RESUMO
PURPOSE: To evaluate the outcome of transhiatal esophagectomy without thoracotomy and with preservation of the vagal trunks for the treatment of advanced megaesophagus. METHODS: Between March 2006 and September 2017, it was performed 136 transhiatal esophagectomies without thoracotomy by laparoscopy, with preservation of the vagus nerves. All patients were evaluated pre and postoperatively for respiratory and nutritional aspects Post operatively, some surgical aspects were evaluated like radiology and endoscopy of the digestive tract. RESULTS: Follow-up for 7 months to 12 years by clinical, radiologic, endoscopic and pH monitoring revealed satisfactory and encouraging outcomes of the procedure. CONCLUSION: The laparoscopic transhiatal esophagectomy is a feasible and safe technique with good postoperative outcomes.
Assuntos
Acalasia Esofágica/cirurgia , Laparoscopia/métodos , Tratamentos com Preservação do Órgão , Nervo Vago , Adolescente , Adulto , Idoso , Esofagectomia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto JovemRESUMO
Purpose: To evaluate the outcome of transhiatal esophagectomy without thoracotomy and with preservation of the vagal trunks for the treatment of advanced megaesophagus. Methods: Between March 2006 and September 2017, it was performed 136 transhiatal esophagectomies without thoracotomy by laparoscopy, with preservation of the vagus nerves. All patients were evaluated pre and postoperatively for respiratory and nutritional aspects Post operatively, some surgical aspects were evaluated like radiology and endoscopy of the digestive tract. Results: Follow-up for 7 months to 12 years by clinical, radiologic, endoscopic and pH monitoring revealed satisfactory and encouraging outcomes of the procedure. Conclusion: The laparoscopic transhiatal esophagectomy is a feasible and safe technique with good postoperative outcomes.(AU)
Assuntos
Humanos , Esofagectomia , Laparoscopia , Acalasia Esofágica/cirurgia , Nervo VagoRESUMO
Abstract Purpose: To evaluate the outcome of transhiatal esophagectomy without thoracotomy and with preservation of the vagal trunks for the treatment of advanced megaesophagus. Methods: Between March 2006 and September 2017, it was performed 136 transhiatal esophagectomies without thoracotomy by laparoscopy, with preservation of the vagus nerves. All patients were evaluated pre and postoperatively for respiratory and nutritional aspects Post operatively, some surgical aspects were evaluated like radiology and endoscopy of the digestive tract. Results: Follow-up for 7 months to 12 years by clinical, radiologic, endoscopic and pH monitoring revealed satisfactory and encouraging outcomes of the procedure. Conclusion: The laparoscopic transhiatal esophagectomy is a feasible and safe technique with good postoperative outcomes.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Nervo Vago , Acalasia Esofágica/cirurgia , Laparoscopia/métodos , Tratamentos com Preservação do Órgão , Índice de Gravidade de Doença , Seguimentos , Resultado do Tratamento , Esofagectomia/métodosRESUMO
BACKGROUND: Cholelithiasis is one of the diseases with greater surgical indication. Currently, laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis. AIM: To analyze the culture of bile from patients with cholelithiasis, mainly in the occurrence of brown and mixed stones. METHODS: Was carried out a prospective study with 246 cases with biliary lithiasis who underwent elective laparoscopic cholecystectomy. Bile culture was performed in all. During anesthetic induction the patients received a single dose of intravenous cefazolin 1 g. At the end of the surgery, the gallbladder was punctured, its contents extracted and immediately placed in a sterile 20 ml propylene flask and promptly sent to bacterioscopy with Maconkey and blood agars. Incubation at 37° C for 24 h was carried out. A protocol was elaborated to include the main factors potentially related to cholelithiasis and the possible presence of associated bacterial infection. RESULTS: Of the 246 patients, 201 had negative bile culture and 45 positive. Of the 45 patients with bacteriobilia, 34 had growth of a single type of bacterium in bile culture and 11 more than one. CONCLUSIONS: It was observed a relationship between bacteriobilia and age, suggesting that age is a risk factor for bacteriobilia. The use of antibiotic prophylaxis in the elderly is therefore recommended.
