Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

Background: Bariatric surgery is the most effective treatment for weight loss and also promotes remission of preoperative metabolic comorbidities.

Aims: The aim of this study was to analyze preoperative comorbidities, evaluate postoperative outcomes, and assess complications 6 months after bariatric surgery in a hospital in the state of Santa Catarina, Brazil.

Methods: A retrospective cohort study was conducted with patients who underwent bariatric surgery between 2021 and 2022 and were followed up for a period of 6 months after the procedure.

Results: There was a predominance of female patients (81.6%), with a mean age of 38.7 years. The preoperative prevalence of hypertension, Type 2 diabetes, dyslipidemia, and hepatic steatosis was 36.7, 22.4, 22.4, and 32.7%, respectively. The postoperative remission rates for these conditions were 55, 64, 70, and 69%, respectively. Except for diabetes, no significant differences were found between the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. There was a significant reduction in weight (p<0.01) and body mass index (BMI) (p<0.01), with no statistical differences between the RYGB and SG groups. Postoperative complications occurred in 73.5% of patients, including anemia, vitamin deficiencies, cholelithiasis, dumping syndrome, anastomotic ulcer, chronic diarrhea, and anastomotic stricture.

Conclusions: The study described the preoperative comorbidity profile, postoperative outcomes, and complications with findings consistent with existing literature, except for underreporting dyslipidemia and hepatic steatosis. No statistical difference was observed between the surgical techniques performed.

Background: Low Anterior Resection Syndrome (LARS) is a common postoperative bowel dysfunction in patients undergoing sphincter-preserving surgery for rectal cancer. Symptoms include fecal and gas incontinence, urgency, increased bowel frequency, and fragmented evacuations. LARS significantly impairs quality of life, affecting up to 90% of patients. Various factors contribute to its development, such as tumor height, extent of mesorectal excision, preoperative radiotherapy, and ileostomy. However, these factors are less studied in South American populations, where racial, cultural, and healthcare system differences may influence outcomes.

Aims: The aim of the study was to evaluate risk factors associated with LARS in a Chilean cohort of rectal cancer patients, with emphasis on cases classified as severe.

Methods: A non-concurrent prospective cohort study including patients who underwent low anterior resection between 2012 and 2021. Perioperative data collected included tumor height, surgical procedure type, preoperative radiotherapy, and protective ileostomy. Univariate and multivariate analyses were conducted to identify factors significantly associated with severe LARS, using the LARS score adapted to Chilean Spanish.

Results: A total of 110 patients were included, with a median follow-up of 51 months. LARS was identified in 52.7% of cases, with 29.1% classified as major. Younger age, lower tumors, total mesorectal excision, preoperative radiotherapy, and ileostomy were significantly associated with severe LARS in univariate analysis. In multivariate analysis, only younger age and preoperative radiotherapy remained as independent risk factors.

Conclusions: In this Chilean cohort, nearly half of patients undergoing sphincterpreserving surgery for rectal cancer developed LARS. About one-third had the severe form, highlighting the need for targeted strategies to mitigate LARS and improve patient quality of life.

Background: The effects of bariatric surgery in metabolically healthy obese (MHO) versus metabolically unhealthy obese (MUO) patients are underexplored in the literature.

Aims: The aim of the study was to compare the impact of bariatric surgery on weight loss, body composition, plasma biochemical parameters, and hepatic steatosis in MHO and MUO individuals.

Methods: Preoperative and 1-year postoperative medical records of 82 men and women aged 18-65 years, with body mass index >30 kg/m2, who underwent bariatric surgery from September 2021 to March 2023 were analyzed. MUO individuals were defined as those, metabolically unhealthy obese, with two metabolic syndrome risk factors, in preoperative data.

Results: The prevalence of MHO and MUO individuals was 22 and 78%, respectively. Preoperative neck circumference and visceral adiposity index were higher in MUO individuals. Hepatic steatosis was the most common comorbidity in both groups. After 1 year, both groups demonstrated similar benefits from bariatric surgery in reducing body weight, adiposity, and anthropometric indices. Bariatric surgery also improved blood glucose, insulin sensitivity, and dyslipidemia in MUO individuals. However, 30% of MUO individuals presented with steatosis, compared to only 5.6% of MHO individuals. This outcome was accompanied by higher plasma levels of ferritin, alanine aminotransferase, and aspartate aminotransferase in MUO individuals.

Conclusions: Bariatric surgery provided similar benefits in body mass for MHO and MUO individuals. However, after 1 year, MUO individuals still exhibited elevated markers of inflammation, liver injury, and steatosis, suggesting greater residual metabolic vulnerability.

Background: Artificial intelligence (AI)-assisted colonoscopy has emerged as a tool to enhance adenoma detection rates (ADRs) and improve lesion characterization. However, its performance in real-world settings, especially in developing countries, remains uncertain.

Aims: The aim of this study was to evaluate the impact of AI on ADRs and its concordance with histopathological diagnosis.

