Association between gamma glutamyl transpeptidase to HDL-Cholesterol (GGT/HDL-C) ratio and metabolic syndrome resolution after sleeve gastrectomy.

OBJECTIVE: To evaluate the association between GGT/HDL-C ratio and resolution of MetS in adults after sleeve gastrectomy (SG). METHODS: We conducted a retrospective cohort study using secondary data from a Peruvian bariatric center. The study population consisted of adults aged 18 and above who underwent laparoscopic SG and were diagnosed with MetS prior to the surgery. The main outcome measured was MetS resolution 6 months post-surgery and the exposure variable was the GGT/HDL-C ratio. RESULTS: We analyzed 137 patients with a mean age of 38.9 ± 10.9 years; 64.2% were females. The median GGT/HDL-C ratio was 1.1 [0.7 - 1.5], and 83.9% of patients experienced resolution of MetS. Furthermore, both the middle tertile of GGT/HDL-C (aRR: 1.28; 95% CI: 1.04 - 1.58; p = .019) and the lowest tertile (aRR: 1.27; 95% CI: 1.01 - 1.60; p = .038) showed a significant association with the resolution of MetS. CONCLUSION: Eight out of 10 patients undergoing SG experience resolution of MetS within 6 months after surgery. Patients in the middle and lower tertiles of the GGT/HDL-C were more likely to achieve this outcome. Therefore, the GGT/HDL-C ratio should be considered a valuable and efficient biomarker for preoperative assessment of bariatric surgery candidates.

Diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has become the most frequent liver disease, closely related with metabolic risk factors such as obesity, insulin resistance, dyslipidemia, diabetes mellitus, and metabolic syndrome. In this context, γ-Glutamyl transpeptidase (GGT) and high-density lipoprotein cholesterol (HDL-C) have shown correlations with steatosis severity and metabolic syndrome, respectively. This positions the GGT/HDL-C ratio as a potential diagnostic indicator for NAFLD. OBJECTIVE: To assess the diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery. METHODS: We conducted an analytical cross-sectional study, designed as a diagnostic test evaluation. A secondary database of 249 adults with obesity was analyzed. The optimal cut-off point was ascertained using three methodologies, and five adjustment models were constructed for the total population, further stratified by sex. RESULTS: The optimal cut-off point was 20.5 U/mmol and the AUC of the ratio was 0.81 (95% CI: 0.64-0.98), with sensitivity and specificity being 82.5% and 77.8%, respectively. In the overall group with an elevated GGT/HDL-C ratio, the prevalence of NAFLD increased by 14% (PR: 1.14; 95% CI: 1.04-1.33). Specifically, women displaying this altered ratio showed a 19% increased prevalence (PR: 1.19; 95% CI: 1.07-1.42) compared to those with normal values. CONCLUSIONS: The GGT/HDL-C ratio is a promising biomarker for the diagnosis of NAFLD in an adult population living with obesity.

Diagnostic Performance of 2D Shear Wave (2D-SWE) for Liver Fibrosis in Adults Undergoing Bariatric Surgery.

BACKGROUND: Among the most recent methods to diagnose liver fibrosis is 2D shear wave elastography (2D-SWE). However, the evidence in the Latin population is limited, and there is no consensus on the cutoff points for each stage of fibrosis. AIM: To evaluate the diagnostic performance of 2D-SWE for liver fibrosis in adults with obesity who underwent bariatric surgery (BS). METHODS: We conducted a cross-sectional study on patients with obesity who underwent BS between 2020 and 2021. Liver stiffness measurement was reported as the mean of valid measurements in kilopascals made with the 2D-SWE. The outcome was biopsy-proven liver fibrosis. ROC curves were constructed for significant fibrosis (F≥2) and advanced fibrosis (F≥3), with their respective area under the curve (AUC). To obtain the best cutoff point for each scenario, we used the Youden index. The 95% confidence intervals (95% CI) for each cutoff point were estimated by bootstrap with 1000 replications. RESULTS: We analyzed data from 227 patients. The mean age was 37.8 ± 11.1 years and 65.2% were women. Overall, the AUC for significant and advanced fibrosis was 0.54 (95% CI: 0.47-0.62) and 0.73 (95% CI: 0.60-0.87), respectively. For advanced fibrosis, higher AUCs were found among women (AUC: 0.82; 95% CI: 0.59-1.00) and among patients with morbid obesity (AUC: 0.78; 95% CI: 0.61-0.99). CONCLUSION: The 2D-SWE appears to be a valuable tool for screening advanced liver fibrosis in candidates for BS, mainly in the female population and in adults with morbid obesity.

Hypertension and Histopathology Severity of Non-Alcoholic Fatty Liver Disease Among Adults with Obesity: A Cross-Sectional Study.

Background: Cardiovascular diseases are responsible for the majority of deaths resulting from non-alcoholic fatty liver disease (NAFLD). NAFLD is associated with hypertension and this is a key predictor of severe liver outcomes and an indicator of nonspecific portal fibrosis. Aim: To assess the association between hypertension and NAFLD severity. Methods: We conducted a secondary analysis of data from Peruvian adults with obesity and NAFLD who attended a Peruvian bariatric center. The severity of NAFLD was assessed using the Fatty Liver Inhibition of Progression algorithm / Steatosis, Activity and Fibrosis score. Hypertension was determined by either being recorded in the medical records or if the patient had a systolic pressure ≥ 140 mmHg or diastolic pressure ≥ 90 mmHg. To evaluate the association of interest, we calculated crude and adjusted prevalence ratios (aPR) using Poisson generalized linear models with logarithmic link function and robust variances. For the multivariable models, we adjusted for age, sex, physical activity and smoking. Results: Our study included 234 participants. The prevalence of hypertension was 19.2%, while the prevalence of severe NAFLD was 46.2%. After adjusting for confounders, the prevalence of hypertension was found to be significantly higher in the severe NAFLD group compared to the non-severe group (aPR = 1.33; 95% CI: 1.03-1.74). When stratified by the presence of metabolic syndrome (MetS), the association remained significant only in the group without MetS (aPR = 1.80; 95% CI: 1.05-3.11). Conclusion: We found an association between hypertension and severe NAFLD in adults with obesity, particularly in those without MetS.

Concordance between Different Criteria for Metabolic Syndrome in Peruvian Adults Undergoing Bariatric Surgery.

BACKGROUND: Metabolic Syndrome (MetS) is a clinical entity that has been linked to several non-communicable diseases. There are various consensuses to determine its presence, such as the IDF, ALAD, Harmonized, AHA/NHLBI, NCEP-ATP III or AACE criteria. However, there is currently no standardization to properly identify it. OBJECTIVE: To assess the diagnostic concordance between different criteria for MetS in Peruvian adults undergoing bariatric surgery. METHODS: We conducted a secondary analysis of the institutional database of a bariatric clinic located in Lima, Peru. We obtained data from adults between 18-59 years who underwent bariatric surgery (Roux-en-Y Gastric Bypass or Sleeve Gastrectomy). According to the Kappa coefficient, a heatplot was designed to analyze the concordance of the criteria. RESULTS: An almost perfect concordance was found between all criteria except AACE. The highest kappa coefficient (κ = 0.980) was recorded between the IDF and ALAD criteria using all the sample. Similar results were obtained when we stratified by sex. CONCLUSIONS: This study shows that, excluding the AACE, different criteria for metabolic syndrome could be used in Latino adults undergoing bariatric surgery with similar results. Given the postoperative implications, we believe that IDF and ALAD would be the best options in our population.

Factors Associated with Nutritional Deficiency Biomarkers in Candidates for Bariatric Surgery: A Cross-Sectional Study in a Peruvian High-Resolution Clinic.

