Esofagocardiomioplastia transversal extramucosa mais esofagogastrofundoplicatura parcial no tratamento do megaesôfago

França, Thomaz de Aquino; Guedes Filho, Natanael; Berindoague Neto, René; Silva, Alcino Lázaro da

doi:10.1590/S0100-69911999000400005

Resumos

Foram estudados, num período de vinte anos, 215 doentes com megaesôfago, predominando o chagásico, tratados com esofagocardiomioplastia transversal extramucosa mais esofagogastrofundoplicatura parcial, que denominamos técnica de "Girard-Toupet-Lind". Ela foi usada nos pacientes portadores de megaesôfago de graus 2, 3 e 4. Os doentes operados foram 55,6% masculinos e 44,4% femininos. A faixa etria predominante foi entre a idade de 30 e 40 anos. Os autores descrevem pormenorizadamente a sistematização da técnica operatória, salientando sua fcil execução por via abdominal, criando uma ampla passagem na região esofagogástrica através de uma esofagocardiomioplastia transversal extramucosa e a confecção de uma válvula parcial anti-refluxo. Complicações pós-operatórias mediatas e imediatas ocorreram em sete doentes (3,2%), e salientam a baixa morbidez e mortalidade transoperatória nula. Os doentes foram avaliados através de exame clínico, estudos radiográficos, endoscópicos e histopatológicos. Com os resultados clínicos, radiográficos, endoscópicos e histopatológicos, neste estudo, pareceu-nos que a operação realizada trouxe benefícios aos doentes e inclusive aos portadores de megaesôfago grau 4.

Acalasia; Megaesôfago; Cardiomioplastia; Válvula anti-refluxo

Two-hundred fifteen patients were followed for a 20 year period, being Chagas disease was the main cause of the disease. All patients were submitted to a transversal extramucosal esophagogastroplasty and parcial esophagogastrofundoplicature, which we call "Girard-Toupet-Lind" procedure. This procedure was used for the 2nd, 3rd and 4th degree megaesophagus. The mean age of the patients ranged from 30 to 40 years, being 55,6% for males and 44,4% for females. The systematization of the surgical technique is described by the authors. Attention is called for the simplicity of the procedure through abdominal approach, as well as the need of large passage in the esophagogastric region through a transverse extramucosal esophago- cardiomioplasty and parcial antireflux valve. The authors report early and late postoperative complications, pointing out the very low morbidity. Long term results of the surgery were carried out through clinic, radiological, endoscopic and histopathologic examinations. The authors realized that this surgical procedure is safe and brought real benefits to the patients with megaesophagus, even to those 4th degree patients.

Achalasia; Megaoesophagus; Cardioplasty; Anti-Reflux valve

ARTIGOS ORIGINAIS

Esofagocardiomioplastia transversal extramucosa mais esofagogastrofundoplicatura parcial no tratamento do megaesôfago

Transversal extramucosal esophagocardiomioplasty plus partial esofagogastrofundoplicature in treatment of megaesophagus

Thomaz de Aquino França^I; Natanael Guedes Filho^II; René Berindoague Neto^II; Alcino Lázaro da Silva, TCBC-MG^III

^IProfessor Assistente Coordenador do Serviço de Cirurgia do Aparelho Digestivo da FCMMG

^IIProfessor Assistente do Serviço de Cirurgia do Aparelho Digestivo da FCMMG

^IIIProfessor Titular do Serviço de Cirurgia do Aparelho Digestivo da FCMMG

^{Endereço para correspondência} Endereço para correspondência: Dr. Thomaz de Aquino França Rua Dr. José Greco, 59 - São Bento 30.360-030 - Belo Horizonte - MG Fone: 297-5158 / 212-5888 / 344-1464

