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Background: Surgeons and radiologists commonly believe that common bile duct dilates after cholecystectomy., Aim: To measure common bile tract diameter before and 12 years after a cholecystectomy for cholelithiasis., Material and Methods: Prospective study of 85 patients (aged 20 to 71 years, 68 females) subjected to a cholecystectomy and followed for 12 years. AH were asymptomatic and had abdominal ultrasound to measure common bile duct diameter, seven days before and 12 years after the surgical procedure., Results: Common bile duct diameter before and 12 years after surgery was 4.6+0.9 and 5.0+1.8 cm respectively (p=NS) among 69 patients aged inverted exclamation markess than 60 years. The figures for 16 patients aged more than 60 years were 5+0.8 and 6.7+1.9 (p <0.03)., Conclusions: Among patients below 60 years of age there is no significant change in bile duct diameter 12 years after surgery. In subjects over 60 years of age there is a significant increase in this diameter.

Background: Non alcoholic fatty liver disease (NAFLD) is associated to diabetes mellitus, obesity, disturbances in serum lipid levels, insulin resistance and metabolic syndrome., Aim: To assess glucose tolerance and the presence of metabolic syndrome among patients with biopsy proven NAFLD., Patients and Methods: Serum lipid levels, hepatic function tests were measured and an oral glucose tolerance test was performed in 46 patients (mean age 45+/-12 years, 36 females) without history of diabetes mellitus and with steatosis in a liver biopsy., Results: Mean body mass index of the sample was 37+/-12 kg/m2. Seventeen percent had pure steatosis, 78% had steatohepatitis with or without fibrosis and 50% had fibrosis in the liver biopsy. Glucose intolerance and diabetes was found in 57% and 15% of cases, respectively. The presence of steatohepatitis was higher in diabetics, compared with subjects with glucose intolerance or a normal glucose response (43, 38 and 8%, respectively, p < 0.0001). Ninety three percent had a metabolic syndrome and the proportion of biopsies with fibrosis was higher among subjects with more than three diagnostic criteria for metabolic syndrome compared with those with three or less criteria (59 and 46%, respectively, p < 0.05)., Conclusions: Glucose intolerance, diabetes and metabolic syndrome are common among patients with NAFLD, even when they are not obese.

Background: Bariatric surgery is a complex procedure not exempt of complications., Aim: To assess mortality and complications of excisional gastric bypass among morbidly obese subjects., Material and Methods: Prospective analysis of 684 morbid obese patients (age range 14-70 years, 525 females) subjected to an excisional gastric bypass. Major postoperative complications and mortality were registered., Results: Mean body mass index (BMI) of the subjects was 43.7 kg/m2. One hundred sixty two patients had a BMI between 35 and 39.9 kg/m2, 419 had a BMI between 40 and 49.9 kg/m2 and 103 had a BMI over 50 kg/m2. Two patients with a BMI of 52 and 56 kg/m2 respectively, died in the postoperative period (0.3%). Thirty six patients had major complications. Anastomotic fistula was the most common complication in 12 patients (1.7%). Fourteen patients required a new operation due to complications. None of these died. The mean operative volume of the surgical team was 124 patients per year., Conclusions: Excisional gastric bypass has a low rate of mortality and complications, if the surgical team operates a large volume of patients.

Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection., Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years., Material and Methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004)., Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively., Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change.

Background: Obesity is an important risk for pathological gastroesophageal reflux., Aim: To assess the effects of gastric bypass on obese subjects with erosive esophagitis., Patients and Methods: Sixty two morbid obese subjects (aged 16 to 70 years, 41 females) with erosive esophagitis at the moment of surgery were studied. These patients were subjected to a gastric bypass with gastric resection. They were followed with upper gastrointestinal endoscopy every one year, looking for the presence of erosions or ulcers in the distal esophagus., Results: The mean follow up period was 21 months. Prior to surgery all patients had heartburn or regurgitation and at two years after surgery, 97% were asymptomatic. Esophagitis was found in 97 and 6.5% before and after surgery, respectively. Two patients had an esophageal ulcer, that healed on follow up endoscopy. There was a 72% reduction of overweight on late follow up., Conclusions: Gastric bypass is effective to control pathological gastroesophageal reflux in patients with morbid obesity.

Several alternatives for esophageal resection and replacement with laparoscopic, thoracoscopic, video-assisted, or completely endoscopic techniques have been reported. All of these have advantages and disadvantages according to the indications, instrumental requirements, cost, and feasibility. Here we report a new alternative procedure, performing the gastric mobilization and transhiatal esophageal dissection by laparoscopic approach and preparation of the gastric tube through a midline 5-cm minilaparotomy. In this manner we handled the GIA staplers outside of the abdomen, avoiding prolongation of the operating time and the excessive increase of the cost of the procedure. Further, this procedure may help to prevent the risk of postoperative leak of the stapler suture line by reinforcing this suture with a invaginating continuous manual 3-0 reabsorbable suture (Monocryl, Johnson & Johnson, Cincinnati, OH, U.S.A.). A left anterolateral cervicotomy was done to complete the dissection of the esophagus, and the gastric tube was ascended through a retrosternal tunnel to the neck for esophagogastroanastomosis. We operated on a 73-year-old woman, who had a T1 squamous carcinoma of middle third of the esophagus. The operation was performed with no intraoperative complications as a result of the procedure. After surgery, pneumonia with a pleural effusion developed and was evacuated. The patient was discharged from the hospital with no symptoms. We believe that this is a safe, inexpensive, and easy procedure for the transhiatal laparoscopic esophagectomy and its replacement by a gastric tube.