1,721,002 research outputs found
Terapia chirurgica del reflusso,dei disturbi della motilità e dei diverticoli dell'esofago
No full textOpen versus endosurgical approach for Zenker diverticulum: the critical role of cricopharyngeal myotomy
No full textTRATTAMENTO TORACOSCOPICO DI PERFORAZIONE ESOFAGEA DA CORPO ESTRANEO
No full textRiportiamo il caso clinico di un uomo, 47 anni, oligofrenico ed epilettico, inviato alla nostra osservazione per ingestione accidentale di corpo estraneo (protesi dentaria) ritenuto a livello dell’esofago toracico superiore. Molteplici tentativi endoscopici non erano andati a buon fine; l’ultimo aveva determinato una perforazione intramurale mucosa riparata parzialmente con endosclips. Si decideva pertanto di procedere alla rimozione del corpo estraneo per via toracoscopica destra in decubito laterale utilizzando tre trocar da 10-12 mm in VI-VII e VIII spazio intercostale. All’esplorazione della cavità toracica si repertava presenza di bombè del compartimento mediastinico a monte della crosse della vena azygos. Si procedeva ad incisione della pleura mediastinica, esofagotomia (circa 3 cm) ed alla rimozione del corpo estraneo (cinque elementi dentari più tre ganci) con concomitante visione endoscopica. La mucosa esofagea è stata suturata con continua di PDS 3-0 del piano mucoso e del piano muscolare. La prova idropneumatica è risultata negativa. La sutura della pleura mediastinica ha completato l’intervento. La dentiera è stata estratta dalla cavità toracica con endocatch dal trocar più anteriore. Il cavo pleurico è stato drenato con Blake n. 24
Thoracoscopic management of chylothorax complicating esophagectomy
No full textBackground: Chylothorax is a relatively uncommon complication of esophageal surgery that may lead to severe respiratory, nutritional, and immunologic deficiencies. Patients and Methods: Between 1992 and 2000, 3 of 316 patients (0.9%) undergoing transthoracic esophagectomy for carcinoma developed postoperative chylothorax. Two of them had previously been treated with neoadjuvant chemoradiation, and one had been submitted to esophagogastric resection through a left thoracotomy. After a 2-week trial of total parenteral nutrition and drainage, two patients underwent thoracic duct ligation via thoracotomy. In the last patient, the operation was completed by thoracoscopy. The azygos vein and the periaortic tissue above the diaphragm were encircled en bloc by a right-angled clamp, and a roticulating endostapler was applied. Results: Reoperation was successful in all patients. The postoperative hospital stay was 4 days. Conclusion: Thoracoscopy is a safe and effective procedure for the treatment of chylothorax complicating esophagectomy. Given the minimal trauma to the patient, early thoracoscopic reoperation can be advocated in patients with high-output chyle loss in order to reduce the hospital stay
Outcome of esophageal adenocarcinoma detected during endoscopic biopsy surveillance for Barrett's esophagus
No full textResults of surgical therapy in patients with Barrett's adenocarcinoma
No full textThe incidence of adenocarcinoma arising from Barrett's esophagus is dramatically increasing in Western countries. The purpose of this study was to report our experience in the surgical management of these patients. Between November 1992 and December 2000, 330 consecutive patients with adenocarcinoma of the esophagogastric junction were observed in our institution. Of these, 105 (31.8%) had Barrett's carcinoma. In 12 individuals (11.4%) adenocarcinoma was discovered during endoscopic surveillance for Barrett's esophagus. Twelve patients with doubtful cleavage planes at preoperative investigation were treated with neoadjuvant chemotherapy. Overall, 80 patients (76.2%) underwent esophagectomy without operative mortality. The Ivor Lewis approach was used in 70 patients; of these, 31 underwent extended mediastinal lymph node dissection. Seventy-four patients (92.5%) had R0 resection. The overall 5-year survival rate was 48%. Survival was significantly associated with stage, lymph node status, and completeness of resection. Early diagnosis remains the prerequisite for curative treatment of esophageal carcinoma. An extended mediastinal lymphadenectomy does not increase morbidity, allows precise tumor staging, and may prove effective in preventing local recurrences. Neoadjuvant therapy requires major improvement before it can be unconditionally recommended outside clinical trials
