Prevenção de aderências em telas de polipropileno protegidas com hidrogel absorvível de Polietilenoglicol (Coseal®): estudo experimental em coelhos

Objetivo: Avaliar a prevencao de aderencias pos-cirurgicas e resposta inflamatoria em telas de poplipropileno, revestidas com hidrogel absorvivel de polietilenoglicol (Coseal®), em contato com alcas intestinais em um modelo experimental em coelhos. Metodos: Foram utilizados 20 animais femeas, que foram submetidos a laparotomia para o implante de duas telas de polipropileno, de 2 x 1cm, nos flancos direito e esquerdo. A tela da direita foi protegida com a pulverizacao de Coseal® (Grupo 1) e a da esquerda nao recebeu nenhum tratamento apos o implante (Grupo 2). Trinta dias apos o implante, os coelhos foram submetidos a laparoscopia para analise da formacao de aderencias, sendo as proteses retiradas em bloco, juntamente com o tecido adjacente, para analise microscopica da inflamacao. Na analise estatistica foram utilizados os testes de Mann-Whitnney, Qui-quadrado e Exato de Fischer. Resultados: Observou-se formacao de aderencias em 5 (36%) das telas do Grupo 1 e 14 (100%) do Grupo 2, estatisticamente significante (p=0,00005). Nao houve diferenca em relacao a resposta inflamatoria, fibrose, reacao de corpo estranho, presenca de colageno e tipo de celulas inflamatorias entre os dois grupos. Conclusoes: A tela de polipropileno revestida com Coseal® apresentou, de forma significante, menor indice de formacao de aderencias, em comparacao com a tela nao protegida, sem interferir na resposta inflamatoria.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)BV UNIFESP: Teses e dissertaçõe

Análise da expressão imuno-histoquímica da grelina na mucosa gástrica e correlação com a perda de peso após gastrectomia vertical

Purpose: Analyze the immunohistochemical expression of ghrelin in the gastric mucosa and its correlation with weight loss, comorbidities and inflammatory changes after Sleeve Gastrectomy (SG). Methods: Thirty-five patients who underwent SG, 29 of whom were female (82.9%), with a mean age of 35.2 years and an average Body Mass Index (BMI) of 38.1 kg/m2, had two mucosal specimens collected through endoscopy, from gastric fundus and antrum. In this material, hematoxylin-eosin, Giemsa and immunohistochemistry for ghrelin were performed. The immunohistochemical expression was assessed in a semi-quantitative way through the area of the stained antibody and this finding was correlated with weight loss at 3, 6 and 12 months and with remission of comorbidities and inflammatory markers. Results: The average loss of excess weight (%EWL) was 52.4, 78.1 and 95.1%, respectively, in 3, 6 and 12 months. A negative correlation was found between weight loss at 3 (s = - 0.536; p = 0.001) and 6 months (s = - 0.339; p = 0.047) and with %EWL at 3 months (s = - 0.365; p = 0.031) with immunohistochemical expression of ghrelin in the endoscopic biopsy of the fundus. There was also agreement between the endoscopes and the specimen in the gastric fundus. There was no correlation with the control of comorbidities or histopathological findings. Conclusion: An immunohistochemical expression of ghrelin in the gastric fundus mucosa obtained through upper digestive endoscopy in the preoperative period was negatively correlated with early weight loss after SG.Objetivo: Analisar a expressão imuno-histoquímica da grelina na mucosa gástrica e sua correlação com a perda de peso, comorbidades e alterações inflamatórias após gastrectomia vertical (GV). Métodos: Foram avaliados 35 pacientes submetidos a GV, sendo 29 do sexo feminino (82,9%), com idade média de 35,2 anos e Índice de Massa Corporal (IMC) médio de 38,1Kg/m2. Em todos foram obtidas amostras endoscópicas da mucosa (fundo e antro gástrico) e do espécime retirado na cirurgia. Nesse material foi realizada coloração hematoxilina-eosina, Giemsa e imuno-histoquímica para grelina. A expressão imuno-histoquímica foi avaliada de forma semi-quantitativa através da área do anticorpo corado e esse achado foi correlacionado com a perda de peso aos 3, 6 e 12 meses e com o controle de comorbidades e alterações inflamatórias. Resultados: A perda do excesso de peso (PEP) média foi, respectivamente, de 52,4, 78,1 e 95,1% em 3, 6 e 12 meses. Foi encontrada correlação negativa entre a expressão imuno-histoquímica de grelina na biópsia endoscópica do fundo e a perda de peso aos 3 (s = - 0,536; p = 0,001) e 6 meses (s = - 0,339; p = 0,047) e com a PEP aos 3 meses (s = - 0,365; p = 0,031). Houve concordância entre as amostras endoscópicas e da peça no fundo gástrico. Não houve correlação com o controle de comorbidades, nem achados histopatológicos. Conclusão: A expressão imuno-histoquímica da grelina na mucosa do fundo gástrico, obtida através endoscopia digestiva alta no pré-operatório, se correlacionou negativamente com a perda de peso precocemente após GV.Dados abertos - Sucupira - Teses e dissertações (2021

