RESUMO
PURPOSE: There is controversy about the necessity of nighttime appendectomy. The aim of this study was to determine whether timing of appendectomy performance plays a role on postoperative complications. METHODS: A retrospective single-center comparative study was performed in children who underwent surgery for acute appendicitis between 2017 and 2021. Patients were divided into groups based on the time slot in which surgery was performed: morning (8:00 h-15:00 h), afternoon (15:00 h-22:00 h) and night (22:00 h-08:00 h). Demographics, intraoperative data, length of hospital stay, and postoperative complications were analyzed and compared. RESULTS: A total of 1643 patients were included: 337 were operated in the morning, 751 in the afternoon and 555 at night. We found no demographic differences. When comparing the intraoperative data, no differences were observed in the percentage of complicated appendicitis. Night group patients presented a higher percentage of open appendectomies (64.5%) when compared to afternoon (49.6%) and morning (46.2%) groups (p < 0.001). Surgery time was also significantly shorter in the night group (45.2 min ± 18.9 min) (p < 0.001). There were no differences in length of hospital stay, postoperative complications rate or readmission rate. CONCLUSION: These results show that in our institution time slot in which the appendectomy is performed has no consequences in postoperative outcomes and complications.
Assuntos
Apendicite , Laparoscopia , Criança , Humanos , Apendicectomia/métodos , Estudos Retrospectivos , Apendicite/cirurgia , Apendicite/complicações , Resultado do Tratamento , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Tempo de InternaçãoRESUMO
Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.
Assuntos
Humanos , Cisto Pancreático/diagnóstico , Cisto Pancreático/terapia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Chile/epidemiologia , ConsensoRESUMO
BACKGROUND: Endoscopic submucosal dissection (ESD) allows en-bloc resection of early gastro-intestinal neoplasms (EGIN) with healing potential. AIM: To describe the results of patients treated with ESD for EGIN by our team. PATIENTS AND METHODS: Descriptive study of patients with EGIN who underwent ESD with curative intention between January 2008 and March 2020. RESULTS: One hundred thirty-two ESD were performed in 127 patients. 77% were gastric lesions, 14% colorectal, 8% esophageal and 1% duodenal. En-bloc resection was achieved in 98.4% of ESDs. Eighty eight percent of patients met curative standards. Overall, cancer-specific, and recurrence-free survival were 95%, 100% and 98% respectively. CONCLUSIONS: ESD allows en-bloc resections with curative potential in selected patients, but with a significant reduction in morbidity and mortality and less impact on quality of life. Our results suggest the feasibility to perform ESD in our country with results comparable to those reported in the literature.
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Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Dissecação , Trato Gastrointestinal , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background: Endoscopic submucosal dissection (ESD) allows en-bloc resection of early gastro-intestinal neoplasms (EGIN) with healing potential. Aim: To describe the results of patients treated with ESD for EGIN by our team. Patients and Methods: Descriptive study of patients with EGIN who underwent ESD with curative intention between January 2008 and March 2020. Results: One hundred thirty-two ESD were performed in 127 patients. 77% were gastric lesions, 14% colorectal, 8% esophageal and 1% duodenal. En-bloc resection was achieved in 98.4% of ESDs. Eighty eight percent of patients met curative standards. Overall, cancer-specific, and recurrence-free survival were 95%, 100% and 98% respectively. Conclusions: ESD allows en-bloc resections with curative potential in selected patients, but with a significant reduction in morbidity and mortality and less impact on quality of life. Our results suggest the feasibility to perform ESD in our country with results comparable to those reported in the literature.
Assuntos
Neoplasias Gástricas , Ressecção Endoscópica de Mucosa , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Trato Gastrointestinal , Dissecação , Recidiva Local de NeoplasiaRESUMO
Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.
