Complications in Patients with Surgically Altered Gastrointestinal Anatomy Undergoing Endoscopic Retrograde Cholangiopancreatography: 15-Year Experience at a Tertiary Care Center in Latin America.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution. METHODS: Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system. RESULTS: A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable. CONCLUSION: ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.

Intestinal intussusception as a postoperative complication of gastric bypass.

The gold standard for bariatric surgery is the laparoscopic gastric bypass, which consists in forming a small gastric pouch and a Roux-en-Y anastomosis. We present the case of a 41-year-old female who underwent a laparoscopic gastric bypass 8 years prior to her admission to the emergency room, where she arrived complaining of severe and colicky epigastric abdominal pain. The abdominal computed tomography showed a jejuno-jejunal intussusception, for which the patient underwent urgent exploratory laparotomy with intussusception reduction. Intestinal intussusception is a possible postoperative complication of a Roux-en-Y gastric bypass.

El Método de referencia en la cirugía bariátrica es el bypass gástrico laparoscópico, que consiste en la creación de una bolsa gástrica pequeña, anastomosada al tracto digestivo mediante una Y de Roux. Presentamos el caso de una mujer de 41 años con el antecedente de un bypass gástrico laparoscópico realizado 8 años antes, quien ingresó al servicio de urgencias refiriendo dolor abdominal grave. La tomografía computarizada abdominal evidenció una intususcepción a nivel de la anastomosis yeyuno-yeyuno, por lo que se realizó una laparotomía exploradora con reducción de la intususcepción. Se debe considerar la intususcepción intestinal como complicación posoperatoria de bypass gástrico.

Gastro-gastric Fistula: Late Complication After Roux-en-Y Gastric Bypass.

INTRODUCTION: Gastro-gastric fistula is a rare complication after divided Roux-en-Y gastric by-pass. VIDEO CONTENT: 52-year-old male with a BMI over 49 who underwent divided Roux-en-Y gastric by-pass presented with weight regain 2 years later and a type 2 gastro-gastric fistula. Laparoscopic revision, excision of the fistula with re-do of gastrojejunal anastomosis and remnant gastrectomy, was performed CONCLUSION: Laparoscopic resolution is a technical challenge in this case due to the local inflammatory environment.

Zinc absorption and zinc status are reduced after either sleeve gastrectomy or Roux-en-Y gastric bypass in premenopausal women with severe obesity studied prospectively over 24 postoperative months.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is known to reduce zinc absorption; the effects of vertical sleeve gastrectomy (SG) and its long-term implications on zinc absorption have not yet been studied. OBJECTIVE: The aim was to evaluate the effects of SG and RYGBP on zinc absorption and zinc status in premenopausal women with severe obesity up to 24 mo after surgery. METHODS: Twenty-six premenopausal women undergoing SG [BMI (in kg/m2): 37.3 ± 3.2] and 32 undergoing RYGBP (BMI: 42.0 ± 4.2) were studied. A series of anthropometric, dietary, and zinc status parameters (plasma and hair zinc), and the size of the exchangeable zinc pool (EZP), as well as percentage zinc absorption from a standardized dose using a stable isotope methodology were evaluated in the patients before the surgical procedure and at 12 and 24 mo after SG or RYGBP. SG patients received 15 mg and RYGBP received 25 mg of supplemental Zn/d. RESULTS: In premenopausal women, zinc absorption was decreased by 71.9% and 52.0% in SG and RYGBP, respectively, 24 mo postsurgery, compared with initial values. According to 2-factor repeated-measures ANOVA, time effect was significant (P = <0.0001), but not time × group interaction (P = 0.470). Plasma zinc below the cutoff point of 70 µg/dL increased from 0 to 15.4% and 38.1% in SG and RYGBP, respectively. Mean EZP was significantly reduced 24 mo after surgery, although no time × group interactions were observed. Hair zinc did not change across time or between groups. CONCLUSIONS: Both SG and RYGBP have profound effects on zinc absorption capacity, which are not compensated for after 24 mo. Although zinc absorption reduction was similar in both types of surgeries, plasma zinc was more affected in RYGBP than SG, despite greater zinc supplementation in RYGBP.This trial was registered at http://www.isrctn.com as ISRCTN31937503.

