Assuntos
Cirurgia Bariátrica , Craniofaringioma/cirurgia , Doenças Hipotalâmicas/terapia , Incretinas/uso terapêutico , Liraglutida/uso terapêutico , Procedimentos Neurocirúrgicos/efeitos adversos , Obesidade/terapia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/terapia , Transtorno da Compulsão Alimentar/etiologia , Transtorno da Compulsão Alimentar/fisiopatologia , Transtorno da Compulsão Alimentar/terapia , Humanos , Doenças Hipotalâmicas/etiologia , Doenças Hipotalâmicas/fisiopatologia , Masculino , Obesidade/etiologia , Obesidade/fisiopatologia , Complicações Pós-Operatórias/etiologia , Resposta de Saciedade/fisiologia , Falha de Tratamento , Aumento de Peso , Adulto JovemRESUMO
Severe obesity is a common consequence of hypothalamic region diseases and their treatment. Only two previous case reports have described hypothalamic lipomas in children with obesity. We described a case of an adult with severe obesity associated with hypothalamic lipoma attached to the third ventricle floor who underwent Roux-en-Y gastric bypass. He lost 38 and 59 kg at 6 and 12 months after surgery, respectively. Weight loss after bariatric surgery was as expected in this patient with severe obesity. At 6 and 12 months, brain magnetic resonance imaging (MRI) showed stability in lipoma's size.
Assuntos
Derivação Gástrica , Neoplasias Hipotalâmicas/complicações , Lipoma/complicações , Obesidade Mórbida/cirurgia , Adulto , Humanos , Neoplasias Hipotalâmicas/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Masculino , Redução de PesoRESUMO
BACKGROUND: Gastro-oesophageal reflux disease (GORD) is a common obesity-related co-morbidity that is assessed objectively by 24-h pH monitoring. Some concerns have been raised regarding the risk of de novo GORD or exacerbation of pre-existing GORD after laparoscopic sleeve gastrectomy. Here, 24-h pH monitoring was used to assess the influence of laparoscopic sleeve gastrectomy on postoperative GORD in obese patients with or without preoperative GORD. METHODS: From July 2012 to September 2014, all patients scheduled for laparoscopic sleeve gastrectomy were invited to participate in a prospective follow-up. Patients who underwent preoperative 24-h pH monitoring were asked to repeat the examination 6 months after operation. GORD was defined as an oesophageal pH < 4 for at least 4·2 per cent of the total time recorded. RESULTS: Of 89 patients, 76 had preoperative pH monitoring for GORD evaluation and 50 had postoperative reassessment. Patients without (group 1, 29 patients) or with (group 2, 21 patients) preoperative GORD were similar regarding age, sex ratio and body mass index. In group 1, the median (i.q.r.) total time at pH < 4 was significantly higher after surgery than before: 5·6 (2·5-9·5) versus 1·6 (0·7-2·9) per cent (P < 0·001). Twenty of the 29 patients experienced de novo GORD as determined by 24-h pH monitoring (P < 0·001). In group 2, total time at pH < 4 after surgery was no different from the preoperative value: 5·9 (3·9-10·7) versus 7·7 (5·2-10·3) per cent (P = 0·296). CONCLUSION: Laparoscopic sleeve gastrectomy was associated with de novo GORD in over two-thirds of patients, but did not seem to exacerbate existing GORD.