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Introduction: This report aimed to analyze the outcomes of patients with obesity who were on a bariatric program during the SARS-Cov-2 pandemic outbreak and compare those who received surgery with the ones who were not operated on. Methods: This was a retrospective study between 2020 and 2021. Patients were divided into two groups: those who underwent surgery (O) and those who were not operated (NO). The evolution of the risk factors identified for severe COVID infection and death was studied (ASMBS criteria). For this study, a follow-up period of 12 months was initiated. Results: In the O group, 83 patients were included and 99 were in the NO group. In the O group, patients with body mass index (BMI) > 35 Kg/m2 before surgery resolved the condition in 73.5% (61) cases, and this was done in the first 30 days by 38 (45.7%). Type 2 diabetes mellitus remission was documented in 18 patients (85.7%) of the O group, and the mean time elapsed for remission was 102.2 days (P < .01). Hypertension remitted in 66.7% (20) of the patients in group O in 82.4 days (P < .01). The subgroup of patients with obesity and one high-risk associated condition (30.2%, 25) resolved both in 44% (11) cases and one in 48% (12) cases. In the group of patients with obesity and two high-risk associated conditions (15.6%, 13), 47% (6) patients resolved the three conditions, 38% (5) resolved two conditions, and 15% (2) resolved one condition. Among the NO group, no comorbidity resolutions were recorded (P < .01). Admission because of COVID infection was necessary for 7.1% of NO and 1.2% of O (P = .04). Conclusion: Bariatric metabolic surgery would not increase the risk of COVID infection or of suffering serious complications resulting from it. Patients undergoing bariatric metabolic surgery rapidly resolved high-risk comorbidities and had less need for hospitalization because of SARS-CoV-2 infection.
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Introduction: This report aimed to compare ventral extended vision extraperitoneal (ETEP) and preaponeurotic repair (REPA) techniques in terms of surgical procedure, outcomes, and patient evolution. Methods: This was a retrospective study performed at a tertiary care academic center between 2017 and 2022. All consecutive patients operated on for midline hernias and rectus diastasis using REPA and ETEP were included. Follow-up visits were at 15 days, 30 days, and 6 months postoperative. Age, sex, BMI, American Surgical Anesthesiologic Classification (ASA), surgical time, need for conversion to open surgery, time of stay, seroma, hematoma, surgical site infection (SSI), recurrence, and re-interventions were assessed. Results: For the present study, 148 patients were included. From them, 62 patients received the REPA procedure and 86 were operated on using the ETEP technique. REPA average time was 105 minutes (interquartile range [IR] 80-130), and ETEP average time was 120 minutes (RIC 95-285) (p = 0.03). Ambulatory procedures were 32.3% (n = 20) REPA and 20.9% (n = 18) ETEP (p = 0.23). In REPA, the mean time for drain extraction was 11.92 days and 8 days in ETEP (p < 0.001). Seroma incidence was identified in 40.3% (n = 25) of the REPA cases and 5.8% (n = 5) of the ETEP procedures (p = 0.001). In a multivariate analysis for seroma incidence REPA technique was associated with a significant risk of its incidence [odds ratio (OR) 16, 67 95% confidence interval ((CI95) 4.67-59.52), p < 0.001]. Conclusion: REPA and ETEP are safe and reproducible. Both approaches reported short hospitalization times and almost no major complications. We found a longer surgical time in ETEP and a higher incidence of seroma in REPA.
