Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience

Purpose To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses. Methods We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed. Results During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT. Conclusions The use of 3D vision in LRYGB significantly reduced the OT, though intra- and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.(AU)

Technical innovation: Intragastric Single Port Sleeve Gastrectomy (IGSG). A feasibility survival study on porcine model

Purpose: To perform technically the laparoscopic sleeve gastrectomy (LSG) using a unique Intragastric Single Port (IGSG) in animal swine model, evidencing an effective and safe procedure, optimizing the conventional technique.Methods: IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy.Results: All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications.Conclusion: Intragastric Single Port is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.(AU)

Evaluation of obstructive sleep apnea in obese patients scheduled for bariactric surgery

PURPOSE: To evaluate the frequency of obstructive sleep apnea (OSA) in obese patients scheduled for bariatric surgery and their identification for risk of OSA by Berlin Questionnaire (BQ) and excessive daytime sleepiness by Epworth Sleepiness Scale (ESS). METHODS: Fifty nine patients were evaluated by BQ and ESS. Out of these individuals, 35 performed a full-night sleep study using a type 3 portable monitoring (PM). The questionnaire results were compared for gender and BMI. The presence and severity of OSA was correlated with gender and both questionnaires. RESULTS: 94.75% of the respondents presented high risk for OSA by BQ and 59.65% presented positivity by ESS. Taking into account the AHI> 5 per hour for OSA diagnosis, all of them presented OSA, average AHI of 45.31±26.3 per hour and 68.6% have severe OSA (AHI>30). The male patients had a higher AHI (p<0.05). There was a positive correlation between the positivity in both questionnaires as well as the severity of OSA measured by AHI (p<0.05). CONCLUSION: The frequency and severe obstructive sleep apnea in the studied group is high. The Berlin Questionnaire and Epworth Sleepiness Scale had a positive correlation with the diagnosis of OSA in the group studied.(AU)

The spectrum of non alcoholic fatty liver disease in morbidly obese patients: prevalence and associate risk factors

PURPOSE: To determine the prevalence of non alcoholic fatty liver disease (NAFLD) and non alcoholic steatohepatitis (NASH) in morbidly obese patients undergoing bariatric surgery and to identify risk factors associated with the disease spectrum. METHODS: Liver biopsy was performed in 60 patients who underwent bariatric surgery, after other causes of liver disease were excluded. Clinical, biochemical and histological features were evaluated. RESULTS: NAFLD was detected in fifty-seven patients (95%) of the sample and forty patients (66.7%) of the total sample met the criteria for NASH. Perisinusoidal fibrosis was only found in three (7.5%) patients with NASH. The γGT was an independent predictive factor associated with the degree of hepatic steatosis. The variables such as dyslipidemia and ALT were independently associated with the presence of Mallory's corpuscles with the following values, respectively, OR 0, 05, 95% CI 0.002 to 0.75, P = 0.031 and OR 10, 99, 95% CI 1.44 to 83.93, P = 0.021. CONCLUSIONS: Non alcoholic fatty liver disease seems to be an obese-related condition with approximately half of asymptomatic morbidly obese patients having histological NASH. The γGT was an independent predictor of the degree of steatosis.(AU)

Anthropometric evolution and classification of pre-scholar and scholar students from public education: Relation to food of animal origin / Classificação e evolução antropométrica de pré-escolares e escolares do ensino público: Relação direta com consumo de produtos de origem animal

The National Program of Scholar Feeding (Programa Nacional de Alimentação do Escolar- PNAE) attend students from public education, aiming the physical, mental and academic development by a ideal alimentation and nutritional education. In Brazil, as in other countries, infant obesity is increasing and there are low weight students and structural deficit, due to several factors including inadequate alimentation. The adiposity excess observed in children is associated to lipolytic profile, arterial pressure, high glucose and consequently higher risk for cardiovascular diseases, hypertension and diabetes despite chronic diseases non-transmitted (DCNT). Considering the change on the morbid-mortality profile and nutrition of todays population, this study aimed to evaluated and classify the risks of child obesity in students of public education system, from pre-school and elementary school at Nova Odessa (CMEIs, EMEIs e EMEFs) comparing the results from last year evaluation. The methodology used comprehend the measurements of weight/height of 3549 students, classified in 979 students from CMEIs e EMEIs (0 to 6 years old) and 2570 students from EMEF (6 to 12 years old) in comparison to results obtained 2010 and 2011. The evaluators were trained and all used a digital platformlike weight scale and an inelastic metric tape. The Z-score was used to evaluate the indices for weight and hei

O artigo não apresenta resumo em português.

Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery / Função pulmonar e qualidade de vida em pacientes obesos mórbidos seis meses após cirurgia bariátrica

PURPOSE: To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation. METHODS: Patients were evaluated before and six months after surgery. The patients were mainly female (75 percent), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05. RESULTS: The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre- and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF25-75 (Forced Expiratory Flow between 25 and 75 percent FVC) and FEV1/FVC percent (Forced Expiratory Volume in the 1st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables. CONCLUSIONS: There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation.(AU)

OBJETIVO: Investigar a evolução do peso corpóreo, da função pulmonar e da qualidade de vida de 20 pacientes obesos mórbidos seis meses após operação de Fobi-Capella. MÉTODOS: Os pacientes foram avaliados antes e seis meses após a cirurgia e o sexo feminino predominou em 75 por cento, com média de idade de 40,5 anos ± 10, 27, média de peso de 110,11 kg ± 21,77 e IMC de 39,93 kg/m² ± 7,13. Para a avaliação da função pulmonar foi realizada espirometria por meio do espirômetro Pulmonet Godart NV Bilt Vetr Holland, e para a qualidade de vida foi aplicado o questionário de Moorehead-Ardelt. As comparações entre os valores espirométricos do pré e do pós-operatório foram realizadas pelo teste t de Student para amostras pareadas, e para a correlação entre a perda de peso e função pulmonar utilizou-se análise de regressão linear simples, adotando-se p < 0,05 para todos os resultados. RESULTADOS: As variáveis espirométricas Freqüência Respiratória (FR), Volume de Reserva Expiratório (VRE) e Capacidade Residual Funcional (CRF) apresentaram, aos seis meses após a operação, diferença estatisticamente significativa com os valores pré-operatórios, porém, não houve diferença significativa de Volume Residual (VR), Capacidade Vital (CV), Capacidade Pulmonar Total (CPT), Fluxo Expiratório Médio entre 25 e 75 por cento da curva de CVF (FEF25-75 por cento) e Razão entre Volume Expiratório Forçado no 1º segundo e Capacidade Vital Forçada (VEF1/CVF por cento). Apenas uma paciente relatou piora da qualidade de vida após a operação. Houve correlação positiva entre a perda da porcentagem do excesso de peso e VRE (p=0,0117, r=0,5514); as demais variáveis não apresentaram correlação significativa. CONCLUSÕES: Houve perda significante de peso, melhora da função pulmonar evidenciada pela redução da freqüência respiratória, aumento do volume de reserva expiratório e da capacidade residual funcional. A qualidade de vida dos pacientes melhorou nos seis meses após a operação de Fobi-Capella.(AU)

Sleeve-gastrectomia: acesso com single port transgástrico em miniporcos estudo experimental

Antecedentes:Sleeve Gastrectomia (LSG) tornou-se um procedimento primário para tratamento da obesidade mórbida. Diferentes abordagens têm sido descritas para torná-lamais simples e minimizar o trauma cirúrgico e complicações, incluindo o acesso por NOTES, e as técnicas de único portal (LESS). Este projeto visa realizar tecnicamente a LSG usando um único portal intragástrico (IGSG) em modelo suíno.IGSG foi realizada em quatro miniporcos, usando um único portal intragástrico percutâneolocalizado na região pré-pilórica. O grampeamento gástrico da curvatura maior foi iniciado a partir da região pré-pilórica para o ângulo de His mediante o sistema Endo GIA ;o espécime foi removido através do acesso cirúrgico único. No dia 30 do pós-operatório, os animais foram sacrificados e submetidos à necropsia. Os procedimentos foram realizados sem conversão, e todos os animais sobreviveram durante os 30 dias. O tempo cirúrgico médio foi de 42 min. Durante o período perioperatório não foram observadas complicações durante a invaginação e o grampeamento. Não houve complicações no pós-operatório. O exame post-mortem não mostrou nenhum vazamento ou complicações infecciosas. IGSG é um processo viável que pode ser uma alternativa adequada à técnica de sleeve gastrectomia para o tratamento da obesidade mórbida.

