Usefulness of Mobile Devices in Learning Process for Residents of Pediatric Surgical Specialties.

INTRODUCTION: In the hospital setting, the use of mobile devices among surgical residents is increasing. To assess the usefulness of mobile devices for residents of pediatric surgical specialties. MATERIALS AND METHODS: The study used a mixed-method design. First, a self-developed online questionnaire with 23 items was used to obtain quantitative data, which was analyzed via simple discriminant analysis. Qualitative data were obtained using the focus group technique with the subsequent triangulation of quantitative and qualitative data. RESULTS: The residents used mobile devices for learning and communication. Using quantitative data, the study found that the major functions of mobile devices were communicating with other residents and taking clinical photos, and that for learning, were speaking with attendings, residents, collecting patient information, and searching for unfamiliar terms. Triangulation analysis confirmed that mobile devices aid in agile communication, the search for data on drugs or diseases, and consultation of medical applications. Qualitative data informed the limitations of devices and the inconsistencies between official regulations and their advantages in clinical practice. CONCLUSIONS: We demonstrate the usefulness of mobile devices among surgical residents in clinical care and recommend that hospitals should regulate policies to maximize the use of mobile devices.

How the training of ultrasonographers influences the certainty of prenatal detection of congenital malformations of interest to the pediatric surgeon.

BACKGROUND: The training needed for doing obstetric ultrasounds is rarely reported. The aim of this study was to determine whether the training of the ultrasonographer influences the prenatal diagnostic certainty of some congenital malformations. METHODS: We conducted a retrospective evaluation of antepartum sonographic findings of newborn infants found ultimately to have a congenital anomaly in a tertiary level pediatric reference center. Data were collected on admission for consecutive patients at a tertiary-level pediatric reference center. The mother´s pregnancy and birth demographic variables and those of the prenatal ultrasound (PUS) were analyzed and correlated with the final diagnosis. RESULTS: Sixty-seven neonates were included. All cases underwent PUS with a mean of 4.6. Prenatal diagnosis was established in 24 cases (35.8%). Thirteen surgical anomalies were detected, particularly anorectal malformation and gastroschisis. The accuracy of PUS was associated with the training of the physician performing the PUS, whereby PUS with the greatest accuracy were performed by gynecologists and maternal-fetal specialists against radiologists and general practitioners (p = 0.005). Patients without an accurate prenatal diagnosis had a greater risk of presenting comorbidities (relative risk [RR]: 1.65, p = < 0.001, 95% confidence interval [CI]: 1.299-2.106). CONCLUSIONS: In our setting, prenatal diagnosis of these malformations is directly determined by the training of the person performing the ultrasound.

INTRODUCCIÓN: Con poca frecuencia se ha reportado el entrenamiento necesario para realizar ultrasonido (US) obstétrico. El objetivo de este estudio fue determinar si el entrenamiento del ultrasonografista influye en la certeza del diagnóstico prenatal de algunas malformaciones congénitas. MÉTODOS: Se llevó a cabo una evaluación retrospectiva de los hallazgos ultrasonográficos prenatales de neonatos que tuvieron malformaciones congénitas en un hospital de referencia pediátrico de tercer nivel. Se realizó al ingreso de neonatos consecutivos en un hospital de referencia de tercer nivel. Se recolectaron y analizaron datos del embarazo y alumbramiento, así como los de los ultrasonidos prenatales (USP) correlacionando con el diagnóstico final. RESULTADOS: Se incluyeron 67 neonatos. Todos tuvieron USP con media de 4.6. Se realizó diagnóstico prenatal en 24 casos (35.8%). Se detectaron 13 malformaciones congénitas, predominando malformación anorectal gastrosquisis. La certeza del USP se asoció con el entrenamiento del individuo que realizó el US y la mayor certeza se encontró cuando lo realizaron ginecólogos y especialistas materno-fetales contra radiólogos y médicos generales (p = 0.005). Los pacientes sin diagnóstico prenatal certero tuvieron mayor riesgo de presentar comorbilidades (riesgo relativo [RR]: 1.65, p = < 0.001, 95% intervalo de confianza [CI]: 1.299-2.106). CONCLUSIONES: En nuestro medio, el diagnóstico prenatal de estas malformaciones está determinado directamente por el entrenamiento de la persona que realiza el ultrasonido.

