RESUMEN

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.

RESUMEN

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.

RESUMEN

BACKGROUND: Obesity is associated with obstructive sleep apnea-hypopnea syndrome (OSA) and both induce endothelial dysfunction. However, the effect of OSA on endothelial function after bariatric surgery has not been investigated yet. OBJECTIVES: This study aims to evaluate the impact of weight loss on endothelial function in patients with and without obstructive sleep apnea (OSA) in the first 6 months after bariatric surgery. SETTING: This study was conducted at a university hospital, in Brazil. METHODS: The sample consisted of 56 patients homogeneously divided into groups with and without OSA. All patients underwent Roux-en-Y gastric bypass (RYGB), and the diagnosis of OSA was performed by polysomnography. The patients were evaluated preoperatively and 6 months after surgery. The evaluations included anthropometric measures, electrical bioimpedance, clinical symptoms of OSA, and endothelial function (flow-mediated dilation). RYGB improved the anthropometric, bioimpedance, and endothelial function results in both groups. RESULTS: Patients presented a significant clinical improvement in OSA symptoms throughout the study. However, patients with OSA had an improvement in the endothelial function 2.5% lower (p < 0.001) than patients without APNEA syndrome. CONCLUSION: This study demonstrates that the existence of OSA prior to bariatric surgery interferes in the improvement of endothelial function.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

JUSTIFICATIVA E OBJETIVOS: O número de pacientes submetidos à cirurgia bariátrica aumenta a cada ano com a ocorrência, cada vez mais freqüente, de complicações relacionadas com esse procedimento. As principais complicações relatadas são as complicações nutricionais, metabólicas, neurológicas e psicológicas/psiquiátricas. Dentre as complicações neurológicas destacam-se pela sua incidência as neuropatias periféricas. O objetivo desses relatos é chamar a atenção para esse tipo de complicação, que pode ter como manifestação inicial dor tipo neuropática, com posterior ou concomitante envolvimento motor e cujo prognóstico depende de diagnóstico e tratamento precoces. RELATO DOS CASOS: Foram relatados os casos de três pacientes, dois do sexo feminino e um do sexo masculino, submetidos à cirurgia bariátrica (método restritivo - bypass gástrico em Y-de-Roux) que evoluíram, no pós-operatório, com quadro de neuropatia periférica cujo sintoma inicial foi dor neuropática, com posterior ou concomitante envolvimento motor. As eletroneuromiografias demonstraram, nos três casos, uma polineuropatia periférica sensitivo-motora de padrão axonal. Em dois pacientes houve comprometimento intenso dos nervos fibulares. Todos tiveram em comum, antes da manifestação dos sintomas neurológicos, importante perda ponderal num curto período de tempo. CONCLUSÕES: As complicações neurológicas são uma das mais temíveis complicações da cirurgia bariátrica. Nenhum outro fator é mais importante na sua patogenia do que as deficiências nutricionais decorrentes da cirurgia. A vigilância nutricional, evitando-se perdas ponderais acentuadas e rápidas, e a reposição de suplementos são fundamentais para evitar as complicações, sobretudo os quadros neurológicos.

BACKGROUND AND OBJECTIVES: The number of patients undergoing bariatric surgery increases every year, and the frequency of complications associated with this procedure has been increasing. The main complications reported are nutritional, metabolic, neurological, and psychological/psychiatric. Among the neurological complications, peripheral neuropathies are important due to their high incidence. The objective of this report was to stress the importance of this type of complication, in which the initial manifestation might be neuropathic pain followed or accompanied by motor involvement, and whose prognosis depends on early diagnosis and treatment. CASE REPORTS: The case of three patients were reported, two females and one male, who underwent bariatric surgery (restrictive method - Roux-en-Y gastric bypass) and developed, postoperatively, peripheral neuropathy with neuropathic pain as the initial symptom, with posterior or concomitant motor involvement. Electroneuromyography demonstrated in all three cases a sensitive-motor axonal peripheral neuropathy. In two patients, the fibular nerves were severely affected. In common, they all had an important weight loss in a short period of time before developing neurological symptoms. CONCLUSIONS: Neurological complications are one of the most feared complications of bariatric surgeries. Nutritional deficiencies secondary to the surgery are the most important factors in its pathogeny. Nutritional surveillance, avoidance of severe and fast weight loss, and nutritional supplements are fundamental to avoid complications, especially neurological complications.

