[Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m²]. / Bypass gástrico en Y de Roux para el tratamiento de pacientes con diabetes mellitus tipo II con IMC de 30 a 35 kg/m²

BACKGROUND: The incidence of obesity and its most feared comorbidity, diabetes mellitus type 2, is increasing and there would not seem to be any medical treatment to help control these pandemics. However, there is a bariatric surgery technique, the Roux-en-Y Gastric Bypass (RYGB), which is safe and not only helps control excess weight, but produces encouraging results in the control and remission of diabetes. METHODS: We present 15 selected patients with a BMI between 30 and 35 kg/mt² and diabetes type 2 who underwent a laparoscopic RYGB with of one-year follow-up. RESULTS: A total of 14 women and one man were operated with the following average values: age: 37 years, weight: 88.3 kg, BMI: 32.8 kg/mt², blood glucose: 120 ± 38.8 mg%, HbA1c: 7.6 ± 0.73. Forty percent (40%) suffered from high blood pressure and 33.3% were dyslipidemic. Average surgical time was 75 minutes, hospital length of stay was two days, and there was a low rate of complications and no mortality. Diabetes remission was achieved in 93% of cases with significant drops in blood glucose and HbA1c (p ≤ 0.05 and p ≤ 0.001 respectively), dyslipidemia was 100% controlled and hypertension was 83.3% controlled. CONCLUSIONS: RYGB in selected patients with obesity type 1 and diabetes mellitus type 2 is a safe and effective technique for metabolic control and obesity control.

Cruce duodenal; visión integral de una derivación biliopancreática en cirugía metabólica / Duodenal switch; a comprehensive view of a biliopancreatic diversion in metabolic surgery

El Switch duodenal es una técnica de cirugía bariátrica que modifica la derivación biliopancreática de Scopinaro, descrita por los cirujanos Hess y Marceaux en 1988, apoyados en la descripción original que hizo De Meester para el tratamiento de la enfermedad por reflujo gastroesofágico recurrente. Es una técnica compleja, probablemente la más laboriosa de todos los procedimientos bariátricos hasta ahora conocidos, que puede y deber ser hecha por laparoscopia y que consta de varios tiempos quirúrgicos. Implica la realización de una gastrectomía vertical con bujías de diferente calibre y de un bypass en Y de Roux al duodeno, con longitudes de las asas variables. La anastomosis duodenoileal es la más difícil y tiene diferentes técnicas. Debe acompañarse de cierre de las brechas y en la mayor parte de los casos de una apendicectomía y una colecistectomía. Se han registrado tiempos quirúrgicos, hospitalización, morbilidad y mortalidad mayores que en el bypass gástrico en Y de Roux. Las complicaciones reportadas son de hasta un 24% de los casos, tempranas o tardías, éstas de índole metabólico fácilmente controlables, con lo que se logra un buen índice de satisfacción, con bajo porcentaje de revisión y una mortalidad no mayor al 1,5%. Se logra una disminución del 70% del exceso de peso a largo plazo, con mejoría de todas las comorbilidades llegando al control metabólico de las dislipidemias y la diabetes alrededor de un 95%. Dados los buenos resultados debería considerarse como una técnica de elección para el tratamiento del paciente obeso metabólicamente enfermo (AU)

The duodenal switch is a technique of Bariatric Surgery that modifies the Scopinaro biliopancreatic diversion, described by Hess and Marceaux in 1988, supported by the original description that made De Meester for the treatment of gastroesophageal reflux recurrent disease. It is a complex technique, probably the most laborious of all bariatric procedures until now known, which can and must be done by laparoscopy and consisting of several surgical steps. It involves the performance of a vertical gastrectomy with bougies of different diameter and a bypass Roux-en-Y into the duodenum, with different lengths limbs. Duodenoileal anastomosis is the most difficult and different techniques are described. It must be accompanied by closure of the defects and in most of the cases of an appendectomy and cholecystectomy. There have been greater than the gastric bypass Roux-en-Y in operating time, hospitalization, morbidity and mortality. Reported complications are up a 24% of the cases, early or late, these are metabolic one and easily controllable, so a good index of satisfaction with low percentage of review and no more than 1.5% mortality. Achieved a decrease of 70% of excess weight in the long term, with improvement in all co-morbidities reaching around a 95% diabetes and metabolic control of the dyslipidemias. Given the good results it should be seen as a technique of choice for the treatment of the obese patient with metabolical disorder (AU)

