-Context -Morbidly obese patients have an increased risk for nonalcoholic fat liver disease. Its severe form, nonalcoholic steatohepatitis may cause liver fibrosis. The diagnosis of advanced fibrosis has great value during the pre operative evaluation for bariatric surgery. Currently, liver biopsy is the gold standard for diagnosis of liver fibrosis. Objective -To evaluate the nonalcoholic fat liver disease fibrosis score in morbidly obese patients undergoing Roux-en-Y gastric bypass in our population. Methods -One hundred fifty-eight morbidly obese patients that had undergone bariatric surgery were included. Age, body mass index, hyperglycemia, platelet count, albumin and AST/ALT ratio were applied to the score formula. Scores above 0.676 were indicative of advanced liver fibrosis and scores under -1,455 absence of advanced liver fibrosis. These scores were compared to liver biopsy findings. Results -The presence of advanced fibrosis could be diagnosed with good accuracy, with a positive predictive value of 83.7%. The score had a higher accuracy to exclude advanced fibrosis with a negative predictive value of 97%. Twenty-five patients (16%) had scores between the cutoffs points and were identified as indeterminate. The score sensibility and specificity was 83% and 97% respectively. Conclusions -The nonalcoholic fat liver disease fibrosis score has high accuracy to identify and exclude advanced liver fibrosis in morbidly obese patients subjected to bariatric surgery.

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Background: Opioid-free anesthesia (OFA) has gained popularity in recent years due to concerns about the abusive use of this drug but also due to the potential benefits of OFA for pain control and decreased side effects. Objectives: This trial aimed to study whether opioid-free anesthesia (OFA) benefits patients submitted to laparoscopic gastroplasty compared to anesthesia with fentanyl. The primary objective was to measure pain score and morphine use for rescue analgesia. The secondary objective was to evaluate the incidence of postoperative nausea and vomiting (PONV) and oxygen desaturation. Methods: Patients undergoing gastroplasty were randomized to receive general anesthesia with fentanyl (n = 30) or OFA (n = 30) according to a predefined protocol. They were assessed for pain using a verbal numerical scale (VNS), morphine consumption and PONV in the post-anesthesia care unit and on the first day after surgery. Besides, oxygen desaturation during the immediate postoperative period was also recorded. The study was blinded to the surgeon and postoperative evaluators. Results: The groups were comparable for all demographic data analyzed. A significance level of 5% was used, and no differences were found in the variables studied. Conclusion: The specific OFA protocol presented in this trial was safe and effective. However, this study did not find any benefit in using it compared with fentanyl anesthesia in videolaparoscopic gastroplasties.

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A limpeza mecânica do cólon e a antibioticoprolaxia profilática foram os procedimentos responsáveis pela significante diminuição de morbidade e mortalidade na cirurgia colorretal. O objetivo do presente estudo foi avaliar, do ponto de vista bacteriológico, a eficácia de alguns métodos de preparo mecânico do cólon associado ou não ao emprego da antibioticoprolaxia. Foram estudados 64 ratos, machos, Wistar, com peso corporal entre 250-350g. Os animais foram divididos em grupos e submetidos a limpeza transoperatória do cólon utilizando-se diferentes tipos de solução (água de torneira, solução salina isotônica (SSI) e solução de polivinilpirrolidona (PVPI) a 5%). Cada grupo foi subdividido em dois subgrupos, que receberam ou não antibioticoprolaxia (cefoxitina sódica, 30 mg/ Kg, via intraperitoneal) 1 hora antes da intervenção cirúrgica. Os resultados foram comparados com o grupo controle no qual não foi realizado qualquer tipo de procedimento. Não se verificou diferença significativa entre os diferentes tipos de preparo mecânico do cólon. Concluímos que houve uma diminuição da flora bacteriana do cólon com o preparo mecânico, todavia a diminuição foi mais acentuada quando se fez uso da antibioticoprolaxia.