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Cirera A, Vilallonga R, Ruiz de Gordejuela AG, Gonzalez O, Caubet E, Balibrea JM, Ciudin A, Blanco R, Vidal L, Fort JM. Complications after Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S) a Retrospective Review of Cases in a High-volume European Center. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.006] [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: 11/30/2022]
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Vilallonga R, García Ruiz de Gordejuela A, Fort JM, Gonzalez O, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Ciudin A, Pera-Ferreruela M, Petrola C, Armengol M. Laparoscopic Versus Robot-Assisted Roux-en-Y Gastric Bypass: A Center of Excellence for the EAC-BC Experience. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34612707 DOI: 10.1089/lap.2021.0528] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: After the first laparoscopic Roux-en-Y gastric bypass (RYGB) in 1994 by Wittgrove, the introduction of robot-assisted procedures was the next step in the surgical race to reduce invasiveness. This breakthrough allowed us to perform bariatric surgery with less surgical trauma in obese patients with metabolic disorders, producing an exponential increase in procedures performed. Methods: This is a retrospective cohort study of a prospective database for patients who underwent RYGB during a 7-year period through two different approaches, laparoscopic and robotic. The robotic cases were performed by two generations of the da Vinci platform (S and Xi), and three groups were identified and compared (L-RYGB, RYGB-S, and RYGB-Xi). Results: A total of 495 patients underwent RYGB, of which 224 by laparoscopy (45.2%) and 271 by robotic approach (54.7%): 134 RYGB-S and 137 RYGB-Xi. The majority of the patients (71.1%) were females, with a mean age of 46.2 years and a mean body mass index of 44 kg/m2. The mean intraoperative time and intraoperative complication rate were higher in the robotic groups, especially in the RYGB-S group. Postoperative complications were higher in the same group, with a rate of 11.9%, where the main leakage occurred on the upper part of the gastric pouch and not in the hand-sewed robotic anastomosis (7.5%). General mortality was 0.6%. We found no significant differences at 1-year percentage of total weight loss (%TWL); at 2 years, the RYGB-Xi group had the lowest %TWL (25.24 ± 14.54, P ≤ .001). Conclusions: The present study reflects our experience during the robotic bariatric introduction and performance since 2011. Features of the da Vinci S platform along our learning curve may explain a higher complication rate. The patients who have been operated by the RYGB-Xi system had lower complications than the laparoscopic group. The robotic approach did not differ with laparoscopy in terms of weight loss and chronic complications after 24 months of follow-up.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- ELSAN Clinic, Surgery Department, Clinique Saint Michel, Av. D'orient, Toulon, France
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Medicine, Federal University of Rondonia, Rondonia, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Ciudin
- Department of Endocrinolgy and Nutrition and Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meritxell Pera-Ferreruela
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Petrola
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Armengol
- Department of General Surgery, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
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Rodríguez-Luna MR, Vilallonga R, Roriz-Silva R, Rangarajan M, García Ruiz de Gordejuela A, Caubet E, Gonzalez O, Palermo M, Fort JM, Armengol M. A Comparison of Clinical Outcomes Between Two Different Models of Surgical Robots in Roux-en-Y Gastric Bypass. J Laparoendosc Adv Surg Tech A 2021; 31:969-977. [PMID: 34525316 DOI: 10.1089/lap.2021.0477] [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] [Indexed: 11/12/2022] Open
Abstract
Introduction: For the past 20 years, robotic surgical systems have been used for the Roux-en-Y gastric bypass (RYGB). The da Vinci Surgical System (Intuitive Surgical, Inc.) has been one of the most used robotic platforms. This study aims to retrospectively compare the performance of two models of surgical robots. Materials and Methods: A retrospective comparative study was conducted from a prospective database including all patients who underwent robotic RYGB (RRYGB) from 2011 to 2020. Results: Of a total of 277 patients included, 134 were in the RRYGB using the da Vinci S™ (RRYGB-S™) group and 143 were in the RRYGB using the da Vinci Xi™ (RRYGB-Xi™) group. The mean operative time in the RRYGB-S and RRYGB-Xi groups was 154 ± 28 and 151 ± 32 minutes, respectively (P = .510). The was no statistically significant difference in terms of intraoperative complications between the groups with regard to positive blue test, bleeding, and failure of stapler line. The readmission rate was higher in the RRGB-S group (14.1%) than in the RRYGB-Xi group (3.4%) (P = .004), and it was mainly due to major complications (P = .003) including pouch and gastrojejunostomy anastomotic leaks (P = .001). The nonsurgical complications were statistically significantly higher in the RRYGB-S group (7.4%) than in the RRYGB-Xi group (2.1%) (P < .05), as well as the surgical complications were higher in the RRYGB-S group (7.5%) than in the RRYGB-Xi group (0%) (P < .001). The mean percentage of the total weight loss at 1 and 2 years of follow-up did not show any statistically significant difference (P = .547). Conclusions: The higher complication rate in the S surgical system might be correlated with the initial learning curve and stressed the need for proper robotic surgical training and accurate strategies when introducing emerging technologies into the surgical practice.
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Affiliation(s)
- María Rita Rodríguez-Luna
- Research Institute against Digestive Cancer, IRCAD, Department of Surgery, Strasbourg, France
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
- ELSAN, Department of Surgery, Clinique St-Michel, Toulon, France
| | - Renato Roriz-Silva
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
- Department of Medicine, Federal University of Rondônia - UNIR, Pôrto Velho, Brazil
- Division of General Surgery, Hospital de Base of Porto Velho, Pôrto Velho, Brazil
| | | | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Mariano Palermo
- Daicim Foundation, Department of Surgery, Training, Research, and Clinical activity in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Department of Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vilallonga R, Fort JM, Rodríguez Luna MR, García Ruiz de Gordejuela A, Gonzalez O, Caubet E, Cirera de Tudela A, Palermo M, Ciudin A, Armengol M. The Panoramic View of Revisional Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34492201 DOI: 10.1089/lap.2021.0506] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: Obesity remains a major public chronic disease, and the multifactorial components of its relapse in many patients remain inevitable. Methods: This article provides a panoramic view of the most commonly performed revisional bariatric surgery (RBS). RBS is a complex procedure; thus, primary procedures should be well chosen and performed to avoid the increasing number of RBS cases. Results: Bariatric surgery is the only successful long-term treatment for obesity. However, a proportion of primary bariatric surgeries has failed during the follow-up period. In recent decades, the solution for these complications is by performing RBS. It is mandatory to understand obesity as a chronic disease to appropriately treat patients. Treatment strategies are needed to determine the indications for revision. RBS requires a meticulous evaluation to facilitate good long-term results. Conclusions: Treatment strategies will be a fundamental pillar to wisely determine the indications for revision and identify the factors influencing failure by prudently and rationally evaluating the revisional procedure that the patient will benefit from and acquiring a high level of surgical skills.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arturo Cirera de Tudela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Andrea Ciudin
- Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Spain
- Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vilallonga R, Cirera de Tudela A, Möller EG, Piñeiro LV, Segura MB, Ferreruela MP, Mata RM, Caubet E, Gonzalez O, Ruiz de Gordejuela AG, Ciudin A, Fort JM, Carrasco MA. Robotic Revisional Experience. Single Centre Prospective Cohort Study and Review of the Literature. Chirurgia (Bucur) 2021; 116:7-15. [PMID: 33638321 DOI: 10.21614/chirurgia.116.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Robotic bariatric surgery (RBS) has increased in recent years. Many doubts continue to exist regarding its utility in terms of postoperative complications, costs and technical aspects. RBS has increased its number and shows a more technical challenge associated with more post-operative complications compared to primary bariatric surgery. We herein present a single institution experience and review to describe its utility in revisional surgery.
Methods: A retrospective review of our experience and a review of the literature has been conducted to evaluate the impact of robotic revisional surgery in the bariatric field.
Results: A total of 17 patients (5 female and 12 male) were operated on. Most frequent surgery was conversion of sleeve gastrectomy to gastric bypass (n=9). No leaks were found nor severe complications. A systematic review showed similar results including a decreased number for complications when performing robotic revisional surgery.
