Comparative study of five different surgical techniques for the treatment of morbid obesity using BAROS

A Comparison of One- and Two-Stage Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding Using the BAROS Score

INTRODUCTION

Revision of a failed band can be done by laparoscopic sleeve gastrectomy (LSG). It can be performed synchronously with band removal or during two separate procedures.

AIM

Comparing single- and two-staged LSG following a failed LAGB in terms of short- and mid-term outcomes, with an emphasis on postoperative quality of life.

METHODS

A retrospective cohort study comparing revisional LSG's safety and efficacy after failed LAGB removal. Data included patients' medical files, as telephone interviews. We compared demographics, weight loss, complications, long-term outcomes, and quality-of-life measures, including the Bariatric Analysis and Reporting Outcome System (BAROS).

RESULTS

Ninety-three patients were enrolled, of which 68 (73.1%) underwent a single-stage revisional LSG. Of these, 40 were males (35.1%) with a mean age of 44.9 years (± 12.9). The two-staged group were older. The reasons for band removal differed between the groups: whereas in the two-stage surgery, the common causes were slippage (29.2%) or band intolerance (25%); in the single-stage group, it was weight gain (51%). There were no differences in short- and mid-term complications, weight loss, and quality of life.

CONCLUSION

In selected cases, laparoscopic sleeve gastrectomy as a revision of failed gastric banding in one stage is as safe as a two-stage procedure in terms of short- and mid-term complications, weight loss, and quality of life. We believe that there is little benefit in performing elective surgery in two stages unless there are clinical indications. Exceptions for two-stage revision should include cases of band erosion and acute slippage with patient preference for band removal.

REPERCUSSÕES DA CIRURGIA BARIÁTRICA SOBRE PARÂMETROS METABÓLICOS. EXPERIÊNCIA DE 15 ANOS EM HOSPITAL DE MACEIÓ - BRASIL

RESUMO - RACIONAL: A obesidade é caracterizada pelo acúmulo excessivo de gordura corporal prejudicial à saúde e nos últimos anos tem crescido significativamente na maioria dos países. A cirurgia bariátrica deverá ser recomendada para pacientes obesos que não obtiveram êxito no tratamento clínico e após análise da equipe multiprofissional. Objetivo: comparar os resultados metabólicos, perda ponderal e parâmetros associados à obesidade no pré e pós-operatório dos pacientes submetidos à cirurgia bariátrica. Métodos: estudo retrospectivo, descritivo, transversal, de abordagem quantitativa através da consulta a prontuários. Os dados foram coletados no período de maio a setembro de 2020, de indivíduos submetidos à cirurgia bariátrica no período de 15 anos (2003 a 2018). Foi realizada análise estatística comparativa e descritiva das variáveis antropométricas, metabólicas, bioquímicas e morbidades associadas. Resultados: a maioria era do sexo feminino (68,50%). Em ambos os sexos a maior prevalência se encontravam na faixa etária de 30 a 39 anos e mais da metade tinha obesidade grau III. A técnica cirúrgica utilizada foi o gastroplastia em Y de Roux. Após 4 meses houve uma redução significativa do perfil lipídico, dos parâmetros antropométricos e enzimas hepáticas em ambos os sexos, os quais permaneceram em declínio no final do primeiro ano, com melhora acentuada da síndrome metabólica. Conclusões: O impacto positivo determinado pela gastroplastia na perda de peso, na redução do IMC e perfil lipídico é bastante relevante já após quatro meses, e se mantém após um ano da realização do procedimento, demonstrando benefícios na redução dos fatores de risco da síndrome metabólica.

Application of BAROS' questionnaire in obese patients undergoing bariatric surgery with 2 years of evolution

BACKGROUND:

-In recent decades, the high prevalence of obesity in the general population has brought serious concerns in terms of public health. Contrarily to conventional treatment involving dieting and physical exercising, often ineffective in generating long term results, bariatric opera-tions have been an effective method for sustained weight loss in morbidly obese individuals. The Bariatric Analysis and Reporting Outcome System (BAROS) is an objective and recognized system in the overall evaluation of results after bariatric surgery.

