Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.529
Filtrar
1.
Am J Gastroenterol ; 117(8): 1197-1220, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35926490

RESUMO

Gastroparesis is characterized by symptoms suggesting retention of food in the stomach with objective evidence of delayed gastric emptying in the absence of mechanical obstruction in the gastric outflow. This condition is increasingly encountered in clinical practice. These guidelines summarize perspectives on the risk factors, diagnosis, and management of gastroparesis in adults (including dietary, pharmacological, device, and interventions directed at the pylorus), and they represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation process. When the evidence was not appropriate for Grading of Recommendations, Assessment, Development, and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.


Assuntos
Gastroenterologia , Gastroparesia , Adulto , Esvaziamento Gástrico , Gastroparesia/diagnóstico , Gastroparesia/etiologia , Gastroparesia/terapia , Humanos , Piloro , Fatores de Risco
2.
eNeuro ; 9(4)2022.
Artigo em Inglês | MEDLINE | ID: mdl-35817566

RESUMO

The levels of voltage-gated and synaptic currents in the same neuron type can vary substantially across individuals. Yet, the phase relationships between neurons in oscillatory circuits are often maintained, even in the face of varying oscillation frequencies. We examined whether synaptic and intrinsic currents are matched to maintain constant activity phases across preparations, using the lateral pyloric (LP) neuron of the stomatogastric ganglion (STG) of the crab, Cancer borealis LP produces stable oscillatory bursts on release from inhibition, with an onset phase that is independent of oscillation frequency. We quantified the parameters that define the shape of the synaptic current inputs across preparations and found no linear correlations with voltage-gated currents. However, several synaptic parameters were correlated with oscillation period and burst onset phase, suggesting they may play a role in phase maintenance. We used dynamic clamp to apply artificial synaptic inputs and found that those synaptic parameters correlated with phase and period were ineffective in influencing burst onset. Instead, parameters that showed the least variability across preparations had the greatest influence. Thus, parameters that influence circuit phasing are constrained across individuals, while those that have little effect simply co-vary with phase and frequency.


Assuntos
Braquiúros , Gânglios dos Invertebrados , Animais , Gânglios , Gânglios dos Invertebrados/fisiologia , Neurônios/fisiologia , Piloro/fisiologia
3.
BMC Surg ; 22(1): 225, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690775

RESUMO

BACKGROUND: The gastric conduit is the best replacement organ for oesophageal reconstruction, but a reversed gastric conduit (RGC) is rare. Oesophageal reconstruction for oesophageal cancer patients with a previous history of complicated gastrointestinal surgery is rather difficult. Here, we report a case in which oesophageal reconstruction was successfully managed using RGC based solely on the left gastroepiploic artery supply. CASE PRESENTATION: A 69-year-old man with oesophageal cancer had a history of endoscopic intestinal polypectomy and pylorus-preserving pancreaticoduodenectomy (PPPD). The right gastroepiploic artery and right gastric artery had been completely severed. The only supply artery that could be used for the gastric conduit was just the left gastroepiploic artery. Because of the complex history of abdominal surgery, we had no choice but to use the RGC to complete the oesophageal reconstruction, in which the gastric conduit was passed reversely through the hiatus to the oesophageal bed and layered end-to-side manual intrathoracic anastomosis with the esophagus. The patient had transient feeding problems with postoperative delayed thoracic stomach emptying but no anastomotic stenosis or thoracic stomach fistula. He was satisfied with his life and had no long-term complications. There was no significant effect on gut physiological function, and RGC could work normally. CONCLUSIONS: Oesophageal reconstruction with RGC is a feasible procedure for complex oesophageal carcinoma that can simplify complicated surgical procedures, has less influence on gut function, is less invasive, and is safe.


