DEPRESSIVE AND EATING DISORDERS IN PATIENTS POST-BARIATRIC SURGERY WITH WEIGHT REGAIN: A DESCRIPTIVE OBSERVATIONAL STUDY.

BACKGROUND: Although bariatric surgery is today's gold standard treatment for obesity, weight regain affects the success rate of the procedure. Recent studies have identified psychiatric and neurological factors as possible causes. AIMS: The aim of this study was to evaluate the influence of psychiatric diseases on the outcome and long-term success of bariatric surgeries and find a weight regain threshold that has an acceptable sensibility to mental health-related issues to be used in research and clinical studies. METHODS: This is a observational study of bariatric patients submitted to Roux-en-Y bypass or sleeve gastrectomy, with a postoperative time of 2-10 years to access weight regain, depression, and binge-eating disorder. RESULTS: Of 217 patients studied, 163 were women and 54 were men, with an average postoperative time of 5.2±2.6 years. Weight regain was experienced in 35% of the patients, binge-eating disorder in 24.9%, and depression in 24%. The greater weight before surgery, body mass index (BMI), percentage increase to maximum weight loss, and time postoperatively all have a significant positive correlation with weight regain (p=0.045, p=0.026, p<0.001, and p<0.001, respectively). A significant association between binge-eating disorder, depression, and anxiety with weight regain (p=0.004, p=0.008, and p=0.001, respectively) was found. CONCLUSIONS: The significant weight regain rates with significant impact on psychiatric disorders highlight the need for continuous postoperative monitoring focused on the psychiatric aspects of obesity to aid surgeries' long-term success.

Depressive and eating disorders in patients post-bariatric surgery with weight regain: a descriptive observational study / Transtorno depressivo e alimentar em pacientes pós-bariátricos cirurgia bariátrica com reganho de peso: um estudo observacional descritivo

ABSTRACT BACKGROUND: Although bariatric surgery is today's gold standard treatment for obesity, weight regain affects the success rate of the procedure. Recent studies have identified psychiatric and neurological factors as possible causes. AIMS: The aim of this study was to evaluate the influence of psychiatric diseases on the outcome and long-term success of bariatric surgeries and find a weight regain threshold that has an acceptable sensibility to mental health-related issues to be used in research and clinical studies. METHODS: This is a observational study of bariatric patients submitted to Roux-en-Y bypass or sleeve gastrectomy, with a postoperative time of 2-10 years to access weight regain, depression, and binge-eating disorder. RESULTS: Of 217 patients studied, 163 were women and 54 were men, with an average postoperative time of 5.2±2.6 years. Weight regain was experienced in 35% of the patients, binge-eating disorder in 24.9%, and depression in 24%. The greater weight before surgery, body mass index (BMI), percentage increase to maximum weight loss, and time postoperatively all have a significant positive correlation with weight regain (p=0.045, p=0.026, p<0.001, and p<0.001, respectively). A significant association between binge-eating disorder, depression, and anxiety with weight regain (p=0.004, p=0.008, and p=0.001, respectively) was found. CONCLUSIONS: The significant weight regain rates with significant impact on psychiatric disorders highlight the need for continuous postoperative monitoring focused on the psychiatric aspects of obesity to aid surgeries' long-term success.

RESUMO INTRODUÇÃO: Embora a cirurgia bariátrica atualmente é considerada o tratamento padrão ouro para a obesidade, o reganho de peso afeta a taxa de sucesso do procedimento. Estudos recentes identificaram fatores psiquiátricos e neurológicos como possíveis causas. OBJETIVOS: Avaliar a influência de transtornos psiquiátricos no resultado a longo prazo das cirurgias bariátricas; testar a sensibilidade e correlação das fórmulas de reganho de peso e de seus respectivos pontos de corte para questões relacionadas à saúde mental. MÉTODOS: Estudo observacional de pacientes pós bariátricos submetidos à by-pass em Y de Roux ou gastrectomia vertical com pós-operatório de 2 a10 anos avaliados quanto a reganho de peso, depressão e transtorno da compulsão alimentar. RESULTADOS: Foram avaliados 217 pacientes, 163 mulheres e 54 homens com pós-operatório de 5,2±2,6 anos. O reganho de peso foi registrado em 35% dos pacientes, o transtorno da compulsão alimentar (TCA) foi encontrado em 24,9% e depressão em 24%. O ganho de peso pré-operatório, o índice de massa corporea (IMC), o aumento percentual para perda máxima de peso e tempo de pós-operatório, apresentaram correlação positiva significativa com o reganho de peso (p=0,045), (p=0,026), (<0,001), (<0,001). Foi encontrada associação significativa entre TCA, depressão e ansiedade com reganho de peso (p=0,004), (p=0,008) e (p=0,001). CONCLUSÕES: As taxas significativas de reganho de peso associado ao impacto dos transtornos psiquiátricos reforçam a necessidade de acompanhamento pós-operatório contínuo focado nos aspectos psiquiátricos da obesidade, para sucesso do tratamento cirúrgico em longo prazo.

