RESUMEN
Background: The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns. Methods: Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated. Results: Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS. Conclusions: Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection.
RESUMEN
Resumo Os leiomiossarcomas de veia cava inferior são tumores raros, que representam menos de 0,7% de todos os leiomiossarcomas retroperitoneais. Eles são mais comuns em mulheres e causam quadros inespecíficos de dor abdominal crônica. Neste relato, apresentamos um caso de paciente do sexo feminino, de 53 anos de idade, com queixa de dor abdominal crônica periumbilical inespecífica com evolução há 8 meses, diagnosticada com leiomiossarcoma de veia cava inferior por angiotomografia computadorizada. A paciente foi tratada com ressecção completa do tumor e reconstrução da veia cava inferior, com interposição de prótese de dácron. O tratamento considerado padrão-ouro consiste na excisão cirúrgica completa, visto que esses tumores são resistentes a quimioterapia e radioterapia. O prognóstico desses pacientes está intimamente relacionado com a precocidade do diagnóstico, e, por isso, é de grande relevância o conhecimento dessa doença como diagnóstico diferencial de dor abdominal crônica e inespecífica por cirurgiões vasculares e cirurgiões gerais.
Abstract Inferior vena cava leiomyosarcomas are rare tumors that account for less than 0.7% of all retroperitoneal leiomyosarcomas. They are more common in women and cause nonspecific chronic abdominal pain. In this report, we present the case of a 53-year-old female patient complaining of chronic nonspecific periumbilical abdominal pain with initial onset 8 months previously who was diagnosed with inferior vena cava leiomyosarcoma by computed tomography angiography. The patient was treated with complete resection of the tumor and reconstruction of the inferior vena cava with interposition of a Dacron prosthetic graft. The treatment considered the gold standard consists of complete surgical excision, because these tumors are resistant to chemotherapy and radiotherapy. The prognosis of these patients is closely related to early diagnosis. Therefore, it is very important that vascular and general surgeons know that this disease is a possible differential diagnosis of chronic abdominal pains.
RESUMEN
ABSTRACT Objective: Infection after the internal fixation of fractures is a major complication. Early infection is particularly challenging, because it occurs when the fracture is not yet united. The objective of this study is to identify possible factors related to the development of early infection in patients treated with internal fixation for fractures. Method: This retrospective observational study analyzed 24 patients with long bone fractures who underwent internal fixation and developed infections in the post-operatory period. The infections were classified as early (diagnosis in the first two weeks after surgery) or late (diagnosis after 2 weeks). Results: Of the 24 patients studied, 11 (46%) developed early infections and 13 (54%) were diagnosed with late infections. The early infection group was significantly younger (37.8 versus 53.1 [p = 0.05]) and underwent more surgeries prior to internal fixation (1.2 versus 0.2 [p < 0.00]). Conclusion: Risk factors for the development of early infection in the postoperative period should be considered when treating patients with internal fracture fixation in order to diagnose this condition as early as possible. Level of Evidence IV; Case series.
RESUMO Objetivo: A infecção após a fixação interna das fraturas é uma complicação grave, sendo a infecção precoce particularmente desafiadora, pois acontece quando a fratura ainda não está consolidada. O objetivo deste estudo é identificar fatores relacionados com o desenvolvimento de infecção precoce em pacientes submetidos à fixação interna de fraturas. Método: Estudo retrospectivo que envolveu 24 pacientes com fraturas de ossos longos submetidos à fixação interna, que evoluíram com infecção no pós-operatório. A infecção foi classificada como precoce (diagnóstico nas primeiras duas semanas após a fixação interna) e tardia (diagnóstico após 2 semanas da realização da fixação). Resultados: Dos 24 pacientes estudados, 11 (46%) desenvolveram infecção precoce e 13 (54%) tiveram infecção tardia. Os pacientes portadores de infecção precoce eram mais jovens (37,8 anos versus 53,1 anos [p = 0,05]) e foram submetidos a um maior número de cirurgias antes da fixação interna (1,2 versus 0,2 [p < 0,00]). Conclusão: É recomendável levar em consideração os fatores de risco de desenvolvimento de infecção no pós-operatório em pacientes submetidos à fixação interna de fraturas visando realizar o diagnóstico o mais breve possível. Nível de Evidência IV; Série de casos.
