Gastroplastia tubular plicada, una nueva técnica para el tratamiento de la obesidad mórbida / Laparoscopic Gastric Plication: a new surgery for the treatment of morbid obesity

Introducción La gastroplastia tubular plicada es una nueva técnica que deriva de la gastrectomía vertical. La plicatura de la curvatura mayor genera un mecanismo restrictivo que ocasiona la pérdida ponderal. En este trabajo se presentan los resultados de los primeros casos en los que se ha aplicado esta técnica en nuestro centro. Métodos Revisión de pacientes intervenidos en nuestro centro entre noviembre de 2009 y diciembre de 2010. Bajo anestesia general y por la paroscopia se realiza la plicatura de la curvatura mayor gástrica sobre sí misma con 3 líneas de sutura y con una sonda orogástrica como guía. Se presentan los resultados relativos a morbilidad, mortalidad y pérdida ponderal. Resultados Se han intervenido 13 pacientes (7 mujeres). El IMC máximo oscila entre 37,11kg/m2 y 51,22kg/m2 en el momento de la intervención. La morbilidad más frecuentemente encontrada son náuseas y vómitos. Dos pacientes requirieron reintervención por vómitos incoercibles y disfagia absoluta, en uno se deshizo la plicación y en el segundo se convirtió a gastrectomía vertical. La pérdida ponderal a los 3 y 6 meses es equivalente a la de la gastrectomía vertical. Conclusiones La gastroplastia tubular plicada es una nueva técnica quirúrgica que presenta resultados a corto plazo equivalentes a los de la gastrectomía vertical. Se trata de una técnica reproductible y reversible con resultados e indicaciones aún por validar (AU)

Introduction: Laparoscopic Gastric Plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital are presented. Methods: A review was made of patients operated on in our hospital between November 2009 and December 2010. Plication of the gastric greater curvature was performed undergeneral anaesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probeas a guide. The results of the morbidity, mortality and weight loss are presented. Results: A total of 13 patients were operated on (7 women). The maximum body mass index(BMI) varied between 37.11 kg/m2 and 51.22 kg/m2 at the time of the operation. The most frequently found morbidity was nausea and vomiting. Two patients required further surgery due intractable vomiting and total dysphagia; in one the plication unfolded, and in the second it was converted into vertical gastrectomy. Conclusions: Laparoscopic Gastric Plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated (AU)

[Laparoscopic Gastric Plication: a new surgery for the treatment of morbid obesity]. / Gastroplastia tubular plicada, una nueva técnica para el tratamiento de la obesidad mórbida.

INTRODUCTION: Laparoscopic Gastric Plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital are presented. METHODS: A review was made of patients operated on in our hospital between November 2009 and December 2010. Plication of the gastric greater curvature was performed under general anaesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probe as a guide. The results of the morbidity, mortality and weight loss are presented. RESULTS: A total of 13 patients were operated on (7 women). The maximum body mass index (BMI) varied between 37.11 kg/m² and 51.22 kg/m² at the time of the operation. The most frequently found morbidity was nausea and vomiting. Two patients required further surgery due intractable vomiting and total dysphagia; in one the plication unfolded, and in the second it was converted into vertical gastrectomy. CONCLUSIONS: Laparoscopic Gastric Plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated.

Is sleeve gastrectomy as effective as gastric bypass for remission of type 2 diabetes in morbidly obese patients?

BACKGROUND: The benefits of Roux-en-Y gastric bypass (RYGB) for the control of type 2 diabetes mellitus (T2DM) in morbidly obese patients are well known, although the implicated mechanisms have not yet been elucidated. However, little is known about the remission of T2DM after sleeve gastrectomy (SG). The aim of our study was to compare the outcomes of T2DM after both procedures. METHODS: We performed a retrospective analysis of diabetic morbidly obese patients who had undergone RYGB or SG. The variables analyzed included weight, fasting glycemia, and glycosylated hemoglobin. RESULTS: A total of 90 patients were included (60 RYGB and 30 SG). The body mass index was 46.22 kg/m(2) for the RYGB group and 56.80 kg/m(2) for the SG group. The fasting glycemia was 10.63 mmol/L and 8.05 mmol/L and the glycated hemoglobin was 8.1% and 7.3% in the RYGB and SG groups, respectively. No significant differences were seen in the amount of weight loss after 2 years between the 2 techniques. Similarly, no significant differences were found in T2DM control after either 1 year (91.8% versus 82.3%) or 2 years (91.8% versus 88.9%). No significant differences were found in the duration of T2DM in either group nor in the percentage of patients treated with insulin and oral hypoglycemic drugs before and 2 years after surgery. CONCLUSION: We did not find any significant differences in weight loss or T2DM resolution between the 2 techniques. Our results highlight that 1 of the mechanisms implicated in T2DM remission after bariatric surgery is weight loss. The role of other factors, such as incretins, that we have not studied cannot be ruled out and should be analyzed further.

