RESUMEN
Delayed gastric emptying (DGE) is common after an Ivor Lewis gastro-esophagectomy (ILGO). The risk of a dilated conduit is the much-feared anastomotic leak. Therefore, prompt management of DGE is required. However, the pathophysiology of DGE is unclear. We proposed that post-ILGO patients with/without DGE have different gut hormone profiles (GHP). Consecutive patients undergoing an ILGO from 1 December 2017 to 31 November 2019 were recruited. Blood sampling was conducted on either day 4, 5, or 6 with baseline sample taken prior to a 193-kcal meal and after every 30 minutes for 2 hours. If patients received pyloric dilatation, a repeat profile was performed post-dilatation and were designated as had DGE. Analyses were conducted on the following groups: patient without dilatation (non-dilated) versus dilatation (dilated); and pre-dilatation versus post-dilatation. Gut hormone profiles analyzed were glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY) using radioimmunoassay. Of 65 patients, 24 (36.9%) had dilatation and 41 (63.1%) did not. For the non-dilated and dilated groups, there were no differences in day 4, 5, or 6 GLP-1 (P = 0.499) (95% confidence interval for non-dilated [2822.64, 4416.40] and dilated [2519.91, 3162.32]). However, PYY levels were raised in the non-dilated group (P = 0.021) (95% confidence interval for non-dilated [1620.38, 3005.75] and dilated [821.53, 1606.18]). Additionally, after pyloric dilatation, paired analysis showed no differences in GLP-1, but PYY levels were different at all time points and had an exaggerated post-prandial response. We conclude that DGE is associated with an obtunded PYY response. However, the exact nature of the association is not yet established.
Asunto(s)
Neoplasias Esofágicas , Gastroparesia , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Vaciamiento Gástrico , Péptido 1 Similar al Glucagón , Humanos , Péptidos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , TirosinaAsunto(s)
Perforación del Esófago/diagnóstico , Hernia Hiatal/cirugía , Herniorrafia , Laparoscopía , Enfermedades del Mediastino/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Anciano , Perforación del Esófago/etiología , Herniorrafia/métodos , Humanos , Masculino , Enfermedades del Mediastino/etiologíaRESUMEN
AIMS: The duodenal switch (DS) has now established itself as an effective, durable and safe bariatric procedure. We present our initial experience on 60 patients from May 2008 to November 2012. METHODS: Retrospective case series from a prospective database. 94.8% follow-up over 4 years. RESULTS: 45 patients have completed 1-year follow-up and 28 patients completed 2-year follow-up. The mean initial body mass index (BMI) was 52.8 kg/m(2) (range 40=66 kg/m(2)). The excess weight loss has been 69.5% at 1 year (n=45) and 73.1% at 2 years (n=28) respectively. The mean hospital stay is 5.08 days (range 3-18). The range of bowel motions at 1 year is one to two movements per day. Comorbidity resolution rates were 95% (n=18) for diabetes, 100% (n=9) for obstructive sleep apnoea, 72% (18/25) or hypertension, and 92% (33/36) or dyslipidaemia. One death from liver failure occurred 9 months following surgery resulting from poor compliance with follow-up and intake of multivitamins. CONCLUSION: In our short-term analysis DS appears to be very efficient in terms of cure rate for morbid obesity and its comorbidities. In terms of risk/benefit DS has appeared safe with adherence to the appropriate follow-up regimen.