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León P, Gabrielli M, Quezada N, Crovari F, Muñoz R. Bariatric Surgery Before and After the SARS-CoV-2 Pandemic: a Comparative Study of Cases Before the Onset of the Pandemic in a High-Volume Academic Center. Obes Surg 2023; 33:3431-3436. [PMID: 37672115 DOI: 10.1007/s11695-023-06677-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION At the beginning of the pandemic, studies showed a higher risk of severe surgical complications and mortality among patients with perioperative SARS-CoV-2 infection, which led to the suspension of elective surgery. Confinement and lockdown measures were shown to be associated with weight gain and less access to medical and surgical care in patients with obesity, with negative health consequences. To evaluate the safety of bariatric surgery during the pandemic, we compared 30-day complications between patients who underwent bariatric surgery immediately before with those who underwent bariatric surgery during the opening phase of the pandemic. METHODS Observational analytical study of a non-concurrent cohort of patients who underwent bariatric surgery in 2 periods: pre-pandemic March 1 to December 31, 2019, and pandemic March 1 to December 31, 2020. Surgical complications were defined using the Clavien-Dindo classification. RESULTS Pre-pandemic and pandemic groups included 256 and 202 patients who underwent primary bariatric surgery, respectively. The mean age was 37.6 + 10.3 years. The overall complication rate during the first 30 days of discharge was 7.42%. No differences between groups were observed in severe complications (pre-pandemic 1.56% vs. pandemic 1.98%, p: 0.58). No mortality was reported. Overall 30-day readmission was 3.28% with no differences between groups. CONCLUSION The findings of this study did not find a difference in the rate of severe complications, nor also we report severe COVID-19 complications in this high-risk population. During the pandemic, with appropriately implemented protocol, the resumption of bariatric surgery is possible with no increased risk for patients.
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Affiliation(s)
- Paula León
- Master in Research in Health Sciences, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Region Metropolitana, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Region Metropolitana, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Region Metropolitana, Chile
| | - Rodrigo Muñoz
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, Santiago, Region Metropolitana, Chile.
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Quezada N, Grimoldi M, Jacubovsky I, Besser N, Riveros S, Achurra P, Crovari F. Midterm Results of the Open and Minimally Invasive Transversus Abdominis Release Technique for the Treatment of Abdominal Wall Hernias in an Academic Center. J Abdom Wall Surg 2022; 1:10407. [PMID: 38314163 PMCID: PMC10831654 DOI: 10.3389/jaws.2022.10407] [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] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/16/2022] [Indexed: 02/06/2024]
Abstract
Introduction: Large hernia defects are a challenge for general and specialized hernia surgeons. The transversus abdominis release (TAR) technique has revolutionized the treatment of complex hernias since it allows the closure of large midline hernias, as well as hernias in different locations. This study aims to report the experience with the TAR technique and mid-term results in the first 101 patients. Methods: Non-concurrent cohort review of our prospectively collected electronic database. All patients submitted to a TAR (open or minimally invasive eTEP-TAR) from 2017 to 2020 were included. Demographic data, comorbidities, hernia characteristics, preoperative optimization, intraoperative variables, and clinical outcomes were gathered. The main outcomes of this study are hernia recurrences and surgical morbidity. Results: A total of 101 patients were identified. The median follow-up was 26 months. Mean age and body mass index was 63 years and 31.4 Kg/m2, respectively. Diabetes was present in 22% of patients and 43% had at least one previous hernia repair. Nineteen patients had significant loss of domain. Mean hernia size and area were 13 cm and 247 cm2, respectively. Ninety-six percent of cases were clean or clean-contaminated. The mean operative time was 164 min and all patients received a synthetic mesh. We diagnosed two hernia recurrences and the overall (medical and surgical) complication rate was 32%. The hernia-specific complication rate was 17%, with seven surgical site infections and seven surgical site occurrences requiring procedural interventions. Notably, weight loss was associated with a lower risk of SSOPI and reoperations. Conclusion: We show an encouraging 2% of recurrences in the mid-term follow-up in the setting of clinically complex hernia repair. However, we observed a high frequency of overall and hernia-specific complications pointing to the complexity of the type of surgery itself and the patients we operated on.
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Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery, Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milenko Grimoldi
- General Surgery Service, Hospital Dr. Sótero Del Río, Santiago, Chile
| | - Ioram Jacubovsky
- General Surgery Service, Hospital Dr. Sótero Del Río, Santiago, Chile
| | - Nicolás Besser
- Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Riveros
- Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Crovari F, Inzunza M, Irarrázaval MJ, Romero C, Achurra P, Quezada N, Gabrielli M, Muñoz R. Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center. Obes Surg 2021; 31:5376-5382. [PMID: 34482520 PMCID: PMC8418454 DOI: 10.1007/s11695-021-05695-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic. OBJECTIVES To determine the risk of symptomatic COVID-19 infection and associated complications during the first 30 days after bariatric surgery. MATERIALS AND METHODS Prospective observational cohort study including all patients who consecutively underwent primary bariatric surgery between August and December 2020. RESULTS A total of 189 patients were included. Median age and BMI were 36 (17-70) years and 38 (35-41) kg/m2, respectively. Forty percent of patients were women (n = 76), 59.3% (n = 112) underwent sleeve gastrectomy (SG), and 40.7% (n = 77) underwent Roux-en-Y gastric bypass (RYGB). All surgeries were performed laparoscopically. The median length of postoperative stay was 2 (0-5) days. Postoperative COVID-19 infection was detected in two patients (1.1%): one patient was readmitted without the need of intermediate or ICU care, and the other was managed as an outpatient. Major complications occurred in three patients (1.6%); none of them was COVID-19 related. Two patients required an unplanned reoperation. No patient required intermediate or ICU care, no severe COVID-19 complications were observed, and no mortality was reported. CONCLUSION Bariatric surgery can be safely performed during the ongoing pandemic, albeit a low risk of COVID-19 symptomatic infection. Rigorous perioperative COVID-19 institutional protocols are required to perform bariatric surgery safely during the current pandemic.