RESUMEN
BACKGROUND: Nonalcoholic fatty liver disease incidence is related to the presence of obesity and insulin resistance. A treatment of this disease in patients with morbid obesity is bariatric surgery and its diagnosis is extremely important due to the possible progression to cirrhosis or hepatocellular carcinoma. The development of clinical-laboratorial analysis tools to this disease and its complications is necessary as the gold standard for its diagnosis is an invasive procedure. The objective of the study is to evaluate the use of BARD score in the selection of patients who should undergo liver biopsy during bariatric surgery. METHODS: It was a retrospective analysis of patients with hepatic disease who were biopsied between 2012 and 2013. Their clinical and laboratory data were analyzed by BARD score. The results of those who presented score >2 were compared to the rest. RESULTS: Two hundred ninety-eight patients with hepatic disease were analyzed and among them 70.27 % had score >2. Of the 76 patients with score <1, 1 was diagnosed with liver fibrosis, determining a negative predictive value of 98.68 % for the test (p < 0.05). CONCLUSIONS: The BARD score is still not ideal for the diagnosis of nonalcoholic fatty liver disease, hepatitis, and fibrosis, but it was proved to be effective in the detection of absence of liver fibrosis in a bariatric population.
Asunto(s)
Cirugía Bariátrica , Técnicas de Diagnóstico Endocrino/normas , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/cirugía , Obesidad Mórbida/cirugía , Adulto , Cirugía Bariátrica/efectos adversos , Biopsia , Carcinoma Hepatocelular/etiología , Femenino , Humanos , Hígado/patología , Cirrosis Hepática/etiología , Cirrosis Hepática/patología , Neoplasias Hepáticas/etiología , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/complicaciones , Enfermedad del Hígado Graso no Alcohólico/patología , Obesidad Mórbida/complicaciones , Obesidad Mórbida/patología , Valor Predictivo de las Pruebas , Proyectos de Investigación/normas , Estudios RetrospectivosRESUMEN
O objetivo do presente estudo foi analisar a obstrução do intestino delgado em pacientes submetidos à cirurgia aberta de bypass gástrico em Y de Roux. Foi realizada análise retrospectiva transversal com 732 pacientes do sexo feminino submetidos ao bypass gástrico em Y de Roux aberto no Serviço de Cirurgia Bariátrica e Metabólica do Hospital Santa Casa de Curitiba no período de janeiro de 2012 a março de 2013. Foram coletados dados sobre a incidência de diferentes complicações: tempo de evolução pós-operatória, etiologia e altura da obstrução em intestino delgado. Apenas 12 pacientes necessitaram de reoperação para correção da obstrução intestinal, resultando numa taxa de 1,64% do total de pacientes. O período de tempo entre a cirurgia e a reabordagem foi de 14,6 meses. Considerando-se as reoperações, 1 caso (8,33%) foi devido à hérnia interna no defeito mesentérico e 2 casos (16,66%) ocorreram por hérnia no espaço de Petersen. Nas outras 9 reabordagens (75%) verificaram-se extensas aderências em intestino delgado. Em 6 casos (50%) observaram-se aderências na alça alimentar, sendo 2 casos em região proximal e 4 casos em porção distal (p=0,5). Nos outros 3 casos (25%) ocorreu obstrução da alça bileopancreática, todos em região distal. O tratamento videolaparoscópico foi possível em todos estes pacientes. A incidência de reoperação por obstrução intestinal foi semelhante à encontrada na literatura. Todos os casos ocorreram no pós-operatório tardio. As aderências restritas ao segmento intestinal manipulado foram a etiologia mais comum, principalmente em alça alimentar. O rápido diagnóstico permitiu a abordagem via laparoscopia.
The aim of this study was to analyze the small bowel obstruction in patients underwent to open surgery Roux-en-Y gastric bypass. Cross retrospective analysis was conducted with 732 patients who underwent to Roux-en-Y gastric bypass in Bariatric Surgery and Metabolic Service of Holy House Hospital in Curitiba between January 2012 to March 2013. Data were collected on the incidence of different complications: postoperative time evolution, etiology and height of the obstruction in the small bowel. Only 12 patients required reoperation for intestinal obstruction correction, resulting in a rate of 1.64% of the total patients. The time period between surgery and reoperations was 14.6 months. Considering reoperations, 1 case (8.33%) was due to internal hernia in mesenteric defect and 2 cases (16.66%) occurred by hernia in Petersen's space. In other 9 reoperations (75%) there were extensive adhesions in small bowel. In 6 cases (50%) were observed adhesions on alimentary limb, 2 cases on proximal portion and 4 cases on distal portion (p = 0.5). In other 3 cases (25%) occurred obstruction on secretory limb, all in distal region. The laparoscopic treatment was possible in all these patients. The incidence of reoperation for intestinal obstruction was similar of the literature. All cases occurred in late postoperative period. The most common etiology was adhesions restricted on the manipulated intestinal segment, especially on alimentary limb. The quick diagnosis allowed laparoscopy approach.
