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Realización de procedimientos bariátricos por residentes de cirugía general. ¿Compromete la efectividad de la intervención y los resultados postoperatorios?
Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised?
Juan Carlos Sebastián-Tomás
Autor para correspondencia
jcst1990@gmail.com

Autor para correspondencia.
, Sergio Navarro-Martínez, Nuria Peris-Tomás, José Ángel Díez-Ares, Paula Gonzálvez-Guardiola, Dolores Periañez-Gómez, Ezequiel Martínez-Mas, Ramón Trullenque-Juan
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Doctor Peset, Valencia, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La prevalencia de la obesidad continua aumentando en todo el mundo&#44; consider&#225;ndose la cirug&#237;a bari&#225;trica como el tratamiento m&#225;s efectivo para conseguir una p&#233;rdida de peso mantenida en el tiempo en pacientes con obesidad m&#243;rbida<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46; Entre las t&#233;cnicas quir&#250;rgicas disponibles&#44; el <span class="elsevierStyleItalic">bypass</span> g&#225;strico laparosc&#243;pico en Y de Roux &#40;BGLYR&#41; sigue siendo uno de los procedimientos m&#225;s empleados<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a>&#46; El BGLYR se considera una intervenci&#243;n demandante por varios motivos&#44; entre los que destacan la constituci&#243;n de los sujetos sometidos a la intervenci&#243;n&#44; la complejidad de los procedimientos laparosc&#243;picos o el riesgo de complicaciones es este grupo de pacientes<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Dentro de nuestro sistema sanitario&#44; el reto de los hospitales que incluyen docencia de m&#233;dicos internos residentes es proporcionarles la mejor y m&#225;s completa formaci&#243;n sin que exista un detrimento en los resultados asistenciales&#46; Este objetivo es m&#225;s dif&#237;cil de lograr cuando implica el aprendizaje de procedimientos t&#233;cnicos y&#47;o quir&#250;rgicos&#44; como es el caso de las especialidades quir&#250;rgicas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En el proceso de aprendizaje de una t&#233;cnica quir&#250;rgica&#44; a medida que se adquiere experiencia el rendimiento tiende a mejorar&#46; La representaci&#243;n gr&#225;fica de este fen&#243;meno constituye la curva de aprendizaje<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Dentro de la cirug&#237;a bari&#225;trica&#44; el procedimiento m&#225;s estudiado en este sentido es el BGLYR&#46; Varios autores han establecido que el n&#250;mero de casos necesarios para completar la curva de aprendizaje del BGLYR est&#225; entre 75-100 procedimientos<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Lublin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> establecen que el n&#250;mero de casos a partir del cual el cirujano se siente confiado para realizar un BGLYR se sit&#250;a en torno los 20-25&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Se han descrito m&#250;ltiples sistemas de aprendizaje&#58; pr&#225;ctica preoperatoria <span class="elsevierStyleItalic">ex-vivo&#44;</span> calentamiento antes de la intervenci&#243;n o revisi&#243;n detallada de la t&#233;cnica antes y durante la operaci&#243;n&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a>&#59; pero parece que el que cuenta con mayor aceptaci&#243;n es el sistema de aprendizaje por pasos<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">10&#8211;12</span></a>&#46; En este sistema&#44; el profesional en formaci&#243;n efect&#250;a progresivamente pasos m&#225;s complejos dentro de un mismo procedimiento hasta realizarlo en su totalidad&#46; Nuestro sistema de ense&#241;anza y aprendizaje sigue este modelo&#44; siempre bajo la supervisi&#243;n de cirujanos bari&#225;tricos expertos &#40;CBE&#41;&#46; El objetivo de este estudio es analizar los resultados de nuestro programa de formaci&#243;n de residentes para la realizaci&#243;n de BGLYR&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio retrospectivo incluyendo pacientes a los que se les realiz&#243; un BGLYR en nuestro servicio&#44; durante el per&#237;odo comprendido entre enero de 2014 y diciembre de 2018&#46; A todos los pacientes se les entreg&#243; el consentimiento informado por escrito para la intervenci&#243;n quir&#250;rgica&#46; El estudio se ha desarrollado en base a la &#250;ltima versi&#243;n de la declaraci&#243;n de Helsinki y se han seguido todas las normas que establece el comit&#233; &#233;tico de nuestro centro&#46; Dado que se trata de un estudio retrospectivo&#44; no se obtuvo el consentimiento informado para la participaci&#243;n en el estudio&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Todos los pacientes cumpl&#237;an las indicaciones de la International Federation for the Surgery of Obesity and Metabolic Disorders para ser candidatos a cirug&#237;a bari&#225;trica &#40;IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> o IMC<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> con