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Herniorrafia , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Herniorrafia/métodos , Hérnia Ventral/cirurgia , Duração da Cirurgia , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do TratamentoRESUMO
Introduction: An applicable and reproducible enhanced recovery protocol was developed and implemented to improve our outcomes in a third-world environment. Methods: We compared the results obtained prospectively. The group treated before the application of the enhanced recovery protocol was called usual care (UC) and included all bariatric surgeries operated on between 2014 and 2017. The new protocol was applied between 2017 and 2019 including all operated patients, and this group was called Fast Track (FT). The variables analyzed were the length of stay, readmissions, and complications recorded during the first 30 days. We also analyzed the milligrams of morphine used by each patient, and a cost analysis was performed. Results: During the study period, 816 patients were studied. Of these, 385 (47.2%) belonged to the UC group and 431 (52.8%) to the FT group. The mean hospital stay was 58.5 hours (UC) versus 40.3 hours (FT) (P = .0001). When comparing the global morbidity of both groups, we did not find significant differences (P = .47). There was also no statistically significant difference when comparing major complications (P = .79). No mortality was recorded. Morphine indication reported a statistically significant difference that favored FT. Costs were significantly higher in UC than in FT (P < .0001). Conclusions: We believe that the implementation of an enhanced recovery protocol in bariatric surgery is a reliable measure and can be implemented even in an underdevelopment environment enlarging the benefit for patients.
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OBJETIVO: Evaluar la reproducibilidad y la seguridad de un programa de cirugía colorrectal laparoscópica en dos centros de Sudamérica. MÉTODO: Se realizó un estudio analítico-descriptivo. Se revisaron retrospectivamente los registros clínicos de pacientes sometidos a cirugía videolaparoscópica colorrectal desde el año 2012 hasta el año 2018, en dos centros académicos de tercer nivel argentinos. Se analizaron datos demográficos, indicaciones y tiempos quirúrgicos, tasa de conversión, evolución posoperatoria, morbimortalidad y resecabilidad oncológica, y se comparó con el abordaje convencional. RESULTADOS: Se realizaron 505 cirugías. La edad media de los pacientes fue de 63.4 años y el 50.9% eran hombres. El tiempo operatorio medio fue de 175 minutos. La principal indicación fue cáncer de colon. La incidencia de conversión fue del 9.5%. El promedio de ganglios por pieza quirúrgica en patología neoplásica fue de 15.9. La morbilidad fue del 35.4%, en su mayoría complicaciones menores. La tasa de fístulas fue del 11.7%. La mortalidad a 30 días fue del 2.5%. CONCLUSIÓN: La cirugía colorrectal laparoscópica podría representar una opción segura y reproducible en un centro de tercer nivel de un país en desarrollo. OBJECTIVE: To evaluate the feasibility and safeness of a colorectal laparoscopic program in two centers form South America. METHOD: We retrospectively review the records of patients who underwent laparoscopic colorectal surgery from 2012 to 2018 in two tertiary care academic centers. Surgical indication, operative time, conversion rate, lymph nodes harvested, surgical margins and complications were analyzed. This results were then compared to the open approach. RESULTS: We collected data from 505 patients, mean age 63.4, 50.9% male. The most frequent indication was colon cancer, mean operative time was 175 minutes. Conversion rate was 9.5%, mean nodes harvested was 15.9 with free resection margins in every case. Morbidity was 35.4% at 30 days, most of them were minor complications. The leak rate was 11.7 %. The 30-day mortality was 2.5%. CONCLUSION: The laparoscopic approach for colorectal surgery might represent a safe and feasible option in an tertiary care hospital from a developing country.
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Neoplasias do Colo , Laparoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Atenção Terciária à SaúdeRESUMO
Solid pseudopapillary tumor of the pancreas is a rare entity, more frequent in women between the 2nd and 4th decades. The diagnosis is usually incidental and it can be reached by computed tomography or magnetic resonance imaging. Subsequent pathological confirmation is necessary for an adequate treatment. A retrospective study of six cases was carried out. All the patients were female, between 14 and 56 years of age, in which 50% the tumor were an incidental finding. We had three cases located in the head and three in the body of the pancreas. We performed three pancreaticoduodenectomies and three distal pancreatectomies with splenic preservation, without disease recurrence.
