IMPACT OF BARIATRIC SURGERY "MOO/FIED CAPELLA TYPE" ON PONDERAL LOSS IN PATIENTS WITH MORBID OBESITY
Keywords:
bariatric surgery, weight loss, obesity, morbidAbstract
Objective
Eva/uate ponderai /oss in patients submitted to /aparoscopic reducing gastroplasty, during a 12-month postoperative period.
Methods
A prospective study was carried out with 90 morbidly obese patients, submitted to /aparoscopic reducing gastroplasty of the modified Capei/a type. Ponderai loss was evaluated through the analysis of data co//ected in the 3rd, 6thand 12th postoperative months, by means of a specific protocol. This contained data on patient identification and nutritional evaluation, such as: pre- and postoperative weight, height, pre- and postoperative body mass índex, ideal weight, excessive weight, and percentage of excess weight Joss. ln arder to compare measurements between both groups, the Mann-Whitney test was used, and to explain variability of measurements in relation to the factors time-of-follow-up, age, and gender,
the variance ana!ysis was employed. Correlations were determined by Spearman's coefficient, adopting a 5% levei of significance (p<0.05).
Results
lt was found that the higher percentage of ponderai /oss occurred in the first 3 postoperative months, with no significant age-related difference between genders (p=0.3948). As regards the studied variables, in the preoperative period, a significant difference in excessive weight between genders was observed (p<0.0001), overweight being higher in men. Along the follow-up period, ponderai !oss occurred in the studied population, a!though not statistica!ly significant (p=0.4448 for the fema!e sex and p=0.4256 for the ma/e sex) Age inf!uence was detected in weight variability for the fema!e sex (0.0082), but the sarne influence was not found for the ma/e sex (0.0314); that is, age on!y had inf!uence on women. ln re!ation to percentage of excess weight !oss ana!ysis, no significant difference in percentage changes occurred between genders, but, for both sexes, a significant change in percentage of excess weight !oss was verified along the fol!ow-up period (p<0.0007). A negative correlation was found between age and percentage of excess weight !oss (3 months after surgery: r=-0. 7 2205, p=0.2578; 6 months after surgery: r=-0.28787, p=0.0077; 72 months after surgery: r=-0.39382, p=0.0077); that is to say that, from the sixth postoperative month onward, the o/der the patient was, the !ower the percentage of excess weight loss. Such situation a!lows us to suppose that age hinders percentage of excess weight loss after surgery.
Conclusion
As verified during the studied period, the bariatric surgery was an efficient method for treatment of the morbidly obese, and the postoperative follow-up showed to be essentia! to assure nutritional fo!low-up with adequate dietary counse!ing regarding the impact of ponderai loss.
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References
Suter M, Giusti V. Surgical options of obesity treatment results and complications. Rev Med Suisse. 2005; 1(12):832-6.
Suter M, Giusti V. lmpact of bariatric surgery on health and quality of life of obese patients. Rev Med Suisse. 2005; 1(12):837-40.
Ogden J, Clementi C, Aylwin S, Patel A. Exploring the impact of obesity surgery on patients health status: a quantitative and qualitative study. Obes Surg. 2005; 15(2):266-72.
Ballantyne GH, Fascrs F. Measuring outcomes following bariatric surgery: weight loss parameters, improvement in co-morbid conditions, change in quality of life and patient satisfaction. Obes Surg. 2003; 13(11):954-64.
World Health Organization. Obesity-Preventing and managing the global epidemie. Geneva: WHO; 1998.
Clinicai guidelines on identification, evaluation, and treatment of overweight and obesity in adults. The evidence report. Bethesda: National lnstitutes of Health; 1998.
Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among USA adults, 1999-2000. JAMA. 2002; 288(14):1723-7.
Primeiro Consenso Latino-Americano de Obesidade. Rio de Janeiro; 1998.
National lnstitute of Health Consensus Development Conference Statement. Gastrointestinal surgery for morbid obesity. Am J Clin Nutr. 1992; 55(2): 615s-9s.
O. Raymond JL, Schipke CA, Becker JM, Lloyd RD, Moody FG. Changes in body composition and dietary intake after gastric partitioning for morbid obesity. Surgery. 1986; 99(1):15-9.
Updegraff TA, Neufeld NJ. Protein, iron and folate status of patients prior to and following surgery for morbid obesity. J Am Diet Assoe. 1981; 78(2):135-40.
Maclean LD, Rhode BM, Shizgal HM. Nutrition following gastric operations for morbid obesity. Ann Surg. 1983; 198(3):347-55.
Szego T, Mendes CJL, Bitran A. Derivaçao gastrojejunal por laparoscopia com e sem anel. ln: Garrido AB Jr. Cirurgia da obesidade. Sao Paulo: Atheneu; 2002. p.189-96.
Capella JF, Capella RF. The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass? Am J Surg. 1996; 171(1):74-9.
Cambi MPC, Michels G, Marchesine JB. Aspectos nutricionais e de qualidade de vida em pacientes submetidos à cirurgia bariátrica. Rev Bras Nutr Clin. 2003; 18(1):8-15.
World Health Organization. Physical status: the use and interpretation of anthropometry. Geneve: WHO; 1995. p.452.
Deitei M, Greenstein RJ. Recommendations for reporting weight-loss. Obes Surg. 2003; 13(2):159-60.
Higa KD, Boone KB, Davies OG. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000; 135(9):1029-33.
The SAS System for Windows (Statistical Analysis System), versão 8.02. Cary, NC: SAS lnstitute lnc; 1999-2001.
Conover WJ. Practical nonparametric statistics. New York: John Wiley & Sons; 1971.
Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: John Wiley & Sons; 1981.
Montgomery DC. Design and analysis of experiments. 3rd ed. New York: John Wiley & Sons; 1991.
Faria OP, Pereira VA, Gangoni CMC, Lins RD, Leite S. Obesos mórbidos tratados com gastroplastia redutora com bypass gástrico em Y-de-Roux. Análise de 160 pacientes. Brasília Méd. 2002; 39(1/4):26-34.
Brolin RE. Gastric bypass. Surg Clin North Am. 2001; 81(5):1077-85.
Maclean LD, Rhode BM, Shizgal HM. Gastroplasty for obesity. Surg Gynecol Obstet. 1981; 153(2):200-8.
Rheinhold RB. Criticai analysis of long-term weight-loss following gastric bypass. Surg Gynecol Obstet. 1982; 155(3):385-94.
Brolin RE, Kender HA, Gorman RC, Cody RP. The dilemma of outcome assessment after operations for morbid obesity. Surgery. 1989; 105(3):337-46.
Garrido ABJr. Cirurgia em obesos mórbidos: expe riência pessoal. Arq Bras Endocrinol Metab. 2000; 44(1):106-13.
Segai A, Libanori HT, Azevedo A. Bariatric surgery in a patient with possible psychiatric contraindications. Obes Surg. 2002; 12(4):598-601.
Barreto Villela N, Braghrolli Neto O, Lima Curvello K, Eduarda Paneili B, Seal C, Santos D, et ai. Quality of life of obese patients submitted to bariatric surgery. Nutr Hosp. 2004; 19(6):367-71.
Westling A, Gustavsson S. Laparoscopic versus open roux-en-y gastric bypass: a prospective randomized triai. Obes Surg. 2001; 11(9):284-92.
