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      Fístula gastrogástrica como complicación de bypass gástrico en Y de Roux. Abordaje laparoscópico


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          Presentamos el caso de una paciente con antecedente de bypass gástrico por laparoscopia, quien desarrolló a los 2 años de la intervención, fístula gastrogástrica caracterizada por dolor abdominal intratable y pérdida de peso insatisfactoria. Se realizó cirugía de revisión por laparoscopia con gastrectomía parcial del reservorio y remanente gástrico con nueva anastomosis gastroyeyunal. La evolución fue normal desapareciendo los síntomas y produciéndose nueva pérdida del exceso de peso.

          Translated abstract

          We present a case of a female patient with a prior laparoscopic gastric bypass who develops two years after surgery a gastrogastric fistula characterized by intractable abdominal pain and unsatisfactory weight loss. A laparoscopic revisional surgery was performed with pouch and remnant gastrectomy and new gastrojejunal anastomosis. The patient evolution was satisfactory, the symptoms were solved and new excess weight loss was achieved.

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          Trends in bariatric surgical procedures.

          The increasing prevalence and associated sociodemographic disparities of morbid obesity are serious public health concerns. Bariatric surgical procedures provide greater and more durable weight reduction than behavioral and pharmacological interventions for morbid obesity. To examine trends for elective bariatric surgical procedures, patient characteristics, and in-hospital complications from 1998 to 2003 in the United States. The Nationwide Inpatient Sample was used to identify bariatric surgery admissions from 1998-2002 (with preliminary data for 12 states from 2003) using International Classification of Diseases, Ninth Revision, codes for foregut surgery with a confirmatory diagnosis of obesity or by diagnosis related group code for obesity surgery. Annual estimates and trends were determined for procedures, patient characteristics, and adjusted complication rates. Trends in bariatric surgical procedures, patient characteristics, and complications. The estimated number of bariatric surgical procedures increased from 13,365 in 1998 to 72,177 in 2002 (P<.001). Based on preliminary state-level data (1998-2003), the number of bariatric surgical procedures is projected to be 102 794 in 2003. Gastric bypass procedures accounted for more than 80% of all bariatric surgical procedures. From 1998 to 2002, there were upward trends in the proportion of females (81% to 84%; P = .003), privately insured patients (75% to 83%; P = .001), patients from ZIP code areas with highest annual household income (32% to 60%, P<.001), and patients aged 50 to 64 years (15% to 24%; P<.001). Length of stay decreased from 4.5 days in 1998 to 3.3 days in 2002 (P<.001). The adjusted in-hospital mortality rate ranged from 0.1% to 0.2%. The rates of unexpected reoperations for surgical complications ranged from 6% to 9% and pulmonary complications ranged from 4% to 7%. Rates of other in-hospital complications were low. These findings suggest that use of bariatric surgical procedures increased substantially from 1998 to 2003, while rates of in-hospital complications were stable and length of stay decreased. However, disparities in the use of these procedures, with disproportionate and increasing use among women, those with private insurance, and those in wealthier ZIP code areas should be explored further.
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            Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.

            To evaluate the short-term outcomes for laparoscopic Roux-en-Y gastric bypass in 275 patients with a follow-up of 1 to 31 months. The Roux-en-Y gastric bypass is a highly successful approach to morbid obesity but results in significant perioperative complications. A laparoscopic approach has significant potential to reduce perioperative complications and recovery time. Consecutive patients (n = 275) who met NIH criteria for bariatric surgery were offered laparoscopic Roux-en-Y gastric bypass between July 1997 and March 2000. A 15-mL gastric pouch and a 75-cm Roux limb (150 cm for superobese) was created using five or six trocar incisions. The conversion rate to open gastric bypass was 1%. The start of an oral diet began a mean of 1.58 days after surgery, with a median hospital stay of 2 days and return to work at 21 days. The incidence of early major and minor complications was 3.3% and 27%, respectively. One death occurred related to a pulmonary embolus (0.4%). The hernia rate was 0.7%, and wound infections requiring outpatient drainage only were uncommon (5%). Excess weight loss at 24 and 30 months was 83% and 77%, respectively. In patients with more than 1 year of follow-up, most of the comorbidities were improved or resolved, and 95% reported significant improvement in quality of life. Laparoscopic Roux-en-Y gastric bypass is effective in achieving weight loss and in improving comorbidities and quality of life while reducing recovery time and perioperative complications.
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              Gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery: clinical and imaging findings.

              To report the complications and imaging findings in a large group of patients who underwent Roux-en-Y gastric bypass (GBP) surgery. Four hundred sixty-three patients were evaluated for upper gastrointestinal (GI) complications following Roux-en-Y GBP surgery. Major complications were those that required surgical or radiologic intervention and minor complications were those that resolved spontaneously. The time from surgery to complication and findings from upper GI series and computed tomography (CT) of the major complications and minor leaks were reviewed. Forty-four patients had 56 major complications: 23 small-bowel obstructions (14 internal hernias and nine adhesions), 16 major leaks, 15 anastomotic strictures, and two fistulas. There were 13 minor leaks and 18 other complications. Internal hernias were late complications and had a variety of findings at upper GI series and CT. Leaks were early complications and usually originated from the gastrojejunal anastomosis; findings from upper GI series and CT demonstrated extraluminal gas, contrast material, or both. Anastomotic strictures were late complications and were diagnosed at upper GI series with rounded dilation of the pouch and delayed emptying. Upper GI complications that required intervention occurred in 9.5% of patients. CT and upper GI series can depict most major complications.

                Author and article information

                Revista de la Facultad de Medicina
                Universidad Central de Venezuela. Facultad de Medicina. Comisión de Publicaciones de la Facultad de Medicina (Caracas, Distrito Capital, Venezuela )
                December 2008
                : 31
                : 2
                : 138-141
                [01] Caracas orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Escuela Luis Razetti Venezuela
                [02] Caracas orgnameHospital Universitario de Caracas orgdiv1Servicio de Cirugía II Venezuela
                S0798-04692008000200011 S0798-0469(08)03100211


                : 17 October 2008
                : 30 October 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 4

                SciELO Venezuela

                Reporte de Caso

                Gastric bypass,Laparoscopy,Gastrogastric fistula,Bypass gástrico,Laparoscopia,Fístula gastrogástrica


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