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PubMed | Clinica Marchesini, Centro Hospitalar Entre Douro e Vouga, The Surgical Center, Federal University of Pernambuco and Hospital Universitari Of Bellvitge
Type: Journal Article | Journal: Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery | Year: 2016

Bariatric surgery is performed all over the world with close to 500.000 procedures per year. The most performed techniques are Roux-en-Y gastric bypass and sleeve gastrectomy. Despite this data, the most effective procedure, biliopancreatic diversion with or without duodenal switch, represents only no more than 1.5% of the procedures. Technical complexity, morbidity, mortality, and severe nutritional adverse effects related to the procedure are the main fears that prevent most universal acceptance.To explain the technical aspects and the benefits of the SADI-S with right gastric artery ligation as an effective simplification from the original duodenal switch.Were included all patients undergoing this procedure from the November 2014 to May 2016, describing and analysing aspects of this technique, the systematization and early complications associated with the procedure.A series of 67 patients were operated; 46 were women (68.7%); mean age of the group was 44 years old (33-56); and an average BMI of 53.5 kg/m2 (50-63.5). Surgical time was 115 min (80-180). A total of five patients (7.5%) had any complication and two (2.9%) had to be reoperated. There were two patients with leak, one at the duodenal stump and other at the esophagogastric angle. There was no mortality. Patients stayed at the hospital a median of 2.5 days (1-25).SADI-S with right gastric artery ligation is a safe procedure with few preliminary complications. The technical variations introduced to the classical duodenal switch are reproducible and may allow this procedure to be more popular. All the complications in this series were not related to the ligation of the right gastric artery.Cerca de 500.000 cirurgias baritricas so realizadas a cada ano em todo o mundo. As tcnicas mais realizadas so o bypass gstrico em Y-de-Roux e a gastrectomia vertical. A derivao biliopancretica, com ou sem duodenal switch, considerada tcnica mais eficaz no tratamento cirrgico do paciente obeso mrbido; entretanto, representa no mais do que 1,5% dos procedimentos na atualidade, pois sua complexidade tcnica, morbimortalidade e graves efeitos adversos nutricionais impedem aceitao mais universal.Descrever os aspectos tcnicos e os benefcios do SADI-S com ligadura da artria gstrica direita como um modo simplificado do duodenal switch original.Foram includos todos os pacientes submetidos a este procedimento entre novembro 2014 e maio de 2016. Alm da descrio da sistematizao da tcnica operatria, foram analisadas as complicaes precoces associadas ao procedimento.Uma srie de 67 pacientes foi operada no perodo analisado; 46 eram mulheres (68,7%) e a mdia de idade foi de 44 anos (33-56). O IMC mdio foi de 53,5 kg/m2 (50-63,5). O tempo cirrgico mdio foi de 115 min (80-180) e a permanncia hospitalar mdia foi de 2,5 dias (1-25). Complicaes foram observadas em cinco pacientes (7,5%) e dois (2,9%) tiveram de ser reoperados. Duas pacientes evoluram com fstula, uma no coto duodenal e outra na juno esofagogstrica. No houve mortalidade.SADI-S com ligadura da artria gstrica direita procedimento seguro com poucas complicaes precoces. A simplificao tcnica em relao ao duodenal switch clssico pode permitir que este procedimento se torne mais popular. Todas as complicaes observadas nesta srie no estavam relacionadas com a ligadura da artria gstrica direita.


Tonelli H.,Clinica Marchesini | Sartori F.M.,Pontifical Catholic University of Parana | Marchesini J.C.D.,Clinica Marchesini | Marchesini J.B.,Clinica Marchesini | Tonelli D.G.,Clinica Marchesini
Jornal Brasileiro de Psiquiatria | Year: 2013

Introduction: Neuroimaging studies suggest that obese people might show hyperactivity of brain areas regarding reward processing, and hypoactivity of brain areas concerning cognitive control, when exposed to food cues. Although the effects of bariatric surgery on the central nervous system and eating behavior are well known, few studies have used neuroimage techniques with the aim of investigating the central effects of bariatric surgery in humans. Objectives: This paper systematically and critically reviews studies using functional neuroimaging to investigate changes on the patterns of activation of central areas related to the regulation of eating behavior after bariatric surgery. Method: A search on the databases Medline, Web of Science, Lilacs and Science Direct on Line, was conducted in February 2013, using the keywords "Neuroimaging", "Positron-Emission Tomography", "Magnetic Resonance Imaging", "Gastric Bypass", "Gastroplasty", "Jejunoileal Bypass", "Bariatric Surgery". Results: Seven manuscripts were included; the great majority studied the central effects of Roux en Y gastric bypass, using positron emission tomography or functional magnetic resonance. Conclusions: Bariatric surgery might normalize the activity of central areas concerned with reward and incentive salience processing, as the nucleus accumbens and mesencephalic tegmental ventral area, as well as circuitries processing behavioral inhibition, as the dorsolateral prefrontal cortex.

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