GASTRIC PLICATION ASSOCIATED WITH FUNDOPLICATION IN INDIVIDUALS WITH CLASS I OBESITY AND GASTROESOPHAGEAL REFLUX DISEASE: WEIGHT LOSS OUTCOMES, REFLUX-RELATED SYMPTOMS, ENDOSCOPIC AND pH MONITORING FINDINGS.

BACKGROUND: The association of gastric plication with fundoplication is a reliable option for the treatment of individuals with obesity associated with gastroesophageal reflux disease. AIMS: To describe weight loss, endoscopic, and gastroesophageal reflux disease-related outcomes of gastric plication with fundoplication in individuals with mild obesity. METHODS: A retrospective cohort study was carried out, enrolling individuals who underwent gastric plication with fundoplication at a tertiary private hospital from 2015-2019. Data regarding perioperative and weight loss outcomes, endoscopic and 24-hour pH monitoring findings, and gastroesophageal reflux disease-related symptoms were analyzed. RESULTS: Of 98 individuals, 90.2% were female. The median age was 40.4 years (IQR 32.1-47.8). The median body mass index decreased from 32 kg/m2 (IQR 30,5-34) to 29.5 kg/m2 (IQR 26.7-33.9) at 1-2 years (p<0.05); and to 27.4 kg/m2 (IQR 24.1-30.6) at 2-4 years (p=0.059). The median percentage of total weight loss at 1-2 years was 7.8% (IQR -4.1-14.7) and at 2-4 years, it was 16.4% (IQR 4.3-24.1). Both esophageal and extra-esophageal symptoms showed a significant reduction (p<0.05). A significant decrease in the occurrence of esophagitis was observed (p<0.01). The median DeMeester score decreased from 30 (IQR 15.1-48.4) to 1.9 (IQR 0.93-5.4) (p<0.0001). CONCLUSIONS: The gastric plication with fundoplication proved to be an effective and safe technique, leading to a significant and sustained weight loss in addition to endoscopic and clinical improvement of gastroesophageal reflux disease.

GASTRIC PLICATION ASSOCIATED WITH FUNDOPLICATION IN INDIVIDUALS WITH CLASS I OBESITY AND GASTROESOPHAGEAL REFLUX DISEASE: WEIGHT LOSS OUTCOMES, REFLUX-RELATED SYMPTOMS, ENDOSCOPIC AND pH MONITORING FINDINGS / PLICATURA GÁSTRICA ASSOCIADA A FUNDOPLICATURA EM INDIVÍDUOS COM OBESIDADE GRAU I E DOENÇA DO REFLUXO GASTROESOFÁGICO: ANÁLISE DE PERDA DE PESO, SINTOMAS DE REFLUXO, ACHADOS ENDOSCÓPICOS E DE pHMETRIA

ABSTRACT BACKGROUND: The association of gastric plication with fundoplication is a reliable option for the treatment of individuals with obesity associated with gastroesophageal reflux disease. AIMS: To describe weight loss, endoscopic, and gastroesophageal reflux disease-related outcomes of gastric plication with fundoplication in individuals with mild obesity. METHODS: A retrospective cohort study was carried out, enrolling individuals who underwent gastric plication with fundoplication at a tertiary private hospital from 2015-2019. Data regarding perioperative and weight loss outcomes, endoscopic and 24-hour pH monitoring findings, and gastroesophageal reflux disease-related symptoms were analyzed. RESULTS: Of 98 individuals, 90.2% were female. The median age was 40.4 years (IQR 32.1-47.8). The median body mass index decreased from 32 kg/m2 (IQR 30,5-34) to 29.5 kg/m2 (IQR 26.7-33.9) at 1-2 years (p<0.05); and to 27.4 kg/m2 (IQR 24.1-30.6) at 2-4 years (p=0.059). The median percentage of total weight loss at 1-2 years was 7.8% (IQR −4.1-14.7) and at 2-4 years, it was 16.4% (IQR 4.3-24.1). Both esophageal and extra-esophageal symptoms showed a significant reduction (p<0.05). A significant decrease in the occurrence of esophagitis was observed (p<0.01). The median DeMeester score decreased from 30 (IQR 15.1-48.4) to 1.9 (IQR 0.93-5.4) (p<0.0001). CONCLUSIONS: The gastric plication with fundoplication proved to be an effective and safe technique, leading to a significant and sustained weight loss in addition to endoscopic and clinical improvement of gastroesophageal reflux disease.