Assuntos
Neoplasias Esofágicas , Esvaziamento Gástrico , Idoso , Anastomose Cirúrgica , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/cirurgia , Humanos , Masculino , Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/cirurgia , Piloro/cirurgia , Estômago/irrigação sanguínea , Estômago/cirurgia
4.
Langenbecks Arch Surg ; 407(4): 1711-1720, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35670857

RESUMO

BACKGROUND: Although several procedures for mechanical anastomosis have recently been reported, intracorporeal manually hand-sewn anastomosis for totally laparoscopic pylorus-preserving gastrectomy (TLPPG) is considered technically difficult. Here, we report a new technique for laparoscopic reconstruction using hand-sewn sutures. METHODS: Together with a proper lymphadenectomy, the stomach was detached and resected using separate two-layer incisions, similar to the original laparotomy method. An approximately 5-cm antral cuff was left in place. The essential concept of this new method was to align the anastomotic site by rotating each clamped gastric stump. This allowed us to perform a secure, hand-sewn, two-layer anastomosis successfully. The short-term surgical outcome after TLPPG was retrospectively compared with that for patients who underwent a conventional laparoscopy-assisted procedure (LAPPG). RESULTS: Of the 20 consecutive patients who underwent pylorus-preserving gastrectomy in our department between 2014 and 2021, the first 8 patients and the subsequent 12 patients underwent LAPPG and TLPPG, respectively. The operation time was significantly longer in the TLPPG group (median, 302 vs. 269 min). The morbidity was comparable (8.3% in TLPPG vs. 12.5% in LAPPG). Postoperative delayed gastric emptying was only observed in one patient in the LAPPG group. TLPPG reduced the cost of the operation by reducing the number of linear stapler cartridges required. CONCLUSION: A purely hand-sewn gastrogastrostomy is safe, feasible, and cost-effective, and it omits the need for a mini-laparotomy in the upper abdomen.


Assuntos
Laparoscopia , Neoplasias Gástricas , Abdome/cirurgia , Anastomose Cirúrgica/métodos , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Piloro/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Técnicas de Sutura , Resultado do Tratamento
5.
J Coll Physicians Surg Pak ; 32(6): 701-705, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35686399

RESUMO

OBJECTIVE: To evaluate the effect of antrectomy in which resection was started from 2 cm or closer to the pylorus on % excess weight loss (EWL), nausea, vomiting, and complication rates. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Antalya Training and Research Hospital, from April 2018 to December 2018. METHODOLOGY: Patients in whom laparoscopic sleeve gastrectomy (LSG)were done starting at a level of 2 cm or closer to pylorus were included in the study. Patients were divided into one of the two groups based on the distance between the pylorus and the resection margin: group 1 having resection ≤10 mm and group 2 at 11-20 mm. Above mentioned parameters were compared in both groups. RESULTS: Ninety-two patients were included. Postoperative nausea and vomiting rates were similar in both groups. At the end of the first year, % EWL was 82.9% and 73.5% in groups 1 and 2 (p=0.003). CONCLUSION: Starting antrectomy at a distance of 2 cm or less from the pylorus is safe and effective. Starting antrectomy at a distance of 1 cm or less from the pylorus in LSG provides effective weight loss without increasing complications. KEY WORDS: Bariatric surgery, Antrectomy, Laparoscopic sleeve gastrectomy, Complications.


Assuntos
Laparoscopia , Obesidade Mórbida , Gastrectomia , Humanos , Obesidade Mórbida/cirurgia , Piloro/cirurgia , Resultado do Tratamento , Redução de Peso
6.
Khirurgiia (Mosk) ; (6): 140-145, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35658146

RESUMO

In January 2020, a patient with a gastrointestinal stromal tumor of the antrum located in close proximity to the pylorus underwent a hybrid laparo-endoscopic organ-sparing gastric resection. There were no intraoperative and postoperative complications. Control endoscopic and X-ray examination of the stomach confirmed normal motor and evacuation function of the stomach. To date, follow-up period is more than 1.5 years. The patient has no complaints. This case demonstrates clear advantages of hybrid access in certain clinical situations, such as localization in anatomically difficult areas and near functional sphincters. Surgical approach ensured pylorus-sparing resection with favorable postoperative result.