Assuntos
Bactérias/isolamento & purificação , Bile/microbiologia , Colecistectomia Laparoscópica , Colelitíase/microbiologia , Colelitíase/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
PURPOSE: To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. METHODS: Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. RESULTS: After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). CONCLUSION: Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.
Assuntos
Exercícios Respiratórios/métodos , Nutrição Enteral/métodos , Esofagectomia/métodos , Esofagectomia/reabilitação , Exercícios de Alongamento Muscular/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Antropometria , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Músculos Respiratórios/fisiopatologia , Espirometria , Fatores de Tempo , Resultado do Tratamento , Capacidade Vital/fisiologiaRESUMO
Purpose: To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up.Methods: Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. Results: After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). Conclusion: Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.(AU)
Assuntos
Humanos , Masculino , Feminino , Cuidados Pré-Operatórios , Esofagectomia , Nutrição Enteral , Exercícios Respiratórios , Testes de Função Respiratória , Avaliação Nutricional , Doenças do EsôfagoRESUMO
Abstract Purpose: To compare pulmonary and nutritional parameters before and after inspiratory muscle training (IMT) and enteral feeding support in patients with esophageal disease undergoing preoperative outpatient follow-up. Methods: Thirty patients with a mean age of 55.83 years, 16 men and 14 women, were included. Pulmonary assessment consisted of the measurement of MIP, MEP, and spirometry. Anthropometric measurements and laboratory tests were performed for nutritional assessment. After preoperative evaluation, inspiratory muscle training and enteral nutrition support were started. A p<0.05 was considered statistically significant. Results: After an outpatient follow-up period of 4 weeks, a significant increase in MIP (-62.20 ± 25.78 to -81.53 ± 23.09), MEP (73.4 ± 31.95 to 90.33 ± 28.39), and FVC (94.86 ± 16.77 to 98.56 ± 17.44) was observed. Regarding the anthropometric variables, a significant increase was also observed in BMI (20.18 ± 5.04 to 20.40 ± 4.69), arm circumference (23.38 ± 3.28 to 25.08 ± 4.55), arm muscle circumference (21.48 ± 3.00 to 22.07 ± 3.36), and triceps skinfold thickness (5.62 ± 2.68 to 8.33 ± 6.59). Conclusion: Pulmonary and nutritional preparation can improve respiratory muscle strength, FVC and anthropometric parameters. However, further studies are needed to confirm the effectiveness of this preoperative preparation.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Exercícios Respiratórios/métodos , Cuidados Pré-Operatórios/métodos , Esofagectomia/métodos , Esofagectomia/reabilitação , Nutrição Enteral/métodos , Exercícios de Alongamento Muscular/métodos , Período Pós-Operatório , Valores de Referência , Espirometria , Fatores de Tempo , Músculos Respiratórios/fisiopatologia , Capacidade Vital/fisiologia , Antropometria , Volume Expiratório Forçado/fisiologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
Abstract Introduction: Diabetes Mellitus (DM) is a multifactorial metabolic disorder. As considered a public health problem needing additional treatment options. Objective: This prospective study aimed at evaluating pulmonary function through spirometry, before and after metabolic surgery without gastric resection in type 2 DM patients. Methods: Sample was composed by 17 type 2 DM females. They were analyzed in pre (24 hours before surgical procedure), immediate post-operative period POST1 (24 hours after surgical procedure) and in the late postoperative period POST2 (two years after surgical procedure). Besides statistical analysis, it was evaluated the following spirometric parameters: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1) and the FEV1 / FVC ratio (%). Results: Spirometric parameters showed a value increase when compared PRE and POS2 values, except for FVC and FEV1, which was not statistically significant. Conclusion: Type 2 DM women submitted to metabolic surgery without gastric resection showed spirometric value increased after two-year surgical procedure, when compared to preoperative period values. It is important additional studies about pulmonary function, diabetic patients and metabolic surgery without gastric resection.
