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

Background: Among the 2.0 billion overweight individuals in the world, Brazil ranks fifth in the number of obese people, therefore requiring treatment options for obesity.

Aim: The aim of this study was to compare the percentage of total body weight loss (%TWL), change in body mass index (BMI), percentage of excess weight loss (%EWL), incidence of reflux esophagitis, and occurrence of Barrett's esophagus in obese patients undergoing gastric bypass (Roux-en-Y gastric bypass [RYGB]) and sleeve gastrectomy (SG), both techniques by videolaparoscopy.

Methods: The study included 100 consecutive patients who underwent RYGB and SG techniques, totaling 200 patients, and were followed up for 60 months, from June 2013 to July 2018.

Results: The frequency of gastroesophageal reflux disease (GERD) was lower in RYGB patients (p<0.05). At 60 months, the %EWL was 77.4±13.3 kg (RYGB) versus 80.5±17.5 kg (SG) (p<0.05). The BMI data were statistically significantly different between groups after 5 years (28.5±3.9 kg/m2 in RYGB and 31.9±5.3 kg/m2 in SG groups, p<0.05). During the follow-up, the RYGB showed higher %EWL compared to the SG (at 60 months, 80.1% vs. 59.1%, respectively, p<0.05). The %TWL was 30% for the RYGB and 19.7% for the SG (p<0.05). The RYGB had a lower frequency of reflux esophagitis and Barrett's esophagus.

Conclusions: The RYGB technique showed greater absolute weight loss, %TWL, BMI reduction, and %EWL in higher obesity classes compared to the SG technique. Additionally, RYGB had a lower frequency of reflux esophagitis and Barrett's esophagus.

Background: Adequate closure of the abdominal wall determines the success of the surgery.

Aims: The aim of this study was to study the healing of the abdominal wall of rats by comparing the use of surgical glue (2-octyl cyanoacrylate) with polypropylene 3.0 thread and poliglecaprone 3.0 thread.

Methods: A total of 60 Wistar rats were divided into two groups: Group 30 and Group 90. Each group was subdivided into three subgroups, surgical glue subgroup (C1), polypropylene subgroup (C2), and poliglecaprone subgroup (C3). An incision was made in the aponeurosis of the abdominal wall while maintaining the integrity of the parietal peritoneum. The 3 subgroups of 10 animals were euthanized on the 30th and 90th postoperative days. The abdominal wall fragments were submitted to macroscopic, histological, and tensiometric analysis.

Results: Macroscopic analysis did not show any abnormality. Tensiometry on the 30th postoperative day showed a mean rupture tension of 30.98N in subgroup C1, 27.90N in subgroup C2, and 23.90N in subgroup C3. On the 90th postoperative day, the mean rupture tension was 30.05N in subgroup C1, 44.42N in subgroup C2, and 34.78N in subgroup C3.

Conclusions: The synthesis of the abdominal aponeurosis performed with surgical glue (2-octyl cyanoacrylate) showed adequate resistance to rupture tension to maintain its integrity when compared with the synthesis with polypropylene thread or poliglecaprone thread, with both methods being equally effective.

Background: Affective temperaments are part of the spectrum of mood disorders and comprise the concepts of hyperthymia, dysthymia and cyclothymia. Numerous studies have demonstrated a strong relationship between obesity and mood disorders.

Aims: The objective of the present study was to evaluate the frequency of affective temperaments in morbidly obese individuals and controls and to establish a possible association between affective temperaments and morbid obesity.

Methods: The study evaluated 106 cases (morbidly obese) and one hundred controls (non-obese). To assess affective temperaments, the Temperament Evaluation in Memphis Pisa and San Diego - Rio de Janeiro TEMPS-Rio de Janeiro scale was applied. Depressive symptoms were assessed using the Hamilton Depression Rating Scale, anxiety symptoms using the Hamilton Anxiety Rating Scale and manic symptoms using the Young Mania Rating Scale. For univariate and multivariate analysis, logistic regression models were adjusted.

Results: The presence of at least one affective temperament was 74.5% in the morbidly obese group and 63% in the non-obese group. When comparing the two groups, the statistical analysis of the age subgroup of individuals aged 50 years or over showed an odds ratio of 2.56 (1.07-6.09) for hyperthymic temperament.

Conclusions: In the age group of 50 years or more, cases of morbid obesity are significantly more likely (2.56 times) to occur in individuals with a hyperthymic temperament. Among the three types of affective temperaments evaluated, only hyperthymia could be a risk factor for morbid obesity.

Background: Obesity represents a chronic pro-inflammatory status that contributes to accelerated atherosclerosis and cell aging. Besides the widely used C-reactive protein and ferritin, other inflammatory markers have gained attention, such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), which are related with the degree of inflammation in various pathological conditions, including obesity and its comorbidities.

