RESUMO
INTRODUCTION: Sleeve gastrectomy is one of the main techniques used to treat severe obesity. The study of the immunohistochemical expression of ghrelin in the gastric mucosa has already been related to weight loss and can be a promising method to predict the surgical outcome. PURPOSE: To analyze the immunohistochemical expression of ghrelin in the gastric mucosa and its correlation with weight loss, comorbidities, and inflammatory changes after sleeve gastrectomy. METHODS: Thirty-five patients submitted to sleeve gastrectomy were evaluated, 29 of whom were female (82.9%), with a mean age of 35.2 years and an average body mass index of 38.1 kg/m2. Endoscopic samples of the mucosa were collected, whose ghrelin expression was evaluated in a semi-quantitative way through the stained antibody area. These data were correlated with weight loss at 3, 6, and 12 months and with the control of comorbidities, and inflammatory alterations. RESULTS: The average total weight loss (TWL%) was 17.7, 26.4, and 32.1%, respectively, at 3, 6, and 12 months. A negative correlation was found between the immunohistochemical expression of ghrelin in the endoscopic biopsy of the fundus and weight loss at 3 (s = - 0.536; p = 0.001) and 6 months (s = - 0.339; p = 0.047). CONCLUSION: The immunohistochemical expression of ghrelin in the mucosa of the gastric fundus was negatively correlated with early weight loss after sleeve gastrectomy.
Assuntos
Derivação Gástrica , Laparoscopia , Obesidade Mórbida , Adulto , Feminino , Humanos , Masculino , Gastrectomia/métodos , Mucosa Gástrica/metabolismo , Grelina/metabolismo , Obesidade Mórbida/cirurgia , Redução de Peso , Imuno-HistoquímicaRESUMO
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2 x 1 cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.
Assuntos
Hérnia Abdominal/cirurgia , Polietilenoglicóis/efeitos adversos , Polipropilenos/uso terapêutico , Telas Cirúrgicas/efeitos adversos , Animais , Colágeno/análise , Modelos Animais de Doenças , Feminino , Fibrose/patologia , Fibrose/prevenção & controle , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/prevenção & controle , Herniorrafia/métodos , Laparoscopia , Teste de Materiais , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Coelhos , Reprodutibilidade dos Testes , Fatores de Tempo , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controle , Resultado do TratamentoRESUMO
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.(AU)
Assuntos
Animais , Coelhos , Hidrogéis/análise , Aderências Teciduais/complicações , Polipropilenos/análise , Coelhos/classificação , InflamaçãoRESUMO
PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal®) in contact with small bowel in an experimental model in rabbits. METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal® spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test. RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups. CONCLUSION: Polypropylene mesh coated with Coseal® showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.
Assuntos
Animais , Feminino , Coelhos , Hérnia Abdominal/cirurgia , Polietilenoglicóis/efeitos adversos , Polipropilenos/uso terapêutico , Telas Cirúrgicas/efeitos adversos , Colágeno/análise , Modelos Animais de Doenças , Fibrose/patologia , Fibrose/prevenção & controle , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/prevenção & controle , Herniorrafia/métodos , Laparoscopia , Teste de Materiais , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/prevenção & controle , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controleRESUMO
BACKGROUND: Under the restrictive component, patients undergoing gastric bypass may have food intolerance with or without complications. METHODS: This study used quantitative, analytical, observational methodology with patients submitted to Roux-en-Y gastric bypass without the placement of a ring at Hospital Universitário do Rio Grande do Norte in the city of Natal, Brazil between July 2005 and August 2010. Out of 176 patients monitored after surgery by the interdisciplinary team, 47 took part in the study. Two questionnaires were applied to participants: one elaborated by Suter et al. and previously validated for assessment of food tolerance and another to characterize schooling and socioeconomic status. Evaluation of food tolerance considered patient satisfaction with eating, most accepted food types, and frequency of vomiting and/or regurgitation. After application of the first questionnaire, a score was generated, characterizing food intolerance. RESULTS: Of the 47 patients evaluated, 85.1% classified their degree of food satisfaction as good or excellent. Red meat was the most cited as being difficult to ingest (38.3%), representing a significant impact on overall tolerance level (P < 0.001); 48.9% of participants exhibited rare episodes of vomiting, which resulted in a mean food tolerance score of 23.02 (2.87 ± SD). Moreover, socioeconomic status showed a significant correlation with tolerance level (P = 0.032). CONCLUSIONS: The degree of food tolerance observed in the study sample was better than that obtained in other investigations using similar methodology. The questionnaire proved to be useful in evaluating food quality and comparing postoperative results. Socioeconomic status was correlated with food tolerance level.