Early Post-operative Weight Change After Roux-en-Y Gastric Bypass Predicts Weight Loss at 12-Month Follow-up.

INTRODUCTION: Sub-optimal weight loss following Roux-en-Y gastric bypass (RYGB) represents an important clinical challenge in a significant number of patients. Early identification of such patients would be advantageous, as it could aid in the selective implementation of targeted adjunct interventions during the first post-operative year. METHODS: Clinical audit data from 1137 patients undergoing RYGB between 2013 and 2016 at the Instituto Sallet in Brazil were prospectively registered in an online database (BOLD) and analyzed. RESULTS: Forty-eight percent of patients achieving less than 5% total weight loss after the first post-operative month achieved a 20% total weight loss at 1 year (n = 626; OR = 0.6 CI = 95%). Eighty-three percent of patients losing between 5 and 10% at 1 month and 95% of patients losing greater than 10% at 1 month had lost at least 20% of total body weight after the first post-operative year. Forty-four percent of patients achieving less than 10% total weight loss after the third post-operative month achieved 20% total weight loss at 1 year (n = 494; OR = 0.3 CI = 95%). CONCLUSION: Total bodyweight reduction after RYGB of < 5% at 1 month and < 10% at 3 months is associated with suboptimal weight loss at 1 year. These results reinforce findings from other studies reporting that patients tend to follow a common weight loss trajectory. Identifying the patients with weight trajectory requiring adjunct therapies early on is crucial so appropriate adjustments can be made to post-operative care.

Application of BAROS' questionnaire in obese patients undergoing bariatric surgery with 2 years of evolution / Aplicação do questionário BAROS em pacientes obesos submetidos à cirurgia bariátrica com 2 anos de evolução

ABSTRACT BACKGROUND -In recent decades, the high prevalence of obesity in the general population has brought serious concerns in terms of public health. Contrarily to conventional treatment involving dieting and physical exercising, often ineffective in generating long term results, bariatric opera­tions have been an effective method for sustained weight loss in morbidly obese individuals. The Bariatric Analysis and Reporting Outcome System (BAROS) is an objective and recognized system in the overall evaluation of results after bariatric surgery. OBJECTIVE To investigate results concerning a casuistic of morbidly obese patients undergoing bariatric surgery over a 2-year follow-up in terms of weight loss, related medical conditions, safety and changes in quality of life. METHODS A total of 120 obese (17 male and 103 female) patients, who underwent bariatric surgery, were assessed and investigated using the BAROS system after a 2- year follow-up. RESULTS Patients obtained a mean excess weight loss of 74.6 (±15.9) % and mean body mass index reduction of 15.6 (±4.4) Kg/m2. Pre-surgical comorbidities were present in 71 (59%) subjects and they were totally (86%) or partially (14%) resolved. Complications resulting specifically from the surgical procedure were observed in 4.2% of cases (two bowel obstructions requiring re-operation, and three stomal stenosis treated with endoscopic dilation). Sixteen subjects (13% of total number of patients) presented minor clinical complications managed through outpatient care. The final scores for the BAROS questionnaire showcased excellent to good results in 99% of cases (excellent 44%, very good 38%, good 23%, acceptable 1%). CONCLUSION According to the BAROS questionnaire, bariatric surgery is a safe and effective method for managing obesity and associated clinical comorbidities, allowing for satisfactory results after a 2-year follow-up. Future studies should address other clinical and psychosocial variables that impact outcome as well as allow for longer follow-ups.

