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In this case series, the simultaneous occurrence of Wernicke's encephalopathy (WE) and dry beriberi was reported in three patients who underwent vertical sleeve gastrectomy (VSG) between May 2021 and May 2023. All patients were obese women who underwent vertical sleeve gastrectomy (VSG) without immediate postoperative complications, but two weeks later, hyperemesis and subsequent encephalopathy with ocular movement abnormalities and weakness were observed over the following thirty days. Patients were referred to neurology, where due to the high suspicion of WE, thiamine replacement therapy was initiated; meanwhile, diagnostic neuroimaging and blood tests were conducted. Neurological and psychiatric evaluations and neuroconduction studies were performed to assess the clinical evolution and present sequelae. One year after diagnosis, all patients exhibited affective and behavioral sequelae, anterograde memory impairment, and executive functioning deficits. Two patients met the criteria for Korsakoff syndrome. Additionally, peripheral nervous system sequelae were observed, with all patients presenting with sensorimotor polyneuropathy. In conclusion, Wernicke's encephalopathy requires a high diagnostic suspicion for timely intervention and prevention of irreversible sequelae, which can be devastating. Therefore, raising awareness among medical professionals regarding the significance of this disease is essential.
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<b><br>Introduction:</b> Obesity's associated comorbidities and treatment costs have risen significantly, highlighting the importance of early weight loss strategies. Bariatric surgeries like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) have been effective in promoting weight loss and improving type 2 diabetes mellitus (T2DM) management.</br> <b><br>Aim:</b> The aim was to determine whether Roux-en-Y gastric bypass is more effective than vertical sleeve gastrectomy in the remission of type 2 diabetes mellitus (T2DM).</br> <b><br>Methods:</b> A systematic review and meta-analysis was performed. A literature search was performed in the databases Web of Science, Medline/PubMed, Embase, Scopus, and Medline/Ovid. A total of 1323 results were identified; after screening, 14 articles were selected and included in the systematic review. Primary and secondary outcomes were measured by RR with a 95% CI.</br> <b><br>Results:</b> The primary outcome of T2DM remission was 15% in favor of VSG (RR: 1.15, [95% CI: 1.04-1.28]). For secondary outcomes, hypertension remission was 7% in favor of VSG (RR: 1.07, [95% CI: 1.00-1.16]). Remission of dyslipidemia was 16% in favor of VSG (RR: 1.16, [95% CI: 1.06-1.26]). BMI after surgery was in favor of RYGB (MD: -1.31, [95% CI: -1.98 to -0.64]). For weight loss, the results favored VSG (MD: 6.50, [95% CI: 4.99-8.01]). In relation to total cholesterol, they were 65% favorable for RYGB (MD: -0.35, [95% CI: -0.46 to -0.24]), with a value of p <0.05. For LDL values, our results were 69% favorable for RYGB (MD: -0.31, [95% CI: -0.45 to -0.16]), p <0.01 value.</br> <b><br>Conclusions:</b> Laparoscopic sleeve gastrectomy is more effective in T2DM remission, hypertension remission, dyslipidemia remission, and weight loss compared to Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is more effective at lowering BMI, total cholesterol, LDL, and TG compared to laparoscopic sleeve gastrectomy.</br>.
