INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients) and laparoscopy (26 patients). Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05). An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%). Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience.

A concomitant epithelial and stromal tumor in stomach is unusual in the literature. The purpose of this paper is to report the case and it's therapeutic management. A 72 year old black male patient , which upper digestive endoscopy showed a gastric neoplasm (Borrmann III) at incisura angularis and the biopsy revealed adenocarcinoma. A subtotal gastrectomy with D2 limphadenectomy and Roux-en-Y reconstruction was performed. The histopathology studies confirmed an adenocarcinoma and a gastric stromal tumor, whose immunohistochemical exam was compatible to GIST. Seventeen months after surgery, a computadorized tomography revealed a retrogastric tumor and laparotomy was indicated to remove the lesion.

RACIONAL: Divertículo faringoesofágico, conhecido como de Zenker, é herniação adquirida na mucosa faríngea através de um defeito muscular entre as fibras oblíquas do músculo constritor inferior da faringe e as transversas do músculo cricofaríngeo. OBJETIVO: estudo retrospectivo, não randomizado, compararando os resultados da diverticulopexia e diverticulectomia, ambas associadas à miotomia do músculo cricofaríngeo, no tratamento do divertículo de Zenker. MÉTODOS: Quarenta pacientes foram submetidos a tratamento cirúrgico entre 1989 e 2003, dos quais 38 (95%) foram seguidos. Vinte e oito eram do sexo masculino (70%) e 12 femininos, com média de idade de 62,5 anos (21 a 85 anos). Vinte e quatro pacientes (60%) foram submetidos à diverticulopexia ou elevação, e 16 à diverticulectomia ou ressecção, através de cervicotomia esquerda, com miotomia do músculo cricofaríngeo. RESULTADOS: Resultados excelentes (Visick I), foram verificados em 84,6% dos pacientes submetidos à diverticulectomia e 66,6% dos pacientes submetidos à diverticulopexia. Na análise global de todos os casos estudados, 27 (11 ressecções e 16 elevações - 72,9%) apresentaram Visick I; 8 (2 ressecções e 6 elevações - 21,6%) apresentaram Visick II; e 2 (elevações - 5,4%) apresentaram Visick III. Não foi registrado nenhum caso na classificação de Visick IV. A incidência de complicações pós-operatórias registrada nos dois grupos foi semelhante (P>0,05). Foi verificado a presença de neoplasia maligna em um caso submetido a ressecção (2,5%). CONCLUSÃO: A diverticulopexia com miotomia do músculo cricofaríngeo é mais indicada em doentes geriátricos, pequenos divertículos e doentes com risco operatório elevado. A diverticulectomia é boa opção em grandes divertículos e doentes jovens, para prevenir o risco de transformação maligna. Esta casuística mostrou melhores resultados com a diverticulectomia em comparação com a diverticulopexia.

BACKGROUND: Pharyngoesophageal diverticulum, known as Zenker, is an acquired herniation in the pharyngeal mucous through a muscular defect between the oblique fibers of the constrictor muscle of the pharynx and the transverse fibers of the cricopharyngeal muscle. AIM: A non-randomized retrospective study was performed, comparing the results of the diverticulopexy and diverticulectomy, both associated to the cricopharyngeal myotomy, in the Zenker diverticulum treatment. METHODS: Forty patients were submitted to surgical treatment between 1989 and 2003, of which 38 (95%) were followed. Twenty-eight patients were males (70%), with an average age of 62,5 years (21 to 85 years). Twenty-four patients (60%) were submitted to diverticulopexy or elevation, and sixteen to the diverticulectomy or resection, through left cervicotomy, followed by cricopharyngeal myotomy. RESULTS: Excellent results (Visick I) were found in 84,6% of the patients submitted to the diverticulectomy and 66,6% of the patients submitted to the diverticulopexy. General analysis showed that 27 cases (11 resections and 16 elevations - 72,9%) presented Visick I; 8 cases (2 resections and 6 elevations - 21,6%) presented Visick II; and 2 cases (elevations - 5,4%) presented Visick III. No cases were registered under Visick IV classification. The incidence of postoperative complications recorded in the two groups was similar (P > 0,05). The presence of malignant neoplasia was verified in a case submitted to resection (2,5%). CONCLUSION: The cricopharyngeal myotomy and diverticulopexy is suitable in geriatric patients, small diverticulum, and patients with operatory risk. Diverticulectomy is a good option in cases of larger diverticulum and young patients to prevent the risk of malignant transformation. This casuistic presented better results with diverticulectomy than diverticulopexy.

OBJETIVOS: Determinar, através de um estudo randomizado e duplo-cego, o efeito de injeções intralesionais de triancinolona associadas à dilatação esofágica nos casos de estenose corrosiva. MÉTODOS: Quatorze pacientes adultos (seis homens e oito mulheres) portadores de graves estenoses corrosivas do esôfago foram randomizados em dois grupos: Grupo A: tratados com dilatação esofágica e posterior injeção intralesional de triancinolona 10 mg/ml; Grupo B: tratados com dilatação esofágica e posterior injeção de solução fisiológica 0,9% (placebo). Aplicações subseqüentes foram feitas baseadas na sintomatologia do paciente. Foram analisados: a freqüência de dilatações, diâmetros obtidos e disfagia antes e após a pesquisa, durante 12 meses. RESULTADOS: Em nosso estudo, onze pacientes ingeriram soda cáustica, dois ingeriram amoníaco e um tomou ácido muriático. Não houve diferença estatisticamente significativa (p > 0,05) em relação à freqüência de dilatações e à disfagia entre os grupos estudados. Entretanto, foi observada melhora no diâmetro obtido no grupo que recebeu corticoesteróides, em relação ao grupo controle (p < 0,05). Comparando-se antes e depois do uso de corticoesteróides, o resultado foi muito favorável (p < 0,01) no grupo A. CONCLUSÕES: O uso de múltiplas injeções intralesionais de hexacetonido de triancinolona 10 mg/ml associado à dilatações esofágicas é eficaz no aumento do diâmetro obtido nas sessões subseqüentes.

OBJECTIVE: To determine triancinolone intralesional injections effects in association with esophageal dilations in corrosive stenosis cases, by means of a double-blind and randomized study. METHOD: Fourteen adults patients (6 men and 8 women) with severe esophageal corrosive stenosis were randomized in two groups: Group A: treated by esophageal dilations and posterior triancinolone 10 mg/ml intralesional injection; Group B: treated by esophageal injections and posterior saline solution 0,9% injection (placebo). New applications were made based on the patient symptomatology. It had been analysed dilation frequency, obtained diameters and dysphagia before and after the research, for 12 months. RESULTS: Eleven patients had ingested sodium hydroxide, two had ingested ammoniac and one had taken muriatic acid. There was no statistic difference (p > 0.05) in dilation frequency and dysphagia between the groups. However, an improvement in obtained diameter was observed in the corticosteroids group in comparison with control group (p < 0.05). By comparing groups before and after steroids, the final results were very favorable in group A CONCLUSION: Multiple intralesional injections of triancinolone hexacetonide 10 mg/ml in association with esophageal dilations increase obtained diameters in succeeding sessions.