Felipe Montes Pena

Laparoscopic transhiatal esophagectomy: outcomes

BackgroundLaparoscopic transhiatal esophagectomy, indicated for benign and malignant esophageal diseases, is a complex operation, often associated with a high rate of morbidity and mortality. During the past decade this technique has became well accepted among specialized surgeons for the treatment of esophageal cancer, avoiding thoracotomy and reducing open access complications. The aim of the present study was to retrospectively analyze patients with esophageal cancer who underwent laparoscopic transhiatal esophagectomy.MethodsFrom November 1993 to August 2006, 78 patients underwent laparoscopic transhiatal esophagectomy. There were 68 cases of esophageal cancer (57 males and 21 females, age range = 28–73 years) with a predominant rate of squamous cell carcinoma (60.2%).ResultsThe conversion rate was 6.4%. The mean operative time was 153 min with a 12.8% rate of cervical leak and a postoperative (30-day) mortality rate of 5.1%. The four-year survival rate was 19% as determined within a subgroup of 21 patients whose followup during the period was possible.ConclusionsLaparoscopic transhiatal esophagectomy is a safe alternative for experienced professionals. This access can improve mortality, hospital stay, and other outcomes when compared with open methods.

Esofagectomia laparocópica transhiatal: resultados imediatos

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.

Auricular perichondritis by piercing complicated with pseudomonas infection

INTRODUCTIONPerichondritis is a slow evolving infection, located on the ear cartilage. They result from lacerations, blunt trauma, surgeries and other affections. Ear piercing induced pinna perichondritis is a frequent affection among the young population. The most commonly found etiologic agent is Pseudomonas aeruginosa and its inoculation caused by pinna cartilage and pericondrium exposure during or after the piercing procedure. Etiologic investigation is mandatory by means of secretion culture and antibiogram. Treatment is based on surgical drainage, systemic antibiotics and anti-inflammatory agents.

Tratamento endovascular em paciente portador de coarctação da aorta: relato de caso

Aortic coarctation is a congenital stenosis in the initial portion of the thoracic aorta. Its incidence ranges between 6-8% of liveborns. Clinical presentations are diversified. The treatment of choice is surgery. We report the case of a 31-year-old female patient with constrictive pain in the cervical region, dyspnea, and intermittent claudication of the lower limbs. She was diagnosed with aortic coarctation associated with severe aortic stenosis, which was treated using a combination of endovascular stent implantation and balloon angioplasty.