RESUMO
Objective. To evaluate the HER2 expression on gastric adenocarcinoma from a Brazilian population and also to analyze the relations between the receptor and clinical characteristics, as well as the survival status. Materials and Methods. A retrospective analysis was conducted from January of 2008 to July of 2012, considering only gastrectomies with curative intent. Tumors were tested for HER2 status using immunohistochemistry. The relation between HER2 status and clinical aspects, surgical findings, and survival were also analyzed. Results. 222 patients with gastric carcinoma were submitted to surgery during that period, but only 121 (54,5%) were with curative intention. The immunohistochemistry revealed that 4 patients (3,3%) were HER2-positive, 6 patients (4,9%) HER2-undetermined, and 111 patients (91,7%) HER2-negative. There was no statistical concordance between HER2 status and survival or the clinical aspects. Conclusion. The HER2 overexpression rate was very low in this Brazilian population sample and cannot be considered as a prognostic factor.
Assuntos
Receptor ErbB-2/metabolismo , Neoplasias Gástricas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Gastrectomia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Receptor ErbB-2/genética , Estudos Retrospectivos , Neoplasias Gástricas/genéticaRESUMO
BACKGROUND: Laparoscopy for bariatric surgery became the surgery of choice for surgeons worldwide. However, it is also more difficult to learn and has a great potential for complications. The specific training is fundamental to maintain the benefits without increasing the complications. This study presents a laparoscopic surgery training method for the treatment of obesity and to analyze its efficiency. METHOD: A training program for 36 surgeons with experience in open bariatric surgery was proposed, and the surgical results of their first laparoscopic surgeries were accompanied as for greater complications, such as death, intestinal obstruction, bleeding and fistula within the first 30 days. RESULTS: Of the 36 surgeons who completed the program, thirteen who performed 403 surgeries were accompanied for 18 months to evaluate morbidity and mortality. There were 4 cases of greater complications (1%). CONCLUSIONS: The proposed program was efficient for this specific group of surgeons, as it permitted the participants to learn the procedure without increasing the initial complications in the learning curve.
Assuntos
Derivação Gástrica/educação , Laparoscopia/educação , Obesidade Mórbida/cirurgia , Competência Clínica , Derivação Gástrica/métodos , Humanos , Capacitação em Serviço/métodos , Laparoscopia/métodos , Curva de Aprendizado , Complicações Pós-Operatórias , Avaliação de Programas e Projetos de Saúde , Cirurgiões/educaçãoRESUMO
BACKGROUND: Bariatric surgery is considered an effective option for the management of morbid obesity. The incidence of obesity has been gradually increasing all over the world reaching epidemic proportions in some regions of the world. Obesity can cause a reduction of up to 22% in the life expectancy of morbidly obese patients. OBJECTIVE: The objective of this paper is to assess the weight loss associated with the first 6 months after bariatric surgery using bioelectric impedance analysis (BIA) for the evaluation of fat mass and fat-free mass. METHOD: A total of 36 morbidly obese patients were subjected to open gastric bypass surgery. The patients weight was monitored before and after the procedure using the bioelectric impedance analysis. RESULTS: Bariatric surgery resulted in an average percentage of weight loss of 28.6% (40 kg) as determined 6 months after the procedure was performed. Analysis of the different components of body weight indicated an undesirable loss of fat-free mass along with the reduction of total body weight. CONCLUSION: Open gastric bypass induced a significant loss of total weight and loss of fat-free mass in patients six months after the surgery. The use of bioelectric impedance analysis resulted in an appropriate estimation of the total weight components in individuals subjected to bariatric surgery allowing a more real analysis of the variation of weight after the surgery.
