[Remnant gallbladder cholecystitis, an increasingly common entity: Case report]. / Colecistitis del remanente vesicular, una entidad en incremento: reporte de caso.

Background: Subtotal cholecystectomy was described in 1985 as an alternative to total cholecystectomy in cases of difficult cholecystectomy. It was classified as reconstituted and fenestrated subtotal. In spite of being a viable alternative, up to 10.6% of biliary leakage is reported and 2.2% of patients present with cholecystitis of the gallbladder remnant. The objective of this report is to describe and emphasize the importance of an adequate diagnosis of complications in patients with a history of subtotal cholecystectomy. Clinical case: 72-year-old male with a history of open subtotal cholecystectomy 6 years prior to his admission to the emergency department due to right hypochondrium pain and vomiting. He had a history of biliary pancreatitis and choledocholithiasis after subtotal cholecystectomy resolved by endoscopic retrograde cholangiopancreatography (ERCP). It was decided to admit the patient and a diagnosis of cholecystitis of the gallbladder remnant was made. Laparoscopic cholecystectomy of the remnant was performed with subsequent clinical resolution. Conclusions: Although subtotal cholecystectomy may be the only option in cases of difficult cholecystectomy, it may result in future complications. The possibility of more complex surgical reinterventions should be considered. Our case report demonstrates that total cholecystectomy in cases of cholecystitis should be performed whenever possible to avoid potential complications caused by subtotal cholecystectomy.

Introducción: la colecistectomía subtotal fue descrita en 1985 como una alternativa a la colecistectomía total en casos de colecistectomía difícil. Fue clasificada como subtotal reconstituida y fenestrada. A pesar de ser una alternativa viable, se reporta hasta un 10.6% de fuga biliar y 2.2% de los pacientes presentan colecistitis del remanente vesicular. El objetivo de este reporte de caso es incluir la colecistitis del remanente vesicular como diagnóstico diferencial en pacientes con antecedente de colecistectomía subtotal y dolor abdominal. Caso clínico: hombre de 72 años con antecedente de colecistectomía subtotal abierta. Seis años antes de su ingreso, acudió a un servicio de urgencias por dolor en hipocondrio derecho y vómito. Contaba con antecedente de pancreatitis biliar y coledocolitiasis posterior a colecistectomía subtotal resueltas por colangiopancreatografía retrógrada endoscópica (CPRE). Se decidió ingresar al paciente y se integró diagnóstico de colecistitis del remanente de la vesícula biliar. Se realizó colecistectomía laparoscópica del remanente con posterior resolución clínica. Conclusiones: a pesar de que la colecistectomía subtotal puede ser la única opción en casos de colecistectomía difícil, esta puede resultar en complicaciones futuras. La posibilidad de reintervenciones quirúrgicas más complejas debe ser considerada. Con nuestro reporte de caso podemos inferir que la colecistectomía total en casos de colecistitis debe realizarse siempre que sea posible para evitar potenciales complicaciones causadas por la colecistectomía subtotal.

[Evolution of type 2 diabetes and carbohydrate intolerance following bariatric surgery in a Mexican mestizo population]. / Evolución de los pacientes con diabetes mellitus tipo 2 e intolerancia a los carbohidratos posterior a cirugía bariátrica en la población mexicana.

