Tranexamic acid effects in postoperative bleeding outcomes in laparoscopic sleeve gastrectomy: a controlled study

Purpose: To demonstrate through a controlled study whether the use of tranexamic acid in bariatric surgeries is effective for bleeding control. Methods: Prospective, comparative, and double-blind study performed with patients from 18 to 65 years old submitted to bariatric surgery. The selected patients received venous tranexamic acid (TXA) during the induction of anesthesia or not (CG). The anesthesia and thromboprophylaxis protocols were similar among the groups. For statistical analysis, the χ2 and analysis of variance tests were performed at a significance level of p < 0.05, using the statistical program SPSS 21.0®. Results: Sixty-one patients were included in the study, 31 in the control group and 30 in the TXA group (GTXA). In the intraoperative period, the bleeding volume was greater in the CG than in the GTXA. In the postoperative period, the tranexamic acid group had a higher value hematocrit, absence of surgical reoperations due to bleeding complications, and shorter hospitalization time than the control group. Conclusions: The use of tranexamic acid was effective in reducing bleeding rates and of hospital stay length, in addition to demonstrating the clinical safety of its use, for not having been associated with any thromboembolic events.

Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment

ABSTRACT Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of obese patients, adherence to clinical follow-up and the influence of factors such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with patients undergoing vertical gastrectomy, operated at Hospital São Domingos, between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%) and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was 56.18%. Among adherent patients (n = 117; 43.82%), most patients were female (n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72 kg/m2. Both BMI and excess weight (EW) showed a statistically significant difference between pre- and postoperative period. Percentage of excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients. Older patients had a statistically significant lower % EWL compared to the other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with significant weight loss.

Comparative analysis between patients undergoing Gastric Bypass and Sleeve Gastroplasty in a private hospital in Sao Luis-MA

Abstract Purpose: To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. Methods: The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. Results: Most patients were female (Bypass - 56% and Sleeve - 67.4%) and aged between 30 and 39 years old (Bypass - 32% and Sleeve - 55.8%). Information (Bypass - 92% and Sleeve - 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass - 92% and Sleeve - 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. Conclusions: Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.

FIXING JEJUNAL MANEUVER TO PREVENT PETERSEN HERNIA IN GASTRIC BYPASS / MANOBRA DE FIXAÇÃO JEJUNAL PARA PREVENÇÃO DE HÉRNIA DE PETERSEN EM BYPASS GÁSTRICO

Background: Among Roux-en-Y gastric bypass complications is the occurrence of intestinal obstruction by the appearance of internal hernias, which may occur in Petersen space or the opening in mesenteric enteroenteroanastomosis.Aim: To evaluate the efficiency and safety in performing a fixing jejunal maneuver in the transverse mesocolon to prevent internal hernia formation in Petersen space.Method: Two surgical points between the jejunum and the transverse mesocolon, being 5 cm and 10 cm from duodenojejunal angle are made. In all patients was left Petersen space open and closing the opening of the mesenteric enteroenteroanastomosis.Results: Among 52 operated patients, 35 were women (67.3%). The age ranged 18-63 years, mean 39.2 years. BMI ranged from 35 to 56 kg/m2 (mean 40.5 kg/m2). Mean follow-up was 15.1 months (12-18 months). The operative time ranged from 68-138 min. There were no intraoperative complications, and there were no major postoperative complications and no reoperations. The hospital stay ranged from 2-3 days. During the follow-up, no one patient developed suspect clinical presentation of internal hernia. Follow-up in nine patients (17.3%) showed asymptomatic cholelithiasis and underwent elective laparoscopic cholecystectomy. During these procedures were verified the Petersen space and jejunal fixation. In all nine, there was no herniation of the jejunum to the right side in Petersen space.Conclusion: The fixation of the first part of the jejunum to left side of the transverse mesocolon is safe and effective to prevent internal Petersen hernia in RYGB postoperatively in the short and medium term. It may be interesting alternative to closing the Petersen space.

Racional: Entre outras complicações do bypass gástrico em Y-de-Roux está a ocorrência de obstrução intestinal pelo aparecimento de hérnias internas, que podem ocorrer no espaço de Petersen ou na abertura mesentérica da enteroenteroanastomose.Objetivo: Avaliar a eficiência e a segurança da realização de uma manobra de fixação do jejuno no mesocólon transverso para evitar formação de hérnia interna no espaço de Petersen.Método: Realizam-se dois pontos de fixação entre o jejuno e o mesocólon transverso, sendo um a 5 cm e outro a 10 cm do ângulo duodenojejunal. Em todos os pacientes foi deixado o espaço de Petersen aberto e realizado o fechamento da abertura mesentérica da enteroenteroanastomose.Resultados: Entre 52 pacientes estudados, 35 eram do sexo feminino (67,3%). A idade variou de 18 a 63 anos, com média de 39,2 anos. O IMC variou de 35 a 56 kg/m2 (média de 40,5 kg/m2). O seguimento médio foi de 15,1 meses (de 12 a 18 meses). O tempo operatório variou de 68-138 min. Não ocorreram intercorrências intra-operatórias, assim como não houve complicações pós-operatórias maiores e nem reoperações. O período de internação hospitalar variou de 2-3 dias. Durante o seguimento, nenhum paciente desenvolveu quadro suspeito de hérnia interna. Neste período, nove pacientes (17,3%) apresentaram quadro de colecistolitíase (por microcálculos) assintomática, e foram submetidos à colecistectomia videolaparoscópica eletiva. Durante estes procedimentos foram verificados o espaço de Petersen e a fixação jejunal. Em todos os nove, não havia herniação do jejuno para o lado direito do espaço de Petersen.Conclusão: A fixação da primeira parte do jejuno ao lado esquerdo do mesocólon transverso é segura e eficiente para evitar hérnia interna de Petersen em pós-operatório de BGYR no curto e médio prazo. Pode ser interessante alternativa ao fechamento do espaço de Petersen.