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Background: Modifications of gastric anatomy, function, and of the esophagogastric junction secondary to sleeve gastrectomy (SG) can worsen the symptoms of gastroesophageal reflux disease (GERD). Its late diagnosis and poor treatment can lead to serious complications. In recent years, attempts have been made to optimize preoperative studies and improve surgical techniques to prevent this problem. The aim of this study was to update on the presence of GERD and their symptoms post-SG. Methods: A literature review of articles based on randomized clinical trials on the presence of GERD after SG was carried out, in a period of 10 years. Results: A result of 336 articles was obtained, of which 327 were discarded and 9 were included. The variables of GERD post-SG were analyzed according to their symptoms ("improved," "worsened," and "unchanged"), "remission," or appearance "de novo." Conclusion: GERD is a frequently associated pathology in obese patients. Several authors reported that symptoms worsen after SG, and has been diagnosed de novo. The application of exhaustive preoperative studies and a correct surgical technique could reduce its incidence.

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Knowledge about animal models for metabolic study is the basis of research in this area. This work aims to review the main animal models used in the study of obesity and metabolic syndrome. For this, we performed a search in the Pubmed database using the terms "animal models", "obesity", "metabolic syndrome" and "bariatric surgery". Several species of animals can be used for the study of metabolic disorders. However, rodents are the most commonly used, both as monogenic models and as diet-induced obesity (DIO) ones. Monogenic animals are the best choice if only one aspect is being evaluated. DIO animals tend to better demonstrate the interaction between disease, environment and genetics. However, they are still not fully effective in providing understanding of all disease mechanisms.

O conhecimento sobre modelos animais para estudo metabólico representa a base da pesquisa nessa área. Este trabalho tem por objetivo revisar os principais modelos animais a serem utilizados no estudo da obesidade e da síndrome metabólica. Para isso, pesquisa no banco de dados Pubmed foi realizada usando as palavras-chave "animal models", "obesity", "metabolic syndrome", e "bariatric surgery". Várias espécies de animais podem ser usadas para o estudo de distúrbios metabólicos, no entanto, os roedores, tanto modelos monogênicos quanto modelos de obesidade induzida por dieta (DIO), são os animais mais utilizados nessa área. Animais monogênicos são a melhor escolha se apenas um aspecto estiver sendo avaliado. Animais DIO tendem a demonstrar melhor a interação entre doença, ambiente e gene. No entanto, eles ainda não são totalmente eficazes para a compreensão de todos os mecanismos dessa doença.

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RESUMO O conhecimento sobre modelos animais para estudo metabólico representa a base da pesquisa nessa área. Este trabalho tem por objetivo revisar os principais modelos animais a serem utilizados no estudo da obesidade e da síndrome metabólica. Para isso, pesquisa no banco de dados Pubmed foi realizada usando as palavras-chave "animal models", "obesity", "metabolic syndrome", e "bariatric surgery". Várias espécies de animais podem ser usadas para o estudo de distúrbios metabólicos, no entanto, os roedores, tanto modelos monogênicos quanto modelos de obesidade induzida por dieta (DIO), são os animais mais utilizados nessa área. Animais monogênicos são a melhor escolha se apenas um aspecto estiver sendo avaliado. Animais DIO tendem a demonstrar melhor a interação entre doença, ambiente e gene. No entanto, eles ainda não são totalmente eficazes para a compreensão de todos os mecanismos dessa doença.

ABSTRACT Knowledge about animal models for metabolic study is the basis of research in this area. This work aims to review the main animal models used in the study of obesity and metabolic syndrome. For this, we performed a search in the Pubmed database using the terms "animal models", "obesity", "metabolic syndrome" and "bariatric surgery". Several species of animals can be used for the study of metabolic disorders. However, rodents are the most commonly used, both as monogenic models and as diet-induced obesity (DIO) ones. Monogenic animals are the best choice if only one aspect is being evaluated. DIO animals tend to better demonstrate the interaction between disease, environment and genetics. However, they are still not fully effective in providing understanding of all disease mechanisms.

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BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery performed worldwide. Improvements in LSG have been suggested to achieve better weight loss or to lessen the complications rates. We propose a change in the standard technique to privilege the use of thinner instruments, the needlescopic sleeve gastrectomy (NSG). METHODS: A 40-year-old female, BMI 40, with no previous abdominal surgery was selected for a NSG. She was placed in a semi-sitting position with the surgeon standing between the legs. Pneumoperitoneum was created through open laparoscopy; 5 trocars were inserted in standard position for laparoscopic gastric surgery. We have used one 12 mm trocar in the navel for a 5 mm scope and for stapling the stomach; one 5 mm trocar for impedance coagulator and also for the scope during the stapling process, and three 3 mm trocars for liver retraction, left hand manipulation, and greater curve exposition. Surgical techniques are basically the same as for a standard LSG until the moment of stapling the stomach, when the 5 mm scope is changed to the right hand trocar. Stapling can be done trough the umbilical port, parallel to the lesser curvature, in contact with the calibration tube. After stapling, hemostasis was achieved by bipolar coagulation, application of titanium clips, and absorbable suture. The 12 mm umbilical orifice is closed after extraction of the resected stomach. RESULTS: Operative time was 76 min. There was no per-operative complication. Recovery was uneventful and patient was discharged at post operative day 2. Pain was considered minor by the patient. One month after surgery, cosmetic results were very convincing. DISCUSSION: There are several proposed technical modifications in LSG. They can influence complication rates or weight loss like the length of antrum resection, the size of Fouchet tube, or the reinforcement of staple line [1-4]. Besides that other concepts regarding reduction of size or number of trocars have also been applied. LSG has been performed with fewer trocars, using for example special designed internal retractors or even the posterior part of the dissected stomach to replace the liver retractor and its trocar [5, 6]. Single port is another well-known possibility [7, 8], but mini-laparoscopy or needlescopic SG is still not well explored in our opinion. We believe that this technical alternative proposed in this video keeps the standards of care and safety of conventional LSG. There is no change in the position of the surgeon, not even the trocars. Specially designed needlescopic instruments show enough strength to be used in bariatrics and allow the surgeon to perform all the routine maneuvers from dissection to suturing. LSG can be done by mini-laparoscopy with a short adaptation period, previewing a short learning curve with no increase in the complications rate. CONCLUSION: NSG is feasible in selected patients and with few modifications in the standard technique. There might be a benefit in terms of pain. Further studies with large series are necessary to observe these potential benefits.

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