How the training of ultrasonographers influences the certainty of prenatal detection of congenital malformations of interest to the pediatric surgeon / Cómo el entrenamiento del ultrasonografista influye en la certeza de la detección prenatal de malformaciones congénitas de interés para el cirujano pediatra

Abstract Background: The training needed for doing obstetric ultrasounds is rarely reported. The aim of this study was to determine whether the training of the ultrasonographer influences the prenatal diagnostic certainty of some congenital malformations. Methods: We conducted a retrospective evaluation of antepartum sonographic findings of newborn infants found ultimately to have a congenital anomaly in a tertiary level pediatric reference center. Data were collected on admission for consecutive patients at a tertiary-level pediatric reference center. The mother´s pregnancy and birth demographic variables and those of the prenatal ultrasound (PUS) were analyzed and correlated with the final diagnosis. Results: Sixty-seven neonates were included. All cases underwent PUS with a mean of 4.6. Prenatal diagnosis was established in 24 cases (35.8%). Thirteen surgical anomalies were detected, particularly anorectal malformation and gastroschisis. The accuracy of PUS was associated with the training of the physician performing the PUS, whereby PUS with the greatest accuracy were performed by gynecologists and maternal-fetal specialists against radiologists and general practitioners (p = 0.005). Patients without an accurate prenatal diagnosis had a greater risk of presenting comorbidities (relative risk [RR]: 1.65, p = < 0.001, 95% confidence interval [CI]: 1.299-2.106). Conclusions: In our setting, prenatal diagnosis of these malformations is directly determined by the training of the person performing the ultrasound.

Resumen Introducción: Con poca frecuencia se ha reportado el entrenamiento necesario para realizar ultrasonido (US) obstétrico. El objetivo de este estudio fue determinar si el entrenamiento del ultrasonografista influye en la certeza del diagnóstico prenatal de algunas malformaciones congénitas. Métodos: Se llevó a cabo una evaluación retrospectiva de los hallazgos ultrasonográficos prenatales de neonatos que tuvieron malformaciones congénitas en un hospital de referencia pediátrico de tercer nivel. Se realizó al ingreso de neonatos consecutivos en un hospital de referencia de tercer nivel. Se recolectaron y analizaron datos del embarazo y alumbramiento, así como los de los ultrasonidos prenatales (USP) correlacionando con el diagnóstico final. Resultados: Se incluyeron 67 neonatos. Todos tuvieron USP con media de 4.6. Se realizó diagnóstico prenatal en 24 casos (35.8%). Se detectaron 13 malformaciones congénitas, predominando malformación anorectal gastrosquisis. La certeza del USP se asoció con el entrenamiento del individuo que realizó el US y la mayor certeza se encontró cuando lo realizaron ginecólogos y especialistas materno-fetales contra radiólogos y médicos generales (p = 0.005). Los pacientes sin diagnóstico prenatal certero tuvieron mayor riesgo de presentar comorbilidades (riesgo relativo [RR]: 1.65, p = < 0.001, 95% intervalo de confianza [CI]: 1.299-2.106). Conclusiones: En nuestro medio, el diagnóstico prenatal de estas malformaciones está determinado directamente por el entrenamiento de la persona que realiza el ultrasonido.

Is colostomy closure without mechanical bowel preparation safe in pediatric patients? A randomized clinical trial.

BACKGROUND: Mechanical bowel preparation (MBP) is largely used worldwide prior to colostomy closure in children, although its benefits are questioned by scientific evidence, and its use can cause adverse reactions. We hypothesized that colostomy closure procedures in children are not associated with increased complications (surgical site infection [SSI] and anastomotic leakage) when performed without MBP. Thus, we conducted a noninferiority trial to compare the safety and efficacy of colostomy takedown with and without MBP. METHODS: A randomized noninferiority clinical trial was conducted at Hospital Infantil de Mexico in Mexico City from 2015 to 2019, in which the experimental group did not receive MBP prior to colostomy closure. A total of 79 patients were analyzed, and the primary outcomes were safety-related. Data were analyzed using the chi-squared test, Student's t-test, or Mann-Whitney U test as appropriate. RESULTS: The demographics in both groups were comparable. Statistical analysis revealed equivalence in safety outcomes (superficial SSI, 22.5% vs 15.3% p = 0.420; deep SSI, 7.5% vs 0% p = 0.081; reoperation, p = 0.320; intestinal occlusion, p = 0.986); no anastomotic leakage was observed in any group. Secondary outcomes such as fasting time and length of hospital stay after surgery were also similar between the groups. However, patients who received MBP were admitted 2 days before surgery. CONCLUSIONS: Our findings indicate that withholding MBP prior to colostomy takedowns in children is not associated with increased complications. Omitting MBP also leads to less discomfort and shortens hospital length of stay, suggesting that it has safer and more effective procedures. LEVEL OF EVIDENCE: Randomized controlled clinical trial with adequate statistical power.

