Cirugía bariátrica: resultados clínicos en términos de pérdida de peso y resolución de comorbilidades / Bariatric surgery: Clinical outcomes in terms of weight loss and resolution of comorbidities

Introducción. La cirugía bariátrica es una estrategia válida de tratamiento en obesidad severa. El objetivo de este estudio fue evaluar la reducción de peso y la resolución de comorbilidades comparando dos técnicas quirúrgicas, baipás gástrico en Y de Roux y manga gástrica. Métodos. Estudio descriptivo de tipo analítico que incluyó pacientes con obesidad grados II y III. Se analizaron variables demográficas y perioperatorias, y las comorbilidades asociadas a la obesidad. La reducción del peso se evaluó con el porcentaje de pérdida del exceso de peso. Se realizó un análisis descriptivo univariado, usando medianas, rangos intercuartílicos, frecuencias y proporciones. Se usaron las pruebas de U de Mann-Whitney y Chi cuadrado para el análisis de grupos. Un valor de p<0,05 fue considerado estadísticamente significativo. Resultados. Fueron incluidos 201 pacientes. La mediana del porcentaje de pérdida del exceso de peso a 18 meses fue de 77,4 % para el grupo de baipás gástrico en Y de Roux vs 69,5 % para el grupo de manga gástrica (p=0,14). La mayoría de los pacientes presentaron resolución o mejoría de la hipertensión arterial (76 %), diabetes mellitus (80 %), dislipidemia (73 %), apnea del sueño (79 %) y artropatías (94 %), sin diferencia significativa según la técnica quirúrgica empleada. La tasa de complicaciones mayores fue del 1,9 %. No se presentó mortalidad. La mediana de seguimiento fue 28 meses. Conclusión. El baipás gástrico en Y de Roux y la manga gástrica son procedimientos muy seguros y efectivos para la reducción del exceso de peso y la resolución de las comorbilidades asociadas a la obesidad

Introduction. Bariatric surgery is a valid strategy of treatment for severe obesity. The aim of this study is to evaluate weight loss and resolution of comorbidities comparing two procedures, Roux-en-Y gastric bypass and sleeve gastrectomy. Methods. Descriptive study of analytical type that included patients with obesity grades II and III. Demographic and perioperative variables were analyzed. The weight reduction was evaluated among others with the percentage of excess of body weight loss. Comorbidities associated with obesity were also analyzed. A univariate descriptive analysis was performed, using medians, interquartile ranges, frequencies, and proportions. The Mann-Whitney U and Chi squared tests were used for analysis of groups. A value of p <0.05 was considered statistically significant. Median follow-up was 28 months. Results. A total of 201 patients were included in the analysis. The median percentage of excess of body weight loss at 18 months was 77.4% for Roux-en-Y gastric bypass group vs 69.5% for sleeve gastrectomy group (p=0.14). The majority of patients presented resolution or improvement of hypertension (76%), diabetes mellitus (80%), dyslipidemia (73%), sleep apnea (79%), and arthropathy (94%), without significant differences according to the surgical technique used. Major complication rate was 1.9%. There was not mortality. The median follow-up was 28 months. Conclusion. Roux-en-Y gastric bypass and sleeve gastrectomy are both very safe and effective procedures for excess weight reduction and resolution of comorbidities associated with obesity

Factores de riesgo asociados a la pérdida insuficiente o ganancia significativa de peso en pacientes sometidos a cirugía bariátrica / Risk factors associated with insufficient weight loss or significant weight gain in patients undergone bariatric surgery

Introducción. La cirugía bariátrica es efectiva para inducir una rápida pérdida del exceso de peso, pero existen dudas sobre la duración de este efecto a largo plazo. Este estudio buscaba identificar la proporción de pacientes operados que presentaron una pérdida insuficiente o una ganancia significativa de peso y los posibles factores relacionados. Métodos. Estudio de cohorte retrospectivo en pacientes adultos sometidos a cirugía bariátrica. Se describieron variables demográficas y clínicas. Se realizó un análisis multivariado para identificar factores relacionados con un peso fuera de metas posterior a la cirugía. Resultados. Se incluyeron 187 pacientes, 117 con baipás gástrico y 70 con manga gástrica. La mediana de índice de masa corporal preoperatorio fue 41,3 kg/m2 y postoperatorio de 28,8 kg/m2. El 94,7 % de los pacientes en ambos grupos logró una adecuada pérdida del exceso de peso. La ganancia de peso mayor del 20 % se presentó en el 43,5 % de los pacientes, siendo mayor en el grupo de manga gástrica (p<0,004). Los factores independientes para ganancia de peso fueron el sexo masculino (OR 5,5), cirugía tipo manga gástrica (OR 3,4), síndrome de apnea del sueño (OR 2,9) y enfermedad mental medicada (OR 2,8). Conclusión. La cirugía bariátrica produce una pérdida del exceso de peso suficiente en casi la totalidad de los pacientes, pero un buen número recuperan peso luego de 3 años. Los principales factores asociados a ganancia de peso son el sexo masculino y la cirugía tipo manga gástrica

Introduction. Bariatric surgery is highly effective in inducing rapid excess body weight loss but there are doubts about its effect on long-term. This study seeks to identify the number of patients that underwent bariatric surgery who present insufficient weight loss or significant weight gain and the possible related factors. Methods. Retrospective cohort study of adult patients who underwent bariatric surgery. Demographic and clinical variables are described. A multivariate analysis was performed to identify factors related to patient weight outside the set goals postoperatively. Results. 187 patients were included (117 gastric bypass, 70 gastric sleeve). The median preoperative body mass index was 41m/kg2 and 28.8m/kg2 postoperatively. 94.7% of the patients in both groups achieved adequate excess body weight loss. Weight gain (>20%) occurred in 43.5% of the patients, with the probability being higher in the gastric sleeve group (p<0.004). Independent factors for weight gain were male gender (OR 5.5), gastric sleeve surgery (OR 3.4), sleep apnea syndrome (OR 2.9), and mental illness under treatment (OR 2.8). Conclusions. Bariatric surgery produces sufficient loss of excess weight in almost all patients, but a good number of them regain weight after 3 years. The main factors associated with weight gain are male gender and gastric sleeve surgery

