DENIS PAJECKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
14 resultados
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- Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity(2014) SANTO, Marco Aurelio; RICCIOPPO, Daniel; PAJECKI, Denis; CLEVA, Roberto de; KAWAMOTO, Flavio; CECCONELLO, IvanOBJECTIVES: The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients. METHODS: Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m(2) (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery. RESULTS: The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days. CONCLUSION: In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.
- Bariatric surgery (sleeve gastrectomy) after liver transplantation: case report(2014) PAJECKI, Denis; CESCONETTO, Danielle Menezes; MACACARI, Rodrigo; JOAQUIM, Henrique; ANDRAUS, Wellington; CLEVA, Roberto de; SANTO, Marco Aurelio; ALBUQUERQUE, Luiz Augusto Carneiro D'; CECCONELLO, Ivan
- Tratamento de curto prazo com liraglutide no reganho de peso após cirurgia bariátrica(2013) PAJECKI, Denis; HALPERN, Alfredo; CERCATO, Cintia; MANCINI, Marcio; CLEVA, Roberto de; SANTO, Marco AurélioOBJECTIVE: To evaluate the results of the use of liraglutide in a group of patients undergoing surgical treatment of morbid obesity with unsatisfactory weight loss or regain of more than 15% of minimum reached weight. METHODS: The authors conducted a retrospective analysis of 15 operated patients who had excess weight loss <50% after two years of follow-up or regained weight more than 15% of the minimum reached weight. We included only patients who had the expected ""surgical anatomy"", assessed by contrast radiography and endoscopy. Mean age was 47.2 ± 12.5 years, and patients received liraglutide at doses from 1.2 to 3.0 mg/day for eight to 28 weeks follow-up. RESULTS: Surgical treatment induced a weight loss of 34.1 ± 16.5 kg. The average weight regain after 5.3 ± 3.3 years was 14.2 ± 12.1 Kg. The average weight was significantly reduced after treatment with liraglutide (100.9 ± 18.3 kg. vs Kg 93.5 ± 17.4, p <0.0001). Six patients had nausea and two discontinued therapy due to the cost of medication. CONCLUSION: medical treatment directed to the control of satiety using liraglutide may be an alternative treatment of patients with poor weight loss or weight regain after surgery when no technical problem has been identified.
- EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment(2013) SANTO, Marco Aurelio; PAJECKI, Denis; RICCIOPPO, Daniel; CLEVA, Roberto; KAWAMOTO, Flavio; CECCONELLO, IvanContext Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.
- OBESITY AND SEVERE STEATOSIS: THE IMPORTANCE OF BIOCHEMICAL EXAMS AND SCORES(2021) SILVA, Miller Barreto de Brito e; TUSTUMI, Francisco; DANTAS, Anna Carolina Batista; MIRANDA, Barbara Cristina Jardim; PAJECKI, Denis; DE-CLEVA, Roberto; SANTO, Marco Aurelio; NAHAS, Sergio CarlosINTRODUCTION: Nonalcoholic fatty liver disease (NAFLD) is considered a public health problem, mainly in severely obese patients. OBJECTIVE: The aim of the present study was to investigate different biochemical-based scores available and determine which one could best serve as an NAFLD predicting tool in a severely obese population. METHODS: This was a cross-sectional study involving severely obese patients. All patients were evaluated with serum laboratory parameters for 1 week before biopsy, and all patients were treated with intraoperative liver biopsy, during bariatric surgery. RESULTS: A total of 143 severely obese patients were included. The median body mass index (BMI) was 48 kg/m(2) (35-65). Diabetes mellitus was present in 36%, and steatosis was present in 93% (severe steatosis in 20%). Only aspartate transaminase (AST) to platelet ratio index (APRI=0.65 (95% CI: 0.55-0.8) and homeostatic model assessment for insulin resistance (HOMA-IR=0.7 (95% CI: 0.58-0.82) showed significant capacity for the prediction of severe steatosis. Hepatic steatosis index (HSI), NAFLD fibrosis score (NAFLDS), alanine aminotransferase (ALT)/AST, and fibrosis-4 (FIB-4) were not able to correctly predict severe steatosis on liver biopsy. APRI showed high specificity of 82% and low sensitivity of 54%. In contrast, HOMA-IR showed high sensitivity of 84% and low specificity of 48%. CONCLUSIONS: NAFLDS, FIB-4, AST/ALT, and HSI have no utility for the evaluation of severe steatosis in severely obese patients. Diabetes and insulin-resistance-related biochemical assessments, such as HOMA-IR, can be used as good screening tools for severe steatosis in these patients. APRI score is the most specific biochemical diagnostic tool for steatosis in severely obese patients and can help clinicians to decide the need for bariatric or metabolic surgery.
