Effects of different gastrointestinal reconstruction techniques on nutrition, anemia, and quality of life in laparoscopic distal gastrectomy for gastric cancer

Purpose: To explore the effect of different gastrointestinal reconstruction techniques on laparoscopic distal gastrectomy of gastric cancer on the nutritional and anemia status, and quality of life (QoL) of patients. Methods: Eligible patients were randomly divided into three groups (n=36/group): Billroth I anastomosis group, Billroth II combined with Braun anastomosis group, and Roux-en-Y anastomosis group. Related indicators were compared and analyzed. Results: The general data were comparable among the three groups (all P>0.05). Among the surgical-related indicators and postoperative recovery indicators, only the comparison of the operation time was statistically significant (P=0.004). The follow-up time was 5~36 months (average 27.9 months). In terms of nutritional and anemia indicators, only the differences in the levels of prealbumin, hemoglobin and serum ferritin in 24 months after operation showed significant differences (P=0.015, P=0.003, P=0.005, respectively). There were no significant differences in hospital readmission rate, overall survival, and QoL among the three groups (all P>0.05). Conclusions: In laparoscopic gastrectomy for stage II~III distal gastric cancer, Billroth I anastomosis has shorter operation time than Billroth II combined with Braun anastomosis and Roux-en-Y anastomosis and advantages in the improvement of nutritional status and anemia recovery.

Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study

Purpose: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. Methods: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. Results: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. Conclusions: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment

Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of obese patients, adherence to clinical follow-up and the influence of factors such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with patients undergoing vertical gastrectomy, operated at Hospital São Domingos, between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%) and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was 56.18%. Among adherent patients (n = 117; 43.82%), most patients were female (n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72 kg/m2. Both BMI and excess weight (EW) showed a statistically significant difference between pre- and postoperative period. Percentage of excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients. Older patients had a statistically significant lower % EWL compared to the other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with significant weight loss.(AU)

Effects of glycerol and sodium pentaborate containing new formulation on sleeve gastrectomy model in rats

ABSTRACT Purpose: The development of cutting surface leakage and postoperative peritoneal adhesions (PPA) after sleeve gastrectomy (SG) are the most serious operative complications. We investigated the effectiveness of the newly developed glycerol and sodium pentaborate containing formulation on the prevention of these complications. Methods: Sixteen Sprague Dawley rats (mean weight 310 ± 50 g, mean age 3 months old) were divided into two groups, consisting of eight rats in each. SG and a double-layer suture technique were performed for each group. In study group, there was the mixture of 2 mL 3% glycerol plus 3% sodium pentaborate formulation, and in the control group 2 mL 0.9% NaCl was injected into the peritoneal cavity. Rats were sacrificed after 30 days, then macroscopic adhesion grade scoring and histopathological evaluations were assessed. Results: Macroscopic PPA scores in the control and study groups were 2.75 ± 0.16 and 1.50 ± 0.327, respectively (p = 0.004). Histopatologic fibrosis scores in the control and study groups were 0.87 ± 0.125 and 2.00 ± 0.26, respectively (p = 0.002). Conclusions: In SG operation model, glycerol plus sodium pentaborate compound decreased PPA formation and also increased stomach cut surface line fibrosis. This new formulation is hopeful for more safe SG operations.