RESUMO RACIONAL: A associação de plicatura gástrica com fundoplicatura é uma opção atrativa para o tratamento de indivíduos com obesidade associada à doença do refluxo gastroesofágico. OBJETIVOS: Descrever a evolução ponderal, clínica, endoscópica e de pHmetria após a gástrica com fundoplicatura em indivíduos com obesidade grau I e doença do refluxo gastroesofágico. MÉTODOS: Um estudo de coorte histórica foi realizado, incluindo indivíduos que realizaram gástrica com fundoplicatura em um hospital privado terciário de 2015 a 2019. Os dados sobre os resultados perioperatórios e de perda de peso, achados endoscópicos e de pHmetria de 24 horas e sintomas relacionados à doença do refluxo gastroesofágico foram analisados. RESULTADOS: Dos 98 indivíduos, 90,2% eram do sexo feminino. A idade mediana foi de 40,4 (IQR 32,1-47,8) anos. A mediana do índice de massa corporal diminuiu de 32 (IQR 30,5-34) kg/m2 para 29,5 (IQR 26,7-33,9) kg/m2 em 1-2 anos (p<0,05); de 2 a 4 anos, foi de 27,4 (IQR 24,1-30,6) kg/m2 (p=0,059). A mediana da porcentagem da perda total de peso em 1-2 anos foi de 7,8% (IQR −4,1-14,7) e em 2-4 anos, foi de 16,4% (IQR 4,3-24,1). Tanto os sintomas esofágicos quanto os extras esofágicos apresentaram redução significativa (p<0,05). Observou-se diminuição significativa na ocorrência de esofagite (p<0,01). A pontuação mediana do escore de DeMeester diminuiu de 30 (IQR 15,1-48,4) para 1,9 (IQR 0,93-5,4) (p<0,0001). CONCLUSÕES: A associação entre plicatura gástrica e fundoplicatura laparoscópica mostrou-se uma técnica eficaz e segura, levando a perda de peso significativa, bem como melhora endoscópica e clínica da doença do refluxo gastroesofágico.

Incidental gastric schwannoma identified during open Roux-en-Y gastric bypass / Schwannoma gástrico incidental identificado durante bypass gástrico em Y de Roux

RESUMEN Durante un procedimiento quirúrgico, ante una masa gástrica, el cirujano debe tomar la decisión de resecarla o posponer la cirugía (menor morbilidad), así como discutir con el equipo médico el mejor tratamiento. Los tumores mesenquimales gástricos que se encuentran durante la cirugía bariátrica son raros, especialmente el schwannoma gástrico (GS). Presentamos el caso de una mujer de 57 años, hipertensa y diabética en tratamiento, con un índice de masa corporal (IMC) de 36 kg/m², refiriendo dificultad para adelgazar con dieta y actividad física. La paciente fue sometida a un bypass gástrico Y de Roux con resección en cuña de un nódulo ubicado en la pared anterior de la escotadura angular. El análisis inmunohistoquímico fue fuertemente positivo para la proteína S100, mientras que c-kit (CD117), CD45, actina de músculo liso (SMA) y AE1/AE3 fueron negativos. El GS debe considerarse como un diagnóstico diferencial de los tumores gástricos. Presentamos una opción de tratamiento que le permite tratar a pacientes obesos con nódulos gástricos en cualquier lugar en el mismo procedimiento que la cirugía bariátrica.