Preliminary results from digestive adaptation: a new surgical proposal for treating obesity, based on physiology and evolution

Abstract

CONTEXT AND OBJECTIVE: Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach. DESIGN AND SETTING: Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná. METHODS: The technique included vertical (sleeve) gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum), i.e. the lower limit for normal adults. The operations on 100 patients are described. RESULTS: The mean follow-up was nine months (range: one to 29 months). The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m², respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7% of patients, all of them resolved without sequelae. There was no mortality. CONCLUSIONS: This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1) and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.

Estudo da correlação do IMC e comprimento do intestino delgado em pacientes obesos submetidos à cirurgia bariátrica

“…A obesidade mórbida está relacionada com alto risco para doenças degenerativas e para alguns tipos de câncer 4,17 . Há ainda muita desinformação a respeito da obesidade sendo que, durante muitos anos, ela era associada à falta de caráter, auto-indulgência ou distúrbios psíquicos dos indivíduos por ela acometidos.…”

Avaliação De Parâmetros Biométricos, Fisiológicos E Bioquímicos Em Pacientes Com Síndrome Metabólica Submetidos a Programa De Atividade Física Após Cirurgia Bariátrica Santoro Ii

“…A técnica cirúrgica bariátrica denominada Santoro II é um procedimento que reestrutura o sistema digestivo e que tem mostrado ótimos resultados em pacientes portadores de SM (SANTORO et al, 2003;. Estudos sobre o acompanhamento de pacientes após as cirurgias bariátricas, associados à prática de exercícios físicos, são escassos e extremamente importantes para o entendimento de como o organismo se comporta frente a essas intervenções.…”

“…A técnica cirúrgica de Santoro II, um procedimento inovador embasado em dados fisiológicos e antropológicos de conotação evolucionária, tem mostrado ótimos resultados em pacientes portadores de SM (SANTORO et al, 2003;.…”

Obesity surgery and satiety control

“…A paper by Santoro et al 8 on this topic appears in this issue of the São Paulo Medical Journal. The authors describe the rationale, technique and preliminary results of a new surgical procedure for the initial treatment of morbidly or severely obese patients.…”

“…In short, the article by Santoro et al 8 makes an important contribution to the search for an effi cient and safe surgical technique for treating severely obese patients. However, care should be taken to ensure that such surgical procedures are only performed in specialized centers, on patients selected according to clinical and psychological criteria and by experienced surgeons with backup from multiprofessional teams for long-term follow-up.…”