Resumo Objetivo Avaliar se a cirurgia de Scopinaro modificada é tão eficaz e segura quanto a cirurgia de Scopinaro clássica para reduzir o excesso de peso, controlar as comorbidades, e avaliar o surgimento de intercorrências clínicas e nutricionais, caso elas ocorram. Métodos O estudo teve 28 participantes obesos, que foram randomizados para a realização de um dos procedimentos cirúrgicos, e acompanhados por uma equipe multiprofissional em saúde para avaliar o impacto das cirurgias no tratamento da obesidade. Foram observadas as seguintes variáveis: comorbidades, e intercorrências clínicas e nutricionais. O protocolo de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa das Faculdades Integradas Pitágoras de Montes Claros (CAAE 26919414.9.0000.5109). Todos os participantes da pesquisa assinaram o termo de consentimento livre e esclarecido. Resultados A média do índice de massa corporal (IMC) pré-cirurgia do grupo Scopinaro clássica e do grupo Scopinaro modificada foi de, respectivamente, 46,89 kg/m2 e 43,22 kg/m2. Após 540 dias da realização das cirurgias, esses valores foram reduzidos para 32,16 kg/m2 e 28,79 kg/m2. A avaliação da porcentagem de IMC perdido (percentage of excess body mass index lost, %EBL, em inglês) no período comprovou o sucesso cirúrgico, com valores de 67,33% para a cirurgia de Scopinaro clássica, e de 80,37% para a cirurgia de Scopinaro modificada. Ocorreu controle das comorbidades, bem como melhora geral do quadro laboratorial para a maioria dos participantes submetidos a quaisquer das duas técnicas. Flatulência e diarreia constituíram as intercorrências clínicas predominantemente encontradas em ambos procedimentos. Conclusão A cirurgia de Scopinaro modificada mostrou-se tão eficaz e segura quanto a cirurgia de Scopinaro clássica na redução de peso e controle das comorbidades, apresentando ainda a possibilidade de acesso endoscópio a todo o estômago e duodeno, reversibilidade cirúrgica, e conversão em outro procedimento cirúrgico.

The triglyceride-to-high-density lipoprotein-cholesterol (TG/HDL-c) ratio is a simple but effective indicator of metabolic imbalance that characterizes metabolic syndrome (MetS) and can consequently indicate a higher cardiovascular risk. It may, therefore, be useful in identifying a high risk for cardiometabolic diseases according to the onset of obesity. The aim of this study was to evaluate the association between MetS and the stage of life at obesity onset and to establish the cutoff point for the TG/HDL-c ratio as a marker of MetS in women with severe obesity. Forty-seven women who were to undergo bariatric surgery were evaluated. Anthropometric and metabolic parameters were measured, and the TG/HDL-c ratio was calculated. The volunteers were grouped according to their stage of life at obesity onset. A receiver operating characteristic (ROC) curve was constructed to define cutoff points for the TG/HDL-c ratio as predictors of MetS. Women who developed obesity early (during infancy/adolescence) had higher weight (p = 0.008), body mass index (p = 0.031), and hip circumference (p = 0.036) than those who developed obesity later (in adulthood); however, no association was found between obesity onset and MetS. The cutoff points for the TG/HDL-c ratio that were established for those who developed early or late obesity were 2.30 and 2.19, respectively. Although the stage of life at the onset of obesity was not related to MetS, different cutoff points for the TG/HDL-c ratio were observed.

Obesity has been growing in Brazil and in the world. It is reaching epidemic proportions, and bariatric surgery is the most effective treatment for patients with this disease. Among the procedures described in the literature, ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight loss and comorbidities control. However, there are concerns regarding long term nutritional problems with these procedures. In this case report the aim is to demonstrate the technical feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in dissecting the retrobulbar region, as occurred here, due to fibrosis in this area. This assures the maintenance of the proposed surgical technique, in such a situation. The dissection and transection of the duodenum was done 7 cm distally to the pylorus, under endoscopic view, proximally to the papillae, where the tissue was normal. Additionally, due the importance of the duodenal mucosa on minerals and trace elements absorption and the release of important hormones in this region, this case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results, long term. In this case report, the extended duodenal length has demonstrated reasonable weight loss, adequate comorbidities control and good nutritional status, so far. These aspects must be evaluated in the long term, by clinical trials.

Introduction: obesity has a complex and multifactorial etiology, difficult treatment and increasing incidence rates in recent decades. The treatment involves clinical and pharmacological approaches and, in case of lack of results, surgical interventions. Roux-en-Y gastric bypass (RYGB) is one of these surgical interventions in which the stomach is divided, creating a small pouch, and the remaining portion of the stomach become excluded and left without endoscopic access. Objective: to evaluate the results of modified RYGB with long pouch and endoscopic access to the remaining stomach. Materials and Methods: prospective clinical trial with sample selected among patients seen at the Alberto Rassi General State Hospital of Goiânia (HGG) and indicated for bariatric and metabolic surgery confirmed by the medical and multidisciplinary team. The study was conducted from January 2020 to August 2021. Clinical history and laboratory test results of the selected patients were collected through consultations with the medical and multidisciplinary team. Results: twelve participants were included in the study. Of these, 11 (91.7%) were women and the mean age was 46.3 years. The weight before surgery was 112.17 kg (92.00 -150.00) and the Body Mass Index (BMI) was 44.89 (35.06 -74.39). After 18 months of surgery, the mean weight was 80.77 kg (±11.92) and the mean BMI was 29.46 (±11.00), showing a significant reduction in both (p = 0.003 and p = 0.002, respectively). All patients underwent endoscopic evaluation of the pouch, remaining stomach and duodenum at 12 months postoperatively. The mean percentage of lost excess weight loss was 68.21%. Conclusion: We conclude that the proposed changes in RYGB (GBLP + GIB -Roux-en-Y gastric bypass with long pouch and ga-How to cite this paper:

Obesity is a difficult disease to control; bariatric surgery is one of the tools used to treat obesity and its comorbidities. The present case was chosen because it concerns a very obese patient whose proposed surgery-duodenal switch-resulted in traoperatively difficult to the medical team because the esophagogastric junction could not be reached due to the presence of hepatomegaly. Due to this unfavorable condition, we decided to perform a duodeno-ileal anastomosis with gastric preservation and without duodenal exclusion. The patient has been under follow-up for 14 years. She has lost 55 kg and maintains the comorbidities controlled to date.