RESUMO
Bladder reconstruction with a gastric portion, as an alternative to other intestinal segments, has gained popularity lately. We have used a vascularized gastric segment for bladder replacement in 20 patients aged 3 to 77 years old, between 1990 and 1993. The surgical indication was due to a severe radiation cystitis in 11 cases, neurogenic bladder in 4, urinary diversion in 4 and cystectomy due to bladder cancer in 2. In 18 cases, associated surgical procedures were performed. Mild complications occurred in 3 cases and no patient died. Postoperative evolution has been excellent. Sixteen patients maintained a normal miction and 4 required self performed urethral intubation. It is concluded that stomach is a good alternative for bladder reconstruction. We are employing it with higher frequency in our practice due to the technical simplicity and the physiological advantages of its use. The metabolic acidosis secondary to ionic absorption that occurs with the use of other intestinal segments, specially in patients with renal failure, is avoided. Also, it facilitates surgical procedures in patients with severe abdominal radiation damage.
Assuntos
Estômago/cirurgia , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Derivação UrináriaRESUMO
After an initial experience with 4 patients who received orthotopic liver transplant (OLT) we analyze the perspectives of establishing liver transplantation programs in Chile. An estimated 100 adult and pediatric patients require OLT a year and no more than 3 centers are required to deal with this and acquire experience with the procedure. A national organization for organ procurement is essential, given the marked difficulties in obtaining cadaver organs at present. Each procedure has an estimated cost of $5 million with 2 more millions in the first year. Thus a program for 15 patients a year may cost $ 100 million, personnel expenses not included.