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Dantas ACB, Jayme VR, Filardi KFXC, Pajecki D, Santo MA. IMPACT OF HELICOBACTER PYLORI ON EARLY POSTOPERATIVE COMPLICATIONS AFTER SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS. Arq Bras Cir Dig 2024; 36:e1788. [PMID: 38324885 PMCID: PMC10836813 DOI: 10.1590/0102-672020230070e1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/10/2023] [Indexed: 02/09/2024]
Abstract
The impact of Helicobacter pylori (HP) on postoperative outcomes after sleeve gastrectomy (SG) is still controversial. A systematic review and meta-analysis were performed to compare the incidence of early complications after SG between HP-positive and HP-negative patients. Eight retrospective comparative studies were included, comprising 4,877 individuals. The prevalence of HP infection in gastric resected specimens ranged from 7.77 to 43.20%. There were no statistically significant differences between groups for overall complications (OR 1.46; 95%CI 0.95-2.23; p=0.08), bleeding (OR 1.35; 95%CI 0.70-2.60; p=0.38), and leak (OR 1.74; 95%CI 0.80-3.81; p=0.17) rates. The need for routine screening and treatment of HP infection before SG remains ambiguous.
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Affiliation(s)
- Anna Carolina Batista Dantas
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Bariatric and Metabolic Surgical Unit - São Paulo (SP), Brazil
| | - Vitoria Ramos Jayme
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | - Denis Pajecki
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Bariatric and Metabolic Surgical Unit - São Paulo (SP), Brazil
| | - Marco Aurelio Santo
- Universidade de São Paulo, Faculty of Medicine, Department of Gastroenterology, Bariatric and Metabolic Surgical Unit - São Paulo (SP), Brazil
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Cremonesi MDC, Duarte-Guerra L, Pajecki D, Santo MA, Lotufo F, Wang YP. VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY. Arq Bras Cir Dig 2023; 36:e1767. [PMID: 37851753 PMCID: PMC10578149 DOI: 10.1590/0102-672020230049e1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.
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Affiliation(s)
| | | | - Denis Pajecki
- Universidade de São Paulo, Department of Gastroenterology – São Paulo (SP), Brazil
| | - Marco Aurelio Santo
- Universidade de São Paulo, Department of Gastroenterology – São Paulo (SP), Brazil
| | - Francisco Lotufo
- Universidade de São Paulo, Department of Psychiatry – São Paulo (SP), Brazil
| | - Yuan-Pang Wang
- Universidade de São Paulo, Department of Psychiatry – São Paulo (SP), Brazil
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Pajecki D, Dantas ACB, Santo MA, Tess BH. Beyond the BMI: a Critical Analysis of the Edmonton Obesity Staging System and the New Guidelines for Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:1276-1278. [PMID: 36805461 DOI: 10.1007/s11695-023-06516-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 02/23/2023]
Affiliation(s)
- Denis Pajecki
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Beatriz Helena Tess
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Cardia L, de Cleva R, Ferreira L, Gadducci AV, Estabile P, Santos Silva PR, Greve J, Santo MA. Postoperative Resting Metabolic Rate and Successful Weight Loss After Roux-en-Y Gastric Bypass. Obes Surg 2023; 33:1178-1183. [PMID: 36808386 DOI: 10.1007/s11695-023-06498-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To analyze whether changes in RMR 6 months after RYGB could be a predictor of weight loss on late follow-up. METHODS Prospective study of 45 individuals submitted to RYGB in a university tertiary care hospital. Body composition was evaluated by bioelectrical impedance analysis and RMR by indirect calorimetry before (T0), 6 (T1), and 36 months (T2) after surgery. RESULTS RMR/day was lower in T1 (1.552 ± 275 kcal/day) than in T0 (1734 ± 372 kcal/day; p < 0.001) with a return to similar values at T2 (1.795 ± 396 kcal/day; p < 0.001). In T0, there was no correlation between RMR/kg and body composition. In T1, there was a negative correlation between RMR and BW, BMI, and % FM, and a positive correlation with % FFM. The results in T2 were similar to T1. There was a significant increase in RMR/kg between T0, T1, and T2 (13.6 ± 2.2 kcal/kg, 16.9 ± 2.7 kcal/kg, and 19.9 ± 3.4 kcal/kg) in the total group and according to gender. Eighty percent of the patients who had increased RMR/kg ≥ 2 kcal at T1 achieved > 50% EWL in T2, particularly in women (odds ratio: 27.09, p < 0.037). CONCLUSIONS The increase in RMR/kg after RYGB is a major factor related to a satisfactory % excess weight loss on late follow-up.
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Affiliation(s)
- Lilian Cardia
- Gastroenterology Department, University of São Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 255, 9 Andar- ICHC, São Paulo, CEP: 05403-000, Brazil.
| | - Roberto de Cleva
- Gastroenterology Department, University of São Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 255, 9 Andar- ICHC, São Paulo, CEP: 05403-000, Brazil
| | - Leandro Ferreira
- Gastroenterology Department, University of São Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 255, 9 Andar- ICHC, São Paulo, CEP: 05403-000, Brazil
| | - Alexandre Vieira Gadducci
- Gastroenterology Department, University of São Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 255, 9 Andar- ICHC, São Paulo, CEP: 05403-000, Brazil
| | - Priscila Estabile
- Gastroenterology Department, University of São Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 255, 9 Andar- ICHC, São Paulo, CEP: 05403-000, Brazil
| | | | - Julia Greve
- Orthopedics and Traumatology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco Aurelio Santo
- Gastroenterology Department, University of São Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 255, 9 Andar- ICHC, São Paulo, CEP: 05403-000, Brazil
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Pajecki D, dos Anjos Pinheiro MC, Dantas ACB, Corsi GC, Dias MCG, Santo MA. Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass for Treating Obesity in Patients > 65 Years Old: 3-Year Outcomes of a Randomized Trial. J Gastrointest Surg 2023; 27:780-782. [PMID: 36717470 PMCID: PMC9886416 DOI: 10.1007/s11605-023-05608-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Denis Pajecki
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 9º Andar, Sao Paulo, SP 05403-000 Brazil
| | - Moisés Carmo dos Anjos Pinheiro
- Divisão de Nutrição E Dietética, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 9º Andar, Sao Paulo, SP 05403-000 Brazil
| | - Giovanna Cavanha Corsi
- Divisão de Nutrição E Dietética, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Maria Carolina Gonçalves Dias
- Divisão de Nutrição E Dietética, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 9º Andar, Sao Paulo, SP 05403-000 Brazil
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Dantas ACB, Branco LT, Tustumi F, de Oliveira DRCF, Pajecki D, Santo MA. One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as Revisional Surgery After Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:4082-4088. [PMID: 36261630 DOI: 10.1007/s11695-022-06326-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/02/2022] [Accepted: 10/11/2022] [Indexed: 01/19/2023]
Abstract
The demand for revisional bariatric surgery after sleeve gastrectomy (SG) has increased, but the ideal procedure remains unclear. A systematic review and meta-analysis were performed to compare the outcomes of weight loss and safety of one-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) as revisional procedures for failed SG. Four retrospective comparative studies were included, comprising 499 individuals. Patients submitted to OAGB had a more significant total weight loss (TWL) (MD = - 5.89%; 95% CI - 6.80 to - 4.97) after revisional surgery. Overall early complication rate was similar between procedures (RD = 0.04; 95% CI: - 0.05 to 0.12). Limited and heterogeneous data prevent meaningful conclusions, but the present analysis suggests that OAGB has a better TWL after revisional surgery.
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Affiliation(s)
- Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil.
| | - Leonardo Torres Branco
- Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Francisco Tustumi
- Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Daniel Riccioppo Cerqueira Ferreira de Oliveira
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Denis Pajecki
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Corsi GC, Pinheiro MCDA, Caldas APS, Dias MCG, Santo MA, Pajecki D. BONE HEALTH ASSESSMENT OF ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY. Arq Gastroenterol 2022; 59:513-521. [PMID: 36515347 DOI: 10.1590/s0004-2803.202204000-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.
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Affiliation(s)
- Giovanna Cavanha Corsi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Moisés Carmo Dos Anjos Pinheiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Ana Paula Silva Caldas
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Maria Carolina Gonçalves Dias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Marco Aurelio Santo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, São Paulo, SP, Brasil
| | - Denis Pajecki
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, São Paulo, SP, Brasil
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Medeiros VGD, Pajecki D, Dias MCG, Dantas ACB, Cleva RD, Santo MA. FOOD TOLERANCE AND NUTRITIONAL RISK AFTER SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS IN ELDERLY PATIENTS WITH SEVERE OBESITY: A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL. Arq Gastroenterol 2022; 59:370-374. [PMID: 36102434 DOI: 10.1590/s0004-2803.202203000-67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. METHODS Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. RESULTS Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. CONCLUSION Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.