Baipás gástrico versus manga gástrica para el controlde diabetes tipo 2 en pacientes obesos / Gastric bypass versus gastric sleeve for the management of type 2 diabetes in obese patients

Introducción. La diabetes mellitus tipo 2 y la obesidad son enfermedades con alta prevalencia, gran morbi-mortalidad y elevados costos en salud. La cirugía bariátrica ha demostrado efectividad para inducir pérdida de peso y un control adecuado de la glicemia. Métodos. Estudio observacional analítico retrospectivo, realizado entre 2014 y 2019 en una institución de alta complejidad. Se incluyeron pacientes prediabéticos y diabéticos sometidos a cirugía bariátrica tipo baipás gástrico en Y-de-Roux o manga gástrica. Se analizaron la mejoría o resolución de la diabetes y la pérdida del exceso de peso a los 6, 12, 24 y 36 meses luego de la cirugía. Resultados. Se incluyeron 103 pacientes en el estudio, 45 pacientes diabéticos y 58 pacientes prediabéticos. La única variable perioperatoria con diferencia estadísticamente significativa fue el tiempo quirúrgico mayor en el baipás (70 vs. 47,5 minutos; p<0,001). La pérdida de exceso de peso fue mayor en el baipás. Los pacientes diabéticos sometidos a baipás tuvieron un mayor porcentaje de resolución o control comparados con los sometidos a manga gástrica. En los pacientes prediabéticos hubo resolución en ambos grupos luego de 24 meses de seguimiento. Conclusión. El baipás gástrico y la manga gástrica presentan excelentes resultados en cuanto a pérdida de peso y control metabólico en pacientes con diabetes mellitus tipo 2 y prediabetes, pero en nuestros pacientes se lograron resultados superiores en ambos aspectos con el baipás gástrico

Introduction. Type 2 diabetes mellitus and obesity are diseases with high prevalence, high morbidity and mortality and high health costs. Bariatric surgery has proven effective in inducing weight loss and adequate glycemic control. Methods. Retrospective analytical observational study conducted between 2014 and 2019 in a high-complex institution. Prediabetic and diabetic patients undergoing Roux-en-Y gastric bypass or gastric sleeve were included; analyzing the improvement or resolution of diabetes and the loss of excess weight at 6, 12, 24 and 36 months after surgery. Results. One-hundred and three patients were included in the study, 45 diabetic patients and 58 pre-diabetic patients. The only perioperative variable with a statistically significant difference was the longer surgical time in the bypass (70 vs. 47.5 min; p<0.001). Loss of excess weight was always greater in bypass. Diabetic patients who underwent bypass had a higher percentage of resolution or control compared to those who underwent the sleeve procedure. In pre-diabetic patients, there was 100% resolution in both groups after 24 months of follow-up. Conclusion. Gastric bypass and gastric sleeve present excellent results in terms of weight loss and metabolic control in patients with type 2 diabetes mellitus and pre-diabetes, but superior results in both aspects were achieved with the first technique in our patients

Endoscopic sleeve gastroplasty: a narrative review on historical evolution, physiology, outcomes, and future standpoints / 中华医学杂志(英文版)

Since its first description in 2013, robust evidence supporting the efficacy and safety of the endoscopic sleeve gastroplasty (ESG) has been on the rise. A large case series and meta-analysis report supported results up to 24 months, while some other studies already described 5-year data. If associated with pharmacotherapy, the ESG may help one to achieve weight loss similar to that of surgical sleeve gastrectomy. Though the results of the ongoing randomized trials on ESG are awaited, currently available data support the clinical use of the ESG, especially for patients who are refusing or unfit for bariatric surgery.

Comparación del tipo de cirugía bariátrica sobre la reducción de peso corporal y su relación con la ghrelina / Comparison between type of bariatric surgery on reduction of body weight and its ghrelin relationship

Resumen Objetivo: La cirugía bariátrica es un procedimiento para disminuir de peso a largo plazo en pacientes con obesidad. El objetivo de este estudio fue evaluar los niveles de ghrelina y la reducción del peso de acuerdo al tipo de cirugía bariátrica, comparando el bypass de una sola anastomosis y la gastrectomía formadora de manga. Materiales y Métodos: Estudio de cohorte que incluyó a 50 pacientes con obesidad, 22 mini-bypass y 28 mangas gástricas. Se evaluó el peso corporal y las concentraciones de ghrelina en la etapa prequirúrgica, en el día 7 y en los meses 1, 3 y 6 después de la cirugía. Resultados: Del total de pacientes, el 86% presentaron > 50% pérdida del exceso de peso (PEPP) a los 6 meses. La concentración de ghrelina disminuyó desde la primera semana en el grupo total de participantes. A los 6 meses, se observó mayor reducción de ghrelina en los pacientes con la manga gástrica (4.636 ± 2.535 vs 1.340 ± 1.001 pg/mL, p < 0,0001). El PEPP en pacientes con mini-bypass fue superior, en comparación con manga gástrica. Conclusiones: La comparación entre las técnicas indicó que, a los 6 meses de evolución posquirúrgica, los pacientes con mini-bypass presentaron mayor reducción de peso corporal y del nivel de ghrelina, en comparación con el grupo de manga gástrica. La concentración de ghrelina es una variable que participa en el control de peso; sin embargo, el tipo de abordaje quirúrgico probablemente tiene mayor relación con la pérdida de peso en estos pacientes.

Introduction: Bariatric surgery is a procedure to reduce weight in the long term in patients with obesity. The objective of this study was to evaluate ghrelin levels and weight reduction according to the type of bariatric surgery, comparing the single anastomosis bypass and the sleeve-forming gastrectomy. Materials and Method: Cohort study that included 50 patients with obesity, 22 Mini-Bypass and 28 gastric sleeve. Body weight and ghrelin concentrations were evaluated in the presurgical stage, on day 7 and in months 1, 3 and 6 after surgery. Results: Of the total of patients, 86% had > 50% excess weight loss (PEPP) at 6 months. The concentration of ghrelin decreased within the first week of the intervention. At 6 months, greater reduction of ghrelin was observed in patients with gastric sleeve (4636 ± 2535 vs 1340 ± 1001 pg/mL, p < 0.0001). The PEPP in patients with Mini-Bypass was superior, compared to gastric sleeve. Conclusion: The comparison between the techniques indicated that, after 6 months of post-surgical evolution, patients with Mini-Bypass had a greater reduction in body weight and ghrelin levels, compared to the gastric sleeve group. Ghrelin concentration is a variable that participates in weight control; however, the type of surgical approach is probably more related to weight loss in these patients.

