Compliance with Enhanced Recovery After Surgery (ERAS) protocol recommendations for bariatric surgery in an obesity treatment center

Abstract Introduction The higher risk of perioperative complications associated with obesity has made anesthesiologists increasingly concerned with the management of obese patients. Measures that improve bariatric surgery patient safety have become essential. The implementation of ERAS protocols in several surgical specialties has made it possible to achieve appropriate outcomes as to surgery safety. The aim of this study was to evaluate patient compliance with the recommendations of an ERAS protocol for Bariatric Surgery (ERABS) at a hospital specialized in obesity treatment. Methods Cross-sectional study, using a medical record database, in a hospital certified as an International Center of Excellence in Bariatric and Metabolic Surgery. The definition of the variables to be assessed was based on the most recent ERABS proposed by Thorell et al. Results were analyzed using descriptive epidemiology. Results The study evaluated all patients undergoing bariatric surgery in 2019. Mean compliance with the recommendations per participant was 42.8%, with a maximum of 55.5%, and was distributed as follows: 22.6% of compliance with preoperative recommendations, 60% to intraoperative recommendations, and 58.1% to postoperative recommendations. The anesthesiologist is the professional who provides most measures for the perioperative optimization of bariatric surgery patients. In our study we found that anesthesiologists complied with only 39.5% of ERABS recommendations. Conclusions Mean compliance with ERABS recommendations per participant was 42.8%. Considering that the study was carried out at a hospital certified as an international center of excellence, the need for introducing improvements in the care of patients to be submitted to bariatric surgery is evident.

Interpretation for indications of metabolic and bariatric surgery released by ASMBS and IFSO in 2022 / 中华胃肠外科杂志

With the increasing number of obese patients worldwide, metabolic and bariatric surgery (MBS) has quickly become an effective way to treat obesity and related metabolic diseases such as type 2 diabetes, hypertension, lipid abnormalities, etc. Although MBS has become an important part of general surgery, there is still controversy regarding the indications for MBS. In 1991, the National Institutes of Health (NIH) issued a statement on the surgical treatment of severe obesity and other related issues, which continues to be the standard for insurance companies, health care systems, and hospital selection of patients. The standard no longer reflects the best practice data and lacks relevance to today's modern surgeries and patient populations. After 31 years, in October 2022, the American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), the world's leading authorities on weight loss and metabolic surgery, jointly released new guidelines for MBS indications, based on increasing awareness of obesity and its comorbidities and the accumulation of evidence of obesity metabolic diseases. In a series of recommendations, the eligibility of patients for bariatric surgery has been expanded. Specific key updates include the following: (1) MBS is recommended for individuals with BMI≥35 kg/m2, regardless of the presence, absence, or severity of co-morbidities; (2) MBS should be considered for individuals with metabolic diseases and BMI 30.0-34.9 kg/m2; (3) the BMI threshold should be adjusted for the Asian population:: BMI≥25 kg/m2 suggest clinical obesity, and BMI ≥ 27.5 kg/m2 population should consider MBS; (4) Appropriately selected children and adolescents should be considered for MBS.

Progress in the study of intragastric occupancy device for weight reduction / 中南大学学报(医学版)

Obesity is a global public health problem that imposes a heavy economic burden on society. The current main strategies for treating obesity include lifestyle interventions, pharmacological treatments, endoscopic treatments and metabolic surgery. With the development of medical technology, weight reduction by intragastric occupancy devices represented by intragastric balloons and intragastric capsules are gradually emerging. Intragastric balloons are used to reduce weight by occupying the volume of the stomach with balloons filled with different volumes of gas or liquid, among which ReShape, Orbera, Obalon, Elipse and Spatz balloons are gradually used in patients with mild to moderate obesity due to their non-invasive, high safety and reusable advantages. Intragastric capsules are recommended in overweight and obese patients for weight loss through hydrogels with transient superabsorbent swelling properties and completely noninvasive. Both approaches achieve weight loss by limiting gastric volume, increasing satiety and reducing food intake. Despite the presence of adverse gastrointestinal events associated with nausea, vomiting, and abdominal distention, they offer new ideas for the non-invasive clinical treatment of obesity.

Gastroplastia como medida terapêutica em pacientes obesos hipertensos / Gastroplastia as a therapeutic measure in obese hypertensive patients

A hipertensão arterial (HA) e a obesidade são doenças crônicas que se interrelacionam por meio de um quadro complexo de comunicação hormonal e uma série de cascatas enzimáticas. Isso faz com que o manejo dessas comorbidades seja complexo e multifatorial, muitas vezes levando a abandono ou falha terapêutica por parte de pacientes e profissionais de saúde, levando, então, às complicações dessas patologias. Há diversas formas de manejo e a gastroplastia, também conhecida como cirurgia bariátrica, é uma técnica cirúrgica que vem apresentando como alternativa satisfatória para o manejo terapêutico (AU).