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Affiliation(s)
- Veronica Garcia de Medeiros
- Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Denis Pajecki
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Carolina Gonçalves Dias
- Divisão de Nutrição e Dietética, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Roberto de Cleva
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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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. Arq Bras Cir Dig 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] [What about the content of this article? (0)] [Affiliation(s)] [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 Moura DTH, Dantas ACB, Ribeiro IB, McCarty TR, Takeda FR, Santo MA, Nahas SC, de Moura EGH. Status of bariatric endoscopy–what does the surgeon need to know? A review. World J Gastrointest Surg 2022; 14:185-199. [PMID: 35317547 PMCID: PMC8908340 DOI: 10.4240/wjgs.v14.i2.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/14/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options available. Currently, there are several multidisciplinary therapeutic options for its management, including conservative, endoscopic, and surgical treatment.
AIM To clarify indications, technical aspects, and outcomes of bariatric endoscopy.
METHODS Narrative review of current literature based on electronic databases including MEDLINE (PubMed), Cochrane Library, and SciELO.
RESULTS Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical complications. Various devices act upon different mechanisms of action, which may be individualized to each patient. Despite favorable results for the endoscopic treatment of obesity, prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic therapies. Regarding the management of bariatric surgery complications, endoscopic therapy may be considered the procedure of choice in a variety of situations. Still, as there is no standardized algorithm, local experience should be considered in decision-making.
CONCLUSION The treatment of patients with obesity is complex, and a multidisciplinary approach is essential. Bariatric endoscopy has shown impressive results both in the treatment of obesity and its surgical complications, and therefore, must be part of the armamentarium in the fight against this disease.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - Anna Carolina Batista Dantas
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Igor Braga Ribeiro
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA 021115, United States
| | - Flávio Roberto Takeda
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Marco Aurelio Santo
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Sergio Carlos Nahas
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Sao Paulo 05403-010, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Departamento de Gastroenterologia, Faculdade de Medicina, Universidade de Sao Paulo, Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSP, Sao Paulo 05403-010, Brazil
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11
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DE-Cleva R, Cardia L, Vieira-Gadducci A, Greve JM, Santo MA. LACTATE CAN BE A MARKER OF METABOLIC SYNDROME IN SEVERE OBESITY? ACTA ACUST UNITED AC 2021; 34:e1579. [PMID: 34133526 PMCID: PMC8195466 DOI: 10.1590/0102-672020210001e1579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
Abstract
Background:
In the last decades, numerous studies have confirmed the importance of lactate - by-product to the nutrient signal of the intracellular redox state - to regulatory functions in energy metabolism.
Aim:
To evaluate changes in blood lactate in patients with severe obesity and its correlation with body composition and metabolic profile.
Methods:
Twenty-four people with severe obesity (BMI=40 kg/m2) were evaluated in a prospective case-control study before and six months after Roux-in-Y gastric bypass. The blood lactate, total cholesterol, and fractions, C-reactive protein and HOMA-IR were analyzed after 12 h fasting. Body mass composition was evaluated by bioelectrical impedance and respiratory quotient was measured by indirect calorimetry.
Results: The initial lactate level was 2.5±1.1 mmol/l and returned to normal level (1.9±3.6 mmol/l, p=0.0018) after surgery. This reduction was positively correlated with a decrease in BMI (p=0.0001), % free fat mass (p=0,001), % fat mass (p=0.001) and HOMA-IR (p=0.01). There was normalization of lactatemia in 70% of patients. There was no correlation between lactatemia and C-reactive protein.
Conclusions:
There was a significant improvement of metabolic parameters, normalization of blood lactate, fat mass loss, although these individuals remained with a high BMI.
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Affiliation(s)
- Roberto DE-Cleva
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Lilian Cardia
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Julia Maria Greve
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Dantas ACB, Santo Filho MA, Jeismann VB, de Faria LL, Muniz RR, Rocha MDS, Herman P, Santo MA. Long-term complete remission of large hepatocellular adenoma after bariatric surgery. Obes Res Clin Pract 2021; 15:300-302. [PMID: 33766489 DOI: 10.1016/j.orcp.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
We report the case of an obese woman with a large hepatocellular adenoma (HCA) of 8.0 cm in diameter, followed for 5 years after Roux-en-Y Gastric Bypass, with a complete radiologic remission of the liver mass. Four other cases have been published with HCA regression after bariatric surgery, but none with long-term follow-up. As the association between obesity and HCA has been increasingly described, bariatric surgery should be considered a therapeutic option for stage 2 obese patients.
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Affiliation(s)
- Anna Carolina Batista Dantas
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Marco Aurelio Santo Filho
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Vagner Birk Jeismann
- Hepatobiliary Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | | | - Renan Rosetti Muniz
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | | | - Paulo Herman
- Hepatobiliary Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Marco Aurelio Santo
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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13
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de Cleva R, Kawamoto F, Borges G, Caproni P, Cassenote AJF, Santo MA. C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass. Clinics (Sao Paulo) 2021; 76:e2906. [PMID: 34378729 PMCID: PMC8311643 DOI: 10.6061/clinics/2021/e2906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.
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Affiliation(s)
- Roberto de Cleva
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Flavio Kawamoto
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Georgia Borges
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Priscila Caproni
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alex Jones Flores Cassenote
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marco Aurelio Santo
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Moreira de Brito C, de Melo ME, Mancini MC, Santo MA, Cercato C. Pharmacokinetics of oral levonorgestrel and ethinylestradiol in women after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2020; 17:673-681. [PMID: 33547015 DOI: 10.1016/j.soard.2020.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/23/2020] [Accepted: 12/06/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Most patients undergoing Roux-en-Y gastric bypass (RYGB) are women in reproductive age. It is not known if bariatric surgery affects the pharmacokinetics of oral contraceptives. OBJECTIVES The primary objective was to evaluate ethinylestradiol (EE) and levonorgestrel (LNG) absorption in women undergoing RYGB, compared with nonoperated controls matched by age and body mass index (BMI). A secondary objective was to assess whether the time since surgery and BMI in the postoperative period influenced the absorption parameters. SETTING University hospital, Brazil. METHODS This study was designed to compare the maximum plasma concentration (Cmax), the time to the peak plasma level (Tmax), the area under the curve (AUC0-8 and AUC0-∞) after a single dose of a combined oral contraceptive with 0.03 mg EE and 0.15 mg LNG among 20 women after RYGB and 20 controls. Blood samples were obtained for 8 hours. RESULTS The mean LNG AUC0-8 and LNG AUC0-∞ were higher in RYGB group (P = .048 and P = .004, respectively). We found a positive correlation for LNG AUC0-8 (P = .045) and AUC0-∞ (P = .004) and the time since surgery, and we found a negative correlation for LNG Cmax (P = .018), AUC0-8 (P = .003), and AUC0-∞ (P = .001) and BMI. CONCLUSION No significant differences were found in oral EE pharmacokinetics. The operated group showed higher mean LNG AUC0-8 and AUC0-∞ but it was not considered clinically significant. The present study suggests that RYGB may not affect EE and LNG absorption.
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Affiliation(s)
- Claudia Moreira de Brito
- Grupo de Obesidade e Síndrome Metabólica, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.
| | - Maria Edna de Melo
- Grupo de Obesidade e Síndrome Metabólica, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Laboratory of Carbohydrates and Raioimmunoassay, ICHC, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marcio C Mancini
- Grupo de Obesidade e Síndrome Metabólica, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Laboratory of Carbohydrates and Raioimmunoassay, ICHC, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica e Metabólica, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Cintia Cercato
- Grupo de Obesidade e Síndrome Metabólica, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil; Laboratory of Lipids, Universidade de São Paulo, São Paulo, Brazil
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15
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ValadÃo JA, Leal PDC, Oliveira EJSGD, Torres OJM, Pinto LEV, Marchi DDD, Gama-Filho OP, Santo MA, Nassif PAN. VERTICAL GASTRECTOMY VS. EXTENDED VERTICAL GASTRECTOMY: WHAT IS THE IMPACT ON GASTROESOPHAGEAL REFLUX DISEASE IN OBESE RATS? Arq Bras Cir Dig 2020; 33:e1513. [PMID: 32844876 PMCID: PMC7448852 DOI: 10.1590/0102-672020190001e1513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. AIM To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. METHODS Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. RESULTS All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. CONCLUSION There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.