Assuntos
Composição Corporal , Impedância Elétrica , Derivação Gástrica , Adulto , Cirurgia Bariátrica , Índice de Massa Corporal , Peso Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
BACKGROUND: Remnant gastric cancer (RGC) is defined as a carcinoma that develops in the gastric remnant from 5 years after gastrectomy, regardless of the primary gastric disease. The pattern of lymph node dissemination in these patients is not well understood. The present study aims to understand the lymph node distribution of patients with RGC in a single center. METHODS: In a total of 1380 patients with gastric cancer, between 1998 and 2020, 43 patients operated on for RGC were analyzed. The pattern of lymph node dissemination was evaluated based on the number of dissected lymph node stations, the number of positive lymph node stations, the positivity index at each analyzed station, the number of dissected lymph nodes per patient, and the positivity index per lymph node station. RESULTS: A mean of 13.0 ± 8.1 lymph nodes were dissected. The incidence of lymph node involvement by dissected station was higher at Stations 19, 11p, 3, 4sb and 7 (50, 40, 37.5, 36 and 31.7%, respectively). Among the positive dissected stations, Station 3 with 52.2%, 4sb with 39.1% and 4sa with 34.8% were the most affected. CONCLUSION: There was no predilection for lymph node involvement when comparing the lesser and greater gastric curvature. The dissection of Stations 3, 4sb and 4sa is fundamental in surgical treatment with curative purposes. The totalization of gastrectomy with lymphadenectomy of the perigastric and supra-pancreatic stations should be the surgery of choice.
Assuntos
Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Metástase Linfática/patologia , Linfonodos/cirurgia , Linfonodos/patologia , Excisão de Linfonodo , Gastrectomia , Estudos RetrospectivosRESUMO
BACKGROUND: Regarding postoperative pain, it remains unclear whether non-fixation of the polypropylene prosthesis in transabdominal preperitoneal inguinal hernia repair produces the same outcomes as mesh fixation with glue or tackers. In addition, hernia recurrence is another aspect to be assessed in the comparison between non-fixation and mesh-fixation techniques (tackers and glue). AIMS: This study aimed to evaluate the incidence, quality of pain, and recurrence in patients undergoing laparoscopic inguinal hernioplasty (transabdominal preperitoneal) technique, comparing the fixation of the mesh with tackers versus with glue versus without fixation. METHODS: This is a prospective, double-blind study in which 63 patients presenting with primary unilateral inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal hernia repair and were randomized into three groups: no mesh fixation (n=21), mesh tacked (n=21), and mesh fixed with fibrin glue (n=21). Patients also responded to questionnaires in order to assess pain and pain quality and were followed up for 2 years. RESULTS: Neither mesh-fixation nor non-fixation techniques were found to affect postoperative chronic pain (p=0.535), but patients undergoing tacker fixation reported more pain descriptors (p=0.0021) and a higher pain index (p=0.002) on the McGill scale in the first 15 postoperative days (T0 and T1). No hernia recurrences were observed. CONCLUSIONS: Both mesh-fixation techniques (tackers and glue) used with the transabdominal preperitoneal approach did not influence the onset of inguinodynia, but tacker fixation was more likely to increase patient sensitivity to pain. Mesh placement without fixation produced the same pain and recurrence outcomes as mesh-fixation techniques. Also, no recurrence was observed in patients without mesh fixation in this study. Consequently, it has become an alternative therapy deserving consideration for hernia repair.
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Dor Crônica , Hérnia Inguinal , Laparoscopia , Dor Crônica/complicações , Dor Crônica/cirurgia , Método Duplo-Cego , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Humanos , Laparoscopia/métodos , Dor Pós-Operatória/epidemiologia , Estudos Prospectivos , Telas Cirúrgicas/efeitos adversosRESUMO
OBJECTIVE: to describe the use of the robotic platform in inguinal hernia recurrence after a previous laparoscopic repair. METHODS: patients with recurrent inguinal hernias following a laparoscopic repair who have undergone robotic transabdominal preperitoneal between December 2015 through September 2020 were identified in a prospectively maintained database. Outcomes of interest included demographics, hernia characteristics, operative details and rates of 30-day surgical site occurrence, surgical site occurrences requiring procedural interventions, surgical site infection and hernia recurrence were abstracted. RESULTS: nineteen patients (95% male, mean age 55 years, mean body mass index 28) had 27 hernias repaired (N=8 bilateral). Average operative time was 168.9 ± 49.3min (range 90-240). There were two intraoperative complications all of them were bleeding from the inferior epigastric vessel injuries. Three SSOs occurred (N=2 seromas and N=1 hematoma. After a median 35.7 months follow-up (IQR 13-49), no recurrence has been diagnosed. One patient developed chronic postoperative inguinal pain. CONCLUSIONS: on a small number of selected patients and experienced hands, we found that the use of the robotic platform for repair of recurrent hernias after prior laparoscopic repair appears to be feasible, safe and effective despite being technically demanding. Further studies in larger cohorts are necessary to determine if this technique provides any benefits in recurrent inguinal hernia scenario.