Billroth I technique application after resection of gastric leiomyoma in a dog

Background: Gastric neoplasia is rare, corresponding to less than 1% of cases, with a lower prevalence of those involving smooth muscle tissues. In these cases, clinical signs worsen in the occurrence of pyloric obstruction, leading to clinical manifestations such as chronic emesis. The exeresis of the neoplasm is promoted as a therapeutic measure to reestablish gastrointestinal flow. There partial gastrectomy followed by gastroduodenal anastomosis, using the Billroth I technique, is among the available surgical techniques. The therapeutic success of the Billroth I technique after pylorectomy was reported in a dog with gastric leiomyoma. Case: A 9-year-old male Poodle dog, weighing 9.5 kg, was referred for clinical evaluation with a history of chronic vomiting starting three months ago, progressive weight loss, and melena, previously treated by another Veterinarian as idiopathic gastroenteritis. The physical evaluation of the animal showed a state of normal consciousness, body score 4/9, pale ocular and oral mucous membranes, respiratory rate 20 mpm, heart rate 166 bpm, a rectal temperature of 37.9°C, and dehydration degree of 8.0%. Blood count showed normocytic normochromic anemia and leukocytosis with shift to the right. Radiographic and endoscopic examinations were not noteworthy. Endoscopic biopsy after a histopathological evaluation showed no cellular or tissue atypia. On the other hand, abdominal ultrasound assessment revealed thickening with loss of echotexture and definition of the muscular layer of the gastric wall, pyloric and duodenum region compatible with benign antral muscle hypertrophy and/or pyloric neoplasia. The animal worsened 5 days after the initial treatment, with progressive episodes of emesis and melena, opting for an exploratory laparotomy. A mass of firm consistency measuring approximately 2.5 × 6.0 cm in diameter was found in the pyloric region, opting for a pylorectomy. The excised fragment was sent for histopathological...

Billroth I technique application after resection of gastric leiomyoma in a dog

Background: Gastric neoplasia is rare, corresponding to less than 1% of cases, with a lower prevalence of those involving smooth muscle tissues. In these cases, clinical signs worsen in the occurrence of pyloric obstruction, leading to clinical manifestations such as chronic emesis. The exeresis of the neoplasm is promoted as a therapeutic measure to reestablish gastrointestinal flow. There partial gastrectomy followed by gastroduodenal anastomosis, using the Billroth I technique, is among the available surgical techniques. The therapeutic success of the Billroth I technique after pylorectomy was reported in a dog with gastric leiomyoma. Case: A 9-year-old male Poodle dog, weighing 9.5 kg, was referred for clinical evaluation with a history of chronic vomiting starting three months ago, progressive weight loss, and melena, previously treated by another Veterinarian as idiopathic gastroenteritis. The physical evaluation of the animal showed a state of normal consciousness, body score 4/9, pale ocular and oral mucous membranes, respiratory rate 20 mpm, heart rate 166 bpm, a rectal temperature of 37.9°C, and dehydration degree of 8.0%. Blood count showed normocytic normochromic anemia and leukocytosis with shift to the right. Radiographic and endoscopic examinations were not noteworthy. Endoscopic biopsy after a histopathological evaluation showed no cellular or tissue atypia. On the other hand, abdominal ultrasound assessment revealed thickening with loss of echotexture and definition of the muscular layer of the gastric wall, pyloric and duodenum region compatible with benign antral muscle hypertrophy and/or pyloric neoplasia. The animal worsened 5 days after the initial treatment, with progressive episodes of emesis and melena, opting for an exploratory laparotomy. A mass of firm consistency measuring approximately 2.5 × 6.0 cm in diameter was found in the pyloric region, opting for a pylorectomy. The excised fragment was sent for histopathological...(AU)

The effect of fibrin glue in preventing staple-line leak after sleeve gastrectomy. An experimental study in rats

Abstract Purpose To evaluate the effect of fibrin glue on staple-line leak after sleeve gastrectomy. Methods Fourteen adult wistar rats 300 gr were randomized into two groups: Control group (n=7) and study group (n=7). All the rats underwent sleeve gastrectomy using lineer stapler. In the study group, fibrin glue was used to reinforce the staple-line. The rats were sacrificed 7 days after surgery. The stomach was resected, submerged in saline and exposed to excess pressure to obtain a burst pressure value. The gastric staple line was evaluated histopathologically according to the Ehrlich Hunt scale. The results of the two groups were compared. Results The mean Ehrlich-Hunt scores for inflammation, fibroblastic activity and neo-angiogenesis were similar between the groups (p>0.05). Collagen deposition was significantly higher in study group (3.42±0.53) when compared with control group (2.57±0.78) (p=0.035). The mean burst pressure was 137.8±8.5 mmHg for control group and 135.0±8.1 mmHg for study group (p=0.536). Conclusion Reinforcement of the staple-line with fibrin glue has no effect on the burst pressure after sleeve gastrectomy. More studies are needed to evaluate the precautions against leak after sleeve gastrectomy.(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)