comorbilidades y fallo del tratamiento m&#233;dico&#41;&#46; Los pacientes siguieron la preparaci&#243;n habitual preoperatoria establecida en nuestro protocolo&#44; que incluye la exclusi&#243;n de cualquier contraindicaci&#243;n m&#233;dica o quir&#250;rgica&#44; una p&#233;rdida preoperatoria del 10&#37; del peso y ejercicio f&#237;sico&#44; una dieta muy baja en calor&#237;as &#40;VLCD&#41; y la evaluaci&#243;n de los candidatos en el comit&#233; multidisciplinar&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Los pacientes se dividieron en 2 grupos&#58; El grupo I incluy&#243; pacientes en los que alg&#250;n paso de la intervenci&#243;n hab&#237;a sido realizado por residentes bajo supervisi&#243;n de un CBE&#44; mientras que el grupo II estuvo compuesto por pacientes en los que toda la intervenci&#243;n se realiz&#243; por uno o 2 CBE&#46; La decisi&#243;n de permitir la realizaci&#243;n de los uno o varios procedimientos dependi&#243; del CBE responsable y fue tomada en el momento de la intervenci&#243;n&#44; en base a la evaluaci&#243;n de la progresi&#243;n de los residentes llevada a cabo gracias a la supervisi&#243;n continuada que realizan los miembros de la unidad de cirug&#237;a bari&#225;trica durante el rotatorio&#46; Todos los pacientes tuvieron un m&#237;nimo de seguimiento de 12 meses&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">T&#233;cnica quir&#250;rgica</span><p id="par0040" class="elsevierStylePara elsevierViewall">Nuestros residentes de cirug&#237;a general de cuarto a&#241;o tienen incluido en su formaci&#243;n un rotatorio por la secci&#243;n de cirug&#237;a bari&#225;trica entre enero y junio&#46; Durante dicho per&#237;odo&#44; realizan progresivamente distintas partes de procedimientos bari&#225;tricos&#44; entre los que se incluye el BGLYR&#44; llegando a realizar la t&#233;cnica completa en algunos casos al final del rotatorio&#46; Esto se realiza siempre tutorizados por CBE&#44; que han realizado individualmente entre 150 y 300 procedimientos bari&#225;tricos a lo largo de los m&#225;s de 20 a&#241;os de experiencia de la unidad&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Nuestra t&#233;cnica quir&#250;rgica de BGLYR consta fundamentalmente de 2 partes<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Creaci&#243;n del pie de asa &#40;anastomosis yeyuno-yeyunal&#41;&#58; tras identificar el &#225;ngulo de Treitz&#44; se realiza la secci&#243;n del asa a 80<span class="elsevierStyleHsp" style=""></span>cm de este con una grapadora lineal de 45 y 2&#44;5<span class="elsevierStyleHsp" style=""></span>mm de altura de grapa&#46; A continuaci&#243;n se mide el asa alimentaria &#40;220<span class="elsevierStyleHsp" style=""></span>cm&#44; aproximadamente&#41; para la realizaci&#243;n del pie de asa mediante una enteroanastomosis latero-lateral mec&#225;nica&#44; cerrando la enterostom&#237;a con una sutura manual continua barbada&#46; Se realiza el cierre de la brecha mesent&#233;rica con una sutura manual continua de seda 3&#47;0&#46; Se confirma la presencia de un asa com&#250;n mayor de 150<span class="elsevierStyleHsp" style=""></span>cm y se asciende desde el compartimento inframesoc&#243;lico por v&#237;a antec&#243;lica&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2&#46;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Creaci&#243;n del reservorio g&#225;strico y anastomosis gastro-yeyunal&#58; se crea un reservorio g&#225;strico de unos 15 a 30<span class="elsevierStyleHsp" style=""></span>cc &#40;<span class="elsevierStyleItalic">pouch</span> o neo-est&#243;mago&#41; con secci&#243;n y grapado del est&#243;mago restante apoyados sobre una sonda de Faucher de 36F&#44; para evitar la recanalizaci&#243;n al est&#243;mago desfuncionalizado&#46; El reservorio g&#225;strico se realiza a expensas de la curvatura menor g&#225;strica&#44; iniciando la disecci&#243;n a 4-5<span class="elsevierStyleHsp" style=""></span>cm de la uni&#243;n gastroesof&#225;gica&#44; entre el 2&#46;&#176; y 3&#46;&#176; vasos g&#225;stricos transversales y manteni&#233;ndose caudal a la arteria g&#225;strica izquierda&#46; La continuidad con el tracto digestivo de realiza sobre un asa de intestino delgado en Y de Roux &#40;asa alimentaria&#41; mediante una anastomosis gastroyeyunal latero-lateral mec&#225;nica&#44; calibrada con grapadora lineal de 30<span class="elsevierStyleHsp" style=""></span>mm de longitud y 3&#44;5<span class="elsevierStyleHsp" style=""></span>mm de altura de grapa&#46; Posteriormente se cierra la enterostom&#237;a de manera an&#225;loga al pie de asa&#46; Esta t&#233;cnica permite la visualizaci&#243;n de la luz y detectar posibles sangrados&#46; Una vez realizada la anastomosis se realiza una prueba de estanqueidad&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Variables</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se incluyeron variables demogr&#225;ficas como edad&#44; sexo&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; American