ABSTRACT
Introduction: This report aimed to analyze the outcomes of patients with obesity who were on a bariatric program during the SARS-Cov-2 pandemic outbreak and compare those who received surgery with the ones who were not operated on. Methods: This was a retrospective study between 2020 and 2021. Patients were divided into two groups: those who underwent surgery (O) and those who were not operated (NO). The evolution of the risk factors identified for severe COVID infection and death was studied (ASMBS criteria). For this study, a follow-up period of 12 months was initiated. Results: In the O group, 83 patients were included and 99 were in the NO group. In the O group, patients with body mass index (BMI) > 35 Kg/m2 before surgery resolved the condition in 73.5% (61) cases, and this was done in the first 30 days by 38 (45.7%). Type 2 diabetes mellitus remission was documented in 18 patients (85.7%) of the O group, and the mean time elapsed for remission was 102.2 days (P < .01). Hypertension remitted in 66.7% (20) of the patients in group O in 82.4 days (P < .01). The subgroup of patients with obesity and one high-risk associated condition (30.2%, 25) resolved both in 44% (11) cases and one in 48% (12) cases. In the group of patients with obesity and two high-risk associated conditions (15.6%, 13), 47% (6) patients resolved the three conditions, 38% (5) resolved two conditions, and 15% (2) resolved one condition. Among the NO group, no comorbidity resolutions were recorded (P < .01). Admission because of COVID infection was necessary for 7.1% of NO and 1.2% of O (P = .04). Conclusion: Bariatric metabolic surgery would not increase the risk of COVID infection or of suffering serious complications resulting from it. Patients undergoing bariatric metabolic surgery rapidly resolved high-risk comorbidities and had less need for hospitalization because of SARS-CoV-2 infection.
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Introduction: An applicable and reproducible enhanced recovery protocol was developed and implemented to improve our outcomes in a third-world environment. Methods: We compared the results obtained prospectively. The group treated before the application of the enhanced recovery protocol was called usual care (UC) and included all bariatric surgeries operated on between 2014 and 2017. The new protocol was applied between 2017 and 2019 including all operated patients, and this group was called Fast Track (FT). The variables analyzed were the length of stay, readmissions, and complications recorded during the first 30 days. We also analyzed the milligrams of morphine used by each patient, and a cost analysis was performed. Results: During the study period, 816 patients were studied. Of these, 385 (47.2%) belonged to the UC group and 431 (52.8%) to the FT group. The mean hospital stay was 58.5 hours (UC) versus 40.3 hours (FT) (P = .0001). When comparing the global morbidity of both groups, we did not find significant differences (P = .47). There was also no statistically significant difference when comparing major complications (P = .79). No mortality was recorded. Morphine indication reported a statistically significant difference that favored FT. Costs were significantly higher in UC than in FT (P < .0001). Conclusions: We believe that the implementation of an enhanced recovery protocol in bariatric surgery is a reliable measure and can be implemented even in an underdevelopment environment enlarging the benefit for patients.
ABSTRACT
Incisión supraumbilical, colocación de trocar de 10 mm, técnica Hasson. Otros trocares bajo visión directa. Apertura de membrana freno esofágica y liberación de esófago de pilares, identificación de nervio vago anterior, separando y preservándolo. Disección de fibras musculares longitudinales y sección de las fibras circulares hasta exposición mucosa esofágica, 6 cm en esófago y 2 cm a nivel gástrico. Funduplicatura tipo Dor con puntos separados 3.0 a nivel de fondo gástrico, muscular esofágica y pilares diafragmáticos. Extracción de trocares bajo visión, exsuflación de neumoperitoneo. Cierre de laparotomía umbilical. Síntesis cutánea.
Subject(s)
Humans , Female , Adult , Esophageal Achalasia/surgery , Laparoscopy/methods , Heller Myotomy/methods , Audiovisual Aids , Treatment Outcome , Video-Audio MediaABSTRACT
PURPOSE: Obesity has an especial implication for women of childbearing age because of a higher risk of adverse outcomes during pregnancy and labor. This report aimed to analyze complications of pregnancy after sleeve gastrectomy (SG) concerning the time after surgery. METHODS: A retrospective descriptive-analytical study was conducted including women of childbearing age who underwent sleeve gastrectomy (SG) from 2006 to 2017. Patients were divided into two groups regarding the time elapsed from SG to pregnancy: less than and greater than one year (group A /group B, respectively). RESULTS: During the studied time, 51 pregnancies with complete clinical records were found. The mean weight and gestational age (GA) of the newborn (NB) were normal. The mean time from surgery to pregnancy was 30.4 ± 21 months. Patients from Group A and B presented 28.6% and 16.7% respectively of preterm NB (p = 0.5). Group A registered no low birth weight (LBW) babies (3.0 ± 0.4 kg) with a GA of 37.2 ± 2.1 weeks, while in Group B, 8.6% of NB were at LBW 2.1 ± 0.1 kg and GA of 33.3 ± 3.8 weeks (p = NS). CONCLUSION: After SG, no differences in terms of maternal and neonatal complications were found concerning the time between surgery and pregnancy.
