RESUMO
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.
Assuntos
Gastrectomia , Redução de Peso , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Obesidade/cirurgia , Período Pós-Operatório , Estudos RetrospectivosRESUMO
BACKGROUND: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. AIM: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. METHODS: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. RESULTS: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. CONCLUSION: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.
Assuntos
Gastrectomia/métodos , Refluxo Gastroesofágico/etiologia , Laparoscopia/efeitos adversos , Obesidade/cirurgia , Animais , Gastrectomia/efeitos adversos , Humanos , Obesidade Mórbida , Distribuição Aleatória , Ratos , Ratos WistarRESUMO
BACKGROUND AND OBJECTIVES: Opioids are associated with sedation and respiratory depression. The primary objective of this study was to assess pain intensity after gastric bypass with lidocaine. The secondary objective was to assess the IL-6 concentration, consumption of morphine, time to morphine request, time to extubation, and side effects. METHODS: Sixty patients aged 18 to 60 years, with ASA (American Society of Anesthesiologists) scores of 2 or 3, who underwent bariatric surgery were allocated to two groups. Patients in group 1 were administered lidocaine (1.5 mg/kg) 5 min before the induction of anesthesia, and group 2 was administered 0.9% saline solution in an equal volume. Subsequently, lidocaine (2 mg/kg/h) or 0.9% saline was infused during the entire surgical procedure. Anesthesia was performed with fentanyl (5 µg/kg), propofol, rocuronium, and sevoflurane. Postoperative patient-controlled analgesia was provided with morphine. The following were evaluated: pain intensity, IL-6, 24-h consumption of morphine, time to the morphine request, time to extubation, and adverse effects. RESULTS: The lidocaine group had a lower pain intensity than the saline group for up to 1 h, with no differences between groups in IL-6 and time to extubation. The lidocaine group consumed less morphine within 24 h, had a longer time until the first supplemental morphine request, and had a lower incidence of nausea. CONCLUSIONS: Lidocaine reduced the intensity of early postoperative pain, incidence of nausea, and consumption of morphine within 24 h and increased time to the first morphine request, without reducing the plasma concentrations of IL-6.
Assuntos
Gastroplastia , Laparoscopia , Obesidade Mórbida , Adolescente , Adulto , Analgésicos Opioides , Anestésicos Locais , Método Duplo-Cego , Humanos , Interleucina-6 , Lidocaína , Pessoa de Meia-Idade , Morfina , Obesidade Mórbida/cirurgia , Medição da Dor , Dor Pós-Operatória/tratamento farmacológico , Adulto JovemRESUMO
PURPOSE: To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. METHODS: The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. RESULTS: Most patients were female (Bypass - 56% and Sleeve - 67.4%) and aged between 30 and 39 years old (Bypass - 32% and Sleeve - 55.8%). Information (Bypass - 92% and Sleeve - 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass - 92% and Sleeve - 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. CONCLUSIONS: Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.
Assuntos
Derivação Gástrica , Gastroplastia , Laparoscopia , Obesidade Mórbida , Adolescente , Adulto , Idoso , Feminino , Gastrectomia , Hospitais Privados , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento , Redução de Peso , Adulto JovemRESUMO
BACKGROUND: Type-2 diabetes (T2D) patients with body mass index (BMI) below 35 kg/m2 carry lower remission rates than severely obese T2D individuals submitted to "standard limb lengths" Roux-en-Y gastric bypass (RYGB). Mild-obese patients appear to have more severe forms of T2D, where the mechanisms of glycemic control after a standard-RYGB may be insufficient. The elongation of the biliopancreatic limb may lead to greater stimulation of the distal intestine, alterations in bile acids and intestinal microbiota, among other mechanisms, leading to better metabolic outcomes. The aim of this study is to evaluate the safety and efficacy of the RYGB with a biliopancreatic limb of 200 cm in the control of T2D in patients with BMI 30-35 kg/m2. METHODS: From January 2011 to May 2015, 102 T2D patients with BMI from 30 to 34.9 kg/m2 underwent laparoscopic RYGB with the biliopancreatic-limb of 200 cm and the alimentary-limb of 50 cm. RESULTS: There were no deaths or reoperations. The mean follow-up was 28.1 months. The mean BMI dropped from 32.5 to 25.1 kg/m2, while the mean fasting glucose decreased from 182.9 to 89.8 mg/dl and the mean glycated hemoglobin (HbA1c) went from 8.7 to 5.2%. During follow-up, 92.2% had their T2D under complete control (HbA1c < 6%, no anti-diabetic medications), while 7.8% were under partial control. Control of hypertension and dyslipidemia were 89.4 and 85.5%, respectively. No patient developed hypoalbuminemia, and there were mild micronutrient deficiencies. CONCLUSIONS: RYGB with long-biliopancreatic and short-alimentary limbs is safe and seems effective in achieving complete control of T2D in patients with BMIs between 30 and 35 kg/m2.
Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica/métodos , Obesidade/cirurgia , Adulto , Glicemia/metabolismo , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/prevenção & controle , Feminino , Derivação Gástrica/efeitos adversos , Hemoglobinas Glicadas/metabolismo , Humanos , Hipertensão/prevenção & controle , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/patologia , Índice de Gravidade de Doença , Resultado do Tratamento , Redução de PesoRESUMO
ABSTRACT 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.
Assuntos
Humanos , Feminino , Adulto , Redução de Peso , Gastrectomia , Período Pós-Operatório , Estudos Retrospectivos , Seguimentos , Pessoa de Meia-Idade , Obesidade/cirurgiaRESUMO
BACKGROUND: Among Roux-en-Y gastric bypass complications is the occurrence of intestinal obstruction by the appearance of internal hernias, which may occur in Petersen space or the opening in mesenteric enteroenteroanastomosis. AIM: To evaluate the efficiency and safety in performing a fixing jejunal maneuver in the transverse mesocolon to prevent internal hernia formation in Petersen space. METHOD: Two surgical points between the jejunum and the transverse mesocolon, being 5 cm and 10 cm from duodenojejunal angle are made. In all patients was left Petersen space open and closing the opening of the mesenteric enteroenteroanastomosis. RESULTS: Among 52 operated patients, 35 were women (67.3%). The age ranged 18-63 years, mean 39.2 years. BMI ranged from 35 to 56 kg/m2 (mean 40.5 kg/m2). Mean follow-up was 15.1 months (12-18 months). The operative time ranged from 68-138 min. There were no intraoperative complications, and there were no major postoperative complications and no reoperations. The hospital stay ranged from 2-3 days. During the follow-up, no one patient developed suspect clinical presentation of internal hernia. Follow-up in nine patients (17.3%) showed asymptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy. During these procedures were verified the Petersen space and jejunal fixation. In all nine, there was no herniation of the jejunum to the right side in Petersen space. CONCLUSION: The fixation of the first part of the jejunum to left side of the transverse mesocolon is safe and effective to prevent internal Petersen hernia in RYGB postoperatively in the short and medium term. It may be interesting alternative to closing the Petersen space.
Assuntos
Derivação Gástrica/métodos , Hérnia/prevenção & controle , Jejuno , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , Mesocolo , Pessoa de Meia-Idade , Adulto JovemRESUMO
Abstract Purpose: To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. Methods: The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. Results: Most patients were female (Bypass - 56% and Sleeve - 67.4%) and aged between 30 and 39 years old (Bypass - 32% and Sleeve - 55.8%). Information (Bypass - 92% and Sleeve - 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass - 92% and Sleeve - 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. Conclusions: Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Adulto Jovem , Obesidade Mórbida/cirurgia , Derivação Gástrica , Gastroplastia , Laparoscopia , Complicações Pós-Operatórias , Redução de Peso , Estudos Retrospectivos , Hospitais Privados , Resultado do Tratamento , Gastrectomia , Pessoa de Meia-IdadeRESUMO
ABSTRACT Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.