OBJECTIVE

- To investigate results concerning a casuistic of morbidly obese patients undergoing bariatric surgery over a 2-year follow-up in terms of weight loss, related medical conditions, safety and changes in quality of life.

METHODS

- A total of 120 obese (17 male and 103 female) patients, who underwent bariatric surgery, were assessed and investigated using the BAROS system after a 2- year follow-up.

RESULTS

- Patients obtained a mean excess weight loss of 74.6 (±15.9) % and mean body mass index reduction of 15.6 (±4.4) Kg/m2. Pre-surgical comorbidities were present in 71 (59%) subjects and they were totally (86%) or partially (14%) resolved. Complications resulting specifically from the surgical procedure were observed in 4.2% of cases (two bowel obstructions requiring re-operation, and three stomal stenosis treated with endoscopic dilation). Sixteen subjects (13% of total number of patients) presented minor clinical complications managed through outpatient care. The final scores for the BAROS questionnaire showcased excellent to good results in 99% of cases (excellent 44%, very good 38%, good 23%, acceptable 1%).

CONCLUSION

- According to the BAROS questionnaire, bariatric surgery is a safe and effective method for managing obesity and associated clinical comorbidities, allowing for satisfactory results after a 2-year follow-up. Future studies should address other clinical and psychosocial variables that impact outcome as well as allow for longer follow-ups.

Post-bariatric surgery weight regain: evaluation of nutritional profile of candidate patients for endoscopic argon plasma coagulation

BACKGROUND

Bariatric surgery is effective treatment for weight loss, but demand continuous nutritional care and physical activity. They regain weight happens with inadequate diets, physical inactivity and high alcohol consumption.

AIM

To investigate in patients undergoing Roux-Y-of gastroplasty weight regain, nutritional deficiencies, candidates for the treatment with endoscopic argon plasma, the diameter of the gastrojejunostomy and the size of the gastric pouch at the time of treatment with plasma.

METHODS

A prospective 59 patients non-randomized study with no control group undergoing gastroplasty with recurrence of weight and candidates for the endoscopic procedure of argon plasma was realized. The surgical evaluation consisted of investigation of complications in the digestive system and verification of the increased diameter of the gastrojejunostomy. Nutritional evaluation was based on body mass index at the time of operation, in the minimum BMI achieved after and in which BMI was when making the procedure with plasma. The laboratory tests included hemoglobin, erythrocyte volume, ferritin, vitamin D, B12, iron, calcium, zinc and serum albumin. Clinical analysis was based on scheduled follow-up.

RESULTS

Of the 59 selected, five were men and 51 women; were included 49 people (four men and 44 women) with all the complete data. The exclusion was due to the lack of some of the laboratory tests. Of this total 19 patients (38.7%) had a restrictive ring, while 30 (61.2%) did not. Iron deficiency anemia was common; 30 patients (61.2%) were below 30 with ferritin (unit); 35 (71.4%) with vitamin B12 were below 300 pg/ml; vitamin D3 deficiency occurred in more than 90%; there were no cases of deficiency of protein, calcium and zinc; glucose levels were above 99 mg/dl in three patients (6.12%). Clinically all had complaints of labile memory, irritability and poor concentration. All reported that they stopped treatment with the multidisciplinary team in the first year after the operation.

CONCLUSION

The profile of patients submitted to argon plasma procedure was: anastomosis in average with 27 mm; multiple nutritional deficiencies with predominance of iron deficiency anemia; ferritin below 30; vitamin B12 levels below 300 pg/ml; labile memory complaints, irritability and poor concentration.

Nutritional repercussions in patients submitted to bariatric surgery

BACKGROUND

Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery.

AIM

To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life.

METHOD

A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%.

RESULTS

The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m(²). In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders.

CONCLUSION

Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight.