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The Nasogastric Tube in the Thorax after Gastric Pull Up!  [PDF]
Puneet Khanna, Rakesh Garg, Amit Chirom Singh
Open Journal of Anesthesiology (OJAnes) , 2012, DOI: 10.4236/ojanes.2012.22009
Abstract: Although nasogastric tube (NGT) is a simple procedure, the blind placement of nasogastric feeding tubes is not without risks. Chest radiogram is done to confirm the correct position of the NGT. We report a case where radiography could not be confirmatory for the correct position of the tube in a specific group of patients.
Operative Benefits of Artificial Pneumothorax in Thoracoscopic Esophagectomy in the Left Lateral Decubitus Position for Esophageal Cancer  [PDF]
Masashi Takemura, Nobuaki Kaibe, Mamiko Takii, Mitsuru Sasako
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.612127
Abstract: Objectives: This study aimed to evaluate operative benefits of artificial pnuemothorax in thoracoscopic esophagectomy in the left lateral decubitus position. Methods: We retrospectively analyzed short-term surgical outcomes including learning curve of 60 consecutive patients who underwent thoracoscopic esophagectomy with artificial pnuemothorax in the left lateral decubitus position between April 2010 and November 2012 in our department. Results: The median operation time and intraoperative blood loss were 443 min and 220 ml, respectively, and these values were 174 min and 95 ml, respectively, in the thoracic phase of surgery. The median number of harvested lymph node was 37. Only 1 patient required conversion to open esophagectomy. The postoperative 30-day mortality rate was 1.7%. The thoracic operation time significantly decreased after an experience of 10 cases and intraoperative blood loss during thoracic phasesignificantly decreased after an experience of 20 cases (p < 0.05), and operation time remained constant for the following cases. The number of harvested lymph nodes did not exhibit significant changes with an increase in the number of case experienced. Conclusions: Artificial pneumothorax provided the shorting of learning curve at the thoracoscopic esophagectomy in the left lateral decubitus position.
Minimally invasive esophagectomy for esophageal cancer in the People's Republic of China: an overview
Zhu C, Jin K
OncoTargets and Therapy , 2013, DOI: http://dx.doi.org/10.2147/OTT.S40667
Abstract: imally invasive esophagectomy for esophageal cancer in the People's Republic of China: an overview Review (292) Total Article Views Authors: Zhu C, Jin K Published Date March 2013 Volume 2013:6 Pages 119 - 124 DOI: http://dx.doi.org/10.2147/OTT.S40667 Received: 24 November 2012 Accepted: 11 January 2013 Published: 04 March 2013 Chengchu Zhu,1 Ketao Jin2 1Department of Cardiothoracic Surgery, 2Department of Surgical Oncology, Taizhou Hospital, Wenzhou Medical College, Linhai, Zhejiang, People's Republic of China Abstract: Since its introduction in the People's Republic of China in 1992, minimally invasive esophagectomy (MIE) has shown the classical advantages of minimally invasive surgery over its open counterpart. Like all pioneers of the technique, cardiothoracic surgeons in the People's Republic of China claim that MIE has a lower risk of pulmonary infection, faster recovery, a shorter hospital stay, and a more rapid return to daily activities than open esophagectomy, while offering the same functional and oncologic results. There has been burgeoning interest in MIE in the People's Republic of China since 1995. The last decade has witnessed nationwide growth in the application of MIE and yielded a significant amount of scientific data in support of its clinical merits and advantages. However, no prospective randomized controlled trials have actually investigated the benefits of MIE in the People's Republic of China. Here we review the current data and state of the art MIE treatment for esophageal cancer in the People's Republic of China.
Análise das complica??es da esofagectomia transmediastinal no tratamento cirurgico do megaes?fago recidivado
Aquino, José Luis Braga de;Said, Marcelo Manzano;Leandro-Merhi, Vania Aparecida;Ichinohe, Liliana Hana;Ramos, Jo?o Paulo Zenum;Machado, Daniel Gustavo Guimar?es;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2011, DOI: 10.1590/S0102-67202011000100007
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.