Assuntos
Tumores do Estroma Gastrointestinal , Neoplasias Gástricas , Gastrectomia/efeitos adversos , Mucosa Gástrica/patologia , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Gastroscopia , Humanos , Piloro/patologia , Piloro/cirurgia , Estudos Retrospectivos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
7.
BMC Surg ; 22(1): 218, 2022 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-35672844

RESUMO

PURPOSE: A new novel technique for the treatment of pediatric hypertrophic pyloric stenosis (HPS), transumbilical single-site laparoscopic pyloromyotomy with a single instrument (TUSSLP), was introduced. TUSSLP was compared with the transabdominal three-site laparoscopic pyloromyotomy (TATSLP) procedure. METHODS: Patients with HPS who underwent TUSSLP and TATSLP between January 2016 and September 2020 were assigned to group A and group B, respectively. The descriptive variables, perioperative clinical characteristics and postoperative follow-up results were retrospectively analyzed and compared between the 2 groups. The primary outcome of this study was the rate of switching to conventional pyloromyotomy. RESULTS: Sixty-four patients were enrolled in this study. Of these patients, 29 (22 males, 7 females, 54.4 ± 22.6 days) who received TUSSLP were assigned to group A. The remaining 35 (28 males, 7 females, 54.5 ± 27.6 days) who received TATSLP were assigned to group B. The data of preoperative patient variables were comparable between the 2 groups (P > 0.05). The mean operative time (ORT) was 28.1 ± 5.6 min in group A, which was not significantly different from 25.8 ± 3.1 min in group B (P = 0.25). The other perioperative features were not significantly different between the 2 groups (P > 0.05). During follow-up (39.1 ± 14.7 m in group A and 35.4 ± 16.1 m in group B, P = 0.51), no significant difference was observed in the overall incidence of vomiting between the 2 groups (P = 0.26). CONCLUSIONS: TUSSLP is a feasible and reliable minimally invasive method for HPS. It has the advantages of an improved cosmetic appearance. The postoperative follow-up results of TUSSLP are comparable with those of TATSLP.


Assuntos
Laparoscopia , Estenose Pilórica Hipertrófica , Piloromiotomia , Criança , Feminino , Humanos , Lactente , Laparoscopia/métodos , Masculino , Estenose Pilórica Hipertrófica/cirurgia , Piloromiotomia/métodos , Piloro/cirurgia , Estudos Retrospectivos
8.
Am J Med Genet A ; 188(8): 2454-2459, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35579050

RESUMO

Epidermolysis bullosa simplex (EBS) with plectin mutations is a very rare subtype of EB usually associated with pyloric atresia (PA) or muscular dystrophy (MD). We report six unrelated children between ages 4 and 14 years from India with varied clinical manifestations. Only one had PA, and none has developed MD to date. All except the one with PA presented with early onset blistering along with laryngeal involvement in the form of hoarseness of voice and nail involvement. Patient with PA presented with aplasia cutis and died in the first week. Two patients had predominantly respiratory and gastrointestinal involvement with varying severity while two had features of myasthenic syndrome but no limb-girdle involvement and one patient phenocopied laryngo-onycho-cutaneous (LOC) syndrome. Using whole-exome sequencing, we identified novel mutations in PLEC. Histopathological analysis (Immunofluorescence antigen mapping) showed absence of staining to plectin antibodies. Our observations propose to append a phenotype of EBS, hoarseness of voice and nail dystrophy or LOC-like phenotype with plectin mutations. Long-term follow up is necessary to monitor for the development of muscular dystrophy.


Assuntos
Epidermólise Bolhosa Simples , Distrofias Musculares , Epidermólise Bolhosa Simples/complicações , Epidermólise Bolhosa Simples/diagnóstico , Epidermólise Bolhosa Simples/genética , Obstrução da Saída Gástrica , Rouquidão/complicações , Humanos , Distrofias Musculares/genética , Mutação , Plectina/genética , Piloro/anormalidades
9.
Am J Physiol Gastrointest Liver Physiol ; 322(6): G553-G560, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35380456

