Navegando por Palavras-chave "Gastroplasty"
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- ItemAcesso aberto (Open Access)Análise radiológica das alterações gastrintestinais após cirurgia de Fobi-Capella(Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2007-08-01) Francisco, Marina Celli [UNIFESP]; Barella, Simone Maluf [UNIFESP]; Abud, Thiago Giansante [UNIFESP]; Vilar, Vanessa Sales [UNIFESP]; Reibscheid, Samuel [UNIFESP]; Arasaki, Carlos Haruo [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The present study was aimed at evaluating radiological findings of delayed postoperative upper gastrointestinal series in patients submitted to Fobi-Capella surgery. MATERIALS AND METHODS: Radiological studies of 41 patients, six to nine months following the surgery. RESULTS: The following pathological alterations have been found: hiatal hernia (17%), gastroesophageal reflux disease (19.5%) and sliding of the silastic ring (4.8%). Least frequent findings have been the following: enterocutaneous fistula (2.4%), stenosis of the gastric pouch outlet (2.4%), bezoar (2.4%), and non-visualization of the silastic ring caused by its removal due to patient intolerance (2.4%). Anatomical alterations resulting from the surgery have been clearly demonstrated. CONCLUSION: The present study could demonstrate anatomical alterations and complications resulting from Fobi-Capella surgery.
- ItemAcesso aberto (Open Access)Avaliação do impacto da gastroplastia na microbiota salivar e status de saúde bucal em pacientes com obesidade mórbida(Universidade Federal de São Paulo, 2022-04-19) Ribeiro, Aianne Souto Pizzolato [UNIFESP]; Castelo, Paula Midori [UNIFESP]; http://lattes.cnpq.br/4525318283387445; http://lattes.cnpq.br/7880967443563554A gastroplastia é considerada uma terapia efetiva para a obesidade mórbida, capaz de melhorar ou reverter comorbidades, embora o conhecimento sobre o impacto na saúde bucal seja restrito. O objetivo foi avaliar as condições de saúde bucal, marcadores salivares inflamatórios e microbiota salivar em pacientes submetidos à gastroplastia (by pass; grupo Gastroplastia), comparando-os com um grupo Controle que recebeu aconselhamento dietético por 6 meses. Material e Métodos: 30 mulheres e 10 homens com obesidade mórbida (IMC≥40 kg/m2 ) e idades entre 23 e 44 anos compuseram a amostra (n=20 em cada grupo pareado para o sexo). Foram coletados dados do histórico médico e dentário e consumo alimentar. O exame clínico incluiu o índice de cárie (CPOD), índice periodontal comunitário (IPC) e medidas antropométricas e coleta de saliva para determinação do fluxo, capacidade tampão, citocinas inflamatórias e ácido úrico. A análise microbiológica salivar foi realizada por sequenciamento 16S rRNA para avaliação da abundância relativa de gênero, espécie e alfa-diversidade. Os dados foram analisados por análise de cluster K-means e ANOVA modelo misto de duas vias. Resultados: Uma associação entre condição de saúde bucal, razão cintura/quadril e alfa diversidade bacteriana salivar foi observada ao baseline. A massa corporal e IMC diminuíram significativamente no grupo Gastroplastia. Embora observada discreta melhora nos marcadores de consumo alimentar, o número de dentes obturados e o índice CPOD aumentaram em ambos os grupos (p<0,001). Uma discreta piora no IPC foi observada no grupo Gastroplastia aos 3 meses, enquanto no grupo Controle observou-se leve melhora no status periodontal aos 3 meses, que voltou a piorar até os 6 meses. O fluxo salivar, capacidade tampão e concentrações de TNFα e ácido úrico não se alteraram no período avaliado. As concentrações de IFNγ e IL10 reduziram significativamente no grupo Gastroplastia até os 3 meses, enquanto no grupo Controle a diminuição ocorreu após 3 meses de acompanhamento dietético; as concentrações de IL6 diminuíram em ambos os grupos. Alterações significativas na abundância relativa de gêneros e espécies foram observadas, com destaque para Actinomyces, Atopobium, Campylobacter e Veillonella e Prevotella tannerae, Prevotella nigrescens e Porphyromonas endodontalis, respectivamente, e na alfa-diversidade bacteriana salivar. Conclusão: A perda de peso e a melhora no quadro inflamatório foi evidenciada pelas alterações nas concentrações de citocinas salivares após a gastroplastia, concomitante a uma modulação na microbiota salivar ao nível de gênero, espécie e alfa-diversidade em ambos os grupos. Embora observada discreta melhora nos marcadores de consumos alimentar, o índice de cárie aumentou e não foi encontrada melhora clinicamente significativa no status periodontal 6 meses após a gastroplastia.
