Colección abscesificada en pared abdominal secundaria a polipectomía colonoscópica. Manejo radiológico / Abdominal wall abscess secondary to colonoscopic polypectomy. Radiological management

No disponible

Perioperative complications following bariatric surgery according to the clavien-dindo classification. Score validation, literature review and results in a single-centre series.

BACKGROUND: There is no unified system for reporting surgical complications after bariatric surgery. One increasingly used system for notifying postoperative complications is the Clavien-Dindo classification, which focuses on their therapeutic implications. OBJECTIVE: The aim of this study is to validate and apply the Clavien-Dindo scale to a series of cases of bariatric surgery and systematically review its use worldwide. SETTING: University hospital. METHODS: A cohort of 321 patients with morbid obesity (Mean BMI: 45.4±5.5 kg/m2) underwent surgery by the same team of surgeons, fundamentally using a laparoscopic gastric bypass. Initially, the Clavien-Dindo scale was translated and validated for its acceptability and reproducibility using the Kappa index. The scale was then applied to the whole of the bariatric series. A systematic review was also conducted in the literature regarding the use of the Clavien-Dindo classification after bariatric surgery. Lastly, a comparison was made with our results. RESULTS: The classification was validated without any difficulty. Most of the postoperative complications are grades I (8.4%) and III (7.8%). We found it used in 15 series (including our own), which accounts for 10,347 patients. The overall results are analogous to our series. CONCLUSIONS: The Clavien-Dindo scale has been validated and translated into Spanish. Application is quick and simple and enables comparisons to be made between centers and series. Our results are similar to those reported by other authors.

Failure of the Obesity Surgery Mortality Risk Score (OS-MRS) to Predict Postoperative Complications After Bariatric Surgery. A Single-Center Series and Systematic Review.

BACKGROUND: The obesity surgery mortality risk score (OS-MRS) was developed to determine the risk of postoperative mortality in patients undergoing bariatric surgery. The aim of the present study is to assess the utility of this score for preventing the risk of postoperative complications from bariatric surgery. METHODS: Prospective study of 321 patients undergoing bariatric surgery to whom the OS-MRS was applied. Postoperative complications were classified according to the Clavien-Dindo system. The relation between the OS-MRS and the appearance of complications and mortality was analyzed. A Medline/Embase search was conducted using bariatric surgery, mortality, and complications as key words. Studies using the OS-MRS to predict morbidity and mortality were included. RESULTS: Of the 321 patients, 303 (94.3%) underwent gastric bypass and the remaining 18 (5.6%) a sleeve gastrectomy. The OS-MRS classified 178 patients as class A (55.5%), 129 as class B (40.2%), and 14 as class C (4.4%). According to the Clavien-Dindo system, 10.4% of the complications were ≥III. There was one death (class B). No significant association was found between the OS-MRS and the rate of complications. CONCLUSIONS: In our study, the OS-MRS is not correlated with the appearance of early complications or mortality. Future studies must focus on systems for predicting the appearance and severity of postoperative complications classified according to the Clavien-Dindo system, and not only on mortality.

Controversias sobre el manejo de la fluidoterapia en cirugía abdominal / Controversies in fluid management during abdominal surgery

No disponible

Uso del plasma rico en plaquetas autólogo en abdominoplastías / Using platelet rich plasma in abdominoplasty

Objective: Evaluation of the effectiveness of autologous platelet rich plasma administered topically in the healing and prevention of complications of abdominoplasty after bariatric surgery. Material and Methods: The data from 30 patients who underwent abdominoplasty were analyzed: Group I: Rich plasma was administered autologous platelets in the surgery. Group II: Control. Study variables: complications (seroma, local infection and bleeding), length of stay and cost. Results: No significant differences were observed in the frequency of complications or length of stay. The use of platelet rich plasma raises the cost of the procedure. Conclusion: Even considering the limitations of the study because of its small sample size and lack of blinding, the results do not support the use of this complementary technique. Further studies are needed in the field of adhesives, sealants and local hemostatic.

