ABSTRACT
BACKGROUND: Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS: To determine if LSG is more effective than RYLGB for weight loss. METHODS: A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS: Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS: The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
Subject(s)
Gastric Bypass , Laparoscopy , Obesity, Morbid , Humans , Gastric Bypass/methods , Quality of Life , Obesity, Morbid/surgery , Obesity, Morbid/complications , Laparoscopy/methods , Gastrectomy/methods , Weight Loss , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Treatment OutcomeABSTRACT
Since the spread of the first cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection much progress has been made in understanding the disease process. However, we are still facing the complications of coronavirus disease 19 (COVID-19). Multiple sequelae may appear as a consequence of acute infection. This set of entities called post-COVID-19 syndrome involves a wide variety of new, recurrent or persistent symptoms grouped together as a consequence of the acute disease process. One of those that has attracted the most attention is the liver and bile duct involvement called post-COVID-19 cholangiopathy. This is characterized by elevation of liver markers such as alkaline phosphatase, bilirubin and transaminases as well as alterations in the bile ducts in imaging studies. Thus, a narrative review of the cases reported until the end of 2021 was carried out. From the findings found, we concluded that patients who have had COVID-19 or during the process have required hospitalization should remain under follow-up for at least 6 months by a multidisciplinary team.
Subject(s)
COVID-19 , Cholangitis, Sclerosing , Humans , Cholangitis, Sclerosing/diagnosis , Post-Acute COVID-19 Syndrome , COVID-19/complications , SARS-CoV-2 , Bile DuctsABSTRACT
ABSTRACT BACKGROUND: Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS: To determine if LSG is more effective than RYLGB for weight loss. METHODS: A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS: Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS: The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
RESUMO RACIONAL: A cirurgia bariátrica é a opção mais eficaz para reduzir o peso em pacientes com obesidade mórbida. Três técnicas são mais empregadas: gastrectomia vertical laparoscópica (LSG), procedimentos cirúrgicos de má absorção intestinal e ambos os tipos, má absorção intestinal e restritiva, e bypass laparoscópico em Y-Roux (RYLGB). OBJETIVOS: Determinar a eficácia da LSG versus RYLGB na perda de peso. MÉTODOS: Uma revisão sistemática e meta-análise foi realizada incluindo cinco ensaios clínicos e dezesseis coortes comparando LSG versus RYLGB na perda de peso e resultados secundários, resolução de comorbidades, complicações pós-operatórias, tempo operatório, permanência hospitalar e melhora da qualidade de vida. RESULTADOS: A perda de excesso de peso foi 10,2% (diferença média (MD) 10,2; IC95% -10,14; -9,90) maior em pacientes submetidos a LSG do que em pacientes operados com RYLGB. Diabetes mellitus tipo 2 foi resolvido em 17% (risco relativo (RR) 0,83; IC95% 0,77-0,90), hipertensão arterial em 23% (RR 0,77; IC95% 0,69-0,84), dislipidemia em 17% (RR 0,83; IC95% 0,77-0,90), mais significativos após LSG. As complicações pós-operatórias foram 73% maiores em pacientes submetidos a RYLGB (MD 0,73; IC95% 0,63-0,83). O tempo operatório foi 35,76 minutos menor na LSG (MD -35,76; IC95% -37,28; -34,24). Finalmente, a qualidade de vida melhorou mais no LSG (MD 0,37; IC95% -0,48; -0,26). CONCLUSÕES: LSG é muito eficaz na redução do excesso de peso, comorbidades, complicações pós-operatórias, tempo e melhora na qualidade de vida.
ABSTRACT
Introducción: Las fracturas humerales diafisarias multifragmentarias con extensión proximal son patrones infrecuentes de lesión causados principalmente por trauma de alta energía. La forma anatómica del húmero, la presencia de la tuberosidad deltoidea y la proximidad del nervio radial al surco radial representan retos a tratar, por ello se recomiendan incisiones mínimamente invasivas y la estabilización de la fractura con placa proximal humeral internal locking system. Objetivo: Demostrar la eficacia de la técnica minimally invasive plate osteosynthesis con el moldeamiento helicoidal de la placa proximal humeral internal locking system. Presentación del caso: Paciente de 29 años que sufrió accidente de tránsito y presentó fractura diafisaria multifragmentaria extendida al húmero proximal. Se trató con la técnica minimally invasive plate osteosynthesis y placa helicoidal proximal humeral internal locking system. Alcanzó la consolidación completa y rápida recuperación funcional. Conclusiones: La técnica minimally invasive plate osteosynthesis con placa helicoidal proximal humeral internal locking system es una opción quirúrgica eficaz y segura para las fracturas humerales diafisarias multifragmentarias con extensión proximal, ya que preserva la inserción muscular deltoidea, mejora el contacto placa hueso con riesgo mínimo de lesión neurológica axilar y radial, favorece la curación ósea y mejora el resultado funcional.