Assuntos
Cisto Pancreático , Neoplasias Pancreáticas , Humanos , Chile/epidemiologia , Consenso , Cisto Pancreático/diagnóstico , Cisto Pancreático/terapia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapiaRESUMO
BACKGROUND: Achalasia is the most common primary motor disorder of the esophagus, but its incidence in pediatric patients is low. Laparoscopic Heller myotomy (LHM) is the current surgical standard of care treatment. Per-oral endoscopic myotomy (POEM) has emerged as a safe and effective therapeutic alternative in adult patients. We herein report the outcomes of a cohort of pediatric patients with achalasia treated by POEM at a Chilean medical center. METHODS: This is a retrospective analysis of prospectively collected data on children who underwent POEM for esophageal achalasia. Clinical follow-up was evaluated by recording the Eckardt score, a high-resolution esophageal manometry (HREM) three months after the procedure, and an annual upper gastrointestinal endoscopy. RESULTS: Five patients with esophageal achalasia confirmed by HREM and with a mean age of 11 (5 to 15) years underwent POEM between 2017 and 2019. One patient had a previous LHM. No morbidity or mortality was observed. All patients resolved their dysphagia and no patient required further interventions. Mean Eckardt score reduced from 10 points preoperatively to 1 point postoperatively. Two patients currently have mild esophagitis (confirmed by endoscopy). CONCLUSION: Our results support the previously reported safety and effectiveness of POEM. Longer follow-up and larger cohorts will be important to confirm its role in the treatment of children with esophageal achalasia. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level IV.
Assuntos
Acalasia Esofágica , Miotomia de Heller , Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Adolescente , Adulto , Criança , Acalasia Esofágica/cirurgia , Esfíncter Esofágico Inferior , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Gastric cancer is the second leading cause of death by cancer worldwide. Endoscopic submucosal dissection (ESD) is a technique that allows en bloc resection of early lesions of the digestive tract. It has curative potential in selected patients and benefits over gastrectomy for the treatment of early gastric cancer (EGC). The aim of this study is to present the results of ESD for EGC in a high-volume center in Chile. MATERIALS AND METHODS: Retrospective descriptive study of patients who underwent ESD for EGC at the Doctor Sótero del Río Hospital. RESULTS: A total of 100 ESDs were performed in 96 patients between 2008 and 2020. Fifty-five percent were female patients, the average age was 68 years (range, 45 to 89 y). En bloc resection was achieved in 98% of cases and the rate of complications Clavien grade III or higher was 8.3%. There were no cases of perioperative mortality. Ninety-three percent of the dissections were classified as R0 and 83% met curative standards according to expanded criteria. The mean follow-up was 42 months (range, 1 to 144 mo). Overall survival was 97%. Cancer-specific survival was 100% and recurrence-free survival was 97%. CONCLUSIONS: The present study describes the largest series of ESD for the treatment of EGC reported in Latin America. Our results support the feasibility of implementing ESD in Chile and indicate good oncological outcomes comparable to those reported in the large Asian series published to date.
Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Gástricas , Idoso , Feminino , Mucosa Gástrica/cirurgia , Gastroscopia , Humanos , América Latina , Masculino , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. AIM: To identify the predictors of severe postoperative morbidity. METHODS: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. RESULTS: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. CONCLUSION: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.
Assuntos
Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. AIM: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. METHODS: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. RESULTS: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. CONCLUSION: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.
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Gastrectomia/mortalidade , Gastrectomia/métodos , Laparoscopia/mortalidade , Laparoscopia/métodos , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile , Detecção Precoce de Câncer , Feminino , Gastrectomia/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/efeitos adversos , Excisão de Linfonodo/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Perioperatório , Complicações Pós-Operatórias , Estudos Retrospectivos , Estatísticas não Paramétricas , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCCIÓN: La acalasia es el trastorno motor primario más frecuente del esófago. Su incidencia reportada es baja, aún más en pacientes pediátricos. La miotomía de Heller laparoscópica corresponde al estándar actual de tratamiento. Durante los últimos años la miotomía endoscópica por vía oral (POEM) se ha posicionado como una alternativa terapéutica segura y tan efectiva como el Heller para la acalasia esofágica. OBJETIVO: Describir la técnica de POEM y reportar el primer caso pediátrico en nuestro país. CASO CLÍNICO: Paciente de 11 años, previamente sano, que se presentó con disfagia ilógica progresiva y baja de peso. El estudio concluyó una acalasia tipo II. Fue sometido a POEM y cursó un postoperatorio sin incidentes. A un año de la intervención se ha documentado resolución de la sintomatología, seguimiento endoscópico y manométrico sin complicaciones. CONCLUSIONES: El caso descrito corresponde al primer POEM en un paciente pediátrico en nuestro país. La acalasia esofágica es infrecuente en pediatría y el POEM ha demostrado éxito clínico y seguridad comparables a la miotomía de Heller laparoscópica en el corto y mediano plazo. El seguimiento a largo plazo permitirá determinar su rol definitivo en el tratamiento de pacientes pediátricos con acalasia esofágica.
