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1.
Rev Assoc Med Bras (1992) ; 66(9): 1289-1295, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33027460

RESUMO

Obesity is a chronic disease characterized by excess fat in the body and a real public health problem. Bariatric surgery, in recent decades, has gained space in its treatment due to the efficiency obtained in weight loss and significant reduction of the related comorbidities. The most commonly performed bariatric procedures include Roux-en-Y gastric bypass, adjustable gastric band, and laparoscopic sleeve gastrectomy. Possible complications described include fistulas, dehiscence, marginal ulcers, intestinal obstruction, internal hernias, and anastomotic stenosis. These complications may have unfavorable clinical outcomes since symptoms are often nonspecific. Abdominal computed tomography (CT) is an important tool in the evaluation of postoperative complications, both in the immediate and late postoperative status of patients undergoing such a procedure. We analyzed the most illustrative tomographic findings of the different complications after reducing gastroplasty in 203 patients without distinction of age or gender. Correct interpretation requires radiologists to understand the surgical technique since postoperative anatomy and surgery-specific complications may be obstacles to proper interpretation.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Humanos , Laparoscopia , Obesidade Mórbida
3.
JAMA ; 324(9): 879-887, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32870301

RESUMO

Importance: Severe obesity and its related diseases, such as type 2 diabetes, hypertension, dyslipidemia, and sleep apnea, are very common in the United States, but currently very few patients with these conditions choose to undergo bariatric surgery. Summaries of the expanding evidence for both the benefits and risks of bariatric surgery are needed to better guide shared decision-making conversations. Observations: There are approximately 252 000 bariatric procedures (per 2018 numbers) performed each year in the US, of which an estimated 15% are revisions. The 1991 National Institutes of Health guidelines recommended consideration of bariatric surgery in patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 40 or higher or 35 or higher with serious obesity-related comorbidities. These guidelines are still widely used; however, there is increasing evidence that bariatric procedures should also be considered for patients with type 2 diabetes and a body mass index of 30 to 35 if hyperglycemia is inadequately controlled despite optimal medical treatment for type 2 diabetes. Substantial evidence indicates that surgery results in greater improvements in weight loss and type 2 diabetes outcomes, compared with nonsurgical interventions, regardless of the type of procedures used. The 2 most common procedures used currently, the sleeve gastrectomy and gastric bypass, have similar effects on weight loss and diabetes outcomes and similar safety through at least 5-year follow-up. However, emerging evidence suggests that the sleeve procedure is associated with fewer reoperations, and the bypass procedure may lead to more durable weight loss and glycemic control. Although safety is a concern, current data indicate that the perioperative mortality rates range from 0.03% to 0.2%, which has substantially improved since early 2000s. More long-term randomized studies are needed to assess the effect of bariatric procedures on cardiovascular disease, cancer, and other health outcomes and to evaluate emerging newer procedures. Conclusions and Relevance: Modern bariatric procedures have strong evidence of efficacy and safety. All patients with severe obesity-and especially those with type 2 diabetes-should be engaged in a shared decision-making conversation about the risks and benefits of surgery compared with continuing usual medical and lifestyle treatment, and the decision about surgery should be driven primarily by informed patient preferences.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Perda de Peso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/etiologia , Feminino , Gastrectomia , Humanos , Hipertensão/etiologia , Masculino , Obesidade Mórbida/complicações , Síndromes da Apneia do Sono/etiologia
4.
Eur Rev Med Pharmacol Sci ; 24(16): 8580-8582, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32894564

RESUMO

OBJECTIVE: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. PATIENTS AND METHODS: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. RESULTS: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. CONCLUSIONS: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased.


Assuntos
Infecções por Coronavirus/patologia , Pacientes/psicologia , Pneumonia Viral/patologia , Adulto , Cirurgia Bariátrica , Betacoronavirus/isolamento & purificação , Índice de Massa Corporal , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Fumar , Inquéritos e Questionários , Listas de Espera , Adulto Jovem
5.
Am Surg ; 86(9): 1169-1174, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862663

RESUMO

BACKGROUND: Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. METHODS: The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. RESULTS: 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. CONCLUSION: Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.


