Análise do perfil lipídico de pacientes submetidos à gastrectomia vertical e à derivação gástrica em Y de Roux / Analysis of the lipid profile of patients submitted to sleeve gastrectomy and Roux-en-Y gastric bypass

RESUMO Objetivo: comparar as melhorias no perfil lipídico de pacientes submetidos à gastrectomia vertical (GV) e à derivação gástrica em Y de Roux (DGYR). Metódos: estudo de coorte misto, em que foram avaliados 334 pacientes submetidos à GV e 178 pacientes submetidos à DGYR no Hospital das Clínicas da Universidade Federal de Pernambuco e no Real Hospital Português de Beneficência, Recife, PE, Brasil. Foram realizadas dosagens séricas de colesterol total, LDL, HDL e triglicerídeos no pré-operatório e com três, seis, 12 e 24 meses de seguimento. Resultados: o grupo submetido à GV foi composto por 58 homens e 276 mulheres. No grupo submetido à DGYR, foram analisados 64 homens e 114 mulheres. A média de idade foi de 37,2±20,5 anos no grupo da GV e de 41,9±11,1 anos no grupo da DGYR. O IMC médio pré-operatório foi de 39,4±2,6kg/m2 e 42,7±5,8kg/m2, para o grupo da GV e da DGYR, respectivamente. No pré-operatório, 80% dos pacientes tinha, no mínimo, uma anormalidade no perfil lipídico. Dois anos após a cirurgia houve melhora do colesterol total, LDL, HDL e triglicerídeos no grupo submetido à DGYR. No grupo submetido à GV, após dois anos houve melhora dos níveis de colesterol total, HDL e triglicerídeos, apenas. Conclusão: ambas as técnicas resultaram em melhorias no perfil lipídico, porém a DGYR foi mais efetiva.

ABSTRACT Objective: to compare the improvements in lipid profile in patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods: in a mixed cohort study, we evaluated 334 patients undergoing SG and 178 patients undergoing RYGB at the University Hospital of the Federal University of Pernambuco and at the Real Hospital Português de Beneficência, Recife, PE, Brazil. We measured serum levels of total cholesterol, LDL, HDL and triglycerides preoperatively and at three, six, 12 and 24 months follow-up. Results: the SG group consisted of 58 men and 276 women. In the group submitted to RYGB, there were 64 men and 114 women. The mean age was 37.2±20.5 years in the SG group and 41.9±11.1 years in the RYGB group. The preoperative mean BMI was 39.4±2.6kg/m2 and 42.7±5.8kg/m2 for the SG and RYGB groups, respectively. In the preoperative period, 80% of the patients had at least one abnormality in the lipid profile. Two years after surgery, there was improvement in total cholesterol, LDL, HDL and triglycerides in the group submitted to RYGB. In the group submitted to SG, after two years there was improvement in total cholesterol, HDL and triglyceride levels. Conclusion: both techniques resulted in improvements in the lipid profile, but the RYGB was more effective.

Repercussões em longo prazo da derivação gástrica em Y de Roux em população de baixa renda: avaliação após dez anos de cirurgia / Long-term repercussions of Roux-en-Y gastric bypass in a low-income population: assessment ten years after surgery

RESUMO Objetivo: avaliar a evolução ponderal, nutricional e a qualidade de vida de pacientes de baixa renda, após dez anos de derivação gástrica em Y de Roux (DGYR). Métodos: estudo longitudinal, retrospectivo e descritivo, que avaliou a perda do excesso de peso, o reganho de peso, a evolução da hipertensão arterial, do diabetes mellitus tipo 2, da anemia e da hipoalbuminemia em 42 pacientes de classes sociais D e E submetidos à DGYR. A qualidade de vida foi avaliada através do Bariatric Analysis and Reporting Outcome System (BAROS). Resultados: dos 42 pacientes, 68,3% se definiram como não praticantes de atividade física regular, e somente 44,4% e 11,9% tinham acompanhamento médico e nutricional regulares, respectivamente. Foi encontrada média da perda do excesso de peso de 75,6%±12 (IC=71,9-79,4) e perda ponderal insuficiente apenas em um paciente. O reganho ponderal médio foi de 22,3%±16,2 (IC=17,2-27,3), com 64,04% da amostra apresentando reganho maior do que 15% do peso mínimo. 52,3% da amostra apresentou anemia após dez anos de cirurgia e 47,6% deficiência de ferro. Hipoalbuminemia foi encontrada em 16,6% da amostra. Houve remissão da HAS em 66% e do diabetes mellitus tipo 2 em 50%. O BAROS demonstrou melhora na qualidade de vida em 85,8% dos pacientes. Conclusão: pudemos observar, em uma população com diversas limitações socioeconômicas, que a DGYR manteve resultados satisfatórios quanto à perda peso, mas o seguimento ineficiente pode comprometer o resultado final, especialmente no que diz respeito às deficiências nutricionais.