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Affiliation(s)
- Fernando Crovari
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martin Inzunza
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María J Irarrázaval
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Romero
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- , Santiago, Chile.
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Tuñón-Suárez M, Reyes-Ponce A, Godoy-Órdenes R, Quezada N, Flores-Opazo M. Exercise Training to Decrease Ectopic Intermuscular Adipose Tissue in Individuals With Chronic Diseases: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6309597. [PMID: 34174085 DOI: 10.1093/ptj/pzab162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of exercise training on ectopic fat within skeletal muscle (intermuscular adipose tissue [IMAT]) in adult populations with chronic diseases. METHODS A literature search was conducted in relevant databases to identify randomized controlled trials (RCTs) from inception. Selected studies examined the effect of aerobic training (AET), resistance training (RT), or combined training (COM) on IMAT as assessed by noninvasive magnetic resonance imagery or computed tomography. Eligibility was determined using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data extraction was performed using the population (P), intervention (I), comparison (C), outcome (O), timing (T), and settings (S) approach. Methodological quality was analyzed by the Cochrane risk of bias assessment. Standardized effect sizes (ES) with 95% CIs were calculated. Heterogeneity among studies was quantified using I2 statistics. Subgroup and meta-regression analyses were included. Risk of publication bias was examined by the Egger regression test. RESULTS Nineteen RCTs included 962 adults (628 women; age range = 34.8-93.4 years) with different chronic conditions that participated in 10 AET, 12 RT, and 5 COM interventions. The quality of studies was deemed moderate. Overall, the effect of exercise on IMAT was small (ES = 0.24; 95% CI = 0.10 to 0.37; heterogeneity I2 = 0.0%) compared with no exercise or control interventions. Moderate-intensity AET and COM had larger ES compared with RT regardless of intensity. This effect was associated with exercise-induced body weight and fat mass losses. Subgroup analysis revealed larger ES in studies assessing IMAT by magnetic resonance imagery compared with computed tomography in adults and middle-aged individuals compared with older adults and in participants who were HIV+ compared with other diagnoses. CONCLUSION AET and COM of moderate intensity reduce IMAT in individuals from 18 to 65 years of age who are affected by chronic diseases. This effect is associated with exercise-induced body weight and fat mass losses. In older individuals who are frail and patients at an advanced disease stage, exercise may result in a paradoxical IMAT accumulation. IMPACT In people affected by chronic conditions, IMAT accumulation induces muscle mass and strength losses, decline in physical performance, inflammation, and metabolic alterations. The present study shows that moderate-intensity AET or COM prevent or reduce IMAT in these conditions. Thus, the deleterious effect of IMAT on skeletal muscle homeostasis may be reverted by a properly prescribed exercise regime. The findings of the present systematic review are critical for physical therapists and health care professionals because they emphasize the therapeutic role of exercise and provide recommendations for exercise prescription that ultimately may have a positive impact on the course of disease, recovery of functionality, and independence. LAY SUMMARY Aerobic exercise (eg, walking/jogging, cycling) alone or combined with resistance exercise (strength training with free-weights, kettle bells, or gym equipment) is effective in reducing fat streaks that infiltrate muscles and impair muscle function and growth, particularly in adults affected by chronic diseases.
