RESUMO
A cirurgia da obesidade vem sendo reconhecida como tratamento eficiente para perda de peso e melhora das comorbidades a ela associadas. Em adultos, os riscos e benefícios de curto e longo prazo já são bem conhecidos na literatura; contudo, em crianças e adolescentes não existem dados precisos. Por envolver mudanças significativas nos hábitos de vida e na alimentação, a decisão pelo tratamento cirúrgico para essa população ainda é delicada e necessita da participação de toda a equipe médica, além do envolvimento familiar. Para isso, o médico responsável deve conhecer os principais aspectos bioéticos implicados na questão a fim de ponderar sobre os passos necessários para conduzir melhor os casos em que a cirurgia bariátrica é a opção mais adequada.
Bariatric surgery is becoming more and more established as an effective form of weight loss and method of treating comorbidities related to this condition. The short and long-term risks and benefits for adults have been well documented in literature, but no accurate data exists for children and adolescents. Given the significant changes in lifestyle habits and diet involved, the decision to undergo surgical treatment is a delicate one, requiring the participation of the entire medical team and the patients family. For this reason the doctor in charge must be aware of the major bioethical aspects involved, and th steps required to effectively manage cases were bariatric surgery is the preferred option.
La cirugía de la obesidad es reconocida últimamente como un tratamiento eficiente para la pérdida de peso y la mejora de las comorbidades que se la asocian. En los adultos los riesgos y beneficios a corto y a largo plazo ya son bien conocidos en la literatura, pero en los niños y adolescentes no existen datos precisos. Por conllevar alteraciones significativas en los hábitos de vida y en la alimentación, la decisión del tratamento quirúrgico para esta población aún es delicada y necesita la participación de todo el equipo médico y el envolvimento familiar. Para eso el médico responsable debe conocer los principales aspectos bioéticos implicados en la cuestión con el fin de ponderar los casos en los cuales la cirugía bariátrica es la opción más adecuada.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adolescente , Cirurgia Bariátrica , Bioética , Criança , Comportamento Alimentar , Comportamento Alimentar , Obesidade Infantil , Proteção da Criança , Doença Crônica , Tomada de Decisões , Doenças Metabólicas , MorbidadeRESUMO
BACKGROUND: Gastric fistula after bariatric surgery has high morbi-mortality, and treatment is a challenge due to persistent abscess and/or distal stenosis. The present study evaluated the efficacy and safety of stricturotomy/internal drainage, a novel endoscopic procedure that can avoid re-operation and allow early oral feeding. METHODS: This prospective, non-randomized study, with no control or sham group, included 27 patients (74.07% were female), approved by the local IRB, who underwent the following bariatric surgeries: Roux-en-Y gastric bypass (RYGB; n = 14, 51.85%), laparoscopic sleeve gastrectomy (LSG; n = 9, 33.33%) and duodenal switch (DS; n = 4, 14.81%). The patients presented with gastric fistulas which were treated by internal drainage/stricturotomy. The mean patient age was 42.67 years, and the mean pre-operative BMI was 40.69 kg/m(2). Balloon dilation was performed if distal stenosis and/or axis deviation was present. The first endoscopic procedure was applied on the 15th day after RYGB and the 30th day after LSG and DS. RESULTS: All patients presented with His angle fistula. Eight patients (57.1%) had stenosis of the anastomosis after RYGB and were treated with balloon dilatation (20 mm). The patients submitted to LSG and DS had stenosis at the angularis incisure and were treated with achalasia balloon dilation (30 mm). The number of endoscopic sessions for stricturotomy ranged from 1 to 6. Two patients experienced bleeding after dilation, and one had perforation. The mean time to achieve fistula closure was 18.11 days (range, 1-72 days) without mortality. All the fistulas closed. CONCLUSIONS: This novel endoscopic procedure is safe, feasible, and effective, avoiding re-operation, allowing early oral feeding and discharge.
