BENOIT JACQUES BIBAS
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
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- Impact of gastroesophageal reflux in the pathogenesis of tracheal stenosis(2020) CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Helio; BIBAS, Benoit Jacques; PEGO-FERNANDES, Paulo ManuelBenign airway stenosis is a multifactorial and heterogeneous disease often occurring after tracheal intubation. Despite the frequent finding of pathological gastroesophageal reflux (GER) in benign tracheal stenosis, the cause-and-effect relationship between these two entities and its impact on the outcome of the stenosis itself have not been established. The altered ventilatory dynamics caused by an increased thoracoabdominal pressure gradient in such patients has been proposed as a central cause. The presence of GER in a setting of microaspiration can also induce changes in the local collagen proliferation response, as well as in the local microbiome of the tracheal stenosis site, which may potentially cause and enhance the harm imposed to the already diseased tracheal wall. Diagnosis of GER remains underestimated in the general population, thus making its accurate detection and treatment in central airway stenosis a matter of investigation. The high prevalence of GER in tracheal stenosis patients often occurs in the absence of typical upper digestive signs and symptoms, therefore requiring an objective assessment using a 24-hour ambulatory esophageal pH/impedance study that has shown abnormal results in more than half the patients. The impact of the treatment of GER in patients with benign tracheal has been scarcely reported. Our group showed recently that the surgical control of GER through laparoscopic fundoplication in selected patients with tracheal stenosis can improve substantially the chance of resolution of the tracheal stenosis as opposed to the medical management with high dose proton pump inhibitors. This chapter describes the impact of GER in the pathogenesis of tracheal stenosis with a focus on its mechanisms, diagnosis and treatment strategy.
- The burden of tracheal stenosis and tracheal diseases health-care costs in the 21st century(2020) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro; HOETZENECKER, Konrad
- Impact of fundoplication for gastroesophageal reflux in the outcome of benign tracheal stenosis(2019) BIANCHI, Edno Tales; CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Helio; BIBAS, Benoit Jacques; SALATI, Michele; PEGO-FERNANDES, Paulo ManuelObjective: This study focuses on the impact of antireflux surgery in the outcome of tracheal stenosis. Methods: We performed a retrospective study including patients with benign tracheal stenosis who underwent esophageal manometry and dual-probe 24-hour ambulatory esophageal pH study. Patients with an abnormal pH study were managed with laparoscopic modified Nissen fundoplication or medically (omeprazole 80 mg/d, orally). Patients with normal pH study results were observed. After a 24-month follow-up, the outcome was considered satisfactory if tracheal stenosis could be managed by resection and there was no need for further dilatation or definitive decannulation. The management groups were compared using propensity score matching. Results: A total of 175 patients were included. Abnormal pH study results were found in 74 patients (42.3%), and 12.6% of patients had typical gastroesophageal reflux symptoms. Follow-up was completed in 124 patients (20 had fundoplication, 32 received omeprazole, and 72 were observed). After propensity score matching, the outcome of tracheal stenosis in the fundoplication group was similar to that of the observation group (odds ratio, 1; P = .99) and better than that of the omeprazole group (odds ratio, 5.31; P = .03). The observation (no gastroesophageal reflux) group had a better outcome of stenosis than those treated with omeprazole (odds ratio, 3.54; P = .02). Conclusions: The outcome of the airway stenosis was superior after laparoscopic fundoplication compared with medical treatment with omeprazole and was similar to the outcome of patients without gastroesophageal reflux. A prospective randomized trial is warranted.
- Treatment of tracheal stenosis with extracorporeal membrane oxygenation support in infants and newborns(2021) REIS, Flavio Pola dos; MINAMOTO, Helio; BIBAS, Benoit Jacques; MINAMOTO, Fabio Eiti Nishibe; CARDOSO, Paulo Francisco Guerreiro; CANEO, Luiz Fernando; PEGO-FERNANDES, Paulo ManuelTracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single-center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO). Five patients were operated and the median age of detection of the tracheal disease was 3.7 months, and the median age at the operation was 5 months. All patients had associated cardiac anomalies. Four patients had congenital tracheal stenosis; two with associated pig bronchus. One patient had acquired subglottic stenosis with concomitant stenosis at the carina. After the operation, the patients were referred to ICU on ECMO with an open chest. Minor ECMO-related complications occurred in two patients (hemothorax and wound infection). All patients required endoscopic evaluation during the postoperative care; median of 3.2 procedures. Two patients are currently in follow-up and three have died. Slide tracheoplasty with VA-ECMO can be successfully performed in infants with prior cardiac surgery. Nevertheless, a difficult postoperative course should be anticipated, with possible prolonged ECMO use, readmissions, and higher morbidity and mortality than in children with tracheal stenosis alone.
