RESUMO
BACKGROUND: The transumbilical route began being clinically feasible with or without unique access devices. SETTING: The setting for this study was a private practice at Clínica Las Condes, Santiago, Chile. OBJECTIVE: The objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments. METHOD: A prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/m2, and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m2. The device insertion technique, the gastrectomy, and postoperative management are described. RESULTS: LSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %. CONCLUSIONS: Single-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m2 using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.
RESUMO
The goal was to study our experience in the management of a series of patients with a potentially curative subserosal gallbladder cancer who were prospectively treated by the authors. Between April 1988 and July 2004, 139 patients were enrolled in our prospective database. Of the above, 120 were operated on with an open procedure and the rest with laparoscopic surgery. In only eight patients was the diagnosis suspected before the cholecystectomy. The majority of tumors were adenocarcinoma. Six patients had an epidermoid tumor, and one had a carcinosarcoma. Of the patients, 74 underwent reoperation, while in 55 (70.2%) it was possible to perform an extended cholecystectomy with a curative aim. Operative mortality was 0%, and operative morbidity was 16%. Lymph node metastases were found in 10 (18.8%), while in 7 (13.2%) the liver was involved. The overall survival rate was 67.7%, while in those who underwent resection, the survival rate was 77%. Through the use of a multivariate analysis, the presence of lymph node metastasis was found to be an independent factor with respect to prognosis. The feasibility of performing an extended cholecystectomy in patients with gallbladder cancer and invasion of the subserosal layer allows for a good survival rate. The presence of lymph node metastases represents the main poor prognosis factor, and some type of adjuvant therapy should be studied in this particular group.
Assuntos
Neoplasias da Vesícula Biliar/cirurgia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistectomia , Colecistectomia Laparoscópica , Estudos de Coortes , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Seguimentos , Doenças da Vesícula Biliar/patologia , Doenças da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Prognóstico , Estudos Prospectivos , Reoperação , Membrana Serosa/patologia , Taxa de SobrevidaRESUMO
BACKGROUND: Sixty percent of adults has typical symptoms of gastroesophageal reflux in Chile. AIM: To report the clinical and laboratory features of patients with gastroesophageal reflux. PATIENTS AND METHODS: Five hundred thirty-four patients (255 male) with gastroesophageal reflux were included in a prospective protocol that included clinical analysis, manometry and endoscopy in all patients, barium swallow in 427, scintigraphy in 195, acid reflux test in 359, 24 h pH in 175, and differential potential of gastroesophageal mucosa in 73 patients. RESULTS: There was no correlation between the severity of symptoms and the endoscopical severity. Patients with Barret esophagus were 12 years older, were male in a greater proportion and had a higher proportion of manometrically incompetent sphincters than patients with esophageal reflux but without esophagitis or with erosive esophagitis. Severity of acid reflux, measured with 24 h pH monitoring was proportional to the endoscopical damage of the mucosa. There was a close relationship between the mucosal change limit determined with differential potentials and with endoscopy. No short esophagi were found. CONCLUSIONS: Patients with symptoms of gastroesophageal reflux must be assessed using several objective measures to determine the severity of their pathological alterations.
Assuntos
Refluxo Gastroesofágico/diagnóstico , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: The classic surgical procedure for patients with Barrett's esophagus (BE) has been either Nissen fundoplication or posterior gastropexy with calibration of the cardia. METHODS: The purpose of our study was to determine late subjective and objective results of these classic surgical techniques in a large number of patients with BE. A total of 152 patients were included in this prospective protocol. RESULTS: There was 1 death (0.7%) after operation. The late follow-up of 100 months demonstrated a high percentage of failures among patients with noncomplicated BE (54%) and an even higher figure in patients with complicated BE (64%). In 15 patients low grade dysplasia appeared at 8 years of follow-up and an adenocarcinoma in 4 patients. Twenty-four-hour pH monitoring demonstrated a decrease in acid reflux into the esophagus, and Bilitec studies also demonstrated a decrease of duodenoesophageal reflux, but in all cases with a higher value than the normal limit. CONCLUSIONS: Classic antireflux surgery in patients with BE results in a high percentage of failures at very late follow-up because it cannot completely avoid acid and duodenal reflux into the esophagus.
