Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test.

BACKGROUND: The relation between hunger, satiation, and integrated gastrointestinal motility and hormonal responses in morbidly obese patients after sleeve gastrectomy has not been determined. OBJECTIVE: The objective was to assess the effects of sleeve gastrectomy on hunger, satiation, gastric and gallbladder motility, and gastrointestinal hormone response after a liquid meal test. DESIGN: Three groups were studied: morbidly obese patients (n = 16), morbidly obese patients who had had sleeve gastrectomy (n = 8), and nonobese patients (n = 16). The participants fasted for 10 h and then consumed a 200-mL liquid meal (400 kcal + 1.5 g paracetamol). Fasting and postprandial hunger, satiation, hormone concentrations, and gastric and gallbladder emptying were measured several times over 4 h. RESULTS: No differences were observed in hunger and satiation curves between morbidly obese and nonobese groups; however, sleeve gastrectomy patients were less hungry and more satiated than the other groups. Antrum area during fasting in morbidly obese patients was statistically significant larger than in the nonobese and sleeve gastrectomy groups. Gastric emptying was accelerated in the sleeve gastrectomy group compared with the other 2 groups (which had very similar results). Gallbladder emptying was similar in the 3 groups. Sleeve gastrectomy patients showed the lowest ghrelin concentrations and higher early postprandial cholecystokinin and glucagon-like peptide 1 peaks than did the other participants. This group also showed an improved insulin resistance pattern compared with morbidly obese patients. CONCLUSIONS: Sleeve gastrectomy seems to be associated with profound changes in gastrointestinal physiology that contribute to reducing hunger and increasing sensations of satiation. These changes include accelerated gastric emptying, enhanced postprandial cholecystokinin and glucagon-like peptide 1 concentrations, and reduced ghrelin release, which together may help patients lose weight and improve their glucose metabolism after surgery. This trial was registered at clinicaltrials.gov as NCT02414893.

[Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome]. / Hernioplastia inguinal electiva en pacientes con anticoagulación oral. ¿Son candidatos a cirugía ambulatoria?

BACKGROUND: Perioperative management of patients on anticoagulant therapy increases the complexity of elective inguinal hernia repair. We assessed the safety of our standardised anticoagulation protocol and investigated the outpatient and one day surgery rates. MATERIAL AND METHODS: The records of 1184 patients undergoing elective inguinal hernioplasty between 2005 and 2007 were reviewed; 14 patients on chronic anticoagulation therapy were identified. We used a standard bridging therapy protocol with low-molecular-weight heparins. Outcomes were assessed at 30 days post-procedure and included bleeding, thromboembolic events or death and type of hospital admission. RESULTS: Mean age was 74+/-10 years; 12 (25%) patients were high risk for thromboembolism and 31 (67%) patients were ASA III. Almost all inguinal repairs were performed using a polypropylene mesh; 6 (13%) patients had a surgical site haematoma and there was 1 (2.7%) major bleeding, that was re-operated on. No thromboembolic events or deaths occurred; 11 (23%) patients were treated on an outpatient basis and 16 (34%) on a one day surgery regimen. Mean hospital stay was 2.4+/-5.1 days. CONCLUSIONS: Elective inguinal hernioplasty in patients on chronic oral anticoagulation therapy using a standard bridging protocol is a safe procedure. Chronic anticoagulation therapy is not a contraindication for ambulatory surgery.

[Planning, management and results of the implantation of laparoscopic surgery of the colon and rectum in a general hospital]. / Planificación, gestión y resultados de la implantación de la cirugía laparoscópica de colon y recto en un hospital general.

INTRODUCTION: The introduction of laparoscopic surgery in a hospital is a slow process requiring the involvement of a multidisciplinary team. PATIENTS AND METHOD: We performed a prospective, descriptive study of all patients who underwent laparoscopic surgery of the colon and rectum in the Mataró Hospital between 2003 and 2006. We also describe the model used to introduce laparoscopic surgery of the colon and rectum in our center. RESULTS: Between 2003 and 2006, 166 patients with colorectal disease underwent laparoscopic surgery. Patients included for rectal disease represented 36% of the total. The conversion rate was 7% of the mean in all the periods studied, with a complications rate of 13.25%. CONCLUSIONS: The controlled development of laparoscopic surgery allows satisfactory results to be obtained in colorectal disease.

