Em decorrência do sucesso da cirurgia bariátrica para o tratamento da obesidade grau III e de suas comorbidades associadas, esta cirurgia vem se tornado cada vez mais indicada. A redução do consumo de cuidados com a saúde tem sido relatada após o tratamento cirúrgico, entretanto a utilização de serviços hospitalares não tem sido bem documentada. O conhecimento do consumo destes serviços na cirurgia bariátrica é importante para dimensionar serviços de saúde e custos resultantes desta cirurgia. Objetivos: Analisar o consumo dos serviços hospitalares e de exames bioquímicos em pacientes submetidos à cirurgia bariátrica. Métodos: O estudo foi retrospectivo. A amostra foi constituída por indivíduos do sexo feminino por ser a predominante na população bariátrica. O consumo de serviços hospitalares foi analisado pela quantidade de atendimentos ambulatoriais, hospitalizações, atendimento em pronto-socorro e exames bioquímicos realizados durante quatro anos pós-operatórios e comparados com o período pré-operatório. Os exames bioquímicos analisados foram hemograma completo, colesterol total e frações, triglicérides, albumina, glicemia, insulina, hemoglobina A1c, uréia e creatinina. Estas variáveis foram comparadas com grupos de obesos em tratamento clínico e pacientes cirúrgicos submetidos à cirurgia curativa de câncer colo-retal. Resultados: A quantidade de consultas ambulatoriais não se modificou ao longo do tempo em todos os grupos. O grupo de obesos em tratamento clínico teve maior demanda para esta variável, seguido pelo grupo bariátrico e cirúrgico respectivamente. Hospitalizações aumentaram no grupo bariátrico, entretanto não houve diferenças significativas quando comparadas com os outros grupos. Atendimentos em pronto-socorro não se alteraram durante o estudo e também não houve diferenças para esta variável entre os grupos. O grupo de obesos em tratamento clínico teve maior demanda de exames bioquímicos durante o período, não havendo alteração ao longo do estudo. Já nos grupos bariátrico e cirúrgico esta variável foi reduzida após a cirurgia. O colesterol total e HDL pré-operatório de todos os grupos se apresentaram com valores alterados e houve melhora somente no grupo bariátrico. Triglicérides não estavam elevados no grupo bariátrico e com a cirurgia houve também redução. Valores de glicemia, insulina, hemoglobina A1c e leucócitos (inflamação sistêmica) reduziram-se somente no grupo bariátrico. A creatinina diminuiu nos grupos bariátrico e de obesos em tratamento clínico. Albumina e uréia permaneceram inalteradas em todos os grupos. O Índice de Massa Corporal (IMC) inicial manifestou diferenças entre os grupos, sendo maior no grupo bariátrico, seguido pelos obesos em tratamento clínico e por último o grupo cirúrgico. Somente o grupo bariátrico teve seus valores reduzidos. Conclusão: A cirurgia bariátrica foi capaz de melhorar a maioria das variáveis laboratoriais, juntamente com a perda de peso. Entretanto, há um grande impacto no consumo de visitas ambulatoriais mantendo-se em níveis elevados até o quarto ano após a cirurgia, exceto para a demanda de exames bioquímicos que se reduziu. O consumo de serviços hospitalares destes pacientes é comparável ao de outros pacientes submetidos a cirurgia abdominal de grande porte. A administração hospitalar bem como autoridades de saúde pública devem ficar atentos para as peculiaridades desta demanda face às dimensões do atual problema com a obesidade. / Due to the success of bariatric surgery in the treatment of obesity class III and associated comorbidities, this surgery is becoming more common. Consumption of healthcare has been shown to diminish after surgical treatment but utilization of hospital services has not been well documented. The knowledge of consumption of this service in bariatric surgery is important to project the requirement for health services and the costs resulting from this surgery. Objectives: Analyze the consumption of hospital services and biochemical tests by patients submitted to bariatric surgery. Methods: Retrospective study. Sample was constituted by female individuals because they are predominant in bariatric population. Consumption of hospital services was analyzed by documentation of outpatient visits, hospitalizations, emergency department visits and biochemical tests during four years in the