Evaluation of quality of life, weight loss and evolution of comorbidities at 6 years after bariatric surgery.

INTRODUCTION: Morbid obesity is a disease with multiple comorbidities and considerably limits the quality of life and life expectancy. Bariatric surgery is an effective therapeutic alternative in these patients; it acts on the decrease and / or absorption of nutrients, achieving a significant weight loss which is maintained over time. The objective of the study is to determine the long-term results, in terms of efficacy, regarding weight loss, the resolution of comorbidities and improvement in the quality of life of our patients. MATERIAL AND METHODS: This was a retrospective study that comprised all patients consecutively undergoing laparoscopic bariatric surgery at our center over a 10 year period. In all patients, the anthropometric and clinical data were collected prior to surgery and in subsequent protocolized visits after surgery. At the end of the follow-up, a BAROS questionnaire was used that recorded weight loss, the resolution of comorbidities, complications and the quality of life test completed by the patients. RESULTS: 353 patients (303 GBPRY and 50 GV), 105 men and 248 women, with a mean age of 42.14 ± 10.16 years, BMI 48.63 kg / m2 and 68.5% had some comorbidity. The mean follow-up was 5.7 ± 2.6 years for 96.7% of the total number operated on. At the end of the follow-up the %EWL was 59.00 ± 19.50, %EBMIL 68.15 ± 22.94, the final BMI 32.65 ± 5.98 and 31.3% of the patients had %EWL ≤ 50. The resolution of comorbidities was as follows: 48.7% hypertension, 70.3% Type 2 Diabetes, 82.6% DLP and 71.6% SAHS. The result of the quality of life test was 1.51 ± 0.93, with 67.2% of patients reporting good or very good quality, with the highest score being for self-esteem, followed by physical condition, work and social activity, and the lowest being for sexual quality of life in that only 40.3% reported an improvement. The BAROS score was 4.35 ±â€¯2.06 with 84.7% of the patients in the good to excellent range, while 91.2% of all patients would undergo surgery again. CONCLUSIONS: Bariatric surgery is an effective technique for reducing weight, resolving comorbidities and improving the quality of life of patients with morbid obesity, mainly in its physical aspect. In our series, the percentage of follow-up and average time was within the range of established quality standards.

Case Report: Extensive Dermatitis Secondary to Severe Malnutrition, Zinc and Vitamin Deficiencies After Malabsorptive Bariatric Surgery.

Bariatric surgery is one of the most effective treatments currently available for obesity and its derived comorbidities. However, complications may occur, especially when malabsorptive surgeries like a biliopancreatic diversion is performed. We present the case of a female patient whose obesity was treated with this technique, and in the 9th year of follow-up developed an extensive dermatitis secondary to zinc deficiency and malnutrition, precipitated by therapeutic non-compliance. A close surveillance of early symptoms and signs of nutritional deficiencies as well as chronic supplementation of vitamins and trace elements is required; this case illustrates the relevance of periodical, lifelong visits to a medical physician with special training and experience in the management of post bariatric surgery patients in order to prevent, diagnosis and early treat related complications.

Efectos del bypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años / Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years

ANTECEDENTES: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de comorbilidades y una disminución del riesgo cardiovascular. MATERIAL Y MÉTODOS: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante bypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. RESULTADOS: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de comorbilidades al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. CONCLUSIONES: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos

BACKGROUND: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. MATERIAL AND METHODS: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. RESULTS: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. CONCLUSION: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures

[Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years]. / Efectos del baypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años.

INTRODUCTION: Background: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.

INTRODUCCIÓN: Antecedentes: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de la comorbilidad y una disminución del riesgo cardiovascular. Material y métodos: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante baypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. Resultados: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de la comorbilidad al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. Conclusiones: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos.

[Enteropathic acrodermatitis in a patient with high-out-put ileostomy]. / Acrodermatitis enteropática en paciente con ileostomía de alto débito.

