Cirurgia robòtica de l'obesitat

Cirurgia robòtica; Obesitat; Cirurgia bariàtrica, LaparoscòpiaRobotic surgery; Obesity; Bariatric surgery, LaparoscopyCirugía robótica; Obesidad; Cirugía bariátrica, LaparoscopiaComunicació sobre l'evolució de la cirurgia bariàtrica, des de la laparoscòpia a la cirurgia robòtica, i beneficis de l'ús de la tecnologia robotitzada en les cirurgies per tractar l'obesitat

Estudio de los parámetros de calidad de la cirugía de la hernia inguinal : valor de un cuestionario postal /

Consultable des del TDXTítol obtingut de la portada digitalitzadaIntroducción: El uso del abdordage preperitoneal en la cirugía de la hernia inguinal es conocido des de hace tiempo. Wantz, siguiendo los principios de Stoppa introdujo la malla con la finalidad de encontrar la técnica ideal de la malla. Otro aspecto importante en la cirugía de la hernia inguinal es el seguimiento de los pacientes. El examen clínico en las consultas externas puede ser impracticable en hospitales terciarios con áreas de influencia sobre grandes grupos poblacionales. El objetivo del presente estudio es analizar los parámetros de la calidad a largo plazo de la cirugía de la hernia inguinal y la utilidad de un cuestionario postal con visita selectiva combinado con llamada telefónica en el seguimiento. Método: Se han incluido los pacientes intervenidos por una hernia inguinal mediante un abordaje preperitoneal y de forma ambulatoria en el Servicio de Cirugía General de un hospital terciario, entre el 1/1/1999 y el 31/12/2003. El cuestionario con seis preguntas con la opción de contestación si o no: ¿era la primera vez que le operaban la hernia?, ¿era del lado derecho, lado izquierdo o los dos a la vez?, ¿ha notado de nuevo un bulto en la zona operada?, ¿ha tenido dolor en la zona operada pasado un mes de la intervención?, ¿le continua doliendo en la actualidad la zona operada?, ¿esta satisfecho con la cirugía que se realizó? Resultados: Un total de 841 pacientes (72.9%) devolvieron el cuestionario después de tres envios (512 después del primero, 205 después del segundo y 124 después del tercero). El cuestionario con respuesta positiva se halló en 152 pacientes (18.1%) y con respuesta negativa en 689 pacientes (81.9%). De los 152 pacientes que respondieron «si» a alguna de las preguntas sobre dolor en la actualidad y/o recurrencia, 91 no quisieron ser visitados en consultas externas, 24 no se pudieron contactar por teléfono, y 37 quisieron ser visitados. De los 312 pacientes que no respondieron el cuestionario postal, 8 habían fallecido, 124 no quisieron ser visitados y 180 no se localizaron. La tasa de recurrencia hallada fue de 2.7% y la de dolor crónico de 5.9%. Conclusiones: 1.La tasa de recidiva herniaria en nuestra serie puede oscilar entre el 4,3% y el 0,12% según como se tomen los criterios de recidiva y como se escoja la muestra de control. 2.El dolor crónico postcirugía no se ha presentado y sólo se ha encontrado un 7,3% de parestesias y molestias inespecíficas en la región operada. 3.El 95,2% de los pacientes que han respondido al cuestionario postal han manifestando estar satisfechos con la cirugía. Cuando se aplica el cuestionario SF-36, todos presentan unas puntuaciones medias superiores a 60 en cualquiera de sus dimensiones. 4.El abordaje preperitoneal en régimen de Cirugía Mayor Ambulatoria es una buena técnica en nuestro ámbito. 5.El uso de un cuestionario postal nos ha determinado una respuesta del 72,9%. Esto nos hace concluir que es una modalidad muy útil para la obtención de datos cuando se pretenden realizar estudios de calidad y de control del procedimiento. 6.El uso del cuestionario postal con visita selectiva no ha aportado datos significativos para control sucesivo de un paciente. 7.Una vez evaluada la calidad de la técnica y establecidos unos resultados a partir de un cuestionario postal, la utilización de un protocolo para el seguimiento no aporta ningún resultado añadido que lo justifique a menos que se modifique la técnica o el equipo. 8.Al paciente intervenido consideramos que se le ha de proponer una única visita postoperatoria, donde a parte de hacer el control posquirúrgico pertinente, hay que informarle de que su hernia operada no necesita más controles.Background: The open preperitoneal surgery for hernia repair is known since ages. Wantz, following Stoppa principles introduced the mesh trying to find, with this way, the ideal hernia repair technique. In the other hand, follow-up of the patient who have had a hernia repair is still an important problem nowadays for the general Surgeon. Classical follow-up with the patient are nearly impossible when the amount of patients is very high, and also, because of the low recurrence rate. This is the reason why we decided to evaluate the quality control parameters in hernia surgery (recurrence and pain) and also to assessed the usefulness of a short postal questionnaire and selective clinical examination combined with repeat mailing and telephone reminders for quality assessment in hernia surgery. Method: All patients (n = 1153) who underwent tension-free hernioplasty through an open preperitoneal approach between 1999 and 2003 received a 6-item questionnaire with a covering letter and a stamped addressed enveloped. Non-responders received two successive new questionnaires and a telephone call. Concerning to the questionnaire, we asked the patients to answer 6 questions: 1-Was it your first hernia surgery procedure? 2-You were operated of the right, left or both hernia? 3-After a month since surgery, have you had a lump in the groin? 4-After a month since surgery, have you had pain in the groin? 5-Do you still have pain in the groin? 6-Are you satisfied with the surgery? Results: A total of 841 (72.9%) patients returned questionnaires after three reminders (512 after the first mailing, 205 after the second, and 124 after the third). Positive questionnaire answers were documented for 152 (18.1%) repairs and negative answers for 689 (81.9%). Of the 152 patients who answered «yes» to either of the questions regarding recurrence and/or current pain, 91 declined clinical appointment, 24 could not be contacted by phone, and 37 underwent physical examination. Of the 312 patients who did not return the questionnaire, 8 had died, 124 were not willing to be visited, and 180 could not be localised. The recurrence rate was 2.7% and the chronic pain rate 5.9%. Conclusions: 1. Recurrence is estimated to be between 4.3% and 0,12% depending recurrence criteria and patients selection. 2. Chronic pain has not been reported and 7.3% of patient refer paresthesias and unspecific pain. 3. In our study, patients are satisfied with surgery (95.2%), SF-36 shows good results and our surgery quality in terms of satisfaction and recurrence is acceptable. 4. Low recurrence rate, no chronic pain and few paresthesias added to a high number of patients satisfied allows us to say that preperitoneal technique in Ambulatory Surgery is a good option in our area. 5. The use of a postal questionnaire in our area could be a useful way to obtain information when a quality control of the surgery is done. 6. The use of a postal questionnaire in our area with selective physical examination, has not added significant data for the control of patients. 7. Once evaluated the quality of the technique and established some results about the postal questionnaire, unless the technique or the team changes, the use of a protocol is not required. 8. The patient who underwent a surgery of inguinal hernia, has to be visited only once after operation and inform him that his hernia does not need more examinations

