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1.
Obes Surg ; 29(4): 1439-1441, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30737760

RESUMO

INTRODUCTION: Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD. CASE REPORT AND MANAGEMENT: A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m2 with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms. CONCLUSION: We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments.

2.
Molecules ; 24(3)2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30759729

RESUMO

Membrane distillation (MD) has recently gained considerable attention as a valid process for the production of fresh-water due to its ability to exploit low grade waste heat for operation and to ensure a nearly feed concentration-independent production of high-purity distillate. Limitations have been related to polarization phenomena negatively affecting the thermal efficiency of the process and, as a consequence, its productivity. Several theoretical models have been developed to predict the impact of the operating conditions of the process on the thermal polarization, but there is a lack of experimental validation. In this study, electrospun nanofiber membranes (ENMs) made of Poly(vinylidene fluoride) (PVDF) and doped with (1, 10-phenanthroline) ruthenium (II) Ru(phen)3 were tested at different operating conditions (i.e., temperature and velocity of the feed) in direct contact membrane distillation (DCMD). The temperature sensitive luminophore, Ru(phen)3, allowed the on-line and non-invasive mapping of the temperature at the membrane surface during the process and the experimental evaluation of the effect of the temperature and velocity of the feed on the thermal polarization.


Assuntos
Sondas Moleculares/química , Nanofibras/química , Destilação/métodos , Água Doce/química , Membranas/química , Membranas Artificiais , Polivinil/química , Rutênio/química , Temperatura Ambiente
3.
Obes Surg ; 28(10): 3012-3019, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29704228

RESUMO

PURPOSE: To compare the effects of the sleeve gastrectomy with transit bipartition (SG + TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D). METHODS: This is a prospective, randomized, controlled trial. Twenty male adults, ≤ 65 years old, with T2D, body mass index (BMI) > 28 kg/m2 and < 35 kg/m2, and HbA1c level > 8% were randomized to SG + TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months. RESULTS: At 24 months, SG + TB group showed a significant decrease in HbaA1c values (9.3 ± 2.1 versus 5.5 ± 1.1%, P = < 0.05) whereas SMT group maintained similar levels from baseline (8.0 ± 1.5 versus 8.3 ± 1.1%, P = NS). BMI values were lower in the SG + TB group (25.3 ± 2.8 kg/m2 versus 30.9 ± 2.5 kg/m2; P = < 0.001). At 24 months, none patient in SG + TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG + TB group (33 ± 8 to 45 ± 15 mg/dL, P < 0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG + TB group and the AUC of the GIP concentrations was lower in the SG + TB group than in the SMT. At 3 months, SG + TB group showed a marked increase in FGF19 levels (74.1 ± 45.8 to 237.3 ± 234 pg/mL; P = 0.001). CONCLUSIONS: SG + TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.


Assuntos
Diabetes Mellitus Tipo 2 , Gastrectomia , Obesidade , Adulto , Idoso , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/estatística & dados numéricos , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/metabolismo , Obesidade/cirurgia , Estudos Prospectivos
4.
BMJ Open ; 6(3): e010245, 2016 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-26975937

RESUMO

INTRODUCTION: Obesity and type 2 diabetes mellitus are increasing worldwide, reaching pandemic proportions. The understanding of the role of functional restriction and gut hormones can be a beneficial tool in treating obesity and diabetes. However, the exact hormonal profiles in different metabolic states and surgical models are not known. METHODS AND ANALYSIS: The HIPER-1 Study is a single-centre cross-sectional study in which 240 patients (in different metabolic states and surgical models) will receive an oral mixed-meal tolerance test (OMTT). At baseline and after 30, 60 and 120 min, peptide YY and glucagon-like peptide 1 levels and glucose and insulin sensitivity will be measured. The primary end point of the study will be the area under the glucagon-like peptide 1 and peptide YY curves after the OMTT. Secondary study end points will include examination of the difference in plasma levels of the distal ileal hormones in subjects with various health statuses and in patients who have been treated with different surgical techniques. ETHICS AND DISSEMINATION: An independent ethics committee, the Institutional Review Board of Istanbul Sisli Kolan International Hospital, Turkey, has approved the study protocol. Dissemination will occur via publication, national and international conference presentations, and exchanges with regional, provincial and national stakeholders. TRIAL REGISTRATION NUMBER: NCT02532829; Pre-results.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Peptídeo 1 Semelhante ao Glucagon/sangue , Resistência à Insulina , Obesidade/cirurgia , Peptídeo YY/sangue , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Hormônios Gastrointestinais/sangue , Teste de Tolerância a Glucose , Humanos , Insulina/sangue , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Obesidade/sangue , Estudos Prospectivos , Projetos de Pesquisa , Turquia
5.
Obes Surg ; 25(8): 1547-9, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26084252