RESUMO CONTEXTO Nas últimas décadas, a alta prevalência de obesidade na população geral trouxe grandes preocupações para a saúde pública. Contrariamente ao tratamento convencional envolvendo dieta e atividade física, quase sempre inefetivo em gerar resultados a longo prazo, a cirurgia bariátrica vem se mostrando um método efetivo de perda de peso mantida em indivíduos com obesidade mórbida. O Bariatric Analysis and Reporting Outcome System (BAROS) é um sistema reconhecido e objetivo para a avaliação global de resultados depois de cirurgia bariátrica. OBJETIVO Investigar os resultados referentes à casuística de pacientes obesos mórbidos submetidos à cirurgia bariátrica em um período de 2 anos em termos de perda de peso, condições clínicas relacionadas, segurança e qualidade de vida. MÉTODOS Um total de 120 pacientes obesos (17 masculinos e 103 femininos) admitidos consecutivamente durante período de 4 meses para cirurgia bariátrica foram avaliados e investigados usando o sistema BAROS após 2 anos de evolução. RESULTADOS Os pacientes apresentaram redução média percentual de excesso de peso de 74,6 (±15,9) % e redução média de índice de massa corporal de 15,6 (±4,4) Kg/m2. Comorbidades pré-cirúrgicas estavam presentes em 71 (59%) pacientes e em todos eles foram total (86%) ou parcialmente (14%) resolvidas. Complicações resultantes especificamente do procedimento cirúrgico foram observadas em 4,2% dos casos (duas obstruções intestinais exigindo reoperação e três estenoses anastomóticas resolvidas com dilatação endoscópica). Dezesseis (13%) pacientes apresentaram complicações clínicas menores resolvidas com manejo clínico ambulatorial. Os escores totais do BAROS classificaram os resultados como excelente até bom em 99% dos casos (44% excelente, 38% muito bom e 23% bom) e aceitável em 1% dos casos. CONCLUSÃO De acordo com o questionário BAROS, a cirurgia bariátrica se mostrou segura e efetiva no controle da obesidade e de comorbidades clínicas associadas, permitindo satisfação geral dos pacientes após 2 anos de seguimento. Estudos futuros deverão também investigar outras variáveis clínicas e psicossociais de possível impacto na evolução e por períodos de seguimento mais longos.

Application of BAROS' questionnaire in obese patients undergoing bariatric surgery with 2 years of evolution.

BACKGROUND:: -In recent decades, the high prevalence of obesity in the general population has brought serious concerns in terms of public health. Contrarily to conventional treatment involving dieting and physical exercising, often ineffective in generating long term results, bariatric opera-tions have been an effective method for sustained weight loss in morbidly obese individuals. The Bariatric Analysis and Reporting Outcome System (BAROS) is an objective and recognized system in the overall evaluation of results after bariatric surgery. OBJECTIVE: - To investigate results concerning a casuistic of morbidly obese patients undergoing bariatric surgery over a 2-year follow-up in terms of weight loss, related medical conditions, safety and changes in quality of life. METHODS: - A total of 120 obese (17 male and 103 female) patients, who underwent bariatric surgery, were assessed and investigated using the BAROS system after a 2- year follow-up. RESULTS: - Patients obtained a mean excess weight loss of 74.6 (±15.9) % and mean body mass index reduction of 15.6 (±4.4) Kg/m2. Pre-surgical comorbidities were present in 71 (59%) subjects and they were totally (86%) or partially (14%) resolved. Complications resulting specifically from the surgical procedure were observed in 4.2% of cases (two bowel obstructions requiring re-operation, and three stomal stenosis treated with endoscopic dilation). Sixteen subjects (13% of total number of patients) presented minor clinical complications managed through outpatient care. The final scores for the BAROS questionnaire showcased excellent to good results in 99% of cases (excellent 44%, very good 38%, good 23%, acceptable 1%). CONCLUSION: - According to the BAROS questionnaire, bariatric surgery is a safe and effective method for managing obesity and associated clinical comorbidities, allowing for satisfactory results after a 2-year follow-up. Future studies should address other clinical and psychosocial variables that impact outcome as well as allow for longer follow-ups.

Age and gender may influence the results of Roux-en-Y gastric bypass? Metabolic syndrome parameters.

