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Bernardo RUEDA TORRES

Hospital Angeles del Pedregal
Ciudad de Mexico, Mexico
MD
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Heller's cardiomyotomy for achalasia
Achalasia stems from Greek and means “a” (not) and “khálasis” (relaxation).
Idiopathic megaesophagus (achalasia) is an esophageal primary motor irregularity. It is characterized by the absence of esophageal peristalsis, together with incomplete relaxation of the lower esophageal sphincter after swallowing.
Differential diagnosis must be made between Chagas disease and esophageal squamous cell carcinoma. The incidence rate ranges from 0.5 to 1 per 100,000 persons-years of study. Although there are several theories, the etiology remains unknown.
The first clinical description was made by Sir Thomas Wills (1672). He used to treat the disease via dilation with a sponge attached to a whalebone. Arthur Hertz was the first to name the disease “achalasia”. Ernest Heller performed the first successful esophagectomy in 1913. Zaaijer was the first to describe the anterior myotomy in 1923.
Other therapeutic procedures include botulinum toxin injection into the lower esophageal sphincter. It has transient effects and patients can develop tolerance to the injections. Another option is endoscopic hydropneumatic dilation, which should be fluoroscopically-guided. When it fails, the efficacy of other therapeutic options decreases. The most serious complication is esophageal perforation.
The diagnostic criteria are based on endoscopic findings. Endoscopy reveals there are food remains as well as esophageal dilation, and decreased motility. X-ray exams show esophageal dilation and narrowing of the lower esophageal sphincter. Manometric findings show decreased esophageal motility, increased lower esophageal sphincter pressure, and incomplete relaxation of the lower esophageal sphincter.
The patient was operated on. Since there was no hiatal hernia, laparoscopic Toupet fundoplication was chosen, based on its efficacy in preventing reflux, as well as in keeping the myotomy free of a wrap.
Surgical intervention
2 months ago
5330 views
25 likes
4 comments
12:40
Heller's cardiomyotomy for achalasia
Achalasia stems from Greek and means “a” (not) and “khálasis” (relaxation).
Idiopathic megaesophagus (achalasia) is an esophageal primary motor irregularity. It is characterized by the absence of esophageal peristalsis, together with incomplete relaxation of the lower esophageal sphincter after swallowing.
Differential diagnosis must be made between Chagas disease and esophageal squamous cell carcinoma. The incidence rate ranges from 0.5 to 1 per 100,000 persons-years of study. Although there are several theories, the etiology remains unknown.
The first clinical description was made by Sir Thomas Wills (1672). He used to treat the disease via dilation with a sponge attached to a whalebone. Arthur Hertz was the first to name the disease “achalasia”. Ernest Heller performed the first successful esophagectomy in 1913. Zaaijer was the first to describe the anterior myotomy in 1923.
Other therapeutic procedures include botulinum toxin injection into the lower esophageal sphincter. It has transient effects and patients can develop tolerance to the injections. Another option is endoscopic hydropneumatic dilation, which should be fluoroscopically-guided. When it fails, the efficacy of other therapeutic options decreases. The most serious complication is esophageal perforation.
The diagnostic criteria are based on endoscopic findings. Endoscopy reveals there are food remains as well as esophageal dilation, and decreased motility. X-ray exams show esophageal dilation and narrowing of the lower esophageal sphincter. Manometric findings show decreased esophageal motility, increased lower esophageal sphincter pressure, and incomplete relaxation of the lower esophageal sphincter.
The patient was operated on. Since there was no hiatal hernia, laparoscopic Toupet fundoplication was chosen, based on its efficacy in preventing reflux, as well as in keeping the myotomy free of a wrap.
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.
Surgical intervention
8 months ago
1454 views
8 likes
0 comments
13:16
Wilkie's syndrome surgery
Wilkie’s syndrome (or superior mesenteric artery syndrome) was first described by Von Rokitansky in 1861. It consists in an extrinsic pressure over the third duodenal portion originating from an uncertain cause. Wilkie found a decreased angle (25 degrees, or less) between the superior mesenteric artery and the aorta, conditioning a duodenal (3rd portion) obstruction of vascular origin. It is associated with weight loss. The real incidence remains unknown due to the lack of diagnosis. However, the estimated incidence varies between 0.013 to 1% of the population. The male/female ratio is 2:3, ranging age between 10 and 39 years old.
Symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, early gastric fullness and anorexia (acute high gastroduodenal obstruction).
Diagnostic studies include barium esophageal gastroduodenal series, CT-scan, MRI, high endoscopy (peptic esophagitis, ulcer). Endoscopic studies must come together with barium esophageal gastroduodenal X-ray studies.
Surgical treatment is performed when there is no response to medical treatment, consisting in duodenojejunal anastomoses, with Treitz’s ligament division. Gastrojejunal anastomosis is an alternative option. Laparoscopic surgical treatment can be performed.