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Ribeiro R, Viveiros O, Taranu V, Rossoni C. One Anastomosis Transit Bipartition (OATB): Rational and Mid-term Outcomes. Obes Surg 2024; 34:371-381. [PMID: 38135740 DOI: 10.1007/s11695-023-06988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The "One-anastomosis transit bipartition" (OATB) is a promising emerging technique in the metabolic syndrome treatment. OBJECTIVE To demonstrate the results achieved with OATB in the first 5 years after surgery. METHOD Cross-sectional, retrospective study, with individuals undergoing primary OATB. Individuals included in the study were: ≥ 18 years, BMI ≥ 35 kg/m2; and excluded smoking habits, drug dependence, inflammatory bowel diseases. The data analyzed demographic, anthropometric, surgical, clinical, and nutritional. RESULTS Sixty eight participants, 75% women, average age 45.5 years and BMI 41 kg/m2. Associated diseases: osteoarthritis (52.9%), hypertension (48.5%) and type 2 diabetes mellitus-T2DM (39.7%). All underwent laparoscopy, without conversions. Average operative time is 122.6 ± 31.7 min, and hospital stay is 2.2 ± 0.8 days. The common channel length 27 and 41 patients with 250 cm and 300 cm respectively. We registered no intraoperative complications, 2 (2.9%) early complications, and 14 (20.6%) late complications. In the first 6 months, 94.7% (250 cm) and 88.9% (300 cm) of the patients no longer used medication for T2DM, with no statistical difference between the two groups. The incidence of nutritional disorders at any time during follow-up: hypovitaminosis D (14.7%), folate hypovitaminosis (14.7%), elevated PTH (7.4%), hypoproteinemia (5.9%) and anemia (5.9%). We found no statistically significant difference between 250 and 300 cm common channel groups. CONCLUSION We conclude that OATB is a safe and effective technique, demonstrating good control of T2DM and metabolic syndrome. There is a requirement to treat previous nutritional deficits. We need more long-term evidence and comparison to other surgical techniques.
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Affiliation(s)
- Rui Ribeiro
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal
- General Surgery Department, Hospital Lusíadas, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, Lisbon, Portugal
| | - Octávio Viveiros
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal
- General Surgery Department, Hospital Lusíadas, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, Lisbon, Portugal
| | - Viorel Taranu
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal
- General Surgery Department, Hospital Lusíadas, Amadora, Portugal
| | - Carina Rossoni
- Multidisciplinary Center for Obesity Treatment, Hospital Lusíadas, 2724-002, Amadora, Portugal.
- School of Sciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal.
- Institute of Environmental Health (ISAMB) - Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
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The Questionable IFSO Position Statement. Obes Surg 2023; 33:665-667. [PMID: 36529832 DOI: 10.1007/s11695-022-06407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
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Estabile PC, Santo MA, de Moura EGH, Kuga R, Caproni P, de Cleva R, Mota FC, Milléo FQ, Artoni RF. SMALL INTESTINAL L CELL DENSITY IN PATIENTS WITH SEVERE OBESITY AFTER ROUX-EN-Y GASTRIC BYPASS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1681. [PMID: 36197372 PMCID: PMC9529080 DOI: 10.1590/0102-672020220002e1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND: Enteroendocrine L cells can be found in the entire gastrointestinal tract and
their incretins act on glycemic control and metabolic homeostasis. Patients
with severe obesity and type 2 diabetes mellitus may have lower density of L
cells in the proximal intestine. AIMS: This study aimed to analyze the density of L cells in the segments of the
small intestine in the late postoperative of Roux-en-Y gastric bypass in
diabetic patients with standardization of 60 cm in both loops, alimentary
and biliopancreatic. METHODS: Immunohistochemistry analysis assays were made from intestinal biopsies in
three segments: gastrointestinal anastomosis (GIA= Point A), enteroenteral
anastomosis (EEA= Point B= 60 cm distal to the GIA) and 60 cm distal to the
enteroenteral anastomosis (Point C). RESULTS: A higher density of L cells immunostaining the glucagon-1 peptide was
observed in the distal portion (Point C) when compared to the more proximal
portions (Points A and B). CONCLUSIONS: The concentration of L cells is higher 60 cm distal to enteroenteral
anastomosis when comparing to proximal segments and may explain the
difference in intestinal lumen sensitization and enterohormonal response
after Roux-en-Y gastric bypass.
