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BACKGROUND: In the late postoperative period of gastric bypass surgery, we observe that many patients weight regain. The objective of this study was to determine the excess weight loss variation at 24 and 60 months postoperative. A secondary objective was to evaluate in the period described, the association of weight regain with red meat intolerance, age, gender, and body mass index. METHODS: Historical cohort study includes only patients who had completed a follow-up of up to 60 months postoperative (93 patients). The variation in percent excess weight loss was determined at 24 and 60 months postoperative to assess any association with the variables preoperative body mass index (BMI), gender, age, and red meat intolerance. RESULTS: The excess weight loss varied about -8.7% (95% CI: -12.1 to -5.4). This weight regain showed a significant association with the variable age, where the patients who regained the least weight tended to be younger than those who regained more (p = 0.012). When comparing the intolerance level to red meat with weight regain, we observed that the lower the intolerance the greater the weight loss, although this finding did not reach statistical significance (p = 0.13). CONCLUSIONS: Weight regain did not compromise therapeutic success. Less weight regain was seen in younger patients. Patients with lower intolerance to red meat tended to show less weight regain. Further studies are needed to elucidate the role of protein intake in weight regain in patients submitted to gastric bypass. No association between weight regain and preoperative BMI or gender was observed.

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BACKGROUND: Based on the reduced gastric volume and the malabsorption produced by Roux-en-Y gastric bypass (RYGBP) and diet therapy, it is essential in the postoperative period to obtain and maintain an adequate nutritional state, with the aim of preventing malnutrition and seeking a healthy life. It is observed that patients have difficulty in understanding the new food choices that must considered, as they have eating habits that are very divergent from those currently proposed. There is often the need for vitamin and mineral replacement after laboratory tests. METHODS: This study calculated and evaluated the 24-h eating records of 210 patients, collected in the course of nutritional visits in follow-ups of the first, third, sixth, ninth, 12th, 18th, and 24th months postoperative. RESULTS: It was possible to observe an increase in the consumption of nutrients in the course of the study period, but it was not regular and significant for all the nutrients. Also, it is noted that the minimal requirements for vitamin A, vitamin C, calcium, iron and B-complex vitamins (except for cyanocobalamin and riboflavin) were not attained. The nutrients in which satisfactory results were obtained were total proteins of high biological value: cyanocobalamin and riboflavin. CONCLUSION: This study demonstrated the concern for nutrient supplementation in the postoperative period of RYGBP. Thus, the routine use of multivitamins is deemed necessary after the first month postoperatively, with its maintenance preferably for the rest of the patient's life, without abandoning periodic clinical and laboratory follow-up.

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Objetivo: O objetivo principal deste artigo é descrever os resultados iniciais do tratamento cirúrgico da obesidade mórbida em um centro multidisciplinar. Métodos: Foram analisados os resultados de 252 pacientes submetidos ao tratamento cirúrgico da obesidade mórbida no período de março de 2000 a março de 2003. As principais variáveis em estudo foram idade, sexo, peso inicial, índice de massa corporal (IMC), presença de doenças associadas e sua melhora no seguimento pós-operatório, qualidade de vida, técnica cirúrgica empregada, presença de complicações e mortalidade. Resultados: A média de idade foi 37,2 anos. O predomínio foi do sexo feminino, com 186 (73,8%) pacientes. A técnica cirúrgica mais utilizada foi a gastroplastia vertical com reconstrução em Y-de Roux com anel restritivo em 250 pacientes. A mortalidade operatória foi de 1 (0,39%) caso. O tempo de seguimento variou de 1 a 36 meses, sendo que 229 (90,8%) pacientes tiveram seus resultados avaliados. A perda de peso média, expressa em percentual de perda do excesso de peso inicial no 2o ano foi de 85,5%. Houve melhora importante na qualidade de vida, e melhora ou resolução das principais doenças associadas. Conclusões: Os resultados encontrados neste estudo demonstram a segurança do procedimento e resultados excelentes em termos de melhora das doenças associadas e dos níveis de qualidade de vida em pacientes submetidos ao tratamento cirúrgico, com baixo índice de mortalidade e complicações operatórias (AU)

Objective: The aim of this study was to evaluate the preliminary results of bariatric surgery in a multi-disciplinary center. Methods: From March 2000 to March 2003, 252 patients underwent operations for morbid obesity and were evaluated prospectively. Study endpoints were surgical complications, operative mortality, percentage of excess body weight loss and impact in quality of life. Results: There were 186 (73.8%) women and 66 (26.2%) male with a mean age of 37.2 years. Roux-en-Y gastic bypass with a silastic ring was used in 250 patients. One (0.39%) operative death ocurred. Follow-up ranged from 1 to 36 months. Mean excess of body weight loss was 85.5% in the second year. Quality of life and comorbidities were significantly improved in the late follow-up. Conclusion: The results of this study show that bariatric operations can be safely performed by a specialized group. Improvement in quality of life and comorbidities, with a low operative mortality are achieved with the surgical treatment of this patients (AU)

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BACKGROUND: Although non-alcoholic hepatitis usually is asymptomatic and benign, this condition may progress to cirrhosis and hepatic failure. Some findings are similar to alcoholic hepatitis, but there is no history of excessive alcohol consumption. Among the factors associated with non-alcoholic hepatitis, obesity, diabetes and dyslipidemia are the most important. METHODS: 77 consecutive patients undergoing bariatric surgery had their liver biopsy compared to the presence of co-morbidities and BMI. RESULTS: 67 patients (87.1%) had an abnormal liver biopsy, mostly due to steatosis (83.1%), but also steatohepatitis (2.6%) and cirrhosis (1.3%). The degree of liver damage was related to higher BMI scores. Co-morbidities were present in 46.9% of the patients with hepatic steatosis. CONCLUSIONS: The authors suggest that a liver biopsy should be performed in all patients at bariatric surgery, in order to evaluate possible liver damage and to assist postoperative care.

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