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Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.

Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.

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The term Choledocholithiasis refers to the presence of biliary stones in the extrahepatic bile ducts, which are found in 5 to 10% of patients undergoing cholecystectomy for gallstones. Nowadays, with the adoption of the laparoscopic cholecystectomy(LC) as a standard, multiple minimally invasive treatment options for bile duct stones are feasible, with no consensus to date on the procedure of choice. The two stage endoscopic techniques involve the use of Endoscopic Retrograde Cholangiopancreatography(ERCP) before or after performing a LC, which has the main advantage of separating the bile duct procedure from the LC. However, the need for two separate anesthesia times, the possibility of blank or failed ERCP, and the chance for calculi migration between procedures increase the length of hospital stay and associated costs. The single stage procedures include the Laparoscopic Bile Duct Exploration (LBDE), and more recently, the performance of a laparoscopy guided intraoperative ERCP(Rendez Vous). The LBDE, when performed by an experienced surgical team, is an effective and safe technique. Nonetheless, it is considered a technically demanding procedure, whose results cannot be extrapolated to the general surgical community. Recently, the Rendez Vous has become a treatment alternative that simplifies both the surgical and the endoscopic procedures, decreases morbidity, and requires a single anesthesia time. On the downside, Rendez Vous technique involves complex operating room (OR) logistics, requiring both a trained surgical and endoscopic team at the same time. (AU)

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Background: Advanced gallbladder cancer has a high mortality. Therefore, this tumor should be diagnosed and treated in early stages. Aim: To analyze the survival rates of patients with an early gallbladder cancer. Material and Methods: Retrospective analysis of medical records of patients with early gallbladder cancer diagnosed until 2003. From that date, all patients with gastrointestinal cancer were registered in a prospective record. Patients with early gallbladder cancer defined as Tis (Carcinoma in situ), T1A (Tumor invades lamina propia) and T1B (Tumor invades muscular layer), were included in this analysis. Results: Eighty patients aged 31 to 87 years (74 percent women) were analyzed. The diagnosis was made during surgery in two patients and during the pathological study in the rest. All 24 patients with Tis tumors were alive after 96 months of follow up. Only one of 16 patients with T1A tumors died of unknown causes. Among the 40 patients with T1B tumors, 24 were re-operated and survival was over 90 percent. Conclusions: This group of patients with early gallbladder cancer had a five years survival over 90 percent. In patients with muscle involvement does not seem necessary to extend the surgery.

Introducción: Dada la elevada mortalidad del cáncer vesicular en etapas avanzadas, lo ideal es diagnosticarlo y tratarlo en una etapa temprana de la enfermedad. Objetivo: Analizar la sobrevida de pacientes con carcinoma temprano de la vesícula biliar y el impacto de una eventual re-operación. Material y Método: Se incluyen en el estudio 80 pacientes con cáncer temprano, siendo la mayoría (65 pacientes) parte de un estudio prospectivo desde mayo de 2004 hasta febrero de 2013. Fueron divididos en 3 grupos: a) carcinoma in situ T1s; b) carcinoma mucoso T1a; c) carcinoma muscular I1b. Seguimiento en el 100 por ciento de los casos. Resultados: El diagnóstico de carcinoma temprano se hizo en 2 pacientes durante la cirugía, en el resto fue un hallazgo del estudio histo-patológico. Los 24 pacientes con carcinoma in situ estaban vivos a los 96 meses de seguimiento. De los 16 pacientes con carcinoma mucoso, sólo 1 (6 por ciento) falleció sin conocerse la causa. Entre los 40 pacientes con cáncer muscular, hubo 24 que no se reoperaron y 16 reoperados. Los resultados anatomo patológicos fueron similares y la sobrevida de ambos grupos fue superior al 90 por ciento. Conclusión: En pacientes con carcinoma de la vesícula biliar in situ y hasta la mucosa, la colecistectomía logra sobrevida mayor del 95 por ciento a largo plazo. En pacientes con carcinoma muscular, ésta se acompaña de una sobrevida mayor a 90 por ciento a 5 años y no parece justificarse ampliar la cirugía.

