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Situs Inversus during Bariatric Surgery: A Retrospective Analyze

Surgical Science 2015年第10期6卷 454-458页

作者： Augusto tinoco Amanda Bussad renam tinoco Luciana El-Kadre Department of Surgery Sao Jose do Avaí Hospital Rio de Janeiro Brazil

Background: We were reporting three cases of Situs Inversus in morbidly obese patients that were submitted a laparoscopic gastric bypass (LGBP). The condition itself was not a serious hazard to normal, healthy patients but, may cause difficulties in the diagnosis and management of abdominal pathology. The incidence of surgical disease did not seem to be different as in the general population, but its presentation, diagnosis and the operative procedure were. This was particularly true for laparoscopic surgery. Methods: From January 1999 to June 2015, 3047 morbidly obese patients underwent. Three patients with Situs Inverse (SI), two of the three with Situs Inversus Totalis (SIT), and one with Situs Inversus Parcialis (SIP) were submitted to a laparoscopic Roux-en-Y gastric bypass with no major difficulties. The mean age was 45 years (39 - 49), BMI 37.7 kg/m2, two of the above patients were female. Results: The LGBP was completed successfully in two of the three patients with SI. The mean duration of surgery was a 167 minutes, ranging from 110 - 210 minutes. The hospital stay was 5 days (3 - 8). Conclusions: The benefits of surgery were evident, even in the patients with SI;as there was no need for ICU admission and patients had an early hospital discharge. Morbidly obese patients with SI might be submitted to LGBP. This procedure was feasible and safe when the diagnosis was pre-operatively confirmed, and the surgical team made proper adjustments.

关键词： Gastric Bypass Laparoscopy Morbid Obesity Situs Inversus Bariatric Surgery

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Iatrogenic Bile Duct Injuries after Cholecystectomy, Is the Laparoscopic Approach a Good Idea?

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Surgical Science 2022年第7期13卷 343-351页

作者： renam tinoco Augusto tinoco Matheus P. S. Netto Luciana J. El-Kadre Júlia M. L. C. Rocha Department of Surgery S&#227o José do Ava&#237 Hospital Rio de Janeiro Brazil

Objective: The treatment of iatrogenic bile duct injuries is still a challenge for hepatobiliary and general surgeons. Roux-en-Y hepaticojejunostomy, one of the most appropriate techniques for the treatment of circumferential lesions, either occurring less than 2 cm from the bifurcation or in the bifurcation of the common hepatic duct, requires experience in advanced laparoscopy and hepatobiliary surgery. This study aims to present the results of laparoscopic hepaticojejunostomy (LHJ) for the treatment of iatrogenic bile duct injuries (IBDI). Methods: A retrospective study analyzing the medical records of patients diagnosed with IBDI and treated using LHJ of patients at the Hospital S?o José do Avaí (HSJA). Sex, age, previous cholecystectomy technique, signs and symptoms, postoperative complications, length of stay, injury classification, and time elapsed from injury to diagnosis were analyzed. Magnetic resonance cholangiography (MRC), endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography. Results: From March 2006 to December 2018, six patients underwent LHJ. In five cases (83.33%), the primary operation was a laparoscopic cholecystectomy (LC) and in one patient (13.66%) open cholecystectomy. The most frequent clinical sign was jaundice. The mean surgical time was 153.2 minutes (range: 115 to 206 minutes), and the hospital stay was 3 to 7 days (mean: 4.16 days). One patient had infection of the umbilical trocar incision and one patient presented with stenosis of the hepaticojejunal anastomosis and was treated with radioscopic pneumatic dilatation. Conclusion: LHJ for circumferential and total IBDI either diagnosed early (during surgery) or late, may be a safe and effective option, with similar results to the conventional technique, a low complication rate and all the known advantages of minimally invasive surgery.

