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2.
BMJ Case Rep ; 13(9)2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933905

RESUMO

A 25-year-old woman brought to the hospital with symptoms of acute confusion, disorientation, diplopia, hearing loss and unsteady gait which started 4 days prior to her presentation with rapid worsening in its course until the day of admission. She had a surgical history of laparoscopic sleeve gastrectomy 2 months earlier which was complicated by persistent vomiting around one to three times per day. She lost 30 kg of her weight over 2 months and was not compliant to vitamin supplementation. CT of the brain was unremarkable. Brain MRI was done which showed high signal intensity lesions involving the bilateral thalamic regions symmetrically with restricted diffusion on fluid-attenuated inversion recovery imaging. Other radiological investigations, such as magnetic resonance venography and magnetic resonance angiography of the brain were unremarkable. An official audiogram confirmed the sensorineural hearing loss. A diagnosis of Wernicke's encephalopathy due to thiamin deficiency post-sleeve gastrectomy was made based on the constellation of her medical background, clinical presentation and further supported by the distinct MRI findings. Consequently, serum thiamin level was requested and intravenous thiamin 500 mg three times per day for six doses was started empirically, then thiamin 250 mg intravenously once daily given for 5 more days. Marked improvement in cognition, eye movements, strength and ambulation were noticed soon after therapy. She was maintained on a high caloric diet with calcium, magnesium oxide, vitamin D supplements and oral thiamin with successful recovery of the majority of her neurological function with normal cognition, strength, reflexes, ocular movements, but had minimal resolution of her hearing deficit. Serum thiamin level later was 36 nmol/L (67-200).


Assuntos
Gastrectomia/efeitos adversos , Perda Auditiva/etiologia , Complicações Pós-Operatórias/etiologia , Encefalopatia de Wernicke/complicações , Adulto , Feminino , Gastrectomia/métodos , Humanos , Encefalopatia de Wernicke/diagnóstico
3.
Arq Bras Cir Dig ; 33(2): e1513, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32844876

RESUMO

BACKGROUND: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. AIM: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. METHODS: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. RESULTS: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. CONCLUSION: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.


Assuntos
Gastrectomia/métodos , Refluxo Gastroesofágico/etiologia , Laparoscopia/efeitos adversos , Obesidade/cirurgia , Animais , Gastrectomia/efeitos adversos , Humanos , Obesidade Mórbida , Distribuição Aleatória , Ratos , Ratos Wistar
4.
Am Surg ; 86(8): 971-975, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32833495

RESUMO

INTRODUCTION: Routine drain placement is still widely used in both sleeve gastrectomy (SG) and Roux en Y gastric bypass (REYGB). There is mounting evidence that drains may increase complication risk without preventing reoperation or other complications. METHODS: Data from 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use File was evaluated for drain use during laparoscopic REYGB and SG. Primary outcomes were superficial and deep surgical site infections (SSI), reintervention/reoperation, and readmission. Preoperative patient risk factors were also compared to evaluate for association with drain placement. RESULTS: A total of 148 260 patients fit the inclusion criteria. Drains were used in 23 190 (15.6%) cases and not used in 125 070 (84.4%). Drain placement during surgery was associated with increased odds of superficial SSI, deep incisional SSI, and organ space SSI. Patients with drains were found to have increased odds of requiring at least 1 reoperation or intervention within 30 days of surgery. Preoperative risk factors associated with drain placement included diabetes mellitus, a history of chronic obstructive pulmonary disease, and oxygen dependence. Smokers were slightly less likely to have a drain placed. There was no significant association with chronic steroid and immunosuppressant usage. CONCLUSION: There is mounting data against drain placement during bariatric surgery. Prior studies using MBSAQIP data have shown an increased complication rate with drains, and our data set supports the idea that drains may increase complications after surgery. While no randomized prospective trials have been performed looking at drain usage in bariatric surgery, the growing retrospective data certainly inform against the regular use of drains.