Is It Safe to Combine a Fundoplication to Sleeve Gastrectomy? Review of Literature

Complicacions; Fundoplicatura; MànigaComplicaciones; Funduplicatura; MangaComplications; Fundoplication; SleeveBackground and Objectives: The rising numbers of laparoscopic sleeve gastrectomy (LSG) procedures now being performed worldwide will likely be followed by an increasing number of patients experiencing gastro-esophageal reflux disease (GERD). The purpose of the current review was to analyze in terms of safety different techniques of fundoplication used to treat GERD associated with LSG. Methods: An online search was performed in PubMed/MEDLINE in December 2020 to identify articles reporting LSG and fundoplication. The following term combination was used: (sleeve, fundoplication), (sleeve, Nissen), (sleeve, Rossetti), (sleeve, Toupet) and (sleeve, Dor). The extracted information included details of the methods (e.g., retrospective case series), demographic characteristics (e.g., age, gender), clinical characteristics, number of patients, rate of conversion, and postoperative outcomes. Results: A total of 154 studies were identified and after an assessment of title according to our exclusion criteria, 116 articles were removed. Of the 38 studies analyzed for full content review, a total of seven primary studies (487 patients) were identified with all inclusion criteria. Analyzing the different types of fundoplication used, we have identified: 236 cases of Nissen-Sleeve, 220 cases with modified Rossetti fundoplication, 31 cases of Dor fundoplication, and no case of Toupet fundoplication. The overall postoperative complication rate was 9.4%, with the most common reported complication being gastric perforation, 15 cases—3.1%. The second most common complication was bleeding identified in nine cases (1.8%) followed by gastric stenosis in six cases (1.2%). The mortality was nil. Conclusions: Different types of fundoplication associated with LSG appear to be a safe surgical technique with an acceptable early postoperative complication rate. Any type of fundoplication associated with LSG to decrease GERD should be evaluated cautiously while prospective clinical randomized trials are needed.This research received no external funding

