Background:In Brazil, there has been a significant increase in obesity rates in all age groups. Data from 2017 show that obesity affects 19% of the population. Due to the magnitude of the problem, public health policies have aimed to prevent complications related to obesity by increasing the offerfor bariatric surgeries. Aim:To analyze the current status of bariatric surgery performed in the Brazilian public health system, including data from macroregions and also the effect of digestive surgery training on the number of procedures. Methods:The database of the public health registry (DATASUS) was assessedbetween 2008 and 2018 for descriptive analysis of data and evaluation of the selected parameters. The main surgical techniques, comorbidities, mortality and the costs profile of the system were evaluated. Results:There was a 339% increase in the number of bariatric surgeries in the period evaluated. Gastric bypass was performed in 94% of cases whereas sleeve in 2.4%. Other techniques were used in 3.6%. There were discrepancies in the number of surgeries performed in different regions of the country. Conclusion:There was a considerable advance in the number of bariatric surgeries performed by the public health system between 2008 and 2018. However, there is a need to increase the offer of this service and alsospecialized training, as well as a correction in the distribution of these procedures in the national territory to achieve integrality among its users.

Introduction: In recent years, there has been an increase in the number of medical residency programs in all regions of Brazil, only in the last 4 years, from 2014 to 2018, there was an increase from 18,953 general spots offered for the first year of medical residency to 26,094, 37% more, this was also observed in General Surgery Residencies around Brazil. As a result, the number of general surgeons has increased substantially, from 12,430 in 2008 to 34,065 in 2018, an absolute percentage increase of 174%. These new surgeons are bringing with them their theoretical and practical knowledge already updated, regarding new techniques and surgical modalities. In this context, in the last 2 decades, video-assisted surgery has become the choice for numerous procedures in Brazil and in the World, considering its benefits for patients, such as less postoperative hospital stay and less metabolic response to surgical trauma, for example. The current study correlates the data between the increase in the number of spots in medical residency programs, related to the graduation of new surgeons in Brazil, to the increase of videolaparoscopic surgeries in the public health system. Methodology: Review and online analysis of the national electronic public health registry database - DATASUS. The most performed Surgeries in Brazil were chosen for our data analysis. Results: The results were divided into five geographically distributed areas in Brazil. At the end of the current study, the number of video-assisted surgeries increased by 233%, accompanied by a 63% increase in the number of medical residency openings and a 174% absolute increase in the number of new surgeons in Brazil at the same period. Conclusion: The current study showed that the increase in the number of video-assisted surgeries in the country is related to the exponential increase in the number of medical residency spots and, consequently, to the number of new graduated general surgeons. This increase occurs more and more in a context of videolaparoscopic techniques, revealing multiple benefits already recognized for patients. We could conclude, therefore, that the increase in the number of medical residencies in general surgery - which are increasingly teaching videolaparoscopic techniques - has contributed as a complementary factor to the increase in the number of video-assisted surgeries observed in all regions of Brazil.

Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. The mesentery and intra-abdominal ligaments can be affected. PCI is classified as primary or secondary and associated with multiple predisposing factors. An asymptomatic 87-year-old man underwent an abdominal tomography for follow-up of bladder carcinoma. The examination revealed intestinal and mesenteric pneumatosis associated with pneumoperitoneum. At laparoscopy, intestinal and mesenteric pneumatosis without intestinal infarction was identified. He was discharged on the fifth postoperative day. PCI is a benign condition that can be confused with mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is unnecessary for its diagnosis or management.