Resumo Introdução: O Diabetes Mellitus (DM) é uma desordem metabólica multifatorial. Considerado um problema de saúde pública necessita de opções de tratamento adicionais. Objetivo: Este estudo prospectivo avaliou a função pulmonar, através da espirometria, antes e após a cirurgia metabólica sem ressecção gástrica em pacientes com diabetes mellitus tipo 2. Métodos: A amostra foi composta por 17 mulheres com diabetes mellitus tipo 2. Elas foram avaliadas no PRE (24 horas antes da cirurgia), pós-operatório imediato POST1 (24 horas após a cirurgia) e no pós-operatório tardio POST2 (dois anos após a cirurgia). Além da análise estatística, foram avaliados os seguintes parâmetros expirométricos: capacidade vital forçada (CVF), volume expiratório forçado no primeiro segundo (VEF1) e relação VEF1/CVF (%). Resultados: os parâmetros expirométricos aumentaram quando comparados aos valores PRE e POS2, exceto para CVF e VEF1, os quais não foram estatisticamente significativos. Conclusão: Mulheres diabéticas tipo 2 que realizaram cirurgia metabólica sem ressecção gástrica aumentaram o valor expirométrico após dois anos do procedimento cirúrgico, quando comparadas aos valores no pré-operatório. Estudos adicionais são importantes sobre a função pulmonar, diabetes e cirurgia metabólica sem ressecção gástrica.
Assuntos
Feminino , Período Pós-Operatório , Diabetes Mellitus , Período Pré-Operatório , Testes de Função Respiratória , Espirometria , Cirurgia BariátricaRESUMO
ABSTRACT Background: Cholelithiasis is one of the diseases with greater surgical indication. Currently, laparoscopic cholecystectomy is the gold standard in the treatment of cholelithiasis. Aim: To analyze the culture of bile from patients with cholelithiasis, mainly in the occurrence of brown and mixed stones. Methods: Was carried out a prospective study with 246 cases with biliary lithiasis who underwent elective laparoscopic cholecystectomy. Bile culture was performed in all. During anesthetic induction the patients received a single dose of intravenous cefazolin 1 g. At the end of the surgery, the gallbladder was punctured, its contents extracted and immediately placed in a sterile 20 ml propylene flask and promptly sent to bacterioscopy with Maconkey and blood agars. Incubation at 37° C for 24 h was carried out. A protocol was elaborated to include the main factors potentially related to cholelithiasis and the possible presence of associated bacterial infection. Results: Of the 246 patients, 201 had negative bile culture and 45 positive. Of the 45 patients with bacteriobilia, 34 had growth of a single type of bacterium in bile culture and 11 more than one. Conclusions: It was observed a relationship between bacteriobilia and age, suggesting that age is a risk factor for bacteriobilia. The use of antibiotic prophylaxis in the elderly is therefore recommended.
RESUMO Racional: A colecistolitíase é uma das doenças que têm maior indicação cirúrgica. Atualmente a colecistectomia laparoscópica é o padrão-ouro no seu tratamento. Objetivo: Analisar a cultura da bile de pacientes portadores de colecistolitíase, principalmente na ocorrência de cálculos com pigmentos marrons e mistos. Métodos: Foi realizado estudo prospectivo de 246 casos de pacientes portadores de litíase biliar, submetidos à colecistectomia laparoscópica eletiva, sendo realizada cultura da bile. Durante a indução anestésica os pacientes receberam dose única de cefazolina 1 g, intravenosa. No final da operação foi puncionada a vesícula biliar, extraído seu conteúdo e imediata colocação em frasco estéril de propileno de 20 ml e prontamente encaminhado para bacterioscopia com semeadura do material coletado em ágar sangue e de Maconkey com posterior incubação em estufa de cultura a 37° C durante 24 h. Foi elaborado um protocolo capaz de englobar os principais fatores potencialmente relacionados à colecistolitíase e a possível presença de infecção bacteriana associada. Resultados: Dos 246 participantes, 201 tiveram cultura de bile negativa e 45 positiva. Dos 45 pacientes com bacteriobilia, 34 tiveram crescimento de um único tipo de bactéria e 11 mais de uma. Conclusões: Foi observada relação entre bacteriobilia e a idade, sugerindo que a idade é fator de risco para bacteriobilia. Recomenda-se assim o emprego de antibioticoprofilaxia nos idosos.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Bactérias/isolamento & purificação , Bile/microbiologia , Colelitíase/cirurgia , Colelitíase/microbiologia , Colecistectomia Laparoscópica , Estudos Prospectivos , Procedimentos Cirúrgicos EletivosRESUMO
Purpose: To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. Methods: Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p 0.05. Results: The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). Conclusion: Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.(AU)
Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica , Força Muscular/fisiologia , ColelitíaseRESUMO
Abstract Purpose: To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. Methods: Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p<0.05. Results: The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). Conclusion: Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Músculos Respiratórios/fisiologia , Colelitíase/cirurgia , Colecistectomia Laparoscópica/métodos , Força Muscular/fisiologia , Fatores de Tempo , Estudos Transversais , Estudos Prospectivos , Resultado do TratamentoRESUMO
Purpose: To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. Methods: Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p 0.05. Results: Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. Conclusion: This study found no significant difference in postoperative pain between the two groups.(AU)
Assuntos
Humanos , Feminino , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/classificação , Medição da Dor/efeitos adversos , Medição da Dor/classificaçãoRESUMO
Abstract Purpose: To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. Methods: Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p<0.05. Results: Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. Conclusion: This study found no significant difference in postoperative pain between the two groups.
