Search

OBJETIVO: Os autores descrevem sua experiencia com o tratamento cirurgico da doenca de refluxo gastroesofagico (DRGE) em pacientes com esclerose sistemica (ES). METODOS: Foram selecionados 10 pacientes com DRGE que apresentavam esofagite grave e estenose esofagica, tratados previamente com doses recomendadas de drogas anti-secretorias (ranitidina e/ou omeprazol) e pro-cineticas (cisapride) por mais de seis meses, sem melhora significativa. Todos os pacientes eram do sexo feminino e 8 eram caucasoides, sendo 7 com ES limitada e 3 com ES difusa. RESULTADOS: O tratamento cirurgico foi realizado atraves de videolaparoscopia em 9 pacientes e por cirurgia aberta no outro paciente. Sete pacientes foram submetidos a tecnica de Nissen modificada e 3 a tecnica de Lind. Seis pacientes com estenose esofagica significativa necessitaram de dilatacoes endoscopicas no periodo pre-operatorio. Avaliacao pos-operatoria tres meses apos a cirurgia revelou que 70% dos pacientes apresentaram resultado favoravel, com melhora significativa da azia e da disfagia; 1 paciente necessitou de nova intervencao cirurgica em consequencia de uma hernia paraesofagica no periodo pos-operatorio, sendo realizada uma gastrectomia em Y de Roux. Uma boa evolucao foi referida por 80% dos pacientes um ano apos cirurgia e por 70% dois anos apos cirurgia, observando-se dois obitos. CONCLUSOES: Os autores concluem que o tratamento cirurgico da DRGE representa uma eficiente opcao terapeutica em pacientes com ES e esofagite grave com estenose.

A doença do refluxo gastroesofagiano é muito freqüente na população e o tratamento cirúrgico é indicado em um número respeitável de pacientes. A escolha da via de acesso é a laparoscopia. Várias técnicas anti-refluxo podem ser empregadas e preferimos a técnica de Nissen modificada. OBJETIVO: Analisar os parâmetros clínicos e funcionais pré-operatórios comparados com os mesmos parâmetros pós-operatórios com a técnica empregada. MÉTODOS: Um grupo de 59 pacientes foi submetido a tratamento cirúrgico pela técnica de Nissen modificada videolaparoscópica. O diagnóstico pré-operatório foi feito por exame radiográfico contrastado e endoscopia digestiva alta em todos os pacientes. A manometria do esôfago realizada em 35 e a cintilografia em 15. Esofagite complicada ocorreu em 54,2% sendo 21 pacientes (35,6%) com epitélio de Barrett. A técnica cirúrgica laparoscópica foi concluída em todos os pacientes. O tempo médio de cirurgia foi de 123,9 minutos. RESULTADOS: Não ocorreram complicações intra-operatórias. A alta se deu em média com 47,6 horas. Sintomas de disfagia, dor, epigastralgia, regurgitação e flatulência até o 30° dia ocorreram em 48,1% dos pacientes. Ocorreu uma reoperação por recurrência da doença e um óbito por necrose do fundo gástrico. O seguimento médio foi de 20,8 meses. Os exames pós-operatórios radiográficos, endoscópicos, manométricos e de cintilografia mostraram melhora significativa, bem como a avaliação clínica, que mostrou excelentes e bom resultados em 93,1% dos pacientes. CONCLUSÃO: A cirurgia de Nissen modificada videolaparoscópica corrigiu a doença do refluxo gastroesofagiano na maioria dos doentes acompanhados, associada à baixa morbimortalidade.BACKGROUND: Gastroesophageal reflux disease is highly common worldwide and surgical treatment is being indicated more frequently. Currently, laparoscopic is the access of choice and several antireflux techniques may be used. We prefer a modified Nissen technique. PURPOSE: To analyze preoperative clinical and functional parameters and compare with postoperative outcome of a modified valve technique performed by laparoscopy. METHODS: A group of 59 patients underwent laparoscopic modified Nissen valve. Preoperative diagnosis was made by radiological contrast exams and endoscopy in all patients. Esophagus manometry was performed in 35 patients and scintigraphy scan in 15 patients. Complicated esophagitis occurred in 54.2%, with 21 (35.6%) patients presenting a Barrett's epithelium. Laparoscopic surgery was performed in all patients with no conversion to open surgery, with an average time of 123.9 minutes. RESULTS: There were no intraoperative complications. Hospital discharge occurred in an average of 47.6 hours. Symptoms as dysphagia, pain, regurgitation and flatus occurred in 48.1% of the patients in the first thirty days. Average follow-up was 20.8 months. Postoperative radiological, endoscopic, manometric and scintigrafic scan exams showed a significant improvement, as well as clinical assessment using Visick's classification, which showed excellent and good results in 93.1% of the patients. CONCLUSION: Comparative analysis of clinical assessment and exam results lad us to conclude that modified Nissen surgery by laparoscopic access corrects gastroesophageal reflux in most patients followed-up.

