Cirugía ° Modificaciones: André Toupet Jacques Dor de la región del hiato se efectúa colocando un separador de tipo valva de. cluded D’Or fundoplication in 35 cases (%), Nissen in 8 cases .. tos pacientes se había realizado funduplicatura tipo D’Or abierta en 2. Se usa en pacientes con dismotilidad severa. Es una funduplicatura anterior de º. Funduplicatura parcial tipo Dor. Elonga el segmento intra-abdominal del.
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There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal’s impact.
Fudnuplicatura measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Achalasia is an uncommon oesophageal motor disorder, with a controversial therapeutic management.
The aim of our study was to analyse our experience in the management of achalasia, assessing the impact of minimally invasive surgery, its complications, and its outcomes in the short and medium term.
A retrospective and descriptive study was designed, including all patients operated on between and with the diagnosis of achalasia. Previous diagnostic tests, duration of symptoms, previous non-surgical treatment, surgical approach, associated antireflux intervention, surgical time, and perioperative complications funduplciatura analysed.
A total of 50 patients, 24 males, and 26 females, with a mean age of 47 years underwent laparoscopic surgery.
Revision bibliografica a proposito de un caso de acalasia.
The mean duration of the disease was 2 years. The surgery was accompanied by a Dor fundoplication in 48 patients, and Toupet fundoplication in the remaining 2. The mean surgical time was min. There were 9 intraoperative complications 5 gastric mucosal perforations, 2 bleeding, 1 liver injury, and 1 aspiration ; 4 postoperative complications 3 scapular pain and 1 sub-phrenic collection were reported.
The mean follow-up was 28 funduplicatkra. Heller cardiomyotomy should be the treatment of choice in selected Achalasia patients, because of its short and long term outcomes, and its low morbidity. El seguimiento medio fue de 28 meses. Achalasia is an oesophageal motor disorder whose aetiology is unknown.
Funduplicstura is characterised by lower oesophageal sphincter LOS relaxation failure during swallowing and absence of wavelike contractions along the oesophagus. Histological studies have confirmed absence, atrophy, or disintegration of ganglion cells of the oesophageal myenteric plexus and a decrease in the number of motor nerve fibres at distal oesophagus level.
The current surgical treatment of choice for this condition is laparoscopic Heller cardiomyotomy. This type of approach offers advantages to both the surgeon better access and visualisation of the cardial area and to the patient, who receives the benefits of a minimally invasive procedure less postoperative pain, decrease in postoperative complications especially those involving the surgical wound, and shorter hospital stay and time off work.
The first laparoscopic Heller myotomy was described by Cuschieri in Since then, the technique has come to be standard, and has undergone changes as technological advances have arrived on the scene. However, since this surgical procedure is not very prevalent, some technical aspects of the surgery are controversial, and there are still disagreements between proponents of different techniques.
The objective of this study is to examine our hospital’s experiences with surgical treatment of achalasia and analyse the effects, complications, and short and long-term results of minimally invasive surgery. We fundupicatura a descriptive and retrospective study, including all patients diagnosed with achalasia who underwent surgery in our hospital between and December The main variable was post-treatment symptom response, with other factors analysed as secondary variables: Continuous quantitative variables are expressed as mean and typical deviation.
Discrete quantitative variables are expressed as median and range.
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Statistical analysis was performed using the software suite SPSS All patients included in the study underwent laparoscopic surgery performed according to the same surgical technique with slight variations: Heller myotomy with partial fundoplication. We used modified lithotomy position with reverse Trendelenburg and the legs abducted. Pneumoperitoneum was established using an open technique. The rest of the trocars were placed under direct vision as showed in Fig. After exposing the anterior face of the oesophagus, we dissected the oesophagogastric junction along 6—8 cm in preparation for the myotomy, identifying and respecting the anterior vagal trunk so as to avoid gastroparesis which could lead to postoperative gastro-oesophageal reflux disease GORD Fig.
Image of the operating field showing the completed myotomy, which has preserved the anterior vagal trunk. The oesophagus was circumferentially dissected and the short vessels were divided only in those cases in which we used a Toupet fundoplication. The myotomy was performed using a combination of monopolar scalpel and ultrasonic scalpel, and extended 2—3 cm toward the stomach and at least 5 cm toward the oesophagus.
fundidor de tipos – English Translation – Word Magic Spanish-English Dictionary
Where accidental perforation of the mucosa occurred, it was sutured with absorbable monofiliment sutures. Once the myotomy was completed, we always performed a partial fundoplication.
During the study period, 50 patients diagnosed with achalasia underwent surgery in our hospital, all through a laparoscopic approach, which supposes a mean of 4—5 patients per year. Of these 50 patients, 24 were males and 26 females, and the mean age at the time of surgery was 47 years range 19— The disease duration varied between 4 and months median: There were 4 cases of pneumatic dilatation, 5 cases of botulinum toxin injections, and 2 patients received a combination of both treatments; all of these patients experienced symptomatic relapse following the endoscopic treatment.
All patients underwent upper endoscopy, a barium swallow study, and oesophageal manometry prior to the surgery, except for 3 patients who refused this last procedure. One patient with a history of Hodgkin’s lymphoma also had a thoraco-abdominal CT and an endoscopic ultrasound study to rule out secondary achalasia. Based on these studies, 37 cases were classified as classic achalasia and 13 as vigourous achalasia.