Effect of a new cross-linked hyaluronan gel on the staple line after sleeve gastrectomy in a rat model

Purpose: To evaluate the effect of a new cross-linked hyaluronan (NCHA) gel on healing of the staple line in an experimental sleeve gastrectomy.Methods: Eighteen rats were randomly divided into three groups. The control group (n = 6) received no medication. In the saline group (n = 6) and NCHA gel group (n = 6), saline and NCHA gel were respectively administered onto the staple line and intraperitoneally into the abdominal cavity after the standard stapling procedure.Results: The fibroblast activity and collagen deposition were significantly higher in the NCHA gel group than in the control group (p = 0.00, p = 0.017) and saline group (p = 0.004, p = 0.015). The tissue hydroxyproline protein level was significantly higher in the NCHA gel group than in the control group (p = 0.041). Adhesion formation was significantly lower in the NCHA gel group than in the control and saline groups (p = 0.015, p = 0.041).Conclusions: New cross-linked hyaluronan gel could be an effective approach to improve staple line wound healing and prevent potential leakage after sleeve gastrectomy. Moreover, NCHA gel helps to prevent adhesion formation without compromising healing of the staple line.(AU)

Lesões gástricas em cães não domiciliados na cidade de Fortaleza / Gastric lesions in houseless dogs in Fortaleza city

Objetivou-se avaliar a presença de lesões gástricas em cães não domiciliados da cidade de Fortaleza. Cães, ambos os sexos, idade variada e sem raça definida foram utilizados neste protocolo. Os cães provenientes de diferentes bairros da cidade de Fortaleza foram destinados ao procedimento de eutanásia pelo canil da Unidade de Vigilância de Zoonoses (UVZ) do município de Fortaleza, Ceará, Brasil. O projeto foi aprovado pelo Comitê de Ética da Universidade Estadual do Ceará. A investigação foi conduzida entre os meses de outubro e novembro de 2004. Foram utilizados 254 cães, sendo 164 machos e 90 fêmeas eutanasiados, e, em seguida, os estômagos foram removidos, abertos ao longo da curvatura maior, lavados, enxugados e avaliados macroscopicamente. As alterações gástricas foram agrupadas de acordo com a localização anatômica. A presença de lesões gástricas foi observada em 60 animais, representando 23,62%, sendo que 14,96% eram machos e 8,66% fêmeas. As alterações macroscópicas foram localizadas no corpo (51%), antro (19%) e fundo (8%) do estômago. Não foram encontradas lesões nas regiões da cárdia e pilórica. As úlceras foram as lesões encontradas com maior frequência (15,5%) acometendo 21 cães. Foram também observadas perdas de pregas da mucosa, alterações na coloração da mucosa gástrica, petéquias, hemorragias, nódulos e lacerações. Pode-se concluir que as gastropatias são frequentes em cães não domiciliados na cidade de Fortaleza. Os resultados apresentados indicam a relevância do assunto pesquisado e a contribuição para a clínica médica veterinária e, consequentemente, para a Saúde Pública.(AU)

The aim of this study was to evaluate the presence of gastric lesions in non-domiciled in the Fortaleza city. Dogs, both sexes, varied age, no race defined were used in this protocol. The dogs from different neighborhoods of Fortaleza city were assigned to the procedure of euthanasia by the Kennel of the Unidade de Vigilância de Zoonoses (UVZ) of the city of Fortaleza, Ceará, Brazil. The project was approved by the Ethics Committee of the State University of Ceará. The study was conducted between October and November 2004. A total of 254 dogs were used, of which 164 males and 90 females were euthanized, and then the stomachs were removed, opened along the greater curvature, washed, dried and macroscopically evaluated. Gastric alterations were grouped according to the anatomical location. The presence of gastric lesions was observed in 60 animals, representing 23.62%, which 14.96% were males and 8.66% females. Macroscopic alterations were found in the body (51%), antrum (19%) and fundus (8%) of the stomach. No lesions were found in the cardia and pyloric regions. Ulcers were the most frequent lesions (15.5%), affecting 21 dogs. Loss of mucosal folds was also observed; changes in the coloration of the gastric mucosa; petechiae, haemorrhages, nodules and lacerations. It can be concluded that gastropathy is frequent in dogs not domiciled in the city of Fortaleza. The results presented indicate the relevance of the subject researched and the contribution to the veterinary medical clinic and consequently to Public Health.(AU)