Aspectos da hipertensão arterial sistêmica antes e após a cirurgia bariátrica do tipo Fobi capella com desvio de y de Roux / Aspects of systemic arterial hypertension before and after fobi capella with deviation Roux-en-y bariatric surgery

A obesidade é uma doença crônica multifatorial que desencadeia diversas comorbidades, sendo a hipertensão arterial uma das principais complicações, tornando-se um risco para o desenvolvimento das doenças cardiovasculares e mortalidade precoce. Assim, este estudo objetivou abordar os aspectos da hipertensão relacionada à obesidade antes e após a realização de cirurgia bariátrica. Tratou-se de um estudo descritivo, envolvendo indivíduos de ambos os gêneros, com idade superior a 18 anos submetidos à cirurgia bariátrica pelo método Fobi Capella com desvio de Y de Roux na cidade de Toledo-PR. Para tanto, 30 participantes responderam um questionário semiestruturado investigando dados sobre a pressão arterial. Os resultados demonstraram que no pré-operatório 66,66% dos avaliados apresentavam hipertensão, sendo os gêneros igualmente afetados, 46,66% referiram três ou mais sintomas da comorbidade e escore de saúde mental (40,8 ±16,7) com repercussão relevante. No pós-operatório os parâmetros de normalidade da pressão arterial foram evidenciados em todos os participantes, 57,14% deixaram de necessitar de medicação de controle e houve uma melhora exponencial do escore de saúde mental (81,9 ±21,7). Concluindo que a cirurgia bariátrica compõe um tratamento altamente eficaz para perda ponderal de peso corroborando para normalização da pressão arterial, redução dos sintomas da hipertensão, da necessidade de tratamento medicamentoso para essa finalidade e melhora da saúde geral do indivíduo.

Obesity is a chronic multifactorial disease that triggers several comorbidities, with arterial hypertension being one of the main complications, becoming a risk for the development of cardiovascular diseases and early mortality. Thus, this study aimed at addressing aspects of hypertension related to obesity before and after bariatric surgery. This is a descriptive study, involving individuals of both genders, aged over 18 years submitted to bariatric surgery by the Fobi Capella method with deviation of Roux-en-Y in the city of Toledo, in the state of Paraná, Brazil. For that purpose, 30 participants answered a semi-structured questionnaire investigating blood pressure data. The results showed that in the pre-surgery period, 66.66% of the patients had arterial hypertension, and the genres were equally affected; 46.66% reported three or more symptoms of comorbidity and mental health score (40.8 ± 16.7) with relevant repercussions. In the post-surgery period, normal blood pressure parameters were evident in all participants, 57.14% no longer required control medication and there was an exponential improvement in the mental health score (81.9 ± 21.7), thus concluding that bariatric surgery is a highly effective treatment for weight loss, corroborating blood pressure normalization, reduction of symptoms of hypertension, the need for drug treatment for this purpose and improvement of the individual's general health.

Knowledge and attitude of candidates to gastroplasty about perioperative: randomized clinical trial / Conocimiento y actitud de candidatos a la gastroplastia sobre perioperatorio: ensayo clínico aleatorizado / Conhecimento e atitude de candidatos à gastroplastia sobre perioperatório: ensaio clínico randomizado

ABSTRACT Objectives: to evaluate the effectiveness of educational intervention in the knowledge and attitude of candidates for gastroplasty. Methods: randomized controlled clinical trial with 56 preoperative patients (intervention=28; control=28). The control group received routine care from the health institution and the intervention group participated in a book-mediated educational intervention. Forms were used for clinical-epidemiological characterization and evaluation of knowledge/attitude about bariatric surgery, which were reapplied seven weeks after intervention. RBR-297fzx. Results: in the pre-test there was no significant difference between the groups (p=0.254). In the post-test, the group that received verbal guidance had a mean score of 19.5 (± 6.17) and the group reading the booklet averaged 31.1 (± 2.96), p=0.000. The attitude is adequate, especially for care such as vitamin supplement intake, water intake and physical activity practice. Conclusions: the educational intervention mediated by booklet was effective in improving knowledge and attitude when compared to verbal guidance. Thus, it can be replicated during the preoperative preparation.

RESUMEN Objetivos: evaluar la efectividad de la intervención educativa en el conocimiento y la actitud de los candidatos a la gastroplastia. Métodos: ensayo clínico controlado aleatorizado con 56 pacientes del preoperatorio (intervención=28; Control=28). El grupo control recibió la atención de rutina de la institución de salud y el grupo intervención participó de intervención educativa mediada por un folleto. Se utilizaron formularios para la caracterización clínico-epidemiológica y evaluación del conocimiento/actitud sobre cirugía bariátrica, que se volvieron a aplicar siete semanas después de la intervención. RBR-297fzx. Resultados: en la pre-prueba, no hubo diferencias significativas entre los grupos (p=0,254). En la prueba posterior, el grupo que recibió orientación verbal tuvo un promedio de aciertos de 19,5 (± 6,17) y el grupo que leyó el folleto tuvo un promedio de aciertos de 31,1 (± 2,96), p=0,000. La actitud es adecuada, especialmente para los cuidados como tomar el suplemento vitamínico, tomar agua y practicar actividad física. Conclusiones: la intervención educativa mediada por un folleto demostró ser efectiva para mejorar el conocimiento y mantener una actitud positiva hacia la cirugía bariátrica, en comparación con la orientación verbal. Por lo tanto, se puede replicar durante la preparación preoperatoria.

