RESUMEN

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure, but it poses challenges in patients with surgically altered gastrointestinal anatomy (SAGA). Alternative techniques like single-balloon enteroscopy (SBE), double-balloon enteroscopy (DBE), or push enteroscopy (PE) have been used, albeit with potential complications. Limited Latin American data exists on ERCP complications in SAGA patients. Our goal is to describe complications of ERCP in SAGA at a national referral institution. METHODS: Retrospective, single-center cohort study. All SAGA ERCP procedures performed at the Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán from January 2008 to May 2023 were included. Extracted data from records included procedure specifics, endoscope type, success, and complications. Complications were evaluated during procedure and 28-day post-procedure and classified using the AGREE system. RESULTS: A total of 266 procedures in 174 patients were included, 74% were women, and the median age was 44 years. Predominant modified anatomy was Roux-en-Y biliary reconstruction (79%), followed by Whipple procedure (13%) and subtotal gastrectomy with Roux-en-Y reconstruction (6.0%). The main indications were cholangitis with stricture (31%), stricture (19%), and cholangitis (19%). DBE was used in 89%, PE in 7.5%, and SBE in 3.4%. Success rates were 77% endoscopic, 72% technical, and 69% therapeutic; in 30%, the procedure was unsuccessful. Complications happened in 18% of cases, most commonly cholangitis (7.5%), followed by perforation (2.6%) and hemorrhage (1.9%). According to the AGREE classification, 10.9% were grades 1 and 2, 6.4% were grade 3, and 0.4% were grade 4 complications. No significant differences emerged between groups with and without complications. Procedures increased over time, but complications and unsuccessful procedures remained stable. CONCLUSION: ERCP complications align with international data, often not requiring invasive treatment. Enhanced exposure to such cases correlates with fewer complications and failures. Prospective studies are essential to identify complication and failure predictors.

Asunto(s)

Colangiopancreatografia Retrógrada Endoscópica , Complicaciones Posoperatorias , Centros de Atención Terciaria , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Anciano , Anastomosis en-Y de Roux/efectos adversos , América Latina/epidemiología , Gastrectomía/efectos adversos , Gastrectomía/métodos

RESUMEN

BACKGROUND: Curative treatment for gastric cancer involves tumor resection, followed by transit reconstruction, with Roux-en-Y being the main technique employed. To permit food transit to the duodenum, which is absent in Roux-en-Y, double transit reconstruction has been used, whose theoretical advantages seem to surpass the previous technique. AIMS: To compare the clinical evolution of gastric cancer patients who underwent total gastrectomy with Roux-en-Y and double tract reconstruction. METHODS: A systematic review was carried out on Web of Science, Scopus, EmbasE, SciELO, Virtual Health Library, PubMed, Cochrane, and Google Scholar databases. Data were collected until June 11, 2022. Observational studies or clinical trials evaluating patients submitted to double tract (DT) and Roux-en-Y (RY) reconstructions were included. There was no temporal or language restriction. Review articles, case reports, case series, and incomplete texts were excluded. The risk of bias was calculated using the Cochrane tool designed for randomized clinical trials. RESULTS: Four studies of good methodological quality were included, encompassing 209 participants. In the RY group, there was a greater reduction in food intake. In the DT group, the decrease in body mass index was less pronounced compared to preoperative values. CONCLUSIONS: The double tract reconstruction had better outcomes concerning body mass index and the time until starting a light diet; however, it did not present any advantages in relation to nutritional deficits, quality of life, and post-surgical complications.

Asunto(s)

Anastomosis en-Y de Roux , Gastrectomía , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/cirugía , Gastrectomía/métodos , Anastomosis en-Y de Roux/métodos , Tránsito Gastrointestinal/fisiología , Procedimientos de Cirugía Plástica/métodos

RESUMEN

The gold standard for bariatric surgery is the laparoscopic gastric bypass, which consists in forming a small gastric pouch and a Roux-en-Y anastomosis. We present the case of a 41-year-old female who underwent a laparoscopic gastric bypass 8 years prior to her admission to the emergency room, where she arrived complaining of severe and colicky epigastric abdominal pain. The abdominal computed tomography showed a jejuno-jejunal intussusception, for which the patient underwent urgent exploratory laparotomy with intussusception reduction. Intestinal intussusception is a possible postoperative complication of a Roux-en-Y gastric bypass.

