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Thermogenic activity in the brown adipose tissue (BAT) of obese individuals is reduced, and this condition may be modified by bariatric surgery (BS).
To characterize fat deposition in BAT from hypothalamic obese (HyO) rats submitted to duodenal-jejunal-bypass (DJB) surgery.
For induction of hypothalamic obesity, newborn male Wistar rats were treated with subcutaneous injections of monosodium glutamate (MSG). The control (CTL) group received saline solution. At 90 days, the HyO rats were submitted to DJB or sham operation, generating the HyO-DJB and HyO-SHAM groups. At 270 days, the rats were euthanized, and the BAT was weighed and submitted to histological analysis.
Compared to BAT from CTL animals, the BAT from HyO-SHAM rats displayed increased weight, hypertrophy with greater lipid accumulation and a reduction in nucleus number. DJB effectively increased nucleus number and normalized lipid deposition in the BAT of HyO-SHAM rats, similar to that observed in CTL animals.
DJB surgery avoided excessive lipid deposition in the BAT of hypothalamic obese rats, suggesting that this procedure could reactivate thermogenesis in BAT, and contribute to increase energy expenditure.
In the Roux-en-Y gastric bypass technique, classic laparoscopic surgical retractors are usually rigid, require an additional incision for its installation, or must be handled by an assistant during the surgical procedure, involving a risk of liver injury.
The aim of this study was to evaluate and validate a technique of the esophagogastric junction exposure obtained by the flexible liver retractor in bariatric surgery, comparing its efficacy with the retractor classically used for this purpose.
This study was performed as a randomized, open, prospective, controlled, and comparative design in patients with medical indications of bariatric surgery. The subjects were distributed in the classic (control) and flexible (test) retractor groups.
A total of 100 patients (n=50 control group, n=50 test group) were included. No statistically significant difference was observed in the mean duration of surgery. Regarding visibility, 100% of the patients in the flexible retractor group demonstrated an optimal visibility level, although without statistical significance concerning the classic retractor group (94%). Invariably, carrying a trocar was necessary when using the classic retractor.
The flexible liver retractor is safe, effective, ergonomic, and inexpensive. Furthermore, it presented a satisfactory aesthetic profile, and the use of specific instruments, new adaptation curve, and training for its handling were not required.
Immunosuppressive drugs are essential for reducing the rejection risk in post-transplant patients, which is commonly associated with this procedure. However, side effects of those drugs on the hypothalamic nuclei involved in the food intake regulation, excessive weight gain, and also associated comorbidities are still unknown.
The purpose of this study was to analyze possible changes in the neuronal morphology and cell density in the paraventricular nuclei, lateral hypothalamic area, dorsomedial nuclei, and ventromedial and arcuate nuclei in Wistar rats submitted to immunosuppressive treatment with tacrolimus (TAC) or mycophenolate mofetil (MMF).
Adult male Wistar rats were randomly assigned to the following groups according to the oral treatment administered for 14 weeks: control, sham (placebo), TAC (1 mg/kg of weight), and MMF (30 mg/kg of weight). After treatment, the animals were sacrificed and their brains fixed for later histological staining. Subsequently, the slides were photodocumented for stereological analysis of the hypothalamic nuclei.
All experimental groups showed a weight gain throughout the study. There was no significant difference in neuronal density/number of cells in the hypothalamic nuclei between groups. Morphological changes were not detected in the hypothalamic neurons.
Treatments with immunosuppressants could not modify the morphological and cell density aspects of the hypothalamic nuclei during this supplementation period.
Obesity is a disease characterized by an excessive accumulation of body fat, which is harmful to health, and it has grown significantly in the past years in the majority of countries. The surgery should be recommended to those patients with obesity who did not succeed in conservative clinical therapy after a rigorous analysis by a multidisciplinary team.
The aim of this study was to compare metabolic results, weight loss, and parameters associated with obesity in the preoperative and postoperative periods of patients treated with bariatric surgery.
This was a retrospective, descriptive, cross-sectional, and quantitative study through consultation medical records. Data were collected from May to September 2020 from individuals treated with bariatric surgery in a period of 15 years (from 2003 to 2018). A comparative and descriptive statistical analysis of anthropometric, metabolic, biochemical, and associated morbidities was performed.
The majority of patients were female (68.50%). In both sexes, the highest prevalence was found in the age group of 30-39 years and more than half had grade III obesity. The surgical technique used was gastroplasty with Roux-en-Y gastric bypass. After 4 months, there was a significant reduction in the lipid profile, anthropometric parameters, and liver enzymes in both sexes, which remained decreasing till the end of the first year, with marked improvement in the metabolic syndrome (MS).
The positive impact resulted from gastroplasty in terms of weight loss, reduction of body mass index, and lipid profile is quite relevant after 4 months and it is maintained until 1 year after the procedure, showing benefits in reducing the risk factors of the MS.
Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients.
The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population.
This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery.
A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m2 (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%.
NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.
Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention.
To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis
A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed.
Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%.
Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.
Obesity and bariatric surgery may be related with mental and oral disorders.
To evaluate the impact of bariatric surgery on anxiety, initial dental caries lesion and gingival bleeding in obese patients.
Eighty-nine patients were divided in two groups: Control Group (CG) - obese patients and Experimental Group (EG) - patients submitted to bariatric surgery. EG was analyzed before and 12 months after bariatric surgery; for the CG, was respected an interval of 12 months between the evaluations. International Caries Detection and Assessment System, Gingival Bleeding Index and Trace-State Anxiety Inventory were used. Medical profile, anthropometrics data, sociodemographic and behavioral variables were considered.
There were no statistically significant differences between groups in evaluation times regarding to initial dental caries lesion and anxiety. However, the number of teeth with initial dental caries lesion (p=0.0033) and gingival bleeding (p<0.0001) increased significantly after bariatric surgery in EG.
These results reinforce the need for multi-professional team follow-up, including dental care, for both obese and bariatric patients.
The increased prevalence of obesity has led to a significant increase in the occurrence of metabolic syndrome, a recognized risk factor for increased morbidity and mortality from cardiovascular diseases. Hyperglycemia or type 2 diabetes mellitus, dyslipidemia and arterial hypertension are its main components. Since 2015, international guidelines have recognized the benefits of bariatric surgery in each isolated factor of this syndrome.
To evaluate the impact of Roux-en-Y gastric bypass in this syndrome comparing pre- and postoperative periods with laboratory analysis and to compare waist/height ratio and BMI in relation to the determination of the cardiometabolic risk profile.
A retrospective study was carried out, selecting 80 patients undergoing Roux-en-Y gastric bypass. Total cholesterol, HDL, LDL, triglycerides, fasting glucose, glycated hemoglobin, insulin, body mass index (BMI), vitamin D, vitamin B12, waist circumference and waist/height ratio in three periods were analyzed: the preoperative period from 1 to 6 months, postoperative from 1 to 6 months and postoperative from 1 to 2 years.
There was an improvement in all parameters of the clinical analyses. The preoperative BMI had a mean value of 39.8, in the preoperative period from 1 to 6 months, the values dropped to 33.2 and in the postoperative period of 1 year, the mean was 26. The perimeter mean values of 118.5 preoperatively, 105.2 postoperatively from 1 to 6 months and 90.3 postoperatively from 1 to 2 years. Waist/height ratio was 0.73, 0.65 and 0.56 in pre, post 1 to 6 months and 1 to 2 years respectively.
Roux-en-Y gastric bypass improves metabolic syndrome and waist-to-height ratio is superior to BMI in the assessment of the cardiometabolic risk profile.
Gastro-omentopexy promotes the reconnection of the stomach to the gastroesplenic and gastrocolic ligaments and constitutes an alternative for the prevention of complications in laparoscopic vertical gastrectomy.
To demonstrate the benefits of the gastro-omentopexy technique in patients undergoing sleeve gastrectomy, with possible reduction in postoperative complications.
Prospective, non-randomized, case series type study, consisting of a clinical population of 179 patients who underwent the technique in 2018, with follow-up between 6-12 months in the postoperative period.
From the participants 71.5% were women, aged between 30-40 years (36.3%). As for the prevalence of complications in the postoperative period, the low prevalence was evident, with emphasis on readmission (1.1%); reoperation (1.1%); wound infection (1.1%); bleeding hemorrhage (0.5%); and stricture (1.1%). However, temporary symptoms were present such as nausea/vomiting, food intolerance, epigastric pain and feeling of fullness, right after surgery.
The technique promoted a significant improvement in quality of life and control of comorbidities. In addition, it was associated with a low prevalence of stenosis, and with no fistula, making the method safer.
Abdominal obesity or android obesity, that is, the increase in adipose tissue in the abdominal region, is considered a risk factor for several morbidities. Different ways of quantifying it have been proposed, one method is the measurement of the abdominal fat area by computed tomography.
To establish correspondence between the groups defined by degree of obesity in relation to the total, subcutaneous and visceral fat area.
Cross-sectional observational study carried out through the analysis of tomographic examinations. Horos v3.3.5 medical image visualization software was used, with abdominal tomography in a single cut including the L4 vertebral body and the umbilical scar, to obtain the areas of total, visceral and subcutaneous fat.
Of the 40 patients, 10 had grade II obesity, 23 grade III and 7 superobese. The amount of total fat showed an increase in relation to the degree of obesity. Visceral fat did not show significant differences between the degrees of obesity, but the data showed a lower average in the group of obesity grade II. The area of subcutaneous fat, as well as total fat, showed an increase in its measurements, according to the progression of the patients’ BMI, but there was no statistical significance in this difference between the groups of grade II and super-obese individuals.
The area of total and subcutaneous fat showed an increase in its measurements according to the progression of the BMI groups, which did not happen with visceral fat.
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