Methods: A matched case-control study was conducted at a colorectal cancer (CRC) referral center, including 146 patients aged 45-75 years who underwent colonoscopy for CRC screening or surveillance. Patients were allocated into two groups: AI-assisted colonoscopy (n=74) and high-definition conventional colonoscopy (n=72). The primary outcome was ADR, and the secondary outcome was the agreement between AI-based lesion characterization and histopathology. Statistical analysis was performed with a significance level of p<0.05.

Results: ADR was higher in the AI group (60%) than in the control group (50%), but this difference was not statistically significant (p>0.05). AI-assisted lesion characterization showed substantial agreement with histopathology (kappa=0.692). No significant difference was found in withdrawal time (29 min vs. 27 min; p>0.05), indicating that AI did not delay the procedure.

Conclusions: Although AI did not significantly increase ADR compared to conventional colonoscopy, it demonstrated strong histopathological concordance, supporting its reliability in lesion characterization. AI may reduce interobserver variability and optimize real-time decision-making, reinforcing its clinical utility in CRC screening.

Background: Groove pancreatitis is an unusual form of chronic pancreatitis that can be mistaken for a pancreatic head neoplasm.

Background: Once the diagnosis is confirmed, clinical management follows the standard recommendations for chronic pancreatitis.

Background: Surgery is indicated when clinical treatment fails or when there is diagnostic uncertainty regarding pancreatic neoplasia.

Background: Pancreatoduodenectomy is an effective treatment option when performed in high-volume referral centers.

Background: Groove pancreatitis (GP) is a rare, segmental form of chronic pancreatitis that primarily affects individuals between 40 and 50 years of age. It has been referred to by various other names, such as paraduodenal pancreatitis, cystic dystrophy of heterotopic pancreas, duodenal dystrophy, duodenal pancreatic hamartoma, paraduodenal wall cyst, and myoadenomatosis. This distinct and sporadic form of pancreatitis (GP) can be classified, depending on the affected segment, into a segmental form - affecting the entire pancreatic head - and a pure form limited to the pancreaticoduodenal groove, with preservation of the remaining pancreatic parenchyma. Its true incidence, as well as its pathophysiological mechanisms, remains unknown.

Background: Groove pancreatitis is a rare, segmental form of chronic pancreatitis that, in some cases, may be mistaken for pancreatic head neoplasia, with imaging modalities including endoscopic ultrasound currently playing a key role in its diagnosis. A review of the medical papers indicates that initial treatment should be multidisciplinary, similar to the management of classic chronic pancreatitis. When there is little or no response to conservative and/or endoscopic treatment, surgical intervention is indicated, and pancreatoduodenectomy is a good option, provided it is performed in centers with extensive experience in pancreatobiliary surgery.

Background: Groove pancreatitis (GP) is a rare and segmental form of chronic pancreatitis that affects the pancreaticoduodenal sulcus. Its pathophysiology is still not well known, and several etiological factors have been attributed, with chronic alcohol consumption being the most common association. Its treatment still generates controversy. The initial clinical approach followed by endoscopic therapies prevails. Surgery is indicated when these treatment options fail.

Aims: The aim of this study was to analyze the clinical, imaging, and surgical treatment data of a series of patients diagnosed with GP.

Methods: The clinical, radiological, surgical, and postoperative follow-up data were analyzed, in addition to the histopathological results of chronic pancreatitis, in patients undergoing pancreaticoduodenectomy.

Results: A total of eight patients were i

Background: Liver transplantation (LT) in patients aged ≥70 years is feasible with selected donors.

Background: Short-term outcomes were comparable to those in younger recipients.

Background: Elderly patients had higher intensive care unit (ICU) stay and transfusion needs.

Background: Advanced age should not be a contraindication for LT when carefully evaluated.

Background: A retrospective analysis of liver transplants was performed, comparing patients over and under 70 years of age. The elderly group was transplanted with careful donor selection and obtained results comparable to those of the younger group.

Background: This study aims to show that elderly patients over 70 years of age can have good results after liver transplantation, comparable to patients under 70 years of age, with good donor selection and perhaps additional points to favor their position on the waiting list.

Background: Liver transplantation (LT) is increasingly recognized as a treatment option for various diseases affecting a growing elderly population. However, its use in patients over 70 years of age remains controversial in centers with suboptimal outcomes or high waitlist mortality.

Aim: The aim of this study was to evaluate the effectiveness of LT as a treatment option for elderly patients aged 70 years or older, in comparison with younger recipients.

Methods: This retrospective study was conducted based on medical record data from 309 liver transplant recipients treated by the same surgical team across three hospitals - two located in São Paulo, São Paulo state (SP) and one in Rio Branco, Acre state (AC). Patients were divided into two groups for comparison: those aged up to 69 years (Group I) and those aged 70 years or older (Group II).

Results: Donor characteristics were similar between the two groups, except for a higher norepinephrine dose in Group I (p<0.05). Group II showed greater transfusion requirements and longer intensive care unit (ICU) stays (p<0.05), as well as higher rates of malnutrition and comorbidities. Notably, 90-day survival was comparable between the groups.

Conclusions: Patients aged 70 years or older can achieve outcomes comparable to those of younger recipients, provided they receive grafts from carefully selected donors. This population should not be excluded from transplant waitlists, and specific allocation policies or scoring adjustments should be considered to ensure equitable access.