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1.
Pan Afr Med J ; 38: 122, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33912292

RESUMO

Congenital segmental dilatation of the intestine is a rare disease. It is rarely located in the jejunum and its etiology is still unknown despite many theories suggesting its mechanism. We report a case of a 17 months girl who experienced nonspecific symptoms (abdominal pain, constipation and loss of appetite) since early her infancy. She had no growth retardation and had moderate abdominal distension on physical examination. Investigations undertaken could not increase suspicion of congenital segmental dilatation of the intestine (CSDI). The diagnosis was made peroperatively and a resection was done, followed by end-to-end jejunal anastomosis. There were no postoperative complications and the patient is doing well after four months. One should think of CSDI in children with chronic subocclusion or digestive hemorrhage.


Assuntos
Anastomose Cirúrgica/métodos , Doenças do Jejuno/diagnóstico , Jejuno/anormalidades , Dor Abdominal/etiologia , Constipação Intestinal/etiologia , Dilatação Patológica/congênito , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Feminino , Humanos , Lactente , Doenças do Jejuno/congênito , Doenças do Jejuno/cirurgia , Jejuno/cirurgia
3.
Arq Bras Cir Dig ; 33(4): e1570, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33759960

RESUMO

BACKGROUND: Ki-67 in ascending colon: A) experiment and B) control. Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. AIM: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. METHOD: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. RESULTS: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p<0.001) and in the colon (p=0.027). There was also a significant difference in relation to the height of the villus in the ileum (p<0.001) and the depth of the crypts in the jejunum (p0.001). The results indicated that there is a significant difference between the groups regarding the expression of Ki-67 in the colon (p<0.001). No significant differences were found between the groups regarding the expression of Ki-67 in the jejunum and ileum. In the P53 evaluation, negative nuclear staining was found in all cases. CONCLUSION: The jejunojejunal deviation performed in the Roux-in-Y gastrojejunal bypass, predispose epithelial proliferative effects, causing an increase in the thickness of the mucosa, height of the villi and depth of the crypts of the jejunum, ileum and ascending colon.


Assuntos
Doenças do Colo , Derivação Gástrica , Animais , Doenças do Colo/etiologia , Derivação Gástrica/efeitos adversos , Humanos , Íleo , Mucosa Intestinal , Intestino Delgado , Intestinos , Jejuno/cirurgia , Antígeno Ki-67/metabolismo , Masculino , Ratos , Ratos Wistar
4.
Khirurgiia (Mosk) ; (2): 14-19, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33570349

RESUMO

OBJECTIVE: To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure. MATERIAL AND METHODS: We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy - 4, right-sided adrenalectomy - 2, gastrectomy with splenectomy - 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach - in 86 (35.5%) cases. RESULTS: Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B - in 8 (28.6%) patients. CONCLUSION: Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.


Assuntos
Pancreaticoduodenectomia , Pancreaticojejunostomia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Humanos , Jejuno/cirurgia , Necrose/etiologia , Necrose/prevenção & controle , Pâncreas/patologia , Pâncreas/cirurgia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estômago/cirurgia , Resultado do Tratamento
6.
BMC Surg ; 21(1): 47, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478457

RESUMO

BACKGROUND: Recently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis following use of circular staplers. METHODS: Since the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases). RESULTS: Comparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5 vs. 26.7%, p < 0.05), especially for LPG (0 vs. 38.5%, p < 0.05). CONCLUSIONS: It is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Constrição Patológica/prevenção & controle , Esôfago/cirurgia , Jejuno/cirurgia , Neoplasias Gástricas , Idoso , Anastomose Cirúrgica/instrumentação , Constrição Patológica/etiologia , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos
7.
Obes Surg ; 31(5): 2344-2345, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33469860

RESUMO

Incidental gastric and small bowel lesions are commonly encountered during bariatric surgery. Resection of these lesions with negative margins in the same sitting is curative; however, this may necessitate intraoperative change of plan. We present a 44-year-old super obese lady in whom an exophytic jejunal mass was found at 80 cm from the ligament of Treitz, which necessitated a change of procedure from one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). The final pathology was ectopic pancreatic tissue. Running the small bowel during initial diagnostic laparoscopy should be a routine step before division of stomach, to avoid technical complexities when operative plan is changed in order to resect an incidentaloma. Bariatric surgeons should be well versed with all the standard bariatric procedures.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adulto , Derivação Gástrica/efeitos adversos , Humanos , Jejuno/cirurgia , Obesidade Mórbida/cirurgia
8.
BMJ Case Rep ; 14(1)2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33514623

