Ursodeoxycholic acid in the prevention of gallstones in patients subjected to Roux-en-Y gastric bypass

Abstract Purpose: To evaluate the contribution of ursodeoxycholic acid (UDCA) in the first 12 months after Roux-en-Y gastric bypass in the prevention of gallstone formation. Methods: A community-based clinical trial was conducted. A total of 137 patients were included in the study; 69 were treated with UDCA, starting 30 days after the surgery, at a dose of 150 mg twice daily (300 mg/day) over a period of 5 consecutive months (GROUP A), and 68 were control patients (GROUP B). The patients were followed-up, and ultrasonography was performed to determine the presence of gallstones at various times during follow-up. Demographic, anthropometric and comorbid indicators were obtained. The data were subjected to normality tests and evaluated using appropriate tests. Results: Patients did not differ in their baseline characteristics. Of the 69 patients who used UDCA, only one patient developed cholelithiasis (1%), whereas 18 controls (26%) formed gallstones (OR = 24.4, p <0.001). Also, other factors were found not to influence the formation of calculi, such as pre-operative or postoperative hepatic steatosis or diabetes (p = 0.759, 0.468, 0.956). Conclusion: The results demonstrated that patients who did not use UDCA showed a 24.4-fold greater probability of developing cholelithiasis.

Ports minimization with mini-port and liver flexible retractor: an ergonomic and aesthetic alternative for single port in laparoscopic gastric bypass / Minimização de portais com miniportes e afastador flexível de fígado: alternativa ergonômica e estética ao single port em bypass gástrico laparoscópico

BACKGROUND: The laparoscopic access, with its classically known benefits, pushed implementation in other components, better ergonomy and aesthetic aspect. AIM: To minimize the number and diameter of traditional portals using miniport and flexible liver retractor on bariatric surgery. METHOD: This prospective study was used in patients with less than 45 kg/m2, with peripheral fat, normal umbilicus implantation, without previous abdominoplasties. Were used one 30o optical device with 5 mm in diameter, four accesses (one mini of 3 mm to the left hand of the surgeon, one of 5 mm to the right hand alternating with optics, one of 12 mm for umbilical for surgical maneuvers as dissection, clipping, in/out of gauze, and one portal of 5 mm for the assistant surgeon), resulting in a total of 25 mm linear incision; additionally, one flexible liver retractor (covered with a nelaton probe to protect the liver parenchyma, anchored in the right diaphragmatic pillar and going out through the surgeon left portal) to visualize the esophagogastric angle. RESULTS: In selected patients (48 operations), gastric bypass was performed at a similar time to the procedures with larger diameters (5 or 6 portals and 10 mm optics, with sum of linear incision of 42 mm) including oversuture line on excluded stomach, gastric tube and mesenteric closing. The non sutured portal of 3 mm and the two of 5 mm with subdermal sutures, were hardly visible in the folds of the skin; the one of 12 mm was buried inside the umbilicus or in the abdominoplasty incision. CONCLUSION: Minimizing portals is safe, effective, good ergonomic alternative with satisfactory aesthetic profile without need for specific instruments, new learning curve and limited movement of the instruments, as required by the single port. .

RACIONAL: A via de acesso laparoscópica com os seus benefícios classicamente conhecidos impulsionou a busca de outros componentes, de ordem estética e ergonômica. OBJETIVO: Minimizar o número e o diâmetro dos portais tradicionais utilizando miniporte e afastador flexível de fígado. MÉTODO: Estudo prospectivo, destinado a pacientes com IMC menor que 45 kg/m2, perfil de gordura periférica, implantação normal do umbigo, com ou sem abdominoplastia. Foram utilizados ótica de 30 graus de 5 mm de diâmetro, quatro portais (um mini portal de 3 mm para a mão esquerda do cirurgião, um de 5 mm para a mão direita alternando com a ótica, um de 12 mm no umbigo para grampeamento, clipagem, entrada e saída de gaze, um portal de 5 mm para o cirurgião auxiliar), com somatória linear de 25 mm de incisão, um afastador flexível de fígado (fio de seda zero enluvado em 7 cm de sonda de nelaton para proteger o parênquima hepático pelo fio, ancorado no pilar diafragmático direito e saindo pelo portal esquerdo do cirurgião) para visibilizar o ângulo esofagogástrico. RESULTADO: Nos pacientes selecionados (48 operações), o bypass gástrico foi realizado em tempo assemelhado aos de paciente com IMC elevado com portais de diâmetros maiores (5 ou 6 portais e ótica de 10 mm, com somatória linear de 42 mm de incisão), inclusive realizando sobressutura das linhas de grampo do estômago excluso, do tubo gástrico e fechamento das brechas mesentéricas. O portal de 3 mm não suturado e os dois de 5 mm com sutura subdérmica ficaram quase imperceptíveis na dobra da pele; o de 12 mm foi sepultado dentro do umbigo ou na incisão da abdominoplastia. CONCLUSÃO: A minimização de portais é alternativa segura, eficaz, ergonômica, ...