Lesões gástricas em cães não domiciliados na cidade de Fortaleza / Gastric lesions in houseless dogs in Fortaleza city

Objetivou-se avaliar a presença de lesões gástricas em cães não domiciliados da cidade de Fortaleza. Cães, ambos os sexos, idade variada e sem raça definida foram utilizados neste protocolo. Os cães provenientes de diferentes bairros da cidade de Fortaleza foram destinados ao procedimento de eutanásia pelo canil da Unidade de Vigilância de Zoonoses (UVZ) do município de Fortaleza, Ceará, Brasil. O projeto foi aprovado pelo Comitê de Ética da Universidade Estadual do Ceará. A investigação foi conduzida entre os meses de outubro e novembro de 2004. Foram utilizados 254 cães, sendo 164 machos e 90 fêmeas eutanasiados, e, em seguida, os estômagos foram removidos, abertos ao longo da curvatura maior, lavados, enxugados e avaliados macroscopicamente. As alterações gástricas foram agrupadas de acordo com a localização anatômica. A presença de lesões gástricas foi observada em 60 animais, representando 23,62%, sendo que 14,96% eram machos e 8,66% fêmeas. As alterações macroscópicas foram localizadas no corpo (51%), antro (19%) e fundo (8%) do estômago. Não foram encontradas lesões nas regiões da cárdia e pilórica. As úlceras foram as lesões encontradas com maior frequência (15,5%) acometendo 21 cães. Foram também observadas perdas de pregas da mucosa, alterações na coloração da mucosa gástrica, petéquias, hemorragias, nódulos e lacerações. Pode-se concluir que as gastropatias são frequentes em cães não domiciliados na cidade de Fortaleza. Os resultados apresentados indicam a relevância do assunto pesquisado e a contribuição para a clínica médica veterinária e, consequentemente, para a Saúde Pública.

The aim of this study was to evaluate the presence of gastric lesions in non-domiciled in the Fortaleza city. Dogs, both sexes, varied age, no race defined were used in this protocol. The dogs from different neighborhoods of Fortaleza city were assigned to the procedure of euthanasia by the Kennel of the Unidade de Vigilância de Zoonoses (UVZ) of the city of Fortaleza, Ceará, Brazil. The project was approved by the Ethics Committee of the State University of Ceará. The study was conducted between October and November 2004. A total of 254 dogs were used, of which 164 males and 90 females were euthanized, and then the stomachs were removed, opened along the greater curvature, washed, dried and macroscopically evaluated. Gastric alterations were grouped according to the anatomical location. The presence of gastric lesions was observed in 60 animals, representing 23.62%, which 14.96% were males and 8.66% females. Macroscopic alterations were found in the body (51%), antrum (19%) and fundus (8%) of the stomach. No lesions were found in the cardia and pyloric regions. Ulcers were the most frequent lesions (15.5%), affecting 21 dogs. Loss of mucosal folds was also observed; changes in the coloration of the gastric mucosa; petechiae, haemorrhages, nodules and lacerations. It can be concluded that gastropathy is frequent in dogs not domiciled in the city of Fortaleza. The results presented indicate the relevance of the subject researched and the contribution to the veterinary medical clinic and consequently to Public Health.