Assuntos
Drenagem/efeitos adversos , Gastrectomia/métodos , Derivação Gástrica/métodos , Laparoscopia , Obesidade Mórbida/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Humanos , Melhoria de Qualidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 648-652, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683824

RESUMO

Different from classical surgical anatomy which only pays attention to the morphology and structure of human organs, modern membrane anatomy focuses on not only the relationship between morphology and structure, but also the biological behavior characteristics of tumors. Membrane antomy is a theoretical system with interpretation on both the structural and disease function, so it has been accepted by more and more gastrointestinal surgeons. However, the theoretical system of gastric membrane anatomy is not mature yet. The stomach and its mesentery have undergone complex rotation and fusion in the process of embryonic development, so that surgeons have different understandings of the gastric membrane anatomy. Therefore, it is easy to cause various confusion and misunderstanding, resulting in deviations between the theory of membrane anatomy and the practice of surgery. In the present study, the mesentery of the stomach is divided into different regions, and the embryonic development process is traced back. The application and compromise encountered in the radical gastrectomy of gastric cancer will be expounded according to the membrane anatomy theory combined with the author's experience of operation.


Assuntos
Gastrectomia/métodos , Mesentério/anatomia & histologia , Mesentério/cirurgia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Mesentério/embriologia , Mesentério/patologia , Estômago/anatomia & histologia , Estômago/embriologia , Estômago/patologia , Neoplasias Gástricas/patologia
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 653-656, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683825

RESUMO

D2 lymphadenectomy combined with complete mesentery excision (CME) for advanced gastric cancer in recent years was a hotspot issue in China, while its safety and effectiveness have been proved. According to the Membrane anatomy of the stomach, both surgical approach and mesogastrium interval is particularly important in Laparoscopic radical gastrectomy. We summarized and shared the following clinical experience for medical colleagues. (1) Lymph nodes of right abdominal aorta-No.7,8,9,12-should be resection as an indivisible whole. This integrity tissue above the portal vein was supposed to the end of the dorsal mesentery of stomach and the continuation of Gerota fascia. (2) No.10 (splenic hilar lymph nodes) lymphadenectomy: The surgical approach enters the Gerota fascia between the left gastric artery(LGA) and the left alongside the splenic artery. When the extent of lymphadenectomy performed to cardia and upper margin of the spleen, then the ultrasonic scalpel should excise the lymph node along the splenic artery to the splenic hilum. (3) Esophagogastric junctional cancer: There is no consensus over the type of resection and the extent of lymphadenectomy that could be a standard of care for this category.While we recommended that paraesophageal lymph node dissection and digestive tract reconstruction should be completed in 3D laparoscopy vision. (4) Infracardiac bursa(ICB): Intentional entry into the ICB provides surgeons with a landmark to identify the location of the pleura, and inferior vena cava. (5)The application of endoscopic aspirator with flushing and electrocautery. The CME concept of gastric cancer emphasizes the membrane anatomy theory rather than the regional lymph node. The precision and homogeneity of the D2 procedure therapy of gastric cancer depend on complete mesentery excision, standard the surgical process, or approach. Only in this way can we find the avascular gaps easily and perfectly cover the extent of lymph node dissection required for the D2 procedure.


Assuntos
Gastrectomia/normas , Excisão de Linfonodo/normas , Mesentério/cirurgia , Neoplasias Gástricas/cirurgia , China , Competência Clínica , Fáscia , Gastrectomia/métodos , Artéria Gástrica/cirurgia , Humanos , Laparoscopia , Excisão de Linfonodo/métodos , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Mesentério/patologia , Veia Porta/cirurgia , Artéria Esplênica/cirurgia , Neoplasias Gástricas/patologia
7.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 657-660, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683826

