Impact of Laparoscopic Fundoplication for the Treatment of Laryngopharyngeal Reflux: Review of the Literature

Laryngopharyngeal reflux (LPR) is part of the so-called extraesophageal manifestations of gastroesophageal reflux disease (GERD). It is presented by unspecific symptoms and signs and is believed to be caused by the reflux of gastric content to the proximal esophagus and larynx. However, evidence considering the role of the antireflux surgery for LPR has failed to demonstrate results comparable to those for GERD. The aim of this paper is to review the current literature regarding the impact of laparoscopic fundoplication for the treatment of LPR

Gastrointestinal Cancer Metastasis

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Epidemiological profile of esophageal cancer mortality in Rio Grande do Sul and its health Regions

Introduction: Malignant esophageal neoplasia is a rare tumor, but it has high morbidity and mortality. Early diagnosis and intensive treatment associated with surgical approach remains the best treatment for the disease. Its epidemiology is extremely diverse in the world, even in the same country.Methodology: This was a retrospective analysis made from 2000-2015, analyzing the mortality rates of malignant esophageal neoplasia in the state of Rio Grande do Sul (RS) in its 30 Health Regions and in Brazil. The mortality data were collected in the Mortality Information System (SIM) and the population data in the Brazilian Institute of Geography and Statistics (IBGE).Results: The esophageal cancer mortality rate was 8.61 (95% CI, 8.49-8.73) per 100,000 inhabitants in RS, while the national rate was 3.66 (95% CI, 3, 49- 3.82), with a significant difference (p <0.0001). The regional distribution was variable, and the West Border region presented the highest rate, 12.91 (95% CI, 12.05-13.77). However, even regions with lower mortality presented twice as much deaths than the national rate. Mortality increased with aging, with the oldest age groups (≥80 years) presenting 69.62 (95% CI, 64.9-74) deaths per 100,000 inhabitants. Conclusion: Esophageal neoplasia is still a very serious condition in the state of RS, being associated with an almost 3-fold higher mortality rate compared to the national rate. Even within the state different epidemiological patterns are found.Keywords: Esophageal cancer; epidemiology; mortalit

Alternative therapies for GERD : a way to personalized antireflux surgery

Gastroesophageal reflux disease (GERD) is a commondisorder, known to affect about20%of theWestern population. Although conventional medical or surgical treatment has proven effective, there is certainly room for improvements. As only 10% of GERD patients are finally treated by antireflux surgery, a large therapeutic window exists. This treatment gap consists of patients who are not effectively treated with proton pump inhibitor but do not want to run the potential risks of conventional surgery. During the last two decades, several novel and intriguing options for the surgical treatment of GERD have been introduced and found their way into clinical use. The following summary will give an update of certain alternative therapeutic options to treat GERD or its pathological consequences

Interaction of HSD11B1 and H6PD polymorphisms in subjects with type 2 diabetes are protective factors against obesity : a cross-sectional study

Background: The enzyme 11-beta hydroxysteroid dehydrogenase type 1 (HSD11B1) converts inactive cortisone to active cortisol in a process mediated by the enzyme hexose-6-phosphate dehydrogenase (H6PD). The generation of cortisol from this reaction may increase intra-abdominal cortisol levels and contribute to the physiopathogenesis of obesity and metabolic syndrome (MetS). The relationship of HSD11B1 rs45487298 and H6PD rs6688832 polymorphisms with obesity and MetS was studied. We also studied how HSD11B1 abdominal subcutaneous (SAT) and visceral adipose tissue (VAT) gene expression is related to body fat distribution. Methods: Rates of obesity and MetS features were cross-sectionally analyzed according to these polymorphisms in 1006 Brazilian white patients with type 2 diabetes (T2DM). Additionally, HSD11B1 expression was analyzed in VAT and SAT in a diferent cohort of 28 participants with and without obesity who underwent elective abdominal operations. Results: Although polymorphisms of the two genes were not individually associated with MetS features, a synergistic efect was observed between both. Carriers of at least three minor alleles exhibited lower BMI compared to those with two or fewer minor alleles adjusting for gender and age (27.4±4.9 vs. 29.3±5.3 kg/m2 ; P=0.005; mean±SD). Obesity frequency was also lower in the frst group (24.4% vs. 41.6%, OR=0.43, 95% CI 0.21–0.87; P=0.019). In the second cohort of 28 subjects, HSD11B1 gene expression in VAT was inversely correlated with BMI (r=− 0.435, P=0.034), waist circumference (r=− 0.584, P=0.003) and waist-to-height ratio (r=− 0.526, P=0.010). Conclusions: These polymorphisms might interact in the protection against obesity in T2DM individuals. Obese individuals may have decreased intra-abdominal VAT HSD11B1 gene expression resulting in decreasing intra-abdominal cortisol levels as a compensatory mechanism against central and general adiposity

