Improvement in Muscle Strength and Metabolic Parameters Despite Muscle Mass Loss in the Initial Six Months After Bariatric Surgery.

BACKGROUND: An aggravation in pre-existing sarcopenia or the onset of sarcopenia may occur in the scenario of extensive and fast weight loss in the initial months following bariatric surgery. The accurate identification of sarcopenia criteria and its metabolic repercussions is vital for its correct management. The aim of this study is to evaluate the correlation between the diagnosis criteria for sarcopenia and metabolic repercussions during the first 6 months following bariatric surgery. METHODS: A prospective single-center cohort study was conducted. Convenience sampling was performed among patients with severe obesity undergoing preoperative evaluation for bariatric surgery. Metabolic parameters, nutritional evaluation, and skeletal muscle evaluation were assessed before surgery and 6 months later. RESULTS: A total of 129 patients were selected, 62 participants were included in the final analysis. Mean age was 37.7 years and 88.4% of participants were women. Mean body mass index was 41.8 kg/m2 and 47.8% of patients were sedentary. Sleeve gastrectomy was performed in 41 patients and Roux-en-Y gastric bypass in 21 patients. Significant improvement regarding muscle strength and function after surgery was observed. Sarcopenia criteria were not met by any participant before and after surgery. Blood glucose and ferritin levels remained independently associated with change in muscle strength. CONCLUSIONS: Functional evaluation methods did not reflect the reduction in skeletal muscle mass demonstrated in bioelectrical impedance analysis 6 months after bariatric surgery in comparison to the preoperative baseline. Improvement in muscle strength was followed by improvement in metabolic parameters.

Polyneuropathy in Severely Obese Women Without Diabetes: Prevalence and Associated Factors.

BACKGROUND: Obesity and its complications are prevalent in women and increase with age. Polyneuropathy (PNP) is a complication of obesity and bariatric surgery (BS). In subjects with severe (grades II and III) obesity and without DM who are candidates for BS, the prevalence of PNP and associated conditions are not well characterized. The aim of this study was to evaluate the prevalence of PNP in severely obese (SO) women without DM or common nutritional deficiencies in order to determine factors associated with the presence of PNP. METHODS: A cross-sectional study was performed on 450 SO women. They were evaluated with the Michigan Neuropathy Screening Instrument, a Sleep Apnea Questionnaire, and the short form of the International Physical Activity Questionnaire. Data on blood pressure, body mass index, waist circumference, serum glucose, glycated hemoglobin, LDL and HDL cholesterol, triglycerides, vitamin B12, and postmenopausal (PM) status were also collected. Patients with DM and other common causes of PNP were excluded. To evaluate which variables were independently associated with PNP (dependent variable), Poisson regression models were used. RESULTS: The prevalence of PNP was 11.6%. In univariate analysis, PNP was associated with age, PM status, and diagnosis of systemic arterial hypertension (p < 0.001, p < 0.001, and p = 0.016, respectively), and there was a trend toward an association with sleep apnea risk (p = 0.101). In multivariate analysis, PM status (PR = 2.836, 95% CI 1.735-4.636, p = 0.001) and age (PR = 1.0511, 95% CI 1.031-1.071, p = 0.001) were independently associated with PNP diagnosis in two different models. CONCLUSION: Even prior to BS, PNP is highly prevalent and is associated with PM status and age in SO women without diabetes.

Evaluation of Metabolic Syndrome in morbidly Obese Patients Submitted to Laparoscopic Bariatric Surgery: Comparison of the Results between Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.

BACKGROUND: Morbid obesity is a state of insulin resistance combined with excess of visceral fat, which contributes to the development of metabolic syndrome (MetS). Nonsurgical treatment of obesity usually improves MetS, but there is no ultimate resolution and weight regain is common. Surgical options like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) result in a significant and sustained weight loss accompanied by improvement of MetS. The aim of this study was to compare the weight loss and improvement of MetS parameters between degree II and III obese patients with MetS undergoing RYGB or SG in a period of 12 months. METHODS: Analysis of medical records of 102 patients diagnosed with MetS (63 undergoing RYGB and 39 undergoing SG) in a reference center (CTO ISCMPA) between 2010 and 2013. RESULTS: After 1-year follow-up, an excess weight loss (EWL) of 77.2 ± 22.5% and of 63.4 ± 20.1% (p = 0.033) was observed in the RYGB and SG groups, respectively. The rate of MetS resolution was very similar (87.3 and 84.6%, respectively; p = 0.971). The percentage of patients with type 2 diabetes was 3.3% for RYGB and 15.4% for SG (p = 0.025). Fasting blood glucose levels followed the same trend with mean values reaching 87.6 ± 16.9 mg/dl in the RYGB group and 97.7 ± 35.5 mg/dl in the group undergoing SG (p = 0.023). CONCLUSIONS: Among the patients studied, both surgical techniques were safe and effective for MetS resolution in 12 months. However, RYGB was more effective for EWL and improvement of some parameters related to glucose metabolism.

