Insurance-Related Delay in Access to Bariatric Surgery, Is It Helpful as Is Thought?

BACKGROUND: In Argentina, health insurances demand a 24-month duration preoperative weight loss program (POWLP) before bariatric surgery. It is unknown whether it enhances weight loss before or after surgery, or even if it is related to comorbidity remission. The main objective of this study was to determine its effectiveness and reliability. METHODS: An observational, longitudinal, retrospective study was carried out from June 2009 to December 2016, enrolling patients who underwent bariatric surgery in Sanatorio Allende Hospital of Cordoba, Argentina. Patients were divided into three groups according time-to-surgery from preoperative assessment initiation (A = before the 6th month, B = from 6th to 24th month, and C = over 24th month; all related to the first visit as previously mentioned). BMI, %EWL, comorbidity remission BMI, %EWL, comorbidity remission, and complications rate were assessed after surgery at 1, 3, 6, 12 months, and then annually until the 5th postoperative year. Revisional surgeries were excluded. RESULTS: Three hundred seventy-six patients were recruited. There were no significant differences in the preoperative and postoperative weight loss, neither co-morbidities resolution between groups. CONCLUSIONS: Insurance-related delay in access to bariatric surgery is not associated to any benefit in comorbidity remission, as well as any improvement in weight loss in all groups studied.

Laparoscopic Sleeve Gastrectomy Resolves NAFLD: Another Formal Indication for Bariatric Surgery?

INTRODUCTION: Obesity is strongly associated with non-alcoholic fatty liver disease (NAFLD); 66-99% of the obese population could suffer some grade of NAFLD. It can progress into cirrhosis, which is associated to hepatocellular carcinoma, and a liver transplant could be indicated. NAFLD represents the third cause of liver transplant, and it is expected to be the first by 2025. Sleeve gastrectomy (SG) is the most common bariatric procedure over the world. There is scant literature regarding NAFLD after SG, and there are no prospective studies published up to date. OBJECTIVE: To evaluate the evolution of NAFLD in patients with obesity after 1 year of SG. METHODS: From January 2009 to December 2013, intraoperative liver biopsy was performed in 63 obese patients who underwent SG. Forty-three patients were again biopsied 1 year after surgery. Demographics, body mass index, percentage of excess weight loss, liver function test, lipid panel, glucose panel, and histological changes were prospectively analyzed. RESULTS: One hundred percent of the patients reversed or reduced the stage of steatosis or steatohepatitis 12 months after surgery, obtaining a statistically significant difference for both steatosis and steatohepatitis. One patient presented complete cirrhosis regression in the pathology. Neither of the patients had worsened liver histology. CONCLUSIONS: NAFLD could be dealt with laparoscopic sleeve gastrectomy, preventing its progression into cirrhosis. SG can be performed in patients with obesity and metabolic syndrome, with NAFLD showing satisfactory results 12 months after surgery. NAFLD should be a formal indication for bariatric surgery.

Tratamiento quirúrgico de la obesidad mórbida / Evaluation of laparoscopic sleeve gastrectomy in the treatment of morbid obesity

Objetivo: determinar los resultados obtenidos en cuanto a la pérdida de peso, porcentaje de exceso de peso perdido (%EPP) y descenso del IMC a los 18 meses del postoperatorio de GML y resolución de las comorbilidades asociadas a la obesidad. Evaluar complicaciones postoperatorias. Material y método: estudio prospectivo desde el año 2004 al 2009. Se realizó GML según técnica estándard. Se evaluaron los resultados a 1,3, 6, 12 y 18 meses. Resultados: n = 65. El peso postoperatorio obtenido fue de 115,3, 102,1, 95,3, 89,5 y 80,03 kg al 1,3,6,12 y 18 meses respectivamente. El IMC fue de 38,89, 34,33, 31,5, 29,96 y 28,72 kg/m2 al 1, 3, 6, 12 y 18 meses respectivamente. El % de EPP fue de 30,62, 40,25, 51,36, 58,63 y 63,4% al 1, 3, 6, 12 y 18 meses respectivamente. El % de complicaciones postoperatorias fue de 4,6 %. El % de comorbilidades fue de 27,66 % se resolvieron en el 92 % de los pacientes. De los 65 pacientes estudiados 42 de ellos llegaron a ser controlados a los 18 meses. En estos pacientes no se consideró necesario un segundo procedimiento bariátrico. Conclusión: la GML es una técnica quirúrgica con buenos resultados en el descenso de peso y control de las comorbilidades en el período estudiado. Se deberían reevaluar los resultados a largo plazo para determinar la eficacia de la GML.

