Laparoscopic versus open transhiatal esophagectomy for distal and junction cancer. Esofagectomía laparoscópica frente a abierta en el cáncer esofágico distal. Request PDF on ResearchGate | Esofagectomía transhiatal por vía abierta y vía laparoscópica para el cáncer de esófago: análisis de los. La esofagectomía transhiatal mínimamente invasiva, en algunos enfermos con acalasia, tiene todos los beneficios del mínimo acceso, y con el empleo de un.
|Published (Last):||14 February 2015|
|PDF File Size:||9.51 Mb|
|ePub File Size:||7.45 Mb|
|Price:||Free* [*Free Regsitration Required]|
Open and laparoscopic trans-hiatal esophagectomy has been successfully performed esofagevtomia the treatment of megaesophagus. However, there are no randomized studies to differentiate them in their results.
Laparoscopic transhiatal esophagectomy: outcomes
To compare the results of minimally invasive laparoscopic esophagectomy EMIL vs. The studied variables were dysphagia score before and after transhhiatal operation at months follow-up; pain score in the immediate postoperative period and at hospital discharge; complications of the procedure, comparing each group.
The median age in the ETHA group was Mean follow-up time was 33 months, with one death in each group, both by fatal aspiration.
There was no statistically significant difference between the EMIL vs. ETHA scores for dysphagia, pain and in-hospital complications.
Esofagectomía transhiatal por SILS (acceso único) para cáncer
The same was true for surgical time, transfusion of blood products and hospital stay. Surgical treatment of advanced megaesophagus is controversial There is no consensus among surgeons on which technique should be indicated in the treatment of their advanced forms. The ones that offer better esofxgectomia in the resolution of dysphagia present higher morbidity and mortality, and those with lower, increase the rate of relapse of the clinical aspects, with possible new interventions 2414 Open-access trans-hiatal esophagectomy, as an option for the treatment of advanced megaesophagus, has been consolidated 614 In the s, surgical diseases were impacted by videolaparoscopic esoragectomia, reducing morbidity and favoring early essofagectomia.
De Paula et al. There is no consensus as to whether the efficacy of the videolaparoscopic approach in the treatment of megaesophagus exceeds open access.
Thus, the objective of this study was to compare the results of minimally invasive laparoscopic esophagectomy EMIL vs. Forty-four patients with advanced megaesophagus groups 3 and 4 of the classification of Rezende 24 were eligible from to Thirteen were excluded because they did not adhere to the proposed treatment. Inclusion criteria were adults, years old, with advanced megaesophagus; were excluded those with recurrent megaesophagus, patients with previous laparotomy in the upper abdomen, the ones with difficult to control comorbidities, and patients with associated portal hypertension.
All had preoperative surgical risk assessment according to ASA American Society of Anesthesiologistsusing the following measurements: The operation was trans-hiatal esophagectomy with truncal vagotomy without pyloroplasty and with manual endolateral esophagogastric anastomosis. The technique was the same in both groups 6 The esfagectomia studied were: The mean age was Regarding group B, it was The gender in group A was seven men and eight women and group B 11 men and esotagectomia women.
The mean follow-up time was 33 months Tganshiatal had epidemiological disease history and previous contact transhoatal triatomine Triatoma infestans. The comparison of the techniques in the esofageftomia score shows that the severity of the dysphagia before the operation was classified as a severe score in any of the transhiatao In the ETHA group, 14 patients The same result occurred when comparing the accesses, laparoscopic vs.
No patient had unbearable pain. However, the absence of complications was In the open group there was one case of tfanshiatal ileus and one case of abdominal infection abscess. No patient in the laparoscopic group had abdominal complication Figure 3. Regarding the length of hospital stay, it was lower in the ETHA group, mean of 14 daysbut with no statistical difference. In group EMIL, the mean length was 17 days The mean was min for open access and for laparoscopic.
No transfusion of blood products was required in any of the operated patients and there was a mortality rate of 6.
Among the concomitant diseases four in the EMIL group presented schistosomiasis mansoni, chagasic cardiopathy, megacolon and gastroesophageal reflux disease, one disease for each patient. At ETHA, two had chagasic cardiomyopathy and one renal lithiasis. None of them had biliary lithiasis detected on total abdomen ultrasound.
There is no consensus among surgeons 16which is the best technique for the treatment of advanced forms of megaesophagus 246141518 Resection and cardioplasties, in their various techniques, are discussed among themselves. There are no randomized studies demonstrating superiority over one another The introduction of laparoscopic access into the surgical arsenal in the s was so shocking that no one was able to serenely assess how far their limits and benefits would go Since then, the series in operations of high complexity began to be reported.