Assuntos
Hérnia Inguinal , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Feminino , Virilha , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Telas Cirúrgicas , Resultado do TratamentoRESUMO
BACKGROUND: Obesity is a major public health problem in both developed and developing countries alike and leads to a series of changes in respiratory physiology. There is a strong correlation between obesity and cardiopulmonary sleep disorders. Weight loss among such patients leads to a reduction in these alterations in respiratory physiology, but clinical treatment is not effective for a long period of time. Thus, bariatric surgery is a viable option. METHODS/DESIGN: The present study involves patients with morbid obesity (BMI of 40 kg/m2 or 35 kg/m2 to 39.9 kg/m2 with comorbidities), candidates for bariatric surgery, screened at the Santa Casa de Misericórdia Hospital in the city of Sao Paulo (Brazil). The inclusion criteria are grade III morbid obesity, an indication for bariatric surgery, agreement to participate in the study and a signed term of informed consent. The exclusion criteria are BMI above 55 kg/m2, clinically significant or unstable mental health concerns, an unrealistic postoperative target weight and/or unrealistic expectations of surgical treatment. Bariatric surgery candidates who meet the inclusion criteria will be referred to Santa Casa de Misericórdia Hospital and will be reviewed again 30, 90 and 360 days following surgery. Data collection will involve patient records, personal data collection, objective assessment of HR, BP, neck circumference, chest and abdomen, collection and analysis of clinical preoperative findings, polysomnography, pulmonary function test and a questionnaire on sleepiness. DISCUSSION: This paper describes a randomised controlled trial of morbidly obese patients. Polysomnography, respiratory mechanics, chemosensitive response and quality of life will be assessed in patients undergoing or not undergoing bariatric surgery. TRIAL REGISTRATION: The protocol for this study is registered with the Brazilian Registry of Clinical Trials - ReBEC (RBR-9k9hhv).
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Cirurgia Bariátrica , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Qualidade de Vida , Adolescente , Adulto , Idoso , Dióxido de Carbono/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Polissonografia , Estudos Prospectivos , Mecânica Respiratória/efeitos dos fármacos , EspirometriaRESUMO
INTRODUCTION/PURPOSE: Obesity increases significantly every year worldwide. Since 1980, the prevalence of individuals with obesity has practically doubled. Obesity plays an important role in the pathophysiology of diseases that arise from a complex interaction of nutritional, genetic, and metabolic factors, characterizing a chronic inflammatory state. This study aimed to verify the systemic inflammatory response through the analysis of IGF-1, IL-23, and resistin levels and the lipid profile in severely obese women undergoing surgery for obesity and weight-related diseases. MATERIALS AND METHODS: This randomized controlled clinical trial includes female patients clinically diagnosed with severe obesity with an indication for bariatric surgery. RESULTS: In the initial evaluation, no significant difference was observed between the control (CG) and bariatric surgery (BSG) groups. The weight, BMI, systolic and diastolic blood pressures, total cholesterol, LDL, HDL, total non-HDL cholesterol, and glucose in BSG patients showed a significant change after surgery. Pre- and post-surgery levels of resistin, IGF-1, and IL-23 showed a significant difference in the BSG group, but only IL-23 was changed after 6 months in the CG. CONCLUSION: The results of this study confirmed that weight loss induced by surgery for obesity and weight-related diseases improved the lipid profile and reduced the chronic inflammatory status in women with severe obesity.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Cirurgia Bariátrica/métodos , Feminino , Humanos , Inflamação , Obesidade/complicações , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Redução de Peso/fisiologiaRESUMO
