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3.
Small ; 18(31): e2201473, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35808958

RESUMO

The control of heat at the nanoscale via the excitation of localized surface plasmons in nanoparticles (NPs) irradiated with light holds great potential in several fields (cancer therapy, catalysis, desalination). To date, most thermoplasmonic applications are based on Ag and Au NPs, whose cost of raw materials inevitably limits the scalability for industrial applications requiring large amounts of photothermal NPs, as in the case of desalination plants. On the other hand, alternative nanomaterials proposed so far exhibit severe restrictions associated with the insufficient photothermal efficacy in the visible, the poor chemical stability, and the challenging scalability. Here, it is demonstrated the outstanding potential of NiSe and CoSe topological nodal-line semimetals for thermoplasmonics. The anisotropic dielectric properties of NiSe and CoSe activate additional plasmonic resonances. Specifically, NiSe and CoSe NPs support multiple localized surface plasmons in the optical range, resulting in a broadband matching with sunlight radiation spectrum. Finally, it is validated the proposed NiSe and CoSe-based thermoplasmonic platform by implementing solar-driven membrane distillation by adopting NiSe and CoSe nanofillers embedded in a polymeric membrane for seawater desalination. Remarkably, replacing Ag with NiSe and CoSe for solar membrane distillation increases the transmembrane flux by 330% and 690%, respectively. Correspondingly, costs of raw materials are also reduced by 24 and 11 times, respectively. The results pave the way for the advent of NiSe and CoSe for efficient and sustainable thermoplasmonics and related applications exploiting sunlight within the paradigm of the circular blue economy.


Assuntos
Energia Solar , Purificação da Água , Destilação/métodos , Membranas , Luz Solar , Purificação da Água/métodos
5.
Virchows Arch ; 478(2): 361-366, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32519036

RESUMO

Drug adulterants containing contaminants have been known to cause lung disease by inhalation or intravenous intake. Talcosis due to intravenous talc injection has been widely described in the literature, whereas the hypothesis of granulomatosis due to asbestos related to adulterated cocaine injection has not yet been explored. Herein, a case of pulmonary granulomatosis due to asbestos fibres related to cocaine injection in a young woman is described. Inorganic material in the lung was first individuated by light microscopy and last was identified using the SEM-EDX method. This case is unique since the occupational and passive inhalation of asbestos was excluded with absolute certainty.


Assuntos
Amianto/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/efeitos adversos , Contaminação de Medicamentos , Granuloma de Corpo Estranho/etiologia , Granuloma do Sistema Respiratório/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Amianto/administração & dosagem , Autopsia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Cocaína/administração & dosagem , Usuários de Drogas , Evolução Fatal , Feminino , Granuloma de Corpo Estranho/patologia , Granuloma do Sistema Respiratório/patologia , Humanos
6.
Arq Bras Cir Dig ; 33(1): e1503, 2020 Jul 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32667533

RESUMO

INTRODUCTION: Vertical gastrectomy and different bowel functions. The wide net of physiological issues involved in metabolic surgery is extremely complex. Nonetheless, compared anatomy and phisiology can provide good clues of how digestive tracts are shaped for more or less caloric food, for more or less fiber, for abundance and for scarcity. OBJECTIVE: To review data from Compared Anatomy and Physiology, and in the Evolutionary Sciences that could help in the better comprehension of the metabolic surgery. METHOD: A focused review of the literature selecting information from these three fields of knowledge in databases: Cochrane Library, Medline and SciELO, articles and book chapters in English and Portuguese, between 1955 and 2019, using the headings "GIP, GLP-1, PYY, type 2 diabetes, vertebrates digestive system, hominid evolution, obesity, bariatric surgery ". RESULTS: The digestive tract of superior animals shows highly specialized organs to digest and absorb specific diets. In spite of the wide variations of digestive systems, some general rules are observed. The proximal part of the digestive tract, facing the scarcity of sugars, is basically dedicated to generate sugar from different substrates (gluconeogenesis). Basic proximal gut tasks are to proportionally input free sugars, insulin, other fuels and to generate anabolic elements to the blood, some of them obesogenic. To limit the ingestion by satiety, by gastric emptying diminution and to limit the excessive elevation of major fuels (sugar and fat) in the blood are mostly the metabolict asks of the distal gut. A rapid and profound change in human diet composition added large amounts of high glycemic index foods. They seem to have caused an enhancement in the endocrine and metabolic activities of the proximal gut and a reduction in these activities of the distal gut. The most efficient models of metabolic surgery indeed make adjustments in this proximal/distal balance in the gut metabolic activities. CONCLUSION: Metabolic surgery works basically by making adjustments to the proximal and distal gut metabolic activities that resemble the action of natural selection in the development the digestive systems of superior animals.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Animais , Compreensão , Peptídeo 1 Semelhante ao Glucagon , Humanos , Obesidade
8.
Membranes (Basel) ; 10(3)2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32110883

