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[PMID]:28440519
[Au] Autor:Wu H; Zhong M; Zhou D; Shi C; Jiao H; Wu W; Chang X; Cang J; Bian H
[Ad] Endereço:Department of General Surgery, Multidisciplinary Team of Bariatric and Metabolic Surgery from Zhongshan Hospital, Fudan University, Shanghai 200032, China. wu.haifu@zs-hospital.sh.cn.
[Ti] Título:[Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(4):393-397, 2017 Apr 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Cirurgia Bariátrica/efeitos adversos
Gastrectomia/efeitos adversos
Derivação Gástrica/efeitos adversos
Hemorragia Gastrointestinal/prevenção & controle
Hemorragia Gastrointestinal/cirurgia
Laparoscopia/efeitos adversos
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/prevenção & controle
Complicações Pós-Operatórias/terapia
Embolia Pulmonar/terapia
Trombose Venosa/prevenção & controle
Trombose Venosa/terapia
[Mh] Termos MeSH secundário: Anticoagulantes/uso terapêutico
Cateterismo
China
Tratamento Conservador
Constrição Patológica/etiologia
Constrição Patológica/terapia
Fístula do Sistema Digestório/etiologia
Fístula do Sistema Digestório/terapia
Endoscopia Gastrointestinal/métodos
Oxigenação por Membrana Extracorpórea
Mucosa Gástrica/patologia
Coto Gástrico/fisiopatologia
Coto Gástrico/cirurgia
Hemorragia Gastrointestinal/etiologia
Hemostasia Cirúrgica/efeitos adversos
Hemostasia Cirúrgica/métodos
Técnicas Hemostáticas
Heparina/uso terapêutico
Seres Humanos
Dispositivos de Compressão Pneumática Intermitente
Intestino Delgado/patologia
Margens de Excisão
Úlcera Péptica/etiologia
Úlcera Péptica/terapia
Embolia Pulmonar/etiologia
Stents
Meias de Compressão
Trombectomia
Terapia Trombolítica
Trombose Venosa/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 9005-49-6 (Heparin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170426
[St] Status:MEDLINE


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[PMID]:28325189
[Au] Autor:Laks S; Meyers MO; Kim HJ
[Ad] Endereço:Division of Surgical Oncology, University of North Carolina, 170 Manning Drive, CB #7213, 1150 Physicians Office Building, Chapel Hill, NC 27599-7213, USA.
[Ti] Título:Surveillance for Gastric Cancer.
[So] Source:Surg Clin North Am;97(2):317-331, 2017 Apr.
[Is] ISSN:1558-3171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This article discusses the current National Comprehensive Cancer Network guidelines and other available Western and Eastern guidelines for the surveillance of gastric cancer following surgical resection. It reviews the literature assessing the utility of intensive surveillance strategies for gastric cancer, which fails to show an improvement in survival. The unique issues relating to follow-up of early gastric cancer and after endoscopic resection of early gastric cancer are discussed. This article also reviews the available modalities for follow-up. In addition, it briefly discusses the advancements in treatment of recurrent and metastatic disease and the implications for gastric cancer survival and surveillance strategies.
[Mh] Termos MeSH primário: Gastrectomia
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: Assistência ao Convalescente/métodos
Consenso
Detecção Precoce de Câncer/métodos
Coto Gástrico/cirurgia
Gastroscopia/métodos
Seres Humanos
Metastasectomia/métodos
Metástase Neoplásica
Recidiva Local de Neoplasia/diagnóstico
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170424
[Lr] Data última revisão:
170424
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE


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[PMID]:28325187
[Au] Autor:Davis JL; Ripley RT
[Ad] Endereço:Surgical Oncology Section, Thoracic & Gastrointestinal Oncology Branch, National Cancer Institute, 10 Center Drive, MSC1201, Room 4-3940, Bethesda, MD 20892, USA. Electronic address: Jeremy.Davis@nih.gov.