Objective: Determine the effectiveness of laparoscopic sleeve gastrectomy in terms of weihgt loss, percentage of excessive weight loss, rduction of BMI and comorbidities associated to obesity within 18 months of surgery. Evaluate postoperative complications. Material and method: Prospective study of 68 patients who underwent LSG performed according to standard technique from 2004 to 2009. Follow up was done by measuring the above mentioned variables 1, 3, 6, 12 and 18 months after surgery. Results: n = 65. The post operative weight obtained was 115.3, 102.1, 95.3, 89.5 and 80.03 kg to the 1, 3, 6, 12 and 18 months respectively. The BMI was 38.89, 34.33, 31.5, 29.96 and 28.72 kg/m2 to the 1, 3, 6, 12 and 18 months respectively. % EWL was 30.62, 40.25, 51.36, 58.63 and 63.4% to the 1, 3, 6, 12 and 18 months respectively. % of complications was 4.6%. % of comorbidities was 27.66 % and was resolved in 92 % of the patients. From 65 studied patients 42 of them arrived to be controlled to the 18 months. In these patients a second bariatric procedure was not considered necessary. Conclusion: The LSG is a surgery technique with good results in terms of weight reduction and controlled comorbidities in the time period evaluated. Further follow up is needed to prove LSG efficacy in the long term.

Simpatectomía torácica videotoracoscópica: nuestra experiencia / Endoscopic thoracic sympathectomy as definitive treatment of palmar and axillary hyperhidrosis: authors' experience

Evaluar los resultados, las complicaciones postoperatorias y el grado de satisfacción de los pacientes intervenidos quirúrgicamente en nuestro servicio con diagnóstico de hiperhidrosis palmar y axilar mediante la realización de simpatectomía torácica videotoracoscópica como tratamiento definitivo de su condición. Material y método: estudio retrospectivo de Enero de 2005 a Enero 2009. Se realizó simpatectomía de los ganglios T2-T4 a los csos que presentaban hiperhidrosis palmar y simpatectomía de los ganglios T2-T5 a los que presentaban hiperhidrosis palmar y axilar. Resultados: Población total 20 pacientes, simpatectomía T2-T4 a 8 (40 %) y simpatectomíaT2-T5 a 12 (60 %). Dieciséis pacientes refirieron mejoría total, los otros 4 mejoraron parcialmente sus síntomas. El 100 % confirmó estr satisfecho con los resultados obtenidos. En el control postoperatorio, todos los pacientes presentron hiperhidrosis compensatoria, siendo severa en 2 casos y no severa en 18. En el 60 % de los pacientes se manifestó en el abdomen y piernas, y en el 40 % restante en la región dorsal. Se observó un caso de neumotórax, cuatro casos de neuralgia interecostal, sequedad de manos se presentó en 3 pacientes y se halló sudoración residual en 4 pacientes. Conclusión: la simpatectomía torácica videotoracoscópica puede ser realizada de forma segura y con excelentes resultados como tratamiento de elección en la hiperhidrosis palmar y axilar. La hiperhidrosis compensatoria es la mayor complicación pero es bien tolerada y no afecta el grado de satisfacción postoperatoria de los pacientes.

To evaluate the results, postoperative complications and the satisfaction of the patients underwent surgery in our department with a diagnosis of palmar and axillary hyperhidrosis by performing endoscopic thoracic sympathectomy as definitive treatment of their condition. Methods: retrospective study from January 2005 to January 2009. For palmar hyperhidrosis, sympathectomy from T2-T4 ganglia eas performed and, for palmar and axillary hiperhidrosis sympathectomy of T2-T5 ganglia. Results: total population 20 patients, sympathectomy T2-T4 was performed at 8 (40 %) and sympathectomy T2-T5 in 12 (60 %). Sixteen patients reported overall imporvement, the other 4 partially imporved his symptoms. Confirmed to be 100 % satisfied with the results. In controlling postoperative, all patients experienced compensatory hyperhidrosis, and severe in 2 cases and not severe in 18, 60 % of patients developed this condition in the abdomen and legs, and the remaining 40 % in the dorsal region. We observed a case of pneumothorax, four cases of intercostal neuralgia, dry hands are presented in 3 patientes and resiudal sweating was found in 4 patients. Conclusion: endoscopic thoracic sympathectomy may be performed safely and with excellent reults as a treatment of choice for palmar and axillary hyperhidrosis. Compensatory hyperhidrosis is the major complication but is ewll tolerated and does not affect the satisfaction level of postoperative patients.

Simpatectomía torácica videotoracoscópica: nuestra experiencia / Endoscopic thoracic sympathectomy as definitive treatment of palmar and axillary hyperhidrosis: authors experience

Evaluar los resultados, las complicaciones postoperatorias y el grado de satisfacción de los pacientes intervenidos quirúrgicamente en nuestro servicio con diagnóstico de hiperhidrosis palmar y axilar mediante la realización de simpatectomía torácica videotoracoscópica como tratamiento definitivo de su condición. Material y método: estudio retrospectivo de Enero de 2005 a Enero 2009. Se realizó simpatectomía de los ganglios T2-T4 a los csos que presentaban hiperhidrosis palmar y simpatectomía de los ganglios T2-T5 a los que presentaban hiperhidrosis palmar y axilar. Resultados: Población total 20 pacientes, simpatectomía T2-T4 a 8 (40 %) y simpatectomíaT2-T5 a 12 (60 %). Dieciséis pacientes refirieron mejoría total, los otros 4 mejoraron parcialmente sus síntomas. El 100 % confirmó estr satisfecho con los resultados obtenidos. En el control postoperatorio, todos los pacientes presentron hiperhidrosis compensatoria, siendo severa en 2 casos y no severa en 18. En el 60 % de los pacientes se manifestó en el abdomen y piernas, y en el 40 % restante en la región dorsal. Se observó un caso de neumotórax, cuatro casos de neuralgia interecostal, sequedad de manos se presentó en 3 pacientes y se halló sudoración residual en 4 pacientes. Conclusión: la simpatectomía torácica videotoracoscópica puede ser realizada de forma segura y con excelentes resultados como tratamiento de elección en la hiperhidrosis palmar y axilar. La hiperhidrosis compensatoria es la mayor complicación pero es bien tolerada y no afecta el grado de satisfacción postoperatoria de los pacientes.(AU)