Assuntos
Esôfago de Barrett/cirurgia , Refluxo Gastroesofágico/prevenção & controle , Adulto , Idoso , Esôfago de Barrett/diagnóstico por imagem , Endoscopia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Prospectivos , RadiografiaRESUMO
The histological appearance of gallbladder mucosa in 95 control subjects and in 80 patients with asymptomatic gallstones separated according to age and sex was determined in a prospective study. The number and size of stones in the latter group were also analyzed. Among controls, 33% showed abnormal histological findings, mainly chronic cholecystitis, which increased with age and was frequently seen among women. All patients with asymptomatic gallstones showed chronic cholecystitis and/or cholesterolosis, and 5% showed acute inflammatory changes. In 55% of them a single stone was found. These findings suggest that chronic inflammatory changes can occur in the gallbladder mucosa prior to the appearance of macroscopic stones at the gallbladder.
Assuntos
Colelitíase/patologia , Vesícula Biliar/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colecistite/patologia , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa/patologia , Estudos ProspectivosRESUMO
OBJECTIVE: To determine the results of a new surgical procedure for patients with Barrett's esophagus. SUMMARY BACKGROUND DATA: In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients. METHODS: Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length. RESULTS: No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients. CONCLUSIONS: This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients.
Assuntos
Esôfago de Barrett/cirurgia , Adulto , Idoso , Esôfago de Barrett/complicações , Esôfago de Barrett/metabolismo , Esôfago de Barrett/patologia , Esôfago de Barrett/fisiopatologia , Refluxo Biliar/complicações , Duodeno/cirurgia , Feminino , Seguimentos , Fundoplicatura/métodos , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Gastrinas/sangue , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/prevenção & controle , Humanos , Concentração de Íons de Hidrogênio , Masculino , Manometria , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Vagotomia/métodosRESUMO
The technical considerations and preliminary results of 119 patients submitted to laparoscopic highly selective vagotomy are presented. There were 33 with duodenal ulcers, 31 with duodenal ulcers plus gastroesophageal reflux, and 55 with gastroesophageal reflux. Operating time varied from 120 to 160 minutes. Six complications occurred: four perforations of the gastric fundus and two bleeding episodes. Conversion to open surgery was done in four cases and reoperation in one case. No deaths occurred, and the mean hospital stay was 3 days. The mean follow-up was 16 months, being 94% of the cases with Visick I or II and 6% with Visick III or IV. This technique is completely feasible by laparoscopic procedure and reproduces exactly what has been done with the laparotomy approach.
Assuntos
Úlcera Duodenal/cirurgia , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Vagotomia Gástrica Proximal/métodos , Adulto , Estudos de Casos e Controles , Úlcera Duodenal/complicações , Estudos de Viabilidade , Feminino , Seguimentos , Fundoplicatura , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. AIM: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. PATIENTS AND METHODS: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. RESULTS: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 +/- 3.9 to 13.0 +/- 3.5 mm Hg and from 8.1 +/- 6.2 to 13.5 +/- 5.4 cm after surgery (p < 0.01). There was a decrease in acid reflux in 82% of patients. CONCLUSIONS: Laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures.
Assuntos
Refluxo Gastroesofágico/cirurgia , Laparoscopia , Adulto , Idoso , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Gravação em VídeoRESUMO
BACKGROUND/AIMS: The number of colonies of bacteria and the number of pyocites present per ml of choledochal bile was studied. PATIENTS AND METHODS: There were 42 controls, 100 patients with symptomatic gallstones, 42 patients with common duct stones without cholangitis and 24 patients with common duct stones and acute cholangitis. RESULTS: Control subjects had no bacteria present at gallbladder bile. Only 3% of patients with gallstones had more than 10(5) colonies per ml which increased to 36% in patients with common duct stones without cholangitis and to 84% among patients with acute cholangitis (p < 0.001). There were more polybacterial flora among patients with acute cholangitis and anaerobic bacteria were not seen in patients with gallstones. Patients with acute cholangitis had significantly more pyocites present at choledochal bile. CONCLUSION: There is a direct correlation between the number of colonies present per ml of choledochal bile and the severity of biliary tract disease. Patients with acute cholangitis had significantly more pyocites present at choledochal bile compared to gallstones or patients with CBD stones without cholangitis.
Assuntos
Bile/microbiologia , Colangite/microbiologia , Colelitíase/microbiologia , Cálculos Biliares/microbiologia , Doença Aguda , Idoso , Bile/citologia , Estudos de Casos e Controles , Colangite/etiologia , Colelitíase/complicações , Contagem de Colônia Microbiana , Feminino , Cálculos Biliares/complicações , Humanos , Macrófagos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings. METHODS: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures. RESULTS: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. CONCLUSIONS: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.
