Laparoscopic Conversion of Gastric Plication to Roux-en-Y Gastric Bypass.

PURPOSE: Laparoscopic gastric plication (LGP) is a relative new bariatric procedure with a high revision rate, mostly to sleeve gastrectomy. There are few reported cases of conversion to Roux-en-Y gastric bypass (RYGB). The purpose of this video was to show the feasibility and safety, as well as the main technical aspects, of a laparoscopic conversion of gastric plication to RYGB. MATERIALS AND METHODS: A 40-year-old morbidly obese woman with a previous LGP, consulted for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD) symptoms, and was converted to RYGB. RESULTS: Surgical technique included lysis of adhesions between the stomach and the greater omentum, take down of the plication, partial gastrectomy of the devascularized fundus and body and conversion to RYGB. At 30 months, she has achieved a total weight loss (TWL) of 42.43% with no GERD symptoms recurrence. CONCLUSION: Conversion to RYGB is a safe and effective option to treat weight recidivism and GERD after LGP.

What have we learned in minimally invasive colorectal surgery from NSQIP and NIS large databases? A systematic review.

BACKGROUND: "Big data" refers to large amount of dataset. Those large databases are useful in many areas, including healthcare. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the National Inpatient Sample (NIS) are big databases that were developed in the USA in order to record surgical outcomes. The aim of the present systematic review is to evaluate the type and clinical impact of the information retrieved through NISQP and NIS big database articles focused on laparoscopic colorectal surgery. METHODS: A systematic review was conducted using The Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. The research was carried out on PubMed database and revealed 350 published papers. Outcomes of articles in which laparoscopic colorectal surgery was the primary aim were analyzed. RESULTS: Fifty-five studies, published between 2007 and February 2017, were included. Articles included were categorized in groups according to the main topic as: outcomes related to surgical technique comparisons, morbidity and perioperatory results, specific disease-related outcomes, sociodemographic disparities, and academic training impact. CONCLUSIONS: NSQIP and NIS databases are just the tip of the iceberg for the potential application of Big Data technology and analysis in MIS. Information obtained through big data is useful and could be considered as external validation in those situations where a significant evidence-based medicine exists; also, those databases establish benchmarks to measure the quality of patient care. Data retrieved helps to inform decision-making and improve healthcare delivery.

Síndrome de Eagle, apófisis estiloides con prolongación hasta el hioides / Eagle syndrome, styloid process with prolongation to the hyoid

Se presenta un caso de un paciente de 48 años que fue tratado inicialmente por síndrome de articulación temporomandibular; posteriormente se diagnosticó apófisis estiloides mayor a 8 cm que se prolongaba hasta el hioides bilateralmente. Refería intenso dolor a predominio izquierdo en cabeza y cuello. La radiografía panorámica y la tomografía computada 3 D permitieron evaluar la dimensión de las apófisis. Se intervino quirúrgicamente el lado izquierdo que resultaba ser el más sintomático, por vía externa con buena evolución sin morbilidad..(AU)

It is presented a case of a 48 year male who was treated initially by temporomandibular malfunction; lately was diagnosed a styloid process longer than 8 cm that extended up to hyoids bilaterally. He referred an intense pain especially in the left side of head and neck. The panoramic radiography and the tomography scan with 3 dimension reconstruction allowed us to evaluate the process dimension. We underwent an external access surgery on the more symptomatic side. The evolution was good without complications..(AU)

Outcomes after bariatric surgery according to large databases: a systematic review.

PURPOSE: The rapid development of technological tools to record data allows storage of enormous datasets, often termed "big data". In the USA, three large databases have been developed to store data regarding surgical outcomes: the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). We aimed to evaluate the clinical impact of studies found in these databases concerning outcomes of bariatric surgery. METHODS: We performed a systematic review using the Meta-analysis of Observational Studies in Epidemiology guidelines. Research carried out using the PubMed database identified 362 papers. All outcomes related to bariatric surgery were analysed. RESULTS: Fifty-four studies, published between 2005 and February 2017, were included. These articles were divided into (1) outcomes related to surgical techniques (12 articles), (2) morbidity and mortality (12), (3) 30-day hospital readmission (10), (4) outcomes related to specific diseases (11), (5) training (2) and (6) socio-economic and ethnic observations in bariatric surgery (7). Forty-two papers were based on data from ACS-NSQIP, nine on data from NIS and three on data from MBSAQIP. CONCLUSIONS: This review provides an overview of surgical management and outcomes of bariatric surgery in the USA. Large databases offer useful complementary information that could be considered external validation when strong evidence-based medicine data are lacking. They also allow us to evaluate infrequent situations for which randomized control trials are not feasible and add specific information that can complement the quality of surgical knowledge.