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Pyloric Sympathectomy: A Novel Way to Get Pylorus Relaxation? Report of Two Bariatric Cases

Surgical Science 2024年第6期15卷 381-395页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro paulo reis esselin de melo Fernando Fornari Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Lusadas Amadora Hospital Lisboa Portugal paulo reis Institute Goinia Brazil Alfredo Nasser University Center (UNIFAN) Goinia Brazil Faculdade de Medicina Universidade de Passo Fundo Passo Fundo Brazil Faculdade de Medicina Universidade Federal da Fronteira do Sul Chapec Brazil

Objective: This case report aimed to demonstrate a possible neuromuscular effect of pyloric sympathectomy on the pylorus motility, leading to its permanent relaxation, observed in two bariatric surgical cases, one primary and the other, revisional. Background: Pyloric sphincter is a physiological barrier to free gastric emptying. In sleeve gastrectomy and in Roux-en-Y gastric bypass revisions, that put the remnant stomach in transit, the pylorus can contribute to generate a high intragastric pressure, which could lead to acute gastric fistulas and/or chronic gastroesophageal reflux disease. The possibility of functionally relaxing the pylorus, promoting intragastric pressure reduction, could represent a protective maneuver against these complications. Methods: We describe herein a surgical maneuver applied in two cases of bariatric surgeries, with the intention of facilitating antrum-duodenal region exposure, in a sleeve gastrectomy and in a Roux-en-Y gastric bypass conversion to SADI-S. For this, a ligation of terminal peripyloric vessels was done, allowing a passage of a tape, which surrounded the pylorus, for its traction. In both cases, 30-day and 1-year endoscopic evaluations were done, to assess esophagitis signs, anastomosis healing and anatomical pouch aspect. A clinical evaluation was also done, to assess gastroesophageal symptoms (validated questionnaire). Results: In the postoperative endoscopic evaluations, no esophagitis were observed in any case and the gastric pouches had normal aspect, with the expected anatomical findings, compatible with the surgeries performed. The anastomosis healed without problems, in the revisional case. Interestingly, in both cases, it was observed a complete pyloric sphincter relaxation, which lasted until 1-year endoscopic evaluation. There were no fistulas, nor esophagitis in any of these cases. Clinically, there were no symptoms of gastroesophageal reflux disease (validated questionnaire). Conclusion: The observation of a

关键词： Roux-en-Y Gastric Bypass Sleeve Gastrectomy Sympathectomy Bariatric Surgery

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Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

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Surgical Science 2024年第3期15卷 135-158页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso paulo reis esselin de melo Rui Ribeiro Paula Volpe Carlos Eduardo Domene Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil paulo reis Institute of Bariatric Surgery Goi&#226nia Brazil Alfredo Nasser University Center (UNIFAN) Goi&#226nia Brazil Lusíadas Amadora Hospital Lisboa Portugal Integrated Center for Advanced Medicine (CIMAMED) S&#227o Paulo Brazil

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution

关键词： Roux-en-Y Gastric Bypass Sleeve Gastrectomy Jejuno Gastric Bypass Vagus Nerve Vagotomy Bariatric Surgery

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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure

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Surgical Science 2024年第4期15卷 244-264页

作者： paulo reis esselin de melo Ricardo Zorron Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz Braga Paula Volpe Carlos Eduardo Domene paulo reis Institute Goiania GO Brazil Alfredo Nasser University Center (UNIFAN) Goiania GO Brazil department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal Victor Dib Institute Manaus AM Brazil Gastrobese Clinic Passo Fundo RS Brazil Lusiadas Amadora Hospital Lisbon Portugal Clianest Group Renaissance Hospital Goiania GO Brazil Integrated Center for Advanced Medicine (CIMAMED) Sao Paulo Brazil

Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. Objective: This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. Methods: This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (ICV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. Results: Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m2 preoperatively to 29.48 kg/m2 after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. Conclusion: Duodenal switch surgery has gained worldwide recog

关键词： Obesity Bariatric Surgery Metabolic Surgery Duodenal Switch

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Transit Bipartition with Duodeno-Ileal Anastomosis, without Duodenal Exclusion, as a First Stage of Bariatric Surgery in Severely Obese Patients: Case Report

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Surgical Science 2022年第11期13卷 497-505页

作者： paulo reis esselin de melo Thonya Cruz Braga Danilo Fossalussa Minari José Humberto Cardoso Resende Instituto paulo reis Goi&#226nia Brazil UNIFAN-Centro Universitário Alfredo Nasser Aparecida de Goi&#226nia Goi&#225s Brazil

Obesity is a difficult disease to control;bariatric surgery is one of the tools used to treat obesity and its comorbidities. The present case was chosen because it concerns a very obese patient whose proposed surgery—duodenal switch—resulted in traoperatively difficult to the medical team because the esophagogastric junction could not be reached due to the presence of hepatomegaly. Due to this unfavorable condition, we decided to perform a duodeno-ileal anastomosis with gastric preservation and without duodenal exclusion. The patient has been under follow-up for 14 years. She has lost 55 kg and maintains the comorbidities controlled to date.