RESUMO Objetivos: avaliar efetividade de intervenção educativa no conhecimento e atitude de candidatos à gastroplastia. Métodos: ensaio clínico controlado randomizado com 56 pacientes do pré-operatório (intervenção=28 e controle=28). O grupo controle recebeu cuidados de rotina da instituição de saúde e o grupo intervenção participou de intervenção educativa mediada por cartilha. Foram utilizados formulários para caracterização clínica-epidemiológica e avaliação do conhecimento/atitude sobre cirurgia bariátrica, os quais foram reaplicados sete semanas após intervenção. RBR-297fzx. Resultados: no pré-teste, não houve diferença significativa entre os grupos (p=0,254). No pós-teste, o grupo que recebeu orientação verbal teve média de acertos de 19,5 (± 6,17) e o grupo que leu a cartilha acertou, em média, 31,1 (± 2,96) p=0,000. A atitude é adequada, principalmente, para cuidados como tomada do suplemento vitamínico, ingesta hídrica e prática de atividade física. Conclusões: a intervenção educativa mediada por cartilha mostrou-se eficaz na melhoria do conhecimento e manutenção de atitude positiva em relação à cirurgia bariátrica, quando comparada à orientação verbal. Assim, pode ser replicada durante o preparo pré-operatório.

Opportunities and challenges of endoscopic sleeve gastroplasty / 南方医科大学学报

Obesity and its complications, such as type 2 diabetes, hypertension, hyperlipidemia, nonalcoholic fatty liver, are serious global public health problems. Endoscopic sleeve gastroplasty (ESG) can reduce the length and width of the stomach by simulating the anatomical structure of surgical sleeve gastrectomy to reduce the capacity of the stomach, and is safe and effective to reduce weight. ESG has the advantages of non- invasiveness, no gastrectomy, repeatability, simple operation, no incision scar, few complications, short hospital stay and quick postoperative recovery. As an intermediate means of medical treatment and surgery, ESG provides a new method for weight loss for obese patients who cannot tolerate or are unwilling to undergo surgery. Herein we trace the origin of ESG, analyze the unique advantages of ESG suture, explore the technical improvement in the development of ESG, and briefly describe the weight reduction effect of ESG and compare the curative effect of ESG with laparoscopic sleeve gastrectomy. ESG has undergone rapid development and maturity but also faces such challenges as the lack of established standard procedures, unclear weight reduction mechanism, and clarification of the indications for operation. Still, ESG is expected to become the mainstream technique for weight reduction.

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.

Randomized, double-blind, placebo-controlled study of the analgesic effect of intraoperative esmolol for laparoscopic gastroplasty

Abstract Purpose To evaluate the analgesic effect of esmolol in patients submitted to laparoscopic gastroplasty. Methods Forty patients aged between 18 and 50 years with American Society of Anesthesiologists (ASA) physical status scores of II and III who underwent gastric bypass were allocated to two groups. Group 1 patients received a 0.5-mg/kg bolus of esmolol in 30 mL of saline before induction of anesthesia, followed by an infusion at 15 µg/kg/min until the end of surgery. Group 2 patients received 30 mL of saline as a bolus and then an infusion of saline. Anesthesia included fentanyl (3 µg/kg), propofol (2-4 mg/kg), rocuronium (0.6 mg/kg), and 2% sevoflurane, with remifentanil if necessary. The following parameters were evaluated: pain intensity over 24h, remifentanil consumption, the first analgesic request, morphine consumption, and side effects. Results Pain intensity was lower in the esmolol group except at T0 (after extubation) and 12h postoperatively. Remifentanil supplementation, recovery time, and postoperative morphine supplementation were lower in the esmolol group. No differences in the time to the first analgesic request or side effects were found between the groups. Conclusion Intraoperative esmolol promotes reductions in pain intensity and the need for analgesic supplementation without adverse effects, thus representing an effective drug for multimodal analgesia in gastroplasty.

Intervenção educativa e indicadores de obesidade de candidatos à gastroplastia: estudo quase-experimental / Intervención educativa e indicadores de obesidad de candidatos a gastroplastía: estudio cuasi experimental / Educational intervention and obesity indicators of gastroplasty candidates: a quasi-experimental study

Resumo Objetivo Avaliar o efeito de intervenção educativa nos indicadores de obesidade de pacientes em pré-operatório da cirurgia bariátrica. Métodos Estudo quase-experimental realizado de junho a agosto de 2017, em hospital de referência na realização de cirurgias bariátricas no Ceará, com 55 participantes (28 no Grupo Controle e 27 no Grupo Intervenção). O Grupo Controle foi submetido às orientações verbais sobre o procedimento cirúrgico, de rotina da instituição. O Grupo Intervenção, além de tal rotina, foi submetido à intervenção educativa realizada por enfermeira, semanalmente, a partir de leitura de cartilha educativa com informações e esclarecimentos acerca do perioperatório, durante três semanas. Para análise foram utilizados o teste de Wilcoxon para comparar os indicadores de obesidade entre os momentos de coleta e o teste de Mann-Whithey para comparar as variáveis entre os grupos. Resultados As variáveis redução de peso, índice de massa corporal, circunferência abdominal, relação cintura estatura e percentual do excesso de peso tiveram aumento no Grupo Controle e redução, com significância estatística, no Grupo Intervenção. Conclusão O acesso às informações no material impresso foi eficaz para aprendizagem e contribui significativamente para redução de indicadores de obesidade, os quais são clinicamente importantes para realização da cirurgia bariátrica. O uso de tecnologias educacionais deve ser estimulado no preparo pré-operatório de candidatos à gastroplastia.