Background: Laparoscopic Sleeve Gastrectomy (LSG) has become a primary procedure for management of morbid obesity. Different approaches have been described to make it simpler and minimize surgical trauma and complications, including NOTES access and single port techniques (LESS). This project aims to perform technically the LSG using a unique intragastric Single Port (IGSG) in an animal swine model. IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy. All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications. IGSG is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.

Doenças de aves selvagens diagnosticadas na Universidade Federal do Paraná (2003-2007) / Diseases of wild birds diagnosed at the Federal University of Paraná, Brazil (2003-2007)

Dentre os 253 atendimentos realizados em aves selvagens entre agosto de 2003 a agosto de 2006 no Ambulatório de Animais Selvagens do Hospital Veterinário da Universidade Federal do Paraná, 45 casos (17,8 por cento) referiram-se a consultas à espécie Serinus canarius (canário-belga). Dentre as aves atendidas e suas respectivas ordens obteve-se uma maior ocorrência da ordem Psittaciforme. As enfermidades mais freqüentemente visualizadas foram as afecções traumáticas com 56 casos (22,13 por cento). Destas, 17 animais (30,91 por cento) possuíam algum tipo de fratura, sendo a fratura rádio-ulnar a mais comum, com 17,65 por cento de ocorrência. As outras moléstias mais relatadas foram a presença de ectoparasitos (12,50 por cento) e endoparasitos (10,68 por cento), doenças respiratórias (10,42 por cento), procedimentos preventivos (7,55 por cento), afecções dermatológicas (6,51 por cento), neoplasias (4,95 por cento), afecções oftálmicas (4,43 por cento), afecções gastrintestinais (3,91 por cento), caquexia (3,39 por cento), afecções neurológicas (2,86 por cento), automutilação (2,86 por cento), obesidade (2,34 por cento), agressão por outros animais (1,56 por cento), doenças nutricionais (1,30 por cento), retenção de ovo (1,04 por cento), bouba aviária (0,78 por cento) e gota úrica (0,52 por cento). Tendo em vista a alta prevalência de traumatismos e presença de ecto e endo parasitas que poderiam ser evitados se estivesse ocorrendo um manejo adequado com a ave, sugere-se a necessidade que o Médico Veterinário assuma um papel mais efetivo na Medicina Veterinária Preventiva buscando informar e debater questões referentes ao modo correto de alimentação, criação e manejo das aves, assim como também o esclarecimento acerca das questões referentes às zoonoses quando da consulta veterinária.(AU)

From 253 wild birds attended at the Wild Animal Ambulatory of the Veterinary Hospital, Paraná Federal University, between August 2003 and August 2006, 45 cases (17.8 percent) were related to the species Serinus canarius (Belgian Canary). Within these attended birds and its respective orders, most morbid conditions occurred with the Psittaciforme order and were caused by traumatism, in 45 cases (14.32 percent). Of these, 17 animals (30.91 percent) had bone fractures; the most common were on radius-ulna (17.65 percent). Other conditions were presence of ectoparasites (12.50 percent) and endoparasites (10.68 percent), respiratory disease (10.42 percent), dermatological ailments (6.51 percent), neoplasms (4.95 percent), ophthalmic illnesses (4.43 percent), gastrointestinal diseases (3.91 percent), cachexia (3.39 percent), neurological diseases (2.86 percent), self-mutilation (2.86 percent), obesity (2.34 percent), aggression by other animals (1.56 percent), nutritional deficiencies (1.30 percent), egg retention (1.04 percent), avian poxvirus (0.78 percent) and uric gout (0.52 percent), as well as there was clinical routine measures to be taken (7.55 percent). Traumas and illnesses were observed as the highest prevalence on the casuistic, which could be prevented by correct husbandry practices.(AU)

Nonalcoholic fatty liver disease and obesity / Doença gordurosa não alcóolica do fígado e obesidade