BACKGROUND: : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. AIM: : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. METHODS: To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS: : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. CONCLUSION: : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
Assuntos
Neoplasias Gástricas , Brasil , Consenso , Gastrectomia , Humanos , Excisão de Linfonodo , Neoplasias Gástricas/cirurgiaRESUMO
OBJECTIVES: Causes may be found in most cases of acute pancreatitis, however no etiology is found by clinical, biological and imaging investigations in 30% of these cases. Our objective was to evaluate results from endoscopic ultrasonography (EUS) for diagnosis of gallbladder microlithiasis in patients with unexplained (idiopathic) acute pancreatitis. METHODS: Thirty-six consecutive non-alcoholic patients with diagnoses of acute pancreatitis were studied over a five-year period. None of them showed signs of gallstones on transabdominal ultrasound or tomography. We performed EUS within one week of diagnosing acute pancreatitis. Diagnosis of gallbladder microlithiasis on EUS was based upon findings of hyperechoic signals of 0.5-3.0 mm, with or without acoustic shadowing. All patients (36 cases) underwent cholecystectomy, in accordance with indication from the attending physician or based upon EUS diagnosis. RESULTS: Twenty-seven patients (75%) had microlithiasis confirmed by histology and nine did not (25%). EUS findings were positive in twenty-five. Two patients had acute cholecystitis diagnosed at EUS that was confirmed by surgical and histological findings. In two patients, EUS showed cholesterolosis and pathological analysis disclosed stones not detected by EUS. EUS diagnosed microlithiasis in four cases not confirmed by surgical treatment. In our study, sensitivity, specificity and positive and negative predictive values to identify gallbladder microlithiasis (with 95% confidence interval) were 92.6% (74.2-98.7%), 55.6% (22.7-84.7%), 86.2% (67.4-95.5%) and 71.4% (30.3-94.9%), respectively. Overall EUS accuracy was 83.2%. CONCLUSIONS: EUS is a very reliable procedure to diagnose gallbladder microlithiasis and should be used for the management of patients with unexplained acute pancreatitis. This procedure should be part of advanced endoscopic evaluation.
Assuntos
Coledocolitíase/diagnóstico por imagem , Pancreatite/complicações , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Coledocolitíase/complicações , Endossonografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To evaluate the association of allelic and genotypic frequencies of PSCA (rs2976392), TNF-α (rs1800629), PARP1 (rs1136410) and TP53 (rs368771578) SNPs with GC susceptibility in a Brazilian population. MATERIALS AND METHODS: This is a retrospective study, which included 102 paraffin-embedded adenocarcinoma tissue samples > 5 years of obtention, with 204 alleles for each studied SNP. Other 102 healthy tissue samples were included as controls. For analysis, the genotyping method Dideoxy Single Allele-Specific - PCR was used. Statistical analysis was performed with the Bioestat software 5.3, determining Hardy-Weinberg's equilibrium for the genotypic frequencies p-values < 0.05 were considered significant. RESULTS: PSCA (rs2976392) and TNF-α (rs1800629) SNPs were associated with GC in the analyzed samples (X2=10.3/102 and p<0.001/0.00001, respectively). TNF-α (rs1800629) SNP presented also a statistically significant relationship between its genotypes and the morphological pattern (intestinal/diffuse) (p<0.032). However, PARP1 (rs1136410) and TP53 (rs368771578) SNPs were in Hardy-Weinberg's equilibrium and, therefore, were not significantly associated with GC in these samples (X2=0.73/2.89 and p<0.39/0.08). CONCLUSIONS: PSCA (rs2976392) and TNF-α (rs1800629) SNPs are potential molecular markers of susceptibility to GC development. PARP1 (rs1136410) and TP53 (rs368771578) SNPs were not associated with the risk of GC development.