ABSTRACT Objective: to evaluate the weight, nutritional and quality of life of low-income patients after ten years of Roux-en-Y gastric bypass (RYGB). Methods: we conducted a longitudinal, retrospective and descriptive study evaluating the excess weight loss, weight regain, arterial hypertension, type 2 diabetes mellitus, anemia and hypoalbuminemia in 42 patients of social classes D and E submitted to RYGB. We assessed quality of life through the Bariatric Analysis and Reporting Outcome System (BAROS). Results: of the 42 patients, 68.3% defined themselves as doing non-regular physical activity, and only 44.4% and 11.9% had regular medical and nutritional follow-up, respectively. We found a mean excess weight loss of 75.6%±12 (CI=71.9-79.4), and in only one patient there was insufficient weight loss. The mean weight loss was 22.3%±16.2 (CI=17.2-27.3) with 64.04% of the sample presenting regain greater than 15% of the minimum weight; 52.3% of the sample presented anemia after ten years of surgery and 47.6%, iron deficiency. We found hypoalbuminemia in 16.6% of the sample. There was remission of hypertension in 66%, and of type 2 diabetes mellitus, in 50%. BAROS showed an improvement in the quality of life of 85.8% of the patients. Conclusion: in a population with different socioeconomic limitations, RYGB maintained satisfactory results regarding weight loss, but inefficient follow-up may compromise the final result, especially with regard to nutritional deficiencies.

Desordens no comportamento alimentar antes e após a cirurgia de bypass gástrico em um hospital público / Disorders in eating behavior before and after gastric bypass surgery in a public hospital

A cohort study with 25 patients was carried out in a public hospital unit aiming to identify the prevalence of eating disorders before bariatric surgery; verify their persistence at 6 months postoperatively; and analyze how such disorders influenced the ponderal weight loss in bariatric patients. Through anthropometric comparative analysis and the applica-tion of questionnaires regarding eating behavior, patients were classified as ?presenting? or ?free from? eating disorders before and 6 months after surgery. Significant reduction was observed in the prevalence of nocturnal eating and binge eating among patients at 6 months postoperatively. Lower loss of excess weight was verified among patients classified as ?presenting? eating disorders in the preoperative phase. Patients affected by eating disorders require monitoring by expert staff, which contributes to achieve satisfactory results.

Con el objetivo de determinar la prevalencia de trastornos alimentarios antes de la cirugía bariátrica, de comprobar si éstos persistieron 6 meses después de la intervención y de analizar cómo tales trastornos influyeron en la pérdida de peso de los pacientes bariátricos, se realizó un estudio de cohorte con 25 pacientes en unidad de hospital público, con medición antropométrica y aplicación de un cuestionario relacionado con el comportamiento alimentario, siendo clasificados, los pacientes, como portadores o libres de trastornos alimentarios, antes de la cirugía y 6 meses después. Se encontró una reducción significativa en la prevalencia de comedores compulsivos y nocturnos entre aquellos pacientes evaluados 6 meses después de la intervención. Se evidenció una menor pérdida del exceso de peso entre los pacientes clasificados como portadores de trastornos alimentarios en la fase preoperatoria. Pacientes que sufren de trastornos alimentarios requieren un seguimiento con personal especializado, contribuyendo, así, al logro de resultados satisfactorios.

Objetivando identificar a prevalência de desordens alimentares antes da cirurgia bariátrica, verificar se persistiram aos 6 meses do pós-operatório e analisar como tais desordens influenciaram na perda ponderal de pacientes bariátricos, realizou-se um estudo de coorte com 25 pacientes em unidade pública hospitalar, com aferição antropométrica e aplicação de questionário referente ao comportamento alimentar, sendo classificados como portadores ou livres de desordens alimentares antes e 6 meses após a realização da cirurgia. Foi verificada uma redução significativa na prevalência de comedores compulsivos e comedores noturnos entre os pacientes aos 6 meses do pós-operatório. Foi evidenciada menor perda do excesso de peso entre os pacientes classificados como portadores de desordens alimentares na fase pré-operatória. Pacientes acometidos por desordens alimentares necessitam de acompanhamento com equipe especializada, contribuindo para o alcance de resultados satisfatórios.

