Skip to main content
Article thumbnail
Location of Repository

Nova técnica de anastomose gastrojejunal no tratamento paliativo do câncer da cabeça do pâncreas New technique of palliative gastrojejunostomy for carcinoma of the head of the pancreas

By Marcel Cerqueira Cesar Machado, José Eduardo Monteiro da Cunha, Sonia Penteado, José Jukemura, Paulo Herman and Marcel Autran Cesar Machado

Abstract

A maioria dos pacientes com câncer de pâncreas apresenta estdios avançados e é tratada paliativamente. Dos que são submetidos exclusivamente a derivação biliar, cerca de 30%-50% vão apresentar na evolução necessidade de tratamento de obstrução duodenal. As técnicas atualmente empregadas para derivação gástrica podem acarretar vômitos pós-operatórios, principalmente quando feitas profilaticamente. Uma nova técnica foi planejada para evitar alterações no mecanismo de esvaziamento gátrico e a recirculação do conteúdo alimentar. Esta técnica consta de anastomose gastrojejunal entre o corpo gátrico e a primeira alça jejunal tipo Braun em que a alça aferente é bloqueada evitando o ciclo vicioso alimentar. A reconstituição do trânsito alimentar é feita a jusante desta anastomose, impedindo o refluxo biliar para o estômago. Dezenove pacientes foram tratados consecutivamente sem complicações. A sonda nasogástrica foi retirada em torno do terceiro dia de pós-operatório e iniciada realimentação no dia seguinte. Não se observaram vômitos no pós-operatório imediato ou tardio em decorrência de retardo do esvaziamento gátrico.<br>Pancreatic cancer is most often diagnosed too late for curative resection. Therefore most of patients with pancreatic cancer are only submitted to palliative procedures. From those submitted to biliary bypass alone about 30 % need treatment for gastric obstruction at some point of the follow up. Surgical techniques for gastroenterostomy currently in use carry themselves delaying in the gastric emptying mechanisms and circulus vitiosus through the non obstructed duodenum. The objetive of this paper is to describe a new technique devised to avoid those problems and to improve the functional results of prophylatic gastroenterostomy. This was accomplished by a gastrojejunostomy in the upper body of the stomach and constructing the jejunal loop in a Braun fashion, whose afferent loop is blocked. The main features of this technique are the position of the gastroenterostomy with a low distubance of gastric motility and the construction of the jejunal loop in order to avoid the circulus vomiting. Nineteen patients were consecutively submitted to this procedure and no post operative complications were observed. Nasogastric tube was taken off in about three days and oral feeding resumed the next day. Vomits were not observed neither in the early post operative period nor in the long term follow up. This newly designed type of reconstruction is a effective gastric beypass and avoids the problem of food reentry

Topics: Câncer do pâncreas, Tratamento paliativo, Anastomose gastrojejunal, Pancreatic Cancer, Palliative treatment, Gastrojejunostomy, LCC:Surgery, LCC:RD1-811, LCC:Medicine, LCC:R, DOAJ:Surgery, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: Colégio Brasileiro de Cirurgiões
Year: 1999
DOI identifier: 10.1590/S0100-69911999000400004
OAI identifier: oai:doaj.org/article:82b07cf5d55d48e78cae4ad048bcc7ea
Journal:
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://doaj.org/search?source=... (external link)
  • Suggested articles


    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.