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Gil PJ, Ruiz-Manzanera JJ, Ruiz de Angulo D, Munitiz V, Ferreras D, López V, Conesa A, Ortiz Á, Martínez de Haro LF, Ramírez P. Learning Curve for Laparoscopic Sleeve Gastrectomy: a Cumulative Summation (CUSUM) Analysis. Obes Surg 2022; 32:2598-2604. [PMID: 35687255 DOI: 10.1007/s11695-022-06145-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Bariatric surgery is currently considered the most effective and durable treatment option for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has become a popular technique and may currently be the most frequently practiced surgical operation to treat obesity. However, no objective analyses of its learning curve have been reported. OBJECTIVE to analyze the learning curve for LSG. MATERIALS AND METHODS We included all LSGs performed in our hospital (University Hospital, Spain; Public Practice) from April 2013 to February 2016. The learning curve for LSG was evaluated using cumulative sum (CUSUM) analysis. All variables among the learning curve phases were compared. RESULTS According to the CUSUM analysis, the learning curve was divided into three unique phases: early learning (the initial 26 patients), acquisition of skills (the middle 30 patients), and mastery of technique (the final 56 patients). The operative time and gastric stenosis significantly decreased with progression of the learning curve without differences in the 30-day postoperative complication rate, postoperative stay, or weight loss. CONCLUSION According to this study, the learning curve for LSG can be divided into 3 distinct phases, and about 25 patients are needed to demonstrate an improvement in surgical skill.
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Affiliation(s)
- Pedro J Gil
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Juan José Ruiz-Manzanera
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain.
| | - David Ruiz de Angulo
- Bariatric Surgery Unit and Upper Gastrointestinal Surgical, General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Vicente Munitiz
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - David Ferreras
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Víctor López
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Ana Conesa
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Ángeles Ortiz
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Luisa F Martínez de Haro
- General Surgery Service, Upper Gastrointestinal Surgical Unit, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, "Virgen de La Arrixaca" Clinical University Hospital, 30120, El Palmar, Murcia, Spain.,Instituto Murciano De Investigación Biosanitaria (IMIB), 30120, El Palmar, Murcia, Spain
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Ruiz de Angulo D, Balaguer Román A, Munitiz Ruiz V, Gil Vázquez PJ, Ruiz Merino G, Ortiz Escandell MÁ, Martínez de Haro LF, Parrilla Paricio P. Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy. Cir Esp 2021; 99:428-432. [PMID: 34130814 PMCID: PMC8114763 DOI: 10.1016/j.cireng.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022]
Abstract
Introduction COVID-19 pandemic has lead to lockdown of population in many countries. In Spain, the state of alarm was established from March 15 to June 20, 2020. Usually this fact decreased people's mobility and physical activity, in addition to producing or exacerbating psychological disorders. Our aim was to determine the influence that this condition had over the short-term ponderal results of patients undergoing laparoscopic vertical gastrectomy from May 2019 to May 2020. Methods Case–control study for comparing the percentage of excess weight lost (%EWL) and the percentage of total weight lost (%TWL) of patients that underwent a VG during the last year, so they were affected by lockdown in April and part of March 2020 (group 1), to the %EWL and %TWL of a control group (group 2), obtained from our previous series. Results The mean %EWL in group 1 is 47.37 ± 18.59 and in group 2 is 51.13 ± 17.59, being P=.438. Meanwhile, the mean %TWL in group 1 is 21.14 ± 8.17 and in group 2 is 24.67 ± 8.01, with P=.115. Conclusions Population lockdown by COVID-19 did not get worse short-term results of vertical gastrectomy. More studies with a larger number of patients are necessary to draw firm conclusions.
