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  • 1
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    Online Resource
    Non-conventional surgical approach to achalasia: mucosectomy and endomuscular pull-through
    OAE Publishing Inc. ; 2017
    In:  Mini-invasive Surgery ( 2017-11-28)
    Details
    In: Mini-invasive Surgery, OAE Publishing Inc., ( 2017-11-28)
    Type of Medium: Online Resource
    ISSN: 2574-1225
    URL: Article
    DOI: 10.20517/2574-1225.2017.29
    Language: Unknown
    Publisher: OAE Publishing Inc.
    Publication Date: 2017
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  • 2
    Online Resource
    Online Resource
    Avaliação da terapêutica cirúrgica do divertículo faringoesofágico pela sutura mecânica
    FapUNIFESP (SciELO) ; 2012
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 25, No. 2 ( 2012-06), p. 91-95
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 25, No. 2 ( 2012-06), p. 91-95
    Abstract: BACKGROUND: Pharyngoesophageal diverticulum presents itself as an uncommon disorder. Thus, choosing the most effective treatment method may be challenging. Surgical treatment remains as the main option. However, establishing the best surgical technique is still controversial. AIM: To evaluate the results of diverticulecomy with chricopharyngeal miotomy and linear stapler closure of the pharynx in a patient sample with Zenker`s diverticulum regarding local and systemic complications. METHODS: Nineteen patients with pharyngoesophageal diverticulum were admitted. All of them presented the clinical conditions required to indicate the surgical procedure. Patients were evaluated with regard to any post-operative complications. This study was conducted retrospectively with patients' data analysis. RESULTS - Patients showed satisfactory results, with no evidence of fistula at the level of the pharyngeal suture. Two out of 19 lost post-operative follow-up and one of them had pharyngeal stenosis reverted with endoscopic dilation. The entire sample reported being satisfied with the procedure emphasizing improvement of the quality of life mainly due to the return of physiological deglutition. CONCLUSION: The diverticulectomy with myotomy and posterior pharyngeal closure with linear surgical stapler proved to be an effective technique, offering a lower risk of post-operative complications and improving the overall quality of life.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202012000200006
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2012
    detail.hit.zdb_id: 2560235-4
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  • 3
    Online Resource
    Online Resource
    Avaliação da anastomose esofagogástrica cervical com sutura mecânica e manual em pacientes com megaesôfago avançado
    FapUNIFESP (SciELO) ; 2009
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 36, No. 1 ( 2009-02), p. 19-23
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 36, No. 1 ( 2009-02), p. 19-23
    Abstract: OBJECTIVES: The aim of the study is to evaluate cervical esophagogastric anastomosis complications between mechanical device versus manual suture. METHOD: Thirty patients with megaesophagus with grade III/IV submitted to the esophagectomy transmediastinal approach were reviewed with average age from 31 to 68 years. The reconstruction was performed by gastric transposition and with anastomosis in the cervical region. The patients were divided in two groups: A) 15 patients had mechanical suture with the DHC 29 mm device, and B) 15 patients had manual suture in two layers. RESULTS: Five patients (16.6%) presented pneumonia, and they were managed clinically. Three patients were in group B and two were in group A, and no statistical significance was found. Six patients (20%) presented leakage at the cervical esophagogastric anastomosis; one in group A (6.6%) and five in group B (33.3%), with no statistical significance. Anastomosis leakage with development of stricture occurred in five patients in group B, and in three in group A, as well in other two without leakage complications. All of them were managed successfully with endoscopic dilatation. Statistical evaluation was not significant for this complication between group B (33.3%) and group A (20%). There were no deaths in this study. CONCLUSION: This study showed that mechanical suture is as adequate as manual suture by presenting anastomosis leakage incidence smaller, however, with no statistical significance, and with similar stricture incidence.