Perception of pediatric residents from a tertiary hospital in the city of México regarding their training during the COVID-19 pandemic.

BACKGROUNDS: On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic, which changed the residents' teaching and learning process. The purpose of this study was to determine residents' satisfaction and impressions on their training during the pandemic in a tertiary pediatric hospital. METHODS: This was a descriptive cross-sectional study. An online survey was designed to determine residents' demographic and personal characteristics, as well as their perception about the theoretical and practical training, as well as about their emotional situation. The analysis separated medical students from surgical students in order to identify any differences existing between these groups, for which χ2 was calculated. RESULTS: Overall, 148 of 171 residents (86.5%) responded to the questionnaire; 75% belonged to the medical specialty and 25% to the surgical specialty. Statistically significant differences were found in terms of those training aspects they were concerned about during the pandemic (p < 0.001) and about the difficulties associated with online learning (p = 0.001). Differences were also found regarding their satisfaction toward the time needed to complete their thesis (p = 0.059) and activities outside the hospital (p = 0.029). Regarding their degree of satisfaction in general, most medical specialty students felt slightly satisfied (43.2%) and surgical specialty students felt mostly neutral (37.8%). Regarding their feelings about their mental health, statistically significant differences were found between both groups (p = 0.038) although both groups reported the same percentage of overall dissatisfaction (2.7%) in this area. CONCLUSION: The COVID-19 pandemic has brought significant challenges to medical education systems. Lack of practice in decision-making and maneuver execution are concerns for residents and may affect their future professional performance.

A Gastroschisis bundle: effects of a quality improvement protocol on morbidity and mortality.

OBJECTIVE: Gastroschisis incidence is rising. Survival in developed countries is over 95%. However, in underdeveloped countries, mortality is higher than 15% often due to sepsis. The aim of this study was to evaluate the effect on morbidity and mortality of a Quality Improvement Protocol for out-born gastroschisis patients. METHODS: The protocol consisted in facilitating transport, primary or staged reduction at the bedside and sutureless closure, without anesthesia, PICC lines and early feeding. Data was prospectively collected for the Protocol Group (PG) treated between June 2014 through March 2016 and compared to the last consecutive patients Historical Group (HG). Primary outcome was mortality. SECONDARY OUTCOMES: need for and duration of mechanical ventilation (MV), time to first feed (TFF) after closure, parenteral nutrition (TPN), length of stay (LOS) and sepsis. Data were analyzed using χ2 and Mann-Whitney U tests. RESULTS: 92 patients were included (46 HG and 46 PG). Demographic data were homogeneous. Mortality decreased from 22% to 2% (p = 0.007). Mechanical ventilation use decreased from 100% to 57% (p = <0.001), ventilator days from 14 to 3 median days (p = <0.0001), TPN days: 27 to 21 median days (p = 0.026), sepsis decreased from 70% to 37% (p = 0.003) and anesthesia from a 100% to 15% (p = <0.001), respectively. No difference was found in NPO or LOS. CONCLUSION: A major improvement in the morbidity and mortality rates was achieved, with outcomes comparable to those reported in developed countries. It was suitable for all patients with gastroschisis. We believe this protocol can be implemented in other centers to reduce morbidity and mortality. LEVEL OF EVIDENCE: III.

Predictive value of procalcitonin for intestinal ischemia and/or necrosis in pediatric patients with adhesive small bowel obstruction (ASBO).

