Javier Miró

Duodenal Switch: An Effective Therapy for Morbid Obesity - Intermediate Results

Background: The duodenal switch (DS) is a variant of the biliopancreatic diversion (BPD), with a vertical subtotal gastrectomy and pylorus preservation. Methods: DS was used to treat morbid obesity in 125 patients, with mean BMI 50, with 65% of the patients super obese (SO). Patients have been followed for an intermediate period. Results: The percentage of excess weight loss (%EWL) was > 70% at 1 year, and reached 81.4% at 5 years when 97% of the patients had a %EWL > 50%. Comorbidities were cured or improved in all patients. Conclusion: DS was very effective for the treatment of the morbid obesity in the SO patients.

Laparoscopic Biliopancreatic Diversion with Duodenal Switch: Technique and Initial Experience

Background: The duodenal Switch (DS) is a variant of the biliopancreatic diversion (BPD) for the surgical treatment of morbid obesity. Materials and Methods: The laparoscopic DS (LapDS) operation is described, and the early surgical outcomes of 16 patients are reported. Results: Postoperative stay was 5 to 8 days. Local wound infection at a trocar site was the most common local complication. Conclusion: LapDS is an advanced, complex and feasible technique in bariatric surgery.

Vertical Banded Gastroplasty at More than 5 Years

Background: Optimal evaluation of the results of surgery for morbid obesity requires a long-term follow-up for at least 5 years. Methods: One hundred patients were operated by vertical banded gastroplasty (VBG) and revised with a follow-up of no less than 5 years. Sixty patients were morbidly obese with a body mass index (BMI) of between 40 and 50 kg/m2, and 40 were superobese with a BMI of >50 kg/m2. Follow-up included 93 patients (93%). Results: Initial surgical mortality was nil. Twenty-five patients required surgery for complications related to the technique (25%) and one patient died due to pulmonary embolism after a re-stapling operation. The percentage excess weight loss was 54.3%, and the BMI was 33 kg/m2 for the 84 patients followed to 5 years post VBG. Only 40 out of 92 patients (43.5%), obtained the weight loss benefit due to the operation. None of them is able to eat a regular diet, and the quality of food intake has been severely affected in some of them. Conclusions: VBG is, in our experience, a safe and technically simple operation, but the long-term results are questionable. The reoperation rate was high, and weight loss and quality of life are superior with other operations.

Internal Hernias and Gastric Perforation After a Laparoscopic Gastric Bypass

A 27-year-old woman underwent laparoscopic Roux-en-Y gastric bypass. A retrocolic-retrogastric herniation of most of the small bowel and later a gastric perforation due to internal hernia at the mesenteric defect of the jejuno-jejunostomy occurred. These unusual, but not rare, complications are directly related to the neoanatomy that follows gastric bypass and can lead to rapidly progressing and life-threatening situations. Proper evaluation of clinical signs and symptoms, early abdominal CT scan, and urgent operative intervention are mandatory to achieve a successful outcome.

Cruce duodenal por laparoscopia en el tratamiento de la obesidad mórbida: técnica y estudio preliminar

Resumen Introduccion El cruce duodenal es una variante de la derivacion biliopancreatica en el tratamiento de la obesidad morbida. Pacientes y metodo Se describe la tecnica de cruce duodenal realizada por laparoscopia y curso preliminar en dos pacientes operadas. Resultados La estancia hospitalaria fue de 5 y 7 dias. Conclusion El cruce duodenal por laparoscopia es una tecnica compleja, avanzada y posible en la cirugia bariatrica.

El cruce duodenal: una terapia efectiva en la obesidad mórbida. Estudio intermedio

Resumen El cruce duodenal es una variante de la derivacion biliopancreatica. Se describen la tecnica, su morbimortalidad, los resultados intermedios, los efectos secundarios y las indicaciones como una tecnica mixta para el tratamiento de la obesidad morbida. El porcentaje de sobrepeso perdido se incrementa del 70% al ano hasta el 81,37% a los 5 anos.

Four Decades of Advances in General Surgery in a Community Hospital of Spain

Changes in the practice of surgery over the last 40 years have been extraordinary. We want to reflect the progress during this period in the Community Hospital of Alcoy, Spain. Technology and staff training have improved in an extraordinary way allowing that medical assistance in the community hospitals is quite similar to that offered at the most sophisticated centers. Correspondence to: Aniceto Baltasar, Alcoy Hospital, Alcoy. España, Spain, Tel: + 34-616.321.021; E-mail: baltasarani@gmail.com

Fístula pancreatocutánea secundaria a pancreatitis postoperatoria tras cruce duodenal laparoscópico

Resumen El cruce duodenal por laparoscopia (CDxLP) es una variante de la derivacion biliopancreatica y representa un tratamiento eficaz para la obesidad morbida. A pesar de los buenos resultados aportados en la perdida de peso del paciente, esta tecnica bariatrica no esta exenta de complicaciones postoperatorias derivadas sobre todo del efecto malabsortivo intestinal y de la dehiscencia anastomotica. En muy escasas ocasiones se han descrito casos de complicacion pancreatica secundaria a este tipo de cirugia. Presentamos un caso de obesidad morbida intervenida por CDxLP que desarrollo en el postoperatorio un episodio de pancreatitis edematosa y que se inicio con una fistulizacion externa cutanea a traves del trayecto labrado por los trocares de laparoscopia.