Introduction: bariatric surgery is currently the only treatment that leads to long-term and sustained weight loss and decreased morbidity and mortality in morbidly obese individuals. Roux-en-Y bypass causes weight loss by restricting food intake associated with reduced intestinal absorption, in addition to multiple endocrine and satiogenic effects. Biliopancreatic diversion promotes weight loss mainly due to poor absorption of the nutrients ingested. Both procedures exclude parts of the gastrointestinal tract. Objective: to describe four cases of revisional surgery after primary bariatric surgery, due to serious nutritional complications, and to review the literature regarding this subject. Methods: a retrospective analysis of patients of Unicamps bariatric center database and review of the literatures were performed. Results: four patients were identified, 2 women and 2 men, with a mean age of 48 years. The mean body mass index before revisional surgery was 23.7 kg/m2. Three patients underwent Scopinaro biliopancreatic diversion, and onde patient underwent Roux-en-Y gastric bypass. The revisional surgeries were revision, conversion, and reversion. One patient died. For the review of the literature 12 articles remained (11 case reports and 1 case series). Another five important original articles were included. Conclusion: fortunately, revision surgery is rarely necessary, but when indicated it has increased morbidity, It can be revision, reverion or conversion according to the severity of the patient and the primary surgery performed.

No abstract

ABSTRACT Objective: to analyze the surgical treatment of patients with recurrent megaesophagus followed at the esophageal-stomach-duodenal outpatient clinic of the Hospital de Clínicas - UNICAMP. Methods: a retrospective study, from 2011 to 2017, with 26 patients with Chagas or idiopathic megaesophagus, surgically treated, and who recurred with dysphagia. Clinical, endoscopic and radiographic aspects were assessed and correlated with the performed surgical procedures. Results: 50% had dysphagia for liquids, 69% regurgitation, 65.3% heartburn, 69.2% weight loss and 69.2% had Chagas disease. In addition, 38.4% had megaesophagus stage 1 and 2 and 61.5% stage 3 and 4. Regarding the reoperations, 53% of them underwent Heller-Pinotti surgery by laparoscopy, Serra-Dória in 30.7% and esophageal mucosectomy in 7.9%. In 72% of the reoperations there were no postoperative complications, and 80% of the patients had a good outcome, with reduction or elimination of dysphagia. Among the reoperated patients undergoing the laparoscopic Heller-Pinotti technique, three reported little improvement of dysphagia in the postoperative period and among those who underwent Serra-Dória surgery, 100% had no dysphagia. It was observed that, when the time between the first procedure and the reoperation was longer, the better the surgical result was, with statistical significant decreased dysphagia (p=0.0013, p<0.05). Conclusions: there was a preference to perform laparoscopic re-miotomy and, as a second option, Serra-Dória surgery, for patients with recurrent megaesophagus. Esophagectomy or esophageal mucosectomy were reserved for more severe patients.

No abstract

r e s u m o informação sobre o artigo Historial do artigo: Recebido a 13 de dezembro de 2018 Aceite a 6 de dezembro de 2019 On-line a 3 de janeiro de 2020 Objetivos: Analisar a via de abordagem cirúrgica, no sentido vestíbulo-palatino, de caninos inclusos maxilares, comparando imagens bidimensionais com tridimensionais (gold standard). A taxa de abordagens corretas foi relacionada com a experiência e especialidade de médicos dentistas, tendo-se ainda avaliado a taxa de pedido de imagens tridimensionais para estudo destes casos. Métodos: A amostra foi constituída por 80 médicos dentistas inscritos na Ordem dos Médicos Dentistas, que voluntariamente aceitaram responder a um questionário constituído por radiografias panorâmicas e telerradiografias de trinta caninos maxilares inclusos. Todos os casos apresentavam tomografia computorizada de feixe cónico (CBCT) analisada por dois cirurgiões orais, que definiram a abordagem cirúrgica mais exata (gold standard) no sentido vestíbulo-palatino para cada canino. Tal serviu para confirmar ou refutar as escolhas das abordagens feitas nos questionários. Resultados: Não parece existir relação entre a taxa de abordagens corretas e a experiência, porém foi encontrada quanto à especialidade, com os cirurgiões orais a escolheram mais vezes a via de abordagem correta do que generalistas (p=0,034). Não foram encontradas diferenças entre as restantes especialidades (p>0,05). Existe associação entre a especialidade e o pedido de CBCT (p=0,008), sendo mais provável que cirurgiões peçam sempre. Conclusão: Com base nos dados obtidos neste estudo verificou-se a existência de uma relação entre a especialidade do Medico Dentista (Cirurgia Oral), o número de abordagens cirúrgicas corretas de caninos maxilares inclusos e o pedido de exames complementares de