ABSTRACT
Background: Advances in three-dimensional (3D) printing technology have allowed the development of customized medical devices. Endoscopic internal drainage (EID) is a novel method to facilitate drainage of an abscess cavity into the lumen of the gastrointestinal tract by placing a double pigtail biliary stent through the fistula opening, originally designed for biliary drainage. They are available in manufacture-determined sizes and shapes. The aim of this study is to explore the feasibility of 3D printing personalized internal drainage stents for the treatment of leaks following gastrointestinal surgery over a sequential period. Methods: We retrospectively identified patients who underwent gastrointestinal anastomotic surgery complicated by postoperative leaks and underwent serial EID for treatment. Computerized Tomography scans were reviewed over a period of time, abscess cavity dimensions and characterizations were evaluated, and 3D reconstructions were obtained. The stents were designed, their shape and size were customized to the unique dimensions of the abscess and lumen of the patient. Stereolithography (SLA) 3D printing technique was used to produce the stents. Results: A total of 8 stents were produced, representing 3 patients. These stents corresponded to 2 or 3 stents per patients. Each patient underwent several endoscopic treatments, before resolution of leak. Conclusions: Customized stents may improve drainage of intra-abdominal abscesses after gastrointestinal surgery, if based on unique anatomy. This proof-of-concept study is a real-world application of personalized health care, which introduces the novel description of customizable 3D printed stents to manage complications following gastrointestinal surgery and may advance therapy for this complex clinical condition. Research Ethics Committees (REC) number is A-2021-012.
Subject(s)
Abscess , Drainage , Humans , Retrospective Studies , Proof of Concept Study , Abscess/surgery , Drainage/methods , Gastrectomy/methods , Stents , Treatment Outcome , Biomedical Technology , Anastomotic Leak/surgery , Postoperative Complications/surgeryABSTRACT
BACKGROUND: Banded Roux-en-Y gastric bypass was designed to avoid or diminish weight regain in the long term. In 2008, we published the initial results of a pilot study design to comparatively evaluate surgical morbidity, mortality, and maximum weight loss in patients undergoing banded and unbanded laparoscopic Roux-en-Y gastric bypass (LRYGB). The present study analyzes the 5-year results. METHODS: A randomized, controlled trial was carried out in 60 morbidly obese patients who underwent LRYGB. Patients were divided in 2 groups. Half of the patients underwent the banded version of the LRYGB, and half underwent the unbanded version. The 5-year excess weight loss (EWL) and loss of body mass index (BMI) were comparatively analyzed. RESULTS: There were 58 females and 2 males with a mean preoperative BMI of 47±4.9 kg/m(2). A total of 21 patients with banded LRYGB and 22 with unbanded LRYGB completed 5-year follow-up. One patient died 3 years after surgery from metastatic melanoma. EWL at 5 years was 61.6%±19.6% versus 59.8%±15.9% (P = ns), and loss of BMI was 32.9%±5.2% versus 32.8%±4.3% (P = ns), respectively, for the banded and unbanded group. CONCLUSIONS: In this small study, there were no statistical differences in the EWL and the BMI lost at 5 years between the group of patients who underwent banded and unbanded LRYGB.
Subject(s)
Gastric Bypass/methods , Gastroplasty/methods , Laparoscopy/methods , Obesity, Morbid/surgery , Adult , Body Mass Index , Female , Humans , Male , Treatment Outcome , Weight Loss/physiologyABSTRACT
INTRODUCTION: Morbid obesity is a serious health problem associated to a significant reduction in life expectancy. OBJECTIVE: To evaluate the anthropometric and metabolic changes observed in obese patients, 3, 6 and 12 months after laparoscopic Roux-en-Y gastric bypass surgery and the complications associated with the procedure. MATERIAL AND METHODS: Retrospective study that included 128 consecutive obese patients submitted for bariatric surgery at the INCMNSZ (2004-2006). RESULTS: Their mean age was 38 +/- 10 years, 83% were women with a BMI of 48 +/- 6 Kg/m2. 65% were hypertensives, 55% had hypertriglyceridemia and 34% diabetes. A year after surgery all patients had at least reduced 20% their body weight and the percentage of excess body weight loss was 73%. The prevalence of hypertension, hypertrigliceridemia and diabetes was reduced to 24%, 17% and 12%, respectively (p < 0.001). Four patients died (3%), all of them had a leak of the anastomosis and intra-abdominal abscess. One died because pulmonary embolism, another with a myocardial infarction (after surgical reinterventions) and the other two with sepsis. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass surgery in morbid obese patients favors significant reductions in body weight and associated co morbidities. This surgery is not free of complications and mortality, reason why it must be done only by surgical and interdisciplinary groups with experience in these procedures.