El tumor sólido-quístico de páncreas es poco frecuente y predomina en mujeres entre la segunda y la cuarta décadas de la vida. Los pacientes son generalmente asintomáticos. El diagnóstico se realiza por imágenes con tomografía o resonancia magnética, y con la posterior confirmación patológica para poder ofrecer un tratamiento adecuado. Presentamos una serie de seis casos. Todas las pacientes fueron de sexo femenino, de entre 14 y 56 años. El 50% fueron un hallazgo incidental. Tuvimos tres casos localizados en la cabeza y tres en el cuerpo del páncreas. Se realizaron tres duodenopancreatectomías cefálicas y tres pancreatectomías distales con preservación esplénica, con buena evolución y sin recidiva.
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Neoplasias Pancreáticas , Feminino , Humanos , Recidiva Local de Neoplasia , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estudos RetrospectivosRESUMO
El mielolipoma es un tumor benigno de baja incidencia cuya localización más frecuente son las glándulas suprarrenales. Histológicamente se caracteriza por células con precursores mieloides y eritroides mezcladas con tejido adiposo maduro. El diagnóstico en general es incidental en una prueba de imagen. Clínicamente cursa asintomático, aunque los de mayor tamaño tienen más riesgo de complicaciones como sangrado o efecto de masa. Los hallazgos incidentales < 4 cm se deben controlar con imágenes; los > 7 cm, o que generen síntomas, deben ser tratados de forma quirúrgica. Se reporta un caso de mielolipoma extrasuprarrenal en un paciente de 78 años.Myelolipoma is a relatively rare benign tumor which is most commonly located in the adrenal glands. Histologically is characterized by eritroid and myeloid precursor cells intermixed with mature adipose tissue. The diagnosis is generally incidental in abdominal imaging studies. Clinically most are asymptomatic, nevertheless larger tumors are at greater risk for complications such as hemorrhage or compression of surrounding structures. Incidental findings smaller than 4 cm should be followed-up by imaging. Tumors measuring more than 7 cm or those that are symptomatic a surgical approach is mandated. We present the case of a 78-year-old man with an extra-adrenal myelolipoma.
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Idoso , Humanos , MasculinoRESUMO
BACKGROUND: Laparoscopic colectomy (LC) presents similar short-term results and oncological outcomes to conventional colectomy (CC) in colon cancer. OBJECTIVES: Compare short-term and oncological outcomes at 3-year follow up between LC and CC. MATERIALS AND METHODS: Patients who underwent LC and CC for colon cancer between January 2010 and December 2017 were retrospectively analyzed. Short-term results and oncological outcomes were studied. RESULTS: Two hundred sixty-nine patients were included in the study. CC was performed in 37.5% and LC in 62.5%. LC presented shorter operative time (157 vs. 175 min, p = 0.01), shorter length of stay (8.4 vs. 10.5 days, p = 0.02), lees readmission (6% vs. 15%, p = 0.02), and lower morbidity (40% vs. 56%, p = 0.01). No differences were found for overall survival (OAS) (LC = 87.1% vs. CC = 82.8%, p = 0.28) and disease-free survival (DFS) (LC = 78.2% vs. CC = 75.3%, p = 0.47). Recurrence was observed in 37 patients (LC = 16.1% vs. CC = 18.3%, p = 0.53). No differences were found for local recurrence (LC = 6.5% vs. CC = 8.6%, p = 0.49) and distant recurrence (LC = 12.1% vs. CC = 16.1%, p = 0.3). Stage analysis showed no difference for recurrence, OAS, and DFS. CONCLUSIONS: LC is a safe procedure with short-term outcomes, OAS, DFS, and recurrence similar to CC. LC should be the initial indication in non-metastatic colon cancer in our population.