Aims: To compare and monitor the levels of NLR and PLR before and after sleeve gastrectomy (SG).

Methods: Retrospective study that included a total of 622 patients with obesity who underwent SG as primer bariatric surgery in our center. Data regarding the presence of comorbidities, including type 2 diabetes (T2D), high blood pressure (HBP) and non-alcoholic fatty liver disease (NAFLD), variations in body weight and body mass index (BMI), and biochemical markers of inflammation, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and C-reactive protein (CRP) were gathered. Values of NLR and PLR were correlated with weight loss and prognosis of comorbidities within the postoperative period.

Results: The sample was predominantly female (79.3%) with average age 36.91±10.04 years, with comorbidities including HBP (25.1%), T2D (8.0%), and NAFLD (80.1%). Patients with HBP showed reduced NLR and CRP post-intervention, while those with T2D experienced decreased CRP but increased PLR. Correlation analysis found no significant correlation between BMI/weight changes and NLR but significant correlation with PLR. Post-surgery, NLR decreased for previously NAFLD patients, and PLR increased.

Conclusions: According to the results, patients with obesity present a significant decrease in NLR and an increase in PLR after SG.

Background: Knowledge of the cystic artery and its variations is essential to perform safe cholecystectomies. The cystic artery originates from the right hepatic artery, passing posterior to the common hepatic duct, anterior to the cystic duct, and branching into two branches at the neck of the gallbladder. However, variations in position, size, and relationship with adjacent structures are common.

Aims: This article presents a literature review regarding cystic artery variations and their frequency during cholecystectomies.

Methods: The articles selected for this review were chosen from the PubMed and SciELO databases. The standardized descriptors used were anatomic variation and cholecystectomy. These were chosen using the "Medical Subject Headings" and combined with the Boolean operator AND and the non-standard descriptor cystic artery.

Results: It was found in 54.5% of the studies that the anatomical pattern of the cystic artery was the most frequent type. A different origin from the standard was cited in 63.6% of the articles. Double irrigation of the gallbladder was found in 59.1%. In 36.4%, the cystic artery was anterior to the common hepatic duct or the cystic duct. Cystic arteries outside Calot's triangle were found in 36.4%. Short cystic arteries were found in 13.6%. The absence or non-identification of the artery was reported in 9.1%.

Conclusions: Variations of the cystic artery are common and are frequently reported. One aspect of a safe cholecystectomy is anatomical knowledge and its possible variations. Thus, surgeons must be familiar with this point in order to reduce vascular and biliary injuries.

Background: Surgery is associated with a high risk for morbidity and mortality, particularly when performed in critical patients requiring intensive care unit (ICU) admission.

Aim: The aim of this study was to investigate risk factors associated with adverse outcomes in a large cohort of patients admitted to a single-center ICU after abdominal surgery.

Methods: All patients admitted to a surgical ICU for postoperative care, from January 2016 to December 2022, were retrospectively evaluated. Data concerning demographics and clinical and perioperative variables were compared to in-hospital mortality.

Results: A total of 1,717 patients (1,096 women, mean age: 61±17 years) were evaluated. Most of the patients underwent colorectal (n=499), pancreatic (n=148), biliary tract (n=147), and gastric surgeries (n=145); liver resection (n=131); and several gynecological or obstetric procedures (n=250). Only 52.3% of these surgical procedures were elective. The mean Charlson Comorbidity Index (CCI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were 4.4±2.8 and 10.1±5.6, respectively. Mortality was observed in 158 (9.2%) patients. Age (70.4±14.3 vs. 60.6±17.1 years in survivors, p=0.002), CCI (6.1±2.5 vs. 4.3±2.8 in survivors, p=0.005), type of surgery (13.6% in emergent/urgent vs. 5.5% in elective surgeries, p<0.001), and APACHE II score (16.7±8.4 vs. 9.4±4.7 in survivors, p<0.0001) were associated with mortality on univariate analysis, but only CCI, type of surgery, and APACHE II score were independently correlated with a higher risk of death on multivariate analysis.

Conclusions: Mortality after abdominal surgery in patients requiring postoperative ICU support is less than 10% nowadays, and it is independently associated with urgent or emergent surgeries, disease severity, and comorbidity.

Background: Pancreaticoduodenectomy (PD) is a major intervention in digestive surgery. Although its mortality is currently low in experienced centers, morbidity remains high, dominated by a pancreatic fistula.

Aims: The aim of this study was to analyze the risk factors for postoperative pancreatic fistula (POPF) after PD.

Methods: A retrospective study was conducted at the General Surgery Department of Habib Thameur University Hospital in Tunis for 12 years (2010-2021). All patients who underwent PD were included regardless of indications.

