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Achados tomográficos das altera??es abdominais pós-operatórias dos pacientes submetidos ao deriva??o gastrojejunal em Y-de-Roux sem anel
Ribas, Fernanda Marcondes;Nassif, Paulo Afonso Nunes;Ribas, Carmen Paredes Marcondes;Dietz, Ulrich Andreas;Tuon, Felipe;Wendler, Eduardo;Enokawa, Marcelo Seiki;Ferri, Kellen Regina;
Revista do Colégio Brasileiro de Cirurgi?es , 2012, DOI: 10.1590/S0100-69912012000300005
Abstract: objective: to evaluate by ct scan in patients undergoing laparoscopic roux-en-y gastric bypass without a ring for treatment of morbid obesity that looked for medical assistance after the operation. methods: we studied 40 ct exams from patients attended at the radiology service with the intention to clarify abdominal complains. the patients were in post-bariatric surgical follow-up and were operated in the same hospital. we excluded patients who had undergone bariatric surgery by other surgical techniques, operated by another surgical team and the ones who did not agree with the administration of oral or intravenous iodinated contrast media and exceeding the weight limit of the examination table. results: the patients were aged from 23 to 70 years, 11 male and 29 female. there were no extra-abdominal changes, and 30 of the 40 patients had ct findings within normal limits. the presence of stenosis at the gastrojejunal anastomosis was found in one patient, internal hernias occurred in five, anastomotic leak in one and the presence of abscess occurred in three of patients. conclusion: total abdominal ct failed to inform the cause of the symptoms in 87.5% of patients seeking medical re-evaluation for symptoms of post-operative bariatric surgery.
Deriva??o gastrojejunal com anel de conten??o no tratamento de obesidade mórbida em paciente com situs inversus totalis
Barros, Cássio Jer?nimo Machado de;Rapoport, Abr?o;Andrade Sobrinho, Josias de;Dedivitis, Rogério Aparecido;Grill, Eduardo Halfen;
Revista do Colégio Brasileiro de Cirurgi?es , 2010, DOI: 10.1590/S0100-69912010000200014
Abstract: the gastric bypass is a good option in the therapy of morbid obesity. nevertheless, it must be considered the rare condition as occurred in a patient with previous abdominal surgery with situs inversus totalis. a 24 year-old male patient with body mass index of 40 kg/ m2, multiple dietary failures, and arterial hypertension as co-morbidities, with a anterior paramedial right incision due to a previous appendicectomy (8 years ago).with a indication for bariatric surgery, was performed roux-en-y gastric bypass by laparoscopic procedure, with previous planning of situs inversus totalis.
Ventila o n o invasiva no pós-operatório imediato de deriva o gastrojejunal com bypass em Y de Roux Noninvasive ventilation in the immediate postoperative of gastrojejunal derivation with Roux-en-Y gastric bypass  [cached]
Kivania C. Pessoa,Gutemberg F. Araújo,Alcimar N. Pinheiro,Maria R. S. Ramos
Brazilian Journal of Physical Therapy , 2010,
Abstract: CONTEXTUALIZA O: Pacientes obesos mórbidos desenvolvem mais atelectasias durante a anestesia geral que pacientes n o obesos, e elas persistem 24 horas após o término do procedimento cirúrgico. OBJETIVOS: Este estudo avaliou o efeito da ventila o n o invasiva com dois níveis pressóricos (BiPAP) na fun o pulmonar, a incidência de complica es pulmonares no pós-operatório imediato e o desenvolvimento de deiscência de anastomoses em pacientes obesos mórbidos submetidos a deriva o gastrojejunal em Y-de-Roux (RYGB). MéTODOS: Estudo analítico, ensaio clínico envolvendo pacientes submetidos à RYGB, com índice de massa corpórea (IMC) de pelo menos 35 kg/cm2, randomizados para receber BiPAP (estudo) ou terapia padr o com oxigênio (controle), nas primeiras quatro horas de pós-operatório. N o foram incluídos pacientes com doen a pulmonar aguda ou cr nica ou que necessitaram