ABSTRACT
PURPOSE: The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery. MATERIALS AND METHODS: Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03864861.
Subject(s)
Bariatric Surgery , Enhanced Recovery After Surgery , Obesity, Morbid , Adult , Bariatric Surgery/adverse effects , Humans , Length of Stay , Obesity, Morbid/surgery , Patient Readmission , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective StudiesABSTRACT
Petersen's space hernia is the most frequent location of internal hernia after a laparoscopic gastric bypass. The diagnosis or a high suspicion of internal herniation are indications for urgent surgery. We present the case of a patient who required an exploratory laparoscopy. He had a computed tomography compatible with internal herniation. We found a Petersen's space hernia and a jejunojenustomy defect. We reduced the protruded loops and we closed both mesenteric defects. The closure of mesenteric defects in primary surgery is a controversial matter. Overall, it is recommended to close them.
Las hernias del espacio de Petersen son la localización más frecuente de las hernias internas tras un bypass gástrico laparoscópico. Su diagnóstico, e incluso su sospecha, son indicación de cirugía urgente. Presentamos el caso de un paciente que requirió una laparotomía exploradora en la que se halló una hernia del espacio de Petersen tras presentar en la tomografía computarizada el signo del «remolino¼. Se realizó la reducción de las asas intestinales herniadas junto al cierre del defecto mesentérico de dicho espacio. El cierre de los defectos mesentéricos en la cirugía primaria continúa generando controversia, pero como norma general se recomienda su cierre.
Subject(s)
Gastric Bypass , Hernia, Abdominal , Laparoscopy , Obesity, Morbid , Hernia , Humans , Internal Hernia , Male , Mesentery , Obesity, Morbid/surgery , Retrospective StudiesABSTRACT
OBJECTIVE: To analyze the risk factors for anastomosis leak in colon cancer surgery (CCS) in our environment, and developed a predictive equation for that risk. METHOD: We performed a case-control study nested in a cohort of 576 consecutive patients undergoing colon cancer surgery with primary anastomosis, univariate statistical tests and univariate logistic regression for statistical analysis of associated factors with anastomosis leak in colon cancer surgery, and multivariate logistic regression for predicting that risk using a predictive equation associated with a ROC curve. RESULTS: We obtained a higher risk of anastomosis leak in patients whose operative time was longer than 180 minutes. The variables: preoperative transfusion, previous pathologies, nutritional status, approach, surgical technique or age do not influence the development of this complication. The equation found has a sensitivity of 64.1% and a specificity of 67.5%. CONCLUSION: Operation time longer than 180 minutes was the main risk factor for anastomosis leak. Our equation can hardly predict this risk. After further validation, our results may help the surgeon make a more individualized, safer decision regarding whether to perform an anastomosis or make a stoma.
OBJETIVO: Analizar los posibles factores de riesgo de dehiscencia de anastomosis tras cirugía de cáncer de colon en nuestro entorno y elaborar una ecuación predictiva del riesgo. MÉTODO: Estudio de casos y controles sobre una cohorte de 576 pacientes intervenidos de cáncer de colon. Se realizó análisis descriptivo, análisis univariante y regresión logística multivariante para la predicción del riesgo de dehiscencia de anastomosis mediante una ecuación predictiva asociada a curva ROC. RESULTADOS: Existe mayor riesgo de presentar dehiscencia de anastomosis cuando el tiempo quirúrgico supera los 180 minutos. La transfusión preoperatoria, la patología previa, el estado nutricional, la vía de abordaje, la técnica quirúrgica y la edad no influyen en el desarrollo de esta complicación. Se ha determinado el punto de corte óptimo para la predicción aplicando la ecuación, que presenta una sensibilidad del 64.1% y una especificidad del 67.5%. CONCLUSIÓN: El tiempo quirúrgico prolongado es el principal factor de riesgo de fuga tras la cirugía. Nuestra ecuación difícilmente puede predecir dicho riesgo. Tras su validación, nuestros resultados pueden ayudar al cirujano a tomar una decisión individualizada y segura sobre realizar una anastomosis primaria o dejar un estoma.
