Importance of technical aspects in the beginnings of a pancreas transplantation program.

Pancreas and kidney transplantation is the treatment of choice for patients with type 1 diabetes mellitus and terminal renal insufficiency. Herein we have presented a series of 35 patients transplanted between 2002 and 2009 including periods before and after 2007 divided based on introduction of some technical aspects. In the first phase (learning period) we have noted complications related to pancreatic surgery with a morbidity among 12 of 18 patients (66.6%). In the second period (stabilization period), complications appeared in 6 out of 17 patients (35.2%; P < .028). The reoperation rate was 83.3% in the learning period and 23.5% in the stabilization period (P < .03). Seven transplantectomies were performed in the first period (P < .004). Five patients died, all of them in the learning group (P < .019). Changes in the technical aspects of the procedure were responsible for improved outcomes obtained among pancreas and kidney transplantations.

[Evolution of the blood parameters after morbid obesity surgery with the duodenal crossing technique]. / Evolución de los parámetros sanguíneos tras cirugía de la obesidad mórbida mediante la técnica del cruce duodenal.

OBJECTIVE: To assess the course of blood parameters from patients with morbid obesity submitted to the duodenal crossing surgical technique. METHODS: 110 patients were studied in whom post-surgical monitoring of ponderal and laboratory parameters (the ones most influenced by this type of surgery such as hematocrit, hemoglobin, glucose, total proteins, albumin, calcium, PTH, ALT, Quick's index, total bilirubin, cholesterol and triglycerides, iron, ferritin, folic acid, and vitamin B12) has been carried out. Postsurgical monitoring has been carried out at months 3, 6, 12,18, 24, 36, 48, and 60. The shortest followup time has been one year. RESULTS: Weight loss is higher than 50% of the weight in excess and is maintained throughout the study, comprising more than 75% of the patients. During the postsurgical follow-up, there is a clear iron deficiency concurrent with the presence of anemia, as well as an evident increase in PTH. Normalization of glycemia, cholesterol, and triglyceride levels reaches almost 100%. CONCLUSIONS: changes in blood parameters presented by patients with morbid obesity submitted to the duodenal crossing technique, indicators of nutritional complications, affect about 10% of the patients (with the exception of iron deficiency and PTH impairment), and most of them are easily corrected with pharmacological and nutritional supplements, the body getting adapted to these deficits, without any severe clinical-biological impairment and with a trend towards normalization.

[Assessment of morbid-obesity-associated comorbidities progression after surgical treatment with the duodenal crossing technique]. / Valoración de la evolución de las comorbilidades de la obesidad mórbida tras tratamiento quirúrgico mediante la técnica del cruce duodenal.

OBJECTIVE: To assess the impact of weight loss in clinical progression of the comorbidities in a group of morbid obese patients submitted to surgical treatment with the duodenal switch technique. STUDY SETTING: Between 2001-2006, we have operated by the duodenal crossing technique a total of 118 morbid obese patients (97 women and 21 men), mean age 42.6 years. Average pre-surgical BMI was 49.7, with average overweight of 69.1 kg. After surgical intervention, we have prospectively assessed the progression of the main comorbidities (arterial hypertension, diabetes, OSAS, osteoarticular pathology, dyslipidemia), according to the subscale of the BAROS scoring system. Postsurgical controls are done at months 3, 6, 12, 18, and 24 and annually thereafter. We have followed-up 110 patients, of whom 90 presented comorbidities, being the ones studied. RESULTS: At 3 months post-surgery, we observed a decrease in the mean value of % WL to 31%, and a mean BMI value of 41.3, the percentage of lost BMI being 40.3%. Most of the weight loss occurred within 2 years, with % WL of 74.8% and a percentage of lost BMI of 97.7%. In 68 patients (75.5%) there was resolution of their comorbidities, 14.4% having improvement, and 10% with no improvement in spite of the surgery. Of patients achieving complete resolution, almost all of them achieved it within two years after surgery. Cure rates correlate with weight loss, so that at 3 months, with a mean weight loss of 25 kg (BMI decrease of 8.4 points) the comorbidity resolution rate is 45.5%. At 12 months, with a mean decrease in BMI of 16.4 points, % WL of 61.6% and % of lost BMI of 70.4%, the comorbidity resolution rate is 89.7%. At two years, by the time most of the main comorbidities resolved (68 patients), the BMI decreased by 22.4 points, the % WL 74.8% and the % of lost BMI 97.9%. CONCLUSION: The aim of bariatric surgery is weight loss and overweight-associated comorbidities improvement. In our study, most of the comorbidities improvement started at the third month, with the highest improvement rate occurring within two years, verifying that there is a direct relationship between post-surgical weight loss comorbidities improvement and resolution in most of the cases.

Síndrome posgastrectomía / Post gastrectomy syndromes

En nuestra experiencia el paciente portador de un síndrome posgastrectomía suele presentar alguna de las siguientes características: el resultado de la primera intervención no se correspondió con las expectativas que se le prometieron, generalmente se han sometido a una o varias reintervenciones sin obtener ninguna mejoría o, en ocasiones, son pacientes con una neurosis de renta. Además, las actitudes terapéuticas adoptadas también reúnen una serie de características comunes: la indicación quirúrgica de la primera intervención no fue la adecuada, la primera intervención no se realizó de forma correcta, generalmente no se practicó un estudio funcional suficiente, las reintervenciones se planificaron basándose en criterios anatómicos o no se valoró la personalidad del paciente, ni su entorno sociofamiliar. Es evidente que la cirugía gástrica resectiva ha disminuido enormemente en los últimos años, viéndose limitada casi a la cirugía de las neoplasias. No obstante, aún seguimos atendiendo a algún enfermo aquejado de molestias encuadrables dentro del conocido síndrome posgastrectomía: síndrome de asa, dumping, gastritis alcalina, úlceras recidivantes, diarreas, malnutriciones, anemias, etc. Se trata de cuadros bien estudiados, sobre los que se ha aportado poco en los últimos años. Sin embargo, vemos aparecer muevas patologías secundarias a intervenciones gástricas generalmente no resectivas, por lo que sería más adecuado hablar de patología poscirugía gástrica; evidentemente se trata de un término mucho más amplio que el del síndrome posgastrectomía, por lo que en esta revisión nos ocupamos parcialmente de él, renunciando a la revisión de sus aspectos más clásicos, para centrarnos en algunos que hoy día son frecuentes y que hemos estudiado: el síndrome de la Y de Roux, la patología secundaria a la cirugía bariátrica y la que puede presentarse tras la cirugía del reflujo gastroesofágico (AU)

[The effect of intravenous amino acids in total parenteral nutrition on the healing of experimental colonic anastomoses in the rat]. / Efecto de los aminoácidos intravenosos en nutrición parenteral total en la cicatrización de las anastomosis cólicas experimentales en la rata.

The authors present a study in two groups of Wistar rats, which were given two different parenteral nutritions with two different amounts of proteins, during different periods of time (4, 7 and 11 days), with the objective of evaluating their influence on the healing of a colonic anastomosis which was performed prior to the initiation of the TPN. To asses the condition of the colonic anastomosis, we studied the rupture pressure of the colon containing the anastomosis, the hydroxyproline concentration of said anastomosis, and the histological study of the same. The results indicate that the group of animals which were fed with a hyperproteinic diet during a longer period of time, showed a better degree of healing than the rest of the study groups.