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El Método de referencia en la cirugía bariátrica es el bypass gástrico laparoscópico, que consiste en la creación de una bolsa gástrica pequeña, anastomosada al tracto digestivo mediante una Y de Roux. Presentamos el caso de una mujer de 41 años con el antecedente de un bypass gástrico laparoscópico realizado 8 años antes, quien ingresó al servicio de urgencias refiriendo dolor abdominal grave. La tomografía computarizada abdominal evidenció una intususcepción a nivel de la anastomosis yeyuno-yeyuno, por lo que se realizó una laparotomía exploradora con reducción de la intususcepción. Se debe considerar la intususcepción intestinal como complicación posoperatoria de bypass gástrico.

Asunto(s)

Derivación Gástrica , Intususcepción , Enfermedades del Yeyuno , Laparoscopía , Obesidad Mórbida , Humanos , Femenino , Adulto , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Intususcepción/diagnóstico por imagen , Intususcepción/etiología , Intususcepción/cirugía , Laparoscopía/métodos , Enfermedades del Yeyuno/diagnóstico por imagen , Enfermedades del Yeyuno/etiología , Enfermedades del Yeyuno/cirugía , Anastomosis en-Y de Roux/efectos adversos , Dolor Abdominal/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones

RESUMEN

Introducción. La duplicación del colédoco es una anomalía congénita poco frecuente. En la mayoría de los casos este defecto se asocia a cálculos en la vía biliar, unión pancreatobiliar anómala, pancreatitis, cáncer gástrico o colangiocarcinoma. Por esta razón, el diagnóstico y el tratamiento temprano son importantes para evitar las complicaciones descritas a futuro. Métodos. Se presenta el caso de una paciente de 30 años, con antecedente de pancreatitis aguda, con cuadro de dolor abdominal crónico, a quien se le realizaron varios estudios imagenológicos sin claro diagnóstico. Fue llevada a manejo quirúrgico en donde se documentó duplicación del colédoco tipo II con unión pancreatobiliar anómala. Resultados. Se hizo reconstrucción de las vías biliares y hepatico-yeyunostomía, con adecuada evolución postoperatoria y reporte final de patología sin evidencia de tumor. Conclusión. El diagnóstico se hace mediante ecografía endoscópica biliopancreática, colangiorresonancia o colangiopancreatografía retrógrada endoscópica. El tratamiento depende de si está asociado o no a la presencia de unión biliopancreática anómala o cáncer. Si el paciente no presenta patología neoplásica, el tratamiento quirúrgico recomendado es la resección del conducto con reconstrucción de las vías biliares.

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Introduction. Double common bile duct is an extremely rare congenital anomaly. This anomaly may be associated with bile duct stones, anomalous biliopancreatic junction, pancreatitis, bile duct cancer, or gastric cancers. Thus, early diagnosis and treatment is important to avoid complications. Clinical case. We report a rare case of double common bile duct associated with an anomalous biliopancreatic junction in a 30-year-old female, with prior history of acute pancreatitis, who presented with chronic abdominal pain. She underwent several imaging studies, without clear diagnosis. She was taken to surgical management where duplication of the type II common bile duct was documented with anomalous pancreatobiliary junction. Results. Reconstruction of the bile ducts and hepatico-jejunostomy were performed, with adequate postoperative evolution and final pathology report without evidence of tumor. Conclusion. Diagnosis is usually performed by an endoscopic ultrasound, magnetic resonance cholangiopancrea-tography, or endoscopic retrograde cholangiopancreatography. Treatment depends on the presence of anomalus biliopancreatic junction or concomitant cancer. In cases without associated malignancy, resection of bile duct and biliary reconstruction is the recommended surgical treatment.

