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Evaluation of the mucosa thickness of the jejunum, ileum and colon in the experimental and control groups.
Source publication
Background:
Ki-67 in ascending colon: A) experiment and B) control. Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer.
Aim:
To analyze the histological and immunohistological changes t...
Context in source publication
Citations
Nas últimas décadas, tem sido verificado que o excesso de peso e a obesidade estão em crescente aumento em vários países, duplicando o número de pessoas obesas e a cirurgia bariátrica torna-se uma alternativa para os indivíduos que já tentaram outros tipos de tratamento, como dieta, exercícios físicos e terapia farmacológica e não obtiveram resultados significativos. Portanto, é necessário analisar as produções científicas sobre cirurgia bariátrica publicados no periódico Arquivos Brasileiros de Cirurgia Digestiva (ABCD), visto que este periódico é referência no Brasil. Para tanto, foi realizado estudo descritivo, com análise bibliométrica. Os trabalhos analisados foram publicados entre os anos 2014 até o ano 2024 e foram disponibilizados no sítio da revista. Assim, foi constatada a prevalência de estudos de campo, com maior predominância de pesquisadores da área da saúde, especialmente da área da Medicina, e publicados na língua portuguesa. O Brasil foi o país que mais obteve destaque, majoritariamente dos estados de Pernambuco (Recife) e Paraná (Curitiba). Os temas mais abordados foram a eficácia da perda de peso, o impacto na saúde metabólica, a qualidade de vida, as complicações pós-operatórias e a avaliação de técnicas cirúrgicas. Por fim, espera-se que os achados dessa análise bibliométrica possibilitem aprofundar o conhecimento do tema e aumentar o interesse e visibilidade nessa área, na tentativa de reduzir as limitações inerentes à discussão do tema.
BACKGROUND
Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences.
AIMS
To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery.
METHODS
Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery.
RESULTS
A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery.
CONCLUSIONS
It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.
HEADINGS:
Bariatric Surgery; Obesity; Vitamin D
Rational:
The metabolic response to surgical trauma is enhanced by prolonged preoperative fasting, contributing to increased insulin resistance. This manifestation is more intense on the 1st and 2nd postoperative days and is directly proportional to the size of the operation.
Aim:
To compare whether preoperative fasting abbreviation and early postoperative refeeding associated with intraoperative and postoperative fluid restriction interfere in the evolution of patients undergoing gastrojejunal bypass.
Methods:
Eighty patients indicated for Roux-en-Y gastrojejunal bypass were selected. They were randomly divided into two groups: Ringer Lactate (RL) group, who underwent a 6 hours solids fasting, with the administration of 50 g of maltodextrin in 100 ml of mineral water 2 hours before the beginning of anesthesia; and Physiologic Solution (PS) group, who underwent a 12 hours solids and liquids fasting. Anesthesia was standardized for both groups. During the surgical procedure, 1500 ml of ringer lactate solution was administered in the RL and 2500 ml of physiological solution (0.9% sodium chloride) in the PS. In both groups, the occurrence of bronchoaspiration was analyzed during intubation, and the residual gastric volume was measured after opening the abdominal cavity. In the postoperative period in Group RL, patients started a liquid diet 24 hours after the end of the operative procedure; whilst for PS group, fasting was maintained for the first 24 hours, it was prescripted 2000 ml of physiological solution and a restricted liquid diet after 36 hours. Each patient underwent CPK, insulin, sodium, potassium, urea, creatinine, PaCO2, pH and bicarbonate dosage in the immediate postoperative period, and 48 hours later, the exams were repeated.
Results:
There were no episodes of bronchoaspiration and gastrojejunal fistulas in either group. In the analysis of the residual gastric volume of the PS and RL groups, the mean volumes were respectively 16.5 and 8.8, which shows statistical significance between the groups. In laboratory tests, there was no difference between groups in sodium; PS group showed a higher level of serum potassium (p=0.029); whilst RL group showed a higher urea and creatinine values; CPK values were even for both; PS group demonstrated a higher insulin level; pH was higher in PS group; sodium bicarbonate showed a significant difference at all times; PaCO2 values in RL group was higher than in PS. In the analysis of the incidence of nausea and flatus, no statistical significance was observed between the groups.
Conclusions:
The abbreviation of preoperative fasting and early postoperative refeeding of Roux-en-Y gastrojejunal bypass with the application of ERAS or ACERTO Project accelerated the patient's recovery, reducing residual gastric volume and insulin level, and do not predispose to complications.