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Affiliation(s)
- Mauro Tuñón-Suárez
- Exercise Physiology and Metabolism Laboratory, School of Kinesiology, Universidad Finis Terrae, Santiago, Chile
| | - Alvaro Reyes-Ponce
- Facultad de Ciencias de la Rehabilitación, Escuela de Kinesiología, Universidad Andres Bello, Viña del Mar, Chile
| | - Rodrigo Godoy-Órdenes
- Clinical Exercise Physiology Program, Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Nicolás Quezada
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Flores-Opazo
- Exercise Physiology and Metabolism Laboratory, School of Kinesiology, Universidad Finis Terrae, Santiago, Chile
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Inzunza M, Romero C, Irarrázaval MJ, Ruiz-Esquide M, Achurra P, Quezada N, Crovari F, Muñoz R. Morbidity and Mortality in Patients with Perioperative COVID-19 Infection: Prospective Cohort in General, Gastroesophagic, Hepatobiliary, and Colorectal Surgery. World J Surg 2021; 45:1652-1662. [PMID: 33748925 PMCID: PMC7982273 DOI: 10.1007/s00268-021-06068-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 12/27/2022]
Abstract
Background Severe acute respiratory syndrome due to coronavirus 2 has rapidly spread worldwide in an unprecedented pandemic. Patients with an ongoing COVID-19 infection requiring surgery have higher risk of mortality and complications. This study describes the mortality and morbidity in patients with perioperative COVID-19 infection undergoing elective and emergency surgeries. Methods Prospective cohort of consecutive patients who required a general, gastroesophageal, hepatobiliary, colorectal, or emergency surgery during COVID-19 pandemic at an academic teaching hospital. The primary outcome was 30-day mortality and major complications. Secondary outcomes were specific respiratory mortality and complications. Results A total of 701 patients underwent surgery, 39 (5.6%) with a perioperative COVID-19 infection. 30-day mortality was 12.8% and 1.4% in patients with and without COVID-19 infection, respectively (p < 0.001). Major surgical complications occurred in 25.6% and 6.8% in patients with and without COVID-19 infection, respectively (p < 0.001). Respiratory complications occurred in 30.8% and 1.4% in patients with and without COVID-19 infection, respectively (p < 0.001). Mortality due to a respiratory complication was 100% and 11.1% in patients with and without COVID-19 infection, respectively (p < 0.006). Conclusions 30-day mortality and surgical complications are higher in patients with perioperative COVID-19 infection. Indications for elective surgery need to be reserved for non-deferrable procedures in order to avoid unnecessary risks of non-urgent procedures.
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Affiliation(s)
- Martin Inzunza
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Romero
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Pablo Achurra
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile. .,School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Quezada N, Grimoldi M, Besser N, Jacubovsky I, Achurra P, Crovari F. Enhanced-view totally extraperitoneal (eTEP) approach for the treatment of abdominal wall hernias: mid-term results. Surg Endosc 2021; 36:632-639. [PMID: 33528665 DOI: 10.1007/s00464-021-08330-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/26/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Multiple minimally invasive techniques have been described for ventral hernia repair. The recently described enhanced view totally extraperitoneal (eTEP) ventral hernia repair seems an appealing option since it allows to address midline and lateral hernias, placing the mesh in the retromuscular position without the use of traumatic fixation. AIM To report on the mid-term result of a series of patients with ventral hernias repaired by the eTEP approach. METHODS A retrospective analysis of our case series between June 2017 and December 2019. Demographic and clinical data were gathered. Hernia characteristics, surgical details, hernia recurrences, and complications are reported. RESULTS 66 patients were included in the study. Median follow-up was 22 months (interquartile range 12-26). 60% of patients were male. Mean age, BMI, % of Type-2 diabetes and % of smoking were 59 ± 12 years, 30 kg/m2, 24% and 23%, respectively. Mean hernia defect size was 5.5 ± 2.9 cm. Forty-three eTEP Rives-stoppa and 23 eTEP-Transversus abdominis release (14 unilateral, 9 bilateral) were performed. 22 inguinal hernias and 15 lateral defects were simultaneously repaired. We report 1 recurrence (1.5%) and 10 surgical site occurrences (15%; 6 seromas, 2 hematomas and 2 surgical site infections). Four patients required reinterventions (6%). CONCLUSION eTEP is a promising approach to treat midline hernias and allows the simultaneous treatment of lateral and inguinal defects, keeping the mesh in the retromuscular position. However, comparative studies must be performed to know its real benefit in laparoscopic ventral hernia repair.
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Affiliation(s)
- Nicolás Quezada
- Surgery Division, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Región Metropolitana, Chile.
| | - Milenko Grimoldi
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Besser
- Surgery Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ioram Jacubovsky
- General Surgery Service, Hospital Dr. Sótero del Río, Santiago, Chile
| | - Pablo Achurra
- Surgery Division, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Región Metropolitana, Chile
| | - Fernando Crovari
- Surgery Division, Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Región Metropolitana, Chile
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Riveros S, Inzunza M, Crovari F, Briceño E, Achurra P, Quezada N. Laparoscopic Revisional Conversion of Sleeve Gastrectomy to Gastric Bypass After Liver Transplantation. Obes Surg 2021; 31:2305-2307. [PMID: 33415610 DOI: 10.1007/s11695-020-05203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Sergio Riveros
- Department of Digestive Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Martín Inzunza
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Chile
| | - Eduardo Briceño
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, 362 Diagonal Paraguay, 4th Floor, Office 410, Santiago, Chile.
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Hamid HKS, Emile SH, Saber AA, Dincer M, de Moura DTH, Gilissen LPL, Almadi MA, Montuori M, Vix M, Perisse LGS, Quezada N, Garofalo F, Pescarus R. Customized bariatric stents for sleeve gastrectomy leak: are they superior to conventional esophageal stents? A systematic review and proportion meta-analysis. Surg Endosc 2020; 35:1025-1038. [DOI: 10.1007/s00464-020-08147-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
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Irarrázaval MJ, Inzunza M, Muñoz R, Quezada N, Brañes A, Gabrielli M, Soto P, Dib M, Urrejola G, Varas J, Valderrama S, Crovari F, Achurra P. Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic. Surg Endosc 2020; 35:6300-6306. [PMID: 33140151 PMCID: PMC7605475 DOI: 10.1007/s00464-020-08130-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/24/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
Summary and background data Recent coronavirus outbreak and “stay at home” policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak. Methods Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed. Results Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, (P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department. Conclusions In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.
