Revisional Robotic Bariatric Surgery. Largest Single Centre Prospective Cohort Study and Review of the Literature.

Introduction: Robotic bariatric surgery (RBS) has seen a surge in popularity in recent years, yet questions persist about its utility concerning postoperative complications, costs, and technical aspects. RBS, while increasing in number, presents a greater technical challenge associated with more post-operative complications compared to primary bariatric surgery. In this study, we present our single institution experience and review the literature to assess the value of robotic revisional surgery. Material and Method: The retrospective review involved 42 patients (31 females, 11 males) who underwent various procedures, with the most frequent being the conversion of sleeve gastrectomy to gastric bypass (n=30). Encouragingly, no leaks or severe complications were identified. Furthermore, a systematic review indicated comparable outcomes, with decreased complication rates favoring robotic revisional surgery. Results: In direct comparison to standard laparoscopic revisional bariatric surgery, revisional robotic surgery demonstrated superior results in terms of efficacy, safety, and reduced hospital stay. However, rates of mortality, morbidity, and reintervention did not significantly differ between the two approaches. Conclusions: Considering these findings, we advocate for surgeons to acquire proficiency in the robotic technique, as part of the broader process of democratization and standardization of bariatric surgery. Embracing revisional robotic bariatric surgery can lead to improved patient outcomes, and its wider implementation may lead to enhanced surgical care and patient satisfaction in the field of bariatric procedures.

Influence of Heat Accumulation on Morphology Debris Deposition and Wetting of LIPSS on Steel upon High Repetition Rate Femtosecond Pulses Irradiation.

The fabrication of laser-induced periodic surface structures (LIPSS) over extended areas at high processing speeds requires the use of high repetition rate femtosecond lasers. It is known that industrially relevant materials such as steel experience heat accumulation when irradiated at repetition rates above some hundreds of kHz, and significant debris redeposition can take place. However, there are few studies on how the laser repetition rate influences both the debris deposition and the final LIPSS morphology. In this work, we present a study of fs laser-induced fabrication of low spatial frequency LIPSS (LSFL), with pulse repetition rates ranging from 10 kHz to 2 MHz on commercially available steel. The morphology of the laser-structured areas as well as the redeposited debris was characterized by scanning electron microscopy (SEM) and µ-Raman spectroscopy. To identify repetition rate ranges where heat accumulation is present during the irradiations, we developed a simple heat accumulation model that solves the heat equation in 1 dimension implementing a Forward differencing in Time and Central differencing in Space (FTCS) scheme. Contact angle measurements with water demonstrated the influence of heat accumulation and debris on the functional wetting behavior. The findings are directly relevant for the processing of metals using high repetition rate femtosecond lasers, enabling the identification of optimum conditions in terms of desired morphology, functionality, and throughput.

Síntesis de biomateriales, pruebas de biocompatibilidad in vitro, primeros pasos en ingeniería tisular en Bolivia / Synthesis of biomaterials, in vitro biocompatibility tests, first steps in tissular engineering in Bolivia

El desarrollo de biomateriales bioactivos como andamios para la osteointegración o regeneración de tejidos ha dado grandes pasos, el presente trabajo, muestra los procesos de síntesis de biomateriales como la hidroxiapatita, biomateriales del sistema SiO2-CaO-P2O5-Al2O3 y biovidrios del sistema SiO2.Li2O, se ha logrado caracterizar los biomateriales obtenidos, con resultados similares a los de otros investigadores por técnicas con la Difracción de Rayos X y la Microscopía Electrónica de Barrido, se ha evaluado su comportamientoen pruebas de biocompatibilidad y bioactividad en soluciones de Plasma Rico en Factores de Crecimiento y Fluido corporal simulado, seguidamente y con el fin de evaluar la incorporación de sustancias antibacteriales se ha dopado uno de ellos con plata, logrando determinar que el material tiene esta capacidad, estos resultados son los primeros pasos para encarar posteriores trabajos en el campo de la Ingeniería Tisular en Bolivia, y de esta forma encarar procesos de ostointegración y regeneración de tejidos en general.

