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Resumen: El término de síndrome metabólico (SM) se ha utilizado desde su definición en el año 2001 por el programa nacional del colesterol (NCEP: ATP III). El concepto ha sido discutido en la literatura científica por décadas. El síndrome X y otros términos como "el cuarteto de la muerte" y el síndrome de resistencia a la insulina, han sido utilizados para describir la asociación entre factores de riesgo metabólico y cardiovascular. En México, la prevalencia de SM en la Encuesta Nacional de Salud y Nutrición (ENSANUT) fue de un 34% para el año 2000; y para el 2012, del 41%. Las modificaciones del estilo de vida junto con aumento en la actividad física, dejar de fumar y limitar el consumo de alcohol son primordiales para el manejo y la prevención debido a que juegan un rol central en las anormalidades metabólicas. Sin embargo, a pesar del impresionante armamento de medicamentos disponible para la diabetes, se ha descrito que hasta el 50% de los pacientes no alcanzan las metas adecuadas de control, definidas por la Asociación Americana de Diabetes (hemoglobina glucosilada <7%). En contraste, la cirugía bariátrica (CB) ha confirmado claramente que contribuye a mejorar la función de las células beta en pacientes con índice de masa corporal (IMC) >35 kg/m2, así como el control de la dislipidemia y otras alteraciones metabólicas.
Abstract: The term Metabolic Syndrome (MS) has been used since its introduction in 2001 by the National Cholesterol Program (NCEP: ATP III). The concept has been discussed in the scientific literature for decades. The X Syndrome and other terms such as "death quartet" and insulin resistance syndrome have been used to describe the association between metabolic and cardiovascular risk factors. In Mexico, the prevalence of MS in the National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición, ENSANUT) was 34% in 2000 and 41% in 2012. Lifestyle modifications along with increased physical activity, quitting smoking, and limiting alcohol consumption are essential for management and prevention because they play a central role in metabolic abnormalities. However, despite the large amount of medications available for diabetes, up to 50% of patients have been reported to fail to achieve adequate control goals, as defined by the American Diabetes Association (glycosylated hemoglobin <7%). In contrast, bariatric surgery (BS) has clearly confirmed that it contributes to improved beta cell function in patients with BMI >35 kg / m2, as well as control of dyslipidemia and other metabolic disorders.
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BACKGROUND: One-anastomosis gastric bypass (OAGB-MGB) is currently the third performed primary bariatric surgical procedure worldwide. However, the procedure is hampered by numerous controversies and there is considerable variability in surgical technique, patient selection, and pre- and postoperative care among the surgeons performing this procedure. This paper reports the results of a modified Delphi consensus study organized by the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO). METHODS: Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote. RESULTS: At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%). CONCLUSION: Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.
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Derivação Gástrica , Doenças Metabólicas , Obesidade Mórbida , Técnica Delphi , Humanos , Obesidade/cirurgia , Obesidade Mórbida/cirurgia , Redução de PesoRESUMO
INTRODUCTION: Among the many techniques available for bariatric surgery, the Mini Gastric Bypass is a safe, technically simple and effective option. However, it may present with postoperative complications, being the perforated gastric ulcer one of the most relevant ones. PRESENTATION OF CASE: A female patient of 41 years of age, with past medical history of a laparoscopic MGB performed 2 year before, presented with 12 hours of sharp and abruptly initiated abdominal pain, with diffuse presentation with suspected perforated acute abdomen after initial medical assessment and examination. Imaging propaedeutic was performed and confirmed a small pneumoperitoneum the patient was submitted to a laparoscopy with closure of the leak and omental patch (Graham's patch) after a thorough abdominal irrigation with saline solution. The patient was discharged from the hospital on the fourth day after surgery. DISCUSSION: One of the most common complications after and MGB surgery is the occurrence of gastric ulcers and main manifestation of the anastomotic marginal ulcers (MU) is the perforation. The treatment of the perforated peptic ulcer can be performed via laparoscopic or laparotomic approach. The main objective, regardless of the method used to access the abdominal cavity, is to identify and close the perforation. CONCLUSION: The perforated gastric ulcer is a complication of the mini bariatric bypasses, and the laparoscopic treatment of the perforation associated with thorough irrigation for of the abdominal cavity and omentoplasty present good results for management of this complication.
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Introducción. La miniderivación (mini-bypass) gástrica por laparoscopia es un procedimiento bariátrico que recientemente ha cobrado popularidad. Las alteraciones del tubo digestivo generadas por estos procedimientos pueden ocasionar diversas complicaciones, algunas raras, como los bezoares.Caso clínico. Se presenta el caso de una mujer de 52 años de edad con antecedentes de diabetes mellitus y obesidad, que fue tratada con una miniderivación gástrica por laparoscopia. Nueve meses después del procedimiento, presentó dolor en el epigastrio, intolerancia a los alimentos y vómito, por lo cual se dio tratamiento sintomático sin obtener mejoría. Se practicó una endoscopia de vías digestivas altas, cuyo hallazgo fue un bezoar de coco que obstruía parcialmente la anastomosis. El bezoar se trituró y se extrajo por endoscopia. Discusión. Los pacientes con antecedentes de cirugía bariátrica tienen mayor riesgo de presentar bezoares por la modificación del tubo digestivo. Estos pacientes presentan frecuentemente síntomas de dispepsia, por lo que la sintomatología inespecífica puede confundirse o subestimarse. Se debe considerar practicar una endoscopia en todos aquellos con antecedentes de cirugía bariátrica que presenten vómito persistente después de ingerir alimentos o síntomas de obstrucción gástrica
Introduction: Laparoscopic Mini-gastric bypass is a bariatric procedure that has gained popularity recently. Alterations to the gastrointestinal tract anatomy created during these procedures, may lead to several complications, some of them very rare, such as the bezoar. Presentation of case: A fifty-two years old female with type II diabetes mellitus and obesity was treated by laparoscopic mini-gastric bypass surgery. Nine months after her surgery she experienced epigastric pain, intolerance to food and vomiting with non-successful symptomatic treatment. One month later, the patient underwent an upper GI endoscopy which reported a coconut bezoar partially obstructing the anastomosis. Bezoar was broken into pieces and removed endoscopically. Two days after, patient returned to normal diet. Conclusion: Patients with bariatric surgeries have a higher risk of presenting such masses because of the gas-trointestinal tract modifications. Symptoms can be confused or overlooked in bariatric patients since there is a frequent complain of dyspeptic symptoms after such procedures. An endoscopy should be considered in every patient who underwent a bariatric procedure and presents with persistent vomiting after food ingestion and/or gastric outlet symptoms