RESUMEN
Background: Among the options for surgical treatment of obesity, the most widely used has been the Roux-en-Y gastric bypass. The gastrojejunal anastomosis can be accomplished in two ways: handsewn or using circular and linear stapled. The complications can be divided in early and late. Aim: To compare the incidence of early complications related with the handsewn gastrojejunal anastomosis in gastric bypass using Fouchet catheter with different diameters. Method: The records of 732 consecutive patients who had undergone the bypass were retrospectively analyzed and divided in two groups, group 1 with 12 mm anastomosis (n=374), and group 2 with 15 mm (n=358). Results: The groups showed anastomotic stenosis with rates of 11% and 3.1% respectively, with p=0.05. Other variables related to the anastomosis were also analyzed, but without statistical significance (p>0.05). Conclusion: The diameter of the anastomosis of 15 mm was related with lower incidence of stenosis. It was found that these patients had major bleeding postoperatively and lower surgical site infection, and in none was observed presence of anastomotic leak.
Racional: Entre as opções para o tratamento cirúrgico da obesidade, o mais utilizado é o bypass gástrico em Y-de-Roux. A anastomose gastrojejunal dele pode ser realizada de duas maneiras, manualmente ou utilizando grampeador linear e circular, e as complicações são dividas em precoces e tardias. Objetivo: Comparar a incidência de complicações precoces relacionadas com a confecção manual da anastomose gastrojejunal no bypass gástrico utilizando sonda de Fouchet com calibres diferentes. Métodos: Foi realizada análise retrospectiva transversal com 732 pacientes submetidos ao procedimento, divididos em dois grupos, grupo 1 com anastomose de 12 mm (n=374), e grupo 2 de 15 mm (n=358). Resultados: Os grupos apresentaram taxas de estenose de anastomose de 11% e 3,1% respectivamente, com p=0,05. Outras variáveis relacionadas à anastomose também foram analisadas, porém sem significância estatística (p>0,05). Conclusão: O diâmetro da anastomose de 15 mm esteve relacionado à menor ocorrência de estenoses. Verificou-se, contudo, que estes pacientes apresentaram maior sangramento no pós-operatório e menor infecção de sítio cirúrgico. Não ocorreram fístulas na presente casuística.
RESUMEN
BACKGROUND: The gastric bypass has nutritional and electrolyte disturbances rate of approximately 17%. The most common deficits are protein malnutrition, ferric and zinc, in addition to the vitamin. Although rare, some malnutrition stages reach such severity that ends up being necessary hospitalization and sometimes revisional or reversal surgical procedures. AIM:: To present a proposal of surgical revision for treatment of severe malnutrition after bariatric surgery. METHODS:: The procedure is to reconstitute the food transit through the duodenum and proximal jejunum, keeping the gastric bypass restrictive component. As an additional strategy, the gastric fundus resection is performed, aiming to intensify the suppression of the greline and avoiding excessive weight regain. RESULTS:: After initial stabilization, nutritional and electrolytic support, the procedure was performed in two patients as definitive treatment of malnutrition status. Good results were observed at one year follow up. CONCLUSION:: As improvement option and/or resolution of the nutritional alterations, surgical therapy is one of the alternatives. There is still no consensus on the surgical technique to be performed. This procedure is based on pathophysiological factors for the treatment of this condition, with good initial results, without significant clinical alterations. Longer follow-up will determine its effectiveness. RACIONAL:: O bypass gástrico consta com taxa de distúrbios nutricionais e eletrolíticos de aproximadamente 17%. Os déficits mais frequentes são a desnutrição proteica, férrica e de zinco, além das vitamínicas. Apesar de raros, alguns quadros de desnutrição atingem tal gravidade que acaba sendo indicada internação e, por vezes, procedimentos cirúrgicos revisionais ou de reversão. OBJETIVO:: Apresentar proposta de cirurgia revisional para tratamento de desnutrição severa após bypass gástrico. MÉTODOS:: O procedimento consiste em reconstituir o trânsito alimentar pelo duodeno e jejuno proximal, mantendo o componente restritivo do bypass gástrico. Como estratégia adicional, é realizada ressecção do fundo gástrico, visando intensificar a supressão da grelina e evitando reganho excessivo de peso. RESULTADO:: Após estabilização inicial com suporte hidroeletrlítico e nutricional, o procedimento foi realizado em dois pacientes como tratamento definitivo do quadro de desnutrição. Bons resultados foram observados em seguimento de um ano. CONCLUSÃO:: Como opção de melhora e/ou resolução da defasagem nutricional, a terapia cirúrgica é uma das alternativas. Ainda não há consenso quanto à técnica a ser utilizada. O procedimento aqui apresentado é baseado em fatores fisiopatológicos para o tratamento desta condição, com bons resultados iniciais, sem efeitos colaterais significativos. Seguimento de mais longo prazo é necessário para determinação de sua eficácia.