Subject(s)
Obesity, Morbid , Pregnancy Complications , Female , Gastrectomy/adverse effects , Humans , Infant, Newborn , Obesity, Morbid/surgery , Pregnancy , Pregnancy Complications/etiology , Pregnancy Outcome , Retrospective StudiesABSTRACT
OBJETIVO: Evaluar la reproducibilidad y la seguridad de un programa de cirugía colorrectal laparoscópica en dos centros de Sudamérica. MÉTODO: Se realizó un estudio analítico-descriptivo. Se revisaron retrospectivamente los registros clínicos de pacientes sometidos a cirugía videolaparoscópica colorrectal desde el año 2012 hasta el año 2018, en dos centros académicos de tercer nivel argentinos. Se analizaron datos demográficos, indicaciones y tiempos quirúrgicos, tasa de conversión, evolución posoperatoria, morbimortalidad y resecabilidad oncológica, y se comparó con el abordaje convencional. RESULTADOS: Se realizaron 505 cirugías. La edad media de los pacientes fue de 63.4 años y el 50.9% eran hombres. El tiempo operatorio medio fue de 175 minutos. La principal indicación fue cáncer de colon. La incidencia de conversión fue del 9.5%. El promedio de ganglios por pieza quirúrgica en patología neoplásica fue de 15.9. La morbilidad fue del 35.4%, en su mayoría complicaciones menores. La tasa de fístulas fue del 11.7%. La mortalidad a 30 días fue del 2.5%. CONCLUSIÓN: La cirugía colorrectal laparoscópica podría representar una opción segura y reproducible en un centro de tercer nivel de un país en desarrollo. OBJECTIVE: To evaluate the feasibility and safeness of a colorectal laparoscopic program in two centers form South America. METHOD: We retrospectively review the records of patients who underwent laparoscopic colorectal surgery from 2012 to 2018 in two tertiary care academic centers. Surgical indication, operative time, conversion rate, lymph nodes harvested, surgical margins and complications were analyzed. This results were then compared to the open approach. RESULTS: We collected data from 505 patients, mean age 63.4, 50.9% male. The most frequent indication was colon cancer, mean operative time was 175 minutes. Conversion rate was 9.5%, mean nodes harvested was 15.9 with free resection margins in every case. Morbidity was 35.4% at 30 days, most of them were minor complications. The leak rate was 11.7 %. The 30-day mortality was 2.5%. CONCLUSION: The laparoscopic approach for colorectal surgery might represent a safe and feasible option in an tertiary care hospital from a developing country.
Subject(s)
Colonic Neoplasms , Laparoscopy , Female , Humans , Male , Middle Aged , Retrospective Studies , Tertiary Care Centers , Tertiary HealthcareABSTRACT
El mielolipoma es un tumor benigno de baja incidencia cuya localización más frecuente son las glándulas suprarrenales. Histológicamente se caracteriza por células con precursores mieloides y eritroides mezcladas con tejido adiposo maduro. El diagnóstico en general es incidental en una prueba de imagen. Clínicamente cursa asintomático, aunque los de mayor tamaño tienen más riesgo de complicaciones como sangrado o efecto de masa. Los hallazgos incidentales < 4 cm se deben controlar con imágenes; los > 7 cm, o que generen síntomas, deben ser tratados de forma quirúrgica. Se reporta un caso de mielolipoma extrasuprarrenal en un paciente de 78 años.Myelolipoma is a relatively rare benign tumor which is most commonly located in the adrenal glands. Histologically is characterized by eritroid and myeloid precursor cells intermixed with mature adipose tissue. The diagnosis is generally incidental in abdominal imaging studies. Clinically most are asymptomatic, nevertheless larger tumors are at greater risk for complications such as hemorrhage or compression of surrounding structures. Incidental findings smaller than 4 cm should be followed-up by imaging. Tumors measuring more than 7 cm or those that are symptomatic a surgical approach is mandated. We present the case of a 78-year-old man with an extra-adrenal myelolipoma.