Arterial hypertension (AH) and obesity are chronic diseases that are interrelated through a complex framework of hormonal communication and a series of enzymatic cascades. This makes the management of these comorbidities complex and multifactorial, often leading to treatment abandonment or failure by patients and health professionals, thus leading to complications of these pathologies. There are several forms of management and gastroplasty, also known as bariatric surgery, is a surgery that has been presented as a satisfactory alternative for therapeutic management (AU),

Vitamin d levels and lipid profile in patients undergoing bariatric surgery / Níveis de vitamina d e perfil lipídico em pacientes submetidos à cirurgia bariátrica

ABSTRACT BACKGROUND: Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS: To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS: Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS: A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS: It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.

RESUMO RACIONAL: Deficiências vitamínicas, minerais e metabólicas ocorrem no pós-operatório de cirurgia bariátrica, a curto e longo prazo, sendo intercorrências preocupantes. OBJETIVOS: Avaliar a associação dos níveis séricos de vitamina D com o perfil lipídico, em pacientes obesos submetidos à cirurgia bariátrica. MÉTODOS: Série de casos de pacientes atendidos de 2010 até 2018, em hospital privado de média e alta complexidade, submetidos à cirurgia bariátrica pelas técnicas da gastrectomia vertical e derivação gástrica em Y de Roux, acompanhados pelo mesmo cirurgião. Foram coletados dados sociodemográficos, clínicos, dados laboratoriais e antropométricos no pré-operatório, 6 meses, 12 meses e 24 meses após cirurgia. RESULTADOS: Foram acompanhados 156 indivíduos, maioria sexo feminino (75,6%), comorbidades mais frequentes foram esteatose hepática (76,3%) e hipertensão (48,27). Em relação aos níveis de vitamina D pré-operatórios, apenas 18,9% da população apresentaram níveis satisfatórios (=30 ng/mL). Observou-se redução do peso e melhora do perfil lipídico pós-cirúrgico. Sobre as correlações entre o perfil lipídico e concentração de vitamina D foram observadas correlações significativas apenas na amostra que passou pela técnica cirúrgica derivação gástrica em Y de Roux: correlação negativa entre o colesterol total e vitamina D após 2 anos de cirurgia; correlação positiva entre triglicerídeo e vitamina D 1 ano pós-operatório; e correlação negativa entre HDL e vitamina D 2 anos pós-operatório. CONCLUSÕES: é essencial acompanhar os níveis de vitamina D e perfil lipídico no pré e pós-operatório de forma rotineira a fim de evitar danos relacionados a deficiência dessa vitamina.

Covid-19 e obesidade: dificuldades enfrentadas por pacientes em pré-operatório para cirurgia bariátrica / COVID-19 and obesity: difficulties faced by patients in the preoperative period for bariatric surgery

RESUMO: Introdução: A obesidade é uma doença crônica que apresenta risco à saúde e está associada a formas graves da Covid-19. Durante a pandemia, pode haver o surgimento mais acentuado de dificuldades psicológicas nesses pacientes. Objetivo: avaliar possíveis impactos durante o enfrentamento da pandemia em pacientes no pré-operatório para cirurgia bariátrica. Método: Estudo transversal e descritivo, de abordagem qualitativa, com dados coletados através de entrevista semiestruturada. Amostra composta por pacientes em pré-operatório para cirurgia bariátrica. Foram previamente estabelecidos três grandes eixos temáticos e após a transcrição das entrevistas as respostas foram analisadas e classificadas em categorias. Resultados: Foram entrevistados 17 pacientes em pré-operatório para cirurgia bariátrica, sendo dez do sexo feminino e sete do sexo masculino. A média de idade dos participantes foi de 36,7 ± 13,6 anos e o índice de massa corporal médio foi de 43,9 ± 8,4 kg/m2. Os pacientes apresentaram dificuldades em seguir o protocolo nutricional e realizar atividades físicas, importantes na preparação para a cirurgia bariátrica. O momento vivido durante a pandemia da Covid-19 trouxe sequelas principalmente no emocional dos entrevistados. Conclusão: É importante manter assiduamente o acompanhamento por equipes multiprofissionais para esses pacientes durante a pandemia, mesmo que remotamente, a fim de melhorar a gestão da sua saúde física e mental no pré-operatório da cirurgia bariátrica. (AU)