A doenca do refluxo gastroesofagiano, em funcao de acometer grande parte da populacao, dos avancos no conhecimento da fisiopatologia da doenca, das novas drogas disponiveis para o tratamento clinico e do desenvolvimento no campo do tratamento cirurgico, com o advento da videocirurgia laparoscopica, sua importância e evidente na sociedade. O tratamento empregado, quer clinico ou cirurgico, deve alcancar a eliminacao dos sintomas e a correcao defmitiva dos fatores que propiciam o refluxo, o que e obtido na maioria das vezes, com a cirurgia. Um grupo de 59 pacientes, com diagnostico de doenca do refluxo gastroesofagiano, foi submetido a tratamento cirurgico pela tecnica de Nissen bmodificada por videolaparoscopia. O tempo medio de historia previa de sintomas foi de 77,4 meses e todos tinham sido submetidos a varios tratamentos clinicos anteriores. O sexo feminino predominou com 54,2% e a idade variou de 15 a 82 anos, com media de 52,5 anos. O diagnostico pre-operatorio foi suspeitado por avaliacao clinica, e confirmado por exame radiografico contrastado e endoscopia em todos os pacientes. A manometria do esofago foi realizada em 35 pacientes e a cintilografia, em 15. O diagnostico de esofagite nao cOmplicada ocorreu em 27 doentes (45,8%) e de esofagite complicada, em 32 deles (54,2%). O epitelio de Barrett foi encontrado em 21 pacientes (35,6%). A tecnica empregada por videolaparoscopia foi possivel em todos os pacientes e sem necessidade de conversao para cirurgia aberta. O tempo medio para a realizacao da cirurgia foi de 123,9 minutos. A colecistectomia foi realizada concomitantemente em nove doentes (15,5%). Um paciente apresentou ulcera duodenal com estenose e diverticulo de Zenker tratados no mesmo ato cirurgico. Nao ocorreram complicacoes intra-operatorias e um obito (1,7%) ocorreu no pos-operatorio precoce devido a necrose parcial do fundo gastrico. A alta hospitalar ocorreu em media com 47,6 horas. Os sintomas imediatos de disfagia, dor, epigastralgia, regurgitacao, flatulencia e um caso de pneumonia ate o 30° dia de pos-operatorio, ocorreram em 48,1% dos pacientes, com resolucao espontânea na maioria deles. O seguimento pos-operatorio medio foi de 20,8 meses. Em media, 10% dos pacientes referiram sintomas de regurgitacao, pirose ou disfagia, com melhora no decorrer do tempo. Houve uma (1,7%) reoperacao tardia por esofagite e estenose, sendo Fea1izado gastrectomia Y -Roux. Observou-se flatulencia em 5,3% dos pacientes. Os examespos-operatorios radiograficos foram realizados em 39 pacientes, a endoscopia, em 53, a manometri3!, em 35 e a cintilografia, em 40. Diagnosticou-se hernia paraesofagiana em 5% dos exames. A maioria dos dados analisados nos exames, em comparacao com o pre-operatorio, mostraraml melhora acentuada. A classificacao de Visick mostrou que 93,10% tiveram resultados excelentes e bons, independente do grau da esofagite no pre-operatorio. A analise comparativa entre a avaliacao clinica pre e pos-operatoria, e os resultados dos exames complementares pre e pos-operatorios, permitiu concluir que, a cirur.gia de Nissen modificada por videolaparoscopia, corrigiu a doenca do refluxo gastroesofagiano na maioria dos doentes acompanhados Abstract

