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.
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.
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 Objetivo: analisar as características clínicas e epidemiológicas, as complicações pós-operatórias e a perda de peso em pacientes submetidos à gastrectomia vertical por via convencional, em uma instituição de saúde do Sistema Único de Saúde (SUS). Métodos: estudo transversal, longitudinal, retrospectivo realizado a partir da coleta de dados de prontuários para análise de variáveis em pacientes submetidos à gastrectomia vertical aberta, no SUS, no período de julho de 2013 a janeiro de 2017. Resultados: foram analisados 296 pacientes operados no período do estudo, dos quais 54% eram do sexo masculino; a média de idade foi de 39,9 anos ±11,4; o índice de massa corporal (IMC) médio no pré-operatório foi de 43,5kg/m² e no pós-operatório, de 30,3kg/m²; a perda de excesso de peso foi de 73,6%; 83,24% apresentaram uma perda de excesso de peso maior do que 50%; o IMC pré-operatório foi maior no grupo com perda de peso menor do que 50%. Observou-se uma taxa de complicações precoces com necessidade de internamento de 5,4% e um índice de mortalidade de 1%. Conclusão: a gastrectomia vertical aberta é uma técnica segura e eficaz para a perda de peso e que pode ser mais realizada no SUS. Dentre as variáveis avaliadas, o IMC prévio foi a única relacionada com o sucesso pós-operatório.
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.
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