Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.754
Filtrar
1.
Rev Med Liege ; 75(2): 111-114, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030936

RESUMO

The use of hormone therapy is an important therapeutic choice in woman's life, both for contraceptive purpose to avoid unwanted pregnancy, as well as for treatment of menstrual disorders, or climacteric symptoms. Medical care must therefore be dynamic, tailored to individual requirements as much as possible, reflecting personal and family background, potential risks related to treatment, and of course patient's wishes. We will first discuss the modalities of contraception in presence of obesity, then the need for potential adjustment following bariatric surgery.


Assuntos
Cirurgia Bariátrica , Anticoncepção , Obesidade , Feminino , Humanos , Obesidade/cirurgia , Gravidez
2.
BJOG ; 127(3): 345-354, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31749274

RESUMO

OBJECTIVES: To describe the population of women having bariatric surgery and compare the pregnancy outcomes for women having bariatric surgery with a non-bariatric surgery population having a first and second pregnancy. DESIGN: Population-based record linkage study. SETTING: New South Wales (NSW), Australia. POPULATION: All women aged 15-45 years with a hospital record in NSW (2002-2014) and all women giving birth in NSW (1994-2015; n = 1 606 737 women). METHODS: Pregnancy and birth outcomes were compared between first and second pregnancies using repeated-measures logistic regression and paired Student's t-tests. Bariatric and non-bariatric groups were also compared. MAIN OUTCOME MEASURES: Maternal diabetes, preterm birth (<37 weeks of gestation) and large for gestational age. RESULTS: There was a 13-fold increase in hospitalisations for primary bariatric surgery during 2002-2014. Compared with the general birthing population, women who had bariatric surgery experienced higher rates of hypertension, diabetes, and preterm birth. Among women who had bariatric surgery between a first and second pregnancy, there were reduced rates of hypertension (OR 0.39, 95% CI 0.29-0.53), spontaneous preterm birth (OR 0.37, 95% CI 0.16-0.86), infants that were large for gestational age (OR 0.63, 95% CI 0.44-0.88), and the admission of infants to a special care nursery or neonatal intensive care (OR 0.64, 95% CI 0.46-0.90) in the second pregnancy. Rates for small-for-gestational age and gestational diabetes following surgery were 8.3 and 11.4%, respectively CONCLUSIONS: Bariatric surgery between a first and second pregnancy was associated with reductions in obesity-related adverse pregnancy outcomes. Bariatric surgery performed for the management of obesity in accordance with current clinical criteria is associated with improved pregnancy outcomes in a subsequent pregnancy. TWEETABLE ABSTRACT: Bariatric surgery for obesity may improve pregnancy and birth outcomes in a subsequent pregnancy.


Assuntos
Cirurgia Bariátrica , Diabetes Gestacional , Obesidade , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Adulto , Austrália/epidemiologia , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Peso ao Nascer , Cesárea/estatística & dados numéricos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Recém-Nascido , Armazenamento e Recuperação da Informação , Obesidade/epidemiologia , Obesidade/cirurgia , Paridade , Gravidez , Resultado da Gravidez/epidemiologia
5.
Ann R Coll Surg Engl ; 101(8): e172-e177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672034

RESUMO

Intragastric balloons have been used as an invasive non-surgical treatment for obesity for over 30 years. Within the last 37 years, we have found only 27 cases reported in the literature of intestinal obstruction caused by a migrated intragastric balloon. We report the laparoscopic management of such a case and make observations from similar case presentations published in the literature. A 26-year-old woman had an intragastric balloon placed endoscopically for weight control 13 months previously. She presented to the emergency department with a four-day history of intermittent abdominal cramps and vomiting. Contrast enhanced computed tomography confirmed the presence of the intragastric balloon within the small bowel. At laparoscopic retrieval, the deflated intragastric balloon was found impacted in the terminal ileum approximately 15 cm from the ileocaecal valve. The balloon was retrieved by enterotomy and primary closure of the ileum without event. The risk of balloon deflation and subsequent migration increases over time but several published cases demonstrate that this complication can occur within six months of insertion. The initial approach to the treatment of migrated intragastric balloons causing small bowel obstruction should be determined by the location of impaction, severity of obstruction and the available skill set of the attending radiologist, endoscopist and/or surgeon. Balloons causing obstruction in the duodenum are likely amenable to endoscopic retrieval whereas impaction within the jejunum or ileum could be managed by percutaneous needle aspiration (in selected cases), endoscopy (double-balloon enteroscopy), laparoscopy or open surgery.


