Critical Analysis of Surgical Treatment Techniques of Morbid Obesity

Abstract

Introduction: Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment. Objective: To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea. Methods: Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria. Results: Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques. Conclusion: The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.

Bariatric Surgery in Brazilian Public Health System: The Good, the Bad and the Ugly, or a Long Way to Go. Yellow Sign!

“…However, when obesity reaches grade III (BMI >40), clinical treatment results are unsatisfactory in 95% of patients, who regain initial weight within two years 21 . Thus, bariatric surgery is the most effective alternative for the treatment of morbid obesity and its complications 13 , 16 , 26 . The main technique currently used is gastric bypass, which reduces the gastric cavity and the amount of food ingested (restrictive), while at the same time decreasing the intestinal absorption surface (disabsorptive).…”

Biomechanical Investigation of the Stomach Following Different Bariatric Surgery Approaches

“…The most controversial issue for LSG is gastroesophageal reflux disease due to both the increase of esophagogastric junction angle and the strong reduction of the stomach [ 14 ]. In general, unsatisfactory weight loss or weight gain is a possible postsurgical complication, and altered food approaches affect up to 25% of bariatric patients [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] ( Figure 1 ), leading to the need for improvements in BS.…”

Duodenal-Jejunal Bypass Reduces Lipid Accumulation in the Brown Adipose Tissue of Hypothalamic Obese Rats

“…Some studies have shown that the thermogenic activity in BAT can be modulated by bariatric surgery (BS) 2 , 10 , 20 , 21 , 27 . The BS is usually effective for achieving weight loss and energy homeostasis reestablishment in morbidly obese patients 8 , 13 , 18 , 19 , 29 . The duodenal-jejunal bypass (DJB), a procedure that maintains the volume of the stomach, but avoids the passage of food through the duodenum and part of the jejunum, improves glucose and lipids homeostasis 1 , 5 , 11 , 24 , however, the effects of DJB on BAT have never been studied yet.…”