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Resumen La pandemia SARS-CoV-2 ha tenido un gran impacto en todo el mundo, siendo Espana uno de los paises mas afectados. La demora en la cirugia bariatrica puede tener consecuencias fatales, ya que hasta el 50% de los pacientes que se encuentran en lista de espera desarrollan una nueva comorbilidad durante el tiempo que permanecen en ella y el 1,5% de pacientes fallecen mientras esperan la intervencion. Es por ello por lo que la cirugia bariatrica no debe demorarse en cuanto la ocupacion del hospital por pacientes COVID-19+ disminuya de forma significativa y se disponga de recursos y seguridad suficiente para realizar la cirugia en pacientes con patologia benigna. Este documento recoge las principales recomendaciones para los programas de cirugia bariatrica en nuestro pais desde el punto de vista tanto de seguridad como de preparacion y seguimiento del paciente bariatrico en el contexto de la pandemia SARS-CoV-2.

Roux-n-Y gastric bypass was considered the gold standard of bariatric surgery for a long time. It is one of the eldest bariatric procedure that continues to be performed. Specific characteristics of the design of this surgery are a small pouch and a moderate or significant malabsorption. The gastrojejunal anastomosis may lead to the appearance of dumping, and distal bypasses may lead to malnutrition. These characteristics are essential in the design of the nutritional reccommendations for operated patients. Recommendations vary from early postoperative time to long-term follow-up. Some food intolerances due to small pouches need to be also considered. This chapter reviews the nutritional recommendations for gastric bypass patients from early stages to long-term follow-up, and management of potential complications.

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.

Obesity is becoming a global health emergency. The treatment of this chronic disease and its comorbidities is one of the most important items in the health budgets of Western countries (Stevens et al., Popul Health Metrics 10(1):22, 2012; Bult et al., Eur J Endocrinolog 158(2):135–45, 2008). Currently, the only long-term treatment proven to be effective for morbid obesity is bariatric surgery.

ResumenObjetivoEvaluamos la utilidad de un cuestionario postal en el seguimiento de la cirugía de la eventración.Pacientes y métodoSe analiza prospectivamente una cohorte de 285 pacientes intervenidos por una eventración entre 1998 y 2003 mediante una técnica con malla prefascial y que recibieron un cuestionario de 6 preguntas e ideogramas, con estrategia de reenvíos y llamada telefónica para aumentar la respuesta. Se citaron a examen clínico a los pacientes sin inconveniente a ser visitados. Se revisaron todas las hojas operatorias. Se estudia la respuesta al cuestionario y hallazgos de la visita (test exacto de Fisher y Chi cuadrado), la concordancia con los datos operatorios (índices Kappa de Cohen y de Fleiss) y el valor predictivo del cuestionario.ResultadosUn total de 215 pacientes devolvieron el cuestionario después de tres envíos, con lo que se recogió información de un 75.4% de la cohorte, que aumentó al 94% después de la llamada telefónica. Un total de 168 pacientes (el 78.2%) aceptaron ser visitados, aunque finalmente solo acudieron 62 (el 36.9%). La concordancia entre las respuestas al cuestionario e ideogramas y los datos de las hojas operatorias fue baja (índice Kappa de Cohen de 0.065 e índice Kappa de Fleiss de 0.170).ConclusionesUn cuestionario postal con medidas para aumentar la respuesta puede ser efectivo para recoger información básica sobre la cirugía de la hernia incisional. La utilidad de dicha información resulta cuestionable por falta de cumplimiento de los pacientes en los controles y por dificultades en la comprensión del cuestionario, aunque este sea corto y/o en forma de ideograma.AbstractAimTo assess the usefulness of a short postal questionnaire as a method of follow-up in incisional hernia repair.Patients and methodAll consecutive patients (n=285) undergoing open mesh repair of incisional hernia using an onlay technique between 1998 and 2003 received a six-item self-administered questionnaire complemented with ideograms. Non-responders received two successive new questionnaires and a telephone call. All patients’ operation forms were reviewed. Patients with no objections to physical examination were contacted by phone for an appointment. The Fisher's exact test or the chi-square (χ2) tests were used to compare categorical variables between clinical visits and response to questionnaire. Agreement between response to the questionnaire and data on the operation forms was measured with the Cohen's kappa index and the Fleiss kappa index. The predictive values of the questionnaire were calculated.Results215 patients returned questionnaires after three reminders, allowing us to reach 75.4% of the study cohort, which in turn increased to 94% after the telephone call. A total of 168 (78.2%) patients were willing to come for a physical examination. Finally 62 (36.9%) patients were examined. The overall agreement between response to the questionnaire and data on the operation forms was poor (Cohen's kappa coefficient = 0.065 and Fleiss kappa coefficient = 0.170).ConclusionsA postal questionnaire can be effective to gather information. However, the usefulness of this information in the follow-up was low due to the small percentage of patients examined and difficulties in comprehension despite making the questionnaire short and illustrated by ideograms.

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.

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.A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL50%. 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.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 EWL50 (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: BMI50kg/mThe SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI50, age50, the presence of several comorbidities, more than 5cm section of the pylorus or bougie40F can increase the risk of weight loss failure.

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).