ABSTRACT
El bypass gástrico en Y-de-Roux (RYGB) trata eficazmente la obesidad y a la vez la enfermedad por reflujo gastroesofágico (ERGE). Desafortunadamente, algunos pacientes que finalmente se presentan para cirugía bariátrica han sido previamente sometidos a una funduplicatura de Nissen por ERGE. La conversión a RYGB después de esta funduplicatura ha demostrado ser segura y eficaz, pero con una mayor morbilidad, tiempo operatorio más prolongado y mayor estancia hospitalaria. Se presenta una paciente de 50 años, con IMC 40,4 kg/m², evaluada para cirugía bariátrica. Había sido sometida a funduplicatura de Nissen laparoscópica siete años atrás. Informamos un caso de eliminación laparoscópica de funduplicatura de Nissen y conversión a RYGB. La funduplicatura previa no es una contraindicación para LRYGB. Estos procedimientos deben ser llevados a cabo por cirujanos experimentados, y el abordaje laparoscópico debe ser el método de elección.
Roux-en-Y gastric bypass (RYGB) effectively treats both obesity and gastroesophageal reflux disease (GERD). Unfortunately, some patients finally present for bariatric surgery have previously undergone Nissen fundoplication due to GERD. Conversion to EYGB after Nissen fundoplication is safe and effective, but is associated with greater morbidity and longer operative time and hospital stay. A 50-year-old female patient with a body mass index (BMI) of 40.4 kg/m² was evaluated for bariatric surgery. She had a history laparoscopic Nissen fundoplication seven years before. We report a case of laparoscopic take-down of Nissen fundoplication and conversion to RYGB. A previous fundoplication is not a contraindication for laparoscopic RYGB. These procedures should be performed by well-trained surgeons and laparoscopic approach should be the method of choice.
Subject(s)
Gastric Bypass/methods , Laparoscopy/methods , Fundoplication/adverse effects , Obesity, Morbid/complications , Gastroesophageal Reflux/surgery , Bariatric Surgery/methods , Contraindications, ProcedureABSTRACT
La cirugía bariátrica ha demostrado que, además de producir pérdida de peso importante y mantenida, puede en la mayoría de casos mejorar el control de la glicemia e incluso la remisión de la diabetes en algunos pacientes. Objetivo: Analizar los efectos del bypass gástrico laparoscópico en pacientes con índice de masa corporal (IMC) ≥ 35 kg/m2 y diabetes mellitus tipo 2 (DMT2) intervenidos en el programa de cirugía bariátrica del Hospital Dr. Miguel Pérez Carreño. Método: La investigación es de tipo descriptiva, longitudinal y retrospectiva. La muestra fue de 20 pacientes de la consulta del programa de cirugía bariátrica a los cuales se les realizó bypass gástrico en Y de Roux (BPGYR) entre 2011 y 2015, con diagnóstico de DMT2. Resultados: Posterior al BPGYR, en el periodo de 1 año se observó una disminución significativa de los valores de glicemia, hemoglobina glicosilada (HbA1c) e IMC. Se observó remisión completa de la DMT2 en 75 % de los pacientes, remisión parcial en 10 % y mejoría metabólica en 15 %. Conclusiones: El BPGYR es efectivo en pacientes con DMT2, logrando una remisión del 75% de los pacientes tratados(AU)
Bariatric surgery has demonstrated that, besides producing significant and sustained weight loss, it can in most cases improve glycemic control and even produce diabetes remission in some patients. Objective: To analyze the effects of Roux-en-Y gastric bypass (RYGBP) in patients with BMI ≥ 35 kg/m2 and type 2 diabetes operated in the bariatric surgery program of Dr. Miguel Pérez Carreño Hospital. Method: The investigation was descriptive, longitudinal and retrospective. The sample consisted of 20 patients attending the bariatric surgery program and underwent laparoscopic Roux-en-Y gastric bypass between 2011 and 2015, with diagnosis of type 2 diabetes (T2DM). Results: After 1 year following RYGBP, significant decrease in glycaemia, glycosylated hemoglobin (HbA1c) and BMI was observed. Complete remission was observed in 75 % of patients, partial remission in 10 % and metabolic improvement in 15 %. Conclusions: RYGBP is effective in patients with T2DM, achieving a remission of 75% of treated patients(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Gastric Bypass , Weight Loss , Body Mass Index , Diabetes Mellitus, Type 2 , Bariatric Surgery , Body Weight , Obesity, Morbid , Laparoscopy , Glycemic ControlABSTRACT
Resumen El bypass gástrico laparoscópico es uno de los procedimientos bariátricos más frecuentes realizados en el mundo. Una de sus complicaciones postoperatorias es la hernia interna. Este tipo de hernias se produce como resultado de una protrusión de intestino delgado a través de los defectos mesentéricos. Esta complicación quirúrgica puede causar obstrucción intestinal, isquemia y perforación, llevando a la muerte. El cierre de los defectos mesentéricos puede tener como resultado menor incidencia de hernias internas, pero la evidencia no es categórica y el cierre podría estar asociado a complicaciones serias como sangramiento y filtración anastomótica. Aun más, el cierre podría llevar a mayor posibilidad de estrangulación del asa de intestino delgado.
