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1.
Medicine (Baltimore) ; 100(6): e24309, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578526

RESUMO

INTRODUCTION: Morbid obesity (body mass index > 40 kg/m2) is a risk factor for the development of left ventricular systolic dysfunction (LVSD) and can complicate the management of LVSD. Bariatric surgery is increasingly recognized as a safe and effective way to achieve marked weight loss, but studies on improving LVSD populations are limited. We retrospectively analyzed the first case of the Asia-Pacific region with morbid obesity and left ventricular ejection fraction (LVEF) < 50% who underwent bariatric surgery at our medical center. PATIENT CONCERNS: The patient was admitted to the hospital due to progressive weight gain for more than 10 years. The patient used to be in good health. One year before admission, the patient was hospitalized in another hospital due to shortness of breath. After the relevant examination, the patient was diagnosed with dilated cardiomyopathy. DIAGNOSIS: The body mass index of the patient was 45.9 kg/m2, and the patient was diagnosed with morbid obesity. He was diagnosed with dilated cardiomyopathy and cardiac function class IV in another hospital. After completing a preoperative examination, the patient was diagnosed with hyperuricemia, hyperlipidemia, fatty liver disease and severe sleep apnea. INTERVENTIONS: The patient successfully underwent laparoscopic sleeve gastrectomy plus jejunal bypass. OUTCOMES: Six months after the surgery, patient weight lost was 33.6 kg, and the LVEF increased from 31% to 55%. The cardiac function of the patient recovered from class IV to class I, and the patient's hyperuricemia, hyperlipidemia and sleep apnea were significantly improved. CONCLUSION: Bariatric surgery may be a safe and effective intervention for morbidly obese patients with LVSD. Bariatric surgery was associated with an improvement in LVEF. However, the specific mechanism still needs further study.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cardiomiopatia Dilatada/fisiopatologia , Obesidade Mórbida/cirurgia , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Ásia/epidemiologia , Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Cardiomiopatia Dilatada/diagnóstico , Humanos , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico , Estudos Retrospectivos , Volume Sistólico/fisiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda/fisiologia , Perda de Peso/fisiologia
2.
Medicine (Baltimore) ; 100(2): e24144, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466188

RESUMO

BACKGROUND: Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated. METHODS: Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment. RESULTS: Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414. CONCLUSION: Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the "entirety" of the tube, including the "specimen-part", is retrieved, to avoid double entrapment.


Assuntos
Intubação Gastrointestinal/efeitos adversos , Erros Médicos/efeitos adversos , Grampeamento Cirúrgico/efeitos adversos , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Intubação Gastrointestinal/instrumentação , Laparoscopia/métodos , Masculino , Erros Médicos/psicologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Grampeamento Cirúrgico/métodos , Grampeamento Cirúrgico/estatística & dados numéricos
6.
Rev Col Bras Cir ; 48: e20202666, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503141

RESUMO

INTRODUCTION: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. OBJECTIVE: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. METHODS: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. RESULTS: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. CONCLUSION: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Desnutrição/etiologia , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Feminino , Derivação Gástrica , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Adv Exp Med Biol ; 1307: 321-330, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32200501

RESUMO

Bariatric surgery is currently the most effective weight loss treatment of severe obesity and its associated comorbidities and is being increasingly used to treat children and adolescents with severe obesity, including those with Type 2 Diabetes (T2D). This review focuses on the conventional management of T2D in children and adolescents, comparison of various types of bariatric surgeries, effect of bariatric surgery on gastrointestinal physiology and metabolism, current literature on the use of bariatric surgery to treat youth with severe obesity and T2D, and the potential complications of bariatric surgery in this population.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adolescente , Cirurgia Bariátrica/efeitos adversos , Criança , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Perda de Peso
9.
Ter Arkh ; 92(6): 53-59, 2020 Jul 09.
Artigo em Russo | MEDLINE | ID: mdl-33346493

RESUMO

AIM: To study the effect of weight loss in the short term after bariatric surgery (BO) on metabolic parameters and glomerular filtration rate (GFR) in patients with morbid obesity. MATERIALS AND METHODS: We studied 40 adult (over 18 years) patients with morbid obesity who underwent bariatric surgery. Metabolic indices and calculated GFR according to the CKD-EPI formula in patients before and after bariatric surgery were compared. RESULTS: In the whole group of operated patients, the average body mass index (BMI) after surgery decreased from 45.8 to 30.5 kg/m2. In 11 (92%) patients with impaired carbohydrate metabolism, remission of diabetes mellitus was achieved and sugar-lowering drugs were canceled. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, there is a tendency towards a decrease in GFR, probably due to a decrease in hyperfiltration. In patients with baseline GFR90 ml/min/1.73 m2 after surgery, a statistically significant increase in the level of GFR was noted. The greater metabolic efficacy of combined operations (mini-gastric bypass, biliopancreatic diversion) in relation to the correction of carbohydrate and fat metabolism was revealed. CONCLUSION: Obesity is a modifiable risk factor for decreased kidney function and the progression of chronic kidney disease. Bariatric surgery is an effective treatment for morbid obesity. The study proved the positive effect of weight loss after BO on renal function, including by improving the course of diseases associated with obesity.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Insuficiência Renal Crônica , Adulto , Cirurgia Bariátrica/efeitos adversos , Taxa de Filtração Glomerular , Humanos , Obesidade Mórbida/cirurgia , Perda de Peso
10.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370962