Bypass gástrico en Y de Roux para el tratamiento de pacientes con diabetes mellitus tipo II con IMC de 30 a 35 kg/m2 / Roux-en-Y gastric bypass for treatment of patients with DM type 2 and BMI of 30 to 35 Kg/m2

La incidencia de obesidad y una de sus comorbilidades más temida la diabetes mellitus tipo II está en aumento y no pareciera haber tratamiento médico que ayude a controlar estas pandemias. Existe una técnica quirúrgica bariátrica, el Bypass Gástrico en Y de Roux (BGYR) que es segura y no sólo ayuda a controlar el exceso de peso sino también produce resultados alentadores en el control y remisión de la diabetes. Métodos: Se presentan 15 pacientes con IMC entre 30 y 35 kg/mt2 diabéticos tipo II seleccionados sometidos a BGYR por laparoscopia con seguimiento de un año. Resultados: Se operaron 14 mujeres y un hombre con los siguientes valores promedios: Edad: 37 años, Peso: 88,3 kg, IMC: 32,8 kg/mt2, Glicemia: 120 ± 38,8 mg%, HbA1c: 7,6% ± 0,73. 40% de hipertensión arterial y 33,3% dislipidémicos. El tiempo quirúrgico promedio fue de 75 minutos, dos días de hospitalización bajo índice de complicaciones y sin mortalidad. Se logró una remisión de la diabetes en el 93%, de los casos, con descensos de la glicemia y HbA1c significativos (p ≤ 0,05 y p ≤ 0,001 respectivamente) con un control de la dislipidemia del 100% y 83,3% de la HTA. Conclusiones: El BGYR en obesos tipo I diabéticos seleccionados es una técnica segura y eficaz en el control metabólico y de la obesidad (AU)

Background: The incidence of obesity and its most feared comorbidity, diabetes mellitus type 2, is increasing and there would not seem to be any medical treatment to help control these pandemics. However, there is a bariatric surgery technique, the Roux-en-Y Gastric Bypass (RYGB), which is safe and not only helps control excess weight, but produces encouraging results in the control and remission of diabetes. Methods: We present 15 selected patients with a BMI between 30 and 35 kg/mt2 and diabetes type 2 who underwent a laparoscopic RYGB with of one-year follow-up. Results: A total of 14 women and one man were operated with the following average values: age: 37 years, weight: 88.3 kg, BMI: 32.8 kg/mt2, blood glucose: 120 ± 38.8 mg%, HbA1c: 7.6 ± 0.73. Forty percent (40%) suffered from high blood pressure and 33.3% were dyslipidemic. Average surgical time was 75 minutes, hospital length of stay was two days, and there was a low rate of complications and no mortality. Diabetes remission was achieved in 93% of cases with significant drops in blood glucose and HbA1c (p ≤ 0.05 and p ≤ 0.001 respectively), dyslipidemia was 100% controlled and hypertension was 83.3% controlled. Conclusions: RYGB in selected patients with obesity type 1 and diabetes mellitus type 2 is a safe and effective technique for metabolic control and obesity control (AU)

[Duodenal switch: a comprehensive view of a biliopancreatic diversion in metabolic surgery]. / Cruce duodenal: visión integral de una derivación biliopancreática en cirugía metabólica.