Zinc deficiency is relatively common in certain pathologies, although its clinical manifestation is uncommon. We present the case of a patient who was admitted presenting hyponatremic dehydration and pre-renal failure secondary to high-output ileostomy and oral intolerance. Although the ileostomy output was normalized within 3 days of admission and initial zinc plasma levels were normal, after being fed with TPN supplemented with 13 mg/day of zinc, he suffered a severe zinc deficit with enteropathic acrodermatitis that was completely resolved after one week with 26.5 mg/day. However, plasma levels did not return to normal until one month on therapy with high doses of zinc. Zinc plasma levels are not a good indicator of zinc stores in the body and many times their changes are a late indicator of zinc deficit. There is not a correlation between the clinical improvement and normalization of zinc levels, being common the clinical resolution within few days of the supplementation without observing an increase of zinc plasma levels.

La deficiencia de zinc es relativamente frecuente en ciertas patologías, pero su manifestación clínica es rara. Se expone el caso de un paciente que ingresó con cuadro de deshidratación hiponatrémica e insuficiencia prerrenal secundaria por ileostomía de alto débito e intolerancia oral. Aunque se normalizó el débito de la ilesotomía al tercer día del ingreso y los niveles plasmáticos de zinc iniciales fueron normales, el paciente después de estar con NPT suplementada con 13 mg/día de zinc, sufrió una deficiencia severa de zinc con acrodermatitis enteropática que se resolvió completamente después de una semana con 26,5 mg/día. Sin embargo, los niveles plasmáticos no se normalizaron hasta pasado un mes de estar en tratamiento con estas macrodosis de zinc. El zinc plasmático no es un buen indicador de los depósitos de zinc en el organismo, y muchas veces, su alteración es un indicador tardío de deficiencia. Tampoco se observa una correlación entre la mejoría clínica y la normalización de sus niveles, siendo frecuente la resolución clínica a los pocos días de la suplementación sin detectarse aumento de zinc en plasma.

Acrodermatitis enteropática en paciente con ileostomía de alto débito / Enteropathic acrodermatitis in a patient with high-out-put ileostomy

La deficiencia de zinc es relativamente frecuente en ciertas patologías, pero su manifestación clínica es rara. Se expone el caso de un paciente que ingresó con cuadro de deshidratación hiponatrémica e insuficiencia prerrenal secundaria por ileostomía de alto débito e intolerancia oral. Aunque se normalizó el débito de la ilesotomía al tercer día del ingreso y los niveles plasmáticos de zinc iniciales fueron normales, el paciente después de estar con NPT suplementada con 13 mg/día de zinc, sufrió una deficiencia severa de zinc con acrodermatitis enteropática que se resolvió completamente después de una semana con 26,5mg/día. Sin embargo, los niveles plasmáticos no se normalizaron hasta pasado un mes de estar en tratamiento con estas macrodosis de zinc. El zinc plasmático no es un buen indicador de los depósitos de zinc en el organismo, y muchas veces, su alteración es un indicador tardío de deficiencia. Tampoco se observa una correlación entre la mejoría clínica y la normalización de sus niveles, siendo frecuente la resolución clínica a los pocos días de la suplementación sin detectarse aumento de zinc en plasma (AU)

Zinc deficiency is relatively common in certain pathologies, although its clinical manifestation is uncommon. We present the case of a patient who was admitted pre -senting hyponatremic dehydration and pre-renal failure secondary to high-output ileostomy and oral intolerance. Although the ileostomy output was normalized within 3days of admission and initial zinc plasma levels were normal, after being fed with TPN supplemented with 13mg/day of zinc, he suffered a severe zinc deficit with enteropathicacrodermatitis that was completely resolved after one week with 26.5 mg/day. However, plasma levels did not return to normal until one month on therapy with high doses of zinc. Zinc plasma levels are not a good indicator of zinc stores in the body and many times their changes are a late indicator of zinc deficit. There is not a correlation between the clinical improvement and normalization of zinc levels, being common the clinical resolution within few days of the supplementation without observing an increase of zinc plasma levels (AU)

Absceso subcutáneo por Actinomyces radingae / Subcutaneous abscess due to Actinomyces radingae

No disponible

Conjuntivitis causada por Gardnerella vaginalis / Conjunctivitis due to Gardnerella vaginalis

No disponible