RESUMO

Foram estudados, num período de vinte anos, 215 doentes com megaesôfago, predominando o chagásico, tratados com esofagocardiomioplastia transversal extramucosa mais esofagogastrofundoplicatura parcial, que denominamos técnica de "Girard-Toupet-Lind". Ela foi usada nos pacientes portadores de megaesôfago de graus 2, 3 e 4. Os doentes operados foram 55,6% masculinos e 44,4% femininos. A faixa etria predominante foi entre a idade de 30 e 40 anos. Os autores descrevem pormenorizadamente a sistematização da técnica operatória, salientando sua fcil execução por via abdominal, criando uma ampla passagem na região esofagogástrica através de uma esofagocardiomioplastia transversal extramucosa e a confecção de uma válvula parcial anti-refluxo. Complicações pós-operatórias mediatas e imediatas ocorreram em sete doentes (3,2%), e salientam a baixa morbidez e mortalidade transoperatória nula. Os doentes foram avaliados através de exame clínico, estudos radiográficos, endoscópicos e histopatológicos. Com os resultados clínicos, radiográficos, endoscópicos e histopatológicos, neste estudo, pareceu-nos que a operação realizada trouxe benefícios aos doentes e inclusive aos portadores de megaesôfago grau 4.

Unitermos: Acalasia; Megaesôfago; Cardiomioplastia; Válvula anti-refluxo.

ABSTRACT

Two-hundred fifteen patients were followed for a 20 year period, being Chagas disease was the main cause of the disease. All patients were submitted to a transversal extramucosal esophagogastroplasty and parcial esophagogastrofundoplicature, which we call "Girard-Toupet-Lind" procedure. This procedure was used for the 2nd, 3rd and 4th degree megaesophagus. The mean age of the patients ranged from 30 to 40 years, being 55,6% for males and 44,4% for females. The systematization of the surgical technique is described by the authors. Attention is called for the simplicity of the procedure through abdominal approach, as well as the need of large passage in the esophagogastric region through a transverse extramucosal esophago- cardiomioplasty and parcial antireflux valve. The authors report early and late postoperative complications, pointing out the very low morbidity. Long term results of the surgery were carried out through clinic, radiological, endoscopic and histopathologic examinations. The authors realized that this surgical procedure is safe and brought real benefits to the patients with megaesophagus, even to those 4th degree patients.

Key words: Achalasia; Megaoesophagus; Cardioplasty; Anti-Reflux valve.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

1. Merendino K, Dillard DH. The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction, with special reference to reflux esophagitis and esophageal varices. Ann Surg 1955;142:486-509.

2. Wendel WZ. Zur Chirurgie des Oesophagus. Arch Koin 1910;93:311.

3. Nissen R. Gastropexxy as the lone procedure in the surgical repair for hiatus hérnia. Am J Surg 1956;92:389-92.

4. Toupet A. Technique d'oesophago-gastroplastie avec phrénogastropexie appliqué dans la cure radicale des hernies hiatales et comme complément de l'opertion de Heller dans les cardiosplasmes. Mem Acad Chir 1963;89:394-399.

5. Lind FJ, Burns MC, Mac Dougall TJ. "Physiological" repair for hiatus hernia. Manometric study. Arch Surg 1965;91:233.

6. Girard M. Société Medicale de Genéve. Rev Med Suisse Rom 1915;35: 280-281.

7. Resende JM. Aspectos clínicos e radiológicos da aperistalse do esôfago. Rev Bras Gastroenterol 1960;12:247-262.

8. Heller E - Extrarnukose cardioplastik beim chronischen cardiopasmus mil dilatation des oesophagus. Med Cir 1913;27:141.

9. Lortat-Jacob JL, Maillard JN, Fekete F. A procedure to prevent reflux after esophagogastric resection: experience with 17 patients. Surgery 1961;50:600-611.

10. Dor J, Humpert P, Dor V, et al - L'interet de la technique de Nissen modifiée dans la prevention du reflux apres cardiomyotomie estramuqueuse de Heller. Mem Acad Chir 1962;88:877-884.

11. Thal AP, Hatafuku T, Kurtzman R. A new method for reconstruction to the esophagogastric juntion. Sur Gynecol & Obstet 1965;120: 1.225.

12. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg 1966;52:164.

13. Jekler J, Lhotka J. Modified Heller procedure to prevent postoperative reflux esophagitis in patients with achalasia. Am J Surg 1967;113: 251-254.

