Brazilian multicenter study of the intragastric balloon.

BACKGROUND: Intragastric balloons have been used in obese patients to provide early satiety and thereby induce weight loss. Several studies have reported promising results with a new balloon (BIB((R))) designed to overcome some of the technical pitfalls of earlier devices. We assessed both safety and effectiveness of the BIB((R)). METHOD: From November 2000 to February 2004, 483 overweight and obese patients were treated with the BIB((R)). 323 patients completed a 6-month follow-up, and 85 of them completed a 1-year follow-up. All patients took part in a multidisciplinary program involving clinical, psychiatric, physical training, and dietary approaches. RESULTS: Compared to baseline values, after a 6-month follow-up subjects showed significant reductions in weight (15.2 +/- 10.5 kg), percent excess weight loss (48.3 +/- 28.1), and BMI (-5.3 +/- 3.4 kg/m(2)) (P < 0.000). At 1-year follow-up, 85 patients have maintained more than 90% of their BMI reduction. The main side-effects were nausea/vomiting (40%), and epigastric pain (20%), requiring removal of the BIB (R) in 11 patients (3.4%). Minor complications were reflux esophagitis (12%) and symptomatic gastric stasis (9%). Balloon impaction occurred in 2 cases (0.6%), and in 1 patient (0.3%) there was spontaneous deflation of the balloon leading to a small-bowel obstruction solved by a surgical approach. CONCLUSION: The BIB((R)) has been effective to temporarily control obesity, inducing an excess weight loss of approximately 48%. It was not associated with mortality and showed minimal risk of major complications.

A cost-effective technique for pure laparoscopic live donor nephrectomy.

OBJECTIVE: Compare two different techniques for laparoscopic live donor nephrectomy (LDN), related to the operative costs and learning curve. MATERIALS AND METHODS: Between April/2000 and October/2003, 61 patients were submitted to LDN in 2 different reference centers in kidney transplantation. At center A (CA), 11 patients were operated by a pure transperitoneal approach, using Hem-O-Lok clips for the renal pedicle control and the specimens were retrieved manually, without using endobags. At center B (CB), 50 patients were also operated by a pure transperitoneal approach, but the renal pedicles were controlled with endo-GIA appliers and the specimens were retrieved using endobags. RESULTS: Operative time (231 +/- 39 min vs. 179 +/- 30 min; p < 0.000), warm ischemia time (5.85 +/- 2.85 min vs. 3.84 +/- 3.84 min; p = 0.002) and blood loss (214 +/- 98 mL vs. 141 +/- 82 mL; p = 0.02) were statistically better in CB, when compared to CA. Discharge time was similar in both centers. One major complication was observed in both centers, leading to an open conversion in CA (9.1%). One donor death occurred in CB (2%). Regarding the recipients, no statistical difference was observed in all parameters analyzed. There was an economy of US$1.440 in each procedure performed in CA, when compared to CB. CONCLUSIONS: Despite the learning curve, the technique adopted by CA, showed no deleterious results to the donors and recipients when compared with the CB. On the other hand, this technique was cheaper than the technique performed in the CB, representing an attractive alternative for LDN, mainly in developing centers.

A cost-effective technique for pure laparoscopic live donor nephrectomy

OBJECTIVE: Compare two different techniques for laparoscopic live donor nephrectomy (LDN), related to the operative costs and learning curve. MATERIALS AND METHODS: Between April/2000 and October/2003, 61 patients were submitted to LDN in 2 different reference centers in kidney transplantation. At center A (CA), 11 patients were operated by a pure transperitoneal approach, using Hem-O-Lokomicron clips for the renal pedicle control and the specimens were retrieved manually, without using endobags. At center B (CB), 50 patients were also operated by a pure transperitoneal approach, but the renal pedicles were controlled with endo-GIA appliers and the specimens were retrieved using endobags. RESULTS: Operative time (231 ± 39 min vs. 179 ± 30 min; p < 0.000), warm ischemia time (5.85 ± 2.85 min vs. 3.84 ± 3.84 min; p = 0.002) and blood loss (214 ± 98 mL vs. 141 ± 82 mL; p = 0.02) were statistically better in CB, when compared to CA. Discharge time was similar in both centers. One major complication was observed in both centers, leading to an open conversion in CA (9.1 percent). One donor death occurred in CB (2 percent). Regarding the recipients, no statistical difference was observed in all parameters analyzed. There was an economy of US$1.440 in each procedure performed in CA, when compared to CB. CONCLUSIONS: Despite the learning curve, the technique adopted by CA, showed no deleterious results to the donors and recipients when compared with the CB. On the other hand, this technique was cheaper than the technique performed in the CB, representing an attractive alternative for LDN, mainly in developing centers.