RESUMO

The biliopancreatic derivation (BPD) is the most powerful bariatric procedure. However, it never became a very popular procedure, except for Italy, because of the high rate of nutritional problems, intense flatulence, and diarrhea. Here, we describe an extremely simple way (just one anastomosis) to revise the BPD, transforming it into an ileal interposition with duodenal exclusion, solving these described problems.


Assuntos
Desvio Biliopancreático/métodos , Duodeno/cirurgia , Íleo/cirurgia , Obesidade Mórbida/cirurgia , Anastomose Cirúrgica , Feminino , Humanos , Pessoa de Meia-Idade
7.
Einstein (Sao Paulo) ; 12(3): 287-94, 2014 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25295447

RESUMO

OBJECTIVE: Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. METHODS: Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. RESULTS: In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. CONCLUSION: The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors.


Assuntos
Gastrectomia/métodos , Refluxo Gastroesofágico/cirurgia , Obesidade/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Refluxo Gastroesofágico/prevenção & controle , Trato Gastrointestinal/diagnóstico por imagem , Trânsito Gastrointestinal , Humanos , Laparoscopia/métodos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Radiografia , Fatores de Tempo , Resultado do Tratamento , Perda de Peso , Adulto Jovem
8.
Einstein (Säo Paulo) ; 12(3): 287-294, Jul-Sep/2014. graf
Artigo em Inglês | LILACS | ID: lil-723914

RESUMO

Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors. .


Objetivo A gastrectomia vertical é o procedimento cirúrgico para tratamento da obesidade que mais cresce em indicações. No entanto, esse procedimento pode causar ou agravar a doença do refluxo gastresofágico. Este artigo buscou descrever originalmente a adição de procedimentos antirrefluxo (remoção de coxins gordurosos do hiato, hiatoplastia, pequena plicatura e fixação do remanescente na posição anatômica), além de relatar seus resultados precoces e tardios. Métodos Foram submetidos à gastrectomia vertical com medidas antirrefluxo 88 oito pacientes obesos com sintomas de doença do refluxo gastresofágico. Dentre esses pacientes, 50 foram submetidos também à bipartição do trânsito. A perda de peso destes foi comparada àquela ocorrida em 360 pacientes consecutivos submetidos à gastrectomia vertical usual e à de 1.140 pacientes submetidos à gastrectomia vertical + bipartição do trânsito. Os sintomas do refluxo gastresofágico foram investigados por meio de questionário em todos os submetidos à gastrectomia vertical com medidas antirrefluxo e comparados com os resultados obtidos em 50 pacientes submetidos à gastrectomia vertical usual e a 60 submetidos à gastrectomia vertical + bipartição do trânsito, também com sintomas prévios de doença do refluxo gastresofágico. Resultados O percentual de perda do excesso de índice de massa corporal após gastrectomia vertical antirefluxo não foi inferior a gastrectomia vertical usual. Além disso, a gastrectomia vertical antirefluxo + bipartição do trânsito não foi inferior a gastrectomia vertical + bipartição do trânsito. Não houve aumento da morbidade na gastrectomia vertical antirefluxo, porém notou-se redução ...