LAPAROSCOPIC TOUPET FUNDOPLICATION WITH BILATERAL RUNNING SUTURES
No full textThe gastrohepatic ligament is opened. The right diaphragmatic crus is dissected free. Dissection of the crura automatically result in a tunnel behind the esophagus. The posterior part of the left crus is now nicely exposed. A penrose drain is passed behind around the esophagus, incorporating both the anterior and posterior vagus nerves. The esophagus is pulled upward, and dissection is carried out in the posterior mediastinum. The lower 5 cm of the esophagus should stay in the abdominal cavity without any tension. Short gastric vessels are then divided. A posterior hiatoplasty is performed using three resorbable prolene 2-0. A space of about 1 cm is left between stitches. The fundus is pulled behind the esophagus to the right side. Tailoring of the wrap is controlled by the shoeshine test. The upper left part of the fundus is fixed with the left crus and the esophagus. Similarly another suture fixes the upper part of the wrap to the right side of the esophagus. A single suture fixes the lower right and left part of the fundus to the esophagus. A running PDS 3-0 suture is used bilaterally to reinforce the wrap within the esophagus
Current status of minimally invasive endoscopic management for Zenker diverticulum
No full textSurgical resection has been the mainstay of treatment of pharyngoesophageal (Zenker) diverticula over the past century. Developments in minimally invasive surgery and new endoscopic devices have led to a paradigm change. The concept of dividing the septum between the esophagus and the pouch rather than resecting the pouch itself has been revisited during the last three decades and new technologies have been investigated to make the transoral operation safe and effective. The internal pharyngoesophageal myotomy accomplished through the transoral stapling approach has been shown to effectively relieve outflow obstruction and restore physiological bolus transit in patients with medium size diverticula. Transoral techniques, either through a rigid device or by flexible endoscopy, are gaining popularity over the open surgical approach due the low morbidity, the fast recovery time and the fact that the procedure can be safely repeated. We provide an analysis of the the current status of minimally invasive endoscopic management of Zenker diverticulum
A putative role of ribonuclear inclusions and MBNL1 in the impairment of gallbladder smooth muscle contractility with cholelithiasis in myotonic dystrophy type 1
No full textMyotonic dystrophy type 1 (DM1) is an autosomal dominant multisystemic disorder caused by expansion of unstable trinucleotide (CTG) repeats at 3' untranslated region of the DMPK gene on chromosome 19q13.3. Mutant transcripts are retained in muscle nuclei as ribonuclear inclusions and interact with RNA-binding proteins, such as muscleblind-like protein 1 (MBNL1), leading to a reduction in their activity. The reduced MBNL1 activity has been associated to skeletal and cardiac muscle dysfunction. However, other organs and systems may be involved. It has been reported that 25-50% of DM1 patients have abdominal symptoms due to cholelithiasis or gallstones. Since impaired gallbladder motility plays an important role in gallstones formation, we have analyzed by FISH combined with MBNL1-immunofluorescence, the gallbladder obtained from a woman affected by DM1 who required a cholecystectomy at the age of 30. Gallbladders obtained from two no-DM1 subjects have been used as controls. Ribonuclear inclusions and MBNL1 foci accumulate and colocalize in nuclei of DM1 gallbladder smooth muscle cells. On the contrary, no ribonuclear inclusions are detectable in cell nuclei of control gallbladders and MBNL1 is uniformly distributed in smooth muscle cell nuclei. These results suggest that nuclear accumulation of MBNL1 and ribonuclear inclusions may have a direct adverse effect on gallbladder smooth muscle contractility and thus contribute to gallstones formation in DM1 patients
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