MARCO AURELIO SANTO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Gastroenterologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/35 - Laboratório de Nutrição e Cirurgia Metabólica do Aparelho Digestivo, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Robotic-assisted (RAMIE) x thoracoscopic esophagectomy (MIE): Comparison on safety and lymph nodal dissection in 181 cases.(2018) SALLUM, Rubens Antonio Aissar; TAKEDA, Flavio Roberto; SANTO, Marco Aurelio; CECCONELLO, IvanconferenceObject Effects Of Exercise Training On Strength And Functionality In Obese Subjects Undergoing Bariatric Surgery: Preliminary Findings(2018) ROSCHEL, Hamilton; GIL, Saulo; DANTAS, Wagner S.; MURAI, Igor H.; MEREGE FILHO, Carlos; SANTO, Marco A.; CLEVA, Roberto; GUALANO, Bruno- Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis(2018) BRUNALDI, Vitor Ottoboni; JIRAPINYO, Pichamol; MOURA, Diogo Turiani H. de; OKAZAKI, Ossamu; BERNARDO, Wanderley M.; GALVO NETO, Manoel; CAMPOS, Josemberg Marins; SANTO, Marco Aurelio; MOURA, Eduardo G. H. deRoux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure. Despite its high efficacy, some patients regain part of their lost weight. Several endoscopic therapies have been introduced as alternatives to treat weight regain, but most of the articles are relatively small with unclear long-term data. To systematically assess the efficacy of endoscopic therapies for weight regain after RYGB. We searched MEDLINE, EMBASE, Scopus, Web of Science, Cochrane, OVID, CINAHL/EBSCo, LILACS/Bireme, and gray literature. Primary outcomes were absolute weight loss (AWL), excess weight loss (EWL), and total body weight loss (TBWL). Thirty-two studies were included in qualitative analysis. Twenty-six described full-thickness (FT) endoscopic suturing and pooled AWL, EWL, and TBWL at 3 months were 8.5 +/- 2.9 kg, 21.6 +/- 9.3%, and 7.3 +/- 2.6%, respectively. At 6 months, they were 8.6 +/- 3.5 kg, 23.7 +/- 12.3%, and 8.0 +/- 3.9%, respectively. At 12 months, they were 7.63 +/- 4.3 kg, 16.9 +/- 11.1%, and 6.6 +/- 5.0%, respectively. Subgroup analysis showed that all outcomes were significantly higher in the group with FT suturing combined with argon plasma coagulation (APC) (p < 0.0001). Meta-analysis included 15 FT studies and showed greater results. Three studies described superficial-thickness suturing with pooled AWL of 3.0 +/- 3.8, 4.4 +/- 0.07, and 3.7 +/- 7.4 kg at 3, 6, and 12 months, respectively. Two articles described APC alone with mean AWL of 15.4 +/- 2.0 and 15.4 +/- 9.1 kg at 3 and 6 months, respectively. Full-thickness suturing is effective at treating weight regain after RYGB. Performing APC prior to suturing seems to result in greater weight loss. Head-to-head studies are needed to confirm our results. Few studies adequately assess effectiveness of other endoscopic techniques.
- Cholecystectomy in Patients Submitted to Bariatric Procedure: A Systematic Review and Meta-analysis(2018) TUSTUMI, Francisco; BERNARDO, Wanderley M.; SANTO, Marco A.; CECCONELLO, IvanWeight loss following bariatric surgery increases risk for biliary stones. This study performed a meta-analysis evaluating cholecystectomy risks in bariatric patients. A systematic review and meta-analysis were performed. We evaluated the incidence rate for biliary complications in patients followed after bariatric surgery. We compared the risks for mortality, complications, and in hospital stay among patient submitted to cholecystectomy before, concomitantly with or after bariatric surgery, as well as patients submitted to bariatric surgery and cholecystectomy, and patients submitted only to bariatric surgery in order to evaluate when to perform cholecystectomy in morbidly obese patients. The incidence rate of biliary complications was 5.54 cases/1000 patient year. The addition of cholecystectomy to bariatric surgery resulted in an increased risk for complications (RD = 0.02). The risk for complications (RD = - 0.09) and reoperation (RD = - 0.02) was lower when performed concomitantly with bariatric surgery compared to post-bariatric procedure. Prophylactic cholecystectomy may be avoided. Patients submitted to bariatric surgery have low incidence rate of biliary complications, and concomitant cholecystectomy increases the risk for postoperative complications and operative time. If cholecystectomy is not indicated, patients should be carefully followed with attention for biliary complications, once cholecystectomy performed post-bariatric surgery is at higher risk for complications and reoperations.