Fibroplasia esclerosante eosinofílica gastrointestinal felina: relato de caso / Feline gastrointestinal eosinophilic sclerosing fibroplasia: case report

A fibroplasia esclerosante eosinofílica gastrointestinal felina (FEEGF) é uma condição inflamatória que acomete gatos domésticos, cuja etiologia é desconhecida. A principal forma de apresentação da doença é uma massa intramural, firme e irregular, localizada na região do trato gastrointestinal. Objetivou-se relatar o caso de um gato persa diagnosticado com FEEGF. O animal apresentava histórico de vômito e diarreia. No exame físico foi verificado espessamento de alças intestinais, confirmado com o exame ultrassonográfico. Optou-se por uma celiotomia exploratória e remoção do tecido intestinal afetado, que incluiu pilorectomia associada à gastroduodenostomia. Fragmentos de intestino e pâncreas foram enviados para histopatológico, sendo os achados compatíveis com FEEGF e pancreatite, respectivamente. Observou-se também extensão focal do processo inflamatório para tecido adiposo mesogástrico. O envolvimento pancreático e hepático pode ter contribuído para a piora do animal, que veio a óbito algumas semanas após cirurgia. Com o presente trabalho, pudemos contribuir para um maior entendimento da FEEGF, principalmente, em suas características clínicas, diagnósticas, histopatológicas e terapêuticas.

Feline gastrointestinal eosinophilic sclerosing fibroplasia (FEEGF) is an inflammatory condition affecting domestic cats, the etiology of which is unknown. The main form of presentation of the disease is anintramural, firm and irregular mass, located in the region of the gastrointestinal tract. The objective was to report the case of a persian cat diagnosed with FEEGF. The animal has a history of vomiting and diarrhea. Physical examination revealed thickening of intestinal loops, confirmed by ultrasonographic examination. We chose an exploratory celiotomy and removal of affected intestinal tissue, which included pilorectomy associated with gastroduodenostomy. Fragments of intestine and pancreas were sent to histopathological, and the findings were compatible with FEEGF and pancreatitis, respectively. It was also observed focal extension of the inflammatory process to mesogastric adipose tissue. Pancreatic and hepatic involvement may have contributed to a worsening animal, which died a few weeks after surgery. With the present study we could contribute to a greater understanding of FEEGF, mainly in its clinical, diagnostic, histopathological and therapeutic characteristics.

Fibroplasia esclerosante eosinofílica gastrointestinal felina: relato de caso / Feline gastrointestinal eosinophilic sclerosing fibroplasia: case report

A fibroplasia esclerosante eosinofílica gastrointestinal felina (FEEGF) é uma condição inflamatória que acomete gatos domésticos, cuja etiologia é desconhecida. A principal forma de apresentação da doença é uma massa intramural, firme e irregular, localizada na região do trato gastrointestinal. Objetivou-se relatar o caso de um gato persa diagnosticado com FEEGF. O animal apresentava histórico de vômito e diarreia. No exame físico foi verificado espessamento de alças intestinais, confirmado com o exame ultrassonográfico. Optou-se por uma celiotomia exploratória e remoção do tecido intestinal afetado, que incluiu pilorectomia associada à gastroduodenostomia. Fragmentos de intestino e pâncreas foram enviados para histopatológico, sendo os achados compatíveis com FEEGF e pancreatite, respectivamente. Observou-se também extensão focal do processo inflamatório para tecido adiposo mesogástrico. O envolvimento pancreático e hepático pode ter contribuído para a piora do animal, que veio a óbito algumas semanas após cirurgia. Com o presente trabalho, pudemos contribuir para um maior entendimento da FEEGF, principalmente, em suas características clínicas, diagnósticas, histopatológicas e terapêuticas.(AU)

Feline gastrointestinal eosinophilic sclerosing fibroplasia (FEEGF) is an inflammatory condition affecting domestic cats, the etiology of which is unknown. The main form of presentation of the disease is anintramural, firm and irregular mass, located in the region of the gastrointestinal tract. The objective was to report the case of a persian cat diagnosed with FEEGF. The animal has a history of vomiting and diarrhea. Physical examination revealed thickening of intestinal loops, confirmed by ultrasonographic examination. We chose an exploratory celiotomy and removal of affected intestinal tissue, which included pilorectomy associated with gastroduodenostomy. Fragments of intestine and pancreas were sent to histopathological, and the findings were compatible with FEEGF and pancreatitis, respectively. It was also observed focal extension of the inflammatory process to mesogastric adipose tissue. Pancreatic and hepatic involvement may have contributed to a worsening animal, which died a few weeks after surgery. With the present study we could contribute to a greater understanding of FEEGF, mainly in its clinical, diagnostic, histopathological and therapeutic characteristics.(AU)