[Thromboembolic prophylaxis in bariatric surgery. A multidisciplinary protocol]. / Cirugía bariátrica. Profilaxis tromboembólica.

Severe or morbid obesity is one of the 21st century epidemics. Surgery is the most important and cost-effective treatment. Bariatric procedures are becoming very common in our Hospitals. Thromboembolic events such us deep venous thrombosis or pulmonary embolism (PE) are the most common medical cause of death after these procedures. Incidence of PE may arise to 3% after surgery and its mortality is about 75%. Prophylactic protocols have not been clearly defined until now. These protocols have to consider special patients, such as morbid obese ones; different kind of procedures, most of the laparoscopic; and patients' comorbidities. By the other hand, treatment for morbid obesity has to be considered by a multidisciplinary approach. Here we present the protocol that has been initiated at our Institution. After a long and high experience in bariatric procedures, we have defined a multidisciplinary protocol to prevent thromboembolic events after surgery where nurses and surgeons play a leading role. The combination of physical, pharmaceutical and educational measures all together are the key for the adequate prevention in these patients.

Cirugía Bariátrica. Profilaxis tromboembólica / Thromboembolic prophylaxis in Bariatric Surgery. A multidisciplinary protocol

La obesidad mórbida es una de las epidemias del siglo xxi. La cirugía ha demostrado ser el tratamiento más importante y coste-efectivo, por esto, la cirugía bariátrica está siendo cada vez más común en nuestros Hospitales. Los eventos tromboembólicos, como la trombosis venosa profunda (TVP) la embolia pulmonar (EP) son la causa médica de mortalidad más frecuente tras estos procedimientos. La incidencia de EP puede llegar al 3% y su mortalidad es de hasta un 75%. Los protocolos de profilaxis tromboembólica en cirugía bariátrica aún no están claramente definidos. Estos protocolos deben considerar que se está tratando pacientes diferentes por su obesidad; por la diversidad de procedimientos que se pueden realizar, la mayoría laparoscópicos; así como por las comorbilidades de los pacientes. Por otro lado, al igual que el tratamiento de la obesidad mórbida, el abordaje debe ser multidisciplinario. En este trabajo presentamos el protocolo que se ha iniciado en nuestro Centro. Tras una larga y dilatada experiencia en cirugía de la obesidad mórbida, hemos diseñado un protocolo multidisciplinar y para la profilaxis de eventos tromboembólicos, donde enfermería y los cirujanos tienen un papel principal. La combinación de medidas físicas, farmacéuticas y educacionales son la calve de la adecuada prevención en estos pacientes(AU)

Severe or morbid obesity is one of the 21st century epidemics. Surgery is the most important and cost-effective treatment. Bariatric procedures are becoming very common in our Hospitals. Thromboembolic events such us deep venous thrombosis or pulmonary embolism (PE) are the most common medical cause of death after these procedures. Incidence of PE may arise to 3% after surgery and its mortality is about 75%. Prophylactic protocols have not been clearly defined until now. These protocols have to consider special patients, such as morbid obese ones; different kind of procedures, most of the laparoscopic; and patients’ comorbidities. By the other hand, treatment for morbid obesity has to be considered by a multidisciplinary approach. Here we present the protocol that has been initiated at our Institution. After a long and high experience in bariatric procedures, we have defined a multidisciplinary protocol to prevent thomboembolic events after surgery, where nurses and surgeons play a leading role. The combination of physical, pharmaceutical and educational measeures all together are the key for the adequate prevention in these patients(AU)

[Laparoscopic adrenalectomy for suspected isolated adrenal metastasis]. / Adrenalectomía laparoscópica por sospecha de metástasis adrenal solitaria.