Fístula cervical pós-anastomose esofagogástrica: é possível diminuir a ocorrência?
Fontes, Paulo Roberto Ott;Kruse, Cristine Kist;Waechter, Fábio Luiz;Nectoux, Mauro;Fochesato, Larissa Bittencourt Saggin;Goettert, Gustavo Ferreira;Silva, Maurício Fraga da;Pereira-Lima, Luiz;
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2008, DOI: 10.1590/S0102-67202008000400002
Abstract: background: the esophageal cancer is the 6th cause of cancer-related death in brazil, and esophagectomy is the cornerstone of the treatment, not only for the curative cases, but with palliative intent as well. the cervical fistula is a very frequent complication of the procedure with a related incidence between 0,8 and 47,8%. aim: prospective analysis to determine the success of a new alternative technique of cervical anastomosis. methods: prospective analysis of 126 patients, distributed in two groups accordingly to the cervical anastomosis technique. group a (n=96) had cervical anastomosis in two layers, the inner continuous type and outer isolated, followed by redundant tissue. group b (n=25) had a technical variation with suture done without mucosa opening at first. results: this alternative technique for the cervical esophagogastric anastomosis presented zero fistulas. conclusion: this alternative was efficient in decrease fistula rate because it allow best exposition and visualization of the anastomosis, facilitating the suture lines.
Complicaciones postoperatorias graves tras esofagectomía para carcinoma esofágico: análisis de factores de riesgo
Arméstar,Fernando; Mesalles,Eduard; Font,Albert; Arellano,Antonio; Roca,Josep; Klamburg,Jordi; Fernández-Llamazares,Jaime;
Medicina Intensiva , 2009,
Abstract: introduction. to identify risk factors for postoperative morbidity and mortality in patients undergoing esophagectomy for esophageal cancer. design and patients. the population comprised 159 patients with locally advanced esophageal cancer, undergoing esophagectomy between january 1985 and december 2004. results. infections were the main cause of both complications and postoperative mortality. the 54% of our patients presented serious complications. the mortality of the series was 12.5%. multiorganic failure secondary to sepsis was the more frequent cause of death. the postoperative complications showed a significant association with: alcoholism (p < 0.04), hepatic cirrhosis (p < 0.03), the location of the tumor in middle third of the esophagus (p < 0.04), and the apache ii score greater of 10 (p < 0.003). mortality was associated significantly with the presence of chronic pulmonary disease (p = 0,03) and with an apache ii score superior to 10 (p = 0,02). conclusions. the apache ii score superior to 10 can be used so much as prognostic factor of mortality like of serious complications. chronic obstructive pulmonary disease is a risk factor for postoperative mortality. alcoholism, hepatic cirrhosis and the location of the tumor, are factors associated to postoperative serious complications
Esofagectomia laparocópica transhiatal: resultados imediatos
Tinoco, Renam Catharina;Tinoco, Augusto Cláudio;El-Kadre, Luciana Janene;Rios, Rodrigo Amaral;Sueth, Daniela Mendon?a;Pena, Felipe Montes;
Arquivos de Gastroenterologia , 2007, DOI: 10.1590/S0004-28032007000200011
Abstract: background: the laparoscopic transhiatal esophagectomy for benign or malignant disease is a complex operation associated with a high rate of morbidity and mortality. in the last decade this procedure gained popularity and acceptance for treatment of the esophagus cancer and other benign diseases. aim: to perform a retrospective analysis in patients with esophageal cancer that was underwent a laparoscopic transhiatal esophagectomy, demonstrated pre and post operative complications and immediate result. methods: from november 1993 to june 2005, 72 patients underwent laparoscopic transhiatal esophagectomy. sixty-four with malignant neoplasm of esophagus. the males are predominant, and the mean age was 56.5 years. the abdominal part of the operation was totally laparoscopic and the cervical one was made the conventional way. the stomach was pulled up to the neck by the posterior mediastinum. results: the laparoscopic transhiatal esophagectomy was initiated in 64 patients. four patients were converted to open surgery. the mean operation time was 153 minutes. the incidence of cervical fistula was 14.06%. the mortality rate 5.6%. conclusion: laparoscopic transhiatal esophagectomy is a secure option in experience centers. the morbility is low, with a faster return to normal activity. maybe in fact this procedure may be reminded and ponder in the treatment of esophageal disease.
