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Contrucci Filho O, Freitas CMDE, Ilias EJ, Fonseca AZ. Abdominal esophagocardiectomy with esophagogastric anastomosis, with vagal preservation and construction of a spiral anti reflux valve in the treatment of advanced megaesophagus. Rev Col Bras Cir 2022; 49:e20223222. [PMID: 36134848 PMCID: PMC10578827 DOI: 10.1590/0100-6991e-20223222_en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/09/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE present a new operative technique characterized by abdominal esophagocardiectomy, with esophagogastrus anastomosis, vagal preservation and spiral anti-reflux valve construction in the treatment of advanced megaesophagus in patients with severe systemic diseases, as well as its result in an initial group of 17 patients. METHOD We selected 17 patients with advanced megaesophagus and comorbidities submitted to new technique. The following parameters were analyzed: age, sex, length of hospital stay, early and late complications, mortality, radiological/endoscopic aspects. RESULTS twelve male patients (70%) and five (30%) were operated on, with mean age of 51.5 years and mean hospital stay of 14.8 days. There was no mortality in the immediate intraoperative or postoperative period and there were no cases of postoperative fistula. During hospitalization there was one case of pulmonary atelectasis (5.8%), one of pleural effusion (5.8%), two of wall infection (11.7%) and one of urinary retention (5.8%). Discussion: We believe it to be an easy technique, made exclusively by the abdominal route, that is, without violating the thoracic cavity. Such a procedure would be beneficial in patients with advanced megaesophagus and important comorbidities, as well as in those with a history of previous surgeries. CONCLUSION the technique described was easy to perform and safe, when performed by an experienced team, with low morbidity and mortality in patients with advanced megaesophagus and important comorbidities, which could increase your complications with more invasive and complex surgeries.
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Affiliation(s)
- Orlando Contrucci Filho
- - Universidade Santo Amaro, Cirurgia - São Paulo - SP - Brasil
- - International Society for Diseases of the Esophagus - Vancouver - Canadá
| | - Carla Micaele DE Freitas
- - Universidade Santo Amaro, Cirurgia - São Paulo - SP - Brasil
- - Colégio Brasileiro de Cirurgiões - São Paulo - SP - Brasil
| | - Elias Jirjoss Ilias
- - Universidade Santo Amaro, Cirurgia - São Paulo - SP - Brasil
- - Colégio Brasileiro de Cirurgiões - São Paulo - SP - Brasil
- - Colégio Brasileiro de Cirurgia Digestiva - São Paulo - SP - Brasil
- - Sociedade Brasileira de Cirurgia Bariátrica e Metabólica - São Paulo - SP - Brasil
| | - Alexandre Zanchenko Fonseca
- - Hospital Regional Sul, Cirurgia - São Paulo - SP - Brasil
- - Colégio Brasileiro de Cirurgia Digestiva - São Paulo - SP - Brasil
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Fonseca AZ, Kunizaki E, Waisberg J, Ribeiro MAF. Managing tube thoracostomy with thoracic ultrasound: results from a randomized pilot study. Eur J Trauma Emerg Surg 2020; 48:973-979. [PMID: 33244615 DOI: 10.1007/s00068-020-01554-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Tube thoracostomy (TT) is a simple and a life-saving procedure; nevertheless, it carries morbidity, even after its removal. Currently, TT is managed and removed by chest X-ray (CXR) evaluation. There are limitations and these are directly linked to complications. The use of thoracic ultrasound (US) has already been established in the diagnosis of pneumothorax (PTX) and hemothorax (HTX); its use, in substitution of CXR can lead to improvement in care. Our aim is to evaluate the efficiency and safety of US in the management of TT. METHODS Prospective and randomized study with patients requiring TT. They were divided in groups according to their thoracic injuries (PTX and HTX) and randomized into two groups according to TT management: US and CXR. Data collected included gender, age, mechanism of injury, days to TT removal, complications after TT removal and presence of mechanical ventilation. RESULTS Sixty-one patients were randomized, of which 68.8% were male. The most frequent diagnosis was PTX, present in 37 cases. Median time for TT removal was 2.5 days in the US group and 4.9 in the control group (p = 0.009). The complication rate was 6.6%, with no morbidity in the US group. TT removal in patients with mechanical ventilation did not increase the incidence of complications. CONCLUSIONS The use of US in the management is efficient and safe. It allows early TT removal regardless the cause of the thoracic injury.
