Publications (17)0.99 Total impact
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Article: [Primary esophageal motor disturbances among patients with esophageal symptoms].
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ABSTRACT: The esophagus can suffer several motor disturbances of striated or smooth muscle. To determine the presence of primary motor disturbances of the esophagus among a group of patients with esophageal symptoms. Prospective study of 5,440 patients consulting for heartburn, chest pain or dysphagia, with primary esophageal motor disturbances, studied between 1994 and 2004. AH were subjected to an esophageal manometry with eight perfused catheters connected to pressure transducers. Nineteen percent of subjects had a normal esophageal manometry, 60% had unspecific motor disturbances usually associated to gastroesophageal reflux, 13% had a nutcracker esophagus, 5% had diffuse esophageal spasm, 2% had achalasia and 0,3% had an hypertensive sphincter. Primary esophageal motor disturbances are common among patients with esophageal symptoms. A manometry should be performed to these patients.Revista medica de Chile 11/2007; 135(10):1270-5. · 0.33 Impact Factor -
Article: [Perioperative risk among morbid obese patients subjected to gastric bypass].
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ABSTRACT: Bariatric surgery is a complex procedure not exempt of complications. To assess mortality and complications of excisional gastric bypass among morbidly obese subjects. Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered. Mean body mass index (BMI) of the subjects was 43.7 kg/m2. One hundred sixty two patients had a BMI between 35 and 39.9 kg/m2, 419 had a BMI between 40 and 49.9 kg/m2 and 103 had a BMI over 50 kg/m2. Two patients with a BMI of 52 and 56 kg/m2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year. Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients.Revista medica de Chile 08/2006; 134(7):849-54. · 0.33 Impact Factor -
Article: [Evolution of resectability and mortality rates of total and subtotal gastrectomy for gastric cancer].
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ABSTRACT: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change.Revista medica de Chile 05/2006; 134(4):426-32. · 0.33 Impact Factor -
Article: Sleeve gastrectomy
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ABSTRACT: Letter -
Article: Displasia de alto grado en el esófago de Barrett. Parte II: Alternativas de tratamiento
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Article: Gastrointestinal stromal tumors. Review of 15 patients
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ABSTRACT: Publicación ISI Email : ibraghet@redclinicauchile.cl Background Gastrointestinal stromal tumors (GIST) are the most common mesenchymatous tumors of the digestive tract. The pathological diagnosis is based on microscopy and immunohistochemistry. Aim To review the experience of our surgical unit in patients with GIST. Material and methods: Review of medical records of 15 patients (aged 66 +/- 13 years, 11 women), with a pathological diagnosis of GIST, treated between 1999 and 2005. Results: The main presenting symptoms were melena in 40% hematemesis in 20%, abdominal pain in 60% and anemia in 13%. In only one patient, the tumor appeared as an incidentaloma. All patients underwent upper gastrointestinal endoscopy. A CAT scan was done in 87%, a barium swallow in 60% and a digestive endosonography in 20%. Thirteen tumors were located in the stomach and two in the small bowel. Mean, tumor diameter was 5.3 +/- 1.7 cm. Surgical management was a tumor resection in 40% a partial gastrectomy in 27%, a total gastrectomy in 20% and an intestinal excision in the rest. Mean hospital stay was 6.9 +/- 4.2 days. No postoperative complications were recorded. Conclusions: The main clinical presentation of GIST in this retrospective series was an upper gastrointestinal bleeding. Surgical treatment was devoid of complications (Rev Med Chile 2007, 135 551-7). -
Article: Resecabilidad y mortalidad operatoria de la gastrectomía subtotal y total en pacientes con cáncer gástrico avanzado, entre 1969 y 2004
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ABSTRACT: Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Material and methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change. -
Article: Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival
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ABSTRACT: Background: Surgical treatment of esophageal cancer is associated with a high rate of morbidity and mortality even in specialized centers. Minimally invasive surgery has been proposed to decrease these complications. Methods: The authors present their results regarding postoperative complications and the survival rate at 3 years, comparing the classic open procedures (transthoracic or transhiatal esophagectomy) with minimally invasive surgery. Surgical procedures were performed according to procedures published elsewhere. Results: The study enrolled 166 patients who underwent surgery between 1990 and 2003. Open transthoracic surgery was performed for 60 patients. In this group of patients, postoperative mortality was observed in 11% of the cases. Major, minor, and late complications were observed in 61.6% of the patients, and the 3-year survival rate was 30% for this group. Open transhiatal surgery was performed for 59 patients. The morbidity, mortality, and 