Assuntos
Cirurgia Bariátrica/métodos , Água Corporal/fisiologia , Hidratação/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Pacientes Ambulatoriais , Complicações Pós-Operatórias/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Complicações Pós-Operatórias/metabolismo , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos
6.
PLoS Med ; 17(9): e1003307, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931494

RESUMO

BACKGROUND: Hypertension, together with obesity, is a leading cause of mortality and disability. Whilst metabolic surgery offers remission of several metabolic comorbidities, the effect for patients with hypertension remains controversial. The objective of the present study was to evaluate the effect of metabolic surgery on cardiovascular events and mortality on patients with morbid obesity (body mass index [BMI] ≥ 35 kg/m2) and hypertension. METHODS AND FINDINGS: We conducted a matched cohort study of 11,863 patients with morbid obesity and pharmacologically treated hypertension operated on with metabolic surgery and a matched non-operated-on control group of 26,199 subjects with hypertension (matched by age, sex, and area of residence) of varied matching ratios from 1:1 to 1:9, using data from the Scandinavian Obesity Surgery Register (SOReg), the Swedish National Patient Registers (NPR) for in-hospital and outpatient care, the Swedish Prescribed Drug Register, and Statistics Sweden. The main outcome was major adverse cardiovascular event (MACE), defined as first occurrence of acute coronary syndrome (ACS) event, cerebrovascular event, fatal cardiovascular event, or unattended sudden cardiac death. The mean age in the study group was 52.1 ± 7.46 years, with 65.8% being women (n = 7,810), and mean BMI was 41.9 ± 5.43 kg/m2. MACEs occurred in 379 operated-on patients (3.2%) and 1,125 subjects in the control group (4.5%). After adjustment for duration of hypertension, comorbidities, and education, a reduction in risk was seen in the metabolic surgery group (adjusted hazard ratio [HR] 0.73, 95% confidence intervals [CIs] 0.64-0.84, P < 0.001). The surgery group had lower risk for ACS events (adjusted HR 0.52, 95% CI 0.41-0.66, P < 0.001) and a tendency towards lower risk for cerebrovascular events (adjusted HR 0.81, 95% CI 0.63-1.01, P = 0.060) compared with controls. The main limitations with the study were the lack of information on BMI and history of smoking in the control group and the nonrandomised study design. CONCLUSION: Metabolic surgery on patients with morbid obesity and pharmacologically treated hypertension was associated with lower risk for MACEs and all-cause mortality compared with age- and sex-matched controls with hypertension from the general population.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Hipertensão/metabolismo , Obesidade Mórbida/cirurgia , Adulto , Cirurgia Bariátrica/tendências , Índice de Massa Corporal , Estudos de Coortes , Feminino , Humanos , Hipertensão/cirurgia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/metabolismo , Obesidade/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/mortalidade , Modelos de Riscos Proporcionais , Fatores de Risco , Suécia/epidemiologia
7.
Eur J Endocrinol ; 183(5): R119-R132, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32869608

RESUMO

Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Fraturas Ósseas/etiologia , Gastrectomia/efeitos adversos , Obesidade Mórbida/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
8.
Eur Rev Med Pharmacol Sci ; 24(16): 8580-8582, 2020 08.
Artigo em Inglês | MEDLINE | ID: covidwho-745636

RESUMO

OBJECTIVE: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. PATIENTS AND METHODS: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. RESULTS: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. CONCLUSIONS: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased.


Assuntos
Infecções por Coronavirus/patologia , Pacientes/psicologia , Pneumonia Viral/patologia , Adulto , Cirurgia Bariátrica , Betacoronavirus/isolamento & purificação , Índice de Massa Corporal , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Fumar , Inquéritos e Questionários , Listas de Espera , Adulto Jovem
12.
Khirurgiia (Mosk) ; (7): 45-53, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736463

