Evaluation of quality of life, weight loss and evolution of comorbidities at 6 years after bariatric surgery.

INTRODUCTION: Morbid obesity is a disease with multiple comorbidities and considerably limits the quality of life and life expectancy. Bariatric surgery is an effective therapeutic alternative in these patients; it acts on the decrease and / or absorption of nutrients, achieving a significant weight loss which is maintained over time. The objective of the study is to determine the long-term results, in terms of efficacy, regarding weight loss, the resolution of comorbidities and improvement in the quality of life of our patients. MATERIAL AND METHODS: This was a retrospective study that comprised all patients consecutively undergoing laparoscopic bariatric surgery at our center over a 10 year period. In all patients, the anthropometric and clinical data were collected prior to surgery and in subsequent protocolized visits after surgery. At the end of the follow-up, a BAROS questionnaire was used that recorded weight loss, the resolution of comorbidities, complications and the quality of life test completed by the patients. RESULTS: 353 patients (303 GBPRY and 50 GV), 105 men and 248 women, with a mean age of 42.14 ± 10.16 years, BMI 48.63 kg / m2 and 68.5% had some comorbidity. The mean follow-up was 5.7 ± 2.6 years for 96.7% of the total number operated on. At the end of the follow-up the %EWL was 59.00 ± 19.50, %EBMIL 68.15 ± 22.94, the final BMI 32.65 ± 5.98 and 31.3% of the patients had %EWL ≤ 50. The resolution of comorbidities was as follows: 48.7% hypertension, 70.3% Type 2 Diabetes, 82.6% DLP and 71.6% SAHS. The result of the quality of life test was 1.51 ± 0.93, with 67.2% of patients reporting good or very good quality, with the highest score being for self-esteem, followed by physical condition, work and social activity, and the lowest being for sexual quality of life in that only 40.3% reported an improvement. The BAROS score was 4.35 ±â€¯2.06 with 84.7% of the patients in the good to excellent range, while 91.2% of all patients would undergo surgery again. CONCLUSIONS: Bariatric surgery is an effective technique for reducing weight, resolving comorbidities and improving the quality of life of patients with morbid obesity, mainly in its physical aspect. In our series, the percentage of follow-up and average time was within the range of established quality standards.

Efectos del bypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años / Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years

ANTECEDENTES: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de comorbilidades y una disminución del riesgo cardiovascular. MATERIAL Y MÉTODOS: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante bypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. RESULTADOS: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de comorbilidades al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. CONCLUSIONES: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos

BACKGROUND: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. MATERIAL AND METHODS: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. RESULTS: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. CONCLUSION: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures

[Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years]. / Efectos del baypass gástrico sobre el riesgo cardiovascular y resolución de comorbilidades: resultados a 5 años.

INTRODUCTION: Background: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.

INTRODUCCIÓN: Antecedentes: la cirugía bariátrica es una alternativa terapéutica eficaz en la obesidad mórbida para conseguir pérdidas de peso importantes y mantenidas en el tiempo, la resolución de la comorbilidad y una disminución del riesgo cardiovascular. Material y métodos: estudio retrospectivo que incluyó a todos los pacientes intervenidos consecutivamente mediante baypass gástrico laparoscópico en nuestro centro durante 10 años, en los que se estudiaron la pérdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugía y al final del seguimiento. Resultados: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 años y un IMC de 48,2 ± 6,0 kg/m2. Se siguió al 96,7 % durante 5,7 ± 2,6 años de media. La resolución de la comorbilidad al final del seguimiento fue: 53,4 % para la hipertensión arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el síndrome de apnea-hipopnea del sueño. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parámetros incluidos en su cálculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El índice de masa corporal y el porcentaje de sobrepeso perdido a los 2 años y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. Conclusiones: el bypass gástrico es un método eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor número de pacientes posible y la comunicación de los resultados a largo plazo para determinar la efectividad real de estos procedimientos.

