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Background: Extended vertical gastrectomy is a variation of the vertical gastrectomy technique requiring studies to elucidate safety in relation to gastroesophageal reflux. Aim: To analyze comparatively vertical gastrectomy (VG) and extended vertical gastrectomy (EVG) in rats with obesity induced by cafeteria diet in relation to the presence of reflux esophagitis, weight loss and macroscopic changes related to the procedures. Methods: Thirty Wistar rats were randomized into three groups, and after the obesity induction period by means of a 28-day cafeteria diet, underwent a simulated surgery (CG), VG and VGA. The animals were followed up for 28 days in the post-operative period, and after euthanasia, the reflux esophagitis evaluation was histopathologically performed. Weight and macroscopy were the other variables; weight was measured weekly and the macroscopic evaluation was performed during euthanasia. Results: All animals presented some degree of inflammation and the presence of at least one inflammation criterion; however, there was no statistically significant difference in the analysis among the groups. In relation to weight loss, the animals in CG showed a gradual increase during the whole experiment, evolving to super-obesity at the end of the study, while the ones with VG and EVG had weight regain after the first post-operative period; however, a less marked regain compared to CG, both for VG and EVG. Conclusion: There is no difference in relation to reflux esophagitis VG and EVG, as well as macroscopic alterations, and both techniques have the ability to control the evolution of weight during postoperative period in relation to CG.

Studies related to obesity have shown association with metabolic syndrome. Data showing that obesity is capable to cause low grade chronic inflammation, without its classic signs and symptoms, call attention to researches to study different cells types and the mechanism of the inflammatory process.To evaluate the variation of glycated hemoglobin (HbA1c) and the pro-inflammatory cytokine interleukin-6 (IL6) in diabetic patients with BMI35 kg/m2 in the pre and postoperative of partial duodenal switch.Nine patients were studied before and one year after the operation and the variation of the serum IL6 was measured by Elisa. The changes of HbA1c were also registered.The pre-operative IL6 levels reached 65,50436±2,911993 pg/ml and one year after de operation 39,47739±3,410057 and the HbA1c average of 10,67 and 5.8 in the same period.The partial duodenal switch was efficient to control one year after the procedure the chronic inflammatory process caused by the diabetes mellitus type 2 with BMI35 by dropping the IL6 levels and bringing the HbA1c to normal.Os estudos relacionados à obesidade têm evidenciado sua associação com a síndrome metabólica. A descoberta que a obesidade é capaz de promover inflamação, sem os sinais clássicos, tem levado vários grupos de pesquisa a caracterizar os tipos celulares que agem e o mecanismo envolvido neste processo.Avaliar a variação da hemoglobina glicada e a secreção da citocina inflamatória, interleucina-6, em indivíduos diabéticos com IMC35 kg/m² no pré e pós-operatório da técnica de desvio duodenal parcial.Nove pacientes foram avaliados antes e um ano após a operação e a variação da concentração da interleucina-6 foi avaliada pela metodologia de Elisa. Também foi avaliada a variação da HbA1c.A quantificação de interleucina-6 apresentou no pré-operatório valor de 65,50436±2,911993 pg/ml e de 39,47739+3,410057 pg/ml após um ano da operação e a hemoglobina glicada apresentou média de 10,67 no pré-operatório e de 5,8 após um ano da operação.O desvio duodenal parcial foi capaz de, um ano após o procedimento, diminuir os efeitos da inflamação crônica demonstrada pela diminuição da concentração da interleucina-6 plasmática e normalizar a hemoglobina glicada em pacientes diabéticos com IMC35 kg/m2.

The surgical technique of sleeve gastrectomy has not been fully standardized and, therefore, there are issues to be solved. There is a tendency to increase its application due to proved efficiency in weight loss, low morbidity and good postoperative results. However, gastroesophageal reflux disease, which can result from it, is still not well understood.To present variant technique for sleeve gastrectomy that leaves the stomach totally with the appearance of a homogeneous tube, without manipulation in pyloric and lower esophageal sphincters.Vertical gastrectomy starts with vessel ligation of the greater curvature at the pylorus till esophagogastric angle. Stapling also starts from the pylorus in the same direction. For modeling was used Fouchet 32 F and all the staple line was done just to it. At the end, oversuture of the staple line and "sump" drainage were done.The procedure was used in 55 patients with BMI between 35 and 41. Complications in this group were two fistulas at the esophagogastric angle, one twist of the gastric tube and one postoperative conversion to Roux-en-Y gastric bypass due to untreatable gastroesophageal reflux disease. Fistulas were treated by endoscopic procedure with dilation and septotomy. Mild dysphagia due to tube twisting responded satisfactorily to dilatation. The longest follow-up was two years. The loss of overweight was 67.7% at one year and 69.7% in two. Patients who were suffering from type 2 diabetes mellitus showed disease control in 84.6 % in the first year and 91.6 % in the second. Comorbidities were controlled in all cases.The variant technique proposed here for sleeve gastrectomy leaves the stomach homogeneously in a shape of a tube and in small caliber, providing small free gastric cavity and keeping natural functional activity of the sphincters. However, it may lead to unwanted gastroesophageal reflux, which needs to be better measured in future research.