One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial.

BACKGROUND: One anastomosis gastric bypass (OAGB) is a relatively novel technique with excellent outcomes, comparable to most accepted procedures. Our aim was to compare OAGB and Roux-en-Y gastric bypass (RYGB) in terms of percent of excess weight lost (%EWL) and resolution of comorbidities. METHODS: Thirty-three patients were randomly assigned (1:2) to two groups (OAGB = 9 and RYGB = 24). Patients were analyzed prospectively. RESULTS: The 5-year follow-up was 85% (28 patients). Both groups were comparable preoperatively in age, weight, body mass index (BMI), and excess weight. One intraoperative complication in OAGB group and no major postoperative complications for both groups were recorded. Progressive decrease in weight, BMI, and %EWL was observed at 1, 6, 12 months, and 5 years, with no differences between groups. Regarding comorbidities, we registered complete remission in type 2 diabetes mellitus (T2DM), insulin resistance, and dyslipidemia with OAGB. RYGB group reported complete remission in T2DM, insulin resistance, dyslipidemia, and gastroesophageal reflux disease (GERD). Mean operative time were 113.3 min ± 41.2 and 143.7 min ± 21.85 for OAGB and RYGB respectively. Mean number of reloads used was 5 for OAGB and 7 for RYGB, which demands further investigations. Postoperative pain was significantly higher in RYGB group. Hospital stay was 3 days for both groups. CONCLUSION: At 5-year follow-up, patients of both techniques achieved similar outcomes in terms of %EWL and resolution of comorbidities, without early or mid-term major complications and no mortality. OAGB demonstrated less use of surgical stapling and unexplainably less postoperative pain compared to RYGB.

Usefulness of Abdominal Drain in Laparoscopic Roux-en-Y Gastric Bypass: A Randomized Controlled Trial.

Background: Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most common procedures to treat morbid obesity. Abdominal drains are often placed during the operation to detect complications earlier. The aim of this study was to assess the benefit of routine drain placement during laparoscopic RYGB. Materials and Methods: A consecutive series of patients undergoing laparoscopic RYGB between 2017 and 2018 was analyzed. The sample was randomized before the procedure into two groups: with abdominal drain (G1) and without abdominal drain placement (G2). Patients with intraoperative complications were excluded from the randomization. Postoperative complications and pain (visual analogue scale) were compared between groups. Results: A total of 84 patients were included; 45 belonged to G1 and 39 to G2. Mean age (G1 44 years versus G2 48 years) and body mass index (G1 43 kg/m2 versus G2 44 kg/m2) were similar in both groups. There were no significant differences between groups in preoperative comorbidities. Mean operative time was 92 minutes in both groups. Mean pain score at postoperative day 0 was similar in both groups (G1 3.2 versus G2 3.5, P = .58), but was higher in G1 at postoperative day 1 (G1 3.1, G2 1.1, P = .02). Postoperative Clavien-Dindo I-II complications were similar in both groups (G1 9% versus G2 1%, P = .37). No major complications, reoperations, or 30-day mortality occurred in the entire cohort. Conclusions: Drain placement in laparoscopic RYGB was associated with greater postoperative pain and did not show benefits in early detection of postoperative complications. Routine placement of abdominal drain in laparoscopic RYGB might not be recommended.

Long-term weight loss outcomes after banded Roux-en-Y gastric bypass: a prospective 10-year follow-up study.