14. Pinotti HW, Gama-Rodrigues JJ, Ellenbogen G, et al. Nova técnica no tratamento cirúrgico do megaesôfago. Esofagocardiomiotomia associada com esofagofundogastropexia. Rev Goiana Med 1974; 20: 331-334.

15. Rossetti M. Achalasia of the esophagus. Operative treatment by abdominal myotomy and fundoplication. Zentralbl Chir 1978; 1.943:1.180-1.187.

16. Brandalise NA, Leonardi LS, Mantovani ME, Fagundes II. Tratamento cirúrgico do megaesôfago: estudo comparativo entre duas técnicas de cardioplastia. Rev Col Bras Cir 1979;6:117-120.

17. Barbosa H, Barichello AW, Vianna AL, et al- Megaesôfago chagásico: tratamento pela cardioplastia à Thal. Rev Col Bras Cir 1981;8:16-29.

18. Ferjat I. Megaesôfago: Estudo de técnica operatória e seus resultados. Rev Goiana Med 1981;27:123-179.

19. Malafaia O, Brenner S, Silva IT, et al. Tratamento cirúrgico do megaesôfago pela técnica de Thal. Rev Col Bras Cir 1981;8:111-118.

20. Murray GF, Battaglin IW, Keagy BA, et al. Selective application of fundoplication in achalasia. Ann Thorac Surg 1984;37:185-188.

21. Skinner DB, Belsey RH. Achalasia. In: Management of esophageal disease W V Saunders Co.Edt., Philadelphia, 1988;453.

22. Rosato EF, Acker M, Curcillo 11 PG, et al. Transabdominal esophago- myotomy and partial fundoplication for treatment of achalasia. Surg Gynecol Obstet 1991;173:137-141.

23. Espinoza FT, Lamache LI. Acalasia del esófago: resultado de su tratamiento quirúrgico. Rev Gastroent Mex 1983; 48:23-29.

24. Felix VN. Tratamento do megaesôfago chagásico incipiente. Tese. FMUSP, S. Paulo. 1994.

25. laakkola A, Ovaska I, Isolauri I. Esophagocardiomyotomy for achalasia. Eur J Surg 1991;157:407-410.

26. Csendes A. Results of surgical treatment of achalasia of the esophagus. Hepato-Gastroenterol 1991 ; 38:474-480.

27. Iamieson GG. Gastroesophageal reflux following myotomy for achalasia. Hepato-Gastroenterol 1991;38:506-509.

28. Scotté M, Téniére P, Denis P, et al. Résultats à long terme du traitement chirurgical de l'achalasie de l'oesophage. J Chir (Paris) 1991;128: 281-284.

29. Téniére P, Scotté M, Le Blanc I, et al. Traitment chirurgical du reflux gastro-oesophagien de l'adulte - Techniques chirurgicales. Appareil Digestif 1994;40: I -16.

30. Silveira GM, Lopes ARC, Vinhaes DI, et al. Megaesôfago chagásico: análise de 111 casos operados. Rev Col Bras Cir 1980;7:207-210.

31. Smart HL, Foster PN, Evans DF, et al. Twenty four hour oesophageal acidity in achalasia before and after pneumatic dilatation. Gut 1987; 28:883-887.

32. De Caestecker IS, Blackwell IN, Pryde A, et al. Daytime gastroesophageal reflux is important in esophagitis. Gut 1987; 28:159.

33. Resende JM. Classificação radiológica do megaesôfago. Rev Goiana Med 1982;28: 187-191.

34. Ellis FH. Esophagomyotomy by the thoracic approach for esophageal achalasia. Hepato-Gastroenterol 1991 ; 38 :498-50 1.

Recebido em 5/11/98

Aceito para publicação em 14/6/99

Trabalho realizado no Hospital Universitário São José e no Serviço de Cirurgia Geral do Professor Mahrdas Salvador Nankran na Santa Casa de Belo Horizonte - MG.

