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Pyloric sympathectomy: A Novel Way to Get Pylorus Relaxation? Report of Two Bariatric Cases

Surgical Science 2024年第6期15卷 381-395页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Paulo Reis Esselin de Melo Fernando Fornari Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Lusadas Amadora Hospital Lisboa Portugal Paulo Reis Institute Goinia Brazil Alfredo Nasser University Center (UNIFAN) Goinia Brazil Faculdade de Medicina Universidade de Passo Fundo Passo Fundo Brazil Faculdade de Medicina Universidade Federal da Fronteira do Sul Chapec Brazil

Objective: This case report aimed to demonstrate a possible neuromuscular effect of pyloric sympathectomy on the pylorus motility, leading to its permanent relaxation, observed in two bariatric surgical cases, one primary and the other, revisional. Background: Pyloric sphincter is a physiological barrier to free gastric emptying. In sleeve gastrectomy and in Roux-en-Y gastric bypass revisions, that put the remnant stomach in transit, the pylorus can contribute to generate a high intragastric pressure, which could lead to acute gastric fistulas and/or chronic gastroesophageal reflux disease. The possibility of functionally relaxing the pylorus, promoting intragastric pressure reduction, could represent a protective maneuver against these complications. Methods: We describe herein a surgical maneuver applied in two cases of bariatric surgeries, with the intention of facilitating antrum-duodenal region exposure, in a sleeve gastrectomy and in a Roux-en-Y gastric bypass conversion to SADI-S. For this, a ligation of terminal peripyloric vessels was done, allowing a passage of a tape, which surrounded the pylorus, for its traction. In both cases, 30-day and 1-year endoscopic evaluations were done, to assess esophagitis signs, anastomosis healing and anatomical pouch aspect. A clinical evaluation was also done, to assess gastroesophageal symptoms (validated questionnaire). Results: In the postoperative endoscopic evaluations, no esophagitis were observed in any case and the gastric pouches had normal aspect, with the expected anatomical findings, compatible with the surgeries performed. The anastomosis healed without problems, in the revisional case. Interestingly, in both cases, it was observed a complete pyloric sphincter relaxation, which lasted until 1-year endoscopic evaluation. There were no fistulas, nor esophagitis in any of these cases. Clinically, there were no symptoms of gastroesophageal reflux disease (validated questionnaire). Conclusion: The observation of a

关键词： Roux-en-Y Gastric Bypass Sleeve Gastrectomy sympathectomy Bariatric Surgery

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Uniportal versus biportal video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis

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Chinese Medical Journal 2009年第13期122卷 1525-1528页

作者： CHEN Yong-bing YE Wu YANG Wen-tao SHI Li GUO Xu-feng XU Zhong-hua QIAN Yong-yue Department of Cardiothoracic Surgery the Second Affiliated Hospital Soochow University Suzhou Jiangsu 215004 China

Background Video-assisted thoracoscopic sympathectomy had replaced open surgery. The aim of this study was to compare the outcomes of using a single port and two ports to perform video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis. Methods Between April 2006 and February 2008, 20 cases underwent video-assisted thoracoscopic sympathectomy through one port （uniportal group） and 25 cases through two ports （biportal group）. The variables including the operating time, hospital stay, pain scores, postoperative complications, incidence of symptom recurrence and patient satisfaction were compared. The mean postoperative follow-up period was 11.5 months （range, 3-25 months）. Results The hands of all patients were warm and dry after operation. No conversion to open surgery was necessary, and no operative mortality was recorded in either group. The mean inpatient pain scores were significantly higher in the biportal group （1.2±0.6） than that in the uniportal group （0.8±0.5, P=0.025）. For the first three weeks after operation, four out of 20 （20%） patients in the uniportal group constantly suffered from mild or moderate residual pain while eight out of 25 （32%） cases in the biportal group （P=0.366）. Among them, two cases in the uniportal group and five cases in the biportal group need to take analgesics. Our mean operative time （bilateral sympathectomy） in the uniportal group （（39.5±10.0） minutes） was shorter than that in biportal group （（49.7±10.6） minutes, P=0.02）. There were no significant differences between two groups in terms of the mean hospital stay, compensatory sweating, and patient satisfaction. Two patients in the biportal group and three in the uniportal group experienced a unilateral pneumothorax. None of them required chest drainage. No patient experienced Homer＇s syndrome, and no recurrent symptoms were observed in either groups Conclusions Both uniportal and biportal video-assisted thoracoscopic sympathectomy are effective, safe, and minimally i

关键词： uniportal hyperhidrosis thoracic surgery, video-assisted sympathectomy

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Intraoperative Rise of Surface Temperature Monitors Success of sympathectomy in Palmoaxillary Hyperhidrosis

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Open Journal of Thoracic Surgery 2013年第1期3卷 8-14页

作者： Sebastian Kramer Axel Skuballa Uwe Eichfeld Department of Thoracic Surgery Klinikum *** gGmbHLeipzigGermany Department of Surgery II AbdominalTrans-plantThoracic and Vascular SurgeryUniversity Hospital LeipzigLeipzigGermany.

