Experiencia de 18 años de cirugía de obesidad en la Pontificia Universidad Católica de Chile / Results of bariatric surgery. Experience over 18 years

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.

Ileo mecánico por cuerpos extraños / Mechanical ileus of foreign bodies

Se analizan 17 pacientes intervenidos por íleo mecánico debido a cuerpos extraños. Catorce pacientes (82%) presentaban condiciones predisponentes, siendo el principal factor la cirugía abdominal previa, presente en 12 casos. La etiología más frecuente correspondió a Bezoares, con trece casos (76%). Todos los pacientes fueron intervenidos de urgencia, siendo la mortalidad operatoria de 5,8%. El tratamiento quirúrgico de urgencia es la única alternativa terapéutica en caso de íleo mecánico por cuerpo extraño, pero para los fitobezoares gástricos diagnosticados oportunamente, existen alternativas de tratamiento médico como son la fracturación endoscópica y la disolución enzimática