Gastrektomia bertikala obesitate morbidoan. Sindrome metabolikoan duen eragina.

[EUS] Sarrera: azken urteetan mundu mailan obesitatearen prebalentzia areagotzen ari da, morbi-mortalitatea areagotzen duen zenbait patologiarekin erlazionaturik egonez. Bereziki, sindrome metabolikoa (obesitate zentrala, DM, HTA, HDL, TG) da arrisku kardiobaskularra ugarituz, morbi-mortalitatean eragin handiena duena. Literaturak dioenez, kirurgia bariatrikoak pisu galera lortzeaz gain, obesitatearekin erlazionaturiko komorbilitateen hobekuntza bermatu dezakeen tratamendu bakarra da. Teknika kirurgiko ororen artean, azken hamarkadan indar gehien hartzen ari dena gastrektomia bertikala dugu, beteak beste gure ospitalean gehien buruturiko teknika izanik. Hori dela eta, gure ikerketaren helburua gastrektomia bertikala burutu eta urte batera sindrome metabolikoaren hobekuntzarik lortzen ote den ikustea da. Material eta metodoak: 2011ko urtarrilak eta 2015eko abenduak bitartean egindako 157 gastrektomia bertikalek urte batera izan dute eboluzioaren azterketa deskriptibo erretrospektiboa burutu da. Azterturiko bariableak sexua, adina, pisua, GMI, gluzemia, HbA1c, triglizeridoak, HDL, LDL, tentsio arteriala eta SAOS izanik. Emaitzak: Kirurgia burutu eta urte batera pisuaren eta GMIaren mediana 125 kg-tatik 81kg-tara eta 45 〖kg/m〗^2-tatik 30.76 〖kg/m〗^2-tara jaitsi da hurrenez hurren, bi kasuetan p < 0.001 izanik. Glukosa mailari dagokionez, 100 mg/dL-tatik 86 mg/dL-tara murriztu da (p < 0.001), HbA1c ere jaitsi da %5.8tik % 5.2ra (p < 0.001). Lipidoei dagokienez, HDL 48 mg/dL-tatik 61 mg/dL-tara igo da ( p < 0.001), TG 130 mg/dl-tatik 79.5 mg/dL-tara jaitsi ( p < 0.001) eta LDL ere 114mg/dL-tatik 110.5 mg/dL-tara jaitsi da ( p < 0.329). TA, berriz, 163/82mmHg-tatik 128/74.5 mmHg-tara (p < 0.001) murriztu da. Komorbilitatei dagokienez 2. motako diabetes mellitusa kasuen % 85.2an, hipertentsioa %62.46, dislipemia % 47.5an eta SAOSa % 76.6an lortu da sendatzea, orotan p < 0.001 suertatuz. Ondorioak: Gure kasua, urte bateko jarraipenaren ondoren, gastrektomia bertikalak 2. motako diabetesa, hipertentsioa, hiperlipemia eta SAOSaren hobekuntza dakarrela baieztatu dugu. Hala ere, ezin bestekoa litzateke epe luzeagorako jarraipena egitea. Hitz gakoak: gastrektomia bertikala, sindrome metabolikoa, obesitatea, kirurgia bariatrikoa.[EN] Introduction: Obesity is a global health problem that is becoming more and more prevalent. It is also associated with various pathologies that increase both morbidity and mortality. It is closely related to “the metabolic syndrome”, which increasing cardiovascular risk, increases morbidity and mortality. Recent publications show that bariatric surgery is the only method able to improve these comorbidities. Among the different surgical techniques, laparoscopic sleeve gastrectomy is becoming more important in the last years, being the most performed surgical technique in our hospital. In this way, the goal of our study is to see metabolic syndrome improvement one year after surgery. Material and methods: A retrospective descriptive study of 157 laparoscopic sleeve gastrectomy surgeries, which include patients operated from January 2011 up to December 2015. All cases have been studied for a year and the analyzed variables have been gender, age, weight, BMI, glucose, HbA1c, HDL, LDL, triglycerides, blood pressure and SAOS. Results: After one year follow-up, weight and BMI has been significant decreased (p 0.001), HbA1c from %5.8 to % 5.2 (p <0.001), TA from 136/82 mmHg to 128/74.5 mmHg (p <0.001), TG from 130 mg/dL to 79.5 mg/dL (p <0.001), LDL from 114 mg/dL to 110.5 mg/dL (p <0.329) and HDL improves from 48 mg/dL to 61 mg/dL (p<0.001). Regarding comorbidities, it has succeeded in curing type 2 DM in 85% of cases, hypertension in 62.46%, dyslipidemia in 74.5% and SAOS in 76.6%, with a p <0.001. Conclusion: After a year of follow-up, we can observe in our study that sleeve gastrectomy improves type 2 diabetes, hypertension, hyperlipemia and SAOS. However, it would be essential to carry out a longer term study. Key words: laparoscopic sleeve gastrectomy, metabolic syndrome, obesity, bariatric surgery

