Comparación del tipo de cirugía bariátrica sobre la reducción de peso corporal y su relación con la ghrelina / Comparison between type of bariatric surgery on reduction of body weight and its ghrelin relationship

Resumen Objetivo: La cirugía bariátrica es un procedimiento para disminuir de peso a largo plazo en pacientes con obesidad. El objetivo de este estudio fue evaluar los niveles de ghrelina y la reducción del peso de acuerdo al tipo de cirugía bariátrica, comparando el bypass de una sola anastomosis y la gastrectomía formadora de manga. Materiales y Métodos: Estudio de cohorte que incluyó a 50 pacientes con obesidad, 22 mini-bypass y 28 mangas gástricas. Se evaluó el peso corporal y las concentraciones de ghrelina en la etapa prequirúrgica, en el día 7 y en los meses 1, 3 y 6 después de la cirugía. Resultados: Del total de pacientes, el 86% presentaron > 50% pérdida del exceso de peso (PEPP) a los 6 meses. La concentración de ghrelina disminuyó desde la primera semana en el grupo total de participantes. A los 6 meses, se observó mayor reducción de ghrelina en los pacientes con la manga gástrica (4.636 ± 2.535 vs 1.340 ± 1.001 pg/mL, p < 0,0001). El PEPP en pacientes con mini-bypass fue superior, en comparación con manga gástrica. Conclusiones: La comparación entre las técnicas indicó que, a los 6 meses de evolución posquirúrgica, los pacientes con mini-bypass presentaron mayor reducción de peso corporal y del nivel de ghrelina, en comparación con el grupo de manga gástrica. La concentración de ghrelina es una variable que participa en el control de peso; sin embargo, el tipo de abordaje quirúrgico probablemente tiene mayor relación con la pérdida de peso en estos pacientes.

Introduction: Bariatric surgery is a procedure to reduce weight in the long term in patients with obesity. The objective of this study was to evaluate ghrelin levels and weight reduction according to the type of bariatric surgery, comparing the single anastomosis bypass and the sleeve-forming gastrectomy. Materials and Method: Cohort study that included 50 patients with obesity, 22 Mini-Bypass and 28 gastric sleeve. Body weight and ghrelin concentrations were evaluated in the presurgical stage, on day 7 and in months 1, 3 and 6 after surgery. Results: Of the total of patients, 86% had > 50% excess weight loss (PEPP) at 6 months. The concentration of ghrelin decreased within the first week of the intervention. At 6 months, greater reduction of ghrelin was observed in patients with gastric sleeve (4636 ± 2535 vs 1340 ± 1001 pg/mL, p < 0.0001). The PEPP in patients with Mini-Bypass was superior, compared to gastric sleeve. Conclusion: The comparison between the techniques indicated that, after 6 months of post-surgical evolution, patients with Mini-Bypass had a greater reduction in body weight and ghrelin levels, compared to the gastric sleeve group. Ghrelin concentration is a variable that participates in weight control; however, the type of surgical approach is probably more related to weight loss in these patients.

THE ONE ANASTOMOSIS GASTRIC BYPASS TECHNIQUE: RESULTS AFTER ONE YEAR OF FOLLOW-UP.