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Affiliation(s)
- José Aparecido ValadÃo
- Postgraduate Program in Principles of Surgery, Medical Research Institute, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
| | | | | | | | | | | | | | - Marco Aurelio Santo
- Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Medical Research Institute, Evangelic Mackenzie Faculty of Paraná, Curitiba, PR, Brazil
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16
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Pajecki D, Dantas ACB, Kanaji AL, de Oliveira DRCF, de Cleva R, Santo MA. Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial). Surg Obes Relat Dis 2020; 16:1436-1440. [PMID: 32753300 DOI: 10.1016/j.soard.2020.05.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population. OBJECTIVES The aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients. SETTING University hospital, São Paulo, Brazil. METHODS We performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged ≥65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification. RESULTS A total of 36 patients, with a BMI between 35.5 and 52.8 kg/m2 were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P = .13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P = .07). Each group had 1 readmission and there was no mortality in 90-day follow-up. CONCLUSIONS Morbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGB in this population setting.
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Affiliation(s)
- Denis Pajecki
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Anna Carolina Batista Dantas
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Ana Lumi Kanaji
- Division of Geriatrics, Department of Internal Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Roberto de Cleva
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marco Aurelio Santo
- Bariatric and Metabolic Surgery Unit, Discipline of Digestive Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Brunaldi VO, Farias GFA, de Rezende DT, Cairo-Nunes G, Riccioppo D, de Moura DTH, Santo MA, de Moura EGH. Argon plasma coagulation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos). Gastrointest Endosc 2020; 92:97-107.e5. [PMID: 32217111 DOI: 10.1016/j.gie.2020.03.3757] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS A significant number of patients regain weight after Roux-en-Y gastric bypass. Ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported for treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking. METHODS This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC for transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ ≥15 mm were considered eligible. The primary outcome was percentage total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life and eating behavior. RESULTS Forty patients meeting the eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between the groups. At 12 months, the mean %TWL was 8.3% ± 5.5% in the APC alone group versus 7.5% ± 7.7% in the FTS-APC group (P = .71). The pre-revisional % solid gastric retention at 1 hour positively correlated with the probability of achieving ≥10% TWL at 12 months. Both groups experienced significant reductions in low-density lipoprotein and triglyceride levels at 12 months, and improvement in eating behavior and quality of life at 3 months. There were 2 cases of stenoses (1 from each group), which were successfully treated with endoscopic balloon dilation. CONCLUSION APC alone is similar to FTS-APC in terms of technical and clinical outcomes within 1 year of follow-up. (Clinical trial registration number: NCT03094936.).
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Affiliation(s)
- Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil; Center for Gastrointestinal Endoscopy, Surgery and Anatomy Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Galileu Ferreira Ayala Farias
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Tavares de Rezende
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Gabriel Cairo-Nunes
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Riccioppo
- Bariatric and Metabolic Surgery Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Marco Aurelio Santo
- Bariatric and Metabolic Surgery Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
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de Cleva R, Cardia L, Riccioppo D, Kawamoto M, Kanashiro N, Santo MA. Anemia Before and After Roux-en-Y Gastric Bypass: Prevalence and Evolution on Long-Term Follow-up. Obes Surg 2020; 29:2790-2794. [PMID: 31087235 DOI: 10.1007/s11695-019-03920-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Anemia due to iron deficiency or inflammatory state is often associated with obesity. Bariatric surgery is responsible for increasing iron deficiency, but weight loss decreases the inflammatory state associated with obesity. The objective of our study was to investigate the prevalence and causes of anemia before and after bariatric surgery for severe obesity in a 5-year follow-up. MATERIALS AND METHODS Retrospective study, with electronic record analysis of obese patients, submitted to Roux-en-Y gastric bypass. Laboratory data were collected before and up to 60 months after surgery. Diagnosis and classification of anemia were done according to hemoglobin levels, serum ferritin, and transferrin saturation. RESULTS Preoperatively, 8.8% of patients had anemia (93.2%, mild), and 43.8% of the patients had anemia due to chronic disease. After 24 months, there was a progressive increase of iron-deficiency anemia (72.4%) and decrease in anemia due to chronic disease (15.5%) and mixed (12.1%), with maintenance of this profile during long-term follow-up. CONCLUSION Anemia is very frequent in severely obese patients and must be investigated both before and after bariatric surgery. The cause of anemia must be determined in order to use the best treatment available. We observed a reduction in the prevalence of chronic disease anemia during long-term follow-up probably due to the improvement in the systemic inflammatory state.
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Affiliation(s)
- Roberto de Cleva
- Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Rua Oscar Freire 2250 - CJ 314, São Paulo, SP, 05409-011, Brazil
| | - Lilian Cardia
- Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Rua Oscar Freire 2250 - CJ 314, São Paulo, SP, 05409-011, Brazil
| | - Daniel Riccioppo
- Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Rua Oscar Freire 2250 - CJ 314, São Paulo, SP, 05409-011, Brazil.
| | - Miwa Kawamoto
- University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Marco Aurelio Santo
- Department of Digestive Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, Rua Oscar Freire 2250 - CJ 314, São Paulo, SP, 05409-011, Brazil
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Pajecki D, Kawamoto F, Dantas ACB, Andrade PC, Brasil NC, Junqueira SM, de Oliveira FMP, Ribeiro RA, Santo MA. Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study. Clinics (Sao Paulo) 2020; 75:e1588. [PMID: 32294671 PMCID: PMC7134550 DOI: 10.6061/clinics/2020/e1588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.
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Affiliation(s)
- Denis Pajecki
- Divisao de Cirurgia, Unidade de Cirurgia Bariatrica e Metabolica, Departamento de Gastroenterologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Flavio Kawamoto
- Divisao de Cirurgia, Unidade de Cirurgia Bariatrica e Metabolica, Departamento de Gastroenterologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Anna Carolina Batista Dantas
- Divisao de Cirurgia, Unidade de Cirurgia Bariatrica e Metabolica, Departamento de Gastroenterologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | | | | | | | - Marco Aurelio Santo
- Divisao de Cirurgia, Unidade de Cirurgia Bariatrica e Metabolica, Departamento de Gastroenterologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Ogassavara NC, Magalhães Dias JG, Pajecki D, de Oliveira Siqueira J, Santo MA, Tess BH. The Edmonton Obesity Staging System: assessing a potential tool to improve the management of obesity surgery in the Brazilian public health services. Surg Obes Relat Dis 2020; 16:40-47. [DOI: 10.1016/j.soard.2019.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023]
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Gil S, Dantas WS, Murai IH, Filho CM, Santo MA, de Cleva R, Pereira RMR, Shinjo SK, Kirwan JP, Gualano B, Roschel H. Exercise Mitigates The Loss In Muscle Mass And Functionality In Obese Women Undergoing Bariatric Surgery. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561753.37493.ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Ravacci GR, Ishida R, Torrinhas RS, Sala P, Machado NM, Fonseca DC, André Baptista Canuto G, Pinto E, Nascimento V, Franco Maggi Tavares M, Sakai P, Faintuch J, Santo MA, Moura EGH, Neto RA, Logullo AF, Waitzberg DL. Potential premalignant status of gastric portion excluded after Roux en-Y gastric bypass in obese women: A pilot study. Sci Rep 2019; 9:5582. [PMID: 30944407 PMCID: PMC6447527 DOI: 10.1038/s41598-019-42082-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
We evaluated whether the excluded stomach (ES) after Roux-en-Y gastric bypass (RYGB) can represent a premalignant environment. Twenty obese women were prospectively submitted to double-balloon enteroscopy (DBE) with gastric juice and biopsy collection, before and 3 months after RYGB. We then evaluated morphological and molecular changes by combining endoscopic and histopathological analyses with an integrated untargeted metabolomics and transcriptomics multiplatform. Preoperatively, 16 women already presented with gastric histopathological alterations and an increased pH (≥4.0). These gastric abnormalities worsened after RYGB. A 90-fold increase in the concentration of bile acids was found in ES fluid, which also contained other metabolites commonly found in the intestinal environment, urine, and faeces. In addition, 135 genes were differentially expressed in ES tissue. Combined analysis of metabolic and gene expression data suggested that RYGB promoted activation of biological processes involved in local inflammation, bacteria overgrowth, and cell proliferation sustained by genes involved in carcinogenesis. Accumulated fluid in the ES appears to behave as a potential premalignant environment due to worsening inflammation and changing gene expression patterns that are favorable to the development of cancer. Considering that ES may remain for the rest of the patient’s life, long-term ES monitoring is therefore recommended for patients undergoing RYGB.
