viernes, 10 de enero de 2014

Cirugía bariátrica/Bariatric surgery

Resultados a corto y mediano tiempo entre bypass gástrico en Y de Roux y manga gástrica laparoscópica para el tratamiento de obesidad mórbida


Short- and midterm results between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy for the treatment of morbid obesity.
Albeladi B, Bourbao-Tournois C, Huten N.
J Obes. 2013;2013:934653. doi: 10.1155/2013/934653. Epub 2013 Sep 2.
Abstract
BACKGROUND:Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most widely used bariatric procedures today, and laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular in Europe. The aim of this study was to compare short- and midterm results between LRYGB and LSG. METHODS: An observational retrospective study from a database of patients undergoing LRYGB and LSG between January 2008 and June 2011. Seventy patients (mean age 39 years) were included. Patients were followed at 6, 12, and 18 months. Operative time, length of stay, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions and mortality were evaluated. ... CONCLUSIONS: Both LRYGB and LSG are safe procedures that provide good results in weight loss and resolution of comorbidities at 18 months
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3775408/pdf/JOBES2013-934653.pdf





Cirugía bariátrica versus manejo no quirúrgico para la obesidad: revisión sistemática y meta-análisis de estudios controlados randomizados

Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials.
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, Bucher HC, Nordmann AJ.
BMJ. 2013 Oct 22;347:f5934. doi: 10.1136/bmj.f5934.
Abstract
OBJECTIVE:To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity. DESIGN:Systematic review and meta-analysis based on a random effects model. DATA SOURCES:Searches of Medline, Embase, and the Cochrane Library from their inception to December 2012 regardless of language or publication status.ELIGIBILITY CRITERIA: Eligible studies were randomised controlled trials with ≥ 6 months of follow-up that included individuals with a body mass index ≥ 30, compared current bariatric surgery techniques with non-surgical treatment, and reported on body weight, cardiovascular risk factors, quality of life, or adverse events. RESULTS:The meta-analysis included 11 studies with 796 individuals (range of mean body mass index at baseline 30-52). Individuals allocated tobariatric surgery lost more body weight (mean difference -26 kg (95% confidence interval -31 to -21)) compared with non-surgical treatment, had a higher remission rate of type 2 diabetes (relative risk 22.1 (3.2 to 154.3) in a complete case analysis; 5.3 (1.8 to 15.8) in a conservative analysis assuming diabetes remission in all non-surgically treated individuals with missing data) and metabolic syndrome (relative risk 2.4 (1.6 to 3.6) in complete case analysis; 1.5 (0.9 to 2.3) in conservative analysis), greater improvements in quality of life and reductions in medicine use (no pooled data). Plasma triglyceride concentrations decreased more (mean difference -0.7 mmol/L (-1.0 to -0.4) and high density lipoprotein cholesterol concentrations increased more (mean difference 0.21 mmol/L (0.1 to 0.3)). Changes in blood pressure and total or low density lipoprotein cholesterol concentrations were not significantly different. There were no cardiovascular events or deaths reported after bariatric surgery. The most common adverse events after bariatric surgery were iron deficiency anaemia (15% of individuals undergoing malabsorptive bariatric surgery) and reoperations (8%). CONCLUSIONS:Compared with non-surgical treatment of obesity, bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome. However, results are limited to two years of follow-up and based on a small number of studies and individuals.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3806364/pdf/bmj.f5934.pdf



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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org

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