ABSTRACT: Introduction: Obesity is a chronic disease that poses health risks and is associated with severe forms of COVID-19. During the COVID-19 pandemic, psychological difficulties may emerge more often in obese patients. Objective: to evaluate possible impacts when coping with the pandemic in patients in the preoperative period for bariatric surgery. Method: A cross-sectional descriptive study with a qualitative approach and data collected through semi-structured interviews. The sample was composed of patients in the preoperative period for bariatric surgery. Three main thematic axes were previously established, and after transcribing the interviews, the answers were analyzed and classified into categories. Results: Seventeen patients in the preoperative period for bariatric surgery were interviewed, 10 females and 7 males. The mean age of participants was 36.7 ± 13.6 years, and the mean body mass index was 43.9 ± 8.4 kg/m2. The patients had difficulties in following the nutritional protocol and performing physical activities, which are important in preparing for bariatric surgery. The moment experienced during the COVID-19 pandemic caused sequels, particularly emotional ones, in the interviewees. Conclusion: It is important to maintain frequent monitoring by multidisciplinary teams for these patients during the pandemic, even if remotely, to improve the management of their physical and mental health in the preoperative period of bariatric surgery

Role and change of the gut microbiota after bariatric surgery / 中华胃肠外科杂志

Gut microbiota have been validated to play a pivotal role in metabolic regulation. As the most effective treatment for obesity and related comorbidities, bariatric surgery has been shown to result in significant alterations to the gut microbiota. Literature have recently suggested temporal and spatial features of alterations to the intestinal bacteria following bariatric surgery, which is possibly attributed to the gut adaptation to the surgical modification on the gastrointestinal tract. More importantly, the gut microbiota have been appreciated as a critical contributor to the metabolic improvements following bariatric surgery. Although not fully elucidated, the underlying mechanisms are associated with the molecular pathways mediating the crosstalk between gut microbiota and host . On the other hand, change of the gut microbiota has been found to be related to the prognosis of patients receiving bariatric surgery. Some studies even point out negative effects of the gut microbiota on certain surgical complications . In this review, we summarize the characteristics of alterations to the gut microbiota following bariatric surgery as well as its relevant impacts to better understand the role of gut microbiota in bariatric surgery.

Influence of visceral lipids obesity on the early postoperative complications after radical gastrectomy / 中华胃肠外科杂志

Objective: To investigate the effect of visceral fat area (VFA) on the surgical efficacy and early postoperative complications of radical gastrectomy for gastric cancer. Methods: A retrospective cohort study method was used. Clinicopathological data and preoperative imaging data of 195 patients who underwent D2 radical gastric cancer surgery at the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2017 were analyzed retrospectively. Inclusion criteria: (1) complete clinicopathological and imaging data; (2) malignant gastric tumor diagnosed by preoperative pathology, and gastric cancer confirmed by postoperative pathology; (3) no preoperative complications such as bleeding, obstruction or perforation, and no distant metastasis. Those who had a history of abdominal surgery, concurrent malignant tumors, poor basic conditions, emergency surgery, palliative resection, and preoperative neoadjuvant therapy were excluded. The VFA was calculated by software and VFA ≥ 100 cm2 was defined as visceral obesity according to the Japan Obesity Association criteria . The patients were divided into high VFA (VFA-H, VFA≥100 cm2, n=96) group and low VFA (VFA-L, VFA<100 cm2, n=99) group . The clinicopathological characteristics, surgical outcomes and early postoperative complications were compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the risk factors of early complications. Receiver operating characteristic (ROC) curve was used to analyze predictive values of VFA for early complications. Pearson's χ2 test was used to analyze the correlation between BMI and VFA. Results: There were no significant differences in terms of gender, age, American Society of Anesthesiologists physical status classification, preoperative comorbidities, preoperative anemia, tumor TNM staging, N staging, T staging and tumor differentiation, surgical method, extent of resection, and tumor location between the VFA-L group and the VFA-H group (all P>0.05). However, patients in the VFA-H group had higher BMI, larger tumor, lower rate of hypoalbuminemia and greater subcutaneous fat area (SFA) (all P<0.05). The VFA-H group presented significantly longer operation time and significantly less number of harvested lymph nodes as compared to the VFA-L group (both P<0.05). However, there were no significant differences in intraoperative blood loss, conversion to laparotomy and postoperative hospital stay (all P>0.05). Complications of Clavien-Dindo grade II and above within 30 days after operation were mainly anastomosis-related complications (leakage, bleeding, infection and stricture), intestinal obstruction and incision infection. The VFA-H group had a higher morbidity of early complications compared to the VFA-L group [24.0% (23/96) vs 10.1% (10/99), χ2=6.657, P=0.010], and the rates of anastomotic complications and incision infection were also higher in the VFA group [10.4% (10/96) vs. 3.0% (3/99), χ2=4.274, P=0.039; 7.3% (7/96) vs. 1.0% (1/99), P=0.033]. Multivariate logistic analysis showed that high BMI (OR=3.688, 95%CI: 1.685-8.072, P=0.001) and high VFA (OR=2.526, 95%CI: 1.148-5.559,P=0.021) were independent risk factors for early complications. The area under the ROC curve (AUC) of VFA for predicting early complications was 0.645, which was higher than that of body weight (0.591), BMI (0.624) and SFA (0.626). Correlation analysis indicated that there was a significantly positive correlation between BMI and VFA (r=0.640, P<0.001). Conclusion: VFA ≥ 100 cm2 is an independent risk factor for early complications after radical gastrectomy for gastric cancer.It can better predict the occurrence of above early postoperative complications.