OBJETIVO: Relatar a experiência inicial do Centro Infantil Boldrini com a esplenectomia laparoscópica (EL) em crianças e adultos jovens. MÉTODO: Foram revisados os prontuários de 40 pacientes (mediana da idade de 6,6 anos; 1 a 22,8) submetidos à EL entre Julho de 2000 e Maio de 2002. As principais indicações de acordo com a doença de base foram: doença falciforme (DF) em 20 pacientes (50%), esferocitose hereditária em 10 (25 %), púrpura trombocitopência idiopática em oito (20 %), doença de Hodgkin em um e anemia hemolítica a esclarecer em um. RESULTADOS: Trinta e oito esplenectomias foram completadas por via laparoscópica (duas conversões) e em doze foi realizada adicionalmente a colecistectomia. A mediana do tempo operatório foi de 127,5 minutos (90-240 min) e sete (17,5 %) baços acessórios foram encontrados. Sangramento intra-operatório foi significativo apenas nas duas conversões, mas não houve necessidade de transfusões. A mediana do peso dos baços foi de 250 g (106-1000; n=36). Complicações pós-operatórias ocorreram em sete (17,5 %) pacientes e, nos portadores de DF, 35% desenvolveram síndrome torácica aguda. A mediana da permanência hospitalar pós-operatória foi de dois dias (2 - 14). O seguimento variou de 23 dias a dois anos (mediana de 11 meses). CONCLUSÕES: A EL pode ser realizada de modo seguro mesmo em baços de grande tamanho e é opção atrativa que pode substituir o procedimento aberto. Em pacientes com DF, a taxa de complicações permanece alta, sugerindo mecanismos outros que vão além da escolha da via de acesso cirúrgica.

The benign esophageal stenoses (BES) are common complications owing to many etiologies: gastroesophageal reflux, ingestion of corrosive agents, esophageal surgery, radiotherapy, postendoscopic variceal sclerotherapy, drug ingestion, prolonged nasogastric intubation, extrinsic compression and esophageal webs. Esophageal dilatations are worldwide recommended to treat this complication, employing dilators of many types and diameters and facilitating the food ingestion.Evaluation of the results and advantages of the conservative treatment of the BES using esophageal dilatations, in outpatient service of upper digestive endoscopy.During the period from 1981 to 1999, 500 patients with BES were treated and followed up at the Gastrocenter - UNICAMP, in an individually Program of Esophageal Dilatation for each case. The highest number of cases was under ages from 31 to 60 years old (52,8%), and males (59,2%). The most predominant etiologies were: peptic stenosis (30,4%), caustic ingestion (23,6%), anastomosis (23,2%), megaesophagus (8,0%) and prolonged nasogastric ingestion entubation (6,4%), totalizing 91,6% of the BES. Most of patients (94,2%) were submitted to the maximum of 25 dilations. Dilators from 10,5 to 16 mm were employed in 95,6% of the cases. The duration of the treatment was 24 months in 76,2% of the BES. Esophageal perforations occurred in 6 patients (1,2%), without mortality.Were considered excellent, good and bad results, respectively in 76,2%, 18,2% and 5,6% of the cases. On the other hand, excellent results were recorded in 81,0% of the peptic stenosis, 66,1% of the caustic stenosis and 82,7% of the anastomotic stenosis. The conservative treatment failed in 9,3% of the caustic stenosis, 4,3% of the anastomotic stenosis and 3,9% of the peptic stenosis. Thus, the caustic stenosis were unsuccessfull in the highest percentage of unsuccessful.The conservative treatment using guidewire dilators (Savary-Gilliard and Eder-Puestow) is the first choice in the BES, is effective for long time, with short complications and the surgical treatment is indicated only when the dilatations failed.