Assuntos
Humanos , Feminino , Adulto , Dor Pós-Operatória , Colelitíase/cirurgia , Colecistectomia Laparoscópica/métodos , Estudos Transversais , Estudos ProspectivosRESUMO
ABSTRACT BACKGROUND Morbid obesity is a multifactorial disease that is increasingly treated by surgery. OBJECTIVE To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. METHODS This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. RESULTS In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in Helicobacter pylori infection (P=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. CONCLUSION There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.
RESUMO CONTEXTO A obesidade mórbida é doença multifatorial cujo tratamento cirúrgico é cada vez mais indicado. OBJETIVO Avaliar alterações histopatológicas gástricas em obesos e comparar com os submetidos à bypass gastrojejunal e a mucosa jejunal após a operação. MÉTODOS Estudo observacional realizado em hospital público terciário avaliando biópsias endoscópicas de 36 pacientes no pré-operatório e 35 no pós-operatório. RESULTADOS: No pré-operatório 80,6% apresentaram gastrite crônica, 38,9% em atividade (77,1% e 20,1%, respectivamente, no pós-operatório). O grupo pós-operatório apresentou diminuição significativa na infecção por Helicobacter pylory (P=0,0001). Maior comprimento do coto gástrico e tempo de operação superior a dois anos associaram-se a infecção por Helicobacter pylori. A mucosa jejunal foi normal em 91,4% e apresentava leve inflamação crônica inespecífica em 8,6%. CONCLUSÃO Houve diminuição da infecção por Helicobacter pylori após a operação. Maior comprimento do coto gástrico e do tempo de operação associaram-se à infecção por Helicobacter pylori. A mucosa jejunal foi considerada normal na maioria absoluta dos pacientes do grupo pós-operatório.
Assuntos
Humanos , Masculino , Feminino , Adulto , Obesidade Mórbida/patologia , Infecções por Helicobacter/patologia , Cirurgia Bariátrica , Mucosa Gástrica/patologia , Gastrite/patologia , Mucosa Intestinal/patologia , Fatores de Tempo , Obesidade Mórbida/cirurgia , Doença Crônica , Endoscopia Gastrointestinal , Infecções por Helicobacter/etiologia , Coto Gástrico , Pessoa de Meia-IdadeRESUMO
O melanoma maligno corresponde a 5% de todas as neoplasias da pele. Apresenta elevada agressividade local e tendência à disseminação através de metástases. O aparelho digestivo não é sítio secundário comum de melanoma, e o estômago é raramente comprometido. Relatamos caso de paciente do sexo masculino, 64 anos, com quadro de astenia progressiva, anemia, episódio de síncope e história de exérese de melanoma maligno nível IV de Clark em asa nasal há 6 anos, com esvaziamento de cadeia linfonodal cervical ipsilateral. Durante a investigação, foi encontrada massa gástrica, sendo submetido à gastrectomia total com reconstrução em Y de Roux, com melhora substancial dos sintomas. O exame anatomopatológico da massa gástrica confirma o resultado de metástase de melanoma maligno pela biópsia endoscópica pré-operatória. O paciente segue em acompanhamento ambulatorial sem manifestações de novas metástases até o momento. (AU)
Malignant melanoma accounts for 5% of all skin cancers. It has high local aggressiveness and tendency to spread through metastases. The digestive tract is not common secondary site of melanoma, and the stomach is rarely compromised. We report the case of a male patient, 64, with progressive asthenia, anemia, syncope and previously excision of malignant melanoma Clark level IV in nasal wing for 6 years with ipsilateral cervical lymph node emptying. During the investigation we found gastric mass and underwent total gastrectomy and Roux-en-Y with substantial improvement in symptoms. The anatomopathological examination of the gastric mass confirms the result of malignant melanoma metastasis by the preoperative endoscopic biopsy. The patient is in outpatient treatment without signs of new metastases so far. (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Estômago , Melanoma , Metástase Neoplásica , Neoplasias Cutâneas , Gastrectomia , Pessoa de Meia-IdadeRESUMO
