ALBERTO MEYER | University of Sao Paulo medical School (original) (raw)
Papers by ALBERTO MEYER
Hernia, 2015
Brazil is the fifth most populous country in the world with widespread regional and social inequa... more Brazil is the fifth most populous country in the world with widespread regional and social inequalities. Regional disparities in healthcare are unacceptably large, with the remote and poor regions of the north and northeast having reduced life expectancy compared to the south region, where life expectancy approaches that of rich countries. We report our experience of a humanitarian surgery mission to the Amazonas state, in the northwest part of Brazil. In August 2014, a team of seven consultant surgeons, and two trainees with the charity 'International Hernia', visited three hospitals in the Amazonas state to provide hernia surgery and training. Eighty-nine hernias were repaired in 74 patients (female = 22, male = 52) with a median age of 44 years (range 2-83 years). Nine patients underwent more than one type of hernia repair, and there were 9 laparoscopic inguinal and ventral incisional hernia repairs. Local doctors were trained in hernia repair techniques, and an International Hernia Symposium was held at the University of the State of Amazonas, Manaus. The humanitarian mission provided hernia surgery to an underserved population in Brazil and training to local doctors, building local sustainability. Continued cooperation between host and international surgeons for future missions to Brazil will ensure continuing surgical training and technical assistance.
HPB
Background: Ductal adenocarcinoma present at an advanced stage with a poor prognosis. No more tha... more Background: Ductal adenocarcinoma present at an advanced stage with a poor prognosis. No more than 5% of all patients with pancreatic cancer will survive 5 years. Patients with localized disease in whom a potentially curative resection can be performed have the only real chance of long-term survival. Objective: Report two rare cases of pancreatic tumour with carcinomatosis diagnosed at intraoperative and long-term survival. Case report: Case 1: A 77-years-old female patient referred to our hospital with mild abdominal pain, weight loss and palpable abdominal mass. Upper digestive endoscopy revealed extrinsic compression in the gastric antrum. Computed tomography revealed solid mass lesion (9.0 cm) coming from the duodenal second portion without cleavage plane with pancreatic head and transverse colon. Duodena pancreatectomy and segmental colectomy (transverse) was undertaken and the stage was IIB (pT3N1Mx). Besides, ascitic fluid positive for malignancy was found during laparotomy. ...
HPB
Background: Minimally invasive techniques have been revolutionary and provide clinical evidence o... more Background: Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to open surgery. Indications in the field of pancreatic surgery should be limited considering the technical difficulties and the characteristics of pancreatic diseases. Intraductal papillary mucinous neoplasm of the pancreas (IPMN) is a rare pancreatic cystic neoplasm. These tumors, even when malignant, are often resectable and have a more favorable prognosis than do ductal adenocarcinoma and classic mucinous cystadenocarcinoma of the pancreas. Objective: Describe the utilization of an alternative approach for laparoscopic distal pancreatectomy. Case report: A 37-year-old man was admitted in emergency with uncharacteristic abdominal pain. Abdominal CT-scan reported a solid-cystic tumor of 45 X 30 mm in the pancreatic body suggesting a mucinous cystadenoma of the pancreas. Laparoscopic distal pancreatectomy with spleen preservation was perform...
Le traitement chirurgical des hernies est la deuxième opération après l'appendicectomie et av... more Le traitement chirurgical des hernies est la deuxième opération après l'appendicectomie et avant la cholécystectomie en France. La coelioscopie est utilisée dans cette indication dans environ 30 % des cas [1]. Le traitement des hernies par coelioscopie est considéré comme difficile surtout pour la technique totalement extra-péritonéale (TeP) [2]. Le but de notre étude est de répondre à la question : la distance ombilico-pubienne a-t-elle une influence sur la technique TeP dans le traitement des hernies inguinales ?