Conclusions: Revisional robotic surgery shows better results compared to standard laparoscopic revisional bariatric surgery in terms of efficacy, safety and hospital stay. No differences were seen in rates of mortality, morbidity and reintervention between both approaches. We encourage surgeons to learn to perform the robotic technique as part of the process of democratization and standardization of bariatric surgery.
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Vilallonga R, Rodríguez-Luna MR, Roriz-Silva R, Caubet E, Gonzalez O, Ruiz de Gordejuela A, Ciudin A, Armengol M, Fort JM. Reversal to Normal Anatomy (With Sleeve Gastrectomy) for Severe Hypoglycemia. Surg Innov 2020; 28:536-543. [PMID: 33381999 DOI: 10.1177/1553350620984647] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background. Laparoscopic Roux-en-Y gastric bypass (GBP) is an essential bariatric surgical procedure which is globally performed because of the associated effective weight loss and resolution of metabolic comorbidities, such as diabetes and dyslipidemia. Although some complications may occur, hypoglycemia is a rare complication, which can lead to lethal consequences. We aimed to describe the technical aspects and surgical results after reversal to normal anatomy (RNA). Methods. We conducted a retrospective data analysis including 16 patients who underwent laparoscopic RNA from 2011 to 2018. All data were archived in a prospective database. Previous bariatric surgery and postoperative outcomes were analyzed. Results. Sixteen patients underwent RNA, most of them after GBP, and 15 patients required sleeve gastrectomy. Among them, 80% were women; 5 patients presented with postoperative complications, such as colitis with intra-abdominal collection (n = 1), gastric leak (n = 2) treated with an endoprosthesis, mesenteric venous thrombosis (n = 1), and intra-abdominal bleeding (n = 1). Mean length of hospital stay was 5.93 (3-30). All patients recovered from their initial condition although 3 patients presented with mild hypoglycemia during follow-up. Seven patients regained weight (43.75%), and another 4 developed gastroesophageal reflux disease (25%). Conclusions. These laparoscopic RNA results are acceptable, indicating a clinical improvement in the hypoglycemic syndrome in all patients.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain.,54809Research Institute against Digestive Cancer, Strasbourg, France
| | - Renato Roriz-Silva
- Department of Medicine, Federal University of Rondônia -Unir, Brazil.,Division of General Surgery, Hospital de Base of Porto Velho, Brazil
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Amador Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Andrea Ciudin
- Endocrinolgy and Nutrition Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, 65462Vall Dd'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, 216810Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
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Cirera de Tudela A, Vilallonga R, Ruiz-Úcar E, Pasquier J, Balibrea Del Castillo JM, Nedelcu A, Fort JM, Armengol Carrasco M. Management of Leak after Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2020; 31:152-160. [PMID: 33347794 DOI: 10.1089/lap.2020.0798] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has been introduced in the past few years for the treatment of morbid obesity. SADI-S has shown good results in terms of long-term results and short-term complications. However, the management of patients undergoing SADI-S and suffering from a leak is a great challenge for surgeons. We present an extensive review of the currently available literature on the management of leak after SADI in morbid obese (MO) patients. We aim at providing objective information regarding the optimal management, including diagnosis, technical options for the different strategies that have been proposed, to facilitate the selection of the best individual approach for each MO patient.
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Affiliation(s)
- Arturo Cirera de Tudela
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain.,ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Elena Ruiz-Úcar
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Fuenlabrada University Hospital, Rey Juan Carlos University, Madrid, Spain
| | - Jorge Pasquier
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Manuel Armengol Carrasco
- Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Beisani M, Vilallonga R, Petrola C, Acosta A, Casimiro Pérez JA, García Ruiz de Gordejuela A, Fernández Quesada C, Gonzalez O, Cirera de Tudela A, Caubet E, Armengol M, Fort JM. Effects of COVID-19 lockdown on a bariatric surgery waiting list cohort and its influence in surgical risk perception. Langenbecks Arch Surg 2020; 406:393-400. [PMID: 33244718 PMCID: PMC7690848 DOI: 10.1007/s00423-020-02040-5] [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: 07/27/2020] [Accepted: 11/17/2020] [Indexed: 11/21/2022]
Abstract
Purpose The COVID-19 outbreak has forced a 2-month lockdown (LD) in Spain. We aimed to assess how that had affected our cohort of bariatric patients waiting for surgery. Methods A review of electronic records and a structured phone interview with each patient were conducted. Changes in severity of obesity were analyzed using the Obesity Surgery Score (OSS) and changes in health-related quality of life (HRQoL) using the validated EQ-5D questionnaire. Other miscellaneous questions about behavior modifications and surgical risk perception were also analyzed. Results All 51 patients fully answered the questionnaires. Mean age was 47 years and mean time on waiting list 91 days. Mean BMI increased during LD (42.7 vs 43.2; p < 0.001). Both OSS (2.84 vs 3; p = 0.011) and EQ-5D (69 vs 64; p < 0.001) mildly worsened during LD, mainly due to psychosocial issues. Twenty-seven patients (53%) thought that perioperative risks were higher under the current circumstances but they were as willing to undergo surgery as those who believed that the risks had not increased (74% vs 87%, p = 0.2). Conclusions COVID-19 LD had a significant but mild effect on our cohort of bariatric surgery waiting list patients. Although perioperative risk perception had increased, patients were still willing to undergo their planned surgeries.
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Affiliation(s)
- Marc Beisani
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Carlos Petrola
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Asunción Acosta
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - José Antonio Casimiro Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Amador García Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Carlos Fernández Quesada
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Arturo Cirera de Tudela
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Vilallonga R, Beisani M, Sanchez-Cordero S, Garcia Ruiz de Gordejuela A, Rodríguez-Luna MR, Fort JM, Armengol Carrasco M. Abdominal Wall Hernia and Metabolic Bariatric Surgery. J Laparoendosc Adv Surg Tech A 2020; 30:891-895. [PMID: 32584652 DOI: 10.1089/lap.2020.0257] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The management of morbidly obese patients with a concomitant ventral hernia (VH) is a great challenge for surgeons. There is controversy over the optimal strategy to tackle both health problems, requiring an individualized approach. Obese patients have a higher recurrence rate after hernia repair, and bariatric surgery in the presence of a VH can be difficult. As morbid obesity is related with severe comorbidities, including increased cardiovascular and anesthetic risks, some advocate for a single-stage strategy. A primary hernia repair carried out during the bariatric surgery, however, may increase morbidity without definitively solving the problem. Biological meshes are expensive and also have a high recurrence rate. The laparoscopic placement of a synthetic mesh offers good results, but it is worrisome because bariatric surgery is a clean-contaminated procedure. Moreover, there is a great chance that a plastic surgery would be necessary after completing the weight-loss process, and the abdominal wall surgery could be performed at that point. There are many arguments, but the evidence is weak. We present an extensive review of the currently available literature on the management of VH in morbidly obese patients. We aim to provide objective information regarding the pros and cons of the different strategies that have been proposed, to facilitate the selection of the best approach to individual morbidly obese patients with abdominal wall hernias precising both of surgical repair.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic, and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Marc Beisani
- Endocrine, Metabolic, and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Sergi Sanchez-Cordero
- Department of General Surgery, Consorci Sanitari de l'Anoia, Hospital d'Igualada, Barcelona, Spain