PURPOSE: Evaluate serum procalcitonin (PCT) level as a predictor of intestinal ischemia or necrosis (IN) in patients with postoperative adhesive small bowel obstruction (ASBO). METHODS: Prospective cohort of consecutive patients with ASBO. Patients previously treated with antibiotics or septic were excluded. PCT was measured at the diagnosis of ASBO and every 24 h afterwards. MAIN OUTCOME: intestinal ischemia or necrosis (IN). RESULTS: Fifty-nine patients were included, 12 of whom were excluded; 47 patients remained in the study; male-to-female ratio = 1.9:1. MANAGEMENT: medical in 15 cases (32%) and surgical in 32 (68%). MAIN OUTCOME: Intestinal necrosis (IN) in 10 patients (21.3%). Mean PCT level was higher in patients with IN (15.11 ng/ml vs. 0.183 ng/ml, p=0.002), the proportion of patients with elevated PCT (>0.5 ng/dl) was higher in patients with IN (70% vs. 8.1%, p=<0.001, RR=26.4 with a 95% CI of 4.39-159.5). Elevated PCT levels at diagnosis had a 70% positive predictive value (PPV) and 91.8% negative predictive value (NPV) for prediction of IN. With a PCT value at diagnosis of >1.0 ng/dl, PPV was 87.5% and NPV, 92.3%. CONCLUSIONS: PCT levels are closely related to the presence of intestinal ischemia and necrosis in children with ASBO. LEVEL OF EVIDENCE: Study of Diagnostic Test, Level II.

[Efficacy of intestinal splinting in hostile abdomen secondary to postoperative flanges in pediatric patients]. / Utilidad de la ferulización intestinal (FI) en abdomen hostil secundario a bridas postoperatorias en pacientes pediátricos.

Objetivo: Mostrar la eficacia de la FI para prolongar el tiempo libre de oclusión intestinal quirúrgica en niños con abdomen hostil secundario a bridas posquirúrgicas. Método: Análisis retrospectivo de FI por abdomen hostil de 2000 a 2011 y su seguimiento a largo plazo. Comparamos el tiempo libre de oclusión quirúrgica antes y después de la FI. Resultados: Se incluyeron 20 FI en 19 pacientes. Predominaron las causas congénitas, la mediana de edad en la cirugía fue de 6 meses, todos tenían cirugías previas con mediana de tres, y dos de ellas fueron por oclusión intestinal previa. La férula se quitó a los 28 días (mediana). Con un seguimiento de 1-183 meses, hubo una recurrencia de oclusión quirúrgica. El tiempo libre de oclusión quirúrgica posferulización fue significativamente mayor que el preferulización mediante la prueba de Wilcoxon, con un valor Z = -3.594; p = < 0.0001. Conclusiones: Esta es la segunda serie exclusiva en niños que muestra que la FI es eficaz para prolongar el tiempo libre de oclusión quirúrgica.

Laparoscopic treatment of nonpalpable testicle. Factors predictive for diminished size.

PURPOSE: The purposes of this study were to demonstrate the usefulness of laparoscopy in intraabdominal testicle (IAT) and to determine factors associated with diminished size during the final outcome after laparoscopic orchidopexy. METHODS: This is a retrospective analysis of consecutive patients from 1999 to 2013 with a minimum follow-up of 1year. Patient and testicular factors were related to diminished size. RESULTS: Sixty one patients, and 92 testicles were included. Median age at operation was 42months. Initially we found 66 normal sized testes (71.7%), 22 hypotrophic (23.9%) and four atrophic (4.3%). Eighty seven testes were brought down laparoscopically, 50 in one surgical stage and 37 in two stages. Mean follow-up was 40.2months and the final outcome was success: 73.5% and diminished size: 26.5%. Variables associated with diminished size were hypotrophy during initial evaluation, short spermatic vessels, section of spermatic vessels, two-stage surgery and tension to reach contralateral inguinal ring. Multivariate analysis showed that initial hypotrophy (odds ratio [OR] 4.96, confidence interval 95% [CI] 1.36-18.10) and tension to reach contralateral ring (OR 4.11, 95% CI 1.18-14.34) were associated with diminished size. CONCLUSIONS: Laparoscopy is useful in treating IAT. Initial size and tension to reach contralateral ring are factors associated with diminished size.

Assessment of the Mexican Board of Pediatric Surgery Certification System.