Assuntos
Migração de Corpo Estranho/cirurgia , Balão Gástrico/efeitos adversos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Laparoscopia/métodos , Adulto , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obesidade/cirurgia , Tomografia Computadorizada por Raios X
6.
Arq Bras Cir Dig ; 32(3): e1453, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644673

RESUMO

BACKGROUND: : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. AIM: To investigate nutritional status in 10 years follow-up. METHODS: : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. RESULTS: : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. CONCLUSIONS: : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.


Assuntos
Derivação Gástrica/reabilitação , Estado Nutricional/genética , Obesidade/cirurgia , Fenótipo , Adulto , Índice de Massa Corporal , Feminino , Ácido Fólico/sangue , Seguimentos , Humanos , Ferro/sangue , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos Nutricionais/sangue , Transtornos Nutricionais/etiologia , Obesidade/complicações , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Vitamina B 12/sangue , Perda de Peso
8.
Plast Reconstr Surg ; 144(4): 847-853, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568289

RESUMO

BACKGROUND: Abdominoplasty is a safe, efficacious body contouring procedure commonly performed on patients after massive weight loss or pregnancy, or because of general aging. However, complication rates and patient satisfaction levels remain largely unexplored for the overweight and obese patient population. The purpose of this study was twofold: to determine the complication rate and to gauge the psychological impact of abdominoplasty in the overweight or obese patient. METHODS: A retrospective review was conducted of consecutive overweight and obese patients undergoing abdominoplasty or panniculectomy over a 12-year period from January of 2004 to December of 2016. Patient medical records were reviewed to identify patient demographics and comorbidities, operative details, and postoperative course. A patient survey was used to assess satisfaction, personal experience with complications, and the recovery process. RESULTS: Forty-six total patients underwent abdominoplasty or panniculectomy during the 12-year period and met the criterion of body mass index greater than or equal to 25 kg/m. The average patient body mass index was 32.0 kg/m, with the majority of the patients categorized as overweight. The average abdominal resection weight was 4834.9 g. Major complications, defined as complications requiring return to the operating room, occurred in four patients (8.7 percent). Minor complications, defined as complications that could be handled in an office setting, occurred in 18 patients (39.1 percent). Thirty-six patients (78.3 percent) responded to the survey. The overwhelming majority of patients who responded to the survey [n = 35 (97.2 percent)] stated that they were satisfied with the final outcome and would choose to have the procedure again. CONCLUSION: Abdominoplasty and panniculectomy in overweight and obese patients are associated with an elevated complication rate, yet patient satisfaction is overwhelmingly high, suggesting the viability of body contouring procedures in this patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Abdominoplastia , Sobrepeso/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Nat Commun ; 10(1): 4179, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519890

RESUMO

The mechanisms underlying improved insulin sensitivity after surgically-induced weight loss are still unclear. We monitored skeletal muscle metabolism in obese individuals before and over 52 weeks after metabolic surgery. Initial weight loss occurs in parallel with a decrease in muscle oxidative capacity and respiratory control ratio. Persistent elevation of intramyocellular lipid intermediates, likely resulting from unrestrained adipose tissue lipolysis, accompanies the lack of rapid changes in insulin sensitivity. Simultaneously, alterations in skeletal muscle expression of genes involved in calcium/lipid metabolism and mitochondrial function associate with subsequent distinct DNA methylation patterns at 52 weeks after surgery. Thus, initial unfavorable metabolic changes including insulin resistance of adipose tissue and skeletal muscle precede epigenetic modifications of genes involved in muscle energy metabolism and the long-term improvement of insulin sensitivity.


