Improvement in Muscle Strength and Metabolic Parameters Despite Muscle Mass Loss in the Initial Six Months After Bariatric Surgery.

BACKGROUND: An aggravation in pre-existing sarcopenia or the onset of sarcopenia may occur in the scenario of extensive and fast weight loss in the initial months following bariatric surgery. The accurate identification of sarcopenia criteria and its metabolic repercussions is vital for its correct management. The aim of this study is to evaluate the correlation between the diagnosis criteria for sarcopenia and metabolic repercussions during the first 6 months following bariatric surgery. METHODS: A prospective single-center cohort study was conducted. Convenience sampling was performed among patients with severe obesity undergoing preoperative evaluation for bariatric surgery. Metabolic parameters, nutritional evaluation, and skeletal muscle evaluation were assessed before surgery and 6 months later. RESULTS: A total of 129 patients were selected, 62 participants were included in the final analysis. Mean age was 37.7 years and 88.4% of participants were women. Mean body mass index was 41.8 kg/m2 and 47.8% of patients were sedentary. Sleeve gastrectomy was performed in 41 patients and Roux-en-Y gastric bypass in 21 patients. Significant improvement regarding muscle strength and function after surgery was observed. Sarcopenia criteria were not met by any participant before and after surgery. Blood glucose and ferritin levels remained independently associated with change in muscle strength. CONCLUSIONS: Functional evaluation methods did not reflect the reduction in skeletal muscle mass demonstrated in bioelectrical impedance analysis 6 months after bariatric surgery in comparison to the preoperative baseline. Improvement in muscle strength was followed by improvement in metabolic parameters.

Petit lumbar hernia--a double-layer technique for tension-free repair.

This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.

Ruptura espontânea para cavidade abdominal de pseudocisto pancreático e seu tratamento / Spontaneous rupture of pancreatic pseudocyst and its treatment: a case report

O pseudocisto de pâncreas é caracterizado como uma coleção fluida rica em enzimas pancreáticas circundada por tecido de fibrose e granulação, sendo mais comum nos casos de pancreatite crônica e, também, na etiologia alcóolica da doença. Sua indicação cirúrgica se baseia nos casos assintomáticos que não tendem à regressão e nas suas complicações. Entre elas, bastante rara, destaca-se a ruptura espontânea do pseudocisto de maneira livre para cavidade abdominal. Relatamos aqui um caso de ruptura espontânea para cavidade abdominal de pseudocisto pancreático com quadro clínico de abdome agudo com pneumoperitônio no raio-x, que foi tratado com drenagem externa do mesmo para a parede abdominal. Apesar de cada vez mais consagrado o tratamento dessa patologia por via endoscópica ou percutânea, relatamos aqui um raro caso aonde a conduta cirúrgica se tornou imperativa, sendo bastante útil para os cirurgiões.

Pseudocyst of the pancreas is characterized as a fluid collection rich in pancreatic enzymes surrounded by fibrotic tissue and granulation, being more common in cases of chronic pancreatitis. Its surgical indication is based on the asymptomatic cases that do not tend to regression and on its complications. Among them, though very rare, there is spontaneous rupture of the pseudocyst freely into the abdominal cavity. Here we report a case of spontaneous rupture of pancreatic pseudocyst into the abdominal cavity with a clinical picture of acute abdomen with radiologic pneumoperitoneum, which was treated with external drainage to the abdominal wall. Although treatment through endoscopic or percutaneous route is increasingly well established, here we report a rare case in which the surgical procedure became imperative.

Tratamento cirúrgico da estenose pilórica / Surgical treatment of pyloric stenosis

Úlcera péptica é definida como uma lesão de mucosa gástrica e/ou duodenal que ocorre quando há desequilíbrio entre fatores de proteção e agressão. É um dos maiores problemas de saúde, com incidência em torno de 1.500 a 3.000 casos a cada 100.000 habitantes por ano. Atualmente, a cirurgia eletiva para essa doença está virtualmente excluída, reservando-se apenas para casos de emergência. A grande maioria desses procedimentos consiste em rafia da parede gástrica ou duodenal por úlcera perfurada. A hemorragia dessas lesões aparece como segunda complicação mais frequente. E, finalmente, apenas cerca de 1 a 2% dos pacientes necessitam de tratamento cirúrgico para aliviar uma obstrução gástrica ou duodenal, já que o processo ulceroso crônico deixa fibrose e estenose na região. No presente estudo, são relatados 3 casos em nossa instituição em que executamos cirurgia devido à estenose péptica do piloro e duodeno refratária ao tratamento clínico num período menor que 8 meses. Em todos os casos, foi realizada uma hemigastrectomia, com reconstrução à Y de Roux, obtendo resultados satisfatórios

Peptic ulcer is defined as injury to the gastric or duodenal mucosa which occurs when there is an imbalance between protective factors and aggression to it. It is one of the biggest health problems, with an incidence of around 1500 to 3000 cases per 100,000 people per year. Currently, elective surgery for this disorder is virtually excluded, reserved for emergency cases only. The vast majority of these surgical procedures consists in suturing the stomach or duodenal wall with perforated ulcer. Hemorrhage from these lesions appears as the second most frequent complication. And finally, only about 1-2% of patients require surgery to relieve a gastric or duodenal obstruction, since the chronic ulcerous process causes fibrosis and ulcerative stenosis in the region. In the present study we report three cases in which we performed surgery due to peptic stenosis of the pylorus and duodenum refractory to medical treatment in a period less than 8 months. In all cases, hemigastrectomy with Roux-Y reconstruction was performed, with satisfactory results