OBJECTIVE: To evaluate the weight loss outcomes of banded Roux-en-Y gastric bypass (RYGB) during a 10-year follow-up. SETTING: Private health-providing service, Brazil. METHODS: A prospective study was conducted on 928 patients with obesity who underwent banded RYGB. Patients were divided into 2 groups according to their initial body mass index (BMI), morbid obesity (BMI 35-49.9 kg/m2) and super obesity (BMI ≥50 kg/m2). The percentages of excess weight loss (%EWL) and total weight loss (%TWL) at 18, 24, 36, 48, 60, 72, 84, 96, 108, and 120 months after surgery were assessed and compared, and the rates of surgical failure were also assessed. RESULTS: There were individuals who were lost to follow-up at each year, including 423 (45.6%) at 18 months, 431 (46.4%) at 24 months, 482 (51.9%) at 36 months, 568 (61.2%) at 48 months, 658 (70.9%) at 60 months, 725 (78.1%) at 72 months, 781 (84.2%) at 84 months, 819 (88.3%) at 96 months, 838 (90.3%) at 108 months, and 819 (88.3%) at 120 months. The maximal %EWL was achieved at 18 months (P<.001). After 10 years, there was no significant change in mean BMI (28.7 ± 4.1 versus 28.5 ± 3.6 kg/m2; P = .07) or %EWL (80.4 ± 19.1 versus 79.7 ± 23.4; P = .065), but the mean %TWL was significantly lower at 10 years (30.8 ± 8.5 versus 32.5 ± 8.1; P = .035) in the morbid obesity group, compared with the values observed over 5 years. In the super obesity group, the %EWL significantly decreased from 77.7 ± 16.5 kg/m2 at 24 months to 71.3 ± 18.1 kg/m2 at 72 months (P = .008); at 5 years, mean BMI (33.1 ± 5.8 kg/m2) did not differ from the one observed at 10 years (36.4 ± 5 kg/m2; P = .21), as well as the mean %TWL (40.1 ± 8.5 versus 34.8 ± 8.9; P = .334). CONCLUSION: Banded RYGB leads to significant and sustained weight loss in a 10-year follow-up. Despite a slight late weight regain evaluated by %TWL, RYGB leads to an optimal weight loss in the majority of the individuals.

DRAIN AMYLASE LEVELS MAY INDICATE GASTROJEJUNOSTOMY LEAKS AFTER ROUX-EN-Y GASTRIC BYPASS.

BACKGROUND: Although the incidence of leaks after Roux-en-Y gastric bypass (RYGB) significantly decreased over time, their detection still remains challenging. OBJECTIVE: This study aimed to determine the usefulness of drain amylase levels to detect leaks after RYGB. METHODS: This is a population-based study which enrolled 170 individuals who underwent RYGB. Drain amylase levels were determined on the first and fourth postoperative days. Two thresholds were evaluated: three times higher than the serum levels (parameter I) and higher than 250 IU/L (parameter II). The main outcomes evaluated were perioperative morbidity, the occurrence of leaks, 30-day readmissions and reoperations, hospital stay, and mortality. RESULTS: Considering the parameter I, high drain amylase levels were significantly associated with leaks (12.5% vs 0; P<0.00001). Considering the parameter II, high drain amylase levels were significantly associated with longer hospital stay (8±5.7 vs 4.5±1.3 days; P=0.00032), 30-day reoperations (50% vs 3%; P=0.000285), and leaks (50% vs 0; P<0.00001). The parameter I presented a sensitivity of 100% and specificity of 95.9%, whereas the parameter II presented a sensitivity of 100% and a specificity of 99.4%. CONCLUSION: The determination of drain amylase levels after RYGB was a significant indicator of leaks, hospital stay, and 30-day reoperations. This finding reinforces the importance of abdominal drainage in the RYGB within this context.

Utilização dos níveis de amilase no dreno abdominal para diagnóstico de fístulas anastomóticas após o bypass gástrico em Y de Roux / Drain amylase levels may indicate gastrojejunostomy leaks after roux-en-y gastric bypass