Results: Our series comprised 50 patients, consisting of 27 men and 23 women. The rate of a pancreatic fistula was 32% (16 patients) with an average time of onset of 5 days (1-12 days). It was observed as a biochemical leak (grade A) in 1 patient (2%), pancreatic fistula grade B in 5 patients (10%), and pancreatic fistula grade C in 10 patients (20%). Pancreatic fistula was responsible for 10% of postoperative mortality (five patients). Univariate analysis showed a statistically significant correlation between POPF and the following factors: diameter of the main pancreatic duct ≤3 mm (p=0.036, p<0.05), soft texture of the pancreas (p=0.025, p<0.05), pancreaticojejunostomy by two semi-overlapping sutures (p=0.049, p<0.05), and fasting blood glucose level ≤8 mmol/l (p=0.025, p<0.05). Multivariate analysis showed that soft pancreatic texture was the only independent risk factor for POPF (p=0.02, p<0.05).

Conclusion: The soft texture of the pancreas is the only independent risk factor for POPF. Prospective randomized studies are still needed to accurately determine the true risk factors for a pancreatic fistula after PD.

Background: The coronavirus disease 2019 (COVID-19) greatly impacted patients undergoing bariatric surgery due to prolonged quarantine and lockdown measures.

Aims: The aim of this study was to qualitatively investigate the impact of the COVID-19 quarantine and lockdown measures on the mental and emotional health of post-bariatric surgery women.

Methods: A qualitative study was carried out, with individual interviews conducted via video calls using a video-communication service (Google Meet®). The moderator guide inquired about three pre-established topics based on the literature: mental and emotional health, social relationship, and the use of health technology.

Results: A total of 12 women participated in this study, with an average age of 43±9.83 years, a body mass of 82.33±13.83 kg, a height of 1.62±0.06 m, a body mass index of 26.32±2.97 kg/m2, and post-surgery time of 12.83±4.37 months. The interviews had an average duration of 50.71±7.26 min. Our results suggested a negative impact of the COVID-19 pandemic on aspects of mental and emotional health, such as increased anxiety, depressive symptoms, fear, stress, and anguish, which were somehow diminished in patients who were closer to family members. Bariatric surgery was mentioned as a positive aspect by the patients for coping with clinical risk conditions.

Conclusions: The study showed a negative impact of the COVID-19 pandemic on aspects of mental and emotional health mostly due to lockdown measures, which led to social isolation and an increased burden with household chores.

Background: Biliary fistula is one of the most common complications after liver resection and is associated with significant morbidity and mortality. One of the methods used to evaluate biliary fistulas is the White test, which consists of injecting a lipid emulsion into the bile duct. However, no standard technique for performing the White test has been published.

Aims: The aim of this study was to standardize the technique for performing the White test in patients undergoing hepatectomies, with and without previous cholecystectomy, and to assess the preliminary results.

Methods: Patients over 18 years of age who were submitted to open hepatectomy were included in the study. The primary outcome was the rate of biliary fistula. Secondary outcomes were the incidence of acute pancreatitis and overall morbidity, measured by the Clavien-Dindo classification.

Results: The standard technique for the White test was performed on 17 patients. In total, three patients had previous cholecystectomy, and two had low insertion of the cystic duct, requiring cannulation of the hepatocholedochal duct. None of the patients developed clinically significant biliary leaks. Acute pancreatitis did not occur in any patient. One patient developed pneumonia requiring mechanical ventilation (Clavien-Dindo IV). All others had minor or no complications.

Conclusions: The standardized technique for performing the White test suggests an appropriate strategy to maximize the detection of intraoperative biliary leaks.

Background: Microscopic analysis of tumor budding (TB) may be an essential predictive tool for regional lymph node metastases in colorectal cancer, especially among patients in intermediate stages, who exhibit considerable prognostic variability.

Aims: The aim of this study was to assess the predictive power of BT regarding the presence of lymph node metastases and its association with other characteristics related to colorectal carcinoma progression.

Methods: This is a cross-sectional, retrospective study with a quantitative approach, focusing on the review of medical records and histopathological reports of patients who underwent oncologic surgery for colorectal cancer.

Results: A total of 153 patient records were examined, with a predominance of the 61-70 age group and a male majority (50.98%). Adenocarcinoma not otherwise specified was the most common histological type (60.78%), with the majority exhibiting moderate differentiation (87.58%). From the total sample, 97 cases (63.39%) exhibited TB, with 51.55% classified as a high budding score. Invasion of adipose tissue/subserosa was the most prevalent, occurring in 46.41% of cases. Regional lymph node metastases and angiolymphatic invasion were observed in 66 and 101 patients, respectively. Cross-tabulation analysis showed a statistically significant association between TB and lymph node metastasis (p<0.05).

Conclusions: The relationship between TB and lymph node metastasis highlights the significance of this histological factor in the risk stratification and prognosis of patients with colorectal cancer, complementing TNM staging. Therefore, the assessment of tumor budding is crucial in histopathological reports, potentially influencing additional therapeutic decisions.