National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile.

INTRODUCTION: The laparoscopic approach for the treatment of gastric cancer has many advantages. However, outside Asia there are few large case series. AIM: To evaluate postoperative morbidity, long-term survival, changes in indication, and the results of laparoscopic gastrectomy. METHODS: We included all patients treated with a laparoscopic gastrectomy from 2005 to 2014. We compared results across 2 time periods: 2005-2011 and 2012-2014. Median follow-up was 39 months. RESULTS: Two hundred and eleven patients underwent a laparoscopic gastrectomy (median age 64 years, 55% male patients). In 135 (64%) patients, a total gastrectomy was performed. Postoperative morbidity occurred in 29%. A significant increase in the indication of laparoscopic surgery for stages II-III (32 vs. 45%; p = 0.04) and higher lymph node count (27 vs. 33; p = 0.002) were observed between the 2 periods. The 5-year overall survival was 72%. According to the stage, the 5-year overall survival was 85, 63, and 54% for stage I, II, and III respectively (p < 0.001). CONCLUSIONS: There was an acceptable rate of postoperative complications and the long-term survival was in accordance with the disease stage. There was a higher indication of laparoscopic surgery in stages II-III disease, and higher lymph node count in the latter period of this study.

Transumbilical sleeve gastrectomy with an accessory lateral port: surgical results in 237 patients and 1-year follow-up.

BACKGROUND: The transumbilical approach has recently been shown to be safe for several surgical procedures. Case series of sleeve gastrectomy (SG) with a transumbilical approach (TUSG) has been reported with various techniques. The objective of this report is to present the technique, surgical results, and 1-year follow-up results of simplified TUSG using rigid instruments. METHODS: All of the patients who had undergone SG since July 2010 were offered a transumbilical approach. The operative technique involves a transumbilical incision and the introduction of a SILS® or GelPoint® multiport and a 5-mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. Gastric transection was made 4-5 cm proximal to the pylorus, calibrated with a 36-Fr bougie. Selected hemostasis to the staple line was achieved with metallic clips. RESULTS: A total of 237 patients underwent TUSG. Patient body mass index ranged from 30 to 46 kg/m(2). The mean operative time was 49.5 ± 14.9 min. Six patients presented with early complications, including hemoperitoneum in three cases, antral leak in one case, intestinal perforation in one case, and portal vein thrombosis in one case. Conversion to the multitrocar technique was required in one patient. There were no mortalities. The mean length of hospital stay was 2.2 ± 1 days. The cosmetic result was satisfactory for all of the patients. CONCLUSIONS: TUSG is a safe and feasible procedure using the described technique. The insertion of a 5-mm assistance trocar simplifies the procedure, allowing the use of rigid instruments.

Predictors of nonalcoholic steatohepatitis (NASH) in obese patients undergoing gastric bypass.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are conditions gaining increasing recognition in hepatology as a potential cause of cirrhosis and end-stage liver disease. Obesity is one of the main risk factors. The aims of this study were to determine the frequency of NAFLD in obese patients and to identify variables that predict NASH. METHODS: A prospective study was conducted of obese patients undergoing gastric bypass over a 20-month period. Assessment included liver function tests and evaluation of insulin resistance with the homeostatic model assessment (HOMA-IR). Liver biopsy was performed in all patients at the time of surgery. Clinical and biochemical variables were analyzed using a multivariate analysis to identify independent predictors of NASH. RESULTS: 127 consecutive patients were included (62% female, 38% male, mean age 40+/-11 years, mean body mass index 42+/-6 kg/m(2)). Arterial hypertension was present in 52 patients (41%) and type 2 diabetes in 18 (14%). NAFLD was confirmed in 80 patients (63%), 47 (37%) had simple steatosis, and 33 (26%) had NASH. Cirrhosis was found in 2 patients corresponding to 1.6% of the total population. On multivariate analysis, AST >31 (IU/L) (OR 3.38, CI 1.17-9.8) and HOMA-IR >5.8 (OR 4.18, CI 1.39-12.49) independently predicted NASH. CONCLUSIONS: NAFLD is highly prevalent in morbidly obese patients. A high proportion of these patients exhibit NASH on histological examination. Insulin resistance represents the main predictor of NASH.

Estudio de algunos parámetros bioquímicos y de la actividad angiogénica del omentum / Study of some biochemical parameters and of the omentuïs angiogenic activity

Se estudió el efecto angiogénico y la composición de proteínas y lípidos del omentum humano a partir de la inoculación intraestomal en la córnea de conejo de los extractos obteniodos tras homogeneizar el material biológico. Se encontraron valores muy bajos de proteínas y muy elevados de triglicéridos fundamentalmente en el extracto 2 de origen lípidico. En relación con la vascularización, ésta se logró con mayor intensidad en la córnea de los animales que se inocularon con el extracto 2 (AU)

Estudio de algunos parámetros bioquímicos y de la actividad angiogénica del omentum / Study of some biochemical parameters and of the omentuïs angiogenic activity

Se estudió el efecto angiogénico y la composición de proteínas y lípidos del omentum humano a partir de la inoculación intraestomal en la córnea de conejo de los extractos obteniodos tras homogeneizar el material biológico. Se encontraron valores muy bajos de proteínas y muy elevados de triglicéridos fundamentalmente en el extracto 2 de origen lípidico. En relación con la vascularización, ésta se logró con mayor intensidad en la córnea de los animales que se inocularon con el extracto 2