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Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - Andrés Balaguer Román
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Vicente Munitiz Ruiz
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pedro José Gil Vázquez
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Guadalupe Ruiz Merino
- Unidad de Bioestadística, Instituto Murciano de Investigación Biosanitaria (IMIB), Spain
| | - M Ángeles Ortiz Escandell
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Luisa F Martínez de Haro
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pascual Parrilla Paricio
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
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Ruiz de Angulo D, Balaguer Román A, Munitiz Ruiz V, Gil Vázquez PJ, Ruiz Merino G, Ortiz Escandell MÁ, Martínez de Haro LF, Parrilla Paricio P. Influence of the lockdown due to COVID-19 on weight-loss results during the first year after sleeve gastrectomy. Cir Esp 2020; 99:428-432. [PMID: 34629481 PMCID: PMC7428729 DOI: 10.1016/j.ciresp.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022]
Abstract
Introducción La pandemia por COVID-19 ha obligado al confinamiento de la población en muchos países. En España, el estado de alarma se estableció desde el 15 de marzo al 20 de junio del 2020. Este hecho, por lo general, disminuyó la movilidad y la actividad física de las personas, además de producir o exacerbar alteraciones psicológicas. Nuestro objetivo es analizar la influencia que esta situación ha ejercido sobre los resultados ponderales a corto plazo de los pacientes tratados mediante una gastrectomía vertical laparoscópica entre mayo del 2019 y mayo del 2020. Métodos Estudio de casos y controles donde se compararon el porcentaje de exceso de peso perdido (%EWL) y el porcentaje de peso total perdido (%TWL) de los pacientes intervenidos en el último año y a los que ha afectado el confinamiento durante el mes de abril y parte de marzo del 2020 (grupo 1; n = 20), con el de un grupo control (grupo 2; n = 40) de nuestra casuística previa. Resultados El %EWL medio en el grupo 1 es de 47,37 ± 18,59 y en el grupo 2 es de 51,13 ± 17,59, siendo la p = 0,438. Por su parte, el %TWL medio en el grupo 1 es de 21,14 ± 8,17 mientras que en el grupo 2 es de 24,67 ± 8,01, resultando la p = 0,115. Conclusiones El confinamiento de la población por COVID-19 no empeoró los resultados ponderales a corto plazo de la gastrectomía vertical. Son necesarios más estudios con un mayor número de pacientes para obtener conclusiones más sólidas.
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Affiliation(s)
- David Ruiz de Angulo
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - Andrés Balaguer Román
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, España
| | - Vicente Munitiz Ruiz
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Pedro José Gil Vázquez
- Servicio de Cirugía General y Aparato Digestivo, Hospìtal Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Ángeles Ortiz Escandell
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Luisa F Martínez de Haro
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Pascual Parrilla Paricio
- Unidad de Cirugía Esofagogástrica y Obesidad, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Munitiz Ruiz V, Jimeno P, Ruiz de Angulo D, Ortiz Á, Martínez de Haro LF, Marín M, Cascales P, Ruiz García G, Ortiz Ruiz E, Parrilla P. Is prophylactic gastrectomy indicated for healthy carriers of CDH1 gene mutations associated with hereditary diffuse gastric cancer? Rev Esp Enferm Dig 2020; 111:189-192. [PMID: 30466290 DOI: 10.17235/reed.2018.5831/2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION hereditary diffuse gastric cancer (HDGC) is a recently reported hereditary cancer syndrome. Patients with suspected HDGC must be under surveillance via endoscopy and multiple biopsies. As an alternative, some studies suggest prophylactic gastrectomy (PG) for disease carriers. The goal of this article was to report our experience with a CDH1 mutation positive family who underwent PG. PATIENTS AND METHODS the index case was a 34-year-old female diagnosed with diffuse gastric adenocarcinoma and massive carcinomatosis. There was a family history of gastric adenocarcinoma in seven family members. A genetic study identified the c.1577G>A mutation, in exon 11 of the CDH1 gene via sequencing analysis. RESULTS this mutation was also present in other six family members, who subsequently underwent prophylactic gastrectomy. The pathology study of resected gastric segments revealed multiple microscopic foci of adenocarcinoma in five of these individuals. These foci were not detected in the multiple endoscopies performed before surgery. CONCLUSIONS we recommend prophylactic gastrectomy for CDH1 mutation carriers even in the absence of lesions during endoscopic screening.