postoperative period, compared to the preoperative year. Variables included hematologic counts, total cholesterol and fractions, triglycerides, albumin, blood glucose, insulin, hemoglobin A1c, urea and creatinine. These variables were compared to conservatively managed obese cases and to surgical patients submitted to curative colorectal cancer operation. Results: Obese nonsurgical participants displayed the highest demand for outpatient visits, followed by bariatric and surgical cases respectively. Hospitalizations increased in bariatric group, however they did reach statistical difference concerning other groups. Emergency visits did not alter along the study and did not have differences between the groups. Obese cases receiving clinical treatment had the highest demand of biochemical tests, without modification along the study. Bariatric and surgical groups demonstrated decrease of this variable after surgery. Preoperatively cholesterol and HDL was abnormal in all groups, subsequent reduction occurring in bariatric group only. Triglycerides were not elevated but again diminished in bariatric group only. Blood glucose, insulin, Hemoglobin A1c and white blood cell count (systemic inflammation) decreased in bariatric subjects only. Creatinine was reduced in bariatric and obese nonsurgical patients. Albumin and urea remained stable in all groups. Initial Body Mass Index was different in all groups, being highest in bariatric group, followed by obese submitted to clinical treatment and colorectal surgical group respectively. Just bariatric subjects had reduction in their values. Conclusion: Bariatric intervention was able to ameliorate most variables, simultaneously to weight loss. However, it has a significant impact on outpatient visits, which maintained high values until four years after surgery. The opposite occurred with biochemical tests which decreased in the follow-up period. Consumption of hospital services by bariatric subjects was comparable to patients requiring major abdominal operations such as colorectal interventions. Hospital administration and public health authorities should consider the characteristics of such demand, since obesity is a significant problem in our days.

Background: Pulmonary embolism (PE) accounts for almost 40% of perioperative deaths after bariatric surgery. Placement of prophylactic inferior vena cava (IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate postoperative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28, 2013. Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity, and Sidik-Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks (RR) and 95% Confidence Intervals (CI). Results: Seven observational studies were identified (n=102,767), with weighted average incidences of DVT (0.9%), PE (1.6%), and mortality (1.0%) for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR 2.81, 95%CI 1.33-5.97, p=0.007; and RR 3.27, 95% CI 0.78-13.64, p=0.1, respectively); there was no difference in the risk of PE (RR 1.02, 95%CI 0.31-3.77, p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery is associated with higher risk of postoperative DVT and mortality. A similar risk of PE in patients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline. Randomized trials are needed before IVC placement can be recommended. / Revisión por pares

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-08T16:45:48Z No. of bitstreams: 1 JanieleFrancine_dissert.pdf: 1508577 bytes, checksum: 82ecb074e63bbafbd5acb669e3055c75 (MD5) / Made available in DSpace on 2018-11-08T16:45:48Z (GMT). No. of bitstreams: 1 JanieleFrancine_dissert.pdf: 1508577 bytes, checksum: 82ecb074e63bbafbd5acb669e3055c75 (MD5) Previous issue date: 2017-06-30 / obesity is a multifactorial disease characterized by excessive body fat accumulation. Objectives: to describe sociodemographic profile of patients who underwent bariatric surgery more than 24 months ago, to investigate presence of symptoms and mental disorders and to assess the evolution of weight lost / gain after surgery. Method: the study was approved by FAMERP Ethics Committee. Patients who underwent bariatric surgery between July and December/2012 at Hospital de Base, São José do Rio Preto, SP, were invited to participate by filling a sociodemographic questionnaire, the Binge-Eating Scale (ECAP), the Hospital