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1.
Int. braz. j. urol ; 48(1): 122-130, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1356274

ABSTRACT

ABSTRACT Purpose: To analyze the association between obesity and urinary incontinence rate in men submitted to robot-assisted radical prostatectomy (RARP) in a high-volume cancer center. Materials and Methods: We reported 1.077 men who underwent RARP as the primary treatment for localized prostate cancer from 2013 to 2017. Patients were classified as non-obese (normal BMI or overweight) or obese men (BMI ≥30kg/m2). They were grouped according to the age, PSA level, D'Amico risk group, Gleason score, ASA classification, pathological stage, prostate volume, salvage/adjuvant radiotherapy, perioperative complications, and follow-up time. Urinary continence was defined as the use of no pads. For the analysis of long-term urinary continence recovery, we conducted a 1:1 propensity-score matching to control confounders. Results: Among the obese patients, mean BMI was 32.8kg/m2, ranging 30 - 45.7kg/m2. Only 2% was morbidly obese. Obese presented more comorbidities and larger prostates. Median follow-up time was 15 months for the obese. Complications classified as Clavien ≥3 were reported in 5.6% of the obese and in 4.4% of the non-obese men (p=0.423). Median time for continence recovery was 4 months in both groups. In this analysis, HR was 0.989 for urinary continence recovery in obese (95%CI=0.789 - 1.240; p=0.927). Conclusions: Obese can safely undergo RARP with similar continence outcomes comparing to the non-obese men when performed by surgeons with a standardized operative technique. Future studies should perform a subgroup analysis regarding the association of obesity with other comorbidities, intending to optimize patient counseling.


Subject(s)
Humans , Male , Prostatic Neoplasms/surgery , Prostatic Neoplasms/complications , Obesity, Morbid , Robotic Surgical Procedures/adverse effects , Prostate/surgery , Prostatectomy/adverse effects , Treatment Outcome , Recovery of Function , Propensity Score
2.
HU rev ; 48: 1-7, 2022.
Article in Portuguese | LILACS | ID: biblio-1371596

ABSTRACT

Introdução: A obesidade é uma doença crônica de alta prevalência no Brasil associada a alta morbimortalidade, sendo a cirurgia bariátrica uma proposta válida para seu controle e tratamento. Nota-se que há uma escassez na literatura nacional de informações referentes a dados epidemiológicos, bem como das complicações que envolvem a cirurgia bariátrica. Objetivo: Investigar o perfil epidemiológico de indivíduos adultos submetidos a cirurgia bariátrica realizadas em hospital público de ensino no município de Juiz de Fora - MG. Método: Trata-se de um estudo de natureza analítica, observacional, transversal do tipo inquérito por meio do levantamento de prontuários. Resultados: Dos 466 indivíduos que realizaram a cirurgia bariátrica, a média de idade dos indivíduos foi de 40,2 anos e 85,2% eram do sexo feminino. Cerca de 84% dos pacientes classificaram-se com obesidade grau III. A comorbidade que mais prevaleceu no grupo pesquisado foi a hipertensão arterial (89%), a taxa de mortalidade foi de 1,9% e a frequência de complicações foram mais observadas em pacientes com obesidade grau III (68%). Conclusão: O perfil dos pacientes que buscaram abordagem cirúrgica para obesidade foi predominantemente de mulheres na terceira e quartas décadas de vida, brancas, com obesidade mórbida, tendo como comorbidade mais frequente DM e HAS, sendo que a presença de comorbidades não esteve associada ao aumento no risco de intercorrências do procedimento. A taxa geral de complicações foi baixa e o grau de obesidade esteve diretamente associado à sua ocorrência. A cirurgia bariátrica para tratamento da obesidade mostrou-se segura, com baixa taxa de complicações em um centro especializado, caracterizando, até o momento, a maior casuística nacional.


Introduction: Obesity is a chronic disease of high prevalence in Brazil associated with high morbidity and mortality, and bariatric surgery is a valid proposal for its control and treatment. It is noted that there is a shortage in the national literature of information regarding epidemiological data, as well as complications involving bariatric surgery. Objective: To investigate the epidemiological profile of adult individuals undergoing bariatric surgery performed in a public teaching hospital in the city of Juiz de Fora-MG. Method: This is an analytical, observational, cross-sectional survey-type study through the survey of medical records. Results: Of the 466 individuals who underwent bariatric surgery, the average age of individuals was 40.2 years and 85.2% were female. About 84% of patients classified as having grade III obesity. The most prevalent comorbidity in the researched group was systemic arterial hypertension (89%), the mortality rate was 1.9% and the frequency of complications was more observed in patients with grade III obesity (68%). Conclusion: The profile of patients who sought a surgical approach for obesity was predominantly women in the third and fourth decades of life, white, morbidly obese, with DM and SAH as the most frequent comorbidity, and the presence of comorbidities was not associated with the increase in the risk of complications of the procedure. The overall rate of complications was low and the degree of obesity was directly associated with its occurrence. Bariatric surgery for the treatment of obesity proved to be safe, with a low rate of complications in a specialized center, characterizing, to date, the largest sample in Brazil.


Subject(s)
Bariatric Surgery , Obesity, Morbid , Comorbidity , Prevalence , Metabolic Syndrome , Hospitals, Teaching
3.
Arch. endocrinol. metab. (Online) ; 65(6): 730-738, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1349983

ABSTRACT

ABSTRACT Objective: Identifying significant fibrosis is crucial to evaluate the prognosis and therapeutic interventions in patients with nonalcoholic fatty liver disease (NAFLD). We assessed the performance of acoustic radiation force impulse (ARFI) elastography, APRI, FIB-4, Forns, NFS and BARD scores in determining liver fibrosis in severe obesity. Subjects and methods: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC). Results: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s. Conclusions: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.