RESUMO

Electrospinning is an emerging technique for the preparation of electrospun fiber membranes (ENMs), and a very promising one on the basis of the high-yield and the scalability of the process according to a process intensification strategy. Most of the research reported in the literature has been focused on the preparation of poly (vinylidene fluoride) (PVDF) ENMs by using N,N- dimethylformamide (DMF) as a solvent, which is considered a mutagenic and cancerogenic substance. Hence, the possibility of using alternative solvents represents an interesting approach to investigate. In this work, we explored the use of dimethyl sulfoxide (DMSO) as a low toxicity solvent in a mixture with acetone for the preparation of PVDF-ENMs. As a first step, a solubility study of the polymer, PVDF 6012 Solef®, in several DMSO/acetone mixtures was carried out, and then, different operating conditions (e.g., applied voltage and needle to collector plate distance) for the successful electrospinning of the ENMs were evaluated. The study provided evidence of the crucial role of solution conductivity in the electrospinning phase and the thermal post-treatment. The prepared ENMs were characterized by evaluating the morphology (by SEM), pore-size, porosity, surface properties, and performance in terms of water permeability. The obtained results showed the possibility of producing ENMs in a more sustainable way, with a pore size in the range of 0.2-0.8 µm, high porosity (above 80%), and water flux in the range of 11.000-38.000 L/m2·h·bar.

9.
ABCD (São Paulo, Impr.) ; 33(1): e1503, 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1130505

RESUMO

ABSTRACT Introduction: The wide net of physiological issues involved in metabolic surgery is extremely complex. Nonetheless, compared anatomy and phisiology can provide good clues of how digestive tracts are shaped for more or less caloric food, for more or less fiber, for abundance and for scarcity. Objective: To review data from Compared Anatomy and Physiology, and in the Evolutionary Sciences that could help in the better comprehension of the metabolic surgery. Method: A focused review of the literature selecting information from these three fields of knowledge in databases: Cochrane Library, Medline and SciELO, articles and book chapters in English and Portuguese, between 1955 and 2019, using the headings "GIP, GLP-1, PYY, type 2 diabetes, vertebrates digestive system, hominid evolution, obesity, bariatric surgery ". Results: The digestive tract of superior animals shows highly specialized organs to digest and absorb specific diets. In spite of the wide variations of digestive systems, some general rules are observed. The proximal part of the digestive tract, facing the scarcity of sugars, is basically dedicated to generate sugar from different substrates (gluconeogenesis). Basic proximal gut tasks are to proportionally input free sugars, insulin, other fuels and to generate anabolic elements to the blood, some of them obesogenic. To limit the ingestion by satiety, by gastric emptying diminution and to limit the excessive elevation of major fuels (sugar and fat) in the blood are mostly the metabolict asks of the distal gut. A rapid and profound change in human diet composition added large amounts of high glycemic index foods. They seem to have caused an enhancement in the endocrine and metabolic activities of the proximal gut and a reduction in these activities of the distal gut. The most efficient models of metabolic surgery indeed make adjustments in this proximal/distal balance in the gut metabolic activities. Conclusion: Metabolic surgery works basically by making adjustments to the proximal and distal gut metabolic activities that resemble the action of natural selection in the development the digestive systems of superior animals.


