Wilson Modesto Pollara

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

A microcirurgia endoscopica transanal (TEM) e procedimento alternativo minimamente invasivo ao tratamento cirurgico radical para excisao de tumores benignos e malignos do reto. Ela oferece possibilidade operatoria aos procedimentos cirurgicos convencionais (resseccao anterior baixa ou amputacoes abdominoperineais), as quais acarretam alta morbimortalidade. Baseada na revisao da literatura e na experiencia propria dos autores, esta revisao tem por objetivo apresentar o metodo e as indicacoes para a TEM.

Primary malignant melanoma of the esophagus: a rare and aggressive disease

Primary malignant melanoma of the esophagus is an uncommon tumor, with approximately 300 cases having been reported thus far. The purpose of this study was to describe a case of a 60 year-old man with a 10 month history of progressive dysphagia and thoracic pain, the investigations of which led to a diagnosis of primary malignant melanoma of the esophagus. The patient underwent a transhiatal esophagectomy with subcarinal lymphadenectomy, and isoperistaltic gastric tube replacement of the esophagus. Nine months after surgery, he developed ischemic colitis, and metastasis in the mesentery was diagnosed. His disease progressed and he died one year after the esophagectomy. A review of the literature was performed.

Long-term Evaluation of Gastroplasty in Achalasia

Surgical treatment of achalasia is elected considering clinical findings prior to surgery. When the esophagus is still not very dilated cardiomyectomy with fundopli-cation to avoid reflux is the treatment of choice [3].

Videolaparoscopia em ratos: um novo modelo experimental

The introduction of videolaparoscopy and its aplication to more complex and extended procedures required the development of animal models for teaching and research. In the beginning, large animals were prefered, but because of their costs and dificulties of handling, small animals were progressively more often used. Our model offers the possibility to use five small animals (rats) concomitantly with only one insuflator. The procedure is based on a system conected in series to the five animals that are submited to the same insuflation pressure facilitating the realization of any kind of experiment. We did not find any problem to maintain the pneumoperitoneum in all animals of this study.

Método laparoscópico no diagnóstico e extensão da carcinomatose peritoneal

INTRODUCTION: The laparoscopic procedure is effective in the diagnosis and verification of level of intra-abdominal malignancies and allows exploration of commitment of the serosa, parietal and visceral peritoneum, liver, epiiplon, pelvic cavity and other organs of the abdominal cavity, and permit to deal with ascites. AIM: To describe laparoscopic technique and method to accomplish the peritoneal carcinomatosis status and indications for peritoniectomies. METHODS: After the introduction of the trocar under direct vision in the region of the umbilicus it is possible to empty ascites to the fullest, and collect material for cytological examination, avoiding contamination with blood. If there is no ascites, peritoneal lavage can be performed. Releases adhesions and adhesions can be also done prior to the operation of the cavity and also several biopsies of parietal peritoneum, diaphragm, omentum and pelvic cavity for confirmation. To determine whether the patient is a candidate for peritoniectomy and / or intra-abdominal hyperthermic chemotherapy, it can permit the realization of index of peritoneal carcinomatosis. For this to occur is essential to use the operating table with the ability to move the positions of Trendelemburg, proclivity and sides. CONCLUSION: The laparoscopic method is good to evaluate ascites, hepatic and peritoneal metastases, and may achieve efficiency, sensitivity and specificity of 100% for these attributes. It should be performed when there is clinical suspicion of intraperitoneal dissemination, but no diagnostic imaging confirmation.

Surgical Management of the Megaesophagus

Megaesophagus constitutes a syndrome characterized by esophageal motor alterations and in most cases dilatation of the esophagus.

Barrett’s Esophagus: Late Results of Conservative Management

Barrett’s esophagus or the metaplasia of squamous to columnar epithelium in the esophagus continues to attract the attention of many investigators because of its clinical implications. The first diagnostic doubts as to the real origin, whether congenital or acquired, and its relationship to reflux esophagitis have been clarified by recent research.

Estenose arterial pós-transplante hepático: tratamento com angioplastia transluminal percutânea

Vascular complications after liver transplantation include oclusion or stenosis at the sites of anastomosis in the hepatic artery, portal vein, and vena cava. Balloon angioplasty of these stenosis carries little risk and is a useful procedure for the treatment of these problems. The purpose of this paper was to assess whether percutaneous transluminal angioplasty can help to prolong allograft survival and impruve allograft function in patient with hepatic artery stenosis after liver transplantation. We report a 43-year-old mate with stenosis of hepatic artery anastomosis after liver transplantation. An abrupt elevation of liver enzymes and serum bilirrubin levels was noted on the fifth postoperative month. The patient underwent percutaneous liver biopsy, which revealed important ductal depletion due to hypoperfusion, even though Doppler ultrasound examination demonstrated arterial flow. An angiogram confirmed severe stenosis of the arterial anastomosis with poor intraparenchymal arterial perfusion pattern. In an attempt to preserve the graft, a percutaneous transluminal angioplasty was performed using microballoons mounted on a hydrophylic micro guidewire. Intervention proceeded without complications. Liver enzimes and bilirrubin levels decreased within twenty-four hours of angioplasty. Normal levels were achieved after one week. Seven month after angioplasty, the patient is in a optimal clinical condition with no signs of graft impairment. We conclude that percutaneous transluminal angioplasty of hepatic artery stenosis after liver transplantation is relatively safe and may help decrease allograft loss.

Esophagectomy Without Thoracotomy Using the Cervicoabdominal Approach for the Management of Esophageal Carcinoma: Results

Obstructive diseases, especially neoplasms of the esophagus, frequently cause serious nutritional disturbances, besides the associated pulmonary changes due to aspiration of stagnant esophageal content. In addition, neoplasms occur in an older age group with a higher incidence of chronic obstructive pulmonary disease. Therefore, in these patients, there is a higher risk of postoperative pulmonary complications when performing esophagectomy via thoracotomy. Pain from thoracotomy also contributes, resulting in decreased ventilation and accumulation of secretions and pleural effusions; also the patient’s lateral position during the operation causes hypoventilation of the contralateral lung and passage of secretions from the compressed lung to the other. In order to eliminate these drawbacks, we remove the esophagus via a cervicoabdominal approach without thoracotomy [2]. This approach also allows the surgical staging of the neoplasm, with visualization of the lymph nodes of the lesser curvature, celiac trunk, and the hepatic parenchyma, and it provides better assessment of resectability without the need for thoracotomy.

Excisão total do mesorreto por laparoscopia

INTRODUCAO: O tratamento cirurgico do câncer do reto passou por grande refinamento tecnico apos a incorporacao da excisao total do mesorreto. A possibilidade de tratamento por laparoscopia ainda permanece como motivo de controversia. Assim, uma revisao atualizada do assunto e pertinente para ajudar a orientar a conduta aos pacientes com esse tumor. METODO: Foram consultadas as bases de dados disponiveis pelo Medline/Pubmed, Scielo e Lilacs cruzando os seguintes unitermos: câncer colorretal, laparoscopia, cirurgia. CONCLUSAO: Ate a presente data, ainda permanece motivo de controversia se o tratamento do câncer de reto deve ser realizado de forma rotineira por laparoscopia. Nao existem dados na literatura que suportem a realizacao minimamente invasiva da excisao total do mesorreto para o tratamento do câncer de reto fora de protocolo de pesquisa, especialmente pela ausencia de indices de sobrevida e de recidiva local com pelo menos cinco anos de seguimento.