RESUMO

Acute confusion in pregnancy is generally uncommon, given the relatively young and healthy population obstetricians care for. We present an unusual and rare case of acute confusion in a term pregnancy with antecedent history of gastrointestinal (GI) bleeding. A primigravida with no medical history of note, was found to have a haemoglobin of 67 g/L at booking and was commenced on oral iron supplementation. In the third trimester, she presented with haematochezia and had several admissions, requiring 18 units of red blood cells during her pregnancy. At term, she was admitted with acute confusion and GI bleeding, and was subsequently delivered by caesarean section to facilitate ongoing investigation and management of her symptoms. She was diagnosed postnatally with an arteriovenous malformation in the jejunum which required interventional radiology and surgical management for symptom resolution. Her confusion was attributed to hyperammonaemic levels secondary to her high protein load.


Assuntos
Malformações Arteriovenosas/complicações , Confusão/etiologia , Hemorragia Gastrointestinal/etiologia , Jejuno/irrigação sanguínea , Doença Aguda , Malformações Arteriovenosas/terapia , Cesárea/métodos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Embolização Terapêutica/métodos , Feminino , Humanos , Hiperamonemia/complicações , Jejuno/diagnóstico por imagem , Jejuno/patologia , Jejuno/cirurgia , Laparotomia/métodos , Gravidez , Resultado do Tratamento , Adulto Jovem
9.
Am J Vet Res ; 81(12): 985-991, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33251840

RESUMO

OBJECTIVE: To determine whether jejunal serosal patches could securely seal large, open defects in duodenal segments harvested from canine cadavers and to compare intraluminal pressures at which leakage first occurred and maximal intraluminal pressures for repaired duodenal segments between 2 suture patterns. SAMPLE: Duodenal and jejunal segments from 9 canine cadavers. PROCEDURES: 20 constructs were created through repair of large, open duodenal defects with circumferential suturing of an intact jejunal segment (jejunal serosal patch). Constructs were randomly assigned to have the serosal patch anastomosed to the duodenal segment by a simple continuous or simple interrupted suture pattern. The pressure at which the first leakage was observed and the maximum pressure obtained during testing were recorded and compared between suture patterns. RESULTS: Initial leakage pressure was significantly higher with the simple interrupted pattern (mean ± SD, 68.89 ± 5.62 mm Hg), compared with the simple continuous pattern (59.8 ± 20.03 mm Hg). Maximum intraluminal pressures did not significantly differ between the simple interrupted (91 ± 8.27 mm Hg) and simple continuous patterns (90.7 ± 16.91 mm Hg). All constructs, regardless of suture pattern, withstood supraphysiologic pressures. CONCLUSIONS AND CLINICAL RELEVANCE: Jejunal serosal patches adequately sealed large, open duodenal defects and prevented leakage in these constructs. Constructs with simple continuous or simple interrupted suture patterns withstood physiologic and supraphysiologic intraluminal pressures, although constructs with a simple interrupted suture pattern initially leaked at higher pressures. (Am J Vet Res 2020;81:985-991).


Assuntos
Doenças do Cão , Suturas , Animais , Cadáver , Cães , Jejuno/cirurgia , Pressão , Técnicas de Sutura/veterinária
10.
Kyobu Geka ; 73(10): 887-891, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130785

RESUMO

Esophageal reconstruction using intestine is often performed for esophageal cancer patients in cases where the stomach cannot be used. We have previously performed reconstruction using ileocolon with supercharge and drainage as our 1st choice in those cases. However, a less invasive, simpler, and safer reconstructive technique using pedicled jejunal flap has recently become popular at our facility. When making the pedicled jejunal flap, the 1st jejunal vascular arcade was preserved, which in many cases allowed it to be pulled up to the cervical region by processing and transection up to the 2nd jejunal vascular branch. But supercharge and superdrainage may be required for pedicled jejunal flap reconstruction when blood flow of jejunal flap is not good condition. And free jejunal reconstruction is performed to reconstruction after cervical esophagectomy. Vascular anastomosis is essential for free jejunal reconstruction. This article describes the surgical technique and perioperative management of esophageal reconstruction with vascular anastomosis.


Assuntos
Neoplasias Esofágicas , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Jejuno/cirurgia , Retalhos Cirúrgicos
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(10): 969-975, 2020 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-33053992

RESUMO

Objective: For gastric cancer patients undergoing total gastrectomy, the esophagojejunal anastomosis is the main site of postoperative anastomotic leakage. How to improve the safety of the esophagojejunal anastomosis is a hot topic. This study evaluated the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy for gastric cancer. Methods: A retrospective cohort study was conducted. Clinical data of 764 gastric cancer patients, who were diagnosed as gastric adenocarcinoma by preoperative gastroscopicbiopsy and were judged to be able to complete R0 resection by imaging examination, in the Affiliated Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from May 2015 to May 2019 were retrospectively collected and analyzed. two and a half layered esophagojejunal anastomosis was used in the treatment group (295 cases), and the routine anastomosis was used in the control group (469 cases). Postoperative complicating including anastomosis-assisted complications were compared between the two groups. Results: The baseline data of two groups were not significantly different (all P>0.05). All the patients successfully completed the operation. In observation group and control group, the total operative time [(140.7±27.0) minutes vs. (139.6±22.8) minutes], intraoperative blood loss [(200.6±111.0) ml vs. (214.4±114.1) ml], anastomosis time [(20.4±4.3) minutes vs. (19.9±4.6) minutes], time to first flatus [(4.1±1.1) days vs. (4.2±1.1) days], time to fluid diet [(5.4±1.0) days vs. (5.5±0.9) days], time to postoperative nasointestinal tube removal [(9.8±3.2) days vs. (10.0±2.3) days], and postoperative hospital stay [(15.4±6.5) days vs. (15.9±5.6) days] were not significantly different (all P>0.05). Compared to the control group, the treatment group had lower rates of anastomosis-associated complications [1.7% (5/295) vs. 4.7% (22/469), χ(2)=4.768, P=0.029] and anastomotic leakage [1.0% (3/295) vs.3.4% (16/469), χ(2)=4.282, P=0.039]. The differences in the incidence of anastomotic stenosis and anastomotic bleeding were not statistically significant between the two groups (both P>0.05). In the treatment group and control group, rates of total postoperative complication [34.2% (101/295) vs. 32.2% (151/469), χ(2)=0.838, P=0.360] and severe complication [Clavinen-Dindo grade III and above; 4.7% (14/295) vs. 7.2% (34/469), Z=-1.465, P=0.143] were not significantly different as well. Conclusion: Two and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy for gastric cancer and can reduce anastomosis-associated complications.


Assuntos
Esofagoplastia , Esôfago/cirurgia , Jejuno/cirurgia , Neoplasias Gástricas , Adenocarcinoma/patologia , Anastomose Cirúrgica , Fístula Anastomótica/etiologia , Gastrectomia , Humanos , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia
12.
PLoS One ; 15(9): e0239857, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986787

RESUMO

OBJECTIVE: The outcomes of children with Choledochal cyst who undergo laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy versus open cyst excision and Roux-en-Y hepaticojejunostomy have not been adequately compared. We conducted a systematic review and meta-analysis to gain further insight into the efficacy and safety of laparoscopic excision in children with choledochal cysts. METHODS: A systematic search of PubMed, Embase, Cochrane Central Register, and ClinicalTrials.gov databases from January 1973 to January 31, 2020 was performed utilizing the PRISMA guidelines. Short-term, long-term and total postoperative complications were the primary endpoint measurements, whereas intraoperative outcomes and other postoperative outcomes were the secondary endpoints. RESULTS: The final analysis included 14 retrospective cohorts comprising 1767 patients. There were no significant differences in the patients' short-term postoperative complications (RR = -1.08; 95% CI = -1.72 to -0.67) between the 2 approaches. However, improvements in long-term (RR = 0.09; 95% CI = 0.01 to 0.18) and total postoperative complications (RR = -0.29; 95% CI = -0.40 to -0.21), estimated intraoperative blood loss and transfusion, time of initial feeding, and length of hospital stay were observed in patients who underwent laparoscopic excision when compared to those who underwent open surgery. CONCLUSIONS: Laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy provides similar or even improved intraoperative, postoperative outcomes when compared to open excision for children with Choledochal cyst.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Cisto do Colédoco/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Adolescente , Anastomose em-Y de Roux , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Jejuno/cirurgia , Tempo de Internação , Fígado/cirurgia , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
13.
Ann Surg ; 272(5): 696-702, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32889869