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Gastrectomia/métodos , Refluxo Gastroesofágico/cirurgia , Obesidade/cirurgia , Índice de Massa Corporal , Seguimentos , Trânsito Gastrointestinal , Refluxo Gastroesofágico/prevenção & controle , Trato Gastrointestinal , Laparoscopia/métodos , Ilustração Médica , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
10.
Ann Surg ; 256(1): 104-10, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22609843

RESUMO

OBJECTIVE: To present 5-year results of sleeve gastrectomy (SG) with transit bipartition (TB) as a metabolic intervention for obesity. BACKGROUND: Recent data suggest that high glycemic index foods may lead to a hormonally hyperactive proximal gut and a hypoactivate distal gut, which are linked to metabolic syndrome. TB was designed to counterbalance these effects. METHODS: A total of 1020 obese patients with body mass index (BMI) ranging from 33 to 72 Kg/m underwent SG and TB (SG + TB). TB creates a gastroileal anastomosis in the antrum after the SG; nutrient transit is maintained in the duodenum, avoiding blind loops and minimizing malabsorption. The stomach retains 2 outflow pathways. A lateral enteroanastomosis connects both segments at 80 cm proximal to the cecum. RESULTS: Adequate follow-up data were collected in 59.1% of patients from 4 months to 5 years. The average percent of excess BMI loss was 91%, 94%, 85%, 78%, and 74% in the first, second, third, fourth, and fifth year, respectively. Patients experienced early satiety and major improvement in presurgical comorbidities, including diabetes (86% in remission), following surgery. Two deaths occurred (0.2%). Other surgical complications occurred in 6% of patients. Signs of malabsorption were rare. CONCLUSIONS: SG + TB is a simple procedure that results in rapid weight loss and remission or major improvement of comorbidities. Strictly aiming at physiological correction, TB avoids prostheses, narrow anastomoses, excluded segments, and malabsorption. Weight and comorbidities are much improved. Diabetes is improved without duodenal exclusion. TB is an excellent complement to an SG.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Síndrome Metabólica/cirurgia , Obesidade Mórbida/cirurgia , Glicemia/análise , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/fisiopatologia , Polipeptídeo Inibidor Gástrico/fisiologia , Índice Glicêmico , Humanos , Íleo/cirurgia , Estado Nutricional , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Assistência Perioperatória , Resposta de Saciedade , Grampeamento Cirúrgico , Técnicas de Sutura , Perda de Peso
13.
Clinics (Sao Paulo) ; 66(7): 1227-33, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21876979

RESUMO

BACKGROUND: Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied. METHODS: Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation. RESULTS: All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred. CONCLUSIONS: Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.


Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Jejuno/cirurgia , Omento/cirurgia , Adulto , Índice de Massa Corporal , Feminino , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Humanos , Masculino , Síndrome Metabólica/cirurgia , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Peptídeo YY/metabolismo , Período Pós-Operatório , Fatores de Tempo , Resultado do Tratamento
14.
Clinics ; 66(7): 1227-1233, 2011. ilus, tab
Artigo em Inglês | LILACS | ID: lil-596913

RESUMO

BACKGROUND: Various digestive tract procedures effectively improve metabolic syndrome, especially the control of type 2 diabetes mellitus. Very good metabolic results have been shown with vertical gastrectomy and entero-omentectomy; however, the metabolic effects of an isolated entero-omentectomy have not been previously studied. METHODS: Nine patients with type 2 diabetes mellitus and a body mass index ranging from 29 to 34.8 kg/m² underwent an entero-omentectomy procedure that consisted of an enterectomy of the middle jejunum and exeresis of the major part of the omentum performed through a mini-laparotomy. Glucagon-like peptide-1 and peptide YY were measured preoperatively and three months following the operation. Fasting and postprandial variations in glycemia, insulinemia, triglyceridemia, hemoglobin A1c, and body mass index were determined in the preoperative period and 3, 18 and, 36 months after the operation. RESULTS: All patients significantly improved the control of their type 2 diabetes mellitus. Postprandial secretion of peptide YY and Glucagon-like peptide-1 were enhanced, whereas hemoglobin A1c, fasting and postprandial glucose, insulin, and triglyceride levels were significantly reduced. Mean body mass index was reduced from 31.1 to 27.3 kg/m². No major surgical or nutritional complications occurred. CONCLUSIONS: Entero-omentectomy is easy and safe to perform. A simple reduction in jejunal extension and visceral fat causes important improvements in the metabolic profile.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , /metabolismo , Jejuno/cirurgia , Omento/cirurgia , Índice de Massa Corporal , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Peptídeo 1 Semelhante ao Glucagon , Síndrome Metabólica/cirurgia , Estado Nutricional/fisiologia , Período Pós-Operatório , Peptídeo YY/metabolismo , Peptídeo YY , Fatores de Tempo , Resultado do Tratamento
18.
Obes Surg ; 18(1): 17-26, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18080721

