[Gargantua and digestive bariatric surgery]. / Gargantúa y lá cirugía bariátrica del tubo digestivo.

Morbid obesity significantly reduces life span and is associated with much co-morbid pathology. Diet, behavioral therapy and drugs therapy are largely unsuccessful, however the surgical treatment offers the best hope. This historic review about the bariatric surgery summarizes the jejuno ileal by-pass and the gastric surgery as the gastric bypass and the horizontal or vertical gastroplasties. Procedures that reduce gastric capacity and dietary in take are now considered preferable to those that alter food absorption as they are associated with fewer side-effects. The vertical banded gastroplasty is probably, the best operation for modern Gargantua's men.

Gargantua y la cirugia bariatrica del tubo digestivo / Digestive bariatric surgery in the gargantua's men

La obesidad mórbida se asocia con diversas enfermedades que disminuyen, notablemente, el promedio de vida de los pacientes. Los regímenes dietéticos y los medicamentos no son suficientes para reducir el excesivo peso de los obesos mórbidos y mantenerlo en niveles aceptables; solamente los tratamientos quirúrgicos han resltado eficaces para obtener resultados satisfactorios. Se analizan, en esta revision histórica los by-pass yeyuno ileales, los by-pass gastroyeyunales y la modernas gastroplastias. Las operaciones que disminuyen la capacidad gástrica, limitando la ingestión alimentaria, son los procedimientos preferidos pues no producen malabsorción ni complicaciones alejadas. La gastroplastia vestical anillada es probablemente, la mejor indicación quirúrgica, en la actualidad, para tratar a éstos modernos Gargantúas.

Gargantua y la cirugia bariatrica del tubo digestivo / Digestive bariatric surgery in the gargantuas men

La obesidad mórbida se asocia con diversas enfermedades que disminuyen, notablemente, el promedio de vida de los pacientes. Los regímenes dietéticos y los medicamentos no son suficientes para reducir el excesivo peso de los obesos mórbidos y mantenerlo en niveles aceptables; solamente los tratamientos quirúrgicos han resltado eficaces para obtener resultados satisfactorios. Se analizan, en esta revision histórica los by-pass yeyuno ileales, los by-pass gastroyeyunales y la modernas gastroplastias. Las operaciones que disminuyen la capacidad gástrica, limitando la ingestión alimentaria, son los procedimientos preferidos pues no producen malabsorción ni complicaciones alejadas. La gastroplastia vestical anillada es probablemente, la mejor indicación quirúrgica, en la actualidad, para tratar a éstos modernos Gargantúas. (AU)

[Cesar Roux and his Roux-en-Y anastomosis]. / Cesar Roux y su anastomosis en Y.

During the last 100 years, since Cesar Roux (1857-1934) began utilizing his "Loop-en-Y" procedure for gastric outlet obstruction, this technique fell into disfavour but later, with the vagotomy, it was adapted for multiple applications. The greatest factor in its revival has been the treatment of postgastrectomy sequels, including alkaline reflux gastritis, reflux esophagitis, dumping and other syndromes. Additionally Roux-en-Y anastomosis has been used to drain diverse organs as the biliary tract, pancreas and esophagus. The main complication of loop-en-Y is the Roux syndrome, secondary to gastric or efferent jejunal stasis, or both. As the centennial of Roux's first use of his eponymic procedure approaches its seems appropriated to remind its memory as a part of our surgical inheritance.

Cesar Roux y su anastomosis en Y. / [Cesar Roux and his Roux-en-Y anastomosis]

During the last 100 years, since Cesar Roux (1857-1934) began utilizing his [quot ]Loop-en-Y[quot ] procedure for gastric outlet obstruction, this technique fell into disfavour but later, with the vagotomy, it was adapted for multiple applications. The greatest factor in its revival has been the treatment of postgastrectomy sequels, including alkaline reflux gastritis, reflux esophagitis, dumping and other syndromes. Additionally Roux-en-Y anastomosis has been used to drain diverse organs as the biliary tract, pancreas and esophagus. The main complication of loop-en-Y is the Roux syndrome, secondary to gastric or efferent jejunal stasis, or both. As the centennial of Rouxs first use of his eponymic procedure approaches its seems appropriated to remind its memory as a part of our surgical inheritance.