- Management of biliary stones in bariatric surgery(2022) TUSTUMI, Francisco; PINHEIRO FILHO, Joao Emilio Lemos; STOLZEMBURG, Lucas Cata Preta; SERIGIOLLE, Leonardo Carvalho; COSTA, Thiago Nogueira; PAJECKI, Denis; SANTO, Marco Aurelio; NAHAS, Sergio CarlosMorbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.
- FOOD TOLERANCE AND NUTRITIONAL RISK AFTER SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS IN ELDERLY PATIENTS WITH SEVERE OBESITY: A PROSPECTIVE, RANDOMIZED CONTROLLED TRIAL(2022) MEDEIROS, Veronica Garcia de; PAJECKI, Denis; DIAS, Maria Carolina Gonçalves; DANTAS, Anna Carolina Batista; CLEVA, Roberto de; SANTO, Marco AurelioABSTRACT Background: Bariatric surgery is still controversial in elderly patients with severe obesity. Most publications focus on safety and early clinical outcomes. Food tolerance and nutritional postoperative risk is unknown for this population. Methods: Thirty-six elderly patients with severe obesity were recruited for an open-label randomized trial from September 2017 to May 2019 comparing laparoscopic sleeve gastrectomy (LSG) to Roux-en-Y Gastric Bypass (LRYGB). Food tolerance was accessed by Quality of Alimentation (QoA) questionnaire and data on weight loss, body composition, and nutritional risk were collected between 6 and 24 months after surgery. Results: Comparing LSG to LRYGB patients, the latter had higher total weight loss (22% vs 31%, P=0.01) and excess weight loss (53% vs 68%, P=0.01). Food tolerance to eight food groups was similar between groups (14 vs 15 points, P=0.270), as Suter score (23 vs 25, P=0.238). Daily protein intake was below recommendation in both groups (40 vs 51 g/d, P=0.105). Nutritional risk, evaluated through Standardized Phase Angle (-1.48 vs -1.99, P=0.027), was worse for LRYGB group. Conclusion: Food tolerance and adequacy of food consumption were similar in both groups. LRYGB patients had higher nutritional risk.
- BONE HEALTH ASSESSMENT OF ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY(2022) CORSI, Giovanna Cavanha; PINHEIRO, Moisés Carmo dos Anjos; CALDAS, Ana Paula Silva; DIAS, Maria Carolina Gonçalves; SANTO, Marco Aurelio; PAJECKI, DenisABSTRACT Background: Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. Objective: To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. Methods: This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. Results: A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. Conclusion: Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.
- VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY(2023) CREMONESI, Mariane de Carvalho; DUARTE-GUERRA, Leorides; PAJECKI, Denis; SANTO, Marco Aurelio; LOTUFO-NETO, Francisco; WANG, Yuan-PangBackground: Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. Aims: This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity.Methods: We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m(2)) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-& Aring;sberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. Results: The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. Conclusions: The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.
- IMPACT OF HELICOBACTER PYLORI ON EARLY POSTOPERATIVE COMPLICATIONS AFTER SLEEVE GASTRECTOMY: A SYSTEMATIC REVIEW AND META-ANALYSIS(2023) DANTAS, Anna Carolina Batista; JAYME, Vitoria Ramos; FILARDI, Kaique Flavio Xavier Cardoso; PAJECKI, Denis; SANTO, Marco AurelioThe impact of Helicobacter pylori (HP) on postoperative outcomes after sleeve gastrectomy (SG) is still controversial. A systematic review and meta-analysis were performed to compare the incidence of early complications after SG between HP-positive and HP-negative patients. Eight retrospective comparative studies were included, comprising 4,877 individuals. The prevalence of HP infection in gastric resected specimens ranged from 7.77 to 43.20%. There were no statistically significant differences between groups for overall complications (OR 1.46; 95%CI 0.95-2.23; p=0.08), bleeding (OR 1.35; 95%CI 0.70-2.60; p=0.38), and leak (OR 1.74; 95%CI 0.80-3.81; p=0.17) rates. The need for routine screening and treatment of HP infection before SG remains ambiguous.