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Affiliation(s)
- Alexandre Zanchenko Fonseca
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil.
| | - Eric Kunizaki
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil
| | - Jaques Waisberg
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil
| | - Marcelo Augusto Fontenelle Ribeiro
- Programa de Pós-Graduação Do Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Av. Ibirapuera, 981 - 2º andar, Vila Clementino, São Paulo, SP, 04029-000, Brazil
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Ribeiro MAF, Barros EA, Carvalho SMDE, Nascimento VP, Cruvinel J, Fonseca AZ. Comparative study of abdominal cavity temporary closure techniques for damage control. Rev Col Bras Cir 2017; 43:368-373. [PMID: 27982331 DOI: 10.1590/0100-69912016005015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/16/2016] [Indexed: 11/22/2022] Open
Abstract
The damage control surgery, with emphasis on laparostomy, usually results in shrinkage of the aponeurosis and loss of the ability to close the abdominal wall, leading to the formation of ventral incisional hernias. Currently, various techniques offer greater chances of closing the abdominal cavity with less tension. Thus, this study aims to evaluate three temporary closure techniques of the abdominal cavity: the Vacuum-Assisted Closure Therapy - VAC, the Bogotá Bag and the Vacuum-pack. We conducted a systematic review of the literature, selecting 28 articles published in the last 20 years. The techniques of the bag Bogotá and Vacuum-pack had the advantage of easy access to the material in most centers and low cost, contrary to VAC, which, besides presenting high cost, is not available in most hospitals. On the other hand, the VAC technique was more effective in reducing stress at the edges of lesions, removing stagnant fluids and waste, in addition to acting at the cellular level by increasing proliferation and cell division rates, and showed the highest rates of primary closure of the abdominal cavity. RESUMO A cirurgia de controle de danos, com ênfase em peritoneostomia, geralmente resulta em retração da aponeurose e perda da capacidade de fechar a parede abdominal, levando à formação de hérnias ventrais incisionais. Atualmente, várias técnicas oferecem maiores chances de fechamento da cavidade abdominal, com menor tensão. Deste modo, este estudo tem por objetivo avaliar três técnicas de fechamento temporário da cavidade abdominal: fechamento a vácuo (Vacuum-Assisted Closure Therapy - VAC), Bolsa de Bogotá e Vacuum-pack. Realizou-se uma revisão sistemática da literatura com seleção de 28 artigos publicados nos últimos 20 anos. As técnicas de Bolsa de Bogotá e Vacuum-pack tiveram como vantagem o acesso fácil ao material, na maioria dos centros, e baixo custo, ao contrário do que se observa na terapia a vácuo, VAC, que além de apresentar alto custo, não está disponível em grande parte dos hospitais. A técnica VAC, por outro lado, foi mais eficaz na redução da tensão nas bordas das lesões, ao remover fluidos estagnados e detritos, além de exercer ação a nível celular, aumentando as taxas de proliferação e divisão celular, e apresentou as maiores taxas de fechamento primário da cavidade abdominal.