Gastrektomia bertikala obesitate morbidoan. Sindrome metabolikoan duen eragina.

[EUS] Sarrera: azken urteetan mundu mailan obesitatearen prebalentzia areagotzen ari da, morbi-mortalitatea areagotzen duen zenbait patologiarekin erlazionaturik egonez. Bereziki, sindrome metabolikoa (obesitate zentrala, DM, HTA, HDL, TG) da arrisku kardiobaskularra ugarituz, morbi-mortalitatean eragin handiena duena. Literaturak dioenez, kirurgia bariatrikoak pisu galera lortzeaz gain, obesitatearekin erlazionaturiko komorbilitateen hobekuntza bermatu dezakeen tratamendu bakarra da. Teknika kirurgiko ororen artean, azken hamarkadan indar gehien hartzen ari dena gastrektomia bertikala dugu, beteak beste gure ospitalean gehien buruturiko teknika izanik. Hori dela eta, gure ikerketaren helburua gastrektomia bertikala burutu eta urte batera sindrome metabolikoaren hobekuntzarik lortzen ote den ikustea da. Material eta metodoak: 2011ko urtarrilak eta 2015eko abenduak bitartean egindako 157 gastrektomia bertikalek urte batera izan dute eboluzioaren azterketa deskriptibo erretrospektiboa burutu da. Azterturiko bariableak sexua, adina, pisua, GMI, gluzemia, HbA1c, triglizeridoak, HDL, LDL, tentsio arteriala eta SAOS izanik. Emaitzak: Kirurgia burutu eta urte batera pisuaren eta GMIaren mediana 125 kg-tatik 81kg-tara eta 45 〖kg/m〗^2-tatik 30.76 〖kg/m〗^2-tara jaitsi da hurrenez hurren, bi kasuetan p < 0.001 izanik. Glukosa mailari dagokionez, 100 mg/dL-tatik 86 mg/dL-tara murriztu da (p < 0.001), HbA1c ere jaitsi da %5.8tik % 5.2ra (p < 0.001). Lipidoei dagokienez, HDL 48 mg/dL-tatik 61 mg/dL-tara igo da ( p < 0.001), TG 130 mg/dl-tatik 79.5 mg/dL-tara jaitsi ( p < 0.001) eta LDL ere 114mg/dL-tatik 110.5 mg/dL-tara jaitsi da ( p < 0.329). TA, berriz, 163/82mmHg-tatik 128/74.5 mmHg-tara (p < 0.001) murriztu da. Komorbilitatei dagokienez 2. motako diabetes mellitusa kasuen % 85.2an, hipertentsioa %62.46, dislipemia % 47.5an eta SAOSa % 76.6an lortu da sendatzea, orotan p < 0.001 suertatuz. Ondorioak: Gure kasua, urte bateko jarraipenaren ondoren, gastrektomia bertikalak 2. motako diabetesa, hipertentsioa, hiperlipemia eta SAOSaren hobekuntza dakarrela baieztatu dugu. Hala ere, ezin bestekoa litzateke epe luzeagorako jarraipena egitea. Hitz gakoak: gastrektomia bertikala, sindrome metabolikoa, obesitatea, kirurgia bariatrikoa.[EN] Introduction: Obesity is a global health problem that is becoming more and more prevalent. It is also associated with various pathologies that increase both morbidity and mortality. It is closely related to “the metabolic syndrome”, which increasing cardiovascular risk, increases morbidity and mortality. Recent publications show that bariatric surgery is the only method able to improve these comorbidities. Among the different surgical techniques, laparoscopic sleeve gastrectomy is becoming more important in the last years, being the most performed surgical technique in our hospital. In this way, the goal of our study is to see metabolic syndrome improvement one year after surgery. Material and methods: A retrospective descriptive study of 157 laparoscopic sleeve gastrectomy surgeries, which include patients operated from January 2011 up to December 2015. All cases have been studied for a year and the analyzed variables have been gender, age, weight, BMI, glucose, HbA1c, HDL, LDL, triglycerides, blood pressure and SAOS. Results: After one year follow-up, weight and BMI has been significant decreased (p 0.001), HbA1c from %5.8 to % 5.2 (p <0.001), TA from 136/82 mmHg to 128/74.5 mmHg (p <0.001), TG from 130 mg/dL to 79.5 mg/dL (p <0.001), LDL from 114 mg/dL to 110.5 mg/dL (p <0.329) and HDL improves from 48 mg/dL to 61 mg/dL (p<0.001). Regarding comorbidities, it has succeeded in curing type 2 DM in 85% of cases, hypertension in 62.46%, dyslipidemia in 74.5% and SAOS in 76.6%, with a p <0.001. Conclusion: After a year of follow-up, we can observe in our study that sleeve gastrectomy improves type 2 diabetes, hypertension, hyperlipemia and SAOS. However, it would be essential to carry out a longer term study. Key words: laparoscopic sleeve gastrectomy, metabolic syndrome, obesity, bariatric surgery