Assuntos
Resistência à Insulina/fisiologia , Músculo Esquelético/metabolismo , Tecido Adiposo/metabolismo , Adulto , Metilação de DNA/genética , Metilação de DNA/fisiologia , Epigênese Genética/genética , Feminino , Derivação Gástrica , Humanos , Resistência à Insulina/genética , Metabolismo dos Lipídeos/genética , Metabolismo dos Lipídeos/fisiologia , Masculino , Pessoa de Meia-Idade , Obesidade/genética , Obesidade/metabolismo , Obesidade/cirurgia
11.
Rev Col Bras Cir ; 46(4): e2238, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508735

RESUMO

OBJECTIVE: to compare the effects of the hydroalcoholic extract from the peel of Camu-Camu, a fruit plant belonging to the Myrtaceae family, widely distributed in the Amazon basin, with those of sleeve gastrectomy, on the weight and glycemia of Wistar rats. METHODS: twenty-four Wistar rats underwent obesity induction through a hyperlipid diet for eight weeks (fat period), and were randomized into three groups: Control Group (CG), Camu-Camu Group (CCG) and Bariatric Surgery Group (BSG). After this period, all animals returned to a normal diet and the intervention period began: CG did not undergo any intervention beyond diet change; CCG animals underwent gavage procedure for administration of Camu-Camu hydroalcoholic extract, 1g/kg/day, for four weeks; and the BSG was submitted to the surgical procedure of sleeve gastrectomy. We followed all animals for four weeks. RESULTS: there was only one loss in BSG due to a gastric fistula. We observed significant variations in the animals' mean weight: the CG evolved with weight gain even after the withdraw of the hypercaloric diet, while the other two groups presented weight reduction. BSG presented a significant reduction of weight and BMI (p<0.05); CCG achieved a significant reduction only of the BMI (p<0.05). There were no statistically significant changes in the glycemic levels. CONCLUSION: in spite of reducing weight, the crude hydroalcoholic extract of the Camu-Camu peel was not able to be as efficient as sleeve gastrectomy in the control of body weight in Wistar rats.


Assuntos
Cirurgia Bariátrica , Myrtaceae/química , Obesidade/dietoterapia , Obesidade/cirurgia , Perda de Peso , Animais , Suplementos Nutricionais , Modelos Animais de Doenças , Frutas/química , Masculino , Terapia Nutricional , Obesidade/etiologia , Ratos , Ratos Wistar
12.
Rev Col Bras Cir ; 46(4): e2252, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508737

RESUMO

OBJECTIVE: to present a descriptive analysis of the results of a care bundle applied to obese patients submitted to bariatric surgery, regarding infection control. METHODS: a care bundle was designed to control surgical site infection (SSI) rates in patients undergoing bariatric surgery. The bundle included smoking cessation, bathing with 4% chlorhexidine two hours before surgery, cefazolin (2g bolus) in anesthetic induction associated with a continuous infusion of the same drug at a dose of 1g over a two-hour period, appropriate trichotomy, glycemic control, supplemental oxygen, normothermia, intraspinal morphine for the relief of pain, and sterile dressing removal 48 hours after surgery. All patients were followed up for 30 days. RESULTS: among the 1,596 included patients, 334 (20.9%) underwent open surgery and 1,262 (79.1%) underwent videolaparoscopic surgery. SSI rates were 0.5% in the group submitted to laparoscopic surgery and 3% in the one submitted to open surgery. The overall incidence of SSI was 1%. Intra-abdominal, respiratory tract, and urinary tract infections occurred in 0.9%, 1.1%, and 1.5% of the sample, respectively. Higher body mass index was associated with higher incidence of SSI (p=0.001). Among patients with diabetes, 2.2% developed SSI, while the rate of infection among non-diabetics was only 0.6%. CONCLUSION: the established care bundle, structured by core evidence-based strategies, associated with secondary measures, was able to maintain low SSI rates after bariatric surgery.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Brasil/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Assistência Perioperatória/métodos , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adulto Jovem
13.
Cir. plást. ibero-latinoam ; 45(3): 275-282, jul.-sept. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-184400

