Impact of Roux-en-Y Gastric Bypass and Vertical Gastrectomy on weight loss: a retrospective and longitudinal study in the State of Paraná, Brazil.

AIM: to compare the impact of Roux's Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) techniques on body weight reduction over 1 and 5 years after bariatric surgery in obese patients in the state of Paraná. METHODS: longitudinal and retrospective study, conducted between January 2010 and December 2013, with 737 patients of both sexes submitted to RYGB or SG and evaluated in the preoperative, 1 and 5 years after bariatric surgery (BS). Age, height, body weight, Body Mass Index (BMI), biochemical and pressure parameters were recorded. RESULTS: of the total of patients, men represented lower frequency, were slightly older, with higher body weight, BMI and worse metabolic and pressure conditions than women in pre-BS (p<0.05). Regardless of sex, RYGB and SG were effective in promoting body weight reduction and BMI in 1 and 5 years after BS; the RYGB technique had greater impact on these variables in both sexes (p<0.05). The highest percentage of lost weight was observed in women who underwent the RYGB technique in the first year after BS. Five years after BS, the RYGB technique promoted a higher rate of body weight reduction in men and women compared to the SG technique (p<0.05). CONCLUSION: regardless of sex, the RYGB technique promotes a higher degree of body weight reduction and BMI over time compared to the SG; having its biggest impacts in the 1 year after BS, especially in women.

Impact of Roux-en-Y Gastric Bypass and Vertical Gastrectomy on weight loss: a retrospective and longitudinal study in the State of Paraná, Brazil / O impacto do Bypass Gástrico em Y de Roux e da Gastrectomia Vertical na perda de peso: um estudo retrospectivo e longitudinal no Estado do Paraná, Brasil

ABSTRACT Aim: to compare the impact of Roux's Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) techniques on body weight reduction over 1 and 5 years after bariatric surgery in obese patients in the state of Paraná. Methods: longitudinal and retrospective study, conducted between January 2010 and December 2013, with 737 patients of both sexes submitted to RYGB or SG and evaluated in the preoperative, 1 and 5 years after bariatric surgery (BS). Age, height, body weight, Body Mass Index (BMI), biochemical and pressure parameters were recorded. Results: of the total of patients, men represented lower frequency, were slightly older, with higher body weight, BMI and worse metabolic and pressure conditions than women in pre-BS (p<0.05). Regardless of sex, RYGB and SG were effective in promoting body weight reduction and BMI in 1 and 5 years after BS; the RYGB technique had greater impact on these variables in both sexes (p<0.05). The highest percentage of lost weight was observed in women who underwent the RYGB technique in the first year after BS. Five years after BS, the RYGB technique promoted a higher rate of body weight reduction in men and women compared to the SG technique (p<0.05). Conclusion: regardless of sex, the RYGB technique promotes a higher degree of body weight reduction and BMI over time compared to the SG; having its biggest impacts in the 1 year after BS, especially in women.

RESUMO Objetivo: comparar o impacto das técnicas Bypass Gástrico em Y de Roux (BGYR) e Gastrectomia Vertical (GV) na redução do peso corporal ao longo de 1 e 5 anos após a cirurgia bariátrica em pacientes obesos no Estado do Paraná. Métodos: estudo longitudinal e retrospectivo, realizado entre janeiro de 2010 a dezembro de 2013, com 737 pacientes de ambos os sexos submetidos a BGYR ou GV e avaliados no pré-cirúrgico, 1 e 5 anos após Cirurgia Bariátrica (CB). Foram registrados idade, estatura, peso corporal, Índice de Massa Corpórea (IMC), parâmetros bioquímicos e pressóricos. Resultados: do total de pacientes, homens representavam menor frequência, eram ligeiramente mais velhos, com maior peso corporal, IMC e pior condição metabólica e pressórica que mulheres no pré-CB (p<0,05). Independente do sexo, BGYR e GV foram efetivas em promover redução do peso corporal e IMC em 1 e 5 anos pós-CB; tendo a técnica de BGYR maior impacto nestas variáveis em ambos os sexos (p<0,05). A maior porcentagem de peso perdido foi observada em mulheres submetidas a técnica da BGYR no primeiro ano após a CB. Cinco anos após a CB, a técnica de BGYR promoveu maior taxa de redução de peso corporal em homens e mulheres comparado a técnica da GV (p<0,05). Conclusão: independente do sexo a técnica de BGYR promove maior grau de redução do peso corporal e IMC ao longo do tempo em comparação com a GV; tendo seus maiores impactos no 1 ano pós-CB sobretudo em mulheres.