Impacts of albumin synergized with hydroxyethyl starch on early microvascular albumin leakage after major abdominal surgery in rabbits

Purpose: To investigate the impacts of albumin synergized with hydroxyethyl starch (HES) on early microvascular albumin leakage after major abdominal surgery in rabbits. Methods: Forty male Japanese rabbits were randomly divided into four groups: the control group, the saline group, the albumin group, and the Syn group (hydroxyethyl starch+albumin). The latter three groups were performed gastrectomy plus resection of pancreatic body and tail and splenectomy. The serum albumin concentration was detected before and 48h after surgery, and the conditions of mesenteric microvascular leakage in these 4 groups were observed under microscope 48 h after surgery to calculate the leakage rate. Results: Compared with the saline group, the albumin group and the Syn group exhibited significantly increased serum albumin concentrations 48h after surgery (P 0.05). The albumin leakage rate was the most obvious in the albumin group, followed by the saline group, while that in the Syn group was the minimal, and there existed significant differences among these groups (P 0.05) . Conclusion: Simple administration of albumin in the early stage after major abdominal surgery could increase the albumin leakage, while the synergization of albumin and hydroxyethyl starch could reduce the albumin leakage.(AU)

Vertical gastrectomy in overweight and non-overweight rats

PURPOSE:To compare the two lines suture (total and seromuscular) after partial gastrectomy in normal and overweight rats.METHODS:Forty Wistar rats were distributed in two groups. Group A received normal diet; group B, normal diet and supplementation with saccharose in the water. When group B progressed to a statistically greater weight than the animals of group A, the experiment (sleeve-like gastrectomy) was conducted with gastrorraphy in two sutures lines (total and seromuscular).The animals were distributed into two subgroups of 10. A1 and A2 subgroups were sacrificed at 7 and 14 days postoperatively as well as B1 and B2. Mortality, morbidity, complications attributed to the gastric suture, biochemical dosages, Lee index, macroscopy, weight of retroperitoneal and gonadal fat, optical microscopy with hematoxylin-eosin and picrosirius-red, were the evaluation parameters.RESULTS:The overweight group achieved statistically greater weight after 16 weeks in induced obesity; there was no mortality or complications with clinical consequences attributable to morbidity. The overweight group had statistically greater weight of gonadal and retroperitoneal fat. The difference was observed in urea, albumin, total cholesterol and indirect bilirubin.CONCLUSION:There was no outcome difference between the overweight and non-overweight group in two suture lines in gastrorrhaphy after sleeve-like gastrectomy.(AU)

Alterations of the gastric stump and not resected stomach mucosa after truncal vagotomy in rats

To evaluate morphological changes of the gastric stump and not resected stomach mucosa after the completion of truncal vagotomy. METHODS: Eighty male Wistar rats were divided into four groups: CT, TV, RY and RYTV. In CT group, abdominal viscera were manipulated and the abdominal cavity was closed, in TV vagal trunks were isolated and sectioned, in RY a partial Roux-en-Y gastrectomy was performed and in RYTV the vagal trunks were sectioned and a partial Roux-en-Y gastrectomy was performed. At the 54th week after surgery, the rats were euthanized. The findings were submitted to histological analyses. RESULTS: None macroscopic or histological alterations in groups TV and CT was observed. Specimens from RY and RYTV groups did not show alterations in the gastric stump mucosa. At the jejunal side of the gastroenterostomy we found shallow ulcerative lesions always single, well-defined and with variable diameter 3 to 6 mm, six times in the RY group and none in the RYTV group (RY>RYTV, p=0.008). Neoplastic or preneoplastic lesions were not diagnosed in all groups. CONCLUSION: Truncal vagotomy is a safe and non-carcinogenic method in not resected and partially resected stomach.(AU)

Quantitative immunohistochemical analysis of duodenal ghrelin cells after sleeve gastrectomy in Wistar rats / Análise imunoistoquímica quantitativa das células de grelina duodenais após gastrectomia vertical em ratos Wistar