BACKGROUND: Bariatric surgery continues to be the best treatment for weight loss and control of obesity related comorbidities. Gastric bypass and sleeve gastrectomy have demonstrated to be the most effective surgeries, but this has not been established in a Mexican (non-American) population. OBJECTIVE: To analyse the improvement in type 2 diabetes mellitus and carbohydrate intolerance in obese patients after bariatric surgery. MATERIAL AND METHODS: A retrospective analysis was performed on the data collected prospectively between 2013 and 2015 on every obese patient with diabetes and carbohydrate intolerance submitted for bariatric surgery. Analysis was performed at baseline, and at 1, 3, 6, 9 and 12 months, and included metabolic, clinical, lipid, and anthropometrical parameters. A peri-operative and morbidity and mortality analysis was also performed. Remission rates for patients with diabetes were also established. RESULTS: The analysis included 73 patients, 46 with diabetes and 27 with carbohydrate intolerance. Sixty-two patients were female with a mean age of 42 years. Baseline glucose and glycosylated haemoglobin were 123±34mg/dl and 6.8±1.6%, and at 12 months they were 90.1±8mg/dl and 5.4±0.3%, respectively. Diabetes remission was observed in 68.7% of patients, including 9.3% with partial remission and 21.8% with an improvement. There was also a significant improvement in all metabolic and non-metabolic parameters. CONCLUSIONS: Bariatric surgery safely improves the metabolic status of patients with diabetes mellitus or carbohydrate intolerance during the first year, inducing high rates of complete remission. It has also shown a significant improvement on blood pressure, lipid, and anthropometric parameters during the first year of follow-up.

La asistencia manual es una alternativa a la conversión a laparotomía durante la sigmoidectomía laparoscópica / Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy

Introducción En el tratamiento de la enfermedad diverticular la cirugía laparoscópica tiene diversos beneficios en comparación con la cirugía abierta. Existen 2 tipos de abordajes, el asistido por laparoscopia (LA) y el laparoscópico asistido con la mano (MA). El objetivo de este estudio es demostrar que la cirugía MA puede ser un recurso previo a la conversión a una laparotomía en caso de encontrar dificultades con el abordaje LA. Material y métodos Se realizó un estudio de cohorte retrospectivo en un hospital privado de tercer nivel en la ciudad de México. Se seleccionó a todo paciente con diagnóstico de enfermedad diverticular en el que se practicó una cirugía LA, incluidos aquellos pacientes en los que hubo dificultad técnica durante el procedimiento y se decidió continuar de manera MA. Resultados Se realizaron 47 sigmoidectomías LA, 33 de éstas se completaron de esta manera, 4 requirieron laparotomía y 10 se completaron de manera MA (de éstas ninguna requirió laparotomía). No hubo diferencia estadísticamente significativa entre los grupos laparoscópicos cuando se comparó el retorno de la función intestinal (p=0,879) y los días de estancia intrahospitalaria (p=0,679).Conclusiones La cirugía laparoscópica MA es una alternativa factible si durante una sigmoidectomía LA hay dificultad con la exposición o con la disección y evita la conversión a cirugía abierta (AU)

Introduction Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy. Material and methods This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach. Results A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted.Conclusions If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy (AU)

[Hand assistance is an alternative to conversion to laparotomy during laparoscopic sigmoidectomy]. / La asistencia manual es una alternativa a la conversión a laparotomía durante la sigmoidectomía laparoscópica.

INTRODUCTION: Laparoscopic surgery in the treatment of diverticular disease offers multiple benefits compared with its open surgery counterpart. There are two distinct techniques, the laparoscopically assisted and the laparoscopic hand assisted approach. The purpose of this study is to demonstrate that the hand assisted approach can be used if, during a laparoscopically assisted approach, there is difficulty in dissection and/or exposure, and before performing a laparotomy. MATERIAL AND METHODS: This study is a retrospective cohort series that was performed in a private tertiary hospital in Mexico City. Patients with the diagnosis of diverticular disease who underwent a laparoscopically assisted sigmoidectomy were selected. These included patients who, during their procedure required conversion to a hand assisted approach. RESULTS: A total of 47 sigmoid colectomies began with assisted laparoscopy, of which 33 were completed, 4 required laparotomy, and 10 where completed using hand assistance (none required laparotomy). There were no statistically significant differences in return of bowel function (P=0.879) and postoperative hospital stay (P=0.679) between the group that was completed by assisted laparoscopy vs. hand assisted. CONCLUSIONS: If there is difficulty in exposure or dissection during a laparoscopically assisted sigmoid colectomy, the hand assisted approach is an alternative before the laparotomy.