Demographic factors, outcomes, and complications in abdominal contouring surgery after massive weight loss in a developing country.

Few reports about body contouring surgery after massive weight loss (MWL) have been produced in the developing countries. As Mexico is considered a developing country, we performed a retrospective analysis of medical records of patients who underwent this type of surgery to evaluate their demographic characteristics as well as their outcomes and complications. Results from 684 patients with MWL, 69 (10%) had abdominoplasty; the type of abdominoplasty influenced the operative time, bleeding, and complications (P < 0.05); the body mass index influenced the weight of resected tissue (P < 0.000) and hospital stay (P < 0.020), but did not affect the type of abdominoplasty performed, surgical time, complications, reoperation, or transfusion rates. In contrast with the developed countries, in these procedures, operating time was higher and the patients had more surgical bleeding with higher rates of transfusion and a longer hospital stay, but with the same clinical results and percentage of complications.

Body image perception and quality of life in patients who underwent breast surgery.

Quality of Life (QoL) has become a standard measure in assessing the effectiveness of medical interventions. We compared the differences between QoL and body image scale (BIS) in a group of patients who underwent breast surgery, including lumpectomy or conservative surgery, modified radical mastectomy and radical mastectomy with breast reconstruction. We included patients who underwent breast surgery between August of 2005 and June of 2006 in two tertiary referral centers in Mexico City. Two self-administered questionnaires assessing body image perception, BIS and quality of life (SF-36), were assigned and a physician-conducted interview was done. We stratified patients by age, marital status, and scholar grade. The sample comprised 202 patients. The BIS results yielded: the group with a benign lesion demonstrated favorable body image perception when compared with the malignant lesion group. A confirmed diagnosis of malignancy hinders QoL in older and younger age groups. Conservative surgery and breast reconstruction improves QoL in younger patients without significance in the older group. The most significant variable that hinders the BIS and QoL is the cancer diagnosis. Impact of conservative surgery and breast reconstruction in body image perception and quality of life is influenced by patient age and educational level.

Predictors of adverse surgical outcome in the management of malignant bowel obstruction.

INTRODUCTION: Malignant bowel obstruction (MBO) is a common problem in patients with advanced colorectal or ovarian cancer. The management of this group of patients is complex and controversial. OBJECTIVE: To analyze the factors associated with morbidity and mortality in patients who underwent surgery for MBO in a tertiary referral center in Mexico City. MATERIAL AND METHODS: Hospital records of patients who underwent surgery for malignant bowel obstruction from January 1987 through December 2005 were retrospectively analyzed. Demographic data, clinical and surgical variables were recorded. Morbidity and mortality within 30-day of surgical procedure were registered. Factors associated with outcome were analyzed with the chi-square test. Survival curves were constructed with the Kaplan-Meier method. RESULTS: One-hundred and thirty patients were included. Primary neoplasm was the cause of bowel obstruction in 51 (39.2%) patients. Resection and anastomosis was performed in 45 patients (34.6%); in 30 cases (23.1%) a palliative estoma was constructed. Hospital mortality rate was 10.8%, and major postoperative morbidity was 16.2%. Factors associated with a significant increase in surgical mortality were: advanced patient age 17.2% (p = 0.009), hipoalbuminemia 14.45% (p = 0.027) and surgery performed for neoplasms different from those of gastrointestinal origin 17.6% (p = 0.005). Surgical morbidity was significantly higher in patients with poor performance status 16.2% (p = 0.017), advanced age 18% (p = 0.04), and low albumin levels 13.5% (p = 0.03). Median survival for the entire cohort was nine months (95% CI 5-13). Actuarial one, three and five year survival were 38.4, 27.5 and 25.4%, respectively. The most significant predictor of survival was performance status. CONCLUSIONS: When surgical management of MBO is considered, a careful assessment of the factors shown here to predict an adverse surgical outcome and poor prognosis is required.

Preemptive total gastrectomy for hereditary gastric cancer.

