Resultados da cirurgia bariátrica e metabólica: gastrectomia vertical versus gastroplastia vertical com derivação em Y-de-Roux. Ensaio clínico prospectivo
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Arquivos
Data
2009
Autores
Miguel, Gustavo Peixoto Soares [UNIFESP]
Orientadores
Azevedo, João Luiz Moreira Coutinho de [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
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Resumo
Objetivos: Avaliar a equivalência da operação gastrectomia vertical com anel (GVA), em relação à operação gastroplastia vertical com anel e derivação gástrica em Y-de-Roux (DGA), na indução de perda ponderal e modificação da composição corporal em obesas mórbidas. Verificar os impactos laboratoriais e clínicos da GVA sobre as principais doenças associadas à obesidade mórbida, e a ocorrência de complicações, em comparação à DGA. Métodos: Ensaio clínico prospectivo não-randomizado, incluindo 65 mulheres obesas mórbidas, distribuídas em dois grupos, GVA (n = 33) e DGA (n = 32). Operadas consecutivamente, pelo mesmo cirurgião, por via laparotômica. Os parâmetros avaliados foram antropométricos; composição corporal, por meio de bioimpedância elétrica; laboratoriais; efeitos sobre as doenças pré-existentes e complicações. Resultados: Ocorreu perda de peso expressiva (p = 0,0000), redução do índice de massa corporal - IMC (p = 0,0000) e cintura abdominal (p = 0,0000) em ambos grupos. O índice cintura/quadril diminuiu (p = 0,0000) após ambas intervenções. A perda do excesso de IMC foi de 86,05% ± 14,2 no grupo GVA e 85,91 ± 15,71 no grupo DGA. A variação da gordura corporal foi de -35,84% ± 8,66 no grupo GVA e de -37,64% ± 9,62 no grupo DGA. A redução dos níveis de triglicerídios (p = 0,0222) foi mais expressiva no grupo DGA. O grupo DGA atingiu os alvos terapêuticos para o colesterol-LDL com maior freqüência (p = 0,0005), que o grupo GVA. Intolerância à glicose, diabetes mellitus tipo 2, hipertensão arterial sistêmica, esteatose hepática e síndrome metabólica, foram controladas de forma semelhante entre as técnicas. Anemia foi mais prevalente no grupo DGA (p=0,0033) e a esofagite erosiva, no grupo GVA (p = 0,0032). Não houve diferença na formação de cálculos biliares entre os grupos. Conclusões: A GVA é tão efetiva quanto a DGA em induzir perda ponderal e modificação favorável da composição corporal. A GVA é menos efetiva no controle da dislipidemia, em relação à DGA. GVA acarreta anemia em menor freqüência e, esofagite erosiva de maneira mais freqüente, que a DGA. GVA não é mais segura que a DGA, mas deve ser considerada intervenção bariátrica efetiva como segunda opção.
Objectives: To compare banded sleeve gastrectomy (BSG) and vertical banded gastric bypass (VBGB), analyzing the effects of the two surgical procedures (and complications thereof) on weight loss and body composition in morbidly obese patients. To evaluate the laboratory and clinical impact of BSG on the most common diseases associated with morbid obesity. Methods: This was a prospective nonrandomized clinical trial that included 65 morbidly obese female patients divided into two groups: the BSG group (n = 33) and the VBGB group (n = 32). The surgical procedures were consecutively performed by the same surgeon. Access was gained via a laparotomy. The following were evaluated: anthropometric parameters; body composition (through electrical bioimpedance); laboratory parameters; effects on preexisting diseases; and complications. Results: Marked weight loss (p = 0.0000), a marked reduction in body mass index (BMI; p = 0.0000) and a marked reduction in waist circumference (p = 0.0000) were observed in both groups. The waist-hip ratio was reduced after the surgical procedures (p = 0.0000). Excess BMI loss was 86.05 ± 14.2% in the BSG group and 85.91 ± 15.71% in the VBGB group. Body fat reduction was 35.84 ± 8.66% in the BSG group and 37.64 ± 9.62% in the VBGB. The reduction in triglyceride levels was more marked in the VBGB group (p = 0.0222), as was the reduction in LDL cholesterol levels (p = 0.0005). The two techniques were similarly effective in controlling glucose intolerance, type 2 diabetes mellitus, systemic arterial hypertension, liver steatosis and metabolic syndrome. Anemia was more prevalent in the VBGB group (p = 0.0033), whereas erosive esophagitis was more prevalent in the BSG group (p = 0.0032). No difference was observed between the two groups regarding gallstone formation. Conclusion: BSG was as effective as VBGB in inducing weight loss and favorable changes in body composition. BSG was less effective in controlling dyslipidemia. BSG led to anemia less often than did VBGB. BSG led to erosive esophagitis more often than did VBGB. BSG did not prove safer than VBGB and therefore should not replace the latter as the bariatric procedure of first choice.
Objectives: To compare banded sleeve gastrectomy (BSG) and vertical banded gastric bypass (VBGB), analyzing the effects of the two surgical procedures (and complications thereof) on weight loss and body composition in morbidly obese patients. To evaluate the laboratory and clinical impact of BSG on the most common diseases associated with morbid obesity. Methods: This was a prospective nonrandomized clinical trial that included 65 morbidly obese female patients divided into two groups: the BSG group (n = 33) and the VBGB group (n = 32). The surgical procedures were consecutively performed by the same surgeon. Access was gained via a laparotomy. The following were evaluated: anthropometric parameters; body composition (through electrical bioimpedance); laboratory parameters; effects on preexisting diseases; and complications. Results: Marked weight loss (p = 0.0000), a marked reduction in body mass index (BMI; p = 0.0000) and a marked reduction in waist circumference (p = 0.0000) were observed in both groups. The waist-hip ratio was reduced after the surgical procedures (p = 0.0000). Excess BMI loss was 86.05 ± 14.2% in the BSG group and 85.91 ± 15.71% in the VBGB group. Body fat reduction was 35.84 ± 8.66% in the BSG group and 37.64 ± 9.62% in the VBGB. The reduction in triglyceride levels was more marked in the VBGB group (p = 0.0222), as was the reduction in LDL cholesterol levels (p = 0.0005). The two techniques were similarly effective in controlling glucose intolerance, type 2 diabetes mellitus, systemic arterial hypertension, liver steatosis and metabolic syndrome. Anemia was more prevalent in the VBGB group (p = 0.0033), whereas erosive esophagitis was more prevalent in the BSG group (p = 0.0032). No difference was observed between the two groups regarding gallstone formation. Conclusion: BSG was as effective as VBGB in inducing weight loss and favorable changes in body composition. BSG was less effective in controlling dyslipidemia. BSG led to anemia less often than did VBGB. BSG led to erosive esophagitis more often than did VBGB. BSG did not prove safer than VBGB and therefore should not replace the latter as the bariatric procedure of first choice.