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INTRODUCTION: surgical treatment of obesity causes important changes in respiratory mechanics. AIM: Comparatively analyze respiratory muscle strength in post bariatric patients underwent to gastric bypass by laparotomy and laparoscopy during hospital stay. METHODS: observational study with a non-randomized longitudinal design, of a quantitative character. Data were collected from 60 patients with BMI 40Kg/m2, divided in laparotomy group (n=30) and laparoscopy group (n=30). Smokers, patients with previous lung diseases and those unable to perform the exam correctly were excluded. Both groups were evaluated at immediate postoperative, first and second postoperative days with manovacuometry for respiratory muscle strength and visual analogue pain scale. RESULTS: the sample was homogeneous in age, sex and BMI. Reduction in maximal respiratory pressures was observed after surgery for those operated on by laparotomy, no return to baseline values on discharge day on the second postoperative day. This group had also more severe pain and longer operative time. There was no difference in respiratory pressure measurements after surgery in the laparoscopy group. CONCLUSION: conventional bariatric surgery reduces muscle strength in the postoperative period and leads to more intense pain during hospitalization when compared to the laparoscopy group.

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ABSTRACT Introduction: surgical treatment of obesity causes important changes in respiratory mechanics. Aim: Comparatively analyze respiratory muscle strength in post bariatric patients underwent to gastric bypass by laparotomy and laparoscopy during hospital stay. Methods: observational study with a non-randomized longitudinal design, of a quantitative character. Data were collected from 60 patients with BMI 40Kg/m2, divided in laparotomy group (n=30) and laparoscopy group (n=30). Smokers, patients with previous lung diseases and those unable to perform the exam correctly were excluded. Both groups were evaluated at immediate postoperative, first and second postoperative days with manovacuometry for respiratory muscle strength and visual analogue pain scale. Results: the sample was homogeneous in age, sex and BMI. Reduction in maximal respiratory pressures was observed after surgery for those operated on by laparotomy, no return to baseline values on discharge day on the second postoperative day. This group had also more severe pain and longer operative time. There was no difference in respiratory pressure measurements after surgery in the laparoscopy group. Conclusion: conventional bariatric surgery reduces muscle strength in the postoperative period and leads to more intense pain during hospitalization when compared to the laparoscopy group.

RESUMO Introdução: o tratamento cirúrgico da obesidade acarreta importantes alterações na mecânica respiratória. Objetivo: analisar comparativamente a força muscular respiratória em pacientes submetidos à cirurgia bariátrica do tipo bypass gástrico por laparotomia e por videolaparoscopia durante o internamento cirúrgico. Métodos: estudo observacional com delineamento longitudinal não-randomizado, de caráter quantitativo. Foram coletados dados de 60 pacientes com índice de massa corporal igual ou superior a 40Kg/m2, candidatos a cirurgia bariátrica e divididos em grupo 1, para os operados por laparotomia (n=30), e grupo 2, para os operados por videolaparoscopia (n=30). Foram excluídos os tabagistas, os pacientes incapazes de executar o exame de forma correta e os portadores de doenças pulmonares prévias. Ambos os grupos foram avaliados no pré-operatório imediato, no primeiro e no segundo dias de pós-operatório através do teste de manovacuometria para a força muscular respiratória e da escala visual analógica de dor. Resultados: a amostra foi homogênea em relação à idade, índice de massa corporal e sexo. Foi observado redução das pressões respiratórias máximas após a cirurgia para os operados por laparotomia, sem retorno aos valores basais no dia da alta hospitalar no segundo dia pósoperatório. Esse grupo também cursou com dor mais intensa e maior tempo cirúrgico. Não houve diferença das medidas de pressão respiratória após a cirurgia no grupo operado por laparoscopia. Conclusões: a cirurgia bariátrica pela via convencional reduz a força muscular respiratória no pós-operatório e cursa com dor mais intensa durante a internação cirúrgica em relação à via laparoscópica.