Subject(s)
Gastric Bypass/methods , Laparoscopy/methods , Adult , Anastomosis, Roux-en-Y/methods , Anastomosis, Roux-en-Y/mortality , Anastomosis, Roux-en-Y/statistics & numerical data , Comorbidity , Diabetes Mellitus, Type 2/epidemiology , Female , Gastric Bypass/statistics & numerical data , Humans , Hypertension/epidemiology , Hypertriglyceridemia/epidemiology , Laparoscopy/statistics & numerical data , Male , Mexico/epidemiology , Middle Aged , Obesity, Morbid/epidemiology , Obesity, Morbid/surgery , Postoperative Complications/mortality , Retrospective Studies , Surgical Wound Dehiscence/mortality , Treatment Outcome , Weight Loss , Young AdultABSTRACT
INTRODUCTION: Nissen funduplication is each time more frequently used for gastroesophageal reflux disease (GERD) treatment. Surgical technique has changed from open to laparoscopic. OBJECTIVE: To analyze in comparative form the results of open and laparoscopic Nissen procedure. MATERIAL AND METHODS: In a period of five years, Nissen funduplication was practiced to 144 patients with confirmed GERD (50 open and 94 laparoscopic). All the patients were follow-up in Outpatient Consultation of the hospital for a minimum period of a year, evaluating in comparative form results and complications of the intervention. Retrospective revision of the files was made. RESULTS: Surgical time average in open surgeries was of 2.6 hours, and laparoscopic 2.57 hours (p = ns). Splenectomy in a patient operated in open form was an only complication. Postoperating complications in four patients (5%) laparoscopic and in 10 (20%) open (p 0.002). Hospital stay in these last ones was of 7.6 days and in laparoscopic 4.7 days (p < 0.0001). A year after the intervention, 19 patients (38%) open surgeries presented suggestive symptoms of reflux or had proton pump inhibitors (PPIs). Of these, in 5 (10%) recurrence of the GERD by some method was confirmed requiring reoperation two of them. In five peptic acid gastro/duodenal disease was confirmed and the rest had drugs without specific indication, demonstrating suitable morphology of the SEGD intervention. In the laparoscopic group, there were 26 symptomatic patients or who had PPIs a year after the intervention (27%). In seven (7%) reflux recurrence was confirmed, becoming necessary the reintervention in two. Another gastric/duodenal pathology in 13 was documented and six had drugs without specific indication. CONCLUSIONS: Nissen operation allows reflux control in 90% of the patients. Laparoscopic intervention requires a smaller hospital stay and is associated to less frequency of complications. The accomplishment of all technical steps of Nissen surgery, open or laparoscopic, is indispensable for good results.
Subject(s)
Fundoplication/methods , Gastroesophageal Reflux/surgery , Laparoscopy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Obesity has become a serious public health problem in Mexico and at present time and the best treatment for morbid obesity is surgery. Recently, laparoscopic techniques have become available for treatment of this disease. Surgery is indicated in patients with body mass index (BMI) >35 kg/m2, and with comorbidity. Restrictive procedures such as adjustable gastric banding and vertical banded gastroplasty have less incidence of postoperative complications; however efficacy in terms of weight loss is not as good as in malabsorptive or mixed procedures. Patients who undergo these malabsorptive or mixed procedures (gastric bypass, biliopancreatic diversion) are at higher risk for postoperative complication. To date, gastric bypass is considered the care standard for treatment of morbid obesity; it confers an approximately 70% of body-weight-loss excess, with an acceptable rate of complications.
Subject(s)
Obesity, Morbid/surgery , Digestive System Surgical Procedures/methods , HumansABSTRACT
Los extremos de la edad se han considerado motivo de contraindicación en el trasplante renal. Sin embargo, existen otros factores más relevantes y determinantes, cuyo cuidado y manejo con éxito de dos pacientes con insuficiencia renal crónica (IRC), que fueron llevados a trasplante de donador vivo relacionado (uno menor de dos años y otro de 73 años), en quienes la edad no se consideró como factor decisivo para el trasplante. La preparación pretrasplante, la obtención de un injerto de donador vivo relacionado y el manejo perioperatorio, fueron los factores que influyeron en el éxito y la edad quedó como factor no relevante