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Affiliation(s)
| | - Pilar Jimeno
- Hospital Clínico Universitario Virgen de la Arrixaca
| | | | - Ángeles Ortiz
- Hospital Clínico Universitario Virgen de la Arrixaca
| | | | - Miguel Marín
- Hospital Clínico Universitario Virgen de la Arrixaca
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Munitiz Ruiz V, Martínez de Haro LF, Parrilla P. Barrett's esophagus is a controversial condition. Rev Esp Enferm Dig 2020; 112:161-162. [PMID: 31985256 DOI: 10.17235/reed.2020.6736/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We wish to respond to the comments provided by José Miguel Esteban López-Jamar and Ravishankar Asokkumar (1) about our report in this Journal (2). Some of the comments were perhaps prompted by inadequately explained or understood concepts, since they mention aspects that we never even considered or stated.
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Affiliation(s)
| | | | - Pascual Parrilla
- Cirugía General, Hospital Clínico Universitario Virgen de la Arrixaca
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Ruiz de Angulo D, Munitiz V, Ortiz MÁ, Martínez de Haro LF, Frutos MD, Hernández A, Parrilla P. Communication between the obese patient and bariatric surgeon. Cir Esp 2015; 93:492-5. [PMID: 25912163 DOI: 10.1016/j.ciresp.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/18/2014] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important.
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Affiliation(s)
- David Ruiz de Angulo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - Vicente Munitiz
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - M Ángeles Ortiz
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Luisa F Martínez de Haro
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - M Dolores Frutos
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Antonio Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Pascual Parrilla
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Ruiz Pardo J, Martínez de Haro LF, Ortiz Escandell A, Munitiz Ruiz V. Afagia por candidiasis esofágica en paciente inmunocompetente. Cir Esp 2015; 93:42. [DOI: 10.1016/j.ciresp.2014.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 10/24/2022]
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Ruiz de Angulo D, Ortiz MÁ, Martínez de Haro LF. Efectos secundarios de los inhibidores de la bomba de protones, ¿una razón más para indicar la cirugía antirreflujo en el esófago de Barrett? Cir Esp 2014; 92:303-4. [DOI: 10.1016/j.ciresp.2014.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/17/2014] [Indexed: 11/16/2022]
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Ruiz de Angulo D, Martínez de Haro LF, Ortiz MÁ, Munitiz V, Navas D, Abrisqueta J, Parrilla P. Valoración del resultado estético percibido por los pacientes apendicectomizados vía laparoscópica mediante tres incisiones. Cir Esp 2011; 89:317-20. [DOI: 10.1016/j.ciresp.2011.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 01/11/2011] [Accepted: 01/11/2011] [Indexed: 11/30/2022]
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Martínez de Haro LF, Munitiz V, Ortiz A, Ruiz de Angulo D, Navarro MD, Parrilla P. [Outpatient monitoring of oesophageal pH with a catheter-free pH-meter (Bravo System). A Study of tolerance, safety and efficacy]. Cir Esp 2008; 84:201-9. [PMID: 18928770 DOI: 10.1016/s0009-739x(08)72620-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE A new catheter-free outpatient oesophageal pH-meter system (Bravo) has recently been developed. The objective of this study is to test the tolerance, safety and efficacy of the system in the measurement of gastric-oesophageal reflux by comparing it with a conventional pH system. PATIENTS AND METHOD The study was performed on a control group consisting of 10 healthy volunteers (group 1) and in a group of 40 patients with symptoms of gastric-oesophageal reflux disease (groups 2 and 3). An upper digestive system endoscopy, oesophageal manometry and oesophageal pH measurements with a conventional system and/or with the Bravo catheter-free system, was performed on all patients. All patients who had both tests done (groups 1 and 2) filled in a questionnaire on any physical problems and changes in their daily activity. RESULTS The test tolerance was higher with the Bravo system in the 9 parameters studied. In the group of healthy volunteers (group 1), the median (range) of the total percentage of pH < 4 was 1.1% (0.5-3.1) with the conventional pH and 1.7% (0-3.4) with the Bravo. When comparing the patients with symptoms of gastric-oesophageal reflux disease (group 2) with those who had only one type of pH measurement made, the acid reflux was significantly higher in patients with Barrett's oesophagus than in the rest of the groups, with conventional pH as well as with the Bravo. If we analyse the patient group with disease due to gastric-oesophageal reflux with those on whom both techniques were used (group 3), 7 of the 10 patients had a pathological reflux that only showed up on measuring pH with the Bravo system. CONCLUSIONS Catheter-free pH measurements (Bravo) is better tolerated and with better satisfaction for the healthy volunteers and patients than with conventional PH, even, on occasions being more efficient for studying acid reflux due to the lower incidence of negative results.