BACKGROUND: Abdominal wall hernia is one of the most common surgical pathologies. The advent of minimally invasive surgery raised questions about the best technique to be applied, considering the possibility of reducing postoperative pain, a lower rate of complications, and early return to usual activities. OBJECTIVE: To evaluate the frequency of open and laparoscopic hernioplasties in Brazil from 2008 to 2018, analyzing the rates of urgent and elective surgeries, mortality, costs, and the impact of laparoscopic surgical training on the public health system. METHODS: Nationwide data from 2008 to 2018 were obtained from the public health registry database (DATASUS) for a descriptive analysis of the selected data and parameters. RESULTS: 2,671,347 hernioplasties were performed in the period, an average of 242,850 surgeries per year (99.4% open, 0.6% laparoscopic). The economically active population (aged 20-59) constituted the dominant group (54.5%). There was a significant reduction (P<0.01) in open surgeries, without a compensatory increase in laparoscopic procedures. 22.3% of surgeries were urgent, with a significant increase in mortality when compared to elective surgeries (P<0.01). The distribution of laparoscopic surgery varied widely, directly associated with the number of digestive surgeons. CONCLUSION: This study presents nationwide data on hernia repair surgeries in Brazil for the first time. Minimally invasive techniques represent a minor portion of hernioplasties. Urgent surgeries represent a high percentage when compared to other countries, with increased mortality. The data reinforce the need for improvement in the offer of services, specialized training, and equalization in the distribution of procedures in all regions.

Introduction: In recent years, there has been an increase in the number of medical residency programs in all regions of Brazil, only in the last 4 years, from 2014 to 2018, there was an increase from 18,953 general spots offered for the first year of medical residency to 26,094, 37% more, this was also observed in General Surgery Residencies around Brazil. As a result, the number of general surgeons has increased substantially, from 12,430 in 2008 to 34,065 in 2018, an absolute percentage increase of 174%. These new surgeons are bringing with them their theoretical and practical knowledge already updated, regarding new techniques and surgical modalities. In this context, in the last 2 decades, video-assisted surgery has become the choice for numerous procedures in Brazil and in the World, considering its benefits for patients, such as less postoperative hospital stay and less metabolic response to surgical trauma, for example. The current study correlates the data between the increase in the number of spots in medical residency programs, related to the graduation of new surgeons in Brazil, to the increase of videolaparoscopic surgeries in the public health system. Methodology: Review and online analysis of the national electronic public health registry database - DATASUS. The most performed Surgeries in Brazil were chosen for our data analysis. Results: The results were divided into five geographically distributed areas in Brazil. At the end of the current study, the number of video-assisted surgeries increased by 233%, accompanied by a 63% increase in the number of medical residency openings and a 174% absolute increase in the number of new surgeons in Brazil at the same period. Conclusion: The current study showed that the increase in the number of video-assisted surgeries in the country is related to the exponential increase in the number of medical residency spots and, consequently, to the number of new graduated general surgeons. This increase occurs more and more in a context of videolaparoscopic techniques, revealing multiple benefits already recognized for patients. We could conclude, therefore, that the increase in the number of medical residencies in general surgery - which are increasingly teaching videolaparoscopic techniques - has contributed as a complementary factor to the increase in the number of video-assisted surgeries observed in all regions of Brazil.

Introduction: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas-filled cysts in the intestinal wall. Although rare, it may also involve other regions, such as the mesentery. PCI is classified as primary or secondary and is associated with multiple predisposing factors. It may be associated with either a benign condition or a potentially fatal condition, such as mesenteric ischemia. The objective of this study was to review the medical literature on the rare benign presentations of PCI, excluding cases associated with intestinal ischemia. Methods:We conducted a systematic literature review according to the PRISMA statement. We searched PubMed and LILACS databases for articles published between January 2015 and December 2020 using the following Medical Subject Headings: "pneumatosis cystoides intestinalis" and "pneumoperitoneum," "pneumatosis intestinalis," and "pneumoperitoneum" or "mesenteric pneumatosis." Results:We included 51 articles comprising 58 patients with PCI and pneumoperitoneum. Most patients were men, and mean patient age was 64.9 years. We identified an idiopathic etiology in 29.31% of cases, and the most common predisposing factor was immune dysfunction (29.31%). A total of 24.13% of patients were asymptomatic. The most commons symptoms were abdominal pain (43.10%), nausea and vomiting (41.37%), and abdominal distention (37.93%). Diagnostic surgery was conducted in 26 patients (44.82%). Only 1 patient underwent surgical treatment.Conclusions: PCI is a clinical condition that may have a benign etiology and not require surgery. Treatment of the benign etiology is conservative. Thus, life-threatening conditions should be excluded in all cases.