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Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are commonly associated with important changes in nutritional status (NS). Both malnutrition and obesity have a negative impact on the course of both diseases, with greater risks of postoperative complications, such as anastomotic dehiscences, reoperations, prolonged hospitalizations, and increased mortality. The diagnostic criteria for identifying individuals at nutritional risk, with clear indication for preoperative nutritional therapy, involves several factors. Oral nutrition should be the first choice of nutritional support. If the patient has difficulty in consuming food, the enteral route is the second option, through elementary (amino acids), semi-elementary (oligopeptides), or polymeric (whole proteins) formulas. When oral or enteral routes are not indicated (in the presence of intestinal obstruction or ischemia, fistula, or bleeding), total parenteral nutrition can meet the daily nutritional needs of the critically ill patient. Nutritional support can be performed exclusively or in an associated way, which will depend on the nutritional severity of the patient with IBD. Nutritional screening should be performed at all stages of the disease, always individually and with professionals with experience in IBD. The reduction of complications in the perioperative period is not only associated with adequate surgical technique, but also with adequate nutritional support and clinical preparation before surgery. Therefore, the dietitian with a focus in IBD has an important role in the multidisciplinary team, collaborating with all stages of treatment and with the optimization of the nutritional status of the surgical patient. (AU)

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This study aims to understand the prevalent practices on the nutritional aspects of the enhanced recovery after surgery (ERAS) protocol based on the knowledge and practice of surgeons, nutritionists, and anesthesiologists who work in the bariatric and metabolic surgery (BMS) units worldwide. This cross-sectional study enrolled BMS unit professionals from five continents-Africa, America, Asia, Europe, and Oceania. An electronic questionnaire developed by the researchers was provided to evaluate practices about the three nutritional aspects of ERAS protocol in BMS (Thorel et al. 2016): preoperative fasting, carbohydrate loading, and early postoperative nutrition. Only surgeons, nutritionists, and anesthesiologists were invited to participate. One hundred twenty-five professionals answered the questionnaires: 50.4% from America and 39.2% from Europe. The profile of participating professionals was bariatric surgeons 70.2%, nutritionists 26.4%, and anesthesiologists 3.3%. Approximately 47.9% of professionals work in private services, for about 11 to 20 years (48.7%). In all continents, a large majority were aware of the protocol. Professionals from the African continent reported having implemented the ERAS bariatric protocol 4.0 ± 0 years ago. It is worth mentioning that professionals from the five continents implemented the ERAS protocol based on the published literature (p = 0.012). About preoperative fasting abbreviation protocol, a significant difference was found between continents and consequently between services (p = 0.000). There is no uniformity in the conduct of shortening of fasting in the preoperative period and the immediate postoperative period. Early postoperative (PO) period protein supplementation is not performed in a standard fashion in all units globally. ERAS principles and practices are partial and insufficiently implemented on the five continents despite the prevalent knowledge of professionals based on evidence. Moreover, there is no uniformity in fasting, immediate postoperative diet, and early protein supplementation practices globally.

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Background: Most of the obese patients undergoing an anti-reflux operation experience recurrence of gastroesophageal reflux disease (GERD). Laparoscopic Roux-en-Y gastric bypass (LRNYGB) has been accepted as the bariatric surgery of choice for a previous GERD-operated obese patients. Methods: We present 85 consecutive patients from a single institution, previously submitted to antireflux surgery and then to LRNYGB. Preoperative endoscopy was carried out in all patients; 49 (57.64%) patients had findings of fundoplication failure or signs of persistent GERD, of those 20 (40.81%) with esophagitis. Results: From the bypass, per or postoperative minor to moderate complications occurred in 12 patients (14.11%): 2 (2.35%) conversions to laparotomy, 1 (1.17%) melena, 8 (9.41%) stenosis of gastrojejunostomy, treated by a simple endoscopic dilatation with a balloon, and 1 (1.17%) gastrogastric fistula. A follow-up endoscopy of 79 of 85 (92.9%) patients was carried out after 6 months of LRNYGB. Eight of 79 (10.12%) patients had persistent esophagitis that represented 40% (8 of 20 patients) of persistent reflux esophagitis even after LRNYGB. All of them were men. Conclusion: LRNYGB after laparoscopic fundoplication is a feasible procedure with an excepted higher rate of complications because of the complexity of the procedure. Nevertheless esophagitis still persisted in many of those patients.

