Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery最新文献

{"title":"Brazilian consensus- and evidence-based recommendations in the diagnosis and treatment of pancreatic exocrine insufficiency in patients after digestive surgeries. Position paper of six brazilian medical societies of surgery.","authors":"Andre Luis Montagnini, Wanderley Marques Bernardo, Paulo Kassab, Claudemiro Quireze Junior, Cassio Virgílio Cavalcante de Oliveira, Alessandro Landskron Diniz, Rodrigo Nascimento Pinheiro, Alexandre Ferreira Oliveira, Pedro Portari Filho, Guilherme de Andrade Gagheggi Ravanini, Nora Manoukian Forones, Marcus Fernando Kodama Pertille, Antonio Carlos Valezi, Anna Carolina Batista Dantas, Maira Andrade Nacimbem Marzinotto, Estela Regina Figueira, José Jukemura, Ulysses Ribeiro Junior, Paulo Herman","doi":"10.1590/0102-67202025000042e1911","DOIUrl":"10.1590/0102-67202025000042e1911","url":null,"abstract":"<p><strong>Background: </strong>Exocrine pancreatic insufficiency (EPI) is a condition characterized by reduced exocrine secretion, leading to decreased food digestion, and digestive tract surgeries can be a cause. Postoperative \"de novo\" EPI is defined as the onset of digestive symptoms following surgeries, which show significant improvement after the initiation of pancreatic enzyme replacement therapy (PERT). The diagnosis of postoperative EPI may be delayed due to mild or nonspecific symptoms, both in pancreatic surgeries and in upper abdominal surgeries.</p><p><strong>Aims: </strong>The aim of this study was to conduct a systematic review on the diagnosis and treatment of \"de novo\" EPI related to digestive surgeries, in collaboration with the development of a consensus among the main surgical societies in Brazil.</p><p><strong>Methods: </strong>The steering committee developed 10 questions related to two areas of interest: diagnosis and treatment. A systematic review was conducted for each of the domains. The evidence was assessed for quality using the GRADEpro tool. Recommendations were formulated for each of the questions. The final report was reviewed by representatives of the surgical societies for the consolidation and approval of the recommendations through a modified Delphi system.</p><p><strong>Results: </strong>\"De novo\" EPI should be considered in case of the onset of postoperative digestive symptoms. Diagnostic methods vary in complexity of execution, with varying sensitivity and specificity in the postoperative condition. Fecal Elastase-1 (FE-1) has limited value in diagnosing EPI in the postoperative setting. PERT can be initiated based on clinical suspicion, and there is no difference in approach regarding the type of surgery performed. PERT should be started at the appropriate dose for the intensity of symptoms and adjusted up or down according to symptom control. Proper treatment of EPI leads to symptom improvement and an increase in quality of life. PERT should be maintained as long as patients have a favorable clinical response.</p><p><strong>Conclusions: </strong>The recommendations encompass the diagnosis and treatment of \"de novo\" EPI and can serve as a basis for the establishment of educational programs led by the participating surgical societies.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1911"},"PeriodicalIF":1.8,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145672674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global strategies for the diffusion of robotic surgery.","authors":"Francisco Tustumi, Louisa Bolm, Rodrigo Camargo Leão Edelmuth, Felipe Antonio Boff Maegawa, Wellington Andraus, Paulo Herman, Tyler McKechnie, Allan Tsung, Sarah Samreen, Ryan Merkow, Nigel D'Souza, Syed Nabeel Zafar, Giovanna Mennitti Shimoda, Nelson Wolosker, Yoshikuni Kawaguchi, Georgios Tsoulfas, Eduardo Esteban Montalvo-Jave, Vikas Dudeja, Puja Gaur Khaitan, Sajid Khan","doi":"10.1590/0102-67202025000039e1908","DOIUrl":"10.1590/0102-67202025000039e1908","url":null,"abstract":"<p><strong>Background: </strong>The global adoption of robotic surgery has advanced rapidly in high-income countries, yet its diffusion remains limited in resource-constrained settings due to financial, infrastructural, and educational barriers. As surgical technology evolves, there is an urgent need to promote countries' equitable access to robotic platforms worldwide.</p><p><strong>Aims: </strong>The aim of this study was to analyze global strategies employed to promote the diffusion of robotic surgery, with a particular focus on overcoming barriers in resource-limited settings, and to provide practical insights that can guide its equitable and sustainable implementation.</p><p><strong>Methods: </strong>This study is a multinational, policy-oriented integrative review conducted under the guidance of the Research Committee of the Society for Surgery of the Alimentary Tract in the USA (SSAT). The study integrates a bibliometric analysis, a literature review, and expert insights from diverse healthcare environments. Contributions were gathered from SSAT members.