RESUMO

Patients with Parkinson's disease (PD) often suffer from delayed gastric emptying, but the underlying mechanism remains unclear. We have shown previously that a PD rat model comprising bilateral substantia nigra destruction by 6-hydroxydopamine (6-OHDA rats) exhibits gastroparesis with alteration of neural nitric oxide synthase (nNOS) and acetylcholine in gastric corpus. However, changes in pyloric motility in the 6-OHDA rats have not been characterized. Solid gastric emptying test, immunofluorescence, Western blot, and in vitro pyloric motility recordings were used to assess pyloric motor function in the 6-OHDA rats. The 6-OHDA-treated rats displayed delayed solid gastric emptying and a lower basal pyloric motility index. In the 6-OHDA rats, high K+-induced transient contractions were weaker in pyloric sphincters. Electric field stimulation (EFS)-induced pyloric sphincter relaxation was lower in the 6-OHDA rats. NG-nitro-l-arginine methyl ester (l-NAME), a nonselective inhibitor of NOS, markedly inhibited the EFS-induced relaxation in both control and 6-OHDA rats. Pretreatment of tetrodotoxin abolished the effect of EFS on the pyloric motility. In addition, nNOS-positive neurons were extensively distributed in the pyloric myenteric plexus, whereas the number of nNOS-immunoreactive neurons and the protein expression of nNOS were significantly decreased in the pyloric muscularis of 6-OHDA rats. However, sodium nitroprusside-induced pyloric relaxations were similar between the control and 6-OHDA rats. These results indicate that the pyloric sphincters of 6-OHDA rats exhibit both weakened contraction and relaxation. The latter may be due to reduced nNOS in the pyloric myenteric plexus. The dysfunction of the pyloric sphincter might be involved in the delayed gastric emptying.NEW & NOTEWORTHY Reduced nitrergic neurons in pyloric myenteric plexus potently contributed to the attenuated relaxation in 6-hydroxydopamine (6-OHDA) rats, subsequently affecting gastric emptying. SNP could well improve the relaxation of pylori in 6-OHDA rats. The present study provides new insight into the diagnosis and treatment of delayed gastric emptying in patients with PD.


Assuntos
Gastroparesia , Doença de Parkinson , Animais , Gastroparesia/etiologia , Humanos , Óxido Nítrico Sintase Tipo I/metabolismo , Oxidopamina , Piloro/metabolismo , Ratos , Ratos Sprague-Dawley
10.
ANZ J Surg ; 92(5): 1153-1158, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35393697

RESUMO

BACKGROUND: Our aims were to determine if the diagnostic threshold for diagnosing hypertrophic pyloric stenosis (HPS) on ultrasound scan (USS) should be adjusted based on birth weight (BW), current weight (CW), gestational age (GA), chronological age (CA) or corrected gestational age (CGA). METHODS: All patients who underwent either an USS and pyloromyotomy (Group 1) or an USS for possible HPS (Group 2) at our tertiary centre between July 2013 and June 2019 were identified. Ideal threshold values are identified by measuring Youden's Index (J = sensitivity + specificity - 1; higher is better). Mean maximum Youden's Index for stratified results was compared to that for combined results. RESULTS: Two hundred and eighty-four patients were included (142 patients in both Group 1 and Group 2). Combined maximum Youden's Index for all patients was 0.92 for pyloric canal thickness (PMT) and 0.87 for pyloric canal length (PCL). Mean maximum Youden's Index was higher when patients were stratified by GA, CGA, BW or CW, and equivalent for CA. For pyloric canal length (PCL), mean maximum Youden's Index was lower for all variables when stratified compared to combined. There was no visual trend observed in the diagnostic thresholds between groups. CONCLUSION: Stratifying USS PMT diagnostic thresholds values based on age and weight is statistically more accurate than a single threshold in diagnosing HPS. However, the lack of visual correlation indicates a larger dataset is required to validate these results.


Assuntos
Estenose Pilórica Hipertrófica , Piloromiotomia , Constrição Patológica , Humanos , Lactente , Estenose Pilórica Hipertrófica/diagnóstico por imagem , Estenose Pilórica Hipertrófica/cirurgia , Piloro/diagnóstico por imagem , Ultrassonografia
13.
Elife ; 112022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35302489