ABSTRACT BACKGROUND: Although the incidence of leaks after Roux-en-Y gastric bypass (RYGB) significantly decreased over time, their detection still remains challenging. OBJECTIVE: This study aimed to determine the usefulness of drain amylase levels to detect leaks after RYGB. METHODS: This is a population-based study which enrolled 170 individuals who underwent RYGB. Drain amylase levels were determined on the first and fourth postoperative days. Two thresholds were evaluated: three times higher than the serum levels (parameter I) and higher than 250 IU/L (parameter II). The main outcomes evaluated were perioperative morbidity, the occurrence of leaks, 30-day readmissions and reoperations, hospital stay, and mortality. RESULTS: Considering the parameter I, high drain amylase levels were significantly associated with leaks (12.5% vs 0; P<0.00001). Considering the parameter II, high drain amylase levels were significantly associated with longer hospital stay (8±5.7 vs 4.5±1.3 days; P=0.00032), 30-day reoperations (50% vs 3%; P=0.000285), and leaks (50% vs 0; P<0.00001). The parameter I presented a sensitivity of 100% and specificity of 95.9%, whereas the parameter II presented a sensitivity of 100% and a specificity of 99.4%. CONCLUSION: The determination of drain amylase levels after RYGB was a significant indicator of leaks, hospital stay, and 30-day reoperations. This finding reinforces the importance of abdominal drainage in the RYGB within this context.

RESUMO CONTEÚDO: Embora a incidência de fistulas após o bypass gástrico em Y de Roux (BGRY) tenha diminuído significativamente com a evolução da técnica, sua detecção continua desafiadora. OBJETIVO: Determinar a acurácia dos níveis de amilase no dreno abdominal para detector fístulas após o BGYR. MÉTODOS: Este é um estudo populacional que avaliou 170 indivíduos submetidos ao BGYR. Os níveis de amilase no dreno foram determinados no primeiro e quarto dias de pós-operatório. Dois pontos de corte foram avaliados: três vezes maior que os níveis séricos (parâmetro I) e acima de 250 UI/L (parâmetro II). Os principais desfechos estudados foram: morbidade perioperatória, ocorrência de fístulas, reinternações e reoperações nos primeiros 30 dias, permanência hospitalar e mortalidade. RESULTADOS: Considerando o parâmetro I, altos níveis de amilase do dreno foram indicadores significativos de fístulas (12,5% vs 0; P<0,00001). Considerando o parâmetro II, altos níveis de amilse no dreno estiveram significativamente associados a maior permanência hospitalar (8±5,7 vs 4,5±1,3 dias; P=0,00032), frequência de reoperações (50% vs 3%; P=0,000285) e ocorrência de fístulas (50% vs 0; P<0,00001). O parâmetro I apresentou sensibilidade de 100% e especificidade de 95,9%, enquanto o parâmetro II apresentou sensibilidade de 100% e especificidade de 99,4%. CONCLUSÃO: A determinação dos níveis de amilase no dreno após o BGYR foi um indicador significativo de fístulas, permanência hospitalar e reoperações. Este achado reforça a importância da drenagem abdominal no BGYR dentro deste contexto.

Resultados de la manometría del cuerpo esofágico y del asa de yeyuno en pacientes operados por cáncer gástrico con gastrectomía total 5 años después de la cirugía / Esophageal manometry in patients with total gastrectomy 5 years after surgery

Resumen Introducción: La técnica de elección para la reconstrucción del tránsito intestinal después de una gastrectomía total es la esófago-yeyuno anastomosis en Y de Roux, la cual evita el reflujo de jugo digestivo alcalino. El objetivo del presente estudio es el de analizar la motilidad del esófago y del asa de yeyuno en pacientes operados con gastrectomía total por cáncer gástrico. Pacientes y método: Se estudió prospectivamente una muestra de 17 pacientes intervenidos mediante gastrectomía total 5 años atrás. En todos ellos se realizaron manometrías esofágicas de alta resolución incluyendo los primeros 7 cm del asa de yeyuno. Resultados: Los resultados de la manometría demostraron motilidad esofágica normal a excepción de la presión máxima intrabolo, la cual se encontraba aumentada en todos los pacientes. La motilidad del asa de yeyuno fue desordenada e inefectiva. Conclusiones: La motilidad del cuerpo esofágico es normal 5 años después de la gastrectomía total. Sin embargo, la presión intrabolo máxima se encuentra aumentada; la causa más probable de este hecho estaría constituida por el asa de yeyuno, que ejerce resistencia al paso del bolo debido a que presenta una actividad motora desordenada y poco propulsiva. El impacto clínico de este hecho es, sin embargo, poco importante.

Abstract Introduction: The most preferred technique to reconstruct the intestinal transit after total gastrectomy for gastric cancer is the Roux-en-Y esophagus-gastrostomy which prevents the reflux of alkaline intestinal juice. The purpose of this study was to analyze the esophageal motility and the motility of the jejunal loop in patients subjected to total gastrectomy. Patients and method: A prospective sample of 17 total gastrectomy patients operated on 5 years before was studied using high resolution esophageal manometry including the first 7 cm of the jejunal loop. Results: Manometry results showed normal esophageal body motility with the exception of the maximum intrabolus pressure that was elevated in all patients. The jejunal loop motility was disordered and ineffective. Conclusions: Esophageal body motility was normal 5 years after the surgical procedure. However, maximum intrabolus pressure was elevated and the most plausible reason would be the jejunal loop that exerts resistance to the bolus passage due to its ineffective motility. However, this fact does not have a significant clinical impact.

Transenteric ERCP for Treatment of Choledocholithiasis After Duodenal Switch.

This article aims to describe step-by-step technique performed with the aid of a video. We report the performance of an endoscopic approach to the biliary tract on 2 patients who had previously undergone duodenal switch (DS). It was successfully performed a laparoscopic-assisted transenteric endoscopic retrograde cholangiopancreatography (ERCP) in both the patients. Although successful experiences with ERCP after Roux-en-Y gastric bypass have been found, few cases of ERCP after DS have been reported. Nevertheless, this is the first study to include a multimedia video with description of details and all technical steps of the transenteric ERCP performed on 2 patients who had previously undergone DS. Transenteric access is a feasible technique for reaching the biliary tract through endoscopy after DS. This technique could avoid most invasive and risky procedures. However, it requires a high level of therapeutic endoscopic training.

IMPACT ON QUALITY OF LIFE, WEIGHT LOSS AND COMORBIDITIES: a study comparing the biliopancreatic diversion with duodenal switch and the banded Roux-en-Y gastric bypass / Impacto na qualidade de vida, perda de peso e comorbidades: estudo comparativo entre as intervenções cirúrgicas derivação biliopancreática tipo “duodenal switch” e derivação gástrica em Y de Roux com anel

Context Few studies have evaluated the results of different types of bariatric surgery using the Medical Outcome Study 36 - Health Survey Short-Form (SF-36) quality of life questionnaire, the Bariatric and Reporting Outcome System (BAROS) and the reviewed Moorehead-Ardelt Quality of Life II Questionnaire (M-A QoLQ II) that is part of BAROS. The Roux-en-Y gastric bypass (RYGB) is the most common morbid obesity surgery worldwide. However, there is evidence indicating that a biliopancreatic diversion with duodenal switch (DS) is more effective than RYGB in weight loss terms. Objectives To evaluate the impact of different types of bariatric surgery on quality of life, comorbidities and weight loss. Methods Two groups of patients who underwent bariatric surgery conventional Banded Roux-en-Y gastric bypass (BRYGB) or DS were evaluated through monitoring at 12 to 36 months after surgery, as well as a control group of obese patients who had not undergone surgery. The tools used for this were SF-36, BAROS and M-A QoLQ II. The DS group consisted of 17 patients and the BRYGB group consisted of 20. The control group comprised 20 independent, morbidly obese individuals. Results The mean age of the patients in the groups was 45.18 in the DS group, 49.75 in the BRYGB group and 44.25 in the control group, with no significant difference. There was no difference in the ratio of men to women in the groups. The patients that had surgery showed a significant improvement in all domains of quality of life vs the control group. Comparing the two groups that underwent surgery, the DS group achieved better quality of life results in terms of “general state of health” and “pain”, according to responses to the SF-36 tool, and in terms of “sexual interest”, according to responses to the M-A QoLQ II tool. There was no significant difference among the three groups regarding the ratio of occurrence of comorbidities. In the ...