CONTEXT: Severe obesity affects the body favoring the development of serious diseases, including hypertension, diabetes mellitus, atherosclerosis and non alcoholic fatty liver disease. Bariatric procedures increased in Brazil in the last decade. OBJECTIVES: The purpose of this study was to verify if gender and age in date of procedure resulted significant differences in metabolic syndrome parameters after surgery. METHODS: The study involved 205 medical records of adult patients undergoing Roux-en-Y gastric bypass, stratified by gender and age groups and followed one year by a multidisciplinary team. RESULTS: It was observed significant decrease in body mass index, fasting glucose and insulin at all ages and both genders. Lipid profile showed significant improvements except high density lipoprotein cholesterol. Ectopic fat in the liver has decreased after 6 months in patients classified with steatosis at baseline. Patients classified as hypertensive blood pressure levels decreased 6 months after surgical intervention. CONCLUSIONS: Roux-en-Y gastric bypass proved to be an important tool in remission of metabolic syndrome parameters. The reduction of body mass accompanied to decrease in insulin resistance resulted in lower prevalence of comorbidities associated with obesity. The benefits were similar and extended both genders and all age groups between 18 and 65 years old.

AGE AND GENDER MAY INFLUENCE THE RESULTS OF ROUX-EN-Y GASTRIC BYPASS? Metabolic syndrome parameters / Idade e gênero podem influenciar nos resultados da derivação gástrica em Y de Roux? Parâmetros da síndrome metabólica

Context Severe obesity affects the body favoring the development of serious diseases, including hypertension, diabetes mellitus, atherosclerosis and non alcoholic fatty liver disease. Bariatric procedures increased in Brazil in the last decade. Objectives The purpose of this study was to verify if gender and age in date of procedure resulted significant differences in metabolic syndrome parameters after surgery. Methods The study involved 205 medical records of adult patients undergoing Roux-en-Y gastric bypass, stratified by gender and age groups and followed one year by a multidisciplinary team. Results It was observed significant decrease in body mass index, fasting glucose and insulin at all ages and both genders. Lipid profile showed significant improvements except high density lipoprotein cholesterol. Ectopic fat in the liver has decreased after 6 months in patients classified with steatosis at baseline. Patients classified as hypertensive blood pressure levels decreased 6 months after surgical intervention. Conclusions Roux-en-Y gastric bypass proved to be an important tool in remission of metabolic syndrome parameters. The reduction of body mass accompanied to decrease in insulin resistance resulted in lower prevalence of comorbidities associated with obesity. The benefits were similar and extended both genders and all age groups between 18 and 65 years old. .

Contexto A obesidade severa favorece o desenvolvimento de doenças graves, como hipertensão, diabetes mellitus, aterosclerose e esteatose hepática. Na última década, houve um aumento de procedimentos bariátricos no Brasil. Objetivos O objetivo deste estudo foi verificar se o gênero e a idade no momento da cirurgia implicam em diferenças significativas nos parâmetros da síndrome metabólica. Métodos Estudo envolveu 205 prontuários de pacientes adultos submetidos à derivação gástrica em Y-de-Roux, estratificada por gênero e faixas etárias, acompanhados por equipe multidisciplinar com seguimento de 1 ano. Resultados Observou-se diminuição significativa do índice de massa corporal, glicemia e insulina em todas as idades e ambos os gêneros. O perfil lipídico apresentou melhorias significativas, exceto na fração da lipoproteína de alta densidade. Os níveis de gordura ectópica no fígado diminuíram depois de 6 meses. Houve uma diminuição na prevalência de hipertensos 6 meses após a intervenção cirúrgica. Conclusões A derivação gástrica em Y-de-Roux mostrou melhora dos parâmetros da síndrome metabólica. A redução da massa corporal acompanhada da diminuição na resistência à insulina resultou em menor prevalência de comorbidades associadas à obesidade. Os benefícios foram similares e estenderam-se para ambos os gêneros e todas as faixas etárias entre 18 e 65 anos de idade. .

The impact of temperament and character inventory personality traits on long-term outcome of Roux-en-Y gastric bypass.