Hernia
Background: incisional hernia repair is a major problem after liver transplantation in immunosupp... more Background: incisional hernia repair is a major problem after liver transplantation in immunosuppressed patients. It is related, in most cases, with obesity, use of steroids and type of incision. Incisional laparoscopic hernia repair shows reduced postoperative pain, faster recovery and lower rate of morbidity. Method: laparoscopic repair of large incisional hernia. Male, 57 years, body mass index of 26 kg/m(2), 01 years after undergoing liver transplantation due to chronic hepatitis C, with umbilical and right transverse hernia. Result: size of transverse hernia defect was 336 cm(2) and umbilical hernia 25 cm(2). The size of mesh was 30 x 20 cm in transverse hernia and 12 cm in diameter in umbilical hernia. The operative time was 66 minutes without drainage. The postoperative hospital stay was less then 24 hours. There were no complications. Conclusion: laparoscopic incisional hernia repair is possible even for major hernias in complex patients.
Hernia
Background: laparoscopic incisional hernia repair (LIHR) has been reported in some studies to be ... more Background: laparoscopic incisional hernia repair (LIHR) has been reported in some studies to be superior to open repair owing to fewer complications, less pain, and earlier return to work. Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial. Method: between January and June 2011 a total of 14 patients underwent LIHR in our institution with incisional hernia > 10 cm. Most patients in this study were affected by more than one comorbiditie and obese (13 patients) with a BMI (body mass index) ≥ 30kg/m2. Parietal defects averaged 15.20 cm in size (range 10–21) and 147.69 ± 49 cm2 in area (range 72.6–331.8). A recurrent incisional hernia following previous repair with mesh was present in four patients. Result: the mean duration of operations was 57.52 ± 46.22 min (range 25–190). Post-operative complications occurre...
Hernia
Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has b... more Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has been accepted as a feasible and safe procedure. Simultaneous surgery can and should be performed, since not increases considerably the surgical time and brings benefits for the patient. Method: female, 78 years, body mass index of 26 kg/m(2), 02 years after convencional incisional hernia repair with polypropylene mesh. CT scan: size of median incisional hernia was 80 cm(2) containing segment of transverse colon; also have an expansive lesion, well-defined, irregular borders, heterogeneous, size 111.32 cm(3) in close contact with posterior wall of the gastric body and the middle third of the splenic vein, no sign of invasion. Laparoscopic incisional hernia repair associated with distal pancreatectomy was performed in 190 minutes. Macrocystic serous adenoma was showed in biopsy. Result: patient developed mild pain in the immediate postoperative period, featuring complete resolution of pain ...
Clinics
INTRODUCTION Distal pancreatectomy with em-bloc splenectomy has been considered the standard tech... more INTRODUCTION Distal pancreatectomy with em-bloc splenectomy has been considered the standard technique for management of benign and malignant pancreatic disorders with a rate of resectability of tumors of the body and tail around 10%. However, splenic preservation has recently been advocated. Lessons learn from patients with malignant neoplasms in the body-tail of the pâncreas suggest that splenectomy has a negative influence on long-term survival after ressection. The technique is usually not performed in the same way by all surgeons. In the literature the incidence of pancreatic fistula after pancreatic left ressection is highly variable, ranging from 3% to 34%. METHODS Cross-sectional study was conducted from May to October 2011, in which four patients were evaluated, three female and one male, mean age 66 years (43-68) Who underwent laparoscopic distal pancreatectomy: three Warshaw´s technique and one distal pancreatectomy with em-bloc splenectomy. The pancreatic resection was p...
