RESUMO
Bariatric and metabolic surgery (BMS), the only effective option for patients with obesity with or without comorbidities, has been stopped temporarily due to the ongoing novel corona virus disease (COVID-19) pandemic. However, there has been a recent change in the governmental strategy of dealing with this virus from 'Stay at Home' to 'Stay Alert' in many countries including India. A host of health services including elective surgeries are being resumed. In view of the possibility of resumption of BMS in near future, Obesity and Metabolic Surgery Society of India (OSSI) constituted a committee of experienced surgeons to give recommendations about the requirements as well as precautions to be taken to restart BMS with emphasis on safe delivery and high-quality care.
Assuntos
Cirurgia Bariátrica/normas , COVID-19/epidemiologia , Pandemias , Sociedades Médicas , COVID-19/prevenção & controle , COVID-19/transmissão , Teste para COVID-19 , Diagnóstico por Imagem , Humanos , Índia/epidemiologia , Controle de Infecções , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Consentimento Livre e Esclarecido , Salas Cirúrgicas/organização & administração , Alta do Paciente , Seleção de Pacientes , Equipamento de Proteção Individual , Cuidados Pós-Operatórios , Cuidados Pré-OperatóriosAssuntos
Derivação Gástrica , Obesidade Mórbida/cirurgia , Humanos , Laparoscopia , Fígado , ReoperaçãoRESUMO
BACKGROUND: Mini-gastric bypass (MGB) is a safe, effective, and reversible procedure for patients with type II diabetes mellitus (T2DM) and morbid obesity. Less is known, however, about its long-term effects in patients with a body mass index (BMI) <35 kg/m(2). METHODS: From February 2007 to February 2014, 1468 patients underwent MGB at our institution, including 983 with T2DM. Of these, 128 (82 women), of mean age 41.6 ± 10.2 years, had a BMI of 30-35 kg/m(2). Prospectively collected data were analyzed retrospectively. Factors assessed included disease duration, family history, medication use, remission, and biochemical indicators, including fasting plasma glucose, glycosylated hemoglobin (HbA1c), serum insulin, and C-peptide concentrations. Remission of T2DM was defined as HbA1c <6.0 % without medication. RESULTS: Prior to surgery, patients had a mean BMI of 33.4 ± 3.3 kg/m(2), mean waist circumference of 104.5 ± 8.2 cm, mean C-peptide concentration of 3.4 ± 1.2 ng/ml, and mean T2DM duration of 6.5 ± 3.1 years. Within 6 months of MGB, 95 % of these patients had attained HbA1c <7 %. Complete remission rates at 1, 2, and 7 years were 64, 66, and 53 %, respectively. Mean HbA1c decreased from 10.7 ± 1.5 % at baseline to 6.2 ± 0.5% at 1 year, 5.4 ± 1.2 % at 3 years, and 5.7 ± 1.8 % at 7 years. No deaths occurred, but two (1.6 %) patients experienced major complications. CONCLUSIONS: MGB provides good, long-term control of T2DM in patients with class I obesity. Early intervention results in higher remission rates.