Background: Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease. However, some authors have questioned the efficacy of this procedure and few studies on the long-term outcomes are available in the literature, especially in Brazil. Aim: To evaluate patients operated for gastro-esophageal reflux disease, for at least 10 years, by Nissen fundoplication. Methods: Thirty-two patients were interviewed and underwent upper digestive endoscopy, esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after Nissen fundoplication. Results: Most patients were asymptomatic, satisfied with the result of surgery (87.5%) 10 years after operation, due to better symptom control compared with preoperative and, would do it again (84.38%). However, 62.5% were in use of some type of anti-reflux drugs. The manometry revealed lower esophageal sphincter with a mean pressure of 11.7 cm H2O and an average length of 2.85 cm. The average DeMeester index in pH monitoring was 11.47. The endoscopy revealed that most patients had a normal result (58.06%) or mild esophagitis (35.48%). Barium swallow revealed mild esophageal dilatation in 25,80% and hiatal hernia in 12.9% of cases. Conclusion: After at least a decade, most patients were satisfied with the operation, asymptomatic or had milder symptoms of GERD, being better and with easier control, compared to the preoperative period. Nevertheless, a considerable percentage still employed anti-reflux medications.
Racional: O tratamento cirúrgico para DRGE empregando a fundoplicatura à Nissen é eficaz e seguro, oferecendo bons resultados no controle da doença. Entretanto, alguns autores têm questionado quanto a sua eficácia, e poucos estudos com avaliação tardia destes doentes são encontrados na literatura, sobretudo no Brasil. Objetivo: Avaliar pacientes operados por doença do refluxo gastroesofágico há pelo menos 10 anos, pela técnica de Nissen. Métodos: Trinta e dois pacientes foram entrevistados e submetidos à endoscopia digestiva alta, manometria esofágica, pHmetria prolongada de 24h e esofagograma baritado, antes e após a fundoplicatura à Nissen. Resultados: A maioria estava assintomático 10 anos após a operação e satisfeitos com o resultado dela (87,5%) e a fariam novamente (84,38%), devido melhor controle sintomático com medicação, em comparação com o período pré-operatório. Entretanto, 62,5% empregavam algum tipo de medicação anti-refluxo. Quanto aos exames, a manometria revelou extensão média de 2,85 cm de esfíncter esofágico inferior, com pressão média de 11,7 cm de H2O. O índice médio de DeMeester na pHmetria foi de 11,47. Na endoscopia a maior parte dos pacientes apresentou exame normal (58,06%), ou esofagite leve (35,48%). O esofagograma revelou discreta dilatação esofágica em 25,80% e hérnia hiatal em 12,9% dos casos. Conclusão: Após no mínimo uma década, a maioria dos doentes estava satisfeita com a operação, assintomática ou apresentava sintomatologia mais branda da DRGE que era de melhor e mais fácil controle, comparado ao período pré-operatório. Porcentagem não desprezível ainda empregava medicações para refluxo.
Assuntos
Fundoplicatura , Refluxo Gastroesofágico/cirurgia , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Satisfação do Paciente , Indução de Remissão , Fatores de TempoRESUMO
Background: Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. Methods: This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.
