Atlas de imágenes Laparoscópicas del Cruce Duodenal (Parte II) / Laparoscopic Imaging Atlas of the Duodenal Switch (Part II)

La Derivación Bilio-Pancreática laparoscópica (DBP) con Cruce Duodenal (CD) es una operación técnicamente desafiante que requiere una extensa disección quirúrgica, transección y restauración de la continuidad intestinal, y habilidades avanzadas de sutura laparoscópica

Laparoscopic Bilio-Pancreatic Diversion (BPD) with Duodenal Switch (CD) is a technically challenging operation that requires extensive surgical dissection, transection and restoration of bowel continuity, and advanced laparoscopic suturing skills

Atlas de imágenes Laparoscópicas del Cruce Duodenal (Parte I) / Laparoscopic imaging atlas of the Duodenal Switch (Part I)

La Derivación Bilio-Pancreática laparoscópica (DBP) con Cruce Duodenal (CD) es una operacióntécnicamente desafiante que requiere una extensa disección quirúrgica, transección y restauración de lacontinuidad intestinal, y habilidades avanzadas de sutura laparoscópica

Laparoscopic Bilio-Pancreatic Diversion (BPD) with Duodenal Switch (CD) is a technically challengingoperation that requires extensive surgical dissection, transection and restoration of bowel continuity, andadvanced laparoscopic suturing skills

Anudado deslizante con autobloqueo y de Aberdeen en las suturas bariátricas laparoscópicas. Video / Sliding and self-locking and Aberdeen knot in laparoscopic bariatric sutures. Video

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Inicios de la cirugía bariátrica y metabólica en España / Beginnings of bariatric and metabolic surgery in Spain

La cirugía bariátrica (CB) de bari = peso y iatrein = cura) trata la obesidad y comienza en España en 1973. Su mayor desarrollo ocurre tras la fundación de SECO (Sociedad Española de Cirugía de la obesidad) en 1997. La finalidad de este trabajo es reflejar los cambios que han ocurrido en éstos 42 años

Bariatric surgery (BS) from the Greek bari = weight and iatrein = cure) treats obesity and began in Spain in 1973. Its greatest development occurs after the founding of SECO (Spanish Society of Obesity Surgery) in 1997. The purpose of this work is to reflect the changes that have occurred in these 22 years

Veinticinco años de cruce duodenal. Cómo cambiar al cruce / Twenty-five years of duodenal switch. How to switch to the duodenal switch

Antecedentes: el cruce duodenal (CD) es un procedimiento que combina una gastrectomía vertical (GV) más una derivación biliopancreática (DBP). Objetivos: informar de nuestra experiencia en 950 CD consecutivos en pacientes con obesidad mórbida (OM) realizados de 1994 a 2011 y con 27 años de seguimiento. Entorno: mezcla de enseñanza e institución privada en un hospital comarcal de España. Métodos: revisión retrospectiva de 950 pacientes consecutivos con obesidad mórbida tratados con cirugía de CD. Resultados: se realizaron 518 CD abiertos (CDA) y 432 CD laparoscópicos (CDL). La mortalidad operatoria fue del 0,84% (1,38% en CDA y 0,38% en CDL). El 4,84% tuvo una fuga, dos tuvieron insuficiencia hepática (0,2%) y la desnutrición estuvo presente en el 3,1%. A los cinco años, el porcentaje de sobrepeso perdido (PSP) de índice de masa corporal (IMC) fue del 80% y el porcentaje de pérdida esperada de IMC fue más del 100%. Conclusiones: el CD es la técnica bariátrica más agresiva pero con mejor pérdida de peso a largo plazo. Se describen las complicaciones operatorias y pautas de seguimiento a largo plazo

Background: the duodenal switch (DS) is a procedure that combines a vertical gastrectomy (VG) plus a biliopancreatic diversion (BPD). Objectives: to report our experience in 950 consecutive DS patients with morbid obesity (MO) performed from 1994 to 2011, with 27 years of follow-up. Environment: mix of teaching and private institution in a regional hospital in Spain. Methods: retrospective review of 950 consecutive morbidly obese patients treated with DS surgery. Results: five hundred and eighteen open DS (ODS) and 432 laparoscopic DS (LDS) were performed. Operative mortality was 0.84% (1.38% in ODS and 0.38% in LDS); 4.84% had one leak, two had liver failure (0.2%) and malnutrition was present in 3.1%. At five years, the body mass index (BMI) percentage of lost overweight (%EWL) was 80% and the percentage of expected BMI loss was more than 100%. Conclusions: the DS is the most aggressive bariatric technique but with the best long-term weight loss. Operative complications and long-term follow-up guidelines are described

[Twenty-five years of duodenal switch. How to switch to the duodenal switch]. / Veinticinco años de cruce duodenal. Cómo cambiar al cruce.

