Glucose tolerance in the proximal versus the distal small bowel in Wistar rats.

BACKGROUND: Type 2 diabetes is an epidemic and insulin resistance is the central etiology of this disease. Obesity increases insulin resistance and glucose intolerance and also exacerbates metabolic abnormalities present in type 2 diabetes. Bariatric surgery is the most effective treatment for severe obesity. Most reported series show that return to euglycemia and normal insulin levels occur days after gastric bypass and biliopancreatic diversion, long before major weight loss has taken place. The mechanisms underlying this dramatic reversal of type 2 diabetes following these bariatric procedures are not well understood. METHODS: Twelve Wistar rats were fed with a palatable hyperlipidic diet for 12 weeks. Body weight, glucose, and intraperitoneal glucose tolerance test were measured regularly. On day 91, they were randomized in two groups (hindgut and controls) and operated. Twenty-one days later, the tests were done again and the hindgut group re-operated. A duodenal exclusion was done. The results of an intraperitoneal glucose tolerance test were compared after the procedures. RESULTS: Body weight increased regularly in all the rats. Some rats developed hyperglycemia 28 days after beginning hyperlipidic diet, but these levels returned to baseline on days 56 and 84. The glucose tolerance test showed an improvement in glycemic levels in the hindgut group 21 days after the first operation (151 +/- 21mg/dl). After the second operation, despite weight loss, the glucose tolerance test of the foregut group worsened again (267 +/- 53 mg/dl) (p < 0.01). CONCLUSION: Comparing the "hindgut hypothesis" and the "foregut hypothesis", our data show an improvement in the 30 min glucose tolerance test in the hindgut group.

Cholecystectomy by single trocar access (SITRACC): the first multicenter study.

BACKGROUND: The advent of endoscopic surgery has radically changed surgery worldwide.The concept of minimally invasive procedures has spread quickly, allowing less pain and more rapid recovery for patients. The authors have developed a device for a new surgical approach, the so-called single trocar access (SITRACC). This study report the first multicenter study of cholecystectomies performed with SITRACC. METHODS: Between December 2008 and June 2009, 81 single trocar cholecystectomies were performed in 9 Brazilian surgery centers. RESULTS: The average operative time was 68 minutes. In all, 10 surgeries required 1 additional trocar because of technical problems, and 3 cholecystectomies were converted to standard video laparoscopies. CONCLUSION: A cholecystectomy using the SITRACC method is feasible and safe.

Single-port cholecystectomy in a patient with situs inversus totalis presenting with cholelithiasis: a case report.

INTRODUCTION: Situs inversus totalis (mirror image organs) is a rare condition and may affect the intra-abdominal viscera as well as the intrathoracic organs. Cholelithiasis is not more common in these conditions, but the diagnosis may be more difficult. CASE PRESENTATION: We present the case of a 59-year-old African woman with gallstones and situs inversus totalis. A single-port cholecystectomy was performed using a single trocar access device (SITRACC). CONCLUSIONS: The procedure was uneventful, showing that this approach may be an option for this kind of surgery even in patients with situs inversus totalis.