RESUMO

Portomesenteric thrombosis is an important but rarely reported complication following bariatric surgery. It has been suggested that the incidence of portal vein thrombosis is directly related to many risk factors inherent in the bariatric population as well as factors related to local and systemic effects of laparoscopic surgery. Possible aetiologies vary from systemic inherited hypercoagulable states to a direct inflammatory reaction of portosystemic vessels. Here we present a case report of a 47-year-old obese women who underwent a robotic sleeve gastrectomy with subsequent development of a main portal vein, complete right intrahepatic portal vein and splenic vein thrombosis ultimately found to have a compound mutation of the methylenetetrahydrofolate reductase C677T and A1298C alleles.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Trombose Venosa/diagnóstico , Dor Abdominal/etiologia , Anticoagulantes/administração & dosagem , Cirurgia Bariátrica/métodos , Feminino , Heparina/administração & dosagem , Humanos , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Tomografia Computadorizada por Raios X , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia
11.
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
13.
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
14.
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
17.
Cardiovasc Diabetol ; 19(1): 103, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631310

RESUMO

BACKGROUND: Both diabetes and obesity are risk factors for perioperative major adverse events. This study aims to evaluate the association between prior bariatric surgery (prior-BS) and perioperative cardiovascular outcomes following noncardiac surgery in patients with type 2 diabetes mellitus (T2DM). METHODS: We used the National Inpatient Sample Database to identify T2DM patients undergoing major noncardiac surgery from 2006 to 2014. The primary outcome was major perioperative adverse cardiovascular and cerebrovascular events (MACCEs), which include death, acute myocardial infarction and acute ischaemic stroke. In-hospital outcomes between patients with prior BS and morbid obesity were compared using unadjusted logistic, multivariable logistic and propensity score matching analyses. RESULTS: A weighted of 1,526,820 patients diagnosed with T2DM who underwent noncardiac surgery were included. The rates of both prior BS and morbid obesity significantly increased during the study period (P < 0.0001). Patients with prior BS were younger, were more likely to be female, and had lower rates of cardiovascular risk factors but had higher rates of smoking, alcohol abuse, anaemia, prior venous thromboembolism and prior percutaneous coronary intervention. The incidence of MACCEs was 1.01% and 3.25% in patients with prior BS and morbid obesity, respectively. After multivariable adjustment, we found that prior BS was associated with a reduced risk of MACCEs (odds ratio [OR] = 0.71; 95% confidence interval [CI] 0.62-0.81), death (OR = 0.64, 95% CI 0.52-0.78), acute kidney injury (OR = 0.66, 95% CI 0.62-0.70) and acute respiratory failure (OR: 0.46; 95% CI 0.42-0.50). CONCLUSIONS: Prior bariatric surgery in T2DM patients undergoing noncardiac surgery is associated with a lower risk of MACCEs. Prospective studies are needed to verify the benefits of bariatric surgery in patients undergoing noncardiac surgery.


Assuntos
Cirurgia Bariátrica , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/epidemiologia , Obesidade Mórbida/cirurgia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/mortalidade , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Causas de Morte , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/mortalidade , Prevalência , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
Ann Surg ; 272(2): 326-333, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675546

RESUMO

OBJECTIVE: The aim of this study was to compare the use and short-term outcome of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Sweden, Norway, and the Netherlands. BACKGROUND: Although bariatric surgery is performed in high volumes worldwide, no consensus exists regarding the choice of bariatric procedure for specific groups of patients. METHODS: Data from 3 national registries for bariatric surgery were used. Patient selection, perioperative data (severe complications, mortality, and rate of readmissions within 30 days), and 1-year results (follow-up rate and weight loss) were studied. RESULTS: A total of 47,101 primary operations were registered, 33,029 (70.1%) RYGB and 14,072 (29.9%) SG. Patients receiving RYGB met international guidelines for having bariatric surgery more often than those receiving SG (91.9% vs 83,0%, P < 0.001). The 2 procedures did not differ in the rate of severe complications (2.6% vs 2.4%, P = 0.382), nor 30-day mortality (0.04% vs 0.03%, P = 0.821). Readmission rates were higher after RYGB (4.3% vs 3.4%, P < 0.001).One-year post surgery, less RYGB-patients were lost-to follow-up (12.1% vs 16.5%, P < 0.001) and RYGB resulted in a higher rate of patients with total weight loss of more than 20% (95.8% vs 84.6%, P < 0.001). While the weight-loss after RYGB was similar between hospitals, there was a great variation in weight loss after SG. CONCLUSION: This study reflects the pragmatic use and short-term outcome of RYGB and SG in 3 countries in North-Western Europe. Both procedures were safe, with RYGB having higher weight loss and follow-up rates at the cost of a slightly higher 30-day readmission rate.


