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  • 1
    Online Resource
    Online Resource
    COMPARATIVE ANALYSIS OF LATE RESULTS OF CERVICAL ESOPHAGOGASTRIC ANASTOMOSIS BY MANUAL AND MECHANICAL SUTURE IN PATIENTS SUBMITTED TO ESOPHAGEAL MUCOSECTOMY THROUGH ADVANCED MEGAESOPHAGUS
    FapUNIFESP (SciELO) ; 2019
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 32, No. 4 ( 2019)
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 32, No. 4 ( 2019)
    Abstract: RESUMO Racional: Das anastomoses do trato gastrointestinal, as do esôfago têm especial interesse devido às varias peculiaridades anatômicas e mesmo sistêmicas. Objetivo: Avaliar retrospectivamente os resultados comparando a sutura mecânica e manual na anastomose esofagogástrica cervical no tratamento do megaesôfago. Métodos: Foram estudados 92 pacientes com diagnóstico de megaesôfago avançado com condições clínicas de serem submetidos à operação. Todos foram submetidos à mucosectomia esofágica, sendo realizada anastomose do coto esofágico com o tubo gástrico no nível cervical. Para a realização desta anastomose, foram divididos em dois grupos: grupo A (n=53) com sutura mecânica circular terminolateral; grupo B (n=39) com sutura manual em dois planos terminolateral. No período pós-operatório foi realizada avaliação precoce, com análise das complicações locais e sistêmicas, e tardia (média 5,6 anos) com análise da deglutição. Resultados: Avaliação precoce: a) deiscência da anastomose esofagogástrica, n=5 (9,4%) no grupo A vs. n=9 (23,0%) no grupo B (p=0.0418); b) estenose da anastomose esofagogástrica n=8 (15,1%) no grupo A vs. n=15 (38,4%) no grupo B (p=0.0105); c) infecção pulmonar n=5 (9,4%) no grupo A vs. n=3 (7,6%) no grupo B (p=1.000); d) derrame pleural n=5 (9,4%) no grupo A vs. n=6 (15,4%) no grupo B (p 〈 0.518). A avaliação tardia demonstrou que 86,4 a 96,0% dos pacientes apresentaram critérios 4 e 5 de SAEED, demonstrando deglutição efetiva e sem diferença significante entre os grupos. Conclusão: A anastomose esofagogástrica pela sutura mecânica é mais adequada que a manual com pequena incidência de complicações locais e, na avaliação em longo prazo, a deglutição demonstrou ser adequada em ambos os grupos e com qualidade semelhante.
    Type of Medium: Online Resource
    ISSN: 2317-6326 , 0102-6720
    URL: Article
    DOI: 10.1590/0102-672020190001e1462
    Language: English
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2019
    detail.hit.zdb_id: 2560235-4
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  • 2
    Online Resource
    Online Resource
    Derivação retroesternal com tubo gástrico isoperistáltico no carcinoma irressecável de esôfago
    FapUNIFESP (SciELO) ; 2003
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 30, No. 2 ( 2003-04), p. 142-147
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 30, No. 2 ( 2003-04), p. 142-147
    Abstract: BACKGROUND: The objective of this study is to determine the beneficial of palliative esophageal bypass with isoperistaltic gastric tube in patients with unresectable esophagus carcinoma. METHODS: We studied 53 patients with unresectable squamous cell carcinoma of the esophagus as showed by endoscopic, radiologic and clinical data. Most of the patients were male and the average age was 56,8 years. The operation performed was an isoperistaltic gastric tube transposed through the retrosternal space. RESULTS: Twenty-eight patients (52%) developed one or more complications and the most frequent ones were leakage or stenosis of cervical anastomosis (15 patients 28,3%). Mortality rate was 9,4%. Of the 48 patients that survived, 37 (77%) refered relief of disphagia in the follow-up. The mean survival rate of 23 patients was 7,5 months (six to 13 months) and 14 patients are doing well after two to 16 months of follow-up. CONCLUSIONS: Isoperistaltic gastric tube has acceptable morbidity and mortality with relief of dysphagia in the majority of the patients.
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912003000200010
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2003
    detail.hit.zdb_id: 2223714-8
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  • 3
    Online Resource
    Online Resource
    Malignant Graves’ Ophthalmopathy
    Scientific Research Publishing, Inc. ; 2014
    In:  International Journal of Otolaryngology and Head & Neck Surgery Vol. 03, No. 02 ( 2014), p. 71-74
    Details
    In: International Journal of Otolaryngology and Head & Neck Surgery, Scientific Research Publishing, Inc., Vol. 03, No. 02 ( 2014), p. 71-74
    Type of Medium: Online Resource
    ISSN: 2168-5452 , 2168-5460
    URL: Article
    DOI: 10.4236/ijohns.2014.32015
    Language: Unknown
    Publisher: Scientific Research Publishing, Inc.