Racional: A obesidade mórbida é doença multifatorial cujo tratamento cirúrgico é cada vez mais indicado. Objetivo: Avaliar alterações histopatológicas gástricas em obesos e comparar com os submetidos à bypass gastrojejunal e a mucosa jejunal após a operação. Métodos: Estudo observacional realizado em hospital público terciário avaliando biópsias endoscópicas de 36 pacientes no pré-operatório e 35 no pós-operatório. Resultados: No pré-operatório 80,6% apresentaram gastrite crônica, 38,9% em atividade (77,1% e 20,1%, respectivamente, no pós-operatório). O grupo pós-operatório apresentou diminuição significativa na infecção por Helicobacter pylory (p=0,0001). Maior comprimento do coto gástrico e tempo de operação superior a dois anos associaram-se a infecção por Helicobacter pylori. A mucosa jejunal foi normal em 91,4% e apresentava leve inflamação crônica inespecífica em 8,6%. Conclusão: Houve diminuição da infecção por Helicobacter pylori após a operação. Maior comprimento do coto gástrico e do tempo de operação associaram-se à infecção por Helicobacter pylori. A mucosa jejunal foi considerada normal na maioria absoluta dos pacientes do grupo pós-operatório.
RESUMO
ABSTRACT Background: Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease. However, some authors have questioned the efficacy of this procedure and few studies on the long-term outcomes are available in the literature, especially in Brazil. Aim: To evaluate patients operated for gastro-esophageal reflux disease, for at least 10 years, by Nissen fundoplication. Methods: Thirty-two patients were interviewed and underwent upper digestive endoscopy, esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after Nissen fundoplication. Results: Most patients were asymptomatic, satisfied with the result of surgery (87.5%) 10 years after operation, due to better symptom control compared with preoperative and, would do it again (84.38%). However, 62.5% were in use of some type of anti-reflux drugs. The manometry revealed lower esophageal sphincter with a mean pressure of 11.7 cm H2O and an average length of 2.85 cm. The average DeMeester index in pH monitoring was 11.47. The endoscopy revealed that most patients had a normal result (58.06%) or mild esophagitis (35.48%). Barium swallow revealed mild esophageal dilatation in 25,80% and hiatal hernia in 12.9% of cases. Conclusion: After at least a decade, most patients were satisfied with the operation, asymptomatic or had milder symptoms of GERD, being better and with easier control, compared to the preoperative period. Nevertheless, a considerable percentage still employed anti-reflux medications.
RESUMO Racional: O tratamento cirúrgico para DRGE empregando a fundoplicatura à Nissen é eficaz e seguro, oferecendo bons resultados no controle da doença. Entretanto, alguns autores têm questionado quanto a sua eficácia, e poucos estudos com avaliação tardia destes doentes são encontrados na literatura, sobretudo no Brasil. Objetivo: Avaliar pacientes operados por doença do refluxo gastroesofágico há pelo menos 10 anos, pela técnica de Nissen. Métodos: Trinta e dois pacientes foram entrevistados e submetidos à endoscopia digestiva alta, manometria esofágica, pHmetria prolongada de 24h e esofagograma baritado, antes e após a fundoplicatura à Nissen. Resultados: A maioria estava assintomático 10 anos após a operação e satisfeitos com o resultado dela (87,5%) e a fariam novamente (84,38%), devido melhor controle sintomático com medicação, em comparação com o período pré-operatório. Entretanto, 62,5% empregavam algum tipo de medicação anti-refluxo. Quanto aos exames, a manometria revelou extensão média de 2,85 cm de esfíncter esofágico inferior, com pressão média de 11,7 cm de H2O. O índice médio de DeMeester na pHmetria foi de 11,47. Na endoscopia a maior parte dos pacientes apresentou exame normal (58,06%), ou esofagite leve (35,48%). O esofagograma revelou discreta dilatação esofágica em 25,80% e hérnia hiatal em 12,9% dos casos. Conclusão: Após no mínimo uma década, a maioria dos doentes estava satisfeita com a operação, assintomática ou apresentava sintomatologia mais branda da DRGE que era de melhor e mais fácil controle, comparado ao período pré-operatório. Porcentagem não desprezível ainda empregava medicações para refluxo.
Assuntos
Humanos , Refluxo Gastroesofágico/cirurgia , Fundoplicatura , Fatores de Tempo , Indução de Remissão , Refluxo Gastroesofágico/tratamento farmacológico , Satisfação do PacienteRESUMO
ABSTRACT Background: Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. Methods: This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.