Hernia
Background: laparoscopic groin hernia repair has been shown to be a safe, well-tolerated procedur... more Background: laparoscopic groin hernia repair has been shown to be a safe, well-tolerated procedure. Here, we report a series of patients who underwent laparoscopic totally extraperitoneal (TEP) mesh repair as day cases. Method: analyzed patients undergoing elective laparoscopic totally extraperitoneal (TEP) inguinal hernioplasty, from May 2009 until July 2011, operated by the same surgeon. We assessed the time of admission, sex and morbidity of the procedures. Result: we performed 174 repairs on 103 patients, 45 had bilateral repairs. Mean operating time was 40 min for unilateral and 63 min for bilateral repairs. Two were converted. Five were readmitted more than 48 h postoperatively. No patients required reoperation or recurred to date. Recovery times were similar for unilateral and bilateral hernia. The majority (92.3%) were discharged with less than 12 hours of hospitalization. Conclusion: laparoscopic hernia repair is suitable for day-case surgery for unilateral, bilateral, and ...
A DII corresponde a qualquer processo inflamatório envolvendo o trato gastrointestinal. Anteriorm... more A DII corresponde a qualquer processo inflamatório envolvendo o trato gastrointestinal. Anteriormente verificadas de forma esporádica na prática clínica, na atualidade tanto a RCUI quanto a DC apresentam aumento significativo no seu diagnóstico, e acarretam um grande impacto negativo na qualidade de vida dos doentes e seus familiares. A incidência da DII tem aumentado em todo o mundo, especialmente devido ao aumento no número de casos de DC, a partir da segunda metade do século XX e em países com alto poder sócio-econômico. De etiopatogenia pouco conhecida, aparentemente as DII resultam de uma ativação constante da cascata inflamatória em indivíduos geneticamente predispostos. O diagnóstico é estabelecido pela combinação de dados de história, apresentação endoscópica, histológica, achados cirúrgicos e também achados sorológicos. O tratamento dos pacientes deve ser individualizado com base na resposta prévia do paciente sintomático e a tolerância a determinado tratamento. A terapia é...
A utilização de “plug” em reparos inguinais apresenta relatos históricos de longa data. Em meados... more A utilização de “plug” em reparos inguinais apresenta relatos históricos de longa data. Em meados do século XIX, Pierre Nicholas Gerdy, em Paris, utilizou um plug de madeira externo sob pele escrotal, permanecendo temporariamente no canal inguinal até a formação de resposta inflamatória, que teoricamente ocluiria o defeito herniário(1). Os estudos sobre o plug nos defeitos herniários perderam a força com o advento da descrição cirúrgica de Bassini em 1890, que consistia na reconstrução do assoalho da parede posterior do anel inguinal interno(2,11). Novas técnicas foram instituidas(13,14,15,16,17,18), porém sem muito sucesso, pois elas apresentavam muita tensão no reparo e uma série de complicações como hematoma, seroma e principalmente queixa do paciente com relação ao desconforto pós operatório. A primeira descrição com utilização de material sintético (prótese) surgiu com Francis Usher em 1950, quando este utilizou uma tela de polipropileno (Marlex®) no reparo inguinal, chamando a...
Clinics
Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has b... more Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has been accepted as a feasible and safe procedure. Simultaneous surgery can and should be performed, since not increases considerably the surgical time and brings benefits for the patient. Method: female, 78 years, body mass index of 26 kg/m(2), 02 years after convencional incisional hernia repair with polypropylene mesh. CT scan: size of median incisional hernia was 80 cm(2) containing segment of transverse colon; also have an expansive lesion, well-defined, irregular borders, heterogeneous, size 111.32 cm(3) in close contact with posterior wall of the gastric body and the middle third of the splenic vein, no sign of invasion. Laparoscopic incisional hernia repair associated with distal pancreatectomy was performed in 190 minutes. Macrocystic serous adenoma was showed in biopsy. Result: patient developed mild pain in the immediate postoperative period, featuring complete resolution of pain ...