RESUMO

The standard treatment for advanced gastric cancer remains surgery-based comprehensive treatment. The D2 radical surgery has made outstanding contributions to the standarlization of gastric cancer surgery, which has improved patients' prognosis and quality of life. In recent years, neoadjuvant chemotherapy has achieved a certain effect on the treatment of advanced gastric cancer. With the continuous development of the concept of membrane anatomy in gastric cancer surgery, new surgical challenges have also been raised. For patients after neoadjuvant therapy, there is heated controversy in the possibility of completing radical gastrectomy with membrane anatomical concept for gastric cancer. We believe that if neoadjuvant therapy pushes mesenteric cancer cell back into the mesentery, theoretically membrane anatomy combined with neoadjuvant therapy is beneficial to the treatment efficacy of advanced gastric cancer. However, membrane anatomy has two important problems when combined with neoadjuvant therapy: (1) After neoadjuvant chemotherapy, there are varying degrees of edema around the stomach tissue, which will affect the visualization of anatomic planes. In addition, because the patients' coagulation function is damaged to a certain extent, it is difficult to avoid bleeding or minimize bleeding during the operation. Therefore, it is still controversial whether the patients with gastric cancer after neoadjuvant chemotherapy can undergo radical gastrectomy with membrane anatomy. (2) For patients with complete pathological remission, whether to obtain the maximum rate of pathological remission through intensive neoadjuvant therapy, or to obtain the survival benefit of patients with membrane anatomy surgery in clinic is still controversial. Faced with these confusions, multi-center clinical researches on the application of membrane anatomy surgery after neoadjuvant therapy is the only solution.


Assuntos
Gastrectomia/métodos , Mesentério/cirurgia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Edema/etiologia , Gastrectomia/efeitos adversos , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Mesentério/patologia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Prognóstico , Qualidade de Vida , Neoplasias Gástricas/patologia
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 661-665, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683827

RESUMO

Membrane anatomy refers to the fascia and/or serosa enveloping the organs and their blood vessels and hanging on the posterior wall of the body cavity, which emphasizes the entirety and integrity of the membrane during operation. The concept can also be applied to most surgical operations. This article mainly expounds the application of the concept of membrane anatomy in the process of laparoscopic sleeve gastrectomy, which is embodied in the key steps of separating the greater omentum, mobilizing the fundus, mobilizing the posterior wall of the stomach, cutting the greater curvature of the stomach, reinforcing the staple line of the stomach, and suturing the greater omentum with staple line, in order to make the laparoscopic sleeve gastrectomy more accurate and precise with less bleeding, fewer complications and faster postoperative recovery.


Assuntos
Gastrectomia/métodos , Estômago/cirurgia , Fáscia/anatomia & histologia , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Omento/cirurgia , Peritônio/anatomia & histologia , Peritônio/cirurgia , Grampeamento Cirúrgico/métodos , Suturas
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 683-688, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683830

RESUMO

Objective: To explore the effects of the application of membrane anatomy concept in sleeve gastrectomy on postoperative nausea and vomiting (PONV) in patients with obesity or metabolic diseases. Methods: A retrospective cohort study was conducted. Clinical data of 88 patients with obesity or metabolic diseases who underwent laparoscopic sleeve gastrectomy in The First Affiliated Hospital of Jinan University from September 2018 to June 2019 were retrospectively analyzed. Forty patients underwent sleeve gastrectomy with membrane anatomy concept as membrane anatomy group, and the other 48 patients underwent traditional sleeve gastrectomy as traditional operation group. There were no significant differences in baseline data between the two groups (all P>0.05). The PONV score of and the times of antiemetic drugs used during 0-6 h and 6-24 h after operation were compared between the two groups. Higher PONV represents more serious nause and vomiting, the score ≥5 is defined as clinical significant PONV. Results: All patients of the two groups successfully completed the operation, and there was no conversion to open, reoperation, and operation-related death. The intraoperative blood loss in the membrane anatomy group was significantly less than that in the traditional surgery group [median: 5.0 (5.0, 5.8) ml vs. 10.0 (5.0, 10.0) ml, Z=-3.265, P=0.001]. There were no significant differences between the two groups in terms of operative time, postoperative hospital stay, gastroesophageal reflux, pain score and postoperative complications (all P>0.05). There was no postoperative bleeding or gastric leakage in either groups. There were no significant differences in PONV score, incidence of clinically significant PONV and use of antiemetics 0-6 h after operation between two groups (all P>0.05). From 6 to 24 hours after operation, compared with traditional surgery group, the membrane anatomy group had lower PONV score (4.6±0.9 vs. 5.1±0.7, t=-2.192, P=0.007), lower incidence of clinically significant PONV [55.0% (22/40) vs. 83.3% (40/48), χ(2)=8.414, P=0.004] and less use of antiemetics [3 times: 10.0% (4/40) vs. 27.1% (13/48), Z=-2.880, P=0.004]. Postoperative follow-up ranged from 1 to 6 months (median 3), 32 cases in membranous anatomy group and 38 cases in the traditional operation group were followed up. One case in the traditional operation group received symptomatic treatment in the local hospital due to functional intestinal obstruction 1 month after surgery and was discharged after recovery. The remaining patients had no postoperative complications and were not readmitted to hospital. Conclusion: Sleeve gastrectomy based on membrane anatomy in the treatment of patients with obesity or metabolic syndrome can make surgical procedure more precise and meticulous, reduce the intraoperative bleeding and the incidence of PONV.