PURPOSE: The aim of this review is to update concepts of the nonalcoholic fatty liver disease (NAFLD) and to establish a relationship between this condition and obesity. METHODS: By means of a comprehensive literature review where special attention was devoted to articles published in the last 5 years, NAFLD is discussed in view of new concepts, diagnosis, staging, and treatment. RESULTS: NAFLD is emerging as one of the main causes of chronic liver disease and it is believed to be the hepatic component of the metabolic syndrome, whose central features include obesity, hyperinsulinemia, peripheral insulin resistance, diabetes, dyslipidemia, and hypertension. The surgical treatment of morbid obesity is one of the options available for the treatment of NAFLD. CONCLUSION: Nonalcoholic fatty liver disease is strongly related with obesity.(AU)

OBJETIVO: O objetivo deste artigo foi atualizar conceitos com relação à doença gordurosa não alcoólica do fígado (DGNAF) e a sua intrínseca relação com a obesidade. MÉTODOS: Por meio de revisão bibliográfica, com atenção especial às publicações dos últimos 5 anos, o assunto foi abordado com relação à conceituação, ao diagnóstico, estadiamento e tratamento. RESULTADO: A DGNAF está emergindo como uma das maiores causas de doença crônica do fígado e representa o componente hepático da síndrome metabólica, caracterizada por obesidade, hiperinsulinemia, resistência periférica à insulina, diabete, hipertrigliceridemia e hipertensão. O tratamento cirúrgico da obesidade mórbida faz parte do arsenal terapêutico da DGNAF. CONCLUSÃO: O tema foi amplamente discutido, baseado em estudos recentes.(AU)

Estudo da variabilidade da frequência cardíaca em cães

A avaliação da variabilidade da frequência cardíaca (VFC) possibilita quantificar a participação do sistema nervoso autônomo simpático e parassimpático. Clinicamente, esta relaciona-se com o prognóstico e risco de morte súbita em diversas afecções no homem, mas ainda permanece incerta em importantes enfermidades caninas como a degeneração mixomatosa valvar e obesidade. Dentre as alternativas terapêuticas capazes de modificar o balanço autonômico de forma benéfica, o exercício físico se destaca para o homem, entretanto, ainda pouco pesquisado em cães. Neste estudo, avaliou-se o comportamento da VFC, no domínio do tempo, em cães com endocardiose e obesidade mórbida, assim como os efeitos do treinamento sobre as funções autonômicas e hemodinâmicas de cães saudáveis. Nos cães do presente estudo, a endocardiose valvar e obesidade mórbida não modificaram os índices de VFC, sendo estes semelhantes aos índices observados nos cães hígidos. Em etapa posterior, o teste de esforço progressivo e treinamento físico preconizados foram bem tolerados pelos cães saudáveis. Maior participação autonômica parassimpática foi detectada por índices de VFC (SDANN, rMSSD e SDNN), frequências cardíacas mínima, máxima e sua amplitude, além da mudança percentual dos ritmos apresentados no teste de esforço após o treinamento. Em seu aspecto hemodinâmico observou-se melhor função diastólica (relação E/A mitral), redução dos índices indicadores de pré-carga (IEPFd e diâmetro AE) e pós-carga (IEPFs)

Heart rate variability (HRV) is a tool capable to measure the sympathetic and parasympathetic autonomic nervous system participation. These measurements are clinically related to prognosis and sudden death risk in different human diseases, but it remains unknown in dogs even in important disorder such as myxomatous valvar degeneration and obesity. Physical exercises has a special role on therapy of patients with heart disorders, leading to an autonomic balance improvement, but these effects are not still studied in dogs. This study evaluated time domain HRV in dogs with endocardiosis and obesity, and in parallel, the effects of physical training on hemodynamic and autonomic function in health dogs. Myxomatous mitral valve degenetation, and obese dogs presented similar HRV measures compared to health dogs. In subsequent study, the progressive physical effort test and training program were well tolerated for health dogs. Increased parasympathetic participation was detected by HRV (SDANN, rMSSD and SDNN), minimum, maximum and amplitude heart frequencies, besides the rhythm percentage modifications in the effort test after training. In the hemodynamic evaluation improvement of diastolic function (E/A mitral), decreased preload (IEPFd and diâmetro AE) and afterload (IEPFs) indexes were observed. Concluding, the dogs from this study with an initial phase of endocardiosis (class Ib) or morbid obesity did not present autonomic damages detectable by HRV, and training cold change the autonomic control and hemodynamic function in health dogs, opening a new research perspective to use it in canine cardiac diseases

