Silastic ring vertical gastric bypass: cohort study with 83% rate of 5-year follow-up.

BACKGROUND: Silastic ring vertical gastric bypass (SRVGB) with jejunal interposition is our standard operation for morbidly obese patients. We present the results of 5 years of follow-up in a cohort of patients who underwent SRVGB in 2001. METHODS: The records of all 160 consecutive patients who underwent SRVGB from January to December 2001 were reviewed. Of the 160 procedures, 143 were primary open cases, 14 were revisions from restrictive procedures, and 3 were laparoscopic cases. At 5 years, the body mass index and percentage of excess weight loss was available for 133 patients (83%) at office visits (n = 91, 68.4%), by telephone (n = 40, 30.1%), or by e-mail (n = 2, 1.5%). RESULTS: Of the 160 patients, 121 were women and 39 were men, with a mean age of 33.15 +/- 10.0 years, percentage of ideal body weight of 195.7% +/- 40.8%, and body mass index of 44.6 +/- 9.3 kg/m(2). The mean hospital stay was 3 +/- 1 days. One patient (.6%) died of a pulmonary embolus. Early complications included 3 cases (1.87%) of upper gastrointestinal bleeding and 4 gastric leaks (2.5%): 2 (1.36%) from primary cases and 2 (14.29%) from revisional cases. Late complications included 32 patients (20%) with incisional hernias, 20 (12.5%) with anemia, 14 (8.8%) with dumping, 4 (2.5%) with gastrojejunal stricture, 2 (1.25%) with intestinal obstruction, and 2 (1.25%) requiring silastic ring surgical removal. The 5-year follow-up data were available for 133 patients (83%). The mean body mass index in this group was 27 +/- 5 kg/m(2), with a percentage of excess weight loss of 83% +/- 18.3% at 5 years postoperatively. CONCLUSION: The results of our study have shown that SRVGB is an effective operation for promoting lasting weight loss, with acceptable mortality and complication rates.

Self-expandable metal stents to treat gastric leaks.

OBJECTIVES: Anastomotic leak is a major complication after gastric bypass (GBP) surgery, and it usually necessitates reoperation and is associated with long-term recovery and death. We present our experience with the use of self-expandable metal stents (SEMS) to treat this complication. METHODS: Seventeen patients (14 males and 3 females, mean body mass index of 43.7 kg/m(2)) with gastro-jejunal leak after GBP underwent covered SEMS placement 1 to 3 weeks after surgery: 8 laparoscopic, 5 open, and 4 revisional procedures. All patients who underwent laparoscopic and revisional procedures had abdominal drains placed at surgery. No drains were placed in the open cases. Five patients required surgery to drain an abdominal abscess. RESULTS: Tolerance for oral feeding was achieved between 2 and 3 days after SEMS placement. One patient persisted with a minimal leak for 2 weeks. To date, all stents have been removed endoscopically 3.2 +/- 1.2 months after placement. Four patients needed a second session to complete removal of the uncovered top of the stent. Two esophageal mucosal tears occurred; both were managed conservatively. Sixteen patients had a totally sealed leak. One remained with a gastro-gastric fistula. One stent spontaneously migrated to the splenic flexure and was removed colonoscopically. CONCLUSIONS: SEMS placement for gastro-jejunal leaks is a safe therapeutic option.

Silastic ring vertical gastric bypass: evolution of an open surgical technique, and review of 1,588 cases.

BACKGROUND: Silastic ring vertical gastric bypass (SRVGBP) has evolved from a stapled (SSRVGBP) to a transected (TSRVGBP), and finally to a transected pouch with jejunal interposition (TSRVGBP with J-I). The creation of the gastroenterostomy evolved from a hand-sewn to a stapled and finally to a combined stapled and hand-sewn anastomosis. The circumference of the ring was increased from 5.5 to 6.0 cm. We address the effect of these modifications on surgical outcome. METHOD: The records of 1,588 consecutive patients (mean BMI of 44.5) since 1990 who had a SRVGBP were indentified from a prospective data-base of all patients undergoing bariatric operations. 205 patients with a prior bariatric operation were excluded from the review, leaving 1,383 patients who had a primary SRVGBP. RESULTS: In the 193 SRVGBP patients, there was 1 gastric leak (0.5%) and 64 gastrogastric fistulas (33.2%). In the 165 TSRVGBP patients, there were 4 gastric leaks (2.4%) and 14 gastrogastric fistulas (8.5%). In the 1,025 patients with TSRVGBP with JI, there were 8 gastric leaks (0.8%) and no gastro-gastric fistulas. In the TSRVGBP with J-I, 367 patients had a hand-sewn, 16 a stapled, and 642 a combined stapled and hand-sewn anastomosis. Stricture rate was 3.8%, 31%, and 2.6% respectively. There were 7 ring migrations (0.7%), all in the totally hand-sewn group. Ring removal was necessary in 20 (5%) with a 5.5-cm and 4 (0.74%) with a 6.0-cm ring. CONCLUSION: TSRVGBP with J-I with a combined stapled and hand-sewn gastrojejunal anastomosis using a 6.0-cm ring decreased the incidence of complications, and is our current technique.

Estrés, salud mental y cambios inmunológicos en estudiantes universitarios / Stress, mental health and immunological changes in university students

El presente trabajo tuvo corno objetivo evaluar la relación entre el estrés, la salud mental y los cambios ínmunológicos en estudiantes universitarios. La muestra estuvo conformada por 20 estudiantes del primer año de la Universidad Simón Bolívar (12 hombres, 8 mujeres, edad media =17,20) quienes fueron evaluados al inicio del período académico y en el período de exámenes (7 semanas más tarde) mediante instrumentos de autoinforme para medir variables psicosociales e inmunofenotipaje para los indicaclores ínmunológicos. Comparando las puntuaciones, se encontró que los niveles de intensidad del estrés, disfunción social, somatización y del porcentaje de células HILA-DR+ aumentaron significativamente durante los exámenes. Paralelamente, se observaron disminuciones significativas en porcentajes y números totales de linfocitos, linfocitos T, células NK, células CD8+ y número de células CD4+ . Los análisis de correlación entre las variables psicosociales e inmunológicas en el período de alta demanda académica mostraron relaciones significativas entre la interleukina-1, algunos porcentajes de células inmunológicas y las variables psicosociales. Estos resultados sugieren cambios ínmunológicos asociados a mayores niveles de estrés y deterioro de la salud mental (AU)