RESUMO

Neural circuits can generate many spike patterns, but only some are functional. The study of how circuits generate and maintain functional dynamics is hindered by a poverty of description of circuit dynamics across functional and dysfunctional states. For example, although the regular oscillation of a central pattern generator is well characterized by its frequency and the phase relationships between its neurons, these metrics are ineffective descriptors of the irregular and aperiodic dynamics that circuits can generate under perturbation or in disease states. By recording the circuit dynamics of the well-studied pyloric circuit in Cancer borealis, we used statistical features of spike times from neurons in the circuit to visualize the spike patterns generated by this circuit under a variety of conditions. This approach captures both the variability of functional rhythms and the diversity of atypical dynamics in a single map. Clusters in the map identify qualitatively different spike patterns hinting at different dynamic states in the circuit. State probability and the statistics of the transitions between states varied with environmental perturbations, removal of descending neuromodulatory inputs, and the addition of exogenous neuromodulators. This analysis reveals strong mechanistically interpretable links between complex changes in the collective behavior of a neural circuit and specific experimental manipulations, and can constrain hypotheses of how circuits generate functional dynamics despite variability in circuit architecture and environmental perturbations.


Assuntos
Braquiúros , Gânglios dos Invertebrados , Animais , Braquiúros/fisiologia , Gânglios dos Invertebrados/fisiologia , Neurônios/fisiologia , Neurotransmissores/fisiologia , Piloro/fisiologia
15.
Obes Surg ; 32(5): 1412-1420, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35304705

RESUMO

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a widely performed procedure nowadays. There is a controversy on whether antrum resection (AR) or antrum preservation (AP) should be done and if this has an effect on BMI, gastric emptying, and associated medical conditions such as diabetes mellitus (DM). STUDY DESIGN: This randomized controlled trial included 56 patients in the AP group and 53 patients in the AR group with BMI 30-40 kg/m2. Weight, BMI, fasting and postprandial blood glucose (FBS and PPBS), HbA1C, oral hypoglycemic drug use, and % gastric emptying by gastric scintigraphy at 30, 60, 90, and 120 min were recorded preoperatively and postoperatively at 3, 6, and 12 months. Postoperative % of total weight loss (TWL) and symptoms of de novo GERD were observed at 3, 6, and 12 months. RESULTS: The AR group had significantly lower BMI and HbA1C and higher %TWL than the AP group. There was a significant difference between the two groups regarding % of gastric emptying with the AP group showing higher values at 30, 60, 90, and 120 min. There were no significant differences regarding FBS, PPBS, and oral hypoglycemic use. The AR group had more incidence of GERD symptoms postoperatively yet with no significant difference. CONCLUSION: LSG with antrum resection (2 cm from the pylorus) had significantly less postoperative BMI, higher %TWL, better control of type II DM, and more retention of gastric contents in patients with BMI 30-40 kg/m2 in comparison with LSG with antral preservation with non-significant increase in incidence of GERD symptoms.


Assuntos
Diabetes Mellitus Tipo 2 , Laparoscopia , Obesidade Mórbida , Antro Pilórico , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/métodos , Esvaziamento Gástrico , Refluxo Gastroesofágico/cirurgia , Hemoglobina A Glicada , Humanos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Antro Pilórico/cirurgia , Piloro , Resultado do Tratamento
16.
Korean J Gastroenterol ; 79(3): 126-129, 2022 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-35342170

RESUMO

The stomach temporarily stores food and secretes gastric juices to break down and digest food. The normal process is the movement of food digested from the stomach to the duodenum, with the pylorus as a passageway. This paper reports the case of a patient with an ectopic gastric pylorus who presented with gastrointestinal bleeding. A 62-year-old man complained of melena with mild dizziness and nausea. An endoscopic examination revealed a gastric ulcer, approximately 1 cm in diameter, and exposed blood vessels on the posterior wall of the upper body. No normal pyloric structure was observed in the distal antrum, and an opening leading to the duodenum was noted in the posterior wall of the upper body adjacent to the ulcer. This case presents a congenital pyloric ectopic opening in the upper body of the stomach, not in the distal antrum, suggesting a rare gastric morphological variation.


Assuntos
Neoplasias Gástricas , Úlcera Gástrica , Duodeno , Hemorragia Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Antro Pilórico , Piloro/anormalidades , Neoplasias Gástricas/diagnóstico , Úlcera Gástrica/complicações , Úlcera Gástrica/diagnóstico
17.
J Surg Res ; 274: 1-8, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35104694

RESUMO

INTRODUCTION: Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique. METHODS: A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death. RESULTS: Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01 h for LP [-8.39 to 2.37 h]) and time to full feeds (-5.86 h for LP [-15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53 min for LP [-3.53 to 4.59 min]). CONCLUSIONS: On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.


