Graciela Valero

Laparoscopic Versus Open Gastric Bypass in the Treatment of Morbid Obesity: A Randomized Prospective Study

Objective:The objective of the study was to compare the results of open versus laparoscopic gastric bypass in the treatment of morbid obesity. Summary Background Data:Gastric bypass is one of the most commonly acknowledged surgical techniques for the management of morbid obesity. It is usually performed as an open surgery procedure, although now some groups perform it via the laparoscopic approach. Patients and Methods:Between June 1999 and January 2002 we conducted a randomized prospective study in 104 patients diagnosed with morbid obesity. The patients were divided into 2 groups: 1 group with gastric bypass via the open approach (OGBP) comprising 51 patients, and 1 group with gastric bypass via the laparoscopic approach (LGBP) comprising 53 patients. The parameters compared were as follows: operating time, intraoperative complications, early (<30 days) and late (>30 days) postoperative complications, hospital stay, and short-term evolution of body mass index. Results:Mean operating time was 186.4 minutes (125–290) in the LGBP group and 201.7 minutes (129–310) in the OGBP group (P < 0.05). Conversion to laparotomy was necessary in 8% of the LGBP patients. Early postoperative complications (<30 days) occurred in 22.6% of the LGBP group compared with 29.4% of the OGBP group, with no significant differences. Late complications (>30 days) occurred in 11% of the LGBP group compared with 24% of the OGBP group (P < 0.05). The differences observed between the 2 groups are the result of a high incidence of abdominal wall hernias in the OGBP group. Mean hospital stay was 5.2 days (1–13) in the LGBP group and 7.9 days (2–28) in the OGBP group (P < 0.05). Evolution of body mass index during a mean follow-up of 23 months was similar in both groups. Conclusions:LGBP is a good surgical technique for the management of morbid obesity and has clear advantages over OGBP, such as a reduction in abdominal wall complications and a shorter hospital stay. The midterm weight loss is similar with both techniques. One inconvenience is that LGBP has a more complex learning curve than other advanced laparoscopic techniques, which may be associated with an increase in postoperative complications.

Experience with the Circular Stapler for the Gastrojejunostomy in Laparoscopic Gastric Bypass (350 Cases)

Background: The increased incidence of morbid obesity has resulted in an increase in bariatric surgery. The gastrojejunostomy performed during Roux-en-Y gastric bypass (RYGBP) operations has technical variability with different outcomes and complication-rates immediate postoperatively and at long-term follow-up. Methods: Between Jan 2000 and Feb 2005, 350 laparoscopic RYGBP procedures were performed. We present our immediate and follow-up rate of complications with total intraabdominal gastrojejunostomy, performed with the circular stapler. Results: Complications of gastrojejunostomy were detected in 24 patients (6.8%): 3 anastomotic leaks (0.8%); 6 bleeding (1.7%) immediately postoperatively, and 4 stenoses (1.1%), 10 ulcers (2.8%) and 1 stenosis plus ulcer (0.3%) during long-term follow-up. There was no mortality related to the gastrojejunostomy. Conclusions: The gastrojejunostomy with circular stapler is an easily reproducible procedure. The rate of complications has been low. Surgeons who perform laparoscopic RYGBP should have a careful learning curve, and should be aware of the potential complications and their management.

Results of Laparoscopic Gastric Bypass in Patients ≥55 Years Old

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a commonly performed surgical intervention for morbid obesity. Some authors considered age ≥55 years as a relative contraindication to bariatric surgery. We examined the operative outcomes, weight loss, hospital stay and resolution of co-morbidities in patients ≥55 years old compared with those <55 years old undergoing LRYGBP. Methods: From Jan 2000 to Feb 2005, 350 LRYGBPs were performed. 48 patients ≥55 years old (13.7%) were compared to the remaining patients. Results: Analysis of the 48 patients ≥55 years old compared with 302 patients <55 revealed no difference in complication rate, although the older patients had a significantly greater percentage of serious complications. Younger patients lost more weight than older patients. Both groups demonstrated resolution of comorbidities, although the difference was not significant. Conclusions: LRYGBP is safe and well tolerated in morbidly obese patients ≥55 years. The older patients had more serious complications and lost less weight; however, their weight loss and resolution of co-morbidities improved their quality of life. Age should not be a contraindication to bariatric surgery.

Apendicectomía laparoscópica mediante incisión única transumbilical: experiencia inicial

INTRODUCTION Appendicitis is the most common abdominal emergency. The treatment is surgical and single incision laparoscopic surgery (SILS) involves performing laparoscopic surgery through a single transumbilical point, in an attempt to improve the results of laparoscopic surgery. MATERIAL AND METHOD A total of 73 patients with suspected acute appendicitis were operated on using the SILS technique between June 2009 and August 2010. All patients were operated on by the same surgical team, and the navel was the only point of entrance. Post-surgical pain was assessed using a numerical scale at the time of discharge. RESULTS None of the patients required conversion to conventional laparoscopy. The mean surgical time was 40±14 (16-80) minutes. There were no complications during or after the surgery. The mean post-surgical pain score was 3±1 (1-7) and the mean hospital stay was 18±7 (9-42) hours. CONCLUSION SILS is a safe and effective technique for appendicitis. In the future, the most common surgical procedures could be performed through the navel. This would be by surgeons, highly experienced in advance laparoscopic surgery in order to introduce this new technique safely without increasing morbidity and mortality.

