RESUMO
BACKGROUND: Gastric pull-up is a useful method for reconstruction of the upper digestive tract, with considerable morbidity/mortality, especially in esophageal cancers (EC). OBJECTIVE: To analyze the experience of a multidisciplinary team with a laparoscopic gastric pull-up (LGPU) method, with or without thoracoscopy, in a series of 120 patients with EC. STUDY DESIGN: Retrospective. PATIENTS AND METHODS: From 1992 to 2004, 120 EC [cervical/cervicothoracic (3.0%), middle third (15.0%), and inferior third (82.0%)]. Most were squamous cell carcinomas (47.0%) and adenocarcinomas (34.0%). Stomach was dissected and mobilized exclusively by laparoscopy. Occasionally, laparoscopic approach was extended cranially, until connecting with cervical dissection. In other cases, dissection of thoracic esophagus was accomplished through a thoracoscopic approach. RESULTS: Eighty-one patients (68.0%) had LGPU; 39 (32.0%) needed thoracoscopy. Mortality was 5.9%. Complications were fistula (10.0%) and pneumonia (10.0%). All fistulae closed spontaneously; 89.2% of patients could swallow a normal oral diet. CONCLUSION: Low morbidity/mortality of LGPU for EC compared favorably with conventional techniques.
Assuntos
Neoplasias Esofágicas/cirurgia , Laparoscopia , Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Esofagoplastia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Faringe/cirurgia , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Estômago/cirurgia , Toracoscopia , Resultado do TratamentoAssuntos
Humanos , Criança , Constipação Intestinal/diagnóstico , Constipação Intestinal/terapia , Impacção Fecal/etiologia , Reto/patologia , Canal Anal/cirurgia , Sulfato de Bário , Constipação Intestinal/dietoterapia , Constipação Intestinal/etiologia , Doença de Hirschsprung/complicações , Enema , Manometria , RetoRESUMO
Os autores apresentam quatro casos de aganglionose de todo o cólon em crianças, tecendo comentários sobre as dificuldades no estabelecimento do diagnóstico e sobre o tratamento cirúrgico utilizado aos pacientes.