[Usefulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery]. / Utilidad del estudio contrastado precoz del tracto digestivo superior después de cirugía bariátrica: ¿se justifica su uso rutinario?

BACKGROUND: Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. AIM: To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. MATERIAL AND METHODS: A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. RESULTS: Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. CONCLUSIONS: Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.

Utilidad del estudio contrastado precoz del tracto digestivo superior después de cirugía bariátrica: ¿se justifica su uso rutinario? / Usefulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery

Background: Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. Aim: To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. Material and Methods: A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. Results: Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. Conclusions: Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.

Correlation between age and weight loss after bariatric surgery.

BACKGROUND: Conflicting evidence exists regarding age as a predictive factor in excess weight loss after bariatric surgery. The objective of this cross-sectional study is to evaluate differences in excess BMI loss (%EBMIL) 1 year after surgery in patients older and younger than 45 years. METHODS: Adult obese patients fulfilling selection criteria underwent either Roux-en-Y gastric bypass or sleeve gastrectomy and were grouped according to age < and ≥45 years with follow-up at least 1 year. Both groups were compared in terms of excess BMI loss (%EBMIL) and other clinical outcomes. Possible relationship between %EBMIL, age, surgical technique, and presence of comorbidities such as diabetes mellitus, hypertension (HT), and dyslipidemia (DL) was searched. RESULTS: Three hundred thirty-seven patients (72.5 % female), 196 (50.1 %) younger than 45 years and 141 (49.9 %) with age ≥45 years. There was significant difference between age group and %EBMIL 12 months after surgery (p < 0.001), showing better results in younger patients. No differences were found in terms of gender, preoperative body mass index (BMI), surgical technique, nor presence of DL. Using multiple regression, we found significant interaction effect between age group (p < 0.001), presence of HT (p = 0.001), and %EBMIL at follow-up. CONCLUSIONS: Patients younger than 45 years lose greater amount of excess BMI than older patients after bariatric surgery. This tendency might be useful as a preoperative weight loss predictor in bariatric patients.

Fundoplicatura de Nissen laparoscópica en el tratamiento del reflujo gastroesofágico patológico / Nissen's laparoscopic fundoplication in pathologic gastroesophageal reflux

En la pasada década se ha producido un importante avance en el diagnóstico y manejo del reflujo gastroesofágico (RGE). Uno de los progresos más notables lo ha constituido la introducción de la cirugía antirreflujo laparoscópica, consolidándose en la operación más efectuada después de la colecistectomía. El objetivo de este trabajo prospectivo es mostrar nuestro método de estudio y selección quirúrgica en pacientes con RGE y además analizar los resultados en pacientes con RGE patológico y operados con técnica de Nissen-Rosetti laparoscópica. En la primera etapa se operaron 30 cerdos y luego, entre julio de 1993 y marzo de 1997, fueron seleccionados para cirugía 50 pacientes, estudiados con endoscopia, radiología, pH esofágico de 24 horas y manometría. Fueron operados 40 pacientes por FIGE patológico ácido, 7 por falla al tratamiento médico y 3 por RGE alcalino. El 10 por ciento de los operados presentó complicaciones intraoperatorias y el 8 por ciento debió ser convertido. El 12 por ciento de los casos presentó complicaciones postoperatorias leves, ninguno requirió de reoperación y no hubo mortalidad. El 98 por ciento de los casos presentó disfagia, la que fue moderada en el 82 por ciento y grave en el 16 por ciento. El 92 por ciento de los pacientes permaneció entre 2 y 3 días hospitalizado y el reintegro laboral fue en promedio de 10 días. El seguimiento de 96 por ciento entre 6 meses y 4 años revela que el 93,6 por ciento de los pacientes está entre Visick 1 y 2. Sólo 16 por ciento de los operados han sido evaluados con pH de 24 horas y manometría en el postoperatorio, encontrándose una notable normalización de todos los índices evaluados. En suma, la reparación laparoscópica del RGE puede ser efectuada con baja morbilidad, recuperación muy rápida y con resultados a mediano plazo equivalentes a la técnica abierta