To evaluate the results, postoperative complications and the satisfaction of the patients underwent surgery in our department with a diagnosis of palmar and axillary hyperhidrosis by performing endoscopic thoracic sympathectomy as definitive treatment of their condition. Methods: retrospective study from January 2005 to January 2009. For palmar hyperhidrosis, sympathectomy from T2-T4 ganglia eas performed and, for palmar and axillary hiperhidrosis sympathectomy of T2-T5 ganglia. Results: total population 20 patients, sympathectomy T2-T4 was performed at 8 (40 %) and sympathectomy T2-T5 in 12 (60 %). Sixteen patients reported overall imporvement, the other 4 partially imporved his symptoms. Confirmed to be 100 % satisfied with the results. In controlling postoperative, all patients experienced compensatory hyperhidrosis, and severe in 2 cases and not severe in 18, 60 % of patients developed this condition in the abdomen and legs, and the remaining 40 % in the dorsal region. We observed a case of pneumothorax, four cases of intercostal neuralgia, dry hands are presented in 3 patientes and resiudal sweating was found in 4 patients. Conclusion: endoscopic thoracic sympathectomy may be performed safely and with excellent reults as a treatment of choice for palmar and axillary hyperhidrosis. Compensatory hyperhidrosis is the major complication but is ewll tolerated and does not affect the satisfaction level of postoperative patients.(AU)

Enfermedad pilonidal sacrococcígea: técnica de Karydakis versus Limberg flap / Sacrococcygeal pilonidal disease: results of Karydakis flap vs. Limberg flap

Comparar la técnica de Karydakis versus la técnica del colgajo romboidal (Limberg Flap) en el tratamiento de la enfermedad pilonidal sacrococcígea para determinar si la realización de la técnica de Karydakis reduce los índices de complicaciones post-quirúrgicas de esta patología (recurrencia y formación de fístulas o abscesos).

To compare Karydakis technique versus rhomboid flap (Limberg flap) technique in the treatment of sacrococcygeal pilonidal disease to determine whether of this technique reduces the complications rates of this desease (recurrence and fistula formation or abscess).

Electrobisturí en las incisiones de hernioplastia inguinal / Comparative study of electrocautery versus conventional scalpel for skin incision in the inguinal hernioplsty

Objetivo: Determinar si el uso del electrobisturí versus el bisturí convencional para realizar la incisión cutánea en la hernioplastia inguinal, predispone un aumento del dolor postoperatorio, mayor requerimiento analgésico postoperatorio y un incremento en la formación de colecciones a nivel de la herida quirúrgica.

Objetive: To determine whether the use of electrocautery versus conventional scalpel for skin incision in the inguinal hernioplasty, predisposes an increased postoperative pain, better postoperative analgesic requeriment and an increase in the formation of collections at the surgical wound.

Enfermedad pilonidal sacrococcígea: técnica de Karydakis versus Limberg flap / Sacrococcygeal pilonidal disease: results of Karydakis flap vs. Limberg flap

Comparar la técnica de Karydakis versus la técnica del colgajo romboidal (Limberg Flap) en el tratamiento de la enfermedad pilonidal sacrococcígea para determinar si la realización de la técnica de Karydakis reduce los índices de complicaciones post-quirúrgicas de esta patología (recurrencia y formación de fístulas o abscesos).(AU)

To compare Karydakis technique versus rhomboid flap (Limberg flap) technique in the treatment of sacrococcygeal pilonidal disease to determine whether of this technique reduces the complications rates of this desease (recurrence and fistula formation or abscess).(AU)

Electrobisturí en las incisiones de hernioplastia inguinal / Comparative study of electrocautery versus conventional scalpel for skin incision in the inguinal hernioplsty

Objetivo: Determinar si el uso del electrobisturí versus el bisturí convencional para realizar la incisión cutánea en la hernioplastia inguinal, predispone un aumento del dolor postoperatorio, mayor requerimiento analgésico postoperatorio y un incremento en la formación de colecciones a nivel de la herida quirúrgica.(AU)

Objetive: To determine whether the use of electrocautery versus conventional scalpel for skin incision in the inguinal hernioplasty, predisposes an increased postoperative pain, better postoperative analgesic requeriment and an increase in the formation of collections at the surgical wound.(AU)