Predictive factors for short gastric vessels division during laparoscopic total fundoplication.

Objective: to determine clinical variables that can predict the need for division of the short gastric vessels (SGV), based on the gastric fundus tension, assessing postoperative outcomes in patients submitted or not to section of these vessels.

Methods: we analyzed data from 399 consecutive patients undergoing laparoscopic fundoplication for gastroesophageal reflux disease (GERD). The section of the SGV was performed according to the surgeon evaluation, based on the fundus tension.

Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil.

Background: In Brazil, gastric cancer is the fourth most common malignancy among men and sixth among women. The cause is multivariate and the risks are well known. It has prognosis and treatment defined by the location and staging of the tumor and number of lymph nodes resected and involved.

Evaluation of training and professional expectations of surgery residents.

Residency programs, especially in surgery, have been undergoing constant changes, not only in our country, but also internationally. Due to the depreciation of medical specialties and their lowering compensation, expectations and profile of residents in surgical fields are changing. The assessment of attitudes, experience in training and professional expectations among residents is an important topic.

Helicobacter pylori has no influence on distal gastric cancer survival.

Context: There is some evidence that Helicobacter pylori correlates with distal gastric cancer genesis. However, few studies analyzed the survival related to H. pylori infection.

Postprandial proximal gastric acid pocket in patients after laparoscopic Nissen fundoplication.

Background: An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). The role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether change in the PPGAP may contribute to GERD control.

Hiatal mesh repair--current status.

Most surgeons believe that cruroplasty (hiatoplasty) is an essential part of antireflux operations. One of the main causes of failure after antireflux operation is gastric (wrap) herniation through the hiatus that may be attributed to breakdown of the hiatal closure or a faulty repair. Surgeons are at present faced with the dilemma of choosing between a risk of recurrence and the fear of complications of prosthetic hiatal reinforcement.

Postprandial proximal gastric acid pocket in patients after Roux-en-Y gastric bypass.

Introduction: An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). The role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether operations that control GERD, such as Roux-en-Y gastric bypass (RYGB) and Nissen fundoplication, change the PPGAP.

Duodenal bypass does not decrease glucose levels of lean individuals with gastric cancer submitted to partial or total gastrectomy.

Change in glucose metabolism after bariatric operations may be credited to duodenal bypass. This study aims to evaluate the effect of duodenal bypass on glucose levels in lean individuals submitted to gastrectomy for gastric cancer. We reviewed 56 non-diabetic and 6 diabetic patients submitted to gastrectomy and Roux-en-Y for gastric cancer (partial gastrectomy in 66%/total gastrectomy in 34%).

Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones.

Background: Gallstones have been frequently diagnosed after Roux-en-Y gastric bypass (RYGBP). Gallbladder stasis associated with duodenal exclusion may play a role in their pathogenesis.

Methods: Gallbladder emptying was studied before and on the 30th and 31st postoperative days (POD) after RYGBP in 20 morbidly obese patients.

Gastrectomy and lymphadenectomy for gastric cancer: is the pancreas safe?

Introduction: Resection of the capsule of the pancreas is part of the radical operation proposed by oriental authors for the treatment of gastric cancer. It is unclear; however, if resection of the capsule is a safe procedure or even if it is necessary. This study aims to assess in patients treated for gastric cancer the occurrence of: (a) pancreatic fistula and (b) metastasis to the pancreatic capsule.

Surgical treatment of primary esophageal motility disorders.

Named primary esophageal motility disorders (PEMD) present with specific manometric patterns classified as: (1) hypertensive lower esophageal sphincter, (2) nutcracker esophagus (also hypercontratile, hypertensive, or hypercontracting esophagus), (3) diffuse esophageal spasm, and (4) achalasia. These conditions, with the exception of achalasia, are rare, poorly understood, and inadequately studied. Treatment of these conditions is based on symptoms and aimed at symptomatic improvement.

Effects of increased intra-abdominal pressure on the healing process after surgical stapling of the stomach of dogs.

Purpose: To assess the initial healing after surgical stapling of the stomach using a linear cutting stapler and creating pneumoperitoneum (12-14 mmHg) for 60 minutes or 120 minutes, and compare it with the healing of a staple line not submitted to increased pressure.

Methods: A total of 30 dogs were divided into three groups of 10 animals each: Group I (control group - surgical stapling), Group II (surgical stapling and increased intra-abdominal pressure for 60 minutes) and Group III (surgical stapling and increased intra-abdominal pressure for 120 minutes). All dogs were maintained under general anesthesia for two hours after surgical stapling.

[Electromanometry and acid pHmetry of 24 hours in postoperative evaluation of the hiatoplasty and total antireflux wrap laparoscopic].

Background: The electromanometry and 24-hour esophageal pHmetry has been proposed as objective method in postoperative evaluation of antireflux surgery.

Aim: Prospective evaluation of the results of cruroplasty and total fundoplication in the treatment of non-complicated gastroesophageal reflux disease based on comparative results of pre and post operative manometry and pHmetry findings.

Methods: Fifty-nine consecutive individuals with typical symptoms of gastroesophageal reflux disease were prospectively studied.

Incidence of regurgitation after the banded gastric bypass.

Background: Frequent regurgitation is a common complication following Roux-en-Y gastric bypass (RYGBP). This study investigated the risk of becoming a chronic regurgitator, by considering silicone ring size and lower esophageal sphincter (LES) function, and their relationship with weight loss.

Methods: 80 morbidly obese patients were randomly selected to undergo surgery using ring length of 62 mm (40 patients, group A) or 77 mm (40 patients, group B), with 6 months' postoperative follow-up.

Obesity and symptomatic achalasia.

Weight loss is a frequent finding in achalasia because of the difficulty in swallowing. Although manometric findings compatible with achalasia have been found in morbidly obese patients, all of them were asymptomatic. The authors report a case of symptomatic achalasia and morbid obesity in a 38-year-old woman.

Are idiopathic and Chagasic achalasia two different diseases?

Although Chagas' disease esophagopaty and idiopathic (primary) achalasia share several similarities, however, some differences between the two diseases have been noticed. To evaluate if treatment options and their results can be accepted universally, the authors review characteristics of both diseases in the international and Latin American literature. Neuronal denervation, sensitivity to gastrin, patient age, duration of symptoms, lower esophageal sphincter pressure, incidence of vigorous achalasia, and cancer risk are considered points of discrepancy between the maladies.

Safety of cystic duct clipping in healthy and cirrhotic livers: a cadaveric study.

Background And Objectives: Biliary leakage through the cystic duct stump due to clip dislodgement has been a concern since the advent of the laparoscopic cholecystectomy. The authors proposed a cadaveric model to test the safety of cystic duct clipping in a hypertensive biliary tract in healthy and cirrhotic livers.

Methods: Twenty fresh cadavers were studied (5 cirrhotic, 15 healthy).

Short esophagus or bad dissected esophagus? An experimental cadaveric study.

Short esophagus is defined as the inability to reduce the gastroesophageal junction below the diaphragm. One of the factors responsible for this inability can be inadequate esophageal mobilization. We evaluated esophageal lengthening achieved by means of dissection in a cadaveric model.

Forensic autopsy costs in the city of São Paulo.

Context: Modern medical practice involves cost analysis of therapeutic and diagnostic procedures. There are no papers dealing with this theme in relation to forensic autopsies in our country.

Objective: Analysis of direct costs of forensic autopsies.