RESUMO
Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Artéria Hepática/anormalidades , Pancreaticoduodenectomia/métodos , Variação Anatômica , Artéria Hepática/cirurgia , Ilustração MédicaRESUMO
Introducción: La obesidad tiene una alta prevalencia mundial, 25,1 por ciento de los chilenos la padece. La técnica de Santoro II (TS), como cirugía bariátrica, ha demostrado ser beneficiosa en el tratamiento de la obesidad y comorbilidades. Objetivo: Determinar variabilidad de índice de masa corporal (IMC) y parámetros metabólicos con TS en el Hospital Hernán Henríquez Aravena - Temuco (HHHA) y Clínica Alemana Temuco (CAT). Hipótesis: Los pacientes sometidos a cirugía bariátrica con TS disminuyen significativamente su IMC y parámetros metabólicos. Material y Método: Se realizó un estudio de corte transversal, muestreo intencional no probabilístico, revisando fichas de pacientes operados con TS entre los años 2005 y 2010 en el HHHA y CAT. Las variables analizadas fueron IMC, glicemia, presión arterial sistólica (PAS) y diastólica (PAD), y perfil lipídico. Los datos fueron analizados con t de Student, X2 y prueba de Fisher según correspondió. Resultados: N=26. Del total, 73 por ciento (19) fueron mujeres, con una edad promedio de 40,16 años (DE 12,07). A los 3 meses se observó una tendencia a la disminución de las variables analizadas, siendo estadísticamente significativas, con excepción de PAD. Un año después, la diferencia de estos valores con los de precirugía fueron mayores, pero la disminución de la PAD tampoco fue estadísticamente significativa. Discusión: En pacientes obesos, la TS es un procedimiento efectivo en el control metabólico, con resultados que se mantienen hasta el año de seguimiento. Nuestros resultados concuerdan según la literatura, pero faltan nuevas investigaciones para respaldar que estos son independientes a la baja de peso.
Introduction: Obesity has high prevalence worldwide, 25.1 percent of chileans suffers from it, with comorbilities associated with cardiovascular risk. The technique of Santoro II (TS) as bariatric surgery, has demonstrated to be beneficial in the treatment of the obesity and comorbidities. Objectives: Determine variability of body mass index (BMI) and metabolic parameters with TS in Hernán Henríquez Aravena Hospital - Temuco (HHHA) and Clínica Alemana Temuco (CAT). Hypothesis: Patients submitted to bariatric surgery with TS significantly decrease their body mass index (BMI), and their metabolic parameters. Material and Method: Cross-sectional study, intentional non-probabilistic sampling, reviewing records of patients operated with TS between 2005 and 2010 in HHHA and CAT. The variables analyzed were BMI, blood sugar, arterial systolic pressure(PAS) and diastolic (PAD), and lipidic profile. The data were analyzed using Students t-test, X2 and Fishers test, when it was correspond. Results: N=26. The 73 percent were women, with an average age of 40.16 years (SD 12.07). A normalization of the variables analyzed was observed 3 months after surgery, being statistically significant, with the exception of PAD. One year later the surgery, the difference of these values, with those presurgeries, was higher but the decrease of the PAD was not statistically significant either Discussion: In obese patients, the TS is an effective procedure in the metabolic control with results that maintain in a year of follow up. Our results are consistent according to the literature, but further research is needed to support that these are independent of the weight loss.