Assuntos
Antígenos de Neoplasias/genética , Predisposição Genética para Doença/genética , Proteínas de Neoplasias/genética , Poli(ADP-Ribose) Polimerase-1/genética , Polimorfismo de Nucleotídeo Único/genética , Neoplasias Gástricas/genética , Fator de Necrose Tumoral alfa/genética , Proteína Supressora de Tumor p53/genética , Adenocarcinoma/genética , Alelos , Biomarcadores Tumorais/genética , Brasil , Estudos de Casos e Controles , Feminino , Proteínas Ligadas por GPI/genética , Frequência do Gene/genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Since the publication of the first Brazilian Consensus on Gastric Cancer (GC) in 2012 carried out by the Brazilian Gastric Cancer Association, new concepts on diagnosis, staging, treatment and follow-up have been incorporated. AIM: This new consensus is to promote an update to professionals working in the fight against GC and to provide guidelines for the management of patients with this condition. METHODS: Fifty-nine experts answered 67 statements regarding the diagnosis, staging, treatment and prognosis of GC 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. This article presents only the responses of the participating experts. Comments on each statement, as well as a literature review, will be presented in future publications. RESULTS: Of the 67 statements, there was consensus in 50 (74%). In 10 declarations, there was 100% agreement. CONCLUSION: The gastric cancer treatment has evolved considerably in recent years. This consensus gathers consolidated principles in the last decades, new knowledge acquired recently, as well as promising perspectives on the management of this disease.
Assuntos
Neoplasias Gástricas , Brasil , Consenso , Humanos , Sociedades MédicasRESUMO
BACKGROUND: The II Brazilian Consensus on Gastric Cancer by the Brazilian Gastric Cancer Association (ABCG) was recently published. On this occasion, several experts in gastric cancer expressed their opinion before the statements presented. AIM: To present the ABCG Guidelines (part 1) regarding the diagnosis, staging, endoscopic treatment and follow-up of gastric cancer patients. METHODS: To forge these Guidelines, the authors carried out an extensive and current review regarding each statement present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases with the following descriptors: gastric cancer, staging, endoscopic treatment and follow-up. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS: Of the 24 statements, two (8.3%) were classified with level of evidence A, 11 (45.8%) with B and 11 (45.8%) with C. As for the degree of recommendation, six (25%) statements obtained grade of recommendation 1, nine (37.5%) recommendation 2a, six (25%) 2b and three (12.5%) grade 3. CONCLUSION: The guidelines presented here are intended to assist professionals working in the fight against gastric cancer with relevant and current information, granting them to be applied in the daily medical practice.
Assuntos
Endoscopia do Sistema Digestório , Estadiamento de Neoplasias , Neoplasias Gástricas , Brasil , Consenso , Seguimentos , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgiaRESUMO
CONTEXT: EUS-FNA is increasingly being used in operable pancreatic carcinoma cases identified by CT. OBJECTIVES: Determine the safety, accuracy and clinical utility of EUS-FNA for T, N and TN staging and vascular injury assessment in proven ductal pancreatic carcinoma. PATIENTS: Fifty-two consecutive patients (29 women and 23 men) with histologically ductal pancreatic carcinoma, with an excellent possibility of mass resection assessed by helical computerized tomography, were studied. Mean age was 62.4 years (range: 27-82 years). Tumor locations were in the head (43 cases), body (5 cases) and tail (4 cases) of the pancreas. Mean tumor size from EUS was 3.7 cm (range: 0.8-6.2 cm). METHODS: We reviewed medical records and abdominal ultrasound, CT, EUS-FNA and the results were compared to surgical and histological findings. RESULTS: Ultrasound identified pancreatic abnormalities in 38 out of 52 patients (73.1%): pancreatic mass (25 cases), pancreatic head enlargement (8 cases), dilation of main pancreatic duct (3 cases), pancreatic cyst (1 case) and pancreatic calcification (1 case). CT showed a pancreatic mass (30 cases), pancreatic enlargement (17 cases), pancreatic cystic lesion (2 cases) and pancreatic calcification (1 case) in 50 out of 52 patients (96.2%). EUS-FNA found a clear pancreatic tumor image in all patients (100%). The accuracy of EUS for evaluating portal blood vessels, superior mesenteric artery, T alone, N alone and combined TN staging was 86.5%, 94.2%, 84.7%, 67.3% and 55.8%, respectively. In addition to cytological material from 50 patients, microfragments from 43 patients were sent for histological analysis. Two patients (3.8%) showed minor complications: self-limited bleeding and acute pancreatitis. CONCLUSIONS: EUS-FNA is safe, and can help gastroenterologists and surgeons make surgical decisions regarding pancreatic carcinoma patients.