Lesões polipóides da vesícula biliar, definida como lesões elevadas da mucosa, são observadas em ... more Lesões polipóides da vesícula biliar, definida como lesões elevadas da mucosa, são observadas em aproximadamente 4% a 7% da população adulta submetida à ultrassonografia abdominal (USG) e em 1% das colecistectomias por colecistolitíase. A incidência é a mesma em ambos os sexos, sendo mais comum entre 30-60 anos. O termo lesões polipóides da vesícula biliar representa um amplo espectro de achados e inclui verdadeiras neoplasias polipóides, tais como os adenomas, leiomioma, lipoma ou hemangioma e pólipos não-neoplásicos como pólipos de colesterol, pólipos inflamatórios ou hiperplasia adenomiomatosa. A lesão mais freqüente é a colesterolose, alteração não-inflamatória caracterizada por hiperemia da mucosa com elevações superficiais amareladas devido ao acúmulo de lipídios, o que contribui para a formação de pólipos de colesterol. Está associada à litíase vesicular em 10-15% das vezes e ocorre em 5 a 35% das vesículas biliares examinadas durante necrópsias. Não há diferenças em sua dist...
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (... more Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anat...
A colestase é caracterizada como resultante do uxo de ciente ou inadequado de bile para o duodeno... more A colestase é caracterizada como resultante do uxo de ciente ou inadequado de bile para o duodeno. Em geral, costuma ser dividida conforme sua localização em: • intra-hepática: doenças da árvore biliar intra-hepática ou insu ciência secretória hepatocelular; • extra-hepática: vias biliares extra-hepáticas. A colestase intra-hepática tem como fatores etiológicos: medicamentos, doenças metabólicas e infecciosas, nutrição parenteral, hepatite alcoólica, entre outras menos comuns. Diferentemente, a colestase extra-hepática (também denominada icterícia obstrutiva devido ao fato de ocorrer obstrução mecânica ao uxo da bile) resulta da obstrução dos ductos biliares localizados fora do fígado ou no hilo hepático. As características dependem da gravidade, duração e causa subjacente. É importante considerar que a obstrução da árvore biliar extra-hepática induz à distensão dos ductos biliares a montante e desencadeia alterações no parênquima hepático que, se não aliviadas, podem levar à brose ...
Hernia, 2015
Brazil is the fifth most populous country in the world with widespread regional and social inequa... more Brazil is the fifth most populous country in the world with widespread regional and social inequalities. Regional disparities in healthcare are unacceptably large, with the remote and poor regions of the north and northeast having reduced life expectancy compared to the south region, where life expectancy approaches that of rich countries. We report our experience of a humanitarian surgery mission to the Amazonas state, in the northwest part of Brazil. In August 2014, a team of seven consultant surgeons, and two trainees with the charity 'International Hernia', visited three hospitals in the Amazonas state to provide hernia surgery and training. Eighty-nine hernias were repaired in 74 patients (female = 22, male = 52) with a median age of 44 years (range 2-83 years). Nine patients underwent more than one type of hernia repair, and there were 9 laparoscopic inguinal and ventral incisional hernia repairs. Local doctors were trained in hernia repair techniques, and an International Hernia Symposium was held at the University of the State of Amazonas, Manaus. The humanitarian mission provided hernia surgery to an underserved population in Brazil and training to local doctors, building local sustainability. Continued cooperation between host and international surgeons for future missions to Brazil will ensure continuing surgical training and technical assistance.
HPB
Background: Ductal adenocarcinoma present at an advanced stage with a poor prognosis. No more tha... more Background: Ductal adenocarcinoma present at an advanced stage with a poor prognosis. No more than 5% of all patients with pancreatic cancer will survive 5 years. Patients with localized disease in whom a potentially curative resection can be performed have the only real chance of long-term survival. Objective: Report two rare cases of pancreatic tumour with carcinomatosis diagnosed at intraoperative and long-term survival. Case report: Case 1: A 77-years-old female patient referred to our hospital with mild abdominal pain, weight loss and palpable abdominal mass. Upper digestive endoscopy revealed extrinsic compression in the gastric antrum. Computed tomography revealed solid mass lesion (9.0 cm) coming from the duodenal second portion without cleavage plane with pancreatic head and transverse colon. Duodena pancreatectomy and segmental colectomy (transverse) was undertaken and the stage was IIB (pT3N1Mx). Besides, ascitic fluid positive for malignancy was found during laparotomy. ...