Contexto Poucos estudos avaliaram os resultados de diferentes cirurgias bariátricas utilizando o questionário de qualidade de vida Medical Outcome Study 36 - Item Health Survey Short-Form (SF - 36), o Bariatric and Reporting Outcome System (BAROS) e o Moorehead-Ardelt Quality of Life II (M-A QoLQ II) revisado, que compõem o BAROS. A derivação gástrica em Y de Roux é a operação mais realizada em todo o mundo para tratamento da obesidade mórbida. Há evidencias sugerindo maior efetividade da operação derivação biliopancreática tipo “duodenal switch” (DS) em relação a derivação gástrica em Y de Roux quanto à perda de peso Objetivos Avaliar o impacto de diferentes intervenções cirúrgicas na qualidade de vida, comorbidades e perda de peso. Métodos Foram avaliados dois grupos de doentes submetidos à cirurgia bariátrica de derivação gástrica em Y-de-Roux com anel (BRYGB) ou “duodenal switch” após seguimento de 12 a 36 meses e, um grupo controle de doentes obesos não operados, utilizando o SF-36, o BAROS e o M-A QoLQ II. O grupo DS foi constituído por 17 doentes e, o BRYGB convencional, por 20. O grupo controle foi formado por 20 doentes obesos mórbidos independentes. Resultados A média de idade dos doentes nos grupos foi respectivamente 45,18 anos no grupo DS, 49,75 anos no grupo BRYGB e, 44,25 anos no grupo controle, sem diferença significante. Não foi observada diferença entre as proporções de sexo nos grupos. O grupo de pacientes operados apresentou melhora significante em todos os domínios de qualidade de vida, em relação ao grupo controle. Na comparação entre os grupos cirúrgicos, o grupo DS apresentou resultados de qualidade de vida melhores nos domínios “estado geral ...

[Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study]. / Complicaciones del bypass gástrico convencional y laparoscópico. Estudio prospectivo y comparativo.

BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4% in the lbg and 34% in the cbg (p < 05, 95%ci 22-38), mostly represented by seromas (25%) and wall abscesses (5.4%). the percentage of late postoperative complications was 2.8% in the lbg group and 9.6% in the cbg (p=0.004, 95%ci 1.4-12.2), the most frequent being incisional hernias (7.18%). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.

Antecedentes: el bypass gástrico en y de roux para el tratamiento de la obesidad mórbida representa hoy en día la opción terapéutica más segura y eficiente. la era laparoscópica ha demostrado sus beneficios en este tipo de cirugía, por lo que algunos autores abogan por su implementación en forma casi sistemática, conduciendo en los últimos años al inexorable cambio en la vía de abordaje. Objetivos: evaluar y comparar las complicaciones del bypass gástrico laparoscópico y convencional en pacientes con obesidad mórbida. Lugar de aplicación: hospital nacional universitario de autogestión. Diseño: estudio comparativo, prospectivo no randomizado. Población: entre el 2002 y 2011, 420 pacientes con obesidad mórbida recibieron un tratamiento quirúrgico para la obesidad ya sea en forma laparoscópica (253) o convencional (167). Resultados: el porcentaje de complicaciones postoperatorias tempranas fue del 4% en el grupo bgl y del 34% en el bgc (p <05, ic95% 22 - 38), representadas en su mayoría por seromas (25%) y abscesos de pared (5,4%). el porcentaje de complicaciones postoperatorias tardías fue del 2,8% en el grupo bgl y del 9,6% en el bgc (p= 0.004, ic95% 1,4 - 12,2), siendo las más frecuentes las eventraciones (7,2%). Conclusiones: de acuerdo a nuestra experiencia y a la literatura consultada, el bypass gástrico laparoscópico es un procedimiento seguro, reproducible y con una menor tasa de complicaciones tanto tempranas como tardías que el bg c, por lo que consideramos y ofrecemos al bgl como técnica ideal en el tratamiento de los pacientes con obesidad mórbida.

Impact on quality of life, weight loss and comorbidities: a study comparing the biliopancreatic diversion with duodenal switch and the banded Roux-en-Y gastric bypass.