Severity of post-Roux-en-Y gastric bypass dumping syndrome and weight loss outcomes: is there any correlation?

Bariatric surgery; Gastric bypass; Weight lossCirugía bariátrica; Bypass gástrico; Pérdida de pesoCirurgia bariàtrica; Bypass gàstric; Pèrdua de pesPurpose The present research was conducted to evaluate the effect of the severity of dumping syndrome (DS) on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) in patients with class III obesity. Methods The present retrospective cohort study used the dumping symptom rating scale (DSRS) to evaluate the severity of DS and its correlation with weight loss outcomes in 207 patients 1 year after their RYGB. The patients were assigned to group A with mild-to-moderate DS or group B with severe DS. Results The mean age of the patients was 42.18 ± 10.46 years and their mean preoperative BMI 42.74 ± 5.59 kg/m2. The total weight loss percentage (%TWL) in group B was insignificantly higher than that in group A, but besides that was not significantly different in the two groups. Conclusion The present findings suggested insignificant relationships between the presence and severity of DS after RYGB and adequate postoperative weight loss.Open Access Funding provided by Universitat Autonoma de Barcelona

Is the Surgical Drainage Mandatory for Leak after Sleeve Gastrectomy?

Septotomy; Sleeve gastrectomy; Surgical drainageSeptotomía; Gastrectomía en manga; Drenaje quirúrgicoSeptotomia; Gastrectomia en màniga; Drenatge quirúrgicIntroduction: Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate the need for surgical drainage for leak following LSG. Methods: All consecutive patients having gone through LSG from January 2017 to December 2020 were enrolled in our study. Once the demographic data and the leak history were registered, we analyzed the outcome of the surgical or endoscopic drainage, the characteristics of the endoscopic treatment, and the evolution to complete healing. Results: A total of 1249 patients underwent LSG and the leak occurred in 11 cases (0.9%). There were 10 women with a mean age of 47.8 years (27–63). The surgical drainage was performed for three patients and the rest of the eight patients underwent primary endoscopic treatment. The endoscopic treatment was represented with pigtails for seven cases and septotomy with balloon dilation for four cases. In two out of these four cases, the septotomy was anticipated by the use of a nasocavitary drain for 2 weeks. The average number of endoscopic procedures was 3.2 (range 2–6). The leaks achieved complete healing after an average duration of 4.8 months (range 1–9 months). No mortality was recorded for a leak. Conclusions: The treatment of the gastric leak must be tailored to each patient. Although there is still no consensus for the endoscopic drainage of leaks after LSG, the surgical approach can be avoided in up to 72%. The benefits of pigtails and nasocavitary drains followed by endoscopic septotomy are undeniable, and they should be included in the armamentarium of any bariatric center