[Gallbladder adenocarcinoma: tumoral staging, histological prognostic factors and survival]. / Adenocarcinoma de vesícula biliar: estadio tumoral, factores pronósticos histológicos y supervivencia.

INTRODUCTION: Gallbladder adenocarcinoma is an aggressive tumor and is one of the digestive tract malignancies with the poorest prognosis. Because of loco-regional extension and delayed diagnosis, curative resection is often impossible. To determine histological prognostic factors and survival in relation to tumoral stage at diagnosis, we performed a retrospective study of our patients with gallbladder carcinoma. PATIENTS AND METHOD: Sixty-two patients with gallbladder adenocarcinoma diagnosed over a 15-year period were retrospectively included in this study. The surgical procedures performed in this group of patients were laparoscopic cholecystectomy, open cholecystectomy and palliative surgery in patients with unresectable tumors. For each tumoral stage, age, sex, cellular differentiation, tumor size, the presence of metastatic nodes, histological variables linked to poor prognosis, and survival were compared. RESULTS: Of the 62 patients included, 45 were women and 17 were men. The mean age was 75 years. No significant differences were found in relation to age or sex among the different tumoral stages. Cellular differentiation and survival were poorer with advanced tumoral stage. A significant predominance of histological factors of poor prognosis was found in T2 and T3 tumors. CONCLUSIONS: Preoperative diagnosis of gallbladder adenocarcinoma is difficult except in advanced cases. It is often incidentally diagnosed at histological examination of gallbladders, and shows little local advancement and a good degree of cellular differentiation. The etiology of this tumor is unknown but its prevalence is greater among women. Clinical symptoms are similar to those caused by gallstones. In this study no relationship was found between age and sex and tumoral stage. In advanced tumoral stages poor cellular differentiation is predominant as well as other histological markers of poor prognosis. Good survival was found in T3 tumors, possibly linked to good cellular differentiation. Due to high associated comorbidity, none of the patients underwent reintervention.

[Diverticular disease of the cecal appendix]. / Enfermedad diverticular del apéndice cecal.

INTRODUCTION: Appendiceal diverticula are uncommon, with an incidence of less than 1% in surgical specimens. We report a series of 14 patients with diverticular disease of the cecal appendix. PATIENTS AND METHOD: A total of 547 patients with a clinical diagnosis of acute appendicitis underwent surgery over 4 years. Of these, 11 patients showed acute appendiceal diverticulitis at histological examination, and three patients showed diverticulosis associated with appendicitis. Clinical features were compared between the group of patients with diverticular disease and the group with acute appendicitis. Statistical analysis was performed using Students t-test and the chi-squared test. RESULTS: The overall incidence of appendiceal diverticula was 2.6%, and 2% of cases had acute diverticulitis. In the group with diverticular disease, the mean age and the percentage of patients under clinical observation before the decision to perform surgery was made were significantly higher. There was a nonsignificant predominance of male over female patients and no differences were found in mean white cell count. No radiological investigations were performed in the diverticular group. CONCLUSIONS: The incidence of appendiceal diverticula was much higher in our series than that reported in the literature. We found no clinical or perioperative data that would serve to differentiate acute diverticulitis from acute appendicitis.

Hernioplastia inguinal electiva en pacientes con anticoagulación oral. ¿Son candidatos a cirugía ambulatoria? / Elective inguinal hernioplasty in patients on chronic anticoagulation therapy. Management and outcome