RESUMO Racional: A gastrectomia vertical ampliada é uma variação da técnica da gastrectomia vertical, necessitando de estudos a fim de elucidar a segurança em relação ao refluxo gastroesofágico. Objetivo: Analisar comparativamente gastrectomia vertical (GV) e gastrectomia vertical ampliada (GVA) em ratos com obesidade induzida por dieta cafeteria em relação à presença de esofagite de refluxo, perda de peso e alterações macroscópicas relacionadas aos procedimentos. Método: Trinta ratos Wistar foram randomizados em três grupos, e após período de indução de obesidade por meio de dieta cafeteria de 28 dias, foram submetidos a operação simulada (grupo controle GC), gastrectomia vertical (grupo GV) e gastrectomia vertical ampliada (grupo GVA). Os animais foram acompanhados por 28 dias no pós-operatório e, após a eutanásia, foi realizada a pesquisa de esofagite de refluxo através de avaliação histopatológica. Peso e avaliação macroscópica foram as outras variáveis de estudo, sendo o peso aferido semanalmente e a avaliação macroscópica no momento da eutanásia. Resultados: Todos os animais apresentaram algum grau de inflamação e a presença de ao menos um critério de inflamação, porém, não houve diferença estatisticamente significante na análise entre os grupos. Em relação à perda de peso, os animais do GC apresentaram aumento gradativo durante todo experimento evoluindo para super-obesidade ao término do estudo, enquanto os dos grupos GV e GVA tiveram reganho de peso após a primeira semana do pós-operatório, porém, reganho menos acentuado se comparável ao GC, tanto para GV quanto para GVA. Conclusões: Não há diferença em relação à esofagite de refluxo entre GV e GVA, bem como em relação às alterações macroscópicas. Ambas as técnicas têm capacidade de controlar a evolução do peso no pós-operatório em relação ao grupo controle.
Assuntos
Humanos , Animais , Ratos , Refluxo Gastroesofágico/etiologia , Laparoscopia/efeitos adversos , Gastrectomia/métodos , Obesidade/cirurgia , Distribuição Aleatória , Ratos Wistar , Gastrectomia/efeitos adversosRESUMO
INTRODUCTION: The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. There is a tendency to increase its application due to proved efficiency in weight loss, low morbidity and good postoperative results. However, gastroesophageal reflux disease, which can result from it, is still not well understood. AIM: To present variant technique for sleeve gastrectomy that leaves the stomach totally with the appearance of a homogeneous tube, without manipulation in pyloric and lower esophageal sphincters. TECNIQUE: Vertical gastrectomy starts with vessel ligation of the greater curvature at the pylorus till esophagogastric angle. Stapling also starts from the pylorus in the same direction. For modeling was used Fouchet 32 F and all the staple line was done just to it. At the end, oversuture of the staple line and "sump" drainage were done. RESULTS: The procedure was used in 55 patients with BMI between 35 and 41. Complications in this group were two fistulas at the esophagogastric angle, one twist of the gastric tube and one postoperative conversion to Roux-en-Y gastric bypass due to untreatable gastroesophageal reflux disease. Fistulas were treated by endoscopic procedure with dilation and septotomy. Mild dysphagia due to tube twisting responded satisfactorily to dilatation. The longest follow-up was two years. The loss of overweight was 67.7% at one year and 69.7% in two. Patients who were suffering from type 2 diabetes mellitus showed disease control in 84.6 % in the first year and 91.6 % in the second. Comorbidities were controlled in all cases. CONCLUSION: The variant technique proposed here for sleeve gastrectomy leaves the stomach homogeneously in a shape of a tube and in small caliber, providing small free gastric cavity and keeping natural functional activity of the sphincters. However, it may lead to unwanted gastroesophageal reflux, which needs to be better measured in future research.