JUSTIFICATIVA Y OBJETIVOS: El número de pacientes sometidos a la cirugía bariátrica aumenta a cada año con el surgimiento cada vez más frecuente, de complicaciones relacionadas con este procedimiento. Las principales complicaciones relatadas son las complicaciones nutricionales, metabólicas, neurológicas y psicológicas/psiquiátricas. Entre las complicaciones neurológicas se destacan por su incidencia las neuropatías periféricas. El objetivo de estos relatos es destacar este tipo de complicación, que puede tener como manifestación inicial, un dolor tipo neuropático, con posterior o concomitante envolvimiento motor, y cuyo pronóstico depende del diagnóstico y del tratamiento precoces. RELATO DE LOS CASOS: Relatamos los casos de tres pacientes, de los del sexo femenino y uno del sexo masculino, sometidos a cirugía bariátrica (método restrictivo - bypass gástrico en Y de Roux), que evolucionaron en el postoperatorio con un cuadro de neuropatía periférica cuyo síntoma inicial fue dolor neuropático, con posterior o concomitante envolvimiento motor. Las electro neuromiografías demostraron en los tres casos, una Polineuropatía periférica sensitivo-motora de estándar axonal. En de los pacientes hubo un comprometimiento intenso de los nervios fibulares. Todos tuvieron en común, antes de la manifestación de los síntomas neurológicos, una importante pérdida ponderal en un corto período de tiempo. CONCLUSIONES: Las complicaciones neurológicas son una de las más temibles complicaciones de la cirugía bariátrica. Ningún otro factor es más importante en su patogenia que las deficiencias nutricionales provenientes de la cirugía. La vigilancia nutricional, evitando las pérdidas ponderales acentuadas y rápidas, y la reposición de suplementos son fundamentales para evitar las complicaciones, particularmente los cuadros neurológicos.

Asunto(s)

RESUMEN

BACKGROUND AND OBJECTIVES: The number of patients undergoing bariatric surgery increases every year and the frequency of complications associated with this procedure has been increasing. The main complications reported are nutritional, metabolic, neurological, and psychological/psychiatric. Among the neurological complications, peripheral neuropathies are important due to their high incidence. The objective of this report was to stress the importance of this type of complication, in which the initial manifestation might be neuropathic pain followed or accompanied by motor involvement, and whose prognosis depends on early diagnosis and treatment. CASE REPORTS: The case of three patients were reported, two females and one male, who underwent bariatric surgery (restrictive method - Roux-en-Y gastric bypass) and developed, postoperatively, peripheral neuropathy with neuropathic pain as the initial symptom, with posterior or concomitant motor involvement. Electroneuromyography demonstrated in all three cases a sensitive-motor axonal peripheral neuropathy. In two patients, the fibular nerves were severely affected. In common, they all had an important weight loss in a short period of time before developing neurological symptoms. CONCLUSIONS: Neurological complications are one of the most feared complications of bariatric surgeries. Nutritional deficiencies secondary to the surgery are the most important factors in its pathogeny. Nutritional surveillance, avoidance of severe and fast weight loss, and nutritional supplements are fundamental to avoid complications, especially neurological complications.

Asunto(s)

RESUMEN

Nesidioblastosis is characterized by hyperfunction of pancreatic islets caused by hypertrophic beta cells. Postprandial symptoms of hypoglycemia are the clinical presentation of the disease. A female patient with diabetes mellitus who underwent a Roux-en-Y gastric bypass began to present postprandial symptoms of hypoglycemia. There was no radiologic (MRI) evidence of insulinoma. Selective arterial calcium-stimulation test identified hyperfunction only in the splenic artery. Laparoscopic spleen-preserving distal pancreatectomy was performed. The patient has been entirely free of any postprandial symptoms for 10 months after the partial pancreatectomy.

Asunto(s)

RESUMEN

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%.

Asunto(s)

Asunto(s)

RESUMEN

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

Asunto(s)

Asunto(s)

RESUMEN

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.

Asunto(s)

RESUMEN

Superior mesenteric artery syndrome is an uncommon and controversial disease. The diagnosis is based on clinical, radiographic, gastroscopic and ultrasound findings. A review of a case is presented, with discussion of the clinical findings and diagnosis. Surgical treatment in indicated on medical treatment failure. Duodenojejunostomy is associated with 90 per cent success rate

Asunto(s)

RESUMEN

Um homem de 56 anos, até entäo saudável, morreu na sala cirúrgica por hemorragia digestiva maciça, uma semana após episódio isolado de odinofagia pós prandial. O espécime cirúrgico do esôfago e da aorta mostrou um trajeto fistuloso, estenddendo-se de uma massa tumoral esofageana para a aorta. O exame histológico mostrou os achados microscópicos do chamado pseudotumor inflamatório (PTI) do esôfago. Até onde sabemos, esse e o primeiro caso relatado de PTI do esôfago com formaçäo de fístula para a aorta

Asunto(s)