Transcript
Gastrectomías y Gastrectomías y reconstruccionesreconstrucciones
Vargas Flores Edgar R3CG
Tipos
• Hemigastrectomía• Gastrectomía subtotal• Gastrectomía total
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
Historia
• 1879 Jules Emile Pean• 1881 Theodore Billroth• 1885 Theodore Billroth II
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
Indicaciones
• Cáncer gástrico• Enfermedad ulcerosa recurrente• Úlcera gástrica sangrante• GIST
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
Contraindicaciones relativas
• Anemia• Hipoproteinemia• Ascitis• Carcinomatosis
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
Complicaciones intraoperatorias
• Sangrado• Daño a estructuras adyacentes – Bazo– Páncreas– Hígado– Vía biliar
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
Complicaciones Post operatorias tempranas
• Sangrado intraluminal• Fuga anastomótica• Fuga de muñón duodenal
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
Complicaciones Post operatorias tardías
• Síndrome de vaciamiento gástrico rápido• Desnutrición• Obstrucción• Ulceración de anastomosis
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
Gastrectomía con Billroth II
Puntos a favor y en contra del B II
• Permite mayor resección de estómago• Facilita la linfadenectomía• Tiene menor tensión• Provoca síntomas de vaciamiento gástrico
rápido• Tiene menor tasa de reflujo biliar
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
DELANEY CP ET AL. NETTER’S SURGICAL ANATOMY AND APPROACHES. SAUNDERS 1 HAR/PSC EDITION. 2013
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
Ligadura de la arteria gàstrica derecha
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
Liberación del bulbo duodenal, sección y cierre
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
1.5x
DELANEY CP ET AL. NETTER’S SURGICAL ANATOMY AND APPROACHES. SAUNDERS 1 HAR/PSC EDITION. 2013
Gastrectomía con Billroth I
DELANEY CP ET AL. NETTER’S SURGICAL ANATOMY AND APPROACHES. SAUNDERS 1 HAR/PSC EDITION. 2013
Puntos a favor y en contra del B I
• Mejor absorción del calcio y hierro• Menor tasa de esteatorrea• Mejor digestión por enzimas pancreáticas• Mayor reflujo biliar• Menor cantidad de cambios histológicos• Menor incidencia de carcinoma
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
Liberación del bulbo duodenal, sección y cierre
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
YEO CJ ET AL. SHACKELFORD’S SURGERY OF THE ALIMENTARY TRACT. SAUNDERS 7TH EDITION. 2012
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
Gastrectomía total
Indicaciones
• Malignidad gástrica• Zollinger Ellison– Acidez no controlada con antisecretores
FISCHER JE ET AL. MASTERY OF SURGERY. LWW 6TH EDITION. 2011
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DRAKE RL ET AL. GRAY’S ANATOMY FOR STUDENTS. CHURCHILL LIVINGSTONE 3RD EDITION. 2014
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
SKANDALAKIS JE ET AL. SKANDALAKIS SURGICAL ANATOMY. PMP 1ST EDITION. 2004
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