Valoración de la satisfacción de los pacientes intervenidos de vesícula biliar por laparoscopia en un servicio de cirugía general / Evaluation of satisfaction in patients after gall bladder laparoscopy in a general surgery department

Introducción: En los servicios quirúrgicos, la evaluación de la calidad asistencial es una herramienta básica para su gestión y es imprescindible en los contratos de servicios sanitarios. El estudio de la opinión del usuario sobre la atención sanitaria recibida constituye una parte fundamental de la evaluación de la calidad asistencial. Objetivo: El objetivo de este trabajo es el estudio de la satisfacción percibida por los pacientes intervenidos de vesícula biliar por laparoscopia en un servicio de cirugía general. Material y método: Se realiza un estudio transversal, durante un año desde enero a diciembre de 2007. La medida da la satisfacción se obtuvo mediante una encuesta. Las variables de opinión analizadas fueron las definidas por el modelo SERCAL adaptado a un servicio quirúrgico. Resultados: La puntuación media de la satisfacción global del servicio fue 9,31 (escala, 0-10). La fidelidad con el servicio fue del 96,7%. El trato personalizado, la garantía que ofrece el personal sanitario y la habitación fueron valorados muy positivamente. La información recibida, el alivio del dolor y la estancia fueron valorados como adecuados. Conocer el nombre del personal sanitario que les atiende y la comida fueron los factores peor valorados. Conclusiones: Los resultados del estudio muestran un aceptable grado de satisfacción de la atención recibida, no obstante se detectan áreas de mejora en las que debemos incidir (identificación, coordinación y comida)

Introduction: The evaluation of quality care in surgical service is a basic management tool and it is part of the health services contract. The study of patient opinion on health care received is an important aspect in the evaluation of quality care. Objective: The aim of this study is to find out patient opinion on the satisfaction of the surgical care received. Material and method: Cross-sectional study. Period of the study: January-December 2007. Opinions on the level of satisfaction level were obtained through a questionnaire. A SERCAL adapted model was used to define the variables on patient satisfaction with the surgery service. Results: The mean score on overall satisfaction of the service was of 9.31 (0-10 scale). The personalised, guaranteed care offered by health professionals and the room, were very positively evaluated. The information received, pain relief and the hospital stay were evaluated as adequate. The confidence in the surgery service was 96.7%. Knowing the names of the health staff and the food were the worse valued factors. Conclusions: Results of the study show an adequate level of satisfaction with the health care; nevertheless areas of improvement are detected where action is needed (identification of staff, coordination and food) (AU)

[Not Available]. / Valoración de la satisfacción de los pacientes intervenidos de vesícula biliar por laparoscopia en un servicio de cirugía general.

INTRODUCTION: The evaluation of quality care in surgical service is a basic management tool and it is part of the health services contract. The study of patient opinion on health care received is an important aspect in the evaluation of quality care. OBJECTIVE: The aim of this study is to find out patient opinion on the satisfaction of the surgical care received. MATERIAL AND METHOD: Cross-sectional study. Period of the study: January- December 2007. Opinions on the level of satisfaction level were obtained through a questionnaire. A SERCAL adapted model was used to define the variables on patient satisfaction with the surgery service. RESULTS: The mean score on overall satisfaction of the service was of 9.31 (0-10 scale). The personalised, guaranteed care offered by health professionals and the room, were very positively evaluated. The information received, pain relief and the hospital stay were evaluated as adequate. The confidence in the surgery service was 96.7%. Knowing the names of the health staff and the food were the worse valued factors. CONCLUSIONS: Results of the study show an adequate level of satisfaction with the health care; nevertheless areas of improvement are detected where action is needed (identification of staff, coordination and food).

Neumatosis intestinal y gas en el territorio venoso portomesentérico en el paciente anciano: etiología, fisiopatología y significado clínico / Pneumatosis intestinalis and portomesenteric venous gas in the elderly: aetiology, physiopathology and clinical significance

La presencia de gas en el territorio venoso portomesentérico y en la pared intestinal, es una entidad infrecuente en el paciente adulto; sin embargo, con el avance del diagnóstico por imagen y el rápido crecimiento de la población anciana, cada vez son más frecuentes los casos publicados en la literatura médica. La etiología más frecuente es la isquemia mesentérica, potencialmente más letal en esta edad. Presentamos el caso de enterocolitis necrosante secundaria a isquemia mesentérica en una mujer de 80 años de edad, que se diagnosticó tras analizar el cuadro clínico y los hallazgos radiológicos. La paciente falleció tras un deterioro rápidamente progresivo. Revisamos los aspectos etiológicos, las manifestaciones clínicas, las pruebas diagnósticas y las opciones terapéuticas de esta entidad en el paciente geriátrico

Pneumatosis intestinalis and portomesenteric venous gas in adults is a rare entity. However, because of the advances in diagnostic imaging and the rapid growth of the elderly population, more cases are being reported in adults. The most frequent cause of hepatic portal venous gas is extensive bowel necrosis, which is potentially fatal in this age group. We present an 80-year-old woman with clinical and radiological signs of portal venous gas and pneumatosis intestinalis secondary to ischaemic necrotizing enterocolitis. The patient's general condition rapidly deteriorated with subsequent fatality. We review the aetiology, clinical manifestations, diagnostic tests and therapeutic options of this disease in the elderly