Objectives: Patients with hyperhidrosis suffer from an extreme perspiration that cannot be aligned with natural or situational standards. Endoscopic sympathectomy is a meaningful option for palmar and axillary hyperhidrosis. A standardized method of monitoring the immediate intraoperative success has not been established yet. The presented investigation shows one proposed sollution by monitoring skin surface temperature. The main aspect is to demonstrate a significant rise in temperature with utility for monitoring the immediate success of surgery. Methods: Twenty patients with primary hyperhidrosis were observed and treated in a standardized setting against a control group (n = 10). We obtained diverse data that permit determination of a point of time of measurement of surface temperature and definition of a degree of temperature variance. Results: After 5 minutes a significant change of 0.5? Celcius was noted on the palms;after 10 minutes on average 1.2? Celcius. Axillary temperature had significantly changed after 10 minutes with a mean temperature variation of 0.8? Celcius on the right side and 0.6? Celcius on the left side. Conclusions: Under consideration of appropriate time intervals of measurement and determined changes in surface temperature an early control of correct clip application in ETS is possible. In the palmar aspect an increase of 0.5? Celcius at an 5 minutes interval, and more than 1? Celcius at 10 minutes after placement of the clip as compared to basic values before application of the clip can be proposed.

关键词： Hyperhidrosis sympathectomy Temperature Monitoring

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Functional Cardiological Changes Resulting from Thoracoscopic Thoracic sympathectomy: Systematic Review

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Surgical Science 2021年第8期12卷 302-312页

作者： Juliano Mendes de Souza Henrique Lechinski Rodrigues Jean Borges Curimbaba Daniele Bruch Department of Surgery Thoracic Surgery Unit Hospital de Clínicas Complex Federal University of Parana Curitiba Brazil Faculdades Pequeno Príncipe Curitiba Brazil

Hyperhidrosis is a condition resulting from a systemic sympathetic hyperactivity. The gold standard treatment is the resection or surgical ablation of the paravertebral sympathetic chain: the endoscopic thoracoscopic sympathectomy (ETS). Non-cardiac thoracic surgeries carry a considerable incidence of pathological postoperative cardiac events, raising attention to possible worsen cardiac functional capacity after the resection of a pair of thoracic sympathetic ganglia. The aim of this study is to investigate literature evidences of postoperative cardiovascular functional changes on patients submitted to ETS as treatment for hyperidrosis. This is a systematic review of the literature. Clinical studies published between January 1999 and April 2019 were analyzed. The PICO strategy was used to construct the question of systematic reviews research. The process of selecting articles was organized according to PRISMA Diagram. The search in electronic databases resulted in seven articles, of which one was excluded for being out of scope of the research, leaving six articles. All studies showed a pattern of heart rate (HR) reduction after endoscopic thoracic sympathectomy. It was suggested a relation between the extension of the procedure and the presence of cardiac functional alterations. There was an improvement in myocardial physical conditioning and maintenance of functional capacity. To elucidate the real mechanisms involved in the maintenance of myocardial function, and even its improvement, it is necessary to develop further studies that directly evaluate them.

关键词： Hyperhidrosis sympathectomy Thoracoscopic Heart Rate Heart Function Tests

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Chinese expert consensus on the surgical treatment of primary palmar hyperhidrosis(2021 version)

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Chinese Medical Journal 2022年第11期135卷 1264-1271页

作者： Yanguo Liu Wenhan Weng Yuanrong Tu Jun Wang 无 Department of Thoracic Surgery Peking University People’s HospitalBeijing 100044China Center of Mini-invasive Thoracic Surgery Peking University People’s HospitalBeijing 100044China Department of Thoracic Surgery The First Affiliated Hospital of Fujian Medical UniversityFuzhouFujian 350005China. on behalf of Chinese Expert Committee on Palmar Hyperhidrosis