HPB
Background: Minimally invasive techniques have been revolutionary and provide clinical evidence o... more Background: Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to open surgery. Indications in the field of pancreatic surgery should be limited considering the technical difficulties and the characteristics of pancreatic diseases. Intraductal papillary mucinous neoplasm of the pancreas (IPMN) is a rare pancreatic cystic neoplasm. These tumors, even when malignant, are often resectable and have a more favorable prognosis than do ductal adenocarcinoma and classic mucinous cystadenocarcinoma of the pancreas. Objective: Describe the utilization of an alternative approach for laparoscopic distal pancreatectomy. Case report: A 37-year-old man was admitted in emergency with uncharacteristic abdominal pain. Abdominal CT-scan reported a solid-cystic tumor of 45 X 30 mm in the pancreatic body suggesting a mucinous cystadenoma of the pancreas. Laparoscopic distal pancreatectomy with spleen preservation was perform...
Le traitement chirurgical des hernies est la deuxième opération après l'appendicectomie et av... more Le traitement chirurgical des hernies est la deuxième opération après l'appendicectomie et avant la cholécystectomie en France. La coelioscopie est utilisée dans cette indication dans environ 30 % des cas [1]. Le traitement des hernies par coelioscopie est considéré comme difficile surtout pour la technique totalement extra-péritonéale (TeP) [2]. Le but de notre étude est de répondre à la question : la distance ombilico-pubienne a-t-elle une influence sur la technique TeP dans le traitement des hernies inguinales ?
Hernia
Background: incisional hernia repair is a major problem after liver transplantation in immunosupp... more Background: incisional hernia repair is a major problem after liver transplantation in immunosuppressed patients. It is related, in most cases, with obesity, use of steroids and type of incision. Incisional laparoscopic hernia repair shows reduced postoperative pain, faster recovery and lower rate of morbidity. Method: laparoscopic repair of large incisional hernia. Male, 57 years, body mass index of 26 kg/m(2), 01 years after undergoing liver transplantation due to chronic hepatitis C, with umbilical and right transverse hernia. Result: size of transverse hernia defect was 336 cm(2) and umbilical hernia 25 cm(2). The size of mesh was 30 x 20 cm in transverse hernia and 12 cm in diameter in umbilical hernia. The operative time was 66 minutes without drainage. The postoperative hospital stay was less then 24 hours. There were no complications. Conclusion: laparoscopic incisional hernia repair is possible even for major hernias in complex patients.
Hernia
Background: laparoscopic incisional hernia repair (LIHR) has been reported in some studies to be ... more Background: laparoscopic incisional hernia repair (LIHR) has been reported in some studies to be superior to open repair owing to fewer complications, less pain, and earlier return to work. Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial. Method: between January and June 2011 a total of 14 patients underwent LIHR in our institution with incisional hernia > 10 cm. Most patients in this study were affected by more than one comorbiditie and obese (13 patients) with a BMI (body mass index) ≥ 30kg/m2. Parietal defects averaged 15.20 cm in size (range 10–21) and 147.69 ± 49 cm2 in area (range 72.6–331.8). A recurrent incisional hernia following previous repair with mesh was present in four patients. Result: the mean duration of operations was 57.52 ± 46.22 min (range 25–190). Post-operative complications occurre...