Assuntos
Hérnia Incisional , Laparoscopia , Estenose Pilórica Hipertrófica , Piloromiotomia , Abscesso/cirurgia , Hematoma/cirurgia , Humanos , Hérnia Incisional/epidemiologia , Hérnia Incisional/etiologia , Hérnia Incisional/cirurgia , Lactente , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Estenose Pilórica Hipertrófica/cirurgia , Piloromiotomia/efeitos adversos , Piloromiotomia/métodos , Piloro/cirurgia , Seroma , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
18.
J Visc Surg ; 159(1S): S8-S15, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35123904

RESUMO

Gastroparesis is the most common gastric motility disorder. The cardinal symptoms are nausea, vomiting, gastric fullness, early satiety, or bloating, associated with slow gastric emptying in the absence of mechanical obstruction. Delayed gastric emptying is demonstrated by a gastric emptying scintigraphy or by a breath test. Gastroparesis can be idiopathic, post-operative, secondary to diabetes, iatrogenic, or post-infectious. Therapeutic care must be multidisciplinary including nutritional, medical, endoscopic and surgical modes. The complications of delayed gastric emptying must be sought and addressed, particularly malnutrition, in order to identify and correct vitamin deficiencies and fluid and electrolyte disturbances. An etiology should be identified and treated whenever possible. Improvement in symptoms can be treated by dietary regimes and pharmaceutical treatments, including prokinetics. If these are not effective, specialized endoscopic approaches such as endoscopic or surgical pyloromyotomy aim at relaxing the pyloric sphincter, while the implantation of an electrical stimulator of gastric muscle should be discussed in specialized centers.


Assuntos
Cirurgia Bariátrica , Terapia por Estimulação Elétrica , Gastroparesia , Piloromiotomia , Gastroparesia/diagnóstico , Gastroparesia/etiologia , Gastroparesia/cirurgia , Gastroparesia/terapia , Humanos , Piloro/cirurgia
20.
Dis Esophagus ; 35(7)2022 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-35178557

RESUMO

BACKGROUND: Delayed gastric emptying (DGE) occurs in up to 40% of patients after esophageal resection and prolongs recovery and hospital stay. Surgically pyloroplasty does not effectively prevent DGE. Recently published methods include injection of botulinum toxin (botox) in the pylorus and mechanical interventions as preoperative endoscopic dilatation of the pylorus. The aim of this study was to investigate the efficacy of those methods with respect to the newly published Consensus definition of DGE. METHODS: A systematic literature search using CENTRAL, Medline, and Web of Science was performed to identify studies that described pre- or intraoperative botox injection or mechanical stretching methods of the pylorus in patients undergoing esophageal resection. Frequency of DGE, anastomotic leakage rates, and length of hospital stay were analyzed. Outcome data were pooled as odd's ratio (OR) or mean difference using a random-effects model. Risk of bias was assessed using the Robins-I tool for non-randomized trials. RESULTS: Out of 391 articles seven retrospective studies described patients that underwent preventive botulinum toxin injection and four studies described preventive mechanical stretching of the pylorus. DGE was not affected by injection of botox (OR 0.87, 95% confidence interval [CI] 0.37-2.03, P = 0.75), whereas mechanical stretching resulted in significant reduction of DGE (OR 0.26, 95% CI 0.14-0.5, P < 0.0001). CONCLUSION: Mechanical stretching of the pylorus, but not injection of botox reduces DGE after esophageal cancer resection. A newly developed consensus definition should be used before the conduction of a large-scale randomized-controlled trial.


Assuntos
Toxinas Botulínicas Tipo A , Neoplasias Esofágicas , Gastroparesia , Neoplasias Esofágicas/cirurgia , Esvaziamento Gástrico , Gastroparesia/etiologia , Gastroparesia/prevenção & controle , Humanos , Complicações Pós-Operatórias/prevenção & controle , Piloro/cirurgia , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...