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Affiliation(s)
- Luisa F Martínez de Haro
- Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
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Munítiz V, Martínez de Haro LF, Ortiz MA, Ruiz de Angulo D, Molina J, Bermejo J, Serrano A, Parrilla P. [Surgical treatment of high-grade dysplasia in Barrett's esophagus]. Cir Esp 2008; 82:214-8. [PMID: 17942046 DOI: 10.1016/s0009-739x(07)71709-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Barrett's esophagus undergoes malignant transformation in 0.5-1% of patients per year following the sequence of low-grade dysplasia, high-grade dysplasia and adenocarcinoma. The aim of the present study was to present our experience in the surgical treatment of Barrett's esophagus with high-grade dysplasia. PATIENTS AND METHOD Of a group of 128 patients with a diagnosis of Barrett's esophagus, 8 (6.2%) developed high-grade dysplasia during a median follow-up of 7 years (2-25). A further 5 patients with high-grade dysplaing out side the study were referred for evaluation and surgical treatment. Eight patients were under medical treatment with omeprazole (40 mg daily) while the remaining 5 patients had undergone open Nissen fundoplication, with a diagnosis of high-grade dysplasia at a median of 5 years (1-16) after treatment initiation. After confirmation of the diagnosis by a second pathologist and tumoral staging, transthoracic esophagectomy with anastomosis at the apex of the thorax was performed in all patients. RESULTS Postoperative mortality was nil. Morbidity was 36% (5 patients). Definitive histological analysis of the surgical specimen revealed high-grade dysplasia in 7 patients (54%) and adenocarcinoma in 6 (46%). All patients remain alive after a median follow-up of 4.7 years (1-14). CONCLUSIONS In patients with Barrett's esophagus with high-grade dysplasia, the best therapeutic option is surgical resection, which can be performed with nil mortality in experienced centers. In almost half of surgical patients, the surgical specimen shows adenocarcinoma. Five-year survival is higher than 90%.