关键词： Bariatric Surgery Biliopancreatic Diversion Gastric Bypass Duodenal Switch

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SADI-S with Extended Duodeno-Bulb Preservation: Case Report

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Surgical Science 2023年第2期14卷 131-142页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso paulo reis esselin de melo Rui Ribeiro Gabriela Trentin Scortegagna Elinton Adami Chaim Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil paulo reis Institute of Bariatric Surgery Goi&#226nia Brazil Alfredo Nasser University Center (UNIFAN) Goi&#226nia Brazil Luziadas Hospital Lisboa Portugal Faculdade de Ciências Médicas (FCM) da Unicamp Campinas S&#227o Paulo Brazil

Obesity has been growing in Brazil and in the world. It is reaching epidemic proportions, and bariatric surgery is the most effective treatment for patients with this disease. Among the procedures described in the literature, ileal surgeries such as biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) present better long-term results in terms of weight loss and comorbidities control. However, there are concerns regarding long term nutritional problems with these procedures. In this case report the aim is to demonstrate the technical feasibility of preserving an extended duodenal bulb segment, in the SADIS-S procedure, when there are difficulties in dissecting the retrobulbar region, as occurred here, due to fibrosis in this area. This assures the maintenance of the proposed surgical technique, in such a situation. The dissection and transection of the duodenum was done 7 cm distally to the pylorus, under endoscopic view, proximally to the papillae, where the tissue was normal. Additionally, due the importance of the duodenal mucosa on minerals and trace elements absorption and the release of important hormones in this region, this case report elicits the evaluation of the impact of this technical modification, which occurred casually, in the nutritional, hormonal and metabolic results, long term. In this case report, the extended duodenal length has demonstrated reasonable weight loss, adequate comorbidities control and good nutritional status, so far. These aspects must be evaluated in the long term, by clinical trials.

关键词： Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy Obesity Bulb Preservation Bariatric Surgery Metabolic Surgery

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Sleeve Gastrectomy Associated with Antral Lesion Resection and Roux-en-Y Antrojejunal Reconstruction

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Surgical Science 2023年第5期14卷 360-376页

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Carlos Eduardo Domene paulo reis esselin de melo Rui Ribeiro Gabriela Trentin Scortegagna Elinton Adami Chaim Victor Dib Institute Manaus Brazil Gastrobese Clinic Passo Fundo Brazil Integrated Center for Advanced Medicine (CIMA) S&#227o Paulo Brazil paulo reis Institute of Bariatric Surgery Goi&#226nia Brazil General Surgery Unit Alfredo Nasser University Center (UNIFAN) Goi&#226nia Brazil Luziadas Hospital Lisboa Portugal department of Surgery Faculty of Medical Sciences (FCM) at UNICAMP Campinas Brazil

Obesity has been growing worldwide, reaching epidemic proportions. Bariatric surgery is the most effective and durable treatment for severe obesity and related diseases. Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) are the most frequently performed bariatric operations, with long-term good results, in terms of weight loss and comorbidities control. Gastroesophageal Reflux Disease (GERD) is commonly associated with obesity. In general, it precludes the indication of sleeve gastrectomy, since this technique has a refluxogenic potential, as shown in many studies. In such cases, RYGB is considered the best surgery, reaching good weight loss and gastroesophageal reflux disease control. The drawback of this technique is that it leaves the remnant stomach, the duodenum, and the proximal part of the jejunum inaccessible. Besides, RYGB makes transoral endoscopic access to the biliary tree impossible. For all these reasons, this bariatric technique is not indicated in cases of gastric polyposis, gastric dysplasia, or strong family history of cancer, among others. We report a case of a morbidly obese patient with intense GERD, for whom a RYGB was precluded due to her strong family history of cancer, even knowing that it would be the best choice for reflux disease control. Instead, SG was chosen, even knowing it could worsen the gastroesophageal reflux disease. The patient signed an informed consent, after being fully enlightened about the risks. During the surgery, a small subserosal whitish lesion was detected, near the pylorus, on the anterior wall of the antrum. Thinking in a Gastrointestinal Stromal Tumor (GIST), it was resected, with a 2 cm safety margin, leaving a 4 to 5 cm hole on the gastric wall. The decision to maintain the proposed sleeve gastrectomy was made, to avoid leaving a remnant stomach, in a patient with such a strong family history of cancer. In the area of the resected lesion, an intraoperative decision was made not to just close the big ga

关键词： Roux-en-Y Gastric Bypass Sleeve Gastrectomy Jejunum Gastric Bypass Bariatric Surgery

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Gastric Bypass with Long Pouch and Transit Bipartition for Endoscopic Access to the Remaining Stomach

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Surgical Science 2022年第8期13卷 353-366页