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PURPOSE: Propose the systematization of nutritional care in the endoscopic treatment of obesity. METHOD: This is a bibliographical review, since the initial proposal was a systematic review. This method became unfeasible due to the inexistence of studies that address this theme. Thus, a bibliographic survey was carried out, considering the endoscopic treatment as a restrictive treatment, as well as the information referring to case reports and multicentric studies. RESULTS: Nutrition participation involves nutritional assessment and diagnosis, dietary planning pertinent to the adequate evolution of food consistency, as well as the use of food supplements compatible with the Gastric Sleeve due to food restriction. The Bariatric Plate Model (BPM) can be useful in the nutritional education of the patient after gastric endosuture, associated with water consumption and the performance of scheduled physical exercise, as well as periodic monitoring with the multiprofessional team. CONCLUSIONS: Specialized nutritional care is necessary, through a protocol of nutritional assistance defined after gastric endosuture, in order to achieve long-term weight loss and maintenance goals. The BPM can be an excellent form of nutritional education, observing protein intake as a macronutrient base.

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BACKGROUND: The Bariatric Plate Model (BPM) may be an adequate form of nutritional guideline after obesity surgery. AIM: Create a food guide, based on the Plate Model for nutritional education of bariatric patients. METHOD: The Plate Model2 was revised from a model initially suggested for dyslipidemic and hypertensive patients to a new objective: adaptation to bariatric patient who needs effective long-term nutritional education. RESULTS: The adaptation of the Plate Model considered protein needs with high biological value, as it is the priority in the BPM, followed by vitamins and minerals and lastly the carbohydrates, especially the whole ones. CONCLUSION: The BPM is a tool that can be effectively used in nutritional education of bariatric patients.

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ABSTRACT Background: The Bariatric Plate Model (BPM) may be an adequate form of nutritional guideline after obesity surgery. Aim: Create a food guide, based on the Plate Model for nutritional education of bariatric patients. Method: The Plate Model2 was revised from a model initially suggested for dyslipidemic and hypertensive patients to a new objective: adaptation to bariatric patient who needs effective long-term nutritional education. Results: The adaptation of the Plate Model considered protein needs with high biological value, as it is the priority in the BPM, followed by vitamins and minerals and lastly the carbohydrates, especially the whole ones. Conclusion: The BPM is a tool that can be effectively used in nutritional education of bariatric patients.

RESUMO Racional: o Modelo de Prato Bariátrico (MPB) pode ser uma forma adequada de orientação nutricional após a cirurgia da obesidade. Objetivo: Criar um guia alimentar, baseado no Modelo de Prato para educação nutricional de pacientes bariátricos. Método: Foi revisado o The Plate Model2, modelo de prato sugerido inicialmente para pacientes dislipidêmicos e hipertensos com o intuito de adaptá-lo ao paciente bariátrico que necessita de educação nutricional efetiva em longo prazo. Resultados: A adaptação foi feita considerando que o uso de proteínas de alto valor biológico é a prioridade no MPB, seguido de vitaminas e minerais e por último os carboidratos, especialmente os integrais. Conclusão: O MPB é ferramenta que pode ser usada de maneira efetiva na educação nutricional de pacientes bariátricos.

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Background: Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities. Aim: Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery. Methods: The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used. Results: In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins. Conclusion: After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic.