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Affiliation(s)
- Graziela Rosa Ravacci
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Robson Ishida
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Raquel Suzana Torrinhas
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Sala
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natasha Mendonça Machado
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Danielle Cristina Fonseca
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gisele André Baptista Canuto
- Departamento de Quimica Analitica, Instituto de Quimica, Universidade Federal da Bahia, Salvador, BA, Brazil.,Departamento de Quimica Fundamental, Instituto de Quimica, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ernani Pinto
- Faculdade de Ciências Farmacêuticas, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Paulo Sakai
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Joel Faintuch
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | | | - Dan Linetzky Waitzberg
- Departamento de Gastroenterologia, Laboratorio Metanutri (LIM35), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Serafim MP, Santo MA, Gadducci AV, Scabim VM, Cecconello I, de Cleva R. Very low-calorie diet in candidates for bariatric surgery: change in body composition during rapid weight loss. Clinics (Sao Paulo) 2019; 74:e560. [PMID: 30892414 PMCID: PMC6399661 DOI: 10.6061/clinics/2019/e560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/28/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To analyze the changes in the body composition of morbidly obese patients induced by a very low-calorie diet. METHODS We evaluated 120 patients selected from a university hospital. Body composition was assessed before and after the diet provided during hospitalization, and changes in weight, body mass index, and neck, waist and hip circumferences were analyzed. Bioimpedance was used to obtain body fat and fat-free mass values. The data were categorized by gender, age, body mass index and diabetes diagnosis. RESULTS The patients consumed the diet for 8 days. They presented a 5% weight loss (without significant difference among groups), which represented an 85% reduction in body fat. All changes in body circumference were statistically significant. There was greater weight loss and a greater reduction of body fat in men, but the elderly showed a significantly higher percentage of weight loss and greater reductions in body fat and fat-free mass. Greater reductions in body fat and fat-free mass were also observed in superobese patients. The changes in the diabetic participants did not differ significantly from those of the non-diabetic participants. CONCLUSIONS The use of a VLCD before bariatric surgery led to a loss of weight at the expense of body fat over a short period, with no significant differences in the alteration of body composition according to gender, age, body mass index and diabetes status.
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Affiliation(s)
- Marcela Pires Serafim
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Alexandre Vieira Gadducci
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Veruska Magalhães Scabim
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ivan Cecconello
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Roberto de Cleva
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia Gastrointestinal, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Fernandes G, Santo MA, Crespo ADFCB, Biancardi GB, Mota FC, Antonangelo L, de Cleva R. Early glycemic control and incretin improvement after gastric bypass: the role of oral and gastrostomy route. Surg Obes Relat Dis 2019; 15:595-601. [PMID: 30803884 DOI: 10.1016/j.soard.2019.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with obesity have a suppressed incretin effect and a consequent imbalance of glycemic homeostasis. Several studies have shown improved type 2 diabetes after Roux-en-Y gastric bypass (RYGB). The mechanisms of early action are linked to caloric restriction, improvement of insulin resistance, pancreatic beta cell function, and the incretin effect of glycogen-like protein 1 and gastric inhibitory polypeptide, but reported data are conflicting. OBJECTIVE The objective of this study was to evaluate glycemic metabolism, including the oral glucose tolerance test and enterohormonal profile in the early postoperative period in severely obese patients who underwent RYGB with gastrostomy, comparing the preoperative supply of a standard bolus of nutrient against the postoperative administration through an oral and a gastrostomy route. SETTING Clinics Hospital of University of São Paulo, Brazil. METHODS Eleven patients with obesity and diabetes underwent RYGB with a gastrostomy performed in the excluded gastric remnant. Patients were given preoperative assessments of glycemic and enterohormone profiles and an oral glucose tolerance test; these were compared with early postoperative assessments after oral and gastrostomy route administrations. RESULTS The mean preoperative body mass index of the group was 44.1 ± 6.6 kg/m2, mean fasting blood glucose of 194.5 ± 62.4 mg/dL, and glycated hemoglobin 8.7 ± 1.6%. In 77.7% of the patients, there was normalization of the glycemic curve in the early postoperative period as evaluated by the oral glucose tolerance test. Significant decreases in glycemia, insulinemia, and homeostatic model assessment-insulin resistance were also observed, regardless of the route of administration. There was significant increase in glycogen-like protein 1 by the postoperative oral route and reduction of gastric inhibitory polypeptide in both routes. Ghrelin did not change. CONCLUSION Glycemia and peripheral insulin resistance reductions were observed in early-postoperative RYGB, independent of the oral or gastrostomy route. Incretin improvement, mediated by glycogen-like protein 1 increased was observed only in the postoperative oral route, while GIP reduced for both routes.
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Affiliation(s)
- Gustavo Fernandes
- Hospital das Clínicas, Digestive Surgery Department, University of São Paulo Medical School, São Paulo - SP, Brazil
| | - Marco Aurelio Santo
- Hospital das Clínicas, Digestive Surgery Department, University of São Paulo Medical School, São Paulo - SP, Brazil
| | | | - Gabriel Barbosa Biancardi
- Hospital das Clínicas, Digestive Surgery Department, University of São Paulo Medical School, São Paulo - SP, Brazil
| | - Filippe Camarotto Mota
- Hospital das Clínicas, Digestive Surgery Department, University of São Paulo Medical School, São Paulo - SP, Brazil.
| | - Leila Antonangelo
- Hospital das Clínicas, Digestive Surgery Department, University of São Paulo Medical School, São Paulo - SP, Brazil
| | - Roberto de Cleva
- Hospital das Clínicas, Digestive Surgery Department, University of São Paulo Medical School, São Paulo - SP, Brazil
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Takesian M, Santo MA, Gadducci AV, Santarém GCDF, Greve J, Silva PR, Cleva RD. TRUNK BODY MASS INDEX: A NEW REFERENCE FOR THE ASSESSMENT OF BODY MASS DISTRIBUTION. Arq Bras Cir Dig 2018; 31:e1362. [PMID: 29947696 PMCID: PMC6050002 DOI: 10.1590/0102-672020180001e1362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Body mass index (BMI) has some limitations for nutritional diagnosis since it does not represent an accurate measure of body fat and it is unable to identify predominant fat distribution. AIM To develop a BMI based on the ratio of trunk mass and height. METHODS Fifty-seven patients in preoperative evaluation to bariatric surgery were evaluated. The preoperative anthropometric evaluation assessed weight, height and BMI. The body composition was evaluated by bioimpedance, obtaining the trunk fat free mass and fat mass, and trunk height. Trunk BMI (tBMI) was calculated by the sum of the measurements of the trunk fat free mass (tFFM) and trunk fat mass (tFM) in kg, divided by the trunk height squared (m2)). The calculation of the trunk fat BMI (tfBMI) was calculated by tFM, in kg, divided by the trunk height squared (m2)). For the correction and adjustment of the tBMI and tfBMI, it was calculated the relation between trunk extension and height, multiplying by the obtained indexes. RESULTS The mean data was: weight 125.3±19.5 kg, height 1.63±0.1 m, BMI was 47±5 kg/m2) and trunk height was 0.52±0,1 m, tFFM was 29.05±4,8 kg, tFM was 27.2±3.7 kg, trunk mass index was 66.6±10.3 kg/m², and trunk fat was 32.3±5.8 kg/m². In 93% of the patients there was an increase in obesity class using the tBMI. In patients with grade III obesity the tBMI reclassified to super obesity in 72% of patients and to super-super obesity in 24% of the patients. CONCLUSION The trunk BMI is simple and allows a new reference for the evaluation of the body mass distribution, and therefore a new reclassification of the obesity class, evidencing the severity of obesity in a more objectively way.
