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      Derivações gástricas em y- de- roux com anel de silicone para o tratamento da obesidade: estudo das complicações relacionadas com o anel Translated title: Roux-en-y gastric bypass with silicone ring for the obesity treatment: study of the complications related to the ring

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          Abstract

          RACIONAL: O anel de silicone é utilizado como fator de contensão do bypass gástrico em Y-de-Roux para induzir maior perda ponderal. No entanto, ele pode ter alguns inconvenientes nesta restrição forçada. OBJETIVO: Analisar as complicações relacionadas ao anel em pacientes submetidos à operação de bypass gástrico em Y-de-Roux. MÉTODOS: De 1994 a 2005, 7 000 pacientes foram submetidos à bypass gástrico em Y-de-Roux com anel de silicone para o tratamento da obesidade mórbida. Apenas 50% foram acompanhados de dois a 11 anos. A perda média de peso em excesso foi de cerca de 85%. Mas complicações do anel foram registrados em 160 pacientes (2,28% do total e 4,56% dos pacientes seguidos). Assim, esta série é composta de 38 pacientes do sexo masculino (23,8%) e 122 pacientes do feminino (76,2%) com idade média de 44 anos e IMC de 54,4 kg/m². RESULTADOS: Cinco tipos de complicações do anel foram encontradas. A mais frequente foi o de deslocamento (61%) causando sintomas de obstrução. A segunda, foi a erosão do anel de luz (22%), causando dor epigástrica e náuseas. A presença de anel estreito, anel aberto e a inadequação do mesmo são outras complicações que acorreram, porém em menor percentual. CONCLUSÕES: As complicações do anel ocorrem em baixa frequência. Sua remoção, cirúrgica ou endoscópica, é o tratamento mais usual, mas com sua realização o paciente tende a recuperar o peso perdido.

          Translated abstract

          BACKGROUND: The silicone ring is used as containment factor of the Roux-en-Y gastric bypass to induce greater ponderal loss. However, it may have some inconveniences from this stressed restriction. AIM: To analyze the complications related to silicone ring in patients who underwent Roux-en-Y gastric bypass surgery with silicon ring. METHODS: From 1994 to 2005, 7 000 patients were submitted to Roux-in-Y gastric bypass with silicone ring in order to treat morbid obesity. Only 50% were followed from two to 11 years. The mean excess weight loss was around 85%. But ring complications were registered in 160 patients (2,28% of the total and 4,56% of the followed patients). Therefore, this series consist of 38 male patients (23.8%) and 122 female patients (76.2%) with average age of 44 years old and BMI of 54.4 kg/m². RESULTS: Five types of ring complications were found. The most frequent was displacement (61%) causing obstructive symptoms. The second most frequent complication was ring erosion to the lumen (22%) causing epigastric pain and nausea. CONCLUSIONS: The ring complications occur in low frequency. Ring removal, either surgical or endoscopically done, is the most usual treatment, but tends to cause partial regain of the weight lost.

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          Evolution of operative procedures for the management of morbid obesity 1950-2000.

          At the turn of the 21st century, obesity is the epidemic with the greatest prevalence in the United States. Fifteen million people, 1 out of 20, in this country have a body mass index (BMI) > or = 35 kgm2. Obesity is not only a medical problem, but also a social, psychological, and economic problem. At present, the morbidly obese are refractory to diet and drug therapy, but have a substantial, sustained weight loss after bariatric surgery. This chronology of the landmark operations in bariatric surgery is based on a review of the medical literature. Bariatric surgery can be classified into 4 categories: malabsorptive procedures, malabsorptive/restrictive procedures, restrictive procedures, and other, experimental procedures. The prototype of malabsorptive procedures and the first operation performed specifically to induce weight loss was the jejunoileal bypass. The problems associated with this operation caused its demise. Today's popular malabsorptive procedures are the biliopancreatic diversion and the duodenal switch. Malabsorptive/restrictive surgery currently is predicated on the Roux-en-Y gastric bypass, both the traditional short-limb, and the long-limb for the super obese. Restrictive procedures are represented by the banded and ringed vertical gastroplasty, as well as gastric banding. Experimental procedures include gastric pacing. All of these operations can be performed by open surgery and laparoscopically. Since bariatric surgery is the only broadly successful treatment for morbid obesity, it is incumbent on all physicians to be familiar with current bariatric operations, and to understand the evolution of bariatric surgery.
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            Vertical Banded Gastroplasty-Gastric Bypass: preliminary report.

            Vertical banded gastroplasty-gastric bypass is a surgical technique combining the advantages of the vertical banded gastroplasty with those of gastric bypass. The procedure was performed on 148 morbidly obese individuals: 83% were female, and 17% were male. Ages ranged from 15 to 64 years, with a mean age of 35. Mean percentage weight was 215% of ideal. The vertical banded gastroplasty is constructed by creating a 10 cc vertical pouch along the lesser curvature with a 5.5 cm supporting band. The pouch is fashioned in a way that the lower portion is free and mobile. This free segment of stomach is anastomosed by triangulation to a Roux-en-Y loop of jejunum, which is brought up in a retrocolic, retrogastric fashion. With 100% follow-up in the 19 patients who have reached 1 year, average excess weight loss has been substantial. There was one early postoperative complication requiring surgery. Two patients required late revisional operations. Vertical banded gastroplasty-gastric bypass is a relatively simple procedure to perform and has a low rate of complications. Gastric bypass in combination with a small banded pouch along the lesser curvature should result in substantial and permanent weight loss.
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              Prevalence of overweight and weight gain in the United States.

              Data from the Second National Health and Nutrition Examination Survey (NHANES II) indicated that in the period 1976-1980 approximately 34 million US adults (25.7%) were overweight, with more women (19 million) than men (15 million) affected. Selected demographic factors, eg, low educational attainment and low family income were associated with the prevalence of overweight and with the incidence of weight gain. Analyses of the NHANES I Epidemiologic Follow-up Survey indicated that in a 10-y period, women had a greater mean weight gain. The overall incidence of a major weight gain (ie, an increase of five or more body mass index units) was twice as great among females (5.3%) than males (2.3%). Data on overweight and weight gain in the United States by selected demographic characteristics are summarized.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abcd
                ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)
                ABCD, arq. bras. cir. dig.
                Colégio Brasileiro de Cirurgia Digestiva (São Paulo )
                2317-6326
                December 2011
                : 24
                : 4
                : 290-295
                Article
                S0102-67202011000400009
                10.1590/S0102-67202011000400009
                9a7eb112-1b52-4932-94fe-5d086331ce05

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0102-6720&lng=en
                Categories
                GASTROENTEROLOGY & HEPATOLOGY
                SURGERY

                Gastroenterology & Hepatology,Surgery
                Anastomosis, Roux-en-Y,Morbid obesity, Postoperative complications,Anastomose em-Y de Roux,Obesidade mórbida,Complicações pós-operatórias

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