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Affiliation(s)
- Priscila Costa Estabile
- Universidade de São Paulo, Postgraduate Program in Science in
Gastroenterology – São Paulo (SP), Brazil,Universidade de São Paulo, Faculty of Medicine, Hospital das
Clínicas – São Paulo (SP), Brazil
| | - Marco Aurélio Santo
- Universidade de São Paulo, Postgraduate Program in Science in
Gastroenterology – São Paulo (SP), Brazil,Universidade de São Paulo, Faculty of Medicine, Hospital das
Clínicas – São Paulo (SP), Brazil
| | | | - Rogério Kuga
- Universidade de São Paulo, Hospital das Clínicas, Faculty of
Medicine, Gastrointestinal Endoscopy Service – São Paulo (SP), Brazil
| | - Priscila Caproni
- Universidade de São Paulo, Postgraduate Program in Science in
Gastroenterology – São Paulo (SP), Brazil,Universidade de São Paulo, Faculty of Medicine, Hospital das
Clínicas – São Paulo (SP), Brazil
| | - Roberto de Cleva
- Universidade de São Paulo, Postgraduate Program in Science in
Gastroenterology – São Paulo (SP), Brazil,Universidade de São Paulo, Faculty of Medicine, Hospital das
Clínicas – São Paulo (SP), Brazil
| | - Filippe Camarotto Mota
- Universidade de São Paulo, Postgraduate Program in Science in
Gastroenterology – São Paulo (SP), Brazil
| | - Fábio Quirillo Milléo
- Universidade Estadual de Ponta Grossa, Department of Structural,
Molecular and Genetic Biology – Ponta Grossa (PR), Brazil
| | - Roberto Ferreira Artoni
- Universidade Estadual de Ponta Grossa, Department of Structural,
Molecular and Genetic Biology – Ponta Grossa (PR), Brazil
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Estabile PC, Almeida MCD, Campagnoli EB, Santo MA, Rodrigues MRDS, Milléo FQ, Artoni RF. IMMUNOHISTOCHEMICAL DETECTION OF L CELLS IN GASTROINTESTINAL TRACT MUCOSA OF PATIENTS AFTER SURGICAL TREATMENT FOR CONTROL OF TYPE 2 DIABETES MELLITUS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1651. [PMID: 35730880 PMCID: PMC9254391 DOI: 10.1590/0102-672020210002e1651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Type 2 diabetes mellitus (T2DM) is a disease of global impact that has led to an increase in comorbidities and mortality in several countries. Immunoexpression of the incretin hormones such as glucagon-like peptide-1 (GLP-1) and peptide YY (3-36) (PYY3-36) can be used as a scorer in the gastrointestinal tract to analyze L-cell activity in response to T2DM treatment. This study aimed to investigate the presence, location, and secretion of L cells in the small intestine of patients undergoing the form of bariatric surgery denominated adaptive gastroenteromentectomy with partial bipartition. METHODS Immunohistochemical assays, quantitative real-time polymerase chain reaction (qPCR), and Western blot analysis were performed on samples of intestinal mucosa from patients with T2DM in both the preoperative and postoperative periods. RESULTS All results were consistent and indicated basal expression and secretion of GLP-1 and PYY3-36 incretins by L cells. A greater density of cells was demonstrated in the most distal portions of the small intestine. No significant difference was found between GLP-1 and PYY3-36 expression levels in the preoperative and postoperative periods because of prolonged fasting during which the samples were collected. CONCLUSION The greater number of L cells in activity implies better peptide signaling, response, and functioning of the neuroendocrine system.