| | - Amador Garcia Ruiz de Gordejuela
- Endocrine, Metabolic, and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | | | - José Manuel Fort
- Endocrine, Metabolic, and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Manuel Armengol Carrasco
- Department of General Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Vilallonga R, Hidalgo M, Garcia Ruiz de Gordejuela A, Caubet E, Gonzalez O, Ciudin A, Rodríguez-Luna MR, Roriz-Silva R, Petrola C, Armengol M, Fort JM. Operative and Postoperative Complications of Laparoscopic Sleeve Gastrectomy in Super and Nonsuper Obese Patients: A Center of Excellence Experience Comparative Study. J Laparoendosc Adv Surg Tech A 2020; 30:501-507. [DOI: 10.1089/lap.2019.0721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
- ELSAN, Clinique St-Michel, Toulon, France
| | - Marta Hidalgo
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amador Garcia Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Andrea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - María Rita Rodríguez-Luna
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Renato Roriz-Silva
- Department of Medicine, Federal University of Rondônia—UNIR, Porto Velho, Brazil
- Division of General Surgery, Hospital de Base of Porto Velho, Porto Velho, Brazil
| | - Carlos Petrola
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, Spain
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Vilallonga R, Mazarro A, Rodríguez-Luna MR, Caubet E, Fort JM, Armengol M, Guirao X. Massive necrotizing fasciitis: a life threatening entity. J Surg Case Rep 2019; 2019:rjz269. [PMID: 31719969 PMCID: PMC6830038 DOI: 10.1093/jscr/rjz269] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 08/07/2019] [Accepted: 09/10/2019] [Indexed: 11/15/2022] Open
Abstract
Necrotizing fasciitis (NF) is a complicated soft tissue infection frequently associated with severe sepsis if an early medical and surgical treatment is not performed. We report two postoperative cases of severe NF after oophorectomy and colorectal resection. Because of the similarity with more benign skin infections at the early steps, clinical suspicion is crucial. Surgical exploration and resection will provide both the diagnosis confirming necrotizing infection of the fascia with vessels and treatment. Also, empirical broad-spectrum antibiotics must be initiated as soon as possible. Regardless of the presence of risk factors, NF is a condition with a high mortality rate and only an expeditious and undelayed treatment may improve the patient's outcome. Surgical focus control requires wide and repeated resections, and planned reconstructive plastic surgery might be necessary.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine Bariatric and Metabolic Unit, General Surgery Department, Universitary Hospital Vall d'Hebron, European Center of Excellence (EAC-BS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,ELSAN, Clinique St-Michel, Toulon, France
| | - Alejandro Mazarro
- General Surgery Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | | | - Enric Caubet
- Endocrine Bariatric and Metabolic Unit, General Surgery Department, Universitary Hospital Vall d'Hebron, European Center of Excellence (EAC-BS), Barcelona, Spain
| | - José Manuel Fort
- Endocrine Bariatric and Metabolic Unit, General Surgery Department, Universitary Hospital Vall d'Hebron, European Center of Excellence (EAC-BS), Barcelona, Spain
| | - Manuel Armengol
- General Surgery Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Xavier Guirao
- Department of General Surgery Parc Tauli, Hospital Universitari, Sabadell, Hospital General de Granollers, Barcelona, Spain
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Sanchez-Cordero S, Villlonga R, Alberti PI, Ruiz de Gordejuela AG, Caubet E, Gonzalez O, Perez M, Martin R, Fort JM. A659 Revisional surgery for early gastric leak after Roux-en-Y gastric bypass (RYGB). Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.09.042] [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: 11/30/2022]
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Gil-Barrionuevo E, Balibrea JM, Caubet E, Gonzalez O, Vilallonga R, Fort JM, Ciudin A, Armengol M. Adrenergic cardiomyopathy and cardiogenic shock as initial presentation of pheochromocytoma. A case report and review of the literature. Int J Surg Case Rep 2018; 49:145-148. [PMID: 30007262 PMCID: PMC6068086 DOI: 10.1016/j.ijscr.2018.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/05/2018] [Accepted: 06/23/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pheochromocytomas are infrequent tumors arised from the chromaphine cells of the adrenal sympathetic system. The excess of circulating catecholamines may lead to different cardiovascular disorders from silent alterations of the myocardial conduction to different forms of cardiomyopathy. The onset as cardiogenic shock is exceptional. PRESENTATION OF CASE A 35-year-old male, with a known history of acute myopericarditis of unknown origin which debuted as acute pulmonary edema, was admitted with dyspnea in the context of a new heart failure episode with pulmonary edema. An initial ECG showed segmentary repolarization changes, reversed in subsequent ECGs. The echocardiogram showed severe left ventricular dysfunction and lateral and apical hypokinesia. Subsequent echocardiograms showed partial recovery of alterations and preserved systolic function. A cardiac MRI showed a subepicardial minimum catchment focus and myocardial edema suggestive of adrenergic myocarditis. A solid nodular lesion was found in the left adrenal gland, suggesting a pheochromocytoma. Laparoscopic left adrenalectomy confirmed a 30 mm adrenal tumor without signs of locoregional invasion. The patient had normal catecholamine excretion and heart function a few weeks after surgery. Histopathology confirmed the diagnosis of pheochromocytoma. DISCUSSION AND CONCLUSIONS Adrenergic cardiomyopathy is a rare entity with a variable clinical presentation. The onset as cardiogenic shock is exceptional. The differential diagnosis of a patient with cardiogenic shock of unknown origin should consider the presence of an underlying pheocromocytoma as well as other states of adrenergic hyperstimulation. The reversibility of the myocardial affection in pheocromocytoma-associated myocardiopathy is common after the tumor resection.
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Affiliation(s)
- Esther Gil-Barrionuevo
- General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - José Maria Balibrea
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ramón Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Andrea Ciudin
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Medical Endocrinology Department, Vall d' Hebron University Hospital, Barcelona, Spain
| | - Manel Armengol
- General Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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González Ó, Zafon C, Caubet E, García-Burillo A, Serres X, Fort JM, Mesa J, Castell J, Roca I, Ramón Y Cajal S, Iglesias C. Selective sentinel lymph node biopsy in papillary thyroid carcinoma in patients with no preoperative evidence of lymph node metastasis. ACTA ACUST UNITED AC 2017; 64:451-455. [PMID: 28895542 DOI: 10.1016/j.endinu.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/14/2017] [Revised: 04/23/2017] [Accepted: 05/08/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Lymphadenectomy is recommended during surgery for papillary thyroid carcinoma when there is evidence of cervical lymph node metastasis (therapeutic) or in high-risk patients (prophylactic) such as those with T3 and T4 tumors of the TNM classification. Selective sentinel lymph node biopsy may improve preoperative diagnosis of nodal metastases. OBJECTIVE To analyze the results of selective sentinel lymph node biopsy in a group of patients with papillary thyroid carcinoma and no evidence of nodal involvement before surgery. PATIENTS AND METHOD A retrospective, single-center study in patients with papillary thyroid carcinoma and no clinical evidence of lymph node involvement who underwent surgery between 2011 and 2013. The sentinel node was identified by scintigraphy. When the sentinel node was positive, the affected compartment was removed, and when sentinel node was negative, central lymph node dissection was performed. RESULTS Forty-three patients, 34 females, with a mean age of 52.3 (±17) years, were enrolled. Forty-six (27%) of the 170 SNs resected from 24 (55.8%) patients were positive for metastasis. In addition, 94 (15.6%) out of the 612 lymph nodes removed in the lymphadenectomies were positive for metastases. Twelve of the 30 (40%) low risk patients (cT1N0 and cT2N0) changed their stage to pN1, whereas 12 of 13 (92%) high risk patients (cT3N0 and cT4N0) changed to pN1 stage. CONCLUSIONS Selective sentinel lymph node biopsy changes the stage of more than 50% of patients from cN0 to pN1. This confirms the need for lymph node resection in T3 and T4 tumors, but reveals the presence of lymph node metastases in 40% of T1-T2 tumors.