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Affiliation(s)
| | | | | | | | - Julia Greve
- Department of Orthopedics and Traumatology, Medical School of University of São Paulo São Paulo, SP, Brazil
| | - Paulo Roberto Silva
- Department of Orthopedics and Traumatology, Medical School of University of São Paulo São Paulo, SP, Brazil
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de Cleva R, Mota FC, Gadducci AV, Cardia L, D’Andréa Greve JM, Santo MA. Resting metabolic rate and weight loss after bariatric surgery. Surg Obes Relat Dis 2018; 14:803-807. [DOI: 10.1016/j.soard.2018.02.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 01/28/2023]
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27
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Sallum RAA, Takeda FR, Santo MA, Cecconello I. Robotic-assisted (RAMIE) x thoracoscopic esophagectomy (MIE): Comparison on safety and lymph nodal dissection in 181 cases. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
150 Background: Robotic-assisted esophagectomy (RAMIE) gained evidence among the major oncological procedures due possibilities on lymph nodal dissection. The concept of esophagectomy and extensive lymphadenectomy with low morbidity boosted by the videothoracoscopic esophagectomy(MIE) is now focused on the robotic approach. Methods: The first 37 cases of RAMIE were studied. The thoracic field performed in the prone position with three robotic arms and abdominal field idem, as performed in the upper GI robotics procedures. Conversion to open or laparoscopic procedures, morbidity and mortality as well as the length of the lymphadenectomy were evaluated. These data were compared to the first 154 cases of MIE operated by the same surgical team in those early results. Also the late survival of the MIE group is presented. Results: All except 2 RAMIE cases were Siewert I or II Adenocarcinoma, 32 post neoadjuvancy: MAGIC (7) or CROSS (25). There was no conversion to lap or open procedures. No patient received blood transfusion. One complication was observed: a partial rotation of gastroplasty in the thorax, that required thoracoscopic approach in the day 7. Mortality (90 days) was zero. Mean resected lymph nodes was 42.5 (30-76). In the MIE group, complications were: respiratory (26.2%), infectious (8.4%), cervical fistula (17.7%), vocal cord palsy (8.4%). 30 and 90 days mortality were one (0.93%) and 3 (2.8%). Mean dissected lymph nodes = 31.6 (± 14.3), 1:57 positives (± 3.21) and RAD 00:05 (± 0:09). The overall five-year survival was 69% (95% CI: 57% - 83%), 75% in stage 0 / I / II and 42% in III/IV. Conclusions: RAMIE with these technical proposal, seams to be safe without mortality. Lymph nodal achieved was equal to greater than the practiced through MIE. After those cases we started a randomized prospective trial on this issue (NCT02292914).
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28
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de Cleva R, Araujo VA, Buchalla CCO, de Oliveira Costa F, Cardoso AF, Pajecki D, Santo MA. Cardiac Remodeling Patterns in Severe Obesity According to Arterial Hypertension Grade. Obes Surg 2017; 28:1047-1054. [DOI: 10.1007/s11695-017-2968-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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29
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CARDIA LILIAN, de Cleva R, araujo V, Santo MA, Buchalla CC, Pajecki D. Cardiac remodeling patterns in severe obesity according to arterial hypertension grade. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Fernandes-Cardoso A, Santos-Furtado M, Grindler J, Ferreira LA, Andrade JL, Santo MA. Epicardial fat thickness correlates with P-wave duration, left atrial size and decreased left ventricular systolic function in morbid obesity. Nutr Metab Cardiovasc Dis 2017; 27:731-738. [PMID: 28739186 DOI: 10.1016/j.numecd.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/20/2017] [Accepted: 05/22/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIM Epicardial fat (EF) is increased in obesity and has important interactions with atrial and ventricular myocardium. Most of the evidence in this scenario can be confused by the presence of comorbidities such as hypertension, diabetes and dyslipidemia, which are very common in this population. The influence of EF on atrial remodeling and cardiac function demands further investigation on morbidly obese without these comorbidities. METHODS AND RESULTS We prospectively recruited 20 metabolically healthy morbidly obese and 20 normo-weights controls. The maximum P-wave duration (PWD) was analyzed by 12-lead electrocardiogram. Left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and EF thickness (EFT) were evaluated by two-dimensional echocardiography. The mean of maximum PWD and LAD were significantly larger in the obese group as compared to the control group: 109.55 ± 11.52 ms × 89.38 ± 11.19 ms and 36.12 ± 3.46 mm × 31.45 ± 2.64 mm, (p < 0.0001). The mean LVEF was lower in the obese group: 63.15 ± 4.25% × 66.17 ± 3.37% (p < 0.017). The mean EFT was higher in the obese group: 7.72 ± 1.60 mm × 3.10 ± 0.85 mm (p < 0.0001). A positive correlation was found between EFT and PWD (r = 0.70; p = 0.001) and LAD (r = 0.667; p = 0.001). An inverse correlation was found between EFT and LVEF (r = -0.523; p = 0.001). In a multiple multivariate regression analysis the EFT remains correlated with LAD and LVEF. CONCLUSIONS In a select group of morbidly obese, the excess of EF had a significant impact on atrial remodeling and cardiac function.
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MESH Headings
- Adipose Tissue/diagnostic imaging
- Adipose Tissue/physiopathology
- Adiposity
- Adult
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/physiopathology
- Atrial Function, Left
- Atrial Remodeling
- Cross-Sectional Studies
- Echocardiography
- Electrocardiography
- Female
- Heart Atria/diagnostic imaging
- Heart Atria/physiopathology
- Humans
- Linear Models
- Male
- Middle Aged
- Multivariate Analysis
- Obesity, Metabolically Benign/complications
- Obesity, Metabolically Benign/diagnosis
- Obesity, Metabolically Benign/physiopathology
- Obesity, Morbid/complications
- Obesity, Morbid/diagnosis
- Obesity, Morbid/physiopathology
- Pericardium/diagnostic imaging
- Pericardium/physiopathology
- Predictive Value of Tests
- Prospective Studies
- Risk Factors
- Stroke Volume
- Systole
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- A Fernandes-Cardoso
- Electrocardiology Service, Medical Clinic Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil.
| | - M Santos-Furtado
- Echocardiography Laboratory, Radiology Institute (InRad), HCFMUSP, Brazil
| | - J Grindler
- Electrocardiology Service, Medical Clinic Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil
| | - L A Ferreira
- Institute of Mathematics and Statistics, Department of Statistics, IMEUSP, Brazil
| | - J L Andrade
- Echocardiography Laboratory, Radiology Institute (InRad), HCFMUSP, Brazil
| | - M A Santo
- Bariatric Surgery Unit, Gastroenterology Department, HCFMUSP, Brazil
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31
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Santo MA, Riccioppo D, Pajecki D, Kawamoto F, de Cleva R, Antonangelo L, Marçal L, Cecconello I. Weight Regain After Gastric Bypass: Influence of Gut Hormones. Obes Surg 2016; 26:919-25. [PMID: 26450709 DOI: 10.1007/s11695-015-1908-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Roux-en-Y gastric bypass (RYGB) is the gold standard bariatric operation. However, a major concern in late follow-up is the substantial weight regain. Understanding the role of gastrointestinal hormone secretion in this situation is relevant. METHODS The aim of the present study was to evaluate the influence of gastrointestinal hormones comparing postprandial secretion of ghrelin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and leptin between patients with weight regain and those with favorable weight control. Twenty-four patients with follow-up from 27 to 59 months were divided into two groups according to sustained weight loss: group A (14 patients) had sustained weight losses, and group B (10 patients) had significant weight regain. Basal serum levels of ghrelin, GIP, GLP-1, and leptin after fasting and 30, 60, 90, and 120 min after a standard meal were measured. RESULTS There was no difference in the ghrelin secretion. There was a difference in the GIP secretion, with a higher percentage increase in 30 min in group A (330% × 192.2%; p = 0.01). There were also differences in the GLP-1 secretion, with higher increases in absolute (p = 0.03) and percentage values after 30 min in group A (124% × 46.5%; p = 0.01). There was also a difference between baseline leptin values, with higher levels in group B (p = 0.02). CONCLUSIONS The secretion of gut hormones in patients with weight regain after RYGB is different from that in patients with satisfactory weight outcome. After meal stimulation, reduced levels of GIP and GLP-1 may indicate the influence of gut hormones in the process of weight regain.