Asunto(s)

Humanos , Anomalías Congénitas , Anastomosis en-Y de Roux , Enfermedades del Conducto Colédoco , Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Conducto Colédoco

RESUMEN

Introducción: La panlitiasis se define como la presencia de múltiples cálculos en el trayecto de la vía biliar. El manejo consiste en realizar una colangiopancreatografía retrógrada endoscópica (CPRE), la exploración de la vía biliar o la anastomosis biliodigestiva (ABD), ya sea coledocoduodenoanastomosis o hepaticoyeyunoanastomosis.Objetivo: Describir el caso clínico de un paciente con panlitiasis biliar, abordando la presentación clínica, los métodos diagnósticos, el tratamiento y la evolución, con el propósito de ofrecer un recurso sólido a la comunidad médica.Presentación del caso: Se presenta un paciente de 60 años colecistectomizado hace 13 años portador de anastomosis bilioentérica con panlitiasis recidivante, se realizó un lavado de la vía biliar con salida de cálculos y pus del interior, finalmente se colocó una sonda Kehr junto con tratamiento clínico. Presentó una evolución favorable. Discusión: Este caso reveló una panlitiasis a la exploración de las vías biliares bajo visión endoscópica, a pesar de que no se encontró obstrucción, el paciente tenía antecedente de colecistectomía y contaba con una derivación hepático-yeyunal por lesión iatrogénica. La decisión del tratamiento debe ser multidisciplinaria ya que cada caso es único y dependerá de las características del paciente y las condiciones clínicas individuales.Conclusiones: La panlitiasis coledociana recidivante requirió un control farmacológico estricto para evitar recurrencia y la subsecuente exploración de la vía biliar que incrementa la morbimortalidad del paciente. Es importante el seguimiento médico continuo del paciente y la predisposición con la que cuenta para la formación de litos, pudiendo ser prevenidos, identificados y tratados de manera oportuna

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Introduction: Panlithiasis is define as the presence of multiple stones in the biliary tract that is classified as primary, secondary, or mixed according to the origin of the stones. Management consists of endoscopic retrograde cholangiopancreatography (ERCP), exploration of the biliary tract, or biliodigestive anastomosis (BDA), either choledochoduodenostomy or hepaticojejunostomy. Objective: Describe the clinical case of a patient with biliary panlithiasis, addressing the cli-nical presentation, diagnostic methods, treatment and evolution, with the purpose of offering a solid resource to the medical community.Case Presentation: We present a 60-year-old male patient who underwent cholecystectomy 13 years ago and has a bilioenteric anastomosis with recurrent panlithiasis. Biliary lavage was performed with the output of stones and pus from the inside. Finally, a Kehr tube was placed along with clinical treatment. The patient showed a favorable outcome.Discussion: This case revealed a panlithiasis upon exploration of the biliary tract under endoscopic vision. Despite finding no obstruction, the patient had a history of cholecystectomy and a hepatic-jejunal diversion due to iatrogenic injury. The treatment decision should be multidisciplinary, as each case is unique and depends on the patient's characteristics and individual clinical conditions.Conclusions: Recurrent choledocholithiasis required strict pharmacological control to prevent recurrence and subsequent exploration of the biliary tract, which increases patient morbidity and mortality. Continuous medical follow-up of the patient and the predisposition with which they have for the formation of stones is important. These can be prevented, identified, and treated in a timely manner.

Asunto(s)

Humanos , Masculino , Persona de Mediana Edad , Anastomosis en-Y de Roux , Coledocolitiasis/cirugía , Conductos Biliares/lesiones , Informes de Casos , Cálculos

RESUMEN

Various complications occur after a biliary-digestive reconstruction. Volvulus of a segment of the biliodigestive loop has not been described. Two patients who underwent biliodigestive bypass, years later, began with sudden and intense abdominal pain, associated with a volvulus with necrosis of a segment of this biliodigestive loop. This complication occurred many years after the initial correction, and manifested with sudden abdominal pain without impaired liver function, as occurred in these patients.

