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The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery.Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions.ClinicalTrials.gov Identifier: NCT03864861.

fifty to 70 percent of pancreatic neuroendocrine tumors are diagnosed incidentally. The objective of this study was to compare the phenotype and oncological outcomes of incidental versus symptomatic pancreatic neuroendocrine tumors.a retrospective study was performed, identifying all incidental and symptomatic tumors resected between 2000 and 2019. Baseline characteristics, symptoms, operative variables and pathological stage were all recorded. Patterns of recurrence and overall and disease-free survival were analyzed in both groups.fifty-one incidental and 45 symptomatic pancreatic tumor resections were performed. Symptomatic tumors were more frequent in females (29 vs 17; p = 0.005) and younger patients (median years; 50 vs 58; p = 0.012) and were detected at a more advanced stage (p = 0.027). There were no differences in location and most resections (n = 49; 51 %) were performed laparoscopically. There were no operative mortalities and 17 (17.7 %) severe complications (≥ IIIb on the Clavien-Dindo classification) were recorded with no differences between the two groups. With a median follow-up of 64.4 months (range 13.5-90), overall survival at five and ten years was 89.7 % and 72.8 % for the non-incidental tumors and 80.9 % and 54.6 % for the incidental tumors (p = ns), respectively. Disease-free survival in both groups (excluding M1a) was 71.2 % and 47.5 %, and 93.7 % and 78.1 %, respectively (p = ns).symptomatic tumors are more frequent in females and present at more advanced pathological stages. There were no significant differences in overall and disease-free survival between the two groups. Resection of incidental tumors ≥ 1.5-2 cm seems advisable, although each case should be assessed on an individual basis.

Severe disease caused by the SARS-CoV coronavirus is characterized by patients presenting with respiratory distress associated with a systemic inflammatory response syndrome (cytokine storm). Sixteen to thirty percent of COVID-19 patients also have gastrointestinal symptoms. Here we present three cases of COVID-19 who developed colonic ischemia. Three males aged 76, 68 and 56 with respiratory distress and receiving mechanical ventilation presented episodes of rectal bleeding, abdominal distension and signs of peritoneal irritation. Endoscopy (case 1) and computed tomography angiography revealed colonic ischemia and pneumoperitoneum.One patient (case 2) underwent surgery in which perforation of the gangrenous cecum and colonic ischemia was confirmed.In all three patients D-dimer levels were markedly increased (2170, 2100 and 7360 ng/mL). All three patients died shortly after diagnosis.In severe COVID-19 disease, the pathogenic cause has increasingly become attributed to the development of disseminated intravascular coagulation secondary to the systemic inflammatory response.

Resumen Introduccion La gastrectomia vertical (GV) se ha convertido en una tecnica con entidad propia cuya indicacion selectiva o global sigue siendo objeto de controversia. Los resultados ponderales a 5 anos son heterogeneos. El objetivo del estudio es identificar posibles factores pronosticos de perdida de peso insuficiente tras GV. Metodos Estudio multicentrico retrospectivo de GV con seguimiento mayor de un ano. Se considera fracaso si el PSP Resultados Se incluye a 1.565 pacientes intervenidos en 29 hospitales. PSP al ano: 70,58 ± 24,8; a los 3 anos 69,39 ± 29,2; a los 5 anos 68,46 ± 23,1. Pacientes con PSP 50 kg/m2, edad > 50 anos, DM2, HTA, SAOS, cardiopatia, varias comorbilidades asociadas, distancia a piloro > 5 cm, bujia > 40 F, tratamiento con antiagregantes. La sobresutura mejora los resultados. Las variables que mostraron ser factores predictivos de fracaso en el seguimiento fueron la DM2 y el IMC. Conclusion La GV asocia una perdida de peso satisfactoria en el 79% de los pacientes en los primeros 5 anos; sin embargo, algunas variables como el IMC > 50, la DM2, la edad > 50, la presencia de varias comorbilidades, la seccion a mas de 4 cm del piloro o la bujia > 40 F pueden aumentar el riesgo de fracaso ponderal.

Resumen La cirugia bariatrica ha demostrado ser muy eficaz en el control de la obesidad y el sindrome metabolico. Sus resultados no solo se expresan en terminos de perdida de peso, sino tambien en la resolucion de comorbilidades, mejoria de la calidad de vida y de las complicaciones derivadas. Los diferentes parametros utilizados para medir estos resultados requieren de una uniformidad y de unos patrones de referencia. Por ello, es fundamental establecer cuales son los indicadores y los criterios de calidad que definen las «buenas practicas» en cirugia bariatrica. En este sentido, la Seccion de Obesidad de la Asociacion Espanola de Cirujanos (AEC), en colaboracion con la Sociedad Espanola de Cirugia de la Obesidad (SECO), se plantea como objetivo identificar los puntos clave que definen la calidad en este tipo de cirugia. Para ello se describen los principales indicadores basados en la literatura publicada, asi como los criterios de remision de las principales comorbilidades segun las evidencias encontradas y sus grados de recomendacion.

Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation.

Introduction: Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. Methods: A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL > 50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. Results: A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58 +/- 24.7; 3 years 69.39 +/- 29.2; 5 years 68.46 +/- 23.1. Patients with EWL < 50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI > 50 kg/m(2), age > 50 years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4 cm, bougie > 40 F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. Conclusion: The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, somevariablessuchasBMI > 50, age > 50, thepresenceofseveralcomorbidities, more than 5 cm section of the pylorus or bougie > 40 F can increase the risk of weight loss failure. (C) 2017 AEC. Published by Elsevier Espanna, S.L.U. All rights reserved.

Introduccion La exploracion laparoscopica de la via biliar principal (ELVBP) es actualmente una alternativa valida en el tratamiento de la coledocolitiasis. Cuando se realiza a traves de una coledocotomia, tradicionalmente se ha empleado la colocacion de un tubo en T o el cierre primario, pero estos metodos no estan exentos de complicaciones. Presentamos nuestra experiencia con un metodo alternativo mediante el cierre del coledoco sobre una endoprotesis. Material y metodo Revisamos retrospectivamente los resultados recogidos de forma prospectiva de 104 pacientes con coledocolitiasis a los que se realizo ELVBP entre enero de 1999 y febrero de 2007. En un primer periodo se empleo el tubo en T. Desde Julio de 2001 el metodo empleado ha sido el cierre de la via biliar principal (VBP) sobre una endoprotesis biliar colocada bajo vision directa durante la intervencion y retirada, posteriormente, de forma ambulatoria mediante una gastroscopia. Resultados La tecnica descrita se empleo en 70 pacientes consecutivos. La mediana del tiempo operatorio fue de 90 min. No hubo conversion a cirugia abierta. En un 4,2% de los pacientes no se pudo desimpactar los calculos. La morbilidad fue del 7%, aunque solo en un 2,8% fue relacionada con el stent (pancreatitis aguda). Un paciente fallecio en el postoperatorio. La estancia hospitalaria mediana fue de 4 dias. Conclusiones La utilizacion de la endoprotesis biliar en el cierre laparoscopico de la VBP proporciona una descompresion eficaz, y aparentemente evita las complicaciones del tubo en T y del cierre primario. Por tanto, debe considerarse como una alternativa valida tras la coledocotomia laparoscopica.

Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation.

Background Complications in sleeve gastrectomy (SG) can cast a shadow over the technique's good results and compromise its safety. The aim of this study is to identify risk factors for complications, and especially those that can potentially be modified to improve safety. Methods A retrospective multicenter cohort study was carried out, involving the participation of 29 hospitals. Data was collected on demographic variables, associated comorbidities, technical modifications, the surgeon's experience, and postoperative morbimortality. A multivariate logistic regression analysis was carried out on risk factors (RFs) for the complications of leak/fistula, hemoperitoneum, pneumonia, pulmonary embolism, and death. Results The following data were collected for 2882 patients: age, 43.85+/-11.6. 32.9 % male; BMI 47.22+/-8.79; 46.2 % hypertensive; 29.2 % diabetes2; 18.2 % smokers; bougie calibre >= 40 F 11.1 %; complications 11.7 % (2.8 % leaks, 2.7 % hemoperitoneum, 1.1 % pneumonia, 0.2 % pulmonary embolism); and death 0.6 %. RFs for complications were as follows: surgeon's experience < 20 patients, OR 1.72 (1.32-2.25); experience> 100 patients, OR 0.78 (0.69-0.87); DM2, OR1.48(1.12-1.95); probe > 40 F, OR 0.613 (0.429-0.876). Leak RFs were the following: smoking, OR1.93 (1.1-3.41); surgeon's experience< 20 patients, OR 2.4 (1.46-4.16); experience of 20-50 patients, OR 2.5 (1.3-4.86); experience > 100 patients, OR 0.265 (0.11-0.63); distance to pylorus > 4 cm, OR 0.510 (0.29-0.91). RFs for death were as follows: smoking, OR 8.64 (2.63-28.34); DM2, OR 3.25 (1.1-9.99); distance to pylorus< 5 cm, OR 6.62 (1.63-27.02). Conclusions The safety of SG may be compromised by nonmodifiable factors such as age > 65, patient comorbidities (DM2, hypertension), and prior treatment with anticoagulants, as well as by modifiable factors such as smoking, bougie size < 40 F, distance to the pylorus < 4 cm, and the surgeon's experience (< 50-100 cases).