The results suggest LSG might be a reasonable choice for patients who fail LAGB. A formal study comparing LSG with other rescue procedures should be performed.

Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

Introduction Metabolic surgery (MS) can be a useful therapeutic strategy in patients with type 2 diabetes (DM2) and obesity. Objective To define the place of MS within DM2 treatment in Mexico. Methods A committee of experts consisting of internists and surgeons representing the leading Mexican associations involved in the field was created. Each one responded to a specific question regarding mechanisms involved in controlling DM2, surgical procedures, and the indications and contraindications for MS. This document was prepared based on the presentation and discussion of such answers.Results Obesity through insulin resistance, incretins, bile salts, and intestinal microbiota plays a determining role in the appearance of DM2. MS improves glucose homeostasis by reducing weight and intake, increasing incretins, and modifying bile salts and microbiota. MS leads to remission of DM2 and reduces cardiovascular risk factors in well-selected cases. We recommend MS as a therapeutic option in DM2 and grade III obesity regardless of metabolic control and grade II and grade I obesity with poor glycemic control. MS could be considered an option in grade II obesity with good metabolic control in the presence of associated comorbidities. Gastric bypass presents the most favorable risk-benefit profile.Conclusions Current evidence endorses the inclusion of MS in the algorithm for treatment of DM2 and obesity. The therapeutic approach must be multidisciplinary at experienced centers.

La acalasia es una enfermedad con una incidencia de uno en cada 100,000 habitantes. Su tratamiento más efectivo es la cardiomiotomía de Heller (CH), siendo su complicación más frecuente el reflujo gastroesofágico (RGE), el cual puede llevar a estenosis esofágica. Caso clínico: Se presenta paciente de sexo masculino de 26 años de edad con antecedente de CH y funduplicatura tipo Dor por acalasia. Después de 10 años presenta estenosis esofágica de origen péptico, la cual no se resuelve mediante dilataciones esofágicas endoscópicas. Se realizó esofagectomía transhiatal con ascenso gástrico por abordaje de mínimo acceso. El objetivo fue efectuar la descripción del caso, su evolución y resultados así como realizar una revisión de los antecedentes y de la situación actual de la esofagectomía con abordaje de mínimo acceso para el manejo de la estenosis esofágica benigna; en este caso como complicación secundaria a RGE en el paciente con acalasia. Conclusión: El abordaje laparoscópico transhiatal es factible en los casos de estenosis esofágica benigna que requieren esofagectomía, es seguro y aporta todas las ventajas de la cirugía de mínimo acceso sin aumentar la morbilidad.

Úlcera gastroyeyunal perforada en paciente con derivación gastroyeyunal posterior a abdominoplastia en posquirúrgico inmediato. Un abordaje preservando lo estético Perforated marginal ulcer in a patient with gastro-yeyunal diversion after abdominoplasty in immediate post-surgery. An approach preserving the aesthetic