RESUMO

OBJECTIVE: The aim of this study was to compare the efficacy and safety of 12-month implantation of a duodeno-jejunal bypass liner (DJBL) with conventional medical care in patients with metabolic syndrome (MS). SUMMARY BACKGROUND DATA: DJBL is an endoscopic device for treating obesity and related disorders. The persistence of favorable results after 6 months has not been tested in a controlled study. METHODS: We conducted a multicenter randomized controlled trial, stratified by center and diabetes status. The primary endpoint was the remission of MS at 12 months. The secondary endpoints included body mass index (BMI), glucose control, blood pressure, and lipids, assessed at 12 months after implantation, and again, at 12 months after the removal of the DJBL. Up to 174 subjects were planned to be randomized into either the DJBL or the control arm at a 2:1 ratio, respectively. Study enrollment was discontinued by the Scientific Monitoring Committee due to the early termination of the ENDO trial (NCT01728116) by the US Food and Drug Administration. The study was terminated after withdrawal of the device's European Conformity marking by the European Medicines Agency, and an interim analysis was performed. RESULTS: A total of 82 patients were enrolled (67.5% female, 48.8% with diabetes). At 12 months after randomization, the primary endpoint was met in 6 (12%) DJBL patients and 3 (10%) controls (P = 0.72). Patients in the DJBL group experienced greater BMI loss [mean adjusted difference (95% confidence interval, CI) -3.1 kg/m (-4.4 to -1.9) kg/m, P < 0.001] and HbA1c change [mean adjusted difference -0.5% (95% CI -0.9 to -0.2); P < 0.001] than those in the control group. No difference remained statistically significant at 12 months after the removal of the DJBL. In the DJBL group, 39% of patients experienced at least one device-related serious adverse event, which was classified as Grade III Dindo-Clavien in 22%, and required premature device explantation in 16%. CONCLUSIONS: The present study showed a transient clinical benefit of DJBL, which was only apparent at 1 year, when the device was still in situ, and was obtained at the risk of serious device-related adverse events in 39% of patients. These results do not support the routine use of DJBL for weight loss and glucose control in patients with MS.


Assuntos
Cirurgia Bariátrica/instrumentação , Duodeno/cirurgia , Jejuno/cirurgia , Síndrome Metabólica/cirurgia , Próteses e Implantes , Endoscopia Gastrointestinal , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Implantação de Prótese , Indução de Remissão , Perda de Peso
14.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1321-1328, July-Aug. 2020. ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1131480

RESUMO

Fifteen New Zealand adult rabbits were randomly allocated into three groups: Sham-operated (group A), Ischemia and Reperfusion (group B) and Carolina Rinse Solution (CRS) (group C). Groups B and C were subjected to one hour of ischemia and two hours of reperfusion. In group C, ten minutes before reperfusion, the bowel lumen was filled with CRS, and the segment immersed in CRS. Necrosis and loss of integrity of the villi were visible in groups B and C. Edema of the submucosa and circular muscle was observed in all groups. Hemorrhage was observed in different layers for groups B and C, but group C showed more severe hemorrhage in different layers during reperfusion. All groups showed polymorphonuclear leukocyte infiltration on the base of the mucosa, submucosa, and longitudinal muscle, in addition to polymorphonuclear leukocytes margination in the mucosal and submucosal vessels. Necrosis of enterocytes, muscles, crypts of Lieberkühn and myenteric plexus was observed in groups B and C during reperfusion. Topical and intraluminal Carolina Rinse Solution did not attenuate the effects of ischemia and reperfusion in the small intestine of rabbits.(AU)


Quinze coelhos da raça Nova Zelândia foram alocados em três grupos: instrumentado (grupo A), isquemia e reperfusão (grupo B) e solução de Carolina rinse (CRS) (grupo C). Os grupos B e C foram submetidos a uma hora de isquemia e a duas horas de reperfusão. No grupo C, 10 minutos antes da reperfusão, o segmento isolado foi imerso e teve seu lúmen preenchido com CRS. Os grupos B e C apresentaram necrose e perda progressiva da integridade das vilosidades. Foi observado edema na submucosa e na camada muscular circular em todos os grupos. Nos grupos B e C, foi observada hemorragia em diferentes camadas, mas, no grupo C, a hemorragia foi mais intensa durante a reperfusão. Todos os grupos apresentaram infiltrado de PMN na base da mucosa, na submucosa e na camada muscular longitudinal e marginação de PMN nos vasos da mucosa e da submucosa. Durante a reperfusão, foi observada necrose dos enterócitos, das camadas musculares, das criptas de Lieberkühn e do plexo mioentérico nos grupos B e C. O uso tópico e intraluminal de CRS não atenuou os efeitos da isquemia e da reperfusão no intestino delgado de coelhos.(AU)