The development of bioactive biomaterials as scaffolds for osseointegration or tissue regeneration has taken great steps, the present work shows the synthesis processes of biomaterials such as hydroxyapatite, biomaterials of the SiO2-CaO-P2O5-Al2O3 system and bio-libraries of the SiO2 system. Li2O, it has been possible to characterize the biomaterials obtained, with results similar to those of other researchers by techniques with X-ray Diffraction and Scanning Electron Microscopy, their behavior in biocompatibility and bioactivity tests in Plasma Rico solutions has been evaluated in Growth factors and simulated body fluid, then and in order to evaluate the incorporation of antibacterial substances, one of them has been doped with silver, managing to determine that the material has this capacity, these results are the first steps to face further work in the field of Tissue Engineering in Bolivia, and thus face Osteintegration processes and tissue regeneration in general.

Biomimetic surface structures in steel fabricated with femtosecond laser pulses: influence of laser rescanning on morphology and wettability.

The replication of complex structures found in nature represents an enormous challenge even for advanced fabrication techniques, such as laser processing. For certain applications, not only the surface topography needs to be mimicked, but often also a specific function of the structure. An alternative approach to laser direct writing of complex structures is the generation of laser-induced periodic surface structures (LIPSS), which is based on directed self-organization of the material and allows fabrication of specific micro- and nanostructures over extended areas. In this work, we exploit this approach to fabricate complex biomimetic structures on the surface of steel 1.7131 formed upon irradiation with high repetition rate femtosecond laser pulses. In particular, the fabricated structures show similarities to the skin of certain reptiles and integument of insects. Different irradiation parameters are investigated to produce the desired structures, including laser repetition rate and laser fluence, paying special attention to the influence of the number of times the same area is rescanned with the laser. The latter parameter is identified to be crucial for controlling the morphology and size of specific structures. As an example for the functionality of the structures, we have chosen the surface wettability and studied its dependence on the laser processing parameters. Contact angle measurements of water drops placed on the surface reveal that a wide range of angles can be accessed by selecting the appropriate irradiation parameters, highlighting also here the prominent role of the number of scans.

Controlling the Wettability of Steel Surfaces Processed with Femtosecond Laser Pulses.

The wettability of a material surface is an essential property that can define the range of applications it can be used for. In the particular case of steel, industrial applications are countless but sometimes limited because of the lack of control over its surface properties. Although different strategies have been proposed to tune the wetting behavior of metal surfaces, most of them require the use of processes such as coatings with different materials or plasma/chemical etching. In this work, we present two different laser-based direct-write strategies that allow tuning the wetting properties of 1.7131 steel over a wide range of contact angles using a high repetition rate femtosecond laser. The strategy consists in the writing of parallel and crossed lines with variable spacing. A detailed morphological analysis confirmed the formation of microstructures superimposed with nanofeatures, forming a hierarchical surface topography that influences the wetting properties of the material surface. Contact angle measurements with water confirm that this behavior is mostly dependent on the line-to-line spacing and the polarization-dependent orientation of the structures. Moreover, we demonstrate that the structures can be easily replicated in a polymer using a laser-fabricated steel master, which enables low-cost mass production. These findings provide a practical route for developing user-defined wetting control for new applications of steel and other materials functionalized by rapid laser structuring.

Leiomiomatosis parásita en Medellín, Colombia: reporte de un caso y revisión de la literatura / Parasitic leiomyomatosis in Medellín, Colombia: a case report and review of the literature

Objetivo: mostrar un caso de leiomiomatosis parásita que se presentó después de miomectomía laparoscópica y revisar la literatura disponible respecto a la histopatología, la fisiopatología, el diagnóstico y el tratamiento de la entidad.Materiales y métodos: se presenta el caso de una paciente de 30 años con antecedente de miomectomía por laparoscopia, que consultó a la clínica las Americas (Medellín, Colombia), centro privado de atención, por sangrado uterino de un mes de evolución. Por ultrasonido pélvico se documentó la presencia de leiomiomas uterinos. Fue sometida a nueva laparoscopia que reveló cuatro miomas parásitos en la cavidad pélvica. Se realizó una búsqueda en las bases de datos Medline vía PubMed y SciELO con los términos MeSH: “leiomyomatosis parasitic”, “myomectomy”, “laparoscopic” y “myoma”, y los términos DeCS: “mioma”, “leiomiomatosis parásito” “miomectomía” y “laparoscopia”.Resultados: se seleccionaron 12 artículos de los cuales 10 son reporte de caso, una serie de casos y una revisión narrativa de la literatura.Conclusión: la leiomiomatosis parásita es un evento que se presenta en la actualidad más frecuentemente después de miomectomía laparoscópica y que puede llegar a requerir manejo quirúrgico.

