Abstract
ABSTRACT Introduction: Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment. Objective: To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea. Methods: Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria. Results: Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques. Conclusion: The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.
Highlights
According to the World Health Organization obesity is a condition of high prevalence in Brazil and in the world and it is on the rise[25]
Bariatric surgery may be indicated in patients with BMI greater than 40 kg/m2 or BMI greater than or equal to 35 kg/m2 associated with comorbidities[2,6,18]
This study proposes to analyze the techniques that have been described most in the literature, being the adjustable gastric band (AGB), vertical gastrectomy (VG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic derivation (BPD) for complications and operative mortality, loss and overweight, and resolution of comorbidities (DM2, hypertension, dyslipidemia and OSA) with the intention of evaluating possible differences between them, contributing to an objective critical assessment regarding the choice of the best technique for each patient
Summary
According to the World Health Organization obesity is a condition of high prevalence in Brazil and in the world and it is on the rise[25] It is defined as accumulation of fatty tissue, which leads to an increase in the body mass index (BMI) to 30 kg/m2 or more and it is considered a risk factor for type 2 diabetes mellitus (T2DM), systemic arterial hypertension (SAH) ), dyslipidemia and obstructive sleep apnea (OSA) among other diseases. Because it is a chronic disease, in the treatment of obesity there must be patient compliance and follow-up with health professionals even after achieving the goal of ideal weight[5,23]. Bariatric surgery may be indicated in patients with BMI greater than 40 kg/m2 or BMI greater than or equal to 35 kg/m2 associated with comorbidities[2,6,18]
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