[Metabolic, clinical and body composition changes in Mexican adults undergoing bariatric surgery]. / Cambios metabólicos, clínicos y de composición corporal en adultos mexicanos sometidos a cirugía bariátrica.

BACKGROUND: morbid obesity is a major public health problem that is increasing. Currently, there are a limited number of studies carried out in the Mexican population that describe the effects of bariatric surgery. OBJECTIVE: to establish in people undergoing a bariatric procedure the metabolic and body composition difference before and after bariatric surgery. MATERIAL AND METHODS: an observational, analytical, and longitudinal study was carried out in 50 patients with morbid obesity who underwent laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB). Body composition and metabolic markers in blood were measured. Differences in the metabolic profile before and after surgery were analyzed in the entire study group and a subanalysis was performed by bariatric surgical technique, determining the percentage of remission of comorbidities. RESULTS: after the intervention, there is a significant decrease in all metabolic and body composition markers, except HDL cholesterol, which showed a tendency to increase without being significant. Women with LRYGB have a greater decrease in fat-free mass. LRYGB decreased the prevalence of fatty liver, gastroesophageal reflux, insulin resistance, and hypercholesterolemia more, while LSG decreased the prevalence of hypertension, osteoarthritis, hypothyroidism, and hypertriglyceridemia more. CONCLUSION: bariatric surgery induces metabolic changes that could contribute to improving comorbidities associated with obesity. In general, metabolic improvement is greater in LRYGB compared to LSG.

Gallbladder plication as a rare complication of endoscopic sleeve gastroplasty: A case report.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure used in the treatment of obesity, with a complication rate of less than 2% of cases. There have been only two reported cases worldwide of gallbladder injuries as a major complication of ESG. CASE SUMMARY: We present the case of a 34-year-old patient who developed a complication after ESG. The patient experienced epigastric and right hypochondrium pain 12 h after the procedure, and a positive Murphy's sign was identified on physical examination. Laboratory results showed a leukocyte count of 17 × 103/µL, and computed tomography indicated the presence of free fluid in the pelvic cavity and perihepatic recesses as well as a possible suture in the wall of the Hartmann's pouch toward the anterior surface of the stomach. A diagnostic laparoscopy was performed, revealing plication of the Hartmann's pouch wall to the anterior stomach wall. Laparoscopic cholecystectomy and lavage were carried out. The patient had a stable recovery and was discharged 72 h after surgery, tolerating oral intake. CONCLUSION: Gallbladder plication should be suspected if signs and symptoms consistent with acute cholecystitis occur after ESG.

Adipocyte Size and Leptin Receptor Expression in Human Subcutaneous Adipose Tissue After Roux-en-Y Gastric Bypass.

The molecular mechanisms implicated in pronounced weight loss and metabolic benefits after bariatric surgery are still unknown. Adipocyte phenotype and metabolism have not been entirely explored. However, some features of adipocyte function have been studied, such as adipocyte size and inflammation, which are both reduced after bariatric surgery. Adipocyte fat metabolism, which is partly regulated by leptin, is likely modified, since adipocyte area is decreased. Here, we show that leptin receptor expression is increased, while adipocyte size is decreased 8 months after Roux-en-Y gastric bypass. Thus, adipocyte function is possibly modified by improved leptin signaling after bariatric surgery.

Correlación de los hallazgos endoscópicos pre y postoperatorios en pacientes sometidos a cirugía bariátrica / Correlation of pre and postoperative endoscopic findings in patients subjected to bariatric surgery

Objetivo: Establecer una correlación de los hallazgos endoscópicos preoperatorios con los síntomas gastrointestinales y hallazgos endoscópicos en el seguimiento de los pacientes sometidos a algún tipo de cirugía bariátrica. Sede: Hospital General ''Dr. Manuel Gea González''. Tercer Nivel de Atención Médica. Diseño: Estudio retrospectivo, descriptivo, transversal y comparativo. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas y χ². Pacientes y método: Pacientes que se operaron en la clínica de obesidad, de junio 2006 a junio 2010, a los cuales se les realizó endoscopia preoperatoria con un seguimiento mínimo de un año. Se identificaron las patologías gastrointestinales con mayor incidencia, hallazgos histopatológicos y la correlación de la endoscopia postoperatoria en el seguimiento de pacientes que por sus síntomas requirieron control endoscópico. Resultados: De un total de 137 pacientes que cumplieron con los criterios de inclusión (111 mujeres, 26 hombres), con edad promedio de 36.41, IMC promedio de 42.04, la patología con mayor incidencia fue gastritis inespecífica no erosiva (45.25%), el resultado histopatológico más frecuente fue gastritis asociada a Helicobacter pylori (HP) (38.6%). A un seguimiento promedio de tres años (DE ± 1.31) a 35 pacientes (25.5%) se les realizó endoscopia de seguimiento por síntomas gastrointestinales; los hallazgos endoscópicos fueron: gastritis inespecífica no erosiva (54.28%), sin alteraciones (31.42%) y estenosis de anastomosis (14.7%). Conclusión: La endoscopia preoperatoria es de gran utilidad, ya que permite identificar patologías que se pueden asociar a otras complicaciones y tomar todas las medidas para prevenirlas.

Objective: To establish a correlation between the pre-operative endoscopic findings with the gastrointestinal syndrome and endoscopic findings during follow-up of patients subjected to bariatric surgery. Setting: General Hospital ''Dr. Manuel Gea González'' (third level health care center). Design: A retrospective, descriptive, cross-sectional, comparative study. Statistical analysis: Percentages as summary measures for qualitative variables and χ². Patients and method: Patients operated in the obesity clinic from June 2006 to June 2010, in whom a preoperative endoscopy was performed with a follow-up of at least 1 years. We identified the gastrointestinal pathologies with the highest incidence, histopathological findings, and the correlation with the postoperative endoscopy during the follow-up of patients, who, due to their symptoms, required endoscopic control. Results: In a total of 137 patients that complied with the inclusion criteria (111 women and 26 men), average age of 36.41 years, average BMI of 42.04, the pathology with the highest incidence was non-specific non-erosive gastritis (45.25%), the most frequent histopathological result was gastritis associated to Helicobacter pylori (HP) (38.6%). At an average follow-up of three years (SD ± 1.31), 35 patients (25.5%) were subjected to follow-up endoscopy due to gastrointestinal symptoms. Endoscopic findings were: non-specific, non-erosive gastritis (54.28%), without alterations (31.42%), and stenosis of the anastomoses (14.7%). Conclusion: Preoperative endoscopy is very useful as it allows identifying pathologies that can be associated to other complications and taking the necessary measures to prevent them.