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Timing of Cholecystectomy After Moderate and Severe Acute Biliary Pancreatitis

IMPORTANCE Considering the lack of equipoise regarding the timing of cholecystectomy in patients with moderately severe and severe acute biliary pancreatitis (ABP), it is critical to assess this issue.OBJECTIVE To assess the outcomes of early cholecystectomy (EC) in patients with moderately severe and severe ABP.DESIGN, SETTINGS, AND PARTICIPANTS This cohort study retrospectively analyzed real-life data from the MANCTRA-1 (Compliance With Evidence-Based Clinical Guidelines in the Management of Acute Biliary Pancreatitis) data set, assessing 5304 consecutive patients hospitalized between January 1, 2019, and December 31, 2020, for ABP from 42 countries. A total of 3696 patients who were hospitalized for ABP and underwent cholecystectomy were included in the analysis; of these, 1202 underwent EC, defined as a cholecystectomy performed within 14 days of admission. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality and morbidity. Data analysis was performed from January to February 2023.MAIN OUTCOMES Mortality and morbidity after EC.RESULTS Of the 3696 patients (mean [SD] age, 58.5 [17.8] years; 1907 [51.5%] female) included in the analysis, 1202 (32.5%) underwent EC and 2494 (67.5%) underwent delayed cholecystectomy (DC). Overall, EC presented an increased risk of postoperative mortality (1.4% vs 0.1%, P &lt;.001) and morbidity (7.7% vs 3.7%, P &lt; .001) compared with DC. On the multivariable analysis, moderately severe and severe ABP were associated with increased mortality (odds ratio [OR], 361.46; 95% CI, 2.28-57 212.31; P = .02) and morbidity (OR, 2.64; 95% CI, 1.35-5.19; P = .005). In patients with moderately severe and severe ABP (n = 108), EC was associated with an increased risk of mortality (16 [15.6%] vs 0 [0%], P &lt; .001), morbidity (30 [30.3%] vs 57 [5.5%], P &lt; .001), bile leakage (2 [2.4%] vs 4 [0.4%], P = .02), and infections (12 [14.6%] vs 4 [0.4%], P &lt; .001) compared with patients with mild ABP who underwent EC. In patients with moderately severe and severe ABP (n = 108), EC was associated with higher mortality (16 [15.6%] vs 2 [1.2%], P &lt; .001), morbidity (30 [30.3%] vs 17 [10.3%], P &lt; .001), and infections (12 [14.6%] vs 2 [1.3%], P &lt; .001) compared with patients with moderately severe and severe ABP who underwent DC. On the multivariable analysis, the patient's age (OR, 1.12; 95% CI, 1.02-1.36; P = .03) and American Society of Anesthesiologists score (OR, 5.91; 95% CI, 1.06-32.78; P = .04) were associated with mortality; severe complications of ABP were associated with increased mortality (OR, 50.04; 95% CI, 2.37-1058.01; P = .01) and morbidity (OR, 33.64; 95% CI, 3.19-354.73; P = .003).CONCLUSIONS AND RELEVANCE This cohort study's findings suggest that EC should be considered carefully in patients with moderately severe and severe ABP, as it was associated with increased postoperative mortality and morbidity. However, older and more fragile patients manifesting severe complications related to ABP should most likely not be considered for EC

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2