Ana María Burgos L

Reflujo gastroesofágico patológico en pacientes con obesidad severa, mórbida e hiper obesidad

Background: Overweight can be a risk factor for pathological gastroesophageal reflux or hiatal hernia. Aim: To study the prevalence of gastroesophageal reflux in patients with severe obesity. Patients and methods: Sixty seven patients, 51 female, aged 17 to 56 years old with a body mass index over 35 kg/m2, were studied. An upper gastrointestinal endoscopy was performed in all, esophageal manometry was done in 32 and 24 h pH monitoring was done in 32 patients. Results: Seventy nine percent of patients complained of heartburn and 66% of regurgitation. In 16 patients, endoscopy was normal. An erosive esophagitis was found in 33 patients, a short columnar epithelium in 12 and a Barret esophagus with intestinal metaplasia in six. Normal endoscopic findings and erosive esophagitis were present with a higher frequency in women. No association between the degree of obesity and esophageal lesions was observed. Lower esophageal sphincter pressure and abdominal length were significantly higher in subjects with a body mass index over 50 compared to those with a body mass index between 35 and 39.9 kg/m2. No differences were observed in 24 h pH monitoring. Conclusions: A high proportion of severely obese patients had symptoms and endoscopical findings of pathological gastroesophageal reflux (Rev Med Chile 2001; 129: 1038-43

Comparación del tratamiento médico y quirúrgico en pacientes con obesidad grado III (obesidad mórbida)

This is a review of publications comparing the results of medical and surgical treatment of morbid obesity. An overall conclusions is that the frequency of cardiovascular complications or cancer is higher among patients receiving medical treatment. Surgical treatment is associated with a better weight loss, reduction in complications and quality of life. Mortality risk decreases significantly after surgical treatment, when compared with patients receiving medical therapy Therefore, management of morbid obesity should be carried out by multidisciplinary teams with experience on gastrointestinal surgery. In this way the complications and mortality of bariatric surgery would be minimized.

Efecto del bypass en la esofagitis erosiva en pacientes con obesidad mórbida

Background: Obesity is an important risk for pathological gastroesophageal reflux. Aim: To assess the effects of gastric bypass on obese subjects with erosive esophagitis. Patients and methods: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus. Results: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up. Conclusions: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity

Efecto del bypass gástrico a largo plazo (7 a 10 años) en pacientes con obesidad severa y mórbida sobre el peso corporal, diabetes, dislipidemia y desarrollo de anemia

weight and complications of obesity, seven to 10 years after gastric bypass surgery. Material and Methods: One hundred eighteen subjects with morbid obesity, aged 15 to 66years (103 women), were followed for a mean of 94 months after surgery. Body weight, fasting blood glucose, total cholesterol, triglycerides and hemoglobin were measured before surgery and during follow up. Results: At 24 months of follow up, all patients lost weight and there was a mild weight increase at 94 months, that paralleled the preo-perative body mass index. Diabetes, hypercholesterolemia and hypertriglyceridemia subsided in 95, 87 and 94% of cases, respectively. Twenty percent of patients had mild anemia and 11% moderate or severe anemia. No patient recovered the preoperative weight. Conclusions: Weight reducing effects of gastric bypass are maintained after 94 months of follow up with the expected health benefits.

Fascitis necrosante grave por Serratia marcescens: Reporte de un caso clínico

An 81 year old female patient with chronic heart failure and atrial fibrillation receiving anticoagulant therapy, was admitted with progressive pain on her right leg for the past 24 hours, associated to local erythema, edema and warmth. The lesion evolved at the same site where she presented a chronic ulcer for the previous 5 months managed only with local care. At admission a necrotic plaque on the affected site was perceived; there was no hypotension or mental confusion but signs of a deep venous thrombosis on the involved leg were found. She was febrile (37.8 degrees C) and with tachychardia (126 per minute). Laboratory evaluation revealed normal white blood cell count and a subtherapheutic anticoagulant INR value. A chest x-ray showed infiltrates on the left lower lung lobe. On the following hours the lesion evolved with increasing pain, haemorrhagic bullae and a purulent discharge through the ulcer, with the patient developing mental deterioration, hypotension, respiratory failure and shock. The patient received intravenous ciprofloxacin and clindamycin and was operated 15 hours after admission performing an over-the knee amputation. A cardiac catheterization demonstrated a low cardiac output (2.3 L/min), and both a high systemic vascular resistance (2888 din.s.cm(-5)) and pulmonary capillary wedge pressure (17 cm H(2)0), results compatible with cardiogenic shock. Evolution was progressively worse and she died of multiple organic failure 36 hours after admission. Two blood culture samples grew Serratia marcescens. No necropsy was performed and cultures taken from the leg remained negative.