As estenoses benignas do esôfago (EBE) são complicações muito freqüentes, resultado de várias etiologias, a saber: refluxo gastro-esofágico, ingestão de agentes corrosivos, pós-cirurgias do esôfago, pós-radioterapia no tórax, pós-escleroterapia endoscópica de varizes do esôfago, ingestão de medicamentos, uso prolongado de cateter nasogástrico, compressão extrínseca e membranas esofágicas congênitas. As dilatações esofágicas são recomendadas no tratamento dessa complicação, empregando dilatadores de vários tipos e diâmetros, facilitando ao doente a ingestão alimentar. OBJETIVOS: Avaliação dos resultados e vantagens do tratamento conservador das EBE através de dilatações esofágicas realizadas ambulatorialmente com auxílio da endoscopia digestiva flexível. MÉTODOS: No período de 1981 a 1999 foram tratados, conservadoramente e seguidos no Gastrocentro -- UNICAMP, 500 doentes com EBE, através de um Programa de Dilatações Esofágicas instituído para cada caso. A maioria era do sexo masculino (59,2%) e a faixa etária mais acometida encontra-se entre 31 anos e 60 anos, compreendendo 52,8% dos pacientes em estudo. As estenoses mais prevalentes foram as estenoses pépticas (30,4%), cáusticas (23,6%), de anastomoses (23,2%), por megaesôfago (8,0%) e por uso prolongado de cateter nasogástrico (6,4%), perfazendo um total de 91,6% das EBE. Quanto ao número de procedimentos, 94,2% dos casos foram submetidos a no máximo 25 dilatações do esôfago. Em 95,6% deles foram utilizados dilatadores com diâmetro entre 10,5 mm e 16,0 mm. A duração do tratamento foi até 24 meses em 76,2% dos casos. Perfurações esofágicas ocorreram em seis doentes (1,2%), sem mortalidade. RESULTADOS: Foram considerados bons em 76,2%, regulares em 18,2% e maus em 5,6% dos doentes. O sucesso do tratamento variou conforme a etiologia da estenose, ocorrendo bons resultados em 81,0% das estenoses pépticas, em 66,1% das estenoses cáusticas e em 82,7% das estenoses de anastomoses. A falha do tratamento conservador ocorreu em 9,3% das estenoses cáusticas, 4,3% das estenoses de anastomose e 3,9% das estenoses pépticas. A estenose cáustica propiciou a falha maior da terapêutica conservadora em relação aos demais. CONCLUSÃO: O tratamento conservador, através de dilatações orientadas por fio-guia (Savary-Gilliard e Eder Puestow), é a primeira escolha nas EBE; é eficaz a longo prazo, com índice mínimo de complicações e o tratamento cirúrgico é apenas indicado se não for possível realizar as dilatações. The benign esophageal stenoses (BES) are common complications owing to many etiologies: gastroesophageal reflux, ingestion of corrosive agents, esophageal surgery, radiotherapy, postendoscopic variceal sclerotherapy, drug ingestion, prolonged nasogastric intubation, extrinsic compression and esophageal webs. Esophageal dilatations are worldwide recommended to treat this complication, employing dilators of many types and diameters and facilitating the food ingestion. PURPOSE: Evaluation of the results and advantages of the conservative treatment of the BES using esophageal dilatations, in outpatient service of upper digestive endoscopy. METHODS: During the period from 1981 to 1999, 500 patients with BES were treated and followed up at the Gastrocenter -- UNICAMP, in an individually Program of Esophageal Dilatation for each case. The highest number of cases was under ages from 31 to 60 years old (52,8%), and males (59,2%). The most predominant etiologies were: peptic stenosis (30,4%), caustic ingestion (23,6%), anastomosis (23,2%), megaesophagus (8,0%) and prolonged nasogastric ingestion entubation (6,4%), totalizing 91,6% of the BES. Most of patients (94,2%) were submitted to the maximum of 25 dilations. Dilators from 10,5 to 16 mm were employed in 95,6% of the cases. The duration of the treatment was 24 months in 76,2% of the BES. Esophageal perforations occurred in 6 patients (1,2%), without mortality. RESULTS: Were considered excellent, good and bad results, respectively in 76,2%, 18,2% and 5,6% of the cases. On the other hand, excellent results were recorded in 81,0% of the peptic stenosis, 66,1% of the caustic stenosis and 82,7% of the anastomotic stenosis. The conservative treatment failed in 9,3% of the caustic stenosis, 4,3% of the anastomotic stenosis and 3,9% of the peptic stenosis. Thus, the caustic stenosis were unsuccessfull in the highest percentage of unsuccessful. CONCLUSION: The conservative treatment using guidewire dilators (Savary-Gilliard and Eder-Puestow) is the first choice in the BES, is effective for long time, with short complications and the surgical treatment is indicated only when the dilatations failed.