[Ti] Título:Postgastrectomy Syndromes and Nutritional Considerations Following Gastric Surgery.
[So] Source:Surg Clin North Am;97(2):277-293, 2017 Apr.
[Is] ISSN:1558-3171
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Postgastrectomy syndromes result from altered form and function of the stomach. Gastrectomy disrupts reservoir capacity, mechanical digestion and gastric emptying. Early recognition of symptoms with prompt evaluation and treatment is essential. Many syndromes resolve with minimal intervention or dietary modifications. Re-operation is not common but often warranted for afferent and efferent loop syndromes and bile reflux gastritis. Preoperative nutritional assessment and treatment of common vitamin and mineral deficiencies after gastrectomy can reduce the incidence of chronic complications. An integrated team approach to risk assessment, patient education, and postoperative management is critical to optimal care of patients with gastric cancer.
[Mh] Termos MeSH primário: Síndromes Pós-Gastrectomia/dietoterapia
[Mh] Termos MeSH secundário: Síndrome da Alça Aferente/etiologia
Síndrome da Alça Aferente/cirurgia
Anastomose em-Y de Roux
Refluxo Biliar/etiologia
Diarreia/etiologia
Suplementos Nutricionais
Síndrome de Esvaziamento Rápido/dietoterapia
Síndrome de Esvaziamento Rápido/etiologia
Esvaziamento Gástrico/fisiologia
Coto Gástrico/fisiopatologia
Gastrite/etiologia
Gastroparesia/etiologia
Seres Humanos
Desnutrição/dietoterapia
Desnutrição/etiologia
Síndromes Pós-Gastrectomia/fisiopatologia
Síndromes Pós-Gastrectomia/cirurgia
Reoperação
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170424
[Lr] Data última revisão:
170424
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE


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[PMID]:28226348
[Au] Autor:Xu H; Wang W; Li P; Zhang D; Yang L; Xu Z
[Ti] Título:[The key points of prevention for special surgical complications after radical operation of gastric cancer].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(2):152-155, 2017 Feb 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Incidence of gastric cancer is high in China and standard radical operation is currently the main treatment for gastric cancer. Postoperative complications, especially some special complications, can directly affect the prognosis of patients, even result in the increase of mortality. But the incidences of these special complications are low, so these complications are often misdiagnosed and delayed in treatment owing to insufficient recognition of medical staff. These special complications include (1) Peterson hernia: It is an abdominal hernia developed in the space between Roux loop and transverse colon mesentery after Roux-Y reconstruction of digestive tract. Peterson hernia is rare and can quickly result in gangrenous ileus. Because of low incidence and without specific clinical symptoms, this hernia does not attract enough attention in clinical practice, so the outcome will be very serious. Once the diagnosis is made, an emergent operation must be performed immediately. Peterson space should be closed routinely in order to avoid the development of hernia. (2) Lymphatic leakage: It is also called chyle leakage. Cisterna chylus is formed by gradual concentration of extensive lymphatic net to diaphragm angle within abdominal cavity. Lymphadenectomy during operation may easily damage lymphatic net and result in leakage. The use of ultrasonic scalpel can decrease the risk of lymphatic leakage in certain degree. If lymphatic leakage is found during operation, transfixion should be performed in time. Treatment includes total parenteral nutrition, maintenance of internal environment, supplement of protein, and observation by clamp as an attempt. (3)Duodenal stump leakage: It is one of serious complications affecting the recovery and leading to death after subtotal gastrectomy. Correct management of duodenal stump during operation is one of key points of the prevention of duodenal stump leakage. Routine purse embedding of duodenal stump is recommend during operation. The key treatment of this complication is to promt diagnosis and effective hemostasis.(4) Blood supply disorder of Roux-Y intestinal loop: Main preventive principle of this complication is to pay attention to the blood supply of vascular arch in intestinal edge. (5) Anastomotic obstruction by big purse of jejunal stump: When Roux-en-Y anastomosis is performed after distal radical operation for gastric cancer, anvil is placed in the remnant stomach and anastomat from distal jejunal stump is placed to make gastrojejunal anastomosis, and the stump is closed with big purse embedding. The embedding jejunal stump may enter gastric cavity leading to internal hernia and anastomotic obstruction. We suggest that application of interruptable and interlocking suture and fixation of stump on the gastric wall can avoid the development of this complication.