We shall analyse different technical aspects of the surgery. The median length of the myotomy was 6 cm at oesophageal level range 5—8 cm and 2 cm at gastric level range 1. Proper completion of the myotomy and absence of complications were demonstrated in 46 cases. This was done by administering a methylene blue solution by nasogastric tube in 41 patients, and by intraoperative upper endoscopy in 5 patients. Fundoplication was associated in all cases: The mean duration of the surgical procedure was min.
Nine intraoperative complications, all of which were mild, occurred in 6 patients: During the immediate postoperative period, 3 patients complained of scapular pain which lengthened the hospital stay with no major repercussions, and 1 presented fever associated with a left pleural effusion and a small left subphrenic fluid collection which resolved with intravenous antibiotic treatment.
There were no associated mortalities during the study period. All of the procedures were completed laparoscopically with no conversions to laparotomy.
The mean follow-up period after surgery was 28 months. It must be stated that our follow-up appointments were discontinued for most of the patients who remained asymptomatic during the second year after the surgery, after which they were monitored by their primary care centres. Both patients presented classic achalasia: We did not employ any protocols requiring manometric or other types of studies during the follow-up period.
Achalasia is the fundupkicatura and best-described primary oesophageal motor disorder. Given that none of its current treatments are capable of producing normal oesophageal function, therapy is palliative and intended to decrease lower oesophageal sphincter funuplicatura.
Drugs, principally calcium channel blockers or long-acting nitrates, are administered to decrease the pressure of the LOS. At present, they are generally not funduplicagura as an isolated means of treatment; rather, they are used as adjunct treatments or employed prior to another type of therapy.
We did not analyse the effects of pharmacological treatment since it was not considered as a therapeutic measure by itself. In our study, 7 patients had received botulinum toxin injections prior to surgery. Although all of them initially reported that their symptoms, particularly dysphagia, had improved, symptoms relapsed a few months later in all cases, and 5 patients had to undergo multiple sessions of endoscopic treatment with the toxin.
We found it subjectively more difficult to perform cardiomyotomy on these patients, due to the fibrotic reaction that made it hard to identify the tissue planes of the oesophageal wall at this level.
Nevertheless, this perception was in no way reflected by the results. However, the results obtained in subsequent sessions are not as good, and the procedure is less effective in young patients.
Its main short-term complication is perforation, and in the medium to long term, GORD. Of the 50 patients included in our study, only 6 had undergone endoscopic pneumatic dilatations.
In all of our cases, the symptoms, especially dysphagia, relapsed within a year. However, these data cannot be used to evaluate the efficacy or failure of this endoscopic technique, since our study includes only those patients who underwent a surgical procedure.
The logical conclusion is that patients who responded well to endoscopic treatment were not referred for surgery. However, there are many articles which compare endoscopic dilatation to surgical cardiomyotomy, and they are often difficult to interpret due to patient heterogeneity and the use of different surgical techniques. A recent systematic review by Campos et al.
On the other hand, the recently published randomised study by Boeckxstaens et al. The use of minimally invasive surgical techniques has certainly contributed to the good result rate of the surgery; beyond any debate, laparoscopy has come to be the approach of choice for treating achalasia, above open surgery and thoracoscopy.
Thorascopic Heller myotomy is a viable option, but it is associated with a longer hospital stay, increased short-term discomfort and increased GORD in the medium to long term.
From both the patient’s and the surgeon’s point of view, laparoscopic Heller myotomy offers obvious advantages when compared to a laparotomic approach. On the one hand, hiatal dissection is simpler if performed by laparoscopy due to offering better access and exposure of the operating field than would be the case with classic laparotomy.
On the other hand, the laparoscopic Heller myotomy grants patients all of the advantages associated with minimally invasive surgery: It seems that the success of a Heller myotomy may be compromised in cases with a long disease duration and oesophageal dilation of more than 4 cm; here, some authors even point to oesophagectomy as the first treatment option.
However, in our experience, patients with sigmoid oesophagus have obtained good results from cardiomyotomy Fig. Considering the significant morbidity and mortality associated with oesophagectomy, we believe that the Heller procedure is the treatment of choice, regardless of the degree of oesophageal dilation. A Sigmoid oesophagus with tapering stenosis of the gastro-oesophageal vestibule and food retention in the oesophageal lumen.
B Two months after the surgical intervention, dilation and tortuosity have decreased and the clinical result is good. Associating an anti-reflux technique has been shown to be effective in preventing postoperative GORD.
While the Nissen fundoplication achieves good control over GORD, it seems to be associated with significantly higher rates of dysphagia recurrence than in the case for partial fundoplications such as the Dor or Toupet procedures.
We tend to use this technique rather than other partial fundoplications such as the Toupet because the myotomy area remains covered by the fundus, thereby minimising the consequences of any potential mucosal microperforations, and because it requires a smaller dissection and preserves the natural posterior anchors of the hiatus. The length of the myotomy has been shown to be directly correlated to the relapse of symptoms, especially dysphagia.
Nevertheless, we cannot analyse individually the impact of myotomy length on surgical success since we do not dispose of a control group. Different questionnaires have been described, which patients use to evaluate the perceived degree of symptom improvement following myotomy.
As a result, and as we see in our study, the results are quite subjective.