RESUMEN
ABSTRACT Background: Among the options for surgical treatment of obesity, the most widely used has been the Roux-en-Y gastric bypass. The gastrojejunal anastomosis can be accomplished in two ways: handsewn or using circular and linear stapled. The complications can be divided in early and late. Aim: To compare the incidence of early complications related with the handsewn gastrojejunal anastomosis in gastric bypass using Fouchet catheter with different diameters. Method: The records of 732 consecutive patients who had undergone the bypass were retrospectively analyzed and divided in two groups, group 1 with 12 mm anastomosis (n=374), and group 2 with 15 mm (n=358). Results: The groups showed anastomotic stenosis with rates of 11% and 3.1% respectively, with p=0.05. Other variables related to the anastomosis were also analyzed, but without statistical significance (p>0.05). Conclusion: The diameter of the anastomosis of 15 mm was related with lower incidence of stenosis. It was found that these patients had major bleeding postoperatively and lower surgical site infection, and in none was observed presence of anastomotic leak.
RESUMO Racional: Entre as opções para o tratamento cirúrgico da obesidade, o mais utilizado é o bypass gástrico em Y-de-Roux. A anastomose gastrojejunal dele pode ser realizada de duas maneiras, manualmente ou utilizando grampeador linear e circular, e as complicações são dividas em precoces e tardias. Objetivo: Comparar a incidência de complicações precoces relacionadas com a confecção manual da anastomose gastrojejunal no bypass gástrico utilizando sonda de Fouchet com calibres diferentes. Métodos: Foi realizada análise retrospectiva transversal com 732 pacientes submetidos ao procedimento, divididos em dois grupos, grupo 1 com anastomose de 12 mm (n=374), e grupo 2 de 15 mm (n=358). Resultados: Os grupos apresentaram taxas de estenose de anastomose de 11% e 3,1% respectivamente, com p=0,05. Outras variáveis relacionadas à anastomose também foram analisadas, porém sem significância estatística (p>0,05). Conclusão: O diâmetro da anastomose de 15 mm esteve relacionado à menor ocorrência de estenoses. Verificou-se, contudo, que estes pacientes apresentaram maior sangramento no pós-operatório e menor infecção de sítio cirúrgico. Não ocorreram fístulas na presente casuística.
RESUMEN
ABSTRACT Background The gastric bypass has nutritional and electrolyte disturbances rate of approximately 17%. The most common deficits are protein malnutrition, ferric and zinc, in addition to the vitamin. Although rare, some malnutrition stages reach such severity that ends up being necessary hospitalization and sometimes revisional or reversal surgical procedures. Aim: To present a proposal of surgical revision for treatment of severe malnutrition after bariatric surgery. Methods: The procedure is to reconstitute the food transit through the duodenum and proximal jejunum, keeping the gastric bypass restrictive component. As an additional strategy, the gastric fundus resection is performed, aiming to intensify the suppression of the greline and avoiding excessive weight regain. Results: After initial stabilization, nutritional and electrolytic support, the procedure was performed in two patients as definitive treatment of malnutrition status. Good results were observed at one year follow up. Conclusion: As improvement option and/or resolution of the nutritional alterations, surgical therapy is one of the alternatives. There is still no consensus on the surgical technique to be performed. This procedure is based on pathophysiological factors for the treatment of this condition, with good initial results, without significant clinical alterations. Longer follow-up will determine its effectiveness.