Previous studies have described multiple nutritional deficiencies after bariatric surgery (BS). However, few studies have evaluated these deficiencies prior to BS, specifically in Latin America. This study aimed to determine the factors associated with nutritional deficiency biomarkers in candidates for BS in Peru. We included adults of both sexes, aged 18 to 59 years, admitted to a Peruvian clinic with a body mass index (BMI) ≥30 kg/m2; they were candidates for BS from 2017 to 2020. We considered the serum levels of hemoglobin and albumin (in tertiles) as the nutritional deficiency biomarkers. In order to assess the associated factors, we calculated crude (cPR) and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI). We analyzed 255 patients: 63.1% were males, with a mean age of 37.1 ± 10.3 years and mean hemoglobin and albumin values of 14.0 ± 1.5 g/dL and 4.6 ± 0.4 g/dL, respectively. We found that males (aPR = 1.86; 95%CI: 1.26-2.73; p = 0.002), participants between 30 and 49 (aPR = 2.02; 95%CI: 1.24-3.28; p = 0.004) or 50 years or more (aPR = 2.42; 95%CI: 1.35-4.35; p = 0.003), participants with a BMI ≥40 kg/m2 (aPR = 1.68; 95%CI: 1.09-2.60; p = 0.018), participants with impaired high-density lipoprotein levels (aPR = 1.43; 95%CI: 1.01-2.05; p = 0.049) and individuals in the high tertile of C-reactive protein (aPR = 6.94; 95%CI: 3.37-14.32; p < 0.003) had a higher probability of being in the lower tertile of albumin. In addition, we found that the male sex (aPR = 6.94; 95%CI: 3.37-14.32; p < 0.001) and elevated cholesterol levels (aPR = 0.71; 95%CI: 0.52-0.97; p = 0.034) were associated with the lowest hemoglobin tertile. In our setting, nutritional deficiency biomarkers were associated with sociodemographic, anthropometric and laboratory markers. The pre-bariatric surgery correction of nutritional deficiencies is essential, and can prevent major complications after surgery.

Latin American Research on Bariatric Surgery: a Bibliometric Study.

We performed a bibliometric analysis of Latin American documents published between 1984 to 2019 in Scopus-indexed journals. A total of 1856 documents were analyzed. The annual scientific production was 64 documents per year, with an annual increase rate of 15.9%. The countries with the highest scientific production on BS were Brazil (64.7%) and Chile (14.5%). Most of the publications were original (76.6%) and review articles (11.9%). The journal with the highest publication record was "Obesity Surgery" (25.8%). The extra-regional collaboration was mainly with the USA. In conclusion, Latin American scientific production on BS has shown a significant increase in recent years. However, more participation is needed, fostering intra-regional collaboration and involving universities and health institutions in BS research.

Hiperhidrosis esencial, recomendaciones para su tratamiento / Essential hyperhidrosis, recommendations for its treatment

La hiperhidrosis esencial, más que un aumento profuso y desproporcionado en la producción y excreción de sudor, de manos y pies, u otras zonas, es una entidad clínica propia, con una sintomatología específica y una manera de sudar cuyas características la hacen patonegmónica. Etiológicamente no está confirmado su origen, pero sí está claro que constituye un problema de salud más frecuente, y a su vez desconocido y subvalorado, que otras tantas enfermedades. Afortunadamente en la actualidad existe un interés científico internacional en el tema y la cirugía se ha convertido en una herramienta útil, considerada esta la mejor opción de tratamiento. Algunos efectos indeseables en su evolución posoperatoria ensombrecen el pronóstico y motivan a los investigadores a buscar variantes técnicas que permitan mejorar los resultados que se tienen hoy. Con este mismo interés se celebra en el Centro Nacional de Cirugía de Mínimo Acceso un taller nacional e internacional de hiperhidrosis cada año. En los últimos 3 años se han realizado reuniones de consensos al final de estos eventos científicos, con los profesares nacionales y foráneos invitados. Las conclusiones de estas reuniones constituyen el motivo de esta presentación, y tiene el objetivo de protocolizar su tratamiento para evitar al máximo efectos indeseables o resultados negativos(AU)