Estudio prospectivo del diámetro de la vía biliar principal antes y 12 años después de colecistectomía

tiempo. Hay una opinion generalizada entre ciru-janos y radiologos, que la via biliar principal sedilata despues de una colecistectomia, debido a laperdida de la funcion absorptiva de la vesiculabiliar y al aumento de la presion intraluminaldentro del sistema ductal biliar. Esta dilatacion«fisiologica» fue enunciada por primera vez porOpie en 1887

Riesgo perioperatorio del bypass gástrico reseccional en pacientes con obesidad mórbida: Estudio prospectivo de 684 pacientes

Background: Bariatric surgery is a complex procedure not exempt of complications. Aim: To assess mortality and complications of excisional gastric bypass among morbidly obese subjects. Material and methods: Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered. Results: Mean body mass index (BMI) of the subjects was 43.7 kg/m 2 . One hundred sixty two patients had a BMI between 35 and 39.9 kg/m 2 , 419 had a BMI between 40 and 49.9 kg/m 2 and 103 had a BMI over 50 kg/m 2 . Two patients with a BMI of 52 and 56 kg/m 2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year. Conclusions: Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients (Rev Med Chile 2006; 134: 849-54). (Key words: Bariatric surgery; Gastric bypass; Obesity, morbid)

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

Antecedentes: El bypass gastrico en obesos morbidos, ademas de ser una alternativa de cirugia bariatrica, es un buen procedimiento antirreflujo dado que no hay produccion de acido en el reservorio gastrico y no existe reflujo duodenal debido a la Y de Roux. Objetivo: Describir el efecto que tiene el bypass gastrico sobre el esofago de Barrett (EB) de pacientes obesos morbidos, ademas discutir nuevos mecanismos fisiopatologicos implicados. Poblacion: De 896 obesos morbidos operados mediante bypass gastrico resectivo abierto, se siguieron a los 14 pacientes diagnosticados con EB mediante endoscopia e histologia. Resultados: De los 14 pacientes con diagnostico de esofago de Barrett, ocho pacientes presentaban EB corto ( 31 mm). Los sintomas de pirosis y/o regurgitacion presentes se resolvieron en un 70% de los casos en una media de 6,5 meses. Hubo una regresion de la metaplasia intestinal a mucosa cardial normal en seis pacientes (75%) con EB corto y en un paciente (16%) con EB largo. Conclusiones: El bypass gastrico es una muy buena alternativa quirurgica antirreflujo en obesos morbidos con EB, demostrado por la desaparicion de los sintomas en la mayoria de los pacientes y la regresion de la metaplasia intestinal en la mitad de ellos, dependiendo del tiempo y de la longitud. Lo anterior, postulamos, que no seria debido solamente a que no hay produccion de acido en el reservorio gastrico y a que no existe reflujo duodenal, sino que habrian otros mecanismos fisiopatologicos implicados.

Resultados del bypass gástrico resectivo en pacientes obesos mórbidos ≤ 18 años y ≥ 65 años

From August 1999to December 2006, 712 patients with morbid obesity were subjected to open resection gastricbypass. A group of 12 patients, aged less than 18 years and a second group of 8 patients agedmore 65 years were selected to prospectively assess weight loss, complications and correction ofassociated comorbidities.

Función pulmonar pre y post operatoria en bypass gástrico laparotómico y laparoscópico por obesidad mórbida

Introduccion: La obesidad esta asociada a multiples comorbilidades, entre ellas la patologia respiratoria, que puede verse incrementada despues de realizar cirugia bariatrica. Objetivo: Evaluar en forma prospectiva las alteraciones en la funcion pulmonar pre y postoperatorias, de pacientes obesos morbidos operados con bypass gastrico por via laparotomica y laparoscopica. Material y Metodo: 39 pacientes consecutivos con obesidad morbida sometidos a bypass gastrico, divididos en 2 grupos: el primero formado por 24 pacientes operados por via laparotomica y el segundo por 15 pacientes operados por via laparoscopica, con evaluacion pre y postoperatorias de radiografia de torax, espirometria y gases arteriales. Resultados: En el postoperatorio un incremento significativo de atelectasias, presentandose en el 1er grupo con cirugia abierta en 45,8% de casos y en el 2° grupo con cirugia laparoscopica en el 33,3%. Aumento del patron restrictivo a 41,7% en el 1er grupo y 33,3% de casos en el 2° grupo. Una disminucion en ambos grupos de la capacidad vital forzada (CVF) y alteraciones en los gases arteriales con descenso mantenido de PaC02 en 36,5 mmHg en el 1er grupo y 33,8 mmHg en el 2° grupo. Conclusiones: Con la cirugia del bypass gastrico en obesos morbidos, por via laparotomica o laparoscopica se producen cambios en la funcion pulmonar postoperatoria, presentandose atelectasia, patrones espirometricos restrictivos, capacidad vital forzada disminuida y alteraciones en la Pa02 y PaC02. Esta ultima tiene significacion estadistica.