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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(7): 1044-1048, 2020 Jul 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895162

RESUMO

OBJECTIVE: To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (T2D) in patients with a body mass index (BMI) < 27.5 kg/m2. METHODS: We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS: All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group (P < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS: LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.


Assuntos
Diabetes Mellitus Tipo 2 , Derivação Gástrica , Laparoscopia , Índice de Massa Corporal , Humanos , Obesidade Mórbida , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso
2.
Acta Cir Bras ; 35(8): e202000806, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32901683

RESUMO

PURPOSE: To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses. METHODS: We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed. RESULTS: During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT. CONCLUSIONS: The use of 3D vision in LRYGB significantly reduced the OT, though intra- and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , Duração da Cirurgia , Resultado do Tratamento
3.
Psychiatr Danub ; 32(Suppl 1): 176-179, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890386

RESUMO

BACKGROUND: Obesity is public health issue; bariatric surgery is considered as the most efficient treatment. However, the risk of developing an alcohol use disorder could increase after Roux-en-Y bypass. The purpose of this review is to emphasize the further research needed in this area. METHODS: Pubmed and Sciencedirect databases were searched. Articles written in another language than French or English as well as abstracts, conference presentations, editorials and expert opinions were excluded. RESULTS: Most of studies included in this review show an increased risk of developing an AUD (alcohol use disorder) after gastric bypass surgery. Male sex, younger age, smoking, regular alcohol consumption, AUD, recreational drug use, lower sense of belonging and undergoing a RYGB (Roux-en-Y gastric bypass) were identified as risk factors. There is an alteration of alcohol metabolism after gastric bypass. Gut hormones could also play a role in the development of AUD. The hypothesis of an addiction transfer is still controversial. CONCLUSIONS: The risk of developing an AUD seems to increase after surgery. Long term follow-up, after the second post-surgery year, is needed. Further researches are needed to understand the mechanisms that underlie the development of AUD.


Assuntos
Consumo de Bebidas Alcoólicas , Alcoolismo , Derivação Gástrica , Humanos , Masculino , Obesidade , Fatores de Risco
7.
N Engl J Med ; 383(8): 721-732, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32813948

RESUMO

BACKGROUND: Some studies have suggested that in people with type 2 diabetes, Roux-en-Y gastric bypass has therapeutic effects on metabolic function that are independent of weight loss. METHODS: We evaluated metabolic regulators of glucose homeostasis before and after matched (approximately 18%) weight loss induced by gastric bypass (surgery group) or diet alone (diet group) in 22 patients with obesity and diabetes. The primary outcome was the change in hepatic insulin sensitivity, assessed by infusion of insulin at low rates (stages 1 and 2 of a 3-stage hyperinsulinemic euglycemic pancreatic clamp). Secondary outcomes were changes in muscle insulin sensitivity, beta-cell function, and 24-hour plasma glucose and insulin profiles. RESULTS: Weight loss was associated with increases in mean suppression of glucose production from baseline, by 7.04 µmol per kilogram of fat-free mass per minute (95% confidence interval [CI], 4.74 to 9.33) in the diet group and by 7.02 µmol per kilogram of fat-free mass per minute (95% CI, 3.21 to 10.84) in the surgery group during clamp stage 1, and by 5.39 (95% CI, 2.44 to 8.34) and 5.37 (95% CI, 2.41 to 8.33) µmol per kilogram of fat-free mass per minute in the two groups, respectively, during clamp stage 2; there were no significant differences between the groups. Weight loss was associated with increased insulin-stimulated glucose disposal, from 30.5±15.9 to 61.6±13.0 µmol per kilogram of fat-free mass per minute in the diet group and from 29.4±12.6 to 54.5±10.4 µmol per kilogram of fat-free mass per minute in the surgery group; there was no significant difference between the groups. Weight loss increased beta-cell function (insulin secretion relative to insulin sensitivity) by 1.83 units (95% CI, 1.22 to 2.44) in the diet group and by 1.11 units (95% CI, 0.08 to 2.15) in the surgery group, with no significant difference between the groups, and it decreased the areas under the curve for 24-hour plasma glucose and insulin levels in both groups, with no significant difference between the groups. No major complications occurred in either group. CONCLUSIONS: In this study involving patients with obesity and type 2 diabetes, the metabolic benefits of gastric bypass surgery and diet were similar and were apparently related to weight loss itself, with no evident clinically important effects independent of weight loss. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02207777.).