BACKGROUND: Obesity is a major health problem. One anastomosis-gastric bypass (OAGB) is a restrictive and malabsorptive weight loss surgery that carries the same characteristics of Roux-en-Y gastric bypass in its status as a weight loss mechanism; but, its results remain controversial. AIM: To describe the technique and outcomes of OAGB and its effects on weight loss and remission of comorbidities. METHODS: Retrospective review of all patients who underwent OAGB procedure from January 2017 to January 2018. Patients' baseline characteristics were recorded. The routine in follow-up were at 1, 3, 6 and 12 months. RESULTS: A total of 51 patients underwent OAGB. The mean age was 43.8±9.3 years, mean weight was 125±31 and mean BMI was 55.8±12 kg/m2. With regard to comorbidities, 64.7% had type 2 diabetes mellitus (T2DM), 43.1% systemic arterial hypertension (SAH) and 51% dyslipidemia. The BMI decreased for 48.4±1.3 to 31±4.4 at 12 months (p=0.0001) and we obtained an average decreased of 65% excess weight loss (EWL) at 12 months of follow-up. There was improvement in the values of total cholesterol (CT) (p=0.348); triglycerides (TGC) (p=0.0001); LDL (p=0.06), HDL (p=0.029) and A1C (p=0.405). Remission of T2DM al 12 months follow-up after surgery was 57% (p=0.124), remission of SAH 37% (p=0.040) and remission of dyslipidemia of 43% (p=0.967). CONCLUSIONS: OAGB is a commonly performed and safe procedure. Short term results appear promising; however, long-term follow-up is necessary to evaluate complications and possible nutritional effects.

Application of the Kiewiet-Van Ruler model to predict the need for relaparotomy in patients with secondary peritonitis.

INTRODUCTION: It is crucial the timely detection of a new infection or the persistence of it to improve the survival rates, there is no index that can determine the need for relaparotomy. OBJECTIVE: To evaluate the diagnostic certainty of the model elaborated by Kiewiet-Van Ruler. METHOD: A retrospective, descriptive, cross-sectional study, patients diagnosed with abdominal sepsis who underwent exploratory laparotomy between January 2013 to and May 2015. RESULTS: We included 109 patients, 63 male patients and 46 female patients. Mortality of 16.5%. 68 cases had a score lower than or equal to 19, of which 17 -patients (43%) did need to reoperate. The second group with a score higher than 20 was 41 patients, of which 22 (56%) required reoperation. In the individual analysis of the variables, a significant value was determined in five of them, with p < 0.05. Only one variable (hemoglobin < 8.1 mg/dl) in the chi-square test and confidence interval was not significant and I do not help so much to predict reoperation. CONCLUSIONS: The utility of the model proposed by Kiewiet-Van Ruler results in an acceptable prediction value for re laparotomy.

INTRODUCCIÓN: Es crucial la detección oportuna de una nueva infección o la persistencia de esta para mejorar los índices de sobrevida. No existe un método que pueda determinar la necesidad de relaparotomía. OBJETIVO: Evaluar la certeza diagnóstica del modelo elaborado por Kiewiet-Van Ruler. MÉTODO: Estudio retrospectivo, descriptivo, transversal, en pacientes con diagnóstico de sepsis abdominal que fueron sometidos a laparotomía exploradora entre enero de 2013 y mayo de 2015. ­. RESULTADOS: Se incluyeron 109 pacientes, 63 de sexo masculino y 46 de sexo femenino. La mortalidad fue del 16.5%. Sesenta y ocho pacientes tuvieron puntaje ≤ 19, de los cuales 17 (43%) sí requerían reoperarse. El segundo grupo con puntaje > 20 fue de 41 pacientes, de los cuales 22 (56%) sí requerían reoperarse. En el análisis individual de las variables se determinó un valor significativo en cinco de ellas, con una p < 0.05. Solo una variable (hemoglobina < 8.1 mg/dl) no fue significativa en la prueba de ji al cuadrado e intervalo de confianza, y por tanto no ayudó para predecir la reoperación. CONCLUSIÓN: La utilidad del modelo propuesto por Kiewiet-Van Ruler resulta en un aceptable valor de predicción para relaparotomía.