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Affiliation(s)
- Marco Aurelio Santo
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil.
| | - Daniel Riccioppo
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Denis Pajecki
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Flavio Kawamoto
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Roberto de Cleva
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
| | - Leila Antonangelo
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil.,Central Laboratory of Hospital das Clínicas, São Paulo, Brazil
| | - Lia Marçal
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil.,Central Laboratory of Hospital das Clínicas, São Paulo, Brazil
| | - Ivan Cecconello
- Department of Digestive Surgery, University of São Paulo School of Medicine, Av. Arnolfo Azevedo 208, São Paulo, SP, 05673-010, Brazil
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Santo MA, Quintanilha SR, Mietti CA, Kawamoto FM, Marson AG, de Cleva R. ENDOSCOPIC CHANGES RELATED TO GASTROESOPHAGEAL REFLUX DISEASE: COMPARATIVE STUDY AMONG BARIATRIC SURGERY PATIENTS. Arq Bras Cir Dig 2016; 28 Suppl 1:36-8. [PMID: 26537271 PMCID: PMC4795304 DOI: 10.1590/s0102-6720201500s100011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/02/2015] [Indexed: 01/02/2023]
Abstract
Background : Obesity is correlated with several comorbidities, including gastroesophageal
reflux disease. Its main complications are detectable by endoscopy: erosive
esophagitis and Barrett's esophagus. Aim : To correlate erosive esophagitis and hiatal hernia with the degree of body mass
index (BMI). Method : Was performed a retrospective analysis of 717 preoperative endoscopic reports of
bariatric patients. Fifty-six (8%) presented hiatal hernia, being 44 small, nine
medium and five large. Esophagitis was classified by Los Angeles classification.
Results : There was no correlation between the presence and dimension of hiatal hernia
with BMI. One hundred thirty-four (18.7%) patients presented erosive esophagitis.
Among them, 104 (14.5%) had esophagitis grade A; 25 (3.5%) grade B; and five
(0.7%) grade C. When considering only the patients with erosive esophagitis, 77.6%
had esophagitis grade A, 18.7% grade B and 3.7% grade C. Were identified only two
patients with Barrett's esophagus (0,28%). Conclusion : There was a positive correlation between the degree of esophagitis with
increasing BMI.
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Affiliation(s)
- Marco Aurelio Santo
- Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | | | - Cesar Augusto Mietti
- Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | | | - Allan Garms Marson
- Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Roberto de Cleva
- Hospital das Clinicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
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Pajecki D, Santo MA, Joaquim HDG, Morita F, Riccioppo D, de Cleva R, Cecconello I. BARIATRIC SURGERY IN THE ELDERLY: RESULTS OF A MEAN FOLLOW-UP OF FIVE YEARS. Arq Bras Cir Dig 2016; 28 Suppl 1:15-8. [PMID: 26537266 PMCID: PMC4795299 DOI: 10.1590/s0102-6720201500s100006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/21/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Surgical treatment of obesity in the elderly, particularly over 65, remains controversial; it is explained by the increased surgical risk or the lack of data demonstrating its long-term benefit. Few studies have evaluated the clinical effects of bariatric surgery in this population. AIM To evaluate the results of surgical treatment of obesity in patients over 60 years, followed for an average period of five years. METHOD This was a retrospective study evaluating 46 patients, 60 years or older, who underwent surgical treatment of obesity, by conventional gastric bypass technique (laparotomy). The average age was 64 years (60-71), mean BMI of 49.6 kg/m2 (38-66), mean follow-up of 5.9 years; 91% of patients were hypertensive, 56% diabetics and 39% had dyslipidemia. RESULTS The incidence of complications (major and minor) in patients under 65 years was 26% and over 65 years 37% (p=0.002). There were no deaths in the group with less than 65 years and there were two deaths (12.5%) over 65 years. The average loss of overweight over 65 years or less was 72% vs 68% (p=0.56). There was total control of the diabetes mellitus in 77% and partial in 23%, with no difference between groups. There was improvement in arterial hypertension in 56% of patients, also no difference between groups. The average LDL levels did not differ between the pre and postoperative (106 mg/dl to 102 mg/dl), an increase of HDL (56 mg/dl to 68 mg/dL) and reduced triglyceride levels (136 mg/dl to 109 mg/dl). There was no statistical difference in the variation of the cholesterol fractions and triglycerides between the groups. Two patients in the group with less than 65 years died in late follow-up, of brain tumor and pneumonia, three and five years after bariatric surgery, respectively. CONCLUSIONS Surgical morbidity and mortality were higher in patients over 65 years, and this group had the same benefits observed in patients lower 65 years for weight loss and comorbidities control.
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Affiliation(s)
- Denis Pajecki
- Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | | | - Flavio Morita
- Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Daniel Riccioppo
- Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Roberto de Cleva
- Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil
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Bernhard AB, Scabim VM, Serafim MP, Gadducci AV, Santo MA, de Cleva R. Modified body adiposity index for body fat estimation in severe obesity. J Hum Nutr Diet 2016; 30:177-184. [PMID: 27524683 DOI: 10.1111/jhn.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The body adiposity index (BAI) comprises a simple method for estimating body fat (BF) that needs to be validated in patients with severe obesity. The present study aimed to determine BAI accuracy with respect to the determination BF in patients with severe obesity. METHODS A cross-sectional prospective study comparing two methods for BF estimation was conducted in 433 patients with severe obesity between August 2012 to December 2014. BF was estimated by bioelectrical impedance analysis (BIA) with specific equations developed for BF estimation in patients with severe obesity and BAI. The BF estimation in 240 patients with severe obesity (Group 1: G1) was used to evaluate BAI limitations and to develop a specific equation in this population. The new equation proposed was validated in another 158 patients with severe obesity (Group 2: G2). RESULTS There was a significant difference between BF determination by BIA and BAI (P = 0.039). The mean (SD) BF in G1 was 52.3% (6.1%) determined by BIA and 51.6% (8.1%) determined by BAI. Sex, waist-hip ratio (WHR) and obesity grade determined significant errors on BF estimation by BAI. A new equation (modified body adiposity index; MBAI) was developed by linear regression to minimise these errors [MBAI% = 23.6 + 0.5 × (BAI); add 2.2 if body mass index ≥ 50 kg m-2 and 2.4 if WHR ≥ 1.05]. The new equation reduced the difference [1.2% (5.9%), P < 0.001 to 0.4% (4.12%), P = 0.315] and improved the correlation (0.6-0.7) between methods. CONCLUSIONS BAI present significant limitations in severe obesity and MBAI was effective for BF estimation in this population.
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Affiliation(s)
- A B Bernhard
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - V M Scabim
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - M P Serafim
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - A V Gadducci
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - M A Santo
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - R de Cleva
- Department of Gastroenterology, Instituto Central-Hospital das Clinicas da Faculdade de Medicina da USP, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Abstract
Esophageal and gastric cancer (GC) are related to obesity and bariatric surgery. Risk factors, such as gastroesophageal reflux and Helicobacter pylori, must be investigated and treated in obese population. After surgery, GC reports are anecdotal and treatment is not standardized. This review aims to discuss GC related to obesity before and after bariatric surgery.
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Affiliation(s)
| | - Marco Aurelio Santo
- Department of Digestive Surgery, University of São Paulo School of Medicine, São Paulo-SP 05403-000, Brazil
| | - Roberto de Cleva
- Department of Digestive Surgery, University of São Paulo School of Medicine, São Paulo-SP 05403-000, Brazil
| | | | - Ivan Cecconello
- Department of Digestive Surgery, University of São Paulo School of Medicine, São Paulo-SP 05403-000, Brazil
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de Cleva R, Duarte LF, Crenitte MRF, de Oliveira CPM, Pajecki D, Santo MA. Use of noninvasive markers to predict advanced fibrosis/cirrhosis in severe obesity. Surg Obes Relat Dis 2016; 12:862-867. [DOI: 10.1016/j.soard.2015.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 12/28/2022]
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Pajecki D, Santo MA, Mancini MC. Letter to "Pharmacotherapy in conjunction with diet and exercise program for the treatment of weight recidivism or weight loss plateau post-bariatric surgery: a retrospective review". Obes Surg 2016; 26:1317-8. [PMID: 27048438 DOI: 10.1007/s11695-016-2146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Denis Pajecki
- Bariatric Surgery Unit - Hospital das Clinicas, University of São Paulo School of Medicine, Rua Emilio de Menezes 96 apto 30 Santa Cecilia, São Paulo, SP, Brazil, CEP: 01221-030.
| | - Marco Aurelio Santo
- Bariatric Surgery Unit - Hospital das Clinicas, University of São Paulo School of Medicine, Rua Emilio de Menezes 96 apto 30 Santa Cecilia, São Paulo, SP, Brazil, CEP: 01221-030
| | - Marcio Correa Mancini
- Obesity Clinic - Endocrinology Department - Hospital das Clinicas, University of São PAulo School ofMedicine, São Paulo, SP, Brazil
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Joaquim H, Aurelio Santo M, Scabim V, Serafim M, Santarém G, Gadducci A, Cleva R, Kawamoto F. Modified body adiposity index for body fat estimation in morbid obesity. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodrigues MRDS, Santo MA, Favero GM, Vieira EC, Artoni RF, Nogaroto V, Moura EGD, Lisboa P, Milleo FQ. Metabolic surgery and intestinal gene expression: Digestive tract and diabetes evolution considerations. World J Gastroenterol 2015; 21:6990-6998. [PMID: 26078577 PMCID: PMC4462741 DOI: 10.3748/wjg.v21.i22.6990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/14/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effects of bariatric surgery on metabolic parameters, incretin hormone secretion, and duodenal and ileal mucosal gene expression.
