RESUMO
INTRODUCTION AND AIMS: At the Upper Gastrointestinal Tract Clinic of the Hospital General de Mexico, achalasia treatment has been standarized through strictly graduated cardiomyotomy. This procedure guarantees a complete myotomy for the satisfactory resolution of dysphagia, a characteristic symptom of achalasia. To ensure the inclusion of the entire lower esophageal sphincter, an 8cm Penrose drain is placed at the surgical site 6cm above the gastroesophageal junction and 2cm in a caudal direction, for accurate laparoscopic measuring. The aim of our study was to evaluate the results of this technique. MATERIALS AND METHODS: A descriptive, retrospective, longitudinal, and observational study was conducted on a cohort of patients diagnosed with achalasia at the Upper Gastrointestinal Tract Clinic of the Hospital General de México "Dr. Eduardo Liceaga". RESULTS: The study included 48 patients, 40 of whom had no prior surgical treatment and 8 that presented with recurrence. Forty-seven patients (97.9%) underwent a laparoscopic procedure and conversion to open surgery was required in 2 of them (4.25% conversion rate). Postoperative progression was satisfactory in all cases, with mean oral diet commencement at 52h and mean hospital stay of 5.7 days. No recurrence was registered during the mean follow-up period of 35.75 months and there were no deaths. CONCLUSIONS: Laparoscopic graduated (strictly measured) cardiomyotomy with anterior fundoplication is a reproducible, efficacious, and safe option for the surgical treatment of achalasia.
Assuntos
Acalasia Esofágica/cirurgia , Fundoplicatura/métodos , Miotomia de Heller/métodos , Laparoscopia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Desde el conocimiento en la década de los 60's del compromiso isquémico del colon, secundario al uso de anticonceptivos orales y de las lesiones visualizadas en la colonoscopia, se han reportado más casos en la literatura. Observando una prevalencia seis veces mayor en mujeres jóvenes con colitis isquémica, secundaria al uso de anticonceptivos orales, afectando principalmente el colon izquierdo, respetando el recto, en algunas ocasiones puede afectar el colon derecho, sin afectar el fondo de saco de ciego o en forma segmentaria, con una regresión total del o de los segmentos afectados en los primeros dos días a una semana al suspender el uso de los anticonceptivos orales