Racional: A cirurgia bariátrica é considerada um dos procedimentos mais eficazes para tratamento da obesidade e objetiva a redução e manutenção da perda de peso em longo prazo, assim como, o controle das comorbidades associadas. Objetivo: Quantificar a ocorrência de alterações funcionais do trato gastrointestinal, sinais sugestivos de carências nutricionais e o uso de suplementos em um grupo de mulheres submetidas à cirurgia bariátrica. Métodos: A amostra foi constituída por mulheres com idades entre 20-65 anos submetidas ao bypass gástrico em Y-de-Roux com seguimento igual ou superior a 24 meses. Para análise qualitativa foi utilizado o Questionário de Frequência Alimentar. Resultados: No período pós-operatório a alopecia foi a mais relatada (79,3%), seguida de alteração na textura das unhas, ambas consideradas preditivos de carências nutricionais. As alterações do trato gastrointestinal foram descritas por 86,2%, e os episódios de dumping foram relatados em 65,5%. Na análise qualitativa foi observado consumo diário reduzido de fontes de proteínas animal e vegetal. Conclusão: Após a cirurgia bariátrica pode ocorrer flatulência, vômitos e síndrome de dumping como sintomas representativos mais frequentes das alterações funcionais digestivas. Alopecia e alterações ungueais são os sinais mais relevantes de carência nutricional. O uso de suplementos alimentares no pós-operatório é escasso e esporádico.

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ABSTRACT Background: Bariatric surgery is deemed one of the most effective procedures for the treatment of obesity and it aims at the reduction and maintenance of weight loss in long term, as the control of the related comorbidities. Aim: Quantify the occurrence of alterations of the gastrointestinal tract, suggestive signs of nutritional deficiencies and the use of supplements in a group of women undergoing bariatric surgery. Methods: The sample consisted of women aged 20-65 years submitted to Roux-en-Y gastric bypass with monitoring equal to or higher than 24 months. For the qualitative analysis, the Feeding Frequency Questionnaire was used. Results: In the postoperative period, alopecia was the most reported (79.3%), followed by changes in the texture of the nails, both considered predictive of nutritional deficiencies. Changes in the gastrointestinal tract were described in 86.2%, and episodes of dumping were reported in 65.5%. Qualitative analysis has shown reduced daily consumption of sources of animal and plant proteins. Conclusion: After bariatric surgery can occur flatulence, vomiting and dumping syndrome as the most frequent representative symptoms of digestive functional disorders. Alopecia and nail changes are the most important signs of nutritional deficiency. The use of dietary supplements in the postoperative period is scarce and sporadic.

RESUMO Racional: A cirurgia bariátrica é considerada um dos procedimentos mais eficazes para tratamento da obesidade e objetiva a redução e manutenção da perda de peso em longo prazo, assim como, o controle das comorbidades associadas. Objetivo: Quantificar a ocorrência de alterações funcionais do trato gastrointestinal, sinais sugestivos de carências nutricionais e o uso de suplementos em um grupo de mulheres submetidas à cirurgia bariátrica. Métodos: A amostra foi constituída por mulheres com idades entre 20-65 anos submetidas ao bypass gástrico em Y-de-Roux com seguimento igual ou superior a 24 meses. Para análise qualitativa foi utilizado o Questionário de Frequência Alimentar. Resultados: No período pós-operatório a alopecia foi a mais relatada (79,3%), seguida de alteração na textura das unhas, ambas consideradas preditivos de carências nutricionais. As alterações do trato gastrointestinal foram descritas por 86,2%, e os episódios de dumping foram relatados em 65,5%. Na análise qualitativa foi observado consumo diário reduzido de fontes de proteínas animal e vegetal. Conclusão: Após a cirurgia bariátrica pode ocorrer flatulência, vômitos e síndrome de dumping como sintomas representativos mais frequentes das alterações funcionais digestivas. Alopecia e alterações ungueais são os sinais mais relevantes de carência nutricional. O uso de suplementos alimentares no pós-operatório é escasso e esporádico.