Society of Anesthesiologists &#40;ASA&#41; score<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a>&#44; historial de comorbilidades y cirug&#237;as previas&#46; Los datos intraoperatorios registrados fueron que cirujano realiz&#243; los procedimientos&#44; conversi&#243;n a cirug&#237;a abierta y tiempo quir&#250;rgico&#46; Respecto al per&#237;odo postoperatorio se recogieron las complicaciones postoperatorias a 90 d&#237;as mediante la clasificaci&#243;n de Dindo-Clavien<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">15</span></a>&#44; estancia hospitalaria y mortalidad a 90 d&#237;as&#46; Como resultados a corto plazo se analizaron las complicaciones tard&#237;as y la p&#233;rdida de peso durante el primer a&#241;o tras la cirug&#237;a mediante el porcentaje de peso total perdido &#40;&#37;PTP&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0065" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se llev&#243; a cabo con el programa SPSS&#174; v&#46; 25&#46;0 &#40;SPSS&#44; Chicago&#44; Illinios&#44; EE&#46; UU&#46;&#41;&#46; Los datos se analizaron utilizando la media &#40;desviaci&#243;n est&#225;ndar&#41; y la mediana &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41; en el caso de las variables cuantitativas y mediante la frecuencia absoluta &#40;&#37;&#41; para las variables categ&#243;ricas&#46; Se utiliz&#243; para el an&#225;lisis de las diferencias entre grupos el test de la t de Student o el test U de Mann-Whitney para de variables cuantitativas&#46; en funci&#243;n de si se trata de variables normales o no normales y el test de Chi-cuadrado o test exacto de Fisher para las variables cualitativas&#46; Se consider&#243; la significaci&#243;n estad&#237;stica como un p-valor &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo del estudio se efectuaron en nuestro centro 243 intervenciones de cirug&#237;a bari&#225;trica&#44; siendo 208 &#40;85&#44;60&#37;&#41; BGLYR&#44; 8 &#40;3&#44;29&#37;&#41; <span class="elsevierStyleItalic">bypass</span> g&#225;stricos abiertos&#44; 19 &#40;7&#44;82&#37;&#41; gastrectom&#237;as verticales &#40;GV&#41; laparosc&#243;picas&#44; 6 &#40;2&#44;47&#37;&#41; GV abiertas y 2 &#40;0&#44;82&#37;&#41; cirug&#237;as de revisi&#243;n&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se incluyeron 208 pacientes en el estudio&#44; 67 &#40;32&#44;31&#37;&#41; en el grupo I y 141 &#40;67&#44;79&#37;&#41; en el grupo II&#46; Las caracter&#237;sticas demogr&#225;ficas de los pacientes se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La mediana de edad fue de 48&#44;12 a&#241;os &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42-57&#41; en el grupo I y 45&#44;56 a&#241;os &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39-53&#41; en el grupo II&#46; El IMC medio en el momento de la intervenci&#243;n fue de 37&#44;93<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;50<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> en el grupo I y de 38&#44;03<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;29<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> en el grupo II&#46; El porcentaje de mujeres fue del 76&#44;11&#37; en el grupo I y del 74&#44;47&#37; en el grupo II&#46; No se encontraron diferencias estad&#237;sticamente significativas respecto a las caracter&#237;sticas demogr&#225;ficas ni en las comorbilidades entre los pacientes de ambos grupos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Los datos referentes a la intervenci&#243;n quir&#250;rgica se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46; Los residentes completaron con &#233;xito 47&#47;49 &#40;95&#44;92&#37;&#41; pies de asa&#44; 11&#47;12 &#40;91&#44;66&#37;&#41; reservorios g&#225;stricos y la totalidad de los 6 BGLYR completos&#44; mientras que en los 3 casos restantes el CBE tuvo que finalizar el procedimiento por dificultades t&#233;cnicas &#40;una nueva confecci&#243;n del pie de asa por defecto t&#233;cnico&#44; otro por un sangrado a la hora del cierre de la brecha mesent&#233;rica tras la confecci&#243;n de la anastomosis yeyuno-yeyunal y el tercero ante la imposibilidad de terminar el cierre del defecto de la anastomosis gastroyeyunal&#41;&#46; Estos pacientes se incluyeron dentro del grupo I dado que en los 3 casos la finalizaci&#243;n de dicho paso por el CBE no se llev&#243; a cabo desde el principio&#44; sino que el residente realiz&#243; gran parte del procedimiento&#46; &#218;nicamente se produjo una conversi&#243;n a cirug&#237;a abierta por sangrado en el grupo II&#46; La media de tiempo quir&#250;rgico fue de 166&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#44;72<span class="elsevierStyleHsp" style=""></span>min en el grupo I y 156&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;63<span class="elsevierStyleHsp" style=""></span>min en el grupo II &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;156&#41;&#46; Analizados de forma individualizada seg&#250;n el a&#241;o de intervenci&#243;n&#44; tampoco hubo diferencias