</p><p><strong>Results: </strong>Robotic platforms are predominantly concentrated in North America, Western Europe, and Eastern Asia, with the USA hosting nearly 60% of all installations. Research output is similarly skewed, with few countries and institutions producing most clinical trials. Key barriers to diffusion include high costs, lack of infrastructure, limited training capacity, regulatory hurdles, and resistance among surgeons. Facilitators include public-private partnerships, philanthropic support, technology transfer, simulation platforms, and curriculum integration by professional societies.</p><p><strong>Conclusions: </strong>Achieving global equity in robotic surgery requires coordinated action across research, education, clinical practice, policy, and infrastructure. Global cooperation and innovation in implementation strategies can help bridge the current disparities and promote safe, cost-effective surgical care in underserved regions, improving patient outcomes.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1908"},"PeriodicalIF":1.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroesophageal reflux disease and the phantom of Barrett's esophagus after most-often-used bariatric procedures: are future investigations necessary?","authors":"Italo Braghetto, Barbara Carreño, Ramón Hermosilla, Rafael Zanabria","doi":"10.1590/0102-67202025000041e1910","DOIUrl":"10.1590/0102-67202025000041e1910","url":null,"abstract":"<p><strong>Background: </strong>Studies have investigated the incidence of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) after common bariatric surgeries. However, many of these studies have bias or limitations. Therefore, it is crucial to determine the true incidence of GERD in long-term follow-ups (FUs) post-surgery.</p><p><strong>Aims: </strong>The aim of this study was to review and summarize long-term data regarding the incidence of post-surgical GERD and BE after various bariatric procedures, discuss the characteristics of current information available, and establish the need for future studies to determine objective functional outcomes that have not yet been reported.</p><p><strong>Methods: </strong>A narrative review was conducted using multiple electronic databases, including the review of 15 meta-analyses and over 200 articles.</p><p><strong>Results: </strong>The quality of studies analyzing GERD and BE following bariatric surgery varies widely. Some papers provide detailed outcomes, while others offer limited information. The reported rate of de novo postoperative GERD development after sleeve gastrectomy varies from 4.06 to 74.7% (mean=33.8±19.1), and the incidence of BE ranges from 0.2 to 27% (mean=8.2±7.5). After Roux-en-Y gastric bypass (RYGB), similar variability is observed, with BE incidence ranging from 1.6 to 17.5% (mean=7.5±5.9). In the case of one-anastomosis gastric bypass (OAGB), scarce information is available and most reports are incomplete. The incidence of erosive esophagitis ranges from 15 to 70%, with BE incidence reported in only two papers (1-9.5%). For procedures such as single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), fundoplication-sleeve, or sleeve bipartition, few specific data are available, with most reports limited to symptoms and lacking findings such as esophagitis, hiatal hernia, or BE.</p><p><strong>Conclusion: </strong>This revision provides evidence that SG may indeed lead to an increased risk of BE. Numerous studies suggest that RYGB protects against BE. Other bariatric procedures must be extensively evaluated. Relatively low quality of available literature on this topic was observed; therefore, well-controlled prospective studies with long-term FUs are necessary to fully understand the effect of bariatric surgery on BE.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1910"},"PeriodicalIF":1.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145497589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of desmoid tumors associated with familial adenomatous polyposis: a three-decade experience of a tertiary center in Brazil.","authors":"Amanda Pereira Lima, Raquel Franco Leal, Michel Gardere Camargo, Carlos Augusto Real Martinez, João José Fagundes, Claudio Saddy Rodrigues Coy, Maria de Lourdes Setsuko Ayrizono","doi":"10.1590/0102-67202025000033e1902","DOIUrl":"10.1590/0102-67202025000033e1902","url":null,"abstract":"<p><strong>Background: </strong>Aggressive fibromatosis, also known as desmoid tumor (DT), is a locally aggressive myofibroblastic neoplasm originating from deep soft tissues, characterized by an infiltrative growth pattern with a tendency for local recurrence. DTs account for 0.03% of all neoplasms, and cases associated with familial adenomatous polyposis (FAP) account for 5-15% of DTs.</p><p><strong>Aims: </strong>The aim of this study was to report the prevalence of DTs in patients operated on for FAP, describe the epidemiological profile, and evaluate the risk factors for tumor development, treatments performed, associated complications, and follow-up.