INTRODUCTION: Isolated adrenal metastasis is uncommon. Both resection and the laparoscopic approach in this entity are controversial. The aim of this study was to evaluate the indications, diagnosis and utility of laparoscopic adrenalectomy (LA) in patients with isolated adrenal metastasis. PATIENTS AND METHOD: A prospective study was conducted in patients with current or previous tumoral disease and with isolated adrenal metastasis. RESULTS: Sixteen patients, with a mean age of 58 years, were selected. Fifteen LA were performed (one patient was found to have an inoperable tumor at surgery). Histopathological analysis revealed non-tumoral disease in two patients. The most common metastatic disease was non-small cell lung carcinoma (NSCLC) (10 patients), followed by colorectal cancer metastasis (two patients). The mean tumor size was 4.7 cm and was 3.8 cm on computed tomography (p = 0.09). The disease-free interval (DFI) in the NSCLC group was shorter than that in the remaining tumors (p = 0.17). The mean length of follow-up was 39 months, with a mean survival of 39.7 months. The mean actuarial survival at 2 and 5 years was 61% and 17%. At the end of the study, five patients were alive: two were disease free, one had recurrent disease, one had margin involvement and one was awaiting resection of the primary tumor. Eight patients died. One patient survived 9 years after surgery. CONCLUSIONS: LA for metastasis can be performed without oncological disadvantage and should be offered to patients with resectable disease, a DFI > 6 months, and a tumoral size that allows laparoscopic resection.

Adrenalectomía laparoscópica por sospecha de metástasis adrenal solitaria / Laparoscopic adrenalectomy for suspected isolated adrenal metastasis

Introducción. La metástasis adrenal solitaria es una afección infrecuente y su resección resulta controvertida. Asimismo, se discute su abordaje laparoscópico. El objetivo de este estudio es evaluar las indicaciones, el diagnóstico y la utilidad de la adrenalectomía laparoscópica (AL) en pacientes con metástasis adrenal solitaria. Pacientes y método. Se realizó un estudio prospectivo en pacientes con enfermedad tumoral actual o previa y con metástasis adrenal solitaria. Resultados. Se seleccionó a 16 pacientes, con una media de edad de 58 años. Se practicaron 15 AL (un caso resultó irresecable); 2 pacientes presentaron histopatología no tumoral. La enfermedad metastásica más frecuente fue el carcinoma pulmonar de no células pequeñas (CPNCP) (10 casos), seguido de la metástasis de carcinoma colorrectal (2 casos). El tamaño tumoral medio fue de 4,7 cm, y en la tomografía computarizada fue de 3,8 cm (p = 0,09). El intervalo libre de enfermedad (ILE) en el grupo con CPNCP fue menor que para las demás tumoraciones (p = 0,17). El tiempo medio de seguimiento fue de 39 meses, con una supervivencia media de 39,7 meses. La supervivencia actuarial media a los 2 y a los 5 años fue del 61 y el 17%. Al finalizar el estudio, 5 pacientes permanecen vivos: 2 libres de enfermedad, 1 con recurrencia metastásica, 1 con márgenes afectos y 1 pendiente de resección del tumor primario. Fallecieron 8 pacientes. Un paciente sobrevivió 9 años tras la cirugía. Conclusiones. La adrenalectomía laparoscópica por metástasis puede realizarse sin ninguna desventaja oncológica y se debe ofrecerla a pacientes con enfermedad resecable, ILE > 6 meses y un tamaño tumoral resecable mediante esta técnica (AU)

Introduction. Isolated adrenal metastasis is uncommon. Both resection and the laparoscopic approach in this entity are controversial. The aim of this study was to evaluate the indications, diagnosis and utility of laparoscopic adrenalectomy (LA) in patients with isolated adrenal metastasis. Patients and method. A prospective study was conducted in patients with current or previous tumoral disease and with isolated adrenal metastasis. Results. Sixteen patients, with a mean age of 58 years, were selected. Fifteen LA were performed (one patient was found to have an inoperable tumor at surgery). Histopathological analysis revealed non-tumoral disease in two patients. The most common metastatic disease was non-small cell lung carcinoma (NSCLC) (10 patients), followed by colorectal cancer metastasis (two patients). The mean tumor size was 4.7 cm and was 3.8 cm on computed tomography (p = 0.09). The disease-free interval (DFI) in the NSCLC group was shorter than that in the remaining tumors (p = 0.17). The mean length of follow-up was 39 months, with a mean survival of 39.7 months. The mean actuarial survival at 2 and 5 years was 61% and 17%. At the end of the study, five patients were alive: two were disease free, one had recurrent disease, one had margin involvement and one was awaiting resection of the primary tumor. Eight patients died. One patient survived 9 years after surgery. Conclusions. LA for metastasis can be performed without oncological disadvantage and should be offered to patients with resectable disease, a DFI > 6 months, and a tumoral size that allows laparoscopic resection (AU)