de ventila o mecanica invasiva ao término da cirurgia. Capacidade vital, press o inspiratória e expiratória máxima, gasometria arterial foram mensurados no pré-operatório e no 1o pós-operatório; radiografia de tórax foi realizada no 3o pós-operatório. RESULTADOS: Dezoito pacientes foram incluídos no estudo, 10 receberam BiPAP e 8 terapia padr o com oxigênio. O grupo do estudo teve melhor press o parcial de oxigênio e menor press o expiratória máxima no pós-operatório que o controle. N o se observou deiscência de anastomose em nenhum grupo. N o houve diferen a significante entre o grupo controle e o do estudo com rela o à perda da capacidade vital, press o inspiratória máxima no pós-operatório e incidência de atelectasias. CONCLUS O: O BiPAP no pós-operatório de gastroplastia foi útil para melhorar a oxigena o, n o aumentando a incidência de deiscência de anastomose. BACKGROUND: Morbidly obese patients develop more atelectasis during general anesthesia than non-obese ones, and these atelectasis persist for 24 hours after the end of the surgical procedure. OBJECTIVES: This study evaluated the effect of noninvasive ventilation with two pressure levels (BiPAP) in the pulmonary function, incidence of immediate postoperative pulmonary complications and the development of anastomotic dehiscence in morbid obese patients submitted to gastrojejunal derivation in Roux-en-Y (RYGB). METHODS: It was an analytical and clinical study involving patients who were submitted to RYGB, had a body mass index (BMI) of at least 35 kg/cm2, and were randomly chosen to receive BiPAP (experimental group) or standard oxygen therapy (control group), in the first four hours of the post-operation period. Patients with chr
Ventila??o n?o invasiva no pós-operatório imediato de deriva??o gastrojejunal com bypass em Y de Roux
Pessoa, Kivania C.;Araújo, Gutemberg F.;Pinheiro, Alcimar N.;Ramos, Maria R. S.;Maia, Sandra C.;
Brazilian Journal of Physical Therapy , 2010, DOI: 10.1590/S1413-35552010005000023
Abstract: background: morbidly obese patients develop more atelectasis during general anesthesia than non-obese ones, and these atelectasis persist for 24 hours after the end of the surgical procedure. objectives: this study evaluated the effect of noninvasive ventilation with two pressure levels (bipap) in the pulmonary function, incidence of immediate postoperative pulmonary complications and the development of anastomotic dehiscence in morbid obese patients submitted to gastrojejunal derivation in roux-en-y (rygb). methods: it was an analytical and clinical study involving patients who were submitted to rygb, had a body mass index (bmi) of at least 35 kg/cm2, and were randomly chosen to receive bipap (experimental group) or standard oxygen therapy (control group), in the first four hours of the post-operation period. patients with chronic or acute pulmonary disease were not included, and neither were the ones who needed invasive mechanical ventilation by the end of the surgery. vital capacity, maximal inspiratory and expiratory pressure, and arterial blood gases were measured in the preoperative and in the first postoperative. chest x-ray was performed in the third postoperative. results: eighteen patients were chosen for the study: ten received bipap and eight received standard oxygen therapy. the study group had better partial oxygen pressure and lower maximal expiratory pressure levels in the postoperative state than the control group. anastomotic dehiscence was not observed in any group. there was no significant difference between the control group and the study group relating to the loss of vital capacity, maximal inspiratory pressure in the postoperative period or the incidence of atelectasis. conclusion: the bipap in the postoperative period of gastroplasty was useful to improve oxygenation and did not increase the incidence of anastomotic dehiscence.