Aprendizaje de la cirugía del cáncer de recto por laparoscopia sin aumento de la morbimortalidad

INTRODUCTION The treatment of rectal cancer via laparoscopy is controversial due to its technical complexity. Several randomized prospective studies have demonstrated clear advantages for the patient with similar oncological results to those of open surgery, although during the learning of this surgical technique there may be an increase in complications and a worse prognosis. OBJECTIVE Our aim is to analyze how the learning curve for rectal cancer via laparoscopy influences intra- and postoperative results and oncological markers. A retrospective review was conducted of the first 120 patients undergoing laparoscopic surgery for rectal neoplasia. The operations were performed by the same surgical team with a wide experience in the treatment of open colorectal cancer and qualified to perform advanced laparoscopic surgery. We analyzed sex, ASA, tumour location, neoadjuvant treatment, surgical technique, operating time, conversion, postoperative complications, length of hospital stay, number of lymph nodes, stage and involvement of margins. RESULTS Significant differences were observed with regard to surgical time (224 min in the first group, 204 min in the second group), with a higher rate of conversion in the first group (22.5%) than in the second (11.3%). No significant differences were noted for rate of conservative sphincter surgery, length of hospital stay, post-surgical complications, number of affected/isolated lymph nodes or affected circumferential and distal margins. CONCLUSIONS It is possible to learn this complex surgical technique without compromising the patients safety and oncological outcome.

Bypass gástrico por laparoscopia en el tratamiento de la obesidad mórbida: resultados preliminares de una nueva técnica

Introduccion El bypass gastrico es una de las tecnicas quirurgicas mas utilizadas para el tratamiento de la obesidad morbida. Habitualmente, se realiza por cirugia abierta y en los ultimos anos ha comenzado a realizarse por via laparoscopica. El objetivo de este trabajo es describir nuestra tecnica quirurgica en el bypass gastrico por laparoscopia (BPGL), asi como los resultados a corto plazo Material y metodos En el periodo entre enero de 2000 y septiembre de 2001, fueron intervenidos 39 pacientes que presentaban obesidad morbida y con criterios para cirugia bariatrica, con una edad media de 34 anos y un indice de masa corporal (IMC) de 47 Resultados De los 39 pacientes intervenidos hubo necesidad de conversion en 4 (10%). El tiempo medio quirurgico fue de 180 min con una diferencia de 61 min entre los primeros 10 casos y los 10 ultimos. Hubo un 23% de complicaciones, siendo precoces ( 30 dias) en un 8%. La estancia media hospitalaria fue de 4,5 dias Conclusiones El bypass gastrico por laparoscopia (BPGL) es una tecnica con buenos resultados en lo que respecta a la perdida de peso, aunque con una curva de aprendizaje de las mas complejas en cirugia laparoscopica. Los cirujanos que consideren el bypass gastrico como la tecnica de eleccion para el tratamiento quirurgico de la obesidad morbida deberian plantearse realizar esta tecnica por via laparoscopica

La quimioterapia y la radioterapia neoadyuvante en el cáncer de recto incrementan las tasas de cirugía conservadora de esfínteres, sin aumentar la dificultad técnica de la intervención ni las complicaciones postoperatorias

Resumen Introduccion La radioquimioterapia neoadyuvante en el cancer de recto disminuye las recidivas locales y algunos autores comunican un aumento de la supervivencia, tambien se ha observado un aumento de la morbimortalidad postoperatoria. El objetivo de este estudio es analizar la dificultad operatoria y las complicaciones postoperatorias en los pacientes con radioquimioterapia preoperatoria. Pacientes y metodo Se estudian 103 pacientes intervenidos de cancer de recto entre enero de 1995 y diciembre de 1999, divididos en dos grupos: grupo A, formado por 53 pacientes sometidos a radioterapia preoperatoria con 45 Gy (1,8 Gy/dia durante 25 dias), junto a quimioterapia con 5-fluorouracilo y acido folinico (la cirugia se realizo 4-6 semanas despues de la finalizacion del tratamiento), y grupo B, compuesto por 50 pacientes con cancer de recto a los que se practico la cirugia tras el diagnostico. Ambos grupos son homogeneos en los datos preoperatorios analizados. Se compara entre los dos grupos la dificultad tecnica mediante datos intraoperatorios, asi como la tasa de complicaciones. Resultados No existen diferencias estadisticamente significativas entre los dos grupos en cuanto a los datos intraoperatorios ni postoperatorios evaluados. En el grupo A existen 20 complicaciones en 17 pacientes (32%), mientras que en el grupo B existen 22 complicaciones en 19 pacientes (38%). La tasa de infeccion de la herida perineal fue similar en los dos grupos: el 9,4% en el grupo A frente al 10% en el grupo B. El porcentaje de fugas anastomoticas fue mayor en el grupo A (5,7%) que en el grupo B (2%), diferencia sin significacion estadistica. En el grupo de radioquimioterapia se realizaron un mayor numero de resecciones anteriores (75%) que en el grupo B (60%). Conclusion El uso de la radioquimioterapia preoperatoria en el cancer de recto no aumenta la incidencia de complicaciones postoperatorias y aumenta la tasa de cirugia conservadora de esfinteres.