After LSG there is a global tendency to an accelerated gastric emptying, although only significant in the antrum preservation group; however, no differences were observed regarding the %EWL between groups after 1 year follow-up.
Background Bariatric surgery in the older population has been the subject of ongoing debate but several studies have recently demonstrated its short-term advantages in this age group. It is not yet clear, however, whether these benefits are long-lasting. Methods We retrospectively analyzed patients with morbid obesity who underwent laparoscopy sleeve gastrectomy (LSG). These patients were divided into two groups: those above 60 years of age (older group) and those of 60 years or under (younger group). Variables evaluated included demographics and anthropometrics data, comorbidities, and daily medication requirements. Results Two hundred fifty-two patients underwent LSG, 57 in the older group and 195 in the younger group. Outcomes related to weight loss in the older subjects were modest compared to those in the younger population (older group %EWL 41.6 vs younger group %EWL 51.1, p < 0.05, older group %TWL 24.9% vs younger group %TWL 25.2%, p < 0.05). During follow-up, both older and younger patients showed an improvement in all the comorbidities: hypertension (older 82.5% vs 38.1%, younger 52.6% vs 29.2%, p < 0.05), type 2 diabetes mellitus (older 38.6% vs 27.3%, 34.9% vs 23.9%, p < 0.05), hyperlipidemia (older 75.4% vs 42.9%, younger 35.9% vs 21.1%, p < 0.05), and OSAHS (older 57.9% vs 30%, younger 40.4% vs 7.1%, p < 0.05). The average number of daily medications used to manage comorbidities decreased in both groups. Conclusion LSG in older patients is effective in terms of weight loss, improvement of comorbidities, and lower daily medication requirements up to 5 years of follow-up. Graphical abstract
Background Spiegel's hernia is a rare form of spontaneous abdominal anterolateral hernia (0.12–2% of abdominal hernias) seen in people between 40 and 70 years old. It is often found at the weak point located at the intersection between the semilunar line and the lateral end of the arched line. Traditionally, it was repaired with an open approach, currently we have multiple minimally invasive techniques (enhanced-view total extraperitoneal eTEP, transabdominal preperitoneal, intraperitoneal onlay mesh repair…) that offer less pain, faster recovery and shorter hospital stay as well as less complications risk and better cosmetic outcomes. None of these has proven superior to others but the eTEP approach requires an extensive learning curve. Aim To show a video of an eTEP approach to Spiegel's hernia. Methods We report the case of a 51 year old woman, without previous abdominal surgery, who consulted for a lump, manually reducible, in the right iliac fossa which appeared 2 years ago, and became progressively painful. She was diagnosed pre-surgically with abdominal tomography and was scheduled electively for an eTEP repair. Results After hernia sac reduction and tension-free closure of the defect with barbed suture 0, 15×15cm polypropylene mesh is placed. Conclusion Spiegel's hernia is an infrequent type of abdominal wall defect and several techniques have been developed. Adequate selection of patients is important to identify the most suitable approach for each one. The eTEP approach allows working in a large extraperitoneal space and has been demonstrated to be safe and effective although a demanding procedure.
Background More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest. Objective To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced. Methods Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done. Results From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased. Conclusion The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.
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