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Previous issue date: 2018-02-28 / There are several studies showing increased weight of the world?s population. Obesity is today responsible for more deaths than malnutrition worldwide. This growth, especially in morbid obesity, resulted in the increase of bariatric surgery. According to the 1991 consensus of the NIH (National Institute of American Health), bariatric surgery was considered to be the only effective treatment for these patients who were not successful with previous clinical treatment
Like any surgical procedure, bariatric surgery presents conditions that hinder their achievement. Several authors emphasize the difficulty of an enlarged and fatty liver to the surgeon during laparoscopy. Due to this need to be able to assess the dimensions of the hepatic left lobe, various techniques through imaging methods have been developed. Among the methods used, the ultrasound has the advantages of not emitting ionizing radiation, low cost and wide availability. Despite these advantages, there are still no criteria for evaluating hepatic size with a focus on bariatric surgery, that is, the dimensions of the liver are not taken into account the gastric esophagus transition.
The aim of the present study is to determine the relationship of left liver lobe measurements and eventual limitation offered by the liver to the intraoperative period of bariatric surgery. For this, special liver measurements were performed using anatomical landmarks of particular interest for bariatric surgery and comparing with eventual transoperative limitation offered by the liver.
Methods: Eighty patients underwent preoperative US to evaluate the size of the left lobe of the liver, 24-48 hours prior to LRYGBP (laparoscopic Roux-en-Y gastric by-pass) or LSG (sleeve gastrectomy). These measures were made in the traditional way and using specific anatomical landmarks. It was possible to obtain all measures in seventy-nine patients and the results were then compared with the intraoperative findings, classified by the surgeon as liver easily removable or removable with difficulty.
Results: There was no significant differences in the traditional measures of the left lobe (p = 0.83). In several measures proposed by this study, there were statistically significant differences between the groups with and without difficulty in removing the liver. Between this new measures, the ones that better separated the two groups were obtained in the following measures: LLL (p <0.001, ES=1.11, AUC=0.74), LLlong x LLL (p=0.13, AS=1.12, AUC=0.74) and the multiplication of the three measures (p=0.019, ES=1.14, AUC=0.73).
Conclusions: The measures proposed were related to the intraoperative difficulty to remove the liver and access the Angle of His in bariatric surgeries by videolaparoscopy. / Existem v?rios estudos mostrando o aumento do peso da popula??o mundial. A obesidade ? hoje respons?vel por mais mortes do que a desnutri??o em todo o mundo. Esse crescimento, especialmente na obesidade m?rbida, resultou no aumento da cirurgia bari?trica. De acordo com o consenso de 1991 do NIH (Instituto Nacional de Sa?de Americana), a cirurgia bari?trica foi considerada o ?nico tratamento efetivo para esses pacientes que n?o tiveram sucesso com o tratamento cl?nico pr?vio.
Como todo procedimento cir?rgico, a cirurgia bari?trica apresenta condi??es que dificultam sua realiza??o. V?rios autores enfatizam a dificuldade do f?gado gorduroso e aumentado para o cirurgi?o durante a laparoscopia. Devido a necessidade de poder avaliar as dimens?es do lobo esquerdo hep?tico, v?rias t?cnicas atrav?s de m?todos de imagem foram desenvolvidas. Entre os m?todos utilizados, o ultra-som tem as vantagens de n?o emitir radia??o ionizante, baixo custo e ampla disponibilidade. Apesar dessas vantagens, ainda n?o existem crit?rios para avalia??o do tamanho hep?tico com enfoque na cirurgia bari?trica, ou seja, as dimens?es do f?gado n?o s?o levadas em considera??o na transi??o do es?fago g?strico.
O objetivo do presente estudo ? determinar a rela??o entre as medidas do lobo hep?tico esquerdo e a eventual limita??o oferecida pelo f?gado no transoperat?rio da cirurgia bari?trica. Pra isso medidas especiais do f?gado foram criadas utilizando reparos anat?micos de interesse particular para a cirurgia bari?trica e posteriormente comparando-as com a eventual limita??o transoperat?ria oferecida pelo f?gado.
M?todos: Oitenta pacientes foram submetidos ? US pr?-operat?ria para avaliar o tamanho do lobo esquerdo do f?gado entre 24 e 48 horas antes do LRYGBP (by-pass g?strico laparosc?pico em Y de Roux) ou LSG (gastrectomia vertical). As medidas do lobo esquerdo foram feitas de maneira tradicional e utilizando reparos anat?micos espec?ficos. Foi poss?vel obter todas as medidas em setenta e nove pacientes e os resultados foram ent?o comparados com os achados
intraoperat?rios, classificados pelo cirurgi?o como f?gado facilmente afast?vel ou afast?vel com dificuldade.
Resultados: N?o houve diferen?as significativas nas medidas tradicionais do lobo esquerdo (p = 0,83). Em v?rias medidas propostas por este estudo, houve diferen?as estatisticamente significantes entre os grupos com e sem dificuldade no afastamento do f?gado. Entre essas novas medidas, as que melhor separaram os dois grupos foram as seguintes: LLL (p <0,001, ES = 1,11, AUC = 0,74), LLlong x LLL (p = 0,13, AS = 1,12, AUC = 0,74 ) e a multiplica??o das tr?s medidas (p = 0,019, ES = 1,14, AUC = 0,73).
Conclus?es: As medidas propostas foram relacionadas ? dificuldade intraoperat?ria para afastamento do f?gado e acesso ao ?ngulo de His em cirurgias bari?tricas por videolaparoscopia.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8122 |
| Date | 28 February 2018 |
| Creators | Volpe, Mariliza |
| Contributors | Padoin, Alexandre Vontobel |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 500, 500, 500, -224747486637135387, -969369452308786627 |
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