Could the Intestinal Epithelial Alterations Promoted by Roux-en-Y Gastric Bypass Explain Higher Tendency for Colonic Diseases in Bariatric Patients?

Wendler, Eduardo; Malafaia, Osvaldo; Ariede, Bruno Luiz; Ribas-Filho, Jurandir Marcondes; Czeczko, Nicolau Gregori; Nassif, Paulo Afonso Nunes

doi:10.1590/0102-672020200004e1570

Cited by 2 publications

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References 33 publications

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“…The surgical and anesthesiological practice is under constant development, which means that the recommendations in the literature need to be questioned and updated 25,29 . There are reasons to believe that successful implementation of ERAS programs will lead to reduced hospital costs.…”

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confidence: 99%

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Wendler

Nassif

Malafaia

et al. 2021

ABCD, arq. bras. cir. dig.

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Rational: The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation. Aim: To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass. Methods: Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated. Results: There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups. Conclusions: The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient’s recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.

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Section: /6mentioning

confidence: 99%

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Wendler

Nassif

Malafaia

et al. 2021

ABCD, arq. bras. cir. dig.

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“…Among the deficiencies, hypovitaminosis D is common in obese individuals and can be aggravated after bariatric surgery. Quite often, serum levels of 25-hydroxyvitamin D (25(OH)D) do not rise after surgery, even with supplementation, that is, its insufficiency can put obese individuals at significant risk, and may lead to osteoporosis, osteopenia and fractures, in addition to other diseases 21,46 .…”

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confidence: 99%

Vitamin D Levels and Lipid Profile in Patients Undergoing Bariatric Surgery

Nascimento

Padilha

Araújo

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS: To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS: Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS: A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS: It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.

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Could the Intestinal Epithelial Alterations Promoted by Roux-en-Y Gastric Bypass Explain Higher Tendency for Colonic Diseases in Bariatric Patients?

Cited by 2 publications

References 33 publications

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Shorten Preoperative Fasting and Introducing Early Eating Assistance in Recovery After Gastrojejunal Bypass?

Vitamin D Levels and Lipid Profile in Patients Undergoing Bariatric Surgery

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