OBJECTIVE: To evaluate the quality of the Mexican Board of Pediatric Surgery (MBPS) certifying system, using contemporary international guidelines. DESIGN: Retrospective assessment of evidence collected during the design and implementation processes of 2 consecutive applications of the MBPS certifying examination, using Cizek's checklist for evaluating credential-testing programs. It includes the relevant guidelines from the American Education Research Association, the American Psychological Association, the National Council on Measurement in Education, and the National Commission for Certifying Agencies. Four independent and previously trained raters used the checklist. They underwent a 2-week training using frame-of-reference and performance dimensions methodologies. SETTING: Certification examinations of MBPS. POPULATION: The 2013 and 2014 MBPS certification examinations, with 111 evidence items of the processes, followed for the assessment of 86 examinees. RESULTS: The checklist internal consistency was 0.89. Absolute interrater agreement was 0.34 for the 2013 and 0.66 for the 2014 editions of the examination. The 2013 examination complied with 55 (64%) of the checklist 86 items, in 2014 with 72 (84%). CONCLUSION: In 2014, the certifying system reached a quality of 84%. For optimal fulfillment of its social responsibility, the MBPS is required to maintain its level of quality and attempt to improve its performance.

[Prognostic factors related to mortality in newborns with necrotising enterocolitis]. / Factores pronóstico para mortalidad en neonatos con enterocolitis necrosante.

BACKGROUND: Necrotizing enterocolitis is the most frequent and severe acquired gastrointestinal disease in newborns and still has high mortality. There are few published papers about prognostic factors of death in our country. OBJECTIVE: To know the factors associated with death in patients with necrotizing enterocolitis. METHODS: Retrospective, descriptive, comparative study with a case-control design was conducted on patients with necrotizing enterocolitis during a 5-year period. RESULTS: Deceased patients had significantly lower platelet counts compared to survivors (P=0.022) and the prognostic factors associated with mortality were anaemia (P=0.006, OR = 15.62), stage III of necrotizing enterocolitis (P<0.001, OR = 47.5), to require surgical treatment (P<0.001, OR = 47.5), to have intestinal necrosis (P=0.001, OR = 48.5) or perforation (P=0.016, OR =24.25), to have medical complications, specifically intravascular disseminated coagulation (P<.001, RR = 98), and multi-organ failure (P<0.001, RR = 2). It was also found that patients with gastrointestinal symptoms and diagnosis of necrotising enterocolitis when they were hospitalized were more likely to have surgical treatment. CONCLUSIONS: We must be aware of the factors associated with mortality, as well as those associated with surgical treatment to reduce overall mortality for this condition.

Misdiagnosis and quality of management in paediatric surgical patients referred to a tertiary care hospital.

BACKGROUND: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. AIM: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. DESIGN: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. SETTING: Third level care hospital, Mexico City. PARTICIPANTS: Newborn to adolescents referred to Paediatric Surgery Department. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Misdiagnosis and quality of management prior to being referred. RESULT: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. CONCLUSION: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible.

[Prognostic factors related to mortality in newborns with jejunoileal atresia]. / Factores pronóstico para mortalidad en neonatos con atresia intestinal yeyuno-ileal.

BACKGROUND: Jejuno-ileal atresia is one of the main causes of intestinal obstruction in neonates. The origin is vascular accidents in the fetal intestine. It is an entity that requires early and specialist management. OBJECTIVE: to know the factors related to mortality in neonates with jejunoileal atresia. METHODS: Case-control nested in a cohort design, comparative study during ten years, between deceased and survivors analyzing factors related to mortality before surgery and during surgery and in the postoperative course. RESULTS: We analyzed 70 patients in 10 years, there were 10 deaths (14.2%). No one had a prenatal diagnosis. Factors related to mortality were: intestinal perforation with a relative risk (RR) of 4.4, peritonitis (RR: 5.6), the need of stomas (RR: 4.9), the presence of sepsis (RR: 4.6) and when the residual small bowel length was below 1 meter (RR: 7.4). CONCLUSION: The delay in diagnosis causes late intervention and increased mortality delayed diagnosis promotes late transport of the neonate and enhances mortality, factors associated with mortality related to intestinal perforation. It is necessary to spread this disease in the medical community to improve prenatal and postnatal diagnosis.

