Avaliação da terapêutica cirúrgica do divertículo faringoesofágico pela sutura mecânica

Aquino, José Luiz Braga de; Said, Marcelo Manzano; Chagas, José Francisco Salles; Leandro‐Merhi, Vânia Aparecida; Gallo-Junior, Eusébio José; Cecchino, Gustavo Nardini; Assunção, Mayra Todeschini

doi:10.1590/s0102-67202012000200006

Cited by 2 publications

(3 citation statements)

References 18 publications

(41 reference statements)

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“…The treatment of this disease is fundamentally surgical, being based on its ethiopathogenesis in such way that most authors have been practicing diverticulectomy followed by myotomy of the cricopharyngeal muscle 1 , 6 , 9 , 11 , 26 . Other authors have been practicing diverticulopexy, associated with cricopharyngeal myotomy, demonstrating similar results when compared with diverticulectomy and myotomy 14 , 15 , 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Little national emphasis has been given on the use of mechanical suture in the closing of the pharynx after diverticulum resection, except for a recent study done by Aquino et al. 6 , which demonstrated good results with this kind of procedure. However, there was no comparison of this type of suture with the manual type to evaluate whether the mechanical technique would be more advantageous.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Mechanical and Manual Suture in the Surgical Treatment of the Pharyngoesophageal Diverticulum

Aquino

Chagas

Said

et al. 2015

ABCD, arq. bras. cir. dig.

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Background: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique. Aim: To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications. Method: Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B). Results: In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual one, because it provided a lower index of local post-surgical complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Mechanical and Manual Suture in the Surgical Treatment of the Pharyngoesophageal Diverticulum

Aquino

Chagas

Said

et al. 2015

ABCD, arq. bras. cir. dig.

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“…Hence, the anastomotic dehiscences in this organ appear with a higher incidence, prolonging the permanence of patients in hospitals as well as increasing hospital costs, causing greater suffering for the patients and showing a relationship with stenosis, which is another obstacle that follows the esophageal surgery 5 , 18 . On the other hand, the mechanical suture demonstrating more safety, precision and fastness, predisposes to a lower incidence of anastomotic fistula, as it has been demonstrated in the literature, both in benign and malignant diseases, being able to improve the quality of life 2 , 4 , 5 , 9 , 20 , 21 , 30 . This preference can be justified by less ischemia, less extensive tissue necrosis and a more pronounced neoangiogenesis, as has been demonstrated in experimental studies 4 , 15 , 18 , 32 .…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Late Results of Cervical Esophagogastric Anastomosis by Manual and Mechanical Suture in Patients Submitted to Esophageal Mucosectomy Through Advanced Megaesophagus

Aquino

Leandro‐Merhi

Mendonça

et al. 2019

ABCD, arq. bras. cir. dig.

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Background:Among the anastomoses of the gastrointestinal tract, those of the esophagus are of special interest due to several anatomical or even general peculiarities. Aim:Evaluate retrospectively the results comparing mechanical vs. manual suture at cervical esophagogastric anastomosis in megaesophagus treatment. Methods:Were included 92 patients diagnosed with advanced megaesophagus with clinical conditions to undergo the surgery. All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. In order to make this anastomosis, the patients were divided into two groups: group A (n=53) with circular mechanical suture, lateral end; group B (n=39) with manual suture in two sides, lateral end. In the postoperative period, an early evaluation was performed, analyzing local and systemic complications and late (average 5.6 y) analyzing deglutition. Results:Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%) in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6 (15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the patients presented the criteria 4 and 5 from SAEED, expressing effective swallowing mechanisms without showing significant differences among the groups. Conclusion:Cervical esophagogastric anastomosis by means of mechanical suture is more proper than the manual with lower incidence of local complications and, in the long-term evaluation, regular deglutition was acquired in both suture techniques in equal quality.

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Avaliação da terapêutica cirúrgica do divertículo faringoesofágico pela sutura mecânica

Abstract: The diverticulectomy with myotomy and posterior pharyngeal closure with linear surgical stapler proved to be an effective technique, offering a lower risk of post-operative complications and improving the overall quality of life.

Cited by 2 publications

References 18 publications

Assessment of Mechanical and Manual Suture in the Surgical Treatment of the Pharyngoesophageal Diverticulum

Assessment of Mechanical and Manual Suture in the Surgical Treatment of the Pharyngoesophageal Diverticulum

Comparative Analysis of Late Results of Cervical Esophagogastric Anastomosis by Manual and Mechanical Suture in Patients Submitted to Esophageal Mucosectomy Through Advanced Megaesophagus

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