[Mh] Termos MeSH primário: Anastomose em-Y de Roux/efeitos adversos
Gastrectomia/efeitos adversos
Gastrectomia/métodos
Excisão de Linfonodo/efeitos adversos
Complicações Pós-Operatórias/prevenção & controle
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: China
Ascite Quilosa/etiologia
Ascite Quilosa/prevenção & controle
Ascite Quilosa/terapia
Duodeno/irrigação sanguínea
Duodeno/cirurgia
Gastrectomia/mortalidade
Obstrução da Saída Gástrica/etiologia
Obstrução da Saída Gástrica/prevenção & controle
Coto Gástrico/cirurgia
Técnicas Hemostáticas
Hérnia/etiologia
Hérnia/prevenção & controle
Hérnia/terapia
Ablação por Ultrassom Focalizado de Alta Intensidade/instrumentação
Seres Humanos
Jejuno/irrigação sanguínea
Jejuno/cirurgia
Excisão de Linfonodo/instrumentação
Sistema Linfático/lesões
Complicações Pós-Operatórias/classificação
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/mortalidade
Prognóstico
Estômago/cirurgia
Neoplasias Gástricas/complicações
Técnicas de Sutura/normas
Ducto Torácico/lesões
Técnicas de Fechamento de Ferimentos/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170223
[St] Status:MEDLINE


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[PMID]:28219214
[Au] Autor:Liu DL; Zhang XW; Lyu FQ
[Ad] Endereço:Department of Pharmacy, Tai'an Tumor Prevention and Treatment Hospital, Tai'an 271000, China.
[Ti] Título:[Analysis of risk factors for postsurgical gastroparesis syndrome (PGS) after operation for gastric cancer].
[So] Source:Zhonghua Zhong Liu Za Zhi;39(2):150-153, 2017 Feb 23.
[Is] ISSN:0253-3766
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To investigate the risk factors for postsurgical gastroparesis syndrome (PGS) after surgery for stomach cancer. A total of 684 patients with gastric cancer who underwent surgery for stomach cancer from Jan. 1, 2010 to Dec. 31, 2014 in Tai'an Tumor Prevention and Treatment Hospital, including 475 males and 209 females, with an average age of 59.9 years were identified and included in this study. There were 206 cases of gastric cardia and gastric fundus cancers and 478 cases of gastric antrum cancer. 206 cases underwent proximal radical subtotal gastrectomy and D2 lymph node dissection, 478 distal radical subtotal gastrectomy, 206 residual esophagogastric anastomosis, 311 Billroth-â…  anastomosis, 99 Billroth-â…¡ anastomosis, and 68 Billroth-â…¡ plus Roux-en-y anastomosis. The incidence and risk factors of PGS were analyzed. All of the 684 patients were successfully operated.Among them, 48 (7.0%)encountered PGS. The univariate analysis showed that age, smoking index, alcohol consumption index, infection, scores of anxiety, preoperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level, abdominal cavity infection, and usage of postoperative analgesia pump were related to the occurrence of PGS ( <0.05 for all), while sex, hypertension, diabetes, perioperative hemoglobin level, perioperative electrolyte imbalance, operation duration, intraoperative blood loss, size of gastric remnant and number of dissected lymph nodes were not significantly related to the occurrence of PGS( >0.05 for all). The multivariate binary logistic regression analysis showed that age, infection, scores of anxiety, perioperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level and abdominal cavity infection were risk factors for PGS ( <0.05 for all); while the age (<67 years old), perioperative albumin level (>35 g/L) and preservation of the vagus nerve trunk were protective factors of PGS ( <0.05 for all). The occurrence of PGS is affected by many factors. Detailed evaluation of patients'symptoms and physical signs before operation and rectifying and eliminating risk factors are important to prevent and reduce the occurrence of PGS in patients with gastric cancer.
