[Advances in bariatric surgery: from the open approach to the biliopancreatic bypass with laparoscopic gastric preservation. Twelve years of experience]. / Evolución en cirugía bariátrica: del abordaje abierto al bypass biliopancreático con preservación gástrica por vía laparoscópica. Doce años de experiencia.

INTRODUCTION: An analysis is presented of the results in the treatment of morbid obesity after 12 years experience. MATERIAL AND METHODS: A retrospective study of patients subjected to surgery for morbid obesity from July 1998 to April 2010. Open techniques were initially used, and from January 2005 using biliopancreatic bypass with gastric diversion by a laparoscopic approach. RESULTS: A total of 165 patients have been subjected to surgery, 65 with open surgery (gastric bypass and Scopinaro), and 100 laparoscopic. The mean age was 40 years, with 74% females. The mean BMI was 48.6±6 kg/m(2), with 35% super-obese. The mean hospital stay was 7 days, with a morbidity of 26% (43 patients). Seven patients required further surgery, and 2 patients died. There was 99.4% follow-up during a median period of 46 months (1 to 141). There were complications of the gastro-jejunostomy in 17 patients. Seven patients required further surgery due to transmesenteric hernias. The rate of overweight lost was 67% (95% CI: 65-72%), 68% (95% CI: 65-72%) and 68% (95% CI: 63-73%) at 12, 36 and 60 months, respectively. The rate of excess BMI lost was 73% (95% CI: 70-76%), 74% (95% CI: 70-79%) and 74% (95% CI: 68-69%) at 12, 36 and 60 months, respectively. Comparing both approaches, there were more post-operative complications, longer hospital stays, and more incisional hernias in the open approach, with no significant differences found in the rest of the parameters analysed. CONCLUSION: Our long-term results are within those classified as excellent, with acceptable morbidity and mortality. A great advance has been observed in the laparoscopic approach due to the less aggressive surgery, and maintaining an excellent weight loss.

[Oat cell carcinoma of the common bile duct]. / Carcinoma oat cell de vía biliar principal.

Oat cell tumors in the common bile duct are extremely rare. We describe the case of a 76-year-old man with skin and mucous jaundice of 15 days' duration without constitutional syndrome. A tumor was diagnosed in the mid portion of the common bile duct. After surgical resection, pathological analysis revealed small-cell (oat cell) carcinoma. The treatment of these tumors is multidisciplinary. Surgery is followed by chemo- and radiotherapy.