Gastroesophageal reflux disease is highly common worldwide and surgical treatment is being indicated more frequently. Currently, laparoscopic is the access of choice and several antireflux techniques may be used. We prefer a modified Nissen technique.To analyze preoperative clinical and functional parameters and compare with postoperative outcome of a modified valve technique performed by laparoscopy.A group of 59 patients underwent laparoscopic modified Nissen valve. Preoperative diagnosis was made by radiological contrast exams and endoscopy in all patients. Esophagus manometry was performed in 35 patients and scintigraphy scan in 15 patients. Complicated esophagitis occurred in 54.2%, with 21 (35.6%) patients presenting a Barrett's epithelium. Laparoscopic surgery was performed in all patients with no conversion to open surgery, with an average time of 123.9 minutes.There were no intraoperative complications. Hospital discharge occurred in an average of 47.6 hours. Symptoms as dysphagia, pain, regurgitation and flatus occurred in 48.1% of the patients in the first thirty days. Average follow-up was 20.8 months. Postoperative radiological, endoscopic, manometric and scintigrafic scan exams showed a significant improvement, as well as clinical assessment using Visick's classification, which showed excellent and good results in 93.1% of the patients.Comparative analysis of clinical assessment and exam results lad us to conclude that modified Nissen surgery by laparoscopic access corrects gastroesophageal reflux in most patients followed-up.

A doença do refluxo gastroesofagiano é muito freqüente na população e o tratamento cirúrgico é indicado em um número respeitável de pacientes. A escolha da via de acesso é a laparoscopia. Várias técnicas anti-refluxo podem ser empregadas e preferimos a técnica de Nissen modificada. OBJETIVO: Analisar os parâmetros clínicos e funcionais pré-operatórios comparados com os mesmos parâmetros pós-operatórios com a técnica empregada. MÉTODOS: Um grupo de 59 pacientes foi submetido a tratamento cirúrgico pela técnica de Nissen modificada videolaparoscópica. O diagnóstico pré-operatório foi feito por exame radiográfico contrastado e endoscopia digestiva alta em todos os pacientes. A manometria do esôfago realizada em 35 e a cintilografia em 15. Esofagite complicada ocorreu em 54,2% sendo 21 pacientes (35,6%) com epitélio de Barrett. A técnica cirúrgica laparoscópica foi concluída em todos os pacientes. O tempo médio de cirurgia foi de 123,9 minutos. RESULTADOS: Não ocorreram complicações intra-operatórias. A alta se deu em média com 47,6 horas. Sintomas de disfagia, dor, epigastralgia, regurgitação e flatulência até o 30° dia ocorreram em 48,1% dos pacientes. Ocorreu uma reoperação por recurrência da doença e um óbito por necrose do fundo gástrico. O seguimento médio foi de 20,8 meses. Os exames pós-operatórios radiográficos, endoscópicos, manométricos e de cintilografia mostraram melhora significativa, bem como a avaliação clínica, que mostrou excelentes e bom resultados em 93,1% dos pacientes. CONCLUSÃO: A cirurgia de Nissen modificada videolaparoscópica corrigiu a doença do refluxo gastroesofagiano na maioria dos doentes acompanhados, associada à baixa morbimortalidade. BACKGROUND: Gastroesophageal reflux disease is highly common worldwide and surgical treatment is being indicated more frequently. Currently, laparoscopic is the access of choice and several antireflux techniques may be used. We prefer a modified Nissen technique. PURPOSE: To analyze preoperative clinical and functional parameters and compare with postoperative outcome of a modified valve technique performed by laparoscopy. METHODS: A group of 59 patients underwent laparoscopic modified Nissen valve. Preoperative diagnosis was made by radiological contrast exams and endoscopy in all patients. Esophagus manometry was performed in 35 patients and scintigraphy scan in 15 patients. Complicated esophagitis occurred in 54.2%, with 21 (35.6%) patients presenting a Barrett's epithelium. Laparoscopic surgery was performed in all patients with no conversion to open surgery, with an average time of 123.9 minutes. RESULTS: There were no intraoperative complications. Hospital discharge occurred in an average of 47.6 hours. Symptoms as dysphagia, pain, regurgitation and flatus occurred in 48.1% of the patients in the first thirty days. Average follow-up was 20.8 months. Postoperative radiological, endoscopic, manometric and scintigrafic scan exams showed a significant improvement, as well as clinical assessment using Visick's classification, which showed excellent and good results in 93.1% of the patients. CONCLUSION: Comparative analysis of clinical assessment and exam results lad us to conclude that modified Nissen surgery by laparoscopic access corrects gastroesophageal reflux in most patients followed-up.