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Diversas complicaciones pueden ocurrir después de una reconstrucción biliodigestiva. El vólvulo de un segmento del asa biliodigestiva no ha sido descrito. Dos pacientes operados de derivación biliodigestiva, años después iniciaron con dolor abdominal súbito e intenso, asociado a un vólvulo con necrosis de un segmento de la asa interpuesta. Se ha descrito el vólvulo de toda el asa interpuesta, pero no el de solo una pequeña porción de esta. La complicación ocurrió muchos años después de la corrección inicial y se manifiesto con dolor abdominal súbito sin deterioro de la función hepática, como sucedió en estos pacientes.

Asunto(s)

Vólvulo Intestinal , Niño , Humanos , Vólvulo Intestinal/etiología , Vólvulo Intestinal/cirugía , Anastomosis en-Y de Roux , Dolor Abdominal/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía

Asunto(s)

Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Humanos , Obesidad Mórbida/cirugía , Anastomosis en-Y de Roux , Estudios Retrospectivos

RESUMEN

BACKGROUND: Gastric neuroendocrine tumors are a heterogeneous group of neoplasms that produce bioactive substances. Their treatment varies according to staging and classification, using endoscopic techniques, open surgery, chemotherapy, radiotherapy, and drugs analogous to somatostatin. AIMS: To identify and review cases of gastric neuroendocrine neoplasia submitted to surgical treatment. METHODS: Review of surgically treated patients from 1983 to 2018. RESULTS: Fifteen patients were included, predominantly female (73.33%), with a mean age of 55.93 years. The most common symptom was epigastric pain (93.3%), and the mean time of symptom onset was 10.07 months. The preoperative upper digestive endoscopy (UDE) indicated a predominance of cases with 0 to 1 lesion (60%), sizing ≥1.5 cm (40%), located in the gastric antrum (53.33%), with ulceration (60%), and Borrmann III (33.33%) classification. The assessment of the surgical specimen indicated a predominance of invasive neuroendocrine tumors (60%), with angiolymphatic invasion in most cases (80%). Immunohistochemistry for chromogranin A was positive in 60% of cases and for synaptophysin in 66.7%, with a predominant Ki-67 index between 0 and 2%. Metastasis was observed in 20% of patients. The surgical procedure most performed was subtotal gastrectomy with Roux-en-Y reconstruction (53.3%). Tumor recurrence occurred in 20% of cases and a new treatment was required in 26.67%. CONCLUSIONS: Gastric neuroendocrine tumors have a low incidence in the general population, and surgical treatment is indicated for advanced lesions. The study of its management gains importance in view of the specificities of each case and the need for adequate conduct to prevent recurrences and complications.

Asunto(s)

Tumores Neuroendocrinos , Neoplasias Gástricas , Humanos , Femenino , Persona de Mediana Edad , Masculino , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/patología , Recurrencia Local de Neoplasia , Gastrectomía/métodos , Anastomosis en-Y de Roux , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Estudios Retrospectivos

RESUMEN

BACKGROUND: Enteroendocrine L cells can be found in the entire gastrointestinal tract and their incretins act on glycemic control and metabolic homeostasis. Patients with severe obesity and type 2 diabetes mellitus may have lower density of L cells in the proximal intestine. AIMS: This study aimed to analyze the density of L cells in the segments of the small intestine in the late postoperative of Roux-en-Y gastric bypass in diabetic patients with standardization of 60 cm in both loops, alimentary and biliopancreatic. METHODS: Immunohistochemistry analysis assays were made from intestinal biopsies in three segments: gastrointestinal anastomosis (GIA= Point A), enteroenteral anastomosis (EEA= Point B= 60 cm distal to the GIA) and 60 cm distal to the enteroenteral anastomosis (Point C). RESULTS: A higher density of L cells immunostaining the glucagon-1 peptide was observed in the distal portion (Point C) when compared to the more proximal portions (Points A and B). CONCLUSIONS: The concentration of L cells is higher 60 cm distal to enteroenteral anastomosis when comparing to proximal segments and may explain the difference in intestinal lumen sensitization and enterohormonal response after Roux-en-Y gastric bypass.