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Affiliation(s)
- Priscila Costa Estabile
- Postgraduate Program in Science in Gastroenterology, University of São Paulo, São Paulo, SP, Brazil
| | - Mara Cristina de Almeida
- Department of Structural, Molecular and Genetics Biology, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | | | - Marco Aurelio Santo
- Associate Professor at University of São Paulo School of Medicine, is Director of Bariatric and Metabolic Surgery Unit at Hospital das Clinicas, Brazil
| | | | | | - Roberto Ferreira Artoni
- Department of Structural, Molecular and Genetics Biology, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
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de Lucena AVS, Cordeiro GG, Leão LHA, Kreimer F, de Siqueira LT, da Conti Oliveira Sousa G, de Lucena LHS, Ferraz ÁAB. Cholecystectomy Concomitant with Bariatric Surgery: Safety and Metabolic Effects. Obes Surg 2022; 32:1093-1102. [PMID: 35064462 DOI: 10.1007/s11695-022-05889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity and fast weight loss in the postoperative period of bariatric surgery increase significantly the risk of cholelithiasis. Moreover, emerging evidence has pointed out the role of bile acids as possible metabolism and weight loss enhancers. This study aims to analyze the influence of cholecystectomy (CL) concomitant with bariatric surgery on weight loss, metabolic repercussions, and postoperative morbidity. STUDY DESIGN Retrospective cohort study. A total of 363 medical records were analyzed between 2002 and 2017, with 255 patients divided into four groups: with concomitant CL: sleeve gastrectomy (SG + CL group) and Roux-en-Y gastric bypass (GB + CL group); without concomitant CL: sleeve gastrectomy (SG group) and RYGB (GB group). RESULTS CL concomitant with bariatric surgery is not related to worse long-term metabolic outcomes when compared to isolated bariatric surgery. In the postoperative follow-up of the isolated bariatric surgeries, 18 (16.5%) patients underwent cholecystectomy. There was no statistical difference between the groups regarding post-surgical complications. CONCLUSION CL did not lead to worse metabolic outcomes and was also not related to a higher incidence of postoperative complications. Cholelithiasis and cholecystitis are important concerns in the postoperative period of bariatric surgery and a careful evaluation of the concomitant procedure should be performed.
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Affiliation(s)
| | - Gabriel Guerra Cordeiro
- Medical School, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, PE, 50670-901, Brazil.
| | | | - Flávio Kreimer
- Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil
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Wendler G, Nassif PAN, Malafaia O, Wendler E, Wendler IBT, Cirpiani LM. HELICAL COMPUTERIZED TOMOGRAPHY CAN MEASURE SUBCUTANEOUS, VISCERAL AND TOTAL FAT AREAS? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1591. [PMID: 35019117 PMCID: PMC8735265 DOI: 10.1590/0102-672020210003e1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/08/2021] [Indexed: 12/03/2022]
Abstract
Background: Abdominal obesity or android obesity, that is, the increase in adipose tissue in the abdominal region, is considered a risk factor for several morbidities. Different ways of quantifying it have been proposed, one method is the measurement of the abdominal fat area by computed tomography. Aim: To establish correspondence between the groups defined by degree of obesity in relation to the total, subcutaneous and visceral fat area. Methods: Cross-sectional observational study carried out through the analysis of tomographic examinations. Horos v3.3.5 medical image visualization software was used, with abdominal tomography in a single cut including the L4 vertebral body and the umbilical scar, to obtain the areas of total, visceral and subcutaneous fat. Results: Of the 40 patients, 10 had grade II obesity, 23 grade III and 7 superobese. The amount of total fat showed an increase in relation to the degree of obesity. Visceral fat did not show significant differences between the degrees of obesity, but the data showed a lower average in the group of obesity grade II. The area of subcutaneous fat, as well as total fat, showed an increase in its measurements, according to the progression of the patients’ BMI, but there was no statistical significance in this difference between the groups of grade II and super-obese individuals. Conclusion: The area of total and subcutaneous fat showed an increase in its measurements according to the progression of the BMI groups, which did not happen with visceral fat.
