Pedro Onari

Cardiomiectomia com fundoplicatura parcial videolaparoscópica no tratamento do megaesôfago não avançado: estudo de 50 casos

This is a prospective study of 50 patients with non-advanced achalasia treated by videolaparoscopic cardiomyectomy with partial fundoplication. The technical standardization of the operative procedure was evaluated, and the patients studied by clinical evaluation, endoscopy, eletromanometry, radiology and 24 hour pHmetry. The operation was completed laparoscopically in all patients, with no convertion to laparotomy. There were six (12%) intra-operative complications (mucosal perforation, pleural lesion and subcutaneous emphysema), two (4%) immediate post-operative ocurrencies and one (2%) death. There was no late complication. Clinical evaluation showed significant improvement of dysphagia, no regurgitation and weight gain after operation, and excellent and good results were obtained in 97.9% of the patients. In the post-operative period ocurred radiological improvement of esophageal dilatation and less endoscopic esophagitis. The eletromanometry showed significative decrease of lower esophageal sphincter pressure after operation, as well as 24 hour pHmetry verified less esophageal stasis and no gastro-esophageal refluxo There was no difference in the treatment of chagasic or non-chagasic patients. The benefits of laparoscopic surgery were obtained: less pain, early oral intake, short hospitalization and fast return to norma activities.

Colecistectomia laparoscópica: estruturação de um modelo de trabalho

The authors showed the results of 1772 laparoscopic cholecystectomies, 1700 of them consecutevely without mortality and low morbidity and fast post-operative recovery. From the 1772 patients, 12,4% were over 70 years old; 49% of them had associated diseases. Surgical risk were evaluated from ASA I to IV. Chronic cholecystitis were present in 94,8% of the patients while, 3,6% had acute cholecystitis, and 0,2% gallblader cancer. Intraoperative cholangiography was performed in 83% of the cases. There were 67 patients with choledocolithiasis, 29 of them with no pre-operative clinical suspection. Conversion rate was less than 1%. Operative technique was standartized, beginning with the patient position in operative bed, trocars positioning, gallblader presentation with the graspers, as well as the timing of the structures dissection. The importance of the technical sistematization utilized is underlined, as well as the use of special instruments for dissection. It is presented a working model for surgical formation on alimentary tract laparoscopic surgery, in a progressive and sistematized way. It begins with the organization of a motivated surgical team, working together in order to improve the laparoscopic surgery methodology. The model for surgical formation of is responsible for the excellent results obtained.