Asunto(s)

Diabetes Mellitus Tipo 2 , Derivación Gástrica , Obesidad Mórbida , Anastomosis en-Y de Roux , Diabetes Mellitus Tipo 2/cirugía , Células Enteroendocrinas/metabolismo , Glucagón/metabolismo , Humanos , Incretinas/metabolismo , Obesidad Mórbida/cirugía , Resultado del Tratamiento

RESUMEN

BACKGROUND: Several methods have been proposed for the reconstruction of digestive transit after pancreatoduodenectomy. Biliary anastomosis positioned before gastric anastomosis helps reduce postoperative reflux and cholangitis. AIMS: The objective of this study was to present the anatomical sequence of gastric and biliary continuity after pancreatoduodenectomy in patients with pancreatic tumor and to evaluate the short- and long-term results in an initial series of cases. METHODS: Two techniques were used: one with Roux-en-Y reconstruction and pancreaticojejunostomy and the other with a single jejunal loop and pancreatogastroanastomosis. In both the cases, the gastric anastomosis was placed performed before the biliary one. An analysis of demographic data, Wirsung's duct and common bile duct dilatation, the use of percutaneous drainage, and postoperative complications was carried out. RESULTS: A total of seven patients (four men and three women), with a mean age of 62 years, underwent surgery. All cases had Wirsung's duct and common bile duct dilatation. A percutaneous external biliary drainage was performed in four patients. There were three postoperative complications: one related to delayed gastric emptying and two related to wound infections. During a median follow-up of 12 months, no episode of cholangitis was recorded. CONCLUSIONS: Elevated percentages of cholangitis are reported in different reconstructions after pancreatoduodenectomy, and it is difficult to conclude reflux as the main etiology. The proposed gastric and biliary reconstructions show conforming results, facilitating posterior endoscopic access. Late follow-up and large number of cases may help assess whether the etiology of postoperative cholangitis is reflux or other factors unrelated to the order of the anastomoses.

Asunto(s)

Procedimientos Quirúrgicos del Sistema Biliar , Colangitis , Anastomosis en-Y de Roux , Procedimientos Quirúrgicos del Sistema Biliar/métodos , Colangitis/etiología , Colangitis/cirugía , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pancreaticoduodenectomía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía

RESUMEN

Introducción: El hígado se lesiona con mayor frecuencia en un trauma de abdomen de alta energía, con una incidencia entre 1 % y 8 %. Las lesiones traumáticas de las vías biliares son muy raras. Casos clínicos: Presentamos dos pacientes con trauma hepático grave, y compromiso ex-trahepático vascular y de la vía biliar; y el abordaje quirúrgico para preservar funcional-mente ambos lóbulos: Masculino de 1 año, trauma hepático grado V, lesión incompleta de vena porta derecha, a nivel de la bifurcación y del conducto biliar hepático izquierdo. Se reparó el daño portal y de la vía biliar. Femenina de dos años, trauma cerrado de abdomen, lesión del parénquima de lóbulo derecho del hígado, sección total del conducto hepático izquierdo, y contusión pancreática asociada. En ambos casos se realizó una hepáticoyeyunostomía en Y de Roux y conservación de ambos lóbulos. Conclusión: En los traumas complejos hepáticos que involucran ambos lóbulos, la evolución depende de calidad de la masa residual. La cirugía conservadora con reconstrucciones vasculares y biliares, evita un fallo hepático agudo, permite ganar tiempo hasta la regeneración funcional del parénquima y proteger de una eventual insuficiencia hepática post-operatoria.