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Background: The bariatric surgery may cause some nutritional deficiencies. Aim: To compare the serum levels of biochemical markers, in iimmediate post-surgical patients who were submitted to bariatric surgery. Methods: Non-concurrent prospective cross-sectional study. The analysis investigated data in medical charts of pre-surgical and immediate post-surgical patients who were submitted to bariatric surgery, focusing total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C reactive protein, vitamin B12 levels, folic acid, homocysteine values, iron and serum calcium at the referred period. Results: Twenty-nine patients of both genders were evaluated. It was observed weight loss from 108.53 kg to 78.69 kg after the procedure. The variable LDL-c had a significant difference, decreasing approximately 30.3 mg/dl after the surgery. The vitamin B12 serum average levels went from 341.9 pg/ml to 667.2 pg/ml. The triglycerides values were in a range of 129.6 mg/dl-173.3 mg/dl, and 81.9 mg/dl-105.3 mg/dl at the pre- and postoperative respectively. CRP levels fall demonstrated reduction of inflammatory activity. The variable homocysteine was tested in a paired manner and it did not show a significant changing before or after, although it showed a strong correlation with LDL cholesterol. Conclusion: Eligible patients to bariatric surgery frequently present pre-nutritional deficiencies, having increased post-surgical risks when they don´t follow an appropriate nutritional follow-up.

Racional: A cirurgia bariátrica pode causar deficiências nutricionais. Objetivo: Comparar os níveis séricos bioquímicos de pacientes submetidos à cirurgia bariátrica no pré e pós-operatório precoce. Métodos: Estudo transversal, retrospectivo não concorrente. A análise considerou a investigação de prontuários de pacientes submetidos à gastroplastia no período pré-operatório e pós-operatório precoce, analisando resultado bioquímicos de colesterol total, HDL colesterol, LDL colesterol, triglicérides, proteína C reativa, dosagens de vitamina B12, ácido fólico, valores de homocisteína, ferro e cálcio séricos, no referido período. Resultados: Compuseram a amostra 29 pacientes de ambos os sexos. Houve redução de peso após o procedimento cirúrgico com média de 108,53 kg para 78,69 kg. A variável LDL-c apresentou diferença significativa com diminuição de aproximadamente 30,3 mg/dl após a gastroplastia. Com relação à média de níveis séricos de vitamina B12 ela passou de 341,9 pg/ml para 667,2 pg/ml. Os valores de triglicérides encontravam-se na faixa de 129,6 mg/dl-173,3 mg/dl, e 81,9 mg/dl-105,3 mg/dl no pré e pós-cirúrgico, respectivamente. Foi evidenciada redução da atividade inflamatória verificada mediante queda dos níveis de PCR. A variável homocisteína foi avaliada de maneira pareada e não apresentou mudança significativa no antes e depois, havendo, contudo, forte correlação com o LDL-colesterol. Conclusão: Pacientes candidatos à cirurgia bariátrica frequentemente apresentam deficiências nutricionais anteriores ao procedimento com riscos aumentados no período pós-cirúrgico quando não aderem ao acompanhamento nutricional adequado.

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ABSTRACT Background: The bariatric surgery may cause some nutritional deficiencies. Aim: To compare the serum levels of biochemical markers, in iimmediate post-surgical patients who were submitted to bariatric surgery. Methods: Non-concurrent prospective cross-sectional study. The analysis investigated data in medical charts of pre-surgical and immediate post-surgical patients who were submitted to bariatric surgery, focusing total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, C reactive protein, vitamin B12 levels, folic acid, homocysteine values, iron and serum calcium at the referred period. Results: Twenty-nine patients of both genders were evaluated. It was observed weight loss from 108.53 kg to 78.69 kg after the procedure. The variable LDL-c had a significant difference, decreasing approximately 30.3 mg/dl after the surgery. The vitamin B12 serum average levels went from 341.9 pg/ml to 667.2 pg/ml. The triglycerides values were in a range of 129.6 mg/dl-173.3 mg/dl, and 81.9 mg/dl-105.3 mg/dl at the pre- and postoperative respectively. CRP levels fall demonstrated reduction of inflammatory activity. The variable homocysteine was tested in a paired manner and it did not show a significant changing before or after, although it showed a strong correlation with LDL cholesterol. Conclusion: Eligible patients to bariatric surgery frequently present pre-nutritional deficiencies, having increased post-surgical risks when they don´t follow an appropriate nutritional follow-up.