Although is complex to identify the factors responsible for the important growth in obesity all over the world, the main causes are increased consumption of energy, highly saturated fats and sugars, and reduced physical activity.To compare rats with normal and supplemented diet with sucrose in relationship to body mass, weight of gonadal and retroperitoneal fat and Lee index.Forty rats were divided into two groups: 20 in the control group that received normal chow diet and water for three months, and 20 animals in the experimental group who received the same diet but supplemented with sucrose 300 g/l of water. The animals were weighed once a week during 91 days. At scheduled death, they had measured the naso-anal length, body weight and Lee index. After laparotomy, retroperitoneal and gonadal fat were isolated, dried and the percentage of weight in relation to body weight at the date of death was evaluated.There was a statistic significant difference between the 14th and 78th day favoring the experiment group indicating that sucrose interferes with weight gain in rats. The average weight was higher in the experimental group in all periods in comparison to initial weight. There was also significant difference in the weight of the gonadal and retroperitoneal fat. There was no significant difference comparing the Lee index.The body mass index was higher in animals treated with diet supplemented with sucrose and had higher gonadal and retroperitoneal fat, but no difference in the Lee index.

About 90% of type 2 diabetic patients are obese or overweight. The obvious clinical improvement observed with surgeries, such as Roux-en-Y gastric bypass, has opened space for research by different factors than only weight loss, as responsible for the return to euglycemia and reduction of medication use.To evaluate the efficacy and safety of surgical treatment of diabetes in obese patients with BMI above 35 kg/m2 underwent to gastric bypass, for the control of diabetes, weight loss, improvement of laboratory findings and complications of diabetes.The protocol was implemented in three stages: initial, after losing 10% of weight, and after a year.Seventeen patients who have lost weight in 10% were included in the surgical protocol. From the total, 11.8% continued needing medication (p0.001). The time for weight loss was a month with significant reduction in fasting glucose, HOMA-IR index, insulin, HbA1c, hemoglobin, AST, urea and C-peptide and there was no variation in hematocrit, albumin, ALT and creatinine. With a year of monitoring, the surgical group showed a significant difference in weight, BMI, blood glucose, HbA1c, C-peptide, insulin and HOMA-IR. The percentage of patients with neuropathy (31.3%) was lower than the number of cases at baseline (52.9%) (p0.05).Gastric bypass with Roux-en-Y derivation is a safe procedure, with good results in control of diabetes type 2 in obese patients with BMI above 35 kg/m2.

Gastroesophageal reflux is the gastrointestinal tract disease most frequently find nowadays. The Nissen-Rossetti fundoplication is widely used for the surgical treatment, and intrathoracic migration of the valve is the most frequent complication.To assess the incidence of the fundoplication and its risk factors.Were analyzed retrospectively medical records of 207 patients undergoing laparoscopic fundoplication by the Nissen-Rossetti technique for the treatment of reflux disease. The variables analyzed were: sex, age, esophagitis grade, size of the herniation, enlargement of the cardia and esophageal shortening. For quantitative variables, was considered the Student's t test. For the nominal, was considered the chi-square or Fisher's exact test. P values ​​0.05 were considered statistically significant.Of the total, 135 were women (65.22%) and 72 men (34.78%) with mean age of 47.43 years. The size of the hernia varied between 2 and 6 cm. Two hundred patients had esophagitis (96.62%) and 113 (56.50%) grade I, 75 grade II (37.50%) and 12 grade III or IV (6%). Enlargement of the cardia and Barrett's esophagus were seen in 153 (73.91%) and 13 (6.28%) cases, respectively. One patient had esophageal shortening. Among women, 33 (24.4%) showed migration and among men, only six (8.3%) (p = 0.005). The average age of patients with and without migration was 54.03 and 45.89 years, respectively (p = 0.001).The incidence of the fundoplication migration was 18.8%. The gender (female) and higher age influence the probability of migration. The degree of esophagitis, size of hernia and enlargement of the cardia were not risk factors for intrathoracic migration of the fundoplication.

Roux-en-Y gastric bypass may result in stenosis of the gastrojejunal anastomosis. There is currently no well-defined management protocol for this complication.Through systematic review, to analyze the results of endoscopic dilation in patients with stenosis, including complication and success rates.The PubMed database was searched for relevant studies published each year from 1988 to 2010, and 23 studies were identified for analysis. Only papers describing the treatment of anastomotic stricture after Roux-en-Y gastric bypass were included, and case reports featuring less than three patients were excluded.The mean age of the trial populations was 42.3 years and mean preoperative body mass index was 48.8 kg/m². A total of 1,298 procedures were undertaken in 760 patients (81% female), performing 1.7 dilations per patient. Through-the-scope balloons were used in 16 studies (69.5%) and Savary-Gilliard bougies in four. Only 2% of patients required surgical revision after dilation; the reported complication rate was 2.5% (n=19). Annual success rate was greater than 98% each year from 1992 to 2010, except for a 73% success rate in 2004. Seven studies reported complications, being perforation the most common, reported in 14 patients (1.82%) and requiring immediate operation in two patients. Other complications were also reported: one esophageal hematoma, one Mallory-Weiss tear, one case of severe nausea and vomiting, and two cases of severe abdominal pain.Endoscopic treatment of stenosis is safe and effective; however, further high-quality randomized controlled trials should be conducted to confirm these findings.