Assuntos
Gastrectomia/métodos , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Sistema de Registros , Reoperação/estatística & dados numéricos , Adulto , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Índice de Massa Corporal , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Derivação Gástrica/efeitos adversos , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Países Baixos , Noruega , Obesidade Mórbida/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Seleção de Pacientes , Estudos Retrospectivos , Medição de Risco , Suécia , Fatores de Tempo , Resultado do Tratamento
19.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(6): 401-407, jun.-jul. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193365

RESUMO

La obesidad es un problema de salud frecuente en nuestra población. La cirugía bariátrica es el tratamiento de elección en los casos graves, es muy efectiva (junto con una adecuada modificación de los hábitos de vida), pero también se asocia a múltiples efectos secundarios. Uno de los más frecuentes y que puede reducir marcadamente la calidad de vida es la diarrea. La diarrea que aparece posterior a una cirugía bariátrica puede ser de distintas causas y mecanismos fisiopatogénicos que van a depender, en parte, del tipo de cirugía realizada. Las causas más frecuentes son el síndrome de dumping, la diarrea por vagotomía, el síndrome de intestino corto, la malabsorción de hidratos de carbono, la malabsorción proteica, las alteraciones de la microbiota, la infección por Clostridium difficile, el sobrecrecimiento bacteriano, la malabsorción de sales biliares, la insuficiencia pancreática, trastornos endocrinológicos, trastornos adictivos y otros trastornos digestivos no necesariamente relacionados con la cirugía


Obesity is a prevalent health problem in our population. Bariatric surgery is the indicated treatment for severe cases. It is very effective (together with an adequate lifestyle modification) but it is also associated with frequent adverse events. One of the most frequent and disturbing adverse event is diarrhea. Diarrhea after bariatric surgery may be secondary to multiple causes and the physiopathogenic mechanisms may depend on the type of surgery performed. The most frequent diarrhea mechanisms are dumping syndrome, vagotomy, short bowel syndrome, carbohydrate malabsorption, protein malabsorption, alterations of the microbiota, Clostridium difficile infection, bacterial overgrowth, bile salt malabsorption, pancreatic insufficiency, endocrinological disorders, addictive disorders, and other digestive disorders not necessarily related to surgery


Assuntos
Humanos , Diarreia/etiologia , Complicações Pós-Operatórias/etiologia , Cirurgia Bariátrica/efeitos adversos , Enteropatias/etiologia , Síndromes de Malabsorção/etiologia , Microbiota , Diarreia/fisiopatologia , Síndrome de Esvaziamento Rápido/etiologia
20.
Rev Col Bras Cir ; 47: e20202480, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32555967

RESUMO

OBJECTIVE: Portomesenteric vein thrombosis (PMVT) is a potentially severe complication that can occur after bariatric surgery. PMVT has gained importance because of the increasing number of bariatric surgeries being performed. to report a rare and severe complication after bariatric surgery, which is difficult to manage. To try to identify common characteristics among the cases and discuss potential causes comparing our data to the available literature. METHODS: We describe six cases of PMVT in young women with different presentations. RESULTS: All six cases occurred in young women 29-41 years old with obesity - body mass index - BMI: 36-39) and weighing 105-121 kg. The patients had few comorbidities (all of which were related to metabolic syndrome) and moderate hepatic steatosis with no sign of cirrhosis. Five patients used oral contraceptives until a few days before the operation. One patient tested positive for thrombophilia. Five patients underwent a laparoscopic sleeve gastrectomy and one underwent a gastric bypass with no complications during the operation (median operating time: 61.3 min, range 52-91 min). The mean duration of follow-up after hospitalization was 12.3 months (range: 7-18 months) and to-date only one patient has had no recanalization. CONCLUSION: The frequency of PMVT appears to be increased in woman and after sleeve gastrectomy. Our findings indicate that patients with abdominal pain weeks after bariatric surgery must be investigated.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Veias Mesentéricas/diagnóstico por imagem , Trombose Venosa/etiologia , Adulto , Feminino , Humanos , Masculino , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico por imagem
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