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Papers by Carlos Ungaro farias
Boletín de la Asociación Internacional de Derecho Cooperativo, 2005
Sumario: Introducción. ¿Qué significa el término valor? El valor cooperativo. Qué se debe entende... more Sumario: Introducción. ¿Qué significa el término valor? El valor cooperativo. Qué se debe entender por cultura. La cultura cooperativa. El concepto de economía. Economía cooperativa. Mensaje. Introducción: El tema Valores de la Cultura Económica Cooperativa es una cuestión de gran actualidad, aunque siempre estuvo vigente desde sus inicios en el movimiento cooperativo como una preocupación permanente de sus dirigentes para dar identidad al mismo. El trabajo necesariamente abordará tres aspectos sustanciales «valores», «cultura» y «economía cooperativa». Los valores cooperativos recobran una importancia inusitada ante un mundo cambiante, donde gran parte de los «valores tradicionales» se han perdido por lo que el tema deviene esperanzador para el cooperativismo mundial.
Obesity Surgery, 2014
Sleeve gastrectomy has become an established primary bariatric surgical technique. Its relatively... more Sleeve gastrectomy has become an established primary bariatric surgical technique. Its relatively lower complexity has made it eligible to be performed by single-incision laparoscopy (single-incision laparoscopic sleeve gastrectomy, SILSG). The aim of this paper is to present our SILSG technique and surgical outcomes and demonstrate that SILSG is a safe and feasible procedure using conventional laparoscopic instruments. All patients who underwent SILSG since December 2012 in our institution were analyzed. The operative technique involved creation of a transumbilical incision and the introduction of a GelPoint device with four trocars. Rigid instruments were used in all patients. Gastric transection was performed 4 cm proximal to the pylorus and calibrated with a 36-Fr bougie. Hemostasis of the staple line was achieved with metallic clips. A total of 74 patients underwent SILSG. Their mean age and body mass index were 34.2 ± 9.2 years and 34.0 ± 3.2 kg/m(2) (range 30.0-42.7 kg/m(2)), respectively. The mean operative time was 48 ± 10 min. No reoperations or deaths occurred. One patient developed portal vein thrombosis. The mean length of hospital stay was 2.4 ± 2.0 days. The cosmetic result was satisfactory in all patients. SILSG is a safe and feasible procedure when performed with the technique described herein. This technique allows for the use of conventional laparoscopic instruments and reasonable operative times. The main benefit of the procedure is an excellent cosmetic result with virtually no visible scars.
Revista chilena de cirugía, 2012
Simplifi ed transumbilical sleeve gastrectomy. Technique and surgical results in 100 patients Bac... more Simplifi ed transumbilical sleeve gastrectomy. Technique and surgical results in 100 patients Background: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplifi ed sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS ® or GelPoint ® multiport, and a 5mm metallic accessory trocar laterally in the left fl ank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confi rming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m 2. Mean operative time was 56.4 ± 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 ± 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left fl ank simplifi es the procedure, allowing the use of rigid instruments.
Obesity Surgery, 2012
Background The transumbilical approach has recently been shown to be safe for several surgical pr... more Background The transumbilical approach has recently been shown to be safe for several surgical procedures. Case series of sleeve gastrectomy (SG) with a transumbilical approach (TUSG) has been reported with various techniques. The objective of this report is to present the technique, surgical results, and 1-year follow-up results of simplified TUSG using rigid instruments. Methods All of the patients who had undergone SG since July 2010 were offered a transumbilical approach. The operative technique involves a transumbilical incision and the introduction of a SILS® or GelPoint® multiport and a 5-mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. Gastric transection was made 4-5 cm proximal to the pylorus, calibrated with a 36-Fr bougie. Selected hemostasis to the staple line was achieved with metallic clips. Results A total of 237 patients underwent TUSG. Patient body mass index ranged from 30 to 46 kg/m 2. The mean operative time was 49.5±14.9 min. Six patients presented with early complications, including hemoperitoneum in three cases, antral leak in one case, intestinal perforation in one case, and portal vein thrombosis in one case. Conversion to the multitrocar technique was required in one patient. There were no mortalities. The mean length of hospital stay was 2.2±1 days. The cosmetic result was satisfactory for all of the patients. Conclusions TUSG is a safe and feasible procedure using the described technique. The insertion of a 5-mm assistance trocar simplifies the procedure, allowing the use of rigid instruments.