    Publication Date: 2014
    detail.hit.zdb_id: 2681392-0
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  • 4
    Online Resource
    Online Resource
    Microsurgical head and neck reconstruction: retrospective analysis of 30 free flaps
    GN1 Sistemas e Publicacoes Ltd. ; 2016
    In:  Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery Vol. 31, No. 4 ( 2016), p. 481-490
    Details
    In: Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, GN1 Sistemas e Publicacoes Ltd., Vol. 31, No. 4 ( 2016), p. 481-490
    Type of Medium: Online Resource
    ISSN: 2177-1235
    URL: Article
    DOI: 10.5935/2177-1235.2016RBCP0080
    Language: English
    Publisher: GN1 Sistemas e Publicacoes Ltd.
    Publication Date: 2016
    detail.hit.zdb_id: 3130895-8
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  • 5
    Online Resource
    Online Resource
    Mucosectomia esofágica no tratamento do megaesôfago avançado: análise de 60 casos
    FapUNIFESP (SciELO) ; 2000
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 27, No. 2 ( 2000-04), p. 108-113
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 27, No. 2 ( 2000-04), p. 108-113
    Abstract: Partial ou total esophagectomy without thoracotomy has been used with greater frequency for the last few years to treat benign affections, specially advanced megaesophagus. Although this procedure presents the advantages of avoiding compromise of lung dynamics, it is not free complications. Among these, we have to emphasize the opening of pleura with hemopneumothorax, together with the potential aggression to other organs in the mediastinum, with a significant postoperative morbidity. On the other hand, in advanced megaesophagus, stasis esophagitis may lead to carcinoma. Based on these considerations, it was proposed, previously in animals and human beings, mucosal and submucosal removal by complete invagination, without thoracotomy. These results were satisfactory in experimental surgery and encouraged the beginning of the clinical experience area. Thus, the aim of the present work is to show, by a detailed analysis, the tecnique of esophageal mucosal and submucosa removal from the muscular layer, main taining it complete at the mediastinum. This procedure was performed by a cervicoabdominal approach in 60 patients with grade III and IV megaesophagus. The reconstruction of the gastrointestinal tract by the stomach transposition was performed through the posterior mediastinum inside the muscular layer or by retrosternal route. The study allowed us the following conclusions: 1) the mucosa removal by the submucosa, through invagination proved to be simple and seasible in 98,4% of the cases; 2) the absence of bleeding from the bed layer muscular esophagus, during or at immediate postoperative period; 3) The incidence of pleura and lung complications - (5,0%.) is low.
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912000000200008
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2000
    detail.hit.zdb_id: 2223714-8
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  • 6
    Online Resource
    Online Resource
    Carcinoma diferenciado da tireóide: a validade da complementação da tireoidectomia
    FapUNIFESP (SciELO) ; 2001
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 28, No. 2 ( 2001-04), p. 121-124
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 28, No. 2 ( 2001-04), p. 121-124
    Abstract: BACKGROUND: Our goal is to analyze tumor invasion of the contralateral thyroid lobe, evaluating the relationship between risk/benefit with complications of a second surgery. METHOD: From October, 1993 to December, 1996 twenty patients with thyroid tumors were operated. The analysed variables were sex, age, type of surgery, complications, histophatologic examination ot the surgical especimen and contralateral lobe invasion. There were 2 men and 18 women; the age ranged from 17 to 89 years old; the most common histologic type was papillary carcinoma (13 cases) followed by follicular carcinoma (6 cases) and Hürtle cell carcinoma (1 case). The initial surgical procedures were 11 lobectomies plus isthmectomies; 4 lobectomies; 3 subtotal thyroidectomies; 1 total thyroidectomy and 1 isthmectomy. Five patients were not submitted to total thyroidectomy (1 by fibrosis, 3 by loose of follow-up and 1 case of microcarcinoma). RESULTS: Analysis of the contralateral lobe (performed in 15 patients) showed that 11 were negative and 4 positive (26,6%). Complications observed were dysphonia (2 cases treated with fonotherapy), and hypoparathyroidism (1 transient and 1 permanent). CONCLUSIONS: The totalization of thyroidectomy is an important procedure for the treatment of malignant tumors of thyroid due by the high rate of contralateral metastasis (26,6%). Moreover, it's a procedure without mortality with lower complications.