- Efficacy and Safety of Stents in the Treatment of Fistula After Bariatric Surgery: a Systematic Review and Meta-analysis(2018) OKAZAKI, Ossamu; BERNARDO, Wanderley M.; BRUNALDI, Vitor O.; CLEMENTE JUNIOR, Cesar C. de; MINATA, Mauricio K.; MOURA, Diogo T. H. de; SOUZA, Thiago F. de; CAMPOS, Josemberg Marins; SANTO, Marco Aurelio; MOURA, Eduardo G. H. deFistula development is a serious complication after bariatric surgery. We performed a systematic review and meta-analysis to assess the efficacy of fistula closure and complications associated with endoscopic stent treatment of fistulas, developed after bariatric surgeries, particularly Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS). Studies involving patients with fistula after RYGB or GS and those who received stent treatment only were selected. The analyzed outcomes were overall success rate of fistula closure, mean number of stents per patient, mean stent dwelling time, and procedure-associated complications. Current evidence from identified studies demonstrates that, in selected patients, endoscopic stent treatment of fistulas after GS or RYGB can be safe and effective.
- Reversal of Improved Endothelial Function After Bariatric Surgery Is Mitigated by Exercise Training(2018) DANTAS, Wagner Silva; GIL, Saulo; MURAI, Igor Hisashi; COSTA-HONG, Valeria; PECANHA, Tiago; MEREGE-FILHO, Carlos Alberto Abujabra; SA-PINTO, Ana Lucia de; CLEVA, Roberto de; SANTO, Marco Aurelio; PEREIRA, Rosa Maria Rodrigues; KIRWAN, John P.; ROSCHEL, Hamilton; GUALANO, Bruno
- Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy Treatments for Obesity: Systematic Review and Meta-Analysis of Short- and Mid-Term Results(2018) BARRICHELLO, Sergio; MINATA, Mauricio Kazuyoshi; GORDEJUELA, Amador Garcia Ruiz de; BERNARDO, Wanderley Marques; SOUZA, Thiago Ferreira de; GALVO NETO, Manoel; MOURA, Diogo Turiani Hourneaux de; SANTO, Marco Aurelio; MOURA, Eduardo Guimares Hourneaux deLaparoscopic greater curvature plication (LGP) has recently emerged as a new bariatric procedure. This surgery provides gastric restriction without resection, which could potentially provide a lower risk alternative, with fewer complications. The real benefit of this technique in the short and long term is unknown. This systematic review aims to compare laparoscopic gastric plication and laparoscopic sleeve gastrectomy for obesity treatment. Clinical trials were identified in MEDLINE, Embase, Cochrane, LILACS, BVS, SCOPUS, and CINAHL databases. Comparison of LGP and laparoscopic sleeve gastrectomy (SG) included hospital stay, operative time, loss of hunger feeling, body mass index loss (BMIL), percentage of excess weight loss (%EWL), complications, symptoms in the postoperative period, and comorbidity remission or improvement. This systematic review search included 17,423 records. Eight studies were selected for meta-analysis. There is no difference in operative time, hospital stay, and complications. Patients in the SG group had improved loss of hunger feeling. BMIL was better in the SG group at 12 and 24 months [mean difference (MD) - 2.19, 95% confidence interval (CI) - 3.10 to - 1.28, and MD - 4.59, 95% CI - 5.55 to - 3.63, respectively]. SG showed improved %EWL compared with gastric plication in 3, 6, 12, and 24 months. However, no difference was found in %EWL long-term results (24 and 36 months). Patients who underwent LGP had more sialorrhea. SG showed better results in diabetes remission. SG showed improved weight loss when compared with LGP, with better satiety, fewer symptoms in the postoperative period, and improved diabetes remission.
- TRUNK BODY MASS INDEX: A NEW REFERENCE FOR THE ASSESSMENT OF BODY MASS DISTRIBUTION(2018) TAKESIAN, Mariane; SANTO, Marco Aurelio; GADDUCCI, Alexandre Vieira; SANTAREM, Gabriela Correia de Faria; GREVE, Julia; SILVA, Paulo Roberto; CLEVA, Roberto deBackground: Body mass index (BMI) has some limitations for nutritional diagnosis since it does not represent an accurate measure of body fat and it is unable to identify predominant fat distribution. Aim: To develop a BMI based on the ratio of trunk mass and height. Methods: Fifty-seven patients in preoperative evaluation to bariatric surgery were evaluated. The preoperative anthropometric evaluation assessed weight, height and BMI. The body composition was evaluated by bioimpedance, obtaining the trunk fat free mass and fat mass, and trunk height. Trunk BMI (tBMI) was calculated by the sum of the measurements of the trunk fat free mass (tFFM) and trunk fat mass (tFM) in kg, divided by the trunk height squared (m(2)). The calculation of the trunk fat BMI (tfBMI) was calculated by tFM, in kg, divided by the trunk height squared (m(2)). For the correction and adjustment of the tBMI and tfBMI, it was calculated the relation between trunk extension and height, multiplying by the obtained indexes. Results: The mean data was: weight 125.3 +/- 19.5 kg, height 1.63 +/- 0.1 m, BMI was 47 +/- 5 kg/m(2) and trunk height was 0.52 +/- 0,1 m, tFFM was 29.05 +/- 4,8 kg, tFM was 27.2 +/- 3.7 kg, trunk mass index was 66.6 +/- 10.3 kg/m(2), and trunk fat was 32.3 +/- 5.8 kg/m(2). In 93% of the patients there was an increase in obesity class using the tBMI. In patients with grade III obesity the tBMI reclassified to super obesity in 72% of patients and to super-super obesity in 24% of the patients. Conclusion: The trunk BMI is simple and allows a new reference for the evaluation of the body mass distribution, and therefore a new reclassification of the obesity class, evidencing the severity of obesity in a more objectively way.
conferenceObject ENDOSCOPIC VACUUM THERAPY FOR ESOPHAGEAL POST-MEGASTENT PERFORATION.(2018) BRUNALDI, Vitor O.; RICCIOPPO, Daniel; MOURA, Diogo T. de; MINATA, Mauricio K.; MORITA, Flavio Hiroshi A.; ROCHA, Rodrigo S.; FARIAS, Galileu F.; SANTO, Marco Aurelio; MOURA, Eduardo G. de- Cardiac Remodeling Patterns in Severe Obesity According to Arterial Hypertension Grade(2018) CLEVA, Roberto de; ARAUJO, Victor Arrais; BUCHALLA, Carla Cristina Ornelas; COSTA, Fabio de Oliveira; CARDOSO, Acacio Fernandes; PAJECKI, Denis; SANTO, Marco AurelioThe purpose of this study is to correlate the left ventricular hypertrophy (LVH) patterns according to severe obesity and arterial hypertension (AHT) grades. A cross-sectional prospective study was conducted in 379 patients with severe obesity. Obesity was classified according to the BMI in the following: morbidly obese (MO; 40 < BMI < 50 kg/m(2)) and super obese (SO; BMI > 50 kg/m(2)). The AHT was classified into classes 1 and 2 according to American Heart Association. The presence of LVH and the pattern of cardiac remodeling were determined by transthoracic echocardiography. LVH was present in 58.6% of patients. Obesity and AHT had additive effects in LVH prevalence. LVH was found in 32.9 and 46.7% of MO with AHT grades 1 and 2, respectively. LVH was diagnosed in 39.1% in SO with AHT grade 1 and in 50% of AHT grade 2. Patients with AHT presented a significantly higher risk of developing LVH (OR 1.97; p = 0.003). Hypertension grade was also a determinant variable in the development of LVH. Patients with AHT 2 had 4.31-fold greater risk (p < 0.001) when compared to normotensive patients. BMI was only considered an independent risk factor for LVH in patients with BMI greater than 47.17 kg/m(2) (OR 1.62; p = 0.023). AHT is a stronger predictive factor of LVH than obesity grade.