RESUMO
INTRODUCTION AND OBJECTIVES: Bariatric surgery is the most effective treatment for weight loss, with comorbidity control. With low complication rates, the reasons for reoperation are major complications or weight loss failure/weight regain. Nonsurgical problems can also present, such as anemia, dehydration, chronic pain, and malnutrition, among others. Our aim was to analyze the main causes of revisional surgery, reoperation, and hospital readmission, at a specialized bariatric center. METHODS: A retrospective study was conducted on patients that underwent bariatric surgery within the time frame of 2012 and 2019. The baseline analysis included demographic, anthropometric, and perioperative data, as well as a sub-analysis of the main readmission causes and complications. RESULTS: A total of 776 primary surgeries were performed (649 RYGBP, 127 SG, and 10 revisional surgeries), and 99 patients were identified for the study: 10 revisional surgeries, 44 reoperations, and 45 readmissions. The incidence of revisional surgery was 1.2%, reoperation was 5.6%, and readmission 5.8%. Fifty percent of the revisional surgeries were performed due to insufficient weight loss or weight regain; the most frequent causes of reoperation were cholecystitis (38.6%) and internal hernias (9.1%); and the most common causes of readmission were nonspecific abdominal pain (35.5%) and dehydration (24.4%). CONCLUSION: The most frequent causes of postoperative readmission were nonsurgical events, followed by non-bariatric reoperations, and finally revisional surgeries. There was a low incidence of early reoperations. Knowledge of the abovementioned data is important for identifying higher-risk patients, to prevent major complications.
RESUMO
Objetivo: analizar la evolución de las comorbilidades mayores e índice de masa corporal a largo plazo en pacientes intervenidos de cirugía bariátrica. Material y métodos: estudio retrospectivo transversal sobre una muestra de 38 pacientes intervenidos de cirugía bariátrica entre los años 2008 y 2011. La muestra se compone de 32 mujeres y 6 varones, con una media de edad de 43,52 años. Las intervenciones quirúrgicas realizadas fueron 8 bandas gástricas, 8 gastrectomías verticales y 22 by-pass. Resultados: la DM mejora en un 71,43% de los casos, la HTA en 47,05%, la DL en un 75% y el SAOS en un 70%. Por encima de los 5 años de seguimiento, el 28,9% de los pacientes presenta obesidad tipo I, el 23,7% presenta sobrepeso, el 23,7% obesidad tipo II y el 23,7% obesidad tipo III. Conclusión: la cirugía bariátrica consigue la resolución de comorbilidades asociadas a la obesidad en un porcentaje muy elevado de casos, siendo la más efectiva la dislipemia. La reganancia de peso a largo plazo sigue siendo un problema en estos pacientes así como su seguimiento por encima de los 5 años.
Objective: The aim of this paper is to analyze the outcome of major comorbidities and body mass index during long-term follow-up in patients undergoing bariatric surgery. Material and methods: A retrospective cross-sectional study was conducted on a sample of 28 patients (32 women and 6 men; mean age: 43.52 years) undergoing bariatric surgery between 2008 and 2011. The surgical procedures performed were adjustable gastric banding (n =8), sleeve gastrectomy (n = 8) and gastric bypass (n = 22). Results: Diabetes mellitus was resolved in 73.43% of cases, hypertension in 47.05%, dyslipidemia in 75% and obstructive sleep apnea syndrome in 70%. Five years after surgery, 28.9% of the patients had obesity class I, 23.7% had overweight, 23.7% had obesity class II and 23.7% had obesity class III. Conclusion: bariatric surgery achieves resolution of comorbidities associated with obesity in a high percentage of cases. This effect is more effective in dyslipidemia. Weight regain in the long-term and follow-up beyond five years after surgery are still pending issues.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Obesidade Mórbida/epidemiologia , Comorbidade , Cirurgia Bariátrica/métodos , Tempo , Índice de Massa Corporal , Estudos Transversais , Estudos RetrospectivosRESUMO
Among obese subjects, bariatric surgery is very effective to achieve weight loss, to improve metabolic disturbances such as diabetes mellitus and to improve quality of live. However, long term follow up studies show that an important proportion of patients gain weight again. This phenomenon commonly occurs between the third and sixth postoperative year. The main risk factors for weight gain are behavioral and psychological issues, that can be detected in the preoperative assessment. This reinforces the concept that bariatric surgery must be managed by experienced multidisciplinary teams.
La cirugía para la obesidad ha probado ser el tratamiento más efectivo para reducir el exceso de peso de cualquier magnitud, lo que favorece la mejoría de las comorbilidades metabólicas, especialmente de la diabetes tipo 2 y de la calidad de vida. Los estudios con seguimiento de largo plazo muestran que un porcentaje importante de pacientes operados regana peso, lo que se observa más frecuentemente entre el tercer y sexto año postoperatorio. Existen cambios anatómicos y factores dependientes de la técnica quirúrgica que pueden explicar la reganancia de peso, pero son los aspectos conductuales y sicológicos, los principales factores de riesgo para que un paciente que ha reducido exitosamente su exceso de peso vuelva a engordar. Varios de estos aspectos, son detectables en la etapa preoperatoria, lo que confirma que la cirugía bariátrica debe ser realizada en centros de excelencia que cuenten con equipo multidisciplinario.