RESUMO Racional: A cirurgia bariátrica pode causar deficiências nutricionais. Objetivo: Comparar os níveis séricos bioquímicos de pacientes submetidos à cirurgia bariátrica no pré e pós-operatório precoce. Métodos: Estudo transversal, retrospectivo não concorrente. A análise considerou a investigação de prontuários de pacientes submetidos à gastroplastia no período pré-operatório e pós-operatório precoce, analisando resultado bioquímicos de colesterol total, HDL colesterol, LDL colesterol, triglicérides, proteína C reativa, dosagens de vitamina B12, ácido fólico, valores de homocisteína, ferro e cálcio séricos, no referido período. Resultados: Compuseram a amostra 29 pacientes de ambos os sexos. Houve redução de peso após o procedimento cirúrgico com média de 108,53 kg para 78,69 kg. A variável LDL-c apresentou diferença significativa com diminuição de aproximadamente 30,3 mg/dl após a gastroplastia. Com relação à média de níveis séricos de vitamina B12 ela passou de 341,9 pg/ml para 667,2 pg/ml. Os valores de triglicérides encontravam-se na faixa de 129,6 mg/dl-173,3 mg/dl, e 81,9 mg/dl-105,3 mg/dl no pré e pós-cirúrgico, respectivamente. Foi evidenciada redução da atividade inflamatória verificada mediante queda dos níveis de PCR. A variável homocisteína foi avaliada de maneira pareada e não apresentou mudança significativa no antes e depois, havendo, contudo, forte correlação com o LDL-colesterol. Conclusão: Pacientes candidatos à cirurgia bariátrica frequentemente apresentam deficiências nutricionais anteriores ao procedimento com riscos aumentados no período pós-cirúrgico quando não aderem ao acompanhamento nutricional adequado.

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BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass, can cause serious nutritional complications arising from poor absorption of essential nutrients. Secondary hyperparathyroidism is one such complications that leads to increased parathyroid hormone levels due to a decrease in calcium and vitamin D, which may compromise bone health. AIM: To compare calcium carbonate and calcium citrate in the treatment of secondary hyperparathyroidism. METHOD: Patients were selected on the basis of their abnormal biochemical test and treatment was randomly done with citrate or calcium carbonate. RESULTS: After 60 days of supplementation, biochemical tests were repeated, showing improvement in both groups. CONCLUSION: Supplementation with calcium (citrate or carbonate) and vitamin D is recommended after surgery for prevention of secondary hyperparathyroidism.

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BACKGROUND: Bariatric surgery is effective treatment for weight loss, but demand continuous nutritional care and physical activity. They regain weight happens with inadequate diets, physical inactivity and high alcohol consumption. AIM: To investigate in patients undergoing Roux-Y-of gastroplasty weight regain, nutritional deficiencies, candidates for the treatment with endoscopic argon plasma, the diameter of the gastrojejunostomy and the size of the gastric pouch at the time of treatment with plasma. METHODS: A prospective 59 patients non-randomized study with no control group undergoing gastroplasty with recurrence of weight and candidates for the endoscopic procedure of argon plasma was realized. The surgical evaluation consisted of investigation of complications in the digestive system and verification of the increased diameter of the gastrojejunostomy. Nutritional evaluation was based on body mass index at the time of operation, in the minimum BMI achieved after and in which BMI was when making the procedure with plasma. The laboratory tests included hemoglobin, erythrocyte volume, ferritin, vitamin D, B12, iron, calcium, zinc and serum albumin. Clinical analysis was based on scheduled follow-up. RESULTS: Of the 59 selected, five were men and 51 women; were included 49 people (four men and 44 women) with all the complete data. The exclusion was due to the lack of some of the laboratory tests. Of this total 19 patients (38.7%) had a restrictive ring, while 30 (61.2%) did not. Iron deficiency anemia was common; 30 patients (61.2%) were below 30 with ferritin (unit); 35 (71.4%) with vitamin B12 were below 300 pg/ml; vitamin D3 deficiency occurred in more than 90%; there were no cases of deficiency of protein, calcium and zinc; glucose levels were above 99 mg/dl in three patients (6.12%). Clinically all had complaints of labile memory, irritability and poor concentration. All reported that they stopped treatment with the multidisciplinary team in the first year after the operation. CONCLUSION: The profile of patients submitted to argon plasma procedure was: anastomosis in average with 27 mm; multiple nutritional deficiencies with predominance of iron deficiency anemia; ferritin below 30; vitamin B12 levels below 300 pg/ml; labile memory complaints, irritability and poor concentration.