Endoscopic Gastric Band Removal

Complication; Endoscopy; Laparoscopic adjustable gastric bandComplicación; Endoscopia; Banda gástrica ajustable laparoscópicaComplicació; Endoscòpia; Banda gàstrica ajustable laparoscòpicaBackground: Laparoscopic adjustable gastric band (LAGB) procedures have declined worldwide in recent years. A known complication is the intraluminal erosion of the prosthetic material. The endoscopic management of gastric band erosion represents the recommended approach nowadays, and it avoids any additional trauma to the gastric wall already damaged by the migration. The purpose of our study was to assess the feasibility of endoscopic management for intraluminal gastric band erosion following LAGB. Methods: From January 2009–December 2020, a total of 29 patients were retrospectively reviewed after undergoing endoscopic gastric band removal. The study included all consecutive patients who underwent endoscopic gastric band removal in this period. No patients were excluded from the study. Data on patient demographic characteristics, case history, operative details (procedural time, adverse events), and complications were reviewed retrospectively. Results: Twenty-nine patients underwent endoscopic gastric band removal: 22 women (75.8%) with a mean age of 45 years (range: 28–63) and mean Body Mass Index (BMI) of 31 ± 4.7 kg/m2 (range: 24–41). The average time to the identification of erosion after LAGB was 42 months (range: 28–137). The initial upper endoscopy found a migrated band of more than half of the diameter in 21 cases, less than a half but more than a third in seven cases and in one case, less than a third (use of a stent). Twenty-seven patients were successfully treated with endoscopic removal, and in two cases, the endoscopic approach failed, and laparoscopy was further performed. Conclusions: The endoscopic management of intraluminal erosion after LAGB can be safe and effective and should be considered the procedure of choice when treating this complication. The percentage of the band migration is important for the timing of the endoscopic removal

Utilidad de un cuestionario postal en el seguimiento de la reparación de la hernia incisional: estudio prospectivo de una cohorte

ResumenObjetivoEvaluamos la utilidad de un cuestionario postal en el seguimiento de la cirugía de la eventración.Pacientes y métodoSe analiza prospectivamente una cohorte de 285 pacientes intervenidos por una eventración entre 1998 y 2003 mediante una técnica con malla prefascial y que recibieron un cuestionario de 6 preguntas e ideogramas, con estrategia de reenvíos y llamada telefónica para aumentar la respuesta. Se citaron a examen clínico a los pacientes sin inconveniente a ser visitados. Se revisaron todas las hojas operatorias. Se estudia la respuesta al cuestionario y hallazgos de la visita (test exacto de Fisher y Chi cuadrado), la concordancia con los datos operatorios (índices Kappa de Cohen y de Fleiss) y el valor predictivo del cuestionario.ResultadosUn total de 215 pacientes devolvieron el cuestionario después de tres envíos, con lo que se recogió información de un 75.4% de la cohorte, que aumentó al 94% después de la llamada telefónica. Un total de 168 pacientes (el 78.2%) aceptaron ser visitados, aunque finalmente solo acudieron 62 (el 36.9%). La concordancia entre las respuestas al cuestionario e ideogramas y los datos de las hojas operatorias fue baja (índice Kappa de Cohen de 0.065 e índice Kappa de Fleiss de 0.170).ConclusionesUn cuestionario postal con medidas para aumentar la respuesta puede ser efectivo para recoger información básica sobre la cirugía de la hernia incisional. La utilidad de dicha información resulta cuestionable por falta de cumplimiento de los pacientes en los controles y por dificultades en la comprensión del cuestionario, aunque este sea corto y/o en forma de ideograma.AbstractAimTo assess the usefulness of a short postal questionnaire as a method of follow-up in incisional hernia repair.Patients and methodAll consecutive patients (n=285) undergoing open mesh repair of incisional hernia using an onlay technique between 1998 and 2003 received a six-item self-administered questionnaire complemented with ideograms. Non-responders received two successive new questionnaires and a telephone call. All patients’ operation forms were reviewed. Patients with no objections to physical examination were contacted by phone for an appointment. The Fisher's exact test or the chi-square (χ2) tests were used to compare categorical variables between clinical visits and response to questionnaire. Agreement between response to the questionnaire and data on the operation forms was measured with the Cohen's kappa index and the Fleiss kappa index. The predictive values of the questionnaire were calculated.Results215 patients returned questionnaires after three reminders, allowing us to reach 75.4% of the study cohort, which in turn increased to 94% after the telephone call. A total of 168 (78.2%) patients were willing to come for a physical examination. Finally 62 (36.9%) patients were examined. The overall agreement between response to the questionnaire and data on the operation forms was poor (Cohen's kappa coefficient = 0.065 and Fleiss kappa coefficient = 0.170).ConclusionsA postal questionnaire can be effective to gather information. However, the usefulness of this information in the follow-up was low due to the small percentage of patients examined and difficulties in comprehension despite making the questionnaire short and illustrated by ideograms

A case of pylephlebitis complicating an acute appendicitis: Uncommon cholangitis-like situation