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Affiliation(s)
- María J Irarrázaval
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martin Inzunza
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Rodrigo Muñoz
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Nicolás Quezada
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Alejandro Brañes
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Mauricio Gabrielli
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pedro Soto
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Martín Dib
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Gonzalo Urrejola
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Julian Varas
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Sebastián Valderrama
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Fernando Crovari
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile
| | - Pablo Achurra
- Department of Gastrointestinal Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077, Santiago, Region Metropolitana, Chile.
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Quezada N, Maturana G, Irarrázaval MJ, Muñoz R, Morales S, Achurra P, Azócar C, Crovari F. Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study. Obes Surg 2020; 30:4724-4731. [PMID: 32808168 DOI: 10.1007/s11695-020-04929-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Laparoscopic bariatric surgery (LBS) in liver end-stage organ disease has been proven to improve organ function and patients' symptoms. A series of LBS in patients with cirrhosis have shown good results in weight loss, but increased risk of complications. Current literature is based on clinical series. This paper aims to compare LBS (69% gastric bypass) between patients with cirrhosis and without cirrhosis. METHODS We conducted a retrospective 1:3 matched case-control study including bariatric patients with cirrhosis and without cirrhosis. Demographics, operative variables, postoperative complications, long-term weight loss, and comorbidity resolution were compared between groups. RESULTS Sixteen Child A patients were included in the patients with cirrhosis (PC) group and 48 in patients without cirrhosis (control) group. Mean age was 50 years; preoperative BMI was 39 ± 6.8 kg/m2. Laparoscopic gastric bypass and laparoscopic sleeve gastrectomy were performed in 69% and 31%, respectively. Follow-up was 81% at 2 years for both groups. PC group had a higher rate of overall (31% vs. 6%; p < 0.05) and severe (Clavien-Dindo ≥ III; 13% vs. 0%; p = 0.013) complications than that of the control group. Mean %EWL of PC at 2 years of follow-up was 84.9%, without differences compared with that of the control group (83.1%). Comorbidity remission in PC was 14%, 50%, and 85% for hypertension, type 2 diabetes, and dyslipidemia, respectively. Patients without cirrhosis had a higher resolution rate of hypertension (65% vs. 14%, p = 0.03). CONCLUSION LBS is effective for weight loss and comorbidity resolution in patients with obesity and Child A liver cirrhosis. However, these results are accompanied by significantly increased risk of complications.
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Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery, Upper Gastrointestinal and Hernia surgery division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 362 Diagonal Paraguay, 4th Floor - Office 410, Santiago, Región Metropolitana, Chile.
| | - Gregorio Maturana
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Avda. Libertador Bernando O'Higgins 340, Santiago, Chile
| | - María Jesús Irarrázaval
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Avda. Libertador Bernando O'Higgins 340, Santiago, Chile
| | - Rodrigo Muñoz
- Department of Digestive Surgery, Upper Gastrointestinal and Hernia surgery division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 362 Diagonal Paraguay, 4th Floor - Office 410, Santiago, Región Metropolitana, Chile
| | - Sebastián Morales
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Avda. Libertador Bernando O'Higgins 340, Santiago, Chile
| | - Pablo Achurra
- Department of Digestive Surgery, Upper Gastrointestinal and Hernia surgery division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 362 Diagonal Paraguay, 4th Floor - Office 410, Santiago, Región Metropolitana, Chile
| | - Cristóbal Azócar
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Avda. Libertador Bernando O'Higgins 340, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Upper Gastrointestinal and Hernia surgery division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 362 Diagonal Paraguay, 4th Floor - Office 410, Santiago, Región Metropolitana, Chile
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Quezada N, Maturana G, Pimentel E, Crovari F, Muñoz R, Jarufe N, Pimentel F. Simultaneous TAPP inguinal repair and laparoscopic cholecystectomy: results of a case series. Hernia 2018; 23:119-123. [PMID: 30259218 DOI: 10.1007/s10029-018-1824-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/04/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cholecystectomy and inguinal hernioplasty are the most frequent surgeries in Chile and the world. Laparoscopic inguinal hernioplasty, being a clean surgery, reports mesh infection rates of less than 2% and adding a simultaneous laparoscopic cholecystectomy is controversial due to an increase in the risk of mesh infection. The aim of this paper is to report the results of simultaneous TAPP hernioplasty with laparoscopic cholecystectomy. METHOD Retrospective analysis of the digestive surgery database. We identified cases in which laparoscopic inguinal TAPP repair and simultaneous laparoscopic cholecystectomy were performed. Demographic, clinical information, hernia type and size, data from the surgery and its complications were also retrieved and analyzed. RESULTS We identified 21 patients, 86% male and with an average age of 61 years range 46-84. 72% of the hernias were unilateral, predominating indirect 50%, direct 28% and the remaining were femoral and mixed. The average hernia size was 2.2 cm. The meshes used were 56% polypropylene, 37% polyester and 5% PVDF. We report one gallblader perforation. At a median time of 40 months of follow-up (range 4-89 months), one hernia recurrence was found (3.7%), there were no reoperations at the time of the interview and there were no cases of mesh infection. Complications of surgery includes one ipsilateral testicular atrophy 4.8% and 1 ipsilateral inguinal seroma 4.8%. CONCLUSIONS In this series of cases, adding clean contaminated surgery to the inguinal TAPP hernioplasty was not associated with an increase in the infection of the mesh.