BACKGROUND: A significant proportion of patients who undergo bariatric surgery fail to achieve enduring weight loss. Previous studies suggest that psychosocial variables affect postoperative outcome, although this subject is still considered unclear. The purpose of this study is to further investigate the impact of psychosocial variables on Roux-en-Y gastric bypass (RYGB) outcomes over long-term follow-up. MATERIALS AND METHODS: Individuals eligible for bariatric surgery were evaluated using validated psychopathological scales and the Temperament and Character Inventory in a specialized clinic for bariatric treatment. Adult patients who had RYGB were selected for the study. Percent of excess weight loss (%EWL) was measured after surgery at 6 months, 1 year, 2 years, and on the last clinical observation. RESULTS: This study included 333 subjects who had RYGB. Before surgery, mean age was 35.4 years (±9.5) and mean BMI was 43.3 kg/m(2) (±4.8). Higher baseline age and BMI were associated with lower %EWL across endpoints, although this association diminished over time. Follow up at 2 years and on the last clinical observation demonstrated that lower scores on the persistence personality variable and lower body dissatisfaction before surgery predicted lower %EWL. CONCLUSIONS: Psychosocial variables and personality traits assessed during preoperative evaluation significantly predicted weight loss after bariatric surgery. Greater impact was observed in long-term follow-up at 2 years. These findings provide guidance in identifying patients at risk for worse outcomes and designing interventions to improve long-term weight loss.

Esofagogastrofundoplicatura videolaparoscópica por técnica mista / Laparoscopic mixed fundoplication

A doença do refluxo gastroesofágico (DRGE) é uma patologia frequente, acometendo cerca de 10 por cento da população geral. Esta incidência tem se elevado nos últimos anos. Tradicionalmente, sua abordagem terapêutica inicial é clínica, porém, o número de indicações cirúrgicas tem aumentado principalmente às custas das vantagens da videolaparoscopia. Durante o período de janeiro de 1993 a março de 1998, 112 pacientes foram submetidos a fundoplicatura e hiatoplastia por videolaparoscopia para o tratamento da DRGE, sendo 62 (55,3 por cento) do sexo masculino e 50 (44,7 por cento) do sexo feminino. A idade variou de 20 a 90 anos, com média de 40 anos. As indicações cirúrgicas foram doença refratária ao tratamento clínico (76,9 por cento), seguido por esôfago de Barrett (16,1 por cento), estenose esofágica (3,5 por cento), hemorragia digestiva alta por úlcera esofágica (2,6 por cento) e hérnia hiatal paraesofágica (0,9 por cento). Para o procedimento cirúrgico foram utilizados cinco trocartes. A hiatoplastia foi realizada com pontos em "X". Na fundoplicatura, após a passagem do fundo gástrico por trás do esôfago abdominal, inicialmente se realiza um ponto tomando as duas extremidades do fundo gástrico, porém sem fixar esta sutura ao esôfago. A partir daí, mais quatro pontos são realizados, sendo dois acima e dois abaixo deste ponto inicial, de maneira a envolver o esôfago, de modo parcial (270§). O tempo médio de cirurgia foi de 80 minutos e o de internação, de 1,8 dias. Ocorreram duas conversões (1,7 por cento). Não houve mortalidade, e as complicações assinaladas foram pneumotórax (0,9 por cento), enfisema subcutâneo (0,9 por cento), disfagia transitória (26 por cento) e disfagia persistente (3,5 por cento). A fundoplicatura mista laparoscópica tem se mostrado um procedimento seguro e eficaz para o tratamento definitivo da DRGE com baixo número de complicações, reunindo as vantagens clássicas da cirurgia laparoscópica: curto período de internação, rápida recuperação e bons resultados estéticos; e às de uma técnica simplificada, visando facilitar as duas etapas mais complicadas da cirurgia: hiatoplastia e fundoplicatura

Ambulatory laparoscopic surgical treatment of reflux esophagitis

A doenca do refluxo gastroesofagico e uma patologia frequente, acometendo cerca de 10 por cento da populacao geral. Tradicionalmente sua abordagem terapeutica inicial e clinica, porem o numero de indicacoes cirurgicas tem aumentado, principalmente as custas dos beneficios e vantagens da videolaparoscopia...

Colecistectomia laparoscópica em regime ambulatorial / Laparoscopic cholecystectomy in the outpatient on ambulatory setting

Durante o período de janeiro de 1994 a janeiro de 1997 foram submetidos ao método 120 pacientes, sendo 42 do sexo masculino (35 por cento) e 78 do sexo feminino (65 por cento). A idade variou de 16 a 60 anos, com média de 38. Todos apresentavam diagnóstico de colecistite calculosa crônica, sendo selecionados em consultório pelos seguintes critérios: inexistência de quadro inflamatório agudo da vesícula biliar, idade máxima de 60 anos, ausência de suspeita de coledocolitíase e classificação anestésica ASA I e II. A cirurgia era realizada em posição semiginecológica com utilização de três trocartes, sendo a colangiografia realizada de rotina. O tempo cirúrgico variou de 20 a 80 minutos com média de 50 minutos...