bookPart Intervenções de urgência em broncoscopia(2019) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro- Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula(2018) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Helio; PEGO-FERNANDES, Paulo ManoelBenign tracheoesophageal fistula (TEF) results from an abnormal communication between the posterior wall of the trachea or bronchi and the adjacent anterior wall of the esophagus. It can be acquired or congenital. The onset of the TEF has a negative impact on the patient's health status and quality of life because of swallowing difficulties, recurrent aspiration pneumonia, and severe weight loss. Several acquired conditions may cause TEF. The most frequent is prolonged orotracheal intubation (75% of the cases). Usually, there is an erosion of the tracheal and esophageal wall by the continuous pressure between the endotracheal tube and the esophageal wall; particularly in the presence of a nasogastric or feeding tube within the esophageal lumen. Furthermore, tracheal stenosis is often associated, and adds complexity to the disease. Preparation for the surgical procedure may take weeks or even months. It includes definitive weaning from mechanical ventilation, treatment of respiratory infection, physiotherapy, and correction of malnutrition through enteral feeding. Surgical repair of a TEF is an elective procedure. It consists of division of the fistula, suture of the esophagus and trachea and protection of the suture lines with a buttressed muscle flap. TEF repair is a complex and challenging procedure, thus, high morbidity and mortality are expected. Nonetheless, surgical management yields excellent long-term results, and it should be considered the first-line treatment for this condition. Definitive fistula closure occurs in about 90-95% of the cases.
- Surgical Management of Benign Acquired Tracheoesophageal Fistulas: A Ten-Year Experience(2016) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Helio; ELOY-PEREIRA, Leandro Picheth; TAMAGNO, Mauro Federico L.; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo ManoelBackground. Benign tracheoesophageal fistulas (TEFs) are rare, and surgical correction is the ideal method of treatment. The objective of this study was to evaluate the results of operative treatment of benign TEFs in patients from a tertiary referral center. Methods. Retrospective study of patients with benign TEFs who were treated between January 2005 and December 2014. Preoperative evaluation included computed tomography of the chest, bronchoscopy, and upper endoscopy. Preoperative treatment included nutritional support by gastrostomy and treatment of lung infections. Surgical repair was done with tracheal resection and reconstruction, laryngotracheal resection, or membranous tracheal repair without resection. Esophageal management consisted of two-layer closure. Results. Twenty patients (11 men) with mean age 48 +/- 17 years were included. The most frequent cause was postintubation injury (n = 16; 80%). The median TEF length was 9 mm (interquartile range [IQR], 2 to 25 mm).The most commonly used surgical approaches were cervicotomy (n =15; 75%) and cervicosternotomy (n = 3; 15%). Eleven patients required tracheal resection; median length was 3 cm (IQR, 3 to 5.5 cm). Seven patients (35%) required intraoperative tracheostomy. Complications occurred in 55% of patients. There was one dehiscence of the tracheal anastomosis, and one procedure-related death. Ninety-five percent of patients had complete closure of the TEF occurred in 95% of cases. Two patients had tracheal stenosis recurrence, and one patient had both TEF and tracheal stenosis recurrence. Two patients have indwelling silicone tracheal stents. Conclusions. Surgical treatment of TEF is effective. Nonetheless, morbidity and mortality are not negligible, even when performed at a referral center and after appropriate preoperative evaluation. (C) 2016 by The Society of Thoracic Surgeons
- Quality-of-life evaluation in patients with laryngotracheal diseases(2020) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Helio; PEGO-FERNANDES, Paulo Manoel
bookPart Fístula traqueoesofágica(2021) CARDOSO, Paulo Francisco Guerreiro; MINAMOTO, Hélio; BIBAS, Benoit J.- Health-related quality of life evaluation in patients with non-surgical benign tracheal stenosis(2018) BIBAS, Benoit Jacques; CARDOSO, Paulo Francisco Guerreiro; SALATI, Michele; MINAMOTO, Helio; TAMAGNO, Mauro Federico Luiz; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo ManuelBackground: The primary objective of the study was to evaluate the health-related quality of life (HRQL) of patients with benign post-intubation tracheal stenosis considered as unfit for surgical treatment. Secondary objectives were: (I) to determine if clinical variables (gender, age, total treatment time, and type of tracheal device) could influence HRQL and (II) to compare the results with a normal standardized population. Methods: Prospective study between August-2014 and December-2016 including patients with tracheal stenosis treated with silicone stents, T-Tubes or tracheostomy. Candidates to airway resection and reconstruction were excluded from the analysis. HRQL was assessed with the SF-36 Health Questionnaire. Backward stepwise regression model analyzed the influence of clinical variables on the SF-36 domains and component summaries. Norm-based results were compared with normative data. Alpha error was 5%. Results: Ninety-three patients (62M/31F; mean age 38 +/- 14 years) were included. Mean overall HRQL in all 8 SF-36 domains was poor. Lowest scores were in the role physical (mean 31.7 +/- 38), bodily pain (mean 39.2 +/- 35), and role emotional domain (mean 48.7 +/- 40). The physical component summary (PCS) was more affected than the mental (P<0.001). Norm-based results indicated that most domains and both physical and mental summaries were below the mean for the USA normative population. ]btal stenting time significantly influenced the physical (P=0.001) and mental component summaries (P=0.001). Conclusions: Quality of life of patients with benign tracheal stenosis is severely impaired, and norm-based results indicate that the HRQL is below normative data. Physical and mental discomfort seems to be attenuated by total treatment time.