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Diabetes Mellitus Tipo 2 , Gastrectomia , Derivação Gástrica , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia/métodos , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Indução de Remissão , Resultado do Tratamento , Redução de PesoRESUMO
Resumen Objetivo: La cirugía bariátrica es un procedimiento para disminuir de peso a largo plazo en pacientes con obesidad. El objetivo de este estudio fue evaluar los niveles de ghrelina y la reducción del peso de acuerdo al tipo de cirugía bariátrica, comparando el bypass de una sola anastomosis y la gastrectomía formadora de manga. Materiales y Métodos: Estudio de cohorte que incluyó a 50 pacientes con obesidad, 22 mini-bypass y 28 mangas gástricas. Se evaluó el peso corporal y las concentraciones de ghrelina en la etapa prequirúrgica, en el día 7 y en los meses 1, 3 y 6 después de la cirugía. Resultados: Del total de pacientes, el 86% presentaron > 50% pérdida del exceso de peso (PEPP) a los 6 meses. La concentración de ghrelina disminuyó desde la primera semana en el grupo total de participantes. A los 6 meses, se observó mayor reducción de ghrelina en los pacientes con la manga gástrica (4.636 ± 2.535 vs 1.340 ± 1.001 pg/mL, p < 0,0001). El PEPP en pacientes con mini-bypass fue superior, en comparación con manga gástrica. Conclusiones: La comparación entre las técnicas indicó que, a los 6 meses de evolución posquirúrgica, los pacientes con mini-bypass presentaron mayor reducción de peso corporal y del nivel de ghrelina, en comparación con el grupo de manga gástrica. La concentración de ghrelina es una variable que participa en el control de peso; sin embargo, el tipo de abordaje quirúrgico probablemente tiene mayor relación con la pérdida de peso en estos pacientes.
Introduction: Bariatric surgery is a procedure to reduce weight in the long term in patients with obesity. The objective of this study was to evaluate ghrelin levels and weight reduction according to the type of bariatric surgery, comparing the single anastomosis bypass and the sleeve-forming gastrectomy. Materials and Method: Cohort study that included 50 patients with obesity, 22 Mini-Bypass and 28 gastric sleeve. Body weight and ghrelin concentrations were evaluated in the presurgical stage, on day 7 and in months 1, 3 and 6 after surgery. Results: Of the total of patients, 86% had > 50% excess weight loss (PEPP) at 6 months. The concentration of ghrelin decreased within the first week of the intervention. At 6 months, greater reduction of ghrelin was observed in patients with gastric sleeve (4636 ± 2535 vs 1340 ± 1001 pg/mL, p < 0.0001). The PEPP in patients with Mini-Bypass was superior, compared to gastric sleeve. Conclusion: The comparison between the techniques indicated that, after 6 months of post-surgical evolution, patients with Mini-Bypass had a greater reduction in body weight and ghrelin levels, compared to the gastric sleeve group. Ghrelin concentration is a variable that participates in weight control; however, the type of surgical approach is probably more related to weight loss in these patients.
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Humanos , Masculino , Feminino , Redução de Peso , Cirurgia Bariátrica , Grelina , Período Pós-Operatório , Derivação Gástrica , GastroplastiaRESUMO
Introducción: La gastrectomía vertical en manga (MG) consiste en resecar el fundus y la curva mayor del estómago preservando la curvatura menor en forma tubular. Estudios reportan aumento de riesgo de enfermedad por reflujo gastro esofágico (ERGE) de novo en pacientes con MG por la eliminación del fundus gástrico, pérdida del ángulo de His,sección de fibras musculares en cincha. Yehoshua demostró disminución de distensibilidad e incremento de presión intragástrica (PIG) después de MG. Pandolfino expuso que la distensibilidad de la unión esófago gástrica (UEG) es indicador del grado de apertura de la misma aumentando la tendencia al reflujo. Objetivos: Evaluar los cambios anatómicos y funcionales de presión y distensibilidad de la UEG mediante impedancia planimétrica (EndoFLIP ®) involucrados en la aparición de reflujo gastroesofágico. Se hipotetizó que los eventos de reflujo ocurren por disminución temporal de la zona de alta presión a nivel de la UEG con aumento del gradiente de presión en sentido gastro esofágico por incremento de la PIG del reservorio y de la distensibilidad de la UEG en presencia de tono normal de la UEG. Pacientes y Métodos: Estudio prospectivo, experimental de cohorte con 23 pacientes sometidos a MG de acuerdo a los criterios