en tiempo quir&#250;rgico entre el grupo I y el grupo II &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Se objetiv&#243; una disminuci&#243;n progresiva en el tiempo quir&#250;rgico conforme aumentaba el n&#250;mero de procedimientos realizados por los residentes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La mediana de estancia hospitalaria fue de 3 d&#237;as &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;25-4&#41; en el grupo I y de 3 d&#237;as &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2-4&#41; en el grupo II &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;955&#41;&#46; No se encontraron diferencias significativas respecto a las complicaciones postoperatorias en ambos grupos&#46; Se registr&#243; una &#40;1&#44;49&#37;&#41; complicaci&#243;n postoperatoria en el grupo I y 7 &#40;4&#44;96&#37;&#41; en el grupo II &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;441&#41;&#46; La complicaci&#243;n m&#225;s frecuente fue la hemorragia postoperatoria&#44; de las cuales solo una requiri&#243; reintervenci&#243;n mediante abordaje laparosc&#243;pico en el grupo II&#46; El resto fueron una fuga anastom&#243;tica manejada con drenaje percut&#225;neo&#44; una infecci&#243;n de herida y una neumon&#237;a&#46; No hubo ning&#250;n caso de mortalidad postoperatoria durante el per&#237;odo del estudio&#46; Los resultados postoperatorios detallados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Los resultados a largo plazo se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; El IMC medio al a&#241;o de la intervenci&#243;n fue de 27&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;74<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> en el grupo I y de 27&#44;60<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;05<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> en el grupo II &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;747&#41;&#46; La mediana del &#37;PTP al a&#241;o de la intervenci&#243;n fue de 38&#44;22 &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#44;80-45&#44;70&#41; en el grupo I y de 39&#44;11 &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#44;37-43&#44;93&#41; en el grupo II &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;696&#41;&#46; No se identificaron diferencias respecto a la presencia de s&#237;ntomas relacionados con malabsorci&#243;n&#44; reflujo gastroesof&#225;gico&#44; disfagia o s&#237;ndrome de Dumping &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los resultados de nuestro estudio apoyan que la realizaci&#243;n de distintos procedimientos del BGLYR por residentes es segura y factible&#44; sin comprometer los resultados peroperatorios ni a largo plazo&#46; Nuestro m&#233;todo de aprendizaje&#44; realizando progresivamente distintos pasos de la intervenci&#243;n&#44; permite que los residentes adquieran las habilidades t&#233;cnicas necesarias sin condicionar la actividad asistencial&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Como dato m&#225;s relevante&#44; no hemos objetivado diferencias significativas en el tiempo quir&#250;rgico independientemente de si el residente realiza alguno de los pasos de la intervenci&#243;n &#40;166&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#44;72 grupo I vs&#46;156&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>47&#44;63 grupo II&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;156&#41;&#46; Un mayor tiempo quir&#250;rgico est&#225; asociado a una mayor tasa de complicaciones postoperatorias<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16&#44;17</span></a> y ha sido propuesto como un marcador de calidad en cirug&#237;a bari&#225;trica<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#46; La mayor&#237;a de los estudios publicados en la literatura muestran diferencias significativas en el tiempo operatorio en los procedimientos en los que se encuentran implicados residentes o profesionales en formaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">10&#44;18&#8211;25</span></a>&#46; La serie m&#225;s amplia es la de Barbat et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> con 477&#46;670 pacientes y establece una diferencia media de 22&#44;3<span class="elsevierStyleHsp" style=""></span>min&#46; Si analizamos los subgrupos de pacientes en los que el residente conforma el reservorio g&#225;strico y la anastomosis gastroyeyunal o el BGLYR completo&#44; s&#237; que apreciamos un aumento del tiempo quir&#250;rgico de 17&#44;73 y 36&#44;73<span class="elsevierStyleHsp" style=""></span>min&#44; respectivamente&#46; Dado el escaso n&#250;mero de pacientes incluidos en estos subgrupos supone una importante limitaci&#243;n&#44; no hemos determinado si existen diferencias estad&#237;sticamente significativas respecto al grupo de pacientes intervenidos por CBE&#46; Podemos apreciar tambi&#233;n como el tiempo quir&#250;rgico disminuye a medida que aumenta el n&#250;mero de procedimientos realizados durante la estancia en la