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Derivação Gástrica , Obesidade/dietoterapia , Obesidade/cirurgia , Perda de Peso/fisiologia , Adulto , Glicemia/análise , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/cirurgia , Feminino , Técnica Clamp de Glucose , Humanos , Insulina/metabolismo , Resistência à Insulina/fisiologia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Indução de Remissão
8.
Rev Med Suisse ; 16(699): 1287-1291, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608585

RESUMO

Gastroesophageal reflux disease (GERD) has a high prevalence in the obese population with a direct correlation between increased BMI and GERD. This correlation is multifactorial, with also more complicated forms (esophagitis and metaplasia) present in obese patients, even in the absence of frank reflux symptoms. Therapeutic success largely depends on weight loss, and bariatric surgery is the cornerstone of treatment for both diseases. Roux-en-Y gastric bypass is the intervention of choice for obese patients suffering from GERD, while sleeve gastrectomy can on the contrary induce increased reflux in the long term. Classic anti-reflux surgery (fundoplication) can also be offered to these patients, while being aware of the high risk of recurrent symptoms for BMI > 30-35 kg/m2.


Assuntos
Cirurgia Bariátrica , Fundoplicatura , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Obesidade/complicações , Derivação Gástrica , Humanos , Obesidade/cirurgia
9.
Arq Bras Cir Dig ; 33(1): e1497, 2020 Jul 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32667527

RESUMO

BACKGROUND: Effects of duodenal-jejunal bypass surgery (DJB) on the proliferation of nuclei and the area of adipocytes in the brown adipose tissue of obese rats. Thermogenic activity in the brown adipose tissue (BAT) of obese individuals is reduced, and this condition may be modified by bariatric surgery (BS). AIM: To characterize fat deposition in BAT from hypothalamic obese (HyO) rats submitted to duodenal-jejunal-bypass (DJB) surgery. METHODS: For induction of hypothalamic obesity, newborn male Wistar rats were treated with subcutaneous injections of monosodium glutamate (MSG). The control (CTL) group received saline solution. At 90 days, the HyO rats were submitted to DJB or sham operation, generating the HyO-DJB and HyO-SHAM groups. At 270 days, the rats were euthanized, and the BAT was weighed and submitted to histological analysis. RESULTS: Compared to BAT from CTL animals, the BAT from HyO-SHAM rats displayed increased weight, hypertrophy with greater lipid accumulation and a reduction in nucleus number. DJB effectively increased nucleus number and normalized lipid deposition in the BAT of HyO-SHAM rats, similar to that observed in CTL animals. CONCLUSION: DJB surgery avoided excessive lipid deposition in the BAT of hypothalamic obese rats, suggesting that this procedure could reactivate thermogenesis in BAT, and contribute to increase energy expenditure.


Assuntos
Tecido Adiposo Marrom , Derivação Gástrica , Tecido Adiposo , Animais , Glicemia , Duodeno , Lipídeos , Masculino , Obesidade , Ratos , Ratos Wistar
10.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 40(7): 1044-1048, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32701241

RESUMO

OBJECTIVE: To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (T2D) in patients with a body mass index (BMI) < 27.5 kg/m2. METHODS: We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS: All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group (P < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS: LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.


Assuntos
Diabetes Mellitus Tipo 2 , Derivação Gástrica , Laparoscopia , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Perda de Peso
11.
Acta Cir Bras ; 35(3): e202000307, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32692798

RESUMO

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 , Perda de Peso , Adulto Jovem
12.
Zhonghua Zhong Liu Za Zhi ; 42(6): 445-448, 2020 Jun 23.
Artigo em Chinês | MEDLINE | ID: mdl-32575938

RESUMO

Objective: To explore the clinical value of totally laparoscopic stomach-partitioning gastrojejunostomy (TLSPGJ) for malignant gastric outlet obstruction. Methods: The clinical data of 9 gastric cancer patients who underwent TLSPGJ in Department of Pancreatic and Gastric Surgery, Cancer Hospital between September 2018 and September 2019 were retrospectively analyzed. Results: The mean operative blood loss of 9 cases were (13.3±5.0) ml, and the average operative time was (103.3±10.6) min. All patients received clear flow food on the first day after surgery. Postoperative first exhaust time was (3.1±0.8) days and the average postoperative hospital stay was (5.4±1.1) days. All of the 9 patients could tolerate semi-liquid food at discharge, and no postoperative complications such as bleeding or delayed gastric emptying occurred. Conclusion: TLSPGJ is an effective treatment for gastric output tract obstruction caused by malignant tumor.


Assuntos
Gastrectomia/métodos , Derivação Gástrica/métodos , Obstrução da Saída Gástrica/patologia , Obstrução da Saída Gástrica/cirurgia , Jejuno/cirurgia , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Estômago/cirurgia , Obstrução da Saída Gástrica/etiologia , Humanos , Duração da Cirurgia , Cuidados Paliativos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(23): e20382, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501984