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Affiliation(s)
- N Quezada
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile.
| | - G Maturana
- Medicine Faculty, Pontifical Catholic University of Chile, Santiago, Chile
| | - E Pimentel
- Medicine Faculty, Pontifical Catholic University of Chile, Santiago, Chile
| | - F Crovari
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
| | - R Muñoz
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
| | - N Jarufe
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
| | - F Pimentel
- Department of Digestive Surgery, Medicine Faculty, Pontifical Catholic University of Chile, Diagonal paraguay 362, Santiago, Region Metropolitana, Chile
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Rolle A, Paredes S, Cortínez LI, Anderson BJ, Quezada N, Solari S, Allende F, Torres J, Cabrera D, Contreras V, Carmona J, Ramírez C, Oliveros AM, Ibacache M. Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients. Br J Anaesth 2018; 120:969-977. [PMID: 29661414 DOI: 10.1016/j.bja.2018.01.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 09/25/2017] [Revised: 12/28/2017] [Accepted: 01/27/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Obesity has been associated with reduced dexmedetomidine clearance, suggesting impaired hepatic function or reduced hepatic blood flow. The aim of this study was to clarify the effect of obesity in dexmedetomidine metabolic clearance. METHODS Forty patients, ASA I-III, 18-60 yr old, weighing 47-126 kg, scheduled for abdominal laparoscopic surgery, were enrolled. Anaesthetic agents (propofol, remifentanil, and dexmedetomidine) were dosed based on lean body weight measured by dual X-ray absorptiometry. Serial venous samples were drawn during and after dexmedetomidine infusion. A pharmacokinetic analysis was undertaken using non-linear mixed-effect models. In the modelling approach, the total body weight, lean body weight, and adjusted body weight were first tested as size descriptors for volumes and clearances. Hepatic blood flow, liver histopathology, liver enzymes, and gene expression of metabolic enzymes (UGT2B10 and UGT1A4) were tested as covariates of dexmedetomidine metabolic clearance. A decrease in NONMEM objective function value (ΔOFV) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. RESULTS A total of 637 dexmedetomidine serum samples were obtained. A two-compartmental model scaled to measured lean weight adequately described the dexmedetomidine pharmacokinetics. Liver blood flow was a covariate for dexmedetomidine clearance (ΔOFV=-5.878). Other factors, including fat mass, histopathological damage, and differential expression of enzymes, did not affect the dexmedetomidine clearance in the population studied (ΔOFV<3.84). CONCLUSIONS We did not find a negative influence of obesity in dexmedetomidine clearance when doses were adjusted to lean body weight. Liver blood flow showed a significant effect on dexmedetomidine clearance. CLINICAL TRIAL REGISTRATION NCT02557867.
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Affiliation(s)
- A Rolle
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Paredes
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L I Cortínez
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - B J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - N Quezada
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Solari
- Departamento de Laboratorio Clínico, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - F Allende
- Departamento de Laboratorio Clínico, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Torres
- Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - D Cabrera
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Ciencias Químicas y Biológicas, Facultad de Salud, Universidad Bernardo O'Higgins, Santiago, Chile
| | - V Contreras
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J Carmona
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Ramírez
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - A M Oliveros
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Ibacache
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Brañes A, Bustamante C, Valbuena J, Pimentel F, Quezada N. Primary leiomyosarcoma of the greater omentum: a case report. Int J Surg Case Rep 2016; 28:317-320. [PMID: 27771602 PMCID: PMC5079381 DOI: 10.1016/j.ijscr.2016.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/23/2016] [Revised: 09/29/2016] [Accepted: 10/07/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Greater omentum leiomyosarcomas are rare tumors with only a few cases reported in literature. PRESENTATION OF CASE We report the case of a 68-year-old man who consulted complaining of diffuse abdominal pain without a palpable mass at physical examination. Imaging studies revealed a solid-cystic lesion in the right lower quadrant. Surgical resection was performed and the tumor was diagnosed as a leiomyoscarcoma by histological and immunohistochemical examinations. DISCUSSION Surgical resection of all lesions seems to be a reasonable therapeutic approach if resection is feasible. Chemotherapy may be used in selected cases. CONCLUSION More cases are needed to define the best treatment approach of this disease.