作者： paulo reis esselin de melo Marcella Giovana Gava-Brandolis Thonya Cruz Braga Danilo Fossalussa Minari Ricardo Augusto Martins Bueno da Costa Jose Geraldo Moraes Sampaio Neto Louise Flores Silva José Humberto Cardoso Resende Hospital Estadual Alberto Rassi Surgical Skills Coordinator Goi&#226nia Brazil UNIFAN Research Coordinator Aparecida de Goi&#226nia Brazil

Introduction: obesity has a complex and multifactorial etiology, difficult treatment and increasing incidence rates in recent decades. The treatment involves clinical and pharmacological approaches and, in case of lack of results, surgical interventions. Roux-en-Y gastric bypass (RYGB) is one of these surgical interventions in which the stomach is divided, creating a small pouch, and the remaining portion of the stomach become excluded and left without endoscopic access. Objective: to evaluate the results of modified RYGB with long pouch and endoscopic access to the remaining stomach. Materials and Methods: prospective clinical trial with sample selected among patients seen at the Alberto Rassi General State Hospital of Goiânia (HGG) and indicated for bariatric and metabolic surgery confirmed by the medical and multidisciplinary team. The study was conducted from January 2020 to August 2021. Clinical history and laboratory test results of the selected patients were collected through consultations with the medical and multidisciplinary team. Results: twelve participants were included in the study. Of these, 11 (91.7%) were women and the mean age was 46.3 years. The weight before surgery was 112.17 kg (92.00 - 150.00) and the Body Mass Index (BMI) was 44.89 (35.06 - 74.39). After 18 months of surgery, the mean weight was 80.77 kg (±11.92) and the mean BMI was 29.46 (±11.00), showing a significant reduction in both (p = 0.003 and p = 0.002, respectively). All patients underwent endoscopic evaluation of the pouch, remaining stomach and duodenum at 12 months postoperatively. The mean percentage of lost excess weight loss was 68.21%. Conclusion: We conclude that the proposed changes in RYGB (GBLP + GIB – Roux-en-Y gastric bypass with long pouch and gastrointestinal bipartition) did not compromise weight loss or control of type 2 diabetes and other comorbidities and proved to be a safe and effective alternative without gastroduodenal exclusion, enabling a better postop

关键词： Obesity Bariatric Surgery Metabolic Surgery Roux-En-Y Gastric Bypass

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Transit Bipartition with Duodeno-Ileal Anastomosis, without Duodenal Exclusion,as a First Stage of Bariatric Surgery in Severely Obese Patients: Case Report

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Surgical Science（外科学） 2022年第11期

作者： paulo reis esselin de melo thonya cruz braga danilo fossalussa minari josé humberto cardoso resende

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SADI-S with Extended Duodeno-Bulb Preservation: Case Report

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Surgical Science（外科学） 2023年第2期

作者： Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso paulo reis esselin de melo Rui Ribeiro Gabriela Trentin Scortegagna Elinton Adami Chaim

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Plant growth and metabolism of exotic and native Crotalaria species for mine land rehabilitation in the Amazon

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Journal of Forestry Research 2024年第1期35卷 143-154页

作者： Hemelyn Soares das Chagas Rafael Silva Guedes Markus Gastauer Paula Godinho Ribeiro Allan Klynger da Silva Lobato Cecílio Frois Caldeira Fabrício William deÁvila AndréRodrigues dos reis Silvio Junio Ramos Instituto Tecnológico Vale Rua Boaventura da Silva955BelémPA 66055-090Brazil Universidade Federal do Sul e Sudeste do Pará XinguaraPABrazil Núcleo de Pesquisa Vegetal Básica e Aplicada Universidade Federal Rural da AmazôniaParagominasPABrazil departamento de Engenharia Florestal Universidade Estadual do Centro-Oeste/UNICENTROIratiPRBrazil School of Sciences and Engineering São Paulo State University(UNESP)TupãSP.CEP 17602-496Brazil

despite its enormous benefits,mining is respon-sible for intense changes to vegetation and soil ***,after extraction,it is necessary to rehabilitate the mined areas,creating better conditions for the establishment of plant species which is *** study evaluated mineral and organic fertilization on the growth,and carbon and nitrogen(N)metabolism of two Crotalaria species[Cro-talaria spectabilis(exotic species)and Crotalaria maypu-rensis(native species from Carajás Mineral Province(CMP)]established on a waste pile from an iron mine in CMP.A control(without fertilizer application)and six fertilization mixtures were tested(i=NPK;ii=NPK+micronutrients;iii=NPK+micronutrients+organic compost;iv=PK;v=PK+micronutrients;vi=PK+micronutrients+organic compost).Fertilization contributed to increased growth of both species,and treatments with NPK and micronutrients had the best results(up to 257%***),while organic fertilization did not show *** Crotalaria had a greater number of nodules,higher nodule dry mass,chlorophyll a and b contents and showed free ammonium as the predominant N form,reflecting greater increments in biomass compared to native *** having lower growth,the use of this native species in the rehabilitation of mining areas should be considered,mainly because it has good development and meets current government legislation as an opportunity to restore local biodiversity.

关键词： Biological nitrogen fixation Mining Nitrogen metabolism Plant nutrition

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