3-year rate were almost the same as for the transthoracic surgery group. For the 47 patients submitted to minimally invasive procedures (thoracoscopic and laparoscopic), the complications and mortality rates were significantly reduced (38.2% and 6.4%, respectively). For the patients submitted to minimally invasive surgery, the 3-year survival rate was 45.4%. It is important to clarify that the patients submitted to minimally invasive surgery manifested early stages of the diseases, and that this the reason why the morbimortality and survival rates were better. Conclusions: The transthoracic and transhiatal open approaches have similar early and late results. Minimally invasive surgery is an option for patients with esophageal carcinoma, with reported results similar to those for open surgery. This approach is indicated mainly for selected patients with early stages of the disease. -
Article: Riesgo perioperatorio del bypass gástrico reseccional en pacientes con obesidad mórbida. Estudio prospectivo de 684 pacientes
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ABSTRACT: Background: Bariatric surgery is a complex procedure not exempt of complications. Aim: To assess mortality and complications of excisional gastric bypass among morbidly obese subjects. Material and methods: Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered. Results: Mean body mass index (BMI) of the subjects was 43.7 kg/m2. One hundred sixty two patients had a BMI between 35 and 39.9 kg/m2, 419 had a BMI between 40 and 49.9 kg/m2 and 103 had a BMI over 50 kg/m2. Two patients with a BMI of 52 and 56 kg/m2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year. Conclusions: Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients. -
Article: Regression of intestinal metaplasia to cardiac or fundic mucosa in patients with Barrett's esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion. A prospective study of 78 patients with more than 5 years of follow up
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ABSTRACT: Background. Regression of intestinal metaplasia to cardiac mucosa in patients with Barrett's (BE) esophagus could alter the natural history of BE. Objective. To determine the regression of intestinal metaplasia to cardiac mucosa in patients followed more than 5 years after operation, by repeated endoscopy with biopsy. Material and Methods. This prospective study included 78 patients with BE submitted to combined vagotomy, antrectomy (an antireflux procedure), and Roux-en-Y gastrointestinal reconstruction with more than 60 months follow up. Patients were divided in 3 groups: (1) 31 with short-segment BE (<= 30 mm length); (2) 42 with long-segment BE (31 to 99 mm length); and (3) 5 with extralong-segment BE (>= 100 mm). Each patient had at least three endoscopic procedures with multiple biopsies during a mean follow up of 95 months (range, 60-220 months). Acid and duodenal reflux were also evaluated. Results. Sixty-four percent of patients with short segment BE had regression to cardiac mucosa at a mean of 40 months after operation. Sixty-two percent of patients with long segment BE had regression to cardiac mucosa at a mean of 4 7 months postoperatively. No regression occurred in the 5 patients with extra-long segment BE. In 20 % of patients, regression to fundic mucosa occurred between 78 to 94 months after surgery. One patient progressed to low grade dysplasia, but no patient progressed to high-grade dysplasia or adenocarcinoma. Acid and duodenal reflux studies demonstrated that in asymplomatic patients, reflux was abolished; 90 % of the patients had a Visick grade of 1 or 2. Conclusions. Vagotomy and antrectomy combined with duodenal bile diversion abolish acid and duodenal reflux into the distal esophagus in patients with BE, which is accompanied by a regression of BE from intestinal to cardiac or fundic mucosa in about 60 % of patients. This regression is time dependent and varies directly with the length of BE. The potential for an antineoplastic effect, especially in young patients with long segment BE, suggests that this operation may become an attractive option as a definitive surgical treatment. Patients with short segment BE submitted to this procedure behave similar to patients submitted to Nissen fundoplication, and therefore in these patients, we do not advocate this complex operation. -
Article: Very late results of esophagomyotomy for patients with achalasia - Clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months
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ABSTRACT: Introduction: Laparoscopic esophagomyotomy is the preferred approach to patients with achalasia of the esophagus, However, there are very few long-term follow-up studies (> 10 years) in these patients. Objective: To perform a very late subjective and objective follow-up in a group of 67 patients submitted to esophagomyotomy plus a partial antireflux surgery (Dor's technique). Material and Methods: In a prospective study that lasted 30 years, 67 patients submitted to surgery were divided into 3 groups: group I followed for 80 to 119 months (15 patients); group 11, with follow-up of 120 to 239 months (35 patients); and group 111, with follow-up more than 240 months (17 patients). They were submitted to clinical questionnaire, endoscopic evaluation, histologic analysis, radiologic studies, manometric determinations, and 24-hour pH studies late after surgery. Results: Three patients developed a squamous cell