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Introduction: The liver is more frequently injured in high-energy abdominal trauma, with an incidence between 1% and 8%. Traumatic injuries to the bile ducts are infrequent. Clinical cases: We present two patients with severe liver trauma and extrahepatic vascular and bile duct involvement and the surgical approach to preserve both lobes functionally: 1-year-old male, grade V liver trauma, incomplete injury to the right portal vein, at the level of the bifurca-tion and the left hepatic bile duct. The portal and bile duct damage was repaired. Two-year-old female, blunt abdominal trauma, injury to the parenchyma of the right lobe of the liver, whole section of the left hepatic duct, and associated pancreatic contusion. In both cases, a Roux-en-Y hepatic jejunostomy was performed, and both lobes were preserved. Conclusion: In complex liver trauma involving both lobes, the evolution depends on the quality of the residual mass. Conservative surgery with vascular and biliary reconstructions avoids acute liver failure, allows time to gain until the funct.

Asunto(s)

Humanos , Preescolar , Historia del Siglo XX , Informes de Casos , Anastomosis en-Y de Roux , Niño , Hígado , Hepatectomía , Traumatismos Abdominales

RESUMEN

PURPOSE: To explore the effect of different gastrointestinal reconstruction techniques on laparoscopic distal gastrectomy of gastric cancer on the nutritional and anemia status, and quality of life (QoL) of patients. METHODS: Eligible patients were randomly divided into three groups (n=36/group): Billroth I anastomosis group, Billroth II combined with Braun anastomosis group, and Roux-en-Y anastomosis group. Related indicators were compared and analyzed. RESULTS: The general data were comparable among the three groups (all P>0.05). Among the surgical-related indicators and postoperative recovery indicators, only the comparison of the operation time was statistically significant (P=0.004). The follow-up time was 5~36 months (average 27.9 months). In terms of nutritional and anemia indicators, only the differences in the levels of prealbumin, hemoglobin and serum ferritin in 24 months after operation showed significant differences (P=0.015, P=0.003, P=0.005, respectively). There were no significant differences in hospital readmission rate, overall survival, and QoL among the three groups (all P>0.05). CONCLUSIONS: In laparoscopic gastrectomy for stage II~III distal gastric cancer, Billroth I anastomosis has shorter operation time than Billroth II combined with Braun anastomosis and Roux-en-Y anastomosis and advantages in the improvement of nutritional status and anemia recovery.

Asunto(s)

Anemia , Laparoscopía , Neoplasias Gástricas , Anastomosis en-Y de Roux/métodos , Anemia/cirugía , Gastrectomía/métodos , Gastroenterostomía , Humanos , Laparoscopía/métodos , Estado Nutricional , Complicaciones Posoperatorias , Calidad de Vida , Neoplasias Gástricas/cirugía , Resultado del Tratamiento

Asunto(s)

Historia del Siglo XIX , Historia del Siglo XX , Suiza , Anastomosis en-Y de Roux/historia

RESUMEN

INTRODUCTION: Gastro-gastric fistula is a rare complication after divided Roux-en-Y gastric by-pass. VIDEO CONTENT: 52-year-old male with a BMI over 49 who underwent divided Roux-en-Y gastric by-pass presented with weight regain 2 years later and a type 2 gastro-gastric fistula. Laparoscopic revision, excision of the fistula with re-do of gastrojejunal anastomosis and remnant gastrectomy, was performed CONCLUSION: Laparoscopic resolution is a technical challenge in this case due to the local inflammatory environment.

