Hyperinsulinemic hypoglicemia with severe neuroglycopenic symptoms has been identified as a late and rare complication in patients submitted to Roux-en-Y gastric bypass. However, the potential gravity of its manifestations requires effective treatment of this condition. The absence of treatment makes it necessary to develop more effective clinical or surgical methods.
To present one surgical option to revisional surgery in the treatment of hyperinsulinemic hypoglicemia
The procedure consists in reconstituting alimentary transit through the duodenum and proximal jejunum, while keeping the restrictive part of the gastric bypass. As an additional strategy to maintain weight loss, is realized gastric fundus resection, aiming to suppress ghrelin production more effectively.
It was used in three patients with successful results in one year of follow-up.
The procedure to reconstruct the food transit through the duodenum and proximal jejunum, keeping the restrictive component of gastric bypass in the treatment of hyperinsulinemic hypoglycemia showed good initial results and validated its application in other cases with this indication.
The rehabilitation of complications related to oral feeding, resulting from gastroplasty is the competence of the speech therapist, to intervene in mastication and swallowing functions, aiming at quality of life.
Check in the postoperative period the efficiency of stimulation, independent judges in readiness for re-introduction of solid food in morbidly obese undergoing gastroplasty.
Cross-sectional study of descriptive and quantitative evaluated mastication and quality of life of 70 morbidly obese patients undergoing gastroplasty, and a group of 35 obese suffered speech therapy.
In the evaluation of mastication for group 1 (pre and post speech therapy), the results show that, except for the lack of chewing, the other variables, such as food court, type of mastication, mastication rhythm, jaw movements, bolus size, excessive mastication and fluid intake, demonstrate statistical insignificance. In evaluating the quality of life when compared groups 1 and 2, the results from the questionnaire on quality of life in dysphagia (SWAL-QoL - Quality of Life in Swallowing) total and 11 domains assessed in the questionnaire, were statistically significant. With these results, the group 2 presented unfavorable conditions for quality of life.
The stimulation protocol, independent judges in readiness for re-introduction of solid food of these patients in the postoperative period, applied in these conditions of the study, was not the distinguishing factor of the rehabilitation process for the observed period.
Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction.
To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty.
Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day.
There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them.
Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.
Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment.
To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea.
Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria.
Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques.
The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.
Desenvolvido por Surya MKT