Resultados del tratamiento quirurgico de las estenosis posoperatorias de la via biliar principal / Results of the surgical treatment of postoperative stenosis of the main bile duct

Se presenta la experiencia adquirida en 28 pacientes, con estenosis posoperatorias de la vía biliar principal, intervenidos quirúrgicamente entre 1964 y 1986. Se establece la superioridad de las anastomosis laterales entre el hepático isquierdo y un ansa yeynal en Y de Roux propuesta por Hepp en 1954. Se considera que esta operación es la de elección en todas las estenosis posperatorias cualquiera sea la extensión y ubicación de la lesión en la vía biliar principal. En ciertos casos, con dificultades para llevar a cabo la anastomosis de Hepp, por un hepático izquierdo corto o una patología hepática asociada, se recomienda la técnica del injerto mucoso de Rodney Smith. Se analizan los resultados alejados de 24 casos con anastomosis hepático yeyunales y de 4 con el procedimiento de Rodney Smith. Los resultados globales señalan curaciones prolongadas en el 92.8 por ciento de los casos

Resultados del tratamiento quirurgico de las estenosis posoperatorias de la via biliar principal / Results of the surgical treatment of postoperative stenosis of the main bile duct

Se presenta la experiencia adquirida en 28 pacientes, con estenosis posoperatorias de la vía biliar principal, intervenidos quirúrgicamente entre 1964 y 1986. Se establece la superioridad de las anastomosis laterales entre el hepático isquierdo y un ansa yeynal en Y de Roux propuesta por Hepp en 1954. Se considera que esta operación es la de elección en todas las estenosis posperatorias cualquiera sea la extensión y ubicación de la lesión en la vía biliar principal. En ciertos casos, con dificultades para llevar a cabo la anastomosis de Hepp, por un hepático izquierdo corto o una patología hepática asociada, se recomienda la técnica del injerto mucoso de Rodney Smith. Se analizan los resultados alejados de 24 casos con anastomosis hepático yeyunales y de 4 con el procedimiento de Rodney Smith. Los resultados globales señalan curaciones prolongadas en el 92.8 por ciento de los casos (AU)

[Results of the surgical treatment of postoperative stenosis of the main bile duct]. / Resultados del tratamiento quirúrgico de las estenosis posoperatorias de la via biliar principal.

Between January 1964 and January 1986, 28 patients with postoperative biliary stenosis were studied and operated. The left hepatic duct were anastomosed with an Y-Roux limb of jejunum in 23 cases; in one case was realized a bi-hepatic jejunostomy and in remaining 4 cases were treated with the Rodney Smith's operation. In the surgical repair of the biliary stenosis the best techniques is the hepato-jejunostomy anastomose described for Hepp in 1954. The very high hepatic stricture may present an almost insoluble problem and the "mucosal graft" of Rodney Smith is the optative operation. The results of the present series is good in the 92.8% of the cases.

Resultados del tratamiento quirúrgico de las estenosis posoperatorias de la via biliar principal. / [Results of the surgical treatment of postoperative stenosis of the main bile duct]

Between January 1964 and January 1986, 28 patients with postoperative biliary stenosis were studied and operated. The left hepatic duct were anastomosed with an Y-Roux limb of jejunum in 23 cases; in one case was realized a bi-hepatic jejunostomy and in remaining 4 cases were treated with the Rodney Smiths operation. In the surgical repair of the biliary stenosis the best techniques is the hepato-jejunostomy anastomose described for Hepp in 1954. The very high hepatic stricture may present an almost insoluble problem and the [quot ]mucosal graft[quot ] of Rodney Smith is the optative operation. The results of the present series is good in the 92.8

of the cases.

[Postoperative alkaline reflux gastritis]. / Gastritis alcalinas por reflujo posoperatorias.

Six patients with alkaline reflux gastritis postoperative were treated between 1977 and 1984 by Roux-en-Y diversion. All of the patients had a typical history of mild epigastric burning pain and bilious vomiting. The diagnosis was reached by endoscopic results of the gastric mucosa. The pain, complaints and the macroscopically apparent gastritis subsided completely after surgery but the histological manifestations of gastritis improved though no disappear. In four cases we used the Roux-en-Y procedure; in two, the Henley jejunal loop with the Soupault-Bucaile, technique. All patients were vagotomized for the fear recurrent peptic ulceration if increased the acid secretion. One patient was most complex because after derivation with Roux-en-Y developed severe diarrhea and was necessary to change to loop jejunal Henley and reversed 10 centimeter the jejunal loop at 1 meter from Treitz angle.