Objetivo: Evaluación de la eficacia del plasma rico en plaquetas autólogo administrado de forma tópica en la cicatrización y prevención de las complicaciones de la abdominoplastía y dermolipectomía tras cirugía bariátrica. Material y Método: Serie de 30 pacientes afectos de faldón abdominal tras cirugía bariátrica, a los que se practicó dermolipectomía y abdominoplastía, divididos en dos grupos de 15 casos con aletorización simple. Grupo I: Se administró plasma rico en plaquetas autólogo en el lecho quirúrgico. Grupo II: Control. Variables de estudio: complicaciones (seroma, infección local y hemorragia), tiempo de estancia y coste. Resultados: No se aprecian diferencias significativas en la frecuencia de complicaciones ni en estancia media. El uso de plasma rico en plaquetas eleva el coste del procedimiento. Conclusión: Aun considerando las limitaciones del estudio por su corto número de casos y no cegamiento, los resultados no apoyan el uso de esta técnica complementaria. Estudios más avanzados son necesarios en el campo de los adhesivos, sellantes y hemostáticos locales.

Necrosis mamaria completa por acenocumarol / Complete mammary necrosis due to acenocoumarol

No disponible

Cirugía bariátrica en pacientes con esclerosis múltiple: ¿un mayor riesgo? / Bariatric surgery in patients with multiple sclerosis

Background: There is limited information about the role of bariatric surgery among patients with motor deficits. Case reports: We report a 38 years old woman with a body mass index (BMI) of 49 kg/m² and a 34 years old woman with a BMI of 40 kg/m², both with multiple sclerosis, subjected to a laparoscopic gastric bypass. Both were unable to lose weight with medical management. No postoperative complication was recorded, both patients lost weight and their quality of life improved.

Introducción: Hay escasa literatura acerca del papel de la cirugía bariátrica en el manejo de las enfermedades neurológicas con déficit motor. Este déficit motor supone una desventaja sobreañadida si además los pacientes son obesos mórbidos. Casos clínicos: Presentamos dos casos de obesidad mórbida y esclerosis múltiple intervenidas de by pass gástrico laparoscópico. El primer caso es una mujer de 38 años con IMC de 49 y el segundo es una mujer de 34 años con IMC de 40. Tras varios intentos fallidos de pérdida de peso e ingresos programados para dieta absoluta son remitidas por los servicios de Endocrinología y neurología para valorar cirugía bariátrica para pérdida de peso y facilitar la dosificación de tratamiento especifico. No se produjo ninguna complicación postquirúrgica inmediata. La pérdida de peso fue favorable al año de seguimiento, mejorando la calidad de vida de estas pacientes.

Endoscopia urgente por hemorragia digestiva tras cirugía bariátrica. Algoritmo terapéutico / Emergency endoscopy for gastrointestinal bleeding after bariatric surgery. Therapeutic algorithm

OBJETIVOS: La hemorragia digestiva alta (HDA) es una potencial complicación tras la cirugía bariátrica, con una incidencia entre el 2 y el 4%. El objetivo de este estudio es presentar nuestra incidencia de HDA tras cirugía bariátrica, su forma de presentación y su manejo mediante un algoritmo terapéutico. Pacientes y método: Estudio observacional prospectivo de una serie de 300 cirugías bariátricas por laparoscopia de manera consecutiva, desde enero del 2004 hasta diciembre del 2012. Se recogen datos demográficos, forma de presentación, diagnóstico y tratamiento de la HDA. En 280 pacientes se practicó bypass gástrico según la técnica de Wittgrove modificada, con anastomosis circular en 265 y anastomosis longitudinal en 15. En 20 pacientes se practicó gastrectomía vertical. RESULTADOS: Aparecieron 27 casos (9%) de HDA tratados con: cirugía en un caso por inestabilidad hemodinámica; con gastroscopia diagnóstica-terapéutica en 13 casos (en 2 casos, 2 veces); en 10 de ellos, apareció de forma precoz (1-6 días) cuyo origen fue la línea de sutura de la anastomosis gastroyeyunal (GY) y en 3 de forma tardía, a los 15-20 días, siendo su origen una úlcera en la boca anastomótica. En el resto (13 pacientes), el manejo fue de forma conservadora. CONCLUSIONES: Aunque el manejo conservador de la HDA resuelve la mayoría de los casos, la clínica y la forma de presentación deben alertarnos, por lo que, en casos graves de sangrado, se requerirá de una endoscopia urgente. Es importante un equipo multidisciplinar y una comunicación estrecha entre cirujanos y endoscopistas para el manejo de esta seria complicación

