LS - LHA - Lusíadas Hospital Amadora
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- Adjustable Gastric Banding Conversion to One Anastomosis Gastric Bypass: Data Analysis of a Multicenter DatabasePublication . Pujol-Rafols, J; Uyanik, O; Curbelo-Peña, Y; Abbas, AA; Devriendt, S; Guerra, A; Herrera, MF; Himpens, J; Pardina, E; Pouwels, S; Ramos, A; Ribeiro, RJ; Safadi, B; Sanchez-Aguilar, H; De Vries, CE; Van Wagensveld, BIntroduction: One anastomosis gastric bypass (OAGB) has been proposed as a rescue technique for laparoscopic adjustable gastric banding (LAGB) poor responders. Aim: We sought to analyze, complications, mortality, and medium-term weight loss results after LAGB conversion to OAGB. Methods: Data analysis of an international multicenter database. Results: One hundred eighty-nine LAGB-to-OAGB operations were retrospectively analyzed. Eighty-seven (46.0%) were converted in one stage. Patients operated on in two stages had a higher preoperative body mass index (BMI) (37.9 vs. 41.3 kg/m2, p = 0.0007) and were more likely to have encountered technical complications, such as slippage or erosions (36% vs. 78%, p < 0.0001). Postoperative complications occurred in 4.8% of the patients (4.6% and 4.9% in the one-stage and the two-stage group, respectively). Leak rate, bleeding episodes, and mortality were 2.6%, 0.5%, and 0.5%, respectively. The final BMI was 30.2 at a mean follow-up of 31.4 months. Follow-up at 1, 3, and 5 years was 100%, 88%, and 70%, respectively. Conclusion: Conversion from LAGB to OAGB is safe and effective. The one-stage approach appears to be the preferred option in non-complicate cases, while the two-step approach is mostly done for more complicated cases.
- Cirurgia Bariátrica e Metabólica: adesão à Dieta Mediterrânica no Pré e Pós-OperatórioPublication . Vieira, B; Santos, Z; Ribeiro, R; Viveiros, O; Rossoni, C; Carolino, E; Novais, F
- Cirurgia Bariátrica e Metabólica: análise dos níveis de fome hedónica no pré e pós-operatórioPublication . Santos, Z; Vieira, B; Ribeiro, R; Rossoni, C; Carolino, E; Novais, F
- Conversion from Roux-En-Y Gastric Bypass to Sadi-S, with a Gastro-Gastric Jejunal Bridge as a Treatment of Obesity Recidivism: Case ReportPublication . Dib, V; Madalosso, C; Scortegagna, G; Ribeiro, RThere is a considerable weight regain after the Roux-en-Y gastric bypass (RYGB) surgery. Surgical conversion to more powerful metabolic techniques, like one anastomosis duodenal switch with sleeve gastrectomy (SADI-S), can be effective in this scenario, but surgically challenging. This case report aims to demonstrate technical modifications that simplifies the conversion of Roux-en-Y gastric bypass to SADI-S, in one stage. Female patient submitted to laparoscopic RYGB 10 years before with nadir of 29,47Kg/m². In the last 4 years, she had regained weight, reaching a body mass index of 46,48Kg/m². Surgical conversion was done laparoscopically, preserving the gastrojejunal anastomosis from the previous RYGB and the proximal 8cm of jejunal alimentary limb, which was transected at this level and used as a bridge between gastric pouch and antrum. Previously, the fundus, gastric body and part of the antrum were removed. The remaining alimentary limb, the gallbladder and the candy cane was removed. This was a single stage procedure, without complications. The interposition of the proximal alimentary limb of gastric bypass, between gastric pouch and antrum, has shown to be safe and feasible in RYGB conversion to SADI-S. The removal of the remnant alimentary limb makes the procedure shorter.
- Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in One or Two Steps: What Is the Best Approach? Analysis of a Multicenter Database Concerning 832 PatientsPublication . Pujol-Rafols, J; Al Abbas, AI; Devriendt, S; Guerra, A; Herrera, MF; Himpens, J; Pardina, E; Pouwels, S; Ramos, A; Ribeiro, RJ; Safadi, B; Sanchez-Aguilar, H; de Vries, C; Van Wagensveld, BBackground: Roux-en-Y gastric bypass (RYGB) is often the preferred conversion procedure for laparoscopic adjustable gastric banding (LAGB) poor responders. However, there is controversy whether it is better to convert in one or two stages. This study aims to compare the outcomes of one and two-stage conversions of LAGB to RYGB. Methods: Retrospective review of a multicenter prospectively collected database. Data on conversion in one and two stages was compared. Results: Eight hundred thirty-two patients underwent LAGB conversion to RYGB in seven specialized bariatric centers. Six hundred seventy-three (81%) were converted in one-stage. Patients in the two-stage group were more likely to have experienced technical complications, such as slippage or erosions (86% vs. 37%, p = 0.0001) and to have had a higher body mass index (BMI) (41.6 vs. 39.9 Kg/m2, p = 0.005). There were no differences in postoperative complications and mortality rates between the one-stage and two-stage groups (13.5% vs. 10.8%, and 0.7% vs. 0.0% respectively, p = ns). Mean final BMI and %total weight loss (%TWL) for the one-stage and the two-stage groups were 31.6 vs. 32.4 Kg/m2 (p = ns) and 30.4 vs. 26.8 (p = 0.017) after a mean follow-up of 33 months. Follow-up at 1, 3, and 5 years was 98%, 75%, and 54%, respectively. Conclusions: One-stage conversion of LAGB to RYGB is safe and effective. Two-stage conversion carries low morbidity and mortality in the case of band slippage, erosion, or higher BMI patients. These findings suggest the importance of patient selection when choosing the appropriate conversion approach
- Desafios da cirurgia bariátrica e metabólica: fome hedónica e adesão à Dieta MediterrânicaPublication . Vieira, B; Santos, Z; Ribeiro, R; Viveiros, O; Rossoni, C; Carolino, E; Novais, F
- Diverted MGB: A New ProcedurePublication . Ribeiro, R; Guerra, A; Viveiros, O
- Enhanced Recovery After Surgery (ERAS) protocol in bariatric and metabolic surgery (BMS)-analysis of practices in nutritional aspects from five continentsPublication . Rossoni, C; Oliveira Magro, D; Santos, ZC; Cambi, MP; Patias, L; Bragança, R; Pellizzaro, D; Parmar, C; Ribeiro, RThis study aims to understand the prevalent practices on the nutritional aspects of the enhanced recovery after surgery (ERAS) protocol based on the knowledge and practice of surgeons, nutritionists, and anesthesiologists who work in the bariatric and metabolic surgery (BMS) units worldwide. This cross-sectional study enrolled BMS unit professionals from five continents-Africa, America, Asia, Europe, and Oceania. An electronic questionnaire developed by the researchers was provided to evaluate practices about the three nutritional aspects of ERAS protocol in BMS (Thorel et al. 2016): preoperative fasting, carbohydrate loading, and early postoperative nutrition. Only surgeons, nutritionists, and anesthesiologists were invited to participate. One hundred twenty-five professionals answered the questionnaires: 50.4% from America and 39.2% from Europe. The profile of participating professionals was bariatric surgeons 70.2%, nutritionists 26.4%, and anesthesiologists 3.3%. Approximately 47.9% of professionals work in private services, for about 11 to 20 years (48.7%). In all continents, a large majority were aware of the protocol. Professionals from the African continent reported having implemented the ERAS bariatric protocol 4.0 ± 0 years ago. It is worth mentioning that professionals from the five continents implemented the ERAS protocol based on the published literature (p = 0.012). About preoperative fasting abbreviation protocol, a significant difference was found between continents and consequently between services (p = 0.000). There is no uniformity in the conduct of shortening of fasting in the preoperative period and the immediate postoperative period. Early postoperative (PO) period protein supplementation is not performed in a standard fashion in all units globally. ERAS principles and practices are partial and insufficiently implemented on the five continents despite the prevalent knowledge of professionals based on evidence. Moreover, there is no uniformity in fasting, immediate postoperative diet, and early protein supplementation practices globally.
- Evaluation of the Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients with Morbid Obesity: a Multicenter StudyPublication . Mahdy, T; Emile, SH; Madyan, A; Schou, C; Alwahidi, A; Ribeiro, R; Sewefy, A; Büsing, M; Al-Haifi, M; Salih, E; Shikora, SBackground: Single anastomosis sleeve ileal (SASI) bypass is a newly introduced bariatric and metabolic procedure. The present multicenter study aimed to evaluate the efficacy of the SASI bypass in the treatment of patients with morbid obesity and the metabolic syndrome. Methods: This is a retrospective, seven-country, multicenter study on patients with morbid obesity who underwent the SASI bypass. Data regarding patients' demographics, body mass index (BMI), percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and improvement in comorbidities at 12 months postoperatively and postoperative complications were collected. Results: Among 605 patients who underwent the SASI, 54 were excluded and 551 (390; 70.8% female) were included. At 12 months after the SASI, a significant decrease in the BMI was observed (43.2 ± 12.5 to 31.2 ± 9.7 kg/m2; p < 0.0001). The %TWL was 27.4 ± 13.4 and the %EWL was 63.9 ± 29.5. Among the 279 patients with type 2 diabetes mellitus (T2DM), complete remission was recorded in 234 (83.9%) patients and partial improvement in 43 (15.4%) patients. Eighty-six (36.1%) patients with hypertension, 104 (65%) patients with hyperlipidemia, 37 (57.8%) patients with sleep apnea, and 70 (92.1%) patients with GERD achieved remission. Fifty-six (10.1%) complications and 2 (0.3%) mortalities were recorded. Most complications were minor. All patients had 12 months follow-up. Conclusions: The SASI bypass is an effective bariatric and metabolic surgery that achieved satisfactory weight loss and improvement in medical comorbidities, including T2DM, hypertension, sleep apnea, and GERD, with a low complication rate.