ANTECEDENTES: La colectomía laparoscópica (CL) presenta resultados a corto plazo y oncológicos similares a los de la colectomía convencional (CC) en cáncer de colon. OBJETIVO: Comparar los resultados a corto plazo y oncológicos a 3 años de seguimiento entre la CL y la CC. MATERIAL Y MÉTODOS: Pacientes intervenidos de CL y CC por cáncer de colon entre enero de 2010 y diciembre de 2017. Se estudiaron los resultados a corto plazo y oncológicos. RESULTADOS: Se incluyeron 269 pacientes (62.5% CL y 37.5% CC). La CL presentó menor tiempo quirúrgico (157 vs. 175 min; p = 0.01), menor estadía hospitalaria (8.4 vs. 10.5 días; p = 0.02), menor reinternación (6% vs. 15%; p = 0.02) y menor morbilidad (40 vs. 56%; p = 0.01). No se observan diferencias para sobrevida global (87.1% CL y 82.8% CC; p = 0.28) y sobrevida libre de enfermedad (78.2% CL y 75.3% CC; p = 0.47). Hubo recidiva en 37 pacientes (16.1% CL y 18.3% CC; p = 0.53). No se encontraron diferencias en recidiva local (6.5% CL y 8.6% CC; p = 0.49), a distancia (12.1% CL y 16.1% CC; p = 0.3), al dividir la recidiva, la sobrevida global y la sobrevida libre de enfermedad por estadios. CONCLUSIONES: La CL es un procedimiento seguro, con una sobrevida global, una sobrevida libre de enfermedad y una tasa de recidiva similares a las de la CC. La CL debería ser la indicación inicial en el cáncer de colon no metastásico en nuestra población.
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Adenocarcinoma/cirurgia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Colectomia/estatística & dados numéricos , Neoplasias do Colo/patologia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background: Accelerated recovery protocols in colorectal surgery have enhanced the perioperative cares optimizing recovery in this group of patients. A reduction in surgical stress and therefore early hospital discharge and lower morbidity is pursued, however, the literature offers few outcomes regarding its application in developing countries. Objective: to analyze short- and medium-term outcomes of the application of an accelerated recovery protocol in a terciary care hospital in Argentina. Methods: In the period between January 2015 and March 2017 patients were included prospectively and consecutively with indication of elective laparoscopic colorectal surgery and under strict follow-up according to the protocol created by the institution. Patients older than 80 years, ASA IV, emergency surgeries and conventional approach were excluded. We analyzed demographic data, diagnosis of surgery, type of intervention, hospital stay, complications, readmissions and reinterventions at 30 postoperative days. Results: Sixty-four patients with a mean age of 62 years were included. The mean hospitalization was 4.9 days, with 10.9% readmissions and 4.7% of reinterventions. We recorded 69% of the patients whit not complications at all and 5 major complications (8%) . Conclusion: Based on the adaptation of the international guidelines to our health reality, it is feasible to create an accelerated recovery protocol applicable in our country, with a low complication rate and early discharge.
Introducción: El desarrollo de los protocolos de recuperación acelerada en cirugía colorrectal ha revalorizado los cuidados que conforman la recuperación perioperatoria de los pacientes sometidos a cirugía. Se persigue una reducción del stress quirúrgico y por tanto alta precoz y menor morbilidad, sin embargo, la literatura aporta pocos resultados respecto a su aplicación en países en desarrollo. Objetivo: analizar los resultados a corto y mediano plazo de un protocolo de recuperación acelerada en un hospital de alta complejidad de nuestro medio. En el periodo comprendido entre enero 2015 y marzo 2017 se incluyeron pacientes de manera prospectiva y consecutiva con indicación deAñadir colaborador/a cirugía colorrectal laparocopica electiva y bajo estricto seguimiento según protocolo creado por la institución. Fueron excluidos pacientes mayores de 80 años, ASA IV, cirugías de urgencia y abordaje convencional. Se analizaron datos demográficos indicación de cirugía, tipo de intervención, estadía hospitalaria en días, complicaciones, readmisiones y reintervenciones a los 30 días de postoperatorio. Resultados: Fueron incluidos 64 pacientes con una edad media de 62 años. El promedio de internación en días fue de 4,9, con 10,9% de reinternaciones y 4,7% de reintervenciones. El 69% de los pacientes no presento complicaciones, registrándose 5 complicaciones mayores (8%). Conclusión: A partir de la adecuación de los lineamientos internacionales a nuestra realidad sanitaria, es factible la creación de un protocolo de recuperación acelerada aplicable en nuestro medio, con baja tasa de complicaciones y alta precoz.