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912009000100006
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2009
    detail.hit.zdb_id: 2223714-8
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  • 4
    Online Resource
    Online Resource
    Reconstrução esofágica pela esofagocoloplastia no megaesôfago avançado em pacientes gastrectomizados
    FapUNIFESP (SciELO) ; 2009
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 22, No. 4 ( 2009-12), p. 197-200
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 22, No. 4 ( 2009-12), p. 197-200
    Abstract: BACKGROUND: Esophagocoloplasty in advanced chagasic megaesophagus is seldom necessary. But, when realized, brings with it a major incidence of complications. AIM: To verify the complications following esophagus reconstruction by esophagocoloplasty in patients with previous gastrectomy submitted to transmediastinal esophagectomy for chagasic megaesophagus end-stage. METHODS: From July 1983 to April 2009, 204 patients with chagasic megaesophagus stage III and IV were submitted to esophageal resection at the Surgery Department at the Hospital Celso Pierro Puc-Campinas, Brasil. Ninety-two patients had the procedure done by esophageal mucosectomy; 84 under-went a transhiatal esophagectomy and in 38, esophagectomies were done through a transthoracic approach. In 194 patients (95%) the reconstruction was done by gastric interposition and in the 10 remaining patients (5%) it was by transposition of the transverse colon. This procedure was recommend due to previous gastrectomy done in all patients. All of them were male with average age of 47.5 years old. RESULTS: Seven patients (70%) developed one or more complications, either systemic or local. Among the systemic complications, one patient had thrombophlebitis in the lower extremity, with good recovery; one had a myocardial infarction with fatal evolution; three patients (30%) had pulmonary infection with good recovery. Amongst the local complications, four patients had cervical anastomotic leak with satisfactory recovery with conservative treatment. Five had cervical anastomotic stricture between the 35th and the 63rd post-operative day, with good recovery after endoscopic anastomotic dilatations. From the eight patients followed during this period, six (75%) had good deglutition for solids and/or semi-solids, and satisfied with the surgery since were able to return to their regular diet. CONCLUSIONS: Despite the fact that the esophagocoloplasty results in a good deglutition and quality of life, in short and medium terms, it must be considered a surgical technic with high morbidity in gastrectomized patients.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202009000400003
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2009
    detail.hit.zdb_id: 2560235-4
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  • 5
    Online Resource
    Online Resource
    Carcinoma epidermóide "in situ" em divertículo de Zenker
    FapUNIFESP (SciELO) ; 2005
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 32, No. 2 ( 2005-04), p. 106-107
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 32, No. 2 ( 2005-04), p. 106-107
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912005000200013
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2005
    detail.hit.zdb_id: 2223714-8
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  • 6
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    Online Resource
    Avaliação das complicações da esofagectomia de resgate na terapêutica cirúrgica do câncer de esôfago avançado
    FapUNIFESP (SciELO) ; 2013
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 26, No. 3 ( 2013-09), p. 173-178
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 26, No. 3 ( 2013-09), p. 173-178
    Abstract: BACKGROUND: Even though the esophageal cancer has innumerous treatment options its prognosis is still unsettled. Because esophagectomy is rarely curative, new and emerging therapies come to light such as isolated chemotherapy and radiotherapy or combined chemoradiation, followed or not by surgery. The rescue esophagectomy is an alternative for those patients with recurrent or advanced disease. AIM: To evaluate the results of the rescue esophagectomy in patients with esophageal cancer who had previously undergone chemoradiation and describe local and systemic complications of the procedure. METHODS: Eighteen patients with unresectable esophageal squamous cell carcinoma were treated with chemoradiation followed by rescue esophagectomy. All of them presented the preoperative clinical conditions required to indicate the surgical procedure. Transthoracic esophagectomy with right side thoracotomy plus midline laparotomy was performed. Patients were evaluated with regard to any postoperative complications. RESULTS: There were five patients with evidence of fistula at the level of the anastomosis, and four of them progressed satisfactorily. Postoperative dilation was needed in five out of eighteen patients due to stenosis of the esophagogastric suture line. Seven patients did develop pulmonary infection with a fatal outcome for two of them. Among the patients who were available for a five-year follow-up, there was a rate of 53.8% of disease-free survival. CONCLUSIONS: These patients presented an elevated morbidity of the procedure related to many factors such as the long period between chemoradiation and surgery, which leads to tissue injury resulting in anastomotic fistulas. Nevertheless, esophagectomy seems to be valuable in cases without any other therapeutic option.