Pancreatic Pseudocyst and Obesity: Video Case Report of Management with the One-Stage Procedure.

Reports of pancreatic pseudocyst drainage during metabolic bariatric surgery are extremely rare. Our patient is a 38-year-old female suffering from obesity grade IV and presents a persistent symptomatic pancreatic pseudocyst 8 months after an episode of acute biliary pancreatitis. After an extensive evaluation and considering other treatment options, our multidisciplinary team and the patient decided to perform a one-stage procedure consisting of laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass. After bringing the patient to the operating room, the surgeon performed an anterior gastrostomy to access the stomach's posterior wall, followed by a 6-cm cystogastrostomy on both the stomach's posterior wall and the cyst. Next, a cholecystectomy which involved dissecting the triangle of Calot was performed. Then, an 18-cm gastric pouch using a 36-Fr calibration tube was created. The cystogastrostomy was left in the remaining stomach. Finally, gastrojejunal anastomosis is done. The patient's postoperative course proceeded smoothly, leading to her home discharge on the third postoperative day. At the 1-year follow-up, the patient had lost 56 kg and was symptom-free; a computer tomography scan showed that the pancreatic pseudocyst had resolved. This case shows a video of a successful laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass (OAGB) used to treat persistent abdominal pain and obesity grade IV. We also conduct a bibliographic review.

[Metabolic profile and concentration of ghrelin and obestatin in children and adolescents with obesity]. / Perfil metabólico, concentración de grelina y obestatina en niños y adolescentes con obesidad.

Background: It has been pointed out that ghrelin and obestatin could have an impact on the genesis of obesity, since they estimulate and inhibit apetite and, therefore, food consumption. Objective: To compare the metabolic profile, lipid profile and the concentrations of ghrelin and obestatin in children with normal weight or obesity. Material and methods: Cross-sectional design with 97 normal weight or obese children, 6 to 18 years of age, who did not present systemic diseases. The serum concentrations of glucose, insulin, total cholesterol, triglycerides, high (HDL), low (LDL) and very low density (VLDL) lipoproteins, aspartate aminotransferase (AST), alanine aminotransferase (ALT), ghrelin and obestatin were determined. Descriptive statistics were performed. Student's t test was used to compare groups, and correlation coefficients of ghrelin and obestatin values with biochemical and anthropometric variables. A p value of ≤ 0.05 was significant. Results: 55 children with normal weight and 42 with obesity were included; mean age was 10.7 years. Triglycerides, LDL, VLDL, ALT and insulin were higher, and HDL lower in obese children (p < 0.05). Ghrelin values were higher in normal weight children (p < 0.05), and there was no difference in obestatin values. Conclusions: The lower concentration of ghrelin in obese children may indicate a negative feedback to regulate energy consumption. Children and adolescents with obesity show metabolic and lipid profile alterations that place them at risk of early development of cardiovascular risk factors.

Introducción: se ha señalado que la grelina y la obestatina podrían incidir en la génesis de la obesidad al estimular o inhibir el apetito y, por ende, el consumo de alimentos. Objetivo: comparar el perfil metabólico, el perfil de lípidos y las concentraciones de grelina y obestatina en niños con normopeso u obesidad. Material y métodos: diseño transversal con 97 niños de 6 a 18 años con normopeso u obesidad que no presentaran enfermedades sistémicas. Se determinaron las concentraciones séricas de glucosa, insulina, colesterol total, triglicéridos, lipoproteínas de colesterol de alta (HDL), baja (LDL) y muy baja densidad (VLDL), aspartato aminotransferasa (AST), alanina aminotransferasa (ALT), grelina y obestatina. Se usó estadística descriptiva. Se utilizó la prueba t de Student para comparar grupos, y coeficientes de correlación de los valores de grelina y obestatina con las variables bioquímicas y antropométricas. Un valor de p ≤ 0.05 fue significativo. Resultados: se incluyeron 55 niños con normopeso y 42 con obesidad; la edad promedio fue de 10.7 años. Los triglicéridos, LDL, VLDL, ALT y la insulina fueron superiores, y el HDL inferior en niños con obesidad (p < 0.05). Los valores de la grelina fueron superiores en niños con normopeso (p < 0.05) y no hubo diferencia en los de la obestatina. Conclusiones: la menor concentración de grelina en niños con obesidad puede indicar una retroalimentación negativa para regular el consumo de energía. Los niños y adolescentes con obesidad muestran alteraciones metabólicas y del perfil de lípidos que los ponen en riesgo de desarrollar tempranamente factores de riesgo cardiovascular.