However, the acceptance of this technique by surgeons has been limited by the difficulty of visualizing the posterior mediastinum, laterally restricted work place, prolonged operative time and difficult learning curve Thus, to date, there are reported series 18122022but not randomized studies that clarify whether there is superiority of laparoscopic trans-hiatal access over open trans-hiatal. To our knowledge, this is the first prospective randomized trial to perform this assessment.
Some series have suggested that minimally invasive laparoscopic esophagectomy is superior when compared to open access for trans-hiatal esophagectomy. The comparative series of case-control studies by Perry et al. In this study, mortality and morbidity did not find statistically significant results that indicated an esofgaectomia over one another method.
There was one death in each group 6.
However, they esofagecgomia out that in the study performed there were two cases of aspiration and both were fatal. The same occurred in this study and the service adopted pyloroplasty in every transposed stomach 6. Stasis appears even in those submitted to pyloroplasty, but afterwards it disappears 36.
The transposed stomach empties within the normal range, especially in orthostatic position. It acquires tubular form when it has normal emptying, and sacular proportional to the degree of stasis. Some degree of gastric atony may be found in the early postoperative period, attributed esofagectonia vagotomy and dysphagia of the chagasic stomach, occasionally requiring the use of prokinetics, even though they are not very effective.
In anterior series 6 the tubular stomach was found in In this randomized series it lasted for some patients esofagrctomia six months to two years to improve the clinical findings. In one case there was dilatation of the pylorus.
In another after eight years of laparoscopic access, gastric stasis was still so important that it required hospitalization, nasogastric intubation, enteral nutritional and clinical handling. It should be noted that at the time it was believed that truncal vagotomy did not involve obligatory pyloroplasty, a topic still controversial and current, where the transposed stomach empties itself into normal patterns, especially if the patient is in orthostasis.
Another variable studied in this study was the pain score, whose results were better for the laparoscopic group, but with no statistical difference. Regarding efficacy in the resolution of dysphagia, analyzed according to criteria well determined by Brandt 9there was no superiority between laparoscopic or open methods. The same occurred in the morbidity, regarding the complications by regions and it was observed that in tranhsiatal there are more sequelae of pneumothorax, but without statistical difference.
Perhaps it could be explained by the pressure of the gas, which, while facilitating dissection, invades the structures more frequently. In the comparison of the efficacy of EMIL vs. ETHA, there was no statistical advantage of one access over the other. However, for a definitive answer it is necessary to have multicentric studies with broader casuistics 1720a limiting factor in this study.
Technically it is worth mentioning that in the case of videolaparoscopy cervical access can only be performed when the operation has advanced greatly in the mediastinum. Otherwise, the gas dissipates and makes it very difficult to follow the surgical procedure.
Sometimes small emphysema occurs in the cervical region and the veins of the region become prominent. No patient received transfusion of blood products; however, some were submitted to enteral or parenteral nutritional recovery to esofaagectomia the preoperative minimum index of BMI. As for the surgical time, the open operation was faster and the shortest esofagectomiz was min mean ; in the laparoscopy it was min mean of There was one death in each group related to gastric stasis due to the lack of pyloroplasty trasnhiatal There was no difference between laparoscopic minimally invasive trans-hiatal esophagectomy EMIL and open trans-hiatal esophagectomy ETHA in all studied variables, thus allowing to be considered equivalent.
To the secretary Luciana Calheiros, Prof. National Center for Biotechnology InformationU.
Arq Bras Cir Dig. Published online Aug Author information Article notes Copyright and License information Disclaimer. Received Mar 20; Accepted May This is an open-access article distributed under the terms of the Creative Commons Attribution License. Open in a separate window. Agarwal AK, Javed A. Evaluation of complications of transmediastinal esophagectomy in the surgical treatment of relapsed megaesophagus.
Surgical treatment analysis of idiopatic esphageal acalasia. Rev Col Bras Cir. Mechanical cervical esophagogastric latero-lateral anastomosis after esphagectomies.
Decreasing morbidity and mortality in consecutive minimally invasive esophagectomies. Intrasphincteric injection of botulin toxin to treatment of chagasic achalasia. Cecconello I, Takeda FR. Management of the cervical esophagogastric anastomotic stricture.
Semin Thorac and Cardiovascular Surgery. Laparoscopic transhiatal subtotal esophagectomy for the treatment of advanced megaesophagus.