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Affiliation(s)
- Óscar González
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Carles Zafon
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, España
| | - Enric Caubet
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Amparo García-Burillo
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier Serres
- Servicio de Radiología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - José Manuel Fort
- Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Mesa
- Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, España.
| | - Joan Castell
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Isabel Roca
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Santiago Ramón Y Cajal
- Servicio de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Patología Molecular Traslacional, Institut de Recerca Vall d'Hebron, Barcelona, España
| | - Carmela Iglesias
- Servicio de Anatomía Patológica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Patología Molecular Traslacional, Institut de Recerca Vall d'Hebron, Barcelona, España
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Lecube A, Valladares S, López-Cano C, Gutiérrez L, Ciudin A, Fort JM, Reñé JM, Matias-Guiu X, de Torres I, Bueno M, Pallarés J, Baena JA. The Role of Morbid Obesity in the Promotion of Metabolic Disruptions and Non-Alcoholic Steatohepatitis by Helicobacter Pylori. PLoS One 2016; 11:e0166741. [PMID: 27893763 PMCID: PMC5125598 DOI: 10.1371/journal.pone.0166741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/02/2016] [Indexed: 12/13/2022] Open
Abstract
Background Helicobacter pylory (HP) infection has been associated to an increased rate of type 2 diabetes (T2D) and liver disease through its effect on insulin resistance and systemic inflammation. However, results are inconstant and no studies exist in morbidly obese patients, in which both insulin resistance and inflammation coexist. Material and Methods Cross-sectional study to evaluate the relationship between HP infection and alterations in carbohydrate metabolism, lipid profile, inflammation markers, and liver disease in patients awaiting for bariatric surgery. HP infection was histologically assessed in gastric antrum biopsy from 416 subjects. Liver biopsy was also available in 93 subjects. Results Both impaired fasting glucose and T2D were similar when comparing subjects with and without HP infection (24.2% vs. 22%, p = 0.290 and 29.4% vs. 29.1%, p = 0.916, respectively), with no differences between groups in the HOMA-IR, lipid profile neither inflammatory parameters. However, HP infection was higher among subjects with a BMI ≥ 40.0 kg/m2 in comparison with lower degrees of obesity (71.7% vs. 60.0%, p = 0.041). In addition, subjects without HP infection showed higher degrees of steatosis (44.1±26.4% vs. 32.0±20.7%, p = 0.038), as well as a lower prevalence of non-alcoholic steatohepatitis (9.3% vs. 30.7%, p = 0.023). Conclusions In patients with morbid obesity, HP infection does not seem to be associated with abnormal carbohydrate metabolism. In addition, less advanced degrees of non-alcoholic fatty disease were observed. We suggest that low-grade inflammation that accompanies obesity mitigates the diabetogenic effect of HP, so the presence of obesity should be considered in studies that evaluate the HP metabolic effects.
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Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, EASO Collaborating Centre for Obesity Management, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
- CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBEREM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- * E-mail:
| | - Silvia Valladares
- Endocrinology and Nutrition Department, EASO Collaborating Centre for Obesity Management, Vall d’Hebron University Hospital, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Carolina López-Cano
- Endocrinology and Nutrition Department, EASO Collaborating Centre for Obesity Management, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
| | - Liliana Gutiérrez
- Endocrinology and Nutrition Department, EASO Collaborating Centre for Obesity Management, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
| | - Andreea Ciudin
- Endocrinology and Nutrition Department, EASO Collaborating Centre for Obesity Management, Vall d’Hebron University Hospital, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Bariatric and Metabolic Surgery Unit, IFSO Centre of Excellence, Vall d’Hebron University Hospital, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Maria Reñé
- Gastroenterology Department. Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
| | - Xavier Matias-Guiu
- Department of Pathology and Molecular Genetics, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
| | - Inés de Torres
- Pathology Department, Vall d’Hebron University Hospital, Vall d’Hebron Institut de Recerca (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Bueno
- Endocrinology and Nutrition Department, EASO Collaborating Centre for Obesity Management, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
| | - Judit Pallarés
- Department of Pathology and Molecular Genetics, Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
| | - Juan Antonio Baena
- Gastrointestinal Surgery Department. Arnau de Vilanova University Hospital, Institut de Recerca Biomèdica (IRB) and University of Lleida, Lleida, Spain
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Lecube A, Zafon C, Gromaz A, Fort JM, Caubet E, Baena JA, Tortosa F. Iodine deficiency is higher in morbid obesity in comparison with late after bariatric surgery and non-obese women. Obes Surg 2015; 25:85-9. [PMID: 24908244 DOI: 10.1007/s11695-014-1313-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Iodine deficiency and obesity are worldwide-occurring health problems. Our purpose was to investigate the relationship between morbid obesity and iodine status, including subjects who lost weight after bariatric surgery. METHODS Ninety morbidly obese women, 90 women with at least 18 months follow-up after bariatric surgery, and 45 healthy non-obese women were recruited. Urinary iodine concentration (UIC) was measured in a spot urinary sample and expressed as the iodine-to-creatinine ratio. RESULTS Obese women showed a significantly lower UIC in comparison with non-obese women (96.6 (25.8-267.3) vs. 173.3 (47.0-493.6) μg/g; p < 0.001), with a lesser proportion of subjects with adequate iodine status (46.6 vs. 83.3 %, p < 0.001). The mean UIC significantly increased among women who underwent bariatric surgery before the collection of the urinary sample (96.6 (25.8-267.3) vs. 131.9 (62.9-496.4) μg/g; p < 0.001). No difference in UIC was detected between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Univariate analysis showed that UIC negatively correlated with body mass index (BMI) (r = -0.278, p < 0.001) and positively with age (r = 0.206, p = 0.002). Finally, multiple linear regression analyses showed that BMI was independently associated with UIC (beta = -0.312, p < 0.001; R (2) = 0.166). CONCLUSION Obesity is an independent risk factor to iodine deficiency, almost in women. Whether more obese population needs to be considered as a vulnerable group and whether bariatric surgery can reverse iodine deficiency still remain to be elucidated.
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Affiliation(s)
- Albert Lecube
- Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Av Rovira Roure, 80, 25198, Lleida, Spain,
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Pardina E, Baena-Fustegueras JA, Fort JM, Ferrer R, Rossell J, Esteve M, Peinado-Onsurbe J, Grasa M. Hepatic and visceral adipose tissue 11βHSD1 expressions are markers of body weight loss after bariatric surgery. Obesity (Silver Spring) 2015; 23:1856-63. [PMID: 26239572 DOI: 10.1002/oby.21173] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 05/06/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Cortisolemia and 11βHSD1 in liver and adipose tissue are altered in obesity. However, their participation in the development of obesity remains unclear. This study analyzed these parameters in the transition from morbid to type 1 obesity after bariatric surgery. METHODS A group of 34 patients with morbid obesity and 22 nonobese subjects were recruited. Initial hypothalamus-pituitary-adrenal (HPA) basal activity and 11βHSD1 mRNA expression in liver, subcutaneous (SAT), and visceral adipose tissue (VAT) were evaluated. A year after bariatric surgery (weight loss of 48 kg), these parameters were reappraised in plasma, SAT, and liver. RESULTS Body weight loss was accompanied by a downshift in basal HPA activity and 11βHSD1 expression in SAT. In patients with morbid obesity, 11βHSD1 expression correlated positively with BMI in VAT and negatively in liver at 6 and 12 months after surgery. In SAT, a correlation was observed with body weight only when patients showed type 1 obesity. Insulin, glucose, and HOMA correlated positively with all the HPA indicators and 11βHSD1 expression in SAT. CONCLUSIONS Body weight loss after bariatric surgery is accompanied by a downshift in basal HPA activity. Hepatic and VAT 11βHSD1 expressions in morbid obesity are predictors of body weight loss.