OBJECTIVE: Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. PATIENTS AND METHOD: From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. RESULTS: Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1st-6th postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively. CONCLUSION: Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication

Emergency endoscopy for gastrointestinal bleeding after bariatric surgery. Therapeutic algorithm.

OBJECTIVE: Gastrointestinal bleeding (GB) is a potential complication after bariatric surgery and its frequency is around 2-4% according to the literature. The aim of this study is to present our experience with GB after bariatric surgery, its presentation and possible treatment options by means of an algorithm. PATIENTS AND METHOD: From January 2004 to December 2012, we performed 300 consecutive laparoscopic bariatric surgeries. A total of 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of a gastrojejunal anastomosis using a circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. Demographics, clinical presentation, diagnostic evaluation and treatment were reviewed. A total of 20 patients underwent a sleeve gastrectomy. RESULTS: Twenty-seven cases (9%) developed GB. Diagnosis and therapeutic endoscopy was required in 13 patients. The onset of bleeding occurred between the 1(st)-6(th) postop days in 10 patients, and the origin was at the gastrojejunostomy staple-lines, and 3 patients had bleeding from an anastomotic ulcer 15-20 days after surgery. All other patients were managed non-operatively. CONCLUSION: Conservative management of gastrointestinal bleeding is effective in most cases, but endoscopy with therapeutic intent should be considered in patients with severe or recurrent bleeding. Multidisciplinary postoperative follow- up is very important for early detention and treatment of this complication.

Estenosis de la anastomosis gastroyeyunal en el bypass gástrico laparoscópico. Experiencia en una serie de 280 casos en 8 años / Gastrojejunal anastomotic stenosis after laparoscopic gastric bypass. Experience in 280 cases in 8 years

INTRODUCCIÓN: La estenosis de la anastomosis gastroyeyunal (GY) representa la complicación más frecuente en la cirugía de derivación gástrica por laparoscopia, llegando en algunas series a alcanzar el 15%. Presentamos nuestra incidencia de estenosis de la anastomosis GY en el bypass gástrico laparoscópico, su forma de presentación y su manejo a largo plazo. MATERIAL Y MÉTODO: Desde enero del 2004 hasta diciembre del 2012 se han realizado 280 bypass gástricos por la laparoscopia, según la técnica de Wittgrove modificada. La anastomosis GY circular se practicó con material de autosutura tipo CEAA n° 21 en 265 casos, en los restantes se realizó con una anastomosis longitudinal con grapadora lineal de 45 mm. A todos los pacientes con intolerancia persistente a la alimentación se les realizó tránsito baritado o gastroscopia. Cuando se evidenció estenosis GY (diámetro <10 mm), se procedió a dilatación neumática endoscópica. RESULTADOS: En 20 casos (7,1%) se desarrolló una estenosis GY, en 4 de ellos el diagnóstico inicial fue con tránsito baritado. Todos los casos fueron confirmados por gastroscopia. De ellos, 5 pacientes tenían antecedentes de hemorragia digestiva alta que precisaron esclerosis endoscópica de la línea de sutura de la anastomosis GY. Todos los casos se han resuelto mediante dilatación endoscópica, precisando en un caso 2 sesiones de dilatación, en otro caso 3 sesiones y el resto, una. No se han detectado reestenosis. Uno de los pacientes sufrió una perforación de úlcera postanastomótica. CONCLUSIONES: La estenosis de la anastomosis GY es una complicación frecuente tras el bypass gástrico en Y de Roux. Favorecida por anastomosis de pequeño calibre. La endoscopia es la piedra angular para el diagnóstico y tratamiento, pues resuelve la mayoría de casos, siendo rara la revisión quirúrgica