</p><p><strong>Methods: </strong>This retrospective study assessed the medical records of patients with FAP who underwent surgery between 1990 and 2021 and developed DTs during follow-up.</p><p><strong>Results: </strong>In the study period, 147 patients with FAP were operated on; of these, 97 underwent total proctocolectomy with ileal-pouch anal anastomosis, 33 underwent total colectomy with ileorectal anastomosis (IRA), 14 underwent total proctocolectomy with terminal ileostomy, and three underwent total colectomy with partial proctectomy and low IRA using an ileal-pouch. A total of 26 patients (17.7%) developed DT; most were female (61.5%), were White (73.1%), and had a family history (84.6%). The most frequent complications were intestinal and ureteral obstructions. Long-term follow-up showed that six patients were free of disease, 14 were stable and undergoing drug therapy, four died due to complications of the disease, and two were lost to follow-up.</p><p><strong>Conclusions: </strong>The prevalence of DT tumor was relatively high and more commonly observed in patients with a family history of the tumor. The disease presented high rates of morbidity and mortality.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1902"},"PeriodicalIF":1.8,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12578409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare occurrence of small bowel intussusception due to synchronous metastasis of renal cell carcinoma.","authors":"Matheus Felipe Ferreira Aguiar, Rodrigo Ambar Pinto, Ulysses Ribeiro-Junior, Pedro Castro Soares, Carlos Frederico Sparapan Marques","doi":"10.1590/0102-67202025000036e1905","DOIUrl":"10.1590/0102-67202025000036e1905","url":null,"abstract":"<p><strong>Background: </strong>Renal carcinoma is the third most common urological cancer, with 30% of patients presenting with metastases at diagnosis. Metastases to the small intestine are rare (0.7-1.1%), and their presentation as intestinal intussusception is even more uncommon, with only a few cases reported in the literature.</p><p><strong>Aims: </strong>The aim of the study was to present a case of stage IV clear cell renal carcinoma with a rare presentation of intestinal intussusception, leading to emergency department admission due to severe anemia and melena.</p><p><strong>Methods: </strong>A 62-year-old man presented with melena for 2 months and a critically low hemoglobin level of 2.9 g/dL (normal range: 13.5-17.5 g/dL). Abdominal and pelvic angiotomography identified an exophytic lesion in the left kidney consistent with renal carcinoma and an approximately 16 cm ileal intussusception.</p><p><strong>Results: </strong>Exploratory laparotomy revealed intestinal intussusception and a 4 cm lesion on the antimesenteric border, suspected to be a tumor. A segmental resection with primary anastomosis was performed, resulting in a favorable postoperative recovery. Histopathological and immunohistochemical analyses confirmed poorly differentiated metastatic clear cell renal carcinoma.</p><p><strong>Conclusions: </strong>This report underscores the need to consider gastrointestinal symptoms in patients with renal carcinoma, as an intestinal metastasis, although rare, is a potential complication. Synchronous metastases are even rarer and present a significant diagnostic challenge.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1905"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between constipation and inguinal hernia: a case-control study in an adult population.","authors":"Giorgia Mostacero-Rojas, Jose Antonio Caballero-Alvarado, Katherine Lozano-Peralta, Gino Vasquez-Paredes, Joaquin Sarmiento-Falen, Victor Eduardo Lau-Torres, Carlos Zavaleta-Corvera","doi":"10.1590/0102-67202025000038e1907","DOIUrl":"10.1590/0102-67202025000038e1907","url":null,"abstract":"<p><strong>Background: </strong>Inguinal hernia is the most frequently diagnosed hernia and affects approximately one-third of the male population. Several risk factors have been identified, including advanced age, limited physical activity, smoking, and increased intra-abdominal pressure, among others.</p><p><strong>Aims: </strong>The aim of the study was to determine whether constipation is a risk factor for inguinal hernia in the adult population.</p><p><strong>Methods: </strong>A case-control study was conducted at the Department of Surgery of one hospital in the north of Peru, including 121 patients with a confirmed diagnosis of inguinal hernia as cases and 242 patients without such a diagnosis as controls. Inclusion and exclusion criteria were applied, and data were collected through individual interviews using a structured questionnaire that addressed clinical aspects, lifestyles, and the presence of constipation, assessed according to the Rome IV criteria.