RESUMO

Introducción y Objetivo. La obesidad es un problema de salud pública mundial. Tras la cirugía metabólica se genera una pérdida masiva de peso tras la cual suele ser necesaria una cirugía reconstructiva que conlleva un alto porcentaje de complicaciones en el sitio quirúrgico, principalmente dehiscencia. Es necesario evaluar los cambios histológicos que sufren estos pacientes y su relación con la evolución de la herida, marcando las diferencias entre los pacientes que pierden peso con dieta y ejercicio (únicamente con sobrepeso previo), en comparación con aquellos sometidos a cirugía bariátrica. Material y método. Estudiamos 4 grupos de pacientes candidatos a abdominoplastía tras pérdida de peso hasta lograr un índice de masa corporal (IMC) óptimo. Grupo A (grupo control): pacientes con sobrepeso (IMC 25.1-29) y pérdida ponderal solo con dieta y ejercicio hasta IMC aceptado < 27.5. Grupo B: obesidad Grado I (IMC 30-34.9); Grupo C: obesidad Grado II (IMC 35-39.9); Grupo D: obesidad Grado III / obesidad mórbida (IMC >40). Los Grupos B, C y D con pérdida ponderal tras bypass gástrico que llevó a un IMC aceptado < 31. Tomamos biopsia de la porción supraumbilical del colgajo abdominal a resecar y analizamos las características histológicas y su relación con la evolución postoperatoria. Resultados. Incluimos 80 pacientes (20 por grupo), 95% mujeres (76 pacientes), con edad promedio de 39.4 años (rango de 29 a 58). Obtuvimos una p < 0.0001 en relación a la densidad y morfología de las fibras elásticas y de colágeno al comparar todos los grupos de obesidad con el grupo control (sobrepeso); un riesgo relativo 5 veces mayor de equimosis y epidermólisis en la obesidad GIII; 8 veces más riesgo de dehiscencia en la obesidad GII; y 14 veces más riesgo de dehiscencia en el GIII. No hubo diferencia estadísticamente significativa para infección. Conclusiones. Los pacientes con mayor grado de obesidad (GII y III) presentan mayores alteraciones histológicas dérmicas, con repercusión directamente proporcional (aumento del riesgo relativo) en la presencia de equimosis, epidermólisis y dehiscencia de las heridas. Recomendamos tener conciencia de este fenómeno al realizar procedimientos quirúrgicos en pacientes con pérdida de peso tras bypass gástrico, y en el momento del cierre quirúrgico, aplicar menor tensión en los bordes de la herida


Background and Objective. Obesity is a global public health problem. Metabolic surgery causes a massive weight loss, and patients usually require reconstructive surgery with a high percentage of complications at the surgical site, mainly dehiscence. Consequently, an analysis of histological changes on these patients and their relationship with wound evolution is required, stressing the differences between a patient who lost weight with diet and exercise (with prior overweight only), compared to one subjected to bariatric surgery. Methods. We formed 4 groups of patients who would undergo abdominoplasty after weight loss until an optimal body mass index (BMI) was obtained. Group A (control group): patients who were overweight (BMI 25.1-29), losing weight only with diet and exercise, leading them to an acceptable BMI < 27.5. Group B: obesity Grade I (BMI 30-34.9). Group C: obesity Grade II (BMI 35-39.9). Group D: obesity Grade III / morbid obesity (BMI > 40). Groups B, C and D with weight loss after gastric bypass, leading to an acceptable BMI < 30. A biopsy was taken from the supraumbilical portion of the abdominal flap to be resected. Histological characteristics and their relationship with postoperative evolution were analyzed. Results. 80 patients were included (20 per group). 95% were female (76 patients), with an average age of 39.4 years old (range from 29 to 58). A p <0.0001 was obtained in relation to density and morphology of elastic and collagen fibers when comparing all obesity groups to the control group (overweight), as well as a relative risk 5 times higher of having ecchymosis and epidermolysis in obesity GIII; 8 times higher risk of having dehiscence in Obesity GII; and 14 times higher risk of dehiscence in grade III. There was no statistically significant difference for infections. Conclusions. Patients with a higher degree of obesity (GII and III) have greater dermal histological alterations, with a directly proportional impact (increased relative risk) on the presence of ecchymosis, epidermolysis and dehiscence of wounds. Therefore, we should be aware of this problem when performing surgical closure, applying less pressure on edges. We recommend to take on count this phenomenon when performing a surgical procedure on a patient who lost weight after a gastric bypass, and so, a lower pressure must be applied to closure


