Conversion to Roux-en-Y gastric bypass surgery through a robotic-assisted hybrid technique after failed sleeve gastrectomy: Short-term results. / Conversión por técnica híbrida robótica a bypass gástrico en Y de Roux posterior a falla de manga gástrica: resultados a corto plazo.

INTRODUCTION AND AIMS: Laparoscopic sleeve gastrectomy (LSG) is the most widely performed bariatric surgery worldwide but complications and failed procedures are on the rise. AIMS: To determine the reasons for failed LSGs and report the results of conversion to gastric bypass surgery, comparing the outcomes with those of primary gastric bypass surgery. MATERIALS AND METHODS: Patients with failed LSG that underwent conversion to gastric bypass surgery through a robotic-assisted and laparoscopic (hybrid) technique were evaluated. Outcomes and follow-up related to weight loss failure (WLF) were compared with those in patients that underwent primary laparoscopic gastric bypass (pLGB) surgery. RESULTS: Revisional surgery was performed on 13 patients due to WLF, on 3 patients because of refractory gastroesophageal reflux disease (GERD), and on 2 patients due to gastric stricture. There were no differences between the preoperative characteristics of the patients with WLF before undergoing conversion to gastric bypass and the patients that underwent pLGB surgery. At postoperative month 36, the percentage of excess weight loss was greater in the patients that underwent pLGB surgery, than in those with WLF that underwent conversion to gastric bypass (69.17±23.73 vs. 54.17±12.48, respectively; P<0.05). Refractory GERD, symptoms due to gastric stricture, and comorbidities all improved after the revisional surgery. CONCLUSION: Revisional surgery resulted in acceptable weight loss at 36 months of follow-up and favored comorbidity remission. In addition, it resolved symptoms of refractory GERD and gastric stricture.

[Toxic shock. Presentation of an obstetrical case]. / Choque tóxico. Presentación de un caso obstétrico.

The case of a 22 years old patient, primigravida, who underwent cesarean for acute fetal distress, and who presented with, at the second day of puerperium, puerperal infection, with clinical picture of shock at the third day, is presented. The clinical picture was preceded by skin rash which became a pyoderma, and ended up as desquamation; there were several alterations: hepatic, renal, hematological (disseminated intravascular coagulation) and digestive (gastroenteritis); and Staphylococcus aureus (coagulase positive) was isolated from the skin, lochia, coproculture; and they were negative to this microorganism the ones from blood, urine and pharynx. The patient received general care for her shock, steroids, blood and fresh plasma and antimicrobial agents (dicloxacillin, cefoperazone and netilmicin). Evolution was favourable, and was discharged at the eleventh day of puerperium in good conditions. A brief summary of the bibliography about this condition, and its very low incidence in our country, is pointed out, as this report is the second one in Latin American literature.