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Introduction: The benefits of liver metastasis excision in gastric cancer are not clearly demonstrated. Aim: To communicate preliminary experience concerning excision of hepatic metastasis and simultaneously performing gastrectomy in patients with gastric cancer. Material and Methods: In a prospective study, 3 of 397 patients treated for gastric cancer that met certain criteria, underwent hepatic metastasis excision. Results: Three patients with gastric cancer and liver metastases. A 58 years old male in whom one liver metastasis was excised and two were treated with radiofrequency ablation, who is alive after 40 months of follow up. A 26 years old female subjected to the excision of one liver metastasis. Eight months later, the lesion relapsed and a right hepatectomy was carried out. The patient died after 19 months of follow up. A 56 years old female subjected to the excision of one liver metastasis, who died 9 months later...

Introducción: En pacientes con cáncer gástrico y metástasis hepáticas sincrónicas, la posibilidad de tener sólo 1 a 3 metástasis es cerca de 2 por ciento, ya que, en la inmensa mayoría, corresponde a una enfermedad sistémica. Objetivos: Comunicar una experiencia preliminar que se refiere a realizar metastasectomía hepática simultánea a la gastrectomía en pacientes con cáncer gástrico. Material y Método: En estudio prospectivo, 3 de 397 pacientes tratados por cáncer gástrico que cumplían algunos criterios, fueron sometidos además a metatasectomía hepática. Resultados: Se incluye a 3 pacientes, 2 con sólo metástasis hepáticas y 1 paciente con metástasis hepáticas y peritoneales, en los que se realizó metastasectomía. La evolución postoperatoria en los 3 fue sin incidentes. En 2 pacientes la metástasis era única y en otro se realizó además radiofrecuencia de 3 pequeñas metástasis, siendo el único paciente vivo a 40 meses; los otros fallecen a los 19 y 9 meses...

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Background: Laparoscopic cholecystectomy is nowadays the standard surgical treatment for cholelithiasis. Aim: To determine surgical mortality of laparoscopic cholecystectomy as compared with the open procedure. Material and Methods: Review of medical records of all patients subjected to open or laparosco-pic surgery in a surgical service of a clinical hospital, in a period of 20 years. Results: The records of 26.441 patients were reviewed. The figures for overall, open and laparoscopic surgery mortality were 0.16, 0.39 and 0.07 percent respectively. Only two of the 43 deceased patients, died as a direct complication of the surgical procedure. In the rest, the causes of mortality were underlying severe medical conditions. Conclusions: La-paroscopic cholecystectomy has a very low mortality that depends mostly on underlying medical conditions and advanced age.

Introducción: La colecistectomía laparoscópica se ha convertido en el gold standard de la cirugía biliar y se emplea masivamente en todo Chile. Objetivos: Determinar la mortalidad operatoria en 4 períodos de 5 años de la colecistectomía laparoscópica comparada con la colecistectomía tradicional. Material y Método: Se incluyó a todos los pacientes sometidos a colecistectomía, ya sea laparotómica o laparoscópica, entre enero de 1991 y diciembre de 2010 (20 años). Se analizó las causas de mortalidad, el grupo etario en que ocurrió y el tipo de abordaje quirúrgico. Resultados: Se operaron un total de 26.441 pacientes, con un promedio de 1.322 operados por año. La mortalidad global de la colecistectomía laparotómica fue de 0,39 por ciento y de la laparoscópica de 0,07 por ciento, con un promedio general de 0,16 por ciento. Las principales causas de mortalidad fueron patologías médica severas. Sólo 2 pacientes de los 43 fallecidos (5 por ciento) tuvieron una complicación directamente derivada de la cirugía como causa de la mortalidad. Conclusiones: La colecistectomía laparoscópica es una operación de muy baja mortalidad (7 de 10.000 operados). Esta complicación se presenta principalmente en pacientes con grave patología biliar, de edad avanzada y con múltiples complicaciones médicas.