Introduction: Multifragmentary diaphyseal humeral fractures with proximal extension are infrequent patterns of injury caused mainly by high-energy trauma. The anatomical shape of the humerus, the presence of the deltoid tuberosity and the proximity of the radial nerve to the radial groove represent challenges to be treated, therefore minimally invasive incisions and fracture stabilization with the proximal humeral internal locking system plate are recommended. Objective: To establish the efficacy of the minimally invasive plate osteosynthesis technique with helical molding of the proximal humeral plate internal locking system. Case report: We report the case of a 29-year-old patient who suffered a traffic accident and had a multifragmentary diaphyseal fracture extended to the proximal humerus. He was treated with the minimally invasive plate osteosynthesis technique and the humeral proximal helical plate internal locking system. He achieved complete consolidation and rapid functional recovery. Conclusions: The minimally invasive plate osteosynthesis technique with the humeral proximal helical plate internal locking system is an effective and safe surgical option for multifragmentary diaphyseal humeral fractures with proximal extension, since it preserves the deltoid muscle insertion, improves bone-plate contact with minimal risk of fracture. Axillary and radial neurological injury, promotes bone healing and improves functional outcome.
ABSTRACT
La enfermedad COVID-19 se caracteriza principalmente por manifestaciones clínicas respiratorias, que pueden ser leves hasta muy severas, sin embargo, hay un grupo de pacientes que pueden cursar con eventos tromboembólicos en cualquier parte del cuerpo. Se realizó una búsqueda de información científica en tres bases de datos PubMed, Scopus y Web of Science, con el objetivo de describir y analizar las potenciales causas de la trombosis mesentérica asociada a la infección por SARS-CoV-2, así como los resultados clínicos, de los pacientes que presentaron y fueron tratados por trombosis mesentérica durante el curso de la enfermedad. Se han reportado diferentes mecanismos fisiopatológicos de eventos tromboembólicos asociados a la COVID-19, dentro de ellos se mencionan el estado de hipercoagulabilidad, una mayor producción de factor Von Willebrand, la expresión de la enzima convertidora de angiotensina 2 en los enterocitos del intestino delgado, que como respuesta a la infección pueden liberar mediadores inflamatorios y el estado de shock presente en las dos terceras partes de los pacientes críticos. Los pacientes con la COVID-19 y sobre todo aquellos que cursan con estadios graves pueden tener diferentes mecanismos que confluyen o exacerban un estado de hipercoagulación, que puede puede afectar cualquier parte del cuerpo como los vasos mesentéricos y llevar a una isquemia gastrointestinal que comprometa su viabilidad y termine en una resección intestinal por necrosis(AU)
COVID-19 disease is mainly characterized by respiratory clinical manifestations, which can be light to very severe; however, there is a group of patients who can present with thromboembolic events in any part of the body. A search of scientific information in three databases, PubMed, Scopus and Web of Science, was carried out with the aim of describing and analyzing the potential causes of mesenteric thrombosis associated with SARS-CoV-2 infection, as well as the clinical outcomes of patients who presented and were treated for mesenteric thrombosis during the course of the disease. Different pathophysiological mechanisms of thromboembolic events associated with COVID-19 have been reported, among them the hyper-coagulable state, an increased production of Von Willebrand factor, the expression of angiotensin-converting enzyme 2 in small intestinal enterocytes, which in response to infection can release inflammatory mediators, and the state of shock present in two thirds of critically ill patients. Patients with COVID-19 and especially those with severe stages may have different mechanisms that converge or exacerbate a state of hyper-coagulation, which can affect any part of the body such as the mesenteric vessels and lead to gastrointestinal ischemia that compromises its viability and ends in intestinal resection due to necrosis(AU)