Primary palmar hyperhidrosis(PPH)is a pathologic condition of excessive sweating on hands that has adverse impacts on patients’social activity,professional life,and psychological *** thoracic sympathicotomy(ETS)is by far the treatment choice for PPH with the most stable and durable curative effects,but special attention should be given to the side effects of the surgery,especially compensatory hyperhidrosis(CH).This consensus is the second version of the Chinese Expert Consensus on the Surgical Treatment of PPH by the China Expert Committee on Palmar Hyperhidrosis(CECPH),which was published 10 years *** consensus emphasizes the need for special attention and careful assessment of the patients’feelings,as well as their emotional and mental state,and emphasizes that distress due to palmar sweating and the desire for treatment are prerequisites for *** also provides a more nuanced delineation of CH and reviews all new attempts to prevent and treat this side *** evidence of the epidemiology,pathogenesis of PPH,and indications for surgery were also assessed or recommended.

关键词： Primary palmar hyperhidrosis Surgical treatment sympathectomy Sympathicotomy Compensatory hyperhidrosis Consensus

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Does the advantage of transcutaneous oximetry measurements in diabetic foot ulcer apply equally to free flap reconstruction?

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World Journal of Clinical Cases 2023年第31期11卷 7570-7582页

作者： Da Woon Lee Yong Seon Hwang Je Yeon Byeon Jun Hyuk Kim Hwan Jun Choi Department of Plastic and Reconstructive Surgery College of MedicineSoonchunhyang UniversityCheonan-si 31151South Korea

BACKGROUND Transcutaneous oxygen pressure(TcpO2)is a precise method for determining oxygen perfusion in wounded *** device uses either electrochemical or optical *** To evaluate the usefulness of TcpO2 measurements on free flaps(FFs)in diabetic foot ulcers(DFUs).METHODS TcpO2 was measured in 17 patients with DFUs who underwent anterolateral thigh(ALT)-FF surgery and compared with 30 patients with DFU without FF *** Significant differences were observed in the ankle-brachial index;duration of diabetes;and haemoglobin,creatinine,and C-reactive protein levels between the two ***2 values were similar between two groups except on postoperative days 30 and 60 when the values in the ALT-FF group remained50 *** Even if the flap is clinically stable,sympathectomy due to adventitia stripping during anastomosis and arteriovenous shunt progression due to diabetic polyneuropathy could lead to low TcpO2 values in the ALT-FF owing to its thick fat tissues,which is supported by the slow recovery of the sympathetic tone following ***,TcpO2 measurements in patients with DFU who underwent FF reconstruction may be less accurate than in those who did not.

关键词： Arteriovenous shunt Surgical Diabetic neuropathies Free tissue flaps sympathectomy Blood gas monitoring Transcutaneous Diabetic angiopathies

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Renal sympathetic denervation for the treatment of resistant hypertension with chronic renal failure： first-in-man experience

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Chinese Medical Journal 2013年第7期126卷 1392-1393页

作者： LUO Di ZHANG Xin LU Cheng-zhi Graduate School Tianjin Medical University Tianjin 300070 China Department of Laboratory Tianjin First Central Hospital Tianjin Medical University Tianjin 300192 China Department of Uarmology Tianjin First Central Hospital Tianjin Medical University Tianjin 300192 China

A39-year-old man with resistant hypertension,presented with headache and dizziness at theemergency department on January 6, 2012. The patient had a history of hypertension for 3 years, his highest blood pressure was 250/110 mmHg, and he was taking antihypertensive medication regimens for at least 6 months. A mitral replacement by bioprosthetic valve had been implanted 6 months before. The patient was in chronic renal failure （CRF） uremia, maintenance of which he underwent the standard hemodialysis treatment three times a week for 6 months.

关键词： sympathectomy hypertension sympathetic nervous system kidney failure, chronic

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Effect of oxytocin on gastric ischemia-reperfusion injury in rats

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Frontiers of Medicine 2007年第4期1卷 433-437页

作者： ZHANG Wenwen ZHANG Jianfu XU Ming ZHANG Yongmei Department of Physiology Xuzhou Medical CollegeXuzhou 221002China Department of Neurobiology Xuzhou Medical CollegeXuzhou 221002China Department of Pathophysiology Xuzhou Medical CollegeXuzhou 221002China

