Abstract Purpose To analyze, in aged obese patients, the weight loss, comorbidity control, and safety postoperative complications of bariatric surgery by Roux-en-Y gastric bypass technique. Methods Twenty-seven patients who underwent laparoscopic weight-reducing gastroplasty with Roux-en-Y gastric bypass to treat obesity were included. All patients were ≥ 60 years old at the time of surgery. The Wilcoxon test was used for statistical analysis, and a p-value ≤0.05it was considered significant. Results Ten (90.9%) patients with dyslipidemia were cured (p < 0.001). Nine (81.8%) patients with type 2 diabetes mellitus had total improvement and 2 (18.2%) had partial improvement (p = 0.003). In 23 patients with systemic arterial hypertension, 9 (39.1%) achieved total improvement and 14 (60.9%) partial improvement (p = 0.140). Five (71.4%) patients with obstructive sleep apnea syndrome were cured (p = <0.001). For other comorbidities, no partial improvement or cure was shown. Conclusions Roux-en-Y gastric bypass surgery in obese elderly patients can be performed safely and with low morbidity and mortality rates. The benefits of weight loss and reduced comorbidities are promising and like those of the younger population.

RESUMO Objetivo: relatar as características, evolução e desfecho de pacientes portadoras de endometriose umbilical primária. Métodos: estudo observacional e descritivo de pacientes portadoras de endometriose umbilical primária diagnosticada entre 2014 e 2017. As variáveis clínicas avaliadas foram: idade, quadro clínico, características das lesões, métodos diagnósticos, tratamento e recidiva. Resultados: seis pacientes com diagnóstico de endometriose umbilical primária, com idades entre 28 e 45 anos foram operadas no período do estudo. Elas apresentavam lesões que variavam de 1,0cm a 2,5cm de diâmetro, de cor violácea em cinco pacientes e eritemato-violácea em uma. O tempo de duração dos sintomas até o diagnóstico variou de um a três anos e em todos os casos estudados o diagnóstico foi feito por meio das manifestações clínicas e confirmado por meio da análise histopatológica. Nenhum caso foi associado com alterações neoplásicas. Todas as pacientes avaliadas apresentavam como manifestação clínica dor e sangramento umbilical no período menstrual. Conclusão: a endometriose umbilical é uma doença pouco frequente e deve ser incluída no diagnostico diferencial de mulheres como nódulo umbilical. O tratamento de eleição é a exérese total da lesão.

ABSTRACT Objective: to report the characteristics, evolution and outcome of patients with primary umbilical endometriosis. Methods: an observational and descriptive study of patients with primary umbilical endometriosis diagnosed between 2014 and 2017. The clinical variables evaluated were age, clinical picture, lesion characteristics, diagnostic methods, treatment and recurrence. Results: six patients diagnosed with primary umbilical endometriosis aged 28 to 45 years were operated on during the study period. They had lesions ranging from one to 2.5cm in diameter, violet in five patients and erythematous-violaceous in one. The duration of the symptoms until diagnosis ranged from one to three years and in all the cases studied the diagnosis was made through the clinical manifestations and confirmed by histopathological analysis. No case was associated with neoplastic alterations. All patients evaluated had pain and umbilical bleeding in the menstrual period. Conclusion: umbilical endometriosis is an uncommon disease and should be included in the differential diagnosis of women as umbilical nodules. The treatment of choice is the total exeresis of the lesion.

RESUMO O divertículo epifrênico é uma patologia rara associada a distúrbios motores esofágicos e, frequentemente, assintomática, tendo indicações cirúrgicas bem estabelecidas. Relatamos um caso de divertículo epifrênico gigante em paciente de 59 anos, sexo feminino, sintomática, diagnosticada por exames complementares. Devido à sintomatologia, optou-se por tratamento cirúrgico, sendo realizada a diverticulectomia esofágica com cardiomiotomia e fundoplicatura parcial anterior laparoscópica.

ABSTRACT Epiphrenic diverticulum is a rare disease associated with esophageal motor disorders that is usually asymptomatic and has a well-established surgical indication. We report a case of giant epiphrenic diverticulum in a 59-year-old symptomatic woman who was diagnosed after underwent complementary exams. Because of her symptoms, the surgical treatment was chosen, and esophageal diverticulectomy was performed along with laparoscopic cardiomyotomy and anterior partial fundoplication.

RESUMO Mulher de 79 anos, com achado incidental em ultrassonografia de abdome de lesão sólida em cauda de pâncreas. Em ressonância magnética, foi confirmada lesão de 12mm. Foi aventada a hipótese diagnóstica de tumor neuroendócrino não secretor, sendo realizada pancreatectomia distal laparoscópica. Em estudo anatomopatológico, diagnosticou-se tecido esplênico, configurando baço acessório intrapancreático. Este tipo de manifestação topográfica de baço é rara, mas deve fazer parte dos diagnósticos diferenciais em tumores sólidos do pâncreas.

ABSTRACT An asymptomatic 79-year-old woman, with incidental finding on abdominal ultrasound of a solid nodule in the tail of the pancreas. Magnetic resonance imaging showed a 12mm solid tumor. The suggested diagnosis was pancreatic neuroendocrine tumor. The pathological examination showed an intrapancreatic splenic tissue. This is a rare ectopic location of spleen tissue and it should be considered in the differential diagnosis of pancreatic solid tumors.

RESUMO Objetivo: avaliar a incidência de dor crônica e o seu impacto na qualidade de vida de pacientes submetidos à hernioplastia inguinal pela técnica de Lichtenstein. Métodos: trata-se de estudo transversal descritivo, de pacientes operados de hérnia inguinal pela técnica de Lichtenstein sob anestesia raquidiana, no período de fevereiro de 2013 a fevereiro de 2015, e que já haviam completado seis meses de pós-operatório. Os pacientes foram questionados sobre a presença de dor inguinal crônica e, caso confirmada, convidados a uma consulta na qual foi feita análise da qualidade da dor e seu impacto na qualidade de vida. Resultados: do total de 158 pacientes submetidos ao procedimento, 7,6% foram identificados como portadores de inguinodinia. Destes, houve impacto na qualidade de vida em 25%. Conclusão: observou-se incidência de inguinodinia pós-hernioplastia com repercussão na qualidade de vida semelhante à literatura mundial.

ABSTRACT Objective : to evaluate the incidence of chronic pain and its impact on the quality of life of patients submitted to inguinal hernioplasty using the Lichtenstein technique. Methods : this was a descriptive, cross-sectional study of patients operated under spinal anesthesia from February 2013 to February 2015 and who had already completed six postoperative months. We questioned patients about the presence of chronic inguinal pain and, if confirmed, invited them to a consultation in which we assessed the pain and its impact on quality of life. Results : out of 158 patients submitted to the procedure, we identified 7.6% as having inguinodynia. Of these, there was an impact on the quality of life in 25%. Conclusion : the incidence of inguinodynia after hernioplasty with repercussion in quality of life was similar to the one of found in the world literature.

Natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery that eliminates abdominal incisions and incision-related complications by combining endoscopic and laparoscopic techniques to diagnose and treat abdominal pathology. Natural orifice transluminal endoscopic surgery refers to the method of accessing the abdominal cavity through a natural orifice under endoscopic visualization. Since its introduction in 2004, numerous reports have been published describing different surgical interventions. Recently, a group of expert laparoscopic surgeons and endoscopists outlined the limitations of this approach and issued recommendations for progress toward human trials. Transluminal surgery is a new method for accessing the abdomen under direct endoscopic visualization. Preliminary studies have demonstrated the feasibility of this technique in animal models; however, further research is warranted to validate its safety in humans.