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912001000200008
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2001
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  • 7
    Online Resource
    Online Resource
    ASSESSMENT OF MECHANICAL AND MANUAL SUTURE IN THE SURGICAL TREATMENT OF THE PHARYNGOESOPHAGEAL DIVERTICULUM
    FapUNIFESP (SciELO) ; 2015
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 28, No. 4 ( 2015-12), p. 239-242
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 28, No. 4 ( 2015-12), p. 239-242
    Abstract: Racional: A ocorrência do divertículo faringoesofágico, ou de Zenker, é pouco frequente no cenário nacional, sendo que a técnica da diverticulectomia com cricomiotomia em divertículos de média e grandes dimensões ainda é a mais indicada. Devido à ressecção do divertículo necessitar de sutura da faringe ocorre possibilidade de deiscência, o que retarda o retorno da deglutição. Daí a ideia de realizar este procedimento cirúrgico, comparando a sutura manual com a mecânica, para avaliar o real benefício da técnica mecânica. Objetivo: Avaliar os resultados da diverticulectomia faringoesofágica com cricomiotomia utilizando à sutura manual e mecânica em relação às complicações locais e sistêmicas. Métodos: Foram estudados 57 pacientes com divertículos faringoesofágicos diagnosticados através da endoscopia digestiva alta e faringoesofagograma. A técnica cirúrgica empreendida foi a diverticulectomia com miotomia do músculo cricofaríngeo, sendo a sutura mecânica realizada em 24 pacientes (42,2%, grupo A) com o aparelho linear e em 33 (57,8%, grupo B) a manual para o fechamento da faringe. Resultados: Na avaliação do pós-operatório precoce, um paciente do grupo A (4,1%) apresentou fístula consequente à deiscência da sutura da faringe e três do grupo B (15,1%) ambos com boa evolução com tratamento conservador. Neste mesmo grupo, três pacientes (9,0%) apresentaram estenose da sutura da faringe, com boa evolução com dilatações endoscópicas sendo que nenhum do grupo A apresentou esta complicação. A infecção pulmonar esteve presente em cinco pacientes, dois (8,3%) do grupo A e três (9,0%) do grupo B, com boa evolução com tratamento específico. Na avaliação tardia, realizada em 43 pacientes, 17(94,4%) do grupo A e 22 (88,0%) do grupo B, os pacientes referiram estarem satisfeitos com o procedimento cirúrgico, pois conseguiram resgatar a deglutição normal. Conclusões: A diverticulectomia com a miotomia do cricofaríngeo demonstrou ser procedimento cirúrgico adequado por restaurar deglutição adequada e o fechamento da faringe com sutura mecânica mostrou-se técnica mais eficaz em relação à sutura manual, com menor índice de complicações pós-operatórias locais
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/s0102-6720201500040005
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2015
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  • 8
    Online Resource
    Online Resource
    Tubo gástrico isoperistáltico de grande curvatura gástrica com sutura mecânica no tratamento cirúrgico do câncer de esôfago irressecável
    FapUNIFESP (SciELO) ; 2009
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 22, No. 3 ( 2009-09), p. 147-152
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 22, No. 3 ( 2009-09), p. 147-152
    Abstract: BACKGROUND: The diagnose of esophageal cancer is in general done clinically late, remaining the palliative treatment the only possibility to improve the quality of life. The isoperistaltic gastric tube transposition may be used, however, if leakage happens, the swallow may be hindered, compromising deglutition. AIM: To evaluate the complications that can happen in the cervical esophagogastric anastomosis done with stapler, in patients with non resectable esophageal cancer. METHOD: Twenty two patients with non resectable esophageal cancer were submitted to an isoperistaltic gastric tube transposition. The esophagogastric anastomosis was made with circular stapler. Systemic and local complications were evaluated. RESULTS: Ten patients (45,5%) presented 1 to 3 complications, and in 6 (27,2%) of them, systemic ones. There were one (4,5%) case of lung embolism (with death), one miocardial infarction and four lung infections (all of them with good clinical evolution). Five had local complications; in three (13,6%), anastomotic leakage, and in four (18,2%), anastomotic stricture among the ones that had previous leakage. Twenty patients were followed through 11 months, and 16 (80%) of them maintained satisfactory swallow to solid and/or semi-solid meals. CONCLUSION: The isoperistaltic gastric tube of greater curvature with stapler suture seems to offer significant improvement on swallow with satisfactory quality of life and acceptable morbi-mortality.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202009000300003
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2009
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  • 9
    Online Resource
    Online Resource
    Evaluation of urgent esophagectomy in esophageal perforation
    FapUNIFESP (SciELO) ; 2014
    In:  ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) Vol. 27, No. 4 ( 2014-12), p. 247-250