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Cirurgia Colorretal/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de TempoRESUMO
BACKGROUND: The association between gastroesophageal reflux disease (GERD) and obesity is clearly defined. The incidence of erosive esophagitis (EE) and Barrett's esophagus (BE) are as high as 26 and 6%, respectively. Gastric bypass (GBP) is considered the gold standard for obese patients with GERD. Evidence about the impact of GBP on EE and BE is not yet clear but more inspiring every day. METHODS: Obese patients operated by GBP with EE or BE were included for this study. Demographics, BMI, %EWL, and the evolution of EE and BE with pre and postoperative upper endoscopy were analyzed. RESULTS: In this study, 64 patients were included, 55 with EE and 9 with BE. The preoperative BMI was 44.29 km/m2 ± 3.5 and the %EWL was 78.5 ± 5.8 in the first year postoperative. Preoperatively, EE was distributed as follows: A: 54.5% (30), B: 34.5% (19), C: 9% (5), D: 2% (1). BE findings were the following: short segment (SSBE): 45% (4) and long segment (LSBE): 55% (5). Postoperatively, 80% of the patients with EE resolved their condition, 11% improved, 7% had no changes, and 2% worsened. From the patients with SSBE, 75% resolved their condition and 40% with LSBE resolved their condition after 24 months and no patient progressed to dysplasia. CONCLUSION: Patients with EE had a statistically significant resolution after GBP. BE was improved or even resolved in many patients without acquiring significance but also without progression. Long-term surveillance data is necessary to define the certain evolution of EE and BE after GBP.
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Esôfago de Barrett , Esofagite , Derivação Gástrica , Obesidade Mórbida , Esôfago de Barrett/cirurgia , Humanos , Obesidade Mórbida/cirurgiaRESUMO
BACKGROUND: Erosive esophagitis (EE) is related to esophageal mucosal damage caused by GERD and is implicated in the development of Barret´s esophagus and adenocarcinoma, which incidence is rising in association with obesity. It is known that the correlation between symptoms and endoscopic findings is relatively poor, with a predictive value of only 40%. The objective of this study is to report the incidence of EE 1 year after sleeve gastrectomy (SG) and gastric bypass (GBP) in consecutive patients in order to obtain an objective parameter of the impact of the two most popular bariatric procedures on esophageal mucosa. METHODS: A retrospective review of a prospective database including every primary GBP and SG consecutive cases performed between January 2014 and December 2016. Esophagitis evolution was compared between patients with adequate weight loss versus those with inadequate weight loss. The comparison of baseline and 1-year EE, BMI, %EWL, and %TWL was made by using the Chi square test for categorical variables and Student "t" test for continuous samples. RESULTS: Two hundred and twenty-seven patients were included. GBP was performed to 35.2% (n = 80) and SG to 64.8% (n = 147). Pre- and postoperatively EE evolution in GBP decreased from 54 to 26.2% (p = 0.002) and in SG increased from 8.2 to 30% (p = 0.04) Barret´s esophagus in GBP decreased from 7.5 to 5% (p = 0.001). No statistical difference was observed when we compared the evolution of EE in patients with adequate or inadequate weight loss in both groups. CONCLUSIONS: The incidence of EE 1 year after SG is greater than GBP. Moreover, not only GBP seems to improve this condition, but also SG tends to worsen EE. These results are to be associated with GERD disease.