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Affiliation(s)
| | - Emily Alves Barros
- Medicine School, University of Santo Amaro (UNISA), Santo Amaro, SP, Brasil
| | | | | | - José Cruvinel
- Medicine School, University of Santo Amaro (UNISA), Santo Amaro, SP, Brasil
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Fonseca AZ, Santin S, Ribeiro M. Spontaneous pneumorrhachis. Am J Emerg Med 2016; 34:2465.e3-2465.e4. [DOI: 10.1016/j.ajem.2016.06.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 11/25/2022] Open
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Ribeiro MAF, Medrado MB, Rosa OM, Silva AJDD, Fontana MP, Cruvinel-Neto J, Fonseca AZ. LIVER TRANSPLANTATION AFTER SEVERE HEPATIC TRAUMA: CURRENT INDICATIONS AND RESULTS. Arq Bras Cir Dig 2016; 28:286-9. [PMID: 26734803 PMCID: PMC4755185 DOI: 10.1590/s0102-6720201500040017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/13/2015] [Indexed: 01/01/2023]
Abstract
Background : The liver is the most injured organ in abdominal trauma. Currently, the treatment
in most cases is non-operative, but surgery may be necessary in severe abdominal
trauma with blunt liver damage, especially those that cause uncontrollable
bleeding. Despite the damage control approaches in order to achieve hemodynamic
stability, many patients develop hypovolemic shock, acute liver failure, multiple
organ failure and death. In this context, liver transplantation appears as the
lifesaving last resource Aim : Analyze the use of liver transplantation as a treatment option for severe liver
trauma. Methods : Were reviewed 14 articles in the PubMed, Medline and Lilacs databases, selected
between 2008-2014 and 10 for this study. Results : Were identified 46 cases undergoing liver transplant after liver trauma; the main
trauma mechanism was closed/blunt abdominal trauma in 83%, and severe trauma
(>grade IV) in 81 %. The transplant can be done, in this context, performing
one-stage procedure (damaged organ removed with immediate transplantation), used
in 72% of cases. When the two-stage approach is performed, end-to-side temporary
portacaval shunt is provided, until new organ becomes available to be
transplanted. If two different periods are considered - from 1980 to 2000 and from
2000 to 2014 - the survival rate increased significantly, from 48% to 76%, while
the mortality decreased from 52% to 24%. Conclusion : Despite with quite restricted indications, liver transplantation in hepatic
injury is a therapeutic modality viable and feasible today, and can be used in
cases when other therapeutic modalities in short and long term, do not provide the
patient survival chances.
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Ribeiro Junior MAF, Barros EA, de Carvalho SM, Nascimento VP, Cruvinel Neto J, Fonseca AZ. Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control? World J Gastrointest Surg 2016; 8:590-597. [PMID: 27648164 PMCID: PMC5003939 DOI: 10.4240/wjgs.v8.i8.590] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/11/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the 3 main techniques of temporary closure of the abdominal cavity, vacuum assisted closure (vacuum-assisted closure therapy - VAC), Bogota bag and Barker technique, in damage control surgery.
METHODS After systematic review of the literature, 33 articles were selected to compare the efficiency of the three procedures. Criteria such as cost, infections, capacity of reconstruction of the abdominal wall, diseases associated with the technique, among others were analyzed.
RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost, what is not observed in the VAC procedure. The VAC technique is the most efficient, not only because it reduces the tension on the boarders of the lesion, but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division. Bogota bag presents the higher rates of skin laceration and evisceration, greater need for a stent for draining fluids and wash-ups, higher rates of intestinal adhesion to the abdominal wall. The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing. The VAC dressing can generate irritation and dermatitis when the drape is applied, in addition to pain, infection and bleeding, as well as toxic shock syndrome, anaerobic sepsis and thrombosis.
CONCLUSION The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity.
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Fonseca AZ, Fontenelle Ribeiro MA. In Reply to: Unusual Complication of a Central Venous Catheter in a Thoracoabdominal Trauma. J Emerg Med 2015; 49:943. [PMID: 26432086 DOI: 10.1016/j.jemermed.2015.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 08/13/2015] [Indexed: 12/01/2022]
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Fonseca AZ, Saad WA, Ribeiro Jr. MA. Complications after Radiofrequency Ablation of 233 Hepatic Tumors. Oncology 2015; 89:332-6. [DOI: 10.1159/000439089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/30/2015] [Indexed: 11/19/2022]
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Fonseca AZ, da S Milhomem J, Rubio Vilca MM, Ribeiro MAF. Unusual complication of a central venous catheter in a thoracoabdominal trauma. J Emerg Med 2014; 47:202-3. [PMID: 24680103 DOI: 10.1016/j.jemermed.2014.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 12/07/2013] [Accepted: 01/30/2014] [Indexed: 11/19/2022]
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Fonseca AZ, Santin S, Gomes LGL, Waisberg J, Jr. MAFR. Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors. World J Hepatol 2014; 6:107-113. [PMID: 24672640 PMCID: PMC3959111 DOI: 10.4254/wjh.v6.i3.107] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/09/2013] [Accepted: 01/16/2014] [Indexed: 02/06/2023] Open
Abstract
Radiofrequency ablation (RFA) has become an important option in the therapy of primary and secondary hepatic tumors. Surgical resection is still the best treatment option, but only a few of these patients are candidates for surgery: multilobar disease, insufficient liver reserve that will lead to liver failure after resection, extra-hepatic disease, proximity to major bile ducts and vessels, and co-morbidities. RFA has a low mortality and morbidity rate and is considered to be safe. Thus, complications occur and vary widely in the literature. Complications are caused by thermal damage, direct needle injury, infection and the patient’s co-morbidities. Tumor type, type of approach, number of lesions, tumor localization, underlying hepatic disease, the physician’s experience, associated hepatic resection and lesion size have been described as factors significantly associated with complications. The physician in charge should promptly recognize high-risk patients more susceptible to complications, perform a close post procedure follow-up and manage them early and adequately if they occur. We aim to describe complications from RFA of hepatic tumors and their risk factors, as well as a few techniques to avoid them. This way, others can decrease their morbidity rates with better outcomes.