Assuntos
Animais , Coelhos , Reperfusão/veterinária , Alopurinol/administração & dosagem , Desferroxamina/administração & dosagem , Glutationa/administração & dosagem , Isquemia/veterinária , Jejuno/cirurgia
16.
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
17.
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
19.
Khirurgiia (Mosk) ; (4): 11-17, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352662

RESUMO

OBJECTIVE: To compare laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical stapling anastomotic devices after laparoscopic gastrectomy for stomach cancer. MATERIAL AND METHODS: There were 34 patients who underwent laparoscopic gastrectomy for stomach in 2015-2018. Roux-en-Y esophagoenterostomy was used to reconstruct the gastrointestinal tract. Manual anastomoses were performed in 18 patients (group 1), stapled anastomoses (endogia 45 mm, covidien, mansfield, ma, usa) - in 16 patients (group 2). There was no randomization. Surgery duration, length of icu-stay, terms of enteral nutrition initiation, postoperative complications, hospital-stay were analyzed. RESULTS: Mean duration of surgery in the first group was 217 (184-302) min, in the second group - 201 (162-311) min. Duration of surgery in the first group was 1.08-fold higher than in the second group (95% CI 1.03-1.13, p=0.05). Mean blood loss was 145 ml in both groups. Mean icu-stay was 20.2 (17-42) hours in the first group and 21.1 (16.2-46) hours in the second group (ratio 0.96, 95% CI 0.92-1.01, p=0.06). Total enteral feeding (sipping) was initiated on the third day in both groups. Mean postoperative hospital-stay was 9.21 (6-13) days in the first group and 9.23 (6-12 days) days in the second group (ratio 0.99, 95% CI 0,95-1.02, p=0.06). Postoperative morbidity was 5.5% in the first group and 6.25% in the second group. CONCLUSION: Laparoscopic manual esophagoenterostomy proposed by our surgical team does not have disadvantages in comparison with stapling anastomotic devices and these methods may be alternative to each other.


Assuntos
Anastomose em-Y de Roux/métodos , Esôfago/cirurgia , Gastrectomia/métodos , Jejuno/cirurgia , Neoplasias Gástricas/cirurgia , Anastomose em-Y de Roux/instrumentação , Humanos , Laparoscopia , Grampeamento Cirúrgico , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(16): e19888, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312016

RESUMO

RATIONALE: Although percutaneous endoscopic gastrojejunostomy (PEG-J) tubes are believed to reduce the side effect of aspiration, cautious catheter management is required. Intussusception is a serious complication of these tubes. PATIENT CONCERNS: A 7-year-old boy bedridden with hypoxic encephalopathy owing to drowning at the age of 1 year was admitted our hospital with urinary retention for 1 month. At the age of 4 years, a PEG-J tube was inserted. Concomitant with hyperaldosteronemia, an intestinal intussusception from the duodenum to the jejunum was observed via computed tomography (CT). The patient's condition worsened dramatically; gastrointestinal perforation was suspected, and laparotomy was performed. DIAGNOSIS: Jejuno-jejunal intussusception. INTERVENTIONS: Open surgery was performed to release the intussusception. By assessing the reduced intestinal tract, the intussusception starting from a 50 cm portion from the Treitz ligament had been extended to 100 cm from the Treitz ligament. The oral side jejunum was dilated. No evidence of intestinal perforation or strangulated ileus was observed, and the intussusception was manually remediable. OUTCOMES: Preoperative CT examination showed intussusception from the duodenum to the jejunum. Laparotomy showed intussusception on the anal side of the Treitz ligament. With regard to the CT findings associated with the progression of intussusception to the duodenal site, as a result of the telescope phenomenon extending to the duodenum due to the relaxation of the Treitz ligament through repeated intussusception, it was considered that CT examination revealed intussusception extending from the jejunum to the duodenum of oral side. After 3 postoperative weeks, the patient was finally able to return home. LESSONS: If the ileus is observed during the insertion of a PEG-J, clinicians should consider the possibility of intussusception even in the duodenum.


Assuntos
Endoscopia Gastrointestinal/métodos , Derivação Gástrica/efeitos adversos , Intussuscepção/etiologia , Jejunostomia/efeitos adversos , Estômago/cirurgia , Criança , Duodeno/patologia , Duodeno/cirurgia , Derivação Gástrica/instrumentação , Humanos , Doença Iatrogênica , Íleus/diagnóstico , Íleus/etiologia , Intussuscepção/patologia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/etiologia , Doenças do Jejuno/patologia , Jejuno/patologia , Jejuno/cirurgia , Laparotomia/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
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