RESUMO Racional: O bypass gástrico consta com taxa de distúrbios nutricionais e eletrolíticos de aproximadamente 17%. Os déficits mais frequentes são a desnutrição proteica, férrica e de zinco, além das vitamínicas. Apesar de raros, alguns quadros de desnutrição atingem tal gravidade que acaba sendo indicada internação e, por vezes, procedimentos cirúrgicos revisionais ou de reversão. Objetivo: Apresentar proposta de cirurgia revisional para tratamento de desnutrição severa após bypass gástrico. Métodos: O procedimento consiste em reconstituir o trânsito alimentar pelo duodeno e jejuno proximal, mantendo o componente restritivo do bypass gástrico. Como estratégia adicional, é realizada ressecção do fundo gástrico, visando intensificar a supressão da grelina e evitando reganho excessivo de peso. Resultado: Após estabilização inicial com suporte hidroeletrlítico e nutricional, o procedimento foi realizado em dois pacientes como tratamento definitivo do quadro de desnutrição. Bons resultados foram observados em seguimento de um ano. Conclusão: Como opção de melhora e/ou resolução da defasagem nutricional, a terapia cirúrgica é uma das alternativas. Ainda não há consenso quanto à técnica a ser utilizada. O procedimento aqui apresentado é baseado em fatores fisiopatológicos para o tratamento desta condição, com bons resultados iniciais, sem efeitos colaterais significativos. Seguimento de mais longo prazo é necessário para determinação de sua eficácia.
RESUMEN
Background : Hyperinsulinemic hypoglicemia with severe neuroglycopenic symptoms has been identified as a late and rare complication in patients submitted to Roux-en-Y gastric bypass. However, the potential gravity of its manifestations requires effective treatment of this condition. The absence of treatment makes it necessary to develop more effective clinical or surgical methods. Aim : To present one surgical option to revisional surgery in the treatment of hyperinsulinemic hypoglicemia Methods : The procedure consists in reconstituting alimentary transit through the duodenum and proximal jejunum, while keeping the restrictive part of the gastric bypass. As an additional strategy to maintain weight loss, is realized gastric fundus resection, aiming to suppress ghrelin production more effectively. Results : It was used in three patients with successful results in one year of follow-up. Conclusion : The procedure to reconstruct the food transit through the duodenum and proximal jejunum, keeping the restrictive component of gastric bypass in the treatment of hyperinsulinemic hypoglycemia showed good initial results and validated its application in other cases with this indication.
Racional : Hipoglicemia hiperinsulinêmica com sintomas neuroglicopênicos severos tem sido identificada como complicação tardia e rara em pacientes submetidos à gastroplastia com bypass em Y-de-Roux. Porém, a gravidade potencial de suas manifestações exige tratamento definitivo desta condição. A falta de tratamento efetivo gera a necessidade de desenvolver métodos clínicos ou cirúrgicos mais eficazes. Objetivo: Apresentar proposta de operação revisional para o tratamento da síndrome de hipoglicemia hiperinsulinêmica. Métodos : O procedimento consiste em reconstituir o trânsito alimentar pelo duodeno e jejuno proximal, mantendo o componente restritivo do by-pass gástrico. Como estratégia adicional de manutenção ponderal, é realizada ressecção do fundo gástrico, visando intensificar a supressão da grelina. Resultado: O procedimento foi realizado em três pacientes com bom resultado em seguimento de um ano. Conclusão : O procedimento de reconstituir o trânsito alimentar pelo duodeno e jejuno proximal, mantendo o componente restritivo do by-pass gástrico no tratamento da hipoglicemia hiperinsulinêmica apresentou bons resultados iniciais podendo validar sua indicação para outros casos.