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Fonseca AZ, Ribeiro M, Contrucci O. Torsion of a wandering spleen treated with partial splenectomy and splenopexy. J Emerg Med 2012; 44:e33-6. [PMID: 22381612 DOI: 10.1016/j.jemermed.2011.06.146] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/06/2011] [Accepted: 06/11/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wandering spleen is a rare and unusual entity, characterized by excessive mobility and displacement of the organ from its normal position. This happens due to congenital or acquired anomalies leading to the lack of the spleen's suspensory ligaments. Clinical presentation is variable; acute abdominal pain may occur when persistent torsion of the splenic pedicle results in splenic infarction. Ultrasonography, computed tomography, and magnetic resonance imaging are modalities that may be used in diagnosis. The treatment of choice is surgery, with splenectomy or splenopexy, the latter being preferred. CASE REPORT The patient was a 38-year-old woman with a 10-day history of left-sided abdominal pain. Imaging demonstrated a wandering spleen with partial infarction of the inferior pole. An open partial splenectomy with splenopexy of the remaining spleen was performed with the use of an absorbable mesh sutured to the abdominal wall and stomach. Her recovery was uneventful and on follow-up she had no signs of recurrence or complications. CONCLUSION Wandering spleen should be considered in cases of acute abdominal pain, and surgery is the treatment of choice, with the goal of preservation of the organ whenever possible.
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Fonseca AZ, Ribeiro MAF, Contrucci O, Pompeo A, Orsetti A, Neto HA. Spleen preserving distal pancreatectomy in an isolated blunt pancreatic trauma. World J Gastrointest Surg 2011; 3:138-41. [PMID: 22007283 PMCID: PMC3192224 DOI: 10.4240/wjgs.v3.i9.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 07/26/2011] [Accepted: 08/05/2011] [Indexed: 02/06/2023] Open
Abstract
Blunt isolated pancreatic trauma is uncommon, accounting for 1%-4% of high impact abdominal injuries. In addition, its diagnosis can be difficult; physical signs may be poor and laboratory findings nonspecific, resulting in delayed treatment. Preserving the spleen during distal pancreatectomy (DP) is controversial. One of the spleen’s functions regards immunity; complications following splenectomy include leukocytosis, thrombocytosis, overwhelming post splenectomy sepsis and some degree of immunodeficiency. This is why many authors favor its preservation. We describe a case of a young man with an isolated pancreatic trauma due to a blunt abdominal trauma with a delayed presentation who was treated with spleen-preserving DP and we discuss the value of this procedure with reference to the literature.
