Made available in DSpace on 2016-04-28T20:40:17Z (GMT). No. of bitstreams: 1 Flavia de Souza Scavone.pdf: 1468651 bytes, checksum: d5ee7e1fa5a0a6c904942e4c28be2c3a (MD5) Previous issue date: 2010-05-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study aims to observe the differences in the feedback of the patients who had good and poor outcomes following adjustable gastric banding (AGB). In-depth interviews were conducted with thirty patients (22 women), from 20 to 73 years old, who had AGB within the past 24 to 92 months. Patients were split into two groups of 15: good outcomes were considered percentage of excess weight loss (%EWL) > 40% and, poor outcomes %EWL £40%. The answers were divided into categories. Statistical analysis was performed (Fischer s Exact Test and X² Test) to test the statistical differences between categories and groups (p £ 0,05). The significant results were qualitatively analyzed based on the theoretical guidelines of analytical psychology and the Jungian approach to psychosomatic illness. Analyzing differences among patients feedback, a relationship between psychological aspects and the outcomes of the AGB was observed. The decision to have AGB based on heath-related issues, psychological treatment, a better understanding of the use of food as a defense mechanism and the development of others strategies to deal with stress was related to good outcomes. Unrealistic expectations to the AGB outcomes, leaving treatment, conflictive relationship with medical team, stressful situations and high intake of sweets were related to poor outcomes. It was understood that the patients from the group with poor results had more difficulty elaborating on the many psychological aspects that are directly related to their eating behavior. This understanding suggests how important is to have psychological guidance after bariatric surgery to achieving good outcomes / Este estudo visa observar diferenças no discurso dos pacientes com bons e maus resultados após colocação da banda gástrica ajustável (BGA). Para isso, foi realizada entrevista semidirigida com trinta pacientes (22 mulheres), entre 20 e 73 anos e com tempo de pós-operatório entre 24 e 92 meses. Os entrevistados foram divididos em dois grupos de quinze, de acordo com critério de divisão em que bons resultados foram considerados porcentagem de perda do excesso de peso (%PEP) > 40% e maus resultados, %PEP £ 40%. As respostas das questões abertas foram transformadas em categorias e realizou-se análise estatística (Teste Exato de Fischer e Teste do x²) buscando diferenças significativas entre as categorias e os grupos (p £ 0,05). As diferenças foram analisadas por meio do referencial teórico da Psicologia Analítica e do modelo da psicossomática junguiana. Foram observadas diferenças no discurso dos pacientes, sugerindo relação entre aspectos psicológicos e resultados pós-cirúrgicos. Escolher o tratamento por preocupações com a saúde, fazer acompanhamento psicológico, compreender o comer demais como mecanismo de defesa e desenvolver outras estratégias para lidar com o estresse foram relacionados a bons resultados. Expectativas irreais sobre os resultados, passar por situações de estresse, abandono precoce do tratamento, não ter bom relacionamento com a equipe e alto consumo de doces foram relacionados a maus resultados. Compreende-se que o grupo dos maus resultados apresentou dificuldade em elaborar os aspectos psicológicos relacionados ao comportamento alimentar, sugerindo a importância do acompanhamento psicológico na busca de melhores resultados após cirurgia bariátrica

It has been estimated that LAGB represents about 42% of bariatric operations performed worldwide. There are a number of different adjustable gastric bands available. Few attempts have been made to compare the influence of band design differences for efficiency and complication rate. There are no accepted criteria for choosing this particular operation. In the dissertation we compared one year results after adjustable gastric banding using different adjustable gastric bands – SAGB and MiniMizer Extra. We have determined that laparoscopic adjustable gastric banding is effective and safe bariatric procedure: the average percentage of initial excess body mass index loss was 33,1 ± 21,9%; 34.1% of patients achieved fair, 30,6% - good, 9,4% - very good and 2,4% - excellent results according to BAROS; only 5 (4,9%) major complications were diagnosed. No radical differences were stated between the efficiency and complication rate of the compared adjustable gastric bands: the average percentage of initial excess body mass index loss in SAGB and MiniMizer Extra groups was 28,9 ± 21,3% and 36,8 ± 22.1% respectively, p=0.075; major complication rate was 0 (0%) and 5 (9.3%) respectively, p=0.069. Patients at the age of 40 and older achieved better results using MiniMizer Extra band - the average percentage of initial excess body mass index loss was 37,5 ± 20,8% versus 23,6 ± 13,8% in SAGB group, p=0.002. Patients with initial BMI ≤ 47 achieved better results using MiniMizer Extra band... [to full text] / Šiuo metu Pasaulyje skrandžio apjuosimo reguliuojama juosta operacijos sudaro apie 43 % visų chirurginių operacijų, atliekamų nutukimui gydyti. Iki šiol nėra pilnai ištirta operacijoje naudojamų skrandį apjuosiančių reguliuojamų juostų konstrukcijos skirtumų įtaka gydymo rezultatams, taip pat nėra priimtų pacientų atrankos šiai operacijai kriterijų. Disertacijoje palyginome vienerių metų nutukimo chirurginio gydymo rezultatus naudojant skirtingas skrandį apjuosiančias reguliuojamas juostas – SAGB ir MiniMizer Extra. Nustatėme, kad skrandžio apjuosimo reguliuojama juosta operacija yra efektyvus ir saugus nutukimo gydymo būdas: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 33,1 ± 21,9%; vertinant pagal BAROS, 34.1% pacientų pasiekė patenkinamą, 30,6% - gerą, 9,4% – labai gerą ir 2,4% – puikų gydymo rezultatą; pasitaikė 5 (4,9%) „didžiosios” komplikacijos. Esminių skirtumų tarp lygintų juostų efektyvumo ir komplikacijų skaičiaus po vienerių metų po operacijos nenustatyta: vidutinis procentinis perteklinio kūno masės indekso sumažėjimas SAGB ir MiniMizer Extra grupėse buvo atitinkamai 28,9 ± 21,3% ir 36,8 ± 22.1%, p=0.075, o „didžiųjų” komplikacijų skaičius atitinkamai 0 (0%) ir 5 (9.3%), p=0.069. 40 metų ir vyresni pacientai geresnių rezultatų pasiekė naudojant MiniMizer Extra juostą - vidutinis procentinis perteklinio kūno masės indekso sumažėjimas buvo 37,5 ± 20,8% prieš 23,6 ± 13,8 % SAGB grupėje, p=0.002. Pacientai, kurių pradinis KMI ≤ 47, geresnių... [toliau žr. visą tekstą]