RESUMO Introdução: A rede de questões fisiológicas envolvidas na cirurgia metabólica é muito complexa. No entanto, a anatomia e fisiologia comparadas podem fornecer boas pistas sobre como o trato digestivo é moldado para alimentos mais ou menos calóricos, para mais ou menos fibras, para abundância e escassez. Objetivo: Selecionar e analisar dados de Ciências Evolucionárias e Anatomia e Fisiologia Comparadas que ajudam na compreensão da cirurgia metabólica. Método: Revisão focada da literatura, selecionando informações desses três campos de conhecimento em bancos de dados da Cochrane Library, Medline e SciELO, artigos e capítulos de livros em inglês e português, entre 1950 e 2019, usando como descritores "GIP, GLP-1, PYY, type 2 diabetes, vertebrates digestive system, hominid evolution, obesity, bariatric surgery". Resultado: O trato digestivo de animais superiores mostra órgãos altamente especializados para digerir e absorver dietas específicas..A parte proximal, diante da escassez de açúcares, é basicamente dedicada à geração de açúcar a partir de diferentes substratos (gliconeogênese). As tarefas básicas do intestino proximal consistem em fornecer proporcionalmente açúcares livres, insulina e outros combustíveis e gerar elementos anabólicos no sangue, alguns deles obesogênicos. Limitar a ingestão pela saciedade, por diminuir o esvaziamento gástrico e limitar a elevação excessiva dos principais combustíveis (açúcar e gordura) no sangue são principalmente as tarefas metabólicas do intestino distal. Mudança rápida e profunda na composição da dieta humana causa elevação nas atividades endócrinas e metabólicas do intestino proximal e redução no intestino distal. Os modelos mais eficientes de cirurgia metabólica fazem ajustes nesse equilíbrio proximal-distal das atividades metabólicas intestinais. Conclusão: A cirurgia metabólica funciona basicamente fazendo ajustes nas atividades metabólicas do intestino proximal e distal que se assemelham à ação da seleção natural no desenvolvimento dos sistemas digestivos de animais superiores.


Assuntos
Humanos , Animais , Diabetes Mellitus Tipo 2 , Cirurgia Bariátrica , Compreensão , Peptídeo 1 Semelhante ao Glucagon , Obesidade
10.
Obes Surg ; 29(4): 1439-1441, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737760

RESUMO

INTRODUCTION: Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD. CASE REPORT AND MANAGEMENT: A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m2 with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms. CONCLUSION: We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Refluxo Gastroesofágico , Obesidade , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/cirurgia , Resultado do Tratamento , Redução de Peso
11.
Obes Surg ; 28(10): 3012-3019, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29704228

RESUMO

PURPOSE: To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D). METHODS: This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m2 and < 35 kg/m2, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months. RESULTS: At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%, P = < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%, P = NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m2 versus 30.9 ± 2.5 kg/m2; P = < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL, P < 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL; P = 0.001). CONCLUSIONS: SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.


Assuntos
Diabetes Mellitus Tipo 2 , Gastrectomia , Obesidade , Adulto , Idoso , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Hemoglobinas Glicadas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/metabolismo , Obesidade/cirurgia , Estudos Prospectivos
12.
BMJ Open ; 6(3): e010245, 2016 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-26975937

RESUMO

INTRODUCTION: Obesity and type 2 diabetes mellitus are increasing worldwide, reaching pandemic proportions. The understanding of the role of functional restriction and gut hormones can be a beneficial tool in treating obesity and diabetes. However, the exact hormonal profiles in different metabolic states and surgical models are not known. METHODS AND ANALYSIS: The HIPER-1 Study is a single-centre cross-sectional study in which 240 patients (in different metabolic states and surgical models) will receive an oral mixed-meal tolerance test (OMTT). At baseline and after 30, 60 and 120 min, peptide YY and glucagon-like peptide 1 levels and glucose and insulin sensitivity will be measured. The primary end point of the study will be the area under the glucagon-like peptide 1 and peptide YY curves after the OMTT. Secondary study end points will include examination of the difference in plasma levels of the distal ileal hormones in subjects with various health statuses and in patients who have been treated with different surgical techniques. ETHICS AND DISSEMINATION: An independent ethics committee, the Institutional Review Board of Istanbul Sisli Kolan International Hospital, Turkey, has approved the study protocol. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders. TRIAL REGISTRATION NUMBER: NCT02532829; Pre-results.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Peptídeo 1 Semelhante ao Glucagon/sangue , Resistência à Insulina , Obesidade/cirurgia , Peptídeo YY/sangue , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Hormônios Gastrointestinais/sangue , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Obesidade/sangue , Estudos Prospectivos , Projetos de Pesquisa , Turquia
13.
Obes Surg ; 25(8): 1547-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26084252

RESUMO

The biliopancreatic derivation (BPD) is the most powerful bariatric procedure. However, it never became a very popular procedure, except for Italy, because of the high rate of nutritional problems, intense flatulence, and diarrhea. Here, we describe an extremely simple way (just one anastomosis) to revise the BPD, transforming it into an ileal interposition with duodenal exclusion, solving these described problems.