The current status and future perspectives of bariatric and metabolic surgery in the management of obesity and its co-morbidities / 中华外科杂志

Bariatric-metabolic surgery (BMS) has the potential of decreasing body weight and improving obesity-related metabolic syndrome by restricting food intake and malabsorption. Laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric banding, biliopancreatic diversion with duodenal switch are four major BMS procedures. Sleeve plus surgery, one-anastomosis gastric bypass, intragastric balloon and endoscopic surgery are also arising and gaining popularity due to their specific efficacy. Currently, BMS is now experiencing an era with deeply integrated interdisciplinarity, optimizing and innovating of surgeries and well-illustrated clinical efficacy, as a result, more obese patients would benefit from BMS.

Safety and learning curve of Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in the treatment of obesity patients / 中华胃肠外科杂志

Objective: To investigate the safety and learning curve of Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in the treatment of obesity patients. Methods: A descriptive case series study was performed. Clinical data of obesity patients who were treated with Da Vinci robotic SADI-S in China-Japan Union Hospital of Jilin University from March 2020 to May 2021 were analyzed retrospectively. Case inclusion criteria: (1) uncomplicated obese patients with body mass index (BMI)≥37.5 kg/m(2); (2) patients with BMI of 28 to <37.5 kg/m(2) complicated with type 2 diabetes or two metabolic syndrome components, or obesity comorbidities; (3) patients undergoing SADI-S by Da Vinci robotic surgery system. Those who received other bariatric procedures other than SADI-S or underwent Da Vince robotic SADI-S as revisional operation were excluded. A total of 77 patients were enrolled in the study, including 31 males and 46 females, with median age of 33 (18-59) years, preoperative body weight of (123.0±26.2) kg, BMI of (42.2±7.1) kg/m(2) and waistline of (127.6±16.3) cm. According to the order of operation date, the patients were numbered as 1-77. The textbook outcome (TO) and Clavien-Dindo grading standard were used to analyze the clinical outcome of each patient and to classify surgical complications, respectively. The standard of textbook outcome was as follows: the operative time less than or equal to the 75th percentile of the patient's operation time (210 min); the postoperative hospital stay less than or equal to the 75th percentile of the patient's postoperative hospital stay (7 d); complication grade lower than Clavien grade II; no readmission; no conversion to laparotomy or death. The patient undergoing robotic SADI-S was considered to meet the TO standard when meeting the above 5 criteria. The TO rate was calculated by cumulative sum analysis (CUSUM) method. The curve was drawn by case number as X-axis and CUSUM (TO rate) as Y-axis so as to understand the learning curve of robotic SADI-S. Results: The operative time of 77 robotic SADI-S was (182.9±37.5) minutes, and the length of postoperative hospital stay was 6 (4-55) days. There was no conversion to laparotomy or death. Seven patients suffered from complications (7/77, 9.1%). Four patients had grade II complications (5.2%), including one with duodeno-ileal anastomotic leakage, one with abdominal bleeding, one with peritoneal effusion and one with delayed gastric emptying; two patients were grade IIIb complications (2.6%) and both of them were diagnosed with gastric leakage; one patient was grade IV complication diagnosed with postoperative respiratory failure (1.3%), and all of them were cured successfully. A total of 51 patients met the textbook outcome standard, and the TO rate was positive and was steadily increasing after the number of surgical cases accumulated to the 46th case. Taking the 46th case as the boundary, all the patients were divided into learning stage group (n=46) and mastery stage group (n=31). There were no significant differences between the two groups in terms of gender, age, weight, body mass index, waist circumference, ASA classification, standard liver volume, operative time and morbidity of postoperative complication (all P>0.05). The percent of abdominal drainage tube in learning stage group was higher than that in mastery stage group (54.3% versus 16.1%, P<0.05). The length of postoperative hospital stay in learning stage group was longer than that in mastery stage group [6 (4-22) d versus 6 (5-55) d, P<0.05)]. Conclusion: The Da Vinci robotic SADI-S is safe and feasible with a learning curve of 46 cases.

