SABISTON TRATADO DE CIRURGIA PDF

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Sabiston Tratado De Cirurgia Pdf

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Bedside conventional tracheostomy

To date, management of GERD includes sleeping while the head is elevated, regulation of the eating habits, weight loss, avoiding tight clothing, medical treatment with antacids, prokinetic agents, H2 receptor blocking agents, proton pump inhibitors, and reflux surgery. Therefore, surgical procedures have gained popularity to treat classical symptoms of GERD and prevent complications related to the pulmonary tissue. Unresponsiveness to medical treatment, atypical symptoms, Barrett esophagus, stricture, severe esophagitis, decreased lower esophageal sphincter pressure and high Demeester score during pH monitoring comprise the indications for surgery in GERD [ 2 , 3 ].

In recent decades, several surgical techniques have been developed to treat it. Nowadays, the Nissen and Nissen-Rossetti procedures are most used due to its high efficiency [ 4 , 5 ].

This study was designed to compare the results of pre- and postoperative pulmonary function tests PFT given to patients with GERD, who were scheduled to undergo surgical treatment.

This study was undertaken in accordance with the Helsinki Declaration and approved by the Local Ethics Committee. Histories of the patients were taken, demographic data such as age, sex, occupation were recorded and patients underwent physical examination.

All patients gave up smoking or they stopped smoking had been ten years. All patients had esophagogastroscopy to determine a possible hiatus hernia and esophagitis. Further, PA and lateral chest radiographs and electrocardiogram were obtained and Ig E test and Prick test for any allergy were carried out. All patients had cruroraphy and laparoscopic Nissen fundoplication.

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Kolmogorov-Smirnov test was used for normally test of numerical characteristics. The results were recorded by the principal investigator and analyzed statistically upon completion of the study.

The statistical analysis was performed using SPSS software, version P value less than 0. Mean duration of reflux was 5. Eleven patients Six patients were allergic to mites, four patients were allergic to pollens while one patient had allergic rhinitis.

Demographic and baseline characteristics of the patients are summarized in Table 1. Results of pulmonary function tests are presented in Table 2. Ventilatory pulmonary function parameters in patients with preoparative and postoperative. This study highlighted three points: In the present study, we compared the results of preoperative and postoperative PFTs and investigated the effects of clinical improvement achieved by surgery on the respiratory system.

GERD is considered to be an important risk factor in the development of pulmonary diseases [ 6 - 8 ]. Various studies reported edema, inflammation of the upper and lower respiratory tract and increased pulmonary resistance secondary to chronic aspiration.

Associations between GERD and chronic coughing, asthma, chronic obstructive lung disease and other pulmonary diseases have been reported in the literature [ 9 , 10 ]. The primary objective of the present study was to explore if surgical correction of the chronic passage of gastric contents to the respiratory system could prevent permanent damage in the respiratory epithelia as a result of chronic irritation.

These results suggested that the pulmonary functions improved though absence of significant improvement in FEV1 casts a doubt. In that case, clinical improvement observed in pulmonary functions gives hope.

We attributed the absence of significant improvement in FEV1 to performing the postoperative pulmonary function tests relatively early. It would be a promising and satisfactory result if pulmonary function tests made in the future show significant improvement in FEV1, which suggests that restoration of pulmonary functions in the postoperative period in patients with GERD is a continuous process.

As such, beneficial effects of surgical procedures on pulmonary functions in reflux patients can be demonstrated by more detailed clinical studies. Preoperative pulmonary function tests of some patients with pathological GER were within normal range.

This is possibly due to prevention of aspiration into the lungs by some defense mechanisms of the upper respiratory tract.

Still, these patients experienced improvements in postoperative pulmonary function tests as well. Embryological developments of the respiratory tract and the esophagus are related and both are innervated by the vagus nerve [ 11 , 12 ].

A few researchers argued that acid reflux to the distal esophagus stimulated the local receptors at the esophageal mucosa. It is believed that this stimulus is conveyed to the central nervous system by the afferent fibers of the vagus nerve and elicits bronchospasm via the efferent fibers of the same nerve.

Therefore it is not surprising to observe edema, inflammation and increased pulmonary resistance both in the upper and lower respiratory tracts [ 10 , 13 ]. Acid reflux to the esophagus, which is significantly diminished in the postoperative period, does not cause vagal stimulation.

High Ig E levels in The present study has clear limitations. Limited number of cases stands at the forefront of these constraints. Furthermore, carrying out a single type of surgical procedure, performing the postoperative pulmonary function test in early stages, not assessing the pre-operative and post-operative exercise capacities by tests and not measuring the pre-operative and post-operative arterial gases are the other constraints.

We believe that the results obtained from this study would be more meaningful when supported by multicenter studies including higher number of patients. Studies which employ different anti-reflux surgical procedures perform postoperative pulmonary function tests in later stages, measure exercise capacities and arterial blood gas levels would yield more detailed information. In conclusion, significant improvements in pulmonary function tests can be acquired in patients with GERD by cruroraphy and laparoscopic Nissen fundoplication.

We conclude that solving the reflux-related problems in early stages by surgical interventions can prevent development of chronic lung diseases by preserving the pulmonary system functions. National Center for Biotechnology Information , U. Int J Clin Exp Med. Author information Article notes Copyright and License information Disclaimer.

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Address correspondence to: Good results were observed at one year follow up. There is still no consensus on the surgical technique to be performed. This procedure is based on pathophysiological factors for the treatment of this condition, with good initial results, without significant clinical alterations.

Longer follow-up will determine its effectiveness. Bons resultados foram observados em seguimento de um ano.

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Today, many techniques are available, but the Roux-en-Y gastric bypass among them is the most performed procedure not only in Brazil but all over the world. The Roux-en-Y gastric bypass is a restrictive-malabsorptive technique that promotes early satiety due to gastric reduction, but has long known complication due to food restriction and malabsorption in relation to gastric reduction and duodenum manipulation, restricting the intestinal space in which the food digestive juices mix happens 4.

Malabsorption associated with a deficient caloric intake after surgery and fast weight loss results in a remarkable rate of nutritional and electrolyte disturbances. The most common disorders are albumin, hemoglobin, iron, zinc and vitamins, especially vitamin B12 and D Each of these components has action on a specific function and optimal pH depending on the production or absorption of hormones, proteins, among others substances which occur in the small intestine or stomach, but modified by surgical technique 7.

The body has reserves that can mask vitamin deficiency over a period which can range from days to years after surgery.

In addition, many patients are admitted to the procedure already with nutritional deficiencies, which can aggravate the situation in the postoperative period 6. Secondary to this vitamin and mineral deficits occur diarrhea and possible development of other conditions such as peripheral neuropathies and visual damage by vitamin deficiency, bone loss by limiting the absorption of calcium and vitamin D, anemia due to lack of iron and proteins and also the dumping syndrome The clinical trial of reversal of these deficits is given mainly by the use of multivitamins, but adherence to this kind of treatment is flawed because it depends on continuity and must be unanimous.Herniology Although nowadays this traditional principle is being questioned, it has its value, by emphasizing the fact that often the appendix is one of the most mobile viscera, although its lack of normal position is not in himself so extraordinary.

Finally, negative methylene blue test is carried out ending the procedure. In the current study, the 2nd and 3rd positions most common are the subcecal Blood supply and position of the vermiform appendix in Zambians.

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