Derivación Duodeno-Ileal de una Anastomosis con Manga Gástrica (SADI-S)
Fecha
2023
Tipo
tesis
Autores
Wehrtmann Vásquez, Fabian Siegfried
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Resumen
La obesidad es una enfermedad cada vez más común a nivel mundial y en Costa Rica. Está relacionada con el síndrome metabólico, diversas comorbilidades sistémicas e incluso el riesgo de desarrollar cáncer. Si no se trata adecuadamente, se convierte en un ciclo vicioso que afecta negativamente tanto la salud física como mental del paciente, deteriorando su calidad de vida y expectativa de vida.
La cirugía bariátrica y metabólica ha surgido como un tratamiento efectivo y duradero para la reducción de peso y la remisión de comorbilidades asociadas, que no se han logrado mediante dietas, cambios en el estilo de vida o medicamentos. Los procedimientos bariátricos más utilizados son la manga gástrica y el bypass gástrico. Sin embargo, estos procedimientos no están exentos de complicaciones a corto y largo plazo.
Con el objetivo de buscar alternativas quirúrgicas, se ha desarrollado recientemente la derivación duodeno-ileal de una anastomosis con manga gástrica, como modificación de la derivación biliopancreática con cruce duodenal. Esta técnica combina componentes restrictivos mediante la manga gástrica con aspectos malabsortivos al realizar una sola anastomosis duodeno-ileal. Ofrece ventajas técnicas y funcionales, como la preservación del píloro, menor tiempo quirúrgico y menos riesgo de fuga de anastomosis y complicaciones relacionadas a la apertura del mesenterio.
El procedimiento ha demostrado excelentes resultados en la pérdida de peso y la resolución de comorbilidades a mediano plazo, incluyendo la diabetes mellitus tipo 2, la hipertensión arterial y la dislipidemia. Además, presenta una tasa aceptable de complicaciones postoperatorias y deficiencias nutricionales, comparable con otras cirugías malabsortivas establecidas.
El SADI-S ha demostrado ser efectivo como procedimiento primario, así como en cirugías de dos etapas y revisionales. Siguiendo las guías y recomendaciones internacionales para la selección y seguimiento adecuados de los pacientes, este procedimiento cuenta con el respaldo de los entes reguladores en cirugía bariátrica y metabólica. Aunque se fomenta su participación en estudios a largo plazo, el SADI-S se establece como una alternativa quirúrgica válida, segura y efectiva para el tratamiento de la obesidad y sus comorbilidades.
Obesity is becoming increasingly prevalent worldwide and in Costa Rica. It is associated with metabolic syndrome, multiple systemic comorbidities, and even the development of cancer. When left untreated, it behaves as a vicious cycle, negatively affecting the patient's physical and mental health and deteriorating their quality and life expectancy. Bariatric and metabolic surgery has emerged as an effective and long-lasting treatment for weight reduction and remission of associated comorbidities, which have not been achieved through diets, lifestyle changes, or medication. The most commonly used bariatric procedures are sleeve gastrectomy and gastric bypass. However, these are not exempt from short-term and long-term complications. In order to search for surgical alternatives, the duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has recently been created as a modification of the biliopancreatic diversion with duodenal switch. This technique combines restrictive components through sleeve gastrectomy with malabsorptive aspects by performing a single duodeno-ileal anastomosis. It offers technical and functional benefits such as preserving the pylorus, shorter surgical time, and a lower risk of anastomosis leakage and complications related to mesenteric openings. It has consolidated with excellent mid-term results in terms of weight loss and resolution of comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, among others. It maintains an acceptable rate of postoperative complications and nutritional deficiencies, comparable to other established malabsorptive surgeries. This procedure has proven to be effective as a primary procedure, a two-stage surgery, and a revisional surgery. By using international guidelines and recommendations for proper patient selection and follow-up, this procedure is supported by bariatric and metabolic surgery regulatory entities. Despite encouraging its participation in long-term studies, SADI-S is established as a valid, safe, and effective surgical alternative for the treatment of obesity and its comorbidities.
Obesity is becoming increasingly prevalent worldwide and in Costa Rica. It is associated with metabolic syndrome, multiple systemic comorbidities, and even the development of cancer. When left untreated, it behaves as a vicious cycle, negatively affecting the patient's physical and mental health and deteriorating their quality and life expectancy. Bariatric and metabolic surgery has emerged as an effective and long-lasting treatment for weight reduction and remission of associated comorbidities, which have not been achieved through diets, lifestyle changes, or medication. The most commonly used bariatric procedures are sleeve gastrectomy and gastric bypass. However, these are not exempt from short-term and long-term complications. In order to search for surgical alternatives, the duodeno-ileal bypass with sleeve gastrectomy (SADI-S) has recently been created as a modification of the biliopancreatic diversion with duodenal switch. This technique combines restrictive components through sleeve gastrectomy with malabsorptive aspects by performing a single duodeno-ileal anastomosis. It offers technical and functional benefits such as preserving the pylorus, shorter surgical time, and a lower risk of anastomosis leakage and complications related to mesenteric openings. It has consolidated with excellent mid-term results in terms of weight loss and resolution of comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, among others. It maintains an acceptable rate of postoperative complications and nutritional deficiencies, comparable to other established malabsorptive surgeries. This procedure has proven to be effective as a primary procedure, a two-stage surgery, and a revisional surgery. By using international guidelines and recommendations for proper patient selection and follow-up, this procedure is supported by bariatric and metabolic surgery regulatory entities. Despite encouraging its participation in long-term studies, SADI-S is established as a valid, safe, and effective surgical alternative for the treatment of obesity and its comorbidities.
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Palabras clave
Cirugía bariátrica, Cirugía metabólica, SADI-S, IMC, OBESIDAD