Cirurgia bariátrica cura a síndrome metabólica?

Abstract

Metabolic syndrome (MS) is a risk condition for the development of systemic atherosclerotic disease. Morbid obesity is a state of insulin resistance (IR) associated with visceral fat accumulation, which is involved in the development of MS. In severe obesity, conservative therapies promote an improvement of MS, but weight regain is frequent, whereas bariatric surgery promotes a more significant and sustained weight loss. Bariatric surgery is recommended for patients with unsatisfactory response to clinical treatment and with IMC > 40 kg/m(2) or > 35 in case of co-morbidities. In those cases, surgical risk must be acceptable and patients submitted to surgery must be informed about complications and postoperative care. Prevention, improvement and reversion of diabetes (DM2) (70 to 90% of cases) are seen in several bariatric surgery modalities. Disabsorptive are more efficient than restrictive procedures in terms of weight reduction and insulin sensitivity improvement, but chronic complications, such as malnutrition, are also more frequent. Vertical gastroplasty with jejunoileal derivation is a mixed surgery in which the restrictive component predominates. In this modality, reversion of DM2 is due to an increase in insulin sensitivity associated with improved beta cell function. Reversion of MS and its manifestations after bariatric surgery are associated with reduction of cardiovascular mortality and, thus, in severe obesity cases, MS can be considered a surgical condition.

Análise do impacto da cirurgia bariátrica em uma população do centro do estado do Rio Grande do Sul utilizando o método BAROS

“…Também é responsável por desencadear artropatias, hipoventilação ou síndrome da apneia do sono e muitas outras condições patológicas, reduzindo, assim, a qualidade de vida e a auto-estima do paciente. Devido a todas comorbidades associadas à obesidade, somandose os aspectos emocionais abalados, pacientes muito obesos têm taxa de mortalidade até 12 vezes maior que a população em geral (2,4,5,7,11,13,15,24,29) . A obesidade também pode estar associada a maior incidência de complicações cirúrgicas e obstétricas, e maior suscetibilidade a acidentes.…”

“…A orientação dietética, a programação de atividade física e o uso de fármacos antiobesidade são os pilares principais do tratamento. Porém, a terapia clínica tem sucesso limitado a curto prazo e quase inexistente a longo prazo (13,27) . De acordo com SEGAL e FANDIÑO (29) não há manutenção na perda de peso, pois cerca de 95% dos pacientes recuperam seu peso inicial em até 2 anos de tratamento convencional.…”

Weight loss promoted by the Intra-oral Alimentary Satiety Device in a morbidly obese patient

“…Morbid obesity is a chronic disease characterized by an excessive accumulation of adipose tissue and visceral fat, and is a determining factor for the development of insulin resistance and Metabolic Syndrome [19][20] .…”

“…In the physiology of satiety, the chewing process produces a rich source of multiple impulses which further stimulate the satiety center, like those generated in muscle proprioceptors excited during the distension and contraction of the different muscle groups involved in 20 . The option of invasive treatment for patients with morbid obesity is bariatric surgery, which has proven effective in controlling various comorbidities and a substantial reduction in the risk of disease and mortality of surgical patients, with an appropriate reduction in BMI and body weight 14 .…”

Quality of life and prevalence of osteoarticular pain in patients submitted to bariatric surgery

“…They are also at risk of developing diabetes, with a 20-fold increase for BMI between 30 and 34.9kg/m² and 38-fold for BMI >35kg/m² (15) . According to other authors, the correlation between the two time points gives a better idea as to how obese patients see life and its repercussions after weight reduction.…”