CONTEXT: Few studies have evaluated the results of different types of bariatric surgery using the Medical Outcome Study 36 - Health Survey Short-Form (SF-36) quality of life questionnaire, the Bariatric and Reporting Outcome System (BAROS) and the reviewed Moorehead-Ardelt Quality of Life II Questionnaire (M-A QoLQ II) that is part of BAROS. The Roux-en-Y gastric bypass (RYGB) is the most common morbid obesity surgery worldwide. However, there is evidence indicating that a biliopancreatic diversion with duodenal switch (DS) is more effective than RYGB in weight loss terms. OBJECTIVES: To evaluate the impact of different types of bariatric surgery on quality of life, comorbidities and weight loss. METHODS: Two groups of patients who underwent bariatric surgery conventional Banded Roux-en-Y gastric bypass (BRYGB) or DS were evaluated through monitoring at 12 to 36 months after surgery, as well as a control group of obese patients who had not undergone surgery. The tools used for this were SF-36, BAROS and M-A QoLQ II. The DS group consisted of 17 patients and the BRYGB group consisted of 20. The control group comprised 20 independent, morbidly obese individuals. RESULTS: The mean age of the patients in the groups was 45.18 in the DS group, 49.75 in the BRYGB group and 44.25 in the control group, with no significant difference. There was no difference in the ratio of men to women in the groups. The patients that had surgery showed a significant improvement in all domains of quality of life vs the control group. Comparing the two groups that underwent surgery, the DS group achieved better quality of life results in terms of "general state of health" and "pain", according to responses to the SF-36 tool, and in terms of "sexual interest", according to responses to the M-A QoLQ II tool. There was no significant difference among the three groups regarding the ratio of occurrence of comorbidities. In the groups that had surgery, the resolution of comorbidities was similar. The final classification according to the BAROS Protocol was excellent for the DS group and very good for the BRYGB group, with a statistical difference in favor of the DS group (P = 0.044*). There was no difference in the percentages of excess weight loss between the DS group (82.1%) and the BRYGB group (89.4%) (P = 0.376). CONCLUSIONS: A comparison of the performance of the groups, which were monitored from 12 to 36 months after surgery, showed that the two types of surgery are effective to improve quality of life, comorbidities and weight loss. The DS surgery produced better results in the quality of life evaluations regarding 2 of 8 domains according to the SF-36, and "sexual interest" according to the M-A QoLQ II. In the groups that had surgery, the patients showed high rates of comorbidity resolution. Weight loss was similar for the two surgical groups.

Complicaciones del bypass gástrico convencional y laparoscópico. Estudio prospectivo y comparativo / [Complications of conventional and laparoscopic gastric bypass. Prospective and comparative study].

BACKGROUND: Roux-en-y gastric bypass for the management of morbid obesity is currently the safest and more efficient treatment option. the laparoscopic era has shown its benefits in this type of surgery, so some authors advocate its implementation in a practical systematic way. all of which has lead in recent years to the unavoidable change in the surgical approach. OBJECTIVES: To evaluate and compare the complications of laparoscopic gastric bypass and the conventional one in patients with morbid obesity. Application site: self-administration national university hospital. DESIGN: Comparative, prospective no randomized study. POPULATION: Between 2002 and 2011, 420 morbidly obese patients received surgical treatment for the obesity either open (167) or laparoscopic (253) surgery RESULTS: Early postoperative complication rate was 4

in the lbg and 34

in the cbg (p < 05, 95

ci 22-38), mostly represented by seromas (25

) and wall abscesses (5.4

). the percentage of late postoperative complications was 2.8

in the lbg group and 9.6

in the cbg (p=0.004, 95

ci 1.4-12.2), the most frequent being incisional hernias (7.18

). CONCLUSIONS: According to our experience and consulted literature, laparoscopic gastric bypass is a safe, reproducible and with a lower rate of both early and late complications than cbg, and so we consider and offer lbg as the ideal technique for the treatment of patients with morbid obesity.