Resección laparoendoscópica de tumor de la unión gastroesofágica

Atypical gastric resection has proved to be beneficial to treat submucosal tumors. The technique is more difficult when these tumors develop next to the gastroesophageal junction (GEJ). Intragastric resection combining endoscopic and laparoscopic approach was proposed to solve this limitation. There are no publications about this technique in our environment. A 42-year-old female patients with a 2-mm subepithelial tumor below the cardia evaluated by upper gastrointestinal (UGI) videoendoscopy and endoscopic ultrasound suggestive of a gastrointestinal stroma tumor (GIST) underwent resection using the combined laparo-endoscopic approach. Under laparoscopic guidance, balloon-tipped trocars were introduced in the abdominal cavity and then into the stomach using endoscopic view. The balloons were inflated to fix the gastirc wall to the abdominal wall. The lesion was resected using mechanical stapler. The combined approach is safe and efficient, and simple to perform for trained professionals, constituting a reproducible option in selected cases

Download Full-text

Endoscopic Ultrasonography in the Diagnosis of Upper Gastrointestinal Submucosal Tumors

Endoscopy ◽

10.1055/s-2006-947657 ◽

2006 ◽

Vol 39 (S 1) ◽

Author(s):

RA Zaydan

Keyword(s):

Endoscopic Ultrasonography ◽

Submucosal Tumors ◽

Upper Gastrointestinal

Download Full-text

Endoscopic Insufflation–Induced Gastric Barotrauma during Percutaneous Endoscopic Gastrostomy: A Report of Three Patients and Review of Literature

Journal of Digestive Endoscopy ◽

10.1055/s-0041-1724134 ◽

2021 ◽

Vol 12 (02) ◽

pp. 103-106

Author(s):

Avnish Kumar Seth ◽

Rinkesh Kumar Bansal

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Gastrointestinal Endoscopy ◽

Gastroesophageal Junction ◽

Upper Gastrointestinal Endoscopy ◽

Proximal Stomach ◽

Endoscopic Gastrostomy ◽

Lesser Curvature ◽

Upper Gastrointestinal ◽

New Onset

Abstract Background We report three patients with endoscopic insufflation–induced gastric barotrauma (EIGB) during upper gastrointestinal endoscopy (UGIE) for percutaneous endoscopic gastrostomy (PEG). A definition and classification of EIGB is proposed. Materials and Methods Records of patients undergoing UGIE over 7 years (April 2013–March 2020) were reviewed. Patients who developed new onset of bleeding or petechial spots in proximal stomach, in an area previously documented to be normal during the same endoscopic procedure, were studied. Results New onset of bleeding or petechial spots in proximal stomach occurred in 3/286 (0.1%) patients undergoing PEG and in none of the 19,323 other UGIE procedures during the study period. All patients were men with median age 76 years (range 68–80 years), with no coagulopathy. Aspirin and apixaban were discontinued 1 week and 3 days prior to the procedure. Fresh blood was noted in the stomach at a median of 275 seconds (range 130–340) seconds after commencement of endoscopy. At retroflexion, multiple linear mucosal breaks of up to 3 cm, with oozing of blood, were noted in the proximal stomach along the lesser curvature, close to the gastroesophageal junction in two patients. In the third patient, multiple petechial spots were noticed in the fundus. The plan for PEG was abandoned and the stomach deflated by endoscopic suction. There was no subsequent hematemesis, melena, or drop in hemoglobin. One week later, repeat UGIE in the first two patients revealed multiple healing linear ulcers of 1 to 3 cm in the lesser curvature and PEG was performed. Conclusion Overinsufflation over a short duration during UGIE may lead to EIGB. Early detection is key and in the absence gastric perforation, patients can be managed conservatively.

Download Full-text

Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000500002 ◽

2005 ◽

Vol 20 (5) ◽

pp. 347-352 ◽

Cited By ~ 30

Author(s):

Alberto Goldenberg ◽

Jacques Matone ◽

Wagner Marcondes ◽

Fernando Augusto Mardiros Herbella ◽

José Francisco de Mattos Farah

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Peritoneal Cavity ◽

Abdominal Cavity ◽

Mesh Fixation ◽

Rabbit Model ◽

Laparoscopic Approach ◽

Preperitoneal Space ◽

Similar Amount ◽

The Right

PURPOSE: Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS: Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist RESULTS: Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78,6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85,7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION: Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

Download Full-text

Surgical Management of Hiatal Hernia in Children with Asplenia Syndrome

European Journal of Pediatric Surgery ◽

10.1055/s-0036-1592135 ◽

2016 ◽

Vol 27 (03) ◽

pp. 274-279

Author(s):

Koji Fukumoto ◽

Masaya Yamoto ◽

Hiroshi Nouso ◽

Masakatsu Kaneshiro ◽

Mariko Koyama ◽

...

Keyword(s):

Hiatal Hernia ◽

Duodenal Obstruction ◽

Abdominal Cavity ◽

The Other ◽

Esophageal Hiatus ◽

Thoracic Cavity ◽

Toupet Fundoplication ◽

Cavity Volume ◽

Upper Gastrointestinal ◽

Asplenia Syndrome

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

Download Full-text

Minimally Invasive Resection of Benign Gastric Tumors in Challenging Locations: Prepyloric Region or Gastroesophageal Junction

The American Surgeon ◽

10.1177/000313481307901002 ◽

2013 ◽

Vol 79 (10) ◽

pp. 968-972 ◽

Cited By ~ 1

Author(s):

Christopher Armstrong ◽

Alana Gebhart ◽

Brian R. Smith ◽

Ninh T. Nguyen

Keyword(s):

Minimally Invasive ◽

Perioperative Complications ◽

Wedge Resection ◽

Gastroesophageal Junction ◽

Surgical Techniques ◽

Surgical Approaches ◽

Anatomic Resection ◽

Submucosal Tumors ◽

Gastric Tumors ◽

Minimally Invasive Surgical

Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. Data on tumor size and location, type of minimally invasive surgical resection, perioperative complications, 90-day mortality, pathology, and recurrence were collected. A total of 70 consecutive patients underwent laparoscopic resection of benign-appearing submucosal gastric tumors; there were 24 patients with lesions close to the GEJ and nine patients with lesions close to the prepyloric region. All lesions were successfully resected laparoscopically. For prepyloric tumors, surgical approaches included enucleation (n = 1), wedge resection (n = 2), and distal gastrectomy with reconstruction (n = 6). For tumors close to the GEJ, surgical approaches included enucleation (n = 16), wedge resection (n = 3), and esophagogastrectomy (n = 5). Complications in this series of 33 patients included late strictures requiring endoscopic dilation in three patients who underwent esophagogastrectomy. The 90-day mortality rate was zero. There were no recurrences over a mean follow-up of 15 months (range, 1 to 86 months). Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.

Download Full-text