INTRODUCTION: Achalasia is the most common primary motor disorder of the esophagus. Its reported incidence is low, even more in pediatric patients. Laparoscopic Heller myotomy is the current stan dard of treatment. During the last years, per-oral endoscopic myotomy (POEM) has been positioned as a safe and effective therapeutic alternative as the Heller procedure for esophageal achalasia. OBJECTIVE: To describe the POEM technique and report the first pediatric case in our country. CLINICAL CASE: 11-year-old patient, previously healthy, who presented with progressive dysphagia for solids and liquids and weight loss. The study concluded a type II achalasia. The patient underwent a POEM and had a postoperative course without incidents. One year after the intervention, symptomatic, endoscopic and manometric resolution have been documented. CONCLUSIONS: The described case is the first POEM in a pediatric patient in our country. Esophageal achalasia is uncommon in pediatrics and POEM has demonstrated clinical success and safety comparable to laparoscopic Heller myotomy in short and medium term. Long-term follow-up will determine its definitive role in the treatment of pediatric patients with esophageal achalasia.
Assuntos
Humanos , Masculino , Criança , Acalasia Esofágica/cirurgia , PiloromiotomiaRESUMO
ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.
RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Neoplasias Esofágicas/cirurgia , Junção Esofagogástrica/cirurgia , Gastrectomia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Estudos de CoortesRESUMO
ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.
RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/mortalidade , Laparoscopia/métodos , Laparoscopia/mortalidade , Gastrectomia/métodos , Gastrectomia/mortalidade , Complicações Pós-Operatórias , Neoplasias Gástricas/patologia , Fatores de Tempo , Chile , Taxa de Sobrevida , Estudos Retrospectivos , Resultado do Tratamento , Laparoscopia/efeitos adversos , Estatísticas não Paramétricas , Estimativa de Kaplan-Meier , Detecção Precoce de Câncer , Período Perioperatório , Gastrectomia/efeitos adversos , Excisão de Linfonodo/mortalidade , Estadiamento de NeoplasiasRESUMO
Resumen Introducción Los tumores submucosos del tracto gastrointestinal alto tienen potencial de malignidad y también pueden ser una carga para el paciente, por lo que se requiere disponer de un tratamiento seguro y eficaz. El surgimiento de la técnica de resección endoscópica por tunelización submucosa (STER) en los últimos años ha mostrado resultados prometedores. Caso clínico Se presenta el caso de un hombre de 47 años asintomático, en quien, en el contexto de un estudio preoperatorio de cirugía bariátrica, se pesquisa una lesión subepitelial en la unión gastroesofágica. La endosonografía alta es compatible con un leiomioma esofágico. Se realiza STER con éxito y sin complicaciones; a las 48 h es dado de alta. El estudio histopatológico confirmó un leiomioma esofágico. Discusión La técnica STER ha demostrado consistentemente ser segura y eficaz en el tratamiento de los tumores submucosos de la unión gastroesofágica. El desafío es difundir la técnica por el resto del país, para mayor beneficio de los pacientes.
Introduction Upper gastrointestinal submucosal tumors are potentially malignant lesions; so safe and efficient treatments are needed. In recent years, submucosal tunneling endoscopic resection (STER) has emerged as a novel therapeutic technique, with promising results. Case report 47-year-old male patient, previously asymptomatic, who was found to have a subepithelial lesion at the gastroesophageal junction. Upper endoscopic ultrasound was compatible with a leiomyoma. He underwent STER to remove the tumor and recovered with any complications. The biopsy confirmed an esophageal leiomyoma. Discussion STER has become a highly feasible and safe therapeutic option for submucosal tumors of the gastroesophageal junction. The challenge is to spread knowledge about this technique, to maximize patient's benefit.
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Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Esofágicas/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Leiomioma/cirurgia , Resultado do Tratamento , Mucosa/cirurgiaRESUMO
Resumen Introducción El tratamiento quirúrgico del cáncer esofágico se asocia a una alta morbimortalidad. El abordaje mínimamente invasivo se ha introducido con el objetivo de disminuir la morbilidad postoperatoria. Objetivo Describir la técnica y los resultados de la esofagectomía mínimamente invasiva (EMI) transtorácica en posición semiprono. Métodos Estudio de cohorte descriptivo. Se incluyeron pacientes con una EMI electiva por cáncer entre abril de 2013 y mayo de 2017. Se registraron variables demográficas, perioperatorias, anatomía patológica y la sobrevida. Resultados Incluimos 33 pacientes (24 hombres, edad 69 años, 91% con comorbilidades). La ubicación predominante del tumor fue en los tercios medio e inferior del esófago (90%). Quince (45%) pacientes recibieron neoadyuvancia. No existieron casos de conversión a toracotomías. La reconstrucción se realizó con estómago en un 93%. Se realizó anastomosis cervical en 66% y torácica en 30%. El tiempo operatorio fue de 420 (330-570) minutos y el sangrado de 200 (20-700) cc. La mortalidad a 90 días fue de 0%. La morbilidad global fue de 78%, se registró un 15% de neumonía y un 9% requirió una reoperación. La estadía hospitalaria fue de 23 (11-81) días. La histología fue carcinoma escamoso en 51% y adenocarcinoma en 45%. Los márgenes fueron RO en 87%. El recuento ganglionar alcanzó 30 (9-45) ganglios. La sobrevida global a 2 años es 68%. Conclusión Los resultados preliminares de esta técnica son favorables; sin ningún caso de mortalidad postoperatoria. Los resultados oncológicos demuestran un alto porcentaje de cirugía RO y adecuado recuento ganglionar.
Introduction Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Análise de Sobrevida , Resultado do Tratamento , Decúbito VentralRESUMO
Introducción: Las lesiones quísticas esplénicas son poco frecuentes; pueden ser clasificadas en primarias y secundarias según la presencia de revestimiento epitelial. Los quistes parasitarios son provocados por especies de Equinococcus y su manejo es específico. Suelen ser lesiones asintomáticas y el tratamiento depende de su tamaño y de la aparición de manifestaciones clínicas. El abordaje quirúrgico tradicional ha sido la esplenectomía, pero con el reconocimiento de las complicaciones inmunológicas, han tenido auge las alternativas que conservan parénquima esplénico. Objetivo: Comunicar la experiencia en el manejo quirúrgico de esta enfermedad en nuestro centro. Resultados: Se presenta la serie de 11 casos de quistes esplénicos no parasitarios que recibieron tratamiento quirúrgico durante los últimos 15 años. La mayoría de las intervenciones fueron laparoscópicas y no se registró morbimortalidad. Discusión: En el tratamiento de los quistes del bazo no parasitarios actualmente se reconoce el valor de preservar parénquima y función esplénica. La esplenectomía, cirugía cuyo estándar actual es mediante laparoscopia, ha sido progresivamente desplazada por alternativas conservadoras. Las opciones terapéuticas dependen del desarrollo de síntomas, del tamaño y de la ubicación de las lesiones. Conclusiones: Los quistes esplénicos son poco frecuentes. Ante la necesidad de tratamiento quirúrgico el abordaje laparoscópico y las cirugías que conservan parénquima esplénico deberían ser de elección.
Introduction: Splenic cysts are rare. They have been classified in primary or secondary lesions based on the presence or absence of an epithelial lining. Parasitic cysts are caused by Echinococcus spp. and have a particular management. Splenic cysts are usually asymptomatic, treatment depends on the development of symptoms and diameter. Traditionally, splenectomy has been the standard surgery, but updated knowledge about the role of the spleen in preventing some infections has led to more conservative options. Objective: To report our experience in surgical management of the disease. Results: Our series includes 11 patients with non-parasitic splenic cysts treated surgically, during the last 15 years. Most were laparoscopic interventions and no morbidity or mortality was registered. Discussion: Surgical treatment for non-parasitic splenic cysts actually favours conservative techniques; salvage of the spleen whenever possible is fully justified based on updated knowledge of the role it plays in promoting protection against infection. Splenectomy, nowadays performed by laparoscopy, has been partially displaced. Treatment options depends on the cyst diameter, development of symptoms and localization. Conclusions: Splenic cysts are unfrequent. If surgical treatment is needed, laparoscopy and interventions conserving splenic parenchyma should be the election.
Assuntos
Humanos , Esplenectomia/métodos , Esplenopatias/cirurgia , Laparoscopia , Cistos/cirurgia , Baço/patologia , Estudos Retrospectivos , Seguimentos , Cistos/patologiaRESUMO
BACKGROUND: Common bile duct (CBD) stones in a Roux-en-Y gastric bypass (RYGB) represent a major challenge for ERCP due to long-limb anatomy. Trans-gastric approach has been proposed but entails high ERCP-related risks. Laparoscopy assisted trans-gastric rendez-vous (LATG-RV) is a one-step procedure that may lower the risks of these patients. METHODS: We describe our initial experience in four patients with past history of RYGB and CBD stones. RESULTS: All patients underwent LATG-RV and had successful CBD stone clearance. Postoperative course was uneventful with normal amylase levels. Average procedure time was 105 min and postoperative stay 2 days. CONCLUSION: LATG-RV is a safe and effective procedure for the clearance of CBD stones in RYGB patients. It may have fewer complications and shorter operative time than regular trans-gastric ERCP.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Cálculos Biliares/cirurgia , Derivação Gástrica , Obesidade Mórbida/cirurgia , Esfinterotomia Endoscópica , Adulto , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Feminino , Cálculos Biliares/complicações , Derivação Gástrica/efeitos adversos , Derivação Gástrica/reabilitação , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Estudos Retrospectivos , Esfinterotomia Endoscópica/métodos , Estômago/cirurgiaRESUMO
BACKGROUND: Acute pseudo-obstruction of the colon is a disorder characterised by an increase in intra-luminal pressure that leads to ischaemia and necrosis of the intestinal wall. The mechanism that produces the lesion is unknown, although it has been associated with: trauma, anaesthesia, or drugs that alter the autonomic nervous system. The pathophysiology of medication induced colon toxicity can progress to a perforated colon and potentially death. OBJECTIVE: Present a case of a colonic pseudo-obstruction in a patient with polypharmacy as the only risk factor and to review the medical literature related to the treatment of this pathology. CLINICAL CASE: The case is presented of a 67 year old woman with colonic pseudo-obstruction who presented with diffuse abdominal pain and distension. The pain progressed and reached an intensity of 8/10, and was accompanied by fever and tachycardia. There was evidence of free intraperitoneal air in the radiological studies. The only risk factor was the use of multiple drugs. The colonic pseudo-obstruction progressed to intestinal perforation, requiring surgical treatment, which resolved the problem successfully. CONCLUSION: It is important to consider drug interaction in patients with multiple diseases, as it may develop complications that can be avoided if detected on time.