1. Merendino K, Dillard DH. The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction, with special reference to reflux esophagitis and esophageal varices. Ann Surg 1955;142:486-509.
2. Wendel WZ. Zur Chirurgie des Oesophagus. Arch Koin 1910;93:311.
3. Nissen R. Gastropexxy as the lone procedure in the surgical repair for hiatus hérnia. Am J Surg 1956;92:389-92.
4. Toupet A. Technique d'oesophago-gastroplastie avec phrénogastropexie appliqué dans la cure radicale des hernies hiatales et comme complément de l'opertion de Heller dans les cardiosplasmes. Mem Acad Chir 1963;89:394-399.
5. Lind FJ, Burns MC, Mac Dougall TJ. "Physiological" repair for hiatus hernia. Manometric study. Arch Surg 1965;91:233.
6. Girard M. Société Medicale de Genéve. Rev Med Suisse Rom 1915;35: 280-281.
7. Resende JM. Aspectos clínicos e radiológicos da aperistalse do esôfago. Rev Bras Gastroenterol 1960;12:247-262.
8. Heller E - Extrarnukose cardioplastik beim chronischen cardiopasmus mil dilatation des oesophagus. Med Cir 1913;27:141.
9. Lortat-Jacob JL, Maillard JN, Fekete F. A procedure to prevent reflux after esophagogastric resection: experience with 17 patients. Surgery 1961;50:600-611.
10. Dor J, Humpert P, Dor V, et al - L'interet de la technique de Nissen modifiée dans la prevention du reflux apres cardiomyotomie estramuqueuse de Heller. Mem Acad Chir 1962;88:877-884.
11. Thal AP, Hatafuku T, Kurtzman R. A new method for reconstruction to the esophagogastric juntion. Sur Gynecol & Obstet 1965;120: 1.225.
12. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg 1966;52:164.
13. Jekler J, Lhotka J. Modified Heller procedure to prevent postoperative reflux esophagitis in patients with achalasia. Am J Surg 1967;113: 251-254.
14. Pinotti HW, Gama-Rodrigues JJ, Ellenbogen G, et al. Nova técnica no tratamento cirúrgico do megaesôfago. Esofagocardiomiotomia associada com esofagofundogastropexia. Rev Goiana Med 1974; 20: 331-334.
15. Rossetti M. Achalasia of the esophagus. Operative treatment by abdominal myotomy and fundoplication. Zentralbl Chir 1978; 1.943:1.180-1.187.
16. Brandalise NA, Leonardi LS, Mantovani ME, Fagundes II. Tratamento cirúrgico do megaesôfago: estudo comparativo entre duas técnicas de cardioplastia. Rev Col Bras Cir 1979;6:117-120.
17. Barbosa H, Barichello AW, Vianna AL, et al- Megaesôfago chagásico: tratamento pela cardioplastia à Thal. Rev Col Bras Cir 1981;8:16-29.
18. Ferjat I. Megaesôfago: Estudo de técnica operatória e seus resultados. Rev Goiana Med 1981;27:123-179.
19. Malafaia O, Brenner S, Silva IT, et al. Tratamento cirúrgico do megaesôfago pela técnica de Thal. Rev Col Bras Cir 1981;8:111-118.
20. Murray GF, Battaglin IW, Keagy BA, et al. Selective application of fundoplication in achalasia. Ann Thorac Surg 1984;37:185-188.
21. Skinner DB, Belsey RH. Achalasia. In: Management of esophageal disease W V Saunders Co.Edt., Philadelphia, 1988;453.
22. Rosato EF, Acker M, Curcillo 11 PG, et al. Transabdominal esophago- myotomy and partial fundoplication for treatment of achalasia. Surg Gynecol Obstet 1991;173:137-141.
23. Espinoza FT, Lamache LI. Acalasia del esófago: resultado de su tratamiento quirúrgico. Rev Gastroent Mex 1983; 48:23-29.
24. Felix VN. Tratamento do megaesôfago chagásico incipiente. Tese. FMUSP, S. Paulo. 1994.
25. laakkola A, Ovaska I, Isolauri I. Esophagocardiomyotomy for achalasia. Eur J Surg 1991;157:407-410.
26. Csendes A. Results of surgical treatment of achalasia of the esophagus. Hepato-Gastroenterol 1991 ; 38:474-480.
27. Iamieson GG. Gastroesophageal reflux following myotomy for achalasia. Hepato-Gastroenterol 1991;38:506-509.
28. Scotté M, Téniére P, Denis P, et al. Résultats à long terme du traitement chirurgical de l'achalasie de l'oesophage. J Chir (Paris) 1991;128: 281-284.
29. Téniére P, Scotté M, Le Blanc I, et al. Traitment chirurgical du reflux gastro-oesophagien de l'adulte - Techniques chirurgicales. Appareil Digestif 1994;40: I -16.
30. Silveira GM, Lopes ARC, Vinhaes DI, et al. Megaesôfago chagásico: análise de 111 casos operados. Rev Col Bras Cir 1980;7:207-210.
31. Smart HL, Foster PN, Evans DF, et al. Twenty four hour oesophageal acidity in achalasia before and after pneumatic dilatation. Gut 1987; 28:883-887.
32. De Caestecker IS, Blackwell IN, Pryde A, et al. Daytime gastroesophageal reflux is important in esophagitis. Gut 1987; 28:159.
33. Resende JM. Classificação radiológica do megaesôfago. Rev Goiana Med 1982;28: 187-191.
34. Ellis FH. Esophagomyotomy by the thoracic approach for esophageal achalasia. Hepato-Gastroenterol 1991 ; 38 :498-50 1.

