Qualidade de vida e imagem corporal após cirurgia bariátrica e de contorno corporal / Quality of life and body image after bariatric and body contouring surgery

Introdução: A procura pela cirurgia de contorno corporal após a cirurgia bariátrica se deve em grande parte a uma insatisfação com a imagem corporal prejudicada pela flacidez e excesso de pele decorrente da grande perda ponderal. O objetivo deste estudo foi avaliar a qualidade de vida e a imagem corporal de pacientes submetidos a cirurgia bariátrica e posteriormente a cirurgia de contorno corporal em uma clínica privada. Método: Este estudo transversal comparou 4 grupos distintos de 21 pacientes cada, pareados por índice de massa corporal e idade antes de realizarem a cirurgia bariátrica. Foram divididos nos tempos antes/depois da cirurgia bariátrica e antes/depois da cirurgia de contorno corporal, formando assim os grupos A, B, C e D, respectivamente. Foi utilizado o questionário SF-36 para avaliação da qualidade de vida e a Escala de Silhuetas proposta por Kakeshita para avaliação da imagem corporal. Para o nível de significância, foi escolhido p<0,05. Resultados: Houve melhora em todos os domínios do SF-36 após a cirurgia bariátrica. Os pacientes que procuraram a cirurgia de contorno corporal apresentaram o menor valor do componente de saúde mental, com pouca alteração após a cirurgia de contorno corporal. Quase todos os grupos superestimaram a sua silhueta, exceto para o grupo de 6 meses após a cirurgia bariátrica, que se viu menor. Conclusão: Pacientes bariátricos que procuram a cirurgia de contorno corporal apresentam escores inferiores de qualidade de vida relacionada à saúde mental e que permanecem menores após a cirurgia de contorno corporal. A distorção da imagem corporal e expectativas irreais podem justificar esse achado.

Introduction: The demand for body contouring surgery after bariatric surgery is largely due to dissatisfaction with body image impaired by sagging and excess skin resulting from massive weight loss. This study aimed to evaluate the quality of life and body image of patients undergoing bariatric surgery and body contouring surgery in a private clinic. Method: This cross-sectional study compared 4 groups of 21 patients, matched by body mass index and age before undergoing bariatric surgery. They were divided into times before/after bariatric surgery and before/after body contouring surgery, thus forming groups A, B, C, and D, respectively. The SF-36 questionnaire assessed the quality of life, and the Silhouette Scale proposed by Kakeshita to assess body image. For the significance level, p<0.05 was chosen. Results: There was an improvement in all SF-36 domains after bariatric surgery. Patients who sought body contouring surgery had the lowest mental health component value, with little change after body contouring surgery. Almost all groups overestimated their silhouette, except for the group of 6 months after bariatric surgery, which saw itself as smaller. Conclusion: Bariatric patients seeking body contouring surgery have lower mental health-related quality of life scores that remain lower after body contouring surgery.

Analysis of hepatic markers and lipid profile of patients submitted to gastric by-pass after 2 years - Cohort retrospective.

Objetive: To assess the impact of %PEP on liver indicators and lipid profile two years after BS. Background: The prevalence of weight gain in the adult population continues to increase, 57.8% of the world's adult population will be overweight or obese by 2030. Methods: This is a retrospective cohort and descriptive study, performed by consulting the database of an Obesity and Digestive Surgery Clinic in the city of Santa Maria - (Rio Grande do Sul, Brazil). The study included 351 patients (284 women, 67 men), aged at least 18 years, who underwent bariatric surgery from March 2014 to March 2016. The following data were obtained from the patients' medical records: Weight, height, age, sex, associated morbidities, biochemical parameters. The data were described by mean and standard deviation, median and interquartile range, count, and percentages. Results: The results showed a significant reduction in excess loss, triglycerides (TG) and low-density lipoprotein (LDLc) cholesterol variables in the prospective period, while high-density lipoprotein (HDLc) cholesterol levels increased, thus minimizing the hepatic changes. There was a reduction in LDLc and an increase in HDLc at 24 months in both groups 1 and 2. Between 6 and 12 months, total cholesterol (TC) increased in group 2, however, in the period between 12 and 18 months, only G1 had triglycerides reduced. In the period of 18 and 24 months, there was a significant reduction in blood glucose in group 1. The variables AST and ALT were within the normal range, without significance. However, 84.3% of patients had grade I hepatic steatosis. Conclusion: Bariatric surgery is effective in reducing the %EWL, modifying the lipid profile and liver markers up to 24 months after the bypass, reducing associated comorbidities. More research is needed to clarify the impact of %PEP on liver indicators and lipid profile two years after SB.