    Details
    In: ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), FapUNIFESP (SciELO), Vol. 27, No. 4 ( 2014-12), p. 247-250
    Abstract: RACIONAL: O trauma de esôfago é considerado uma das lesões mais graves do trato digestivo. O tratamento de escolha para casos de perfuração esofágica ainda é controverso, visto que esta decisão envolve inúmeras variáveis. As condições clínicas do paciente, as condições locais no segmento do esôfago perfurado, a gravidade das lesões associadas e o tempo de atendimento são essenciais para que a equipe cirúrgica possa instituir o tratamento adequado. OBJETIVO: Demonstrar e analisar os resultados da esofagectomia de urgência em uma série de pacientes com perfuração do esôfago. MÉTODO: Estudo retrospectivo incluindo 31 pacientes com confirmação diagnóstica de perfuração esofágica. A maior parte das lesões foi consequente à dilatação endoscópica de afecções benignas do esôfago que evoluíram com estenose. O diagnóstico da perfuração foi baseado em parâmetros clínicos, exames laboratoriais, radiológicos e endoscopia digestiva alta. A principal técnica cirúrgica utilizada foi a esofagectomia transmediastinal seguida da reconstrução do trânsito digestivo em um segundo tempo cirúrgico. Os pacientes foram avaliados em relação ao desenvolvimento de complicações sistêmicas e locais, notadamente deiscência e estenose da anastomose do esôfago cervical com o estômago ou cólon transposto. RESULTADOS: A avaliação pós-operatória precoce demonstrou sobrevida de 77,1% em relação ao ato cirúrgico proposto, sendo que 45% não apresentou qualquer complicação. Os outros pacientes apresentaram uma ou mais complicações, sendo a infecção pulmonar e a fístula anastomótica as mais frequentes. Sete pacientes (22,9%) evoluíram a óbito por quadro séptico. Tais pacientes foram submetidos à ressecção esofágica após 48 horas do diagnóstico da perfuração. Na avaliação a médio e longo prazo, a maioria dos pacientes relatou estar satisfeito com o ato cirúrgico, referindo boa qualidade de vida. CONCLUSÕES: Apesar da morbidade não desprezível, a esofagectomia de urgência tem sua validade, principalmente em casos de perfuração esofágica consequentes à dilatação endoscópica para estenoses benignas.
    Type of Medium: Online Resource
    ISSN: 0102-6720
    URL: Article
    DOI: 10.1590/S0102-67202014000400005
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2014
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  • 10
    Online Resource
    Online Resource
    Avaliação dos resultados da cirurgia conservadora do câncer da laringe
    FapUNIFESP (SciELO) ; 2002
    In:  Revista do Colégio Brasileiro de Cirurgiões Vol. 29, No. 2 ( 2002-04), p. 99-105
    Details
    In: Revista do Colégio Brasileiro de Cirurgiões, FapUNIFESP (SciELO), Vol. 29, No. 2 ( 2002-04), p. 99-105
    Abstract: BACKGROUND: This is of a retrospective study of the results obtained from partial laryngectomy for epidermoid carcinoma. METHODS: Twenty-eight males (93.5%) and 2 females (6.5%), between 42 years and 66 years old (mean age, 58 years). The surgical procedure varied in accordance to the site, extension and stage of the tumor. The technique most used was the frontolateral laryngectomy, performed on 12 patients (40%), followed by the vertical laryngectomy on 8 patients (26.6%), the supraglottic laryngectomy on 4 patients (13.3%), supracricoid laryngectomy on 4 patients (13.3%), near total laryngectomy on 1 patient (3.3%) and chordectomy on 1 patient (3.3%). RESULTS: An early postoperative assessment showed that 3 patients (10%) had complications. Two of them had pharyngocutaneous fistulas that responded well to conservative treatment and the remaining patient had pneumothorax, which improved after thoracic drainage. Deglutition assessment revealed that 5 patients (16.6%) presented difficulty in oral ingestion as a result of recurrent aspirations that occurred at periods that varied between 15 days to 180 days (average 180 days) and caused recurrent pneumonia. The only remaining option was total laryngectomy. The next assessment was performed after a period that varied between 6 months to 125 months (mean of 29 months) and revealed that 4 patients (13.3%) had recurrence in the same region. Two of these patients underwent vertical laryngectomy, 1 patient had a frontolateral laryngectomy and the remaining patient underwent supracricoid laryngectomy. All patients underwent total laryngectomy and/or radiotherapy, but the disease caused the death of 2 patients. Twenty four patients (84%) demonstrated that their voice was preserved and at the end of the assessment, 90% of the patients were alive and without any signs of the disease. These patients had a far better quality of life as they presented fairly satisfactory voice and oral ingestion. CONCLUSION: The conservative surgery of the larynx provided good disease control and increased the patient's life span.
    Type of Medium: Online Resource
    ISSN: 0100-6991
    URL: Article
    DOI: 10.1590/S0100-69912002000200008
    Language: Unknown
    Publisher: FapUNIFESP (SciELO)
    Publication Date: 2002
    detail.hit.zdb_id: 2223714-8
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