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Affiliation(s)
- Guilherme Wendler
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Rocio Hospital, Campo Largo, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil
| | - Osvaldo Malafaia
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil
| | - Eduardo Wendler
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Rocio Hospital, Campo Largo, PR, Brazil
| | - Ilana Barrichello Torres Wendler
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Rocio Hospital, Campo Largo, PR, Brazil
| | - Luiza Marcelli Cirpiani
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical Faculty of Paraná/Medical Research Institute, Curitiba, PR, Brazil
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LIMA RR, GARCIA JHP, STUDART MS, PINHEIRO FS, PINTO JOG, SALES LA, SOARES LM, SANTOS PDA. ACCURACY OF ELASTOGRAPHY IN THE ASSESSMENT OF REDUCTION IN LIVER STEATOSIS AND FIBROSIS IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERY. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1671. [PMID: 36043649 PMCID: PMC9423716 DOI: 10.1590/0102-672020220002e1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND: Nonalcoholic hepatic steatosis is found in most obese patients and has a
strong association with metabolic syndrome. The Roux-en-Y gastric bypass and
the sleeve gastrectomy are the two techniques of bariatric surgery. Patients
who underwent bariatric surgery have regression of nonalcoholic
steatohepatitis due to a reduction in body mass index and changes in
incretin hormones. AIMS: This study aimed to analyze the acuity of elastography in the regression of
hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y
gastric bypass and sleeve gastrectomy 2 months after surgery. METHODS: Patients in the preoperative period of bariatric surgery underwent an
anthropometric evaluation and hepatic elastography to quantify fibrosis and
hepatic steatosis. Two months after surgery, the same evaluation was
performed again. RESULTS: All 17 patients who met the inclusion criteria participated in the study. Out
of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y
gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels
postoperatively compared to preoperatively (p=0.029, p<0.05). As for
steatosis, patients who underwent Roux-en-Y gastric bypass had lower
postoperative values (p=0.01, p<0.05). There was also a reduction in
fibrosis postoperatively in the sleeve gastrectomy group compared to
preoperatively (p=0.037, p<0.05). CONCLUSIONS: Elastography accurately demonstrated decreased hepatic steatosis and fibrosis
in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y
gastric bypass and sleeve gastrectomy are suitable surgical methods to
improve hepatic steatosis and fibrosis within 2 months postoperatively.
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Affiliation(s)
- Ramon Rawache LIMA
- Universidade Federal do Ceará, Brazil; Walter Cantídeo University Hospital, Brazil; Centro Universitário Christus, Brazil
| | - José Huygens Parente GARCIA
- Universidade Federal do Ceará, Brazil; Walter Cantídeo University Hospital, Brazil; Walter Cantídeo University Hospital, Brazil
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VOLPE P, DOMENE CE, SANTANA AV, MIRA WG, SANTO MA. COMPLICATIONS AND LATE FOLLOW-UP OF SCOPINARO’S SURGERY WITH GASTRIC PRESERVATION: 1570 PATIENTS OPERATED IN 20 YEARS. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1646. [PMID: 35730875 PMCID: PMC9254384 DOI: 10.1590/0102-672020210002e1646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/15/2022] [Indexed: 01/28/2023]
Abstract
Scopinaro-type biliopancreatic diversion (BPD-S) and its variations are the
surgeries that offer the best immediate results in weight loss and regain in the
late follow-up. It has a high rate of immediate complications and demands
control with frequent laboratory tests.
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Affiliation(s)
- Paula VOLPE
- Integrated Center for Advanced Medicine, Brazil
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PIATTO VB, FERDINANDO DLT, FUNES HLX. DOES SLC11A2 GENE MUTATION ASSOCIATE WITH IRON-REFRACTORY IRON-DEFICIENCY ANEMIA AFTER BARIATRIC SURGERY? ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1645. [PMID: 35730874 PMCID: PMC9254381 DOI: 10.1590/0102-672020210002e1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
ABSTRACT - BACKGROUND: After bariatric surgery, if there is iron-refractory iron-deficiency anemia (IRIDA) and does not respond to supplemental iron therapy, excluding other possible etiologies, genetic changes involved in iron metabolism should be considered. AIM: This study aimed to investigate the association of both mutations 1285G-C and 1246C-T, in the SLC11A2 gene, and the etiopathogenesis of anemia refractory to iron supplementation in patients undergoing bariatric surgery using Roux-en-Y gastric bypass (RYGB). METHODS: A case-control study was conducted, in which 100 patients were evaluated as Cases Group [subdivided into (i) with Anemia and (ii) without Anemia] and 100 individuals as Controls, comprising both sexes. Inherited and acquired causes of IRIDA were excluded. DNA was extracted from leukocytes of peripheral blood, and the regions that cover both mutations have been amplified by the molecular techniques such as polymerase chain reaction/restriction fragment length polymorphism. RESULTS: The 1285G-C mutation was not determined in any of the 400 alleles analyzed. Regarding the 1246C-T mutation, the wild CC genotype was found with a higher prevalence in the Control Group (34%) (OR 0.5475; 95%CI 0.2920-1.027; p=0.0827). The mutant TT genotype was found only in the Cases Group I (with Anemia) (13%). CONCLUSION: The results show the association between 1246C-T mutation, in the SLC11A2 gene, and the etiopathogenesis of IRIDA to iron supplementation in the evaluated sample. There are differences, at the molecular level, in patients with and without IRIDA after bariatric surgery using RYGB.