Introducción El tratamiento perioperatorio de los pacientes con anticoagulantes orales (ACO) incrementa la complejidad de la hernioplastia inguinal electiva. Objetivo Analizar la seguridad de nuestro protocolo de tratamiento en pacientes con ACO intervenidos de hernioplastia inguinal electiva y valorar el porcentaje de pacientes tratados mediante cirugía ambulatoria y cirugía de corta estancia. Material y métodos Se revisaron los datos administrativos de 1.184 pacientes intervenidos de hernioplastia inguinal en 2005 2007 y se identificó a 47 pacientes en tratamiento con ACO. Se utilizó, como tratamiento puente perioperatorio, un protocolo estandarizado con heparinas de bajo peso molecular (HBPM). Los resultados se analizaron hasta 30 días después del procedimiento e incluían las siguientes variables: hemorragia, episodios tromboembólicos o muerte y régimen hospitalario (cirugía mayor ambulatoria, corta estancia o ingreso convencional).Resultados La media de edad fue 74±10 años; 12 (25%) pacientes tenían un alto riesgo tromboembólico y 31 (67%) pacientes tenían la categoría ASA III. La técnica quirúrgica de elección fue la hernioplastia sin tensión con mallas de polipropileno. En 6 (13%) pacientes se diagnosticó hematoma de la herida quirúrgica y 1 (2,1%) paciente sufrió una hemorragia mayor que precisó de reintervención. Ningún paciente tuvo episodios tromboembólicos y no hubo fallecimientos. A 11 (23%) pacientes se trató de forma ambulatoria y a 16 (34%), en régimen de cirugía de corta estancia. La media de estancia hospitalaria fue 2,4±5,1 días. Conclusiones La hernioplastia inguinal electiva en pacientes con ACO, mediante una terapia puente con HBPM, es un procedimiento seguro. La anticoagulación oral no es una contraindicación absoluta para la cirugía ambulatoria (AU)

Background Perioperative management of patients on anticoagulant therapy increases the complexity of elective inguinal hernia repair. We assessed the safety of our standardised anticoagulation protocol and investigated the outpatient and one day surgery rates. Material and methods The records of 1184 patients undergoing elective inguinal hernioplasty between 2005 and 2007 were reviewed; 14 patients on chronic anticoagulation therapy were identified. We used a standard bridging therapy protocol with low-molecular-weight heparins. Outcomes were assessed at 30 days post-procedure and included bleeding, thromboembolic events or death and type of hospital admission. Results Mean age was 74±10 years; 12 (25%) patients were high risk for thromboembolism and 31 (67%) patients were ASA III. Almost all inguinal repairs were performed using a polypropylene mesh; 6 (13%) patients had a surgical site haematoma and there was 1 (2.7%) major bleeding, that was re-operated on. No thromboembolic events or deaths occurred; 11 (23%) patients were treated on an outpatient basis and 16 (34%) on a one day surgery regimen. Mean hospital stay was 2.4±5.1 days. Conclusions Elective inguinal hernioplasty in patients on chronic oral anticoagulation therapy using a standard bridging protocol is a safe procedure. Chronic anticoagulation therapy is not a contraindication for ambulatory surgery (AU)

Planificación, gestión y resultados de la implantación de la cirugía laparoscópica de colon y recto en un hospital general / Planning, management and results of the implantation of laparoscopic surgery of the colon and rectum in a general hospital

Introducción. La introducción de la cirugía laparoscópica avanzada en un hospital es un proceso lento que requiere la implicación de un equipo multidisciplinario. Pacientes y método. Presentamos un estudio prospectivo y descriptivo de todos los pacientes intervenidos por laparoscopia de colon y recto en el Hospital de Mataró entre los años 2003 y 2006. Conjuntamente se describe el modelo de implantación de la cirugía laparoscópica de colon y recto en nuestro centro. Resultados. Entre 2003 y 2006 se intervino por laparoscopia a 196 pacientes con enfermedad colorrectal. El porcentaje de pacientes intervenidos por afección rectal alcanzó en el último período el 36% del total. La media del índice de conversión en todos los períodos estudiados fue el 7%, con una tasa de complicaciones del 13,25%. Conclusiones. El desarrollo de la técnica laparoscópica de forma controlada permite obtener unos resultados satisfactorios en la cirugía de colon y recto (AU)

Introduction. The introduction of laparoscopic surgery in a hospital is a slow process requiring the involvement of a multidisciplinary team. Patients and method. We performed a prospective, descriptive study of all patients who underwent laparoscopic surgery of the colon and rectum in the Mataró Hospital between 2003 and 2006.We also describe the model used to introduce laparoscopic surgery of the colon and rectum in our center. Results. Between 2003 and 2006, 166 patients with colorectal disease underwent laparoscopic surgery. Patients included for rectal disease represented 36% of the total. The conversion rate was 7% of the mean in all the periods studied, with a complications rate of 13.25%. Conclusions. The controlled development of laparoscopic surgery allows satisfactory results to be obtained in colorectal disease (AU)

Fístula aortoentérica secundaria: revisión de la literatura a propósito de un caso / No disponible

Las fistulas aortoentéricas constituyen una complicación grave de la cirugía protésica por su elevada morbi-motalidad. La forma de presentación clínica más frecuente es en forma de hemorragia digestiva alta masiva, hipotensión y shock. No obstante, en algunos casos las manifestaciones clínicas aparecen en forma de fiebre y molestias abdominales poco específicas que permiten realizar su diagnóstico. La tomografía axial computerizada y la fibrogastroscopia constituyen los estudios diagnósticos de elección por su elevada resolución. El tratamiento debe ser siempre quirúrgico, con la resección de la prótesis en su totalidad, ligadura de la arteria aorta a nivel infrarrenal, revascularización de las extremidades mediante un bypass axilo-bifemoral y extirpación del segmento de intestino delgado perforado (AU)

Aortoenteric fistulas are an important complication of protesic surgery due to their high morbidity an mortality. The most frequent form of clinical manifestation is the massive upper gastrointestinal bleeding, hypotension and shock. However, in some cases the feber and the abdominal pain may be the only manifestation. The computerized tomography and the oral endoscopy are the most useful complementary techniques. Treatment almost always requires excision of the infected graft and revascularization with an extra anatomic bypass followed by perforated duodenum excision (AU)

Adenocarcinoma de vesícula biliar: estadio tumoral, factores pronósticos histológicos y supervivencia / Gallbladder adenocarcinoma: tumoral staging, histological prognostic factors and survival

Introducción. El adenocarcinoma de vesícula biliar, debido a su comportamiento biológico sumamente agresivo, es uno de los tumores digestivos de peor pronóstico. En muchas ocasiones, debido a la afección locorregional y al retardo del diagnóstico, la resecabilidad con intención curativa es imposible. Presentamos, desde el punto de vista histopatológico, un estudio retrospectivo de los adenocarcinomas de vesícula biliar diagnosticados en nuestra área de influencia y evaluamos, según el estadio tumoral, los factores pronósticos histológicos y la supervivencia. Pacientes y método. Se considera a un total de 62 casos de adenocarcinoma de vesícula biliar en un período de 15 años. Realizamos la colecistectomía por vía laparoscópica, por laparotomía o tratamiento paliativo en los casos irresecables. Se comparan para cada estadio tumoral la edad, el sexo, el grado de diferenciación celular, el tamaño tumoral, la presencia de adenopatías metastásicas, los factores de mal pronóstico histológico y la supervivencia. Resultados. Predomina el número de mujeres respecto al de varones (45/17). La edad media del grupo es de 75 años. No hallamos diferencias significativas respecto a la edad y el sexo entre los diferentes grupos. El grado de diferenciación celular y la supervivencia van empeorando a medida que progresa el estadio tumoral. Hay un predominio significativo de los factores de mal pronóstico histológico en los estadios T2 y T3. Conclusiones. Es difícil diagnosticar el adenocarcinoma de la vesícula biliar de forma preoperatoria, excepto en los casos avanzados. Suelen ser hallazgos incidentales en el estudio histológico postoperatorio, localmente poco avanzados y con buen grado de diferenciación celular. La etiología es desconocida, aunque con un gran predominio en las mujeres. La clínica se superpone a la patología de la vesícula habitada. En nuestro estudio, la edad y el sexo no se relacionan con el estadio tumoral. En estadios tumorales avanzados predomina la mala diferenciación celular, junto con factores de mal pronóstico histológico. Se describe una alta supervivencia para los tumores en estadio T3, posiblemente por la buena diferenciación celular. No hemos reintervenido a ningún paciente, dada la elevada comorbilidad asociada (AU)