Assuntos
Gastrectomia/métodos , Obesidade/cirurgia , HumanosRESUMO
Background: Among Roux-en-Y gastric bypass complications is the occurrence of intestinal obstruction by the appearance of internal hernias, which may occur in Petersen space or the opening in mesenteric enteroenteroanastomosis.Aim: To evaluate the efficiency and safety in performing a fixing jejunal maneuver in the transverse mesocolon to prevent internal hernia formation in Petersen space.Method: Two surgical points between the jejunum and the transverse mesocolon, being 5 cm and 10 cm from duodenojejunal angle are made. In all patients was left Petersen space open and closing the opening of the mesenteric enteroenteroanastomosis.Results: Among 52 operated patients, 35 were women (67.3%). The age ranged 18-63 years, mean 39.2 years. BMI ranged from 35 to 56 kg/m2 (mean 40.5 kg/m2). Mean follow-up was 15.1 months (12-18 months). The operative time ranged from 68-138 min. There were no intraoperative complications, and there were no major postoperative complications and no reoperations. The hospital stay ranged from 2-3 days. During the follow-up, no one patient developed suspect clinical presentation of internal hernia. Follow-up in nine patients (17.3%) showed asymptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy. During these procedures were verified the Petersen space and jejunal fixation. In all nine, there was no herniation of the jejunum to the right side in Petersen space.Conclusion: The fixation of the first part of the jejunum to left side of the transverse mesocolon is safe and effective to prevent internal Petersen hernia in RYGB postoperatively in the short and medium term. It may be interesting alternative to closing the Petersen space.
Racional: Entre outras complicações do bypass gástrico em Y-de-Roux está a ocorrência de obstrução intestinal pelo aparecimento de hérnias internas, que podem ocorrer no espaço de Petersen ou na abertura mesentérica da enteroenteroanastomose.Objetivo: Avaliar a eficiência e a segurança da realização de uma manobra de fixação do jejuno no mesocólon transverso para evitar formação de hérnia interna no espaço de Petersen.Método: Realizam-se dois pontos de fixação entre o jejuno e o mesocólon transverso, sendo um a 5 cm e outro a 10 cm do ângulo duodenojejunal. Em todos os pacientes foi deixado o espaço de Petersen aberto e realizado o fechamento da abertura mesentérica da enteroenteroanastomose.Resultados: Entre 52 pacientes estudados, 35 eram do sexo feminino (67,3%). A idade variou de 18 a 63 anos, com média de 39,2 anos. O IMC variou de 35 a 56 kg/m2 (média de 40,5 kg/m2). O seguimento médio foi de 15,1 meses (de 12 a 18 meses). O tempo operatório variou de 68-138 min. Não ocorreram intercorrências intra-operatórias, assim como não houve complicações pós-operatórias maiores e nem reoperações. O período de internação hospitalar variou de 2-3 dias. Durante o seguimento, nenhum paciente desenvolveu quadro suspeito de hérnia interna. Neste período, nove pacientes (17,3%) apresentaram quadro de colecistolitíase (por microcálculos) assintomática, e foram submetidos à colecistectomia videolaparoscópica eletiva. Durante estes procedimentos foram verificados o espaço de Petersen e a fixação jejunal. Em todos os nove, não havia herniação do jejuno para o lado direito do espaço de Petersen.Conclusão: A fixação da primeira parte do jejuno ao lado esquerdo do mesocólon transverso é segura e eficiente para evitar hérnia interna de Petersen em pós-operatório de BGYR no curto e médio prazo. Pode ser interessante alternativa ao fechamento do espaço de Petersen.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Derivação Gástrica/métodos , Hérnia/prevenção & controle , Jejuno , Complicações Pós-Operatórias/prevenção & controle , MesocoloRESUMO