Objective: To present a case of parasitic leiomyomatosis occurring after laparoscopic myomectomy, and a review of the literature on the histopathology, pathophysiology, diagnosis, and treatment of this condition.Materials and methods: 30 year-old female patient with a history of laparoscopic myomectomy who presented to Clínica las Américas (Medellín, Colombia), a private healthcare centre, complaining of uterine bleeding lasting one month. The presence of leiomyomas was document on ultrasound. The patient was taken again to laparoscopy and four parasitic leiomyomas were found in the pelvic cavity. A search was conducted in the Medline databases through PubMed and SciELO using the MeSH terms “leiomyomatosis, parasitic”, “myomectomy”, “laparoscopic”, “myoma”, and the DeCS terms “myoma”, “parasite leiomyomatosis”, “myomectomy” and “laparoscopy”.Results: Overall, 12 articles were selected, including 10 case reports, 1 case series and 1 narrative review of the literature.Conclusion: Parasitic leiomyomatosis is an event found most frequently at the present time after laparoscopic myomectomy, and may require surgical management.

Choledochal cysts in adults.

BACKGROUND: Choledochal cysts are usually diagnosed during childhood. They mainly affect females. Abdominal pain and jaundice are the two most common symptoms. Our objective was to report the experience of a third-level referral center in the management of choledochal cysts in adults. METHODS: We performed a 17-year retrospective review of patients with choledochal cysts who underwent surgical interventions in a gastrointestinal surgery department. RESULTS: There were 23 patients with a median age of 26 years; 16 were females. The most frequent symptoms were abdominal pain and jaundice. Only four patients had an abdominal mass. The most frequently used diagnostic studies were abdominal sonography and endoscopic retrograde cholangiopancreatography. According to the classification of Todani, most cysts were type I and were found in 17 patients, two patients had type II, three patients had type III (choledocele) and one patient had type IVA. Eighteen patients underwent complete removal of the cyst with a concomitant hepatic-jejunostomy, three patients had transduodenal sphincteroplasty and two patients had only cystectomy. Seven patients developed postoperative complications, representing a morbidity rate of 35%. None of the patients died during the first 30 postoperative days. Cholangiocarcinoma was found in the resected specimen in only one case. CONCLUSIONS: The surgery of choice for choledochal cysts in the adult is hepatojejunostomy, which has a low surgical morbidity and mortality.

Quistes de colédoco en adultos / Choledochal cysts in adults

Introducción: Los quistes de colédoco en adulto son muy raros ya que la mayoría se diagnostica antes de los 10 años de edad. Los síntomas más frecuentes son dolor abdominal e ictericia, principalmente en mujeres. El objetivo de esta investigación fue informar la experiencia en el manejo de quistes de colédoco en adultos en un hospital de tercer nivel. Material y métodos: Estudio retrospectivo, descriptivo, observacional y transversal de la evolución posoperatoria de pacientes adultos con diagnóstico de quistes de colédoco tratados en un servicio de cirugía general en un periodo de 17 años. Resultados: Fueron en total 23 pacientes, de los cuales 16 fueron mujeres, con una mediana de edad de 26 años. Los síntomas principales fueron dolor abdominal (87 %) e ictericia (57 %). Solo cuatro pacientes (17 %) tuvieron además de estos síntomas tumor abdominal. El método diagnóstico más utilizado fue ultrasonido (100 %) seguido de colangiografía endoscópica (78 %) y tomografía computarizada de abdomen (74 %). De acuerdo con la clasificación de Todani, el tipo de quiste fue I en 17 pacientes, II en dos pacientes, III en tres pacientes y IV-A en un paciente. Todos fueron intervenidos quirúrgicamente, a 18 se les realizó resección del quiste y hepatoyeyuno anastomosis, a dos resección del quiste y a tres esfinteroplastia transduodenal. Hubo complicaciones posoperatorias en siete pacientes (35 %) y no hubo mortalidad operatoria. Solo en uno se informó colangiocarcinoma. Conclusiones: La cirugía de elección para el manejo de los quistes de colédoco es la resección del mismo, con morbilidad y mortalidad aceptables.