Indução de aderência intrabdominal por prótese de retícula de polipropileno : estudo experimental em ratos

INTRODUCTION: The correction of groin hernias using a transperitoneal videolaparoscopic method with a polypropylene mesh is becoming increasingly common. This could lead to an increased incidence of adhesion formation. MATERIALS AND METHODS: The incidence of adhesions induced by mesh placement and by reperitonization was observed in 40 male adult Wistar rats, randomly allocated to four groups of 10 rats (Group A = no mesh, no reperitonization; B = no mesh, reperitonization; C = mesh, no reperitonization; D = mesh and reperitonization). After opening the abdominal cavity, the iliac fossa was identified and a peritoneal opening, measuring about 2 by 2 cm, was done on the parietal wall. In the rats in which a polypropylene prosthesis was used, a piece of Marlex mesh, measuring about 1.5 by 1.5 cm was placed on the peritoneal opening. A simple suture was performed in the animals submitted to reperitonization, using a 5.0 monofilamentar polypropylene thread on a cardiovascular (atraumatic) needle. The animals were killed 15 days after the operation. Macroscopic analysis was done by an investigator blinded to intervention group. Fisher’s exact test and the c2 test were used for statistical analysis of the results. A P < 0.05 was considered as significant. RESULTS: Adhesions were significantly more common in the groups in which the prosthesis was placed (59% vs. 95%; P = 0.01), as well as in the groups in which reperitonization was performed (58% vs. 100%; P = 0.03). CONCLUSIONS: The results suggest that polypropylene mesh placement and reperitonization are each independent factors that have a role in inducing the formation of adhesions.INTRODUÇÃO: A correção de hérnias na virilha através de um método videolaparoscópico transperitoneal está se tornando cada vez mais comum. Contudo, este método poderia levar a um aumento na incidência de formação de aderências. MATERIAIS E MÉTODOS: A incidência de aderências induzidas pela colocação de retícula e pela reperitonização foram observadas em 40 ratos Wistar adultos, machos, divididos aleatoriamente em quatro grupos com 10 ratos cada um (Grupo A = sem retícula, sem reperitonização; B = sem retícula, com reperitonização; C = com retícula, sem reperitonização; D = retícula e reperitonização). Após a abertura da cavidade abdominal, a fossa ilíaca foi identificada e fez-se uma abertura de aproximadamente 2 x 2 cm na parede parietal. Nos ratos em que uma prótese de polipropileno foi utilizada, uma retícula Marlex com 1,5 x 1,5 cm foi colocada sobre a abertura peritoneal. Nos outros animais, a reperitonização foi feita com sutura simples, utilizando-se fio de polipropileno monofilamentar 5.0 com uma agulha cardiovascular (atraumática). Os animais foram sacrificados 15 dias depois da operação. A análise macroscópica foi realizada por um investigador cego quanto ao grupo de origem dos animais. A análise estatística utilizou o teste exato de Fisher e o c2. Um P < 0,05 foi considerado significativo. RESULTADOS: As aderências foram significativamente mais comuns nos grupos nos quais a prótese foi utilizada (59% vs. 95%; P = 0,01), assim como nos grupos nos quais foi feita a reperitonização (58% vs. 100%; P = 0,03). CONCLUSÕES: Os resultados sugerem que a retícula de polipropileno e a reperitonização são fatores independentes entre si quanto à indução de formação de aderências