Resumen Objetivo Evaluar los efectos de la intervención educativa en los indicadores de obesidad de pacientes en preoperatorio de cirugía bariátrica. Métodos Estudio cuasi experimental realizado de junio a agosto de 2017, en hospital de referencia en realización de cirugías bariátricas en el estado de Ceará, con 55 participantes (28 en el Grupo de Control y 27 en el Grupo Experimental). Al Grupo de Control se le dieron instrucciones verbales sobre el procedimiento quirúrgico, de rutina de la institución. El Grupo Experimental, además de recibir dicha rutina, recibió una intervención educativa realizada por enfermera, semanalmente, a partir de la lectura de manual educativo con información y explicaciones sobre el perioperatorio, durante tres semanas. Para el análisis se utilizó la Prueba de Wilcoxon para comparar los indicadores de obesidad entre los momentos de recolección y la prueba de Mann-Whitney para comparar las variables entre los grupos. Resultados Las variables reducción de peso, índice de masa corporal, circunferencia abdominal, relación cintura/estatura y porcentaje de exceso de peso aumentaron en el Grupo de Control y se redujeron, con significación estadística, en el Grupo Experimental. Conclusión El acceso a la información del material impreso fue eficaz para el aprendizaje y contribuyó significativamente para la reducción de indicadores de obesidad, los cuales son clínicamente importantes para la realización de la cirugía bariátrica. El uso de tecnologías educativas debe ser estimulado en la preparación preoperatoria de candidatos a gastroplastía.

Abstract Objective To assess the effect of educational intervention on obesity indicators in preoperative bariatric surgery patients. Methods A quasi-experimental study conducted from June to August 2017 at a referral hospital for bariatric surgery in Ceará, with 55 participants (28 in the Control Group and 27 in the Intervention Group). The Control Group was submitted to verbal instructions on the surgical procedure, routine of the institution. The Intervention Group, in addition to this routine, underwent an educational intervention performed by a nurse, weekly, from reading an educational booklet with information and clarifications about the perioperative period for three weeks. The Wilcoxon test was used for analysis to compare obesity indicators between collection times and the Mann-Whitney test to compare variables among groups. Results The variables weight reduction, body mass index, waist circumference, waist-to-height ratio and percentage of overweight increased in the Control Group and statistically significantly reduced in the Intervention Group. Conclusion Access to information in the printed material was effective for learning and significantly contributes to the reduction of obesity indicators, which are clinically important for bariatric surgery. The use of educational technologies should be encouraged in the preoperative preparation of gastroplasty candidates.

Lipoabdominoplastia em âncora / Anchor lipoabdominoplasty

A obesidade mórbida se caracteriza por acúmulo de tecido adiposo que se distribui de maneira heterogênea em todo o organismo, tendo a gastroplastia como o mais recente método de tratamento cirúrgico. Após perda considerável de peso, o doente apresenta sobras cutâneas, sob essas sobras acumulam-se secreções que favorecem a instalação de infecções cutâneas que podem ser minimizadas com a execução de dermolipectomias. Os autores descrevem a técnica de lipoabdominoplastia em âncora, adaptando os princípios de descolamento reduzido do retalho, lipoaspiração de abdome e flancos, e preservação da fáscia de Scarpa infraumbilical associado à marcação pré-cirúrgica em "Fleur-de-Lis". A técnica foi realizada em 17 pacientes em pós-operatório tardio de gastroplastia, entre janeiro de 2018 e junho de 2019, com idade entre 35 a 66 anos, sendo 16 pacientes do sexo feminino e 1 do sexo masculino. Todos os pacientes foram operados com exames pré-operatórios dentro da normalidade, condições clínicas satisfatórias e IMC<30. Na presente série de casos, um paciente apresentou epidermólise de coto umbilical; todos os pacientes apresentaram edema e equimoses, e um paciente apresentou seroma no 13º dia de pós-operatório. Hematoma, necrose, infecção, deiscência de ferida operatória ou eventos tromboembólicos não foram observados em nenhum paciente. A técnica demostrou ser segura e eficaz no tratamento de pacientes com excedente cutâneo abdominal, com melhora do contorno corporal, porém há necessidade de maior tempo de acompanhamento pós-operatório e maior número de casos operados para melhor mensurar os resultados, bem como a incidência de complicações.

Morbid obesity is characterized by the accumulation of adipose tissues distributed heterogeneously throughout the body, and gastroplasty is the latest method of surgical treatment. After considerable weight loss, patients present with excess skin under which secretions accumulate, increasing susceptibility for skin infections, which can be minimized with dermolipectomy. Herein, we describe the anchor lipoabdominoplasty technique, adapting the principles of reduced flap detachment, abdominal and flank liposuctions, and preservation of the infraumbilical Scarpa's fascia associated with the preoperative fleurde- lis marking. The technique was used for seventeen patients, including sixteen women and one man, with late postoperative gastroplasty, aged 35­66 years in the period from January 2018 to June 2019. The patients presented with normal preoperative testing, satisfactory clinical conditions, and body mass index scores less than 30 kg/m2. In the present case series, one patient had umbilical cord remnant epidermolysis; all patients had edema and ecchymosis; and one patient had seroma on postoperative day 13. Hematoma, necrosis, infection, wound dehiscence, or thromboembolic events were not observed in any patient. The technique is safe and effective in the treatment of patients with abdominal excess skin, improving their body contour. However, longer postoperative follow-up periods and more cases are necessary to better measure the results and incidence of complications.

Weight loss comparison after sleeve and roux-en-y gastric bypass: systematic review / Comparação da perda de peso após sleeve e bypass gástrico em y-de-roux: revisão sistemática

ABSTRACT Introduction: Bariatric surgery is currently the gold standard treatment for obesity. The two most accomplished surgeries are the Roux-en-Y gastric bypass and the sleeve gastrectomy, and controversies exist in which is better. Objective: To compare the two techniques in relation to weight loss with at least five years of follow-up. Methods: Search in Medline, PubMed, Embase, SciElo, Lilacs, Cochrane databases from 2001 (beginning of vertical gastrectomy) until 2018, using the following headings: "sleeve" or "sleeve gastrectomy" combined with "gastric bypass" or "Roux-en-Y gastric bypass", "weight loss" and "clinical trial". Criteria for inclusion of articles were patients aged between 18 and 65 years; clinical trial; comparison between the two techniques; minimum five-year follow-up; outcome with weight loss assessment. Results: The initial search identified 1940 articles, of which 185 publications were identified as clinical trials. One hundred and forty-one were excluded, 67 because they did not compare the two techniques, 57 not addressed weight loss and 17 were repeated articles. Thirty-four studies were retrieved for a more detailed analysis; 36 studies were excluded due to a follow-up of less than five years, and another compared the mini-gastric bypass. In total, seven studies were included in the systematic review, but there was no significant difference in three of them. Conclusion: The gastric bypass had a greater weight loss than the vertical gastrectomy in all the evaluated studies.

