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The most feared complication of esophagectomy is anastomotic leak. Its management conservative or operative depending on clinical impact and its magnitude. We report the case of a patient with peptic esophageal stricture who is operated, performing thoracoscopic and laparoscopic Ivor-Lewis esophagectomy. He develops an anastomotic leak with sepsis in the second postoperative day, which is treated with surgery. During surgery a leak of one third of the anastomosis is found; then a suture over T-tube is made, with omentoplasty, chest washout and jejunostomy. Clinical evolution was good, with closure of T-tube after barium control 14 days later, and removal 2 months later. T-tube repair was first described as a treatment for esophageal perforations, being an alternative of simple suture. Its utility can be extended to esophagogastric anastomotic leaks, mainly when they are partial and no ischemia is found., La complicación más temible de la esofagectomía es la fuga anastomótica, cuyo manejo puede ser conservador o quirúrgico según el impacto clínico y la extensión de la misma. Se presenta el caso de un paciente con estenosis esofágica péptica intervenido mediante esofagectomía Ivor-Lewis toraco-laparoscópica. Al segundo día postoperatorio desarrolla dehiscencia anastomótica, la cual requiere tratamiento quirúrgico. Se evidencia anastomosis dehiscente en un tercio por lo se realiza sutura sobre tubo de Kehr y epiploplastia, junto a lavado de cavidad torácica y yeyunostomía. La evolución fue favorable con cierre de Kehr tras control baritado a los 14 días y retirada definitiva a los 2 meses. El uso de la fistulización dirigida con Kehr fue descrito inicialmente como tratamiento de perforaciones esofágicas como alternativa a la sutura primaria simple. Su utilidad puede extenderse a la dehiscencia de anastomosis esofagogástrica, particularmente en el contexto de que ésta sea parcial y no exista isquemia.

[Background]] The immune response of visceral adipose tissue (VAT) in obesity, in particular the role of invariant natural killer T (iNKT) cells, has not yet been fully elucidated., [Objective] To characterize iNKT cells and its activation status in VAT and peripheral blood mononuclear cells (PBMC) in morbidly obese subjects (MO), and to analyze their association with metabolic parameters., [Subjects and Methods] Twenty non-obese and 20 MO subjects underwent Roux-en-Y gastric bypass (RYGB) and were studied before and 6 months after RYGB. VAT and PBMC were obtained., [Results] A decrease in VAT iNKT cells from MO was found, however, not in PBMC. Visceral adipocytes from MO presented increased CD1d expression (p = 0.032). MO presented an increase in early activated CD69+ iNKT cells in PBMC before RYGB (p < 0.001), but not after RYGB nor in VAT, and an increase in later activated CD25+ iNKT in VAT (p = 0.046), without differences in PBMC. The co-expression of early and later markers (CD69+CD25+) in iNKT cells was increased in MO in VAT (p = 0.050) and PBMC (p = 0.006), decreasing after RYGB (p = 0.050). CD69+ iNKT and CD69+CD25+ iNKT cells in PBMC after RYGB correlated negatively with glucose, insulin, and insulin resistance levels., [Conclusions] There is a tissue-specific phenotype and activation of iNKT cells in VAT in morbid obesity, which could be involved in VAT immunometabolism dysregulation. Also, the increase in CD1d expression could be to offset the lack of VAT iNKT cells.

Roux-en-Y gastric bypass (RYGB) is the “gold standard” bariatric surgical procedure. Today, over 90% of RYGB are performed laparoscopically. The aim of this paper is to describe tips and tricks in our technique in order to minimize possible complications. We recommend performing the gastrojejunostomy with an endocutter cartridge , closing the anastomotic incision by hand-sewn technique, as it saves time and reduces the incidence of complications in gastric bypass surgery. We also recommend the antecolic pathway of the Roux-limb, for it decreases the incidence of internal herniation. The learning curve for RYGB is long and standarizing the technique helps to reduce the risk complications., El bypass gástrico (BGYR) es el "gold standar" de los procedimientos quirúrgicos bariátricos. En la actualidad más del 90% de BGYR se realizan por vía laparoscópica. El objetivo de este trabajo es describir los trucos y consejos de nuestra técnica para minimizar las complicaciones. Recomendamos la realización de la gastroyeyunostomía con endograpadora lineal y cierre de la incisión con sutura continua, ya que ahorra tiempo y reduce la incidencia de las complicaciones. También recomendamos la reconstrucción antecólica de la Y de Roux ya que reduce el riesgo de hernias internas. La curva de aprendizaje para BGYR es larga y la sistematización de la técnica reduce el riesgo de complicaciones.