RESUMO
BACKGROUND: Several studies conducted in adults suggest that intragastric balloon (IGB) is an effective and safe method for weight loss. Although the prevalence of obesity in adolescents has increased in recent years, the outcomes of IGB treatment in this age group are not known. The aim of this study was to evaluate the safety and efficacy of IGB treatment for weight loss in adolescents followed up for 6 months. METHODS: This is a retrospective longitudinal study including 27 adolescents (14-19 years; 23 female). All participants were referred to IGB treatment by their attending physician, presented body mass index (BMI) ≥ 29 kg/m2 (>p97 BMI/age index) and failed to lose weight in clinical treatments. A liquid-filled nonadjustable IGB with a volume of 600 to 700 ml was used for 6 months. All patients were included in a multidisciplinary program, and adherence to this program was evaluated as the number of attended appointments. RESULTS: There were no serious complications or deaths. The BMI decreased from 37.04 to 31.18 kg/m2 (p < 0.0001), body weight decreased from 102.21 to 86.23 kg (p < 0.0001), and excess weight diminished from 35.18 to 19.12 kg (p < 0.0001). The % excess weight loss (%EWL) was 56.19 and % total weight loss (%TWL) 16.35. Adherence to the multidisciplinary program correlated directly with %EWL (r = 0.55; p = 0.0033) and %TWL (r = 0.53; p = 0.0052). CONCLUSION: Endoscopic treatment of obesity with an IGB is safe, effective, and may be an emerging therapeutic option for adolescents.
Assuntos
Balão Gástrico , Intubação Gastrointestinal , Obesidade Infantil/terapia , Adolescente , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Balão Gástrico/efeitos adversos , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/instrumentação , Intubação Gastrointestinal/métodos , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Aumento de Peso , Redução de Peso , Adulto JovemRESUMO
BACKGROUND: Among the possible complications of bariatric surgery, fistula and partial dehiscence of the gastric suture are well known. Reoperation often is required but results in significant morbidity. Endoscopic treatment of some bariatric complications is feasible and efficient. METHODS: A modified metallic stent was placed between the gastroaesophageal junction and the alimentary jejunal limb, allowing the passage of a nasoenteric feeding tube into the jejunal limb. RESULTS: Endoscopy showed disruption of nearly the entire staple line at the gastric pouch. The modified stent was placed and allowed wound healing. After 31 days, the stent had migrated and was removed endoscopically. Total closure of the fistula was reported 30 days afterward. CONCLUSIONS: Endoscopic treatment of some bariatric surgery complications is feasible and has been reported previously. This report presents a case of a serious leakage treated by placement of a self-expandable metal stent to bridge the fistula.
Assuntos
Derivação Gástrica/métodos , Gastroscopia/métodos , Obesidade Mórbida/cirurgia , Stents , Dor Abdominal/etiologia , Adulto , Fístula Anastomótica/etiologia , Emergências , Feminino , Humanos , Reoperação , Sepse/etiologia , Deiscência da Ferida Operatória/etiologiaRESUMO
BACKGROUND: The purpose of this study was to evaluate the effect of the duodenal-jejunal bypass liner (DJBL), a 60-cm, impermeable fluoropolymer liner anchored in the duodenum to create a duodenal-jejunal bypass, on metabolic parameters in obese subjects with type 2 diabetes. METHODS: Twenty-two subjects (mean age, 46.2±10.5 years) with type 2 diabetes and a body mass index between 40 and 60 kg/m(2) (mean body mass index, 44.8±7.4 kg/m(2)) were enrolled in this 52-week, prospective, open-label clinical trial. Endoscopic device implantation was performed with the patient under general anesthesia, and the subjects were examined periodically during the next 52 weeks. Primary end points included changes in fasting blood glucose and insulin levels and changes in hemoglobin A1c (HbA1c). The DJBL was removed endoscopically at the end of the study. RESULTS: Thirteen subjects completed the 52-week study, and the mean duration of the implant period for all subjects was 41.9±3.2 weeks. Reasons for early removal of the device included device migration (n=3), gastrointestinal bleeding (n=1), abdominal pain (n=2), principal investigator request (n=2), and discovery of an unrelated malignancy (n=1). Using last observation carried forward, statistically significant reductions in fasting blood glucose (-30.3±10.2 mg/dL), fasting insulin (-7.3±2.6 µU/mL), and HbA1c (-2.1±0.3%) were observed. At the end of the study, 16 of the 22 subjects had an HbA1c<7% compared with only one of 22 at baseline. Upper abdominal pain (n=11), back pain (n=5), nausea (n=7), and vomiting (n=7) were the most common device-related adverse events. CONCLUSIONS: The DJBL improves glycemic status in obese subjects with diabetes and therefore represents a nonsurgical, reversible alternative to bariatric surgery.
Assuntos
Cirurgia Bariátrica/métodos , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Duodeno/cirurgia , Endoscopia , Jejuno/cirurgia , Obesidade/sangue , Remoção de Dispositivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Seleção de Pacientes , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
The erosion of a laparoscopic adjustable gastric band (LAGB) can cause pain that is not controlled by analgesics. In such cases, early endoscopic removal may be indicated, but only when gastric penetration is greater than 50%. We report the case of a patient with severe shoulder pain due to a small area of LAGB erosion, which was treated with early endoscopic removal through an incision in the gastric wall. The pain worsened after eating and gastroscopy revealed slight gastric erosion of the band under the cardia. The gastric wall covering the LAGB was incised using an endoscopic needle knife. In a second upper endoscopy performed 7 days later at the endoscopy suite, endoscopic scissors were used to cut the thread and part of the band lock. The open band was then removed orally. This novel endoscopic incision in the gastric wall hastened band erosion and avoided abdominal reoperation.