Introduction. Gallbladder adenocarcinoma is an aggressive tumor and is one of the digestive tract malignancies with the poorest prognosis. Because of loco-regional extension and delayed diagnosis, curative resection is often impossible. To determine histological prognostic factors and survival in relation to tumoral stage at diagnosis, we performed a retrospective study of our patients with gallbladder carcinoma. Patients and method. Sixty-two patients with gallbladder adenocarcinoma diagnosed over a 15-year period were retrospectively included in this study. The surgical procedures performed in this group of patients were laparoscopic cholecystectomy, open cholecystectomy and palliative surgery in patients with unresectable tumors. For each tumoral stage, age, sex, cellular differentiation, tumor size, the presence of metastatic nodes, histological variables linked to poor prognosis, and survival were compared. Results. Of the 62 patients included, 45 were women and 17 were men. The mean age was 75 years. No significant differences were found in relation to age or sex among the different tumoral stages. Cellular differentiation and survival were poorer with advanced tumoral stage. A significant predominance of histological factors of poor prognosis was found in T2 and T3 tumors. Conclusions. Preoperative diagnosis of gallbladder adenocarcinoma is difficult except in advanced cases. It is often incidentally diagnosed at histological examination of gallbladders, and shows little local advancement and a good degree of cellular differentiation. The etiology of this tumor is unknown but its prevalence is greater among women. Clinical symptoms are similar to those caused by gallstones. In this study no relationship was found between age and sex and tumoral stage. In advanced tumoral stages poor cellular differentiation is predominant as well as other histological markers of poor prognosis. Good survival was found in T3 tumors, possibly linked to good cellular differentiation. Due to high associated comorbidity, none of the patients underwent reintervention (AU)

Enfermedad diverticular del apéndice cecal / Diverticular disease of the cecal appendix

Introducción. Los divertículos apendiculares constituyen una rareza y su incidencia es < 1%. Se presenta una serie de 14 pacientes con este diagnóstico. Pacientes y método. De un total de 547 pacientes intervenidos por apendicitis aguda durante un período de 4 años, 11 presentaban una diverticulitis apendicular aguda y 3 una diverticulosis asociada a apendicitis. Se comparan las características clínicas entre el grupo de pacientes con enfermedad diverticular del apéndice y el grupo de apendicitis aguda. El estudio estadístico se realiza mediante el test de la t de Student y el test de la (..) (AU)

Introduction. Appendiceal diverticula are uncommon, with an incidence of less than 1% in surgical specimens. We report a series of 14 patients with diverticular disease of the cecal appendix. Patients and method. A total of 547 patients with a clinical diagnosis of acute appendicitis underwent surgery over 4 years. Of these, 11 patients showed acute appendiceal diverticulitis at histological examination, and three patients showed diverticulosis associated with appendicitis. Clinical features were compared between the group of patients with diverticular disease and the group with acute appendicitis. Statistical analysis was performed using Student’s t-test and the chi-squared test. Results. The overall incidence of appendiceal diverticula was 2.6%, and 2% of cases had acute diverticulitis. In the group with diverticular disease, the mean age and the percentage of patients under clinical observation before the decision to perform surgery was made were significantly higher. There was a nonsignificant predominance of male over female patients and no differences were found in mean white cell count. No radiological investigations were performed in the diverticular group. Conclusions. The incidence of appendiceal diverticula was much higher in our series than that reported in the literature. We found no clinical or perioperative data that would serve to differentiate acute diverticulitis from acute appendicitis (AU)

Metástasis cutánea de carcinoma de vejiga urinaria productor de gonadotrofina coriónica humana / Skin metastasis from urinary bladder carcinoma producing human chorionic gonadotropin

Las metástasis cutáneas de carcinomas originados en órganos internos son infrecuentes. Entre ellas, las metástasis originadas en un carcinoma de vejiga urinaria son excepcionales. Presentamos el caso de un paciente de 74 años con un carcinoma de células transicionales de la vejiga urinaria al que se practicó una resección endoscópica; con posterioridad recibió tratamiento quimioterápico. En el curso evolutivo de la enfermedad, el paciente desarrolló una lesión exofítica en la piel preesternal. Tras la exéresis quirúrgica de la lesión cutánea, mediante estudio inmunohistoquímico pudo demostrarse la presencia de gonadotrofina coriónica humana, tanto en la tumoración de la piel como en el carcinoma de células transicionales, estableciéndose así el diagnóstico de metástasis cutánea. La transformación parcial del tejido del carcinoma de células transicionales de vejiga urinaria en tejido sincitiotrofoblástico causó la producción y secreción de gonadotrofina coriónica humana. Asimismo, se determinaron las concentraciones plasmáticas de hormona, que resultaron muy elevadas, lo que parece asociarse con una mayor agresividad tumoral y un peor pronóstico (AU)