RESUMEN
BACKGROUND: Revisional bariatric surgery presents a challenge for bariatric surgeons. This procedure can be considered for patients with inadequate weight loss or weight regain after an initial satisfactory response following bariatric surgery. However, the surgical management of weight regain following RYGB remains controversial. We present a case of successful weight gain management after a single anastomosis duodenoileal bypass with sleeve gastrectomy (SADIS) as a revisional procedure for patients with weight regain after RYGB. METHODS: A 23-year-old female with a body mass index (BMI) of 52 kg/m2 and no comorbidities underwent RYGB. Postoperatively, she reached an excess weight loss of 75% of her initial body weight, with a BMI of 32 kg/m2. Eight years after her RYGB, she started regaining weight, reaching a BMI of 47 kg/m2. The surgical team decided to perform a revisional surgery, a conversion of RYGB to SADIS. RESULTS: There were no intraoperative complications. An upper gastrointestinal series was obtained on the third postoperative day which resulted normal and oral feedings were resumed. The patient was then discharged on fifth postoperative day. There were no complications within the first 30 postoperative days. CONCLUSIONS: We attach a video that illustrates the management and technique used to deal with the weight regain after primary bariatric surgery RYGB. We consider that in patients with super morbid obesity refractory to RYGB, conversion to SADIS is an excellent alternative due to its safety and feasibility.
Asunto(s)
Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Adulto , Femenino , Gastrectomía , Derivación Gástrica/métodos , Humanos , Obesidad Mórbida/cirugía , Reoperación/métodos , Estudios Retrospectivos , Aumento de Peso , Pérdida de Peso , Adulto JovenRESUMEN
Appendectomy is the most frequently performed emergent surgical procedure in western countries. There is still controversy about which alternative is clinically and economically superior: open or laparoscopic appendectomy (LA). Our aim was to determine clinical outcomes and cost of both procedures in our academic institution. A retrospective comparative study was performed including patients undergoing appendectomy from January to December 2011. Demographic data, operating room occupancy time, hospital length of stay, complications, and economic data were obtained. A total of 116 appendectomies were performed along the time of study, 23.27% laparoscopic and 76.72% open. Groups were similar in terms of demographics and intraoperative findings. Operating room occupancy time was longer in laparoscopic group and hospital stay was shorter. No significant differences were found respecting to postoperative complications rate. Cost minimization analysis showed that LA saved 1561.08&OV0556; per patient. In our teaching setting, LA may have clinical and economic advantages over open appendectomy.