Subject(s)
Humans , Obesity, Morbid/complications , Obesity, Morbid/diagnostic imaging , Prospective Studies , Elasticity Imaging Techniques , Non-alcoholic Fatty Liver Disease/pathology , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Acoustics , Biopsy , Risk Factors , ROC Curve , Liver/pathology , Liver/diagnostic imaging , Liver Cirrhosis/pathology , Liver Cirrhosis/diagnostic imaging
4.
Säo Paulo med. j ; 139(6): 598-606, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1352299

ABSTRACT

ABSTRACT BACKGROUND: Few reports have examined the effects of Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) on changes to serum albumin (Alb) and liver enzyme levels. OBJECTIVE: To compare short-term post-surgery changes in serum Alb, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALKP) levels. Body composition changes were also measured and compared among three groups. DESIGN AND SETTING: Retrospective cohort study conducted in Tehran, Iran. METHODS: 151 OAGB, RYGB and SG patients referred to the obesity clinic of Hazrat-e Rasool General Hospital, Tehran, Iran, were evaluated. Physical characteristics and biochemical parameters were measured pre-surgery and then after three and six months. RESULTS: Through repeated measurements to determine intragroup changes, significant changes in serum AST (P = 0.003) and ALT (P < 0.001) were observed in follow-ups. However, Alb levels did not change (P = 0.413). Body fat, fat-free mass and muscle mass decreased significantly in each group (P < 0.05). In a univariate general linear model for determining intergroup changes, SG showed greater decreases in ALT and AST at three and six months (P < 0.05) and in ALKP at six months (P = 0.037), compared with OAGB. There were no significant differences in Alb levels. Also, RYGB had a greater effect on reducing fat percentage (three months, P = 0.011; six months, P = 0.059) and fat mass (three months, P = 0.042) than OAGB. CONCLUSION: SG and RYGB may be superior to OAGB in reducing liver enzymes and body fat, respectively. However, Alb levels showed no significant differences.


Subject(s)
Humans , Obesity, Morbid/surgery , Gastric Bypass , Bariatric Surgery , Serum Albumin , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Gastrectomy , Iran , Liver
5.
Rev. Assoc. Med. Bras. (1992) ; 67(9): 1274-1278, Sept. 2021. tab
Article in English | LILACS | ID: biblio-1351460

ABSTRACT

SUMMARY Obesity is a disease characterized by the accumulation of abnormal or excessive fat that can damage health. Bariatric surgery, an effective and safe way to treat this disease, requires multidisciplinary monitoring with an educational nature to change lifestyle. Adherence to routine physical activity can be a part of adopting a healthier lifestyle and can assist in the treatment of this disease and its related comorbidities. OBJECTIVE: Thus, the aim of this study was to analyze the correlation between the evolution of anthropometric variables and the domains of quality of life at different times, including at one year after bariatric surgery in very active and irregularly active individuals. METHODS: This was a longitudinal, observational, prospective, and analytical study. The collected data included anamnesis, level of physical activity (International Physical Activity Questionnaire Short Form), height, weight, body mass index (BMI), average waist circumference, percentage of fat, and the World Health Organization Quality of Life Assessment Bref. RESULTS: Seven female individuals were evaluated and divided into two groups: a very active group and an irregularly active group. In the very active individuals, significant results were found in the evolutionary variables: weight (p<0.001); body mass index (p<0.001); average waist circumference (p<0.001); percentage of fat (p<0.001); and quality of life general (p=0.001). In the irregularly active individuals, a significant result was found only in one evolutionary variable: body mass index (p<0.001). CONCLUSION: Thus, it is evident that the improvement and maintenance of good health is more effective in bariatric individuals who maintain a routine with regular physical activity.


Subject(s)
Humans , Female , Obesity, Morbid/surgery , Bariatric Surgery , Quality of Life , Body Mass Index , Anthropometry , Prospective Studies
6.
Rev. colomb. cir ; 36(2): 352-357, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1247572

ABSTRACT

Las anomalías del uraco representan un bajo porcentaje de las patologías abdominales, no obstante, forman parte del diagnóstico diferencial del abdomen agudo por las complicaciones que puede tener. Aunque son de difícil diagnóstico debido a los síntomas inespecíficos, las imágenes diagnósticas son de gran utilidad para su identificación y caracterización. En pacientes con obesidad mórbida, la presentación del cuadro aumenta el riesgo de morbimortalidad. Por ende, en estos pacientes es necesario un control postoperatorio estricto para evaluar complicaciones secundarias a la resección del uraco. Dado los casos limitados en la literatura, se requieren estudios clínicos adicionales, para brindar un seguimiento adecuado, en aras de identificar complicaciones y el tratamiento precoz de estas


Urachal abnormalities represent a low percentage of abdominal pathologies; however, they are part of the differential diagnosis of acute abdomen due to the complications it may have. Although they are difficult to diagnose due to nonspecific symptoms, diagnostic images are especially useful for their identification and characterization. In patients with morbid obesity, the presentation of the picture increases the risk of morbidity and mortality. Therefore, in these patients, strict postoperative control is necessary to evaluate complications secondary to urachal resection. Given the limited cases in the literature, additional clinical studies are required to provide adequate diagnosis and follow-up in order to identify complications and their early treatment


Subject(s)
Humans , Obesity, Morbid , Intestinal Obstruction , Urachal Cyst , Urachus
7.
Gac. méd. Méx ; 157(1): 67-73, ene.-feb. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279076

ABSTRACT

Resumen Introducción: En México no se han utilizado los instrumentos Shorth Form 36 Items (SF-36) ni Baryatric Assesment Reporting Outcomes System (BAROS) para evaluar la calidad de vida (CV) antes y después de la cirugía bariátrica (CB). Objetivo: Describir los cambios en la CV con los cuestionarios SF-36 y BAROS, en pacientes con obesidad severa antes y después de la CB. Métodos: Se recolectaron los datos clínicos y antropométricos de pacientes sometidos a cirugía baríatrica entre 2015 y 2016. Se consideró con significación estadística una p < 0.05. Resultados: Se analizaron 230 pacientes, 98 y 132 antes y después de la CB; la mayoría fue del sexo femenino (81 %). El índice de masa corporal inicial fue de 48 kg/m2 (44-53). La CV medida con el SF-36 demostró un incremento en la puntuación del componente físico de 43 a 54.2 (p < 0.001) y en el componente mental, de 53.3 a 56.6 después de la CB. Con BAROS, en 98.5 % se registraron resultados buenos a excelentes en la CV en los primeros tres meses. Conclusión: Al ser medida con los cuestionarios SF-36 y BAROS se definió que la CV de los pacientes mexicanos con obesidad severa mejora después de la CB.