Appendicitis; Cholangitis presentation; PhylephlebitisApendicitis; Presentación de colangitis; PileflebitisApendicitis; Presentació de colangitis; PileflebitisIntroduction Pylephlebitis represents an uncommon but serious condition with significant mortality which can complicate intrabdominal sepsis of any etiology. One of the most common predisposing infections is appendicitis. Presentation of case A 21-year-old male with 4 days of epigastric and right upper quadrant pain with associated fever and chills with hyperbilirubinemia and leukocytosis in blood test was orientated as cholangitis at first diagnostic. Poor response to antibiotic treatment with persistent fever and bacteriemia with E. coli and S. constellatus isolated in blood cultures led to complete the study with a CT scan which revealed an acute appendicitis complicated with thrombosis of the superior mesenteric vein (SMV) up to the splenoportal confluence. Appendectomy, treatment with broad-spectrum antibiotic and anticoagulation treatment led to full recovery. Follow-up after 6 months showed almost complete SMV patency. Discussion Pylephlebitis can present as a clinical cholangitis-like picture with hyperbilirubinemia with or without liver abscess formation. CT scan seems to be the most sensitive diagnostic test as it identifies the underlying focus of infection, the extension of the thrombosis and detects liver abscesses. Surgical removal of the source of infection as appendectomy and adequate antibiotic treatment adjusted by culture should be initiated promptly. Anticoagulant treatment should be considered in the case of poor clinical outcome or thrombosis progression. Conclusion Pylephlebitis should be suspected mainly in patients with appendicitis and diverticulitis with erratic behavior despite surgical removal and/or antibiotic treatment with abnormal liver tests and persistent bacteriemia. CT scan is the preferred image study

Massive necrotizing fasciitis: a life threatening entity

Fascitis necrosant; Diagnòstic; AntibiòticsNecrotizing fasciitis; Diagnostics; AntibioticsFascitis necrosante; Diagnóstico; AntibióticosNecrotizing fasciitis (NF) is a complicated soft tissue infection frequently associated with severe sepsis if an early medical and surgical treatment is not performed. We report two postoperative cases of severe NF after oophorectomy and colorectal resection. Because of the similarity with more benign skin infections at the early steps, clinical suspicion is crucial. Surgical exploration and resection will provide both the diagnosis confirming necrotizing infection of the fascia with vessels and treatment. Also, empirical broad-spectrum antibiotics must be initiated as soon as possible. Regardless of the presence of risk factors, NF is a condition with a high mortality rate and only an expeditious and undelayed treatment may improve the patient’s outcome. Surgical focus control requires wide and repeated resections, and planned reconstructive plastic surgery might be necessary

Analysis of the Variability in Different Criteria to Define the Success of Bariatric Surgery: Retrospective Study 5-Year Follow-Up after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

Bariatric surgery; Sleeve gastrectomy; Success criteriaCirurgia bariàtrica; Gastrectomia de màniga; Criteris d'èxitCirugía bariátrica; Gastrectomía de manga; Criterios de éxito(1) Background: The current criteria for defining good or bad responders to bariatric surgery based on the percentage of weight loss do not properly reflect the therapeutic impact of the main bariatric techniques. At present there is an urgent need to fill this gap and provide scientific evidence that better define the success or failure of bariatric surgery in the long term. (2) Methods: This is a retrospective database study of a prospective cohort with 5-year follow-up. We established the success or failure of bariatric surgery in terms of weight loss according to a selected criterion: (1) Halverson and Koehler; (2) Reinhold modified by Christou; (3) Biron; (4) TWL > 20%; (5) percentage of changeable weight (AWL > 35%). We analyzed sensitivity and specificity for successful weight loss. (3) Results: 223 (38.7%) patients underwent sleeve gastrectomy (LSG) and 353 (61.2%) underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). The success rates at 5 years are: EWL > 50% 464 (80%), Reinhold 436 (75.6%), Biron 530 (92%), TWL > 20% 493 (85.5%), AWL 35 were the most adequate criteria as their specificities and sensibility were far above >80%. (4) Conclusions: The present study shows how the different definitions of success or failure are inconsistent in relation to the outcomes of BS. However, there are some criteria that associate statistically significant differences for the resolution of comorbidities and show the highest sensitivity and specificity rates