Short- and Long-Term Effects of Weight Loss on the Complement Component C3 After Laparoscopic Gastric Bypass in Obese Patients.

BACKGROUND: The C3 complement component (C3c) is increasingly recognized as a cardiometabolic risk factor, but how it is affected after weight loss through gastric bypass is a question yet to be answered. METHODS: A total of 66 obese patients underwent laparoscopic gastric bypass. Anthropometric parameters, total cholesterol (TC), triglycerides, high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), glucose, insulin, HOMA-IR, liver enzymes, high-sensitivity C-reactive protein (hsCRP), and C3c levels were evaluated at baseline and at 1 and 5 years post-surgery. RESULTS: All anthropometric and biochemical parameters improved significantly after surgery, although a deterioration was detected with respect to the percentage of excess of weight loss, insulin, TC, LDLc, and lactate dehydrogenase 5 years post-surgery. Despite this, a remission rate of 84 % was observed in the presence of metabolic syndrome after 5 years follow-up. hsCRP and C3c were reduced significantly after surgery and maintained throughout the experimental period. In addition, C3c was correlated with BMI and insulin at all time points. The multivariate regression model, in which C3c was a dependent variable, revealed that aspartate aminotransferase and BMI were independent variables at baseline, alkaline phosphatase and insulin were independent at 1 year post-surgery, and insulin, BMI, and TC were independent at 5 years post-surgery. CONCLUSIONS: C3c may be a marker of the chronic inflammatory process underlying insulin resistance. Its association with BMI and liver enzymes supports a major role in metabolic activity, although future research is needed to clarify the nature of the molecular mechanisms involved and the physiological significance of these findings.

Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer.

BACKGROUND: Esophageal resection for the treatment of esophageal cancer is usually associated with high morbido-mortality risks, that can be reduced using laparoscopy. Laparoscopic transhiatal esophagectomy (LTE) has the potential to improve these results but, to-date, only a few limited series of cases have been reported. This report summarizes our experience in 24 cases. OBJECTIVE: To assess the outcomes following LTE. METHODS AND MATERIALS: Between 1998 and 2005, LTE was performed in 24 patients; 18 men and 6 women with an overall mean age of 63 years (range: 36-85). Indication for surgery was lower third esophageal cancer; 11 squamous cell carcinoma and 13 adenocarcinoma. Neoadjuvant chemotherapy and radiotherapy were used in 18 patients (75%). A laparoscopic transhiatal approach was used to perform an esophagectomy with curative intent. A cervical esophagogastric anastomosis was created. RESULTS: No reversion to conventional open surgery was required. Mean anesthesia time was 293.8 min (range: 255-360). Major complications occurred in 7 patients (29.2%). Two patients (8.3%) had leakage from the cervical anastomosis. Surgical mortality was 8.3%. The median stay in Intensive Care Unit was 5 days (range: 1-29). Median hospital stay was 11.5 days (range: 7-54). At a mean follow-up of 24.9 months, 8 patients (36.4%) had disease recurrence (36.4%), global survival rate was 62.5%, and diseasefree survival rate was 50%. CONCLUSIONS: Assisted laparoscopic transhiatal esophagectomy for lower third esophageal cancer is a potentially safe and effective method when performed by surgeons with expertise in the field. Benefits from this approach need to be confirmed by further randomized studies.

Assisted laparoscopic transhiatal esophagectomy for the treatment of esophageal cancer

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Background. Esophageal resection for the treatmentof esophageal cancer is usually associatedwith high morbido-mortality risks, that can be reducedusing laparoscopy. Laparoscopic transhiatalesophagectomy (LTE) has the potential to improvethese results but, to-date, only a few limited seriesof cases have been reported. This report summarizesour experience in 24 cases.Objective. To assess the outcomes following LTE.Methods and materials. Between 1998 and 2005,LTE was performed in 24 patients; 18 men and 6women with an overall mean age of 63 years(range: 36-85). Indication for surgery was lowerthird esophageal cancer; 11 squamous cell carcinomaand 13 adenocarcinoma. Neoadjuvant chemotherapyand radiotherapy were used in 18 patients(75%). A laparoscopic transhiatal approach wasused to perform an esophagectomy with curativeintent. A cervical esophagogastric anastomosis wascreated.Results. No reversion to conventional open surgerywas required. Mean anesthesia time was 293.8 min(range: 255-360). Major complications occurred in 7patients (29.2%). Two patients (8.3%) had leakagefrom the cervical anastomosis. Surgical mortalitywas 8.3%. The median stay in Intensive Care Unitwas 5 days (range: 1-29). Median hospital stay was11.5 days (range: 7-54). At a mean follow-up of 24.9months, 8 patients (36.4%) had disease recurrence(36.4%), global survival rate was 62.5%, and diseasefreesurvival rate was 50%.Conclusions. Assisted laparoscopic transhiatal esophagectomyfor lower third esophageal cancer is apotentially safe and effective method when performedby surgeons with expertise in the field.Benefits from this approach need to be confirmedby further randomized studies

Formación del residente en cirugíalaparoscópica: resultados de nuestraexperiencia / Resident training in laparoscopic surgery: results of our experience

Objetivo. La aparición de la laparoscopia ha revolucionado la cirugía de la última década. Es fundamental, por tanto, la formación adecuada de nuestros residentes que permita su progresiva incorporación a la realización de intervenciones por vía laparoscópica. Material y método. Analizamos las intervenciones laparoscópicas realizadas por los cinco últimos residentes formados en nuestro servicio. Describimos el tipo y número de intervenciones laparoscópicas en las que ha participado cada residente, como cirujano o como ayudante. Distinguimos entre cirugía urgente y programada. Analizamos detalladamente las dos intervenciones más frecuentes: apendicectomía y colecistectomía laparoscópicas. Resultados. El total de intervenciones laparoscópicas en las que participaron los residentes fue de 985.En 373 lo hicieron como cirujano principal, siendo urgentes 235 (63 por ciento) y programadas 138 (37 por ciento). Las intervenciones laparoscópicas realizadas fueron: laparoscopia diagnóstica, apendicectomía, colecistectomía, sutura de ulcus perforado, confección de colostomía en asa, funduplicatura 360o, coledocotomía y sigmoidectomía. Hemos constatado una progresión en la incorporación de los residentes a la realización de intervenciones laparoscópicas como cirujano. Este hecho se ve reflejado claramente al analizar las apendicectomías y colecistectomías laparoscópicas. Dicha progresión se cumple tanto en intervenciones urgentes como programadas. Con respecto a la participación como ayudantes, existe una completa incorporación desde el inicio de su formación, no existiendo diferencias entre residentes. Conclusión. Presentamos la demostración práctica de cómo podemos formar a nuestros residentes en laparoscopia. Su incorporación a la cirugía laparoscópica es prioritaria. El residente debe concluir su formación dominando, como poco, la práctica de la apendicectomía y de la colecistectomía laparoscópicas (AU)

Complicaciones postoperatorias en cirugía laparoscópica del colon / Postoperative complications after laparoscopic surgery of the colon

La aparición de complicaciones postoperatorias en la cirugía laparoscópica del colon es dependiente de la capacidad técnica del cirujano y de la curva de aprendizaje. Comparado con la cirugía laparotómica, la infección de la herida quirúrgica es menos frecuente, y no se observan diferencias en las complicaciones mayores (fuga anastomótica, estenosis). El talón de Aquiles de esta cirugía es la técnica de doble grapado. La técnica laparoscópica parece reducir la morbilidad general de la cirugía colorrectal (AU)