Abstract Introduction: In Mexico, neither the 36-item Short Form Health Survey (SF-36) nor the Bariatric Analysis and Reporting Outcome System (BAROS) instruments have been used to assess quality of life (QoL) before and after bariatric surgery (BS). Objective: To describe changes in QoL using the SF-36 and BAROS questionnaires in patients with severe obesity before and after BS. Methods: Clinical and anthropometric data of patients undergoing bariatric surgery between 2015 and 2016 were collected. Statistical significance was considered with a p-value < 0.05. Results: 230 patients were analyzed, 98 before and 132 and after BS; most were females (81 %). Initial body mass index was 48 kg/m2 (44-53). SF-36-measured QoL showed an increase in the physical component score from 43 to 54.2 points (p < 0.001), and in the mental component, from 53.3 to 56.6 points after BS. With BAROS, 98.5 % showed good to excellent QoL results within the first three months after BS. Conclusion: When measured with the SF-36 and BAROS questionnaires, QoL of Mexican patients with severe obesity was found to improve after BS.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Obesity, Morbid/surgery , Obesity, Morbid/psychology , Bariatric Surgery/psychology , Postoperative Period , Body Mass Index , Health Surveys , Preoperative Period , Mexico
8.
Einstein (Säo Paulo) ; 19: eAO5701, 2021. tab, graf
Article in English | LILACS | ID: biblio-1154090

ABSTRACT

ABSTRACT Objective: To examine epidemiologic, anthropometric and clinical variables associated with stress urinary incontinence in obese women, before and after bariatric surgery, and to identify predictive factors of stress urinary incontinence resolution. Methods: Prospective observational study with women enrolled in a bariatric surgery program between 2015 and 2016. Patients were assessed prior to and 6 months after bariatric surgery using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale. Patient assessment also included physical examination and bladder stress tests. Results: A total of 43 women completed the study. There was a 72.7% reduction in stress urinary incontinence (p=0.021). Predictive factors for preoperative diagnosis of stress urinary incontinence included age (p=0.024) and abdominal waist circumference (p=0.048). Urinary symptoms improved after weight loss, especially nocturia (p=0.001) and stress urinary incontinence (p=0.026). Menopause was the most significant predictive factor for persistence of stress urinary incontinence within six months of bariatric surgery (p=0.046). Self-reported outcomes and scores obtained in the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, the Patient Global Impression of Improvement and the Visual Analogue Scale were associated with significant improvement (p=0.012, p=0.025, and p=0.002 respectively). Conclusion: Older women with larger waist circumference have a higher risk of developing stress urinary incontinence prior to bariatric surgery. Menopausal women are highly prone to persistent stress urinary incontinence, even after weight loss. Weight loss achieved through bariatric surgery improved stress urinary incontinence symptoms and mitigated related impacts on quality of life in the vast majority of women.


RESUMO Objetivo: Examinar as variáveis epidemiológicas, antropométricas e clínicas associadas à incontinência urinária de esforço em mulheres obesas antes e após a cirurgia bariátrica e identificar fatores preditivos da resolução desse tipo de incontinência. Métodos: Estudo observacional prospectivo com mulheres de um programa de cirurgia bariátrica, realizado entre 2015 e 2016. As pacientes responderam ao International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, à Clinical Global Impression-Improvement e à Escala Visual Analógica, sendo submetidas ao exame físico e ao teste de incontinência antes e 6 meses após cirurgia bariátrica. Resultados: Completaram o estudo 43 mulheres. Houve redução de 72,7% na incontinência urinária de esforço (p=0,021). Fatores preditivos para o diagnóstico pré-operatório da incontinência urinária incluíram idade (p=0,024) e circunferência abdominal (p=0,048). Todos os sintomas urinários demonstraram melhora após perda de peso, notadamente noctúria (p=0,001) e incontinência urinária de esforço (p=0,026). A menopausa foi o fator mais crítico para predizer a persistência da incontinência urinária de esforço 6 meses após a cirurgia bariátrica (p=0,046). Os resultados relatados do International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, da Patient Global Impression of Improvement e da Escala Visual Analógica tiveram melhora significativa (p=0,012, p=0,025, p=0,002, respectivamente). Conclusão: Mulheres idosas e com maior circunferência abdominal têm maior risco de desenvolver incontinência urinária de esforço antes da cirurgia. Mulheres na menopausa são fortemente propensas a persistir com a incontinência urinária de esforço, mesmo após a perda de peso. A perda de peso após a cirurgia bariátrica melhora os sintomas de incontinência urinária de esforço e seus impactos na qualidade de vida na maioria das mulheres.


Subject(s)
Humans , Female , Urinary Incontinence, Stress/etiology , Obesity, Morbid/surgery , Obesity, Morbid/complications , Bariatric Surgery , Quality of Life , Menopause , Prospective Studies , Surveys and Questionnaires , Age Factors , Treatment Outcome , Waist Circumference
9.
Rev. Col. Bras. Cir ; 48: e20202638, 2021. tab
Article in English | LILACS | ID: biblio-1287892

ABSTRACT

ABSTRACT Introduction: bariatric surgery is the main treatment for cases of severe obesity and body contour surgery to correct body dysmorphia resulting from weight loss. However, these procedures are associated with a significant number of postoperative complications. Objective: this study aims to analyze complications in post-bariatric patients undergoing body contour surgeries and correlating them with the age and BMI of these patients. Methods: the current study is a retrospective study evaluating 180 consecutive patients undergoing body contour surgery after bariatric surgery within a period of three years (2014-2016). Data such as age, gender, Body Mass Index before bariatric and plastic surgeries, type of surgery performed and complications were collected, and correlated the age as well as the BMI of the patients in the pre-bariatric (PB) and pre-plastic (PP) periods with the complications presented. Results: of the 180 patients evaluated, 91.7% were females (n = 165), and the mean age was 46.3 ± 1.7 years. The most performed surgery was abdominoplasty (48.9%), followed by mammaplasty (21.1%). Some complications occurred in 26.1% of the patients with partial dehiscence (40.4%) and seroma (14.9%) being the most frequent. Patients who presented complications had a higher mean age (50.8 years) than those who presented with no complications, and major complications accounted for 2.7% of the sample. Conclusions: a statistically significant number of surgeries progressed without complications and, when they occurred, there were minor complications in most of the sample. Complications were more frequent in older patients with some of them having a BMI over 30 Kg/m2.


RESUMO Introdução: a cirurgia bariátrica é o principal tratamento para os casos de obesidade grave e a cirurgia de contorno corporal trata a dismorfia corporal resultante desta perda de peso. No entanto, estes procedimentos estão associados a um número significativo de complicações pós-operatórias. Objetivo: analisar as complicações maiores e menores que ocorreram nos pacientes pós-bariátricos submetidos a cirurgias reparadoras do contorno corporal e correlacioná-las com idade e IMC destes pacientes. Métodos: estudo retrospectivo que avaliou 180 pacientes consecutivos submetidos a cirurgia de contorno corporal, após cirurgia bariátrica, no período de 3 anos (2014-2016). Foram coletados dados como idade, gênero, IMC pré-bariátrica e pré-plástica, tipo de cirurgia realizada e complicações, correlacionando a idade e o IMC dos pacientes nos períodos pré-bariátrica (PB) e pré-plástica (PP) com as complicações apresentadas. Resultados: dos 180 pacientes avaliados, 91,7% eram do gênero feminino (n=165) e a idade média foi de 46,3 ± 1,7 anos. A cirurgia mais realizada foi abdominoplastia (48,9%), seguida da mamoplastia (21,1%). Complicações ocorreram em 26,1% dos pacientes, sendo deiscência parcial a principal (40,4%) seguida de seroma (14,9%). Pacientes com complicações apresentaram média etária maior (50,8 anos) que os sem complicações, sendo que as complicações maiores ocorreram em 2,7% da amostra. Conclusões: a maioria estatisticamente significante das cirurgias cursou sem complicações e, quando ocorreram, foram complicações menores na maior parte da amostra. As complicações foram mais frequentes nos pacientes de idade mais avançada, dos quais alguns com IMC maior que 30kg/m2.


Subject(s)
Humans , Female , Adult , Aged , Obesity, Morbid/surgery , Bariatric Surgery , Abdominoplasty , Body Contouring , Postoperative Complications/surgery , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Retrospective Studies , Middle Aged
10.
ABCD arq. bras. cir. dig ; 34(4): e1627, 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1360012

ABSTRACT

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


ABSTRACT - BACKGROUND: Obesity is a disease characterized by an excessive accumulation of body fat, which is harmful to health, and it has grown significantly in the past years in the majority of countries. The surgery should be recommended to those patients with obesity who did not succeed in conservative clinical therapy after a rigorous analysis by a multidisciplinary team. Objective: The aim of this study was to compare metabolic results, weight loss, and parameters associated with obesity in the preoperative and postoperative periods of patients treated with bariatric surgery. Methods: This was a retrospective, descriptive, cross-sectional, and quantitative study through consultation medical records. Data were collected from May to September 2020 from individuals treated with bariatric surgery in a period of 15 years (from 2003 to 2018). A comparative and descriptive statistical analysis of anthropometric, metabolic, biochemical, and associated morbidities was performed. Results: The majority of patients were female (68.50%). In both sexes, the highest prevalence was found in the age group of 30-39 years and more than half had grade III obesity. The surgical technique used was gastroplasty with Roux-en-Y gastric bypass. After 4 months, there was a significant reduction in the lipid profile, anthropometric parameters, and liver enzymes in both sexes, which remained decreasing till the end of the first year, with marked improvement in the metabolic syndrome (MS). Conclusions: The positive impact resulted from gastroplasty in terms of weight loss, reduction of body mass index, and lipid profile is quite relevant after 4 months and it is maintained until 1 year after the procedure, showing benefits in reducing the risk factors of the MS.


Subject(s)
Humans , Male , Female , Adult , Obesity, Morbid/surgery , Bariatric Surgery , Brazil , Cross-Sectional Studies , Retrospective Studies , Follow-Up Studies , Hospitals
11.
ABCD arq. bras. cir. dig ; 34(4): e1631, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360010

ABSTRACT

RESUMO - RACIONAL: Os afastadores clássicos de cirurgia laparoscópica são geralmente rígidos, necessitando de uma incisão adicional para sua instalação ou de um auxiliar para manuseio durante o ato cirúrgico e ainda, podem envolvem risco de injúria hepática. OBJETIVOS: Avaliar e validar uma técnica de exposição da junção esofagogástrica obtida pelo afastador flexível de fígado em cirurgia bariátrica comparando sua eficácia com a de afastador classicamente utilizado para este fim. MÉTODOS: Tratou-se de um estudo prospectivo, aberto, controlado e comparativo em pacientes com indicação de cirurgia, distribuídos de forma randomizada em dois grupos: clássico (controle) e afastador flexível (teste). RESULTADOS: Foram incluídos 100 pacientes (n=50 grupo controle, n=50 grupo teste), sem diferença estatística na distribuição por idade e por morbidades, havendo diferença estatística somente no gênero (grupo controle obteve proporção maior de homens, p=0,020). Em relação ao tempo médio de realização das operações, não foi constatada diferença estatística. No quesito visibilidade, verificou-se que 100% dos pacientes do grupo afastador flexível obteve nível de visibilidade ótima, porém sem significância estatística com relação ao grupo clássico (94%). Invariavelmente, foi necessário um portal a mais de trocarte quando do uso do afastador clássico. CONCLUSÃO: O afastador flexível de fígado demonstrou-se seguro, eficaz, ergonômico, de baixo custo, de perfil estético satisfatório, não requerendo instrumental específico para uso ou nova curva de adaptação e aprendizado para manuseio.


ABSTRACT - BACKGROUND: In the Roux-en-Y gastric bypass technique, classic laparoscopic surgical retractors are usually rigid, require an additional incision for its installation, or must be handled by an assistant during the surgical procedure, involving a risk of liver injury. Aim: The aim of this study was to evaluate and validate a technique of the esophagogastric junction exposure obtained by the flexible liver retractor in bariatric surgery, comparing its efficacy with the retractor classically used for this purpose. Methods: This study was performed as a randomized, open, prospective, controlled, and comparative design in patients with medical indications of bariatric surgery. The subjects were distributed in the classic (control) and flexible (test) retractor groups. Results: A total of 100 patients (n=50 control group, n=50 test group) were included. No statistically significant difference was observed in the mean duration of surgery. Regarding visibility, 100% of the patients in the flexible retractor group demonstrated an optimal visibility level, although without statistical significance concerning the classic retractor group (94%). Invariably, carrying a trocar was necessary when using the classic retractor. Conclusions: The flexible liver retractor is safe, effective, ergonomic, and inexpensive. Furthermore, it presented a satisfactory aesthetic profile, and the use of specific instruments, new adaptation curve, and training for its handling were not required.


Subject(s)
Humans , Obesity, Morbid , Gastric Bypass , Bariatric Surgery , Prospective Studies , Esophagogastric Junction/surgery
12.
ABCD arq. bras. cir. dig ; 34(4): e1634, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360005

ABSTRACT

RESUMO - RACIONAL: Os fatores relacionados à perda de peso nos pacientes obesos submetidos à cirurgia bariátrica sempre foram exaustivamente estudados na tentativa de propor a melhor técnica cirúrgica com maior perda de peso e resolução as comorbidades à longo prazo. Os pacientes apresentam variações anatômicas no que tange o comprimento do intestino delgado. Há estudos que demonstram alterações de peso nos pacientes que apresentam diferentes comprimentos das alças intestinais na técnica do by-pass em Y de Roux. O presente trabalho realizou um estudo entre a influência do IMC, a perda de peso e o comprimento da alça comum nos resultados cirúrgicos à longo prazo. MÉTODOS: Estudo transversal descritivo pela análise retrospectiva de 112 prontuários de pacientes submetidos à cirurgia bariátrica aberta pela técnica do bypass gástrico no Hospital de Clínicas -UFPR. Os dados foram correlacionados em programas estatísticos para este fim. RESULTADOS: Dos 112 pacientes, 83,03% eram do sexo feminino, média de idade de 41,52 anos. O comprimento médio do intestino delgado total dos pacientes foi de 5,02 metros. Houve uma relação diretamente proporcional entre o comprimento do intestino delgado e a perda de peso (p=0,0428). CONCLUSÃO: Há uma ampla gama de variáveis relacionadas à perda de peso nos pacientes submetidos à cirurgia bariátrica, tais como a técnica utilizada, o comprimento das alças no by-pass gástrico em Y de Roux e a rotina de acompanhamento nutricional e físico do paciente. É importante considerar os detalhes técnicos do procedimento cirúrgico, e verificar a perda de peso avaliando-se o paciente como um todo e outras variáveis.


