Rol de la cirugía bariátrica/metabólica en el manejo de la diabetes mellitus 2. Consenso SOCHED/SCCBM / Consensus statement of the Chilean endocrinological society on the role of bariatric surgery in type 2 diabetes

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.

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.

Simulación en educación médica: una sinopsis / Simulation in medical education: a synopsis

Clinical simulation is defined as a technique (not a technology) to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive fashion. Over the pastfew years, there has been a significant growth in its use, both as a learning tool and as an assessment for accreditation. Example of this is the fact that simulation is an integral part of medical education curricula abroad. Some authors have cited it as an unavoidable necessity or as an ethical imperative. In Chile, its formal inclusion in Medical Schools' curricula has just begun. This review is an overview of this important educational tool, presenting the evidence about its usefulness in medical education and describing its current situation in Chile.

Gastrectomía laparoscópica en cáncer gástrico: Experiencia preliminar / Laparoscopic gastrectomy in gastric cancer: Experience in four patients

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.

Análisis uni y multivariado de los factores pronósticos en cáncer de colon / Uni and multivariate analysis of pronostic factors in colon cancer

El objetivo de esta comunicación es evaluar la importancia de distintas variables clínicas e histopatológicas involucradas en el pronóstico de pacientes con CC. Este estudio retrospectivo incluye 308 pacientes operados con intención curativa en el período Enero 1975 a Diciembre 1996. La información fue obtenida de la base de datos computarizada y la sobrevida certificada a través de registros clínicos, entrevista telefónica y certificados de defunción. Se realizó un análisis uni y multivariado (regresión logística-Cox) para predictores de recidiva tumoral. La sobrevida fue estimada a través del método de Kaplan-Meier. La edad promedio fue de 63 (23-94) años, un 48 por ciento (149) fueron sexo masculino. La distribución de las lesiones en el colon derecho, colon transverso, colon izquierdo y sigmoides, fue de 37 por ciento (114), 8 por ciento (23), 15 por ciento (46) y 40 por ciento (124) respectivamente. Según la clasificación TNM, un 10 por ciento, 58 por ciento, 27 por ciento y 5 por ciento correspondieron a etapas I, II, III y IV respectivamente. El tiempo de seguimiento medio fue de 108 meses. La sobrevida libre de enfermedad a 5 años fue de un 73 por ciento. En el análisis univariado no se encontró significancia estadística para la edad, localización tumoral y grado de diferenciación tumoral. La invasión de la pared más allá de la muscular propia y el compromiso ganglionar, fueron los únicos factores independientes para recidiva de la enfermedad en el análisis multivariado (OR=2.9, OR=2.4 respectivamente). En conclusión, el compromiso ganglionar y la invasión de la pared son variables que predicen la recidiva de la enfermedad, por lo que se deben considerar para el uso de la terapia adyuvante.