The Impact of Sleeve Gastrectomy on Gastroesophageal Reflux Disease in Patients with Morbid Obesity.

INTRODUCTION: The impact of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) has not been widely quantified, and the data in the literature remain controversial. MATERIALS AND METHODS: Candidates for LSG underwent barium swallow, esophageal manometry, ambulatory 24-h esophageal pH monitoring (APM), and gastric emptying scintigraphy before and after surgery (1 and 18 months). Symptoms were evaluated using a gastroesophageal reflux disease questionnaire (GERDq). Esophagogastroduodenoscopy was performed preoperatively in all patients and at 18 months postoperatively in patients who had suffered from preoperative esophagitis. RESULTS: Fifty-two patients were included in the study (64.4% women and 34.6% men) with a median age of 46 years (25-63 years) and BMI of 45.0 ± 5.6 kg/m2. The follow-up rates at 1 and 18 months were 82.7% and 80.8%. At 18 months, the percentage of weight loss (%TWL) was 33.6 ± 10.4% and the percentage of excess BMI loss (%EBMIL) was 77.6 ± 25%. Postoperatively, a significant increase in accelerated gastric emptying and impaired esophageal body motility occurred at 1 and 18 months. A significant worsening of all the values obtained at both 1 and 18 months postoperatively becomes evident when comparing the results of the APM. After surgery, 76.4% of patients had developed "de novo" GERD at 1 month and 41% at 18 months. No improvement was found in patients with symptomatic GERD. CONCLUSION: Based on the results of this study, LSG led to a considerable rate of postoperative "de novo" GERD. In addition, no improvement was found in patients with symptomatic GERD.

Alteraciones metabólicas tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal. Seguimiento a largo plazo / Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up

Introducción La técnica del cruce duodenal (CD) es considerada una cirugía compleja y con serias complicaciones metabólicas por su carácter malabsortivo, lo que hace que su uso no se haya extendido entre los cirujanos bariátricos. A pesar de ello la consideramos una técnica adecuada en superobesos. Pacientes y métodos Estudio prospectivo de 110 pacientes con obesidad mórbida intervenidos consecutivamente con la técnica del CD y seguidos durante un período mínimo de cuatro años tras la cirugía. Hemos evaluado la pérdida de peso, evolución de las comorbilidades y las complicaciones metabólicas. Resultados La pérdida del exceso de peso fue superior al 50% en el 75% de los pacientes después de 12 meses de seguimiento. Un total de 68 pacientes (75,5%) experimentaron completa corrección de las comorbilidades que presentaban. Las alteraciones metabólicas más frecuentes fueron el déficit de hierro y la elevación de la PTH. Conclusiones El CD es una técnica segura y eficaz para el tratamiento de la obesidad mórbida, con buenos resultados ponderales, elevado porcentaje de remisión de las comorbilidades, morbimortalidad similar a otras técnicas y con alteraciones nutricionales corregibles y por tanto asumibles (AU)

Introduction The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. Patients and methods A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. Results The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH).Conclusions DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable (AU)

[Metabolic changes after morbid obesity surgery using the duodenal switch technique. Long term follow-up]. / Alteraciones metabólicas tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal. Seguimiento a largo plazo.

INTRODUCTION: The duodenal switch (DS) technique is considered to be complex surgery with a series of metabolic complications due to its malabsorptive character. For these reasons, it has not been extensively used by bariatric surgeons. Despite this, we consider it to be a suitable technique for the grossly obese. PATIENTS AND METHODS: A retrospective study was performed on 110 patients with morbid obesity operated on using the DS technique and who were followed up for a minimum period of four years after surgery. We evaluated the weight loss, the outcomes of the comorbidities, and the metabolic complications. RESULTS: The loss of excess weight was greater than 50% in 75% of the patients after 12 months follow up. The comorbidities suffered by 68 patients (75.5%) were completely resolved. The most frequent metabolic complications were iron (Fe) deficiency and an increased parathyroid hormone (PTH). CONCLUSIONS: DS is a safe and effective technique for the treatment of morbid obesity, with good weight loss results, a high percentage of remission of the comorbidities, a similar morbidity and mortality to other techniques, and with correctable nutritional changes, and thus acceptable.

Hemoperitoneo por divertículo solitario de sigma / Hemoperitoneum due to solitary sigmoid diverticulum

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