ABSTRACT - BACKGROUND: Factors related to weight loss in obese patients undergoing bariatric surgery have always been exhaustively studied in an attempt to propose the best surgical technique with greater weight loss and long-term resolution of comorbidities. Patients present anatomical variations regarding the length of the small intestine. Some studies demonstrate weight changes in patients with different lengths of the intestinal loops in the Roux-en-Y bypass technique. The present work carried out a study on the influence of body mass index, weight loss, and common loop length on long-term surgical outcomes. METHODS: This is a descriptive cross-sectional study by retrospective analysis of 112 medical records of patients undergoing open bariatric surgery using the gastric bypass technique at University Hospital - UFPR. The data were correlated in statistical programs for this purpose. RESULTS: Out of 112 patients, 83.03% were women, with mean age of 41.52 years. The mean length of the total small bowel of the patients was 5.02 m. There was a directly proportional relationship between the length of the small intestine and weight loss (p=0.0428). CONCLUSION: There is a wide range of variables related to weight loss in patients undergoing bariatric surgery, such as the technique used, the length of the loops in the Roux-en-Y gastric bypass, and the routine of nutritional and physical monitoring of the patient. It is important to assess the technical details of the surgical procedure and to verify the weight loss by evaluating integrally the patient and other variables.


Subject(s)
Humans , Female , Adult , Obesity, Morbid , Weight Loss , Cross-Sectional Studies , Retrospective Studies , Intestine, Small/surgery
13.
ABCD arq. bras. cir. dig ; 34(3): e1598, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1355503

ABSTRACT

ABSTRACT Background: Gastro-omentopexy promotes the reconnection of the stomach to the gastroesplenic and gastrocolic ligaments and constitutes an alternative for the prevention of complications in laparoscopic vertical gastrectomy. Aim: To demonstrate the benefits of the gastro-omentopexy technique in patients undergoing sleeve gastrectomy, with possible reduction in postoperative complications. Methods: Prospective, non-randomized, case series type study, consisting of a clinical population of 179 patients who underwent the technique in 2018, with follow-up between 6-12 months in the postoperative period. Results: From the participants 71.5% were women, aged between 30-40 years (36.3%). As for the prevalence of complications in the postoperative period, the low prevalence was evident, with emphasis on readmission (1.1%); reoperation (1.1%); wound infection (1.1%); bleeding hemorrhage (0.5%); and stricture (1.1%). However, temporary symptoms were present such as nausea/vomiting, food intolerance, epigastric pain and feeling of fullness, right after surgery. Conclusion: The technique promoted a significant improvement in quality of life and control of comorbidities. In addition, it was associated with a low prevalence of stenosis, and with no fistula, making the method safer.


RESUMO Racional: A gastro-omentopexia promove a reconexão do estômago aos ligamentos gastroesplênico e gastrocólico e pode constituir alternativa para prevenção de complicações na gastrectomia vertical laparoscópica. Objetivo: Demonstrar os benefícios da gastro-omentopexia em pacientes submetidos à gastrectomia vertical laparoscópica com redução de complicações. Métodos: Estudo prospectivo, não randomizado, do tipo série de casos, constituído por população de 179 pacientes que realizaram a técnica, com acompanhamento entre 6-12 meses no pós-operatório. Resultados: Dos participantes 71,5% eram mulheres, com faixa etária entre 30-40 anos (36,3%). Quanto às complicações no pós-operatório evidenciou-se baixa prevalência delas com destaque para reinternação (1,1%); reoperação (1,1%); infecção de ferida (1,1%); sangramento/hemorragia (0,5%); e estenose gástrica (1,1%). Entretanto, surgiram sintomas temporários como náusea/vômito, intolerância alimentar, dor epigástrica e sensação de plenitude, logo após a operação. Houve melhora nas variáveis de qualidade de vida analisadas. Conclusão: A técnica promoveu melhora na qualidade de vida e no controle das comorbidades. Além disso, esteve associada à baixa prevalência de estenose, e sem ocorrência de fístula, tornando o método mais seguro.


Subject(s)
Humans , Female , Adult , Obesity, Morbid/surgery , Laparoscopy , Postoperative Complications/surgery , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Quality of Life , Stomach , Prospective Studies , Retrospective Studies , Treatment Outcome , Gastrectomy
14.
ABCD arq. bras. cir. dig ; 34(1): e1579, 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1284900

ABSTRACT

ABSTRACT Background: In the last decades, numerous studies have confirmed the importance of lactate - by-product to the nutrient signal of the intracellular redox state - to regulatory functions in energy metabolism. Aim: To evaluate changes in blood lactate in patients with severe obesity and its correlation with body composition and metabolic profile. Methods: Twenty-four people with severe obesity (BMI=40 kg/m2) were evaluated in a prospective case-control study before and six months after Roux-in-Y gastric bypass. The blood lactate, total cholesterol, and fractions, C-reactive protein and HOMA-IR were analyzed after 12 h fasting. Body mass composition was evaluated by bioelectrical impedance and respiratory quotient was measured by indirect calorimetry. Results: The initial lactate level was 2.5±1.1 mmol/l and returned to normal level (1.9±3.6 mmol/l, p=0.0018) after surgery. This reduction was positively correlated with a decrease in BMI (p=0.0001), % free fat mass (p=0,001), % fat mass (p=0.001) and HOMA-IR (p=0.01). There was normalization of lactatemia in 70% of patients. There was no correlation between lactatemia and C-reactive protein. Conclusions: There was a significant improvement of metabolic parameters, normalization of blood lactate, fat mass loss, although these individuals remained with a high BMI.


RESUMO Racional: Nas últimas décadas, inúmeros estudos confirmam a importância do lactato - subproduto ao sinal de nutrientes do estado redox intracelular - às funções reguladoras do metabolismo energético. Objetivo: Avaliar alterações no lactato sanguíneo em pacientes com obesidade grave e sua correlação com a composição corporal e o perfil metabólico. Métodos: Vinte e quatro pacientes com obesidade grave (IMC=40 kg/m2) foram avaliadas em um estudo prospectivo antes e após seis meses do bypass gástrico em Y-de-Roux. O lactato sanguíneo, colesterol total e frações, proteína C-reativa e HOMA-IR foram analisados após 12h de jejum. A composição corporal foi avaliada por bioimpedância elétrica e o quociente respiratório por calorimetria indireta. Resultados: O nível inicial de lactato foi de 2,5±1,1 mmol/l e retornou ao nível normal após a operação (1,9±3,6 mmol/l, p=0,0018). Essa redução foi correlacionada positivamente com a diminuição do IMC (p=0,0001), % de massa livre de gordura (p=0,001) e % de massa de gordura (p=0,001) e HOMA-IR (p=0,01). Houve normalização da lactatemia em 70% dos pacientes. Não houve correlação entre lactatemia e proteína C-reativa. Conclusões: Houve melhora significativa dos parâmetros metabólicos e normalização da lactatemia, perda de massa gorda, embora esses indivíduos permanecessem com IMC elevado.


Subject(s)
Humans , Obesity, Morbid/surgery , Obesity, Morbid/complications , Gastric Bypass , Metabolic Syndrome , Body Mass Index , Case-Control Studies , Prospective Studies , Lactic Acid
15.
REVISA (Online) ; 10(1): 181-194, 2021.
Article in Portuguese | LILACS | ID: biblio-1177803

ABSTRACT

Objetivo: Analisar a frequência de implementação de cirurgias bariátricas (CB) realizadas no "Brasil" entre os anos de "2011 a 2019", ou seja, nove (09) anos. Método: Estudo exploratório, descritivo e de abordagem quantitativa. Os dados foram extraídos junto a Sociedade Brasileira de Cirurgia Bariátrica e Metabólica (SBCBM). Foi implementada análise estatística do tipo descritiva. Os resultados foram apresentados por meio de tabelas explicativas e de gráficos. Resultados: Foi identificado o universo de 493.212 CB realizadas, com média e desvio padrão de (54.801±11.300,2). O ano de 2019 registrou a maior preponderância com 13,9% (n=68.530) e 2011 registrou a menor preponderância com 7% (n=34.629). Foram identificadas 79,9% (n=394.101) CB financiadas pelos Planos de Saúde, 15,3% (n=75.624) pelo SUS e 4,8% (n=23.487) por instituições particulares. Considerações finais: Foi verificado aumento na frequência de registros de CB realizadas no recorte geográfico e histórico analisados.


Objective: To analyze the frequency of implementation of bariatric surgery (CB) performed in "Brazil" between the years "2011 to 2019", that is, nine (09) years. Method: Exploratory, descriptive study with a quantitative approach. The data were extracted from the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM). Descriptive statistical analysis was implemented. The results were presented using explanatory tables and graphs. Results: The universa of 493.212 CB performed was identified, with a mean and standard deviation of (54,801±11,300.2). The year 2019 registered the highest preponderance with 13.9% (n=68.530) and 2011 registered the lowest preponderance with 7% (n=34.629). 79.9% (n=394.101) CB were financed by Health Plans, 15.3% (n=75.624) by SUS and 4.8% (n=23.487) by private institutions. Final considerations: There was an increase in the frequency of CB records made in the analyzed geographical and historical section.


Objetivo: Analizar la frecuencia de implementación de la cirugía bariátrica (CB) realizada en "Brasil" entre los años "2011 a 2019", es decir, nueve (09) años. Método: Estudio exploratorio, descriptivo con enfoque cuantitativo. Los datos fueron extraídos de la Sociedad Brasileña de Cirugía Bariátrica y Metabólica (SBCBM). Se implementó un análisis estadístico descriptivo. Los resultados se presentaron mediante tablas explicativas y gráficos. Resultados: Se identificó el universo de 493,212 CB realizados, con una media y desviación estándar de (54,801±11,300.2). El año 2019 registró la mayor preponderancia con 13,9% (n=68.530) y 2011 registró la menor preponderancia con 7% (n=34.629). 79,9% (n=394,101) CB fueron financiados por Planes de Salud, 15,3% (n=75,624) por SUS y 4,8% (n=23,487) por instituciones privadas. Consideraciones finales: Hubo un aumento en la frecuencia de registros de CB realizados en el tramo geográfico e histórico analizado.


Subject(s)
Obesity, Morbid , Bariatric Surgery , Obesity
16.
Rev. Col. Bras. Cir ; 48: e20212982, 2021. graf
Article in English | LILACS | ID: biblio-1351523

ABSTRACT

ABSTRACT Objective: minimally invasive bariatric surgery is clearly superior over open procedures including better early outcomes. Different surgical approaches are used to treat the severely obese, having Roux-en-Y gastric bypass (RYGB) being a highly frequent procedure. Robotic surgery overcomes some laparoscopic limitations adding ergonomics, articulating instruments and a three-dimensional high definition camera. Based on our vast robotic experience, we present our referred group case series and a standardized Robotic Roux-en-Y gastric bypass (rRYGB) technique as well as its outcomes. Methods: a review of a prospective maintained database was conducted in patients submitted to robotic Roux en Y bariatric surgery between April 2015 and July 2019. Surgical technique is described and illustrated. We also reported patients demographics, outcomes and its follow-up. Results: a Retrospective analysis identified 329 patients submitted to Robotic Roux-en-Y gastric bypass. Both da Vinci Si and Xi platforms were used. Mean age was 34.4 years, with median BMI of 44.2 kg/m2. Mean console time was 102 min and there was no conversion. No surgical hospital readmission rates were seen in the first 30 days. Conclusion: this study represents our initial experience of robotic Roux-en-Y gastric bypass (rRYGB), its short outcomes and a standardized surgical technique. Our results encourage that rRYGB is technically feasible and safe, and might offer some advantages showing good outcomes and minimal complications.