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Affiliation(s)
- Eva Pardina
- Department of Biochemistry and Molecular Biology, University of Barcelona, Barcelona, Spain
| | | | - José Manuel Fort
- Endocrinology Surgery Unit, Institut De Recerca Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Roser Ferrer
- Biochemistry Department, Institut De Recerca Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Joana Rossell
- Department of Biochemistry and Molecular Biology, University of Barcelona, Barcelona, Spain
| | - Montserrat Esteve
- Department of Nutrition and Food Science, University of Barcelona, Barcelona, Spain
- Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- CIBER Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
| | - Julia Peinado-Onsurbe
- Department of Biochemistry and Molecular Biology, University of Barcelona, Barcelona, Spain
| | - Mar Grasa
- Department of Nutrition and Food Science, University of Barcelona, Barcelona, Spain
- Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- CIBER Obesity and Nutrition, Institute of Health Carlos III, Madrid, Spain
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Vilallonga R, Fort JM, Caubet E, Gonzalez O, Balibrea JM, Ciudin A, Armengol M. Robotically Assisted Single Anastomosis Duodenoileal Bypass after Previous Sleeve Gastrectomy Implementing High Valuable Technology for Complex Procedures. J Obes 2015; 2015:586419. [PMID: 26491560 PMCID: PMC4605372 DOI: 10.1155/2015/586419] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Staged bariatric procedures in high risk patients are a common used strategy for morbid obese patients nowadays. After previous sleeve gastrectomy, surgical treatments in order to complete weight loss or comorbidities improvements or resolutions are possible. One strategy is to perform a novel technique named SADI (single anastomosis duodenoileal bypass-sleeve). We present the technique for totally intracorporeal robotically assisted SADI using five ports and a liver retractor. We aim to see if the robotic technology offers more advantageous anastomosis and dissection obtained by the robotic approach in comparison to standard laparoscopy. The safety, feasibility, and reproducibility of a minimally invasive robotic surgical approach to complex abdominal operations such as SADI are discussed.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
- *Ramon Vilallonga:
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Enric Caubet
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - José Maria Balibrea
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Andrea Ciudin
- Endocrinology Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
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González O, Iglesias C, Zafon C, Castellví J, García-Burillo A, Temprana J, Caubet E, Vilallonga R, Mesa J, Cajal SRY, Fort JM, Armengol M, María Balibrea J. Detection of Thyroid Papillary Carcinoma Lymph Node Metastases UsingOne Step Nucleic Acid Amplification(OSNA): Preliminary Results. J INVEST SURG 2014; 28:153-9. [DOI: 10.3109/08941939.2014.990123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zafon C, Baena JA, Castellví J, Obiols G, Gonzalez O, Fort JM, Vilallonga R, Caubet E, Armengol M, Mesa J. Evolution of differentiated thyroid cancer: a decade of thyroidectomies in a single institution. Eur Thyroid J 2014; 3:197-201. [PMID: 25538902 PMCID: PMC4224230 DOI: 10.1159/000365416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/19/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Numerous studies have shown an increase in the incidence of thyroid cancer (TC) in recent years. OBJECTIVES In this paper, we reviewed the incidence of TC in a series of patients undergoing thyroid surgery at a single institution over a 10-year period. PATIENTS AND METHODS The cohorts were divided into two periods (2001-2005 and 2006-2010) with the purpose of comparing various clinicopathologic variables. RESULTS A total of 1,263 patients were included. A significant increase in the number of malignancies was shown in the second period, namely 90 cases in 2001-2005 (15.2% of all interventions) compared to 163 cases in 2006-2010 (24.3%) (p < 0.001). These differences were attributed to an increase in papillary thyroid carcinoma (PTC), as there were 66 PTC cases in the first period (11.13% of thyroidectomies performed) compared to 129 cases in the second period (19.25%). There were no clinicohistological differences among PTC cases in these two periods. CONCLUSIONS Over the last decade, there has been an increase in the incidence of TC in patients undergoing thyroid surgery. This increase is exclusively due to increases in PTC. Our study verifies the existence of this trend in our geographical area, similar to that noted in other parts of the world.
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Affiliation(s)
- Carles Zafon
- Department of Endocrinology, Universitat Autònoma de Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain
- *Dr. Carles Zafon, Department of Endocrinology Hospital Vall d'Hebron, Universitat Autonòma de Barcelona, Pg. Vall d'Hebron 119-129, ES-08035 Barcelona (Spain), E-Mail
| | - Juan Antonio Baena
- Endocrine, Bariatric and Metabolic Unit, Department of General Surgery, Universitat Autònoma de Barcelona, Spain
| | - Josep Castellví
- Department of Pathology, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Gabriel Obiols
- Department of Endocrinology, Universitat Autònoma de Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Bariatric and Metabolic Unit, Department of General Surgery, Universitat Autònoma de Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Bariatric and Metabolic Unit, Department of General Surgery, Universitat Autònoma de Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Unit, Department of General Surgery, Universitat Autònoma de Barcelona, Spain
| | - Enric Caubet
- Endocrine, Bariatric and Metabolic Unit, Department of General Surgery, Universitat Autònoma de Barcelona, Spain
| | - Manuel Armengol
- Endocrine, Bariatric and Metabolic Unit, Department of General Surgery, Universitat Autònoma de Barcelona, Spain
| | - Jordi Mesa
- Department of Endocrinology, Universitat Autònoma de Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona and CIBERDEM (ISCIII), Barcelona, Spain
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Vilallonga R, Fort JM, Himpens J. Chronic fistula after laparoscopic vertical gastrectomy. Cir Esp 2014; 92:700-1. [PMID: 25125268 DOI: 10.1016/j.ciresp.2014.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 06/14/2014] [Accepted: 06/18/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Ramón Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, España; Division of Bariatric Surgery, AZ St-Blasius, Dendermonde , Bégica.
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Barcelona, España
| | - Jacques Himpens
- Division of Bariatric Surgery, AZ St-Blasius, Dendermonde , Bégica
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Vilallonga R, Zafon C, Fort JM, Mesa J, Armengol M. Past and present in abdominal surgery management for Cushing's syndrome. SAGE Open Med 2014; 2:2050312114528905. [PMID: 26770719 PMCID: PMC4607216 DOI: 10.1177/2050312114528905] [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: 10/08/2013] [Accepted: 02/24/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Data on specific abdominal surgery and Cushing's syndrome are infrequent and are usually included in the adrenalectomy reports. Current literature suggests the feasibility and reproducibility of the surgical adrenalectomies for patients diagnosed with non-functioning tumours and functioning adrenal tumours including pheochromocytoma, Conn's syndrome and Cushing's syndrome. DISCUSSION Medical treatment for Cushing's syndrome is feasible but follow-up or clinical situations force the patient to undergo a surgical procedure. Laparoscopic surgery has become a gold standard nowadays in a broad spectrum of pathologies. Laparoscopic adrenalectomies are also standard procedures nowadays. However, despite the different characteristics and clinical disorders related to the laparoscopically removed adrenal tumours, the intraoperative and postoperative outcomes do not significantly differ in most cases between the different groups of patients, techniques and types of tumours. Tumour size, hormonal type and surgeon's experience could be different factors that predict intraoperative and postoperative complications. Transabdominal and retroperitoneal approaches can be considered. Outcomes for Cushing's syndrome do not differ depending on the surgical approach. Novel technologies and approaches such as single-port surgery or robotic surgery have proven to be safe and feasible. CONCLUSION Laparoscopic adrenalectomy is a safe and feasible approach to adrenal pathology, providing the patients with all the benefits of minimally invasive surgery. Single-port access and robotic surgery can be performed but more data are required to identify their correct role between the different surgical approaches. Factors such as surgeon's experience, tumour size and optimal technique can affect the outcomes of this surgery.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Universitary Hospital Vall d’Hebron, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Carles Zafon
- Department of Endocrinology, Universitary Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Diabetes and Metabolism Research Unit (VHIR), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Universitary Hospital Vall d’Hebron, Center of Excellence for the EAC-BC, Barcelona, Spain
| | - Jordi Mesa
- Department of Endocrinology, Universitary Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Diabetes and Metabolism Research Unit (VHIR), Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Barcelona, Spain
| | - Manel Armengol
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Universitary Hospital Vall d’Hebron, Center of Excellence for the EAC-BC, Barcelona, Spain
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Julve J, Pardina E, Pérez-Cuéllar M, Ferrer R, Rossell J, Baena-Fustegueras JA, Fort JM, Lecube A, Blanco-Vaca F, Sánchez-Quesada JL, Peinado-Onsurbe J. Bariatric surgery in morbidly obese patients improves the atherogenic qualitative properties of the plasma lipoproteins. Atherosclerosis 2014; 234:200-5. [PMID: 24674904 DOI: 10.1016/j.atherosclerosis.2014.02.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of weight loss induced in morbidly obese subjects by Roux-en-Y gastric bypass bariatric surgery on the atherogenic features of their plasma lipoproteins. METHODS Twenty-one morbidly obese subjects undergoing bariatric surgery were followed up for up to 1 year after surgery. Plasma and lipoproteins were assayed for chemical composition and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity. Lipoprotein size was assessed by non-denaturing polyacrylamide gradient gel electrophoresis, and oxidised LDL by ELISA. Liver samples were assayed for mRNA abundance of oxidative markers. RESULTS Lipid profile analysis revealed a reduction in the plasma concentrations of cholesterol and triglycerides, which were mainly associated with a significant reduction in the plasma concentration of circulating apoB-containing lipoproteins rather than with changes in their relative chemical composition. All patients displayed a pattern A phenotype of LDL subfractions and a relative increase in the antiatherogenic plasma HDL-2 subfraction (>2-fold; P < 0.001). The switch towards predominantly larger HDL particles was due to an increase in their relative cholesteryl ester content. Excess weight loss also led to a significant decrease in the plasma concentration of oxidised LDL (∼-25%; P < 0.01) and in the total Lp-PLA2 activity. Interestingly, the decrease in plasma Lp-PLA2 was mainly attributed to a decrease in the apoB-containing lipoprotein-bound Lp-PLA2. CONCLUSION Our data indicate that the weight loss induced by bariatric surgery ameliorates the atherogenicity of plasma lipoproteins by reducing the apoB-containing Lp-PLA2 activity and oxidised LDL, as well as increasing the HDL-2 subfraction.
