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Introduction: The percentage of obese people is growing at a rapid pace, increasing the number of patients the number of patients undergoing bariatric surgery. It is known that non-alcoholic fatty liver disease is known to progress to cirrhosis. Currently there is no consensus about the surgical technique indicated for the cirrhotic patient who will cirrhotic patient who will undergo bariatric surgery. Gastric bypass surgery in Y is a classic technique widely used. However, when compared with the gastric Sleeve, the by-pass has disadvantages such as more difficult technique, longer surgical time, and more postoperative postoperative and nutritional complications. Case Presentation: Obese, hypertensive, diabetic patient who had his RYGB suspended after the intraoperative finding of cirrhosis. He was subsequently classified as CHILD A and underwent vertical gastrectomy. After one year of follow-up he presented good weight loss, good control of hypertension, diabetes arterial hypertension, diabetes, and improved liver function and lipid profile. Conclusion: It is understood, that gastric Sleeve may soon become the surgery of choice for cirrhotic patients CHILD A.

Opioids are associated with sedation and respiratory depression. The primary objective of this study was to assess pain intensity after gastric bypass with lidocaine. The secondary objective was to assess the IL-6 concentration, consumption of morphine, time to morphine request, time to extubation, and side effects. Sixty patients aged 18 to 60 years, with ASA (American Society of Anesthesiologists) scores of 2 or 3, who underwent bariatric surgery were allocated to two groups. Patients in group 1 were administered lidocaine (1.5 mg/kg) 5 min before the induction of anesthesia, and group 2 was administered 0.9% saline solution in an equal volume. Subsequently, lidocaine (2 mg/kg/h) or 0.9% saline was infused during the entire surgical procedure. Anesthesia was performed with fentanyl (5 μg/kg), propofol, rocuronium, and sevoflurane. Postoperative patient-controlled analgesia was provided with morphine. The following were evaluated: pain intensity, IL-6, 24-h consumption of morphine, time to the morphine request, time to extubation, and adverse effects. The lidocaine group had a lower pain intensity than the saline group for up to 1 h, with no differences between groups in IL-6 and time to extubation. The lidocaine group consumed less morphine within 24 h, had a longer time until the first supplemental morphine request, and had a lower incidence of nausea. Lidocaine reduced the intensity of early postoperative pain, incidence of nausea, and consumption of morphine within 24 h and increased time to the first morphine request, without reducing the plasma concentrations of IL-6.

Type-2 diabetes (T2D) patients with body mass index (BMI) below 35 kg/m2 carry lower remission rates than severely obese T2D individuals submitted to “standard limb lengths” Roux-en-Y gastric bypass (RYGB). Mild-obese patients appear to have more severe forms of T2D, where the mechanisms of glycemic control after a standard-RYGB may be insufficient. The elongation of the biliopancreatic limb may lead to greater stimulation of the distal intestine, alterations in bile acids and intestinal microbiota, among other mechanisms, leading to better metabolic outcomes. The aim of this study is to evaluate the safety and efficacy of the RYGB with a biliopancreatic limb of 200 cm in the control of T2D in patients with BMI 30–35 kg/m2. From January 2011 to May 2015, 102 T2D patients with BMI from 30 to 34.9 kg/m2 underwent laparoscopic RYGB with the biliopancreatic-limb of 200 cm and the alimentary-limb of 50 cm. There were no deaths or reoperations. The mean follow-up was 28.1 months. The mean BMI dropped from 32.5 to 25.1 kg/m2, while the mean fasting glucose decreased from 182.9 to 89.8 mg/dl and the mean glycated hemoglobin (HbA1c) went from 8.7 to 5.2%. During follow-up, 92.2% had their T2D under complete control (HbA1c

Surgical trauma, pain and opioids can cause nausea, vomiting, ileus and increased length of hospital stay. The primary objective of the study was to evaluate the time to recovery of gastrointestinal function and the time to meet hospital discharge criteria after laparoscopic bariatric surgery with intraoperative intravenous lidocaine administration. Secondary objectives were to evaluate morphine consumption during the first 24 h and the side effects of opioids. Fifty-eight patients aged 18 to 60 years who underwent bariatric surgery were allocated into two groups. Group 1 patients received intravenous lidocaine (1.5 mg/kg) 5 min before induction of anaesthesia, followed by infusion (2 mg/kg/h) until the end of surgery. Group 2 patients were given 0.9% saline solution (placebo) and infusion of 0.9% saline solution during surgery, in same volume as group 1. Anaesthesia was performed with fentanyl (5 μg/kg), propofol (2 mg/kg), rocuronium (0.6 mg/kg) and sevoflurane. Postoperative patient-controlled analgesia was with morphine. There were two groups that were evaluated: time to recovery of gastrointestinal function and time to meet discharge criteria. There was no significant difference between groups regarding the time to first flatus, time to meet discharge criteria and occurrence of side effects. Consumption of intraoperative sevoflurane and morphine over 24 h was significantly lower in the lidocaine group. Side effects observed were nausea and vomiting, with no difference between groups. Perioperative intravenous lidocaine is feasible and easily accessible when administered at appropriate doses. Lidocaine reduces morphine consumption.

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.