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Introduction: Bariatric surgery is effective and safe in treating obese patients with BMI > 40, however, higher preoperative weight could increases morbidity and mortality. Aim: To describe and compare the perioperative and mid term outcomes between hiperobese and morbidly obese patients submitted to gastric bypass. Material and Method: A prospective study of hiperobese patients submitted to gastric bypass over the past 10 years. We analyzed clinical characteristics, perioperative morbimortality and resolution of comor-bidities. The results were compared with a group of morbidly obese patients matched by age and sex. Results: 146 hiperobese were operated and compared with 165 morbidly obese patients. 66.8 percent were female and the average age of the total group was 39.9 +/- 12.4 years, with no significant differences between groups by sex and age. The average BMI was 53 and 44.4 respectively. 21.5 percent had diabetes mellitus 2, 39.5 percent hypertension, 31 percent dislipidemia and 8.4 percent osteoarthritis, with no significant differences between groups except for a higher prevalence of dyslipidemia in the morbidly obeses (p = 0.001). 10.4 percent had surgical complications during the postoperative period, with no differences between both groups (p = 0.24). One year later all patients had a significant decrease in weight, however, hiperobeses showed a more pronounced decrease (p = 0.001). The fasting glucose, cholesterol and triglycerides levels also showed a significant decrease without reaching differences between the groups. Conclusions: The gastric bypass is effective in achieving weight loss and resolution of comorbidities in morbidly obese as well as hiperobese patients, with no significant differences in surgical complications and mortality.

Introducción: La cirugía bariátrica es efectiva y segura en el tratamiento de obesos con IMC > 40, sin embargo, a mayor peso preoperatorio podría aumentar la morbimortalidad. Objetivo: Describir y comparar los resultados perioperatorios y a mediano plazo entre hiperobesos y obesos mórbidos sometidos a bypass gástrico. Material y Método: Estudio prospectivo de pacientes hiperobesos operados de bypass gástrico los últimos 10 años. Se analizaron características clínicas, morbimortalidad perioperatoria y resolución de comorbilidades. Se compararon los resultados con un grupo de obesos mórbidos pareados por edad y sexo. Resultados: Se operaron 146 hiperobesos, que fueron comparados con 165 obesos mórbidos. El 66,8 por ciento fueron mujeres y el promedio de edad fue 39,9 +/- 12,4 años, no encontramos diferencias significativas entre ambos grupos por sexo y edad. El IMC promedio fue 53 y 44,4 respectivamente. El 21,5 por ciento tenía diabetes mellitus 2, el 39,5 por ciento hipertensión arterial, el 31 por ciento dislipidemia y el 8,4 por ciento artrosis, sin encontrar diferencias significativas, a excepción de una mayor prevalencia de dislipidemia en los obesos mórbidos (p = 0,001). Un 10,4 por ciento presentó complicaciones quirúrgicas durante el postoperatorio, no existiendo diferencias entre ambos grupos (p = 0,24). Al año todos los pacientes presentaban un descenso significativo del peso, sin embargo, los hiperobesos presentaban un descenso más acentuado (p = 0,001). Los niveles de glicemia en ayunas, colesterol y triglicéridos también presentaron un descenso significativo sin lograr diferencias entre ambos grupos. Conclusiones: El bypass gástrico es efectivo en la baja de peso y resolución de comorbilidades tanto en obesos mórbidos como hiperobesos, sin presentar diferencias significativas en las complicaciones quirúrgicas y mortalidad.

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Background: Surgery for gastric cancer may have high rates of complications and mortality. Aim: To analyze operative mortality of total and subtotal gastrectomy in the period 2004-2010. Material and Methods: Prospective study 345 patients with gastric cancer, mean age 62 years, 64 percent males, subjected to a total or subtotal R0, R1 or R2 gastrectomy. All patients were assessed in the postoperative period and all complications were recorded. Results: Total and subtotal gastrectomies were performed in 224 and 69 patients respectively. Postoperative complications consisted in anastomotic leaks, duodenal stump leaks, hemoperitoneum, pulmonary infections and intestinal obstruction. Mortality of total gastrectomy R1 or R2 was 2.1 percent whereas palliative gastrectomy, to improve quality of life, had 15 percent mortality. Subtotal gastrectomy had 1.4 percent mortality. Conclusions: There has been a reduction in operative mortality of gastrectomy for gastric cancer, however the rate of complications has not changed.

