RESUMO
The author dilated 3,112 patients with esophageal strictures over 36 years. Most strictures were peptic, esophageal rings, cervical webs or eosinophilic. Strictures were assessed for presence of hiatal hernia, hernia size, stricture diameter, and type and size of dilator used. Complex strictures were present in 19.7% of patients. Re-dilation was needed in 30% of patients within five years. Three adverse reactions occurred, one perforation and two bleeds in 3,112 patients (0.1%) and 5,960 dilations (0.05%).
Assuntos
Estenose Esofágica , Constrição Patológica , Dilatação , Estenose Esofágica/epidemiologia , Estenose Esofágica/terapia , Humanos , Prática Privada , Estudos Prospectivos , Estudos RetrospectivosRESUMO
We analyzed 202 patients undergoing Laparoscopic Nissen fundoplication. One hundred and three patients (90.6%) had typical reflux symptoms. Hiatal hernias were present in 84.6%. Most patients had erosive esophagitis; sixty-four patients (31.6%) had strictures. Complications occurred in 38 patients (18.8%), with major complications in 15 patients (7.4%). Major complications included bleeding in six, two requiring transfusion, slipped Nissen in three, pneumothorax in two, and esophageal leak in two patients. Eleven patients had postoperative dysphagia that responded to dilation therapy within three months. There was no mortality.
Assuntos
Fundoplicatura , Hospitais Comunitários , Laparoscopia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagite/cirurgia , Feminino , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Segurança , Resultado do TratamentoRESUMO
Diverticulosis accounts for 50% of adult cases of lower gastrointestinal bleeding. Recurrent or persistent bleeding usually is treated surgically. Recent studies suggest that 20% of patients with diverticular bleeding can have the site identified and treated endoscopically. Treatment modalities include injection techniques, thermal therapy and hemoclips. This paper reports three cases successfully treated with band ligation, after initial epinephrine injection therapy had failed.
Assuntos
Diverticulite/cirurgia , Hemorragia Gastrointestinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Diverticulite/complicações , Endoscopia Gastrointestinal/métodos , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Ligadura/métodos , MasculinoRESUMO
OBJECTIVES: To assess the efficacy of laparoscopic Nissen fundoplication for esophageal reflux in a community hospital. METHODS: One hundred nineteen patients (76%) of 157 patients having laparoscopic fundoplication for symptomatic reflux disease completed a questionnaire. All patients were evaluated with esophagoscopy, esophageal motility, and pH studies. RESULTS: Mean follow-up was 49 months. Ninety-three patients (78%) no longer had heartburn. Seven patients still had daily heart-burn (5.9%). One hundred three patients (86.6%) had no sour regurgitation. Seventy-five patients (63%) had no dysphagia after surgery. Forty-two patients had some dysphagia after surgery (36.8%). Six patients (5.0%) had significant dysphagia. Only 4 patients stated that dysphagia interfered with their quality of life. Twenty-six patients (22.8%) thought that belching and bloating were worse, whereas 42 patients (36.8%) thought that belching and bloating were better after surgery. Antacids, histamine-2 antagonist, and proton pump inhibitors were still being used by 12.6%, 14.3%, and 21.8% of patients, respectively. CONCLUSIONS: Eighty-seven patients were completely satisfied (73.1%), 26 patients somewhat satisfied (22.8%), and 6 patients unsatisfied (5.3%) with surgery. Overall satisfaction with the surgery was 94.7%. One hundred five patients (88.2%) would recommend the surgery to others. Laparoscopic Nissen fundoplication can be effectively done in a community hospital setting.