ABSTRACT
Diabetes Mellitus (DM) and obesity are a public health problem in Chile. Bariatric surgery is the most effective treatment alternative to achieve a significant and sustained weight reduction in patients with morbid obesity. The results of controlled clinical trials indicate that, compared to medical treatment, surgery for obese patients with DM2 allows a better control of blood glucose and cardiovascular risk factors, reduces the need for medications and increases the likelihood for remission. Consensus conferences and clinical practice guidelines support bariatric surgery as an option to treat DM2 in Class III Obesity (Body Mass Index (BMI) > 40) regardless of the glycemic control and the complexity of pharmacological treatment and in Class II Obesity (BMI 35-39,9) with inadequate glycemic control despite optimal pharmacological treatment and lifestyle. However, surgical indication for patients with DM2 and BMI between 30-34.9, the most prevalent sub-group, is only suggested. The Chilean Societies of Endocrinology and Diabetes and of Bariatric and Metabolic Surgery decided to generate a consensus regarding the importance of other factors related to DM2 that would allow a better selection of candidates for surgery, particularly when weight does not constitute an indication. Considering the national reality, we also need a statement regarding the selection and characteristics of the surgical procedure as well as the role of the diabetologist in the multidisciplinary team.
Subject(s)
Humans , Diabetes Mellitus, Type 2/surgery , Bariatric Surgery/methods , Obesity/surgery , Societies, Medical , Body Mass Index , Chile , Risk Factors , Treatment Outcome , Medical IllustrationABSTRACT
Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma/surgery , Gastrectomy/methods , Gastric Outlet Obstruction , Laparoscopy/methods , Postoperative Complications , Stomach Neoplasms/surgery , Adenocarcinoma/mortality , Anastomotic Leak , Chile , Conversion to Open Surgery/statistics & numerical data , Follow-Up Studies , Gastrectomy/statistics & numerical data , Hospitals, Public , Laparoscopy/statistics & numerical data , Length of Stay , Operative Time , Perioperative Period , Reoperation , Retrospective Studies , Stomach Neoplasms/mortality , Survival Rate , Treatment OutcomeABSTRACT
Background: Bariatric surgery is the gold-standard treatment for morbid obesity because it has low morbidity rates in high-volume centers and generates long term sustained weight loss. Aim: To describe our experience in bariatric surgery since the creation of our bariatric program in 1992. Material and Methods: Retrospective analysis of all patients subjected to bariatric surgery from 1992 to December 2010. Data was obtained from the electronic institutional registry. The Procedures per-formed were open and laparoscopic Roux-en-Ygastric bypass (BPGA and BPGL, respectively), laparoscopic adjustable gastric band (BGAL) and laparoscopic sleeve gastrectomy (GML). Results: A total of 4943 procedures were performed, 768 (16%) BPGA, 2558 (52%) BPGL, 199 (4%) BGAL and 1418 (29%) GML. The number of procedures progressively increased, from 100 cases in 2000 to over 700 cases in 2008. Proportion of femóles and preoperative mean body mass Índex fluctuated between 69 and 79% and 35 and 43 kg/m², respectively, among the different procedures. Early and late complications fluctuated between Oto 1% (higher on BPGA) and 3 to 32.7% (higher on BGAL), respectively. The excess weight lost atfiveyears was 76.1 % in BPGA, 92.5%o in BPGL and 53.7% in BGAL. The figure for GML at three years was 73.7%. Conclusions: The complication rates ofthis series of patients are similar to those reported in large series abroad. BPGL is still the most effective procedure; however GML is an attractive alternative for less obese patients.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Bariatric Surgery/methods , Obesity, Morbid/surgery , Bariatric Surgery/adverse effects , Body Mass Index , Gastric Bypass , Program Evaluation , Retrospective Studies , Treatment OutcomeABSTRACT
Background: Achalasia is characterized by an incomplete relaxation of the lower esophageal sphincter. The best treatment is surgical and the laparoscopic approach may have good results. Aim: To assess the results of laparoscopic Heller myotomy among patients with achalasia. Material and methods: Prospective study of patients subjected to a laparoscopic Heller myotomy between 1995 and 2004. Clinical features, early and late operative results were assessed. Results: Twenty seven patients aged 12 to 74 years (12 females) were operated. All had disphagia lasting for a mean of 32 months. Mean lower esophageal sphincter pressure ranged from 18 to 85 mmHg. Eight patients received other treatments prior to surgery but symptoms persisted or reappeared. The preoperative clinical score was 7. No patient died and no procedure had to be converted to open surgery. In a follow up of 21 to 131 months, all patients are satisfied with the surgical results and the postoperative clinical score is 1. Only one patient with a mega esophagus maintained a clinical score of six. Conclusions: In this series of patients, laparoscopic Heller myotomy was an effective and safe treatment for esophageal achalasia.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Esophageal Achalasia/surgery , Laparoscopy/methods , Deglutition Disorders/physiopathology , Esophageal Achalasia/diagnosis , Esophageal Sphincter, Lower/physiopathology , Gastric Mucosa/pathology , Gastric Mucosa/physiopathology , Gastroesophageal Reflux/physiopathology , Laparoscopy/adverse effects , Prospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
Background: The development of the laparoscopic surgery has allowed its incorporation to the surgical treatment of gastric cancer. Aim: To evaluate the feasibility and safety of laparoscopic gastrectomy in gastric cancer in our institution. Patients and methods: Prospective data in four patients who underwent laparoscopic gastrectomy for gastric cancer from May to August of 2005 was reviewed. Demographic data, clinical characteristics and postoperative results were registered. Patients were staged according to TNM-AJJC staging system. Results: Four patients aged 48 to 80 years (three males), underwent a completely laparoscopic R0 gastrectomy with lymph node dissection. Two patients underwent total gastrectomy. A subtotal Billroth II gastrectomy was performed in the other two patients. The mean operative time was 260 minutes (Range 180-330). There were no conversions to open surgery. The mean postoperative hospital stay was 6.5 days (Range 6-7 days). There were no complications. According to pathology, one patient presented carcinoma in stage IA, two patients in stage IB and one patient in stage IIIB. The mean number of lymph nodes dissected was 40 (Range 35-54). Conclusions: Laparoscopic gastrectomy is a feasible procedure with good postoperative results in this preliminary experience.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma/surgery , Gastrectomy/methods , Laparoscopy , Stomach Neoplasms/surgery , Carcinoma/pathology , Feasibility Studies , Lymph Node Excision , Neoplasm Staging , Prospective Studies , Stomach Neoplasms/pathologyABSTRACT
Con el fin de conocer los resultados quirúrgicos de los pacientes operados por hidatidosis hepática, se llevó a cabo un estudio retrospectivo, mediante la revisión de fichas clínicas en el período entre enero de 1983 y diciembre de 1997, dividiendo el período en dos mitades. Se consideró cirugía radical a aquella que incluye la eliminación completa del parásito y la periquística, y conservadora a aquella que no incluye la remoción de la periquística. En el análisis de la asociación entre las complicaciones y los factores que pudieran explicarlas se usó el test de Chi cuadrado y Fisher exacto. Se calculó el Odds Ratio (OR) con un intervalo de confianza de 95 por ciento. Al analizar los factores asociados a complicaciones, alcanzaron significación estadística el tamaño mayor o igual a 10 cm (OR=4,13), la presencia de 3 o más quistes (OR=4,41) y la comunicación a vía biliar (OR=3,80). No alcanzaron significación ni la cirugía de urgencia (OR=2,27) ni el uso de técnicas conservadoras (OR-2,95)