Perforated gastric ulcer post mini gastric bypass treated by laparoscopy: A case report.

INTRODUCTION: Among the many techniques available for bariatric surgery, the Mini Gastric Bypass is a safe, technically simple and effective option. However, it may present with postoperative complications, being the perforated gastric ulcer one of the most relevant ones. PRESENTATION OF CASE: A female patient of 41 years of age, with past medical history of a laparoscopic MGB performed 2 year before, presented with 12 hours of sharp and abruptly initiated abdominal pain, with diffuse presentation with suspected perforated acute abdomen after initial medical assessment and examination. Imaging propaedeutic was performed and confirmed a small pneumoperitoneum the patient was submitted to a laparoscopy with closure of the leak and omental patch (Graham's patch) after a thorough abdominal irrigation with saline solution. The patient was discharged from the hospital on the fourth day after surgery. DISCUSSION: One of the most common complications after and MGB surgery is the occurrence of gastric ulcers and main manifestation of the anastomotic marginal ulcers (MU) is the perforation. The treatment of the perforated peptic ulcer can be performed via laparoscopic or laparotomic approach. The main objective, regardless of the method used to access the abdominal cavity, is to identify and close the perforation. CONCLUSION: The perforated gastric ulcer is a complication of the mini bariatric bypasses, and the laparoscopic treatment of the perforation associated with thorough irrigation for of the abdominal cavity and omentoplasty present good results for management of this complication.

Treatment of abdominal wall hernia with suture, or polypropylene, or collagen prosthesis.

PURPOSE: To develop an experimental model for incisional hernias and to compare morphological and functional aspects of hernia repairs by suture, polypropylene mesh and collagen mesh. METHODS: A defect measuring 7cm x 2cm was created in the anterior abdominal of 28 New Zealand male rabbits, divided into four groups (n = 7): (1) control, (2) suture of the anterior sheath of the rectus abdominal muscle, (3) setting of polypropylene mesh, and (4) setting of collagen mesh. On the 90th postoperative day, the animals were examined to verify the presence of incisional hernia. Samples of abdominal wall and scar were collected for histological study. RESULTS: Incisional hernia was identified in 85.7% of the control group, 57.1% of the suture group, 42.9% of the collagen mesh group, and none in the polypropylene mesh group (p = 0.015). Mesh exposure could be identified in 71.4% of the animals in group 3 and in no animal in group 4 (p = 0.021). The polypropylene mesh is effective in the treatment of abdominal wall defects, causing an intense inflammatory reaction. CONCLUSION: The collagen mesh is biocompatible, producing a minimal inflammatory reaction, but fails in the treatment of abdominal wall defects.

Treatment of abdominal wall hernia with suture, or polypropylene, or collagen prosthesis

ABSTRACT PURPOSE: To develop an experimental model for incisional hernias and to compare morphological and functional aspects of hernia repairs by suture, polypropylene mesh and collagen mesh. METHODS: A defect measuring 7cm x 2cm was created in the anterior abdominal of 28 New Zealand male rabbits, divided into four groups (n = 7): (1) control, (2) suture of the anterior sheath of the rectus abdominal muscle, (3) setting of polypropylene mesh, and (4) setting of collagen mesh. On the 90th postoperative day, the animals were examined to verify the presence of incisional hernia. Samples of abdominal wall and scar were collected for histological study. RESULTS: Incisional hernia was identified in 85.7% of the control group, 57.1% of the suture group, 42.9% of the collagen mesh group, and none in the polypropylene mesh group (p = 0.015). Mesh exposure could be identified in 71.4% of the animals in group 3 and in no animal in group 4 (p = 0.021). The polypropylene mesh is effective in the treatment of abdominal wall defects, causing an intense inflammatory reaction. CONCLUSION: The collagen mesh is biocompatible, producing a minimal inflammatory reaction, but fails in the treatment of abdominal wall defects.

Cardiac tamponade as a complication of parenteral nutrition.

INTRODUCTION: Complications arising from the use of central venous catheters are numerous, but cardiac tamponade is a complication well defined, very rare and often fatal. The mortality rate is 47-77% in the literature. PRESENTATION OF CASE: We report a case of successful diagnosis and treatment of cardiac tamponade by parenteral nutrition in a 31-year-old female. DISCUSSION: There are only few cases of cardiac tamponade reported in the world literature since 1958. The true incidence is unclear and the most cases occur in children. Despite the rarity of this condition, it has a high mortality rate. The clinical findings are pain and discomfort in the epigastrium and chest region, nausea, dyspnea, tachycardia, distended jugular veins, paradoxical pulse, hypotension, electrocardiographic tracing signals with low voltage and enlargement of cardiac area. The immediate diagnosis and the treatment of cardiac tamponade are capital for patient survival. CONCLUSION: Cardiac tamponade should be suspected among patients with sudden onset of shock in use of parenteral nutrition, and therefore immediately treated.