Obesity Surgery, 2012
Single-port laparoscopic surgery has undergone significant development over the past 5 years. Sin... more Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass-TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach.
Obesity Surgery, 2009
The treatment of pain in obese patients is always a challenge. These patients have low pain thres... more The treatment of pain in obese patients is always a challenge. These patients have low pain thresholds, and the use of opioids can be especially harmful. Intraoperative nervous fiber section and the high temperatures of electrical scalpels probably contribute to the generation of postoperative neuropathic pain. We hypothesized that an antineuropathic pain drug like pregabalin could be helpful to optimize postoperative analgesia by reducing the requirement for opioids and their associated side effects. Eighty adults undergoing laparoscopic sleeve gastrectomy were randomly assigned to orally receive either placebo capsules (control) or pregabalin (150 mg) 2 h before surgery. Postoperative morphine consumption during the first 24 postoperative hours was registered. Visual analog pain scores (VAS) were assessed at 1, 2, 4, 6, 8, 12, 16, and 24 h after surgery. Both the incidence of adverse reactions and patient satisfaction were also assessed. Over a 24-h period, the morphine consumption in the pregabalin group was 11.51 ± 7.93 mg, whereas in the control group, it was 23.07 ± 9.57 mg (p < 0.0001). VAS scores were significantly lower in the pregabalin group. Postoperative nausea and vomiting and the consumption of antiemetics were reduced in the pregabalin group. A single preoperative oral dose of 150 mg pregabalin is useful for reducing morphine consumption after a sleeve gastrectomy, and it guarantees effective and safe analgesia with a low incidence of adverse effects.
Boletín de la Asociación Internacional de Derecho Cooperativo, 2005
Sumario: Introducción. ¿Qué significa el término valor? El valor cooperativo. Qué se debe entende... more Sumario: Introducción. ¿Qué significa el término valor? El valor cooperativo. Qué se debe entender por cultura. La cultura cooperativa. El concepto de economía. Economía cooperativa. Mensaje. Introducción: El tema Valores de la Cultura Económica Cooperativa es una cuestión de gran actualidad, aunque siempre estuvo vigente desde sus inicios en el movimiento cooperativo como una preocupación permanente de sus dirigentes para dar identidad al mismo. El trabajo necesariamente abordará tres aspectos sustanciales «valores», «cultura» y «economía cooperativa». Los valores cooperativos recobran una importancia inusitada ante un mundo cambiante, donde gran parte de los «valores tradicionales» se han perdido por lo que el tema deviene esperanzador para el cooperativismo mundial.
Obesity Surgery, 2014
Sleeve gastrectomy has become an established primary bariatric surgical technique. Its relatively... more Sleeve gastrectomy has become an established primary bariatric surgical technique. Its relatively lower complexity has made it eligible to be performed by single-incision laparoscopy (single-incision laparoscopic sleeve gastrectomy, SILSG). The aim of this paper is to present our SILSG technique and surgical outcomes and demonstrate that SILSG is a safe and feasible procedure using conventional laparoscopic instruments. All patients who underwent SILSG since December 2012 in our institution were analyzed. The operative technique involved creation of a transumbilical incision and the introduction of a GelPoint device with four trocars. Rigid instruments were used in all patients. Gastric transection was performed 4 cm proximal to the pylorus and calibrated with a 36-Fr bougie. Hemostasis of the staple line was achieved with metallic clips. A total of 74 patients underwent SILSG. Their mean age and body mass index were 34.2 ± 9.2 years and 34.0 ± 3.2 kg/m(2) (range 30.0-42.7 kg/m(2)), respectively. The mean operative time was 48 ± 10 min. No reoperations or deaths occurred. One patient developed portal vein thrombosis. The mean length of hospital stay was 2.4 ± 2.0 days. The cosmetic result was satisfactory in all patients. SILSG is a safe and feasible procedure when performed with the technique described herein. This technique allows for the use of conventional laparoscopic instruments and reasonable operative times. The main benefit of the procedure is an excellent cosmetic result with virtually no visible scars.
Revista chilena de cirugía, 2012
Simplifi ed transumbilical sleeve gastrectomy. Technique and surgical results in 100 patients Bac... more Simplifi ed transumbilical sleeve gastrectomy. Technique and surgical results in 100 patients Background: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplifi ed sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS ® or GelPoint ® multiport, and a 5mm metallic accessory trocar laterally in the left fl ank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confi rming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m 2. Mean operative time was 56.4 ± 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 ± 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left fl ank simplifi es the procedure, allowing the use of rigid instruments.
