Óscar Lozano

Changes in glucagon-like peptide-1 (GLP-1) secretion after biliopancreatic diversion or vertical banded gastroplasty in obese subjects

Background: Bariatric operations promote weight loss and improve glucose homeostasis. Glucagon-like peptide-1 (GLP-1) is considered as a possible mediator of the antidiabetic effects of such operations. Methods: The present study aimed to gain information on the time course for changes in glucose tolerance, as well as insulin, glucagon and GLP-1 secretion, during an oral glucose tolerance test (OGTT), in 31 obese patients examined 1, 3 and 6 months after Larrads biliopancreatic diversion (BPD) or 6 months after vertical banded gastroplasty (VBG). Results: A time-related progressive decrease in body weight coincided with lowering of plasma triglycerides, decrease of basal plasma glucose and its incremental area during OGTT, and reduction of basal plasma insulin together with an increase of its incremental area. The time-related decrease of plasma glucagon during OGTT was comparable before and after surgery. Both the basal plasma GLP-1 concentration and its incremental area during the OGTT increased strikingly after surgery, a steady-state situation being reached 3 months after surgery. The most striking differences between the somewhat older and less glucose-tolerant subjects of VBG compared to BPD after surgery, consisted in a decrease in cholesterol and LDL only observed in BPD and a much more pronounced increase in basal and incremental plasma GLP-1 in BPD. GLP-1, like glucagon, increased lipolysis, but failed to duplicate the lipogenetic action of insulin in isolated adipocytes obtained at the time of surgery. Conclusion: These findings support the postulated role of GLP-1, secreted by the hindgut, as a key mediator of the antidiabetic effects of bariatric operations.

Modifications to Rives technique for midline incisional hernia repair

Abstract. Between 1990 and 1997, 284 patients were treated in our hospital for abdominal hernias. In the original group, 239 patients (84.15%) had midline hernia, and 45 (15.8%) had lateral hernia. A total of 152 midline hernia patients (63.5%) were treated using our variant of Rives technique. In all these cases, preperitoneal and retromuscular polypropylene mesh was used as a reinforcement and was subsequently attached by means of absorbable sutures to the external border of the rectus muscles. There were no deaths. A total of 42 of all patients operated on (27.6%) suffered from long-term postoperative pain. In seven cases (4.6%) it was necessary to remove the prosthesis because of chronic infection, and there were two recurrences in patients in whom the prosthesis had to be removed. In our experience, the Rives technique is a suitable and safe treatment for the repair of midline incisional hernias. The use of absorbable sutures and fixation of the mesh to the external oblique aponeurosis can reduce the original problems of abdominal pain and unaesthetic skin scars.

Changes In Lipid Profile after Biliopancreatic Diversion

Background: Bariatric operations have varying degrees of effectiveness and different mechanisms of action. Our objective was to evaluate the efficacy of the biliopancreatic diversion (BPD) in reduction of weight and serum lipids. Methods: A prospective study was conducted with follow-up from 12 to 72 months (average 39.4 months) of 58 patients with morbid obesity (10 men, 48 women, mean BMI 49.4 kg/m2). Their lipid levels were generally normal or slightly high. All the patients were subjected to subtotal gastrectomy and BPD with jejunoileostomy 50 cm proximal to the ileocecal valve, and they were instructed to maintain the same hypocaloric diet as before BPD. Serum lipoproteins and apolipoproteins B and A1 were measured before BPD and every 6 months during follow-up. Results: Early and very significant reduction (P<0.001) of total cholesterol (32.8%), LDL (46.3%), total cholesterol / HDL ratio (29.7%) and apolipoprotein B (37%), with more moderate decrease of triglycerides (21.3%, P=0.004), were observed. This lipid decrease was maximum at 1 year after BPD. Important and persistent weight reduction that did not correlate with changes in lipids was observed. The youngest patients and those with high basal lipid levels proved to benefit most from BPD. There were no important side-effects. Conclusion: BPD, with careful selection of patients, is a well tolerated procedure that offers excellent results in the short- and mid-term in reduction in weight and blood levels of most atherogenic lipoproteins.

Incisional hernia following appendectomy. Surgical experience

SummaryAppendectomy is a very frequent cause of incisional hernia. In this paper the rate of recurrence after the hernia repair by simple suture and mesh repair was studied. 17 lateral incisional hernias secondary to appendectomy were repaired over a 9 year period. Prosthetic repair was carried out in 9 cases and primary closure in the remaining 8 cases. All the patients were followed over a period that ranged from 1 to 8 years (mean 5.6 years). There was one recurrence, though 2 patients (11.7%) with mesh repair complained about abdominal pain during the first postoperative year. The study concludes that both techniques can be successfully implemented if the correct indications based on the extent of the defect and the clinical characteristics of the patient are respected.

Enfermedad de Ménétrier y cáncer gástrico

Resumen La enfermedad de Menetrier es una gastropatia hipertrofica muy infrecuente, asociada a hipoproteinemia y de etiologia desconocida. Es una condicion preneoplasica, ya que se asocia a cancer gastrico en un 10-15% de los casos. Presentamos a un paciente de 66 anos diagnosticado de enfermedad de Menetrier 13 anos antes, que en el seguimiento presento un cancer gastrico antral avanzado. Se realiza una puesta al dia del manejo terapeutico idoneo, ya que no esta claramente definido.

Linfoma primario de intestino delgado

Resumen Presentamos a 4 pacientes afectados de linfoma no hodgkiniano de intestino delgado. Tres eran varones. En 2 pacientes se inicio con un cuadro de abdomen agudo por perforacion de la tumoracion, y los otros 2 presentaban dolor abdominal y efecto masa. La tumoracion se situaba en la zona del ileon (un caso), yeyuno (2 casos) y yeyunoileal (un caso). A todos ellos se efectuo reseccion del segmento intestinal afectado. En 3 casos se trataba de linfomas B de celulas grandes y el restante, un linfoma T asociado a celiaquia. Los pacientes han recibido diversas combinaciones de quimioterapia. Unicamente ha fallecido el paciente afectado de linfoma T por progresion de la enfermedad. Se debaten los aspectos clinicos y la estrategia terapeutica de estos tumores.

Adenoma de la vía biliar extrahepática

Las neoplasias biliares extrahepáticas benignas son una entidad rara, con una incidencia menor del 0,1%1. Estas neoplasias benignas tienen riesgo de transformación maligna, y la exéresis local de la lesión se asocia con un elevado porcentaje de recurrencias. Presentamos un caso tratado en nuestro servicio en el que se diagnosticó una neoplasia benigna de la vía biliar como causa de la ictericia obstructiva.