Assuntos
Bactérias/isolamento & purificação , Bile/microbiologia , Colelitíase/microbiologia , Cálculos Biliares/microbiologia , Doença Aguda , Adulto , Fatores Etários , Idoso , Colecistite/etiologia , Colecistite/microbiologia , Colelitíase/complicações , Doença Crônica , Ducto Colédoco , Feminino , Vesícula Biliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND/AIMS: This prospective study evaluates the peristaltic activity of the thoracic esophagus in a group of patients with gastroesophageal reflux disease grouping them according to the endoscopic findings. MATERIALS AND METHODS: The peristaltic activity and the manometric features of the lower esophageal sphincter were prospectively evaluated in 109 controls and 321 patients with reflux esophagitis, divided according to the degree of endoscopic esophagitis employing Savary's classification. RESULTS: Gastro esophageal sphincter pressure was progressively lower according to the severity of the tissue damage. Motor peristaltic activity of the thoracic esophagus measured by several different parameters was significantly altered in Grade IV esophagitis compared to other groups (p < 0.01). The manometric changes were more pronounced at the distal esophagus compared to the proximal esophagus. The percentage of patients with severe motor disturbances, defined as lower esophageal sphincter (LES) pressure less than 6 mm, less than 50% of peristaltic waves after swallowing and amplitude of contractile waves of less than 50 mmHg were significantly greater in patients with severe esophageal injury (p < 0.001). CONCLUSION: Gastroesophageal esophageal reflux may exhibit a wide spectrum of motor disturbances in the distal part of the esophagus even before the presence of the tissue damage, but it increases in proportion to the severity of endoscopic esophagitis.
Assuntos
Esofagite/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Peristaltismo , Adolescente , Adulto , Idoso , Esofagoscopia , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND/AIMS: The presence of aerobic and/or anaerobic bacteria in the liver parenchyma, gallbladder bile, and common bile duct was investigated. MATERIALS AND METHODS: There were 15 control subjects, 32 cases with symptomatic gallstones, 16 patients with common bile duct stones without acute cholangitis and 8 cases with common bile duct stones with an acute suppurative cholangitis. RESULTS: No bacteria were isolated in controls. The percentage of positive cultures in liver parenchyma increased in proportion to the severity of the biliary tract disease. There was no clear correlation between normal and altered hepatic histology and the presence or absence of bacteria except in patients with acute cholangitis. CONCLUSIONS: When biliary tract obstruction is present, the biliary tract is more vulnerable to invasion of bacteria and therefore increases the chance of spread into the liver parenchyma.
Assuntos
Bactérias Aeróbias/isolamento & purificação , Bactérias Anaeróbias/isolamento & purificação , Colangite/microbiologia , Colelitíase/microbiologia , Cálculos Biliares/microbiologia , Fígado/microbiologia , Doença Aguda , Idoso , Bile/microbiologia , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Manejo de EspécimesRESUMO
The late results of primary repair of accidental injuries to the common bile duct occurring during cholecystectomy were evaluated in 53 cases. These lesions occurred in 20 patients who had distal perforation produced by the Bakes dilator, in 17 cases with accidental tearing of the anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In cases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign stricture soon after surgery. When sphincteroplasty or choledochoduodenostomy was added, a stricture developed in only 1 out of 7 cases. In cases with accidental tears, suturing of the lesion plus choledochostomy produced very good late results. In patients with accidental ligation or suturing of the common bile duct, two different postoperative complications were seen: seven cases had biliary fistula and all developed benign stricture 2 years after surgery. In nine cases jaundice appeared 6 months after surgery, and a benign stricture developed in 7 of them. The most important "treatment" of these lesions is to prevent them from occurring during cholecystectomy by employing a meticulous surgical technique.