A influência do anel na evolu o ponderal após quatro anos da deriva o gástrica em y-de-roux laparoscópica Ring influence on ponderal evolution after four years of laparoscopic Roux-en-Y gastric bypass  [cached]
Irineu Rasera-Junior,Natalia Moreno Gaino,Maria Rita Marques de Oliveira,Patrícia Fátima Sousa Novais
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2012,
Abstract: RACIONAL: A utiliza o de anel nas deriva es gástricas em Y-de-Roux ainda é motivo de polêmica entre os cirurgi es bariátricos. N o há consenso quanto às suas repercuss es em rela o à perda ponderal e à manuten o do peso em longo prazo. OBJETIVO: Avaliar a influência do anel sobre a evolu o do peso corporal no decorrer de quatro anos após opera o bariátrica. MéTODO: Foram analisadas retrospectivamente 143 mulheres submetidas à deriva o gástrica em Y-de-Roux videolaparoscópica pareadas pela utiliza o ou n o do anel de Silastic . O tempo de seguimento foi de até 48 meses. Os critérios de inclus o foram idade superior a 18 anos, opera o bariátrica primária e frequência regular à clínica no período de interesse para a pesquisa. A técnica manteve reservatório gástrico de pequena curvatura, volume estimado em 30 ml. A al a alimentar media 150 cm e a biliar 40 cm a partir do angulo duodenojejunal. O grupo "com anel" utilizou anel tubular de Silastic com comprimento de 6,5 cm, colocado à 2 cm da anastomose gastrojejunal. O anel era fechado por cinco nós com fio de polipropileno em seu interior. Na manh seguinte ao procedimento cirúrgico as pacientes recebiam líquidos isot nicos; no segundo dia dieta líquida salgada sem resíduos e alta hospitalar no terceiro dia. Dieta pastosa iniciava a partir do 20o dia e sólida no 30o, juntamente com uma drágea diária de polivitamínico. RESULTADOS: O emagrecimento do grupo com anel foi maior que o sem anel em todos os períodos analisados a nível de 10% e de 5% apenas no 3o ano pós-operatório. A propor o das operadas que n o atingiram perda do excesso de peso de 50% foi significativamente maior no grupo sem anel que no grupo com anel (31% entre as sem anel e 8% das com anel no 4o ano). N o houve diferen a entre os grupos na recupera o tardia do peso perdido na opera o. CONCLUS ES: Os resultados foram favoráveis à utiliza o do anel ao se analisar exclusivamente a perda de peso. BACKGROUND: Use of ring in Roux-en-Y gastric bypass is still a matter of controversy among bariatric surgeons. There is no consensus on its impact in relation to weight loss and weight maintenance in the long term. AIM: To evaluate the influence of the ring on the evolution of body weight over four years after bariatric surgery. METHODS: Retrospective analyzis of 143 women who underwent laparoscopic Roux-en-Y gastric bypass paired on the use or not use of Silastic ring. Follow-up time was 48 months. Inclusion criteria were age over 18 years, primary bariatric operation and regular attendance at the clinic during the period of interest for r
Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection  [PDF]
M. Wayne,A. Cooperman,R. Narang,B. Abbadessa,J. Bratcher,W. Brown,J. Steele,F. Kasmin
International Journal of Surgical Oncology , 2012, DOI: 10.1155/2012/976268
Abstract: Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late) of proximal gastrojejunal (PGJ) reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas. 1. Introduction Alimentary reconstruction during pancreaticoduodenal resection invariably places the gastric or duodenal jejunal anastomoses distal to the biliary and pancreatic anastomoses [1, 2]. Despite absence of supporting literature this is done for alleged fears of pancreatic and biliary fistulas that will delay oral feedings and prolong hospitalization. With more PDRs being done for premalignant and malignant pancreatic cystic and ductal lesions, surveillance of the remnant pancreatic duct mucosa for multicentricity may be necessary [3]. We undertook this study to determine the value and risk of proximal B1 gastrojejunal reconstruction. There has been an increase in cystic malignant and premalignant lesions being treated by pancreaticoduodenal resection. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct for future surveillance because multicentricity is characteristic of some of these malignancies. Endoscopic
Tratamento do diabetes melito gestacional  [cached]
Maganha Carlos Alberto,Vanni Diana Gertrudes Barenboim Salles,Bernardini Maria Augusta,Zugaib Marcelo
Revista da Associa??o Médica Brasileira , 2003,
Abstract: Neste artigo, os autores analisam os mais recentes avan os no tratamento do diabetes gestacional, enfatizando pontos importantes na abordagem terapêutica: dieta, exercícios, controle glicêmico, utiliza o da insulina, assim como a utiliza o de hipoglicemiantes orais. O artigo traz propostas atuais para o tratamento do diabetes melito gestacional bem como ressaltar suas peculiaridades quanto patologia clínico-obstétrica.
Actividad hepatoprotectora del "ergopanin" melito
Pérez de Alejo,José L.; Sotolongo Baró,María del C.; Miranda Flores,Roberto; Rodríguez Rodríguez,Gilda;
Revista Cubana de Medicina Militar , 1997,
Abstract: the hepatoprotective activity of "ergopanin" melito was pharmacologically assayed in an experimental model of hepatotoxicity due to carbon tetrachloride (c14c) by intraperitoneal route and with a dose of 0,5 ml/kg, twice a week for 3 weeks. the hepatoprotective activity was evaluated by th determination of transaminase (pyruvic and oxaloacetic) values and histologic examination at the second and third weeks after the administration of c14c. it was found that the preparation "ergopanin" in a dose of 10 mg/hg reduces the concentrations of both transaminases to normal values at the second and third weeks of treatment, decreasing the degree of the histologic indexes measured during the same period.
Actividad hepatoprotectora del "ergopanin" melito Hepatoprotective activity of "ERGOPANIN" MELITO  [cached]
José L. Pérez de Alejo,María del C. Sotolongo Baró,Roberto Miranda Flores,Gilda Rodríguez Rodríguez
Revista Cubana de Medicina Militar , 1997,
Abstract: Se ensaya farmacológicamente la actividad hepatoprotectora del "ergopanin" melito en un modelo experimental de hepatoxicidad por tetracloruro de carbono (C14C) con administración intra peritoneal (IP) y a la dosis de 0,5 ml/kg, 2 veces por semana, durante 3 semanas. La actividad hepatoprotectora se evalúa mediante valores de transaminasas (pirúvica y oxalacética) y examen histológico a la segunda y tercera semanas de administrado el Cl4C. Se encuentra que el preparado "ergopanin" en dosis de 10 mg/kg reduce a valores normales las concentraciones de ambas transaminasas a la segunda y tercera semanas de tratamiento, disminuyendo a su vez el grado de los índices histológicos medidos en el mismo período. The hepatoprotective activity of "ergopanin" melito was pharmacologically assayed in an experimental model of hepatotoxicity due to carbon tetrachloride (C14C) by intraperitoneal route and with a dose of 0,5 ml/kg, twice a week for 3 weeks. The hepatoprotective activity was evaluated by th determination of transaminase (pyruvic and oxaloacetic) values and histologic examination at the second and third weeks after the administration of C14C. It was found that the preparation "ergopanin" in a dose of 10 mg/hg reduces the concentrations of both transaminases to normal values at the second and third weeks of treatment, decreasing the degree of the histologic indexes measured during the same period.
Gastrojejunal anastomosis stricture after laparoscopic gastric bypass: Our experience with 62 patients
Campillo-Soto,A.; Torralba-Martínez,J. A.; Martín-Lorenzo,J. G.; Lirón-Ruiz,R.; Bento-Gerard,M.; Pérez-Cuadrado,E.; Aguayo-Albasini,J. L.;
Revista Espa?ola de Enfermedades Digestivas , 2010, DOI: 10.4321/S1130-01082010000300005
Abstract: objective: gastrojejunal stricture (gys), not only is a common complication after laparoscopic gastric bypass (lgbp), but its frequency is about 15% according to bibliography. our aim is to present our experience after 62 lgbp. patients and method: from january 2004 to september-2006, we performed 62 consecutive laparoscopic gastric bypass (wittgrove's technique). the gastrojejunal anastomosis is performed with auto suture material type ceaa no 21 termino-lateral (ils, ethicon). in 4 cases (6.45%) was converted to laparotomy, perform the anastomosis in the same way. monitoring has a range of 3-35 months, conducted in 61 patients because one patient died of pulmonary thromboembolism in the immediate postoperative period after reoperation, after two weeks of gastric bypass, by necrosis of a small fragment of the remnant gastric. in all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. when gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation (recommending dilate the anastomosis to a maximum 1.5 cm). results: five cases (8.1%) developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and in 1 case by endoscopy. two patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion (circumferentially sclerosis within 48 hours of surgery and sclerosis of bleeding points). all cases were resolved by endoscopic dilatation. at follow-up has not been detected re-stricture. conclusion: clinically, gastrojejunal stricture results in a progressive oral intolerance, revealing stenosis between 1 and 3 months postoperatively. the situations of sclerosis of the bleeding lesions favor, especially in cases of extensive sclerosis. in cases of suspected barium transit offers us a high diagnostic yield. endoscopic dilatation resolved, so far, all cases.
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