[Mh] Termos MeSH primário: Gastrectomia/efeitos adversos
Gastroparesia/etiologia
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: Anastomose em-Y de Roux/efeitos adversos
Feminino
Gastrectomia/métodos
Coto Gástrico
Seres Humanos
Incidência
Modelos Logísticos
Excisão de Linfonodo/estatística & dados numéricos
Masculino
Complicações Pós-Operatórias
Fatores de Risco
Síndrome
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170222
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0253-3766.2017.02.016


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[PMID]:28194797
[Au] Autor:Jun W; Wei W; Weibing W; Jing X; Fuxi Z; Xiaoxiang X; Bihong L; Tong Z; Liang C; Jinhua L
[Ad] Endereço:Department of Thoracic and Cardiovascular Surgery, Jiangsu Province People's Hospital and the First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
[Ti] Título:Clinical outcome of using gastric remnant or jejunum or colon conduit in surgery for esophageal carcinoma with previous gastrectomy.
[So] Source:J Surg Oncol;115(6):729-737, 2017 May.
[Is] ISSN:1096-9098
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: For esophageal carcinoma patients with early gastrectomy, individualized surgical plans-including selection of replacement conduit and operation route based on patient's new lesion and surgical history-can achieve the desired therapeutic effect and improve postoperative life quality. We investigated the outcomes at our institution. METHODS: The clinical data of 42 esophageal carcinoma patients with early gastrectomy were analyzed retrospectively. RESULTS: Esophagectomy was performed combining replacement with remnant stomach in 16 patients, jejunum in 17, and colon in 9. Esophagectomy combining replacement with gastric remnant got advantages of shorter operation time and less bleeding over that of replacement with jejunum or colon. Gastric remnant group scored higher on the QLQ-C30 questionnaire than jejunum or colon group with respect to overall quality of life, physical function, and social relationships. In QLQ-OES18 questionnaire, the scores of appetite recovery and reflux mitigation were more favorable in remnant stomach group than those in jejunum or colon group. Survival analysis showed no significant difference in survival rate among the patients undergoing replacement with gastric remnant, jejunum, or colon. CONCLUSIONS: For esophageal carcinoma patients with early gastrectomy, esophagus-gastric remnant anastomosis possesses advantages of shorter operation time, less surgical trauma, and greater life quality after surgery.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/métodos
Colo/cirurgia
Neoplasias Esofágicas/cirurgia
Jejuno/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Esofagectomia/métodos
Feminino
Gastrectomia
Coto Gástrico/cirurgia
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170215
[St] Status:MEDLINE
[do] DOI:10.1002/jso.24564


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[PMID]:28105623
[Au] Autor:Chen L; Wei S; Ye Z; Wang Y; Zheng Q; Zhuo C; Xiao J; Zeng Y
[Ad] Endereço:Department of Gastrointestinal Surgery, Fujian Provincial Tumor Hospital, Fuzhou 350014, China. wydoc2012@163.com.