Assuntos
Colecistectomia/efeitos adversos , Ducto Colédoco/lesões , Coledocostomia/efeitos adversos , Ducto Colédoco/cirurgia , Doenças do Ducto Colédoco/etiologia , Constrição Patológica/etiologia , Feminino , Seguimentos , Humanos , Ligadura/efeitos adversos , Masculino , Estudos Retrospectivos , Ruptura , Suturas/efeitos adversosRESUMO
In this study the location of the lower oesophageal sphincter measured by manometry and the location of the squamous columnar junction measured by endoscopy were determined in 109 healthy controls and 778 patients with different degrees of endoscopic oesophagitis. No significant differences in the prevalence and severity of the heartburn and regurgitation were observed when different degrees of oesophagitis were compared but dysphagia was more common and severe in patients with complicated Barrett's oesophagus (p < 0.001). This group also showed a male predominance and older age compared with other groups. The total length of the oesophagus, measured by the location of the distal end of the lower oesophageal sphincter was similar in all patients; however, the location of the squamous columnar junction extended more proximally and was related to the increasing severity of endoscopic oesophagitis. The manometric defects at the cardia were more frequent in severe oesophagitis (p < 0.001). These results suggest that, during the course of oesophagitis, the squamous columnar junction is displaced proximally. This displacement is limited to the mucosa, however, and does not involve the muscular layer, because the lower oesophageal sphincter undergoes no dislocation.
Assuntos
Esofagite/patologia , Junção Esofagogástrica/patologia , Mucosa Gástrica/patologia , Cárdia/patologia , Esofagite/fisiopatologia , Junção Esofagogástrica/fisiopatologia , Esofagoscopia , Feminino , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/fisiopatologia , Gastroscopia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
The postoperative and late results of 99 patients with benign strictures of the biliary tract are presented. Patients were classified according to Bismuth into 24 cases with lesion type I, 36 cases with type II, 35 cases with type III and 4 patients with type IV. All were submitted to hepaticojejunostomy with a long Roux-en-Y loop. The etiology of the strictures varied according to the type of stricture. In patients of type I, inflammatory and iatrogenic causes were observed. Among type II and III patients, previous cholecytocholedochal fistulas were the main cause, together with accidental section or ligature of the common bile duct. Operative mortality was absent in strictures of types I and II, while it was around 25% in cases of types III and IV. At late control, the best results were seen among patients with strictures of types I and II. We believe that the main factor determining the early and late outcome of these cases with benign strictures is the location of the stricture and the quality of the proximal duct.
Assuntos
Doenças do Ducto Colédoco/cirurgia , Ducto Colédoco/cirurgia , Complicações Pós-Operatórias/cirurgia , Adulto , Anastomose em-Y de Roux , Doenças do Ducto Colédoco/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , ReoperaçãoRESUMO
The prevalence of gallbladder cancer in 10,468 cholecystectomy patients was studied: 3.4% of the female and only 1.32% of the male population had gallbladder cancer (p < 0.001). The female population had 2.7 times more cholelithiasis, and 7.9 times more cancer than the male population. Cancer incidence increases progressively with age, specially after the 5th decade.
Assuntos
Carcinoma/epidemiologia , Colecistectomia , Colelitíase/cirurgia , Neoplasias da Vesícula Biliar/epidemiologia , Adulto , Fatores Etários , Biópsia , Carcinoma/complicações , Carcinoma/patologia , Distribuição de Qui-Quadrado , Chile/epidemiologia , Colelitíase/complicações , Estudos Transversais , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores SexuaisRESUMO
The results of the surgical treatment in 251 patients with intrahepatic stones are discussed. The mean age of the group was 48 years, with a predominance of females. Gallstones were observed in 72% of the cases, because 28% had had previous cholecystectomy. Associated common bile duct stones were present in 222 (88%) cases, while primary intrahepatic stones were seen in 29 patients. The intrahepatic stones were usually bilateral. Three main operations were employed. Choledochostomy with or without cholecystectomy was performed in 166 (66%) cases with 6 deaths (3.6%). Bilioenteric anastomosis such as sphincteroplasty or choledochoduodenostomy were used in the rest with similar results. However, residual stones were documented in 32% after choledochostomy, while only 4% were seen after choledochoduodenostomy. In our groups, intrahepatic stones originated from migrated stones from the gallbladder, and surgical treatment should be orientated towards complete extraction of the stones and prevention of their further appearance.