Assuntos
Gastrectomia/efeitos adversos , Gastrectomia/métodos , Doenças Metabólicas/cirurgia , Obesidade/cirurgia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Mesentério/cirurgia , Peritônio/anatomia & histologia , Peritônio/cirurgia , Náusea e Vômito Pós-Operatórios/etiologia , Estudos Retrospectivos
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 717-719, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683835

RESUMO

Uncut Roux-en-Y anastomosis is widely used in gastrointestinal reconstruction procedure after radical gastrectomy for distal gastric cancer. However, the proximal jejunal closure point recanalization of the input loop is an important complication of postoperative patients with prolonged time, resulting in pancreatic juice or bile reflux, which can lead to inflammatory lesions of the remnant stomach or esophagus. Poor selection of the location of the closure point during anastomosis causes a large amount of food deposited in the blind loop to be pushed and impacted, resulting in loosened threads or failed U-shaped staples, which may cause recanalization complications. Most scholars believe that the shortening of the jejunal tube closure point to the optimal position of 2 to 3 cm from the residual gastrojejunostomy can significantly reduce food retention, decrease the pressure of the closure point and the incidence of recanalization. At present, the application of new anastomotic techniques and materials such as four-row and six-row U-shaped staples and 7# wire ligation under laparoscopy can prevent the occurrence of recanalization of the closure point. Uncut Roux-en-Y anastomosis is safe and has few complications, and is expected to become one of the best ways of digestive tract reconstruction.


Assuntos
Anastomose em-Y de Roux/métodos , Gastrectomia/métodos , Derivação Gástrica/métodos , Jejuno/cirurgia , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Anastomose em-Y de Roux/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Resultado do Tratamento
11.
Ann Surg ; 272(2): 319-325, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675545

RESUMO

OBJECTIVE: To stratify the postsurgical computed tomography (CT) surveillance based on a risk-scoring system for predicting extragastric recurrence after surgical resection of early gastric cancer (EGC). SUMMARY OF BACKGROUND DATA: Postsurgical CT surveillance should not be routinely performed in all patients because of the low incidence of extragastric recurrence and potential risk of radiation exposure. METHODS: Data from 3162 patients who underwent surgical resection for EGC were reviewed to develop a risk-scoring system to predict extragastric recurrence. Risk scores were based on the predictive factors for extragastric recurrence, which were determined using Cox proportional hazard regression model. The risk-scoring system was validated by Uno censoring adjusted C-index. External validation was performed using an independent dataset (n = 430). RESULTS: The overall incidence of extragastric recurrence was 1.4% (44/3162). Five risk factors (lymph node metastasis, indications for endoscopic resection, male sex, positive lymphovascular invasion, and elevated macroscopic type), which were significantly associated with extragastric recurrence, were incorporated into the risk-scoring system, and the patients were categorized into 2 risk groups. The 10-year extragastric recurrence-free survival differed significantly between low- and high-risk groups (99.7% vs 96.5%; P < 0.001). The predictive accuracy of the risk-scoring system in the development cohort was 0.870 [Uno C-index; 95% confidence interval (95% CI), 0.800-0.939]. Discrimination was good after internal (0.859) and external validation (0.782, 0.549-1.000). CONCLUSION: This risk-scoring system might be useful to predict extragastric recurrence of EGC after curative surgical resection. We suggest that postsurgical CT surveillance to detect extragastric recurrence should be avoided in the low-risk group.