关键词： Cholecystectomy Bile Duct Injury Iatrogenic Bile Duct Injury Laparoscopic Hepaticojejunostomy

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Outcomes of Total and Subtotal Laparoscopic Gastrectomy with D2 Lymphadenectomy in Advanced Gastric Cancer in a Brazilian Hospital

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Surgical Science 2020年第6期11卷 166-176页

作者： Augusto C. A. tinoco Matheus P. S. Netto renam C. tinoco Thammy L. Bastos Bárbara S. F. Paula Leonardo El-Kadre tinoco Luciana J. El-Kadre Department of surgery S&atilde o José do Avaí Hospital Itaperuna Brazil Iguaç u University Itaperuna Brazil

Background: Although laparoscopic gastrectomy is becoming more popular as a curative therapy for gastric cancer, there are concerns about its oncological adequacy. We have compared the outcomes of laparoscopic total gastrectomy (LTG) and laparoscopic subtotal gastrectomy (LSG), both with modified D2 lymphadenectomies for the treatment of advanced gastric cancers. Aim: To compare the outcomes of laparoscopic (total and subtotal) gastrectomy with modified D2 lymphadenectomy for the treatment of gastric cancer, contributing to the literature regarding the overall survival of these patients and postoperative complications. Methods: From 1993 to 2014, 239 patients were operated on laparoscopic gastrectomy at our department. The routinely laparoscopic gastrectomy was performed in all patients with gastric cancer including those presenting with obstruction and bleeding. Data could be collected, on a retrospective way, from 2006 to 2014, from the medical records of 103 patients who underwent LSG (n = 72) or LTG (n = 31). We excluded patients with metastatic disease and those who could not have a complete tumor resection. Results: Most patients were in advanced stages of cancer. Adenocarcinoma was the most common find, with 43% of cases in stage IIA and 31% in stage IIIB. Intracorporeal Roux-en-Y or Billroth II anastomoses were employed. Postoperative complications, for LSG and LTG, were 18% and 35.4%;mortality rate, during hospital stay, was 4.9% and 7.7%;three-year survival rate, 53.1% and 59.3%;and five-year survival rate, 46.9% and 40.7%. Mean hospital stay was 7.08 days, being significantly lower in LSG group (p Conclusions: Both LSG and LTG with modified

关键词： Minimally Invasive Surgical Procedures Gastric Neoplasms Postoperative Period

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Portomesenteric Venous Thrombosis in Patients after Laparoscopic Bariatric Surgery

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Surgical Science 2022年第9期13卷 419-428页

作者： Augusto tinoco renam C. tinoco Luciana El-Kadre Matheus P. S. Netto Júlia M. Rocha Diogo R. de Souza Douglas G. Tavares Department of Surgery S&#227o Jos&#233 do Ava&#237 Hospital Itaperuna RJ Brazil São José do Avaí Hospital Itaperuna RJ Brazil

Objective: Obesity has become a worldwide epidemic that is directly related to chronic tissue inflammation and impaired fibrinolysis, both of which lead to an increased risk of thrombosis. The management of complications after bariatric surgery is still a challenge. The study aims to report the incidence of portomesenteric venous thrombosis (PMVT) in patients undergoing bariatric surgery. Introduction: Bariatric surgery is the procedure of choice for the treatment of obesity type III. Despite the safe technique, the surgeon must be aware of the risks linked to laparoscopy such as the PMVT. Computed tomography (CT) with intravenous contrast was the imaging method of choice for diagnosis. Materials and Methods: We performed a retrospective analysis of 4790 patients from August 1999 to June 2020 was observed the incidence of PMVT in this group. Of all patients, 72.8% were female and 27.2% male. The mean age was 46.3 years (34 - 72) and the mean BMI before bariatric surgery was 41.4 kg/m2. Results: The study showed an incidence of PMVT of 0.12% (N = 6), portal vein thrombosis was of 0.10% (n = 5) and 0.03% of MVT (n = 1). Of these, 72.5% (n = 3473 patients) underwent laparoscopic gastric bypass, 23.6% (n = 1131 patients) were submitted to the laparoscopic sleeve gastrectomy and 3.8% (n = 186 patients) to other procedures. The mean postoperative hospital stay for bariatric surgery was 3.3 days. The average time of hospital stay of patients complicated with PMVT range from 5 to 14 days. No patient died of complications related to PMVT. Conclusion: Portomesenteric vein thrombosis is a rare presentation after laparoscopic bariatric surgery. However, it is a serious complication that has a high index of suspicion for making its diagnosis. Conservative treatment using anticoagulants and thrombolytics is effective, it should always be considered the main treatment option. However, these patients must be followed up in the long term, as late complications can occur i

关键词： Morbid Obesity Laparoscopy Portomesenteric Venous Thrombosis Bariatric Surgery

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