Bariatric Surgery Waiting Lists in Spain.

Bariatric surgery is one of the most common general surgery procedures in countries that, like Spain, have public healthcare systems, but is also one of the procedures for which patients have to wait the longest. The Spanish Society of Obesity Surgery (SECO) conducted a survey to estimate the situation of bariatric surgery waiting lists in Spain's public hospitals and to gather information on a number of related aspects. METHODS: An online survey was sent to the members of the SECO. The survey received 137 visits, all via the click-through link provided, from 52 health centers (47 public and 5 private). The data collected were included in a database and later analyzed using the SPSS18.0 statistical software package. RESULTS: A total of 4724 patients were on bariatric surgery waiting lists (BWLs), at an average of 100 per public hospital. Sixty-eight percent had been waiting for more than 6 months. The mean delay per patient was 397 days, and the longest wait was 1661 days. A further 46.2% of respondents were able to recall cases of patients who in the past 5 years had suffered cardiovascular events with sequelae while awaiting surgery, and 21.2% recalled at least one fatal cardiovascular event in that time. CONCLUSION: Our data revealed an unacceptably long wait for obesity surgery. Notwithstanding the limitations and potential biases of our research, the long wait for surgery in our context inevitably has serious consequences for a potentially significant number of patients.

[Perioperative anesthetic management of 300 morbidly obese patients undergoing laparoscopic bariatric surgery and a brief review of relevant pathophysiology]. / Tratamiento anestésico perioperatorio de 300 pacientes con obesidad mórbida sometidos a cirugía bariátrica laparoscópica y breve revisión fisiopatológica.

OBJECTIVES: Laparoscopic bariatric surgery is a challenge for anesthesiologists because morbidly obese patients are at high risk and laparoscopy may complicate respiratory and hemodynamic management. The aim of this study was to analyze the perioperative anesthetic management of morbidly obese patents undergoing laparoscopic bariatric surgery. MATERIAL AND METHODS: Prospective study of 300 consecutive patients diagnosed with morbid obesity and scheduled for laparoscopic bariatric surgery. Patients were positioned with a wedge cushion under the head and shoulders. A rapid sequence induction of anesthesia was carried out. A short-handled, articulated-blade McCoy laryngoscope was used for intubation; an intubation laryngeal mask airway (Fastrach) was on hand as a rescue device. Propofol and remifentanil were used for maintenance of anesthesia and morphine was administered at the end of surgery. Incentive spirometry was initiated in the postanesthetic recovery unit. RESULTS: Eighty percent of the patients were women with a mean (SD) body mass index (kg/m2) of 46 (5). The first choice of direct laryngoscopic intubation was successful in 98.6% of cases. All patients were successfully intubated. Only 5 patients required intensive care. Postoperative complications (mainly respiratory problems, bleeding, and infections) were observed in 17%. No patient died. CONCLUSIONS: Perianesthetic management of morbidly obese patients who undergo laparoscopic surgery is safe. To minimize pulmonary complications, preoxygenation and rapid sequence induction should be performed correctly and incentive spirometry should be initiated in the immediate postoperative period. The McCoy laryngoscope ensures intubation in most cases.

Lipoma of the liver associated with hepatocellular carcinoma and polycystic liver disease.

BACKGROUND/AIMS: We report on a patient with lipoma of the liver associated with hepatocellular carcinoma (HCC) and polycystic liver disease. METHODS: Clinical features of a patient with lipoma, HCC and polycystic liver disease are presented. A right liver lobectomy was performed. RESULTS: Histological examination revealed a poorly differentiated multicentric HCC, as well as bile duct cysts and an encapsulated tumor of adipose tissue. The postoperative course was uncomplicated. The patient died 4 years after surgery with local recurrence of HCC. CONCLUSION: We find the report to be of interest because of the unusual nature of this association and the low prevalence of lipoma of the liver. The association of liver polycystic disease with other types of tumor is discussed and the literature dealing with lipomas of the liver reviewed.

Gastric and duodenal stents: follow-up and complications.