Objetivos: Analizar la morbilidad y mortalidad operatoria de la gastrectomía total y subtotal en el período 2004-2010 y compararlo con las cifras publicadas en los últimos 40 años. Material y Método: El presente estudio prospectivo incluye a los pacientes sometidos a gastrectomía total o subtotal R0 R1 o R2 entre mayo de 2004 y diciembre de 2010. Se evaluaron la morbilidad y la mortalidad postoperatoria. Resultados: La gastrectomía total se realizó en 244 pacientes y la subtotal en 69 pacientes. La morbilidad postoperatoria correspondió a filtración de la anastomosis, filtración del muñón duodenal, hemoperitoneo, infecciones pulmonares y obstrucción intestinal. La mortalidad de la gastrectomía total R0 o R1 fue de 2,1 por ciento, mientras que la gastrectomía de aseo tuvo un 15 por ciento de mortalidad. La gastrectomía subtotal presentó una mortalidad de 1,4 por ciento. Conclusiones: Como consecuencia de todos los adelantos técnicos y materiales en la cirugía del cáncer gástrico, que significó una baja muy importante en la mortalidad operatoria, las complicaciones postoperatorias no han variado estos últimos 40 años.

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The post-transplant lymphoproliferative disorder (PTLD) corresponds to a heterogeneous group of lymphoproliferative diseases that develop in solid organ and bone marrow transplant recipients. It occurs in 3-10 percent of patients receiving solid organ transplants, mostly children. It is called early PTLD if it occurs in the first year after transplantation, if it affects B-cell lymphocytes and is associated with infection by Epstein-Barr virus. Late presentation occurs after the first year of transplantation and its pathogenesis is less clear. Clinical manifestations vary from a benign mononucleosis-like clinical setting to high-grade tumors with high mortality (40-60 percent). Treatment depends on the extent of the disease, including reduction of immunosuppressive therapy, radiotherapy, surgery and, more recently, the use of anti-CD20 monoclonal antibody. We report the case of a 67 year-old woman presenting with PTLD on the eighth month after receiving a liver graft.

La enfermedad linfoproliferativa difusa postrasplante (ELDP), corresponde a un grupo heterogéneo de desórdenes linfoproliferativos que se desarrollan en receptores de órganos sólidos y médula ósea. Ocurre en 3 a 10 por ciento de los pacientes receptores de órganos sólidos, fundamentalmente pediátricos. Se denomina ELDP precoz si se presenta en el primer año posterior al trasplante, afecta a los linfocitos de estirpe B y se asocia a la infección por virus Epstein-Barr. La presentación tardía ocurre luego del primer año de trasplante y su etiopatogenia es menos clara. Las manifestaciones clínicas varían desde un cuadro benigno similar a la mononucleosis a neoplasias de alto grade, con elevada mortalidad (40-60 por ciento). El tratamiento dependerá de la extensión de la enfermedad, incluyendo reducción del tratamiento inmunosupresor, radioterapia, cirugía y más recientemente el uso de anticuerpos monoclonales anti CD20. Presentamos el caso clínico de una mujer de 67 años, que al octavo mes de recibir un injerto hepático presenta ELDP.

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Los cultivos de hepatocitos entregan un valioso acercamiento al estudio de las funciones metabólicas específicas del hígado, evaluación de citotoxicidad. No existen líneas humanas inmortales con función normal. La inmortalización de hepatocitos humanos con el método UCHT1(medio de cultivo condicionado por células tumorales de tiroides) permitirá prolongar la sobrevida y función de estos, siendo útil para evaluar funcionalidad y citotoxicidad. Objetivo: Optimizar el cultivo de hepatocitos humanos. Metodología: En cultivos primarios de hepatocitos humanos, se agregó medio UCHT1 cultivando en superficies de colágeno, polilisina, gelatina y matrigel. Como control positivo, se utilizó línea Gherschenson (GER) para evaluar curva de crecimiento y producción de Glucógeno (PAS). Se evaluó citotoxicidad (LIVE/DEAD) en hepatocitos GER expuestos a Metotrexato (10, 100 y 1000 mM) a 24, 48 y 72 hrs. Resultados: Se realizó 3 cultivos primarios. Fue efectiva la utilización de Polilisina y Colágeno. Duración 8 meses. No se ha realizado la curva de crecimiento, ni evaluación de funcionalidad en hepatocitos humanos. La línea GER tiene un crecimiento exponencial (tiempo duplicación: 36 hrs). Se observó producción de glucógeno en condiciones de diferenciación hasta 120 hrs. La citotoxicidad por Metotrexato tiene una curva dosis dependiente, significativa en todas las concentraciones (p<0,001) (CL50 a 1000 mM a 24 hrs). Conclusiones: Se logró establecer una línea primaria de hepatocitos humanos. La polilisina y el colágeno han optimizado el establecimiento de cultivos primarios. El método PAS permitió evaluar producción de glucógeno (diferenciación). Los valores de citotoxicidad demostraron un efecto dosis dependiente en las condiciones experimentales. Logrando estandarizar el método para evaluación futura de líneas celulares humanas.