Evaluación de la vía clínica de la colecistectomía laparoscópica en un servicio de cirugía general / Evaluation of a clinical pathway for laparoscopic cholecystectomy in a general surgery service

Objetivos: Evaluar la vía clínica (VC) de la colecistectomía laparoscópica (CL) tras un año de su implantación. Material y método: El 1 de febrero 2005 se implantó en nuestro servicio la VC de la colecistectomía laparoscópica. Se ha estudiado a todos los pacientes incluidos en la vía clínica desde su puesta en marcha. Los criterios de evaluación incluyen el grado de cumplimiento, los indicadores de efectividad en la atención clínica, el impacto económico y los indicadores de satisfacción basados en la encuesta. Los resultados se comparan con los de una serie de pacientes intervenidos durante el año anterior (2004) a la implantación de la VC. Resultados: Se ha revisado una serie de 170 pacientes intervenidos durante el año anterior a la puesta en marcha de la vía clínica, 136 mujeres y 34 varones con una media de edad de 51 años. La estancia media y el gasto medio del proceso de estos pacientes fueron de 1,29 días y 1.354 euros, respectivamente. Durante un año tras la implantación de la VC se realizaron 170 colecistectomías laparoscópicas, que se incluyeron en el estudio, a 133 mujeres y 37 varones con una media de edad de 50 años. La estancia media de estos pacientes fue de 1,28 días y el gasto medio por proceso, 1.334,7 euros. El grado de cumplimiento de la estancia fue del 85,3%. El grado de satisfacción fue del 96,8%. Conclusiones: El estudio muestra que la estancia media y el gasto medio por proceso han disminuido tras la implantación de la VC y con un alto grado de satisfacción de los pacientes

Objectives: To evaluate a clinical pathway for laparoscopic cholecystectomy 1 year after its introduction. Material and method: A clinical pathway for laparoscopic cholecystectomy was introduced in our service on 1st February, 2005. All patients included in the clinical pathway after its introduction were studied. The evaluation criteria included the degree of compliance, indicators of the effectiveness of clinical care, economic impact, and indicators of satisfaction based on a survey. The results were compared with those obtained in a series of patients who underwent surgery during the year before the introduction of the clinical pathway (2004). Results: A series of 170 patients who underwent surgery in the year prior to the introduction of the clinical pathway was evaluated (136 women and 43 men). The mean age was 51 years. In these patients, the mean length of hospital stay was 1.29 days and the mean cost of the process was 1,354 euros. In the first year after the introduction of the clinical pathway, 170 laparoscopic cholecystectomies were performed and included in this study. There were 133 women and 37 men. The mean age of these patients was 50 years. The mean length of hospital stay was 1.28 days and the mean cost in patients included in the clinical pathway was 1,334.7 euros. The degree of compliance with length of hospital stay was 85.3%. The degree of satisfaction was 96.8%. Conclusions: The mean length of hospital stay and the mean cost per process decreased after the creation of the clinical pathway. Patient satisfaction was high

Hematoma espontáneo de la pared abdominal asociado a la terapia antiagregante en el paciente geriátrico / Spontaneous haematoma of the abdominal wall associated with antiaggregant therapy in the elderly patient

Se presenta un caso de hematoma espontáneo de la pared abdominal (HEPA), en un paciente varón de 85 años de edad, ocurrido durante el tratamiento antiagregante con 300 mg/día de ácido acetilsalicílico. El paciente presentó dolor en hipocondrio derecho y anemia aguda, por lo que se le realizó una tomografía computarizada (TC), en la que se detectó un hematoma en la pared abdominal. Se optó por un tratamiento conservador, y se observó regresión del hematoma tras realizar TC evolutivos. El paciente fue dado de alta por mejoría 15 días después. Concluimos que el tratamiento de elección del HEPA debe ser conservador y se indica el cambio del medicamento antiagregante una vez que el paciente se haya estabilizado

We report a case of spontaneous haematoma of the abdominal wall in an 85-year-old man who was under long-term antiaggregant therapy consisting of 300 mg/day of acetylsalicylic acid. The patient presented with right hypochondriac pain. Computed tomography (CT) scan showed haematoma of the abdominal wall. Conservative treatment was given and follow-up CT scans revealed regression of the haematoma. The patient was discharged from the hospital on the 15th day. We conclude that the treatment of choice of a non-ruptured spontaneous haematoma of the abdominal wall should be conservative with close observation. A switch from acetylsalicylic acid therapy to another antiaggregant therapy once the patient is stable is strongly recommended