Asunto(s)
Adulto , Femenino , Humanos , Derivación Gástrica/efectos adversos , Hiperinsulinismo/etiología , Hiperinsulinismo/cirugía , Hipoglucemia/etiología , Hipoglucemia/cirugía , ReoperaciónRESUMEN
BACKGROUND: DiaRem score consists in preoperative model for predicting remission of type 2 diabetes mellitus in obese patients who underwent gastric bypass. AIM: To evaluate the applicability of DiaRem comparing the scores obtained preoperatively with remission of T2DM after surgery. METHOD: Preoperative parameters such as age, use of insulin, oral hypoglycemic agents and glycated hemoglobin, were retrospectively evaluated in diabetic patients undergoing gastric bypass during the period between July 2012 to July 2013. Through these data the DiaRem score were applied. The results of fasting blood glucose and glycated hemoglobin were requested prospectively. RESULTS: Were selected 70 patients; the remission of T2DM after surgery was found in 42 (60%) and no remission in 28 (40%). Checking the final score, it was observed that: from 0 to 2 points, 94.1% of patients remitted completely; between 3 and 7 had remission in 68.9%, of which 42.8% complete; from 8 to 12, 57.1% achieved complete remission; between 13 to 17, 87.5% did not achieve remission and was not seen this complete remission group; between 18 to 22, 88.9% were not remitted. CONCLUSION: The DiaRem score showed appropriate tool to assess remission of T2DM in obese patients who will undergo gastric bypass.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Derivación Gástrica , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Adulto , Factores de Edad , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina Glucada/análisis , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Modelos Teóricos , Obesidad Mórbida/sangre , Valor Predictivo de las Pruebas , Cuidados Preoperatorios , Pronóstico , Inducción de Remisión , Estudios RetrospectivosRESUMEN
BACKGROUND: Hyperinsulinemic hypoglicemia with severe neuroglycopenic symptoms has been identified as a late and rare complication in patients submitted to Roux-en-Y gastric bypass. However, the potential gravity of its manifestations requires effective treatment of this condition. The absence of treatment makes it necessary to develop more effective clinical or surgical methods. AIM: To present one surgical option to revisional surgery in the treatment of hyperinsulinemic hypoglicemia Methods : The procedure consists in reconstituting alimentary transit through the duodenum and proximal jejunum, while keeping the restrictive part of the gastric bypass. As an additional strategy to maintain weight loss, is realized gastric fundus resection, aiming to suppress ghrelin production more effectively. RESULTS: It was used in three patients with successful results in one year of follow-up. CONCLUSION: The procedure to reconstruct the food transit through the duodenum and proximal jejunum, keeping the restrictive component of gastric bypass in the treatment of hyperinsulinemic hypoglycemia showed good initial results and validated its application in other cases with this indication.
Asunto(s)
Derivación Gástrica/efectos adversos , Hiperinsulinismo/etiología , Hiperinsulinismo/cirugía , Hipoglucemia/etiología , Hipoglucemia/cirugía , Adulto , Femenino , Humanos , ReoperaciónRESUMEN
Background:DiaRem score consists in preoperative model for predicting remission of type 2 diabetes mellitus in obese patients who underwent gastric bypass.Aim:To evaluate the applicability of DiaRem comparing the scores obtained preoperatively with remission of T2DM after surgery.Method:Preoperative parameters such as age, use of insulin, oral hypoglycemic agents and glycated hemoglobin, were retrospectively evaluated in diabetic patients undergoing gastric bypass during the period between July 2012 to July 2013. Through these data the DiaRem score were applied. The results of fasting blood glucose and glycated hemoglobin were requested prospectively.Results:Were selected 70 patients; the remission of T2DM after surgery was found in 42 (60%) and no remission in 28 (40%). Checking the final score, it was observed that: from 0 to 2 points, 94.1% of patients remitted completely; between 3 and 7 had remission in 68.9%, of which 42.8% complete; from 8 to 12, 57.1% achieved complete remission; between 13 to 17, 87.5% did not achieve remission and was not seen this complete remission group; between 18 to 22, 88.9% were not remitted.Conclusion:The DiaRem score showed appropriate tool to assess remission of T2DM in obese patients who will undergo gastric bypass.
Racional: Escore DiaRem consiste em modelo pré-operatório de predição de remissão de diabete melito tipo 2 (DM2) em pacientes obesos que serão submetidos exclusivamente ao bypass gástrico.Objetivo: Avaliar a aplicabilidade desse escore comparando a pontuação obtida pré-operatoriamente com a remissão de DM2 após realização da operação.Método: Foram avaliados retrospectivamente, dados clínicos e laboratoriais pré-operatórios necessários para aplicar o escore (idade, uso de insulinoterapia, uso de hipoglicemiantes orais e hemoglobina glicada) de pacientes diabéticos submetidos à gastroplastia laparotômica do tipo bypass, e após um a dois anos de acompanhamento pós-operatório, verificou-se a remissão ou não do DM2.Resultados:Selecionou-se 70 pacientes; a remissão completa foi encontrada em 35 (50%), parcial em sete (10%) e não houve remissão em 28 (40%). Verificando a pontuação final, foi visto que as expectativas lançadas pelo escore DiaRem foram atingidas, pois o grupo de pacientes que alcançou a remissão foi o mesmo que obteve as menores pontuações.Conclusão: O escore DiaRem mostrou-se ferramenta apropriada para avaliar remissão de DM2 em obesos que serão submetidos ao bypass gástrico.