Guillermo Duza

Early surgical complications after gastric by-pass: a literature review

Introduction Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones. Method Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. Results There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula. Conclusion Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

Complicações cirúrgicas tardias após bypass gástrico: revisão da literatura

INTRODUCAO: O bypass gastrico e hoje o procedimento bariatrico mais realizado, mas, apesar disso, varias complicacoes podem ocorrer com variada morbimortalidade. Provavelmente todos os cirurgioes bariatricos conhecem essas complicacoes, mas como a cirurgia bariatrica continua a se espalhar, o cirurgiao geral deve estar familiarizado com essas complicacoes e seu manuseio. As complicacoes do bypass gastrico podem ser divididas em dois grupos: as precoces e tardias, tendo em conta o periodo de duas semanas apos a operacao. Este artigo ira focar as tardias. METODO: Foi realizada revisao da literatura utilizando as bases Medline/PubMed, Cochrane Library, SciELO, e informacoes adicionais sobre sites institucionais de interesse cruzando os descritores: bypass gastrico AND complicacoes; seguimento AND complicacoes; complicacoes pos-operatorias AND anastomose, Roux-en-Y; obesidade AND complicacoes pos-operatorias. A lingua usada para a busca foi o ingles. RESULTADOS: Foram selecionados 35 estudos que combinavam com os descritores. As complicacoes tardias foram consideradas como: estenose de anastomose, ulceracao marginal e fistula gastrogastrica. CONCLUSAO: O conhecimento sobre as estrategias de como reduzir o risco e incidencia das complicacoes deve ser adquirido ao longo do tempo, e cada cirurgiao deve estar familiarizado com essas complicacoes, a fim de reconhece-las precocemente e realizar a melhor intervencao.

Most common robotic bariatric procedures: review and technical aspects.

AbstractSince its appear in the year 1997, when Drs. Cadiere and Himpens did the first robotic cholecystectomy in Brussels, not long after the first cholecystectomy, they performed the first robotic bariatric procedure. It is believed that robotically-assisted surgery’s most notable contributions are reflected in its ability to extend the benefits of minimally invasive surgery to procedures not routinely performed using minimal access techniques. We describe the 3 most common bariatric procedures done by robot. The main advantages of the robotic system applied to the gastric bypass appear to be better control of stoma size, avoidance of stapler costs, elimination of the potential for oropharyngeal and esophageal trauma, and a potential decrease in wound infection. While in the sleeve gastrectomy and adjustable gastric banding its utility is more debatable, giving a bigger advantage during surgery on patients with a very large BMI or revisional cases.

Vesícula de porcelana.: Caso clínico y revisión de la literatura

Porcelain bladder is defined as calcification of the gallbladder wall. It is a rare condition and is seen in 0.06% to 0.8% of cholecystectomies. It origin is still unknown. We report two cases of patients with a porcelain gallbladder. One case is a 60 year-old male patient who was seen due to having biliary symptoms. The diagnosis was made by ultrasound and computed tomography, and he was surgically intervened by performing a partial cholecystectomy. The histopathology reported a gallbladder wall with sclerohyalinosis and dystrophic calcification foci. The other case is a 98 year-old female patient, whose form of presentation was incidental given that she suffered from symptoms of an intestinal obstruction. A cholecystectomy was performed with a good post-surgical outcome. A series published in between 1950 and 1960 show that the porcelain bladder can be frequently observed in patients with cancer of the gallbladder, although this relationship is currently being rejected. The reason why these cases are being presented is because of their low incidence and the controversy over what treatment to use, due to its association with gallbladder cancer.

Porcelain gallbladder: a clinical case and a review of the literature

Abstract Porcelain bladder is defined as calcification of the gallbladder wall. It is a rare condition and is seen in 0.06% to 0.8% of cholecystectomies. It origin is still unknown. We report two cases of patients with a porcelain gallbladder. One case is a 60 year-old male patient who was seen due to having biliary symptoms. The diagnosis was made by ultrasound and computed tomography, and he was surgically intervened by performing a partial cholecystectomy. The histopathology reported a gallbladder wall with sclerohyalinosis and dystrophic calcification foci. The other case is a 98 year-old female patient, whose form of presentation was incidental given that she suffered from symptoms of an intestinal obstruction. A cholecystectomy was performed with a good post-surgical outcome. A series published in between 1950 and 1960 show that the porcelain bladder can be frequently observed in patients with cancer of the gallbladder, although this relationship is currently being rejected. The reason why these cases are being presented is because of their low incidence and the controversy over what treatment to use, due to its association with gallbladder cancer.

Single Port Laparoscopic Gastrostomy

Introduction: Since the first classic descriptions of surgical gastrostomies for feeding by supraumbilical medial incisions, patients were operated under general anesthesia, with prolonged time of surgery, these were patients in poor health status, undernourished due to inadequate intake or to neurological or tumor involvement, with prolonged hospitalization, both for the recovery of the intestinal motility as well as for the recovery of post-surgical wounds. Material and Methods: Between July 2012 and December 2013, 10 patients underwent a single port laparoscopic gastrostomy. Six were females and 4 males. The range of age was from 54 to 87 y/o with a mean age of 72. Results: The mean time of the procedure was 43 minutes. Nine patients underwent glucose intake tolerance test after 12 hours and one 24 hours later. Enteral feeding was indicated after the glucose intake tolerance. No complications related with the procedure were observed.f Discussion: Nowadays, the gold standard technique to perform a gastrostomy is the percutaneous approach. In patients with head and neck disorders when is not possible to insert a nasogastric tube to insuflate the stomach, a laparoscopic gastrostomy would be indicated. We describe a new technique, step by step, to perform less invasive laparoscopic surgery by a single port laparoscopic gastrostomy. Conclusion: The lumen created is the same than with open techniques but with a minimally invasive approach, that allows to start feeding earlier providing high quality feeding