</p><p><strong>Results: </strong>The results revealed significant differences between the groups of patients with and without inguinal hernia in terms of age, sex, and anthropometric characteristics. In addition, statistically significant associations were found between the presence of an inguinal hernia and type 2 diabetes, smoking, and constipation. A multivariate analysis showed that age, male sex, body mass index, high blood pressure, and constipation were significant and independent factors associated with the presence of inguinal hernia.</p><p><strong>Conclusions: </strong>Constipation is a significant risk factor for inguinal hernia in the adult population. These results support the importance of considering constipation as a risk factor in the evaluation and management of patients with inguinal hernia, highlighting the relevance of adequate clinical care in this group of patients.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1907"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female donor gender is associated with a decrease in liver transplant survival of male recipients independent of donor and recipient anthropometrics.","authors":"Marcio Fernandes Chedid, Lucas Prediger, Gabriel Lazzarotto-DA-Silva, Jane Cronst, Alexandre DE Araujo, Tomaz de Jesus Maria Grezzana Filho, Luciano Zubaran Goldani","doi":"10.1590/0102-67202025000024e1893","DOIUrl":"10.1590/0102-67202025000024e1893","url":null,"abstract":"<p><strong>Background: </strong>Data on the influence of donor gender on post-liver transplant outcomes is scarce and is lacking.</p><p><strong>Aims: </strong>The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver transplantation (LT) with a thorough evaluation of the influence of the donor variables.</p><p><strong>Methods: </strong>All patients undergoing LT at a single center from December 2011 to December 2018 were included. The main outcome measure of the study was overall patient survival. The mortality predictors were evaluated using Cox regression.</p><p><strong>Results: </strong>The study analyzed 202 patients, 118 (58.1%) being males, and the average age was 54.19±11.66 years. Post-LT survival for the entire cohort of 202 patients as assessed by the KaplanMeier method at 1, 3, 5, and 7 years was 81.6, 73.1, 67.6, and 63%, respectively. The only predictor of increased overall mortality was female donor gender [HR 1.918, 95%CI 1.150-3.201, p=0.013]. Weight and height differences between donor and recipient were not related to mortality (p=0.545 for weight and p=0.964 height).</p><p><strong>Conclusions: </strong>Female donor gender was associated with an increase in overall post-LT mortality, especially for male recipients, regardless of anthropometric parameters. For male patients receiving livers from female donors, infection was the most common cause of mortality, occurring in the first year following LT.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1893"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of gastric adenocarcinoma: what factors influence the prognosis?","authors":"Carlos Roberto Naufel Junior, Anelyse Pulner Agulham, Beatriz Alvarez Mattar","doi":"10.1590/0102-67202025000035e1904","DOIUrl":"10.1590/0102-67202025000035e1904","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is the fifth most common cancer in the world and the fourth leading cause of deaths in oncology.</p><p><strong>Aims: </strong>The aim of this study was to investigate the factors that affect the survival of patients with gastric adenocarcinoma undergoing gastrectomy in a tertiary center in South Brazil.</p><p><strong>Methods: </strong>This was a cross-sectional, observational, and retrospective study of 82 patients with gastric adenocarcinoma who underwent surgical treatment from January 2018 to August 2022. Epidemiological and prognostic factors were analyzed, such as age, sex, tumor location in the stomach, lymph node invasion, tumor extension, angiolymphatic invasion, tumor differentiation, presence of distant metastasis, compromised surgical margins, adjuvant or neoadjuvant chemotherapy, and patient survival time.</p><p><strong>Results: </strong>Of the 82 patients, 41.5% died during the follow-up period, with a maximum follow-up period of 56 months. The median time to death was 22.4 months after performing the gastrectomy. Advanced age (hazard ratio [HR]=2.76; p=0.014, p<0.05), location of the tumor in the fundus of the stomach (HR=2.77; p=0.020, p>0.05), and presence of distant metastasis (HR=2.13; p=0.039) showed a significant negative impact on survival in the multivariate analysis. On the other hand, patients undergoing adjuvant (HR=5.33; p=0.001, p<0.05) or neoadjuvant (HR=3.36; p=0.006, p<0.05) chemotherapy had a positive impact.</p><p><strong>Conclusions: </strong>The present study demonstrated that survival in patients with gastric adenocarcinoma is negatively influenced by advanced age, tumor location in the fundus of the stomach, and the presence of distant metastases, in contrast to the positive impact of performing adjuvant or neoadjuvant chemotherapy.