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Ruzzon A, Nassif PAN, Prigol L, Buzo L, Wendler G, Wendler E, Wendler IBT, Ruzzon I, Goveia CHM, Gonçalves LAP. ROUX-IN-Y GASTROJEJUNAL BYPASS: WHICH ANESTHETIC TECHNIQUE HAS BEST RESULTS? ACTA ACUST UNITED AC 2021; 34:e1530. [PMID: 34008703 PMCID: PMC8121063 DOI: 10.1590/0102-672020200002e1530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
Background:
As the number of bariatric operations increases, there is a greater interest in knowledge, experience and skills in the operative and anesthetic management of obese people. Anesthetic recovery is an important point in the therapeutic approach and less adverse effects delaying discharge of these patients are necessary to be kept in mind by the surgical team.
Aim:
To compare anesthetic-analgesic techniques in the opioid-sparing era through epidural administration of local anesthetic associated with low-dose morphine vs. clonidine and analyze the impact of analgesia on the effectiveness of postoperative recovery by comparing these two techniques.
Methods:
Randomized, double-blind clinical trial with 66 patients candidates for Roux-en-Y gastrojejunal bypass divided into two groups: morphine group and clonidine group. Multimodal analgesia included epidural anesthesia with 0.375% ropivacaine 20 ml at the eighth thoracic vertebra with the association of morphine (morphine group) at a dose of 15 mcg / kg or clonidine (clonidine group) at a dose of 1 mcg / kg.
Results:
The groups were homogeneous and statistical significance was found when analyzing the difference in pain between them in the first postoperative period. The pain was higher in the clonidine group, as in this period, analgesic rescue was also better in this group. In the other times, there was no significance in the differences regarding pain and rescue. The return of intestinal motility in the morphine group was earlier in the first postoperative period. Nausea, vomiting and hospital discharge did not show significant differences between groups.
Conclusion:
Epidural anesthesia with low-dose morphine allowed less pain during the entire hospital stay, with a positive impact on patient recovery.
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Affiliation(s)
- Arthur Ruzzon
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical College of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Rocio Hospital, Campo Largo, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical College of Paraná/Medical Research Institute, Curitiba, PR, Brazil.,Rocio Hospital, Campo Largo, PR, Brazil
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BABADOPULOS RFDAL, MOURA-JR LGD, FECHINE V, ROCHA MBS, ANTUNES N, COSTA TA, COSTA BA, DE-MORAES MO. TÉCNICA DE EXPOSIÇÃO DA JUNÇÃO ESOFAGOGÁSTRICA OBTIDA POR MEIO DE AFASTADOR FLEXÍVEL DE FÍGADO EM CIRURGIA BARIÁTRICA: ENSAIO CLÍNICO RANDOMIZADO. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1631. [PMID: 35107493 PMCID: PMC8846480 DOI: 10.1590/0102-672020210002e1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
In the Roux-en-Y gastric bypass technique, classic laparoscopic surgical
retractors are usually rigid, require an additional incision for its
installation, or must be handled by an assistant during the surgical procedure,
involving a risk of liver injury.
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KORN O, CSENDES A, BURDILES P, LANZARINI E, HENRÍQUEZ A. DANOS ANATÔMICOS AO ESFÍNCTER ESOFÁGICO INFERIOR APÓS GASTRECTOMIA SUBTOTAL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2021; 34:e1633. [PMID: 35107495 PMCID: PMC8846423 DOI: 10.1590/0102-672020210002e1633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
Dysfunction of the lower esophageal sphincter (LES), gastroesophageal reflux
disease, and erosive esophagitis in patients undergoing subtotal gastrectomy are
commonly recognized occurrences, but until now the causes remain unclear.
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Affiliation(s)
- Owen KORN
- Clinical Hospital University of Chile, Chile
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