RESUMO Introdução: A cirurgia bariátrica é atualmente o tratamento padrão-ouro para o tratamento da obesidade não passível de controle clínico. As duas operações mais feitas são o bypass gástrico em Y-de-Roux e a gastrectomia vertical, e por isso tem sido foco de muita discussão. Objetivo: Comparar as duas técnicas em relação à perda de peso com pelo menos cinco anos de acompanhamento. Métodos: As buscas dos trabalhos foram realizadas nas bases de dados eletrônicas Medline, PubMed, Embase, SciElo, Lilacs, Cochrane de 2001 (início da gastrectomia vertical) até 2018, usando os seguintes descritores: "sleeve" ou "sleeve gastrectomy" combinada com "gastric bypass" ou "Roux-en-Y gastric bypass","weight loss" e "clinical trial". Critérios de inclusão foram: trabalhos com pacientes com idade entre 18 e 65 anos; ensaio clínico; comparação entre as duas técnicas; acompanhamento mínimo de cinco anos; desfecho com avaliação de perda de peso. Resultados: A busca inicial identificou 1940 artigos, destes 185 publicações foram identificadas como ensaios clínicos. Cento e quarenta e um foram excluídos devido a que 67 não compararem as duas técnicas, 57 não abordaram a perda de peso e 17 por serem artigos repetidos. Foram recuperados 44 estudos para uma análise mais detalhada, 36 deles foram excluídos devido ao seguimento menor que cinco anos e outro por comparar o minibypass gástrico. No total sete estudos foram incluídos na revisão sistemática; no entanto, não houve diferença estatisticamente significativa em três deles. Conclusão: O bypass gástrico teve perda de peso maior que a gastrectomia vertical em todos os trabalhos avaliados.

Critical analysis of surgical treatment techniques of morbid obesity / Análise crítica das técnicas de tratamento cirúrgico da obesidade mórbida

ABSTRACT Introduction: Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment. Objective: To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea. Methods: Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria. Results: Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques. Conclusion: The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.

RESUMO Introdução: A obesidade é afecção de alta prevalência no Brasil e no mundo e a cirurgia bariátrica, com suas diferentes técnicas, é alternativa para o tratamento. Objetivo: Comparar as técnicas da banda gástrica ajustável (BGA), gastrectomia vertical (GV), gastroplastia com derivação em Y-de-Roux (GDYR) e derivação biliopancreática (DBP) focando fístula, sangramento, óbito, perda e reganho ponderal, e resolução das comorbidades diabete melito tipo 2 (DM2), hipertensão arterial sistêmica (HAS), dislipidemia e apneia obstrutiva do sono (AOS). Métodos: Buscou-se os estudos na base de dados PubMed de 2003 a 2014 usando os descritores: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass e adjustable gastric banding. Dessa busca foram recuperadas 244 publicações sendo selecionados 116 após aplicar os critérios de inclusão/exclusão. Resultados: A perda de excesso de peso (PEP) após cinco anos foi 48,35% na BGA; 52,7% na GV; 71,04% na GDYR e 77,90% na DBP. A mortalidade pós-operatória foi 0,05% na BGA; 0,16% na GV; 0,60% na GDYR e 2,52% na DBP. A ocorrência de fístulas foi 0,68% para BGA; 1,93% para GV; 2,18% para GDYR e 5,23% para DBP. A ocorrência de sangramento foi 0,44% na BGA; 1,29% na GV; 0,81% na GDYR e 2,09% na DBP. A taxa do DM2 resolvida foi de 46,80% na BGA, 79,38% na GV, 79,86% na GDYR e 90,78% na DBP. A taxa de dislipidemia, apneia e hipertensão resolvidas não demonstraram diferenças estatísticas entre as técnicas. Conclusões: A BGA apresenta a menor morbimortalidade e é a pior em PEP e resolução do DM2. A GV apresenta baixa morbimortalidade, boa resolução das comorbidades e PEP inferior às GDYR e DBP. A GDYR apresenta morbimortalidade superior à BGA, boa resolução das comorbidades e PEP semelhante à DBP. A DBP é a pior em mortalidade e sangramento e melhor em PEP e resolução das comorbidades.

Oral health promotion in patients with morbid obesity after gastroplasty: a randomized clinical trial / Promoção de saúde bucal em pacientes com obesidade mórbida após gastroplastia: ensaio clínico randomizado

ABSTRACT Background: The bariatric surgery may have negative repercussions on oral conditions. Aim: To evaluate the impact of oral health educational/preventive program developed with patients submitted to gastroplasties. Method: The sample consisted of 109 patients randomly allocated to two groups: intervention group (IG), where they participated in the oral health promotion program that include multiple educational-preventive approaches; control group (CG), where they received usual care from the bariatric clinic staff, without participation in the program. The oral conditions investigated in the pre-operative and postoperative periods of one month (1M) and six months (6M) were: dental caries, periodontal disease, tooth wear, dental plaque and salivary flow. Results: After bariatric surgery, patients in IG presented: fewer changes in enamel (6M: p=0.004), dentin (6M: p=0.005) and gingival bleeding (6M: p<0.0001), reduction in plaque index (1M, 6M: p<0.0001) and increased salivary flow (6M: p=0.039), when compared with CG. Incipient tooth wear was recorded in both groups (6M: p=0.713). Conclusion: There was a positive impact of the implemented program in the prevention of the main oral health problems in patients who underwent gastroplasties, contributing to their quality of life.