OBJETIVE: Gastrojejunal stricture (GYS), not only is a common complication after laparoscopic gastric bypass, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 280 laparoscopic gastric bypass. PATIENTS AND METHOD: From January 2004 to December 2012, 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of the gastrojejunal anastomosis is performed with circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation. RESULTS: Twenty cases (7.1%) developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and all case were confirmed by endoscopy. Five patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion. All cases were resolved by endoscopic dilatation. One patient suffered a perforation and a re-intervention. At follow-up has not been detected re-stricture. CONCLUSION: Structure at the gastrojejunal anastomosis after gastric bypass is the commonest complication early after surgery. Endoscopic balloon dilatation is a safe and effective therapy

Sobre la importancia del informe de alta hospitalaria / The importance of the discharge summary reports

No disponible

Gastrojejunal anastomotic stenosis after laparoscopic gastric bypass. Experience in 280 cases in 8 years.

OBJECTIVE: Gastrojejunal stricture (GYS), not only is a common complication after laparoscopic gastric bypass, but its frequency is about 15% according to bibliography. Our aim is to present our experience after 280 laparoscopic gastric bypass. PATIENTS AND METHOD: From January 2004 to December 2012, 280 patients underwent a laparoscopic Roux en Y gastric bypass with creation of the gastrojejunal anastomosis is performed with circular stapler type CEAA No 21 in 265 patients and with a linear stapler in 15 patients. In all patients with persistent feeding intolerance were performed barium transit and/or gastroscopy. When gastrojejunal stricture showed proceeded to endoscopic pneumatic dilation. RESULTS: Twenty cases (7.1%) developed a gastrojejunal stricture, in 4 of these cases the initial diagnosis was made by barium transit and all case were confirmed by endoscopy. Five patients had a history of digestive bleeding that required endoscopic sclerosis of the bleeding lesion. All cases were resolved by endoscopic dilatation. One patient suffered a perforation and a re-intervention. At follow-up has not been detected re-stricture. CONCLUSION: Structure at the gastrojejunal anastomosis after gastric bypass is the commonest complication early after surgery. Endoscopic balloon dilatation is a safe and effective therapy.

Complicaciones y nivel de satisfacción tras la realización de una dermolipectomía y abdominoplastia después de efectuar una cirugía bariátrica / Complications and level of satisfaction after dermolipectomy and abdominoplasty post-bariatric surgery

INTRODUCCIÓN: Las abdominoplastias se han convertido en un proceso quirúrgico frecuente en pacientes con pérdida masiva de peso tras cirugía bariátrica. Este tipo de procedimientos no están exentos de complicaciones que afectan a la calidad de vida y satisfacción del paciente. El objetivo de este estudio es encontrar los factores de riesgo para desarrollar dichas complicaciones y evaluar la satisfacción de nuestros pacientes. MATERIAL Y MÉTODOS: A un total de 72 pacientes, de los 175 intervenidos de cirugía bariátrica, se les realizó una abdominoplastia entre 2003 y 2008. Fueron revisados, retrospectivamente: datos demográficos, estado pre- y poscirugía, comorbilidades, tasa de complicaciones y reintervención. El nivel de satisfacción fue medido mediante una encuesta expresada en una escala tipo Likert. Se realizó un análisis comparativo de las distintas variables entre pacientes con y sin complicaciones. RESULTADOS: a) Complicaciones: tasa global del 45,5%. La más frecuente fue el seroma (23,6%); infección (13,9%), sangrado (11,1%), hematoma (6,9%) (requiriendo transfusión [6,9%]), necrosis de piel (6,9%) y necrosis umbilical (4,2%). Se reintervino a 8 pacientes (11,1%). b) Satisfacción: 1) muy satisfecho: 51,4%; 2) satisfecho: 31,9%; 3) insatisfecho: 8,3%; 4) muy insatisfecho: 8,3%.c) Se encuentra una relación estadísticamente significativa entre complicaciones, reintervención, estancia media y satisfacción (p < 0,001). CONCLUSIÓN: Las complicaciones son relativamente frecuentes en este tipo de pacientes, alargando la estancia media y posteriores controles ambulatorios. No hemos identificado factores de riesgo que ayuden a prevenir este tipo de complicaciones. El grado de insatisfacción está en relación con las complicaciones postoperatorias del procedimiento quirúrgico y no con el resultado estético