METHODS: Nine patients with type 2 diabetes mellitus (T2DM), chronic serum hyperglycemia for more than 2 years, and a body mass index (BMI) of 30-35 kg/m2 underwent metabolic surgery sleeve gastrectomy with transit bipartition between May 2011 and December 2011. Blood samples were collected pre and 3, 6 and 12 mo postsurgery. Duodenal and ileal mucosa samples were collected pre- and 3 mo postsurgery. Pre- and postoperative blood samples were collected in the fasting state before ingestion of a standard meal (520 kcal) and again 30, 60, 90, and 120 min after the meal to determine hemoglobin A1c (HbA1c) levels and the lipid profile, which consisted of triglyceride and total cholesterol levels. Intestinal gene expression of p53 and transforming growth factor (TGF)-β was analyzed using quantitative reverse-transcription PCR. Gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) were quantified using the enzyme-linked immunoassay method and analyzed pre- and postoperatively. Student’s t test or repeated measurements analysis of variance with Bonferroni corrections were performed as appropriate.
RESULTS: BMI values decreased by 15.7% within the initial 3 mo after surgery (31.29 ± 0.73 vs 26.398 ± 0.68, P < 0.05) and then stabilized at 22% at 6 mo postoperative, resulting in similar values 12 mo postoperatively (20-25 kg/m2). All of the patients experienced improved T2DM, with 7 patients (78%) achieving complete remission (HbA1c < 6.5%), and 2 patients (22%) achieving improved diabetes (HbA1c < 7.0% with or without the use of oral hypoglycemic agents). At 3 mo postoperatively, fasting plasma glucose had also decreased (59%) (269.55 ± 18.24 mg/dL vs 100.77 ± 3.13 mg/dL, P < 0.05) with no further significant changes at 6 or 12 mo postoperatively. In the first month postoperatively, there was a complete withdrawal of hypoglycemic medications in all patients, who were taking at least 2 hypoglycemic drugs preoperatively. GLP-1 levels significantly increased after surgery (149.96 ± 31.25 vs 220.23 ± 27.55) (P < 0.05), while GIP levels decreased but not significantly. p53 gene expression significantly increased in the duodenal mucosa (P < 0.05, 2.06 fold) whereas the tumor growth factor-β gene expression significantly increased (P < 0.05, 2.52 fold) in the ileal mucosa after surgery.
CONCLUSION: Metabolic surgery ameliorated diabetes in all of the patients, accompanied by increased anti-proliferative intestinal gene expression in non-excluded segments of the intestine.
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Sala P, Machado N, Belarmino G, Ishida R, Guarda I, Giannella‐Neto D, Santo MA, Moura E, Sakai P, Silva I, Ye J, Heymsfield S, Waitzberg D. Reduced Transcobalamin I Gene Expression Following Roux‐en‐Y Gastric Bypass Surgery Can Contribute to B12 Deficiency. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Priscila Sala
- Body CompositionPennington Biomedical Research CemterBaton RougeLAUnited States
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Natasha Machado
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Giliane Belarmino
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Robson Ishida
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Ismael Guarda
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Daniel Giannella‐Neto
- Escola de MedicinaUniversidade 9 de Julho São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Marco Aurelio Santo
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Eduardo Moura
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Paulo Sakai
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Ismael Silva
- Escola de MedicinaUniversidade 9 de Julho São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Jianping Ye
- Body CompositionPennington Biomedical Research CemterBaton RougeLAUnited States
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Steven Heymsfield
- Body CompositionPennington Biomedical Research CemterBaton RougeLAUnited States
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
| | - Dan Waitzberg
- Gastroenterologia Faculdade de Medicina daUniversidade de São Paulo São PauloSão PauloBrazil
- Laboratório de ProteômicaUNIFESP São PauloSão PauloBrazil
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Costa RCNDC, Yamaguchi N, Santo MA, Riccioppo D, Pinto-Junior PE. Outcomes on quality of life, weight loss, and comorbidities after Roux-en-Y gastric bypass. Arq Gastroenterol 2015; 51:165-70. [PMID: 25296074 DOI: 10.1590/s0004-28032014000300002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/07/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Bariatric surgery has become the most effective method for producing weight loss in obese patients. The evaluation of improvement of comorbidities and changes in the quality of life are important outcome factors; however, it is necessary to investigate whether they persist over the long term. METHODS A cross-sectional study was conducted on 143 obese patients from our institution from February 2007 to February 2008. These patients were divided into five independent groups, one being a control group, plus four other groups with 1, 2, 3, 4 or more years following surgical Roux-en-Y gastric bypass with a silicon ring banded. quality of life forms and anthropometric measurements were performed and its scores correlated with social factors, weight loss success, and status of obesity-related conditions. RESULTS For the group that was 1 year postoperative, a significant percentage of excess body weight loss (EBWL%) of 81.7% was observed. The groups with 2, 3, 4 or more years of post-surgical follow-up showed a EBWL decline, but without significant difference. The main comorbidity percentages in all patients who had the surgery was as follows: 69.7% for hypertension; 88.2% for diabetes mellitus; and 27.5% for arthropathy. There was a significant decrease in the rate for diabetes resolution (P = 0.035) observed by evolutionary assessment of the comorbidity resolution. The results obtained by BAROS were good, very good, or excellent in more than 96% of patients in all evaluations that were performed. The use of the Moorehead-Ardelt Questionnaire (M/A) demonstrated improvement in the quality of life. Moreover, the quality of life, when evaluated through SF-36, also showed improvement in all related areas after 1 year; however, after 4 years, improvement remained elevated only in the areas of general state of health and functional capacity. CONCLUSIONS The Roux-en-Y gastric bypass procedure was able to achieve EBWL of 81.7% after 1 year following surgery, remaining steady with little decline after this period. Important resolution of comorbidities, such as hypertension and diabetes, was also seen. Immediate surgical outcomes assessed by SF-36 and M/A in the area of quality of life were satisfactory, but the general state of health and functional capacity areas were sustained satisfactory at a later time only.
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Affiliation(s)
| | | | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
| | - Daniel Riccioppo
- Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clínicas da FMUSP, São Paulo, SP, Brasil
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Cleva RD, Assumpção MSD, Sasaya F, Chaves NZ, Santo MA, Fló C, Lunardi AC, Jacob Filho W. Correlation between intra-abdominal pressure and pulmonary volumes after superior and inferior abdominal surgery. Clinics (Sao Paulo) 2014; 69:483-6. [PMID: 25029580 PMCID: PMC4081878 DOI: 10.6061/clinics/2014(07)07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/04/2013] [Accepted: 01/29/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Patients undergoing abdominal surgery are at risk for pulmonary complications. The principal cause of postoperative pulmonary complications is a significant reduction in pulmonary volumes (FEV1 and FVC) to approximately 65-70% of the predicted value. Another frequent occurrence after abdominal surgery is increased intra-abdominal pressure. The aim of this study was to correlate changes in pulmonary volumes with the values of intra-abdominal pressure after abdominal surgery, according to the surgical incision in the abdomen (superior or inferior). METHODS We prospectively evaluated 60 patients who underwent elective open abdominal surgery with a surgical time greater than 240 minutes. Patients were evaluated before surgery and on the 3rd postoperative day. Spirometry was assessed by maximal respiratory maneuvers and flow-volume curves. Intra-abdominal pressure was measured in the postoperative period using the bladder technique. RESULTS The mean age of the patients was 56 ± 13 years, and 41.6% 25 were female; 50 patients (83.3%) had malignant disease. The patients were divided into two groups according to the surgical incision (superior or inferior). The lung volumes in the preoperative period showed no abnormalities. After surgery, there was a significant reduction in both FEV1 (1.6 ± 0.6 L) and FVC (2.0 ± 0.7 L) with maintenance of FEV1/FVC of 0.8 ± 0.2 in both groups. The maximum intra-abdominal pressure values were similar (p=0.59) for the two groups. There was no association between pulmonary volumes and intra-abdominal pressure measured in any of the groups analyzed. CONCLUSIONS Our results show that superior and inferior abdominal surgery determines hypoventilation, unrelated to increased intra-abdominal pressure. Patients at high risk of pulmonary complications should receive respiratory care even if undergoing inferior abdominal surgery.