RESUMO Objetivo: a cirurgia bariátrica minimamente invasiva é claramente superior aos procedimentos abertos, incluindo melhores resultados iniciais. Diferentes abordagens cirúrgicas são usadas para tratar os gravemente obesos, sendo o bypass gástrico em Y de Roux (RYGB) um procedimento muito frequente. A cirurgia robótica supera algumas limitações laparoscópicas adicionando ergonomia, instrumentos de articulação e uma câmera tridimensional de alta definição. Com base em nossa experiência em cirurgia robótica, apresentamos uma série de casos operados com uma técnica de bypass gástrico em Y de Roux robótico (rRYGB) padronizada, bem como seus resultados. Métodos: foi realizada uma revisão de um banco de dados prospectivamente de pacientes submetidos à cirurgia robotica de bypass gastrico em Roux en Y entre abril de 2015 e julho de 2019. A técnica cirúrgica é descrita e ilustrada. Também relatamos dados demográficos dos pacientes, resultados e seu acompanhamento. Resultados: uma análise retrospectiva identificou 329 pacientes submetidos ao bypass gástrico em Y de Roux robótico. Ambas as plataformas da Vinci, Si e Xi foram usadas. A média de idade foi de 34,4 anos, com mediana de IMC de 44,2 kg/m2. O tempo médio do console foi de 102 min e não houve conversão. Nenhuma taxa de readmissão hospitalar cirurgica foi observada nos primeiros 30 dias. Conclusão: este estudo representa a experiência inicial de bypass gástrico em Y-de-Roux robótico (rRYGB), seus resultados iniciais e uma padronização da técnica cirúrgica. Nossos resultados são encorajadores, com uma técnica viável, segura, e potencial benefício ao paciente mostrando bons resultados e mínimas complicações.


Subject(s)
Humans , Adult , Obesity, Morbid/surgery , Gastric Bypass , Laparoscopy , Robotic Surgical Procedures , Prospective Studies , Retrospective Studies , Treatment Outcome
17.
Rev. Col. Bras. Cir ; 48: e20213030, 2021. tab
Article in English | LILACS | ID: biblio-1351518

ABSTRACT

ABSTRACT Introduction: obstructive Sleep Apnea Syndrome (OSAS) is a serious confition that compromises the quality of life and survival of patients. Its main risk fator in adults is obesity and the gold standard test for diagnosis is polysomnography (PSG), mainly through the apneia-hypopnea index (AHI). Objective: to analyze the sleep pattern of obese patients with indication for bariatric surgery, determining the main polisomnographic parameters compromised by obesity. Methods: This work is a cross-sectional study with analysis of polysomnography perfomed in patients with obesity in the peroperative period of bariatric surgery at a clinic in Vitória da Conquista/BA during 2017. The Epi Info 7 platform was used for analysis of the data. Results: 58 polysomnographic reports were analyzed, with 56,9% morbdly obese and 43,1% non-morbid. The prevalence of OSAS was 70,68% and de AHI ranged from zero to 84,6 with a mean of 19,47±22,89 e/h. morbidly obese, compared to "non-morbid", had a longer saturation time below 80% and 90% (0,4±0,93 vs. 0,12±0,45 e 4,87±7,38 vs. 1,36±2,87 respectively; p-value=0,02 in both), worse index respiratory disorders ((29,24±25,36 vs. 16,88±16,21; p-value=0,02), higher AHI (24,71±25,68 vs. 12,56±16,67; p-value=0,02), higher hypopnea index values (16,41±17,10 vs. 6,99±8,52; p-value=0,006) and lower minimum saturation (78,24±9,80 vs. 85,24±6,33; p-value=0,004). Conclusions: the high prevalence of OSAS found confirms its indication in the preoperative period of bariatric surgery. The main respiratory event involved in most individuals with OSAS was the hypopnea index.


RESUMO Introdução: a Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) é uma grave patologia que compromete a qualidade de vida e sobrevida dos portadores. Seu principal fator de risco em adultos é a obesidade e o exame padrão ouro para diagnóstico é a polissonografia (PSG), sobretudo através do índice de apneiahipopneia (IAH). Objetivo: analisar o padrão de sono dos pacientes obesos com indicação à cirurgia bariátrica, determinando os principais parâmetros polissonográficos comprometidos pela obesidade. Métodos: Este trabalho se trata de um estudo transversal com análise das polissonografias feitas em pacientes com obesidade no préoperatório de cirurgia bariátrica em uma clínica em Vitória da Conquista/BA durante o ano de 2017. Foi utilizada a plataforma Epi Info 7 para análise dos dados. Resultados: analisados 58 laudos polissonográficos, sendo 56,9% obesos mórbidos e 43,1% não mórbidos. A prevalência de SAHOS foi 70,68% e o IAH variou de zero a 84,6 com média de 19,47±22,89 e/h. Os obesos mórbidos, comparados aos "não mórbidos", tiveram maior tempo de saturação abaixo de 80% e 90% (0,4±0,93 vs. 0,12±0,45 e 4,87±7,38 vs. 1,36±2,87 respectivamente; p=0,02 em ambos), pior índice de distúrbios respiratórios (29,24±25,36 vs. 16,88±16,21; p=0,02), maior IAH (24,71±25,68 vs. 12,56±16,67; p=0,02), valores de índices de hipopneia superiores (16,41±17,10 vs. 6,99±8,52; p=0,006) e menor saturação mínima (78,24±9,80 vs. 85,24±6,33; p=0,004). Conclusões: a alta prevalência de SAHOS encontrada ratifica sua indicação no pré-operatório de cirurgia bariátrica. O principal evento respiratório envolvido na maioria dos indivíduos com SAHOS foi o índice de hipopneia.


Subject(s)
Humans , Adult , Obesity, Morbid/surgery , Obesity, Morbid/complications , Bariatric Surgery , Quality of Life , Cross-Sectional Studies , Polysomnography
18.
Psico (Porto Alegre) ; 52(1): 35760, 2021.
Article in English | LILACS | ID: biblio-1282708

ABSTRACT

Self-esteem is a set of feelings and thoughts a person has about his/her own worth and competence, which is reflected in a positive or negative attitude toward himself/herself. This study examined the factor structure of the Rosenberg Self-Esteem Scale with scores of 288 obese brazilian women waiting for bariatric surgery. Psychometric studies have found controversial results regarding the factor structure of this measure with samples from different profiles. In this investigation, the unifactor, two-oblique-factor and bifactor models were tested by Confirmatory Factor Analysis. The results clearly support the existence of a single dimension for the scale, but also for the method effects relating to the positively and negatively worded items. Further investigations with the inclusion of obese males are suggested.


A autoestima é um conjunto de sentimentos e pensamentos da pessoa sobre o seu próprio valor e competência, que se reflete em atitude positiva ou negativa em relação a si mesma. Este estudo examinou a estrutura fatorial da Rosenberg Self-Esteem Scale com escores de 288 mulheres brasileiras obesas que aguardavam à cirurgia bariátrica. Os estudos psicométricos têm encontrado resultados controversos acerca da estrutura fatorial desta medida com amostras de variados perfis. Na investigação atual, foram testados por meio de Análise Fatorial Confirmatória os modelos unifatorial, dois fatores oblíquos e bifator. Os resultados mostram um claro apoio à existência de uma única dimensão para a escala, mas também de efeitos do método relativos aos itens de redação positiva e negativa. Sugere-se que novas investigações sejam realizadas com a inclusão de obesos do sexo masculino.