Abstract Laparoscopic Gastric Bypass is one of the most frequent bariatric procedures done around the world. One of its postoperative complications are internal hernias. This kind of hernias are caused by the protrusion of a small bowel portion through mesenteric defects. This surgical complication may cause small bowel obstruction, ischemia and perforation causing death. Mesenteric defects closure may decrease the incidence of internal hernias but the evidence is not categoric and mesenteric closure might be associated to major complications like bleeding and anastomosis leaks. Even more, deficient mesenteric closure may be the cause of small bowel strangulation related to internal hernias.
Subject(s)
Humans , Gastric Bypass/methods , Laparoscopy/methods , Hernia, Abdominal/prevention & control , Mesentery/surgery , Postoperative Complications/prevention & control , Gastric Bypass/adverse effects , Suture Techniques , Hernia, Abdominal/etiologyABSTRACT
Objective To explore impact of BMI on the clinical efficacy of treatment of type 2 diabetes mellitus after the laparoscopic gastric bypass. Methods Twenty patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25 ~28 kg/m2 after laparoscopic gastric bypass surgery in our hospital from 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28~35 kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI≥35 kg/m2 . Accordingly,the total of 60 patients were divided into low BMI group,middle BMI group and high BMI group. The difference of the rate of blood glucose control and other indicators between three groups were compared and analyzed. Results The rate of blood glucose control in low BMI group was 75%,middle BMI group was 85%, and high BMI group was 90%. There was no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery. The blood glucose and weight obviously improved in all patients,and fasting insulin and postprandial ser-um insulin decreased at 12 months after laparoscopic gastric bypass surgery. Conclusion All the patient of type 2 diabetes mellitus with dif-ferent BMI in three group can acquire satisfying clinical therapeutic effect after the laparoscopic gastric bypass.
ABSTRACT
Objecyive To investigate the perioperative nursing of type Ⅱ diabetes mellitud treated by laparoscopic gastric bypass surgery.Methods Pefioperative nursing and follow up were performed for twenty five patients with type Ⅱ diabetes who were treated by laparoscopic gastric bypass surgery.Results The conditions of these patients were improved significantly by prompts of fasting blood glucose and 2h post-prandial blood glucose after glucose tolerance test was performed for every patient.Conclusions Pertinent perioperative nursing has proactive effect on recovery of patients with type diabetes mellitus and treated by laparoscopic gastric bypass.
ABSTRACT
RACIONAL: A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. OBJETIVO: Apresentar a viabilidade de um método com menor uso de suturas mecânicas. MÉTODOS: Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81 por cento), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. RESULTADOS: O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6 por cento), estenose (1,6 por cento) e fístula na anastomose gastrojejunal (1,6 por cento) e torção da anastomose intestinal (1,6 por cento). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. CONCLUSÃO: Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas.
BACKGROUND: To perform laparoscopic gastric bypass in public university hospital has been difficult due to the high cost of the surgical staplers. This fact induced to look for different technical options, with low cost, maintaining the efficacy. AIM: To present the viability of a new method with the use of a low number of stapler devices. METHODS: Sixty three patients were operated in two university hospitals, 12 men and 51 women (81 percent), with mean age of 33.5y and average BMI of 43. The surgical technique used followed this sequence: loop section with electrical scalpel 50 cm of the duodenojejunal angle; termino-lateral anastomosis; retrogastric-retrocolic passage of the Roux limb; construction of the lateral wall of the pouch using 1 blue load of 45 and other of 60 mm after horizontal section with electrical scalpel; suture of the excluded stomach and gastrojejunal anastomosis. The anastomoses were hand-sewn made and a single-layer continuous absorble suture was performed. RESULTS: The average surgical time was 5.5 hours. The early complications were: fistula in the esophago-gastric angle (1.6 percent), stenosis (1.6 percent); fistula in the gastro-jejunal anastomosis (1.6 percent); obstruction of the intestinal anastomosis (1.6 percent). The stenosis was treated by endoscopic dilation. The remaining complications, with 3 re-operations (2 with laparoscopic and 1 with laparotomic approaches). The length of hospital stay was in average 4 days. CONCLUSION: This method is viable with low cost; however, it is complex and requires ability mainly in laparoscopic handsewn sutures.