RESUMO Racional: A cirurgia bariátrica pode repercutir negativamente nas condições bucais. Objetivo: Avaliar o impacto de um programa educativo/preventivo em saúde bucal desenvolvido em pacientes submetidos à gastroplastia. Método: A amostra foi constituída por 109 pacientes aleatoriamente alocados em dois grupos: grupo de intervenção (GI), onde participaram do programa de promoção de saúde bucal com abordagens educativo-preventivas; grupo controle (GC), onde receberam cuidado da equipe da clínica, sem participação no programa. As condições bucais investigadas nos períodos pré e pós-operatório de um mês (1M) e seis meses (6M) foram: cárie dentária, doença periodontal, desgaste dentário, placa dentária e fluxo salivar. Resultados: Após a gastroplastia, pacientes do GI apresentaram: menor alteração em esmalte (6M: p=0,004), dentina (6M: p=0,005) e sangramento gengival (6M: p<0,0001); redução no índice de placa (1M, 6M: p<0,0001) e aumento do fluxo salivar (6M: p=0,039), quando comparados aos do GC. Desgaste dentário incipiente foi registrado em ambos os grupos (6M: p=0,713). Conclusão: Houve impacto positivo do programa implementado na prevenção dos principais problemas de saúde bucal em pacientes submetidos à gastroplastia, contribuindo para sua qualidade de vida.

Cirurgias bariátricas realizadas pelo Sistema Único de Saúde no período 2010-2016: estudo descritivo das hospitalizações no Brasil / Cirugías bariátricas realizadas por el Sistema Único de Salud en el período 2010-2016: estudio descriptivo de las hospitalizaciones en Brasil / Bariatric surgeries performed by the Brazilian National Health System in the period 2010-2016: a descriptive study of hospitalizations

Objetivo: caracterizar as hospitalizações pelo Sistema Único de Saúde (SUS) para realização de cirurgias bariátricas no Brasil, no período 2010-2016. Métodos: estudo descritivo de séries temporais, com dados do Sistema de Informações Hospitalares do SUS (SIH/SUS); sua população-alvo, pacientes na idade de 16 ou mais anos. Resultados: foram realizadas 46.035 internações (6.576/ano; 4,3/100 mil hab./ano); a média de idade foi de 39,0 anos (desvio-padrão: 10,4); o sexo feminino predominou (85,4%) e a faixa etária de 35-39 anos concentrou 18,0% dos casos; 16.923 pacientes (36,8%) necessitaram de unidade de tratamento intensivo (UTI); ocorreram 99 (0,2%) óbitos intra-hospitalares; a mediana de permanência hospitalar foi de 3 dias, e o intervalo interquartil, de 2 dias; o gasto médio anual foi de R$ 39.410.919,37 e o valor médio por internação atingiu R$ 5.992,75 (R$ 1.464,15/dia). Conclusão: as cirurgias bariátricas caracterizaram-se como procedimentos com adultos jovens do sexo feminino, uso frequente de UTI e baixa letalidade.

Objetivo: caracterizar hospitalizaciones por el Sistema Único de Salud (SUS) para cirugía bariátrica en Brasil, en el período 2010-2016. Métodos: estudio descriptivo con datos del Sistema de Información Hospitalaria del SUS (SIH/SUS); la población objeto se constituyó de pacientes con edad de 16 años o superior. Resultados: se realizaron 46.035 admisiones (6.576/año; 4,3/100 mil habitantes/año); la edad promedio fue de 39,0±10,4 años; el sexo femenino predominó (85,4%) y el grupo de edad de 35-39 años concentró 8.308 (18,0%) casos; 16.923 pacientes (36,8%) necesitaron unidad de tratamiento intensivo (UCI); se produjeron 99 (0,2%) muertes intrahospitalarias; la mediana de permanencia hospitalaria fue de 3 días y el rango intercuartil de 2 días; el gasto promedio anual fue de R$ 39.410.919,37 y el valor promedio por hospitalización de R$ 5.992,75 (R$ 1.464,15/día). Conclusión: las cirugías bariátricas se caracterizaron como procedimientos de mujeres adultas jóvenes, uso relativamente frecuente de la UCI y baja letalidad.

Objective: to characterize Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in Brazil, in the period 2010-2016. Methods: this was a descriptive study of time series using data from the SUS Hospital Information System (SIH/SUS); the target population consisted of patients aged 16 years and older. Results: there were 46,035 hospitalizations (6,576/year; 4.3/100,000 inhabitants/year); average age was 39.0 years old (SD:10.4); female sex predominated (85.4%), and the 35-39 age group accounted for 18.0% of cases; 16,923 patients (36.8%) needed to be admitted to the intensive care unit (ICU); there were 99 (0.2%) in-hospital deaths; the median hospital stay was 3 days, and the interquartile range was 2 days; average annual expense was R$ 39,410,919.37 and the average cost of hospitalization was R$ 5,992.75 (R$ 1,464.15/day). Conclusion: bariatric surgeries were characterized as procedures involving young female adults, frequent ICU use and low lethality.

Current Status of Bariatric Endoscopy in Obesity Control / 대한내과학회지

Obesity and metabolic syndrome affect ~40% of individuals in the United States alone. They are significant conditions that can cause severe economic problems. Obesity is also a global issue, with ~400 million obese adults worldwide. Moreover, the number of overweight children is increasing. Bariatric surgery is the gold standard treatment for obesity; however, endoscopic approaches may have a significant role in improving metabolic syndrome and achieving weight loss. Many endoscopic methods have been introduced, some of which are currently available and some that are undergoing experimentation. Endoscopists have a role in the treatment of obesity because endoscopic therapies are expected to become safer and more efficacious in the coming years. Endoscopic bariatric therapies can be categorized as space occupying, malabsorption, and gastric volume reduction. In this review, we summarize the currently available endoscopic procedures.