Background Objectives To describe the experience with the surgical treatment for gastroesophageal reflux disease (GRD) in systemic sclerosis (SSc). Methods From 202 patients with the diagnosis of SSc attended at the Scleroderma outpatient clinic in the period 1991–2000, ten patients (5%) who presented GRD, with severe chronic esophagitis and stricture, were submitted to surgical treatment. All the patients were female and eight were Caucasian, with seven presenting limited SSc (mean age 53 years and mean disease duration 17 years) and three diffuse SSc (mean age 44 years and mean disease duration 6 years). Results The correction of the gastroesophageal reflux was performed through videolaparoscopy in nine patients. Seven patients underwent modified Nissen technique and three patients Lind technique. There was satisfactory clinical response, with significant improvement in the heartburn and dysphagia in all the patients. After a mean followup of 34 months (12–76 months), one patient presented clinical relapse (after 54 months) and another patient needed a surgical ressection of a paraesophageal hernia (Y-Roux). Conclusion The surgical treatment of GRD represents an efficient therapeutic option in SSc patients with severe esophagitis and stricture.

The laparoscopy has been more and more frequently indicated in the last years, for the complementary diagnosis of intraabdominal diseases and abdominal repercussion of systemic diseases. Modern equipaments including videolaparoscopy and the use of either forceps or biopsy needle permit higher safety and significant diagnostic capacity.To perform laparoscopy for the diagnosis of intraabdominal and sistemic diseases.During the last 9 years 168 patients were submitted to laparoscopy and the main indications were: ascites--43 cases (25.5%); liver diseases--42 cases (25%); gastric cancer--37 cases (22%); lymphoma--17 cases (10.1%); abdominal tumour--9 cases (5.4%); peritoneal tuberculosis--8 cases (4.8%); liver tumour--6 cases (3.6%); mesenteric cyst--1 case (0.6%) and other diseases--5 cases (3.0%). Ninety nine patients were male (58.9%) aging from 9 to 78 years old (median 47.6 years). Liver biopsies were performed in 92 cases (54.7%) and other tumour biopsies in 26 cases (15.4%).The diagnosis of the diseases were established or confirmed by laparoscopy in 145 patients (86.3%). In 25 cases of gastric cancer (67.5%) laparoscopy contraindicated the laparotomy, owing to advanced disease. Two patients presented bleeding (1.2%) after liver biopsies and laparotomy was immediately indicated. One of them, whose diagnosis was systemic lupus, presented abdominal abscess, bronchopneumony and died (0.6%).Laparoscopy has small number of complications, and when employed as a diagnostic complementary method therapeutic procedures, avoids laparotomies and accelerate therapeutic procedures.

Transmediastinal gastric transposition and pharyngogastric anastomosis is perhaps one of the most widely accepted methods for restoration of the alimentary continuity after pharyngoesophageal resection. The need of neck dissection, mediastinal tracheostomy, and previous radiotherapy may favor exposure and rupture of major vessels. Protection with omentum may prevent this complication. A comprehensive review of omentum flap use in surgery was undertaken.A modified omentum pedicled flap was used in 6 out of 36 patients submitted to total pharyngolaryngoesophagectomy and gastric transposition (PLEGT).None of the patients had major vessel rupture as compared with a 13% carotid and innominate artery rupture of a series of 30 patients previously operated on without omentum pedicled flap protection.The omental pedicled flap, performed as described, may provide reliable protection for carotid and innominate artery exposure, adding little time to the procedure.

