ABSTRACT
Bariatric surgery is performed usually in a videolaparoscopic form. This involves that surgeons must have the abilities of advanced laparascopy. The learning curve was previously analyzed in numerous reports. This curriculums for the fellowships include the development of cognitive abilities and clinicotechnical training. Through the Course of Specialists for Metabolic and Bariatric Surgery from the Buenos Aires University, four fellows have been formed. In this study, the training modality is described
La cirugía bariátrica se realiza generalmente de forma videolaparoscópica. Esto implica que los cirujanos tengan habilidades de laparoscopía avanzada. La curva de aprendizaje se ha analizado en numerosos trabajos. Las currículas para los fellowship incluyen el desarrollo de habilidades cognitivas y clínico-técnicas. A través de la Carrera de Especialista en Cirugía Bariátrica y Metabólica de la UBA se han formado cuatro fellows. En este trabajo se describe la modalidad de aprendizaje
Subject(s)
Humans , Obesity, Morbid/surgery , Laparoscopy/education , Educational Measurement , Health Postgraduate Programs , Bariatric Surgery/education , Fellowships and Scholarships , Learning CurveABSTRACT
INTRODUCTION: The so-called Schloffer tumor (ST) is a rare inflammatory pseudotumor. It usually appears several years after abdominal surgery or trauma. PRESENTATION OF CASE: A 32-year-old man was referred to our hospital complaining of a painful mass in the left hypochondrium, postprandial distension and a weight loss of about 14kg. He had had a left inguinal hernioplasty without mesh the previous year. Ultrasonography of the abdomen showed a 2cm×2cm hypoechoic lesion in contact with the abdominal wall. Computerized tomography of the abdomen showed a heterogeneous mass in the great omentum. Laparoscopic exploration revealed an omental mass firmly attached to the abdominal wall. A great deal of purulent fluid spread during the procedure. Due to the difficult exploration, the procedure converted to hand assisted laparoscopy. We find an omental tumor involving the stomach and the transverse colon. Inside the mass there were purulent material and non-absorbable sutures. A drain was left inside the cavity of the abscess. Histological examination showed chronic inflammation. DISCUSSION: ST characteristically presents a central chronic abscess containing non-absorbable sutures. It has been described after appendectomy, hernioplasty, hysterectomy, gastrectomy or colonic resections. Although benign, its progressive growth and infiltrating behavior resemble malignant tumors. CONCLUSION: We suggest that a mini-invasive approach should always be performed. The interesting thing about this case is the appearance of the tumor in a place far away from the previous surgical site. A simple drainage and removal of suture material solves the problem of these patients.
ABSTRACT
The appropriate management of gallstones and gallbladder disease in patients undergoing gastric bypass remains unknown. Several therapeutic modalities are used and include performing cholecystectomy on all patients at the time of gastric bypass, performing concomitant cholecystectomy only when patients have gallstones and performing cholecystectomy only in the presence of both symptoms and gallstones. Some groups administer ursodeoxycholic acid for gallstone prevention in the postoperative period. All treatment modalities are analyzed and their results and rationality are discussed.
Subject(s)
Gallbladder Diseases/etiology , Gallbladder Diseases/therapy , Gallstones/etiology , Gallstones/therapy , Gastric Bypass/adverse effects , Cholagogues and Choleretics/pharmacology , Cholecystectomy , Gallbladder Diseases/prevention & control , Gallstones/prevention & control , Humans , Ursodeoxycholic Acid/pharmacologyABSTRACT
Since the realization in 1991 of the National Institutes of Health Consensus Development Conference Draft Statement on Gastrointestinal Surgery for Severe Obesity, the bariatric surgery become accepted by the medical community as the most long-term efficient procedure for the treatment of morbid obesity. The surgical suggestion is based mainly in the Body Mass Index of the patient wight/height (kg/m2). Bariatric surgical techniques can be classified according to their main mechanism of action in: restrictives (adjustable gastric banding, sleeve gastrectomy, open vertical banded gastroplasty), malabsorptives: biliopancreatic derivation Scopinaro type or biliopancreatic derivation with duodenal switch (Marceau) and finally the Roux-en-Y gastric bypass. All these aspects are treated in the article.
Subject(s)
Humans , Anastomosis, Roux-en-Y/methods , Bariatric Surgery , Body Mass Index , Gastrectomy , Gastric Bypass , Obesity, Morbid/pathology , Video-Assisted SurgeryABSTRACT
Since the realization in 1991 of the National Institutes of Health Consensus Development Conference Draft Statement on Gastrointestinal Surgery for Severe Obesity, the bariatric surgery become accepted by the medical community as the most long-term efficient procedure for the treatment of morbid obesity. The surgical suggestion is based mainly in the Body Mass Index of the patient wight/height (kg/m2). Bariatric surgical techniques can be classified according to their main mechanism of action in: restrictives (adjustable gastric banding, sleeve gastrectomy, open vertical banded gastroplasty), malabsorptives: biliopancreatic derivation Scopinaro type or biliopancreatic derivation with duodenal switch (Marceau) and finally the Roux-en-Y gastric bypass. All these aspects are treated in the article.(AU)
Subject(s)
Humans , Obesity, Morbid/pathology , Bariatric Surgery , Body Mass Index , Anastomosis, Roux-en-Y/methods , Gastric Bypass , Gastrectomy , Video-Assisted SurgeryABSTRACT
INTRODUCTION: The management of patients with gallstone disease and ductal calculi is controversial. The main options are one-stage or two-stage management. MATERIAL AND METHOD: We performed a retrospective analysis of the experience gained over 10 years in the one-stage management of common duct stones in a high-volume tertiary hospital. RESULTS: A total of 569 patients were initially treated by laparoscopy. Of these, 412 (76.3%) underwent the transcystic approach, 128 (23.7%) underwent laparoscopic choledochotomy and 29 (5%) were converted to open surgery. Overall morbidity and mortality were 2.46% and 0.52%, respectively. CONCLUSIONS: In high-volume centers, one-stage laparoscopic management of common duct stones is safe and feasible, with a high proportion of patients that only require a transcystic approach.