Asunto(s)

Derivación Gástrica , Fístula Gástrica , Laparoscopía , Obesidad Mórbida , Anastomosis en-Y de Roux/efectos adversos , Gastrectomía/efectos adversos , Derivación Gástrica/efectos adversos , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía

RESUMEN

Introducción: El abdomen catastrófico o abdomen hostil es una entidad quirúrgica de gran importancia por la pérdida de los distintos espacios entre los órganos de la cavidad abdominal y las estructuras de la cavidad abdominal. Estas alteraciones producen cambios anatómicos grandes por un síndrome adherencial severo. Objetivo: Demostrar la presentación de un abdomen catastrófico posterior a manejo de íleo biliar en un paciente adulto. Caso clínico: Paciente masculino de 43 años que producto de un abdomen agudo obstructivo por íleo biliar evolucionó tórpidamente en otra casa asistencial. Se realizaron 3 intervenciones quirúrgicas, hasta llegar a nuestra casa asistencial donde se le trata de manera multidisciplinaria e integral. Estuvo 120 días hospitalizado y se le realizó 5 intervenciones quirúrgicas para aplicación y recambio de terapia de presión negativa abdominal abierta (ABThera). Durante la última intervención al encontrar una cavidad limpia y sin fugas se realiza gastroentero anastomosis en Y de Roux con una buena evolución clínico-quirúrgica hasta el alta, con seguimiento dos meses posteriores por consulta externa. Conclusiones: El abdomen catastrófico es un reto para el manejo por los cirujanos porque se requiere aparte de un vasto conocimiento también el apoyo de otras especialidades para poder combatir esta entidad(AU)

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Introduction: Catastrophic abdomen or hostile abdomen is a surgical entity of great significance due to the loss of the different spaces between organs and the structures of the abdominal cavity. These alterations produce major anatomical changes due to a severe adhesive syndrome. Objective: To show the presentation of a catastrophic abdomen following gallstone ileus management in an adult patient. Clinical case: A 43-year-old male patient who, as a consequence of an acute obstructive abdomen due to gallstone ileus, had a torpid evolution into another care facility. Three surgical interventions were performed before he arrived at our care facility, where he was treated in a multidisciplinary and comprehensive way. He was hospitalized for 120 days and underwent five surgical interventions for application and replacement of the open abdomen negative pressure therapy (ABThera). During the last intervention, upon finding a clean cavity without leaks, a Roux-en-Y gastroenteric anastomosis was performed, with a good clinical-surgical evolution until discharge and follow-up of two months thereafter in the outpatient clinic. Conclusions: Catastrophic abdomen is a challenge to be managed by surgeons because it requires, apart from vast knowledge, the support of other specialties to combat this entity(AU)

Asunto(s)

Humanos , Masculino , Adulto , Procedimientos Quirúrgicos Operativos , Cálculos Biliares , Cavidad Abdominal/cirugía , Abdomen Agudo/cirugía , Anastomosis en-Y de Roux/métodos , Cuidados Posteriores

RESUMEN

RATIONAL: The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation. AIM: To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass. METHODS: Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated. RESULTS: There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups. CONCLUSIONS: The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient's recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.

Asunto(s)

Ayuno , Derivación Gástrica , Anastomosis en-Y de Roux , Humanos , Estómago/cirugía , Factores de Tiempo

RESUMEN

The Roux-en-Y gastric bypass surgery improper technique can cause complications such as Roux-en-O, which is caused by an inadvertent anastomosis of the biliopancreatic limb to the gastric pouch, creating an "O" form to the bypass. We present intraoperative images of a mistaken Roux-en-Y's technique that caused the "O" anatomy and its successful reconstruction.

Asunto(s)

Derivación Gástrica , Laparoscopía , Obesidad Mórbida , Anastomosis en-Y de Roux , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Humanos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Estómago/cirugía

