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Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones.
Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.
There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction.
Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.
Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery.
To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life.
A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%.
The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m². In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders.
Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight.
Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone whose effects are predominantly trophic on the intestinal mucosa.
Critically evaluate the current literature on the influence of bariatric/metabolic surgery on the levels of GLP-2 and its potential clinical implications.
s: Narrative review through online research on the databases Medline and Lilacs. There were six prospective human studies, two cross-sectional human studies, and three experimental animal studies selected.
There is evidence demonstrating significant increase in the levels of GLP-2 following gastric bypass, Scopinaro operation, and sleeve gastrectomy. There are no differences between gastric bypass and sleeve gastrectomy in regards to the increase in the GLP-2 levels. There is no correlation between the postoperative levels of GLP-2 and the occurrence of adequate or insufficient postoperative weight loss.
GLP-2 plays significant roles on the regulation of nutrient absorption, permeability of gut mucosa, control of bone resorption, and regulation of satiety. The overall impact of these effects potentially exerts a significant adaptive or compensatory effect within the context of varied bariatric surgical techniques.
Obesity is an epidemic and chronic disease that can bring other comorbidities to the patient. Non-alcoholic fatty liver disease is present in up to 90% of these patients and can progress to hepatitis and hepatocarcinoma. The relationship of this liver disease and obesity is already well known; however, it is possible that some parameters of the comorbidities are more related than others in the pathophysiology of the disease.
Was analyzed the relationship between non-alcoholic fatty liver disease (NAFLD) and the comorbidities of metabolic syndrome in morbidly obese patients.
Was involved ultrasonography and laboratory assessment of obese patients before bariatric surgery. NAFLD was assessed using the same sonography parameters for all patients. Based on the results, the patients were divided into groups with and without NAFLD. Comparisons between them involved clinical and laboratory variables such as fasting blood glucose, insulin, HOMA-IR (homeostasis model assessment - insulin resistance), glycated hemoglobin, total cholesterol and fractions, triglycerides, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase, C-reactive protein, albumin and ferritin. Patients who reported alcohol abuse (defined as the consumption of >14 drinks per week) or who had hepatitis were excluded.
Eighty-two patients (74 women and 8 men) were studied, of whom 53 (64.6%) had NAFLD and 29 (35.4%) did not. The levels of glycated hemoglobin (p=0.05) and LDL cholesterol (p=0.01) were significantly altered in patients with NAFLD. However, weight, body mass index and excess weight did not differ significantly between the groups (p=0.835, p=0.488 and p=0.727, respectively).
Altered LDL cholesterol and glycated hemoglobin levels were related to the presence of NAFLD.
The role of gut hormones in glucose homeostasis and weight loss achievement and maintenance after bariatric surgery appears to be a key point in the understanding of the beneficial effects observed following these procedures.
To determine whether there is a correlation between the pre and postoperative levels of both GLP-1 and GLP-2 and the excess weight loss after Roux-en-Y gastric bypass (RYGB).
An exploratory prospective study which enrolled 11 individuals who underwent RYGB and were followed-up for 12 months. GLP-1 and GLP-2 after standard meal tolerance test (MTT) were determined before and after surgery and then correlated with the percentage of excess loss (%EWL).
GLP-2 AUC presented a significant postoperative increase (945.3±449.1 vs.1787.9±602.7; p=0.0037); GLP-1 AUC presented a non-significant trend towards increase after RYGB (709.6±320.4 vs. 1026.5±714.3; p=0.3808). Mean %EWL was 66.7±12.2%. There was not any significant correlation between both the pre and postoperative GLP-1 AUCs and GLP-2 AUCs and the %EWL achieved after one year.
There was no significant correlation between the pre and postoperative levels of the areas under the GLP-1 and GLP-2 curves with the percentage of weight loss reached after one year.
Studies related to obesity have shown association with metabolic syndrome. Data showing that obesity is capable to cause low grade chronic inflammation, without its classic signs and symptoms, call attention to researches to study different cells types and the mechanism of the inflammatory process.
To evaluate the variation of glycated hemoglobin (HbA1c) and the pro-inflammatory cytokine interleukin-6 (IL6) in diabetic patients with BMI <35 kg/m2 in the pre and postoperative of partial duodenal switch.
Nine patients were studied before and one year after the operation and the variation of the serum IL6 was measured by Elisa. The changes of HbA1c were also registered.
The pre-operative IL6 levels reached 65,50436±2,911993 pg/ml and one year after de operation 39,47739±3,410057 and the HbA1c average of 10,67 and 5.8 in the same period.
The partial duodenal switch was efficient to control one year after the procedure the chronic inflammatory process caused by the diabetes mellitus type 2 with BMI <35 by dropping the IL6 levels and bringing the HbA1c to normal.