The duodenal switch is a technique of Bariatric Surgery that modifies the Scopinaro biliopancreatic diversion, described by Hess and Marceaux in 1988, supported by the original description that made De Meester for the treatment of gastroesophageal reflux recurrent disease. It is a complex technique, probably the most laborious of all bariatric procedures until now known, which can and must be done by laparoscopy and consisting of several surgical steps. It involves the performance of a vertical gastrectomy with bougies of different diameter and a bypass Roux-en-Y into the duodenum, with different lengths limbs. Duodenoileal anastomosis is the most difficult and different techniques are described. It must be accompanied by closure of the defects and in most of the cases of an appendectomy and cholecystectomy. There have been greater than the gastric bypass Roux-en-Y in operating time, hospitalization, morbidity and mortality. Reported complications are up a 24% of the cases, early or late, these are metabolic one and easily controllable, so a good index of satisfaction with low percentage of review and no more than 1.5% mortality. Achieved a decrease of 70% of excess weight in the long term, with improvement in all co-morbidities reaching around a 95% diabetes and metabolic control of the dyslipidemias. Given the good results it should be seen as a technique of choice for the treatment of the obese patient with metabolical disorder.

Manometría esofágica en pacientes sometidas a gastrectomía vertical laparoscópica: servicio de cirugía dos / Esophageal manometry in patients undergoing laparoscopic vertical gastrectomy: servicio de cirugia dos

Evaluar mediante manometría, la motilidad esofágica y las características del esfinter esofágico inferior, en pacientes obesos antes y después de ser sometidos a gastrectomía vertical laparoscópica (GVL). Estudio descriptivo, correlacional y prospectivo comparando los hallazgos en la manometria esofágica en el postoperatorio respecto al preoperatorio en 12 pacientes sometidos a GVL. Unidad de Cirugía Endoscópica del Servicio de Cirugía Dos del Hospital Universitario de Caracas. No hubo diferencias estadísticamente significativa en los valores de la manometría esofágica, antes y después del procedimiento, para longitud total e intraabdominal del esfinter esofágico interior (EEI) (p=0,76 y p=0,43 respectivamente), presion de reposo del EEI (p=0,37) y amplitud esofágica distal (p=0,65). Se observó una disminución estadísticamente significativa, en los valores postoperatorios del porcentaje de relación del EEI (p=0.04) y del porcentaje de contracciones peristálticas (p=0.03). Las alteraciones manométricas evidenciadas pueden predisponer o incrementar la enfermedad por reflujo gastroesofágico (ERGE), ya que implican un manor vaciamiento esofágico. Sin embargo el mecanismo por el cual los individuos obesos sometidos a GVL. Desarrollan ERGE es complejo y multifactorial, ya que no obedece únicamente a posibles alteraciones del EEI, sino que esta asociado a otros factores como peristalsis esofágica, vaciamiento gástrico y presión intragástrica.

Assess by manometry esophageal motility and the characteristic of the lower esophageal sphincter (LES) in obese patients before and alter laparoscopic vertical gastrectomy (LVG). Descriptive, correlational and prospective investigation, comparing findings in the esophageal manometry in the postoperative compared to the preoperative in 12 patients undergoing LVG. Unit of Endoscopic Surgery of the Hospital Universitario de Caracas, Servicio de Cirugia Dos. There was no statistically significant difference in the values, of esophageal manometry before and alter the procedure, for total and intra-abdominal length of the LES (p=0.76 and p-0.43 respectively), resting LES pressure (p=0.37) and distal esophageal amplitude (p=0,65). There was a statististically significant decrease in postoperative values of the relaxation percentage of the LES (p=0.04) and percentage of peristaltic contractions (p=0.03). Manometric abnormalities that were detected in this study may predispose or increase gastroesophageal reflux disease (GERD), since they imply a lower esophageal emptying rate. However, the mechanism by which obese individuals, that underwent to LVG, develop GERD is complex and multifactorial, and not due solely to alterations of the LES, but is associated to other factors such as esophageal peristalsis, gastric emptying and intragastric pressure.