Assuntos
Gastrectomia/métodos , Metástase Linfática/patologia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Intervalo Livre de Doença , Detecção Precoce de Câncer , Feminino , Gastrectomia/efeitos adversos , Mucosa Gástrica/patologia , Gastroscopia/métodos , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , República da Coreia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Análise de Sobrevida
12.
Ann Surg ; 272(2): 326-333, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675546

RESUMO

OBJECTIVE: The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands. BACKGROUND: Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients. METHODS: Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied. RESULTS: A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG. CONCLUSION: This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.


Assuntos
Gastrectomia/métodos , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Sistema de Registros , Reoperação/estatística & dados numéricos , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Países Baixos , Noruega , Obesidade Mórbida/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco , Suécia , Fatores de Tempo , Resultado do Tratamento
13.
Nutr. hosp ; 37(3): 474-482, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193854

RESUMO

INTRODUCCIÓN: la obesidad se ha convertido en un problema de salud a nivel mundial de primera magnitud por su relación con la morbimortalidad cardiovascula. Así, la cirugía bariátrica se plantea como una de las soluciones principales para la corrección del exceso de peso y, consecuentemente, la mejoría de las cardiopatías asociadas. OBJETIVO: comparar la gastrectomía vertical (GV) con la derivación biliopancreática de tipo Scopinaro (DBP) para observar la repercusión, desde el punto de vista ecocardiográfico, de los cambios que se producen en la estructura cardiaca tras la cirugía. Además, evaluar el resultado quirúrgico en función de la escala BAROS. MATERIAL Y MÉTODOS: se recogieron los resultados de la ecocardiografía incluida en el estudio preoperatorio de los pacientes candidatos a cirugía bariátrica de nuestro hospital, intervenidos en un periodo de 2 años (de enero 2014 a diciembre 2015), junto a los datos antropométricos y de comorbilidad. Estos se compararon con los resultados postoperatorios medidos a los 3 años de la cirugía. RESULTADOS: finalmente se seleccionaron 26 pacientes (13 GV y 13 DBP), con una edad media de 42 años. GV: IMC inicial de 44,6 ± 17,1; IMC final de 31,8 ± 111,3 (p < 0,01). DBP: IMC inicial de 48,1 ± 14,2; IMC final de 32,7 ± 110,4 (p < 0,01). Ecocardiografía: función sistólica normal: 100% vs. 92%; función diastólica normal: 88,5% vs. 69,2%; sin valvulopatía: 80% vs. 69%; aurícula izquierda normal: 76,9% vs. 73,1% (p > 0,05); HTA: 38% vs. 19% (p < 0,05), en el preoperatorio y postoperatorio, respectivamente. CONCLUSIONES: no se encontraron diferencias significativas entre los dos grupos estudiados con técnicas diferentes, si bien pudo encontrarse un ligero deterioro de la función diastólica en ambos grupos. Las comorbilidades asociadas a la obesidad mejoraron en ambos grupos y el grado de evaluación de la cirugía fue positivo. La escasa variación de la ecocardiografía hace replantearse su uso sistemático en el preoperatorio de estos pacientes por el bajo índice coste-beneficio


