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Background: The objective of this study was to analyze the factors associated with change in body mass index (BMI) and with percentage of excess weight loss (%EWL) in patients undergoing Roux-en-Y gastric bypass (RYGB). The following factors were analyzed: sex, age, surgical access (laparotomy vs. laparoscopy), preoperative BMI, waist circumference (WC), type 2 diabetes mellitus (T2DM), high blood pressure, and dyslipidemia., Methods: Retrospective cohort study using a convenience sample of 2070 patients of both sexes, aged 18 to 65 years, undergoing RYGB between 2000 and 2013. The outcomes of interest were BMI and %EWL at 0, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months after RYGB., Results: After 36, 48, and 60 months, approximately 50 % of patients had BMI >30 kg/m(2). As for %EWL, 60-month results were poor for 17 % of patients (%EWL <50 %), good for 40 % of patients (%EWL 50-75 %), very good for 24 % of patients (%EWL from >75-90 %), and excellent for 19 % of patients (%EWL >90 %). The four most significant predictors of BMI change 60 months after RYGB (in descending order of magnitude) were preoperative BMI, preoperative WC, surgical access, and age; and of %EWL, surgical access, preoperative BMI, preoperative WC, and age., Conclusions: After 60 months of follow-up, the most relevant predictors of weight loss after RYGB were lower preoperative BMI and WC, videolaparoscopy as surgical access, and younger age. Further studies must be carried out to elucidate the impact of these factors on RYGB outcomes.

Background: Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB)., Methods: A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB., Results: In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost., Conclusion: This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs.

Background: Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy., Aim: 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures., Methods: A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed., Results: From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy., Conclusion: 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.

Background: Evidence indicates that eating habits established during childhood related to food intake persist when the child becomes an adult. Parental obesity is positively associated with the development of obesity in the offspring, who tend to become sick and obese young adults during the reproductive phase and end up looking for bariatric surgery in order to reverse the non-communicable diseases (NCDs) already established., Methods: This cross-sectional study evaluated 40 children aged 0 to 10 years, whose mothers underwent bariatric surgery at the Center of Morbid Obesity, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL PUCRS)., Results: Among these children, 45 % were overweight and 16 had high waist circumference values. The total energy intake and sodium consumption were above the Dietary Reference Intakes (DRIs) for the age group, while dietary fiber and potassium intakes were below DRIs. Obese children had higher percentage of lipid caloric intake (28.3 vs. 25.3 %, p < 0.025), while the non-obese group tended to have an increased consumption of carbohydrate (62.6 vs. 60 %, p < 0.066) when compared to the respective DRIs. The presence of NCDs in children's relatives was 100 %., Conclusions: There is probably a significantly higher prevalence of obesity among children of morbidly obese parents when compared to the general child population. Since the familial aggregation of NCDs was absolute, these results point to the need for careful evaluation when dealing with children. However, further studies with a larger number of individuals are needed to confirm these results.

With the high prevalence of obesity and associated comorbidities, the costs of health services produce a great economic impact. The objective of this work was to evaluate the economic benefits of bariatric surgery and to relate the costs to the impact on the health of the individual. A historic cohort study was conducted, with review of medical charts of 194 patients who fulfilled the inclusion criteria for the study. The costs for medications, professional care, and examinations in the pre- and postoperative periods were analyzed, taking into consideration the comorbidities DM2, SAH, and dyslipidemia. The study demonstrated a reduction in the medical costs in the course of the postoperative period, in relation to expenses for medications, professional care, and examinations in the preoperative period. Comparing the preoperative expenses with different times in the postoperative period, a statistically significant difference was seen at all time evaluated (p < 0.001). The resolution of comorbidities was higher than 95% at 36 months after surgery. No statistically significant difference was seen with respect to the prevalence of comorbidities between the sexes in the pre- and postoperative periods (p > 0.05). With regard to age, younger patients showed lower rates of comorbidities in the pre- and postoperative periods (p < 0.001). The costs of the surgery are high, but the expenditures for medications, professional care, and examinations decrease progressively after the operation, where this is more evident in patients with more associated comorbidities.