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Affiliation(s)
- Alejandro Brañes
- Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Caroll Bustamante
- Pathology Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - José Valbuena
- Pathology Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Fernando Pimentel
- Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Nicolás Quezada
- Digestive Surgery Department, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
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Quezada N, Maiz C, Daroch D, Funke R, Sharp A, Boza C, Pimentel F. Effect of Early Use of Covered Self-Expandable Endoscopic Stent on the Treatment of Postoperative Stapler Line Leaks. Obes Surg 2016; 25:1816-21. [PMID: 25840555 DOI: 10.1007/s11695-015-1622-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 12/17/2022]
Abstract
BACKGROUND Postoperative leaks are a dreaded complication after bariatric surgery (BS). Its treatment is based on nutritional support and sepsis control by antibiotics, collections drainage and/or prosthesis, and/or surgery. OBJECTIVES The aim of this study is to report our experience with coated self-expandable endoscopic stents (SEES) for leaks treatment. SETTING This study was performed in a University Hospital, (censored). METHODS We performed a retrospective analysis of our BS database from January 2007 to December 2013. All patients with leak after BS treated with SEES were included. RESULTS We identified 29 patients; 17 (59%) were women, with median age of 37 (19-65) years, and preoperative body mass index of 40 (28.7-56-6) kg/m(2). Nineteen (65.5%) patients had a sleeve gastrectomy and 10 (34.5%) a Roux-en-Y gastric bypass. All patients had a leak in the stapler line. Median time from surgery to leak diagnosis was 7 (1-51) days, and SEES were installed 8 (0-104) days after diagnosis. Twenty-one (72%) patients also had abdominal exploration. Median length of SEES use was 60 (1-299) days. Patients who had SEES as primary treatment (with or without simultaneous reoperation) had a shorter leak closure time (50 [6-112] vs 109 [60-352] days; p = 0.008). Twenty-eight (96.5%) patients successfully achieved leak closure with SEES. There were 16 migrations in 10 (34%) patients, 1 (3%) stent fracture, 1 opening of the blind end of alimentary limb (3%), and 5 patients (17%) required a second stent due to leak persistence. CONCLUSIONS SEES is a feasible, safe, and effective management of post BS leaks, although patients may also require prosthesis revision and abdominal exploration. Primary SEES placement is associated with a shorter leak resolution time.
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Affiliation(s)
- Nicolás Quezada
- Department of Digestive Surgery. School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
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Quezada N, León F, Jones A, Varas J, Funke R, Crovari F, Raddatz A, Pérez G, Escalona A, Boza C. High frequency of internal hernias after Roux-en-Y gastric bypass. Obes Surg 2015; 25:615-21. [PMID: 25638655 DOI: 10.1007/s11695-014-1302-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 11/26/2022]
Abstract
BACKGROUND Internal hernias (IH) after Roux-en-Y gastric bypass (RYGB) are a serious concern among surgeons and are often under-diagnosed due to heterogeneity of clinical manifestations. Our aim is to assess the frequency of IH after a RYGB in symptomatic and asymptomatic patients. METHODS Retrospective analysis of our bariatric surgery unit's database between 2001 and 2013 is obtained. Patients are surgically explored after RYGB due to acute bowel obstruction (ABO), intermittent abdominal pain (IAP), or being asymptomatic (during an elective cholecystectomy) in whom anatomical presence of IH was established. Also, we compared patients with retrocolic and antecolic technique. Statistical analysis with non-parametric tests and chi-square are used. RESULTS Of the patients, 3,656 submitted to RYGB during this period, 81.9% (2,993) by laparoscopy and 26.3% (963) with retrocolic technique. Of the patients, 130 (3.5%) were surgically explored due to ABO, 27 patients (0.7%) due to IAP, and 93 patients (2.5%) submitted to an elective cholecystectomy with exploration for IH. IH was present in 75% of the obstructed patients, and in 69%, it was the cause of obstruction. Patients with IAP showed 59% of IH, but only 15% have herniated bowel. In asymptomatic patients, 25% showed IH and none of them have herniated bowel. Retrocolic technique showed a higher risk of whole causes of ABO and IH than the antecolic technique, with a relative risk of 1.53 (1.07-2.17) and 1.62 (1.06-2.47), respectively. CONCLUSIONS A high frequency of IH exists in all operated patients of this series. All members of the bariatric team should be aware of the symptoms related to IH and actively pursue it during follow-up.
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Affiliation(s)
- Nicolás Quezada
- Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago, Chile,
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León F, Maiz C, Daroch D, Quezada N, Gabrielli M, Muñoz C, Boza C. Laparoscopic hand-sewn revisional gastrojejunal plication for weight loss failure after Roux-en-Y gastric bypass. Obes Surg 2015; 25:744-9. [PMID: 25618780 DOI: 10.1007/s11695-014-1463-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Revisional surgery has become a widely accepted alternative for weight loss failure/regain after bariatric surgery. However, it is associated to higher morbi-mortality and lesser weight loss than primary bariatric procedure. Our aims are to present a novel technique for weight loss treatment after failed laparoscopic Roux-en-Y gastric bypass (LRYGB) and to report its short-term results. METHODS This is a retrospective analysis of patients submitted to a revisional hand-sewn double-layer gastrojejunal plication (GJP) for treatment of weight loss failure/regain after LRYGB. Analysis of demographics, body mass index (BMI), and percentage of excess weight loss (%EWL) at the 6th month complications, and financial costs involved was included. RESULTS Four patients were submitted to revisional GJP. Three patients were female and the mean age at revision was 30 ± 9 years (21-44). The median time interval between LRYGB and GJP was 51 months (24-120). The median BMI at the moment of GJP and the 3rd and 6th month was 35.6 kg/m2 (32.0-37.8), 32.2 kg/m2 (29.7-34.1), and 30.7 kg/m2 (28.1-32.1), respectively. The median %EWL at the 3rd and 6th month was 35.4% (13.6-38.9) and 46.2 % (45.1-55.5), respectively, reaching a cumulative (combined surgeries) %EWL of 62.9% (16.5-67.9) and 71.7% (65.1-77.6), respectively. There were no complications or mortality. Financial costs were significantly lower compared to revisional gastrojejunal stapled reduction (US $1400 cheaper). CONCLUSION Revisional GJP is a feasible, safe, and cost-effective novel procedure for treatment of weight loss failure/regain after LRYGB. Mid- and long-term results are necessary in order to establish its real effectiveness.