PURPOSE: To assess the efficacy of self-expanding metallic stents in treating inoperable gastric and duodenal stenoses during follow-up and to evaluate the complications encountered. METHODS: A total of 31 patients suffering from gastroduodenal obstruction (29 malignant, 2 benign) were treated with a self-expanding metallic stent (Wallstent). In 24 cases insertion was by the peroral route, in seven cases via gastrostomy. RESULTS: All the strictures were successfully negotiated under fluoroscopic guidance without having to resort to endoscopy. A total of 27 patients (87%) were able to resume a regular diet, a soft diet, or a liquid diet orally. Complications included one case of stent malpositioning, one case of leakage of ascitic fluid through the gastrostomy orifice, one case of perforation and fistula to the biliary tree, and two cases of hematemesis. In two patients (6%) additional stents were implanted to improve patency. In all patients follow-up was maintained until death. Recurrence of symptoms immediately before death occurred in seven cases (23%). Mean survival time of patients was 13.3 weeks (SE +/- 4.6). CONCLUSIONS: The deployment of gastroduodenal stents resulted in good palliation of inoperable gastric and duodenal stenoses. Certain technical aspects, e.g., adaptation of stents to bowel morphology, is critical to proper stent function and avoidance of complications.

Tissucol application in dermolipectomy and incisional hernia repair.

Biological adhesives have a lot of applications in surgical procedures. Here we present a prospective study with the aim of analyzing results of the application of Tissucol between the muscle layers and subcutaneous tissue after incisional hernia repair with polypropylene mesh and associated dermolipectomy. We assess clinical and technical parameters, local morbidity, and hospital stay. Fifty-six patients were divided into two groups. Patients with whom we used fibrin glue were older, with more obesity (P < 0.005) with associated diseases, and their incisional hernias were larger and more complicated to repair. Patients in the Tissucol group developed less local morbidity (hematomas or abscesses; P < 0.01), had a shorter mean hospital stay (P < 0.01), and required less wound care. The use of Tissucol improves the results of surgical repair of large abdominal incisional hernias repaired by mesh placement and dermolipectomy, and it decreases global morbidity and hospital stay are reduced.

[Gas gangrene secondary to carcinoma of the colon]. / Gangrena gaseosa secundaria a carcinoma de colon.

Systemic infections due to enteric bacteria can develop in patients with occult intestinal tumours. A patient with a sigmoid adenocarcinoma that developed crepitation and necrosis of soft tissues in gluteous region and thigh of left lower limb is presented. No pus or free fluid was observed in the peritoneal cavity; a sigmoid tumor infiltrating and perforating the retroperitoneum with necrosis of the psoas muscle was found. The infection spread subsequently through the inguinal canals and sciatic foramen to the lower limb. Necrotizing infections of soft tissues without previous trauma or ischemic accident leads to the suspicion of an occult digestive disease.

[Nonepithelial malignant degeneration of esophageal duplication]. / Degeneración maligna no epitelial de una duplicación esofágica.

A communicating duplication of the distal esophagus was diagnosed in an elderly patient. The lesion was removed and the connection with the esophageal lumen closed. A high grade leiomyosarcoma involving all duplication layers and the right pleural surface was demonstrated. This is the first reported instance of a nonepithelial malignant tumor in an alimentary tract duplication.

Congenital oesophagobronchial fistula in an adult involving left main bronchus.

Congenital fistulae between the tracheobronchial tree and oesophagus usually originate from the lower end of the trachea or right main bronchus. The case history is presented of a man in whom a fistula between the oesophagus and left main bronchus was not diagnosed until the age of 48.

[Massive lithiasis of the intra and extrahepatic bile ducts. Presentation of a clinical case]. / Litiasis masiva de la vía biliar intra y extrahepática. Presentación de un caso clínico.

A case of massive intra and extrahepatic lithiasis in a 52 year-old-man is presented. Diagnosis was confirmed by ultrasonography, CT and percutaneous cholangiography. The value of the different diagnostic procedures is analyzed. The need for elective surgical treatment is insisted on in order to remove the majority of the calculi, treatment of stenosis and adequate biliary drainage. Our case was treated with an hepatico-jejuno-duodenostomy (end to side) on an isolated jejunal loop with sphincteroplasty for drainage of the distal choledochus. In the postoperative period the patient was treated with Methyl-tert-butyl-ether for dissolution of the remaining calculi.