RESUMEN
Obesity has long been recognized as a global epidemic. One of the most effective treatments is bariatric surgery. Since the first modern procedure was reported, it has evolved over time, and multiple techniques have emerged. More than 20 years ago, one of the most widely used techniques was the non-adjustable gastric band (NAGB), which showed very promising short-term results. However, over time, it became apparent that it was not as effective in the long term. Associated gastrointestinal symptoms, such as reflux and constant vomiting, along with considerable weight regain, caused this technique to fall out of favor and be replaced by other procedures like the gastric sleeve (GS). Although the technique has fallen into disuse and is no longer recommended in the literature, there are still patients with associated complications. Few recent cases associated with these complications have been reported. Most undergo band removal, and whether to perform another procedure remains with limited evidence. We present the case of a patient who underwent an NAGB procedure 10 years ago and later experienced symptoms (reflux) and weight regain. She successfully underwent band removal and conversion to a GS at our institute in Mexico.
RESUMEN
Obesity is a pathology that is increasing in incidence globally and threatens public health. Currently, one of its most effective treatments is bariatric surgery, which has shown the best long-term results. One of the most frequently performed surgical procedures in this area is laparoscopic sleeve gastrectomy (LSG) or vertical sleeve. It is a restrictive technique that has had positive results in weight loss. Situs inversus totalis (SIT) is a strange condition with a low incidence in which thoracic and abdominal organs are on the opposite side of the already-known anatomic site, seen on a sagittal plane. The high demand for laparoscopic bariatric surgeries predisposes surgeons to find rare congenital anomalies in patients. Low prevalence and the anatomic mirror image condition may be challenging even for expert surgeons. Medical teams need to have knowledge of these cases and adjust the technique and procedure to complete the surgery without complications. We present a SIT case successfully treated with LSG in a male patient in Mexico.
RESUMEN
Biliary fistula is a rare (less than 8%) cholecystectomy complication, internal fistulae being the most common of them (mainly colonic and duodenal). However, the presence of two fistulas at the same time is extremely rare, with a small number of cases reported in the literature to date. Symptoms tend to be non-specific, leading to a difficult preoperative diagnosis. The standard treatment for bilioenteric fistulas is open cholecystectomy and subsequent closure of the fistula. Nonetheless, modern techniques including laparoscopic and endoscopic approaches have been reported lately for their treatment with favorable results. We present a case of concomitant cholecystoduodenal and cholecystocolic fistula successfully treated with subtotal cholecystectomy and primary closure of the fistulous tracts by laparoscopic approach in a female Hispanic patient.
RESUMEN
BACKGROUND: The management of gallbladder perforation (GBP) with fistulous communication (Neimeier type I) is controversial. AIM: To recommend management options for GBP with fistulous communication. METHODS: A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines. The search strategy was conducted in Scopus, Web of Science, MEDLINE, and EMBASE (May 2022). Data extraction was obtained for patient characteristics, type of intervention, days of hospitalization (DoH), complications, and site of fistulous communication. RESULTS: A total of 54 patients (61% female) from case reports, series, and cohorts were included. The most frequent fistulous communication occurred in the abdominal wall. Patients from case reports/series had a similar proportion of complications between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) (28.6 vs 12.5; P = 0.569). Mortality was higher in OC (14.3 vs 0.0; P = 0.467) but this proportion was given by only one patient. DoH were higher in OC (mean 26.3 d vs 6.6 d). There was no clear association between higher rates of complications of a given intervention in cohorts, and no mortality was observed. CONCLUSION: Surgeons must evaluate the advantages and disadvantages of the therapeutic options. OC and LC are adequate options for the surgical management of GBP, with no significant differences.
RESUMEN
Low-grade fibromyxoid sarcoma (LGFMS) is a soft tissue neoplasm that occurs preferentially in young, male adults as a slowly growing, asymptomatic mass. According to current literature, the most common anatomical sites where it occurs are the trunk and lower extremities, especially the thigh, perineum, and groin. The risk factors are still unknown. Surgical intervention (simple resection and wide excision) is nowadays considered the best treatment option; however, patients require a long follow-up due to the high recurrence and metastasis rates. We present a low-grade fibromyxoid sarcoma case located in the abdominal wall of a female Hispanic patient.
RESUMEN
AIM: During the paranasal sinuses surgery different complications may occur, both vascular and bony. The objective of the present study was to evaluate the ethmoidal roof configuration through the Keros and Yenigun classifications, analyzing results stratified by gender and side. MATERIALS AND METHODS: We retrospectively analyzed 120 high-resolution computed tomography paranasal sinus study images and measured the depth of the cribriform plate in a coronal view and the anterior-posterior length in a cross section. RESULTS: The Keros Type II was the most frequent and no statistically significant difference was found when comparing by gender. Yenigun type I was more prevalent, and a statistically significant difference was found between men and women in types I and II (p = 0.010 and p = 0.049, respectively). Statistical difference was observed in anterior-posterior means in the comparison between both classifications. In both, right and left side for men (p = 0.003 and p = 0.05) and women (p = 0.029 and p = 0.039). CONCLUSION: We demonstrate the morphological variability that exists in this region. Gender differences that must be considered by the surgeon to avoid complications. Further studies are needed to evaluate the value of these findings when predicting surgical complications. A CT before PNS surgery is already widely accepted.