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Abdominoplastia/métodos , Ferida Cirúrgica/complicações , Obesidade/epidemiologia , Cirurgia Bariátrica/métodos , Obesidade/cirurgia , Perda de Peso , Equimose/complicações , Equimose/cirurgia
16.
Nutr. hosp ; 36(4): 840-845, jul.-ago. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184709

RESUMO

Introduction: the increase on prevalence of obesity has been linked to a higher number of bariatric surgeries, being sleeve gastrectomy (SG) the most frequent bariatric procedures in the world. However, there are few studies that determine the impact of SG on health's determinants such as physical fitness (PF) and physical activity (PA). Objectives: to describe the changes in PF and PA of patients after SG. Methods: twenty-three women with obesity (mean 36.1 ± 11.1 years old and body mass index [BMI] of 35.1 ± 3.4 kg/m2) were evaluated preoperatively to SG and at one and three months after surgery. An assessment of PF was conducted, including handgrip (HGS) and quadriceps muscle strength (QMS) with dynamometers and cardiorespiratory fitness (CRF) with an ergospirometer. PA was assessed with a three-axis accelerometer. Results: the absolute VO2 peak decreased after the first and third month (p < 0.001) post SG. The VO2 peak relative to body weight showed an increase from baseline after the SG (p = 0.002). After SG, there was a reduction in absolute values for HGS and QMS (p < 0.001) and an increase in relative HGS after three months post-surgery compared to preoperative (p = 0.011), without changes in relative QMS (p = 0.596). No changes in PA were observed. Conclusions: after SG, there is a short term decline on PF when it is expressed on absolute values. However, when it is expressed in relative terms to body weight, some components of PF improve, while others showed no change. There was no modification in PA levels of the participants


Introducción: el incremento en la prevalencia de la obesidad se ha relacionado con un mayor número de cirugías bariátricas, siendo la gastrectomía vertical (SG) el procedimiento bariátrico más frecuente en el mundo. Sin embargo, hay pocos estudios que analicen el impacto de la SG en determinantes de la salud, como la condición física (PF) y la actividad física (PA). Objetivo: describir los cambios en la PF y la PA después de la SG. Métodos: veintitrés mujeres con obesidad (36,1 ± 11,1 años e índice de masa corporal [IMC] de 35,1 ± 3,4 kg/m2) fueron evaluadas previo a una SG y al primer y tercer mes postoperatorio. Las evaluaciones incluyeron la valoración de fuerza de prensión manual (HGS) y de cuádriceps (QMS) con dinamómetros y de capacidad cardiorrespiratoria (CRF) con ergoespirometría. La PA fue evaluada con acelerómetros triaxiales. Resultados: el VO2 peak absoluto disminuyó al primer y tercer mes (p < 0,001) luego de la SG. El VO2 peak relativo al peso corporal aumentó después de la SG (p = 0,002). Luego de la cirugía disminuyeron HGS y QMS absolutas (p < 0,001) y aumentó HGS relativa al peso corporal al tercer mes postoperatorio (p = 0,011), sin cambios en QMS relativa (p = 0,559). No se observaron cambios en la PA posterior a SG. Conclusiones: después de SG hay un deterioro a corto plazo de la PF expresada en términos absolutos, pero al expresarse en relación al peso corporal, algunos componentes de la PF no cambian y otros mejoran. No se observaron cambios en la PA poscirugía


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Atividade Motora , Obesidade/cirurgia , Gastrectomia/métodos , Cirurgia Bariátrica , Índice de Massa Corporal , Antropometria
17.
BMC Surg ; 19(1): 97, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337375