Abdominoplastia em pacientes pós-bariátricos: perfil antropométrico, comorbidades e complicações / Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

Introdução: Os pacientes submetidos à gastroplastia apresentam importante perda de peso e a cirurgia plástica representa um importante meio de tratamento do excesso de pele. Método: Estudo prospectivo foi realizado em pacientes submetidos à abdominoplastia pós-gastroplastia no período de janeiro de 2011 a dezembro de 2016 em hospital público. As variáveis analisadas foram: IMC (Índice de Massa Corporal) antes da gastroplastia e antes da cirurgia plástica, perda de peso, peso do retalho retirado, comorbidades e complicações. Resultados: 107 pacientes que realizaram abdominoplastia foram incluídos. Média de idade foi 41 anos. O IMC médio antes da cirurgia plástica foi 27,6 ± 3,7 Kg/m2. Perda de peso médio foi 47,7 ± 17,3 Kg. O IMC máximo antes da gastroplastia foi 45,5 ± 7,5 Kg/m2 e o IMC foi 18,6 ± 9,3 Kg/m2. Comorbidades presentes antes da plástica foram: hipertensão arterial (11,1%), artropatia (4,6%), diabete melito (5,6%) e síndrome metabólica (5,6%). Catorze (13,1%) pacientes realizaram herniorrafia durante a abdominoplastia. A taxa de complicações foi 31,5%. O peso antes da gastroplastia, IMC antes da gastroplastia, perda de peso médio, comorbidades, peso do retalho do abdome e IMC > 20Kg/m2 foram fatores associados significativamente a complicações pós-operatórias. Conclusões: A gastroplastia em Y de Roux foi uma terapêutica efetiva na resolução de comorbidades em obesos. Comorbidades, peso antes da gastroplastia, perda de peso médio, quantidade de tecido retirado do abdome e IMC > 20Kg/m2 levaram significativamente a mais complicações em pacientes pósbariátricos submetidos à abdominoplastia. A cirurgia plástica é importante no cuidado integral ao paciente obeso e otimizou os resultados alcançados com a cirurgia bariátrica.

Introduction: Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin. Methods: A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications. Results: For this study, 107 patients who underwent AP were included. The patients' mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBGRYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications. Conclusions: VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB.

Pacientes submetidos a cirurgias bariátricas: fatores associados a complicações pós-operatórias de sítio cirúrgico / Patients undergoing bariatric surgeries: factors associated with post-operative complications from the surgical site / Pacientes sometidos a cirugías bariátricas: factores asociados con complicaciones postoperatorias del sitio quirúrgico

Objetivo: Verificar a prevalência e os fatores associados às complicações pós-operatórias de sítio cirúrgico em pacientes submetidos a cirurgias bariátricas. Método: Estudo transversal, retrospectivo, analítico, com abordagem quantitativa. Foram analisados 197 casos de pacientes obesos submetidos à cirurgia bariátrica entre janeiro de 2013 e janeiro de 2016 em Pernambuco, Brasil. As variáveis relacionadas dicotomizadas foram analisadas por teste do χ2. O risco de complicações foi estimado pela odds ratio (OR). Assumiu-se significância de p<0,05. Resultados: Entre os 30 pacientes que compuseram a amostra, foram observadas 45 complicações pós-operatórias de sítio cirúrgico. Houve maior incidência nos indivíduos acima de 45 anos (70,0%). Dos fatores que poderiam estar associados aos desfechos, destacaram-se abordagem cirúrgica aberta (OR=5,35), inserção de drenos (OR=4,48) e período de tempo de pós-operatório superior a 3 dias de internação (OR=5,03). Conclusão: Comprovou-se maior prevalência de seroma como complicação de sítio cirúrgico, além da técnica cirúrgica (bypass em Y de Roux), faixa etária maior de 45 anos, tipo de abordagem cirúrgica convencional/aberta, presença de inserção de dreno cavitário e tempo de internação superior a 3 dias como predisponentes a um maior desenvolvimento de complicações.

Objective: To verify the prevalence and the factors associated with postoperative surgical site complications in patients undergoing bariatric surgeries. Method: A cross-sectional, retrospective, analytical study with a quantitative approach. 197 cases of obese patients undergoing bariatric surgery were analyzed between January 2013 and January 2016 in Pernambuco, Brazil. Dichotomized variables were analyzed using the χ2 test. The risk of complications was estimated by the odds ratio (OR). A significance of p <0.05 was assumed. Results: Among the 30 patients that made up the sample, 45 postoperative surgical site complications were observed. There was a higher incidence in individuals over 45 years of age (70.0%). The factors that stood out as possibly being associated with the outcomes were: an open surgical approach (OR = 5.35), the insertion of drains (OR = 4.48), and a postoperative period longer than 3 days of hospitalization (OR = 5.03). Conclusion: The following showed a high disposition for the development of complications from the surgical site: a high prevalence of seroma, the Roux-en-Y bypass surgical technique, the patient's age over 45 years old, a conventional/ open surgical approach, the insertion of cavitary drainage, and a hospitalization stay longer than 3 days.

Objetivo: Verificar la prevalencia y los factores asociados con las complicaciones del sitio quirúrgico postoperatorio em pacientes sometidos a cirugías bariátricas. Método: Estudio transversal, retrospectivo y analítico con enfoque cuantitativo. Se analizaron 197 casos de pacientes obesos sometidos a cirugía bariátrica entre enero de 2013 y enero de 2016, em Pernambuco, Brasil. Las variables dicotomizadas se analizaron usando la prueba χ2. Le riesgo de complicaciones es estimó mediante la odds ratio (OR). Se asumió una significancia de p<0,05. Resultados: entre los 30 pacientes em la muestra, 45 complicaciones postoperatorias fueran observadas en el sitio quirúrgico. Hubo una mayor incidencia em individuos mayores de 45 años (70,0%). Los factores que se destacaron como posiblemente asociados con los resultados fueron: un abordaje quirúrgico abierto (OR = 5,35), la inserción de drenajes (OR = 4,48), y un periodo postoperatorio mayor a 3 días de hospitalización (OR = 5,03). Conclusión: Los siguientes mostraron una alta disposición para el desarrollo de complicaciones del sitio quirúrgico: alta prevalencia de seroma, técnica quirúrgica de derivación Roux-em-Y, edad del paciente mayor de 45 años, abordaje quirúrgico convencional/abierto, inserción de denaje cavitario y hospitalización por más de 3 días.

Treatment of posterior gastric wall gastrointestinal stromal tumor with gastric sleeve: a case report

Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial tumors of the gastrointestinal tract. The most usual location is the stomach, followed by the small intestine, where it may cause digestive bleeding and anemia. Surgical resection of the tumor is the gold standard treatment, and definitive diagnosis is based on immunohistochemical analysis of the surgical specimen. We report the case of a 53-year-old man with gastric GIST presenting with endophytic and exophytic growth, located at the posterior wall of the stomach, in the antrum-body transitional zone, treated with gastric sleeve. (AU)