Protocolo de Manejo de Cirugía Metabólica y Bariátrica del Hospital de Especialidades Carlos Andrade Marín / Management Protocol for Metabolic and Bariatric Surgery at the Carlos Andrade Marín Specialties Hospital

1. INTRODUCCIÓN. La obesidad mórbida es una enfermedad crónica multifactorial asociada a complicaciones físicas y psicológicas que empeoran la calidad de vida de los pacientes y disminuyen su esperanza de vida; es un problema sanitario de primera magnitud debido al incremento de esta patología en Ecuador y a las dificultades que entraña su prevención y tratamiento. La cirugía de la obesidad es compleja, no exenta de complicaciones, cuyo objetivo es reducir de manera significativa las comorbilidades asociadas y mejorar el bienestar de los pacientes, cuya técnica quirúrgica sea fácil de reproducir, con porcentajes de revisión bajos y que constituya un tratamiento eficaz y seguro para la obesidad clínicamente grave, con evidencia que demuestra reducción de la mortalidad por todas las causas, mejoría en la expectativa y calidad de vida de los pacientes1.

1. INTRODUCTION. Morbid obesity is a multifactorial chronic disease associated with physical and psychological complications that worsen the quality of life of patients and decrease their life expectancy; it is a health problem of the first magnitude due to the increase of this pathology in Ecuador and the difficulties involved in its prevention and treatment. Obesity surgery is complex, not exempt of complications, whose objective is to significantly reduce associated comorbidities and improve the well-being of patients, whose surgical technique is easy to reproduce, with low revision percentages and that constitutes an effective and safe treatment for clinically severe obesity, with evidence that shows a reduction in all-cause mortality, improvement in life expectancy and quality of life of patients1.

Prática de atividade física de pacientes submetidos à cirurgia bariátrica: estudo transversal / Practice of physical activity in patients undergoing bariatric surgery: a cross-sectional study / Práctica de actividad física en pacientes sometidos a cirugía bariátrica: estudio transversal

OBJETIVO: Avaliar se pacientes submetidos à cirurgia bariátrica eram fisicamente ativos, antes e após o processo cirúrgico, além de identificar os fatores associados à inatividade física. MÉTODO: Estudo transversal, com 307 adultos submetidos à cirurgia bariátrica entre 2012 a 2014 em um hospital geral de Minas Gerais. A prática de atividade física (>150 minutos/semana) antes e após o procedimento cirúrgico foi considerada como variável desfecho deste estudo. A magnitude da associação entre a variável dependente e os fatores de interesse foi estimada pelas odds ratio pelo modelo logístico longitudinal. RESULTADOS: Após a cirurgia bariátrica, houve aumento da realização da atividade física. Na análise multivariada, cor de pele autorreferida amarela ou indígena, índice de massa corporal e percepção ruim ou muito ruim do estado de saúde associaram-se à AF. CONCLUSÃO: A prática de atividade deve ser incentivada, visto que favorece mudança de hábitos, englobando os âmbitos físico, psicológico e social.

OBJECTIVE: To assess whether patients undergoing bariatric surgery were physically active before and after the surgical procedure, in addition to identifying factors associated with physical inactivity. METHOD: A cross-sectional study conducted with 307 adults undergoing bariatric surgery between 2012 and 2014 in a general hospital in Minas Gerais. Practicing physical activity (>150 minutes/week) before and after the surgical procedure was considered as the outcome variable of this study. The magnitude of the association between the dependent variable and the factors of interest was estimated by the odds ratios using the longitudinal logistic model. RESULTS: After the bariatric surgery, there was an increase in physical activity. In the multivariate analysis, self-reported Asian or indigenous skin color, body mass index and bad or very bad perception of the health status were associated with PA. CONCLUSION: The practice of physical activity must be encouraged, as it favors change in habits, encompassing the physical, psychological and social spheres.

OBJETIVO: Evaluar si los pacientes sometidos a cirugía bariátrica estaban físicamente activos antes y después de la cirugía, e identificar los factores asociados con la inactividad física. MÉTODO: Estudio transversal con 307 adultos sometidos a cirugía bariátrica entre 2012 y 2014 en un hospital general de Minas Gerais. La práctica de actividad física (> 150 minutos/semana) antes y después del procedimiento quirúrgico se consideró como variable de resultado de este estudio. La magnitud de la asociación entre la variable dependiente y los factores de interés se estimó mediante el odds ratio utilizando el modelo logístico longitudinal. RESULTADOS: Después de la cirugía bariátrica, hubo un aumento de la actividad física. En el análisis multivariante, el color de piel indígena o amarilla autoinformado, el índice de masa corporal y una percepción mala o muy mala del estado de salud se asociaron con la AF. CONCLUSIÓN: Se debe fomentar la práctica de actividad, dado que favorece el cambio de hábitos, en los aspectos físico, psicológico y social.

Association between bariatric surgery and oral health: a literature review

Objective: to review the literature on the relationship between oral health and bariatric surgery in obese individuals. Methods: articles published until March 2021 were searched in the Medline/PubMed, LILACS, BBO, and Web of Science databases. The search used a combination of descriptors related to the words: obesity, bariatric surgery, and oral health. Results: one hundred thirty-five studies were identified in the database search. Of these, 47 were included in this review. The oral changes investigated in the literature for individuals who underwent bariatric surgery were dental caries, tooth wear/erosion, hypersensitivity, periodontal disease, hyposalivation, halitosis, and changes in mastication and oral soft tissue. The evaluated articles showed methodological controversy regarding the study design, follow-up period, sample size, and assessed clinical parameters, which complicated the comparison of studies. Final considerations: there is no consensus in the literature regarding the relationship between oral health and bariatric surgery in obese individuals. Further prospective cohort studies should be conducted to investigate this association better.(AU)

Objetivo: revisar a literatura sobre a relação entre saúde bucal e cirurgia bariátrica em indivíduos obesos. Métodos: foi realizada uma busca de estudos publicados até março de 2021 nas bases de dados Medline/PubMed, LILACS, BBO e Web of Science. Foi utilizada uma combinação de descritores relacionada às palavras: obesidade, cirurgia bariátrica e saúde bucal. Resultados: foram identificados 135 estudos nas bases de dados pesquisadas. Desses, 47 estudos foram incluídos nesta revisão. As alterações bucais investigadas em indivíduos que realizaram cirurgia bariátrica apresentadas na literatura foram: cárie dentária, desgaste dentário/erosão dentária, hipersensibilidade, doença periodontal, hipossalivação, halitose, alterações da função mastigatória e alterações no tecido mole bucal. Os estudos avaliados mostraram controvérsia metodológica em relação a: tipo de desenho de estudo, tempo de seguimento, tamanho da amostra e parâmetros clínicos avaliados, fato que dificultou comparar os estudos. Considerações finais: não há consenso na literatura sobre a relação entre saúde bucal e cirurgia bariátrica em indivíduos obesos. Mais estudos de coorte prospectivos devem ser realizados para estudar melhor essa associação.(AU)

One-year outcomes of laparoscopic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy versus laparoscopic sleeve gastrectomy for the treatment of obesity and obesity-related metabolic diseases / 中华胃肠外科杂志

Objective: To compare the efficacy and safety of laparoscopic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) and laparoscopic sleeve gastrectomy (SG) in the treatment of obesity and obesity-related metabolic diseases. Methods: A retrospective cohort study method was used to analyze the clinical data of 22 patients with obesity who underwent laparoscopic SADI-S in the China-Japan Union Hospital of Jilin university from May 2018 to December 2019 (SADI-S group). Meanwhile, 22 patients with obesity undergoing laparoscopic SG at the same period were selected in this study whose preoperative demographics, including sex, age, body weight, body mass index, metabolic diseases and blood index, were comparable to those of SADI-S group. All the patients were followed up at 3 months, 6 months and 12 months after operation to compare the weight loss [body weight, body mass index, percent of excess weight loss (%EWL) and percent of total weight loss (%TWL), etc.], remission of obesity-related metabolic diseases (hypertension, hyperuricemia, and type 2 diabetes mellitus, etc.) and nutritional deficiency (albumin, retinal-binding-protein, vitamin B12, vitamin D and iron protein, etc.) between the two groups. Results: All the patients successfully underwent laparoscopic bariatric surgery without conversion to laparotomy or death. Compared with SG group, SADI-S group had longer operative time [(204.8±38.3) minutes vs. (109.2±22.4) minutes, t=10.107, P<0.001], higher rate of intraoperative drainage tube [100.0% (22/22) vs. 50.0% (11/22), P<0.001], longer duration of indwelling drainage tube [4 (2-7) days vs. 1 (0-7) days, U=131.000, P=0.008], and the differences were statistically significant (all P<0.05). There was no significant difference between the SG group and the SADI-S group in terms of postoperative hospital stay and complication rate. The weight loss efficacy of SADI-S group and SG group was compared at 3, 6 and 12 months after operation. The results showed that with the increase of follow-up time, the patient's body weight and body mass index gradually decreased, %EWL and %TWL gradually increased (all P<0.05). There were no statistically significant differences in body weight, body mass index and %EWL between the SADI-S group and the SG group at 3, 6 and 12 months after operation (all P>0.05). There was no statistically significant difference of %TWL between two groups at 3 months after operation (F=0.846, P=0.368), but SADI-S group had higher %TWL at 6 and 12 months after operation and the differences were statistically significant (6-month: 34.0±5.1 vs. 30.2±4.3, F=5.813, P=0.025; 12-month: 42.9±6.8 vs. 34.8±7.6, F=14.262, P=0.001). Except for that the remission rate of total cholesterol of SADI-S group was higher than that of SG group, remission rates of metabolic diseases were not significantly different at different follow-up points (all P>0.05). As for the nutrient deficiency (albumin, retinal-binding-protein, iron protein, vitamin B12, vitamin D and folic acid) and the incidence of gallstones, no significant differences were found between two groups (all P>0.05). Conclusion: Both SADI-S and SG are safe and effective for the treatment of obesity and obesity-related metabolic diseases, but the former is more effective.

Are enterotypes in obese modified by bariatric surgery, the use of probiotic supplements and food habits? / Enterótipos em obesos são modificados pela cirurgia bariátrica, uso de suplementos probióticos e hábitos alimentares?

ABSTRACT Introduction: Studies suggest that bariatric surgery, use of probiotic supplements and the dietary pattern can change enterotypes, as well as the entire microbial population. Objective: To verify the influence of bariatric surgery, the use of probiotic supplements and eating habits on enterotypes in obese patients. Methods: Articles published between the 2015 and 2020 were searched in Lilacs and PubMed with the headings: probiotics, eating behavior, food consumption, food, diet, microbiota, gastrointestinal microbiome, bariatric surgery, gastric bypass and the keyword enterotype in Portuguese, English and Spanish. Results: Of the 260 articles found, only studies carried out in obese adults relating changes in the enterotype after bariatric surgery or use of probiotics or dietary patterns and original articles were selected. In the end, eight papers on enterotype change and bariatric surgery were selected and categorized, four on the relationship between food consumption and microbiota and one on the effects of probiotics on enterotypes. Conclusion: The microbial structure is widely modified after bariatric surgery, since the use of probiotic supplement does not bring lasting changes. Enterotypes appear to be shaped by long-term dietary patterns, can modulate how nutrients are metabolized and can be a useful biomarker to improve clinical management.

RESUMO Introdução: Estudos sugerem que a cirurgia bariátrica, uso de suplementos probióticos e o padrão alimentar podem mudar enterótipos, assim como toda a população microbiana. Objetivo: Verificar a influência da cirurgia bariátrica, do uso de suplementos probióticos e de hábitos alimentares nos enterótipos de pacientes obesos. Métodos: Foi realizada a busca de artigos publicados entre os anos de 2015 e 2020 nas bases de dados Lilacs e PubMed com os descritores: probióticos, comportamento alimentar, consumo alimentar, alimentação, dieta, microbiota, microbioma gastrointestinal, cirurgia bariátrica, bypass gástrico e a palavra-chave enterótipo em português, inglês e espanhol. Resultados: Dos 260 artigos encontrados, foram selecionados os estudos originais realizados em adultos obesos relacionando mudanças de enterótipo após cirurgia bariátrica, a padrões alimentares ou ao uso de probiótico. Ao final, foram selecionados e categorizados oito estudos sobre mudança de enterótipo e cirurgia bariátrica, quatro sobre relação entre consumo alimentar e microbiota e somente um sobre efeitos dos probióticos nos enterótipos. Conclusão: A estrutura microbiana é amplamente modificada após a cirurgia bariátrica. O uso de suplemento probiótico não parece trazer mudanças duradouras. Os enterótipos parecem ser moldados por padrões alimentares em longo prazo e podem modular como os nutrientes são metabolizados, podendo vir a ser um biomarcador útil para melhorar o manejo clínico de pacientes obesos.

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.

Suprapubic lipectomy with a "Ω" incision for buried penis in obese adult men / 中华男科学杂志

Objective@#To investigate the application of suprapubic lipectomy with a "Ω" incision to removal of the prepubic fat pad for the management of buried penis in obese adult patients.@*METHODS@#We retrospectively analyzed the clinical data on 20 obese adult patients with buried penis treated by suprapubic lipectomy via a "Ω" incision between August 2016 and September 2019.@*RESULTS@#The operations were successfully completed in all the cases, with a mean operation time of 3.7 ± 0.6 hours and an average hospital stay of 8.3 ± 3.3 days. There were no such severe surgery-related complications as hematoma, urethral injury, or fat embolism in any of the cases. Fat liquefaction-related superficial wound infection developed in 1 patient postoperatively, which was cured by combined topical and systemic antibiotic therapy. A 3-month follow-up showed a 95% satisfaction of the patients with the postoperative appearance of the penis and suprapubic incision, but no complications such as ED, abnormal penile sensation, or penile retraction.@*CONCLUSIONS@#Suprapubic lipectomy with a "Ω" incision to remove the prepubic fat pad is an effective surgical approach to the management of buried penis in obese adult males, which is an anatomy-based surgical correction and has the advantages of slight injury, rapid recovery and few complications./.