Cistoadenoma mucinoso de pâncreas durante a gravidez / Mucinous cystadenoma of the pancreas developing during pregnancy

Cistoadenoma mucinoso de pâncreas durante a gravidez é extremamente raro e relatado somente cinco vezes na literatura. Nós descrevemos caso de uma mulher de 26 anos, na sua segunda gestação, com um acentuado aumento de volume intra-abdominal por massa cística, cuja gestação foi interrompida durante a trigésima primeira semana por severa pré-eclâmpsia. A cirurgia de retirada do cisto ocorreu 26 dias após o parto, com enucleação total da lesão. O exame anatomopatológico evidenciou o cisto como cistoadenoma mucinoso, que mediu 23x20x15 cm e pesou 9070 g. Até onde é do nosso conhecimento, é um dos maiores cistoadenomas mucinosos pancreáticos relatados durante a gestação

Mucinous cystadenoma of the pancreas during pregnancy is an extremely rare condition and was reported only five times in the literature. We report the case of a 26-year-old female who, in her second pregnancy, had a sharp intra-abdominal volume increase due to cystic mass, whose pregnancy was interrupted at the thirty-first week of gestation because of severe pre-eclampsia. The surgery to remove the cyst was performed 26 days after delivery, with total enucleation of the lesion. The anatomico-pathological examination showed a mucinous cystadenoma that measured 23x20x15 cm and weighed 9,070 g. To the best of our knowledge this is one of the largest pancreatic mucinous cystadenomas reported during pregnancy

O valor da ultra-sonografia no diagnóstico da apendicite aguda / The role of the ultra-sonography in the diagnosis of acute appendicitis

Apendicite aguda é a causa mais comum de abdome agudo e o principal motivo de cirurgia abdominal de emergência. É diagnosticada com base na avaliação clínica, contagem de leucócitos e exames de imagem. O objetivo do trabalho é avaliar a ultra-sonografia como método complementar em casos suspeitos de apendicite aguda, comparando-a com o resultado do anatomopatológico. Revisamos prontuários dos 320 pacientes submetidos a apendicectomias, no Complexo Hospitalar Santa Casa de Porto Alegre, entre janeiro de 2005 e dezembro de 2006, analisando-se a impressão diagnóstica definida pelo ultra-sonografista e o resultado do exame anatomopatológico. No total, 251 pacientes (78,4%) foram submetidos ao ultra-som no pré-operatório. Destes, 216 pacientes foram diagnosticados com apendicite aguda, pelo exame anatomopatológico. Em 170 pacientes (78,70%) a ecografia abdominal sugeriu o diagnóstico de apendicite aguda, em 21 casos (9,72%) o exame não foi sugestivo e em 25 casos (11,57%) houve dúvida diagnóstica. A sensibilidade verificada do ultra-som foi de 78%, enquanto que a especificidade foi de 42%. O valor preditivo positivo foi de 89,47% e o negativo de 24,59%. A acurácia calculada foi de 73,70%. Excluindo a dúvida, sensibilidade da ecografia foi de 89%, a especificidade de 35%. Valores preditivos positivo e negativo foram, respectivamente, de 89,47% e 34,37%. A acurácia foi de 81,53%. Concluímos que a ultra-sonografia mostra-se como uma importante ferramenta no diagnóstico da apendicite aguda e um excelente método para o diagnóstico diferencial dos quadros sindrômicos da fossa ilíaca direita. Contudo, não se devem substituir as rotinas de anamnese e exame físico para estabelecer o diagnóstico

Acute appendicitis is the most common cause of acute abdominal inflammatory disease and it is the main reason for emergency laparotomy. The diagnosis is based in the clinical evaluation, white blood cels count and diagnostic imaging exams. The aym of the study is to evaluate ultrasonography as a complemental diagnosis method in cases of acute appendicitis comparing with pathologycal exam. We reviewed promptuaries of 320 patients submited to appendicectomies in Santa Casa Hospital of Porto Alegre between January 2005 and December 2006 to analyse the impression of the ultrasonographist and the pathologycal examination of the surgical material. Of those, 251 patients (78,4 %) were submitet to ultrasonography in the pre-operatory. 216 of those had diagnosticaded acute appendicitis in the pathologycal examination. In 170 patients (78,7%), ultrasonography suggested diagnosis of acute appendicitis. In 21 cases (9,72 %) the exam did not suggest inflammatory process and in 25 patients (11,57%) the ultrasonographist had doubt about the diagnosis. The sensibility verificated was 78% and the specificity was 35%. The positive and negative predictive values were 89,47% and 24,59%, respectively. The acuracy was 73,7%. If we eliminate the doubt, the sensibility was 89%, specificity 35%, positive and negative predictive values were 89,47% and 34,37%, respectively. The acuracy was 81,53%. We concluded that ultrasonography is an important diagnostic tool to the appendicitis and an excelent method to discriminate other acute diseases of the right inferior quadrant. However, the exam should not substitute anamnesis and physical examination to establish the diagnosis of acute appendicitis