Assuntos
Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/cirurgia , Estadiamento de Neoplasias/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Endossonografia , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Pâncreas/irrigação sanguínea , Pâncreas/cirurgia , Valor Preditivo dos Testes , Cuidados Pré-Operatórios , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada EspiralRESUMO
INTRODUCTION: Gastric emptying (GE) and food tolerance (FT) can be altered after Roux-en-Y gastric bypass (RYGB) has been performed, especially when it involved the use of a restrictive mechanism (such as a silastic ring). AIM: To assess GE and FT in patients who underwent banded (BRYGB) or non-banded Roux-en-Y gastric bypass (RYGB). METHODS: Forty-seven BRYGB patients and 47 RYGB patients underwent gastric emptying scintigraphy (GES) and FT assessment (by means of a questionnaire) between 6 months and 2 years postoperatively. RESULTS: GES was performed on average 11.7 ± 5.0 months (6 to 24) postoperatively. T½ medians (time taken for the gastric radioactivity to decrease to half of the original value in the gastric pouch) in the RYGB and BRYGB groups were 48.7 min (40.6-183.0 min) and 56.3 min (41.1-390.9 min), respectively (p = 0.031). The median of total questionnaire scores was 24 points (18-27) in the RYGB group and 20 points (13-27) in the BRYBG group (p < 0.001). CONCLUSIONS: The band (silastic ring) delays GE time and does not affect patient satisfaction or food tolerance to vegetables, bread, or rice, but does affect tolerance to the intake of meat, salad, and pasta. The best tolerated foods are vegetables, salad, and fish. Banded patients are more likely to regurgitate and vomit. Gastric emptying does not affect FT.
Assuntos
Intolerância Alimentar/etiologia , Derivação Gástrica/efeitos adversos , Esvaziamento Gástrico , Obesidade/cirurgia , Adulto , Feminino , Derivação Gástrica/métodos , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Satisfação do Paciente , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Estômago/fisiopatologia , Estômago/cirurgia , Redução de PesoRESUMO
BACKGROUND: Bariatric surgery for morbid obesity achieves an accentuated weight loss, with skin and soft tissue redundancy in some corporal segments, including the thighs. The thigh lift is a plastic surgery that improves this redundant tissue in the medial thigh area, but this surgical procedure may have complications, such as inferior migration of the scar, delayed wound healing, vulvar distortion, and lymphatic system alterations. METHODS: To evaluate the effect of the thighplasty on the lymphatic system, 14 patients were prospectively included in this study. Lymphoscintigraphy was performed before thighplasty, and this result was compared to the new examination performed 6 months after thighplasty. The exclusion standards include patients with clinical alterations and abnormal lymphoscintigraphy in previous surgery. RESULTS: The statistical analysis was performed on 26 inferior members, according to exclusion standards. All the members had normal lymphoscintigraphy in the preoperative period. After thighplasty, eight members (30.8%) demonstrated abnormal lymphoscintigraphy (p = 0.008) resulting in significant functional and anatomic alterations in the lymphatic system. CONCLUSION: The thigh lift changes lymphatic drainage in lower extremities according to lymphoscintigraphy analyses.