RESUMO

OBJECTIVE: To analyze an effectiveness of laparoscopic surgery with simultaneous abdominoplasty in patients with superficial abdominal obesity. MATERIAL AND METHODS: Laparoscopic abdominal, retroperitoneal and pelvic surgery with simultaneous abdominoplasty was performed in 25 patients with body mass index >40 kg/m2. RESULTS: Surgery time and intraoperative blood loss were significantly higher after simultaneous surgery (p<0.05). However, these differences did not influence postoperative period. Duration of analgesic therapy, activation of patients and length of hospital-stay, as well as overall postoperative morbidity were similar in both groups (p>0.05). Simultaneous abdominoplasty resulted significantly better quality of life according to almost all parameters (p<0.05). CONCLUSION: According to certain indications, abdominoplasty is advisable as the first stage of simultaneous surgery in patients with large subcutaneous fat apron after bariatric surgery or in those with primary superficial abdominal obesity. The positive aspects of abdominoplasty are simplification of laparoscopic stage, reduced intra-abdominal pressure in postoperative period, excellent and good aesthetic effect and improved quality of life.


Assuntos
Abdominoplastia , Cirurgia Bariátrica , Laparoscopia , Obesidade Abdominal/cirurgia , Humanos , Obesidade/cirurgia , Equipe de Assistência ao Paciente , Qualidade de Vida
14.
Medicine (Baltimore) ; 99(34): e21673, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846783

RESUMO

The incidence of obesity and type 2 diabetes mellitus is growing, and bariatric surgery was applied as a new therapy in the past few decades. However, bariatric surgery started rather late in China, and the number of surgeries and the follow-up data is limited.We assessed body weight, glucose, lipid levels, and blood pressure at baseline and 6-month, 1-year, 3-year in patients who underwent bariatric surgery. Vitamins and trace elements were investigated at 3-year after surgery. The quality of life was assessed at 3-year and compared with the control group.In total 20 patients were recruited in the study, and all the 20 patients underwent surgery and completed all follow-ups. Results showed that the body weight, body mass index, glycated hemoglobin (HbA1C), glucose, and insulin level were decreased, and islet function improved significantly in 6-month and 1-year (P < .001), and the changes were more obvious in the first 6 months. However, all the indexes rebound significantly at the 3-year (P < .05), but still better than baseline (P < .05). Weight regain was 50% after 3 years, and the mean weight regain rate was 31.45%. Besides, blood pressure and lipid levels decreased significantly compared with baseline (P < .001). At the 3-year follow-up, we found that 100% of the patients showed vitamin D deficiency, 50% calcium deficiency, 20% vitamin B12 deficiency, 20% iron deficiency, and 15% suffered from anemia. Compared with the control group, the quality of life was better in patients who underwent surgery, especially in the physical health (P < .05).The current study showed that the body weight, glucose and islet function improved significantly after bariatric surgery, and the indexes changed mainly in the first 6 months, but there seemed to be a rebound after 3 years. Furthermore, the surgery may improve the blood pressure, lipid profile, and the quality of life. However, some patients may suffer anemia, calcium deficiency, iron deficiency, vitamin D, and vitamin B12 deficiency after 3 years.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/complicações , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Adulto , Grupo com Ancestrais do Continente Asiático , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
20.
Harefuah ; 159(8): 607-611, 2020 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-32852163

RESUMO

INTRODUCTION: Obesity has become one of the most challenging diseases in the modern world due to its high prevalence, its metabolic pathways and its medical impacts. Although bariatric surgeries have become the main treatment for obesity, a new issue is being created - loose skin. Massive weight loss patients undergo body contouring plastic surgery (BCPS) to remove the excess skin and improve their quality of life. Patients' age, physical and medical status, amount of redundant skin and patients' personal preferences dictate the number of anatomical areas contoured at every surgical stage. Recent studies have shown that BCPS are a significant protective factor against long-term weight regain following bariatric surgery. Specifically, the number of operated areas have a direct influence on weight control: BCPS in three or more anatomical areas following massive weight loss (MWL) is associated with a higher chance of long-term weight loss following body-contouring surgery in comparison to surgery in one area alone. In summary, BCPS have become a fundamental part of the holistic treatment recommended for patients suffering from obesity.


Assuntos
Cirurgia Bariátrica , Contorno Corporal , Obesidade Mórbida , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Obesidade , Qualidade de Vida , Perda de Peso
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