RESUMO
Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure in patients with obesity and gastroesophageal reflux (GERD), but in patients with preoperative hiatal hernia (HH) or GERD, who are unfit for RYGB, there are no clear guidelines. Ligamentum teres cardiopexy (LTC) has been proposed as an effective alternative. The purpose of this study was to analyze medium-term results of LTC procedure associated with laparoscopic sleeve gastrectomy (LSG) in patients with GERD or HH, according to the absence of pathologic acid reflux in esophageal 24 h pH monitoring test, symptom release, or PPI reduction. Five patients underwent LSG-LTC between March 2018 and October 2019. In one patient, the effectiveness of LTC as an anti-reflux procedure could not be assessed because of conversion to RYGB was required. After a follow-up period of 30 [24-42] months and excessive BMI loss of 62.74 ± 18.18%, GERD recurrence was observed in 75% of patients. The study was discontinued due to unsatisfactory preliminary results with LTC. Our results suggest that LTC might not prevent GERD after LSG in patients with preoperative GERD or HH.
Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Obesidade Mórbida , Ligamentos Redondos , Humanos , Obesidade Mórbida/cirurgia , Refluxo Gastroesofágico/prevenção & controle , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/complicações , Hérnia Hiatal/complicações , Derivação Gástrica/métodos , Gastrectomia/métodos , Ligamentos Redondos/cirurgia , Laparoscopia/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Obstrução Intestinal/etiologia , Hérnia Diafragmática/complicações , Hérnia Diafragmática/cirurgia , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/patologia , Tomografia Computadorizada por Raios X , Colo Transverso/diagnóstico por imagemAssuntos
Hérnias Diafragmáticas Congênitas/complicações , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Idoso de 80 Anos ou mais , Colo/diagnóstico por imagem , Colo/cirurgia , Feminino , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Obstrução Intestinal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.