Assuntos
Ductos Biliares Intra-Hepáticos , Colelitíase/cirurgia , Ducto Hepático Comum , Feminino , Humanos , Masculino , Métodos , Pessoa de Meia-Idade , ReoperaçãoRESUMO
Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of the women and 25% of the men over 20 years of age have gallstones. Biliary tract surgery accounts for about 35% of all the operations performed in Chilean general hospitals. The present paper aims at assessing the risk factors associated with a higher mortality in patients over 70 years of age subjected to elective or emergency surgery for gallstones or common bile duct stones. No specific factors of mortality were found in the group of elderly patients subjected to elective cholecystectomy. There was also no correlation between types of cholecystitis and postoperative mortality. However, acute suppurative cholangitis made the postoperative mortality rate increase almost 20-fold in patients with common bile duct stones. The mortality also shows a steep increase (up to 12%) if cholecystectomy is performed in acute cholecystitis. Cholecystostomy seems to be associated with a low mortality risk and hence should be appropriate in exceptionally high-risk patients, but is not considered useful by the authors in necrotic or gangrenous cholecystitis, or in cases with common bile duct stones and cholangitis. Postoperative mortality in patients submitted to cholecystectomy alone seems to depend exclusively on the concomitant presence of medical complications, mainly of a respiratory and cardiovascular nature. Septic complications are important causes of postoperative mortality in emergency cholecystectomy. Patients at high surgical risk are those suspected of cholangitis, those over 80 years of age, and those suffering from Charcot's triad, anemia, uremia, leukocytosis, hyperbilirubinemia or hypoprothrombinemia; in these, an endoscopic procedure could be chosen.
Assuntos
Colecistectomia/mortalidade , Coledocostomia/mortalidade , Colelitíase/mortalidade , Cálculos Biliares/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Chile , Colangite/complicações , Colelitíase/complicações , Colelitíase/cirurgia , Emergências , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Fatores de RiscoRESUMO
Se estudiaron 408 pacientes con esofagitis por reflujo en un protocolo prospectivo entre 1976 y 1987. Se analizan las características clínicas endoscópicas, manométricas y cintográficas (reflujo G-E, vaciamiento gástrico y reflujo duodenogástrico). Según el estudio endoscópico se clasificó a los pacientes en esofagitis grado I o leve (presencia de erosiones aisladas), grado II o moderada (erosiones múltiples o confluentes), esofagitis grado III (metaplaisa columnar del esófago distal o síndrome de Barret no complicado) y esofagitis grado IV (presencia de úlcera y/o estenosis esofágica o síndrome de Barret complicado). A los pacientes grado III y IV se les catalogó como esofagitis severa. Hubo 210 pacientes con esofagitis grado I, 52 en grado II, 56 en grado III y 90 en grado IV. No hubo diferencias significativas en la presencia de síntomas, salvo en disfagia y hemorragia digestiva que se presentó en la esofagitis severa. La presión del EGE fue similar en todos los grupos, pero la incidencia de trastornos motores fue significativamente mayor en la esofagitis severa. El reflujo cintilográfico fue severo en la mayoría y nos se detectaron diferencias significativas en la velocidad de vaciamiento gástrico de sólidos y en la positividad del reflujo duodeno gástrico. En conclusión, hay diferencias importantes tanto en análisis subjetivo y objetivo de la magnitud de la esofagitis por reflujo en los diferentes pacientes lo que obliga al médico tratante a emplear diversas estrategias de tratamiento
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Esofagite Péptica/fisiopatologia , Esofagite Péptica , Junção Esofagogástrica/fisiopatologia , Esvaziamento Gástrico , Manometria , PressãoRESUMO
Se estudiaron 408 pacientes con esofagitis por reflujo en un protocolo prospectivo entre 1976 y 1987. Se analizan las características clínicas endoscópicas, manométricas y cintográficas (reflujo G-E, vaciamiento gástrico y reflujo duodenogástrico). Según el estudio endoscópico se clasificó a los pacientes en esofagitis grado I o leve (presencia de erosiones aisladas), grado II o moderada (erosiones múltiples o confluentes), esofagitis grado III (metaplaisa columnar del esófago distal o síndrome de Barret no complicado) y esofagitis grado IV (presencia de úlcera y/o estenosis esofágica o síndrome de Barret complicado). A los pacientes grado III y IV se les catalogó como esofagitis severa. Hubo 210 pacientes con esofagitis grado I, 52 en grado II, 56 en grado III y 90 en grado IV. No hubo diferencias significativas en la presencia de síntomas, salvo en disfagia y hemorragia digestiva que se presentó en la esofagitis severa. La presión del EGE fue similar en todos los grupos, pero la incidencia de trastornos motores fue significativamente mayor en la esofagitis severa. El reflujo cintilográfico fue severo en la mayoría y nos se detectaron diferencias significativas en la velocidad de vaciamiento gástrico de sólidos y en la positividad del reflujo duodeno gástrico. En conclusión, hay diferencias importantes tanto en análisis subjetivo y objetivo de la magnitud de la esofagitis por reflujo en los diferentes pacientes lo que obliga al médico tratante a emplear diversas estrategias de tratamiento (AU)