INTRODUCTION: obesity has become a worldwide health problem due to its relationship with cardiovascular morbimortality, thus bariatric surgery is considered as one of the main solutions for the correction of excess weight and, consequently, the improvement of its associated heart diseases. OBJECTIVE: to compare vertical gastrectomy (VG) and biliopancreatic diversion (BPD) by observing echocardiographic characteristics both before and after surgery, as well as to evaluate surgical outcome in terms of the BAROS scale. METHODS: results were collected from the echocardiographic testing requested for the preoperative study of patients who underwent surgery over the course of 24 months (from January 2014 to December 2015), as well as their anthropometric data. These were compared with postoperative parameters measured at 3 years after surgery. RESULTS: finally, 26 patients were selected (13 VG and 13 BPD) with a mean age of 42 yrs. VG: initial BMI: 44.6 ± 17.1; final BMI: 31.8 ± 111.3 (p < 0.01); BPD: initial BMI: 48.1 ± 114.2; final BMI: 32.7 ± 110.4 (p < 0.01). Echocardiography: normal systolic function: 100% vs 92%; normal diastolic function: 88.5% vs 69.2%; no valvulopathy: 80% vs 69%; normal left atrium: 76.9% vs 73.1% (p > 0.05); HTA: 38.5% vs 19.2% (p < 0.05), preoperatively and postoperatively, respectively. CONCLUSIONS: no significant differences were found between the two groups studied with different techniques, although a slight deterioration in diastolic function was found in both groups. The comorbidities associated with obesity improved in both groups, and the surgery was scored as positive. The scant variation revealed by echocardiography prompts to reconsider its systematic preoperative use in these patients given the low cost-benefit ratio


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Desvio Biliopancreático/métodos , Gastrectomia/métodos , Ecocardiografia/métodos , Cirurgia Bariátrica/métodos , Período Pré-Operatório , Perda de Peso/fisiologia , Inquéritos e Questionários , Antropometria
14.
Rev. cir. (Impr.) ; 72(3): 257-261, jun. 2020. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1115552

RESUMO

Resumen El cáncer gástrico es una patología de alta incidencia en Chile. Afortunadamente es baja la incidencia de márgenes R1 cuando se realiza una cirugía con intención curativa. Al tener un tumor subcardial o cardial es perentorio realizar una biopsia rápida (intraoperatoria), en caso que ésta resulte positiva, es difícil tomar una decisión sobre qué realizar a continuación, ya que el realizar una esofagoyeyunoanastomosis intratorácica aumenta el riesgo quirúrgico. Para esto, es de suma importancia tener la información de las características histopatológicas del tumor, el riesgo de filtración, la recurrencia, la sobrevida, las terapias adyuvantes y la realidad país. Se realizó una revisión de la literatura con el fin de poder guiar la toma de decisiones.


Gastric cancer is a pathology with a high incidence in Chile, fortunately, the incidence of R1 margins is low when performing surgery with curative intent. When having a sub cardial or cardial tumor, it is essential to perform a rapid (intraoperative) biopsy, if this is positive when cutting the esophagus just under the pillars, it is difficult to make the decision of what to do next, since performing an inthrathoracic esophagojejunostomy increases the surgical risk. For this, it is very important to have information about the histopathological characteristics of the tumor, the leakage risk, there currence, the survival, the adjuvant therapies and the reality of the country. A review of the literature was done in order to guide the decisions.


Assuntos
Humanos , Neoplasias Gástricas/cirurgia , Biópsia/métodos , Margens de Excisão , Recidiva , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Gastrectomia/métodos , Período Intraoperatório
15.
Zhonghua Zhong Liu Za Zhi ; 42(6): 445-448, 2020 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-32575938

RESUMO

Objective: To explore the clinical value of totally laparoscopic stomach-partitioning gastrojejunostomy (TLSPGJ) for malignant gastric outlet obstruction. Methods: The clinical data of 9 gastric cancer patients who underwent TLSPGJ in Department of Pancreatic and Gastric Surgery, Cancer Hospital between September 2018 and September 2019 were retrospectively analyzed. Results: The mean operative blood loss of 9 cases were (13.3±5.0) ml, and the average operative time was (103.3±10.6) min. All patients received clear flow food on the first day after surgery. Postoperative first exhaust time was (3.1±0.8) days and the average postoperative hospital stay was (5.4±1.1) days. All of the 9 patients could tolerate semi-liquid food at discharge, and no postoperative complications such as bleeding or delayed gastric emptying occurred. Conclusion: TLSPGJ is an effective treatment for gastric output tract obstruction caused by malignant tumor.