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202013000300004
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2013
    detail.hit.zdb_id: 2560235-4
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  • 7
    Online Resource
    Online Resource
    Avaliação tardia da mucosectomia esofágica com conservação da túnica muscular em pacientes com megaesôfago avançado
    FapUNIFESP (SciELO) ; 2007
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 34, No. 1 ( 2007-02), p. 9-15
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 34, No. 1 ( 2007-02), p. 9-15
    Abstract: BACKGROUND: To perform a long term evaluation the technique of the esophageal mucosectomy in patients with advanced mega esophagus. METHOD: 50 patients with advanced mega esophagus submitted the esophageal mucosectomy with conservation of muscular layer in period of January 1991 to December of 1997 underwent a late evaluation between 6 to 15 years after the surgical procedure. The age varied between 30 and 69 years (mean age of 53.5 years), 32 (64%) of them were males. The quality of deglution, the presence of regurgitation, alterations of the intestinal habit, the heavy evolution, the satisfaction with the surgery and with regard to normal work were assessed in all patients. Additionally, the morphological and functional evaluation with a contrast radiological study, upper digestive endoscopy and the thoracic CT scan were also performed. Each of the parameters were considered as good, excellent, regular and bad in accordance with total of the assigned points. RESULTS: In global clinical evaluation, 44 patients (88%) were considered as between excellent and good, while regular and bad in the others. In a global radiological evaluation, excellent and good had been presented in 47 patients (94%) and regular and bad in the others. In global endoscopic evaluation, 45 patients (90%) had excellent and good results, while regular and bad in the others. In relation the thoracic CT scan, 31 patients were considered good in all patients where the reconstruction of transit was carried through by the retroesternal route and excellent and good in all the patients where the reconstruction was through the transmediastinal route. CONCLUSION: The long term evaluation of patients submitted to esophageal mucosectomy for advanced mega esophagus showed excellent and good results in morphological, functional and clinical results in the majority of them.
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912007000100004
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2007
    detail.hit.zdb_id: 2223714-8
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  • 8
    Online Resource
    Online Resource
    Análise das complicações da esofagectomia transmediastinal no tratamento cirurgico do megaesôfago recidivado
    FapUNIFESP (SciELO) ; 2011
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 24, No. 1 ( 2011-03), p. 30-35
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 24, No. 1 ( 2011-03), p. 30-35
    Abstract: BACKGROUND: The best option for the treatment of patients with achalasia and recurrent symptoms after previous treatment, has always been very controversial. In literature review, there is no surgical technique considered the best to deal with this condition. The idea to use a more selective treatment with transmediastinal esophagectomy without thoracotomy in patients with advanced megaesophagus in relapsed cases after prior cardiomyotomy can be considered. AIM: To evaluate the results of transmediastinal esophagectomy in recurrent megaesophagus regarding local and systemic complications. METHODS: Thrity two patients were treated with recurrent symptoms after previous surgery to achalasia and indication for esophagectomy with gastric transmediastinal transposition through the posterior mediastinum for grade IV megaesophagus. They were 25 men (78.1%) and seven women (21.9%), aged from 34 to 72 years. All underwent previous myotomy varying from five to 39 years to the day of transmediastinal esophagectomy. RESULTS: Some patients had complications. Among these, eight had pulmonary infection (25.0%) resulting in good outcome to the specific clinical treatment; two died due to hemodynamic effect caused by injury to the azygos vein and the other due to trachea injury; nine (28.1% ) had cervical esophagogastric anastomotic dehiscence doing well with conservative treatment. Of the 21 patients in whom monitoring was carried out in the long term - six months to 14 years -, 17 reported good swallowing solids and pastes, four (19.0%) had gastroesophageal reflux with clinical improvement with specific medical treatment. CONCLUSIONS: Transmediastinal esophagectomy, although providing adequate swallowing in most cases, is a procedure of high morbidity. This technique should not be recommended as first treatment option for relapsed megaesophagus.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202011000100007