PROFILE OF PATIENTS WHO SEEK THE BARIATRIC SURGERY / PERFIL DE PACIENTES QUE BUSCAM A CIRURGIA BARIÁTRICA

Background : Nowadays obesity is a chronic disease considered one of the greatest problems in public healthy. Showing to be effective in a short and long term, the bariatric surgery has emerged as an optional treatment for morbid obesity. Aim: Identify the profile of patients seeking bariatric surgery. Methods: Were interviewed 100 patients in preoperative nutritional monitoring of bariatric surgery. The study was conducted by applying a questionnaire prepared according to the research objectives. Results: From the individuals that were seeking bariatric surgery, 78% were female, 62% were married and 69% reported physical activity. The average age of those surveyed was 37±10.83 years and mean body mass index (BMI) was 43.51± 6.25 kg/m². The comorbidity more prevalent in this group was high blood pressure (51%). In previous treatments for weight reduction, 92% have already done hypocaloric diet followed by anorectic drug (83%). The success of these treatments was reported by 92% of patients; however, the weight lost was recovered in less than one year of 75%. Patients with diabetes mellitus and dyslipidemia had higher BMI values. The patients with comorbidities showed lower levels of BMI. Conclusion: The profile of patients who sought surgical treatment for their obesity were predominantly women with a family background of obesity and obesity-related comorbidities, especially hypertension and diabetes mellitus.

Racional : A obesidade é doença crônica considerada atualmente um dos maiores problemas de saúde pública. Mostrando-se eficaz em curto e longo prazo a cirurgia bariátrica surgiu como opção de tratamento para a obesidade grau III. Objetivo : Identificar o perfil dos pacientes que procuram a cirurgia bariátrica. Métodos : Foram entrevistados 100 pacientes em acompanhamento nutricional pré-operatório de cirurgia bariátrica. O estudo foi realizado através da aplicação de um questionário elaborado de acordo com os objetivos da pesquisa. Resultados : Dos indivíduos que buscaram a cirurgia bariátrica, 78% eram do sexo feminino, 62% casados e 69% dos entrevistados afirmaram praticar atividade física. A média de idade dos indivíduos pesquisados foi de 37±10,83 anos e a média de IMC foi de 43,51±6,25 kg/m². A comorbidade que mais prevaleceu no grupo pesquisado foi a hipertensão arterial (51%). Dos tratamentos prévios para redução de peso, 92% já realizou dieta hipocalórica seguido de medicamento anorexígeno (83%). O sucesso destes tratamentos foi relatado por 92% dos pacientes; porém, o peso perdido foi recuperado em menos de um ano por 75%. Ao associarem-se as comorbidades com o IMC, encontrou-se diferença significativa entre os pacientes com e sem diabete melito, assim como os com e sem dislipidemia. Os pacientes que apresentavam comorbidades mostraram menores níveis de IMC. Conclusão : O perfil dos pacientes que buscaram correção cirúrgica para sua obesidade eram predominantemente mulheres, com histórico familiar de obesidade, com média de idade de 37 anos e com comorbidades relacionadas à obesidade, com destaque para hipertensão arterial e diabete melito.

PROFILE OF PATIENTS WHO SEEK THE BARIATRIC SURGERY.