Guía de práctica clínica para el manejo quirúrgico de la obesidad en adultos / Clinical practice guideline for the surgical management of obesity in adults

Según la Organización Mundial de la Salud, la obesidad se define como una acumulación excesiva de grasa corporal (1), que tiene una estrecha relación con la aparición o complicación de enfermedades crónicas como la diabetes, enfermedades cardiovasculares, y el cáncer (2). En la actualidad, la obesidad es considerada como una pandemia a nivel mundial (3) que afecta a más de 650 millones de adultos, con una prevalencia de 13% para el 2016, y una tendencia al alza (2). En países con altas prevalencias de obesidad, como México, se ha estimado un costo de la obesidad equivalente al 0.5% del producto bruto interno, que constituye el 9% del gasto en salud, y un costo por mortalidad prematura asociada a obesidad de 1390 millones de dólares (3). Frente a esto se han priorizado las estrategias de prevención y manejo de la obesidad. Sin embargo, en ciertas personas con obesidad, los cambios en los estilos de vida y el tratamiento farmacológico no es suficiente para el manejo de esta condición, sobre todo en aquellos que presentan un estadio severo (4). Por lo cual se han propuesto alternativas de tratamiento para la obesidad como la cirugía bariátrica/metabólica. La cirugía bariátrica corresponde al conjunto de intervenciones quirúrgicas cuyo objetivo es la reducción de peso en pacientes con obesidad severa, mientras que la cirugía metabólica es el término que se aplica cuando el objetivo de la intervención es el control de la comorbilidad adyacente a la obesidad severa (5, 6). El Seguro Social de Salud (EsSalud) priorizó la realización de la presente guía de práctica clínica (GPC) para establecer lineamientos basados en evidencia para el manejo quirúrgico de la obesidad en adultos.

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.

Significados en torno a la experiencia de someterse a una segunda intervención quirúrgica para bajar de peso / MEANING ABOUT THE EXPERIENCE OF SUBMITTING A SECOND SURGICAL INTERVENTION TO LOSE WEIGHT

Diversos motivos inciden en que los pacientes se sometan a cirugía bariátrica para hacer frente a la obesidad. Pese a ser el procedimiento más eficaz contra el exceso de peso, existe una alta tasa de pacientes que después de la cirugía, recuperan un porcentaje importante del peso perdido. Esta re-ganancia de peso genera consecuencias médicas, físicas y psicológico-emocionales; y en muchos casos lleva a que los pacientes vuelvan a someterse a intervenciones quirúrgicas con el objetivo de reactivar la pérdida de peso. No obstante, las re-operaciones no suelen tener la misma eficacia en términos de la pérdida de peso y su mantención. Esta investigación se centra en los significados psicológicos de la experiencia de someterse a más de una intervención quirúrgica para perder peso, con el objetivo de comprender lo que implica este proceso para los pacientes, así como también las repercusiones que trae consigo someterse a más de una intervención de este tipo. La metodología que se utilizó fue cualitativa con un enfoque desde la Teoría Fundamentada y con un alcance descriptivo para comprender lo que deben vivir estos pacientes. Para llevar a cabo esta investigación, se realizaron entrevistas semi-estructuradas a cuatro mujeres y un hombre, quienes previamente se habían sometido a una intervención quirúrgica para perder peso, y luego de unos años y de haber recuperado el peso perdido se sometieron a una cirugía bariátrica. La elección de la segunda intervención se asoció a la creencia que la recuperación de peso se debió principalmente a la técnica de la primera intervención, evaluación que cambia hacia una percepción de bajo control en la alimentación, tras la re-ganancia de peso post-segunda intervención. Se observa niveles importantes de frustración tras esta segunda re-ganancia.

There are several reasons why patients choose to undergo bariatric surgery to cope with obesity. Despite being the most effective procedure against excess weight, there is a high rate of patients who, after surgery, recover a significant percentage of the weight lost. This regain of weight generates medical, physical and psychological-emotional consequences; and in many cases it leads to patients re-undergo surgery with the aim of reactivating weight loss. However, re-operations are usually not as effective in terms of weight loss and weight maintenance. This research focuses on the psychological meanings of a patient's experience of more than one surgical intervention to lose weight, with the aim of understanding what this process implies for patients, as well as the repercussions of obtaining more than one intervention of this type. The specified methodology was qualitative with an approach from the Grounded Theory and with a descriptive scope to understand what these patients must live. To carry out this research, semi-structured interviews were conducted with four women and one man, who had previously undergone surgery to lose weight, and after a few years and having recovered the lost weight, underwent surgery. bariatric The choice of the second intervention was associated with the belief that weight recovery was mainly due to the technique of the first intervention, an evaluation that changes towards a perception of low control in the diet, after the post-weight gain second intervention. Significant levels of frustration are seen after this second regain