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Affiliation(s)
- Felipe León
- Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
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Maiz C, Alvarado J, Quezada N, Salinas J, Funke R, Boza C. Bariatric surgery in 1119 patients with preoperative body mass index<35 (kg/m(2)): results at 1 year. Surg Obes Relat Dis 2015; 11:1127-32. [PMID: 26645489 DOI: 10.1016/j.soard.2015.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/04/2014] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. OBJECTIVES To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. SETTING University hospital (censored). METHODS A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011. Demographic and anthropometric data, preoperative co-morbidities, and perioperative variables were retrieved. Weight loss and co-morbidities progression were analyzed 1 year after surgery and compared among procedures. A P value<.05 was considered significant. RESULTS We identified 1119 patients: mean age 38.8±11.4, 951 (85%) women, preoperative weight 87.5±9.3 kg and BMI 33.1 (31.9-34.1) kg/m(2). Preoperatively, 11.7% had type 2 diabetes mellitus, 25.9% arterial hypertension, 55.6% insulin resistance, and 53.2% dyslipidemia. In total, 283 patients (25.2%) underwent LRYGB and 836 (74.8%) SG. One year after surgery (follow-up: 66.67%) patients reached 24.5 (22.8-26.4) BMI and the percentage of excess of weight loss (%EWL) was 107.9±36.6%. Diabetes, hypertension, insulin resistance, and dyslipidemia remission/improvement rates were 54/39%, 58/29%, 72/17%, and 54/30%, respectively. CONCLUSIONS Bariatric surgery in selected class I obesity patients can safely be performed. We have observed good results in terms of weight loss and co-morbidity improvement/remission. Long-term follow-up is required.
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Affiliation(s)
- Cristóbal Maiz
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Alvarado
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Quezada
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Salinas
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Funke
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Camilo Boza
- Department of Digestive Surgery, Bariatric Surgery Unit, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Quezada N, Acevedo F, Marambio A, León F, Galindo H, Roa JC, Jarufe N. Complete pathological response to Imatinib mesylate in an extraintestinal gastrointestinal stromal tumor. Int J Surg Case Rep 2014; 5:681-5. [PMID: 25194604 PMCID: PMC4189531 DOI: 10.1016/j.ijscr.2014.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/27/2014] [Accepted: 05/14/2014] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the digestive tract. Extraintestinal locations (EGIST) have been described showing similar pattern of immunohistochemical markers than GIST. Inhibitors of tyrosine kinases such as Imatinib or Sunitinib are the mainstay treatment in the management of advanced or metastatic GIST. Complete pathological response to these agents is an extremely rare event, especially in the case of EGIST due to its more aggressive behavior reported. PRESENTATION OF CASE Here we describe the case of a 61 years old woman, with an advanced GIST, who was operated after 10 months of Imatinib mesylate. The biopsy demonstrated the extra intestinal location of the tumor and a complete pathological response was confirmed. DISCUSSION Complete pathological response to Imatinib is a rare event. To our knowledge, this is the first report of complete response in an EGIST. New clinical, radiological and metabolic criteria of tumoral response to neoadjuvant treatment are revised. CONCLUSION EGIST complete pathological response to Imatinib can be achieved. However, recommendation of systematic neoadjuvant therapy with Imatinib remains investigational and more studies are warranted in the future.
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Affiliation(s)
- Nicolás Quezada
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile
| | - Francisco Acevedo
- Hematology-Oncology Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile
| | - Andrés Marambio
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile
| | - Felipe León
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile
| | - Hector Galindo
- Hematology-Oncology Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile
| | - Juan Carlos Roa
- Pathology Department, School of Medicine. Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile
| | - Nicolás Jarufe
- Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, Patio Interior, Santiago 8320000, Chile.
