PROSPECTIVE META-ANALYSIS OF RELEASED WEIGHT LOSS AND SUCCESS RATE OF ARGON PLASMA COAGULATION TO SUTURE AND SURGERY PROCEDURES POST-BARIATRIC SURGERY: STATUS OF THE ART OF ENDOSCOPIC TREATMENT

Introduction: Currently, 30% of the world’s population is overweight or obese. Roux-en-Y gastric bypass (BGYR) and vertical gastrectomy are the most commonly performed techniques in Brazil and worldwide. Objective: Conduct a meta-analysis of the results of using argon plasma coagulation (APC), suture (SUT), and surgery (SUR), to clarify the safety and efficacy of using argon plasma to other procedures. Methods: The quality of the evidence was classified as high, moderate, low, or very low, according to the risk of bias. The Variance (α2) and One-Way (ANOVA) test were applied, adopting the α level less than 0.05 with a statistically significant difference for the 95% CI. The value of R-sq (R2) was analyzed to discover the imprecision or heterogeneity of the analyzes. Results: A total of 34 studies were found, eight to APC, twenty to SUT, and six to SUR. For relapsed weight loss (RWL), the means for APC, SUT, and SUR were respectively 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for SR, the means were respectively 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57. There was a small difference between the values of APC averages with SUT and SUR, both in relation to RWL and SR, with p>0.05, with a high association (R2 ≥ 50%). Conclusion: It was shown that the APC technique showed excellent results in terms of RWL and SR compared to the other techniques, with no statistically significant difference. Thus, the results of the APC strongly point to its potential use.

ARE THERE BENEFITS IN PERFORMING GASTRO-OMENTOPEXY IN LAPAROSCOPIC VERTICAL GASTRECTOMY?

ABSTRACT Background: Gastro-omentopexy promotes the reconnection of the stomach to the gastroesplenic and gastrocolic ligaments and constitutes an alternative for the prevention of complications in laparoscopic vertical gastrectomy. Aim: To demonstrate the benefits of the gastro-omentopexy technique in patients undergoing sleeve gastrectomy, with possible reduction in postoperative complications. Methods: Prospective, non-randomized, case series type study, consisting of a clinical population of 179 patients who underwent the technique in 2018, with follow-up between 6-12 months in the postoperative period. Results: From the participants 71.5% were women, aged between 30-40 years (36.3%). As for the prevalence of complications in the postoperative period, the low prevalence was evident, with emphasis on readmission (1.1%); reoperation (1.1%); wound infection (1.1%); bleeding hemorrhage (0.5%); and stricture (1.1%). However, temporary symptoms were present such as nausea/vomiting, food intolerance, epigastric pain and feeling of fullness, right after surgery. Conclusion: The technique promoted a significant improvement in quality of life and control of comorbidities. In addition, it was associated with a low prevalence of stenosis, and with no fistula, making the method safer.

VERTICAL GASTRECTOMY VS. EXTENDED VERTICAL GASTRECTOMY: WHAT IS THE IMPACT ON GASTROESOPHAGEAL REFLUX DISEASE IN OBESE RATS?

ABSTRACT 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.