unidad y esto ocurre en todos los casos en mayor o menor medida &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; lo cual coincide con los resultados de otros estudios sobre el tema<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">12&#44;25&#44;26</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En cuanto a las complicaciones postoperatorias existe mayor variabilidad en los resultados&#46; Algunos autores defienden que la tasa de complicaciones postoperatorias&#44; especialmente las complicaciones menores&#44; es mayor cuando personal en formaci&#243;n participa activamente en la cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">10&#44;19&#44;20&#44;22&#8211;24</span></a>&#46; Otros&#44; en cambio&#44; no encuentran diferencias&#44; o estas no son cl&#237;nicamente relevantes<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">21&#44;27&#44;28</span></a>&#46; En nuestra serie la tasa de complicaciones no es mayor en grupo donde el residente realiza parcial o totalmente el BGLYR&#46; Esto puede ser debido a que en todas las intervenciones siempre participa activamente un residente&#44; independientemente de que realice o no alg&#250;n procedimiento de la intervenci&#243;n&#44; y no conlleva un aumento de las complicaciones postoperatorias de acuerdo con lo establecido en la literatura para el BGLYR<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">29&#8211;31</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El estudio&#44; que tambi&#233;n refleja tanto las complicaciones como el &#37;PTP al a&#241;o de la cirug&#237;a&#44; tampoco muestra diferencias estad&#237;sticamente significativas entre grupos y se encuentra en concordancia con los resultados de la bibliograf&#237;a disponible<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;32&#8211;36</span></a>&#46; Existen datos similares que tambi&#233;n han sido publicados en otros art&#237;culos&#44; como un porcentaje de exceso de peso perdido similar al a&#241;o de la intervenci&#243;n entre el grupo de pacientes donde el residente ha realizado alg&#250;n procedimiento y el grupo de pacientes intervenidos por CBE<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">18&#44;37</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Nuestro trabajo presenta varias limitaciones&#46; En primer lugar&#44; se trata de un estudio retrospectivo&#44; por lo que presenta mayor riesgo de sesgo de selecci&#243;n y confusi&#243;n&#46; En segundo lugar&#44; el n&#250;mero de pacientes incluido no es demasiado elevado&#46; Los datos reflejan que la creaci&#243;n del pie de asa es el procedimiento realizado por residentes con mayor frecuencia&#44; siendo el n&#250;mero de reservorios o BGLYR completos inferiores&#44; lo que supone una limitaci&#243;n a la hora de analizar los resultados&#46; Existe una inevitable variabilidad en cuanto a las habilidades entre residentes&#44; sin embargo&#44; estas diferencias est&#225;n atenuadas por el hecho de que todos los residentes realizan su estancia en la Unidad de Cirug&#237;a bari&#225;trica durante el mismo periodo formativo&#46; Tampoco se ha contemplado la inevitable ayuda que recibe el residente por parte del CBE mientras realiza alg&#250;n paso de la cirug&#237;a ni la participaci&#243;n de otros profesionales como enfermer&#237;a o anestesia en el proceso asistencial&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A modo de conclusi&#243;n&#44; nuestros datos reflejan que el m&#233;todo de aprendizaje por pasos parece efectivo y seguro&#46; De esta manera&#44; los residentes consiguen realizar distintos procedimientos del BGLYR con confianza sin comprometer la efectividad de la intervenci&#243;n ni los resultados postoperatorios&#46; Sin embargo&#44; ser&#237;an necesarios m&#225;s estudios prospectivos para confirmar estos resultados&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Autor&#237;as</span><p id="par0125" class="elsevierStylePara elsevierViewall">Dise&#241;o y concepto del estudio&#58; Sebasti&#225;n-Tom&#225;s JC&#44; Navarro-Mart&#237;nez S&#44; Diez-Ares JA y Peris-Tom&#225;s N&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Recogida de datos&#58; todos los autores&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">An&#225;lisis estad&#237;stico&#58; Sebasti&#225;n-Tom&#225;s JC&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Aprobaci&#243;n final del manuscrito&#58; todos los autores&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">No se ha requerido financiaci&#243;n alguna para la realizaci&#243;n del estudio&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Todos los autores declaran que no existe conflicto de intereses&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Aprobaci&#243;n &#233;tica</span><p id="par0155" class="elsevierStylePara elsevierViewall">Todos los procedimientos se han realizado de acuerdo con los est&#225;ndares &#233;ticos de nuestro centro y a la &#250;ltima versi&#243;n de la declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Consentimiento informado</span><p id="par0160" class="elsevierStylePara elsevierViewall">Dado que se trata de un estudio retrospectivo&#44; no se obtuvo consentimiento informado de los pacientes&#46;</p></span></span>"