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Affiliation(s)
- Alexandre Zanchenko Fonseca
- Alexandre Zanchenko Fonseca, Marcelo Augusto Fontenelle Ribeiro Jr, Orlando Contrucci, Alexandre Pompeo, Adriana Orsetti, Herico Arsie Neto, Department of General Surgery, University of Santo Amaro, São Paulo-SP, CEP 04601-060, Brazil
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Fonseca AZ, Ribeiro MAF, Frazão M, Costas MC, Spinelli L, Contrucci O. Esophagectomy for a traumatic esophageal perforation with delayed diagnosis. World J Gastrointest Surg 2009; 1:65-7. [PMID: 21160799 PMCID: PMC2999122 DOI: 10.4240/wjgs.v1.i1.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 07/16/2009] [Accepted: 07/23/2009] [Indexed: 02/07/2023] Open
Abstract
Esophageal perforations are rare, and traumatic perforations are even more infrequent. Due to the rarity of this condition and its nonspecific presentation, the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients, which leads to a high mortality rate. An 18-year-old male patient was brought to the emergency room with a penetrating neck injury, caused by a gunshot wound. He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo- and pneumothorax. During the procedure, a 2 cm lesion was detected in the esophagus, and the patient underwent a primary repair. A contrast leakage into his right hemithorax was noticed on the 4th postoperative day; he was submitted to new surgery, and a subtotal esophagectomy and jejunostomy were performed. He was discharged from the hospital in good condition 20 d after the last procedure. The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment. In early diagnosed patients, more conservative therapeutics should be performed, such as primary repair, while in those with delayed diagnosis, the patient should be submitted to more aggressive and definitive treatment.
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Affiliation(s)
- Alexandre Zanchenko Fonseca
- Alexandre Zanchenko Fonseca, Marcelo Augusto Fontenelle Ribeiro Jr, Mariana Frazão, Maurício Campanelli Costas, Lanes Spinelli, Orlando Contrucci, Department of General Surgery, University of Santo Amaro, São Paulo-SP, CEP 04601-060, Brazil
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Ribeiro MAF, Fonseca AZ, Chaib E, D'Ippolito G, Carnevale FC, Rodrigues JJG, Saad WA. An unusual approach to the spontaneous rupture of hepatocellular carcinoma. Hepatogastroenterology 2007; 54:1235-8. [PMID: 17629077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Our aim is to describe an unusual approach to the spontaneous rupture of a large hepatocellular carcinoma (HCC). A 45-year-old man, Hepatitis C virus (+) (HCV+), complaining of abdominal pain. During the investigation, a tumor affecting liver segments V, VI, VII and VIII, with the presence of fluid within the peritoneal cavity, suggesting hemoperitoneum, was found. The patient was submitted to an exploratory laparotomy, revealing a large hepatic tumor mass with capsule rupture in segment V, biopsy verified the diagnosis of HCC. After one week, a superselective chemoembolization of the nutrient artery of the tumor was performed; one month later, the patient was submitted to an embolization of the right portal branch, aimed at causing hypertrophy of the left lateral portion of the liver. A right hepatectomy was performed, as well as a nodulectomy in segment II, without complications along the 40 days subsequent to the portal embolization. The patient is currently on his 53rd postoperative month and evidences no tumor recurrence to the moment. Although the spontaneous rupture of HCC is uncommon, it can be today treated by combining interventionist radiology procedures and conventional liver resections, offering the patient a better chance of survival.
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Ribeiro MAF, Rodrigues JJG, Habr-Gama A, Chaib E, D'Ipolitto G, Fonseca AZ, Saad WA, Saad WA. Radiofrequency ablation of primary and metastatic liver tumors--4 years experience. Hepatogastroenterology 2007; 54:1170-5. [PMID: 17629064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND/AIMS Radiofrequency ablation of primary and metastatic liver tumors has been shown to be one of the promising new modalities to treat or to palliate liver tumors. It has been used as a bridge to liver transplantation as well as an approach to recurrent tumors after resection. METHODOLOGY We present a series of 78 cases, 39 females and 39 males with a mean age of 61 years, the RFA has been used either by laparotomy or percutaneously to treat 117 lesions. There were 32 cases of hepatocellular carcinoma, 35 metastases of colorectal cancer and 11 cases of other tumors. RESULTS The mean number of lesions treated were 1.5 per case with a average size of 3.6 cm per lesion. All liver segments were compromised specially IV, VII, VIII. The morbidity was 28% and the mortality was 2.5%. In 20.5% of the cases we were able to find recurrence after the procedure, with a mean time of 10.5 months. CONCLUSIONS The RFA procedure is safe, can be performed by different ways and in the group of patients who are candidates to liver transplantation, while waiting for the organ. For the metastatic diseases it does not substitute surgery but can be used in patients who cannot be operated.
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Affiliation(s)
- Marcelo A F Ribeiro
- Liver Surgery and Portal Hypertension Service, Hospital das Clinicas, Brazil.
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