Assuntos
Gastrectomia/métodos , Derivação Gástrica/métodos , Obstrução da Saída Gástrica/patologia , Obstrução da Saída Gástrica/cirurgia , Jejuno/cirurgia , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Obstrução da Saída Gástrica/etiologia , Humanos , Duração da Cirurgia , Cuidados Paliativos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(21): e20460, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481349

RESUMO

To investigate the different expression of epidermal growth factor receptor 1 (EGFR) and human epidermal growth factor receptor 2 (HER2) in gastric cancer based on tumor locations and its impact on patients survival.Gastric cancer is heterogeneous disease, recent years have established a molecular classification and described distribution of molecular subtypes in stomach. However, the difference of EGFR and HER-2 expression among tumor location is still unknown.Between January 2010 and August 2014, 2477 consecutive patients with gastric cancer were treated in our surgery department. The tumor locations were classified into 4 groups: cardia, fundus, corpus, and antrum. Based on tumor locations, the clinicopathologic characteristics, EGFR and HER-2 expression, and follow-up data were analyzed by univariant analysis and Kaplan-Meier analysis retrospectively.There were difference of gender, age, Borrmann type, pathological type, differentiation, T-stage, tumor size, gastrectomy method, and complications among the locations. The positive rate of EGFR expression in fundus was 18.18%, which was lower than cardia (46.21%), corpus (43.62%), and antrum (48.83%) (P < .001). The 5-year survival rate in EGFR positive patients was 50.8%, which was significantly lower than EGFR negative patients (64.0%, P = .021). The positive rate of HER-2 expression in cardia was 48.15%, which was significantly higher than fundus (37.5%), corpus (35.45%), and antrum (38.54%) (P = .009), but HER-2 expression did not correlate with 5-year survive (P = .548).Our results suggest that there exist difference of EGFR and HER-2 expression based on tumor locations, and the distribution of EGFR impact on patients survival. Emphasizing the role of EGFR and HER-2 in the context of location contribute to make appropriate treatment strategy and improve prognosis of gastric cancer.


Assuntos
Receptores ErbB/análise , Gastrectomia/estatística & dados numéricos , Fragmentos de Peptídeos/análise , Neoplasias Gástricas/mortalidade , Adulto , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/sangue , China/epidemiologia , Receptores ErbB/sangue , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Estudos Retrospectivos , Neoplasias Gástricas/sangue , Neoplasias Gástricas/epidemiologia , Análise de Sobrevida
17.
Medicine (Baltimore) ; 99(21): e20325, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481317

RESUMO

Gastric cancer (GC) continues to be 1 of the malignant tumors with high morbidity and mortality worldwide. Although the improvements in targeted inhibitor therapy have promoted survival, the first choice for GC patients is still surgery. However, prolonged surgery may tire surgeons and affect surgical outcomes.To detect whether different time-of-day radical gastrectomy influenced short-term and long-term surgical outcomes.This study included 117 patients between 2008 and 2012 who underwent a radical gastrectomy. These patients were grouped into the morning (before 13:00) and afternoon (after 13:00) groups or divided into 2 groups according to the median operation start time (before or after 11:23). Then, the relevant influence of the surgical start time was analyzed.The morning group (before 13:00) and the front median group (before 11:23) showed longer operative time (P = .008 and P = .016, respectively), lower estimated blood loss (P < .001 and P = .158, respectively), and longer time before resuming oral intake (P < .001 and P < .173, respectively) than the afternoon group (after 13:00) or latter median group (after 11:23). Starting the operation in the morning had no effect on the rate of postoperative complications. The operation start time had no significant influence on the overall survival of patients who underwent a radical gastrectomy. However, in subgroup analysis, patients who underwent a distal gastrectomy faced poor prognosis when their surgery started after 13:00 (P = .030).The results suggest that the operation start time might be an indicator of total operative time, estimated blood loss, and the time to resuming oral intake. The operation start time may also influence the prognosis of radical gastrectomy in patients with GC.


