ROBOTIC VERSUS LAPAROSCOPIC ROUX-EN-Y-GASTRIC BYPASS: A RETROSPECTIVE STUDY IN A SINGLE CENTER

ABSTRACT BACKGROUND: Bariatric surgery is the best treatment option for patients with obesity. As a result of the advancement of technology, the robotic gastric bypass presents promising results, despite its still high costs. AIMS: The aim of this study was to compare patients submitted to a robotic versus a laparoscopic gastric bypass at a single center by a single surgeon. METHODS: This retrospective study collected data from the medical records of 221 patients (121 laparoscopic procedures versus 100 with daVinci platform). The variables analyzed were sex, age, body mass index, comorbidities, surgical time, length of stay, and complications. RESULTS: The mean surgical time for patients in the robotic group was shorter (102.41±39.44 min versus 113.86±39.03 min, p=0.018). The length of hospital stay in robotic patients was shorter (34.12±20.59 h versus 34.93±11.74 h, p=0.007). There were no serious complications. CONCLUSIONS: The group submitted to the robotic method had a shorter surgical time and a shorter hospital stay. No difference was found regarding strictures, bleeding, or leakage

Manifestações clínicas da Chikungunya congênita em neonatos: uma revisão narrativa da literatura

A febre chikungunya, doença debilitante que já foi identificada em 94 países incluindo o Brasil, tem como vetor principal o mosquito Aedes aegypti. Entretanto, uma forma menos difundida de transmissão da doença é a vertical. Em 2005, na Ilha Reunião, um território francês no Oceano Índico, foi realizado o primeiro relato de transmissão vertical e suas repercussões ao neonato. A literatura é escassa em relação à chikungunya congênita e, especialmente às suas manifestações clínicas que possam causar danos nos neonatos que apresentaram a doença, o que motivou a realização deste estudo. Foi realizada uma revisão narrativa da literatura disponível, com a finalidade de reunir as melhores evidências acerca das manifestações clínicas nos neonatos expostos a infecção congênita do vírus chikungunya. Além disso, foi abordado o que se sabe sobre a patogenia dessa infecção e detalhes da transmissão vertical. Nos neonatos filhos de mães infectadas no período periparto, os sinais e sintomas são febre, edema, exantema, dor generalizada e irritabilidade. Manifestações mais graves como sepse, desconforto respiratório, dermatite bolhosa e encefalopatia também são recorrentes, representam um risco a vida aos neonatos, e demandam internação para cuidados intensivos. Também, há relatos de atraso no neurodesenvolvimento em longo prazo, podendo gerar incapacidades por toda a vida. Assim, o conhecimento das manifestações e de sua possível gravidade é um alerta para pediatras se atentarem a esse diagnóstico diferencial, principalmente, durante surtos e em locais susceptíveis, sendo relevante para uma valorização de sua profilaxia, para um diagnóstico precoce, para um correto manejo, e consequentemente redução de morbidade.Chikungunya fever, a debilitating disease that has already been identified in ninety-four countries including Brazil, has as its main vector the Aedes aegypti mosquito. However, a less widespread form of transmission of the disease is vertical. In 2005, on Réunion Island, a French territory in the Indian Ocean, the first report of vertical transmission and its repercussions on the neonate was carried out. The literature is scarce in relation to congenital chikungunya and, especially, its clinical manifestations that can cause damage in neonates who presented the disease, which motivated this study. A narrative review of the available literature was carried out in order to gather the best evidence about the clinical manifestations in neonates exposed to congenital infection from chikungunya virus. In addition, what is known about the pathogenesis of this infection and details of vertical transmission were also addressed. In neonates born to infected mothers during the peripartum period, the signs and symptoms are fever, edema, rash, generalized pain and irritability. More severe manifestations such as sepsis, respiratory distress, bullous dermatitis and encephalopathy are also recurrent, represent a risk to the neonates' lives and require hospitalization for intensive care. There are also reports of delayed neurodevelopment in the long term, which may lead to lifelong disabilities. Thus, the knowledge of the manifestations and their possible severity is an alert for pediatricians to pay attention to this differential diagnosis, especially during outbreaks and in susceptible places, being relevant for an appreciation of its prophylaxis, for an early diagnosis, for a correct management, and consequently reduction of morbidity.37 f