RESUMEN

A obesidade é um dos fatores de risco para o desenvolvimento de Doença do Refluxo Gastroesofágico (DRGE). Embora os tratamentos de primeira linha para DRGE envolvam principalmente terapias de estilo de vida e não cirúrgicas, as intervenções cirúrgicas provaram ser eficazes. Na atualidade, o Bypass gástrico laparoscópico é a técnica mais comumente empregada em cirurgia bariátrica com vistas à redução da obesidade. Objetivo: Analisar a presença de esofagite no pré-operatório de pacientes submetidos à cirurgia bariátrica (Bypass gástrico e Fobi-Capella) e no pós-peratório, comparando o exame endoscópico realizado antes e após 1 ano da cirurgia. Casuística e Método: Trata-se de um estudo retrospectivo de pacientes do Hospital do Servidor Público Municipal da clínica de cirurgia do aparelho digestivo, localizado na cidade de São Paulo - SP, submetidos à cirurgia bariátrica no Serviço entre os anos de 2006 e 2020, e que serão divididos em 2 grupos. O primeiro grupo incluirá os pacientes submetidos à cirurgia de Bypass gástrico em Y de Roux e Fobi-Capella, com esofagite ao exame de endoscopia, buscando avaliar a evolução da doença quanto à regressão ou progressão do quadro. O segundo grupo incluirá pacientes submetidos às mesmas técnicas de cirurgias bariátricas, todavia sem esofagite, onde se buscará avaliar se no pós-operatório houve o desenvolvimento da doença. Casuística: Este trabalho analisou 117 pacientes com aproximadamente 45 anos, IMC médio de 44, em sua maioria mulheres operadas principalmente pela técnica de Bypass. Resultados: Dos 39 pacientes com esofagite no pré-operatório, 31 evoluíram com regressão completa. Em contrapartida, dos 78 pacientes com endoscopia normal no pré-operatório, observamos a evolução para esofagite edematosa em 39. Conclusão: As cirurgias foram capazes de tratar quase 80% dos casos de esofagite prévia, especialmente o Bypass, embora exista um grupo de pacientes que evoluiu com esofagite no pós-operatório, porém, de leve intensidade. Palavras-chave: Endoscopia. Cirurgia Bariátrica. Esofagite. Anastomose em Y-Roux.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anastomosis en-Y de Roux , Derivación Gástrica , Reflujo Gastroesofágico , Endoscopía , Esofagitis , Cirugía Bariátrica/efectos adversos

RESUMEN

La cirugía bariátrica es reconocida como una terapia altamente efectiva para la obesidad, ya que logra una pérdida de peso sostenida, una reducción de las comorbilidades y la mortalidad relacionadas con la obesidad; además mejora de la calidad de vida de los pacientes. Sin embargo, las deficiencias nutricionales son un problema inherente en el período postoperatorio y, a menudo, requieren una suplementación de por vida. Los tipos de desnutrición después de la cirugía incluyen desnutrición proteico-energética y deficiencias de micronutrientes, como hierro, ácido fólico, vitamina A y vitamina B12. Lamentablemente, no existen regímenes estandarizados de cuidados posteriores, y los costos de los suplementos nutricionales los pagan los propios pacientes. Esta revisión se enfoca en el estudio de la desnutrición poscirugía bariátrica, recorriendo las principales deficiencias y sus causas

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Bariatric surgery is recognized as a highly effective therapy for obesity, as it achieves sustained weight loss, a reduction in comorbidities and obesity-related mortality; It also improves the quality of life of patients. However, nutritional deficiencies are an inherent problem in the postoperative period and often require lifelong supplementation. Types of malnutrition after surgery include protein-energy malnutrition and micronutrient deficiencies, such as iron, folic acid, vitamin A, and vitamin B12. Currently, there are no standardized aftercare systems, and the costs of nutritional supplements are paid by the patients themselves. This review focuses on the study of malnutrition after bariatric surgery, covering the main deficiencies and their causes.

Asunto(s)

Complicaciones Posoperatorias , Anastomosis en-Y de Roux , Suplementos Dietéticos , Cirugía Bariátrica , Trastornos Nutricionales/complicaciones , Obesidad/patología

Asunto(s)

Quiste del Colédoco , Laparoscopía , Litiasis , Anastomosis en-Y de Roux , Quiste del Colédoco/diagnóstico por imagen , Quiste del Colédoco/cirugía , Humanos