Adhesion prevention in reabsorbable polyethylene glycol hydrogel (Coseal (R)) coated polypropylene mesh in rabbits

PURPOSE: To evaluate of postoperative adhesion prevention and inflammatory response to polypropylene mesh, coated with reabsorbable hydrogel of polyethylene glycol (Coseal (R)) in contact with small bowel in an experimental model in rabbits.METHODS: Twenty female rabbits underwent laparotomy to implant two polypropylene meshes, 2x1cm, in the right and left flanks. The right mesh was protected with Coseal (R) spray (Group 1) and the left mesh received no treatment after implantation (Group 2). Thirty days after implantation, the rabbits underwent laparoscopy for adhesion analysis; the prosthesis were removed en bloc with the adjacent tissue for microscopic analysis of inflammation. Statistical analysis used the Mann-Whitney test.RESULTS: There was adhesion formation in five meshes (36%) from Group 1 and in 14 meshes (100%) from Group 2, with statistical significance (p<0.01). There were no differences in the inflammatory response, fibrosis, foreign body reaction, presence of collagen and type of inflammatory cells between the two groups.CONCLUSION: Polypropylene mesh coated with Coseal (R) showed a significantly lower rate of adhesion formation when compared with uncoated meshes, without interfering with inflammatory response.Rio Grande do Norte Fed Univ UFRN, Postgrad Program Interdisciplinary Surg Sci, BR-59072970 Natal, RN, BrazilRio Grande do Norte Fed Univ UFRN, Integrated Med Dept, BR-59072970 Natal, RN, BrazilUFRN, Dept Surg, Rio Grande Do Norte, BrazilUFRN, Dept Pathol, Rio Grande Do Norte, BrazilUFRN, Onofre Lopes Univ Hosp, Rio Grande Do Norte, BrazilSao Paulo Fed Univ UNIFESP, Dept Surg, Surg Gastroenterol Div, Sao Paulo, BrazilSao Paulo Fed Univ UNIFESP, Dept Surg, Surg Gastroenterol Div, Sao Paulo, BrazilWeb of Scienc

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age &gt;= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients &gt;= 65-years-old (Group I) and patients &lt; 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = &lt; 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those &gt;= 65 years of age compared to those &lt; 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of &gt; 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI &lt; 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI &gt; 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 &amp; PLUSMN; 24.4 Kgs and 43.03 &amp; PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = &lt; 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of &gt; 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI &gt; 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n&nbsp;=&nbsp;122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7&nbsp;± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n&nbsp;=&nbsp;146; 85.9%), only 42.4% (n&nbsp;=&nbsp;72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n&nbsp;=&nbsp;9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients