Assuntos
Hiperlipidemias/cirurgia , Hipertensão/cirurgia , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica/métodos , Desvio Biliopancreático/métodos , Ablação por Cateter/métodos , Denervação/métodos , Resistência a Medicamentos , Humanos , Hiperlipidemias/tratamento farmacológico , Hipertensão/tratamento farmacológico , Neuroestimuladores Implantáveis , Derivação Jejunoileal/métodos , Laparoscopia/métodos , Obesidade Mórbida/tratamento farmacológico , Pressorreceptores/fisiologia , Resultado do TratamentoRESUMO
The aim of this study was to report the incidence, risk factors, and management of gastric conduit dysfunction after esophagectomy in 177 patients over a 3-year period in a single center. Patients with anastomotic strictures or delayed gastric emptying (DGE) were identified from a prospective database. Anastomotic strictures occurred in 48 patients (27%). Eighty-three percent of early anastomotic strictures (<1 year) were benign, and all late strictures (>1 year) were malignant. Dilatation was effective in 98% of benign and 64% of malignant strictures. DGE occurred in 21 patients (12%), and was associated with both anastomotic leak (P = 0.001) and anastomotic stricture (P = 0.001). 4/8 patients with late DGE (>3 months postesophagectomy) were tumor-related. Pyloric dilatation was effective in 92% of early and 63% of late DGE. Pyloric stents were inserted in 3 patients with tumor-related DGE. After esophagectomy, early anastomotic strictures (within 1 year) and early delayed gastric emptying (within 3 months) are usually benign and respond to dilatation. However, patients presenting later with tumor-related obstruction are unlikely to respond to anastomotic or pyloric dilatation and should be stented.
Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Gastroparesia/epidemiologia , Gastroparesia/terapia , Estômago/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Estudos de Coortes , Constrição Patológica/epidemiologia , Constrição Patológica/patologia , Constrição Patológica/terapia , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Feminino , Esvaziamento Gástrico , Gastroparesia/diagnóstico , Humanos , Incidência , Intubação Gastrointestinal/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Minimally invasive surgery is rapidly becoming an integral part of general surgery. Many general surgeons have been trained to undertake laparoscopic cholecystectomy. It has been recommended that laparoscopic appendicectomy should be the training operation for junior surgeons. The aim of our study was to assess whether laparoscopic appendicectomy training can safely be introduced to junior surgeons in a district general hospital. During the 11 month study period, 27 laparoscopic and 38 open appendicectomies were performed. The median anaesthetic time was 80 min for laparoscopic and 52.5 min for open appendicectomies. Laparoscopic appendicectomies cost, on average, 618 pounds and open appendicectomies 770 pounds per case. The complication rate between the two procedures was equal. We therefore showed that laparoscopic appendicectomy by junior surgeons is both safe and cost-effective. Although the registrar did most of the laparoscopic appendicectomies, with resultant less operating for the SHO, laparoscopic appendicectomy provided the SHO with training in diagnostic laparoscopy and laparoscopic dissection. We conclude that basic laparoscopic training should be introduced early in surgical training, after which laparoscopic appendicectomy is a safe procedure for surgical trainees.