INTRODUÇÃO: A técnica operatória da gastrectomia vertical ainda não foi totalmente padronizada e, por isso, existem questões a serem resolvidas. Há tendência dela ter seu uso cada vez mais frequente, uma vez que já provou ser efetiva na perda de peso, com baixa morbimortalidade e bons resultados pós-operatórios. Contudo, a doença do refluxo gastroesofágico, que pode dela resultar, ainda não está bem elucidada. OBJETIVO: Apresentar variante técnica para a gastrectomia vertical que deixa o estômago totalmente tubulizado e sem manipulação nos esfíncteres pilórico e esofágico inferior. TÉCNICA: Inicia-se a gastrectomia vertical com a ligadura dos vasos da grande curvatura tendo como referência anatômica o piloro até o ângulo esofagogástrico. O grampeamento inicia-se também a partir do piloro na mesma direção. Para modelagem é utilizada sonda de Fouchet 32 F . O grampeamento é feito justo à sonda modeladora. Finaliza-se com sobressutura da linha de grampeamento e drenagem tipo "sump". RESULTADOS: O procedimento foi utilizado em 55 pacientes portadores de IMC entre 35 e 41. As complicações nesse grupo foram: duas fístulas ao nível do ângulo esofagogástrico, uma torção do tubo gástrico e uma conversão pós-operatória para derivação gástrica em Y-de-Roux por refluxo gastroesofágico intratável com medicamentos. As fístulas foram tratadas por procedimento endoscópico com dilatação e septotomia. Disfagia leve por torção respondeu satisfatoriamente com dilatação endoscópica. O maior período de seguimento foi de dois anos. A perda do excesso de peso foi de de 67,7% em um ano e de 69,7% em dois. Os pacientes que eram portadores de diabete melito tipo 2 apresentaram controle da doença em 84,6% no primeiro ano e 91,6% no segundo. Outras comorbidades tiveram controle em todos os casos. CONCLUSÃO: A variante técnica proposta para a gastrectomia vertical deixa o estômago totalmente tubulizado, em pequeno calibre, propiciando diminuição da cavidade gástrica livre e manutenção da atividade funcional dos esfíncteres naturais. Contudo, pode levar a refluxo gastroesofágico indesejado, que precisa ser melhor mensurado em pesquisas futuras.
INTRODUCTION: The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. There is a tendency to increase its application due to proved efficiency in weight loss, low morbidity and good postoperative results. However, gastroesophageal reflux disease, which can result from it, is still not well understood. AIM: To present variant technique for sleeve gastrectomy that leaves the stomach totally with the appearance of a homogeneous tube, without manipulation in pyloric and lower esophageal sphincters. TECNIQUE: Vertical gastrectomy starts with vessel ligation of the greater curvature at the pylorus till esophagogastric angle. Stapling also starts from the pylorus in the same direction. For modeling was used Fouchet 32 F and all the staple line was done just to it. At the end, oversuture of the staple line and "sump" drainage were done. RESULTS: The procedure was used in 55 patients with BMI between 35 and 41. Complications in this group were two fistulas at the esophagogastric angle, one twist of the gastric tube and one postoperative conversion to Roux-en-Y gastric bypass due to untreatable gastroesophageal reflux disease. Fistulas were treated by endoscopic procedure with dilation and septotomy. Mild dysphagia due to tube twisting responded satisfactorily to dilatation. The longest follow-up was two years. The loss of overweight was 67.7% at one year and 69.7% in two. Patients who were suffering from type 2 diabetes mellitus showed disease control in 84.6 % in the first year and 91.6 % in the second. Comorbidities were controlled in all cases. CONCLUSION: The variant technique proposed here for sleeve gastrectomy leaves the stomach homogeneously in a shape of a tube and in small caliber, providing small free gastric cavity and keeping natural functional activity of the sphincters. However, it may lead to unwanted gastroesophageal reflux, which needs to be better measured in future research.