Background: Hepatocyte cultures are a valuable tool to study specific metabolic liver functions and cytoxicity. Human hepatocyte cell lines with normal function do not exist. Immortalization of human hepatocytes with a rat thyroid cell line (UCHT1) allows long-term survival and function of these cells, becoming useful to evaluate functionality and cytotoxicity. Aim: To optimize long-term culture of human hepatocytes. Material and Methods: UCHT1 media was added to primary cultures of human hepatocytes, seeding in collagen, gelatin, matrigel and polilisine surfaces. Gherschenson cell line (GER) was used as a positive control to evaluate the growth curve and Glycogen production (PAS). Cytotoxicity was evaluated (LIVE/ DEAD) in GER hepatocytes exposed to Metotrexate (10, 100 and 1000 µM) 24, 48 and 72 hrs. Results: Three primary cultures were made. The use of Polilisine and Collagen was effective. Cultures were kept for 8 months. Growth curves or evaluation of functionality in human hepatocytes, were not carried out. GER cell line had an exponential growth (duplication time: 36 hrs). Production of glycogen in differentiation conditions was observed up to 120 hrs. Cytotoxicity by Metotrexate had a dose dependent curve with a 50% lethal dose calculated as 1000 µM at 24 hrs. Conclusions: A primary line of human hepatocytes was obtained. Polilisine and collagen optimized the establishment of primary cultures. PAS method allowed the evaluation of glycogen production (differentiation). Cytotoxicity demonstrated a dose dependent effect in experimental conditions.

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BACKGROUND: Non alcoholic fatty liver disease (NAFLD) is associated to diabetes mellitus, obesity, disturbances in serum lipid levels, insulin resistance and metabolic syndrome. AIM: To assess glucose tolerance and the presence of metabolic syndrome among patients with biopsy proven NAFLD. PATIENTS AND METHODS: Serum lipid levels, hepatic function tests were measured and an oral glucose tolerance test was performed in 46 patients (mean age 45+/-12 years, 36 females) without history of diabetes mellitus and with steatosis in a liver biopsy. RESULTS: Mean body mass index of the sample was 37+/-12 kg/m2. Seventeen percent had pure steatosis, 78% had steatohepatitis with or without fibrosis and 50% had fibrosis in the liver biopsy. Glucose intolerance and diabetes was found in 57% and 15% of cases, respectively. The presence of steatohepatitis was higher in diabetics, compared with subjects with glucose intolerance or a normal glucose response (43, 38 and 8%, respectively, p < 0.0001). Ninety three percent had a metabolic syndrome and the proportion of biopsies with fibrosis was higher among subjects with more than three diagnostic criteria for metabolic syndrome compared with those with three or less criteria (59 and 46%, respectively, p < 0.05). CONCLUSIONS: Glucose intolerance, diabetes and metabolic syndrome are common among patients with NAFLD, even when they are not obese.

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BACKGROUND: Bariatric surgery is a complex procedure not exempt of complications. AIM: To assess mortality and complications of excisional gastric bypass among morbidly obese subjects. MATERIAL AND METHODS: Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered. RESULTS: Mean body mass index (BMI) of the subjects was 43.7 kg/m2. One hundred sixty two patients had a BMI between 35 and 39.9 kg/m2, 419 had a BMI between 40 and 49.9 kg/m2 and 103 had a BMI over 50 kg/m2. Two patients with a BMI of 52 and 56 kg/m2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year. CONCLUSIONS: Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients.