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Affiliation(s)
- Vicente Munítiz
- Unidad de Patología Esofágica, Servicio de Cirugía General I, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Munítiz V, Ortiz Á, Martínez de Haro LF, Glover G, Ferri B, Parrilla P. Diagnóstico y tratamiento de la distrofia oculofaríngea. Presentación de 3 casos de una misma familia. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Munítiz V, Ortiz-Escandell Á, Martínez de Haro LF, Antonio García-Marcilla J, Molina J, Ruiz de Angulo D, Carlos Navalón J, Parrilla P. Resultados del cáncer de esófago resecado. Estudio comparativo entre el adenocarcinoma y el carcinoma epidermoide. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72367-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parrilla P, Martínez de Haro LF, Ortiz A, Munitiz V, Serrano A, Torres G. Barrett's esophagus without esophageal stricture does not increase the rate of failure of Nissen fundoplication. Ann Surg 2003; 237:488-93. [PMID: 12677144 PMCID: PMC1514485 DOI: 10.1097/01.sla.0000059971.05281.d2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether the presence of Barrett's esophagus (BE) modifies the results of Nissen fundoplication. SUMMARY BACKGROUND DATA Some authors consider that BE, whether or not there is associated stricture, significantly increases the failure rate of standard antireflux surgery; they recommend using different and more aggressive surgical procedures in all patients with BE. METHODS One hundred seventy-seven patients with gastroesophageal reflux disease, without esophageal stricture, were included in a retrospective study. Patients were divided into two groups: those with BE (n = 57) and those without BE (n = 120). Nissen fundoplication was performed in all patients by the same surgical team. Clinical, endoscopic, and functional (manometry and 24-hour pH monitoring) results in the two study groups were compared. RESULTS After a median follow-up of 5 years (range 1-18) in the BE group and 6 years (range 1-18) in the non-BE group, the rate of clinical recurrence was 8% in the BE group and 10% in the non-BE group, with no statistically significant difference. The rate of pH-metric recurrence was the same in both groups (15%). CONCLUSIONS The presence of BE without esophageal stricture does not increase the rate of failure of Nissen fundoplication.
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Affiliation(s)
- Pascual Parrilla
- Department of Surgery, University Hospital Virgen de la Arrixaca, Ctra. Madrid-Cartagena, El Palmar-30120, Murcia, Spain.
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Parrilla P, Martínez de Haro LF, Ortiz A, Munitiz V, Molina J, Bermejo J, Canteras M. Long-term results of a randomized prospective study comparing medical and surgical treatment of Barrett's esophagus. Ann Surg 2003; 237:291-8. [PMID: 12616111 PMCID: PMC1514316 DOI: 10.1097/01.sla.0000055269.77838.8e] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To compare the results of medical treatment and antireflux surgery in patients with Barrett's esophagus (BE). SUMMARY BACKGROUND DATA The treatment of choice in BE is still controversial. Some clinical studies suggest that surgery could be more effective than medical treatment in preventing BE from progressing to dysplasia and adenocarcinoma. However, data from prospective comparative studies are necessary to answer this question. METHODS One hundred one patients were included in a randomized prospective study, 43 with medical treatment and 58 with antireflux surgery. All patients underwent clinical, endoscopic, and histologic assessment. Functional studies were performed in all the operated patients and in a subgroup of patients receiving medical treatment. The median follow-up was 5 years (range 1-18) in the medical treatment group and 6 years (range 1-18) in the surgical treatment group. RESULTS Satisfactory clinical results (excellent to good) were achieved in 39 of the 43 patients (91%) undergoing medical treatment and in 53 of the 58 patients (91%) following antireflux surgery. The persistence of added inflammatory lesions was significantly higher in the medical treatment group. The metaplastic segment did not disappear in any case. Postoperative functional studies showed a significant decrease in the median percentage of total time with pH below 4, although 9 of the 58 patients (15%) showed pathologic rates of acid reflux. High-grade dysplasia appeared in 2 of the 43 patients (5%) in the medical treatment group and in 2 of the 58 patients (3%) in the surgical treatment group. In the latter, both patients presented with clinical and pH-metric recurrence. There was no case of malignancy after successful antireflux surgery. CONCLUSIONS These results show that there are no differences between the two types of treatment with respect to preventing BE from progressing to dysplasia and adenocarcinoma. However, successful antireflux surgery proved to be more efficient than medical treatment in this sense, perhaps because it completely controls acid and biliopancreatic reflux to the esophagus.
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Affiliation(s)
- Pascual Parrilla
- Department of Surgery, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
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Munítiz Ruiz V, Martínez de Haro LF, Ortiz Escandell Á, Serrano Jiménez A, Ruiz de Angulo D, Parrilla Paricio P. El esófago de Barrett no incrementa la tasa de fallos de la fundoplicatura de Nissen. Cir Esp 2003. [DOI: 10.1016/s0009-739x(03)72128-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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