Prognostic factors related to mortality in newborns with Bochdalek hernia: a case-control study.

BACKGROUND: Bochdalek hernia remains an entity carrying a high mortality. Because there are no published studies about prognostic factors for mortality in Bochdalek hernia in underdeveloped countries, we designed the present study. Our objective was to determine the prognostic factors related to mortality in Bochdalek hernia in countries such as Mexico. METHODS: We designed a case (deceased)-control (alive) study during a 10-year period analyzing epidemiological and pre-, intra- and postoperative factors related to mortality. Our protocol is to operate when the patient is hemodynamically stable. RESULTS: We analyzed 11 cases and 38 controls. There was pulmonary hypertension in 65% of the patients. Associated anomalies were not related to mortality. Low Apgar score (p = 0.016), the need for high frequency ventilation (p = 0.003) or having postoperative complications (p = 0.025) were related to mortality with pulmonary hypertension being the main cause. Odds ratios showed that immediate intubation, preoperative pulmonary hypertension (p = 0.05) and the necessity for preoperative stabilization (p = 0.043) increased mortality risk by 1.5 times. Using preoperative high-frequency ventilation increased the risk nine times and, when needed postoperatively, increases the risk 11 times. CONCLUSIONS: Factors related to mortality were low Apgar score, immediate intubation, need for stabilization, postoperative complications and need for high-frequency ventilation.

Unnecessary gastric decompression in distal elective bowel anastomoses in children: a randomized study.

BACKGROUND: The goal of this study was to investigate the role of nasogastric drainage in preventing postoperative complications in children with distal elective bowel anastomosis. Nasogastric drainage has been used as a routine measure after gastrointestinal surgery in children and adults to hasten bowel function, prevent postoperative complications, and shorten hospital stay. However, there has been no study that shows in a scientific manner the benefit of nasogastric drainage in children. METHODS: We performed a clinical, controlled, randomized trial comprising 60 children who underwent distal elective bowel anastomoses and compared postoperative complications between a group with nasogastric tube in place (n = 29) and one without it (n = 31). RESULTS: Demographic data and diagnoses were comparable in both groups (P = NS). No anastomotic leaks or enterocutaneous fistulae were found in any patient. There were no significant differences between the two groups with respect to abdominal distension, infection, or hospital stay. Only one patient in the experimental group required placement of the nasogastric tube due to persistent abdominal distension (3.2%). CONCLUSIONS: The routine use of nasogastric drainage after distal elective intestinal surgery in children can be eliminated. Its use should depend on the individual patient's situation.

Cirugía bariátrica en los niños: ¿Necesidad o exageración? / Bariatric surgery in children: necessity or exaggeration?

El incremento de la prevalencia de la obesidad a nivel mundial y particularmente en México, los malos resultados con las técnicas conservadoras para el control de peso y la identificación de los riesgos asociados a esta patología han provocado una gran polémica relacionada con la aplicación de otros procedimientos más agresivos, como la cirugía bariátrica en los niños (adolescentes). Primeramente, debe insistirse en la prevención ya que los métodos conservadores permiten obtener resultados muy limitados. Dado que la expectativa de vida y la mortalidad en los adolescentes se ve afectada por las enfermedades asociadas o comorbilidades, hoy por hoy la esperanza de vida para el adolescente obeso es la cirugía bariátrica, particularmente porque permite en un gran porcentaje no sólo reducir su exceso de peso, sino controlar la diabetes tipo 2, la hipertensión arterial y otros factores de riesgo para enfermedad cardiovascular, músculo-esquelética, psicológica y de calidad de vida entre otros.

Increase in the prevalence of obesity at a worldwide level, particularly in Mexico, has shown poor results with conservative measures for weight control. Identification of risks associated with this pathology has provoked a great controversy related to using other more aggressive procedures such as bariatric surgery in adolescents. Prevention of obesity should be the first priority because conservative methods produce only very limited results. Because life expectancy and mortality in adolescents are affected by associated or comorbid diseases, at the present time the hope for a better life expectancy for the obese adolescent is bariatric surgery, particularly because in a great percentage of patients it not only results in reduction of excessive weight but may also control type 2 diabetes, arterial hypertension and other risk factors for cardiovascular diseases, musculoskeletal disorders, psychological problems, and quality of life, among others.