INTRODUCTION: Background: the duodenal switch (DS) is a procedure that combines a vertical gastrectomy (VG) plus a biliopancreatic diversion (BPD). Objectives: to report our experience in 950 consecutive DS patients with morbid obesity (MO) performed from 1994 to 2011, with 27 years of follow-up. Environment: mix of teaching and private institution in a regional hospital in Spain. Methods: retrospective review of 950 consecutive morbidly obese patients treated with DS surgery. Results: five hundred and eighteen open DS (ODS) and 432 laparoscopic DS (LDS) were performed. Operative mortality was 0.84% (1.38% in ODS and 0.38% in LDS); 4.84% had one leak, two had liver failure (0.2%) and malnutrition was present in 3.1%. At five years, the body mass index (BMI) percentage of lost overweight (%EWL) was 80% and the percentage of expected BMI loss was more than 100%. Conclusions: the DS is the most aggressive bariatric technique but with the best long-term weight loss. Operative complications and long-term follow-up guidelines are described.

INTRODUCCIÓN: Antecedentes: el cruce duodenal (CD) es un procedimiento que combina una gastrectomía vertical (GV) más una derivación biliopancreática (DBP). Objetivos: informar de nuestra experiencia en 950 CD consecutivos en pacientes con obesidad mórbida (OM) realizados de 1994 a 2011 y con 27 años de seguimiento. Entorno: mezcla de enseñanza e institución privada en un hospital comarcal de España. Métodos: revisión retrospectiva de 950 pacientes consecutivos con obesidad mórbida tratados con cirugía de CD. Resultados: se realizaron 518 CD abiertos (CDA) y 432 CD laparoscópicos (CDL). La mortalidad operatoria fue del 0,84% (1,38% en CDA y 0,38% en CDL). El 4,84% tuvo una fuga, dos tuvieron insuficiencia hepática (0,2%) y la desnutrición estuvo presente en el 3,1%. A los cinco años, el porcentaje de sobrepeso perdido (PSP) de índice de masa corporal (IMC) fue del 80% y el porcentaje de pérdida esperada de IMC fue más del 100%. Conclusiones: el CD es la técnica bariátrica más agresiva pero con mejor pérdida de peso a largo plazo. Se describen las complicaciones operatorias y pautas de seguimiento a largo plazo.

Four decades of bariatric surgery in a community hospital of Spain.

INTRODUCTION: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present. METHODS: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively. RESULTS: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. CONCLUSIONS: The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the field through all avenues of scientific interaction and publication.

Four decades of bariatric surgery in a community hospital of Spain / Cuatro décadas de la cirugía bariátrica en un hospital comarcal

Introduction: Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present. Methods: Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively. Results: Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. Conclusions: The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the fi eld through all avenues of scientific interaction and publication (AU)

Introducción: los cambios en la práctica de cirugía bariátrica en un hospital comarcal han sido muy importantes. Presentamos la evolución en el Hospital Comarcal de Alcoy desde su origen en 1977 hasta el presente. Métodos: se revisan retrospectivamente las técnicas quirúrgicas bariátricas empleadas en un entorno comarcal a lo largo en cuatro décadas. Resultados: los cirujanos Alcoy, han estado involucrados en la evolución de la gestión de los pacientes de cirugía bariátrica y las técnicas quirúrgicas desde 1977 hasta la actualidad. Durante los 40 años trascurridos, 1.475 pacientes fueron tratados en nuestras clínicas comenzando con la derivación gástrica (DG) en la década de 1970, la gastroplastia vertical anillada (GVA) en la década de 1980, el cruce duodenal (CD) bilio-pancreático en la década de 1990, y con el acceso por vía laparoscópica desde la década de 1990. Los resultados y los enfoques para la prevención y el tratamiento de las complicaciones de la cirugía bariátrica así como la contribución en la nomenclatura de cirugía bariátrica y la notificación de pérdida de peso son revisados desde una perspectiva comarcal. Conclusiones: la práctica de la cirugía bariátrica en el entorno comarcal debe ser actualizada continuamente. Los cirujanos bariátricos pueden contribuir con sus experiencias en el ámbito comarcal con actualizaciones y publicaciones (AU)

Stapling the bougie in sleeve gastrectomy: video.

Laparoscopic sleeve gastrectomy has become the most popular bariatric surgical operation. Based on the lesser curvature, the sleeve is created with endo-staplers, which separate the lesser curvature longitudinally and vertically from the rest of the stomach, including the greater curvature. The use of a bougie (a medical instrument used in an esophageal dilation) helps to calibrate the diameter of the sleeve. Intraoperative bougie stapling is a serious complication that should be prevented; when it happens, correction is mandatory. We present 3 cases with a video.

Sleeve-forming gastrectomy is the right terminology.

Gastric sleeve is the final result when a vertical or sleeve-forming gastrectomy is performed. There is controversy about the nomination of the procedure to make a lesser curvature gastric sleeve (LCS) since the term sleeve gastrectomy, used commonly, is grammatically a misnomer. Lexicon incorrectness should not be accepted scientifically for any nomination. The Spanish Royal Academy of Medicine and seven leaders of the International Federation for the Surgery of Obesity (IFSO) were consulted. Four past IFSO presidents, four chief editors of the Obesity Surgery journal and two presidents of national associations all agree that the sleeve gastrectomy term is a misnomer and sleeve-forming gastrectomy is proposed as the correct term.

Laparoscopic gastric sleeve, subtotal antrectomy and omentoplasty.