Obesity Surgery, 2012
Background The transumbilical approach has recently been shown to be safe for several surgical pr... more Background The transumbilical approach has recently been shown to be safe for several surgical procedures. Case series of sleeve gastrectomy (SG) with a transumbilical approach (TUSG) has been reported with various techniques. The objective of this report is to present the technique, surgical results, and 1-year follow-up results of simplified TUSG using rigid instruments. Methods All of the patients who had undergone SG since July 2010 were offered a transumbilical approach. The operative technique involves a transumbilical incision and the introduction of a SILS® or GelPoint® multiport and a 5-mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. Gastric transection was made 4-5 cm proximal to the pylorus, calibrated with a 36-Fr bougie. Selected hemostasis to the staple line was achieved with metallic clips. Results A total of 237 patients underwent TUSG. Patient body mass index ranged from 30 to 46 kg/m 2. The mean operative time was 49.5±14.9 min. Six patients presented with early complications, including hemoperitoneum in three cases, antral leak in one case, intestinal perforation in one case, and portal vein thrombosis in one case. Conversion to the multitrocar technique was required in one patient. There were no mortalities. The mean length of hospital stay was 2.2±1 days. The cosmetic result was satisfactory for all of the patients. Conclusions TUSG is a safe and feasible procedure using the described technique. The insertion of a 5-mm assistance trocar simplifies the procedure, allowing the use of rigid instruments.
Obesity Surgery, 2012
Single-port laparoscopic surgery has undergone significant development over the past 5 years. Sin... more Single-port laparoscopic surgery has undergone significant development over the past 5 years. Single port is used in various procedures, including bariatric surgery. The aim of this paper is to describe a surgical technique for gastric bypass with a transumbilical approach (transumbilical gastric bypass-TUGB) with hand-sewn gastrojejunostomy, in selected patients who may be benefited by a better cosmetic result. The procedure begins with a transumbilical vertical incision. We use the GelPOINT single-port device and a 5-mm assistant trocar in the left flank (in the first two cases, a 2-mm subxiphoid liver retractor was used). A gastric pouch is made and calibrated with a 36-Fr bougie. The gastrojejunal anastomosis is performed by hand-sewing in two layers. A Roux-en-Y with a biliary limb of 50 cm and an alimentary limb of 120 cm is performed with a stapler. Three women were subjected to TUGB. The women were aged 28, 31, and 42 years; they had body mass indexes of 40.3, 33, and 38.2; and the operating times were 150, 200, and 150 min, respectively. The first two women underwent a Roux-en-Y gastric bypass (RYGB), and the last woman underwent a RYGB with a resection of the stomach remnant. There were no conversions to open or multitrocar techniques. No complications or deaths occurred. The three patients were satisfied with the cosmetic result. The technique described for TUGB is a feasible procedure for surgeons who have previous experience with the transumbilical approach.
Obesity Surgery, 2009
The treatment of pain in obese patients is always a challenge. These patients have low pain thres... more The treatment of pain in obese patients is always a challenge. These patients have low pain thresholds, and the use of opioids can be especially harmful. Intraoperative nervous fiber section and the high temperatures of electrical scalpels probably contribute to the generation of postoperative neuropathic pain. We hypothesized that an antineuropathic pain drug like pregabalin could be helpful to optimize postoperative analgesia by reducing the requirement for opioids and their associated side effects. Eighty adults undergoing laparoscopic sleeve gastrectomy were randomly assigned to orally receive either placebo capsules (control) or pregabalin (150 mg) 2 h before surgery. Postoperative morphine consumption during the first 24 postoperative hours was registered. Visual analog pain scores (VAS) were assessed at 1, 2, 4, 6, 8, 12, 16, and 24 h after surgery. Both the incidence of adverse reactions and patient satisfaction were also assessed. Over a 24-h period, the morphine consumption in the pregabalin group was 11.51 ± 7.93 mg, whereas in the control group, it was 23.07 ± 9.57 mg (p < 0.0001). VAS scores were significantly lower in the pregabalin group. Postoperative nausea and vomiting and the consumption of antiemetics were reduced in the pregabalin group. A single preoperative oral dose of 150 mg pregabalin is useful for reducing morphine consumption after a sleeve gastrectomy, and it guarantees effective and safe analgesia with a low incidence of adverse effects.