Assuntos
Humanos , Gastrectomia/métodos , Obesidade/cirurgiaRESUMO
Este estudo tem por objetivo analisar experimentalmente as características macroscópicas e microscópicas de cálculos biliares humanos na cavidade peritoneal de ratos. Foram utilizados 32 ratos Wistar, machos, pesando entre 205 e 268 g. Estes animais foram distribuídos em dois grupos e o procedimento cirúrgico foi realizado em cada grupo: no grupo A (n=16), os animais foram submetidos a manipulaçao intestinal; no grupo B (n=16), cálculos biliares humanos foram colocados na cavidade peritoneal. Os ratos foram avaliados no 21º e 42º dias do período pós-operatório. Os resultados mostraram que a simples manipulaçao causou aderências no animais (n=10). As aderências foram notadas em 11 cálculos no grupo B. Histologicamente nao houve fibrose intensa em torno do cálculo, principalmente no 42º dia do período pós-operatório. Nao foram observados macro ou micro abscessos e nao houve evidências de fluído livre intra-peritoneal. Este estudo demonstra que apesar da baixa incidência de complicaçoes, todas as tentativas devem ser feitas para recuperar cálculos perdidos durante colecistectomia.
Assuntos
Animais , Ratos , Colecistectomia Laparoscópica , Colelitíase , Cavidade Peritoneal , Etil-Éteres/administração & dosagem , Ratos WistarRESUMO
Os autores apresentam estudo retrospectivo de 78 pacientes submetidos a laparotomia exploradora desnecessária devido a traumatismo abdominal contuso e penetrante, no Serviço de Cirurgia de Urgência do Hospital Municipal Djalma Marques, em Säo Luiz-MA, no período de maio de 1990 a outubro de 1992. O índice de achados negativos em relaçäo a todas as laparotomias por trauma abdominal naquele período foi de 20,7 por cento. Nossos índices de complicaçöes (32 por cento) ocorreram principalmente por problemas pulmonares e infecçäo da ferida operatória. De grande significado é que dos 78 casos de laparotomia negativa näo houve um único óbito. Conclui-se que a exploraçäo abdominal apresenta baixa morbitalidade e näo deve ser descartada como procedimento do diagnóstico e terapêutico em pacientes que sofreram trauma abdominal e nos quais os achados sejam duvidosos
Assuntos
Humanos , Masculino , Feminino , Traumatismos Abdominais/diagnóstico , Baço/lesões , Hérnia Ventral/complicações , Infecção da Ferida Cirúrgica/complicações , Infecções Urinárias/complicações , Laparotomia , Obstrução Intestinal/complicações , Pneumonia/complicaçõesRESUMO
Os autores apresentam estudo retrospectivo de 17 pacientes submetidos a tratamento cirúrgico por obstruçao intestinal provocada por Ascaris Lumbricoides. Clinicamente os pacientes apresentavam dor e distensao abdominal, vômitos e parada de eliminaçao de gases e fezes. Os procedimentos cirúrgicos realizados foram enterotomia com retirada dos vermes, mobilizaçao distal por ordenha e ressecçao com anastomose intestinal. Ocorreram dois óbitos (11,8 por cento). Os autores discutem a necessidade de avaliaçao cuidadosa destes pacientes.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Ascaríase/complicações , Enteropatias Parasitárias/complicações , Obstrução Intestinal/parasitologia , Ascaríase/cirurgia , Ascaríase/diagnóstico , Ascaris lumbricoides , Enteropatias Parasitárias/cirurgia , Enteropatias Parasitárias/diagnóstico , Obstrução Intestinal/cirurgia , Obstrução Intestinal/diagnóstico , Estudos RetrospectivosRESUMO
Os autores apresentam estudo retrospectivo de 130 pacientes vítimas de traumatismo esplênico tratados no Serviço de Cirurgia de Urgência do Hospital Municipal Djalma Marques, em São Luís - MA, no período de janeiro de 1990 a dezembro de 1995. Haviam 110 pacientes do sexo masculino (84,6 por cento) e 20 do sexo feminino (15,4 por cento), com média de idade de 22,6 anos. O principal mecanismo de lesão foi o trauma contuso e o tratamento cirúrgico consistiu em esplenoctomia total na maioria dos pacientes. A infecção da ferida operatória foi a complicação mais freqüente e ocorreram nove óbitos (6,9 por cento). Os autores discutem e destacam o valor do autotransplante esplênico nos casos de esplenectomia total.