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Affiliation(s)
- Josep Julve
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Barcelona, Spain; Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Pardina
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Montserrat Pérez-Cuéllar
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Roser Ferrer
- Departament de Bioquímica i Unitat de Cirurgia, Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joana Rossell
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | | | - José Manuel Fort
- Departament de Bioquímica i Unitat de Cirurgia, Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Albert Lecube
- Departament d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Universitat de Lleida, Lleida, Spain; Unitat de Recerca en Diabetes i Metabolisme, Institut de Recerca Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Barcelona, Spain; Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Blanco-Vaca
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Barcelona, Spain; Departament de Bioquímica i Biologia Molecular, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Luis Sánchez-Quesada
- Institut d'Investigació Biomèdica de l'Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Departament de Bioquímica i Biologia Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.
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Vilallonga R, Zafon C, Ruiz-Marcellan C, Obiols G, Fort JM, Baena JA, Villanueva B, Garcia A, Sobrinho-Simões M. Malignant thyroid teratoma: report of an aggressive tumor in a 64-year-old man. Endocr Pathol 2013; 24:132-5. [PMID: 23702575 DOI: 10.1007/s12022-013-9250-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Malignant teratoma of the thyroid is a rare and aggressive tumor, frequent in children than in adults. Histologically, thyroid teratomas usually show a predominance of a neuroectodermal component. Mature cartilage and bone may be present. We present the case of primary malignant teratoma of the thyroid in a 64-year-old man. Histologically, the tumor displayed a predominant neuroectodermal component. The diagnosis was confirmed by immunohistochemistry. The patient underwent a radical thyroidectomy with central neck dissection as primary treatment and radioiodine treatment afterwards. The patient had local and distant recurrence. A second surgery was performed with poor results and the patient died 3 months afterwards.
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Affiliation(s)
- R Vilallonga
- Endocrine, Bariatric and metabolic Unit, Center of Excellence, General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
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Vilallonga R, Lecube A, Fort JM, Boleko MA, Hidalgo M, Armengol M. Internet of things and bariatric surgery follow-up: Comparative study of standard and IoT follow-up. MINIM INVASIV THER 2013; 22:304-11. [PMID: 23470010 DOI: 10.3109/13645706.2013.779282] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Follow-up of obese patient is difficult. There is no literature related to patient follow-up that incorporates the concept of Internet of Things (IoT), use of WiFi, Internet, or portable devices for this purpose. MATERIAL AND METHODS This prospective observational study commenced in June 2011. Patients were prospectively offered to participate in the IoT study group, in which they received a WiFi scale (Withing®, Paris) that provides instant WiFi data to the patient and surgeon. Other patients were admitted to the standard follow-up group at the outpatient clinic. A total of 33 patients were included in our study (ten in the IoT group). RESULTS Twelve patients did not have WiFi at home, ten lacked of computer knowledge, and seven preferred standard for follow-up. All patients underwent different surgical procedures. There were no complications. Excess weight loss (EWL) was similar in both groups. More than 90% of patients were satisfied. In the IoT group, patients considered it valuable in saving time, and considered seeing their evolution graphics extremely motivating. CONCLUSION IoT technology can monitor medical parameters remotely and collect data. A WiFi scale can facilitate preoperative and follow-up. Standard follow-up in a classical outpatient clinic setting with the surgeon was preferred globally.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, University Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC , Barcelona , Spain
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MESH Headings
- Acromegaly/etiology
- Acromegaly/prevention & control
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/prevention & control
- Female
- Gastric Bypass/adverse effects
- Growth Hormone-Secreting Pituitary Adenoma/complications
- Growth Hormone-Secreting Pituitary Adenoma/drug therapy
- Growth Hormone-Secreting Pituitary Adenoma/physiopathology
- Growth Hormone-Secreting Pituitary Adenoma/surgery
- Hormone Antagonists/therapeutic use
- Human Growth Hormone/antagonists & inhibitors
- Human Growth Hormone/blood
- Human Growth Hormone/metabolism
- Humans
- Insulin-Like Growth Factor I/analysis
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/surgery
- Obesity, Morbid/blood
- Obesity, Morbid/complications
- Obesity, Morbid/physiopathology
- Obesity, Morbid/surgery
- Pituitary Gland/drug effects
- Pituitary Gland/metabolism
- Pituitary Gland/surgery
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Recurrence
- Remission Induction
- Sleep Apnea Syndromes/complications
- Sleep Apnea Syndromes/physiopathology
- Sleep Apnea Syndromes/prevention & control
- Treatment Outcome
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Vilallonga R, Yeste D, Lecube A, Fort JM. Cirugía bariátrica en adolescentes. Cir Esp 2012; 90:619-25. [DOI: 10.1016/j.ciresp.2012.09.003] [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: 07/03/2012] [Revised: 09/04/2012] [Accepted: 09/06/2012] [Indexed: 11/29/2022]
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Vilallonga R, Yeste D, Lecube A, Armengol M, Fort JM. [A bariatric surgery programme in adolescents. Preliminary results]. Cir Esp 2012; 91:685-7. [PMID: 23044252 DOI: 10.1016/j.ciresp.2012.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 05/07/2012] [Accepted: 06/24/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Ramón Vilallonga
- Unidad de Cirugía Endocrina, Bariátrica y Metabólica, Servicio de Cirugía General, Hospital Universitario Vall d'Hebron, European Center of Excellence (EAC-BS), Barcelona, España.