PURPOSE: Sleeve gastrectomy (SG) removes substantial part of the gastric mucosa, which produces ghrelin. This reduction is expected to force other organs, such as the duodenum, to compensate by increasing the number of ghrelin-producing cells. The purpose of this study was to evaluate whether this response occurs. METHODS: Twelve adult male, Wistar rats underwent SG and were reoperated 30 or 60 days after the initial surgery. During the second surgery, a segment of the duodenum was resected to count ghrelin cells using immunohistochemistry. In six animals, SG was not performed, and the duodenal segment served as a control for ghrelin cell counts. The ghrelin cell index (GCI), which is the number of ghrelin cells divided by the number of villi in each segment, was measured and used in statistical analysis by one-way analysis of variance (ANOVA). RESULTS:There were increases in the absolute numbers of cells 30 and 60 days after SG, but statistical analysis by ANOVA showed no significant difference between the groups. CONCLUSION: A compensatory increase in the number of duodenal immunopositive ghrelin cells did not occur as a response to sleeve gastrectomy.(AU)

OBJETIVO: A gastrectomia vertical (GV) remove a maior parte das células produtoras de grelina. Esta redução poderia induzir o duodeno a produzir mais células de grelina de forma compensadora. O objetivo deste trabalho foi estudar se esta compensação ocorre. MÉTODOS: Doze ratos Wistar, machos, foram submetidos à GV e reoperados 30 e 60 dias depois (grupos 30D e 60D) quando um segmento de duodeno foi ressecado para contagem de células de grelina por imunoistoquímica. Em seis animais não foi realizada a GV e um segmento de duodeno foi ressecado para contagem de células de grelina por imunoistoquímica (grupo controle). O índice de células de grelina (ICG), que é o número de células imunopositivas para grelina dividido pelo número de vilosidades do segmento foi calculado e utilizado na análise estatística pelo teste da análise de variância (ANOVA). RESULTADOS: Houve aumento no número absoluto de células 30 e 60 dias depois da gastrectomia vertical, mas a análise estatística por ANOVA não mostrou diferenças significantes entre os grupos. CONCLUSÃO: Não foi observado aumento compensatório no número de células de grelina duodenais após a gastroplastia vertical.(AU)

Perioperative care in an animal model for training in abdominal surgery: is it necessary a preoperative fasting? / Cuidados perioperatórios em modelo animal de treinamento em cirurgia abdominal: é necessário jejum pré-operatório?

PURPOSE: Demonstrate that the rabbit may be used in the training of surgery, in addition to present its perioperative care. METHODS: Thirty two animals, with age and weight, respectively, from 3 to 5.5 months old and 3000 to 4200 grams, were undergone different periods of pre-operative fasting, exclusive intramuscular anesthesia (ketamine+xylazine), laparotomy with total gastrectomy and total splenectomy. It was dosed the pre-operative (initial) and post-surgical (end) serum blood glucose, in addition to quantify the gastric content after the resection of the part. RESULTS: The anesthetical-surgical procedure presented a mortality rate of 3.125% (1:32) and a morbidity rate of 6.25% (2:32). It was evidenced an initial mean blood glucose = 199.4 mg/dl and the end = 326.1 mg/dl. In spite of extended fasting (minimum of 2 hours for the absolute fasting and maximum of 8.5 hours for liquids, and 20.5 hours for solids) all animals presented at the end of the surgical procedure any gastric content and a blood glucose increase. Those with fasting for liquids and solids when compared to the quantity of solid gastric content, presented a moderate negative degree of correlation. CONCLUSION: The rabbit is a good model to be used in training of surgery, with a low morbi-mortality, able to be anesthetized intramuscularly, with no need of pre-operative fasting and does not present hypoglycemia even with the extended fasting period.(AU)