The effect of peripherally administered oxytocin(OT)on gastric ischemia-reperfusion injury(GI-RI)and its possible mechanism were *** Sprague-Dawley(SD)rats were randomly divided into different treatment groups(n=6).The animal GI-RI model was established by clamping the celiac artery for 30 min to induce ischemia and then released to allow reperfusion for 1 h,and the degree of GI-RI was assessed by scoring the gastric mucosal damage index(GMDI),the gastric fluid output,gastric fluid output,gastric acidity were measured and the surgical preparations of vagotomy and sympathectomy were used to investigate the possible mechanism of OT on *** results were as *** with the control group(NS plus GI-R only,GMDI 121.33P10.40,n=6),the intra peritoneal(ip)administration of oxytocin(20,100μg/0.5 mL)obviously attenuated GI-RI(Psympathectomy(GMDI 6.83P8.89,29.67P5.54,n=6),compared with the GI-R group and the oxytocin group(P<0.01).These results indicated that the oxytocin could significantly protect gastric mucosal against injury induced by ischemia-reperfusion,and the oxytocin receptor was *** effect of oxytocin may be mediated through the vagus and sympathetic nerve,and then lead to the reduction of gastric juice output and the depression of gastric acidity.

关键词： oxytocin ischemia reperfusion injury gastric mucosal damage index vagotomy sympathectomy

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Single-Port Bilateral Thoracscopic Dorsal Sympathectmy for Primary Hyperhidrosis:Long-Term Outcome

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World Journal of Cardiovascular Surgery 2014年第4期4卷 56-68页

作者： Aram Baram Salam Al Bermani Department of Thoracic and Cardiovascular Surgery Faculty of Medical SciencesSchool of MedicineUniversity of SulaimaniFrancois Mitterrand StreetSulaymaniyah46001Iraq Departement of Thoracic Surgery Sulaimani Directorate of HealthTeaching HospitalFrancois Mitterrand StreetSulaymaniyah46001Iraq

Background: Primary hyperhidrosis of the upper limbs is characterized by over activity of the eccrine sweat glands, primarily occurring on palmar, plantar and axillary regions. It is distressing and often socially disabling condition. Conservative treatment is usually not effective in controlling the disease mainly due to adverse effect of therapies. Endoscopic thoracic sympathectomy is considered as the treatment of choice, causing minimal morbidity and high success rates and patient satisfaction. Objective: The study aims to evaluate the long-term outcomes of single port bilateralthoracoscopic dorsal sympathectomyin treatment of primary hyperhidrosis of the palm and axilla. Methods: In this prospective study, performed primarily by a single surgeon, between August 1st 2010, and August 1st 2012, we performed 200 thoracoscopies on 100 patients with signs and symptoms of primary palmar and axillary hyperhidrosis in different age groups and in both genders, and all were studied and analyzed following treatment by single-port bilateral thoracoscopic dorsal sympathectomy in Sulaimani teaching hospital. Results: Total of 99 patients were satisfied with the outcome of post-surgery with a follow-up in the mean of 27 months and only one patient was reported no change in symptoms postoperatively. Complications reported in 6 patients inform of compensatory sweating (n = 2), Gestatory sweating (n = 1), Pneumothorax (n = 1), Intraoperative minor bleeding (n = 1) and only 1% failure rate was reported. No mortality was reported. Conclusions: Single port bilateral thoracoscopic thoracic sympathectomy is a very effective method in the management of primary hyperhidrosis. Single port provides less postoperative pain, safety, short operative time, and quick method for the treatment of primary hyperhidrosis in comparison to two or three ports approaches.

关键词： Primary Hyperhidrosis Single-Port sympathectomy Long-Term Outcome

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THE　STUDY　OF　THE　CHANGES　AND　MECHANISM　OF　HINDQUARTER　VASCULAR　RESISTANCE　IN　RATS　WITH　MYOCARDIAL　INFARCTION

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Journal of Pharmaceutical Analysis 1995年第1期9卷 1-4,24页

作者：秦金

Studies were performed on female WJ *** vascular resishatc(HVR)inrats 8￣11 weeks after left coronary thery occluslou was *** model of perfusedhindquarter with its own blood by pump control was *** results showed:①OHVR in rats withmyocardial infarction(MI)rose;②HVR in rats with small myocards inflect size decreased afterlumbar sympethatic chain(LSC)denervation;③HVR in rats with large myocardial infarct size didnot change obviously after LSC denervation. Therefore,neuregenic influence Predominated in mechanism of eleretion of HVR in myoardial infarct rats.

关键词： at vascular resisance myocardial infarction sympathectomy

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