Assuntos
Gastrectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Idoso , China/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Tempo de Internação/tendências , Masculino , Duração da Cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(23): e20535, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502012

RESUMO

BACKGROUND: A numerous studies have reported that obese patients (OP) are easily to have type 2 diabetes mellitus (T2DM). Although a variety of managements are available to treat such disorder, their efficacy is still limited. Previous studies have reported that laparoscopic sleeve gastrectomy (LSGT) can benefit OP with T2DM. However, no study specifically and systematically explores this topic. Thus, this study will assess the efficacy and complications of LSGT for the management of OP with T2DM. METHODS: The search strategy will be performed in the electronic databases from inception to the March 31, 2020 without limitations of language and publication time: PUBMED, EMBASE, Cochrane Library, Scopus, Web of Science, CINAHL, AMED, WANGFANG, VIP, and CNKI. Two authors will independently identify the articles, collect the data, and assess the risk of bias using Cochrane risk of bias tool. We will invite a third author to solve any differences between two authors. We will use RevMan 5.3 software to investigate the statistical analysis. RESULTS: This study will supply a high-quality synthesis of randomized controlled trials (RCTs) on the analysis of LSGT for the management of OP with T2DM. CONCLUSIONS: This study will help to build proposals that aim at providing high quality RCTs in the management of LSGT in OP with T2DM. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040128.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Gastrectomia/métodos , Laparoscopia , Obesidade/cirurgia , Índice de Massa Corporal , Proteína C-Reativa/análise , Diabetes Mellitus Tipo 2/sangue , Hemoglobina A Glicada/análise , Humanos , Lipídeos/sangue , Metanálise como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
20.
BMC Surg ; 20(1): 117, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493359

RESUMO

BACKGROUND: Recent data support the use of bariatric surgery in adolescents with severe obesity following unsuccessful non-surgical treatments. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have demonstrated reasonably similar weight loss and reduction of obesity related comorbidities in randomized trials in adults. SG has internationally become the most commonly used procedure in adolescents, yet long-term outcome data are lacking. No randomized controlled trial comparing SG and RYGB has been performed in adolescents. OBJECTIVE: Determine whether SG is non-inferior to RYGB in terms of total body weight (TBW) loss in adolescents with severe obesity. METHODS: A multicenter randomized controlled non-inferiority trial. Two hundred sixty-four adolescents aged 13-17 (Tanner stage ≥IV) with severe obesity (corrected for age and sex) will be included. Adolescents agreeing to participate will be randomized to either RYGB or SG. The primary outcome is the proportion of participants achieving 20% TBW loss at 3 years postoperatively. Secondary outcomes include (i) change in body weight, body mass index (BMI) and BMI standard deviation score, (ii) incidence of adverse health events and need for additional surgical intervention, (iii) resolution of obesity-related comorbidities, (iv) prevalence of cardio metabolic risk factor measures, (v) bone health measures and incidence of bone fractures, (vi) quality of life including psychosocial health, patient satisfaction and educational attainment and (vii) body composition. Follow-up will extend into the long term. RESULTS: Not applicable. DISCUSSION: This study will, to our knowledge, be the first randomized controlled trial comparing SG and RYGB in adolescents with severe obesity. TRIAL REGISTRATION: The trial is registered at the Netherlands Trial Register on July 26th, 2018 - NTR7191 - https://www.trialregister.nl/trial/7191 (protocol version 5.0 - February 3th 2020).


Assuntos
Gastrectomia/métodos , Derivação Gástrica/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Adolescente , Índice de Massa Corporal , Humanos , Países Baixos , Satisfação do Paciente , Qualidade de Vida , Fatores de Risco
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