In the Western world, the population developed an overweight profile. The morbidly obese generate higher cost to the health system. However, there is a gap in this approach with regard to individuals above the eutrofic pattern, who are not considered as morbidly obese.
To correlate nutritional status according to BMI with the costs of laparoscopic cholecystectomy in a public hospital.
Data were collected from medical records about: nutritional risk assessment, nutricional state and hospital cost in patients undergoing elective laparoscopic cholecystectomy.
Were enrolled 814 procedures. Average age was 39.15 (±12.16) years; 47 subjects (78.3%) were women. The cost was on average R$ 6,167.32 (±1830.85) to 4.06 (±2.76) days of hospitalization; 41 (68.4%) presented some degree of overweight; mean BMI was 28.07 (±5.41) kg/m²; six (10%) individuals presented nutritional risk ≥3. There was a weak correlation (r=0.2) and not significant (p <0.08) between the cost of hospitalization of the sample and length of stay; however, in individuals with normal BMI, the correlation was strong (r=0,57) and significant (p<0.01).
Overweight showed no correlation between cost and length of stay. However, overweight individuals had higher cost of hospitalization than those who had no complications, but with no correlation with nutritional status. Compared to those with normal BMI, there was a strong and statistically significant correlation with the cost of hospital stay, stressing that there is normal distribution involving adequate nutritional status and success of the surgical procedure with the consequent impact on the cost of hospitalization.
Bariatric operations have variable range of complications and postoperative benefits. Gastroesophageal reflux is considered potential factor that may result in damage to the esophageal mucosa and this subject is quite controversial in the literature.
To evaluate patients who underwent to Roux-en-Y gastrojejunal bypass correlating epidemiologic and endoscopic findings in pre and postoperative periods.
A retrospective, paired study which evaluated 110 patients. Inclusion criteria were formal indication for bariatric surgery and patients with pre and postoperative endoscopy. Exclusion criteria were previous bariatric surgery, patients subjected to other types of bariatric surgery and those who had no pre or postoperative upper digestive endoscopy. The epidemiological variables were: sex, age, body mass index, type 2 diabetes mellitus or impaired glucose tolerance, and preoperative dyslipidemia.
The preoperative upper endoscopy was normal in 26.4% of the patients. Among endoscopic alterations, the hiatus hernia was the most prevalent followed by non-erosive gastritis. The postoperative upper endoscopy was normal in 40.9% and stenosis was the most prevalent followed by marginal ulcer. Correlation on pre and postoperative endoscopies, was found 100% reduction of hiatal hernias and 88% of esophagitis. There was no statistical significance in relationship to anastomotic stenosis with preoperative other variables.
There was significant decrease in postoperative hiatus hernia, erosive esophagitis, non-erosive esophagitis, erosive gastritis and non-erosive gastritis with the operation. Stenosis of the gastrojejunostomy anastomosis was the most prevalent postoperative complication with no correlation with preoperative variables.
Currently, bariatric surgery has promoted weight loss and improved glycemic control in obese patients through different techniques, including vertical sleeve gastrectomy.
Present and update the different vertical sleeve gastrectomy ways of action, both in the treatment of obesity and diabetes, approaching its potential effect on gastrointestinal physiology, as well as the benefits achieved by this manipulation.
Pubmed database search was used crossing the headings: obesity, type 2 diabetes and sleeve gastrectomy.
Published data have shown that short-term weight loss tends to be higher in patients undergoing vertical sleeve gastrectomy compared to Roux-en-Y gastric bypass. In relation to glycemic control, the procedure demonstrated remission of diabetes in up to 60% after one year of surgery. After three years, however, differences in remission rate between surgical and clinical group was not observed, questioning the durability of the technical in a long-term.
Despite showing good results, both in the weight loss and co-morbidities, conflicting results reinforce the need for more studies to prove the efficiency of the vertical sleeve gastrectomy as well as to understand its action about the molecular mechanisms involved in the disease.
In recent years, a surgical technique known as single-anastomosis gastric bypass or mini-gastric bypass has been developed. Its frequency of performance has increased considerably in the current decade.
To describe the mini-gastric bypass technique, its implementation and preliminary results in a university hospital.
This is an ongoing prospective trial to evaluate the long-term effects of mini-gastric bypass. The main features of the operation were: a gastric pouch with about 15-18 cm (50-150 ml) with a gastroenteric anastomosis in the pre-colic isoperistaltic loop 200 cm from the duodenojejunal angle (biliopancreatic loop).
Seventeen individuals have undergone surgery. No procedure needed to be converted to open approach. The overall 30-day morbidity was 5.9% (one individual had intestinal obstruction caused by adhesions). There was no mortality.
Mini-gastric bypass is a feasible and safe bariatric surgical procedure.
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