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    "fechaRecibido" => "2020-04-13"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es evaluar los resultados de nuestro programa de formaci&#243;n de residentes para la realizaci&#243;n de <span class="elsevierStyleItalic">bypass</span> g&#225;strico laparosc&#243;pico en Y de Roux &#40;BGLYR&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo en el que se incluyeron pacientes a los que se les realiz&#243; un BGLYR en nuestro centro durante el per&#237;odo comprendido entre enero de 2014 y diciembre de 2018&#46; Los residentes de cuarto a&#241;o de nuestro centro realizaron progresivamente distintos pasos de la intervenci&#243;n siempre tutorizados por cirujanos bari&#225;tricos expertos &#40;CBE&#41;&#46; Se compararon los resultados obtenidos en las intervenciones en las que el residente ha realizado alg&#250;n paso o la totalidad del BGLYR &#40;grupo I&#41;&#44; con aquellas realizadas en su totalidad por CBE &#40;grupo II&#41;&#46; Se analizaron datos demogr&#225;ficos de los pacientes&#44; comorbilidades&#44; resultados intraoperatorios&#44; morbimortalidad postoperatoria y resultados al a&#241;o de la intervenci&#243;n&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 208 pacientes en el estudio&#44; 67 en el grupo I y 141 en el grupo II&#46; Ambos grupos fueron comparables&#46; No se objetivaron diferencias significativas en el tiempo operatorio &#40;166&#44;45<span class="elsevierStyleHsp" style=""></span>min en el grupo I vs&#46; 156&#44;69<span class="elsevierStyleHsp" style=""></span>min en el grupo II&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;156&#41;&#46; La conversi&#243;n a cirug&#237;a abierta&#44; la estancia hospitalaria y la morbilidad postoperatoria tampoco presentaron diferencias estad&#237;sticamente significativas&#46; No hubo mortalidad durante este per&#237;odo&#46; Los resultados tras el primer a&#241;o fueron similares en ambos grupos&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La realizaci&#243;n de distintos procedimientos del BGLYR por residentes es segura y no compromete la efectividad ni los resultados postoperatorios&#44; siempre que se realice bajo la supervisi&#243;n de un CBE&#46;</p></span>"
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            "titulo" => "Material y m&#233;todos"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Laparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass &#40;LRYGB&#41; are technically demanding and require a long learning curve&#46; Little is known about whether surgical resident &#40;SR&#41; training programs to perform these procedures are safe and feasible&#46; This study aims to evaluate the results of our SR training program to perform LRYGB&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We designed a retrospective study including patients with LRYGB between January 2014 and December 2018&#44; comparing SR results to experienced bariatric surgeons &#40;EBS&#41;&#46; In our country&#44; SR have a five-year surgical formative period&#44; and in the fourth year they are trained for 6 months in our bariatric surgery unit&#44; from January to June&#46; In the beginning&#44; they perform different steps of this procedure&#44; to finally complete an LRYGB&#46; We collected demographic data&#44; comorbidities&#44; intraoperative outcomes&#44; and postoperative complications and outcomes after a one-year follow-up&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Two hundred and eight patients were eligible for inclusion&#58; 67 in group I &#40;SR&#41;&#44; and 141 in group II &#40;EBS&#41;&#46; Both groups were comparable&#46; There was no statistically significant difference in operating time &#40;166&#46;45<span class="elsevierStyleHsp" style=""></span>min in group I vs&#46; 156&#46;69<span class="elsevierStyleHsp" style=""></span>min in group II&#59; <span class="elsevierStyleItalic">P</span>&#61;0&#46;156&#41;&#46; Conversion to open surgery&#44; hospital stay&#44; postoperative complications&#44; and short-term outcomes had no significant differences between the two groups&#46; There was no mortality registered during this period&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Implementation of LRYGB stepwise learning as part of an SR training program is safe&#44; and results are comparable to EBS&#44; without loss of efficiency&#46; Therefore&#44; it is feasible to train SR in bariatric surgery under EBS supervision&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Los resultados de este estudio fueron seleccionados para su presentaci&#243;n en el 24th IFSO World Congress 2019 celebrado en Madrid y en la XXII Reuni&#243;n Nacional de Cirug&#237;a 2019 celebrada en Santander&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;&#44; mediana &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">48&#44;12 &#40;42-57&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;054&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;25&#44;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51 &#40;76&#44;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">105 &#40;74&#44;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC m&#225;ximo &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; mediana &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43&#44;14 &#40;40-47&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44 &#40;39-48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC intervenci&#243;n &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; media &#40;DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37&#44;07 &#40;4&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37&#44;25 &#40;4&#44;42&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;920&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente cirug&#237;a bari&#225;trica</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleItalic">&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;7&#44;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;5&#44;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;760&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente cirug&#237;a abdominal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">29 &#40;43&#44;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">38 &#40;26&#44;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;625&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ASA &#40;I&#47;II&#47;III&#47;IV&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">8&#47;45&#47;14&#47;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;848&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Colelitiasis&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15 &#40;22&#44;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;17&#44;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;426&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hernia de hiato&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">10 &#40;14&#44;93&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">25 &#40;17&#44;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;613&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hernia abdominal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5 &#40;7&#44;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;8&#44;51&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;797&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hipertensi&#243;n arterial&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">32 &#40;47&#44;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 &#40;36&#44;88&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;234&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diabetes mellitus&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">25 &#40;37&#44;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47 &#40;33&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;573&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dislipemia&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">32 &#40;47&#44;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">73 &#40;51&#44;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;571&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">SAHS&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;11&#44;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">29 &#40;20&#44;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clavien I-II&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;1&#44;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clavien IIIa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clavien IIIb&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Clavien IV-V&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1 &#40;0&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">D&#237;as de ingreso &#40;d&#237;as&#41;&#44; mediana &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#44;25-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;955&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mortalidad&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Datos referentes a la intervenci&#243;n quir&#250;rgica y el curso postoperatorio</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo I&#58; 67 &#40;32&#44;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Grupo II&#58; 141 &#40;67&#44;79&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">27&#44;80 &#40;3&#44;74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;22 &#40;30&#44;80-45&#44;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;11 &#40;34&#44;37-43&#44;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;696&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones largo plazo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5 &#40;7&#44;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">19 &#40;13&#44;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;433&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;lcera marginal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;2&#44;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5 &#40;3&#44;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>F&#237;stula&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hernia interna&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#44;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;553&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malabsorci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;1&#44;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome de Dumping&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;2&#44;98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;2&#44;84&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;674&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diarrea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#44;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;630&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RGE&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Disfagia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  """
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                0 => """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reservorio &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC m&#225;ximo &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; mediana &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;20 &#40;40-47&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&#44;49 &#40;38&#44;93-44&#44;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;45 &#40;40-48&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC intervenci&#243;n &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; media &#40;DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;43 &#40;4&#44;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;98 &#40;3&#44;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">37&#44;05 &#40;5&#44;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente cirug&#237;a bari&#225;trica</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">a</span></span><span class="elsevierStyleItalic">&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#44;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Antecedente cirug&#237;a abdominal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;36&#44;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;83&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo quir&#250;rgico &#40;min&#41;&#44; media &#40;DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157&#44;73 &#40;46&#44;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">174&#44;33 &#40;32&#44;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">193&#44;33 &#40;15&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones postoperatorias&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;04&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">D&#237;as de ingreso &#40;d&#237;as&#41;&#44; mediana &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2-4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3-4&#44;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;5-3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">IMC un a&#241;o &#40;k&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;&#44; media &#40;DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;63 &#40;3&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;60 &#40;3&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;45 &#40;3&#44;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#37;PTP&#44; mediana &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;94 &#40;32&#44;24-45&#44;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#44;43 &#40;30&#44;37-46&#44;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;83 &#40;26&#44;95-45&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones largo plazo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#44;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#44;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#218;lcera marginal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;08&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>F&#237;stula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hernia interna&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Malabsorci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;ndrome de Dumping&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#44;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;16&#44;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diarrea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;04&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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Información del artículo
ISSN: 0009739X
Idioma original: Español
DOI:10.1016/j.ciresp.2020.05.032
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