Anxiety and Depression Scale (HAD), the CAGE to assess the level of alcohol dependence screening test for problem drinking, the Sexual Addiction Screening Scale, and an analogic scale to assess patients´ satisfaction with surgery. Results: participants were 19 patients (mean age: 44.11 ± 8.90), predominantly females (n = 18), white, married, graduated from high school, working on the tertiary sector, with a family income of one and a half minimum wage, and from the Sao Jose do Rio Preto area. Eleven, of the 26 participants presented weight regain. Data from the questionnaires indicated binge eating 9,09% (n=1), anxiety symptoms 18,18% (n=2), depressive symptoms 18,18% (n=2), alcohol abuse 18,18% (n=2) and sex addiction 36,36% (n=4) on the post-operatory period for patients with weight regain. Conclusion: there was a predominance of females and high satisfaction with surgery. Important symptoms of mental disorders were identified and must receive attention since they may impair treatment adherence and patients’ quality of life. / A obesidade é considerada uma doença crônica de origem multifatorial, caracterizada pelo acúmulo excessivo de gordura corporal. Objetivos: descrever o perfil sociodemográfico de pacientes submetidos à cirurgia bariátrica há mais de 24 meses, investigar a presença de sintomas e de transtornos mentais, e avaliar a evolução da perda/ ganho de peso após a cirurgia. Método: após aprovação do projeto pelo Comitê de Ética em Pesquisa da FAMERP, pacientes submetidos à cirurgia bariátrica no período entre julho e dezembro de 2012, no Hospital de Base de São José do Rio Preto, SP, foram convidados a participar do estudo e responderam a um Questionário de dados sócio-demográficos, à Escala de Compulsão Alimentar Periódica (ECAP), Escala de Ansiedade e Depressão Hospitalar (HAD), Inventário CAGE para avaliação do nível de dependência de álcool, Escala de rastreamento de dependência de sexo e Escala Analógica para avaliar satisfação com a cirurgia. Resultados: participaram 19 pacientes, com idade entre 28 e 59 anos (média: 44,11; ± 8,90). Houve predomínio do sexo feminino (n = 18), cor branca e casadas, ensino médio completo, com profissão no setor terciário, renda familiar de um salário mínimo e meio e procedência da região de São José do Rio Preto. Dos pacientes analisados, 11 apresentaram reganho de peso. Os resultados dos instrumentos indicaram presença de sintomas de compulsão alimentar periódica 9,09% (n=1), sintomas de ansiedade 18,18% (n=2) e de depressão 18,18% (n=2), abuso de álcool 18,18% (n=2) e dependência de sexo 36,36% (n=4) no pós-operatório dos pacientes com reganho de peso. Conclusão: Houve predomínio do sexo feminino e alto grau de satisfação com a cirurgia. Foram identificados importantes sintomas de transtornos mentais, que devem receber atenção da equipe, pois podem prejudicar a adesão ao tratamento e a qualidade de vida do paciente.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A obesidade mÃrbida à uma doenÃa muito freqÃente nos dias de hoje. O paciente obeso mÃrbido apresenta importantes alteraÃÃes fisiolÃgicas e anatÃmicas, alÃm de comorbidades de grande significado clÃnico, particularmente cardiovasculares, respiratÃrias e metabÃlicas, exigindo do mÃdico anestesiologista pleno conhecimento dessas peculiaridades, para que possa realizar uma abordagem segura, tendo em vista que os procedimentos cirÃrgicos tÃm sido cada vez mais constantes nesse grupo de indivÃduos. O objetivo deste estudo clÃnico, prospectivo e nÃo aleatÃrio, foi avaliar os efeitos da administraÃÃo do agente agonista &#945;2 adrenÃrgico clonidina, como fÃrmaco coadjuvante de tÃcnica anestÃsica padronizada para cirurgia da obesidade em 36 pacientes que pertenciam ao grupo de obesidade mÃrbida do Hospital UniversitÃrio Walter CantÃdio. Foram distribuÃdos em dois grupos: o primeiro grupo composto por 25 pacientes recebeu clonidina administrada em infusÃo contÃnua na dose de 2 mcg/kg de peso ideal, iniciada dez minutos antes da induÃÃo anestÃsica e mantida em seguida, na dose de 0,4 a 0,7 mcg/kg/h de peso ideal, tendo sido descontinuada no inÃcio do fechamento da aponeurose; o segundo grupo composto por 11 pacientes, nÃo recebeu a infusÃo do agente agonista, entretanto todo o restante da tÃcnica anestÃsica foi igual. As principais variÃveis avaliadas foram a pressÃo arterial sistÃlica e diastÃlica, a freqÃÃncia cardÃaca, o Ãndice bispectral (BIS), a concentraÃÃo expirada de sevoflurano (CESEV), a sensaÃÃo de dor, o mini-exame do estado mental (MEEM) e os nÃveis glicÃmicos. Quanto aos dados demogrÃficos, nÃo houve diferenÃa entre os dois grupos estudados. Com relaÃÃo aos parÃmetros hemodinÃmicos, houve aumento da pressÃo sistÃlica e diastÃlica no momento da incisÃo cirÃrgica no grupo controle (P < 0,05). NÃo houve diferenÃa na funÃÃo cognitiva. Foi verificada uma melhor analgesia pÃs-operatÃria no grupo clonidina (P< 0,05). NÃo houve diferenÃa significativa no comportamento glicÃmico no perÃodo peri-operatÃrio quando foram analisados os dois grupos, porÃm quando se analisou apenas os pacientes do grupo clonidina, observou-se que nos nÃo diabÃticos, ocorreu um aumento significativo da glicemia durante o perÃodo intra-operatÃrio (P < 0,05), no entanto, sem ultrapassar o valor de 200 mg/dl. Houve maior controle hemodinÃmico intra-operatÃrio com a utilizaÃÃo da clonidina. O grupo clonidina apresentou um despertar mais rÃpido ao final da cirurgia e tambÃm obteve melhor analgesia no perÃodo pÃs-operatÃrio. O uso do fÃrmaco nÃo interferiu com o retorno das funÃÃes cognitivas. Em baixas doses, a clonidina nÃo determinou alteraÃÃes nos nÃveis glicÃmicos no perÃodo peri-operatÃrio, entretanto, nos pacientes diabÃticos em que o agonista foi administrado, observou-se um melhor controle da glicemia, o que nÃo foi demonstrado nos pacientes nÃo diabÃticos. Os pacientes dos dois grupos nÃo apresentaram efeitos adversos. / Morbid obesity is very frequent nowadays. The morbidly obese patient presents important anatomical and physiological changes, and comorbidities of great clinical significance, particularly cardiovascular, respiratory and metabolic demands of the physician anesthesiologist must be aware of these peculiarities, so you can make a safe approach, considering that the surgical procedures have been increasingly appearing in this group of individuals. The objective of this clinical, prospective and not randomized, was to evaluate the effects of administration of the &#945;2-adrenergic agonist clonidine as an adjunct to drug standardized anesthetic technique for obesity surgery in 36 patients who belonged to the group of morbid obesity at the university hospital . Were divided into two groups: the first group of 25 patients received clonidine administered by continuous infusion at a dose of 2 mcg / kg ideal body weight, which started ten minutes before induction of anesthesia and then maintained at a dose from 0,4 to 0,7 mcg / kg / h of ideal weight, having been discontinued in the early closure of the aponeurosis and the second group of 11 patients did not receive the infusion of the agonist, however the rest of the anesthetic technique was equal. The main variables evaluated were systolic and diastolic blood pressure, heart rate, bispectral index (BIS), the expired concentration of sevoflurane, pain sensation, the mini-mental state examination (MMSE) and levels glucose. With regard to demographics, there was no difference between the two groups. With respect to hemodynamic parameters, an increase of systolic and diastolic blood pressure at the time of surgical incision in the control group (P <0.05). There was no difference in cognitive function. It was observed a better postoperative analgesia in the clonidine group (P <0.05). There was no significant difference in glycemic levels in the peri-operative when they examined the two groups, but when we examined only patients in the clonidine group, we observed that in nondiabetic patients, there was a significant increase in blood glucose during the intraoperative (P <0.05), however, not to exceed 200 mg / dl. There was greater intraoperative hemodynamic control with the use of clonidine. The clonidine group showed a more rapid awakening at surgery and also achieved better analgesia in the postoperative period. The use of the drug did not interfere with the recovery of cognitive function. At low doses, clonidine did not cause changes in glucose levels in the perioperative period, however, in diabetic patients in which the agonist was administered, there was a better glucose control, which was not demonstrated in nondiabetic patients. Patients in both groups showed no adverse effects.

Introduction: Obesity is a major health problem that affects an individual's overall health. Bariatric metabolic surgery is most important and has permanent impact on weight loss in comparison with conservative therapy. The downside is that it often leads to a row nutritional deficiencies requiring long-term supplementation. Object: The aim of the thesis is to map the intake of nutrients in the diet of bariatric patients six months and one year after the procedure. The research is primarily focused on the intake of vitamin D and calcium in diet, vitamin D, parathyroid hormone and calcium levels are also evaluated. Marginally, laboratory values are assessed prior to surgery as deficiencies are known to occur before surgery. Methodology: The research sample consists of 30 respondents who are six months (M6) and one year (Y1) from the procedure. Micronutrients are evaluated from three-day dining records recorded by respondents for at least one week. The research laboratory data was used from the medical information system of the hospital information system. The evaluation parameters for vitamin D-25 (OH)D (limit level was established to > 30 ng/ml). To assess the parathyroid hormone concentration, a minimum limit is set to 1.58 pmol/l, calcium 2.00-2.75 (mmol/l). We were wondering if the profile of...

Hyperproinsulinemia is associated with type 2 diabetes (T2DM) and obesity and is a predictor for future coronary heart disease. This thesis examines the effect of bariatric surgery on glucometabolic status including insulin and proinsulin responses after meal. Further we explored longitudinally the effects of bariatric surgery on glucose, insulin and proinsulin secretion as well as lipids, liver enzymes and magnesium concentrations. We explored by a standardised meal test the postprandial dynamics of proinsulin and insulin and effects on glucose and lipids in patients treated with gastric bypass (RYGBP) surgery and in patients treated with bileopancreatic diversion with duodenal switch surgery (BPD-DS). Comparisons were made to morbidly obese patients and normal weight controls (NW). RYGBP surgery markedly lowers fasting and postprandial proinsulin concentrations although BMI was higher compared to NW-controls. BPD-DS surgery induces a large weight loss and normalises postprandial responses of glucose, proinsulin and insulin and markedly lowers triglycerides. We evaluated non-diabetic morbidly obese patients who underwent bariatric surgery followed-up for up to four years after surgery. Long-term follow-up showed that RYGBP surgery is not only characterized by markedly and sustained lowered BMI but also lowered concentrations of proinsulin, insulin, ALT and increased HDL-C possibly via reduced hepatic insulin resistance. We also examined how magnesium status is affected by bariatric surgery as magnesium has been shown to be inversely related to glucose and to insulin resistance. The serum magnesium concentrations increased by 6% after RYGBP and 10% after BPD-DS. In summary, RYGBP and BPD-DS surgery results in marked weight loss, alterations in insulin and proinsulin dynamics, lowered fasting and postprandial proinsulin concentrations and improved glucometabolic and magnesium status.

Bakgrund: I Sverige är övervikt och fetma ett folkhälsoproblem. Detta tenderar till att bli allt större vilket kan ge en ökad risk för bl.a. hjärt- och kärlsjukdomar samt diabetes typ 2. En allmänsjuksköterska möter överviktsopererade patienter varhälst i vårdsektorn hon/han arbetar. Därför är det viktigt att känna till hur dessa människor upplever sin nya vardag för att på bästa sätt kunna erbjuda dem en optimal, hälsofrämjande vård. Syftet: Syftet med denna studie var att belysa människors upplevelser av vardagen efter en överviktsoperation. Metod: En självbiografisk kvalitativ studie baserat på sju böcker. Resultat: Ur analysen av datamaterialet identifierades tre huvudteman ”Ett bättre liv”, ”Kroppsliga och själsliga besvärligheter” samt ”Den nya livssituationen” samt nio subteman vilka alla belyser individers upplever av vardagen efter en överviktsoperation. Diskussion: Individer som genomgår en överviktsoperation har svårt att anpassa sig till sin nya livsstiuation trots att de samtidigt upplever ett stort välbefinnade över att bland annat ha nått sitt mål. Ett förändrat bemötande från omvärlden är ibland svår att hantera vilket leder till en osäkerhet inför den egna kroppen och kroppsuppfattning. För sjuksköterskan är det viktigt att förstå att förändringen efter en överviktoperation inte endast är fysisk utan även i allra högsta grad psykisk. Slutsats: För att livsstilsförändringen ska fortgå efter en överviktsoperation krävs att individen känner meningsfullhet i sin nya situation. Genom utbildning, inför och efter det kirurgiska ingreppet, är det lättare att leva med denna livsstilsförändring. Med tanke på att livet kan förlängas med tio år genom kraftig viktreducering och därmed även frånvaro av överviktsrelaterade sjukdomar, bör ämnet om hälsobefrämjande åtgärder för fetmadrabbade individer inkluderas i sjuksköterskans grundutbildning. / Background: Overweight and obesity is a public health problem in Sweden. This tends to become larger and may increase the risk of cardiovascular diseases and diabetes type 2. A general nurse meet patients who had undergone bariatric surgery wherever in the health sector, she/he is working. Therefore, it is important to know how these people feel about their new living in order to offer them an optimal health care. Aim: The aim of this study was to highlight people's experiences of everyday life after obesity surgery. Method: An autobiographical qualitative study based on seven books. Result: The analysis of the data identified three main themes; "A better life", "The physical and emotional discomforts” and "The new life situation” together with nine subthemes that illustrates how individuals experience their everyday lives after an bariatric surgery. Discussion: For individuals who undergo bariatric surgery has it been difficult to adapt the new life situation, even though they often experience a feeling of well-being as well as a feeling of that they have reached their goal. The changed attitude from the ‘outside world’ is sometimes difficult to manage. This leads to uncertainty about the own bodie and body image. As a nurse, it is important to understand that the difficulties after bariatric surgery are not only physical but also a mental distress and discomfort. Conclusion: To achieve that the new lifestyle should proceed after bariatric surgery it requires that the individual feel meaningfulness in their new situation. Through training before and after surgery, it is easier to live with this change. Given that life can be extended with ten years due to severe weight reduction and thus the absence of sequelae, it may be recommended that education of health promotion among obesity affected individuals should be included in the nurse’s education.

Importance: Childhood and adolescent overweight and obesity have more than tripled over the past two decades. Bariatric surgery is becoming more common for adolescents. Currently, there are few studies that describe outcomes after bariatric surgery in adolescents and no studies that describe nutritional behaviors that predict sustained weight loss in this population post-surgery. Objective: To describe pre-surgery dietary intake in adolescents who underwent a sleeve gastrectomy between 2011 and 2013 at an outpatient pediatric weight loss clinic. This study specifically aims to determine whether there is a correlation between fruit and vegetable intake before surgery and weight loss post-surgery in adolescents. Design, Setting, and Participants: The participants in this study received the sleeve gastrectomy procedure. Patients were between the ages of 13-17 years old and had a BMI between 35 kg/m2 to 60 kg/m2. All patients had undergone extensive counseling and assessment by a team of medical professionals (pediatrician, psychologist, exercise physiologist, nurse, and dietitian) for at least six months before surgery. Weekly number of servings of fruits and vegetables, cups of sweetened beverages (separated as fruit juice or soda), servings of fried foods eaten, and meals eaten from or at restaurants as reported at the initial consultation were collected and analyzed. Results: The mean age of participants (n=11) was 17.1 ± 1.51 years. Mean servings of vegetables consumed at baseline was 7.32 ± 4.38 servings per week and mean weekly consumption of fruits was 6.0 ± 4.16 servings per week. There were no statistically significant correlations between baseline fruit (p = 0.50) and vegetable (p = 0.44) consumption with weight (kg) lost six months after surgery. Conclusion: While the relationship between fruit and vegetable consumption with weight lost six months post-surgery failed to reach significance, there was a trend such that patients who consumed more servings of fruits and vegetables at baseline had lost more weight at 6 months. It is interesting to note that none of the patients in the study consumed the recommended daily servings of fruits or vegetables at baseline in accordance with the USDA guidelines. A longer study may reveal a more significant relationship between dietary patterns before surgery and changes in weight after surgery.

