RESUMO
PURPOSE: Our goal was to present the experience of bariatric surgeons with medical tourism on a global scale. MATERIALS AND METHODS: An online-based survey was sent to bariatric surgeons worldwide regarding surgeon's country of practice, number and types of bariatric procedures performed, number of tourists treated, their countries of origin, reasons for travel, follow-up, and complications. RESULTS: Ninety-three responders performed 18,001 procedures in 2017. Sixty-four of those 93 responders operated on foreign patients performing a total of 3740 operations for them. The majority of the responders practice in India (n = 11, 17%), Mexico (n = 10, 16%), and Turkey (n = 6, 9%). Mexico dominated the number of bariatric surgeries for tourists with 2557 procedures performed in 2017. The most frequent procedures provided were laparoscopic sleeve gastrectomy (LSG) provided by 89.1% of the respondents, laparoscopic Roux-en-Y gastric bypass (40.6% of respondents), and one anastomosis gastric bypass (37.5% of respondents). CONCLUSION: At least 2% of worldwide bariatric procedures are provided for medical tourists. Countries such as Mexico, Lebanon, and Romania dominate as providers for patients mainly from the USA, UK, and Germany. The lack of affordable bariatric healthcare and long waiting lists are some of the reasons for patients choosing bariatric tourism.
Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Turismo Médico/estatística & dados numéricos , Obesidade/epidemiologia , Obesidade/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Cirurgia Bariátrica/economia , Cirurgia Bariátrica/métodos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Gastrectomia/economia , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/economia , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Geografia , Humanos , Internacionalidade , Laparoscopia/economia , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Turismo Médico/economia , Motivação , Padrões de Prática Médica/economia , Inquéritos e Questionários , Resultado do Tratamento , Redução de PesoAssuntos
Medicina Bariátrica/educação , Cirurgia Bariátrica/educação , Internet , Sociedades Médicas , Feminino , Humanos , MasculinoRESUMO
A 28-year-old female presented with a 4 year history of intermittent right upper quadrant pain. Clinical examination and ultrasound suggested a diagnosis of cholelithiasis and the patient was eventually booked for a laparoscopic cholecystectomy. Intraoperatively the patient was found to have gallbladder agenesis and small bowel malrotation with the duodenojejunal flexure to right of midline. The gallbladder fossa was filled with fibrous tissue. Both gallbladder agenesis and midgut malrotation are rare congenital abnormalities. Gallbladder agenesis has a similar presentation to more common gallbladder pathologies, such as cholecystitis. This case illustrates the limitations of and our over reliance on radiological imaging. Moreover, it highlights the need to have a high index suspicion of gallbladder agenesis when ultrasound is inconclusive. Further investigations and imaging with modalities such as MRI should be used to reduce the risks associated with unnecessary surgical intervention.
Assuntos
Dor Abdominal/etiologia , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica , Vesícula Biliar/anormalidades , Cálculos Biliares/diagnóstico , Volvo Intestinal/congênito , Adulto , Diagnóstico Diferencial , Anormalidades do Sistema Digestório , Feminino , Humanos , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgiaRESUMO
Although endometriosis is a common condition in young women, symptomatic involvement of the small bowel is rare. The authors report the case of a 44-year-old lady initially thought to have irritable bowel syndrome who presented 1 month later with acute small bowel obstruction. A CT scan showed small bowel dilatation with a transition point in the ileum, but no distinct lesion. The patient had an exploratory laparotomy where an obstructing lesion in the terminal ileum and several enlarged mesenteric lymph nodes were identified. Consequently, a right hemicolectomy was performed. Pathology specimens showed multiple endometriotic foci in the bowel with stricturing of terminal ileum and appendiceal intussusception. This likely resulted in subocclusive episodes and intestinal obstruction. This case highlights the difficulty in establishing a preoperative diagnosis of endometriosis. Small bowel endometriosis should, therefore, be considered in the differential diagnosis of women of childbearing age who present with symptoms of obstruction.
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Apêndice , Doenças do Colo/complicações , Endometriose/complicações , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Intussuscepção/complicações , Adulto , Colectomia , Doenças do Colo/patologia , Doenças do Colo/cirurgia , Constrição Patológica/complicações , Endometriose/patologia , Endometriose/cirurgia , Feminino , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , RadiografiaRESUMO
BACKGROUND: Data on laparoscopic bariatric surgery in the extremely obese are limited. Technical difficulties, in addition to the patients' severe weight-related co-morbidities, can compromise the safety of bariatric surgery in these patients. Our objectives were to assess the safety and feasibility of laparoscopic bariatric surgery in extremely obese patients and to compare the outcomes of different surgical approaches at a bariatric surgery center of excellence in an academic medical center. METHODS: We reviewed our prospectively collected database and identified all patients with a body mass index (BMI) of ≥ 70 kg/m(2) who had undergone bariatric surgery. The data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved. RESULTS: A total of 49 patients with a mean BMI of 80.7 kg/m(2) (range 70-125) underwent 61 bariatric procedures. Of the 49 patients, 26 underwent sleeve gastrectomy, 11 gastric bypass, and 12 underwent a 2-stage procedure (sleeve gastrectomy followed by gastric bypass). At a mean follow-up of 17.4 months, the average BMI had decreased to 60.9 kg/m(2) (36% excess weight loss). Overall, the patients who underwent a 2-stage procedure achieved greater percentage of excess weight loss (54.5%) than did those who underwent either single-stage sleeve gastrectomy or gastric bypass (25.4%, P = .002 and 43.8%, P = .519, respectively). Of the 61 cases, 60 (98.4%) were completed laparoscopically. The early complication rate was 16.4% overall; most were minor complications. The late complication rate was 14.8%. A single late mortality occurred in this series. CONCLUSION: Laparoscopic bariatric surgery can be performed safely on patients with a BMI of ≥ 70 kg/m(2). A staged approach might offer better weight loss results.