Obesity is the fifth leading cause of global deaths. The efficacy and safety of obesity treatment is still controversial. The objective of the thesis is to evaluate the efficacy and safety of bariatric surgery, through a systematic review of the current evidence and meta- analysis of important outcomes. Nineteen (19) randomized controlled trials (RCTs) with 1346 participants were included. Bariatric surgery resulted in greater weight loss when compared to non-surgical treatment. Weight loss was also associated with resolution and/or improvement of obesity related comorbidites such as diabetes, hypertension, hyperlipidemia, and sleep apnea. Weight loss and safety varied across the surgical procedures. Biliopancreatic diversion/duodenal switch had the greatest weight loss, followed by sleeve gastrectomy and Roux-en-Y gastric bypass, purely restrictive procedures such as vertical banded gastroplasty and adjustable gastric banding resulted in the least weight loss. Long term, high quality, and adequately powered trials are still needed to support the available evidence

Obesity is the fifth leading cause of global deaths. The efficacy and safety of obesity treatment is still controversial. The objective of the thesis is to evaluate the efficacy and safety of bariatric surgery, through a systematic review of the current evidence and meta- analysis of important outcomes. Nineteen (19) randomized controlled trials (RCTs) with 1346 participants were included. Bariatric surgery resulted in greater weight loss when compared to non-surgical treatment. Weight loss was also associated with resolution and/or improvement of obesity related comorbidites such as diabetes, hypertension, hyperlipidemia, and sleep apnea. Weight loss and safety varied across the surgical procedures. Biliopancreatic diversion/duodenal switch had the greatest weight loss, followed by sleeve gastrectomy and Roux-en-Y gastric bypass, purely restrictive procedures such as vertical banded gastroplasty and adjustable gastric banding resulted in the least weight loss. Long term, high quality, and adequately powered trials are still needed to support the available evidence

Abstract Morbid obesity is the most rapidly increasing health threat of developed countries, and the costs caused by it are already higher than those of smoking. In an increasing number of developing countries both starvation and morbid obesity are increasing simultaneously. Obesity in children and adolescents is also increasing rapidly. Conservative treatment almost invariably fails when treating morbid obesity. Results of pharmacotherapy have been disappointing after great expectations. Laparoscopic gastric banding has been used in the treatment of morbid obesity since 1993. The method was first used mostly in Europe. In the USA either an open or laparoscopic gastric bypass have been the most common methods of surgery. The aim of this study was to investigate the operation results of 280 patients operated in Vaasa Central Hospital during the 11 years after March 1996. Of these patients, 123 have been followed at least 5 years. The results have been analyzed with BAROS that measures the quality of life. Quality of life was measured prospectively 1 year after surgery with the 15D questionnaire that is validated in the Finnish population. The effect of gastric banding in esophageal motility and reflux was studied prospectively in 31 patients. Late results were analyzed in 123 patients 11 years after the first operation. Mean excess weight loss (EWL) was 56% in patients who had their band in place 7 years after surgery, and 46% in all patients. There was no mortality related to the operation, and there was only one serious complication. Disease-specific quality of life improved in 78.8% of the patients in 28 months of follow-up. Health-related quality of life was significantly improved 12 months after surgery, but improvement was not connected to the amount of weight loss. The band inhibited reflux 19 months after surgery. Complications, failures, and reoperations increase with longer follow-up. Weight loss is moderate 9 years after a gastric banding operation, and in carefully selected patients this operation is still a good option in the treatment of morbid obesity.