RESUMO

BACKGROUND: Previous studies have reported that roux-en Y gastric bypass surgery (RYGBS) can benefit patients with type 2 diabetes mellitus (T2DM). However, their conclusions are still inconsistent. Thus, this study will aim to assess the effect of RYGBS for patients with T2DM. METHODS: In this study, the electronic databases of MEDLINE, EMBASE, CENTRAL, CINAHL, AMED, and CNKI from inceptions to the present without any limitations to language and publication status. All randomized controlled trials on assessing the effect of RYGBS for patients with T2DM will be included in this study. Two independent authors will carry out study search and selection according to the previous designed inclusion and exclusion criteria. At the same time, 2 authors will independently evaluate the risk of bias assessment by Cochrane risk of bias tool. Any disagreements between 2 authors will be solved by a third author through discussion. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: This study will summarize the most recent studies and will provide a deeper understanding about using the effect of RYGBS for patients with T2DM. CONCLUSIONS: The findings of this study will present the existing evidence for the effect of RYGBS for patients with T2DM. SYSTEMATIC REVIEW REGISTRATION: INPLASY202040127.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Derivação Gástrica/normas , Obesidade/cirurgia , Adulto , Protocolos Clínicos , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Humanos , Metanálise como Assunto , Obesidade/complicações , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
17.
BMC Infect Dis ; 20(1): 361, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434466

RESUMO

BACKGROUND: Neisseria meningitidis has rarely been described as an agent of necrotic soft tissue infection. CASE PRESENTATION: We report a case of a septic shock with necrotizing cellulitis due to Neisseria meningitidis serogroup W, treated by urgent extensive surgical debridement followed by skin grafts. The invasive meningococcal disease occurred together with a complement deficiency, possibly acquired after bypass surgery that took place 1 year before. CONCLUSIONS: Necrotic tissue infections should be considered part of the invasive meningococcal diseases spectrum and should prompt clinicians to look for complement deficiencies. Gastric bypass surgery associated malnutrition may be implicated but further verification is needed.


Assuntos
Celulite (Flegmão)/microbiologia , Derivação Gástrica/efeitos adversos , Infecções Meningocócicas/complicações , Bacteriemia/microbiologia , Bacteriemia/terapia , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/terapia , Proteínas do Sistema Complemento/deficiência , Desbridamento , Feminino , Humanos , Infecções Meningocócicas/terapia , Pessoa de Meia-Idade , Neisseria meningitidis , Choque Séptico/etiologia , Choque Séptico/terapia , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia
18.
Am Surg ; 86(4): 300-307, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32391753

RESUMO

As bariatric surgery increases, there is a growing population of patients with biliary obstruction and anatomy which precludes transoral access through endoscopic retrograde cholangiopancreatography (ERCP). Minimally invasive transgastric ERCP (TG-ERCP) offers a feasible alternative for the treatment. A retrospective review was performed of all patients who underwent laparoscopic or robotic-assisted TG-ERCP between 2010 and 2017. Chart abstraction collected demographics, procedural details, success rate, and postoperative outcomes. Forty patients were identified, of which 38 cases were performed laparoscopically and two robotically. Median operative time was 163 minutes, with an estimated blood loss of 50 cc. TG-ERCP was performed successfully in 36 cases (90%); sphincterotomy was completed in 35 patients (97%). Sixty per cent already had a cholecystectomy; in the remaining patients, it was performed concurrently. Major complications included stomach perforation (n = 1), pancreatitis (n = 3), and anemia requiring transfusion (n = 2). In patients with biliary obstruction and anatomy not suitable for ERCP, TG-ERCP can be performed in a minimally invasive fashion, with a high rate of technical success and low morbidity. We describe a stepwise, reproducible technique because it is an essential tool for the shared armamentarium of endoscopists and surgeons.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocolitíase/cirurgia , Cálculos Biliares/cirurgia , Derivação Gástrica/efeitos adversos , Adulto , Idoso , Coledocolitíase/etiologia , Feminino , Cálculos Biliares/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos , Esfinterotomia Endoscópica/métodos , Resultado do Tratamento
20.
FP Essent ; 492: 30-36, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32383846

RESUMO

Bariatric surgery remains the most effective intervention for long-term sustained weight loss and resolution of comorbidities. It should be considered for patients with a body mass index of 40 kg/m2 or greater regardless of comorbidities and for patients with a body mass index of 30 kg/m2 with significant comorbidities, such as diabetes and sleep apnea. For these patients, laparoscopic bariatric surgery, including sleeve gastrectomy, Roux-en-Y gastric bypass, and duodenal switch, is safe with minimal perioperative risks of morbidity and mortality. Surgical management is associated with a survival benefit and resolution of common morbidities compared with nonsurgical management, despite the risk of postsurgical complications. These include gastroesophageal reflux disease, weight regain, bleeding, infection, and deep venous thrombosis. All patients who have undergone bariatric surgery require lifelong follow-up, including vitamin supplementation, annual laboratory testing, and multidisciplinary care (eg, dietary and psychological support). Bariatric surgery also has been shown to be safe in appropriate adolescent and elderly patients.


Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adolescente , Idoso , Gastrectomia , Humanos , Obesidade , Obesidade Mórbida/cirurgia
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