The one anastomosis gastric bypass technique: results after one year of follow-up / Bypass gástrico com somente uma anastomose: resultados após um ano de acompanhamento

ABSTRACT Background: Obesity is a major health problem. One anastomosis-gastric bypass (OAGB) is a restrictive and malabsorptive weight loss surgery that carries the same characteristics of Roux-en-Y gastric bypass in its status as a weight loss mechanism; but, its results remain controversial. Aim: To describe the technique and outcomes of OAGB and its effects on weight loss and remission of comorbidities. Methods: Retrospective review of all patients who underwent OAGB procedure from January 2017 to January 2018. Patients' baseline characteristics were recorded. The routine in follow-up were at 1, 3, 6 and 12 months. Results: A total of 51 patients underwent OAGB. The mean age was 43.8±9.3 years, mean weight was 125±31 and mean BMI was 55.8±12 kg/m2. With regard to comorbidities, 64.7% had type 2 diabetes mellitus (T2DM), 43.1% systemic arterial hypertension (SAH) and 51% dyslipidemia. The BMI decreased for 48.4±1.3 to 31±4.4 at 12 months (p=0.0001) and we obtained an average decreased of 65% excess weight loss (EWL) at 12 months of follow-up. There was improvement in the values of total cholesterol (CT) (p=0.348); triglycerides (TGC) (p=0.0001); LDL (p=0.06), HDL (p=0.029) and A1C (p=0.405). Remission of T2DM al 12 months follow-up after surgery was 57% (p=0.124), remission of SAH 37% (p=0.040) and remission of dyslipidemia of 43% (p=0.967). Conclusions: OAGB is a commonly performed and safe procedure. Short term results appear promising; however, long-term follow-up is necessary to evaluate complications and possible nutritional effects.

RESUMO Racional: A obesidade é um grande problema de saúde. Bypass gástrico com uma anastomose (OAGB) é operação de perda de peso restritiva e disabsortiva que carrega as mesmas características do bypass gástrico em Y-de-Roux em seu status de mecanismo de perda de peso, mas seus resultados permanecem controversos. Objetivo: Descrever a técnica e os resultados do OAGB e seus efeitos na perda de peso e na remissão de comorbidades. Método: Revisão retrospectiva de todos os pacientes que foram submetidos a OAGB de janeiro de 2017 a janeiro de 2018. As características basais dos pacientes foram registradas. O acompanhamento de rotina foi de 1, 3, 6 e 12 meses. Resultados: Um total de 51 pacientes foi submetido a OAGB-HGM. A idade média foi de 43,8±9,3 anos, o peso médio foi de 125±31 e o IMC médio de 55,8±12 kg/m2. Em relação às comorbidades, 64,7% apresentavam diabete melito tipo 2 (DM2), 43,1% hipertensão arterial sistêmica (HAS) e 51% dislipidemia. O IMC diminuiu para 48,4±1,3 a 31±4,4 em 12 meses (p=0,0001) e a redução média foi de 65% de perda de excesso de peso (EWL) em 12 meses de seguimento. Houve melhora nos valores do colesterol total (CT) (p=0,348); triglicéridos (TGC) (p=0,0001); LDL (p=0,06), HDL (p=0,029) e A1C (p=0,405). A remissão do DM2 ao seguimento de 12 meses após a operação foi de 57% (p=0,124), remissão da HAS 37% (p=0,040) e remissão da dislipidemia de 43% (p=0,967). Conclusões: OAGB-HGM é procedimento comumente realizado e seguro. Resultados de curto prazo parecem promissores; no entanto, o acompanhamento em longo prazo é necessário para avaliar as complicações e possíveis efeitos nutricionais

[Giant Amyand hernia]. / Hernia de Amyand gigante.

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1%. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand's hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Hernia de Amyand gigante / [Giant Amyand hernia].

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1

. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyand’s hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.

Hernia de Amyand gigante. / [Giant Amyand hernia].

The finding of the appendix inside an hernial sac is called "Amyand hernia": The global incidence is 0.28 to 1

. Clinical manifestations are the presence of an inflamed inguinal mass, tense, hypersensitivensible, with variable size, non-reducible, and associated to abdominal pain, vomit and very rarely true appendicitis manifestations. Surgical treatment depends on the case presentation and the intraoperative findings. We present a case of a giant Amyands hernia successfully treated with surgery by performing the hernia repair with Bassini technique and transherniotomy appendectomy.