establecidos por la ISGC.Fueron excluidos los pacientes con diagnóstico de ERGE y hernia hiatal (HH); y a los incluidos se les realizó gastroscopia y Manometría esofágica de alta resolución (MAR) preoperatoria. Durante la cirugía se midió presión y distensibilidad de la UEG con el sistema EndoFLIP® en 2 momentos: al estabilizarse el neumoperitoneo y una vez finalizada la gastrectomía, incluyendo la medición de presión y distensibilidad del reservorio gástrico. Resultados: Se evaluaron 23 pacientes,16 mujeres, edad promedio: 44 años (29-67). Promedio de Índice de masa corporal (IMC) 39.14 kg/m2. (31.2 - 45). La medición inicial expuso presión del EEI de 32.6 mmHg, y distensibilidad 11.69 mm2/mmHg. La segunda medición mostró presión de 35.8 mmHg y distensibilidad de 15.19 mm2/mmHg. La medición del reservorio gástrico registró presión de 38.9 mm2/mmHg). La prueba de t de Student pareada encontró diferencias significativas en las presiones y distensibilidades post operatorias (p= 0.0357) y (p< 0.0001) respectivamente. Cuando estos valores se correlacionaron con el IMC se observó que los pacientes con menor IMC aumentaron la presión luego de la MG y los pacientes con mayor IMC reportaron el fenómeno inverso, las distensibilidades mostraron muy poca variación antes y después de la MG, por lo cual no hubo asociación entre éstas y el IMC. Conclusión: Existe una relación positiva y media entre las variables con significación estadística (p<0.05), a un nivel de confianza de 95%, diferente a cero, determinando que los factores implicados en la génesis del ERGE posterior a MG están condicionados a una importante elevación de la presión del reservorio gástrico y aumento de distensibilidad de la UEG.
Introduction: Vertical sleeve gastrectomy (VSG) consists in resecting the fundus and the larger curve of the stomach while preserving the lesser curvature in tubular form. Studies report an increasing risk of de novo gastroesophageal reflux disease (GERD) in patients with VSG due to the elimination of the gastric fundus, loss of the His angle, section of muscle fibers in girth. Yehoshua showed decreased distensibility and increased intragastric pressure (IGP) in the reservoir after VSG. Pandolfino stated that the distensibility of the esophagogastric junction (EGJ) is indicative of the degree of opening thereof increasing tendency to reflux.Objectives: To evaluate the anatomical and functional changes in pressure and distensibility of the EGJ by planimetric impedance (EndoFLIP®) involved in the development of gastroesophageal reflux. We hypothesized that reflux events occur by the temporary decrease of the high pressure área at the EGJ with increased pressure gradient in gastroesophageal sense by increasing the reservoirs IGP and the distensibility of the EGJ in the presence of normal EGJ tone. Patients and methods: Prospective cohort pilot study with 23 patients undergoing VSG according to the criteria established by the ISGEPC. Patients with GERD and hiatal hernia (HH) diagnosis were excluded and those included underwent gastroscopy and preoperative high resolution esophageal manometry (HRM). During surgery pressure and distensibility of the EGJ were measured with the EndoFLIP® system at 2 times: once the pneumoperitoneum was stabilized and when the gastrectomy was over, including pressure measurement and distensibility of the gastric pouch. Results: 23 patients were evaluated, 16 wo-men, 44 years old, average age (29-67). Average body mass index (BMI) of 39.14 kg/m2. (31.2 - 45). The initial measure-ment of LES pressure exhibited 32,6 mmHg and distensibility 11,69mm2/mmHg. The second pressure measurement showed 35,8 mmHg and distensibility 15,19 mm2/mmHg. Measuring gastric reservoir pressure recorded 38,9 mm2/mmHg). The paired Students T Test found significant differences in the postoperative pressures and compliances (p = 0.0357) and (p <0.0001) respectively. When these values were correlated with BMI was observed that patients with lower BMI increased after pressure from the VSG and patients with higher BMI reported the reverse phenomenon, the distensibilities showed very little variation before and after the VSG, thus there was no association between these and BMI.Conclusion: There is a positive relationship between the variables with statistical significance (p <0.05), determining that the factors involved in the genesis of GERD after VSG are conditioned to a significant elevation of gastric reservoir pressure,increased distensibility of the EGJ and inverse relationship between the BMI and the EGJ pressure measured by the EndoFLIP®.