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The introduction and subsequent widespread adaptation of minimally invasive approaches for bariatric surgery have not only changed the outcomes of bariatric surgery but also called into question the management of co-morbid surgical conditions, in particular gallbladder disease. The American Society for Metabolic and Bariatric Surgery Foregut Committee performed a systematic review of the published literature from 1995-2018 on management of gallbladder disease in patients undergoing bariatric surgery. The papers reviewed generated the following results. (1) Routine prophylactic cholecystectomy at the time of bariatric surgery is not recommended. (2) In symptomatic patients who are undergoing bariatric surgery, concomitant cholecystectomy is acceptable and safe. (3) Ursodeoxycholic acid may be considered for gallstone formation prophylaxis during the period of rapid weight loss. (4) Routine preoperative screening and postoperative surveillance ultrasound is not recommended in asymptomatic patients. In the era of minimally invasive surgery, the management of gallbladder disease in patients undergoing bariatric surgery continues to evolve.

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OBJECTIVE: Review and determination of ideal characteristics for the management of obesity by intragastric balloon, in Monterrey, Mexico. METHOD: Retrospective analysis of 152 patients, with overweight and obesity from January 2009 to December 2015, to whom an intragastric balloon was placed. Demography, weight loss, decrease in body mass index (BMI) and complications were analyzed. The objective was to determine the group of patients that will benefit the most after endoscopic intragastric balloon placement. RESULTS: A sample of 120 women and 32 men was analyzed. As expected, greater weight loss was observed in patients with BMI > 40 (n = 10, 6.57%, m = 26.29 ± 5.69; p = 0.001) and the lowest in patients with a BMI < 29.9 (n = 24, 15.78 %). Greater satisfaction was detected among patients with an average loss of 15.24 ± 2.75 kg (p < 0.001), and greater indifference among patients with greater losses. There is a tendency among women towards dissatisfaction. CONCLUSIONS: The greatest weight loss was observed among patients with a BMI > 40, although the highest satisfaction was observed among men with an average BMI of 32, which is why we recommend the procedure for these patients. We consider it to be an excellent bridge procedure for patients with BMI > 50.

OBJETIVO: Revisión y determinación de las características ideales para el manejo de la obesidad por medio de balón intragástrico, en Monterrey, México. MÉTODO: Análisis retrospectivo de 152 pacientes, con sobrepeso y obesidad, de enero de 2009 a diciembre de 2015, a quienes se colocó un balón intragástrico. Se analizaron la demografía, la pérdida de peso, la disminución del índice de masa corporal (IMC) y las complicaciones. El objetivo fue determinar el grupo de pacientes que mejores resultados obtendrán tras la colocación del dispositivo por endoscopia. RESULTADOS: Se obtuvo una muestra de 152 pacientes, 120 mujeres y 32 hombres. Como era de esperar, se observó la mayor pérdida de peso en los pacientes con IMC > 40 (n = 10, 6.57%, m = 26.29 ± 5.69; p = 0.001) y la menor en los pacientes con IMC < 29.9 (n = 24, 15.78%). Se detectó una mayor satisfacción en los pacientes con una pérdida promedio de 15.24 ± 2.75kg (p < 0.001), y mayor indiferencia en los pacientes con mayores pérdidas. Se observa una tendencia en las mujeres hacia la insatisfacción. CONCLUSIONES: La mayor pérdida de peso se observó en los pacientes de IMC > 40, aunque la mayor satisfacción se observó en los hombres con IMC promedio de 32, por lo que lo recomendamos para estos pacientes. Consideramos que es un excelente procedimiento puente para pacientes con IMC > 50.

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BACKGROUND: Cholecystectomy is one of the most performed procedures worldwide. Many surgeons defend the use of routine intraoperative cholangiography (IOC), but this action is getting less practiced because other preoperative tools that can omit IOC. OBJECTIVE: Evaluate the utility of performing intraoperative cholangiography in patients whom got a preoperative imaging or endoscopy study. We analized the association between the diagnostic-therapeutic approach and hospital readmissions because of bile duct obstruction. METHOD: Retrospective and comparative study of 117 patients admitted with choledocholithiasis and submitted to cholecystectomy between January 2014 and December 2016. The statistical analysis was performed comparing groups using chi squared test with a statistical significance of p < 0.05. RESULTS: Patients whom got a preoperative study and had performed an intraoperative cholangiography didn't readmitted. The study reported nine readmissions, being residual gallbladder stone the diagnostic. Patients whom didn't get an intraoperative cholangiography reported the most readmissions. The studied group who registered the most readmissions was the one who didn't get performed an intraoperative cholangiography nor a preoperative study. No mortality was reported. CONCLUSION: Patients who had IOC performed reported less readmissions for residual stone.

ANTECEDENTES: La colecistectomía es uno de los procedimientos quirúrgicos más realizados. Muchos cirujanos defienden la colangiografía transoperatoria (CTO) sistemática, pero su uso es cada vez menos frecuente por la disponibilidad de otras herramientas de estudio empleadas preoperatoriamente que pueden obviar este procedimiento. OBJETIVO: Valorar la utilidad de la CTO cuando se cuenta con un estudio de imagen o endoscópico preoperatorio. Analizar la relación entre el reingreso por un cuadro obstructivo de vía biliar y el abordaje al que se sometió el paciente. MÉTODO: Estudio retrospectivo y comparativo de 117 pacientes ingresados por coledocolitiasis en un periodo de 2 años. Las variables analizadas fueron demográficas, diagnóstico, CTO, estudio previo y reingreso. Se incluyeron pacientes mayores de 18 años con diagnóstico de coledocolitiasis en quienes se realizó colecistectomía. El análisis estadístico se hizo comparando grupos mediante la prueba de ji al cuadradocon una significancia estadística de p < 0.05. RESULTADOS: El grupo con estudio preoperatorio y CTO no presentó reingresos. Hubo nueve reingresos, siendo el diagnóstico de lito residual. Los grupos sin CTO presentaron más reingresos. El grupo con mayor número de reingresos fue el que no se realizó CTO y no contaba con estudio preoperatorio. No se reportó mortalidad. CONCLUSIÓN: Los grupos en los que se realizó CTO presentaron menos reingresos por lito residual.

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BACKGROUND: Historically, the operating room has been the training setting for both surgeons and students. Nowadays, an alternative is represented by surgical simulators. In the same way a not-very-well-built mirror cannot reflect trustworthy images (distortion), a not well-built, calibrated or programmed simulator will be unable to reflect the training level of the operator. Our aim is to indirectly evaluate the Surgical SIM® simulator. METHODS: Twelve surgical residents were classified according to novices, intermediates and experts, and 15 tasks were applied with three dimensions of evaluation in each using the Surgical SIM® simulator. Pearson's correlation test was used to establish validity. RESULTS: In general, from the three dimensions evaluated, results showed a statistically significant difference for time (p = 0.001), trajectory (p = 0.01) and errors (p = 0.001). CONCLUSIONS: Effectiveness of Surgical SIM® was indirectly demonstrated.

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