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Affiliation(s)
- Roberto de Cleva
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marianna Siqueira de Assumpção
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Flavia Sasaya
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Natalia Zuniaga Chaves
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Fló
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Adriana C Lunardi
- Gastroenterology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob Filho
- Geriatric Medicine, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Santo MA, Riccioppo D, Pajecki D, Cleva RD, Kawamoto F, Cecconello I. Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity. Clinics (Sao Paulo) 2014; 69:828-34. [PMID: 25627995 PMCID: PMC4286674 DOI: 10.6061/clinics/2014(12)07] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/16/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients. METHODS Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m2 (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery. RESULTS The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days. CONCLUSION In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.
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Affiliation(s)
- Marco Aurelio Santo
- Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Daniel Riccioppo
- Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Denis Pajecki
- Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Roberto de Cleva
- Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Flavio Kawamoto
- Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
| | - Ivan Cecconello
- Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil
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Santo MA, Domene CE, Riccioppo D, Barreira L, Takeda FR, Pinotti HW. Common bile duct stones: analysis of the videolaparoscopic surgical treatment. Arq Gastroenterol 2012; 49:41-51. [PMID: 22481685 DOI: 10.1590/s0004-28032012000100008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 08/31/2011] [Indexed: 01/26/2023]
Abstract
CONTEXT About 9% of the Brazilian population has gallstones and the incidence increases significantly with aging. The choledocholithiasis is found around 15% of these patients, and a third to half of these cases presented as asymptomatic. Once the lithiasis in the common bile duct is characterized through intraoperative cholangiography, the laparoscopic surgical exploration can be done through the transcystic way or directly through choledochotomy. OBJECTIVE To evaluate the results and outcomes of the laparoscopic treatment of common bile duct lithiasis. METHODS Seventy consecutive patients were evaluated. They prospectively underwent the treatment of the lithiasis in the common bile duct and the exploration ways were compared according to the following parameters: criteria on their indication, success in the clearance, surgical complications. It was verified that about ½ of the choledocholithiasis carriers did not show any expression of predictive factors (clinical antecedents of jaundice and/or acute pancreatitis, compatible sonographic data and the pertaining lab tests). The laparoscopic exploration through the transcystic way is favored when there are no criteria for the practice of primary choledochotomy, which are: lithiasis in the proximal bile duct, large (over 8 mm) or numerous calculi (multiple calculosis). RESULTS The transcystic way was employed in about 50% of the casuistic and the choledochotomy in about 30%. A high success rate (around 80%) was achieved in the clearance of the common bile duct stones through laparoscopic exploration. The transcystic way, performed without fluoroscopy or choledochoscopy, attained a low rate of success (around 45%), being 10% of those by transpapilar pushing of calculi less than 3 mm. The exploration through choledochotomy, either primary or secondary, if the latter was performed after the transcystic route failure, showed high success rate (around 95%). When the indication to choledochotomy was primary, the necessity for choledochoscopy through choledochotomy to help in the removal of the calculi was 55%. However, when choledochotomy was performed secondarily, in situations where the common bile duct diameter was larger than 6 mm, the use of choledochoscopy with the same purpose involved about 20% of the cases. There was no mortality in this series. CONCLUSION The laparoscopic exploration of the common bile duct was related to a low rate of morbidity. Therefore, the use of laparoscopy for the treatment of the lithiasis in the common bile duct depends on the criteria for the choice of the best access, making it a safe procedure with very good results.
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Affiliation(s)
- Marco Aurelio Santo
- Departmento de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo, Brasil
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Seguro FCBC, Santo MA, Szachnowicz S, Maluf Filho F, Kishi HS, Falcão AM, Nasi A, Sallum RAA, Cecconello I. Use of multiple channel pH monitoring for evaluation of ultra-distal reflux in patients after fundoplication for treatment of Barrett's esophagus. Dis Esophagus 2011; 24:381-7. [PMID: 21309910 DOI: 10.1111/j.1442-2050.2010.01160.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dysplasia and esophageal adenocarcinoma may arise in patients with Barrett's esophagus after fundoplication esophageal pH monitoring showing no acid in esophagus. This suggests the need to develop methodology to evaluate the occurrence of ultra-distal reflux (1cm above the LES). The objective of the study was to compare acid exposition in three different levels: 5cm above the upper border of the LES, 1cm above the LES and in the intrasphincteric region. Eleven patients with Barrett's esophagus after Nissen fundoplication with no clinical, endoscopic and radiologic evidence of reflux were selected. Four-channel pH monitoring took place: channel A, 5cm above the upper border of the LES; channel B, 1cm above the LES; channel C, intrasphincteric; channel D, intragastric. The results of channels A, B and C were compared. There was significant increase in number of reflux episodes and a higher fraction of time with pH <4.0 in channel B compared to channel A. There was significant decrease in fraction of time with pH <4.0 in channel B compared to channel C. Two cases of esophageal adenocarcinoma were diagnosed in the studied patients. The region 1cm above the upper border of the LES is more exposed to acid than the region 5cm above the upper border of the LES, although this exposure occurred in reduced levels. The region 1cm above the upper border of the LES is less exposed to acid than the intrasphincteric region.
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Affiliation(s)
- F C B C Seguro
- Digestive Surgery Divison, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
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Rubio IGS, Galrão AL, Santo MA, Zanini AC, Medeiros-Neto G. Levothyroxine Absorption in Morbidly Obese Patients Before and After Roux-En-Y Gastric Bypass (RYGB) Surgery. Obes Surg 2011; 22:253-8. [DOI: 10.1007/s11695-011-0452-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Santo MA, Takeda FR, Sallum RAA. Staplers in digestive surgery: technological advancement in surgeons' own hands. Arq Gastroenterol 2011; 48:1-2. [PMID: 21537533 DOI: 10.1590/s0004-28032011000100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Santo MA, Domene CE, Nasi A, Onari P, Volpe P, Pinotti HW. Videolaparoscopic cholecystectomy. Analysis of the clinical and functional aspects of mechanical lifting of the abdominal wall. Arq Gastroenterol 2001; 38:32-9. [PMID: 11582962 DOI: 10.1590/s0004-28032001000100007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mechanical lifting of the abdominal wall, a method based on traction and consequent elevation of the abdominal wall, is an alternative procedure to create enough intra-abdominal space necessary for videolaparoscopic surgery, dispensing the need for intraperitoneal gas insufflation. OBJECTIVE This study aims to evaluate the technical feasibility of this procedure to carry out a videolaparoscopic cholecystectomy, while analyzing the clinical and functional aspects of this technique. PATIENTS AND METHODS In the Digestive Tract Surgery Discipline of the Medical School at the University of São Paulo, São Paulo, SP, Brazil, was created the equipment to perform videolaparoscopic surgery using this method. The equipment has two sections: an external part which consisted of a frame attached to the operating table, inside which there is a sliding steel cable, moved by a ratched which is located at the lower end of one of the frame rods; the internal rod, the support, has an "L" shape, and its horizontal branch is made up of three turning rods and which is connected to the steel cable after insertion into the abdominal cavity. Ten patients underwent videolaparoscopic cholecystectomy using this equipment. The time taken to install the equipment, the operating area characteristics, the interference from the lifting equipment on surgical movements and on the intra-operative cholangiography, the measurements made of the force used during traction and extension of the abdominal wall elevation, and the medication required for postoperative analgesia were all evaluated. RESULTS There were no intra-operative complications, and in none of the cases was it found necessary to convert to open surgery. We considered the insertion a safe and uncomplicated procedure, and the traction system efficient. Apart from the elevation of the abdominal wall, the distribution of the viscera inside the abdominal cavity is fundamental for the operating area. Depending on the position of the epigastric trocar, the lifting equipment can interfere with the surgical instruments mobility. It may be necessary to reposition the support to perform the intra-operative cholangiography. The tensional force applied to the peritoneal surface by the lifting rods is small, and no additional postoperative pain was observed using this procedure. CONCLUSION These results show that using the equipment described in this study, mechanical lifting of the abdominal wall is a feasible alternative for undertaking videolaparoscopic cholecystectomy.
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Affiliation(s)
- M A Santo
- Videolaparoscopic Surgery Unit of the Digestive Tract Surgery Discipline at São Paulo University Medical School, São Paulo, SP, Brazil.
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