Racional: As ressecções hepáticas evoluíram, tornando-se mais seguras, permitindo ampliação das indicações. Objetivo : Avaliar os resultados com ampliação da indicação. Método : Estudo prospectivo de todas as hepatectomias realizadas para ressecção de tumores hepáticos. Foram incluídos pacientes com tumores primários e secundários, benignos e malignos e anotados idade, gênero, diagnóstico pré-operatório, tratamento realizado no pré-operatório, tipo de operação realizada, necessidade de transfusão, exame anatomopatológico final e evolução pós-operatória. Os pacientes foram divididos em dois grupos: grupo A, aqueles com indicação tradicional de hepatectomia e grupo B, com indicação ampliada (tumor nos dois lobos hepáticos, ressecções extensas de cinco ou mais segmentos, fígados cirróticos e pós-quimioterapia com drogas hepatotóxicas). Resultados: Foram operados 38 pacientes e realizadas 40 operações, 28 no grupo A e 10 no B. A média de idade foi 57,7 anos, sendo 25 mulheres. Três do grupo B foram operados em dois tempos. Os grupos A e B receberam em média 1,46 e 5,5 concentrados de hemácias por operação, respectivamente. Os pacientes do grupo A tiveram três complicações (10,7%) e os do B seis (60%). A mortalidade no grupo A foi de 3,5% (n=1) e no grupo B ocorreram quatro óbitos (40%). Os exames de imagem foram sensíveis para presença de tumor, mas não para definir o tipo. As transfusões, a morbidade e a mortalidade foram maiores no grupo com ampliação das indicações e operações mais extensas. Conclusão: Deve-se indicar a biópsia hepática com maior frequência no pré-operatório, assim como a embolização ou ligadura do ramo da veia porta. Para diminuir transfusão intra-operatória há necessidade de trabalho conjunto com o serviço de anestesia e usar equipamentos modernos para secção do parênquima.

Background: Hepatic resection has evolved to become safer, thereby making it possible to expand the indications. Aim : To assess the results from a group of patients presenting these expanded indications. Method: Were prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs). Results: Were operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery. Conclusion: The indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion.

RACIONAL: As alterações na digestão e perdas de nutrientes são aspectos relevantes na redução do peso e na manutenção do estado nutricional do paciente submetido à gastroplastia, mas poucos estudos estão disponíveis na literatura. OBJETIVO: Estudar as alterações sistêmicas decorrentes da redução de peso ao longo do tempo, após o tratamento cirúrgico. MÉTODO: Estudo tipo coorte prospectivo com amostra de 44 indivíduos, obesos mórbidos, operados com derivação gástrica em Y-de-Roux e com anel de silicone. Análises clínicas foram realizados em tempos distintos: período pré-operatório, seis meses após a operação e durante os anos de 2006 e 2007. Os exames efetuados foram: glicemia de jejum; albumina sérica; colesterol total; hemoglobina; gordura fecal; substância redutora nas fezes; sangue oculto nas fezes. Endoscopia digestiva alta também foi realizada para medir o anel em centímetros. Ainda foram estudados o genero, idade, altura, peso, IMC, diabetes, e o tempo após a operação. RESULTADOS: A mediana do peso foi de 141 kg (91 - 216) e o IMC, teve mediana de 49,28 kg/m² (36,3 - 80,31). A anemia se manifestou em oito (18,2%) pacientes e 13 (29,5%) apresentaram albumina com valores reduzidos. No final do estudo, a média dos meses de seguimento foi de 52,56 + 8,84 meses. O peso médio foi de 86,96 + 15,44 kg e a média do IMC foi de 32,41 + 4,82 kg/m². A pesquisa de gordura fecal foi positiva em 16 pacientes (36,4%), substância redutora positiva nas fezes em um (2,3%) paciente e presença de sangue oculto nas fezes foi positiva em 13(29,5%) pacientes. O diâmetro interno do anel de silicone apresentou uma média de 0,75 cm + 0,23 cm. CONCLUSÃO: Após a operação ocorreu perda significativa de peso, porém, o IMC ainda se mantinha acima de 35 kg/m² na maioria dos pacientes acompanhados por longo tempo. Houve melhora substancial dos níveis de colesterol e glicemia. O diâmetro do anel não demonstrou associação significativa com a redução do peso; contudo, os pacientes com anel superior a 1 cm, não apresentaram anemia ou hipoaluminemia, estando clinicamente melhores do que aqueles com anel menor.

BACKGROUND: Changes in digestion and nutrients losses are relevant aspects in weight reduction and maintenance of the nutritional status of patients undergoing gastroplasty, but few studies are available in the literature. AIM: To study the systemic changes arising from the reduction in weight over time after surgery. METHOD: A prospective cohort study with 44 morbid obese patients operated on between July 2001 and April 2005. The operation performed was a gastric by pass Roux-en-Y with silicon ring. Medical tests were conducted at different times: preoperatively, six months after the operation and during the years 2006 and 2007. The examinations performed were: fasting glucose, serum albumin, total cholesterol, hemoglobin, fecal fat, reducing substance in stool, occult blood in the stool. Endoscopy was also performed to measure the ring in centimeters. Also studied were the gender, age, height, weight, BMI, diabetes, and time after operation. RESULTS: The initial weight ranged from 91 to 216 kg (Md = 141 kg) and BMI at this stage was between 36,3 and 80,3 kg/m² (Md = 49,28 kg/m²). Anemia manifested in eight patients (18,2%) and 13 (29,5%) had albumin with reduced values. Follow-up ranged from 32 to 79 months (X = 52,5 months, SD = 8,8). The final weight ranged from 60,3 to 122,9 kg (mean = 83,95 kg, 1º and 3º quartile = 75,7 and 83,95) and BMI was between 24,62 and 45,54 kg/m² (mean = 31,69 kg/m², 1º and 3º quartile = 28,93 and 35,89). The percentage of weight reduction at this stage was 36,31% (p>0,001), one patient had weight gain, in three (6,8%) patients the albumin level was reduced and nine had anemia. The faecal fat was positive in 16 patients (36,4%), reducing substance in stool was positive in one patient and the presence of faecal occult blood was positive in 13 patients (29,5%). The internal diameter of the silicon ring was between 0,45 and 1,4 cm (mean 0,75, SD = 0,22). CONCLUSION: After surgery there is a significant weight loss, but the BMI is still above 35 kg/m² in 26 patients (59%), followed for a long time. There is a substantial improvement in cholesterol and glucose blood levels. The diameter of ring in the small stomach showed no significant association with weight reduction, while patients with greater than 1 cm ring did not show anemia or low levels of albumin, clinically better than those with rings smaller than 1 cm.

Sump Syndrome after choledochoduodenostomy is becoming rare, mainly because endoscopic procedures are replacing this surgery. We report a case of this syndrome where the only symptom was pain. The diagnosis was made after 3 years and many doctors attended the patient. The treatment was endoscopic and the result was excellent.

A case of primary extragonadal yolk sac tumor in the retroperitoneum of a young adult male is reported. The symptoms were melena and weakness for two months. Radiologic studies suggested a retroperitoneal tumor infiltrating the duodenum, artery aorta and vein cava, was found. Partial resection was performed, remaining tumor around the vessels. Microscopic examination disclosed a yolk sac tumor infiltrating the duodenum. The patient was managed unsuccessfully with radiotherapy, but good results were actived with chemotherapy. Few cases like that were reported in the literature.