Hereditary gastric cancer is a recently described clinical syndrome, associated with truncating mutation of the E-cadherin gene, named CDH1. It is characterized by autosomal dominant transmission, presentation at an early age, and with diffuse type of gastric adenocarcinoma. Clinical management of these patients is challenging and includes intense endoscopic surveillance or prophylactic gastrectomy, which is associated with short- and long-term morbidity. We report four patients submitted to a prophylactic gastrectomy performed in members of three families with hereditary gastric cancer in a tertiary referral center in Mexico City. These are the first Hispanic families with hereditary gastric cancer reported in the literature.

Morbidity-associated factors after gastrojejunostomy for malignant gastric outlet obstruction.

Palliative care of malignant gastric outlet obstruction symptoms is critical for improved quality of life. We reviewed 66 consecutive patients with malignant gastric outlet obstruction who underwent palliative gastrointestinal bypass. The objective was to analyze morbidity and mortality-associated factors of this surgical procedure. Surgical morbidity and mortality were 39 per cent and 31 per cent, respectively. Reintervention was necessary in 16.6 per cent of cases. The only variable associated with surgical mortality was a Karnofsky score less than 80 (P = 0.02). Median survival of patients was 4 months (range, 2.11-5.9 months). Variables associated with shorter survival rates were an advanced stage of the disease and a Karnofsky score less than 80. Nine of 45 (20%) patients who survived after the gastrointestinal bypass surgery were unable to tolerate a normal diet. Palliative gastrojejunostomy in patients with malignant gastric outlet obstruction is associated with high morbidity and mortality; it is necessary to improve nonsurgical options such as endoscopic stenting.

[Total gastrectomy in the management of Ménétrie's disease. Institutional experience and review of the literature]. / Gastrectomía total en el manejo de la enfermedad de Ménétrier. Experiencia institucional y revisión de la literatura.

OBJECTIVE: Analyze retrospectively the clinical, histopathological and surgical characteristics of patients with Mindtrier's disease (MD) at our Institution. BACKGROUND DATA: Ménétrier's disease (MD) includes hipertophy of gastric mucosa, hipo or hiperchloridria and severe hipoalbuminemia. In the literature, it has been underestimated its relationship with the development of gastric carcinoma. METHODS: We analyzed retrospectively the clinical trials of patients with MD treated surgically at our Institution during the last three decades (From 1970 through 2002). RESULTS: Three patients with clinical diagnosis of MD underwent total gastrectomy during the study period. All of them were corroborated histopathologically and in one patient carcinoma in situ was demonstrated in the surgical specimen. CONCLUSIONS: There is a very limited experience with surgical treatment of MD and it is limited to patients who have severe hipoalbuminemia or associated malignant disease. However accordig to our experience and literature review, surgical treatment should be considered early in the course of the disease for the relationship between MD and gastric adenocarcinoma.

Radioguided occult lesion localization (ROLL) versus wire-guided lumpectomy for non-palpable breast lesions: a randomized prospective evaluation.

BACKGROUND: It is important to optimize the localization technique for non-palpable breast lesions. METHODS: One hundred consecutive women with non-palpable breast lesions were randomized to radioguided occult lesion localization (ROLL) or wire localization (WL). For ROLL technique (99m)Tc-labeled particles of human serum albumin were injected under breast-imaging control. Localization of the lesion was done in the operating room with the aid of a gamma-probe. All lesions were identified in an X-ray control of the surgical specimen. Categorical variables were analyzed with the Chi-square method. Significance was considered at P < 0.05. RESULTS: All procedures were performed on the same day of excision, on ambulatory basis. Both techniques resulted in 100% retrieval of the lesions. Localization time was reduced with ROLL (P < 0.001). Clear margins were achieved in 88.9% ROLLs and 62.5% WLs (P < 0.05) reducing the requirement of re-excision. There were significant differences in the subjective ease of the procedures in favor of ROLL technique as rated by surgeons and radiologists. CONCLUSIONS: ROLL technique is as effective as WL for excision of non-palpable breast lesions, reduce localization time and probably the incidence of pathologically involved margins of excision. ROLL appears to improve the learning curve for surgical residents and cosmesis. ROLL is an attractive alternative to WL.