- ItemSomente MetadadadosEarly Changes in Postprandial Gallbladder Emptying in Morbidly Obese Patients Undergoing Roux-en-Y Gastric Bypass: Correlation with the Occurrence of Biliary Sludge and Gallstones(Springer, 2009-01-01) Bastouly, Michel [UNIFESP]; Arasaki, Carlos Haruo [UNIFESP]; Ferreira, Jael Brasil; Zanoto, Arnaldo; Borges, Fabiola Gouveia H. P.; Del Grande, José Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Santa Casa Santos; Universidade de São Paulo (USP)Gallstones have been frequently diagnosed after Roux-en-Y gastric bypass (RYGBP). Gallbladder stasis associated with duodenal exclusion may play a role in their pathogenesis.Gallbladder emptying was studied before and on the 30th and 31st postoperative days (POD) after RYGBP in 20 morbidly obese patients. Gallbladder volume after fasting and every 15 min during a 2-h period following administration of a standard liquid meal was determined by sonography. On the 31st POD, the meal was administered through the gastrostomy in order to promote its transit through the duodenum. Fasting volume (FV), maximum ejection fraction (Max EF), and residual volume (RV) were determined. Biliary sludge and calculi were investigated after 1 and 6 months, respectively.FV was 39.4 +/- 20.2 ml, 50.1 +/- 22.7 ml, and 47.9 +/- 23.4 ml, respectively, for the preoperative and two postoperative assessments (P = 0.09). RV was 7.6 +/- 8.7 ml, 25.1 +/- 20.0 ml, and 24.6 +/- 20.9 ml; and Max EF was 80.5 +/- 20.9%, 54.3 +/- 21.4%, and 50.5 +/- 29.0%, respectively, for the pre-, postoral, and postgastrostomy infusion measurements. There was only a significant difference between the preoperative value and the two postoperative values (P < 0.001). Biliary sludge was detected in 65% of the patients and 46% of them subsequently developed gallstones.Gallbladder emptying became significantly compromised after RYGBP. This impairment was unrelated to duodenal exclusion but it was associated with biliary sludge and stone formation.
- ItemSomente MetadadadosEstudo comparativo entre derivação gástrica em Y de Roux e derivação gástrica em anastomose única em relação ao refluxo biliar e outros resultados, até 6 meses da cirurgia bariátrica(Universidade Federal de São Paulo (UNIFESP), 2020-12-18) Katayama, Rafael Caue [UNIFESP]; Lopes Filho, Gaspar De Jesus [UNIFESP]; Universidade Federal de São PauloObjectives: This paper intends to compare One Anastomosis Gastric Bypass (OAGB) with Roux-en-Y Gastric Bypass (RYGB) in terms of biliary reflux, effectiveness and complications. Methods: Twenty patients with morbid obesity were randomized in two groups with ten members. One group was submitted to OAGB and the other to RYGB. We carry out clinical study using the Short Form Healthy Survey 36 (SF-36) questionnaire and patient satisfaction with Visick scale. Upper digestive endoscopy was performed in the preoperative and after three and six months with gastric and esophageal biopsies for posterior histophatological analysis. Results: After six months, the weight loss was equal among the groups (Group OAGB: 43,17 ± 3,74 kg/m² preoperative, 32,05 ± 4,49 kg/m² after 6 months; Group RYGB: 43,06 ± 3,88 kg/m² postoperative, 31,83 ± 3,92 kg/m² after 6 months; p=0,88), just as the satisfaction with the surgery and the improvement of life quality evaluated by the Visick scale and SF 36 questionnaire applied before six months. We did not have major complications postoperatively. The total surgical time was considerably shorter in the OAGB Group, with 78,00 ± 13,37 minutes long, comparing to DGYR Group, with 125,50 ± 10,92 minutes long, (p=0,0001). Histopathological study were performed and did not demonstrate statistical difference of the gastric and esophageal inflammation grade after three and six months from the surgery among the groups. However, Glandular cystic degeneration, which can mean biliary reflux, was more frequent in the postoperative period after both procedures (p=0,004). No histopathological changes related to severe bile reflux were observed on postoperative period of both Groups. Conclusion: The procedures are equally effective when analyzing weight loss, patient satisfaction and life quality improvement after six months from the procedures. The inflammation grade and cellular damage in the gastric pouch and in the esophagus were similar in both groups. One Anastomosis Gastric Bypass required significantly shorter operative time than Roux-en-Y Gastric Bypass with similar postoperative complication rates.