esophageal carcinoma 5, 7, and 15 years after surgery. At the late follow-up, Visick III and IV were seen in 7%, 23%, and 35%, according to the length of follow-up of each group. Endoscopic examination revealed a progressive nonsignificant deterioration of esophageal mucosa, histologic analysis distal to squamous-columnar junction showed a significant decrease of fundic mucosa in patients of group 111, with increase of intestinal metaplasia, although not significant time. Lower esophageal sphincter showed a significant decrease of resting pressure I year after surgery, which remained similar at the late control. There was no return to peristaltic activity. Acid reflux measured by 24-hour pH studies revealed a progressive increase, and the follow-up was longer. Nine patients developed Barrett esophagus: 6 of them a short-segment and 3 a long-segment Barrett esophagus. Final clinical results in all 67 patients demonstrated excellent or good results in 73% of the cases, development of epidermoid carcinoma in 4.5%, and failures in 22.4% of the patients, mainly due to reflux esophagitis. Incomplete myotomy was seen in only I case. Conclusion: In patients with achalasia submitted to esophagomyotomy and Dor's antireflux procedure, there is a progressive clinical deterioration of initially good results if a very long follow-up is performed (23 years after surgery), mainly due to an increase in pathologic, acid reflux disease and the development of short- or long-segment Barrett esophagus. -
Article: Laparoscopic splenectomy in hematological diseases
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ABSTRACT: Idiopathic thrombocytopenic purpura (ITP) is the most common indication for elective splenectomy. The laparoscopic approach has been used over the past ten years. Aim: To report our experience with laparoscopic splenectomy. Patients and methods: Retrospective review of 27 patients subjected to splenectomy due to hematological diseases. Among them, 17 patients (78% female, age range 17-70 years old) were subjected to a laparoscopic splenectomy. Eligibility criteria were the presence of benign disease, an informed consent by the patient, a spleen size of less than 20 cm by ultrasound and absence of previous surgery in the upper left quadrant. The rest of the patients were subjected to an open splenectomy. Results: Seventy one percent of patients subjected to laparoscopic splenectomy had an ITP. Mean operating time was 184 minutes. The mean spleen size was 11 cm and the mean weight was 186 g (70-450). No patient died or had complications. No patient required a conversion to an open surgery. Transfusions were not required. The median hospital stay was 3 days. Conclusions: Elective laparoscopic splenectomy is a safe and low risk surgical procedure -
Article: Scintigraphic Evaluation of Gastric Emptying in Obese Patients Submitted to Sleeve Gastrectomy Compared to Normal Subjects
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ABSTRACT: Sleeve gastrectomy (SG) has been accepted as an option for surgical treatment for obesity. This operation could be associated with motor gastric dysfunction and abnormal gastric emptying. The purpose of this prospective study is to present the results of gastric emptying to liquids and solids using scintigraphy in patients who underwent SG compared to normal subjects. Twenty obese patients were submitted to laparoscopic SG and were compared to 18 normal subjects. Gastric emptying of liquids and solids was measured by scintigraphic technique. Results were expressed as half time of gastric emptying and the percentage of retention at 20, 30, and 60 min for liquids and at 60, 90, and 120 min for solids. In the group of operated patients, 70% of them (n = 14) presented accelerated emptying for liquids and 75% (n = 15) for solids compared to 22.2% and 27.7%, respectively, in the control group. The half time of gastric emptying (T (1/2)) in patients submitted to SG both for liquids and solids were significantly more accelerated compared to the control group (34.9 +/- 24.6 vs 13.6 +/- 11.9 min for liquids and 78 +/- 15.01 vs 38.3 +/- 18.77 min for solids; p < 0.01). The gastric emptying for liquids expressed as the percentage of retention at 20, 30, and 60 min was 30.0 +/- 0.25%, 15.4 +/- 0.18%, and 5.7 +/- 0.10%, respectively, in operated patients, significantly less than the control subjects (p < 0.001). For solids, the percentage of retention at 60, 90, and 120 min was 56 +/- 28%, 34 +/- 22%, and 12 +/- 8%, respectively, for controls, while it was 25.3 +/- 0.20%, 9 +/- 0.12%, and 3 +/- 0.05%, respectively, in operated patients (p < 001). Gastric emptying after SG is accelerated either for liquids as well as for solids in the majority of patients. These results could be taken in consideration for the dietary indications after surgery and could play a significant role in the definitive results during the late follow-up. -
Article: Barrett's esophagus can develop after antireflux surgery