INTRODUÇÃO: A técnica operatória da gastrectomia vertical ainda não foi totalmente padronizada e, por isso, existem questões a serem resolvidas. Há tendência dela ter seu uso cada vez mais frequente, uma vez que já provou ser efetiva na perda de peso, com baixa morbimortalidade e bons resultados pós-operatórios. Contudo, a doença do refluxo gastroesofágico, que pode dela resultar, ainda não está bem elucidada. OBJETIVO: Apresentar variante técnica para a gastrectomia vertical que deixa o estômago totalmente tubulizado e sem manipulação nos esfíncteres pilórico e esofágico inferior. TÉCNICA: Inicia-se a gastrectomia vertical com a ligadura dos vasos da grande curvatura tendo como referência anatômica o piloro até o ângulo esofagogástrico. O grampeamento inicia-se também a partir do piloro na mesma direção. Para modelagem é utilizada sonda de Fouchet 32 F . O grampeamento é feito justo à sonda modeladora. Finaliza-se com sobressutura da linha de grampeamento e drenagem tipo "sump". RESULTADOS: O procedimento foi utilizado em 55 pacientes portadores de IMC entre 35 e 41. As complicações nesse grupo foram: duas fístulas ao nível do ângulo esofagogástrico, uma torção do tubo gástrico e uma conversão pós-operatória para derivação gástrica em Y-de-Roux por refluxo gastroesofágico intratável com medicamentos. As fístulas foram tratadas por procedimento endoscópico com dilatação e septotomia. Disfagia leve por torção respondeu satisfatoriamente com dilatação endoscópica. O maior período de seguimento foi de dois anos. A perda do excesso de peso foi de de 67,7% em um ano e de 69,7% em dois. Os pacientes que eram portadores de diabete melito tipo 2 apresentaram controle da doença em 84,6% no primeiro ano e 91,6% no segundo. Outras comorbidades tiveram controle em todos os casos. CONCLUSÃO: A variante técnica proposta para a gastrectomia vertical deixa o estômago totalmente tubulizado, em pequeno calibre, propiciando diminuição da cavidade gástrica livre e manutenção da atividade funcional dos esfíncteres naturais. Contudo, pode levar a refluxo gastroesofágico indesejado, que precisa ser melhor mensurado em pesquisas futuras.

Objetivo: Este estudo tem como objetivo apresentar os resultados iniciais do transplante hepático ortotópico experimental em suínos da Universidade Federal do Maranhão. Material e Métodos: No período de abril de 2004 a abril 2005 foram realizados 18 transplantes de fígado utilizando 36 porcos fêmeas, raça Landrace, pesando entre 32 e 38 Kg. Estes animais foram divididos em dois grupos, doador e receptor, que receberam enxerto total. O procedimento cirúrgico foi dividido em quatro fases: captação, operação de mesa (back-table), hepatectomia do receptor e reimplantação do fígado. Os dados analisados foram a pressão arterial média, pressão venosa central, freqüência cardíaca, pO2, pCO2, HCO3, excesso de base, SO2, pH, Na+, K+, Cl- e Ca++. Registramos o tempo da cirurgia, obtenção da perfusão hepática, isquemia fria, back table, fase anepática e o tempo para realização das anastomoses. Resultados: Observamos um tempo longo de isquemia fria do enxerto, entretanto as anastomoses da veia cava supra-hepática e veia porta foram consideradas satisfatórias resultando em uma fase anepática curta. Foram observadas alterações clínicas e gasométricas importantes na fase de reperfusão do enxerto. Valores laboratoriais do sódio e cloro séricos estiveram alterados nas fases anepática e de reperfusão do enxerto. Conclusão: O transplante hepático ortotópico experimental em suínos é capaz de otimizar a técnica cirúrgica bem com estimular o desenvolvimento de pesquisas em transplante hepático.

Este estudo tem por objetivo analisar experimentalmente as características macroscópicas e microscópicas de cálculos biliares humanos na cavidade peritoneal de ratos. Foram utilizados 32 ratos Wistar, machos, pesando entre 205 e 268 g. Estes animais foram distribuídos em dois grupos e o procedimento cirúrgico foi realizado em cada grupo: no grupo A (n =16), os animais foram submetidos a manipulação intestinal; no grupo B (n=16), cálculos biliares humanos foram colocados na cavidade peritoneal. Os ratos foram avaliados no 21º e 42º dias do período pós-operatório. Os resultados mostraram que a simples manipulação causou aderências nos animais (n=10). As aderências foram notadas em 11 cálculos no grupo B. Histologicamente não houve fibrose intensa em torno do cálculo, principalmente no 42º dia do período pós-operatório. Não foram observados macro ou micro abscessos e não houve evidências de fluído livre intra-peritoneal. Este estudo demonstra que apesar da baixa incidência de complicações, todas as tentativas devem ser feitas para recuperar cálculos perdidos durante colecistectomia.The aim of the present study is to analize in an experimental study, the macroscopical and microscopical features of the human gallstones on the peritoneal cavity of rats. Thirty-two male Wistar rats, weighting between 205 to 268g, were used. The animals were divided into two groups. The surgical procedure was performed in each one group: in group A (n =16), the animals were underwent to intestinal mobilization; in group B (n =16), human gallstones were left on the peritoneal cavity. The rats were evaluated at postoperative days 21 and 42. The results showed that simple bowel mobilization caused adhesions on the animals (n =10). Adhesions were noted in 11 gallstones in group B. Histologically there was no exuberant fibrosis surrounding the gallstone, mainly at postoperative day 42. No macro or micro abscesses were noted, and there was no evidence of free intra peritoneal fluid. This study suggest that despite of low incidence of complications , every attempt should be made to retrieve stones lost during cholecystectomy.

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.