A laparoscopia tem sido mais freqüentemente indicada nos últimos anos na complementação diagnóstica de afecções abdominais e na identificação de repercussões abdominais de doenças sistêmicas. Modernos equipamentos incluindo video-laparoscopia e o uso de agulhas de biópsias e outros instrumentais permitem elevada segurança e significante capacidade diagnóstica. OBJETIVO: Empregar a laparoscopia no diagnóstico de doenças abdominais e sistêmicas. MÉTODOS: Durante os últimos 9 anos, 168 doentes foram submetidos a laparoscopia e as principais indicações foram: ascites (43 casos - 25,5%); doenças hepáticas (42 casos - 25%); câncer gástrico (37 casos - 22%); linfomas (17 casos - 10,1%); tumores abdominais (9 casos - 5,4%); tuberculose peritoneal (8 casos - 4,8%); tumores hepáticos (6 casos - 3,6%); cisto mesentérico (1 caso - 0,6%) e outras doenças (5 casos - 3,0%). Noventa e nove pacientes eram masculinos (58,9%), com idade variando de 9 a 78 anos (47,6 anos). Biópsias hepáticas foram realizadas em 92 casos (54,7%) e outras biópsias tumorais em 26 casos (15,4%). RESULTADOS: O diagnóstico da doença foi estabelecido ou confirmado em 145 casos (86,3%). Em 25 casos de câncer gástrico (67,5%), a laparoscopia contra-indicou a laparotomia em função de detecção de doença avançada. Dois pacientes apresentaram hemorragia (1,2%) após biópsias hepáticas e a laparotomia foi imediatamente indicada. Um doente, cujo diagnóstico era de lupus sistêmico, apresentou abscesso abdominal, broncopneumonia e faleceu (0,6%). CONCLUSÃO: O procedimento tem pequeno número de complicações e quando empregado como método diagnóstico complementar, evita a laparotomia e agiliza medidas terapêuticas. The laparoscopy has been more and more frequently indicated in the last years, for the complementary diagnosis of intraabdominal diseases and abdominal repercussion of systemic diseases. Modern equipaments including videolaparoscopy and the use of either forceps or biopsy needle permit higher safety and significant diagnostic capacity. PURPOSE: To perform laparoscopy for the diagnosis of intraabdominal and sistemic diseases. METHODS: During the last 9 years 168 patients were submitted to laparoscopy and the main indications were: ascites - 43 cases (25,5%); liver diseases - 42 cases (25%); gastric cancer - 37 cases (22%); lymphoma - 17 cases (10,1%); abdominal tumour - 9 cases (5,4%); peritoneal tuberculosis - 8 cases (4,8%); liver tumour - 6 cases (3,6%); mesenteric cyst - 1 case (0,6%) and other diseases - 5 cases (3,0%). Ninety nine patients were male (58,9%) aging from 9 to 78 years old (median 47,6 years). Liver biopsies were performed in 92 cases (54,7%) and other tumour biopsies in 26 cases (15,4%). RESULTS: The diagnosis of the diseases were established or confirmed by laparoscopy in 145 patients (86,3%). In 25 cases of gastric cancer (67,5%) laparoscopy contraindicated the laparotomy, owing to advanced disease. Two patients presented bleeding (1,2%) after liver biopsies and laparotomy was immediately indicated. One of them, whose diagnosis was systemic lupus, presented abdominal abscess, bronchopneumony and died (0,6%). CONCLUSION: Laparoscopy has small number of complications, and when employed as a diagnostic complementary method therapeutic procedures, avoids laparotomies and accelerate therapeutic procedures.

It is very important in the clinical practice to identify the individuals with Barrett's esophagus, because they are at risk to develop adenocarcinoma in the columnar epithelium. The objective of this research is to verify the incidence of this specific kind of epithelium at the "Gastrocentro", at State University of Campinas-UNICAMP, Campinas, SP, Brazil, among the total of 15,976 upper digestive endoscopies, performed from january of 1992 to December of 1995. From the total examinations performed were identified 2,381 patients (14.9%) presenting reflux esophagitis (grades I-IV, Savary-Miller). Among this group of patients, the endoscopist suspected of Barrett's esophagus in 110 cases (4.6%) and biopsed the distal esophagus. However, only in 85 cases (77.3%) the pathologist confirmed the diagnosis of Barrett's epithelium. The patients with Barrett's esophagus were 53 males (62.3%), presenting the mean age of 52.2 years and the following grades of esophagitis: grade I-33 cases (38.8%); grade II-15 cases (17.7%); grade III-15 cases (17.7%), grade IV-12 cases (14.1%) and without esophagitis-10 cases (11.7%). The incidence of Barrett's esophagus among the patients with reflux esophagitis was 3.57%, and among the total of examinations performed at the "Gastrocentro" during the period of four years was 0.53%, totalizing 22,4 cases/100,000 habitants.