BACKGROUND: Nowadays obesity is a chronic disease considered one of the greatest problems in public healthy. Showing to be effective in a short and long term, the bariatric surgery has emerged as an optional treatment for morbid obesity. AIM: Identify the profile of patients seeking bariatric surgery. METHODS: Were interviewed 100 patients in preoperative nutritional monitoring of bariatric surgery. The study was conducted by applying a questionnaire prepared according to the research objectives. RESULTS: From the individuals that were seeking bariatric surgery, 78% were female, 62% were married and 69% reported physical activity. The average age of those surveyed was 37±10.83 years and mean body mass index (BMI) was 43.51± 6.25 kg/m². The comorbidity more prevalent in this group was high blood pressure (51%). In previous treatments for weight reduction, 92% have already done hypocaloric diet followed by anorectic drug (83%). The success of these treatments was reported by 92% of patients; however, the weight lost was recovered in less than one year of 75%. Patients with diabetes mellitus and dyslipidemia had higher BMI values. The patients with comorbidities showed lower levels of BMI. CONCLUSION: The profile of patients who sought surgical treatment for their obesity were predominantly women with a family background of obesity and obesity-related comorbidities, especially hypertension and diabetes mellitus.

Linfangioma cístico do pâncreas / Cystic lymphangioma of the pancreas

Lymphangiomas are benign neoplasias of lymphatic tissue, extremely rare in the pancreas. Three lymphangioma types exist: capillary, cavernous and cystic. The authors report a case of cystic lymphangioma of the pancreas, with incidental diagnosis to the abdominal ultrasonography on investigation of urinary symptoms in male patient. To the laparotomy upper cystic mass was identified in the pancreas, that was totally resected. The histological examination demonstrated a cystic lymphangioma of the pancreas. The cystic lymphangioma of the pancreas was discovered accidentally, being assintomatic in most of the cases. Treatment of choice is complete resection, otherwise recidive is higher than 50%.

Apendicectomia laparoscópica: experiência pessoal / Laparoscopic appendectomy: personal experience

Os autores relatam 40 casos de apendicite aguda, objetivando analisar os achados transoperatórios, tempo cirúrgico, tempo de hospitalização e complicações pós-operatórias. O tempo cirúrgico variou de 30 a 180 minutos - média de 70 minutos. Os achados transoperatórios foram dois (5 por cento) casos de abscesso periapendicular e um caso de hérnia inguinal direta direita. O tempo de hospitalização variou de 12 a 480 horas - média de 70 horas. As complicações pós-operatórias foram infecção no trajeto do trocarte da fossa ilíaca direita em três casos (7,5 por cento) e hérnia no trocarte da fossa ilíaca direita em um paciente (2,5 por cento). A técnica videolaparoscópica é uma alternativa segura, com algumas vantagens em relação à cirurgia convencional, tornando-a um método eficaz no tratamento da apendicite aguda

Lesäo iatrogênica das vias biliares: estudo de 11 casos / Iatrogenic injury of the bile ducts: study of 11 cases

Foram estudados 11 pacientes com lesao iatrogênica de via biliar. Em todos os casos a lesao ocorreu após uma colecistectomia com ou sem exploraçao das vias biliares. Dos 11 pacientes submetidos à cirurgia das vias biliares, nove (81,81 por cento) foram operados eletivamente e somente dois (18,18 por cento) em caráter de urgência. Considerando-se o local da lesao no trato biliar, os pacientes foram agrupados de acordo com a classificaçao de Bismuth. Dez dos 11 pacientes foram operados na tentativa de se corrigir a lesao da via biliar. O tratamento cirúrgico mais freqüentemente empregado foi a derivaçao jejunal em alça exclusa em y de Roux (nove pacientes). Um paciente foi tratado sem reintervençao cirúrgica. O resultado foi considerado bom em oito (72,72 por cento) dos 11 pacientes, estando relacionado ao número de reoperaçoes, ao local da lesao e da ocorrência de fístulas pós-operatórias.