Hernia
Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has b... more Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has been accepted as a feasible and safe procedure. Simultaneous surgery can and should be performed, since not increases considerably the surgical time and brings benefits for the patient. Method: female, 78 years, body mass index of 26 kg/m(2), 02 years after convencional incisional hernia repair with polypropylene mesh. CT scan: size of median incisional hernia was 80 cm(2) containing segment of transverse colon; also have an expansive lesion, well-defined, irregular borders, heterogeneous, size 111.32 cm(3) in close contact with posterior wall of the gastric body and the middle third of the splenic vein, no sign of invasion. Laparoscopic incisional hernia repair associated with distal pancreatectomy was performed in 190 minutes. Macrocystic serous adenoma was showed in biopsy. Result: patient developed mild pain in the immediate postoperative period, featuring complete resolution of pain ...
Clinics
INTRODUCTION Distal pancreatectomy with em-bloc splenectomy has been considered the standard tech... more INTRODUCTION Distal pancreatectomy with em-bloc splenectomy has been considered the standard technique for management of benign and malignant pancreatic disorders with a rate of resectability of tumors of the body and tail around 10%. However, splenic preservation has recently been advocated. Lessons learn from patients with malignant neoplasms in the body-tail of the pâncreas suggest that splenectomy has a negative influence on long-term survival after ressection. The technique is usually not performed in the same way by all surgeons. In the literature the incidence of pancreatic fistula after pancreatic left ressection is highly variable, ranging from 3% to 34%. METHODS Cross-sectional study was conducted from May to October 2011, in which four patients were evaluated, three female and one male, mean age 66 years (43-68) Who underwent laparoscopic distal pancreatectomy: three Warshaw´s technique and one distal pancreatectomy with em-bloc splenectomy. The pancreatic resection was p...
Hernia
Background: laparoscopic groin hernia repair has been shown to be a safe, well-tolerated procedur... more Background: laparoscopic groin hernia repair has been shown to be a safe, well-tolerated procedure. Here, we report a series of patients who underwent laparoscopic totally extraperitoneal (TEP) mesh repair as day cases. Method: analyzed patients undergoing elective laparoscopic totally extraperitoneal (TEP) inguinal hernioplasty, from May 2009 until July 2011, operated by the same surgeon. We assessed the time of admission, sex and morbidity of the procedures. Result: we performed 174 repairs on 103 patients, 45 had bilateral repairs. Mean operating time was 40 min for unilateral and 63 min for bilateral repairs. Two were converted. Five were readmitted more than 48 h postoperatively. No patients required reoperation or recurred to date. Recovery times were similar for unilateral and bilateral hernia. The majority (92.3%) were discharged with less than 12 hours of hospitalization. Conclusion: laparoscopic hernia repair is suitable for day-case surgery for unilateral, bilateral, and ...
A DII corresponde a qualquer processo inflamatório envolvendo o trato gastrointestinal. Anteriorm... more A DII corresponde a qualquer processo inflamatório envolvendo o trato gastrointestinal. Anteriormente verificadas de forma esporádica na prática clínica, na atualidade tanto a RCUI quanto a DC apresentam aumento significativo no seu diagnóstico, e acarretam um grande impacto negativo na qualidade de vida dos doentes e seus familiares. A incidência da DII tem aumentado em todo o mundo, especialmente devido ao aumento no número de casos de DC, a partir da segunda metade do século XX e em países com alto poder sócio-econômico. De etiopatogenia pouco conhecida, aparentemente as DII resultam de uma ativação constante da cascata inflamatória em indivíduos geneticamente predispostos. O diagnóstico é estabelecido pela combinação de dados de história, apresentação endoscópica, histológica, achados cirúrgicos e também achados sorológicos. O tratamento dos pacientes deve ser individualizado com base na resposta prévia do paciente sintomático e a tolerância a determinado tratamento. A terapia é...