During the period from August 1st, 1990 to June 15, 1992, 117 patients with portal hypertension and upper gastrointestinal bleeding were examined at the "GASTROCENTRO"--State University of Campinas--UNICAMP, Campinas, SP, Brazil few hours after hospital admission. The objectives were to study the association of gastroduodenal acute lesions and esophageal varices. The predominant ages were thirties and sixties years (83.76%), being 70.08% of males. The hematemesis occurred in 94.02% of the cases. The etiologies of the bleeding were: esophageal varices, 47.87%; gastroduodenal acute mucosal lesions, 34.19%; gastric varices, 9.4%; gastric ulcers, 5.98% and duodenal ulcers, 2.56%. The authors concluded that exists a significant association of acute gastroduodenal lesions and esophageal varices causing upper gastrointestinal bleeding. It is essential to examine early and in detail the gastroduodenal mucosa during upper digestive endoscopy in the patient with portal hypertension and esophageal varices to diagnose the etiology of the bleeding. It is advisable to perform endoscopic examination twice a year when the dyspeptic symptoms are constant, with previous treatment for gastroduodenal acute mucosal lesions or peptic ulcers, and annual in the others.

gastroduodenal mucosa of two groups of patients with chronic liver disease was studied: schistosomotic mansoni patients (SH) and non-schistosomic patients (NSH). Results were compared to serum-gastrin levels. TYPE: prospective study.Unicamp University Hospital (Hospital das Clínicas), Campinas, São Paulo, Brazil.24 patients were included in the results, out of 26 patients studied. Two groups of study: 12 patients with schistosomiasis and liver fibrosis (SH), and 12 patients with liver cirrhosis (NSH) secondary to alcoholism or to hepatitis.esophagogastroduodenoscopies and biopsies of gastric antrum and duodenum. Function tests of the liver were also studied.results of gastrinemia were found within normal ranges in both groups. Student test ("t") did not show differences between groups at the 5% level. However, patients with chronic liver cirrhosis had more significant and severe endoscopic findings and chronic inflammatory processes of the gastroduodenal mucosa (acute gastritis, duodenitis and ulcers) than patients with liver fibrosis.patients with liver cirrhosis due to high risk of gastroduodenal bleeding should be maintained under continuous vigilance, appropriate diet and mucosa cytoprotectors. Furthermore, more research is required to study the etiology of gastroduodenal lesions in these specific groups of patients.

A case of mesenteric panniculitis is presented in which the main signal was an abdominal pulsable mass and severe obstruction of the lymphatic vessels of the mesentery. A review of the literature was done.

The authors study 84 patients that had damages of the duodenum and or pancreas and underwent different types of surgery. In 39 patients who had damage only in the duodenum; there were 2 (4.0%) duodenal fistulas, and 3 (6.0%) intraperitoneal abscess. In 38 patients who had injuries only in the pancreas; there were 6 (13.1%) acute pancreatities, pancreatic fistulas and 1 (2.2%) pancreatic pseudocyst. In 7 cases, injuries were found to both pancreas and duodenum. The author reports 1 case of duodenal fistula (14.3%) 1 case of acute pancreatitis (14.3%) and 3 cases of pancreatic fistula (43.0%). Only 7 patients died (8.3%), and of these 2 died for reasons not directly related to the operatory technic used. A simple suture can be performed in those cases where a complete section of the duodenum is unnecessary and there is no injury to the duodenal papilla. A burying suture of the stomas associated with a side-to-side duodenojejunal anastomosis should be preferred in the complete section of the duodenum localized beyond the ampulla of Vater. In all superficial wounds of small extension a suture of the pancreas should be performed. Distal pancreatectomy of body or tail should be made in the wounds with a possible lesion to the Wirsung duct and when there is an extensive glandular lesion. The associate wounds of duodenum and pancreas should be treated as if they were isolated lesions.

Benign neoplasms are rare events in the extrahepatic biliary ducts, and scanty literary references on the subject are available. Four cases of obstructive jaundice caused by benign tumours of the extrahepatic biliary ducts have been reviewed. Two of them have also displayed lithiasis of the gallbladder and common bile duct. In three cases histopathologic confirmation was obtained, in contrast to the remaining case in which only a gross pathologic presumptive diagnosis was possible. Three patients underwent surgical resection, and in one of them hepatojejunostomy was performed. The patient with a presumptive diagnosis of "inflammatory polyp" was not submitted to surgery, due to the special circumstances of the case. The undisturbed follow-up of the four cases attested to the worthiness of the surgical procedures.