RESUMO Racional: A obesidade mórbida é doença multifatorial cujo tratamento cirúrgico é cada vez mais indicado. Objetivo: Avaliar alterações histopatológicas gástricas em obesos e comparar com os submetidos à bypass gastrojejunal e a mucosa jejunal após a operação. Método: Estudo observacional realizado em hospital público terciário avaliando biópsias endoscópicas de 36 pacientes no pré-operatório e 35 no pós-operatório. Resultados: No pré-operatório 80,6% apresentaram gastrite crônica, 38,9% em atividade (77,1% e 20,1%, respectivamente, no pós-operatório). O grupo pós-operatório apresentou diminuição significativa na infecção por Helicobacter pylory (p=0,0001). Maior comprimento do coto gástrico e tempo de operação superior a dois anos associaram-se a infecção por Helicobacter pylori. A mucosa jejunal foi normal em 91,4% e apresentava leve inflamação crônica inespecífica em 8,6%. Conclusão: Houve diminuição da infecção por Helicobacter pylori após a operação. Maior comprimento do coto gástrico e do tempo de operação associaram-se à infecção por Helicobacter pylori. A mucosa jejunal foi considerada normal na maioria absoluta dos pacientes do grupo pós-operatório.
RESUMO
Background: Immunological and inflammatory mechanisms play a key role in the development and progression of type 2 diabetes mellitus. Aim: To raise the hypothesis that alterations in immunological parameters occur after duodenojejunal bypass surgery combined with ileal interposition without gastrectomy, and influences the insulin metabolism of betacells. Methods: Seventeen patients with type 2 diabetes mellitus under clinical management were submitted to surgery and blood samples were collected before and six months after surgery for evaluation of the serum profile of proinflammatory (IFN-γ, TNF-α, IL-17A) and anti-inflammatory cytokines (IL-4, IL-10). In addition, anthropometric measures, glucose levels and insulin use were evaluated in each patient. Results: No changes in the expression pattern of proinflammatory cytokines were observed before and after surgery. In contrast, there was a significant decrease in IL-10 expression, which coincided with a reduction in the daily insulin dose, glycemic index, and BMI of the patients. Early presentation of food to the ileum may have induced the production of incretins such as GLP-1 and PYY which, together with glycemic control, contributed to weight loss, diabetes remission and the consequent good surgical prognosis of these patients. In addition, the control of metabolic syndrome was responsible for the reduction of IL-10 expression in these patients. Conclusion: These findings suggest the presence of low-grade inflammation in these patients during the postoperative period, certainly as a result of adequate glycemic control and absence of obesity, contributing to a good outcome of surgery.
Racional: Mecanismos imunológicos e inflamatórios desempenham papel-chave no desenvolvimento e progressão do diabete melito tipo 2. Objetivo: Levantar a hipótese de que alterações nos parâmetros imunológicos ocorrem após operação duodenojejunal combinada com interposição ileal sem gastrectomia, e influenciam o metabolismo da insulina das células beta. Métodos: Dezessete pacientes com diabete melito tipo 2 sob manejo clínico foram submetidos à cirurgia e amostras de sangue foram coletadas antes e seis meses após para avaliação do perfil de sorológico de citocinas pró-inflamatórias (IFN-γ, TNF-α, IL-17A) e anti-inflamatórias(IL-4, IL-10). Além disso, parâmetros antropométricos, glicemia e uso de insulina foram avaliados em cada paciente. Resultados: Não ocorreram alterações no padrão de expressão de citocinas pró-inflamatórias observadas antes e depois da operação. Em contraste, houve diminuição significativa na expressão de IL-10, que coincide com redução da dose diária de insulina, com o controle glicêmico e redução do IMC dos pacientes. Apresentação precoce de alimentos para o íleo pode ter induzido a produção das incretinas tais como GLP-1 e PYY, que, juntamente com o controle da glicemia, contribuíram para a perda de peso, remissão do diabete e o bom prognóstico consequente cirúrgico. Além disso, o controle de síndrome metabólica foi responsável pela redução da expressão de IL-10 nestes doentes. Conclusão: Baixo grau de inflamação estava presente nesses pacientes no pós-operatório, certamente pelo adequado controle glicêmico e ausência de obesidade, o que contribuiu para bom resultado cirúrgico.