BACKGROUND: Choledochal cysts are usually diagnosed during childhood. They mainly affect females. Abdominal pain and jaundice are the two most common symptoms. Our objective was to report the experience of a third-level referral center in the management of choledochal cysts in adults. METHODS: We performed a 17-year retrospective review of patients with choledochal cysts who underwent surgical interventions in a gastrointestinal surgery department. RESULTS: There were 23 patients with a median age of 26 years; 16 were females. The most frequent symptoms were abdominal pain and jaundice. Only four patients had an abdominal mass. The most frequently used diagnostic studies were abdominal sonography and endoscopic retrograde cholangiopancreatography. According to the classification of Todani, most cysts were type I and were found in 17 patients, two patients had type II, three patients had type III (choledocele) and one patient had type IVA. Eighteen patients underwent complete removal of the cyst with a concomitant hepatic-jejunostomy, three patients had transduodenal sphincteroplasty and two patients had only cystectomy. Seven patients developed postoperative complications, representing a morbidity rate of 35%. None of the patients died during the first 30 postoperative days. Cholangiocarcinoma was found in the resected specimen in only one case. CONCLUSIONS: The surgery of choice for choledochal cysts in the adult is hepatojejunostomy, which has a low surgical morbidity and mortality.

Comparative reductions of bacterial indicators, bacteriophage-infecting enteric bacteria and enteroviruses in wastewater tertiary treatments by lagooning and UV-radiation.

A two-year monitoring program of microbiological and physical-chemical parameters at 2 waste water treatment plants (WWTPs) in Mallorca (Spain) was performed in order to (1) evaluate the efficiency of lagooning and UV radiation as tertiary treatment processes; (2) determine the characteristics of wastewater effluent for its potential agricultural reuse; and (3) establish correlations between bacteriological and virological parameters. The presence of currently established bacterial indicators (total coliforms, faecal coliforms, Escherichia coli, enterococci, and spores of sulphite-reducing clostridia), virological (enteroviruses, somatic coliphages, F-specific coliphages, and phages infecting Bacteroides fragilis and Bacteroides thetaiotaomicron), and helminth eggs were tested during this study. Bacterial and viral indicators were removed at least with one log reduction in the lagooning system, and to a lesser extent with UV-radiation treatment. The lagooning system was less efficient in removing phages and viruses than were bacterial indicators, with the exception of F-specific phages. Phages of B. fragilis and B. thetaiotaomicron were less removed than all of the other microbiological parameters. In the UV-radiation treatment, however, the faecal coliforms proved the most sensitive, while clostridial spores, somatic coliphages, Bacteroides phages, and enteric viruses were the more resistant. Helminth eggs were not detected in any samples from effluents of either the secondary or tertiary treatments.Indicator levels in both treatments met the established regulations of both local and national authorities for the disposal or reuse of wastewater in irrigation for non-human crop. We demonstrate that somatic coliphages are effective indicators of enteric viruses in both of the WWTPs studied.

Successful treatment of severe gastrointestinal bleeding secondary to Crohn disease with recombinant factor VIIa.

A 58-year-old man diagnosed with ileocolonic Crohn disease was admitted to the emergency room with massive lower gastrointestinal hemorrhage and hypovolemic shock. Treatment was started with methylprednisolone, metronidazole and omeprazole. Within the next 24 hours, he received a total of 9 U of red blood cell concentrate and 2 U of fresh frozen plasma. Because of persistence of bleeding, hypovolemic shock and life-threatening situation, we started therapy with rFVIIa. One dose of 120 microg/kg and another dose of 120 microg/kg three hours after the first dose were administered as compassionate use, with resolution of bleeding in the next 12 hours. On day 4 the patient was stabilized. We performed a total colonoscopy and intubation of the ileocecal valve that showed patchy deep ulcerations in the rectum with bleeding inflammatory pseudopolyps. Acute gastrointestinal bleeding is an unusual complication in Crohn disease. In this case, the use of recombinant activated factor VIIa controlled the massive gastrointestinal bleeding secondary to Crohn disease and without clinically significant adverse effect. There are few case reports documenting the use of recombinant activated factor VIIa for this type of off-label indication. Clinical trials should be carried out to define the dosage and dose interval schedule of rFVIIa in the treatment of uncontrolled massive gastrointestinal bleeding secondary to Crohn disease.