Assuntos
Lipectomia/efeitos adversos , Sistema Linfático/fisiopatologia , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Coxa da Perna , Adulto , Cirurgia Bariátrica , Feminino , Seguimentos , Humanos , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico por imagem , Estudos Prospectivos , Resultado do Tratamento , Redução de PesoRESUMO
BACKGROUND: Gastric adenocarcinoma is the major cause of death by cancer in Brazil. For the planning of the treatment and evaluation of the prognosis, the preoperative staging according to the TNM classification is very important. AIM: To evaluate the results of endoscopic ultrasound for the T and N categories. METHODS: We examined 30 patients with gastric adenocarcinoma in the period of 1 year. We used a Olympus GIF UM-20. After positioning in the third portion of the duodenum, we started to evaluate the lymph node stations 16, 13, 12, 6, 5, 4, 3, 8, 7, 9, 10, 11, 1 and 2, using the frequency of 7.5 MHz. The depth of the tumor in the gastric wall was evaluated with the frequencies of 7.5 and 12 MHz. The results T and N were compared with the conclusive findings. In the unresectable cases, the correlation was made by the macroscopic findings. RESULTS: We performed 16 total gastrectomies, 7 subtotal gastrectomies, 5 exploratory laparotomies and 2 laparoscopies. For T category, endoscopic ultrasound results were correct in 25/30 cases (83.3%). All the other 16.7% were overestimated. The accuracy varied from 90% to 96.7% according to the subcategories T1 to T4. For the N category, endoscopic ultrasound results were correct in 23/30 cases (76.7%). Sixteen point six percent were underestimated and 6.7% overestimated. The accuracy varied from 76.7% to 90%, in agreement with the subcategories N1 to N3. CONCLUSION: There was a clear correlation between endoscopic ultrasound and the surgical and pathological findings in the evaluation of T and N categories in patients with gastric adenocarcinoma.
Assuntos
Adenocarcinoma , Endossonografia , Neoplasias Gástricas , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
PURPOSE:: To identify and evaluate changes in the ocular surface in obese patients with bariatric surgery. METHODS:: The study included 89 randomly selected patients; 81 (91.0%) were women, 35 were preoperative, 32 were included 0-12 months after surgery, and 22 were included >12 months after surgery. All patients completed a dry eye-specific questionnaire and were evaluated by the tear ferning test, tear-film breakup time (BUT), Schirmer's test I, examination of the ocular surface by 1% rose Bengal staining, and impression cytology. Patients were questioned about compliance with nutritional supplementation. RESULTS:: The pre- and postoperative groups did not differ significantly in age (p=0.082), but did differ in body mass index (p<0.001). All test values are within the normal range and there was no statistically significant difference in ocular surface disease index score between the preoperative and postoperative periods. The mean tear-film BUT was lower than that considered normal (10 s) at each time it was tested. No statistically significant group differences were observed in Schirmer's test, BUT, rose Bengal staining, or impression cytology. A high rate of noncompliance with nutritional supplementation was observed. CONCLUSIONS:: No symptoms of xerophthalmia developed in this series of bariatric surgery patients. No changes were observed in any of the specific tests used to evaluate the ocular surface up to 5 years after surgery compared with presurgery results.
Assuntos
Cirurgia Bariátrica/efeitos adversos , Síndromes do Olho Seco/diagnóstico , Adulto , Estudos Transversais , Síndromes do Olho Seco/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Resultado do Tratamento , Xeroftalmia/diagnóstico , Xeroftalmia/etiologiaRESUMO
Perforated gastric carcinoma is a rare condition that is hard to diagnose preoperatively. It is associated with advanced cancer stages and has a high mortality, particularly in cases presenting preoperative shock. Few studies have investigated the presentation and adequate management of these carcinomas. In addition, there are no reports in the literature on perforations extending to the spleen, as described in this case, making the management of these lesions challenging. Our article reports a case of gastric tumor perforation extending to the spleen, which presented as a perforated acute abdomen. The patient was treated with total gastrectomy and D2 lymph node resection with splenectomy and progressed well with current survival of one year at disease stage IV.