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2011
    detail.hit.zdb_id: 2560235-4
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  • 9
    Online Resource
    Online Resource
    Esofagocardioplastia no tratamento cirúrgico do megaesôfago não avançado recidivado
    FapUNIFESP (SciELO) ; 2012
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 25, No. 1 ( 2012-03), p. 20-24
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 25, No. 1 ( 2012-03), p. 20-24
    Abstract: BACKGROUND: It has always been very controversial to choose an ideal operation for patients with no advanced recurrent megaesophagus after previous treatment. The various existing techniques and the different degrees of disease are the major factors to this difficulty. AIM: To evaluate the early and late results of the Serra-Doria esophagocardioplasty in patients who had recurrence of symptoms in non-advanced megaesophagus after having been submitted to cardiomyotomy. METHODS: Were studied 32 patients. The age ranged from 32 to 63 years. Nineteen had mild and 13 moderate dysphagia, and 14 had some degree of regurgitation. These subjects underwent the Serra-Doria esophagocardioplasty and were evaluated the local and systemic complications occurred postoperatively. RESULTS: After the procedure could be followed 27 patients, 22 began to show normal swallowing, five mild dysphagia and three remained with some regurgitation. No patient died. Three had early pneumonia and in one occurred anastomotic leak. CONCLUSIONS: The Serra-Doria esophagocardioplasty is adequate procedure for the surgical treatment of relapsed non advanced megaesophagus.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202012000100005
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2012
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  • 10
    Online Resource
    Online Resource
    Pneumomediastino espontâneo (síndrome de Hamman) relato de dois casos
    Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais ; 2016
    In:  Revista de Medicina Vol. 95, No. 3 ( 2016-12-15), p. 138-
    Details
    In: Revista de Medicina, Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais, Vol. 95, No. 3 ( 2016-12-15), p. 138-
    Abstract: Objetivo: Descrever dois casos de pneumomediastino espontâneo na mesma unidade de serviço, em pacientes jovens de sexo diferentes e que apresentaram boa evolução com tratamento conservador. Métodos: O primeiro caso é de um paciente do sexo masculino, 18 anos, com queixa de cervicalgia à direita e disfonia há 2 dias. Negou traumatismos ou ingesta de corpos estranhos, esforços físicos intensos, acessos de tosse e vômitos ou uso de drogas. TC de tórax e pescoço revelou presença de enfisema subcutâneo cervical anterior bilateral, presença de pneumomediastino e ausência de pneumotórax. O segundo caso a ser analisado trata-se de uma paciente do sexo feminino, 16 anos, com queixa de dispneia súbita e mudança do padrão de voz (nasalada). Identificou-se crepitação fina à palpação cervical sugestiva de enfisema subcutâneo. Negou qualquer causa provável de pneumomedisatino secundário. TC de tórax e pescoço revelou pneumomediastino acentuado com extensão para os espaços cervicais profundos. Resultado: Ambos os casos partilham de sinais e sintomas previamente descritos na literatura e tiveram seus diagnósticos obtidos por meio de tomografia computadorizada de tórax. O tratamento sintomático associado a repouso foi eficaz em ambas situações. Conclusões: Pneumomediastino espontâneo pode ser subdiagnosticado devido aos seus sinais e sintomas inespecíficos, contribuindo para seu caráter raro. É importante estabelecer-se os diagnósticos diferenciais e eventos a que os pacientes estiveram expostos. Uma anamnese detalhada acompanhada de aparatos radiológicos permitem o diagnóstico preciso e tratamento correto.
    Type of Medium: Online Resource
    ISSN: 1679-9836 , 0034-8554
    URL: Article
    DOI: 10.11606/issn.1679-9836.v95i3p138-141
    Language: Unknown
    Publisher: Universidade de São Paulo. Agência de Bibliotecas e Coleções Digitais
    Publication Date: 2016
    detail.hit.zdb_id: 3117838-8
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