Experiencia en el manejo quirúrgico de la colitis ulcerosa en el Hospital de Especialidades, Centro Médico Nacional Siglo XXI / Experience with the surgical management of ulcerative colitis in the Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City

La colitis ulcerosa, es un proceso inflamatorio que involucra la mucosa colónica y ocasiona trastornos en la función intestinal y síntomas de inflamación. Objetivo: describir la experienca en el manejo quirúrgico en pacientes con diagnóstico de colitis ulcerosa. Tipo de estudio: estudio retrospectivo, transversal y observacional. Material y métodos: pacientes con diagnóstico de colitis ulcerosa que ingresaron para cirugía electiva o de urgencia para lograr su control, en el periodo de 1988 a 1998. Resultados: las indicaciones de cirugía fueron: mala respuesta al tratamiento médico, hemorragia, megacolon tóxico, perforación de colon y estenosis maligna. Los pacientes, siete hombres y ocho mujeres, con edad promedio de 38 años, se agruparon si fueron sometidos a cirugía de urgencia o a cirugía electiva. La mortalidad secundaria al procedimiento quirúrgico en todos los pacientes fue del 6 por ciento. Conclusiones: la resección completa del intestino grueso es curativa de esta enfermedad

Síndrome de intestino corto. Opciones quirúrgicas / Surgical options in the short bowel syndrome

El objetivo de este trabajo es describir algunas opciones quirúrgicas en cirugía tardia para mejorar la calidad de vida de los pacientes con intestino corto. Se realizo un estudio retroscopico de 31 pacientes con esta patología, 13 hombres y 18 mujeres con edad promedio de 51 años. Se formaron dos grupos. El grupo A esta integrado por 17 pacientes con intestino residual menor de 50 cm; a seis de éstos se les formó neoválvula intestinal, interposición de colon a uno y otro más se creó túnel cutáneo. A los nueve restantes, que tenian preservada la válvula ileocecal, se les practicó entero-enteroanastomosis. El grupo B estuvo constituido por 14 pacientes con intestino residual mayor de 50 cm; en cuatro de ellos se realizó neoválvula intestinal y en 10 entero-enteroanastomosis, incluyendo dos que tenian preservada la válvula ileocecal. Los pacientes a quienes se les realizó neoválvula intestinal tuvieron menor número de evacuaciones en comparación con aquellos a quienes se les realizó entero-enteroanastomosis. Se confirma que la utilidad de la construcción de una nueva válvula intestinal para mejorar la calidad de vida en los pacientes con intestino corto

Isquemia y gangrena del colon: revisión de 89 pacientes / Ischemia and gangrene of the colon

Objetivo. Analizar la experiencia obtenida en el Hospital de Especialidades del Centro Médico Nacional Siglo XXI del IMSS, en isquemia y gangrena del colon. Sede. Servicio de Cirugía General del HECMN Siglo XXI del IMSS. Diseño. Estudio retrospectivo, longitudinal descriptivo y observacional. Pacientes y método. Ochenta y nueve pacientes operados por isquemia o gangrena del colon confirmadas por estudio hitopatológico. Se analizaron las siguientes variables: sexo, edad, cuadro clínico, enfermedades asociadas, métodos de diagnóstico, tratamiento y mortalidad. Resultados. Cincuenta y un pacientes correspondieron al sexo masculino y 38 al femenino, su promedio de edad fue de 54 años, con extremos de 18 a 90 años. En el cuadro clínico predominaron: taquicardia (94 por ciento), dolor abdominal (87 por ciento) e hipotensión arterial (84 por ciento). La hemoglobina varió de 7.2 a 16 g/dl con promedio de 11.6; en 80 pacientes existió leucocitosis. La placa simple de abdomen mostró en 80 enfermos dilatación de segmentos colónicos, niveles hidroaéreos en 64 e impresiones digitales en 39. En 4 pacientes se realizó estudio angiográfico de aorta y mesentérica superior. A 30 sujetos se les practicó rectosigmoidoscopia, en 5 se observaron úlceras y edema de la mucosa. Se efectuaron las siguientes operaciones: colectomía en 7 y transverectomía en 3. Hubo 91 por ciento de complicaciones abdominales y/o extra-abdominales y fallecieron 24 pacientes (26 por ciento). Conclusión. La isquemia y gangrena del colon tiene una elevada mortalidad, por lo que el cirujano debe incluirla en el diagnóstico diferencial en pacientes con dolor abdominal, pues su participación oportuna evita la progresión de las lesiones