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Vilallonga R, Barbaros U, Sümer A, Demirel T, Fort JM, González O, Rodriguez N, Carrasco MA. Single-port transumbilical laparoscopic cholecystectomy: A prospective randomised comparison of clinical results of 140 cases. J Minim Access Surg 2012; 8:74-8. [PMID: 22837593 PMCID: PMC3401720 DOI: 10.4103/0972-9941.97586] [Citation(s) in RCA: 36] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 03/23/2011] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION A novel single port access (SPA) cholecystectomy approach is described in this study. We have designed a randomised comparative study in order to elucidate any possible differences between the standard treatment and this novel technique. MATERIALS AND METHODS Between July 2009 and March 2010, 140 adult patients with gallbladder pathologies were enrolled in this multicentre study. Two surgeons (RV and UB) randomised patients to either a standard laparoscopic (SL) approach group or to an SPA cholecystectomy group. Two types of trocars were used for this study: the TriPort™ and the SILS™ Port. Outcomes including blood loss, operative time, complications, length of stay and pain were recorded. RESULTS There were 69 patients in the SPA group and 71 patients in the SL group. The mean age of the patients was 43.2 (17-77) for the SPA group and 42.6 (19-70) for the SL group. The mean operative time was 63.9 min in the SPA group and 58.4 min in the SL group. For one patient, the SPA procedure was converted to a standard laparoscopic technique and to open approach in the SL group. Complications occurred in eight patients: Five seromas (two in the SPA group) and three hernias (one in the SPA group).The mean hospital stay was 38.5 h in the SPA group and 24.1 h in the SL group. Pain was evaluated and was 2 in the SPA and 2.9 in the SL group, according to the visual analogue scale (VAS) after 24 h (P<0.001). The degree of satisfaction was higher in the SPA group (8.3 versus 6.7). Similar results were found for the aesthetic result (8.8 versus 7.5). (P<0.001). CONCLUSION Single-port transumbilical laparoscopic cholecystectomy can be feasible and safe. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. The SPA approach can be undertaken without the expense of additional operative time and provides patients with minimal scarring. The cosmetic results and the degree of satisfaction appear to be significant for the SPA approach.
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Affiliation(s)
- Ramon Vilallonga
- Department of General Surgery, Universitary Hospital Vall d'Hebron, Barcelona, Spain
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Vilallonga R, González O, Bergamini S, Fort JM, Armengol M. Gallbladder variceal bleeding in a patient with alcoholic cirrhosis: a rare entity. Rev Esp Enferm Dig 2012; 104:153-4. [PMID: 22449161 DOI: 10.4321/s1130-01082012000300012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vilallonga R, Fort JM, Iordache N, Armengol M, Clèries X, Solà M. Use of images in a surgery consultation. Will it improve the communication? Chirurgia (Bucur) 2012; 107:213-217. [PMID: 22712351] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The interviews and interactions with patients are part of everyday health care provider. However, there is sometimes a difficulty in communication, linked to several factors. For this reason, the use of images to illustrate the medical conditions in the outpatient clinic can improve patient communication. We report our initial experience with the use of images to manage the quality of care to surigcal patients. METHODOLOGY He used a computer to show pictures of the following conditions: surgery for an inguinal hernia, cholelithiasis, cholecystitis and the choledocholithiasis and finally thyroid pathology. Were randomized two groups of patients. Each of the affected patients in any stage of the disease, they explained their problems. In one of the groups also showed the patient was using the current image and continued to give appropriate explanations related to pathology. Thereafter, patients in both groups filled in an anonymous questionnaire in which they responded to what degree it was considered useful this methodology, and degree of satisfaction received outpatient treatment with or without the deployment of images by computer. We have analyzed the average time expected and made a visit. RESULTS 187 patients will be visited in the consultations over a period of 8 months. In 83 patients have been using images to give the explanations in external consultations. Of these, 24 patients suffering from thyroid, 24 hernias or incisional hernias and 35 patients with biliary tract pathology. Patients in the group were shown images of conditions have responded mostly be very satisfied with the use of images while the explanations are given on the patient's illness. Also, over 80% of patients report being satisfied with this system. The visiting time was not lengthened. DISCUSSION Despite the existence of different variables that can influence patient satisfaction, use of images to illustrate surgical diseases to patients improves communication and flow of the explanations of the physician. CONCLUSIONS The relationship doctor-patient communication is the key event in an outpatient setting. It determines a good overall result of the clinical interview. The use of images in an outpatient improves communication between patients and doctors. Moreover, the degree of satisfaction is high and the degree of understanding of the disease. It seems useful to incorporate in our outpatient clinic.
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Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Universitary Hospital Vall d'Hebron, Barcelona, Spain.
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Lecube A, Baena-Fustegueras JA, Fort JM, Pelegrí D, Hernández C, Simó R. Diabetes is the main factor accounting for hypomagnesemia in obese subjects. PLoS One 2012; 7:e30599. [PMID: 22291997 PMCID: PMC3265490 DOI: 10.1371/journal.pone.0030599] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 12/22/2011] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Type 2 diabetes (T2DM) and obesity are associated with magnesium deficiency. We aimed to determine whether the presence of type 2 diabetes and the degree of metabolic control are related to low serum magnesium levels in obese individuals. METHODS A) Case-control study: 200 obese subjects [50 with T2DM (cases) and 150 without diabetes (controls)] prospectively recruited. B) Interventional study: the effect of bariatric surgery on serum magnesium levels was examined in a subset of 120 obese subjects (40 with type 2 diabetes and 80 without diabetes). RESULTS Type 2 diabetic patients showed lower serum magnesium levels [0.75±0.07 vs. 0.81±0.06 mmol/L; mean difference -0.06 (95% CI -0.09 to -0.04); p<0.001] than non-diabetic patients. Forty-eight percent of diabetic subjects, but only 15% of non-diabetic subjects showed a serum magnesium concentration lower than 0.75 mmol/L. Significant negative correlations between magnesium and fasting plasma glucose, HbA1c, HOMA-IR, and BMI were detected. Multiple linear regression analysis showed that fasting plasma glucose and HbA1c independently predicted serum magnesium. After bariatric surgery serum magnesium increased only in those patients in whom diabetes was resolved, but remain unchanged in those who not, without difference in loss weight between groups. Changes in serum magnesium negatively correlated with changes in fasting plasma glucose and HbA1c. Absolute changes in HbA1c independently predicted magnesium changes in the multiple linear regression analysis. CONCLUSIONS Our results provide evidence that the presence of diabetes and the degree of metabolic control are essential in accounting for the lower levels of magnesium that exist in obese subjects.
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Affiliation(s)
- Albert Lecube
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Diabetes and Metabolism Research Unit, Endocrinology Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Ciudin A, Baena-Fustegueras JA, Fort JM, Encabo G, Mesa J, Lecube A. Successful treatment for the Dunnigan-type familial partial lipodystrophy with Roux-en-Y gastric bypass. Clin Endocrinol (Oxf) 2011; 75:403-4. [PMID: 21521325 DOI: 10.1111/j.1365-2265.2011.04057.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vilallonga R, Rius J, Fort JM, Armengol M. Single port access sleeve gastrectomy: Is it reasonable? J Minim Access Surg 2011; 7:156-7. [PMID: 21523242 PMCID: PMC3078482 DOI: 10.4103/0972-9941.78354] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/05/2011] [Indexed: 01/07/2023] Open
Abstract
This short letter is in response to the article published in your publication about single-incision laparoscopic bariatric surgery, by Chih-Kun Huang. We want to focus on the technical aspects.
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Affiliation(s)
- Ramon Vilallonga
- Department of General Surgery, Endocrine, Bariatric and Metabolic Unit, Universitary Hospital Vall d'Hebron, Barcelona, Spain
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Vilallonga R, Ciudin A, Fort JM, Baena JA, Gonzalez O, Armengol M, Mesa J, Ruiz Marcellán MC. Isolated langerhans cell histiocytosis of the thyroid in an adult female: one-year followup. Int J Endocrinol 2011; 2011:898302. [PMID: 21461403 PMCID: PMC3065032 DOI: 10.1155/2011/898302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 12/09/2010] [Accepted: 01/13/2011] [Indexed: 11/17/2022] Open
Abstract
Thyroid gland involvement as the unique presentation of Langerhans cell histiocytosis is a rare phenomenon that can result in misdiagnosis. We report a case of Langerhans cell histiocytosis (LCH) presenting as a thyroid mass. It is a 52-year-old woman who presented an enlarged, diffusely firm, nontender, nonmobile, and not particularly nodular thyroid gland with mild compressive symptoms. Ultrasound and fine-needle aspiration showed a unique right node with benign signs. Patient was referred to our Ambulatory Surgery Department, where a hemithyroidectomy was performed. Histologic evaluation of the right thyroid gland revealed an involvement by LCH, confirmed by immunohistochemical analysis showing Langerhans cells that were positive for CD1a. LCH was a completely incidental occult finding apparent only after surgical resection and examination of the gland. Patient was evaluated, and no evidence of systemic affectation was found. LCH can rarely involve the thyroid gland in adults. Few cases have been reported in the literature. Most patients had evidence of LCH involving other anatomic sites.