Herramienta gráfica con recomendaciones de alimentación para personas con obesidad sometidas a Cirugía Bariátrica y Metabólica / Graphic tool with feeding recommendations for people with obesity undergoing Bariatric and Metabolic Surgery

RESUMEN Objetivo: diseñar y evaluar la comprensión de una Herramienta Gráfica (HG) con recomendaciones de alimentación para personas con obesidad sometidas a Cirugía Bariátrica y Metabólica (CByM), con base en las guías propuestas por la American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS), así como las recomendaciones del Colegio Mexicano de Cirugía para Obesidad y Enfermedades Metabólicas (CMCOEM) para el uso educativo de la persona profesional en nutriología-paciente. Metodología: se elaboró una HG nombrada "HG de alimentación pos-CByM" considerando las guías nutricionales propuestas por la ASMBS, AACE y TOS en conjunto con las recomendaciones de la CMCOEM. Además de realizar cuatro gráficos representando las fases que componen dicha HG, se incorporó una fase donde se aplicó un cuestionario de autollenado a tres grupos diferentes: 27 estudiantes de medicina, 8 pacientes posquirúrgicos y 16 pacientes prequirúrgicos. Se buscó identificar si el mensaje percibido era claro y conciso. Resultados: >70 % de la población intervenida entiende el mensaje de la HG diseñada, no existe significancia estadística entre los grupos entrevistados (p<0.05). Sin diferencia significativa (p<0.05) entre pacientes pre y posquirúrgicos, en ninguna de las respuestas. Conclusión: la educación en nutrición bariátrica es esencial para que las personas comprendan la transición de las fases posteriores a la intervención, los grupos, consistencia, tolerancia y porción de los alimentos. Esta HG puede ser de utilidad en la consulta nutricional exclusivamente para pacientes que se someterán a este tipo de cirugía o ya están en el proceso de recuperación.

ABSTRACT: Objectives: The purpose of this study is to Design and evaluate a graphic tool (GT) with feeding recommendations for people with obesity after bariatric surgery, based on the guidelines proposed by the American Society for Metabolic and Bariatric Surgery (ASMBS), American Association of Clinical Endocrinologists (AACE) y The Obesity Society (TOS) as well as the recommendations of the Mexican College of Surgery for Obesity and Metabolic Diseases (CMCOEM) for the educational use of the nutritionist-Bariatric patient. Methods: A GT named "Graphic tool for post bariatric surgery feeding" was elaborated based on the nutritional guidelines proposed by the ASMBS, AACE and TOS in conjunction with the recommendations of the CMCOEM. In addition to making four graphs representing each of the phases that conform the GT, a self-administered questionnaire was incorporate, it was carried out in three different groups: 27 medical students, 16 pre surgical patients and 8 postsurgical patients. We sought to identify if the perceived message was clear and brief. Results: More than 70% of the intervened population understood the message of the HG designed, there was no statistical significance among the groups interviewed (p <0.05) without significant difference (p <0.05) between pre and postsurgical patients, in none of the answers. Conclusion: Bariatric nutrition education is essential for the patient to understand the transition of the postsurgical phases, the food groups, the consistency, tolerance and portion of the food. This GT can be useful in the nutritional consultation exclusively for patients who will undergo this type of surgery or are already in the process of recovery.

Acute appendicitis in an overweight and obese Mexican population: A retrospective cohort study.

INTRODUCTION: México is the second place in overweight and obese adults. Acute appendicitis (AA), is the most common indication for an emergency surgery around the world, with an estimated lifetime incidence of 7-14%. Laparoscopic appendectomy (LA) has been described as a safe and good surgery approach for this group of patients. Nevertheless, in México, there is not any evidence supporting these outcomes in our population. METHODS: All the patients that came to the ER from July to December 2014 with age >16-year, body mass index (BMI) > 25 kg/m(2) (overweight) and, BMI >30 kg/m(2) (obese) were included in the study. We recorded the age, gender, BMI, grade of appendicitis, complications classified by the Clavien-Dindo Classification, and a follow-up period of 7-day, 30-day, 6-month, and 1-year. RESULTS: 27 patients met the inclusion criteria, five had overweight (18.5%), and twenty-two were obese (81.5%). No surgical conversion was needed. The overall complications rate was 29.6%%, with 22.2% mild complications and 7.4% of moderate complication. The average in-hospital cost for the procedure was $15,860 MXN (range $12,860-$22,860 MXN). The surgical time was ≈53.7 ± 19.93 h and the LOS ≈1.6 ± 0.6 days. CONCLUSION: The outcomes in the Mexican adult obese population with acute appendicitis when a laparoscopic appendectomy is performed are as good as reported in other countries.