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Cirurgia Bariátrica/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Adulto , Índice de Massa Corporal , Conversão para Cirurgia Aberta , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The authors present the case of a 43-year-old gentleman who was admitted for an elective surgical removal of an eroded gastric band. The patient reported no medical concerns and other than a mild anaemia of haemoglobin of 10.6, his preoperative assessment was non-significant. Postoperatively, the patient spiked temperatures on multiple occasions. When a travel history was subsequently taken, the patient revealed he had returned from Nigeria the night before his elective surgery. The patient tested positive for Plasmodium falciparum malaria for which he was successfully managed with oral quinine and doxycycline, and recuperated well both from malaria and the surgery. P falciparum malaria is a medical emergency and increases the morbidity and mortality of anaesthesia and surgery. Travel histories are not currently routinely taken as part of the preoperative assessment for elective surgical admissions; the authors argue that it should become a mandatory part.
Assuntos
Malária Falciparum/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/parasitologia , Adulto , Procedimentos Cirúrgicos Eletivos , Humanos , Malária Falciparum/etiologia , Masculino , Nigéria , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , ViagemAssuntos
Infecções Bacterianas/etiologia , Colo Sigmoide/patologia , Divertículo do Colo/complicações , Fasciite Necrosante/etiologia , Coxa da Perna/patologia , Idoso , Infecções Bacterianas/diagnóstico por imagem , Divertículo do Colo/patologia , Fasciite Necrosante/diagnóstico por imagem , Fasciite Necrosante/patologia , Feminino , Humanos , Laparotomia , Pelve/diagnóstico por imagem , Pelve/patologia , Coxa da Perna/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: International smuggling of cocaine by internal concealment is a serious and growing problem. People who engage in this practice are commonly referred to as body packers or mules. The most serious risks associated with body packing include intestinal obstruction and death from cocaine intoxication. These patients were previously managed primarily by surgical retrieval. This was associated with significant mortality due to rupture of poorly constructed cocaine packages. More recently, conservative management using whole bowel irrigation with polyethylene-glycol (Klean-prep Norgine) has been shown to be safe for most patients. To date, however, a consistent approach for the management of these patients has not been established. METHODS: We retrospectively reviewed the case notes, prescription charts and radiological investigations of all body packers admitted to our unit between 2000 and 2005, concentrating on initial management, complications and outcome. RESULTS: We identified 61 patients for inclusion. Of these, 56 were managed conservatively with a selection of aperients and laxatives. Six patients were treated successfully for cocaine toxicity and 5 required surgical retrieval of cocaine packets. CONCLUSION: Our results confirm the safety of a conservative approach. Based on our experience and a review of the literature, we have devised a treatment protocol to reduce the risk of complications and the length of stay in hospital.
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Transtornos Relacionados ao Uso de Cocaína/etiologia , Transtornos Relacionados ao Uso de Cocaína/terapia , Cocaína/intoxicação , Crime , Corpos Estranhos/complicações , Adulto , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Estudos de Coortes , Overdose de Drogas , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Drogas Ilícitas/intoxicação , Laparotomia/métodos , Laxantes/uso terapêutico , Masculino , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Irrigação Terapêutica/métodos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Common femoral endarterectomy and/or profundoplasty are procedures commonly performed on patients with functional or critical limb ischaemia. CASE PRESENTATION: A 61-year-old Caucasian British man was referred to our unit with recent onset of severe left calf and thigh claudication and rest pain in his left foot. Magnetic resonance angiography revealed occlusive disease of the left common femoral artery, proximal superficial and profunda femoral arteries. These findings were confirmed intraoperatively and an endarterectomy was subsequently performed from the left common femoral onto the proximal superficial femoral artery and then onto the proximal profunda femoris artery. The arteriotomy was closed with a Dacron patch and its distal end was bisected into two to patch the profunda femoris and superficial femoral arteries. The patient made an uneventful recovery with a full clinical improvement of his left leg. CONCLUSION: A Dacron patch that was bisected distally to make a bifurcated patch for simultaneous patching of the profunda femoris artery and the superficial femoral artery was used to treat our patient's occlusions. This technique has not been previously described in the published literature and we have found it easy to do with little time added to conventional operation.
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Abscesso Abdominal/tratamento farmacológico , Acetilcisteína/administração & dosagem , Expectorantes/administração & dosagem , Pancreatite Alcoólica/tratamento farmacológico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Alcoólica/complicações , Pancreatite Alcoólica/cirurgia , Período Pós-OperatórioAssuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Gastrectomia , Excisão de Linfonodo , Linfocele/cirurgia , Complicações Pós-Operatórias/cirurgia , Anastomose Cirúrgica , Quilotórax/diagnóstico , Quilotórax/patologia , Quilotórax/cirurgia , Humanos , Linfocele/diagnóstico , Linfocele/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Reoperação , Sepse/diagnóstico , Sepse/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/cirurgia , Grampeadores Cirúrgicos , Técnicas de Sutura , Toracostomia , ToracotomiaRESUMO
Pacemaker migration is a rare, but important, complication of pacemaker insertion mainly documented in children. We report the case of a 60-year-old woman who was admitted with right iliac fossa pain thought to be caused by appendicitis. She was noted to have both an epicardial and endocardial pacemaker in situ. Imaging and laparoscopy revealed migration of the epicardial pacemaker to the right iliac fossa. We describe the possible mechanisms of pacemaker migration.