Ruptura espontânea para cavidade abdominal de pseudocisto pancreático e seu tratamento / Spontaneous rupture of pancreatic pseudocyst and its treatment: a case report

O pseudocisto de pâncreas é caracterizado como uma coleção fluida rica em enzimas pancreáticas circundada por tecido de fibrose e granulação, sendo mais comum nos casos de pancreatite crônica e, também, na etiologia alcóolica da doença. Sua indicação cirúrgica se baseia nos casos assintomáticos que não tendem à regressão e nas suas complicações. Entre elas, bastante rara, destaca-se a ruptura espontânea do pseudocisto de maneira livre para cavidade abdominal. Relatamos aqui um caso de ruptura espontânea para cavidade abdominal de pseudocisto pancreático com quadro clínico de abdome agudo com pneumoperitônio no raio-x, que foi tratado com drenagem externa do mesmo para a parede abdominal. Apesar de cada vez mais consagrado o tratamento dessa patologia por via endoscópica ou percutânea, relatamos aqui um raro caso aonde a conduta cirúrgica se tornou imperativa, sendo bastante útil para os cirurgiões.

Pseudocyst of the pancreas is characterized as a fluid collection rich in pancreatic enzymes surrounded by fibrotic tissue and granulation, being more common in cases of chronic pancreatitis. Its surgical indication is based on the asymptomatic cases that do not tend to regression and on its complications. Among them, though very rare, there is spontaneous rupture of the pseudocyst freely into the abdominal cavity. Here we report a case of spontaneous rupture of pancreatic pseudocyst into the abdominal cavity with a clinical picture of acute abdomen with radiologic pneumoperitoneum, which was treated with external drainage to the abdominal wall. Although treatment through endoscopic or percutaneous route is increasingly well established, here we report a rare case in which the surgical procedure became imperative.

Tratamento cirúrgico da estenose pilórica / Surgical treatment of pyloric stenosis

Úlcera péptica é definida como uma lesão de mucosa gástrica e/ou duodenal que ocorre quando há desequilíbrio entre fatores de proteção e agressão. É um dos maiores problemas de saúde, com incidência em torno de 1.500 a 3.000 casos a cada 100.000 habitantes por ano. Atualmente, a cirurgia eletiva para essa doença está virtualmente excluída, reservando-se apenas para casos de emergência. A grande maioria desses procedimentos consiste em rafia da parede gástrica ou duodenal por úlcera perfurada. A hemorragia dessas lesões aparece como segunda complicação mais frequente. E, finalmente, apenas cerca de 1 a 2% dos pacientes necessitam de tratamento cirúrgico para aliviar uma obstrução gástrica ou duodenal, já que o processo ulceroso crônico deixa fibrose e estenose na região. No presente estudo, são relatados 3 casos em nossa instituição em que executamos cirurgia devido à estenose péptica do piloro e duodeno refratária ao tratamento clínico num período menor que 8 meses. Em todos os casos, foi realizada uma hemigastrectomia, com reconstrução à Y de Roux, obtendo resultados satisfatórios

Peptic ulcer is defined as injury to the gastric or duodenal mucosa which occurs when there is an imbalance between protective factors and aggression to it. It is one of the biggest health problems, with an incidence of around 1500 to 3000 cases per 100,000 people per year. Currently, elective surgery for this disorder is virtually excluded, reserved for emergency cases only. The vast majority of these surgical procedures consists in suturing the stomach or duodenal wall with perforated ulcer. Hemorrhage from these lesions appears as the second most frequent complication. And finally, only about 1-2% of patients require surgery to relieve a gastric or duodenal obstruction, since the chronic ulcerous process causes fibrosis and ulcerative stenosis in the region. In the present study we report three cases in which we performed surgery due to peptic stenosis of the pylorus and duodenum refractory to medical treatment in a period less than 8 months. In all cases, hemigastrectomy with Roux-Y reconstruction was performed, with satisfactory results

New hybrid approach for NOTES transvaginal cholecystectomy: preliminary clinical experience.

OBJECTIVES: Natural orifice translumenal endoscopic surgery (NOTES) represents the first step toward scar-less surgery. The objective of this study is to evaluate early clinical results of transvaginal cholecystectomy using a new technique. METHODS: Institutional review board approval was obtained and transvaginal NOTES cholecystectomy was performed in 12 women for cholelithiasis. A 2-channel videoendoscope was inserted in the abdominal cavity through a posterior colpotomy. Two 3-mm trocars were inserted deep in the umbilicus, and a 10-mm trocar was placed through the colpotomy parallel to the endoscope. Dissection was performed with endoscopic instruments combined with 3-mm laparoscopic instruments. RESULTS: Mean operative time was 125.8 minutes. All procedures occurred without intraoperative complications or conversions, except for 1 vulvar laceration. There were no postoperative complications in the clinical follow-up. CONCLUSION: Transvaginal NOTES is a feasible and safe alternative for cholecystectomy in this preliminary clinical experience, allowing good cosmetic benefits and low analgesic requirement.