Assuntos
Abdome Agudo/etiologia , Pseudo-Obstrução do Colo/induzido quimicamente , Motilidade Gastrointestinal/efeitos dos fármacos , Perfuração Intestinal/etiologia , Idoso , Anastomose Cirúrgica/métodos , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Atorvastatina/efeitos adversos , Atorvastatina/uso terapêutico , Antagonistas Colinérgicos/efeitos adversos , Antagonistas Colinérgicos/farmacologia , Antagonistas Colinérgicos/uso terapêutico , Colo/cirurgia , Colo Sigmoide/cirurgia , Pseudo-Obstrução do Colo/fisiopatologia , Pseudo-Obstrução do Colo/cirurgia , Sinergismo Farmacológico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Íleo/cirurgia , Perfuração Intestinal/cirurgia , Cetoconazol/uso terapêutico , Levetiracetam , Meropeném , Nifedipino/efeitos adversos , Nifedipino/farmacologia , Nifedipino/uso terapêutico , Peritonite/tratamento farmacológico , Peritonite/etiologia , Piracetam/efeitos adversos , Piracetam/análogos & derivados , Piracetam/uso terapêutico , Polimedicação , Fumarato de Quetiapina/efeitos adversos , Fumarato de Quetiapina/uso terapêutico , Cloridrato de Raloxifeno/efeitos adversos , Cloridrato de Raloxifeno/uso terapêutico , Respiração Artificial , Fatores de Risco , Tienamicinas/uso terapêuticoRESUMO
BACKGROUND: Controversial evidence exists regarding the laparoscopic approach in patients with acute appendicitis complicated with peritonitis due to a higher rate of surgical complications. The aim of this study was to compare post-operatory outcomes in patients with acute appendicitis complicated exclusively with peritonitis approached by laparoscopy versus open surgery. METHODS: Single center retrospective analysis of clinical records of patients with appendicitis complicated with peritonitis operated from January 2003 until October 2013. Demographic data, intra-operative variables, length of stay, surgical complications, mortality, readmissions and reoperations were retrieved. RESULTS: 227 patients were identified, 43% males, mean age 39±17 years (range: 12-85 years). Ninety-seven patients (43%) underwent laparoscopic appendectomy, 13 of them were converted to open surgery (13%). Ninety-four patients presented with diffuse peritonitis (41.4%). Laparoscopic appendectomy showed longer operative time but shorter hospital stay (p<0.05). There were no differences in post-operatory complications (intra-abdominal abscess, surgical site infection and prolonged ileus). Laparoscopic appendectomy was associated with lower odds for developing any surgical complication in the multivariate analysis (OR 0.301, p=0.036). CONCLUSION: Both approaches showed no differences in complications in the management of appendicitis complicated exclusively with peritonitis. In our experience, laparoscopic appendectomy is a safe approach in cases of appendicitis complicated exclusively with peritonitis.
Assuntos
Apendicectomia/métodos , Apendicite/complicações , Apendicite/cirurgia , Laparoscopia/efeitos adversos , Peritonite/etiologia , Abscesso Abdominal/etiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/efeitos adversos , Criança , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Íleus/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Razão de Chances , Duração da Cirurgia , Reoperação , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Adulto JovemRESUMO
BACKGROUND: Simulation may provide a solution to acquire advanced laparoscopic skills, thereby completing the curriculum of residency programs in general surgery. This study was designed to present an advanced simulation-training program and to assess the transfer of skills to a live porcine model. METHODS: First-year residents were assessed in a 14-session advanced laparoscopic training program followed by performing a jejunojejunostomy in a live porcine model. Previous and after training assessments at the bench model were compared to a single performance of six expert laparoscopic surgeons. Results obtained by trainees at the porcine model assessment were compared to those of 11 general surgeons without any laparoscopic lab-simulation training and 6 expert laparoscopic surgeons. In all assessments, global and specific OSATS scores, operative time, and covered path length of hands were registered. RESULTS: Twenty-five residents improved significantly their global and specific OSATS score median at the bench model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05 and 7 (range, 4-8) vs. 18 (range, 18-19); p < 0.05, respectively] and obtained significantly better scores on the porcine model compared with general surgeons with no lab-simulation training [21 (range, 20.5-21) vs. 8 (range, 12-14); p < 0.05]. The results were comparable to those achieved by expert certificated bariatric surgeons. Total path lengths registered for trainees were more efficient post-training and significantly lower compared with general surgeons on the porcine model [7 (range, 6-11) vs. 23 (range, 21-24); p < 0.05] with no statistical difference compared with experts. CONCLUSIONS: Trainees significantly improved their advanced laparoscopic skills to a level compared with expert surgeons. More importantly, these acquired skills were transferred to a more complex live model.