RESUMO

BACKGROUND: Surgical robots are increasingly being used in bariatric surgery. While several studies describe the safety of using barbed sutures in laparoscopic gastric bypass surgery, no reports are available for robotic bariatric procedures. The aim of our article is to determine whether barbed sutures can be used safely in robotic Roux-en-Y bypass (RYGB) surgery. METHODS: This was a single-center, single-surgeon case series of RYGB procedures using the da Vinci® Xi Surgical System (Intuitive Surgery, Sunnyvale, CA, USA) in combination with the use of barbed sutures (Stratafix, Ethicon, Johnson & Johnson, Cincinnati, OH, USA). RESULTS: Fifty robotic proximal and distal RYGB surgeries were performed. A linear stapled, side-to-side gastrojejunostomy was carried out, whereby the enterotomy was completed with a running resorbable unidirectional barbed suture, Stratafix 2-0. In one case after robotic proximal RYGB, revision surgery was required due to omentum necrosis. Another patient was readmitted due to gastrointestinal bleeding from anastomosis. No anastomotic insufficiencies, no stenoses, or higher-grade complications according to Clavien-Dindo 4a-5 were found. CONCLUSIONS: We found that the use of self-fixing barbed sutures in robotic RYGB is safe. The self-fixing suture enables the robotic surgeon to perform a simple continuous suture without the need for recurrent retraction. Although we are the first to report this procedure, we had a low number of cases and no control group; thus, further studies with a higher level of evidence are required.


Assuntos
Derivação Gástrica/instrumentação , Obesidade/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Técnicas de Sutura/instrumentação , Suturas , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento , Perda de Peso
19.
J Orthop Surg Res ; 14(1): 229, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331364

RESUMO

STUDY DESIGN: This study is a comparative, literature review. OBJECTIVE: The aim of this study is to provide a comparative analysis of open vs. minimally invasive TLIF using a literature review and a meta-analysis. Lumbar interbody fusion is a well-established surgical procedure for treating several spinal disorders. Transforaminal lumbar interbody fusion (TLIF) was initially introduced in the early 1980s. To reduce approach-related morbidity associated with traditional open TLIF (OTLIF), minimally invasive TLIF (MITLIF) was developed. We aimed to provide a comparative analysis of open vs. minimally invasive TLIF using a literature review. METHODS: We searched the online database PubMed (2005-2017), which yielded an initial 194 studies. We first searched the articles' abstracts. Based on our inclusion criteria, we excluded 162 studies and included 32 studies: 18 prospective, 13 retrospective, and a single randomized controlled trial. Operative time, blood loss, length of hospital stay, radiation exposure time, complication rate, and pain scores (visual analogue scale, Oswestry Disability Index) for both techniques were recorded and presented as means. We then performed a meta-analysis. RESULTS: The meta-analysis for all outcomes showed reduced blood loss (P < 0.00001) and length of hospital stay (P < 0.00001) for MITLIF compared with OTLIF, but with increased radiation exposure time with MITLIF (P < 0.00001). There was no significant difference in operative time between techniques (P = 0.78). The complication rate was lower with MITLIF (11.3%) vs. OTLIF (14.2%), but not statistically significantly different (P = 0.05). No significant differences were found in visual analogue scores (back and leg) and Oswestry Disability Index scores between techniques, at the final follow-up. CONCLUSION: MITLIF and OTLIF provide equivalent long-term clinical outcomes. MITLIF had less tissue injury, blood loss, and length of hospital stay. MITLIF is also a safe alternative in obese patients and, in experienced hands, can also be used safely in select cases of spondylodiscitis even with epidural abscess. MITLIF is also a cost-saving procedure associated with reduced hospital and social costs. Long-term studies are required to better evaluate controversial items such as operative time.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Obesidade/epidemiologia , Obesidade/cirurgia , Medição da Dor/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/epidemiologia
20.
Int J Surg ; 68: 114-116, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31279133

RESUMO

Despite an epidemic of obesity, the availability of bariatric surgery is limited. Negative beliefs about obesity and bariatric surgery are one of the barriers to access. In this article, we address and dispel some of the common myths surrounding obesity and bariatric surgery.


Assuntos
Cirurgia Bariátrica/métodos , Obesidade/cirurgia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA