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Previous issue date: 2013-03-25 === Background: The gastric bypass surgery is one of the most used worldwide for the treatment of obesity and there is no consensus on the ideal size of intestinal loops in gastric bypass of bariatric surgeries. This study assessed the metabolic outcome of patients submitted to gastric bypass with alimentary and biliopancreatic loops of different sizes. Materials and Methods: We conducted a retrospective cohort study in diabetic obese patients (BMI ≥35 kg/m2) with metabolic syndrome submitted to gastric bypass. The patients were divided into 3 groups according to the size of the intestinal loop: group 1, biliopancreatic loop of 50 cm and alimentary loop of 100 cm; group 2, biliopancreatic loop of 50 cm and alimentary loop of 150 cm; and group 3, biliopancreatic loop of 100 cm and alimentary loop of 150 cm. The effect of gastric bypass with different sizes of intestinal loops in relation to the parameters that define metabolic syndrome according to IDF was determined. The postoperative periods evaluated were: 3, 6, 12 and 24 months Results: Sixty-three patients were evaluated, and they had a mean age of 44.7?9.4 years; 62 (98.4%) were hypertensive and 51 (82.2%) dyslipidemic. The 3 groups studied were homogeneous in relation to the variables studied. In 24 months, there was a remission of systemic arterial hypertension in 65% of patients in group 1, 62.5% in group 2 and 68.4% in group 3. Remission of DM2 occurred in 85% of patients in group 1, 83% in group 2 and 84% in group 3. There was no statistical difference in %LEW between the groups, and waist measurements decreased in a homogeneous way in all groups. The size of loops also had no influence on the improvement in dyslipidemia. Conclusion: Variation in size of intestinal loops does not appear to influence improvement in metabolic syndrome in this group of patients. === Objetivo: O bypass g?strico ? uma das cirurgias mais utilizadas no mundo para o tratamento da obesidade e n?o h? consenso sobre o tamanho ideal das al?as intestinais na confec??o desta t?cnica. Propomos um estudo para avaliar os desfechos metab?licos destes pacientes submetidos ao bypass g?strico com al?a intestinal alimentar e biliopancre?tica de tamanhos diferentes. M?todos: Realizamos uma coorte retrospectiva, em pacientes obesos (IMC ≥35Kg/m2) diab?ticos com s?ndrome metab?lica submetidos ao bypass g?strico. Os pacientes foram divididos em 3 grupos conforme a dimens?o das al?as intestinais: grupo 1, al?a biliopancre?tica de 50 cm e al?a alimentar de 100 cm; grupo 2, al?a biliopancre?tica de 50 cm e al?a alimentar de 150 cm; grupo 3, al?a biliopancre?tica de 100 cm e al?a alimentar de 150 cm. Foi avaliado o efeito do bypass g?strico com dimens?es diferentes de al?as intestinais em rela??o aos par?metros que comp?em a s?ndrome metab?lica conforme a IDF. Os per?odos p?s-operat?rios avaliados foram: 3, 6, 12 e 24 meses. Resultados: Foram avaliados 63 pacientes, sendo 48 (76%) do sexo feminino. A m?dia de idade foi de 44.7?9.4 anos; 62 pacientes (98.4%) eram hipertensos e 51 (82.2%) dislipid?micos. Os 3 grupos estudados eram homog?neos em rela??o ?s vari?veis estudadas, P>0,05. Em 24 meses houve remiss?o da HAS em 65% dos pacientes do grupo 1, 62.5% no grupo 2 e 68.4% (P>0,05). A remiss?o do DM2 ocorreu em 85% dos pacientes do grupo 1, 83% no grupo 2, e 84% no grupo 3 (P >0.05). N?o houve diferen?a estat?stica na %PEP entre os grupos e as medidas da circunfer?ncia abdominal reduziram de forma homog?nea em todos os grupos (P>0,05), mas apenas 3% alcan?aram medidas abaixo dos crit?rios sugeridos pelo IDF. A redu??o m?dia dos triglicer?deos e a perman?ncia abaixo de 150 mg/dL ocorreu em 80% no grupo 1, 64,3% grupo 2 e 76,9% no grupo 3 (P>0,05). Houve aumento do HDL nos 3 grupos e n?o houve diferen?a estat?stica na compara??o dos grupos. Conclus?o: A varia??o da dimens?o das al?as intestinais parece n?o influenciar na melhora da s?ndrome metab?lica, entretanto n?o h? consenso do tamanho ideal das al?as intestinais no bypass g?strico.
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