Gastrectomías y reconstrucciones

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