Cirurgia endoscópica translumenal por orifícios naturais (notes): revisão / Natural orificies transfuminal endoscopic surgery: a review

A busca por uma técnica cirúrgica cada vez menos invasiva culminou com o uso da videocirurgia, e sua evolução natural parece ser o desenvolvimento das técnicas operatórias sem incisões, ou seja, as cirurgias realizadas por orifícios naturais.As vantagens apresentadas por essa técnica emergente consistem na ausência de incisões abdominais, proporcionando um pós-operatório tranqüilo ao paciente, além de recuperação mais rápida, represen¬tando menor período de hospitalização do paciente.A cirurgia endoscópica translumenal pode tomar-se a técnica de eleição utilizada em pacientes críticos, como em casos de obesidade mórbida e de pacientes com risco cirúrgico.Atualmente, as vias de acesso utilizadas pela técnica de NOTES são diversas, e incluem o acesso trans¬gástrico, transvaginal, trascolônico e transvesical. O intuito desta revisão é discorrer, através de infor¬mações recentes, sobre a técnica de NOTES e suas vias de acesso(AU)

The NOTES technique expands the role of surgery in order to diagnose and treat pathological proce¬dures, increasing the possibility of surgical indications. The advantages presented by this emerging technology are the absence of abdominal incisions, provi¬ding a smooth post-operative patient, and postoperative recovery was faster and shorter hospital stay and hospitalization of the patient. Endoscopic surgery translumenal is the technique of choice used in critical1y ill patients, in cases of morbid obesity and risk surgical patients. Currently, the access routes used by the technique of NOTES are diverse, including access transgas¬tric, transvaginal, transcatheter, transcolonic. The purpose of this review is to discuss the technical of NOTES and its access roads, showing the latest information on the subject(AU)

Cirurgia endoscópica translumenal por orifícios naturais (notes): revisão / Natural orificies transfuminal endoscopic surgery: a review

A busca por uma técnica cirúrgica cada vez menos invasiva culminou com o uso da videocirurgia, e sua evolução natural parece ser o desenvolvimento das técnicas operatórias sem incisões, ou seja, as cirurgias realizadas por orifícios naturais.As vantagens apresentadas por essa técnica emergente consistem na ausência de incisões abdominais, proporcionando um pós-operatório tranqüilo ao paciente, além de recuperação mais rápida, represen¬tando menor período de hospitalização do paciente.A cirurgia endoscópica translumenal pode tomar-se a técnica de eleição utilizada em pacientes críticos, como em casos de obesidade mórbida e de pacientes com risco cirúrgico.Atualmente, as vias de acesso utilizadas pela técnica de NOTES são diversas, e incluem o acesso trans¬gástrico, transvaginal, trascolônico e transvesical. O intuito desta revisão é discorrer, através de infor¬mações recentes, sobre a técnica de NOTES e suas vias de acesso

The NOTES technique expands the role of surgery in order to diagnose and treat pathological proce¬dures, increasing the possibility of surgical indications. The advantages presented by this emerging technology are the absence of abdominal incisions, provi¬ding a smooth post-operative patient, and postoperative recovery was faster and shorter hospital stay and hospitalization of the patient. Endoscopic surgery translumenal is the technique of choice used in critical1y ill patients, in cases of morbid obesity and risk surgical patients. Currently, the access routes used by the technique of NOTES are diverse, including access transgas¬tric, transvaginal, transcatheter, transcolonic. The purpose of this review is to discuss the technical of NOTES and its access roads, showing the latest information on the subject

Anthropometric evolution and classification of pre-scholar and scholar students from public education: Relation to food of animal origin / Classificação e evolução antropométrica de pré-escolares e escolares do ensino público: Relação direta com consumo de produtos de origem animal