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Affiliation(s)
- Ramon Vilallonga
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
- *Ramon Vilallonga:
| | - Andrea Ciudin
- Endocrinology Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - José Manuel Fort
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Juan Antonio Baena
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Oscar Gonzalez
- Endocrine, Bariatric and Metabolic Unit, General Surgery Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Manuel Armengol
- General Surgery Department, University Hospital Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Jordi Mesa
- Endocrinology Department, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
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Vilallonga R, Fort JM, Gonzalez O, Baena JA, Lecube A, Armengol M. Management of patients with hernia or incisional hernia undergoing surgery for morbid obesity. J Obes 2011; 2011:860942. [PMID: 21188167 PMCID: PMC3003955 DOI: 10.1155/2011/860942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 10/26/2010] [Indexed: 12/22/2022] Open
Abstract
Morbidly obese patients (MOPs) are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or splits of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair.
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Affiliation(s)
- Ramon Vilallonga
- General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
- *Ramon Vilallonga:
| | - José Manuel Fort
- General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Oscar Gonzalez
- General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Juan Antonio Baena
- General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Albert Lecube
- Obesity Unit, Endocrine Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Manuel Armengol
- General Surgery Department, Universitary Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
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Vilallonga R, Fort JM, Armengol M. [Laparoscopic transumbilical cholecystectomy. Results with the gel device and literature review]. Cir Esp 2010; 88:277-8; author reply 278-9. [PMID: 20705286 DOI: 10.1016/j.ciresp.2010.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 05/16/2010] [Indexed: 11/16/2022]
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Vilallonga R, Baena JA, Fort JM, Gonzalez O, Gemar E, Armengol Carrasco M. Colouterine fistula complicating diverticulitis in elderly women. Int J Colorectal Dis 2009; 24:599-600. [PMID: 19089434 DOI: 10.1007/s00384-008-0630-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2008] [Indexed: 02/04/2023]
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Ponseti JM, Azem J, Fort JM, López-Cano M, Vilallonga R, Buera M, Cervera C, Armengol M. Long-term results of tacrolimus in cyclosporine- and prednisone-dependent myasthenia gravis. Neurology 2005; 64:1641-3. [PMID: 15883336 DOI: 10.1212/01.wnl.0000160392.32894.6d] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [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: 11/15/2022] Open
Abstract
Seventy-nine patients with cyclosporine- and prednisone-dependent myasthenia gravis (MG) after thymectomy received tacrolimus for a mean of 2.5 +/- 0.8 years. Prednisone was withdrawn in all but two patients. Anti-acetylcholine antibodies and MG score for disease severity decreased significantly and muscular strength increased by 39%. Complete stable remission was achieved in 5% of patients and pharmacologic remission in 87.3%. All patients resumed full activities of daily living.
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Affiliation(s)
- J M Ponseti
- Myasthenia Gravis Unit, Department of Surgery, Hospital General Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
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Obiols G, Catalán R, Alasà C, Baena JA, Fort JM, Gémar E, Mesa J. [Usefullness of intraoperatory parathyroid hormone measurement in surgical management of primary hyperparathyroidism due to a parathyroid adenoma]. Med Clin (Barc) 2003; 121:287-91. [PMID: 14499082 DOI: 10.1016/s0025-7753(03)73920-7] [Citation(s) in RCA: 3] [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: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgical neck exploration of the 4 parathyroid glands is quite an aggressive procedure for most patients with primary hyperparathyroidism (PHPT) due to a parathyroid adenoma. Intraoperatory measurement of parathyroid hormone (PTH) seems to be a useful tool for the management of these cases, allowing the use of minimally invasive surgical techniques with a lower morbidity. Our aims was to assess the usefulness of PTH intraoperatory measurement for the surgical management of PHPT. PATIENTS AND METHOD We studied 27 consecutive patients, diagnosed with PHPT secondary to parathyroid adenoma. Localization studies included neck ultrasonography and Tc-MIBI scintigraphy. PTH at the stage of anesthesia induction as well as 5 and 10 minutes after the removal of the adenoma was determined. A PTH decrement greater than 50% at 10 minutes was considered as curative. PTH was measured by an immunoluminometric method (Advantage, Nichols). RESULTS In all cases, calcium levels were normal 24 hours after the operation, and therefore all them were considered as cured. PTH levels decreased more than 50% in all patients. In one case, PTH levels remained high after the exeresis of a preoperatively localized lesion. The pathologic study confirmed that it was a normal parathyroid gland. We then continued the surgical exploration which eventually allowed us to find a contralateral adenoma. A further PTH measurement showed an over 50% decrease. Therefore, PTH was predictive of surgical success in all 28 measurements. CONCLUSIONS Intraoperatory determination of PTH is useful for the surgical management of PHPT and it could allow the use of minimally invasive surgical techniques.
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Affiliation(s)
- Gabriel Obiols
- Servicio de Endocrinología y Nutrición, Hospital Vall d'Hebron, Barcelona, España.
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Catalán R, Alasà C, Antonio Baena J, Obiols G, Manuel Fort J, Gémar E, Mesa J. Utilidad de la determinación intraoperatoria de parathormona en el tratamiento quirúrgico del hiperparatiroidismo primario por adenoma de paratiroides. Med Clin (Barc) 2003. [DOI: 10.1157/13050720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ponseti JM, Fort JM, Carbó C, Marco V. [Myasthenia gravis, thymoma and intestinal pseudoobstruction]. Med Clin (Barc) 2000; 114:597. [PMID: 10846680 DOI: 10.1016/s0025-7753(00)71371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sánchez JL, Espín E, Fort JM, de Lara F, de Torres I, Armengol M. [Sarcoma in the diverticulum of Meckel]. Rev Esp Enferm Dig 1997; 89:334-5. [PMID: 9221027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
BACKGROUND & AIMS Scarce data suggest that cholecystectomy may alter bowel habit. The aim of this study was to determine whether cholecystectomy modifies gut transit. METHODS Five experimental groups were studied: 29 patients with uncomplicated gallstones before and 1 month after elective cholecystectomy, 22 patients 4 years after elective cholecystectomy, 14 patients with postcholecystectomy diarrhea, 5 patients with acute infectious diarrhea (disease controls), and 13 patients before and 1 month after other elective surgery (surgical controls). All participants underwent measurement of colonic transit by a modified radiopaque pellet method and orocecal transit by the standard lactulose breath H2 test. RESULTS One month postoperatively, cholecystectomy had substantially accelerated total colonic transit (51 +/- 5 hours before vs. 38 +/- 5 hours after; P < 0.05) and delayed slightly orocecal transit (80 +/- 4 minutes before vs. 103 +/- 8 minutes after; P = 0.05). Similar colonic and orocecal transit times were measured 4 years after cholecystectomy (40 +/- 4 hours and 105 +/- 8 minutes, respectively). Colonic transit times in patients with the postcholecystectomy diarrhea syndrome were accelerated as much as in patients with infectious diarrhea, who served as controls (19 +/- 3 hours and 15 +/- 4 hours, respectively). Surgery per se had no effect on gut transit. CONCLUSIONS Cholecystectomy shortens gut transit by accelerating colonic passage. These sequelae develop early and persist at least 4 years after cholecystectomy. The postcholecystectomy diarrhea syndrome probably represents a magnification of the above colonic sequelae.
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Affiliation(s)
- J M Fort
- Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain
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Fort JM. Bacteria and What We Know about Them. Tex Med J (Austin) 1905; 20:487-496. [PMID: 36955386 PMCID: PMC9612999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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Fort JM. Reminiscences of an Old Doctor. Tex Med J (Austin) 1905; 20:357-364. [PMID: 36955415 PMCID: PMC9613045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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