Laparoscopy appendectomy: technical procedure

Foram submetidos a apendicectomia por videolaparoscopia 154 pacientes, sendo 92 (59,7 por cento) do sexo masculino e 62 (40,3 por cento) do feminino. A idade variou de 13 a 74 anos, com media de 31 anos. O acesso a cavidade abdominal era realizado com a utilizacao de tres trocateres. Tratava-se o mesoapendice em sua base com eletrocauterizacao bipolar e sua posterior seccao. O apendice era tratado da mesma maneira utilizando-se coagulacao bipolar para cauterizar e selar sua base. A seguir, procedia-se ligadura do apendice junto ao ceco com auxilio de no endoscopico previamente montado. O apendice era seccionado na regiao eletrocoagulada e retirado do abdome em bolsa plastica de protecao...

Laparoscopic cholecystectomy in children and adolescents

During the period between August 1991 and November 1995, seven patients under age 17 were submitted to videolaparoscopic cholecystectomy (LC). Two were males and five females with ages ranging from 12 to 16 years (mean 13.8 years). The diagnosis of chronic cholecystitis with gallstones was made by the clinical history and physical and ultrasonographic examinations. There was no evidence of an association with hemolytic diseases, familial hyperlipidemia or Glucose-6-phosphate dehydrogenase (G6PD) deficiency. The surgery was performed under general anesthesia and the abdomen approached by four ports: a 10 mm umbilical incision, a 5 mm cystic, a 5 mm one at the xiphoid appendix and a 10 mm one at the left lateral margin of the left rectus abdominal muscle between the umbilical scar and the xiphoid appendix. Operative time averaged 120 minutes (105-150 min). One case required conversion to laparotomic approach because of Mirizzi's Syndrome, which was diagnosed by intraoperative cholangiography performed in all cases. There were no deaths or major postoperative complications. Hospital stays ranged from 1-3 days in the six patients submitted to LC. Thus LC in children can be considered a good method, requiring only more care regarding the use of proper equipment, complete and careful dissection of the biliary hilus, and intraoperative cholangiography. The latter is indispensable, as these children can present a higher rate of anatomic anomalies. The advantages of this techniques include a less painful postoperative period with a faster recovery, and it is especially recommended in children, who are less tolerant to physical restriction and pain than adults.

Carcinoma epidermóide de esôfago induzido pela dietilnitrosamina (DEN) / The epidermoid carcinoma of the esophagus induced by diethylnitrosamine

O objetivo desta pesquisa foi verificar a ocorrência de carcinoma epidermóide de esôfago induzido pela DEN, em ratos WISTAR. A DEN foi administrada a dois grupos de 20 animais (peso 250-300 grs.), na água de beber (10 mg/Kg/pêso) durante 72 hs/semana, respectivamente por 120 dias e 200 dias (T120 e T200). Outros 10 animais ingerindo apenas água serviram de controles. Os 50 animais foram sacrificados e seus esôfagos estudados macro e microscopicamente. No grupo controle nao ocorreram carcinomas, nem lesoes pré-neoplásicas. Nos grupos T120 e T200 ocorreram, respectivamente, 47 e 58 carcinomas, "in situ"; 1 e 20 carcinomas submucosos (p<0,05); 4 e 17 carcinomas micro-invasivos (p<0,05); 4 e 11 carcinomas avançados (p<0,05); 1 e 1 hiperplasias benignas. Além disso, foram encontrados carcinomas pulmonares e hepáticos. A maioria das lesoes macroscópicas avançadas no grupo T200 foram polipóides, exofiticas e nao invasivas à microscopia. Este estudo permite concluir que a DEN é efetiva na carcinogênese do esôfago do rato WISTAR e que as lesoes sao dose dependentes.