EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. .

Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período pós-operatório de cirurgias para o tratamento da obesidade grave são semelhantes aos associados a outras cirurgias de grande porte do trato gastrointestinal. Não obstante, dada a ocorrência mais frequente de comorbidades associadas à obesidade mórbida, esses pacientes necessitam de atenção especial no pós-operatório. O diagnóstico precoce e o tratamento adequado dessas complicações estão diretamente associadas a maior probabilidade de controle clínico. Método Os prontuários de 538 pacientes obesos mórbidos submetidos a tratamento cirúrgico (bypass gástrico em Y-de-Roux) foram revisados. Noventa e três (17,2%) pacientes eram do sexo masculino e 445 (82,8%) eram do sexo feminino. As idades dos pacientes variaram de 18 a 70 anos (média = 46) e seus índices de massa corporal variaram entre 34,6-77 kg/m2. Resultados As complicações imediatas ocorreram em 9,6% e foram distribuídos da seguinte forma: 2,6% apresentaram sangramento, obstrução intestinal ocorreu em 1.1%, infecções peritoniais ocorreram em 3,2% e 2,2% desenvolveram infecções da parede abdominal requerendo hospitalização. Três (0,5%) pacientes tiveram tromboembolismo pulmonar. Conclusão A padronização de cirurgia para o tratamento da obesidade mórbida tem contribuído significativamente para os baixos índices de complicações e mortalidade. A incidência de complicações precoces foi baixa. O ...

Cirurgia pós-bariátrica do tronco superior: abdominoplastia em Y / The Y pattern postbariatric surgery upper trunk reshaping

Introdução: Após grande perda de peso, observa-se flacidez de pele em várias regiões do corpo. O abdome com grande excesso de pele necessita da combinação de incisões mistas para correção desta flacidez com maior eficiência. Contudo, as incisões clássicas em âncora permitem o tratamento do abdome médio e inferior, entretanto não corrigem satisfatoriamente a flacidez epigástrica residual em alguns pacientes. Método: Seis pacientes previamente operadas de dermolipectomia abdominal em âncora e que mantinham flacidez epigástrica residual e mamária realizaram a mamoplastia com pedículo inferior associada à dermolipectomia reversa em âncora no mesmo ato operatório. Com seguimento mínimo pós-operatório de três meses, foram feitas avaliações desta nova técnica, quanto ao tempo de recuperação do paciente, viabilidade da técnica cirúrgica, complicações intra e pós-operatórias, características das cicatrizes, adequada correção da flacidez epigástrica e da ptose mamária e satisfação do paciente. Resultados: As cirurgias foram realizadas sem complicações intra-operatórias. As incisões utilizadas permitiram exposição adequada do campo operatório e facilidade no tratamento das estruturas abordadas com pequeno acréscimo à cicatriz da mastopexia na região esternal. Os pacientes apresentaram expressiva melhora do contorno corporal na região epigástrica e satisfatória correção da ptose mamária. Todos se mostraram satisfeitos com o resultado. Conclusão: A abordagem permitiu o tratamento da flacidez abdominal em epigástrio e correção da ptose mamária, com resultados satisfatórios, seguros e reprodutíveis para os pacientes com grandes perdas ponderais.

Introduction: After massive weight loss, there is a large amount of undesirable soft-tissue in many parts of the body. The breasts and the abdomen are usually the prioritary regions to be treated. However, the satisfactory treatment of the upper abdomen in post bariatric patients is sometimes a challenge for the surgeons. The reverse abdominoplasty do not satisfactorily correct the residual epigastric laxity in some patients with previously abdominal reshaping surgery, once this technique can not remove undesirable circumferential soft-tissue of the upper trunk. Methods: Six female patients who had undergone massive weight loss were treated with a new technique. This technique consists of a vertical reverse abdominoplasty with horizontal incisions through the submmamary folds and a simultaneous mammaplasty. Results: There were no serious complications. The technique allows satisfactory and simultaneous correction of: (1) the epigastric looseness, (2) the excess of skin of the armpit, (3) the dorsal rolls, (4) breast ptosis and (5) the lower infra mammary folds with only a small addition to the mammaplasty scar in the sternal region. All patients reported being completely satisfied with the results obtained in the treated regions. Conclusion: The method described allowed for satisfactory correction of epigastric laxity and breast ptosis and was demonstrated to be a safe procedure for patients who had undergone massive weight loss.

Effects of Behavior Modification on Obesity Index, Skinfold Thickness, Body Fat, Serum Lipids, Serum Leptin in Obese Elementary School Children / 간호학회지

PURPOSE: This study was performed to investigate effects of behavior modification on obesity index, skinfold thickness, body fat, serum lipids, serum leptin in obese elementary school children. METHOD: Forty seven students were selected from two elementary schools. Twenty four children in one school were assigned to experimental group and twenty three children in another school were assigned to control group. Experimental group was received 60-70 minutes of behavior modification once a week for 8 weeks. RESULT: Obesity index of the experimental group was significantly decreased after behavior modification. But there was no significant difference between two groups. The increase of skinfold thickness was significantly low in the experimental group compared to the control group. Percentage of body fat and fat mass were significantly decreased in the experimental group. Fat free mass was significantly increased in the experimental group. HDL-C, triglyceride and serum leptin between the experimental group and control group showed no significant difference. CONCLUSION: These results indicate that behavior modification is effective in decreasing percentage of body fat and fat mass, in less increasing skinfold thickness and in increasing fat free mass. In conclusion, behavior modification can be used as effective strategy for managing obesity in elementary school children.