Endereço para correspondência:

Dr. Thomaz de Aquino França

Rua Dr. José Greco, 59 - São Bento

30.360-030 - Belo Horizonte - MG

Fone: 297-5158 / 212-5888 / 344-1464

Datas de Publicação

Publicação nesta coleção
26 Jan 2010
Data do Fascículo
Ago 1999

Histórico

Recebido
05 Nov 1998
Aceito
14 Jun 1999

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Merendino K, Dillard DH. The concept of sphincter substitution by an interposed jejunal segment for anatomic and physiologic abnormalities at the esophagogastric junction, with special reference to reflux esophagitis and esophageal varices. Ann Surg 1955;142:486-509.

[2] 2. Wendel WZ. Zur Chirurgie des Oesophagus. Arch Koin 1910;93:311.

[3] 3. Nissen R. Gastropexxy as the lone procedure in the surgical repair for hiatus hérnia. Am J Surg 1956;92:389-92.

[4] 4. Toupet A. Technique d'oesophago-gastroplastie avec phrénogastropexie appliqué dans la cure radicale des hernies hiatales et comme complément de l'opertion de Heller dans les cardiosplasmes. Mem Acad Chir 1963;89:394-399.

[5] 5. Lind FJ, Burns MC, Mac Dougall TJ. "Physiological" repair for hiatus hernia. Manometric study. Arch Surg 1965;91:233.

[6] 6. Girard M. Société Medicale de Genéve. Rev Med Suisse Rom 1915;35: 280-281.

[7] 7. Resende JM. Aspectos clínicos e radiológicos da aperistalse do esôfago. Rev Bras Gastroenterol 1960;12:247-262.

[8] 8. Heller E - Extrarnukose cardioplastik beim chronischen cardiopasmus mil dilatation des oesophagus. Med Cir 1913;27:141.

[9] 9. Lortat-Jacob JL, Maillard JN, Fekete F. A procedure to prevent reflux after esophagogastric resection: experience with 17 patients. Surgery 1961;50:600-611.

[10] 10. Dor J, Humpert P, Dor V, et al - L'interet de la technique de Nissen modifiée dans la prevention du reflux apres cardiomyotomie estramuqueuse de Heller. Mem Acad Chir 1962;88:877-884.

[11] 11. Thal AP, Hatafuku T, Kurtzman R. A new method for reconstruction to the esophagogastric juntion. Sur Gynecol & Obstet 1965;120: 1.225.

[12] 12. Belsey R. Functional disease of the esophagus. J Thorac Cardiovasc Surg 1966;52:164.

[13] 13. Jekler J, Lhotka J. Modified Heller procedure to prevent postoperative reflux esophagitis in patients with achalasia. Am J Surg 1967;113: 251-254.