La autoestima es un conjunto de sentimientos y pensamientos de la persona sobre su propio valor y competencia, que se refleja en una actitud positiva o negativa hacia sí misma. Este estudio examinó la estructura factorial de la Rosenberg Self-Esteem Scale con puntuaciones de 288 mujeres brasileñas obesas en espera de cirugía bariátrica. Los estudios psicométricos han encontrado resultados controvertidos con respecto a la estructura factorial de esta medida con muestras de varios perfiles. En la investigación actual, los modelos unifactorial, dos factores oblicuos y bifactor se probaron mediante análisis factorial confirmatorio. Los resultados muestran un claro apoyo a la existencia de una sola dimensión para la escala, pero también a los efectos del método en los elementos de redacción positivos y negativos. Se sugieren investigaciones adicionales con la inclusión de hombres obesos.


Subject(s)
Humans , Female , Psychometrics , Obesity, Morbid , Self Concept , Bariatric Surgery
19.
ABCD arq. bras. cir. dig ; 34(3): e1614, 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1355515

ABSTRACT

ABSTRACT Background: Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention. Aim: To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis Methods: A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed. Results: Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%. Conclusions: Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.


RESUMO Racional: O bypass gástrico em Y-de-Roux (RYGB) tem sido o procedimento bariátrico de escolha para pacientes com refluxo sintomático - e é conhecido por ser eficaz na redução da necessidade de medicação anti-refluxo no pós-operatório. No entanto, um pequeno número de pacientes com RYGB ainda pode desenvolver sintomas de refluxo graves que requerem uma intervenção cirúrgica. Objetivo: Examinar e descrever a população de pacientes que requer procedimento anti-refluxo após RYGB avaliando dados demográficos, características, sintomas e diagnóstico. Métodos: Revisão retrospectiva de prontuários foi realizada em 32 pacientes submetidos a hérnia hiatal e / ou fundoplicatura Nissen após RYGB em 1º de julho de 2014 a 31 de dezembro de 2019. Os pacientes foram identificados por meio do banco de dados MBSAQIP e seus prontuários eletrônicos foram revisados. Resultados: A maioria dos pacientes era do sexo feminino (n = 29 - 90,6%). A média de idade foi de 52,8 anos e o índice de massa corporea (IMC) médio de 34,1 kg / m2 na época do procedimento anti-refluxo. Os pacientes foram submetidos ao procedimento anti-refluxo em média 7,9 anos após o procedimento do BGYR. A porcentagem média de perda do excesso de IMC durante o tempo entre o BGYR e o procedimento anti-refluxo foi de 63,4%. Conclusões: Pacientes do sexo feminino com perda de peso significativa podem desenvolver sintomas graves de refluxo anos após o BGYR. Sintomas de refluxo após RYGB não devem ser negligenciadas. Acompanhamento cuidadoso e tratamento adequado (incluindo intervenção cirúrgica) são necessários para essa população.


Subject(s)
Humans , Female , Obesity, Morbid/surgery , Gastric Bypass , Gastroesophageal Reflux/surgery , Gastroesophageal Reflux/etiology , Laparoscopy , Postoperative Complications/epidemiology , Reoperation , Retrospective Studies , Treatment Outcome , Middle Aged
20.
ABCD arq. bras. cir. dig ; 34(3): e1612, 2021. tab
Article in English, Portuguese | LILACS | ID: biblio-1355511

ABSTRACT

ABSTRACT Background: Although considered a safe procedure, sleeve gastrectomy (SG) has a non-negligible risk of major postoperative complications related to it, with special attention to gastric leaks. Aim: Evaluate the clinical value of the methylene blue test (MBT) in predicting the occurrence of post-SG leaks. Methods: Retrospective study that included 1136 patients who underwent SG with intraoperative MBT between 2012 and 2016. Sensitivity, specificity, positive predictive value (PPV) and negative predicted value (NPV) were calculated to determine the clinical correlation between the MBT and the occurrence of postoperative leaks. Staple line oversewing was performed in all patients who presented positive MBT. Results: Laparoscopic SG was performed in 97.0% of cases; open in 2.3%, and robotic in 0.7%. MBT was positive in 19 cases (1.67%). One positive MBT occurred during an open SG and the other 18 at laparoscopy. Moreover, there were nine cases (0.8%) of postoperative leaks, among which, only two presented positive MBT. MBT diagnostic value was evaluated through the calculation of sensitivity (22.0%), specificity (98.0%), PPV (11.0%) and NPV (99.0%). There were no cases of allergic reaction or any other side effect with the use of the methylene blue solution. Conclusion: MBT showed high specificity and negative predictive value, thus presenting an important value to rule out the occurrence of postoperative leaks.


RESUMO Racional: Embora considerada procedimento seguro, a gastrectomia vertical (GV) apresenta risco não desprezível de complicações pós-operatórias importantes relacionadas a ela, com atenção especial para fístulas gástricas Objetivo: Avaliar a aplicabilidade clínica do teste do azul de metileno (TAM) na predição da ocorrência de fístulas após a GV. Método: Estudo retrospectivo que incluiu 1136 pacientes operados entre 2012 e 2016 com aplicação do TAM intraoperatório. Sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) foram calculados na tentativa de determinar a correlação clínica entre os resultados do TAM e a ocorrência de fístulas pós-operatórias. Sobressutura da linha de grampos foi realizada em todos os pacientes que apresentaram TAM positivo. Resultados: GV laparoscópica foi realizada em 97,0% dos casos; por laparotomia em 2,3% e roboticamente em 0,7%. TAM foi positivo em 19 casos (1,67%). Um dos casos positivos ocorreu na laparotomia e os outros 18 na laparoscopia. Ainda, houve nove casos (0,8%) de fístulas pós-operatórias, dentre os quais, apenas dois apresentaram TAM positivo. O valor diagnóstico do TAM foi avaliado através dos cálculos de sensibilidade (22,0%), especificidade (98,0%), VPP (11,0%) e VPN (99,0%). Não houve casos de reação alérgica ou qualquer outro efeito colateral advindo do uso da solução de azul de metileno. Conclusão: TAM mostrou alta especificidade e VPN, apresentando importância em descartar a ocorrência de fístulas pós-operatórias.


Subject(s)
Humans , Obesity, Morbid/surgery , Laparoscopy , Postoperative Complications/diagnosis , Retrospective Studies , Treatment Outcome , Gastrectomy , Methylene Blue
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