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Background:Bariatric surgery, especially Roux-en-Y gastric bypass, can cause serious nutritional complications arising from poor absorption of essential nutrients. Secondary hyperparathyroidism is one such complications that leads to increased parathyroid hormone levels due to a decrease in calcium and vitamin D, which may compromise bone health.Aim: To compare calcium carbonate and calcium citrate in the treatment of secondary hyperparathyroidism.Method: Patients were selected on the basis of their abnormal biochemical test and treatment was randomly done with citrate or calcium carbonate.Results: After 60 days of supplementation, biochemical tests were repeated, showing improvement in both groups.Conclusion: Supplementation with calcium (citrate or carbonate) and vitamin D is recommended after surgery for prevention of secondary hyperparathyroidism.

Racional:A cirurgia bariátrica, especialmente a gastroplastia em Y-de-Roux, pode causar complicações nutricionais importantes que derivam da má absorção de nutrientes essenciais. O hiperparatireoidismo secundário é uma delas que cursa com o aumento do hormônio da paratireoide e consequente diminuição de cálcio e vitamina D, o que pode comprometer a saúde óssea.Objetivo: Comparar o tratamento do hiperparatireoidismo secundário com o uso de carbonato e citrato de cálcio.Métodos: Os pacientes foram selecionados a partir de seus exames bioquímicos alterados e o tratamento foi sugerido aleatoriamente com citrato ou carbonato de cálcio.Resultados: Após 60 dias de suplementação foram reavaliados os exames bioquímicos e percebeu-se melhora em ambos os grupos, tanto com citrato como com carbonato de cálcio.Conclusão: Recomenda-se o uso de suplementação de cálcio (citrato ou carbonato) e vitamina D após a operação para prevenção do hiperparatireoidismo secundário.

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BACKGROUND: Bariatric surgery is effective treatment for weight loss, but demand continuous nutritional care and physical activity. They regain weight happens with inadequate diets, physical inactivity and high alcohol consumption. AIM: To investigate in patients undergoing Roux-Y-of gastroplasty weight regain, nutritional deficiencies, candidates for the treatment with endoscopic argon plasma, the diameter of the gastrojejunostomy and the size of the gastric pouch at the time of treatment with plasma. METHODS: A prospective 59 patients non-randomized study with no control group undergoing gastroplasty with recurrence of weight and candidates for the endoscopic procedure of argon plasma was realized. The surgical evaluation consisted of investigation of complications in the digestive system and verification of the increased diameter of the gastrojejunostomy. Nutritional evaluation was based on body mass index at the time of operation, in the minimum BMI achieved after and in which BMI was when making the procedure with plasma. The laboratory tests included hemoglobin, erythrocyte volume, ferritin, vitamin D, B12, iron, calcium, zinc and serum albumin. Clinical analysis was based on scheduled follow-up. RESULTS: Of the 59 selected, five were men and 51 women; were included 49 people (four men and 44 women) with all the complete data. The exclusion was due to the lack of some of the laboratory tests. Of this total 19 patients (38.7%) had a restrictive ring, while 30 (61.2%) did not. Iron deficiency anemia was common; 30 patients (61.2%) were below 30 with ferritin (unit); 35 (71.4%) with vitamin B12 were below 300 pg/ml; vitamin D3 deficiency occurred in more than 90%; there were no cases of deficiency of protein, calcium and zinc; glucose levels were above 99 mg/dl in three patients (6.12%). Clinically all had complaints of labile memory, irritability and poor concentration. All reported that they stopped treatment with the multidisciplinary ...