Assuntos
Desvio Biliopancreático/métodos , Duodeno/cirurgia , Íleo/cirurgia , Obesidade Mórbida/cirurgia , Anastomose Cirúrgica , Feminino , Humanos , Pessoa de Meia-Idade
15.
Einstein (Sao Paulo) ; 12(3): 287-94, 2014 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25295447

RESUMO

OBJECTIVE: Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. METHODS: Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. RESULTS: In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. CONCLUSION: The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.


Assuntos
Gastrectomia/métodos , Refluxo Gastroesofágico/cirurgia , Obesidade/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Refluxo Gastroesofágico/prevenção & controle , Trato Gastrointestinal/diagnóstico por imagem , Trânsito Gastrointestinal , Humanos , Laparoscopia/métodos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Radiografia , Fatores de Tempo , Resultado do Tratamento , Redução de Peso , Adulto Jovem
16.
Einstein (Säo Paulo) ; 12(3): 287-294, Jul-Sep/2014. graf
Artigo em Inglês | LILACS | ID: lil-723914

RESUMO

Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors. .


Objetivo A gastrectomia vertical é o procedimento cirúrgico para tratamento da obesidade que mais cresce em indicações. No entanto, esse procedimento pode causar ou agravar a doença do refluxo gastresofágico. Este artigo buscou descrever originalmente a adição de procedimentos antirrefluxo (remoção de coxins gordurosos do hiato, hiatoplastia, pequena plicatura e fixação do remanescente na posição anatômica), além de relatar seus resultados precoces e tardios. Métodos Foram submetidos à gastrectomia vertical com medidas antirrefluxo 88 oito pacientes obesos com sintomas de doença do refluxo gastresofágico. Dentre esses pacientes, 50 foram submetidos também à bipartição do trânsito. A perda de peso destes foi comparada àquela ocorrida em 360 pacientes consecutivos submetidos à gastrectomia vertical usual e à de 1.140 pacientes submetidos à gastrectomia vertical + bipartição do trânsito. Os sintomas do refluxo gastresofágico foram investigados por meio de questionário em todos os submetidos à gastrectomia vertical com medidas antirrefluxo e comparados com os resultados obtidos em 50 pacientes submetidos à gastrectomia vertical usual e a 60 submetidos à gastrectomia vertical + bipartição do trânsito, também com sintomas prévios de doença do refluxo gastresofágico. Resultados O percentual de perda do excesso de índice de massa corporal após gastrectomia vertical antirefluxo não foi inferior a gastrectomia vertical usual. Além disso, a gastrectomia vertical antirefluxo + bipartição do trânsito não foi inferior a gastrectomia vertical + bipartição do trânsito. Não houve aumento da morbidade na gastrectomia vertical antirefluxo, porém notou-se redução ...


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Gastrectomia/métodos , Refluxo Gastroesofágico/cirurgia , Obesidade/cirurgia , Índice de Massa Corporal , Seguimentos , Trânsito Gastrointestinal , Refluxo Gastroesofágico/prevenção & controle , Trato Gastrointestinal , Laparoscopia/métodos , Ilustração Médica , Fatores de Tempo , Resultado do Tratamento , Redução de Peso
18.
Ann Surg ; 256(1): 104-10, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22609843

RESUMO

OBJECTIVE: To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity. BACKGROUND: Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects. METHODS: A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum. RESULTS: Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare. CONCLUSIONS: SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Síndrome Metabólica/cirurgia , Obesidade Mórbida/cirurgia , Glicemia/análise , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Polipeptídeo Inibidor Gástrico/fisiologia , Índice Glicêmico , Humanos , Íleo/cirurgia , Estado Nutricional , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Assistência Perioperatória , Resposta de Saciedade , Grampeamento Cirúrgico , Técnicas de Sutura , Redução de Peso
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