America's obesity ̒epidemic̕, coupled with increasing use of biomedical technologies in healthcare, has helped usher in new technoscientific methods to medically manage the bodies of overweight and obese individuals. Potential patients now have several surgical options to choose from in efforts to lose weight and (potentially) improve health outcomes, including gastric bypass, sleeve gastrectomy, and gastric banding; this research focuses on the gastric band, an implantable and adjustable silicone device designed to restrict the amount of food consumed. This study involves: in-depth interviews with predominantly female gastric banding patients, medical practitioners, bariatric surgeons, and representatives from the two U.S.-based biomedical firms that manufacture the gastric band; a multi-site ethnography examining the patient experience and the clinical encounter; and content analysis of scientific and non-scientific texts. Through this mixed methodological approach, this study charts the band's evolution and the complex forces guiding its design, development and adoption, and draws attention to the ways in which gendered assumptions enter into the pre- and post-surgical space with repercussions for patient care. Findings suggest that patients̕ decision-making process is shaped by - and shapes - multiple social, political, economic, and regulatory contexts. As a contested and unstable technology, the band's efficacy and ̒foreignness̕ is continually both challenged and reaffirmed by a diverse arena of social actors with a vested interest in the bariatric surgical space. These actors construct the band's role in the obesity epidemic in oppositional ways, affecting its use and perceived misuse: the depiction of the band as a safe, less invasive and - most significantly - removable technology helps drive its use, directing some patients away from other options - specifically, the anatomically changing gastric bypass procedure - portrayed as unnatural and extreme, though simultaneously more effective. While the band's reversibility represents freedom over technology and control over their bodies, it also reflects patients̕ struggle for both autonomy and desire for technological assistance in managing their weight. However, despite patients̕ attempt to assert themselves as active agents, the gastric band emerges as a disciplinary weight loss technology which serves to reinforce the perceived need for clinical intervention in the care and treatment of obesity. This study contributes to our understanding of the possibilities and limitations offered by biomedical technologies, and the ways in which humans resist, comply or are ambivalent toward their adoption and use.

Bakgrund: År 2014 utfördes 6,800 bariatriska operationer i Sverige med syfte att minska individers vikt och förbättra välbefinnandet. Studien utfördes för att beskriva patienters subjektiva erfarenheter av processen efter operation och förankrades i Dorothea Orems egenvårdsteori.   Syfte: Syftet var att beskriva patienters erfarenheter efter bariatrisk kirurgi.   Metod: En systematisk litteraturstudie som utgick från Forsberg och Wengströms (2013) metodologi.   Resultat: Resultatet presenterades som ett övergripande tema: En önskan om att återfå hälsa genom viktminskning, med sex tillhörande kategorier. Många av deltagarna beskrev att erfarenheter efter bariatrisk kirurgi överlag var positiva. De upplevde också att relationen till mat förändrades. Självkänslan samt sociala och fysiska förmågor förbättrades. Några upplevde svårigheter att anpassa sig efter operationen vilket påverkade deras erfarenheter negativt.   Slutsats: Många av dem som genomgick bariatrisk kirurgi ökade sin livskvalitet på många sätt. Utöver det kirurgiska ingreppet som förminskar magsäcken behövdes ytterligare åtgärder i form av livsstilsförändringar och egenvård. Ett ansvar som till stor del låg hos individen själv, dessutom fanns också ett ansvar hos sjukvårdspersonalen, att uppmärksamma vilken hjälp patienten kunde komma att behöva i den fortsatta hälsoprocessen och stötta dem i detta. / Background: In 2014, there were 6,800 bariatric surgeries performed in Sweden, in order to reduce an individual's weight and improve well-being. This study was conducted to describe the patients' subjective experiences of the process after surgery and were anchored in Dorothea Orem's self-care theory.   Aim: The aim was to describe patients' experiences after bariatric surgery.   Method: A systematic literaturereview emanated from Forsberg and Wengström’s (2013) methodology.   Result: The results are presented with an overarching theme: A desire to regain health through weight loss, and six associated categories. Experience after bariatric surgery was described by many of the participants generally positive. The most common experience was that the relationship with food changed. For many of the participants there was an improvement in both self-esteem and social and physical abilities. Some experienced difficulties adjusting after surgery which affected their experience negatively.   Conclusion: Most people who underwent bariatric surgery increased their quality of life in many ways. In addition to the surgical procedure that reduces the stomach, most of them needed additional measures in terms of lifestyle changes and self-care. A responsibility that largely lay with the individual himself, though even healthcare professionals have a responsibility in the subsequent care.