A utilização de “plug” em reparos inguinais apresenta relatos históricos de longa data. Em meados... more A utilização de “plug” em reparos inguinais apresenta relatos históricos de longa data. Em meados do século XIX, Pierre Nicholas Gerdy, em Paris, utilizou um plug de madeira externo sob pele escrotal, permanecendo temporariamente no canal inguinal até a formação de resposta inflamatória, que teoricamente ocluiria o defeito herniário(1). Os estudos sobre o plug nos defeitos herniários perderam a força com o advento da descrição cirúrgica de Bassini em 1890, que consistia na reconstrução do assoalho da parede posterior do anel inguinal interno(2,11). Novas técnicas foram instituidas(13,14,15,16,17,18), porém sem muito sucesso, pois elas apresentavam muita tensão no reparo e uma série de complicações como hematoma, seroma e principalmente queixa do paciente com relação ao desconforto pós operatório. A primeira descrição com utilização de material sintético (prótese) surgiu com Francis Usher em 1950, quando este utilizou uma tela de polipropileno (Marlex®) no reparo inguinal, chamando a...
Clinics
Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has b... more Background: recently with advances in laparoscopic surgery, laparoscopic pancreatic surgery has been accepted as a feasible and safe procedure. Simultaneous surgery can and should be performed, since not increases considerably the surgical time and brings benefits for the patient. Method: female, 78 years, body mass index of 26 kg/m(2), 02 years after convencional incisional hernia repair with polypropylene mesh. CT scan: size of median incisional hernia was 80 cm(2) containing segment of transverse colon; also have an expansive lesion, well-defined, irregular borders, heterogeneous, size 111.32 cm(3) in close contact with posterior wall of the gastric body and the middle third of the splenic vein, no sign of invasion. Laparoscopic incisional hernia repair associated with distal pancreatectomy was performed in 190 minutes. Macrocystic serous adenoma was showed in biopsy. Result: patient developed mild pain in the immediate postoperative period, featuring complete resolution of pain ...
Lesões polipóides da vesícula biliar, definida como lesões elevadas da mucosa, são observadas em ... more Lesões polipóides da vesícula biliar, definida como lesões elevadas da mucosa, são observadas em aproximadamente 4% a 7% da população adulta submetida à ultrassonografia abdominal (USG) e em 1% das colecistectomias por colecistolitíase. A incidência é a mesma em ambos os sexos, sendo mais comum entre 30-60 anos. O termo lesões polipóides da vesícula biliar representa um amplo espectro de achados e inclui verdadeiras neoplasias polipóides, tais como os adenomas, leiomioma, lipoma ou hemangioma e pólipos não-neoplásicos como pólipos de colesterol, pólipos inflamatórios ou hiperplasia adenomiomatosa. A lesão mais freqüente é a colesterolose, alteração não-inflamatória caracterizada por hiperemia da mucosa com elevações superficiais amareladas devido ao acúmulo de lipídios, o que contribui para a formação de pólipos de colesterol. Está associada à litíase vesicular em 10-15% das vezes e ocorre em 5 a 35% das vesículas biliares examinadas durante necrópsias. Não há diferenças em sua dist...
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (... more Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anat...
A colestase é caracterizada como resultante do uxo de ciente ou inadequado de bile para o duodeno... more A colestase é caracterizada como resultante do uxo de ciente ou inadequado de bile para o duodeno. Em geral, costuma ser dividida conforme sua localização em: • intra-hepática: doenças da árvore biliar intra-hepática ou insu ciência secretória hepatocelular; • extra-hepática: vias biliares extra-hepáticas. A colestase intra-hepática tem como fatores etiológicos: medicamentos, doenças metabólicas e infecciosas, nutrição parenteral, hepatite alcoólica, entre outras menos comuns. Diferentemente, a colestase extra-hepática (também denominada icterícia obstrutiva devido ao fato de ocorrer obstrução mecânica ao uxo da bile) resulta da obstrução dos ductos biliares localizados fora do fígado ou no hilo hepático. As características dependem da gravidade, duração e causa subjacente. É importante considerar que a obstrução da árvore biliar extra-hepática induz à distensão dos ductos biliares a montante e desencadeia alterações no parênquima hepático que, se não aliviadas, podem levar à brose ...