Morbilidad y mortalidad trans y posoperatoria temprana en cáncer gástrico: experiencia en el Hospital General de México / Trans- and early postoperative complications in gastric surgery for gastric carcinoma: experience from the General Hospital of Mexico

OBJECTIVE: We undertook this study to determine the morbimortality in gastric surgery for gastric carcinoma. METHODS: We carried out a retrospective, observational study performed at the Gastroenterology Service of the General Hospital of Mexico City between January 2004 and October 2005. Variables included sex, age, diagnosis, surgery performed and trans- and postoperative complications. RESULTS: Clinical files of 2208 patients were reviewed: 36 (1.63%) cases with gastric carcinoma were found. Twenty patients fulfilled inclusion criteria; there were nine (45%) females and 11 (55%) males with a median age of 60.3 years. Radiological studies performed were upper gastrointestinal series, esophagogastroduodenoscopy, chest x-ray, and computed tomography (CT). Localization of the tumors was as follows: 15 in the antrum, three in the fundus and body and two in the body portion of the stomach. Clinical staging was T3 N0 M0. Surgical procedures were as follows: 11 partial gastrectomies and 4 gastrojejunostomies. In three cases, total gastrectomy was done and in two cases lymphatic biopsy was done. No mortality was reported. Morbidity was reported in one case (5%) with enterocutaneous fistula. CONCLUSIONS: Surgery is the treatment for gastric carcinoma. Preoperative staging is done with CT and laparoscopy. There was no mortality in our study. Morbidity is similar to that reported by other hospitals.

Experiencia de 10 años con el bypass gástrico / Long term results of gastric bypass for morbid obesity

Introducción: El bypass gástrico es el estándar para el obeso mórbido. Es importante un seguimiento apropiado para conocer su real utilidad. Material y método: 1000 pacientes operados con bypass y seguidos entre Mayo 1996 y Marzo 2006. 545 pacientes tuvieron un seguimiento prolongado, algunos hasta 10 años. Controles de peso periódicos, midiendo el porcentaje de baja del exceso de peso ( por ciento EWL). Evolución de las comorbilidades, complicaciones postoperatorias. Encuesta BAROS II, para la calidad de vida. Resultados: por ciento EWL se estabiliza entre 72 y 79 por ciento entre los 12 y 84 meses. Pero a más largo plazo, a los 120 meses los pocos pacientes que hay recuperan peso, manteniendo el EWL en 55 por ciento. BAROS muestra un 84 por ciento de excelentes y buenos resultados 14 por ciento regular y 2 por ciento disconforme. Complicaciones: Tromboembolismo 0,2 por ciento, hemorragia digestiva 0,3 por ciento (3 casos); uno requirió gastrectomía, filtraciones 2 por ciento (11 casos), 6 requirieron reoperación, un caso de fasceítis necrotizante grave, hemoperitoneo 0,3 por ciento, neumopatía aguda 2 por ciento, un fallecido, por tromboembolismo pulmonar masivo. Infección herida operatoria 1 por ciento. En el largo plazo hernias 4 por ciento, colecistolitiasis 3 por ciento, caída del cabello 15 por ciento, anemia hipocroma 5 por ciento, úlcera de boca anastomótica 2 por ciento, una úlcera perforada, obstrucción intestinal 1,5 por ciento, 3 por estenosis mesocolon, 1 por hernia interna 2 por bridas, 1 por migración anillo de PTFE, 2 migraciones de anillo al interior del estómago. Estenosis de anastomosis gastroyeyunal 2 por ciento. Las complicaciones son más frecuentes en bypass laparoscópico. Reducción comorbilidades cercano 100 por ciento. Conclusiones: La evolución del peso es excelente en el bypass, pero hay una tendencia a recuperar peso en el largo plazo, especialmente en los pacientes que no se someten a control periódico. Las comorbilidades y la...

Background: Gastric bypass is the standard surgical procedure for morbid obesity. Aim: To evaluate long term results of gastric bypass. Patients and methods: Prospective follow up of 1000 consecutive patients (800 women) subjected to gastric bypass between May 1996 and March 2006. A long term follow up was achieved in 545 patients. Percentage of excess weight loss ( percent EWL), postoperative complications and evolution of complications associated to obesity were studied. Quality of life was assessed using the BAROS II test . Results: percent EWL stabilizes in a range from 72 to 79 percent and between 12 to 84 months after operation. However, patients followed for 120 months, gain weight and percent EWL is reduced to 55 percent. According to BAROS II, 84 percent of patients considered results as excellent or good, 14 percent considered results regular and 2 percent were dissatisfied with surgical outcome. Complications recorded were thromboembolism in 0.5 percent, gastrointestinal bleeding in 0.1 percent, leaks in 2 percent, necrotizing fasciitis in 0.1 percent, hemoperitoneum in 0.3 percent acute pneumonia in 2 percent and wound infection in 1 percent. One patient died due to a massive pulmonary embolism. As late complications, hernias appeared in 4 percent, cholelithiasis in 3 percent, hair loss in 15 percent, hypocromic anemia 5 percent, anastomotic ulcers in 2 percent, intestinal Obstruction in 1.5 percent, PTFE ring migration and anastomosis obstruction in 2 percent. Complications were more common in laparoscopic bypass. In all patients there was a reduction of complications associated to obesity. Conclusions: percent EWL is excellent with gastric bypass, but there is weight gain in the long term follow up. Complications associated to obesity are almost always corrected.