- ItemAcesso aberto (Open Access)Estudo randomizado, controlado com placebo, duplo encoberto do efeito analgésico do esmolol intraoperatório para gastroplastia laparoscópica(Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Morais, Vinicius Barros Duarte De [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal de São PauloBackground and Objectives: Opioids are effective for postoperative pain but, especially in large doses, may cause adverse effects in morbidly obese patients, and multimodal analgesia is recommended. Some studies have indicated that beta blockers decrease the need for anesthetics and postoperative analgesic consumption. The aim of this study was to evaluate the analgesic effect of esmolol in patients undergoing laparoscopic gastroplasty. Methods: The study was prospective, randomized and double blinded. Forty patients, aged 18 to 60 years, of both genders, physical status ASA I or II, submitted to laparoscopic by-pass gastroplasty, were evaluated, divided into two groups. Group 1 (Esmolol) participants received 0.5mg / kg bolus of esmolol in 30mL of isotonic saline prior to anesthetic induction, followed by intravenous infusion of 15ug / kg / min until surgery completion; Group 2 (Saline) patients received 30mL of isotonic saline in bolus and isotonic saline infusion at the same volume as the esmolol group until surgery was completed. General anesthesia was with fentanyl (3ug / kg), propofol (2-4mg / kg), rocuronium (0.6mg / kg), 50% oxygen without nitrous oxide, and sevoflurane 2%. If necessary, they received remifentanil infusion. There were evaluated: intraoperative remifentanil consumption, time to need of postoperative analgesic complementation, intensity of postoperative pain during 24h, number of patients requiring supplementation and total morphine dose in 24h. Adverse effects were noted. Results: There were evaluated for elegibility, 41 participants, with esclusion of 1 patient, and randomized 40, 20 per group. The number of patients who needed intraoperative remifentanil supplementation was lower in esmolol group, as the dose of remifentanil. Time to recovery was shorter in esmolol group. Postoperative morphine supplementation dose were lower in the esmolol group; Pain intensity was lower in the esmolol group during 24h, except at T0 and after 12h. There were no differences in adverse effects, nausea, vomiting, hipotension and bradicardia. Conclusions: Intraoperative esmolol promotes analgesic effect without causing adverse effects, being an effective drug for multimodal analgesia in obese submitted to gastroplasty.
- ItemSomente MetadadadosLean and Fat Mass Loss in Obese Patients Before and After Roux-en-Y Gastric Bypass: A New Application for Ultrasound Technique(Springer, 2012-04-01) Pereira, A. Z. [UNIFESP]; Marchini, J. S.; Carneiro, G. [UNIFESP]; Arasaki, C. H. [UNIFESP]; Zanella, M. T. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)This study aims to evaluate the thickness of the femoral quadriceps and biceps brachii and brachialis muscles bilaterally and the adjacent subcutaneous fat in patients undergoing gastric bypass Roux-en-Y before and after surgery, using ultrasound as the diagnostic method of choice.We studied 12 patients undergoing this surgical method preoperatively and during the first, third, and sixth postoperative months. During these periods, patients were evaluated by ultrasound to determine the thickness of subcutaneous adipose tissue and muscle of the upper and lower limbs.Postoperatively, these patients showed a reduction in the thickness of the upper and lower extremities muscle and adipose tissue as compared to their preoperative values. There was a significant difference in the loss of muscle thickness in all postoperative months and in the thickness of fatty tissue in the sixth month after surgery, compared to the preoperative muscle and fatty tissue thickness.Ultrasound can be considered as the diagnostic method of choice when assessment of the fat and lean body mass is required in morbidly obese patients before and after bariatric surgery.
- ItemAcesso aberto (Open Access)Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder(Instituto de Medicina Tropical, 2008-04-01) Dinelli, Maria Isabel Saraiva [UNIFESP]; Moraes-Pinto, Maria Isabel de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Decreased responses to hepatitis B vaccine have been associated with some host conditions including obesity. Susceptible non-responders to a primary three-dose vaccine series should be revaccinated. Those who maintain a non-responder condition after revaccination with three vaccine doses are unlikely to develop protection using more doses. This is a description of an obese woman who received six doses of hepatitis B vaccine and persisted as a non-responder. She was submitted to a vertical banded gastroplasty Roux-en-Y gastric bypass Capellas's technique. After weight reduction, she received three additional doses of vaccine and seroconverted. Further studies should help clarify the need to evaluate antibody levels and eventually revaccinate the increasing population of individuals who undergo weight reduction.