[Ti] Título:[Study on the clinicopathologic characteristics and prognostic difference of gastric stump cancer between non-anastomotic site and anastomotic site].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(1):67-72, 2017 Jan 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To evaluate the clinicopathologic characteristics and prognostic difference of gastric stump cancer between non-anastomotic site and anastomotic site. METHODS: Clinicopathologic data of 149 patients with gastric stump cancer undergoing operation (radical resection and palliative resection) in our department from January 1999 to June 2015 were analyzed retrospectively. Gastric stump cancer was defined as a primary carcinoma detected in the remnant stomach more than 5 years after subtotal gastrectomy for a benign disease(87 cases) or over 10 years after radical subtotal gastrectomy for a malignant disease (62 cases). Patients were divided into the anastomotic site group (72 cases) and the non-anastomotic site group (77 cases) according to tumor sites within the remnant stomach. Clinicopathologic characteristics, operative data, lymph node metastasis and prognosis were compared between the two groups. RESULTS: Compared with non-anastomotic site group, the T stage, N stage and TNM stage were later in the anastomotic site group. Number of case of T1, T2, T3, and T4 stage in anastomotic site group was 1(1.4%), 2 (2.8%), 17(23.6%) and 52(72.2%), while such number in non-anastomotic site group was 8(10.4%), 10(13.0%), 27(35.1%) and 32(41.6%) respectively(χ =17.665, P=0.001). Number of case of N0, N1, N2, and N3 in anastomotic site group was 28 (38.9%), 10 (13.9%), 23 (31.9%) and 11 (15.3%), while such number in non-anastomotic site group was 55 (71.4%), 10 (13.0%), 7 (9.1%) and 5 (6.5%) respectively(χ =19.421, P=0.000). Number of case of stage I(, II(, III( and IIII( in anastomotic site group was 3(4.2%), 10(13.9%), 47(65.3%) and 12(16.7%), while such number in non-anastomotic site group was 16(20.8%), 40 (51.9%), 15(19.5%) and 6(7.8%) respectively(χ =45.294, P=0.000). The histology and Borrmann classification were worse in anastomotic site group. Anastomotic site group had 19 cases(26.4%) of good differentiation and 53 cases(73.6%) of bad differentiation, while non-anastomotic site group had 43 cases (55.8%) of well-differentiated and 34 cases (44.2%) of poorly-differentiated tumors respectively(χ =13.287, P=0.000). Anastomotic site group had 3 cases (4.2%) of Borrmann I(, 17 cases (23.6%) of Borrmann II(, 47 cases(65.3%) of Borrmann III( and 5 cases (6.9%) of Borrmann IIII(, while non-anastomotic site group had 18 cases (23.4%) of Borrmann I(, 16 cases (20.8%) of Borrmann II(, 34 cases (50.6%) of Borrmann III( and 4 cases (5.2%) of Borrmann IIII( respectively(χ =11.445, P=0.010). Compared with non-anastomotic site group, anastomotic site group had a lower curative resection rate [63.9% (46/72) vs. 89.6% (69/77), χ =13.977, P=0.000], a higher combined organ resection rate [33.3% (24/72) vs. 16.9% (13/77), χ =5.394, P=0.020] and a more metastatic lymph nodes (4.3±4.9 vs. 1.9±3.6, t=3.478, P=0.000). The lymph node metastasis rates of No.4, No.10 and jejunal mesentery root lymph node in anastomotic site group and non-anastomotic site group were 15.3% (11/72) and 5.2% (4/77)(χ =4.178, P=0.041), 9.7% (7/72) and 1.3% (1/77) (χ =5.196, P=0.023), and 25.0% (18/72) and 3.9% (3/77)(χ =13.687, P=0.000), respectively. Median followed up of all the patients was 37(2 to 154) months and the overall 5-year survival rate was 44.1%. The 5-year survival rate was 33.1% in anastomotic site group and 55.2% in non-anastomotic site group, and the difference was statistically significant between two groups (P=0.015). In the subgroup analysis according to the histology differentiation, the 5-year survival rate of patients with well-differentiation was not significantly different between two groups (43.7% vs. 56.2%, P=0.872), but the 5-year survival rate of patients with bad differentiation in anastomotic site group was significantly lower than that in non-anastomotic site group(29.8% vs. 53.8%, P=0.029). CONCLUSION: Gastric stump cancer locating in anastomotic site indicates worse differentiation histology, higher lymph node metastasis rate, lower curative resection rate and poorer prognosis.