Pancreatectomia videolaparoscópica em tumores malignos: experiência inicial e resultados perioperatórios / Videolaparoscopic pancreatectomy in malignant tumors: initial experience and perioperative results

Com os resultados cirurgia minimamente invasiva em outras áreas, houve interesse em estender a videolaparoscopia para a cirurgia do pâncreas, contudo, ainda existem controvérsias na literatura. Buscou-se descrever a morbimortalidade perioperatória dos primeiros pacientes submetidos à pancreatectomia videolaparoscópica por neoplasia maligna em um serviço de cirurgia do aparelho digestivo. Trata-se de um estudo descritivo e retrospectivo, em uma população de pacientes com câncer de pâncreas/periampular, que foram submetidos à pancreatectomia videolaparoscópica. Todos os pacientes foram incluídos. Buscou-se descrever os principais resultados do intraoperatório até 60 dias após a cirurgia. Entre 2013 e 2015, 9 pacientes foram submetidos à pancreatectomia videolaparoscópica. A média de idade foi de 57 anos e os tumores do tipo adenocarcinoma foram os mais comuns (78%). 3 pacientes foram submetidos a pancreatectomia distal laparoscópica e 6 foram submetidos a gastroduodenopancreatectomia laparoscópica. A morbidade perioperatória foi de 67%, entretanto, apenas um paciente apresentou complicação grave. Houve dois casos de fístula pancreática. Não ocorreram óbitos no período perioperatório. Todas as ressecções apresentaram margens cirúrgicas negativas. Os dados indicam que a pancreatectomia videolaparoscópica é segura e apresenta viabilidade técnica em relação aos resultados perioperatórios.

The results of minimally invasive surgery in other areas have led to interest in extending the laparoscopic approach to pancreatic surgery, however, controversies still exist in the literature. The aim was to describe the perioperative morbidity and mortality of the first patients that underwent laparoscopic pancreatectomy for malignancy in a service of gastrointestinal surgery. This is a descriptive/retrospective study in a population of patients with pancreatic/periampullary cancer, who underwent laparoscopic pancreatectomy. All patients were included. We aimed to describe the main results from the intraoperative up to 60 days after surgery. Between 2013 and 2015, 9 patients underwent laparoscopic pancreatectomy. The average age was 57 years and adenocarcinoma were the most common tumor type (78%). 3 patients underwent laparoscopic distal pancreatectomy and 6 underwent laparoscopic gastroduodenopancreatectomy. Perioperative morbidity was 67%, however, only one patient had serious complications. Pancreatic fistula occurred in two cases. There were no deaths in the perioperative period. All resections showed negative surgical margins. The data indicate that laparoscopic pancreatectomy is safe and feasible regarding perioperative results.

The importance of three-dimensional anorectal ultrasound in the study of patients with anal pain / A importância da ultra-sonografia anorretal tridimensional no estudo de pacientes portadores de dor anal

OBJECTIVES: Anal pain can be caused by various medical conditions; the exclusion of organic causes for proper treatment is important. Three-dimensional anorectal ultrasound can identify organic causes of anal pain. The objective of this study was to evaluate the importance of three-dimensional anorectal ultrasound in the detection of organic abnormalities in patients with anal pain. METHODS: Twenty-two patients (mean age: 49 years; 13 women) with chronic anal pain were enrolled to join a prospective study between June 2009 and June 2011. A complete proctology and colonoscopy examination was normal. Subsequently, the patients underwent three-dimensional anorectal ultrasound. RESULTS: Intersphincteric sepsis was found in 14 patients (63.6%). Two female patients (9.1%) had anal sphincter injury, one of them with the presence of a grade II rectocele. There was an increase in the thickness of the subepithelial tissue in three patients (13.6%). In one patient (4.6%), the presence of a hypoechoic circular retrorectal (presacral) cyst of the middle and lower rectum was observed. The three-dimensional anorectal ultrasound examination showed no abnormalities in two patients (9.1%). CONCLUSION: The three-dimensional anorectal ultrasound is a simple, economical, fast and useful test for the study of anorectal diseases and should be included in the examination of patients with anal pain, to exclude organic causes. (AU)

OBJETIVOS: A dor anal pode resultar várias condições clínicas e se faz necessário excluir causas orgânicas para o tratamento adequado. A ultra-sonografia anorretal tridimensional (3D-US) pode identificar causas orgânicas de dor anal. O objetivo deste estudo foi avaliar a importância da 3D-US para detectar anomalias orgânicas em pacientes com dor anal. MÉTODOS: Vinte e dois pacientes (média de idade: 49 anos; treze mulheres) com dor anal crônica foram incluídos em um estudo prospectivo entre junho de 2009 e junho de 2011. O exame proctológico completo e colonoscopia foram normais. Posteriormente, os pacientes foram submetidos à 3D-US. RESULTADOS: Sepse interesfincteriana foi evidenciada em quatorze pacientes (63,6%). Duas pacientes (9.1%) apresentaram lesão do esfíncter anal, sendo uma com presença de retocele grau II. O aumento da espessura do tecido subepitelial apresentou-se em três pacientes (13,6%). Em um paciente (4,6%), foi evidenciada a presença de cisto retrorretal circular hipoecoico no reto médio e inferior. O exame de US-3D não evidenciou anormalidades em dois indivíduos (9.1%). CONCLUSÃO: A ultra-sonografia anorretal tridimensional é um exame simples, econômico, rápido e útil no estudo de doenças anorretais e deve ser incluído no estudo dos pacientes com dor anal para descartar causas orgânicas. (AU)