Alex Gandsas, MD, MBA
Reduccion del tiempo de internacion                  Menos problemas con la herida     1994Bypass Gastrico   Disminucion d...
Defectos creados por el bypass gastrico con tecnica retrocolica.                  Kendrick M L , Dakin G F Mayo Clin Proc....
Tecnica Antecolica
Antecolic versus retrocolic alimentary limb in laparoscopicRoux-en-Y gastric bypass: a comparative study    Escalona A; et...
Three-year follow-up study of retrocolic versus antecoliclaparoscopic Roux-en-Y gastric bypass.                   Muller M...
LONG-TERM RESULT OF PROSPECTIVERANDOMIZED COMPARISON OF ANTECOLIC VS.RETROCOLIC ROUX LIMB FOR ROUX-EN-Y GASTRICBYPASSSuh e...
Laparoscopic antecolic Roux-En-Y gastric bypass with closure ofinternal defects leads to fewer internal hernias than the r...
Small bowel obstruction after antecolic and antegastric laparoscopic Roux-en-Y gastric bypass: could the incidence be redu...
Internal Hernias after Laparoscopic Roux-en-YGastric Bypass: Incidence, Treatment and Prevention                          ...
Frequency and management of internal hernias after laparoscopic antecolicantegastric Roux-en-Y gastric bypass without divi...
Retrocolica          AntecolicaPasaje mas corto y   Pasaje mas largo pordirecto del asa      encima del colon y/oalimentar...
Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity.          ...
Conclusiones:1.    Ambas tecnicas son seguras2.    Mayor incidencia de hernias internas con tecnica      retrocolica.3.   ...
Anastomosis pre o retro cólica
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Anastomosis pre o retro cólica

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Anastomosis pre o retro cólica

  1. 1. Alex Gandsas, MD, MBA
  2. 2. Reduccion del tiempo de internacion Menos problemas con la herida 1994Bypass Gastrico Disminucion de la incidencia de obstruccion laparoscopico instestinal por aderencias Disminucion de la incidencia TVP y/o EP
  3. 3. Defectos creados por el bypass gastrico con tecnica retrocolica. Kendrick M L , Dakin G F Mayo Clin Proc. 2006;81:S18-S24
  4. 4. Tecnica Antecolica
  5. 5. Antecolic versus retrocolic alimentary limb in laparoscopicRoux-en-Y gastric bypass: a comparative study Escalona A; et al. Surgery for Obesity and Related Diseases 3 (2007) 423–427
  6. 6. Three-year follow-up study of retrocolic versus antecoliclaparoscopic Roux-en-Y gastric bypass. Muller MK. Et al. Obes Surg. 2007 Jul;17(7):889-93.•  66 pacients•  33 con tecnica Retro colica •  hernias internas 9% •  Estenosis 12%•  33 con tecnica Ante colica •  hernias internas 6% •  Estenosis 9%
  7. 7. LONG-TERM RESULT OF PROSPECTIVERANDOMIZED COMPARISON OF ANTECOLIC VS.RETROCOLIC ROUX LIMB FOR ROUX-EN-Y GASTRICBYPASSSuh et al. Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283 •  N=50 pacientes randomizados •  Seguimiento a 1 ano •  Incidencia de hernias internas=0
  8. 8. Laparoscopic antecolic Roux-En-Y gastric bypass with closure ofinternal defects leads to fewer internal hernias than the retrocolicApproach. Steele K. et al. Surg Endosc (2008) 22:2056–2061 N=479 pacientes seguimiento: 18 meses 274 con tecnica retrocolica à 7 hernias internas 2 meso transeverso 1 Petersen’s 4 jejuno-jejunostomia 205 con tecnica antecolica à 0 hernias internas
  9. 9. Small bowel obstruction after antecolic and antegastric laparoscopic Roux-en-Y gastric bypass: could the incidence be reduced? Grupo 1: Antecolico N:187 cierre de la brecha mesenterica 15% SIN cierre del espacio de Petersen (16 meses)359 pacientes Grupo 2: Antecolico N:172 SIN division del mesenterio 1.1% Con cierre del espacio de Petersen (16 meses)Rodriguez A. et al. Obes Surg. 2010 Oct;20(10):1380-4.
  10. 10. Internal Hernias after Laparoscopic Roux-en-YGastric Bypass: Incidence, Treatment and Prevention Higa. K. et al. Obesity Surgery, 13, 350-354 •  2000 pacientes •  BPG con tecnica Retro colica – Anti-gastrica •  CON cierre del mesenterio •  CON cierre del mesocolon •  CON cierre del espacio de Petersen •  incidencia de obstruccion intestinal: 3.1% (66) •  44 mesocolon •  14 mesenterio de la anastomosis jejuno-jejunal •  5 Espacio de Petersen
  11. 11. Frequency and management of internal hernias after laparoscopic antecolicantegastric Roux-en-Y gastric bypass without division of the small bowelmesentery or closure of mesenteric defects: review of 1400 consecutive cases Rosenthal R. et al. Surg Obes Relat Dis. 2006 Mar-Apr;2(2):87-91. •  1400 pacientes •  BPG con tecnica antecolica •  SIN division del mesenterio •  SIN cierre del espacio de Petersen •  incidencia de obstruccion intestinal a >10 meses: 0.2% (N=3) •  Espacio de Petersen
  12. 12. Retrocolica AntecolicaPasaje mas corto y Pasaje mas largo pordirecto del asa encima del colon y/oalimentaria epiplonSin tension Con tension
  13. 13. Anastomotic Leak following Antecolic versus Retrocolic Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Edwards MA. Obes Surg. 2007 Mar;17(3):292-7 •  N= 353 •  135 Ante colica •  218 Retrocolica •  Circular stapler •  Seguimiento 28 semanas
  14. 14. Conclusiones:1.  Ambas tecnicas son seguras2.  Mayor incidencia de hernias internas con tecnica retrocolica.3.  Evitar tension en la anastomosis gastrojejunal con la tecnica antecolica. (isquemia/fistulas/estrecheces)4.  Cierre de todos los espacios herniogenos5.  El cirujano debe estar familiarizado con ambas tecnicas.

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