Subject(s)
Gallstones/surgery , Laparoscopy/methods , Video-Assisted Surgery/instrumentation , Choledochostomy/instrumentation , Humans , Retrospective StudiesABSTRACT
Introducción. El manejo de los pacientes con litiasis vesicular y coledociana plantea controversias. El tratamiento en uno o en dos tiempos son las principales opciones. Material y método. Análisis retrospectivo de la experiencia de 10 años en el tratamiento en un tiempo de la coledocolitiasis en un centro terciario de alto volumen. Resultados. Se trató inicialmente por laparoscopia a 569 pacientes; se resolvieron con un abordaje transcístico 412 (76,3%); mediante coledocotomía laparoscópica, 128 (23,7%) y se convertió a cirugía abierta a 29 (5%). La morbilidad y la mortalidad general fueron del 2,46 y el 0,52%, respectivamente. Conclusiones. En centros de alto volumen el tratamiento en un tiempo y por laparoscopia de la coledocolitiasis es factible y seguro, con una alta proporción de pacientes que sólo necesitan de un abordaje transcístico (AU)
Introduction. The management of patients with gallstone disease and ductal calculi is controversial. The main options are one-stage or two-stage management. Material and method. We performed a retrospective analysis of the experience gained over 10 years in the one-stage management of common duct stones in a high-volume tertiary hospital. Results. A total of 569 patients were initially treated by laparoscopy. Of these, 412 (76.3%) underwent the transcystic approach, 128 (23.7%) underwent laparoscopic choledochotomy and 29 (5%) were converted to open surgery. Overall morbidity and mortality were 2.46% and 0.52%, respectively. Conclusions. In high-volume centers, one-stage laparoscopic management of common duct stones is safe and feasible, with a high proportion of patients that only require a transcystic approach (AU)
Subject(s)
Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Humans , Cholecystolithiasis/surgery , Laparoscopy/methods , Choledochostomy/methods , Retrospective Studies , Treatment OutcomeABSTRACT
Antecedentes: estudiantes universitarios y médicos jóvenes no son capaces de pensar eficazmente con operaciones abstractas. Objetivo: analizar esta hipótesis y la actitud de los docentes. Método: se sometieron 50 médicos jóvenes a 4 pruebas que evaluaban aspectos del pensamiento lógico y abstracto. Además, se encuestaron 30 docentes para evaluar su actitud y opinión sobre el tema. Resultados: las fallas en el uso del pensamiento abstracto se observaron en el 42, 24, 14 y 100 por ciento de los jóvenes para las pruebas 1, 2, 3 y 4 respectivamente. De acuerdo a los docentes, el 56 por ciento de los alumnos no usa generalmente el pensamiento abstracto en su proceso de aprendizaje. Conclusiones: el 30 por ciento de los médicos jóvenes estuvieron por debajo del nivel esperado en la lógica empleada para la resolución de pruebas de habilidad intelectual, dato que contó con el consenso de los docentes
Subject(s)
Humans , Adult , Cross-Sectional Studies , Education, Medical, Undergraduate/trends , Teaching/trends , Intelligence Tests/standards , Physicians/psychology , Thinking , Faculty, Medical/statistics & numerical data , Education, Medical/statistics & numerical data , Education, Medical/standards , Education, Medical/trends , Concept Formation/physiologyABSTRACT
Antecedentes: estudiantes universitarios y médicos jóvenes no son capaces de pensar eficazmente con operaciones abstractas. Objetivo: analizar esta hipótesis y la actitud de los docentes. Método: se sometieron 50 médicos jóvenes a 4 pruebas que evaluaban aspectos del pensamiento lógico y abstracto. Además, se encuestaron 30 docentes para evaluar su actitud y opinión sobre el tema. Resultados: las fallas en el uso del pensamiento abstracto se observaron en el 42, 24, 14 y 100 por ciento de los jóvenes para las pruebas 1, 2, 3 y 4 respectivamente. De acuerdo a los docentes, el 56 por ciento de los alumnos no usa generalmente el pensamiento abstracto en su proceso de aprendizaje. Conclusiones: el 30 por ciento de los médicos jóvenes estuvieron por debajo del nivel esperado en la lógica empleada para la resolución de pruebas de habilidad intelectual, dato que contó con el consenso de los docentes (AU)
