective and easily reproducible technique. The aim of this study is to evaluate a cohort of patients >6 years after SRVG for morbid obesity. METHODS: From 1991 to 1996, 273 consecutive patients were eligible for SRVG. The evaluation criteria included weight loss, evolution of co-morbidities, long-term morbidities, satisfaction of patients and quality of life. RESULTS: Among these 273 patients, 1 patient died in the postoperative period (0.4%). Postoperative morbidities occured in 27 patients (10%). The long-term follow-up involved 213 patients (78%). Late postoperative complications consisted of outlet stoma stenosis (14%), staple-line dehiscence (5.6%) and incisional hernia (8.5%). 23 patients (10%) needed a re-do operation. Co-morbidities drastically improved. BMI fell from 45.3 to 30.7. Failure of SRVG was statistically associated with male gender and super-obese patients. 69% of the patients were satisfied, and 73% would recommend this operation. CONCLUSION: SRVG is very effective in a selected group of morbidly obese patients.


Assuntos
Gastroplastia , Adolescente , Adulto , Comorbidade , Feminino , Seguimentos , Gastroplastia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Falha de Tratamento , Redução de Peso
16.
Surg Endosc ; 18(5): 818-20, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15216865

RESUMO

BACKGROUND: We investigated the feasibility, safety, and efficacy of laparoscopic antireflux surgery (LARS) after failure of Enteryx injection in the lower esophageal sphincter for the treatment of gastroesophageal reflux disease (GERD). METHODS: Four patients underwent LARS after failure of Enteryx injection. Particular care was taken during the procedure to identify unusual material or fibrosis. RESULTS: All patients underwent LARS successfully. In three patients, tight adhesions with fibrous tissues and black foreign material were observed around the esophagus. No complications occurred during the procedures. The postoperative period was uneventful and functional results were excellent. CONCLUSION: LARS following Enteryx injection is feasible. Careful dissection is mandatory to avoid operative complications. Both techniques may be considered as options for treating GERD.


Assuntos
Junção Esofagogástrica , Fundoplicatura/métodos , Refluxo Gastroesofágico/terapia , Laparoscopia , Polivinil/administração & dosagem , Adulto , Idoso , Junção Esofagogástrica/patologia , Feminino , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade
17.
Surg Endosc ; 18(3): 554-6, 2004 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15115027

RESUMO

Laparoscopic cholecystectomy (LC) seems to be associated with an increased risk of biliary or vascular injuries. Hepatic artery pseudoaneurysms (HAP) are rare complications of LC. HAP can occur in the early or late postoperative period. Patients with HAP present with abdominal pain, hemobilia, and liver function test (LFT) alterations. We report the case of a patient who was affected with a cystic duct stump leak associated with a right HAP and was treated by endoscopic biliary drainage and angiographic coil embolization.


Assuntos
Falso Aneurisma/etiologia , Colecistectomia Laparoscópica , Ducto Cístico/lesões , Artéria Hepática/lesões , Complicações Pós-Operatórias/etiologia , Esfinterotomia Endoscópica , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Falso Aneurisma/terapia , Angiografia Digital , Colangiopancreatografia Retrógrada Endoscópica , Colecistite/complicações , Colecistite/cirurgia , Colelitíase/complicações , Colelitíase/cirurgia , Terapia Combinada , Ducto Cístico/cirurgia , Drenagem , Embolização Terapêutica , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/cirurgia , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/etiologia , Período Pós-Operatório , Risco
18.
Acta Chir Belg ; 103(2): 233-4, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12768871

RESUMO

The gallbladder is rarely the site of distant metastases and in most cases malignant melanoma is the primary tumor. We report a case of a 64-year-old man with a gallbladder metastasis secondary to a renal cell carcinoma. Renal cell carcinoma has a tendency toward metastatic disease, the most notable features of this tumor being its unusual pattern of metastatic disease. Pre-operative imaging studies are often futile in the differentiation between primary and secondary tumors of the gallbladder. Since primary tumors of the gallbladder often coexist with gallstones, a polypoid lesion in an acalculous gallbladder is more consistent with metastasis than a primary tumour. If feasible, surgical resection of the gallbladder is mandatory because it could guarantee better chances of survival for patients with metastatic renal carcinoma.


Assuntos
Carcinoma de Células Renais/secundário , Neoplasias da Vesícula Biliar/secundário , Neoplasias Renais/patologia , Carcinoma de Células Renais/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
19.
Surg Endosc ; 17(4): 659, 2003 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12574933

RESUMO

A superior mesenteric artery syndrome (SMAS) was diagnosed in two young women with, respectively, a 2- and 1-year history of postprandial vomiting and epigastric pain. The patients underwent a laparoscopic duodenojejunal bypass, and resumed a normal diet on the fifth postoperative day. The patients are still symptom-free with patent anastomosis on gastrointestinal radiographic control at 24 and 6 months, respectively, following their operation. Herein we also describe the varying clinical presentation of this rare syndrome, as well as treatment options. We conclude that laparoscopic duodenojejunostomy offers a new therapeutic approach to SMAS. It is reliable and safe; the operating time is acceptable; and diet recovery and hospital stay are both short. However, these preliminary results still need to be confirmed by further observations.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/cirurgia , Jejuno/cirurgia , Laparoscopia , Síndrome da Artéria Mesentérica Superior/cirurgia , Adolescente , Adulto , Feminino , Humanos , Síndrome da Artéria Mesentérica Superior/diagnóstico
20.
Rev Med Brux ; 23 Suppl 2: 51-5, 2002.
Artigo em Francês | MEDLINE | ID: mdl-12584913

RESUMO

The Department of Digestive Surgery was born in 1977. It is a part of the medical surgical unit of gastroenterology and hepatopancreatology. The various developed sectors concern hepatic surgery and liver transplantation (treatment of hepatic tumors and cirrhosis), pancreatic surgery and surgery of the biliary tract (treatment of benign and malignant pancreatic tumors, tumor of the biliary tract, chronic pancreatitis and biliary stones), surgery of morbid obesity (gastroplasty or gastric by-pass), surgery of the upper digestive tract (benign and malignant tumors of the oesophagus or the stomach, treatment of gastroesophageal reflux), surgery of the abdominal wall, colorectal surgery and surgery of the inflammatory bowel diseases (colorectal cancer, familial polyposis, Crohn's disease, ulcerative colitis), proctologic surgery and surgery of anorectal functional disorders, neonatal and paediatric surgery.


Assuntos
Gastroenterologia , Centro Cirúrgico Hospitalar , Bélgica , Pesquisa Biomédica , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Gastroenteropatias/cirurgia , Hospitais Universitários , Humanos
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