The National Program of Scholar Feeding (Programa Nacional de Alimentação do Escolar- PNAE) attend students from public education, aiming the physical, mental and academic development by a ideal alimentation and nutritional education. In Brazil, as in other countries, infant obesity is increasing and there are low weight students and structural deficit, due to several factors including inadequate alimentation. The adiposity excess observed in children is associated to lipolytic profile, arterial pressure, high glucose and consequently higher risk for cardiovascular diseases, hypertension and diabetes despite chronic diseases non-transmitted (DCNT). Considering the change on the morbid-mortality profile and nutrition of todays population, this study aimed to evaluated and classify the risks of child obesity in students of public education system, from pre-school and elementary school at Nova Odessa (CMEIs, EMEIs e EMEFs) comparing the results from last year evaluation. The methodology used comprehend the measurements of weight/height of 3549 students, classified in 979 students from CMEIs e EMEIs (0 to 6 years old) and 2570 students from EMEF (6 to 12 years old) in comparison to results obtained 2010 and 2011. The evaluators were trained and all used a digital platformlike weight scale and an inelastic metric tape. The Z-score was used to evaluate the indices for weight and hei

O artigo não apresenta resumo em português.

Gastroplastia vertical restritiva com derivação gastrointestinal em Y de Roux em suínos: aspectos histopatológicos do segmento gástrico isolado

OBJECTIVE: Establish an animal model for the Roux en Y gastric bypass and to evaluate its weight loss and amount of food intake, as well as verify macroscopic, morphometric and histopathologic aspects of the bypassed segment. METHODS: Sixteen male pigs were studied in two groups. The Group Surgery was composed of 8 animals submitted to a Roux en Y gastric bypass. The Group Control comprised 8 pigs receiving identical care, except for the surgical procedure. Group Surgery was followed for 90 days, when the bypassed gastric segment was resected. Group Control was followed for 84 days, when the stomach was resected. RESULTS: Weight loss and the amount of food intake were evaluated in both groups. Macroscopic findings, histopathologic changes of the gastric wall, gastric gland morphometry and the amount of collagen type I and III of the gastric mucosa in the bypassed gastric segment were evaluated. Group Control exhibited a significant larger weight gain and food intake compared to surgery. The gastric glands were smaller and type I collagen was predominant in Surgery compared to Control. No changes were noted in the type III collagen. Fat tissue was identified among the muscle fibers in the isolated segment of Group Surgery. CONCLUSION: This model of Roux en Y gastric bypass in pigs offers consistent weight and food intake reduction. Secondly, Roux en Y gastric bypass in pigs does not induce macroscopic changes in mucosa. Finally, the histopathological findings are consistent with initial atrophy of the isolated gastric segment.

OBJETIVO: Estabelecer um modelo animal de gastroplastia restritiva com derivação gastrointestinal em Y de Roux, avaliando alterações na quantidade da ingesta, na perda de peso e os aspectos macroscópicos da mucosa e histopatológicos da parede do segmento gástrico isolado. MÉTODOS: Dezesseis suínos machos, foram alocados em dois grupos. O Grupo Cirurgia incluiu 8 animais submetidos a gastroplastia restritiva com derivação gastrointestinal em Y de Roux. O Grupo Controle foi composto por 8 suínos intactos, submetidos ao mesmo cuidado e dieta. O Grupo Cirurgia foi observado por 90 dias, quando foi sacrificado para estudo do segmento gástrico isolado. O Grupo Controle foi observado por 84 dias, quando os animais foram sacrificados para ressecção gástrica. RESULTADOS: Foram avaliados a variação ponderal e o volume da ingesta alimentar de ambos os grupos. Avaliou-se alterações macroscópicas da mucosa, alterações morfométricas das glândulas gástricas, características histopatológicas e quantidade de colágeno tipo I e III na camada mucosa no segmento gástrico isolado do Grupo Cirurgia. O peso dos animais e a ingesta alimentar foi significativamente maior no Grupo Controle que no Cirurgia. Ocorreu diminuição no tamanho das glândulas gástricas, maior quantidade de colágeno tipo I na camada mucosa e deposição de tecido gorduroso na camada muscular do segmento gástrico isolado. CONCLUSÃO: O modelo suíno de gastroplastia restritiva com derivação gastrointestinal em Y de Roux proporciona redução da ingesta e perda ponderal. A gastroplastia restritiva com derivação gastrointestinal em Y de Roux em suínos não proporciona alterações macroscópicas no segmento gástrico isolado e que os achados histopatológicos são compatíveis com os de atrofia inicial do segmento gástrico isolado.