ABSTRACT
Objetivo: evaluar la utilidad de un índice de puntuación clínicano invasivo para predecir fibrosis hepática en la esteatosis asociadaa la obesidad mórbida.Pacientes y métodos: se incluyeron 88 pacientes, intervenidosde cirugía bariátrica en el área sanitaria de León, que presentaronen la biopsia hepática una esteatosis mayor del 5%. Se tratade un estudio retrospectivo en el que se calculó el índice de fibrosisa partir de los datos analíticos del preoperatorio, y se comparósu resultado con los datos de la biopsia hepática intraoperatoriarealizada. Para el análisis los pacientes fueron agrupados segúnpresentaban en la biopsia hepática fibrosis avanzada (grado 3-4) ono (grado 0-2). El punto de corte usado para diagnosticar fibrosisavanzada fue 0,676 (punto de corte alto), y el punto de corte paraexcluir fibrosis avanzada fue -1,455 (punto de corte bajo).Resultados: la prevalencia de fibrosis avanzada en las muestrashistológicas fue del 5,5% y el 65,9% de los pacientes no presentabanfibrosis. Para el punto de corte bajo el valor predictivonegativo fue del 100% y la sensibilidad del 100%. Para el puntode corte alto el valor predictivo positivo fue del 1,7% y la especificidaddel 31,3%.Conclusiones: el sistema de puntuación analizado permite,en los pacientes con obesidad mórbida candidatos a cirugía bariátrica,detectar aquellos sin fibrosis avanzada, pero no permite predeciraquellos que pueden tener una fibrosis avanzada(AU)
Objective: to evaluate the usefulness of a non-invasive clinicalscore to predict liver fibrosis in the steatosis associated with morbidobesity.Patients and methods: we included 88 patients, who underwentbariatric surgery in the Sanitary Area of León, Spain, andwho showed a liver biopsy with steatosis greater than 5%. This isa retrospective study in which the rate of fibrosis is calculated fromtests performed during the preoperative period, and is then comparedto data from intraoperative hepatic biopsies. The analysispopulation was grouped according to the presence of advanced fibrosisin the liver biopsy (grade 3-4) or its absence (grade 0-2).The cutoff used for diagnosing advanced fibrosis was 0.676 (highcutoff point), and the cutoff point to exclude advanced fibrosis was-1.455 (low cutoff).Results: the prevalence of advanced fibrosis in the histologicalsamples was 5.5%, and 65.9% of patients had no fibrosis. Thecutoff for a low negative predictive value was 100%, and sensitivitywas 100%. The cutoff point for a high positive predictive valuewas 1.7%, and specificity was 31.3%.Conclusions: this scoring system for morbidly obese patientseligible for bariatric surgery allows to identify those without advancedfibrosis, but cannot predict who may have advanced fibrosis(AU)
Subject(s)
Humans , Male , Female , Predictive Value of Tests , Liver Cirrhosis/diagnosis , Obesity/complications , Obesity/diagnosis , Biopsy/methods , Bariatric Surgery/methods , Retrospective Studies , Fatty Liver/diagnosis , Fatty Liver/pathologyABSTRACT
Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.
