RESUMEN
BACKGROUND: Roux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution. METHODS: Patients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed. RESULTS: 523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett's esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms. CONCLUSION: Standard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high.
Asunto(s)
Endoscopía del Sistema Digestivo/métodos , Gastrectomía/métodos , Derivación Gástrica/métodos , Laparoscopía/métodos , Exámenes Obligatorios , Cuidados Preoperatorios/métodos , Adolescente , Adulto , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: The ilioinguinal approach is well established for the treatment of pelvic fractures. As an alternative, the modified Stoppa approach can be used to expose pelvic and acetabular fractures. We describe our experience with this approach in patients with pelvic and acetabular fractures with respect to fracture reduction, technical aspects, and the incidence of intra- and postoperative complications. METHODS: This retrospective study describes a series of 25 consecutive patients where a modified Stoppa approach was used for pelvic or acetabular fracture fixation. RESULTS: Fifteen patients with acetabular fractures, six patients with a pelvic ring injury not involving the acetabular joint and four patients with a combined fracture were operated through a Stoppa approach. Nine patients had a total of 13 complications, none of which required reoperation. Anatomic or satisfactory reduction was achieved in 95% of the acetabular fractures. Pelvic ring fractures had an anatomic (displacement <1 cm) postoperative result in all 10 cases. CONCLUSION: The modified Stoppa approach allows an adequate exposure and good postoperative results for treatment of pelvic ring fractures and acetabular fractures that are eligible for an anterior approach.