Obesidad y SARS-CoV-2: consideraciones sobre la cirugía bariátrica y recomendaciones para el inicio de la actividad quirúrgica / Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity

La pandemia SARS-CoV-2 ha tenido un gran impacto en todo el mundo, siendo España uno de los países más afectados. La demora en la cirugía bariátrica puede tener consecuencias fatales, ya que hasta el 50% de los pacientes que se encuentran en lista de espera desarrollan una nueva comorbilidad durante el tiempo que permanecen en ella y el 1,5% de pacientes fallecen mientras esperan la intervención. Es por ello por lo que la cirugía bariátrica no debe demorarse en cuanto la ocupación del hospital por pacientes COVID-19+ disminuya de forma significativa y se disponga de recursos y seguridad suficiente para realizar la cirugía en pacientes con patología benigna. Este documento recoge las principales recomendaciones para los programas de cirugía bariátrica en nuestro país desde el punto de vista tanto de seguridad como de preparación y seguimiento del paciente bariátrico en el contexto de la pandemia SARS-CoV-2

The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia

Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. / Obesidad y SARS-CoV-2: consideraciones sobre la cirugía bariátrica y recomendaciones para el inicio de la actividad quirúrgica.

The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.

Acerca de la enfermedad por reflujo gastroesofágico en un paciente con un IMC 30 kg/m2 y gastroplastia vertical endoscópica previa: indicación para un bypass gástrico de una anastomosis / Gastroesophageal reflux disease in a patient with a BMI of 30 kg/m2 and previous endoscopic sleeve gastroplasty: Indication for a one-anastomosis gastric bypass

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Prognostic factors of weight loss after sleeve gastrectomy: Multi centre study in Spain and Portugal. / Factores predictivos de pérdida ponderal tras la gastrectomía vertical. Estudio multicéntrico hispano-portugués.

INTRODUCTION: Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. METHODS: A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL>50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. RESULTS: A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58±24.7; 3 years 69.39±29.2; 5 years 68.46±23.1. Patients with EWL<50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI>50kg/m2, age>50years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4cm, bougie>40F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. CONCLUSION: The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI>50, age>50, the presence of several comorbidities, more than 5cm section of the pylorus or bougie>40F can increase the risk of weight loss failure.

Factores predictivos de pérdida ponderal tras la gastrectomia vertical. Estudio multicéntrico hispano-portugués / Prognostic factors of weight loss after sleeve gastrectomy: Multicenter study in Spain and Portugal

INTRODUCCIÓN: La gastrectomía vertical (GV) se ha convertido en una técnica con entidad propia cuya indicación selectiva o global sigue siendo objeto de controversia. Los resultados ponderales a 5 años son heterogéneos. El objetivo del estudio es identificar posibles factores pronósticos de pérdida de peso insuficiente tras GV. MÉTODOS: Estudio multicéntrico retrospectivo de GV con seguimiento mayor de un año. Se considera fracaso si el PSP < 50%. Se realiza estudio univariado y multivariado de regresión de Cox para determinar los factores que influyen en el fracaso ponderal a 1, 2 y 3 años de seguimiento. RESULTADOS: Se incluye a 1.565 pacientes intervenidos en 29 hospitales. PSP al año: 70,58 ± 24,8; a los 3 años 69,39 ± 29,2; a los 5 años 68,46 ± 23,1. Pacientes con PSP <50 (considerado fracaso ponderal): 17,1% en el primer año, 20,1% a 3 años, 20,8% a 5 años. Las variables que mostraron relación con el fracaso ponderal en el estudio univariado fueron: IMC > 50 kg/m2, edad > 50 años, DM2, HTA, SAOS, cardiopatía, varias comorbilidades asociadas, distancia a píloro > 5 cm, bujía >40 F, tratamiento con antiagregantes. La sobresutura mejora los resultados. Las variables que mostraron ser factores predictivos de fracaso en el seguimiento fueron la DM2 y el IMC. CONCLUSIÓN: La GV asocia una pérdida de peso satisfactoria en el 79% de los pacientes en los primeros 5 años; sin embargo, algunas variables como el IMC > 50, la DM2, la edad > 50, la presencia de varias comorbilidades, la sección a más de 4cm del píloro o la bujía > 40 F pueden aumentar el riesgo de fracaso ponderal

INTRODUCTION: Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. METHODS: A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL > 50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. RESULTS: A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58 ± 24.7; 3 years 69.39 ± 29.2; 5 years 68.46 ± 23.1. Patients with EWL< 50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI > 50 kg/m2, age > 50 years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4cm, bougie > 40F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. CONCLUSION: The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI > 50, age > 50, the presence of several comorbidities, more than 5 cm section of the pylorus or bougie > 40F can increase the risk of weight loss failure

Criterios de calidad en cirugía bariátrica: revisión de conjunto y recomendaciones de la Asociación Española de Cirujanos y de la Sociedad Española de Cirugía de la Obesidad / Quality criteria in bariatric surgery: Consensus review and recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery

La cirugía bariátrica ha demostrado ser muy eficaz en el control de la obesidad y el síndrome metabólico. Sus resultados no solo se expresan en términos de pérdida de peso, sino también en la resolución de comorbilidades, mejoría de la calidad de vida y de las complicaciones derivadas. Los diferentes parámetros utilizados para medir estos resultados requieren de una uniformidad y de unos patrones de referencia. Por ello, es fundamental establecer cuáles son los indicadores y los criterios de calidad que definen las «buenas prácticas» en cirugía bariátrica. En este sentido, la Sección de Obesidad de la Asociación Española de Cirujanos (AEC), en colaboración con la Sociedad Española de Cirugía de la Obesidad (SECO), se plantea como objetivo identificar los puntos clave que definen la calidad en este tipo de cirugía. Para ello se describen los principales indicadores basados en la literatura publicada, así como los criterios de remisión de las principales comorbilidades según las evidencias encontradas y sus grados de recomendación

Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation

Quality criteria in bariatric surgery: Consensus review and recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery. / Criterios de calidad en cirugía bariátrica: revisión de conjunto y recomendaciones de la Asociación Española de Cirujanos y de la Sociedad Española de Cirugía de la Obesidad.

Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice¼ principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality¼ in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation.

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study.

BACKGROUND: Complications in sleeve gastrectomy (SG) can cast a shadow over the technique's good results and compromise its safety. The aim of this study is to identify risk factors for complications, and especially those that can potentially be modified to improve safety. METHODS: A retrospective multicenter cohort study was carried out, involving the participation of 29 hospitals. Data was collected on demographic variables, associated comorbidities, technical modifications, the surgeon's experience, and postoperative morbimortality. A multivariate logistic regression analysis was carried out on risk factors (RFs) for the complications of leak/fistula, hemoperitoneum, pneumonia, pulmonary embolism, and death. RESULTS: The following data were collected for 2882 patients: age, 43.85 ± 11.6. 32.9 % male; BMI 47.22 ± 8.79; 46.2 % hypertensive; 29.2 % diabetes2; 18.2 % smokers; bougie calibre ≥40 F 11.1 %; complications 11.7 % (2.8 % leaks, 2.7 % hemoperitoneum, 1.1 % pneumonia, 0.2 % pulmonary embolism); and death 0.6 %. RFs for complications were as follows: surgeon's experience < 20 patients, OR 1.72 (1.32-2.25); experience > 100 patients, OR 0.78 (0.69-0.87); DM2, OR1.48(1.12-1.95); probe > 40 F, OR 0.613 (0.429-0.876). Leak RFs were the following: smoking, OR1.93 (1.1-3.41); surgeon's experience < 20 patients, OR 2.4 (1.46-4.16); experience of 20-50 patients, OR 2.5 (1.3-4.86); experience >100 patients, OR 0.265 (0.11-0.63); distance to pylorus > 4 cm, OR 0.510 (0.29-0.91). RFs for death were as follows: smoking, OR 8.64 (2.63-28.34); DM2, OR 3.25 (1.1-9.99); distance to pylorus < 5 cm, OR 6.62 (1.63-27.02). CONCLUSIONS: The safety of SG may be compromised by nonmodifiable factors such as age >65, patient comorbidities (DM2, hypertension), and prior treatment with anticoagulants, as well as by modifiable factors such as smoking, bougie size <40 F, distance to the pylorus <4 cm, and the surgeon's experience (<50-100 cases).

Manejo quirúrgico del estreñimiento crónico grave / Surgical management of severe chronic constipation

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Apendicetomía en gestantes / Appendicectomy in pregnant women

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Neumoperitoneo idiopático / Idiopathic pneumoperitoneum

Comunicamos el caso de un paciente varón de 48 años que presentó un cuadro de insuficiencia respiratoria aguda y requirió ingreso en la unidad de cuidados intensivos y que, una vez dado de alta, presentó un cuadro de neumoperitoneo masivo. Ninguna de las exploraciones complementarias realizadas aportó información relevante para el diagnóstico, y el paciente fue intervenido pero no se halló una causa aparente para explicar el neumoperitoneo. Creemos que este caso es interesante, ya que es una entidad frecuente que conduce a numerosas laparotomías de urgencia, y la mayoría de las veces su causa es la perforación de una víscera hueca, pero en un porcentaje importante es un neumoperitoneo no quirúrgico o idiopático (AU)

We report the case of a 48-year-old man who was admitted to the intensive care unit for acute respiratory distress. After discharge, the patient showed massive pneumoperitoneum. None of the complementary investigations provided information on the cause. The patient underwent surgery but no intraoperative diagnosis was reached. We believe that this case is of interest since pneumoperitoneum is a frequent entity that often leads to emergency laparotomy. The cause is usually perforation, although in a substantial proportion of cases the pneumoperitoneum is non-surgical, or idiopathic (AU)

[Idiopathic pneumoperitoneum]. / Neumoperitoneo idiopático.

We report the case of a 48-year-old man who was admitted to the intensive care unit for acute respiratory distress. After discharge, the patient showed massive pneumoperitoneum. None of the complementary investigations provided information on the cause. The patient underwent surgery but no intraoperative diagnosis was reached. We believe that this case is of interest since pneumoperitoneum is a frequent entity that often leads to emergency laparotomy. The cause is usually perforation, although in a substantial proportion of cases the pneumoperitoneum is non-surgical, or idiopathic.