Assuntos
Endoscopia Gastrointestinal/métodos , Gastroplastia/efeitos adversos , Adulto , Remoção de Dispositivo/métodos , Falha de Equipamento , Humanos , Masculino , Dor de Ombro/etiologiaRESUMO
BACKGROUND: Silastic rings are used in gastric bypass procedures for the treatment of obesity, but ring slippage may lead to gastric pouch outlet stenosis (GPOS). Conventional management has been ring removal through abdominal surgery. OBJECTIVE: To describe a novel, safe, minimally invasive, endoscopic technique for the treatment of GPOS caused by ring slippage after gastric bypass. DESIGN: Case series. SETTING: Federal University of Pernambuco and São Paulo University. PATIENTS: This study involved 39 consecutive patients who were screened for inclusion. INTERVENTION: Endoscopic dilation with an achalasia balloon. MAIN OUTCOME MEASUREMENTS: Technical success and safety of the procedure. RESULTS: Among the 39 patients, 35 underwent endoscopic dilation at the ring slippage site for the relief of GPOS. The 4 patients who did not undergo endoscopic dilation underwent surgical removal of the ring, based on the exclusion criteria. The endoscopic approach was successful in 1 to 4 sessions in 100% of cases with radioscopic control (n = 12). The duration of the procedures ranged from 5 to 30 minutes, and the average internment was 14.4 hours. Dilation promoted either rupture (65.7%) or stretching (34.3%) of the thread within the ring, thereby increasing the luminal diameter of the GPOS. Complications included self-limited upper digestive tract hemorrhage (n = 1) and asymptomatic ring erosion (n = 4). There were no recurrences of obstructive symptoms during the follow-up period (mean of 33.3 months). LIMITATIONS: This was not a randomized, comparison study, and the number of patients was relatively small. CONCLUSION: The technique described promotes the relief of GPOS with low overall morbidity and avoids abdominal reoperation for ring removal.
Assuntos
Cateterismo , Dimetilpolisiloxanos , Migração de Corpo Estranho/terapia , Derivação Gástrica/instrumentação , Obstrução da Saída Gástrica/terapia , Complicações Pós-Operatórias/terapia , Próteses e Implantes , Adulto , Cateterismo/efeitos adversos , Falha de Equipamento , Feminino , Seguimentos , Migração de Corpo Estranho/diagnóstico por imagem , Obstrução da Saída Gástrica/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Gravação em VídeoRESUMO
BACKGROUND: The advent of endoscopic surgery has radically changed surgery worldwide.The concept of minimally invasive procedures has spread quickly, allowing less pain and more rapid recovery for patients. The authors have developed a device for a new surgical approach, the so-called single trocar access (SITRACC). This study report the first multicenter study of cholecystectomies performed with SITRACC. METHODS: Between December 2008 and June 2009, 81 single trocar cholecystectomies were performed in 9 Brazilian surgery centers. RESULTS: The average operative time was 68 minutes. In all, 10 surgeries required 1 additional trocar because of technical problems, and 3 cholecystectomies were converted to standard video laparoscopies. CONCLUSION: A cholecystectomy using the SITRACC method is feasible and safe.
Assuntos
Colecistectomia Laparoscópica/instrumentação , Estudos de Viabilidade , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: The association between medical and dietetic-behavioral treatments of type 2 diabetes mellitus (T2DM) has demonstrated to have variable results. The surgical treatment of T2DM is justifiable after the observation of a successful glycemic control in patients submitted to Roux-en-Y gastric bypass and biliopancreatic diversion. Experiments have shown an important role of the proximal intestine in glycemia decrease and diabetes control. METHODS: Twenty diabetic patients underwent laparoscopic duodenal-jejunal exclusion. The variables studied were body mass index (BMI), fasting glycemia, glycosylated hemoglobin (HbA1c), and C-peptide, in the preoperative period and after 3 and 6 months. RESULTS: There was a BMI decrease up to the third month and a weight stabilization between the third and sixth months. There was a significant reduction in fasting glycemia (43.8%) and HbA1c (22.8%) up to the sixth month (p<0.001). C-peptide did not show any significant alteration until the third month, although there was a considerable increase (25%) between the third and the sixth months (p<0.001). Only two patients were on oral medication after the sixth month. CONCLUSIONS: Preliminary results have shown an important effect of the laparoscopic duodenal-jejunal exclusion in the treatment of T2DM. Studies with longer follow-up and a larger number of patients are necessary to better define the role of this new and promising procedure.
Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Duodenostomia , Derivação Jejunoileal/métodos , Laparoscopia , Sobrepeso/complicações , Adolescente , Adulto , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The staplerless Roux-en-Y gastric bypass (RYGBP) is a new option in bariatric surgery. The first to describe it was Himpens (2004) utilizing the LigaSure Atlas (LSA) in a series of 10 patients. The laparoscopic RYGBP is performed utilizing the LSA for the gastric and jejunal partition; after that, an imbricating running suture is performed to ensure stomach and bowel hermetic closure. All anastomoses are hand-sewn. Technical disadvantages are: learning curve; complications related to suture failure; possible thermal/electricity related injuries; longer operating time. Advantages are: stapler-associated bleeding, leaks, staple-line disruption, and fistulas are avoided; cost reduction. The staplerless RYGBP is complex; the surgeon involved requires expertise and ability. This technique will evolve and will be used by more surgeons. It is a new option for the surgeon preoccupied with costs, which is particularly important in developing countries.