RESUMO
BACKGROUND: Obesity is a public health problem, for which the prevalence has increased worldwide at an alarming rate, affecting 1.7 billion people in the world. OBJECTIVE: To describe the technique employed in incomplete penetration of gastric band where endoscopic management and/or primary closure is not feasible. MATERIAL AND METHODS: Laparoscopic removal of gastric band was performed in five patients with incomplete penetrance using Foley catheterization in the perforation site that could lead to the development of a gastro-cutaneous fistula. CLINICAL CASES: The cases presented include a leak that required surgical lavage with satisfactory outcome, and one patient developed stenosis 3 years after surgical management, which was resolved endoscopically. In all cases, the penetration site closed spontaneously. DISCUSSION: Gastric band erosion has been reported in 3.4% of cases. The reason for inserting a catheter is to create a controlled gastro-cutaneous fistula, allowing spontaneous closure. CONCLUSIONS: Various techniques have been described: the totally endoscopic, hybrid techniques (endoscopic/laparoscopic) and completely laparoscopic. A technique is described here that is useful and successful in cases where the above-described treatments are not viable.
Assuntos
Remoção de Dispositivo/métodos , Falha de Equipamento , Gastroplastia/instrumentação , Gastrostomia/métodos , Adulto , Fístula Anastomótica/etiologia , Cateterismo , Gerenciamento Clínico , Feminino , Gastrite/etiologia , Gastroplastia/efeitos adversos , Gastroplastia/métodos , Gastroscopia , Humanos , Laparoscopia , Masculino , Complicações Pós-Operatórias/etiologia , Infecção da Ferida Cirúrgica/etiologia , Irrigação TerapêuticaRESUMO
INTRODUCTION: pancreatic focal neoplastic lesions (PFNL) should be characterized through image methods to differentiate from no neoplastic lesions, suggesting one or more probable diagnosis, and staging of malignant lesions, in order to help define the estrategy of medial or surgical management. The multidetector computed tomography (MDCT) offers multiple properties and advantages that enable adequate characterization of the PFNL. The objective of this study is to evaluate de usefulness of MDCT in characterizing PFNL. MATERIAL AND METHODS: a descriptive, retrospective caseseries study has been conducted. It consisted of reviewing MDCT studies in which PFNL were found, over a period of 4 years 11 months from January 2006 to November 2010. RESULTS: we obtained 54 cases of PFNL which were characterized by MDCT; 75.9% for a specific diagnosis, and were categorized as indeterminate 24.1%, considering more than one possible diagnosis. The most frequent PFNL type was pancreatic ductal adenocarcinoma in 51.9%. Pancreatic cystic neoplasms accounted for 16.7%. CONCLUSIONS: MDCT is useful for identifying and characterizing LFNP, this means the possibility of establishing one or more diagnostic possibilities and guide medical management.