Assuntos
Abdome Agudo/diagnóstico , Adenocarcinoma/diagnóstico , Perfuração Espontânea/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Diagnóstico Diferencial , Intervalo Livre de Doença , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Perfuração Espontânea/etiologia , Perfuração Espontânea/cirurgia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgiaRESUMO
ABSTRACT BACKGROUND: Regarding postoperative pain, it remains unclear whether non-fixation of the polypropylene prosthesis in transabdominal preperitoneal inguinal hernia repair produces the same outcomes as mesh fixation with glue or tackers. In addition, hernia recurrence is another aspect to be assessed in the comparison between non-fixation and mesh-fixation techniques (tackers and glue). AIMS: This study aimed to evaluate the incidence, quality of pain, and recurrence in patients undergoing laparoscopic inguinal hernioplasty (transabdominal preperitoneal) technique, comparing the fixation of the mesh with tackers versus with glue versus without fixation. METHODS: This is a prospective, double-blind study in which 63 patients presenting with primary unilateral inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal hernia repair and were randomized into three groups: no mesh fixation (n=21), mesh tacked (n=21), and mesh fixed with fibrin glue (n=21). Patients also responded to questionnaires in order to assess pain and pain quality and were followed up for 2 years. RESULTS: Neither mesh-fixation nor non-fixation techniques were found to affect postoperative chronic pain (p=0.535), but patients undergoing tacker fixation reported more pain descriptors (p=0.0021) and a higher pain index (p=0.002) on the McGill scale in the first 15 postoperative days (T0 and T1). No hernia recurrences were observed. CONCLUSIONS: Both mesh-fixation techniques (tackers and glue) used with the transabdominal preperitoneal approach did not influence the onset of inguinodynia, but tacker fixation was more likely to increase patient sensitivity to pain. Mesh placement without fixation produced the same pain and recurrence outcomes as mesh-fixation techniques. Also, no recurrence was observed in patients without mesh fixation in this study. Consequently, it has become an alternative therapy deserving consideration for hernia repair.
RESUMO RACIONAL: Em relação à inguinodinia, há que se perguntar se a não fixação da tela pela técnica da hernioplastia inguinal videolaparoscópica transbadominal pré-peritoneal teria os mesmos resultados em relação à fixação de telas com cola ou grampos. Além disso, a recorrência de hérnia é outro aspecto a ser avaliado na comparação entre as técnicas de não fixação e de fixação com tela (grampos e cola). OBJETIVOS: Avaliar a incidência, qualidade da dor e recorrência em pacientes submetidos à técnica de hernioplastia inguinal laparoscópica (transbadominal pré-peritoneal), comparando a fixação da tela com grampos vs. com cola vs. sem fixação. MÉTODOS: Este é um trabalho prospectivo, duplo-cego, em que 63 doentes portadores de hérnia inguinal submetidos à hernioplastia inguinal videolaparoscópica pela técnica transbadominal pré-peritoneal foram randomizados em três grupos: no primeiro a tela não foi fixada; no segundo foi fixada por grampos; e no terceiro foi fixada com cola. Estes pacientes foram submetidos a questionários para avaliação de dor, sendo acompanhados por dois anos. RESULTADOS: O método de fixação da tela, assim como a não fixação dela não interferiu no aparecimento da dor crônica pela Escala Visual Analógica; porém, os que foram submetidos à fixação por grampos tiveram mais descritores e índice de dor pela escala de McGill. Não foram observadas recidivas herniárias. CONCLUSÕES: O método de fixação da tela na técnica transbadominal pré-peritoneal não influencia no aparecimento da inguinodinia. A não fixação teve os mesmos resultados em termos de dor e recidiva, tornando-se alternativa terapêutica a ser considerada, pois não acarretou recidivas.