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ABSTRACT: BACKGROUND: Surgical treatment in patients with gastroesophageal reflux disease (GERD) without Barrett's esophagus (BE) is an excellent alternative therapy to medical treatment, preventing the development of complications and the appearance of BE. PURPOSE: To determine the newly developed BE in a group of patients without BE prior to surgery, the patients were submitted to a late subjective and objective follow-up. METHODS: From 115 non-BE patients submitted to surgery and followed up for a long period, 12 (10.4%) developed intestinal metaplasia after operation. They were submitted to endoscopic, histologic, manometric and functional studies (24-h pH and Bilitec). RESULTS: The 12 patients had an average of 5 endoscopies after surgery with several biopsy samples. Symptoms of recurrent reflux were present in only 10 patients (83%) at a mean of 80 months after surgery. The mean follow-up was 135 months. Four patients showed the absence of pathologic reflux measured by 24-h pH and Bilitec monitoring, while 8 had the presence of abnormal acid reflux. There were no significant differences between endoscopic, histologic and functional studies comparing patients with the presence or absence of pathologic reflux. The time of appearance to intestinal metaplasia from cardiac or oxynto-Cardiac mucosa was 58-90 months. Four patients showed regression of intestinal metaplasia to cardiac mucosa after intensive medical treatment. CONCLUSIONS: Antireflux surgery in patients without BE does not prevent the late appearance of BE in near 10% of the cases, provided that a long-term follow-up is performed and several endoscopic and histologic evaluations are repeated. Near 2/3 of these patients showed the presence of acid reflux, while 1/3 showed no abnormal reflux. With this method of follow-up, metaplastic changes from cardiac to intestinal metaplasia and from intestinal metaplasia to low-grade dysplasia can be documented, as well as regression from intestinal metaplasia to cardiac mucosa. -
Article: Acalasia en obesos mórbidos. Reporte de casos
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ABSTRACT: Achalasia is uncommon in morbidly obese patients. We report two patients with both conditions. A 71 years old diabetic male with a body mass index (BMI) of 36 kg/m2. He consulted for dysphagia and a manometry showed a lack of relaxation of the lower esophageal sphincter. He was subjected to unsuccessful pneumatic dilatations in two occasions. Finally the patient was subjected to a total gastrectomy and Roux en Y esophago-jejunal anastomosis. Eight months after surgery the patient reports slight dysphagia and lost 24 kg. A 66 years old male with a BMI of 44 kg/m2 consulting for regurgitation. Manometry confirmed the diagnosis of achalasia. The patient was subjected to a esophagomyotomy, subtotal gastrectomy and Roux en Y gastro jejunal and jejuno-jejunal anastomosis. Two years after surgery the patient had a slight dysphagia and lost 20 kg. -
Article: Postoperative Results After Laparoscopic Approach for Treatment of Large Hiatal Hernias: Is Mesh Always Needed? Is the Addition of an Antireflux Procedure Necessary?
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ABSTRACT: Laparoscopic approach has been suggested as the definitive treatment for large hiatal hernias. Reinforcement of the hiatoplasty and the need to perform antireflux surgery is still undergoing discussion. The purpose of this study was to evaluate the postoperative results, with special emphasis on the recurrence rate and reflux after surgery comparing the use or not of mesh reinforcement. This prospective study included 81 patients with a complete evaluation through a clinical questionnaire, barium sulfate radiologic evaluation, endoscopy, manometry, and 24-hour intraesophageal pH monitoring before and after a hiatoplasty with an antireflux procedure. Mesh reinforcement was used in 23 patients. Postoperative complications occurred in 11 patients (13.6%), without mortality. Recurrent hernia was observed in 10 patients without mesh reinforcement (12.3%), whereas those with mesh reinforcement showed no hiatal hernia recurrence (P = 0.33). Normal resting lower esophageal sphincter pressure was obtained after fundoplication in 87.2% of patients, and abnormal acid reflux was observed in 12.8% of patients after surgery. In conclusion, mesh reinforcement in patients with large Type IV could prevent recurrent hiatal hernias, and an antireflux procedure must be performed in order to avoid postoperative acid reflux. -
Article: Prevalencia de los diferentes trastornos motores primarios del esófago. Estudio prospectivo de 5.440 casos
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ABSTRACT: Background: The esophagus can suffer several motor disturbances of striated or smooth muscle. Aim: To determine the presence of primary motor disturbances of the esophagus among a group of patients with esophageal symptoms. Material and methods: Prospective study of 5,440 patients consulting for heartburn, chest pain or dysphagia, with primary esophageal motor disturbances, studied between 1994 and 2004. All were subjected to an esophageal manometry with eight perfused catheters connected to pressure transducers. Results: Nineteen percent of subjects had a normal esophageal manometry, 60% had unspecific motor disturbances usually associated to gastroesophageal reflux, 13% had a nutcracker esophagus, 5% had diffuse esophageal spasm, 2% had achalasia and 0,3% had an hypertensive sphincter. Conclusions: Primary esophageal motor disturbances are common among patients with esophageal symptoms. A manometry should be performed to these patients.
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2007
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University of Santiago, Chile
Santiago, Region Metropolitana de Santiago, Chile
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