Name: Paulo Henrique Oliveira de Souza
Type: MSc dissertation
Publication date: 24/05/2019
Advisor:
Name |
Role |
|---|---|
| Gustavo Peixoto Soares Miguel | Advisor * |
Examining board:
| Name |
Role |
|---|---|
| Claudio Ferreira Borges | Internal Alternate * |
| Doglas Gobbi Marchesi | Internal Alternate * |
| Gustavo Peixoto Soares Miguel | Advisor * |
| Otávio Cansanção de Azevedo | External Examiner * |
Summary: Introduction: obesity is a very prevalent disease in the population dependent on Brazilian Unified Health System (SUS), whose socioeconomic and comorbidities profile is more severe. The most performed surgical treatment in SUS is Roux-en-Y gastric bypass (RYGB), which can be done laparoscopically (LRYGB) or by open technique (ORYGB), however the advantages of the minimally invasive technique are not well known over this population. Objectives: to compare the evolution of patients who underwent LRYGB and ORYGB in a reference public service. Methods: retrospective cohort study, that includes all patients who underwent primary RYGB, with no other concomitant procedures, between July/2016 and September/2017. One hundred and six (106) patients were studied: 34 underwent LRYGB and other 72 underwent ORYGB. Were analyzed weight loss, in terms of BMI and %EBMIL, and also incidence of deaths, readmissions and complications, according to Clavien-Dindo Classification. Results: The whole samples BMI decreased from 45,05kg/m² to 31,32kg/m² postoperatively, equivalent to %EBMIL=72,39%. The patients had a mean of 2,87 days of length of stay (LOS) and a mean follow up of 17,57 months. The current BMI of LRYGB group is 29,46kg/m², that represents 81,01% of %EBMIL, and the ORYGB group presents a current mean BMI=32,22kg/m² and a %EBMIL=68,20%. The ORYGB group had more complications than LRYGB group (54,2% x 38,2%). We divided the complications in non-severe (Clavien-Dindo I-II) and severe (Clavien-Dindo III-V), and we observed more severe complications in ORYGB group (48,7% x 15,4%). The surgical emergency department admissions were more frequent in ORYGB group (9,7% x 2,9%), that also had higher incidences of incisional hernia (9,7%), internal hernia (2,8%), wound complications (12,5%) and need for revisional procedure (1,4%), all of these parameters were null in LRYGB group. Conclusion: patients of LRYGB group present more satisfactory postoperative evolution than ORYGB patients, with better weight loss, less complications, mainly severe complications, besides lower mortality, readmissions and reoperations.
Keywords: obesity, bariatric surgery, gastric bypass, laparoscopy
