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WJOLS

Obesity-related Metabolic Comorbidities Remission in Postbariatric Surgery Patients
laparoscopic Roux-en-Y gastric bypass (LRYGB) are line was subsequently reinforced with PDS 2/0 and all
equally effective in the management of obesity, for the of them underwent an air leak test. Finally, closure of the
resolution of comorbidities, or in terms of influencing the ports of 12 mm with endoclose needle and prolene 1/0
course of the chronicity of diseases. 8 was performed. No drains were left routinely.
The impact of bariatric surgery on the health system LRYGB: In the French position, technique with five trocars,
is significant because once a patient’s excess body weight three 12 mm: Umbilical and bilateral paraumbilical and
is removed, between 97 and 98% of their comorbidities 2 of 5 mm: Left costal margin and subxiphoid. The first
are resolved. This translates into fewer medical visits, step is to create the gastric pouch, below the third gastric
decreased or absent need for medications, and fewer vessel, and the space dissection was performed with an
complications from chronic diseases, which means a ultrasonic scalpel and the back face of the stomach was
decrease of up to 50% in the demands on the health dissected and the first cartridge of 45 mm blue was fired;
insurance system. 4 it subsequently passed the 36 F bougie and two shots were
In the USA, in 2008, 9.1% of the health care budget performed with 45 mm blue cartridge. The transverse
was allocated to the management of comorbidities in colon was lifted to identify the Treitz ligament and, at
patients with morbid obesity. The discrimination indi- 70 cm, the first jejunostomy was performed with a white
viduals with obesity experience is also significant, in cartridge of 45 mm for biliopancreatic limb. Next, the
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terms of accessing employment. Hawkins et al showed 120 cm was measured for the alimentary limb and the Roux-
that after a bariatric surgery, 32% of patients managed in-Y laterolateral was performed with a 45 mm cartridge
to find a job or improved their current employment with a distal closure with vicryl 3/0. In all patients, the meso
conditions. was closed with vicryl 3/0 to avoid internal hernias. Last
step, laterolateral gastrojejunal anastomosis with a 45 mm
MATERIALS AND METHODS blue cartridge, an air test leak was performed and closing
the 12 mm ports with endoclose needle and 1/0 prolene;
After approval by the Institutional Review Board (IRB) no drain left.
and in accordance with requirements for submission of Routinely we did not order barium studies. Discharge
the International Committee of Medical Journal Editors, was given 1 day after the procedure and patients began
this study was performed. Data of all patients with docu- hypoglucid half portion clear liquids per day 4; then they
mented ORD who were admitted in the institution with turned to liquid diet.
a body mass index (BMI) of 35 to 50 kg/m², according In order to classify each patient according to their
to the American Society for Metabolic Bariatric Surgery comorbidity, and to attempt to achieve the remission of
(ASMBS) guide, were prospectively collected. All the these comorbidities, the following definitions were used:
patients were assessed and managed by a multidisci- • Arterial hypertension was defined as systolic pres-
plinary group for clinical obesity, and according to their sure > 140 and/or diastolic pressure > 90, or the use
comorbidities, food habits, and their risk of regaining of antihypertensive agents.
weight, the patients were evaluated by a board of special- • Diabetes is diagnosed with a fasting glycemia
ists and the best procedure was chosen for each patient. > 126 mg/dL, > 200 mg/dL 2 hours after a glucose load,
The surgical alternatives were LSG and LRYGB; the or the use of hypoglycemic agents/insulin.
choice of one or the other was made using the criterion • Hyperlipidemia is defined as a lipid profile of high-
of the surgeon and board. Data were collected as patient’s density lipoproteins (HDL) < 40 mg/dL for men and
follow-up, including initial BMI, the patient’s ideal weight, < 50 mg/dL in women and/or triglycerides > 150 and/
and the comorbidities associated with obesity, such as or low-density lipoproteins (LDL) > 100 mg/dL, or the
hypertension, type I and II diabetes, hyperlipidemia, use of medications to decrease lipids.
OSAHS, and osteomuscular diseases. • The diagnosis of OSAHS was based on repeated
The surgical techniques used were the following: episodes of occlusion of the respiratory tract, greater
LSG: In the French position, using a 5 trocar technique, during sleep, or whilst the patient is awake and a high
two 12 mm umbilical and left paraumbilical, and three rate of apnea/hypopnea evidenced in the polysomno-
5 mm right paraumbilical, left low costal border, and gram or if a continuous positive airway pressure
subxiphoid; traction of the left hepatic lobe; with an ultra- (CPAP) was needed whilst the patient was asleep. 6,11
sonic scalpel, the major curve was released until the left The criteria for remission are the following:
crura and 6 cm from the pylorus to the antrum. A 36 F • Diabetes, according to the American Diabetes Asso-
bougie was used for calibration, and the tubulization was ciation definition, which defines partial remission as
initiated with 5 cartridges 60 mm Echelon Johnson and a fasting glycemia < 126 and glycosylated Hb < 7 for
Johnson staples, first green and the rest blue. The staple 1 year without medication, complete remission as a
World Journal of Laparoscopic Surgery, January-April 2017;10(1):30-34 31