RESUMO

BACKGROUND: Recent physiological knowledge allows the design of bariatric procedures that aim at neuroendocrine changes instead of at restriction and malabsorption. Digestive adaptation is a surgical technique for obesity based in this rationale. METHODS: The technique includes a sleeve gastrectomy, an omentectomy and a jejunectomy that leaves initial jejunum and small bowel totaling at least 3 m (still within normal variation of adult human bowel length). Fasting ghrelin and resistin and fasting and postprandial GLP-1 and PYY were measured pre- and postoperatively. PATIENTS: 228 patients with initial body mass index (BMI) varying from 35 to 51 kg/m(2); follow-up: 1 to 5 years; average EBMIL% was 79.7% in the first year; 77.7% in the second year; 71.6% in the third year; 68.9% in the fourth year. PATIENTS present early satiety and major improvement in presurgical comorbidities, especially diabetes. Fasting ghrelin and resistin were significantly reduced (P < 0.05); GLP-1 and PYY response to food ingestion was enhanced (P < 0.05). Surgical complications (4.4%) were resolved without sequela and without mortality. There was neither diarrhea nor detected malabsorption. CONCLUSIONS: Based on physiological and supported by evolutionary data, this procedure creates a proportionally reduced gastrointestinal (GI) tract that amplifies postprandial neuroendocrine responses. It leaves basic GI functions unharmed. It reduces production of ghrelin and resistin and takes more nutrients to be absorbed distally enhancing GLP-1 and PYY secretion. Diabetes was improved significantly without duodenal exclusion. The patients do not present symptoms nor need nutritional support or drug medication because of the procedure, which is safe to perform.


Assuntos
Cirurgia Bariátrica/métodos , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/cirurgia , Adaptação Fisiológica , Adulto , Idoso , Feminino , Gastrectomia , Grelina/sangue , Peptídeo 1 Semelhante ao Glucagon/sangue , Humanos , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/sangue , Omento/cirurgia , Peptídeo YY/sangue , Resistina/sangue
19.
J Pediatr Endocrinol Metab ; 20(7): 751-61, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17849736

RESUMO

In view of the increasing prevalence of obesity all over the world, we have seen morbid obesity occurring at earlier ages, and especially in adolescents. The first and main approach has been a conservative one, including change of lifestyle - implying better feeding habits and physical activity. However, our weapons to deal with this 'pandemic of obesity' have not solved a large number of cases, and we have to admit that bariatric surgery should be contemplated in special cases. Many different approaches have been devised by bariatric surgeons and although the complications over the short- and long-term are high and potentially severe, in some cases it is the only approach that has the potential to put the patient back to a more 'normal' metabolic situation with a significant weight loss. We discuss the main surgical approaches for morbid obesity and we comment on the pros and cons of each of them.


Assuntos
Cirurgia Bariátrica/métodos , Obesidade Mórbida/cirurgia , Adolescente , Fatores Etários , Cirurgia Bariátrica/efeitos adversos , Índice de Massa Corporal , Feminino , Humanos , Masculino , Obesidade Mórbida/fisiopatologia
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