OBJETIVO: Demonstrar que o coelho pode ser utilizado no treinamento em cirurgia, além de apresentar seus cuidados perioperatórios. MÉTODOS: Trinta e dois animais, com idade e peso respectivamente, entre 3 a 5,5 meses e 3000 a 4200 gramas, foram submetidos a variados tempos de jejum pré-operatório, anestesia intramuscular exclusiva (quetamina+xilasina), laparotomia com gastrectomia e esplenectomia totais. Dosou-se a glicemia sérica pré-operatória (inicial) e pós-cirúrgica (final), além de quantificado o conteúdo gástrico pós-gastrectomia. RESULTADOS: O procedimento anestésico-cirúrgico apresentou taxa de mortalidade de 3,125 % (1:32) e morbidade de 6,25 % (2:32). Evidenciou-se glicemia média inicial = 199,4 mg/dl e final = 326,1 mg/dl. Apesar de jejuns prolongados (mínimo de 2 horas para jejum absoluto e máximo de 8,5 horas para líquidos, e 20,5 horas para sólidos) todos os animais apresentaram no final do procedimento cirúrgico algum conteúdo gástrico e aumento da glicemia. Aqueles com jejum para líquidos e sólidos quando comparados com a quantidade de conteúdo gástrico sólido e total apresentaram grau moderadamente negativo de correlação linear. CONCLUSÃO: O coelho é um bom modelo para ser utilizado em treinamento de cirurgia, com baixa morbimortalidade, passível de ser anestesiado por via intramuscular, sem necessidade de jejum pré-operatório e ausência de hipoglicemia.(AU)

Ingestion of polydextrose increase the iron absorption in rats submitted to partial gastrectomy / A ingestão de polidextrose aumenta a absorção de ferro em ratos submetidos à gastrectomia parcial

PURPOSE: To investigate whether polydextrose stimulates iron absorption in rats submitted to partial gastrectomy and sham operated. METHODS: The rats were submitted to partial gastrectomy (Billroth II) or laparotomy (sham-operated control), in groups of 20 and 20 each respectively. The animals were fed with a control diet (AIN-93M) without polydextrose or a diet containing polydextrose (50g/Kg of diet) for eight weeks. They were divided into four subgroups: sham-operated and Billroth II gastrectomy and with or without polydextrose. Two animals died during the experiment. All rats submitted to gastrectomy received B-12 vitamin (intramuscular) each two weeks. The hematocrit and hemoglobin concentration were measured at the start and on day 30 and 56 after the beginning of the experimental period. At the end of the study, the blood was collected for determination of serum iron concentration. RESULTS: The diet with polydextrose reduced the excretion of iron. Apparent iron absorption was higher in the polydextrose fed groups than in the control group. The haematocrit and haemoglobin concentration were lower after Billroth II gastrectomy rats fed the control diet as compared to the polydextrose diet groups. CONCLUSION: Polydextrose increase iron absorption and prevents postgastrectomy anemia.(AU)

OBJETIVO: Investigar se a polidextrose estimula a absorção de ferro em ratos submetidos à gastrectomia parcial e sham operados. MÉTODOS: Os ratos foram submetidos à gastrectomia parcial (Billroth II) e à laparotomia (controle sham-operados) em grupos de 20 e 20 cada, respectivamente. Os animais foram alimentados com uma dieta controle (AIN-93M), sem polidextrose ou uma dieta contendo polidextrose (50g/kg de dieta) durante oito semanas. Foram divididos em quatro grupos: sham-operados e com gastrectomia BII e com ou sem polidextrose. Dois animais morreram durante o experimento. Todos os ratos com gastrectomia receberam vitamina B-12 (intramuscular) a cada duas semanas. O hematócrito e a hemoglobina foram dosados no início e nos dias 30 e 56 após o início do período experimental. No final do estudo, o sangue foi coletado para determinação da concentração de ferro sérico. RESULTADOS: A dieta com polidextrose reduziu a excreção de ferro e a absorção de ferro aparente foi maior nos grupos alimentados com polidextrose do que no grupo controle. As dosagens de hematócrito e hemoglobina foram menores em ratos com gastrectomia alimentados com a dieta controle em relação aos grupos de dieta com polidextrose. CONCLUSÃO: A polidextrose aumenta a absorção do ferro e previne a anemia pós-gastrectomia.(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.