[Mh] Termos MeSH primário: Anastomose Cirúrgica/efeitos adversos
Carcinoma/patologia
Gastrectomia/efeitos adversos
Coto Gástrico/patologia
Coto Gástrico/cirurgia
Neoplasias Gástricas/patologia
[Mh] Termos MeSH secundário: Idoso
Anastomose Cirúrgica/mortalidade
Anastomose Cirúrgica/estatística & dados numéricos
Carcinoma/mortalidade
Carcinoma/terapia
Feminino
Seres Humanos
Linfonodos
Metástase Linfática
Masculino
Meia-Idade
Gradação de Tumores/estatística & dados numéricos
Prognóstico
Estudos Retrospectivos
Neoplasias Gástricas/classificação
Neoplasias Gástricas/mortalidade
Neoplasias Gástricas/terapia
Taxa de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170908
[Lr] Data última revisão:
170908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170121
[St] Status:MEDLINE


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Almeida, Elia Claudia de Souza
Texto completo SciELO Brasil
[PMID]:28079245
[Au] Autor:Rodrigues RS; Almeida ÉC; Terra JA; Guimarães LC; Duque AC; Etchebehere RM
[Ad] Endereço:Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brasil.
[Ti] Título:Gastric and jejunal histopathological changes in patients undergoing bariatric surgery.
[So] Source:Arq Gastroenterol;54(1):75-78, 2017 Jan-Mar.
[Is] ISSN:1678-4219
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: - Morbid obesity is a multifactorial disease that is increasingly treated by surgery. OBJECTIVE: - To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. METHODS: - This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. RESULTS: - In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in Helicobacter pylori infection (P=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. CONCLUSION: - There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients.
[Mh] Termos MeSH primário: Cirurgia Bariátrica
Mucosa Gástrica/patologia
Gastrite/patologia
Infecções por Helicobacter/patologia
Mucosa Intestinal/patologia
Obesidade Mórbida/patologia
[Mh] Termos MeSH secundário: Adulto
Doença Crônica
Endoscopia Gastrointestinal
Feminino
Coto Gástrico
Infecções por Helicobacter/etiologia
Seres Humanos
Masculino
Meia-Idade
Obesidade Mórbida/cirurgia
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY; RETRACTED PUBLICATION
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170607
[Lr] Data última revisão:
170607
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170113
[St] Status:MEDLINE


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[PMID]:27783369
[Au] Autor:Amor IB; Debs T; Petrucciani N; Martini F; Kassir R; Gugenheim J
[Ad] Endereço:Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France.
[Ti] Título:A Simple Technique of Gastric Pouch Resizing for Inadequate Weight Loss After Roux-en-Y Gastric Bypass.
[So] Source:Obes Surg;27(1):273-274, 2017 Jan.
[Is] ISSN:1708-0428
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Weight regain after Roux-en-Y gastric bypass (RYGB) is increasingly reported in the literature Debs et al. Surg Obes Relat Dis (2016). Laparoscopic resizing of the gastric pouch and the gastrojejunal anastomosis is an accepted surgical option Nguyen et al. (Obes Surg 25:928-34, 2015); Iannelli et al. (Surg Obes Relat Dis 9:260-7, 2013); Al-Bader et al. (Obes Surg 25:1103-8, 2015). The aim of this video is to present a simple technique of en bloc resection. METHODS: We present the case of a 42-year-old woman with a BMI of 44 kg/m who underwent laparoscopic RYGB in 2007. In 2015, she regained weight till reaching a BMI of 38 kg/m . 3D CT volumetry was performed that showed a pouch volume of 220 cm and a gastrojejunal anastomosis diameter of 20 mm. RESULTS: There are often a lot of adherences between the gastric pouch and the residual stomach, which makes the dissection difficult and tedious, with the possibility to devascularize the residual stomach and lead to a gastric fistula from this residual stomach. We present in this video a simple technique of gastric pouch resizing that consists of en bloc resection of the gastric pouch, the residual stomach, and ± the gastrojejunal anastomosis. We recommend this technique in case of severe adherences and inability to identify a cleavage plane between the excess gastric pouch and the resected stomach. CONCLUSION: Insufficient weight loss or weight regain after RYGBP is becoming more frequently encountered. As a result, revisional surgery will be more frequently performed. This simple technique allows an easier dissection across healthier tissues and is easier to perform in the presence of severe adherences between the gastric pouch and the residual stomach.