RACIONAL: A cirurgia bariátrica é tratamento efetivo para a perda ponderal, mas demanda cuidados contínuos com a nutrição e a atividade física. A recidiva de peso é verificada quando há retorno aos hábitos alimentares errôneos, sedentarismo e alto consumo alcoólico. OBJETIVO: Investigar nos pacientes submetidos à gastroplastia em Y-de- Roux a recidiva de peso, as deficiências nutricionais, os candidatos ao tratamento de plasma endoscópico de argônio e o diâmetro da anastomose gastrojejunal no momento da realização do tratamento com plasma. MÉTODOS: Estudo prospectivo não randomizado e sem grupo controle com 59 pacientes submetidos à gastroplastia, com recidiva de peso e candidatos ao procedimento endoscópico de plasma de argônio. A avaliação cirúrgica constou de investigação de complicações no aparelho digestório e verificação do aumento do diâmetro da anastomose gastrojejunal. A nutricional foi baseada no índice de massa corporal no momento da operação, o IMC mínimo que o paciente chegou após ela e o IMC em que se encontrava no momento de realizar procedimento com plasma. A análise laboratorial incluiu hemoglobina, volume globular, ferritina, vitaminas D, B12, ferro, cálcio, albumina sérica e zinco. A análise de seguimento baseou-se nos retornos programados. RESULTADOS: Dos 59 selecionados, cinco eram homens e 51 mulheres. Foram incluídos 49 pessoas (quatro homens e 44 mulheres) de ambos os sexos com todos os dados completos. A exclusão ocorreu pela falta de alguns dos exames laboratoriais. Deste total ao fazer o procedimento, 19 pacientes (38,7%) possuíam o anel restritivo, enquanto 30 (61,2%) não. Anemia ferropriva foi quadro comum; 30 pacientes (61,2%) encontravam-se com ferritina abaixo de 30 (unidade); 35 (71,4%) estavam com vitamina B12 abaixo de 300 pg/ml; deficiência de vitamina D3 ocorreu em mais de 90%; não houve casos de deficiência de proteínas, cálcio e zinco; glicemia estava acima de 99 mg/dl em três pacientes (6,12%). ...

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BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

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BACKGROUND: Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. AIM: The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. METHOD: We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. RESULTS: We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. CONCLUSION: Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known. .

RACIONAL: A cirurgia bariátrica, em especial o bypass gástrico em Y-de-Roux é tratamento efetivo para a obesidade mórbida refratária, promovendo perda de 75% do excesso de peso inicial. Após o procedimento, no entanto, pode ocorrer reganho em 10-20% dos casos. Para auxiliar, há a fulguração com argônio endoscópico que objetiva a redução do diâmetro anastomótico. Muitos pacientes que se submetem a este tratamento, nem sempre conhecem o processo e seus respectivos cuidados. OBJETIVO: Analisar o modo como o candidato ao procedimento de plasma endoscópico de argônio, entende o processo e absorve as informações transmitidas pela equipe multiprofissional. MÉTODO: Foi elaborado um questionário com 12 questões do tipo Verdadeiro/Falso no intuito de avaliar o conhecimento do paciente acerca do método ao qual estava prestes a ser submetido. O questionário foi aplicado pelo médico cirurgião no momento de sua consulta no período pré-procedimento. Os pacientes foram convidados livremente a preencher o questionário. RESULTADOS: Verificou-se que a maioria conhecia o procedimento através da internet; sabia que era tratamento ambulatorial; que a anestesia era similar à da endoscopia; que necessitava de dieta líquida. Mas, nem todos sabiam que ela era para melhorar a cicatrização local. CONCLUSÃO: Os pacientes bariátricos que possuem uma segunda chance para retomar o emagrecimento, precisam de orientações permanentes. A internet debe ser usada pela equipe multiprofissional para conscientização de que o PEA não será suficiente para a perda e manutenção de peso em longo prazo. Ainda há a necessidade de re-esclarecer o prejuízo da ingestão de álcool no processo de perda de peso, amplamente divulgando seu ...

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