[14] 14. Pinotti HW, Gama-Rodrigues JJ, Ellenbogen G, et al. Nova técnica no tratamento cirúrgico do megaesôfago. Esofagocardiomiotomia associada com esofagofundogastropexia. Rev Goiana Med 1974; 20: 331-334.

[15] 15. Rossetti M. Achalasia of the esophagus. Operative treatment by abdominal myotomy and fundoplication. Zentralbl Chir 1978; 1.943:1.180-1.187.

[16] 16. Brandalise NA, Leonardi LS, Mantovani ME, Fagundes II. Tratamento cirúrgico do megaesôfago: estudo comparativo entre duas técnicas de cardioplastia. Rev Col Bras Cir 1979;6:117-120.

[17] 17. Barbosa H, Barichello AW, Vianna AL, et al- Megaesôfago chagásico: tratamento pela cardioplastia à Thal. Rev Col Bras Cir 1981;8:16-29.

[18] 18. Ferjat I. Megaesôfago: Estudo de técnica operatória e seus resultados. Rev Goiana Med 1981;27:123-179.

[19] 19. Malafaia O, Brenner S, Silva IT, et al. Tratamento cirúrgico do megaesôfago pela técnica de Thal. Rev Col Bras Cir 1981;8:111-118.

[20] 20. Murray GF, Battaglin IW, Keagy BA, et al. Selective application of fundoplication in achalasia. Ann Thorac Surg 1984;37:185-188.

[21] 21. Skinner DB, Belsey RH. Achalasia. In: Management of esophageal disease W V Saunders Co.Edt., Philadelphia, 1988;453.

[22] 22. Rosato EF, Acker M, Curcillo 11 PG, et al. Transabdominal esophago- myotomy and partial fundoplication for treatment of achalasia. Surg Gynecol Obstet 1991;173:137-141.

[23] 23. Espinoza FT, Lamache LI. Acalasia del esófago: resultado de su tratamiento quirúrgico. Rev Gastroent Mex 1983; 48:23-29.

[24] 24. Felix VN. Tratamento do megaesôfago chagásico incipiente. Tese. FMUSP, S. Paulo. 1994.

[25] 25. laakkola A, Ovaska I, Isolauri I. Esophagocardiomyotomy for achalasia. Eur J Surg 1991;157:407-410.

[26] 26. Csendes A. Results of surgical treatment of achalasia of the esophagus. Hepato-Gastroenterol 1991 ; 38:474-480.

[27] 27. Iamieson GG. Gastroesophageal reflux following myotomy for achalasia. Hepato-Gastroenterol 1991;38:506-509.

[28] 28. Scotté M, Téniére P, Denis P, et al. Résultats à long terme du traitement chirurgical de l'achalasie de l'oesophage. J Chir (Paris) 1991;128: 281-284.

[29] 29. Téniére P, Scotté M, Le Blanc I, et al. Traitment chirurgical du reflux gastro-oesophagien de l'adulte - Techniques chirurgicales. Appareil Digestif 1994;40: I -16.

[30] 30. Silveira GM, Lopes ARC, Vinhaes DI, et al. Megaesôfago chagásico: análise de 111 casos operados. Rev Col Bras Cir 1980;7:207-210.

[31] 31. Smart HL, Foster PN, Evans DF, et al. Twenty four hour oesophageal acidity in achalasia before and after pneumatic dilatation. Gut 1987; 28:883-887.

[32] 32. De Caestecker IS, Blackwell IN, Pryde A, et al. Daytime gastroesophageal reflux is important in esophagitis. Gut 1987; 28:159.

[33] 33. Resende JM. Classificação radiológica do megaesôfago. Rev Goiana Med 1982;28: 187-191.

[34] 34. Ellis FH. Esophagomyotomy by the thoracic approach for esophageal achalasia. Hepato-Gastroenterol 1991 ; 38 :498-50 1.

Brasil

Brasil

Esofagocardiomioplastia transversal extramucosa mais esofagogastrofundoplicatura parcial no tratamento do megaesôfago

Transversal extramucosal esophagocardiomioplasty plus partial esofagogastrofundoplicature in treatment of megaesophagus

Resumos

Datas de Publicação

Histórico