[Mh] Termos MeSH primário: Derivação Gástrica
Coto Gástrico/cirurgia
Obesidade Mórbida/cirurgia
Reoperação/métodos
Perda de Peso
[Mh] Termos MeSH secundário: Parede Abdominal/cirurgia
Adulto
Feminino
Coto Gástrico/patologia
Seres Humanos
Laparoscopia/métodos
Tamanho do Órgão
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171105
[Lr] Data última revisão:
171105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161027
[St] Status:MEDLINE
[do] DOI:10.1007/s11695-016-2424-5


  10 / 494 MEDLINE  
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[PMID]:27738969
[Au] Autor:Zorron R; Branco A; Sampaio J; Bothe C; Junghans T; Rasim G; Pratschke J; Guel-Klein S
[Ad] Endereço:Center of Innovative Surgery (ZIC), Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany. Ricardo.Zorron@charite.de.
[Ti] Título:One-Anastomosis Jejunal Interposition with Gastric Remnant Resection (Branco-Zorron Switch) for Severe Recurrent Hyperinsulinemic Hypoglycemia after Gastric Bypass for Morbid Obesity.
[So] Source:Obes Surg;27(4):990-996, 2017 Apr.
[Is] ISSN:1708-0428
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The anatomical and physiological changes after Roux-en-Y gastric bypass for morbid obesity can lead to severe hyperinsulinemic hypoglycemia with neuroglycopenia in a small percentage of patients. The exact physiologic mechanism is not completely understood. Surgical reversal to the original anatomy and distal or total pancreatectomy are current therapeutic options to reverse the hypoglycemic effect, with substantial associated morbidity. Our group reports a pilot clinical series of a novel surgical technique using one-anastomosis jejunal interposition with gastric remnant resection (Branco-Zorron Switch). METHODS: Patients with severe symptomatic hyperinsulinemic hypoglycemia refractory to conservative therapy were treated using the technique. The procedure started with resection of the remnant stomach close to pylorus. The alimentary limb was sectioned at 20 cm from the gastrojejunal anastomosis, and the rest of the alimentary limb was resected until the Y-Roux anastomosis. A hand-sutured anastomosis was then performed with the proximal alimentary limb and the remnant antrum. RESULTS: Four patients were successfully submitted to the procedure with reversal of the symptomatology and normalization of insulin levels, postprandial glucose levels, and oral glucose tolerance test, with a mean follow-up of 24.3 months. Mean operative time was 188 min, and patients recovered without postoperative complications. CONCLUSION: Patients suffering from severe hyperinsulinemic hypoglycemia after gastric bypass may be efficiently treated by this innovative procedure, avoiding extreme surgical therapy such as pancreatectomy or restoring the gastric anatomy, while still maintaining sustained weight loss. Studies with larger series and longer follow-up are still needed to define the role of this therapy in managing this entity.
[Mh] Termos MeSH primário: Gastrectomia/métodos
Derivação Gástrica/efeitos adversos
Coto Gástrico/cirurgia
Hiperinsulinismo/cirurgia
Hipoglicemia/cirurgia
Jejuno/cirurgia
Obesidade Mórbida/cirurgia
[Mh] Termos MeSH secundário: Anastomose Cirúrgica
Doença Crônica
Feminino
Derivação Gástrica/métodos
Seres Humanos
Hiperinsulinismo/etiologia
Hipoglicemia/etiologia
Laparotomia
Masculino
Meia-Idade
Projetos Piloto
Recidiva
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171105
[Lr] Data última revisão:
171105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161015
[St] Status:MEDLINE
[do] DOI:10.1007/s11695-016-2410-y



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