BACKGROUND: Body contouring surgery is in high demand following the increase in bariatric surgery. But these types of procedures are associated with high complication rates that cause long hospital stays and have a negative effect on patient satisfaction. The purpose of this study is to identify predictors of complications in order to optimize outcomes in these patients and find a relationship between complication rate and satisfaction. MATERIAL AND METHODS: Out of a group of 175 post-bariatric patients, 72 patients underwent body contouring surgery following massive weight loss from 2003-2008. They were reviewed retrospectively for demographic data, pre- and postoperative weight status, co-morbidities and complications and reoperation rate. Patient satisfaction was evaluated. RESULTS: a) Complications: The overall complication rate was 45.8%. The most frequent were seromas (23.6%); infection (13.9%), bleeding (11.1%), hematoma (6.9%) (needing transfusions [6.9%]), skin necrosis (6.9%) and umbilical necrosis (4.2%). A total of 8 patients required reoperation (11.1%).b) Satisfaction rating: 1) very satisfied: 51.4%, 2) satisfied: 31.9%, 3) dissatisfied: 8.3%, 4) very dissatisfied: 8.3%.c) The presence of complications was significantly associated with patients' satisfaction, reoperation rate and longer hospital stays (P<.001). CONCLUSIONS: Post operative complications were frequent. No predictors could be found to prevent these complications and optimize patient selection and appropriate timing of surgery. Patients with complications had a significantly higher reoperation rate, longer hospital stay and more dissatisfaction. The patients' satisfaction was negatively influenced by complication occurrence and not by the aesthetic results

Reflexiones sobre los fines de semana y festivos en los hospitales / Reflexions on week-ends and holidays in hospitals

No disponible

[Complications and level of satisfaction after dermolipectomy and abdominoplasty post-bariatric surgery]. / Complicaciones y nivel de satisfacción tras la realización de una dermolipectomía y abdominoplastia después de efectuar una cirugía bariátrica.

BACKGROUND: Body contouring surgery is in high demand following the increase in bariatric surgery. But these types of procedures are associated with high complication rates that cause long hospital stays and have a negative effect on patient satisfaction. The purpose of this study is to identify predictors of complications in order to optimize outcomes in these patients and find a relationship between complication rate and satisfaction. MATERIAL AND METHODS: Out of a group of 175 post-bariatric patients, 72 patients underwent body contouring surgery following massive weight loss from 2003-2008. They were reviewed retrospectively for demographic data, pre- and postoperative weight status, co-morbidities and complications and reoperation rate. Patient satisfaction was evaluated. RESULTS: a) COMPLICATIONS: The overall complication rate was 45.8%. The most frequent were seromas (23.6%); infection (13.9%), bleeding (11.1%), hematoma (6.9%) (needing transfusions [6.9%]), skin necrosis (6.9%) and umbilical necrosis (4.2%). A total of 8 patients required reoperation (11.1%). b) Satisfaction rating: 1) very satisfied: 51.4%, 2) satisfied: 31.9%, 3) dissatisfied: 8.3%, 4) very dissatisfied: 8.3%. c) The presence of complications was significantly associated with patients' satisfaction, reoperation rate and longer hospital stays (P<.001). CONCLUSIONS: Post operative complications were frequent. No predictors could be found to prevent these complications and optimize patient selection and appropriate timing of surgery. Patients with complications had a significantly higher reoperation rate, longer hospital stay and more dissatisfaction. The patients' satisfaction was negatively influenced by complication occurrence and not by the aesthetic results.