IntroductionGastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.ResultsThere were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction.ConclusionsKnowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

IntroductionGastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.ResultsThere were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula.ConclusionKnowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

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Background: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. Aim: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. Methods: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. Results: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. Conclusion: “Percutaneous radiofrequency assisted liver partition with portal vein embolization” (PRALLPS) is a feasible procedure.

Background: learning basic surgical procedures in medical school, involves acquisition of certain bloody skills. Therefore, to teach this kind of procedure on the patient is becoming more difficult nowadays. An educational alternative is proposed to teach basics surgical skills in undergraduate students in Medical School. Methods: during entire 2002, two theoretical-practical courses on Basic Surgical Maneuvers were developed in the Medicine School of UNNE. These courses were assigned to the 5 th and 6 th year's students. Used models included meet piece, bovine's bowel, heart and lungs, chick's wings; additionally live anesthetized swine and cadavers. All the students had to practice different procedures leaded by an instructor. Before performing these procedures theoretical explanation was supplied in the classroom. Attend to al least 80% of all given class, and to pass a practical final test were the only conditions to pass these courses. All the students had to fill up a survey to assess the perfomance of these courses. Results: the quota of 50 students by each course was completely covered. All the students (100%) passed successfully the courses. The survey reflected this experience as excellent (96%) or very good (4%) in teaching basic surgical procedures. Conclusion: the training in Biologic Models has shown as an excellent strategy to undergraduate surgical education. Key word: teaching-basic surgical maneuvers-bilogical models "The teaching of basic surgical skills in the biologic simulators. Undergraduate educational experience."

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Type 2 diabetes mellitus (T2DM) is one of the largest health emergencies of the 21st century given the worldwide increase of obesity during the last decades and its close association. T2DM is an inherited, polygenic and chronic disease caused by the interaction between several genetic variants in genes and the environment. The continuous search for new and more effective tools to achieve appropriate glycemic control became imperative in order to reduce long-term complications and mortality rates related to T2DM. Treatment options includes lifestyle modifications and several pharmacotherapies as first step in the therapeutical algorithm, but high corps of evidence have shown that gastrointestinal (GI) operations, especially those that involve food rerouting through the GI tract, are safe interventions and achieve superior outcomes for improvement in glucose metabolism when comparing with optimal medical and lifestyle changes. GI Surgery, specially Roux-en-Y gastric bypass (RYGB), is currently the most accepted surgical procedure to treat T2DM, and has also demonstrated to reduce significantly other cardiovascular risk factors (lipids and blood pressure control) when compared with optimal medical treatment, with good long-term effects on cardiovascular risks and mortality. Although the most effective technique in achieving diabetes remission is biliopancreatic diversion, the effectiveness-adverse effects balance is superior for RYGB. For these reasons, metabolic surgery (which was defined as "the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain") has been considered and accepted as a new step in the therapeutic algorithm for T2DM when optimal lifestyle and medical interventions don't achieve optimal glycemic goals. for T2DM are glycated hemoglobin (A1c) <7%, low-density lipoprotein cholesterol levels <100 mg/dL and blood pressure <130-80 mmHg (3,6), and less than 20% of USA patients achieve these levels in triple target despite having the best medical treatment. Bariatric surgery was first described just for reducing weight in severely obese patients. A Swedish Obese Subjects (SOS) study, demonstrated that the surgery group arm not only had more drastic and sustainable average reduction of excess body weight but also had remarkable beneficial effects on cardiovascular risk factors, such as waist circumference, blood pressure, glucose and insulin levels, uric acid, triglyceride and HDL cholesterol levels when compared with conventionally treated patients (7-10). Even though the SOS study showed a reduction of the number of cardiovascular events and overall mortality in the surgery group (HR 0.76, CI 95%) (11,12), one of the most relevant points was the finding of absence of significant relationship between cardiovascular mortality and body mass index (BMI) (7,13).Gastrointestinal (GI) operations have demonstrated, especially those that involve food rerouting through the GI tract that are safe and provide better outcomes for weight loss and...

Since its appear in the year 1997, when Drs. Cadiere and Himpens did the first robotic cholecystectomy in Brussels, not long after the first cholecystectomy, they performed the first robotic bariatric procedure. It is believed that robotically-assisted surgery’s most notable contributions are reflected in its ability to extend the benefits of minimally invasive surgery to procedures not routinely performed using minimal access techniques. We describe the 3 most common bariatric procedures done by robot. The main advantages of the robotic system applied to the gastric bypass appear to be better control of stoma size, avoidance of stapler costs, elimination of the potential for oropharyngeal and esophageal trauma, and a potential decrease in wound infection. While in the sleeve gastrectomy and adjustable gastric banding its utility is more debatable, giving a bigger advantage during surgery on patients with a very large BMI or revisional cases.