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Background: Non alcoholic fatty liver disease (NAFLD) is associated to diabetes mellitus, obesity, disturbances in serum lipid levels, insulin resistance and metabolic syndrome. Aim: To assess glucose tolerance and the presence of metabolic syndrome among patients with biopsy proven NAFLD. Patients and methods: Serum lipid levels, hepatic function tests were measured and an oral glucose tolerance test was performed in 46 patients (mean age 45±12 years, 36 females) without history of diabetes mellitus and with steatosis in a liver biopsy. Results: Mean body mass index of the sample was 37±12 kg/m². Seventeen percent had pure steatosis, 78 percent had steatohepatitis with or without fibrosis and 50 percent had fibrosis in the liver biopsy. Glucose intolerance and diabetes was found in 57 percent and 15 percent of cases, respectively. The presence of steatohepatitis was higher in diabetics, compared with subjects with glucose intolerance or a normal glucose response (43, 38 and 8 percent, respectively, p <0.0001). Ninety three percent had a metabolic syndrome and the proportion of biopsies with fibrosis was higher among subjects with more than three diagnostic criteria for metabolic syndrome compared with those with three or less criteria (59 and 46 percent, respectively, p <0.05). Conclusions: Glucose intolerance, diabetes and metabolic syndrome are common among patients with NAFLD, even when they are not obese.

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Background: Bariatric surgery is a complex procedure not exempt of complications. Aim: To assess mortality and complications of excisional gastric bypass among morbidly obese subjects. Material and methods: Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered. Results: Mean body mass index (BMI) of the subjects was 43.7 kg/m2. One hundred sixty two patients had a BMI between 35 and 39.9 kg/m2, 419 had a BMI between 40 and 49.9 kg/m2 and 103 had a BMI over 50 kg/m2. Two patients with a BMI of 52 and 56 kg/m2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year. Conclusions: Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients.

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BACKGROUND: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. AIM: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. MATERIAL AND METHODS: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). RESULTS: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. CONCLUSIONS: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change.

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Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Material and methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change.

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Introducción: La obesidad severa y mórbida ha aumentado en forma muy importante en Chile durante la última década. Objetivo: Evaluar los resultados del bypass gástrico con gastrectomía en cuanto al riesgo quirúrgico y los resultados de perdida de peso a 20 meses después de la cirugía. Material y Método: Es un estudio prospectivo descriptivo que incluye 286 pacientes consecutivos operados en un período de casi 4 años. Todos fueron sometidos a un bypass gástrico con asa en Y-de-Roux de 125 a 150 cm, resecando segmento distal excluido del estomago. Se realizó un seguimiento promedio de 20 meses, determinando la baja de peso, el índice de masa corporal (IMC) antes y después de la cirugía y la perdida del exceso de peso preoperatorio. Resultados: El grupo comprendió 233 mujeres y 51 hombres con una edad promedio de 39,9 años. Hubo 62 por ciento de los pacientes con IMC entre 40 y 49, 23 por ciento entre 35 y 39 y 11 por ciento con un IMC sobre 50 Kg/m². Se controló a todos los pacientes por 20 meses promedio, apreciando una significativa baja de peso y del IMC en todos los grupos. La baja del exceso de peso preoperatorio fue de 71 por ciento. Conclusiones: El bypass gástrico con gastrectomía puede ser una alternativa quirúrgica para pacientes con obesidad mórbida, especialmente en países con alta prevalencia de patología gastroduodenal.

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There is controversy in some aspects of the surgical treatment of non-mucosal gallbladder carcinoma. An accurate staging based on T (wall) involvement is crucial, otherwise understanding may yield falsely pessimistic results. The decision about the type of resection to be performed should be based on patient status (age, performance, comorbidities, etc) and tumor characteristics (histological type, vascular, neural or lymphatic spread, cell differentiation, tumor involvement of surgical margins in cystic duct, etc). For muscular (T1b) involvement, there is a great controversy about performing a simple cholecystectomy or en-block radical resection. For T2 there is consensus that an en-block radical surgery including liver resection (IVb - V) and lymphonodal clearance should be performed, since this approach has a great impact in survival. The role of surgical excision for tumors with serosal or liver involvement is controversial, due to the poor survival of these patients. However we have observed a 13% actuarial survival at 5 years, in this subset of patients.

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