Sleeve-forming gastrectomy (SFG) is the operation to make a gastric sleeve (GS). The video presents the subtotal removal of the antrum and the use of sliding self-locking stitch and Aberdeen knots as suture reinforcement with omentoplasty of the GS staple line with the aim of decreasing bleeding and leaks.

Liver failure and transplantation after duodenal switch.

Liver failure (LF) and liver transplant (LT) are rare after a biliopancreatic diversion/duodenal switch procedure for obesity, but occasionally it may happen. Two clinical cases are presented. One patient, 18 years ago, had LF, but a liver donor could not be found, and the patient died. The second patient, 2 years ago, received a successful LT and is now well and asymptomatic. Careful follow-up, medical management and surgical intervention may prevent the occurrence of LF. Transplantation and bowel reversal may be necessary.

Inicios de la cirugía bariátrica y metabólica en España / Beginnings of bariatric and metabolic surgery in Spain

El inicio y cronología de la cirugía bariátrica en España, hasta la fecha, es un tema controvertido y nada preciso. Ha existido cierta discusión y confusión en cuanto a quién, cuándo y dónde se realizó el primer gesto quirúrgico bariátrico en nuestro país. Este artículo, tras un exhaustivo estudio de revisión histórica, pretende identificar y definir en el tiempo a estos iniciadores bariátricos, pioneros en la cirugía bariátrica (AU)

When bariatric and metabolic surgery initially began in Spain, it was a subject of debate, due to not knowing exactly who were the first surgeons to perform it. A study has revealed the authors of the first interventions (AU)

[Beginnings of bariatric and metabolic surgery in Spain]. / Inicios de la cirugía bariátrica y metabólica en España.

When bariatric and metabolic surgery initially began in Spain, it was a subject of debate, due to not knowing exactly who were the first surgeons to perform it. A study has revealed the authors of the first interventions.

Recomendaciones para el manejo perioperatorio de los pacientes de cirugía bariátrica: resultados de una encuesta nacional / Recommendations for the peri-operative management of bariatric surgery patients: results of a national survey

Para homogeneizar posibles protocolos perioperatorios de cirugía bariátrica, se elaboró una encuesta para que fuese respondida por los miembros de la Sociedad Española de Cirugía de la Obesidad (SECO), y aprobada en el XII Congreso Nacional. Contestaron 47 miembros de la SECO de 14 comunidades autónomas, y fue aprobada por unanimidad en el Congreso. Como procedimientos perioperatorios altamente recomendables se propusieron: analítica completa (98%) con estudio endocrino (90%), ECG (96%), RX de tórax (98%), una prueba de imagen esófago-gástrica (endoscopia o tránsito EGD) (98%), profilaxis antibiótica (92%) y uso preoperatorio (96%) y durante 2 semanas (83%) de heparinas de bajo peso molecular. Como procedimientos recomendables se establecieron la ecografía abdominal (86%), espirometría (80%), dieta preoperatoria (88%) y estudio psicológico (76%) preoperatorios, y la utilización de medias elásticas (76%), tests de estanqueidad (92%) y drenajes (90%) operatorios (AU)

To standardise possible peri-operative bariatric surgery protocols, a survey was prepared to be filled in by members of the Spanish Society for Obesity (Sociedad Española de Cirugía de la Obesidad) (SECO), and to approve it at the XII National Congress. A total of 47 members of SECO from 14 autonomous communities responded, and it unanimously approved by the Congress. As highly recommended peri-operative procedures, were proposed: full laboratory analysis (98%) with an endocrine study (90%), ECG (96%), chest x-ray (98%), an oesophageal-gastric imaging test (endoscopy or gastro-duodenal transit study (98%), antibiotic prophylaxis (92%) and use of low molecular weight heparins pre-operatively (96%), and for 2 weeks (83%). Pre-surgical, abdominal ultrasound (86%), spirometry (80%), diet (88%) and psychological study (76%), and during surgery, use of elastic stockings (76%), leak tests (92%) and drainages (90%), were established as advisable procedures (AU)

[Recommendations for the peri-operative management of bariatric surgery patients: results of a national survey]. / Recomendaciones para el manejo perioperatorio de los pacientes de cirugía bariátrica: resultados de una encuesta nacional.

To standardise possible peri-operative bariatric surgery protocols, a survey was prepared to be filled in by members of the Spanish Society for Obesity (Sociedad Española de Cirugía de la Obesidad) (SECO), and to approve it at the XII National Congress. A total of 47 members of SECO from 14 autonomous communities responded, and it unanimously approved by the Congress. As highly recommended peri-operative procedures, were proposed: full laboratory analysis (98%) with an endocrine study (90%), ECG (96%), chest x-ray (98%), an oesophageal-gastric imaging test (endoscopy or gastro-duodenal transit study (98%), antibiotic prophylaxis (92%) and use of low molecular weight heparins pre-operatively (96%), and for 2 weeks (83%). Pre-surgical, abdominal ultrasound (86%), spirometry (80%), diet (88%) and psychological study (76%), and during surgery, use of elastic stockings (76%), leak tests (92%) and drainages (90%), were established as advisable procedures.