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1904"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bariatric surgery: pre-operative comorbidities, postoperative results, and complications: a single-center retrospective cohort analysis.","authors":"Raphael Sidney Bandeira, Kaio Waltrick Vieira, Beatriz Schuelter Trevisol, Fabiana Schuelter-Trevisol, Daisson José Trevisol","doi":"10.1590/0102-67202025000034e1903","DOIUrl":"10.1590/0102-67202025000034e1903","url":null,"abstract":"<p><strong>Background: </strong>Bariatric surgery is the most effective treatment for weight loss and also promotes remission of preoperative metabolic comorbidities.</p><p><strong>Aims: </strong>The aim of this study was to analyze preoperative comorbidities, evaluate postoperative outcomes, and assess complications 6 months after bariatric surgery in a hospital in the state of Santa Catarina, Brazil.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted with patients who underwent bariatric surgery between 2021 and 2022 and were followed up for a period of 6 months after the procedure.</p><p><strong>Results: </strong>There was a predominance of female patients (81.6%), with a mean age of 38.7 years. The preoperative prevalence of hypertension, Type 2 diabetes, dyslipidemia, and hepatic steatosis was 36.7, 22.4, 22.4, and 32.7%, respectively. The postoperative remission rates for these conditions were 55, 64, 70, and 69%, respectively. Except for diabetes, no significant differences were found between the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. There was a significant reduction in weight (p<0.01) and body mass index (BMI) (p<0.01), with no statistical differences between the RYGB and SG groups. Postoperative complications occurred in 73.5% of patients, including anemia, vitamin deficiencies, cholelithiasis, dumping syndrome, anastomotic ulcer, chronic diarrhea, and anastomotic stricture.</p><p><strong>Conclusions: </strong>The study described the preoperative comorbidity profile, postoperative outcomes, and complications with findings consistent with existing literature, except for underreporting dyslipidemia and hepatic steatosis. No statistical difference was observed between the surgical techniques performed.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1903"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding risk factors for low anterior resection syndrome in a South American cohort.","authors":"María Inés Gaete, Cristián Ignacio Jarry, Daniel Moreno, José Tomás Larach, Felipe Bellolio","doi":"10.1590/0102-67202025000037e1906","DOIUrl":"10.1590/0102-67202025000037e1906","url":null,"abstract":"<p><strong>Background: </strong>Low Anterior Resection Syndrome (LARS) is a common postoperative bowel dysfunction in patients undergoing sphincter-preserving surgery for rectal cancer. Symptoms include fecal and gas incontinence, urgency, increased bowel frequency, and fragmented evacuations. LARS significantly impairs quality of life, affecting up to 90% of patients. Various factors contribute to its development, such as tumor height, extent of mesorectal excision, preoperative radiotherapy, and ileostomy. However, these factors are less studied in South American populations, where racial, cultural, and healthcare system differences may influence outcomes.</p><p><strong>Aims: </strong>The aim of the study was to evaluate risk factors associated with LARS in a Chilean cohort of rectal cancer patients, with emphasis on cases classified as severe.</p><p><strong>Methods: </strong>A non-concurrent prospective cohort study including patients who underwent low anterior resection between 2012 and 2021. Perioperative data collected included tumor height, surgical procedure type, preoperative radiotherapy, and protective ileostomy. Univariate and multivariate analyses were conducted to identify factors significantly associated with severe LARS, using the LARS score adapted to Chilean Spanish.</p><p><strong>Results: </strong>A total of 110 patients were included, with a median follow-up of 51 months. LARS was identified in 52.7% of cases, with 29.1% classified as major. Younger age, lower tumors, total mesorectal excision, preoperative radiotherapy, and ileostomy were significantly associated with severe LARS in univariate analysis. In multivariate analysis, only younger age and preoperative radiotherapy remained as independent risk factors.</p><p><strong>Conclusions: </strong>In this Chilean cohort, nearly half of patients undergoing sphincterpreserving surgery for rectal cancer developed LARS. About one-third had the severe form, highlighting the need for targeted strategies to mitigate LARS and improve patient quality of life.</p>","PeriodicalId":72298,"journal":{"name":"Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery","volume":"38 ","pages":"e1906"},"PeriodicalIF":1.8,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12571443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}