Tratamiento quirúrgico de la achalasia de esófago en estadio avanzado
Revista chilena de cirugía , 2008, DOI: 10.4067/S0718-40262008000600005
Abstract: esophageal excisión is recommended in advanced stages of achalasia, when the esophagus acquires a sigmoid morphology. we report four patients with achalasia aged 59, 60, 66 and 67 years (two males) that were treated with esophagectomy, gastroplasty and cervical anastomosis. three were operated using a trasnhiatal approach and one required a thoracotomy. in the postoperative period, two patients had a pleural effusion, two had transient dysphonia and one had an eventration. after a follow up ranging from two to 11 years, all are asymptomatic.
Tratamento do cancer de es?fago: ensaio clinico controlado
Mirra, Antonio Pedro;Justo, Fernando Antonio;Schneider, Carlos Alberto Rodrigues;Trippe, Nivaldo;
Revista do Colégio Brasileiro de Cirurgi?es , 1998, DOI: 10.1590/S0100-69911998000200009
Abstract: a 65-case-clinical trial on esophagus cancer was conducted at the hospital a.c. camargo between 1986 and 1990. a controlled clinical trial studied three therapeutic groups, as follows: group 1 - surgery alone (20 cases); group 2 - surgery plus postoperative radiotherapy (27 cases); and group 3 - preoperative chemotherapy plus surgery followed by postoperative radiotherapy and chemotherapy (18 cases). surgery occurred in a one-step procedure with large ressection of the esophagus, mainly by transpleural access to tumors in the middle third and transmediastinal to the lower third and abdominal segment of the esophagus. included in the same surgical procedure was the removal of regional lymph nodes as well as the reconstruction using the stomach, with extrathoracic cervical anastomosis and stomach placement into the posterior mediastinum. radiotherapy was employed at the posterior mediastinum in a total dose of 4.500-5.000 cgy applied in five sessions. cisplatin (800 mg/m2), vincristine (1.5 mg/m2) and bleomicine (10 mg/m2) were administered through pre and postoperative chemotherapy regimen. a 5-year survival was observed in 61.9% of the group 1 cases; 52.6% of the group 2 cases and 68.7% of the group 3 cases. relative to clinical staging, this survival was of 52.0% for clinical stage i + ii a and 45.5% for clinical stage ii b + iii these results were not statiscally significant. five-year survival rates for groups 1 and 2 ranged from 40.4% to 60.6% when clinical stages were i + ii a; the other stages did not present a 5-year survival. for better assessment, a greater number of cases is necessary. this would be achieved if more esophageal cancer services entried in similar clinical trials.
Esofagectomia na perfura??o esofágica com diagnóstico tardio
Andrade, Aderivaldo Coelho de;Marinho Filho, Luiz Joaquim Fonseca;Lima Filho, Marco Ant?nio Ayres Corrêa;Alencar, Adriano Rocha;
Revista do Colégio Brasileiro de Cirurgi?es , 2007, DOI: 10.1590/S0100-69912007000600013
Abstract: esophageal perforations are related to high mortality rates, especially if there is a delayed diagnostic and treatment. we report an esophageal perforation caused by caustic ingestion, in a suicidal attempt, successfully treated by esophagectomy after a long period of misdiagnosis that lead to infectious complications.
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