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Aziza A, Panda A, Quezada N, Cherian G. Nutrient digestibility, egg quality, and fatty acid composition of brown laying hens fed camelina or flaxseed meal. J APPL POULTRY RES 2013. [DOI: 10.3382/japr.2013-00735] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Oeffner S, Qu Y, Just J, Quezada N, Ramsing E, Keller M, Cherian G, Goddick L, Bobe G. Effect of flaxseed supplementation rate and processing on the production, fatty acid profile, and texture of milk, butter, and cheese. J Dairy Sci 2013; 96:1177-88. [DOI: 10.3168/jds.2012-5941] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 10/21/2012] [Indexed: 11/19/2022]
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Ulmer-Franco AM, Cherian G, Quezada N, Fasenko GM, McMullen LM. Hatching egg and newly hatched chick yolk sac total IgY content at 3 broiler breeder flock ages. Poult Sci 2012; 91:758-64. [PMID: 22334753 DOI: 10.3382/ps.2011-01757] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During the first week of the posthatching period, before the immune system is mature enough to produce its own B lymphocytes, a chick's humoral immunity depends on maternal antibodies (IgY) received from the egg yolk. During incubation and after hatching, the yolk sac (YS) membrane transfers nutrients (including IgY) from the egg yolk to the developing embryo or newly hatched chick. The objective of this study was to determine the effects of breeder flock age on the total IgY content of egg yolks and chick YS from a commercial broiler breeder strain. Hatching eggs from the same broiler breeder flock were collected at 32, 40, and 55 wk of age. One group of eggs per flock age was used to determine the egg yolk total IgY content. Another group of eggs was incubated for 21.5 d, and upon hatching, the YS of newly hatched chicks were collected to determine the total IgY content. Egg and egg yolk weight increased with flock age, but YS weights did not reflect egg yolk weight. The total IgY content per gram of egg yolk increased with flock age; this fact plus the observed yolk weight increase with flock age notably increased the total IgY contained in yolks of eggs laid by 55-wk-old breeders. However, chicks hatching from 55-wk-old breeders had less IgY per gram of YS than chicks from 32- and 40-wk-old breeders. Whether there are differences in the rates of YS absorption between chicks of different breeder ages is unknown. This research provided total IgY values for broiler breeder egg yolk and chick YS of a commonly used meat-type chicken strain. Differences in egg yolk and YS total IgY contents due to flock age in this type of bird had not been previously reported. Research on the physiological consequences of YS absorption rates in chicks from different breeder ages is advised.
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Affiliation(s)
- A M Ulmer-Franco
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
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Aziza A, Quezada N, Cherian G. Antioxidative effect of dietary Camelina meal in fresh, stored, or cooked broiler chicken meat. Poult Sci 2010; 89:2711-8. [DOI: 10.3382/ps.2009-00548] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aziza A, Quezada N, Cherian G. Feeding Camelinasativa meal to meat-type chickens: Effect on production performance and tissue fatty acid composition. J APPL POULTRY RES 2010. [DOI: 10.3382/japr.2009-00100] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Margozzini P, Rigotti A, Ferreccio C, Quezada N, Garrido M, Valdés G. Hypertension and the cardiometabolic syndrome in Chile: a review of concepts and consequences for the developing world. Ther Adv Cardiovasc Dis 2009; 1:83-90. [PMID: 19124397 DOI: 10.1177/1753944707082716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We review some recent developments regarding the concept of cardiometabolic syndrome and its relation with hypertension and overall cardiovascular disease risk. We emphasize how this new clinical entity has helped to understand multimorbidity in chronic diseases. This concept has important consequences for individual patient treatment as well as public health policy. The challenge derived from cardiovascular disease and other chronic conditions is increasing worldwide, but the highest burden is located in the developing world. Thus, new and cost-effective approaches are needed for diseases that are mainly occurring in the poorest and less educated populations. We illustrate this situation analyzing hypertension and cardiometabolic syndrome data derived from a recent national health survey in Chile.
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Affiliation(s)
- P Margozzini
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 434, Santiago, Chile.
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Quezada N, Asencio M, Valle J, Aguilera J, Gómez B. Antioxidant Activity of Crude Extract, Alkaloid Fraction, and Flavonoid Fraction from Boldo (Peumus boldus Molina) Leaves. J Food Sci 2006. [DOI: 10.1111/j.1365-2621.2004.tb10700.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cortés V, Quezada N, Rigotti A, Maiz A. [New heterodimeric nuclear receptors: key metabolic regulators with relevance in the pathophysiology and therapy of dyslipidemias and diabetes mellitus]. Rev Med Chil 2006; 133:1483-92. [PMID: 16446877 DOI: 10.4067/s0034-98872005001200011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/17/2022]
Abstract
The regulation of gene expression is crucial for the normal development and the homeostatic maintenance of body tissues. Thus, its malfunction may determine a variety of human disease conditions. A growing body of evidence has shown the overwhelming relevance of a new class of gene expression regulators: the heterodimeric nuclear receptors, a family of structurally related proteins involved in multiple biological functions. In response to activating ligands, these molecules bind to specific genomic regulatory regions where they can coordinately modify the transcriptional activity of several genes involved in the main metabolic pathways of lipids and carbohydrates in cells. These functional properties have stimulated the study of the relationships between heterodimeric nuclear receptors and various disease conditions, such as dyslipidemias and diabetes mellitus. Here we review the experimental, clinical and epidemiological evidences that support the relevance of these transcriptional regulators in the pathophysiology of the most prevalent and lethal diseases in Western countries. We also explore the potential therapeutic impact of new strategies based in the pharmacological modulation of the heterodimeric nuclear receptors.
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Affiliation(s)
- Víctor Cortés
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Quezada N. [Iron kinetics in the anemia of chronic renal insufficiency]. Rev Med Chil 1971; 99:750-3. [PMID: 5139655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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