[Morbid obesity. Reflections on a surgical protocol (II). The experience accumulated over 5 years]. / Obesidad mórbida. Reflexiones sobre un protocolo quirúrgico (II). Experiencia acumulada durante cinco años.

Bariatric surgery is done on a selected, ill patient (morbid obesity), with a surgical risk which is intrinsic to his condition and morbidity. The results on any program are more a function of the adequate selection, information and control, than of the surgical model itself. The first 125 patients of the present surgical series have been reviewed, with a minimum of 18 months of follow up, and the complications are detailed, with emphasis on the compulsory and necessary radiological evaluation in the immediate post-operative period, during the follow up, and in the face of any complication. The effectiveness criteria of the technique and the real value of the weight loss are reevaluated, as well as defining the criteria of failure of surgical treatment. Finally, we end with an up dating of the psychological results observed, as well justifying the need for a bariatric surgery protocol, with its ethical-legal implications. The final conclusion is that bariatric surgery shall only be clinically and ethically accepted if it complies with the principles for which it was designed.

[Severe obesity: its surgical treatment in 120 patients. The results and a prospective focus]. / Obesidad severa: tratamiento quirúrgico en 120 pacientes. Resultados y enfoque prospectivo.

Severe or morbid obesity (M.O.) is a pathological state which is very difficult to treat by non-surgical means. It is defined internationally on the basis of anthropometric measurements when a body mass index (BMI) of 40 kg/m2 is exceeded. In such cases, the pathological increase in body fat influences patient mortality and morbidity. The present state of bariatric surgery is reviewed in the series presented. The guidelines are submitted which are currently used as an approach to surgery, and the reasons are set out used by the authors, on the base of 5 years' experience and more than 110 patients operated on (ringed vertical gastroplasty-RVG, inflatable silicone gastric band, Salmon's technique) in a prospective approach to new surgical projects. The series presented is divided into two groups. It is shown that not all the severely obese (SMO) (BMI > 50 kg/m2) respond adequately to a simple restrictive technique (RVG) notwithstanding very considerable weight loss. Other techniques are currently under consideration for this group. It is concluded that bariatric surgery demonstrates effective and permanent results if the right technique is used on the patient selected.

Prepapillary intradiverticular bezoar as cause of obstructive jaundice. Removed by endoscopy.

Obstructive jaundice was cured in a 70-years-old woman after endoscopic removal of a bezoar located in a prepapillary duodenal diverticulum.