The essential hyperhidrosis more than a profuse and disproportionate increase in production and excretion of sweat in hands and feet and other sites, is an own clinical entity with a specific symptomatology and a way of to sweat whose features becomes pathognomonic. From the etiological point of view its origin is not confirmed but it is clear that it is a frequent health problem and in turn unknown and undervalued than many other diseases. Fortunately nowadays there is an international scientific interest on this subject and surgery becomes a useful tool, considered it as the better option of treatment. Some undesirable effects in its postoperative evolution cast a shadow on the prognosis and motivate researchers to look for techniques variants allowing for improve the current results. With this same interest in the National Center of Minimal Access a national and international workshop on hyperhidrosis is held each year. In past three years at the end of these scientific events consensus meeting have been held together with the invited national and foreign professors. Conclusions from these meeting are the objective of present paper to add its treatment to protocol avoiding most of undesirable effects or the negative effects(AU)

Tratamiento laparoscópico de los quistes hidatídicos hepáticos / Laparoscopic treatment of the hydatid liver cysts

En el tratamiento de los quistes hidatídicos hepáticos se han experimentado diversas técnicas quirúrgicas que van desde la aspiración, drenaje, capitonaje o marsupialización, hasta la escisión completa del mismo acompañada de resección segmentaria hepática. Con el advenimiento de la cirugía laparoscópica se inician nuevas opciones de abordaje para esta patología relativamente frecuente en nuestro país. En el presente trabajo mostramos la técnica laparoscópica que usamos para el tratamiento de los quistes hidatídicos hepáticos. Se realiza el diagnóstico por criterios de imágenes, epidemiológicos y de laboratorio. Se realiza el tratamiento médico con Albendazol 400 mg por día durante 90 días, previos a la cirugía. Usamos antibióticos profilaxis con un bactericida de amplio espectro. La cirugía se realiza con el paciente en posición decúbito dorsal y con portadas: umbilical, 10mm para la óptica angulada (30-45º), epigástrico, 10mm para el aspirador de 10mm, subcostal derecho sobre la línea medioclavicular. 5mm pinzas, y subcostal derecho sobre la línea axilar anterior para pinzas. Se realiza una laparoscopía diagnóstica y reconocimiento del quiste hepático. Se introducen gasas embebidas de CINa al 21 por ciento rodeando el quiste y especialmente la parte más protuida que será la zona de trabajo. Luego se realiza la punción del quiste, tomando muestras para laboratorio en búsqueda de escólex al examen en fresco, aspiración del contenido e inyección de CINa al 21 por ciento que permanece 5 minutos, realizando estos cambios 4-5 veces. Se toma un segmento de las paredes del quiste y adventicia que va a anatomía patológica. De encontrarse la membrana germinativa e hidátides hijas, se introduce uno o más bolsas de extracción de piezas para recogerlas. Se extrae con sumo cuidado la germinativa y las hidátides hijas para colocarlas en las bolsas y aproximarlas a la portada epigástrica, para desde fuera extraer su contenido hacia un recipiente con CINa al 21 por ciento...

Colecistectomía laparoscópica: reporte de 43 casos / Laparoscopic cholecystectomy: 43 cases report

La colecistectomía laparoscópica se está convirtiendo rápidamente en el procedimiento de elección para la extracción de la vesícula biliar. Este método ofrece indiscutibles ventajas en cuanto a la estancia hospitalaria, reincorporación al trabajo, dolor postoperatorio y resultado cosmético. Se presentan cuarentitres pacientes operados bajo este método, con nula mortalidad, sin complicaciones mayores y escasas complicaciones menores. Un caso fue convertido a cirugía abierta. Todos los pacientes evolucionaron favorablemente. Se confirma que la colecistectomía laparoscópica es un procedimiento seguro y factible de realizar en nuestro medio