DANIEL RICCIOPPO CERQUEIRA FERREIRA DE OLIVEIRA
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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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.
- 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.
bookPart Avaliação e preparo do paciente para cirurgia bariátrica e metabólica(2016) PAJECKI, Denis; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; SANTO, Marco Aurelio; KAWAMOTO, FlavioconferenceObject LATE POSTOPERATIVE OUTCOME OF ROUX-EN-Y GASTRIC BYPASS IN MORBIDLY OBESE PATIENTS - ANALYSIS OF THE INFLUENCE OF GASTROINTESTINAL HORMONES IN WEIGHT REGAIN(2015) SANTO, Marco; RICCIOPPO, Daniel; PAJECKI, Denis; KAWAMOTO, Flavio; JOAQUIM, Henrique; CLEVA, Roberto; ANTONANGELO, Leila; MARCAL, Lia; GARMS, Alan; CECCONELLO, IvanconferenceObject ROBOTIC REVISIONAL GASTRIC BYPASS: POUCH ""REDO"" AND HIATAL HERNIA REPAIR(2015) PAJECKI, Denis; SANTO, Marco Aurelio; PUZZO, Daniel Bauab; JOAQUIM, Henrique; RICCIOPPO, Daniel- One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as Revisional Surgery After Sleeve Gastrectomy: a Systematic Review and Meta-analysis(2022) DANTAS, Anna Carolina Batista; BRANCO, Leonardo Torres; TUSTUMI, Francisco; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; PAJECKI, Denis; SANTO, Marco AurelioThe demand for revisional bariatric surgery after sleeve gastrectomy (SG) has increased, but the ideal procedure remains unclear. A systematic review and meta-analysis were performed to compare the outcomes of weight loss and safety of one-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) as revisional procedures for failed SG. Four retrospective comparative studies were included, comprising 499 individuals. Patients submitted to OAGB had a more significant total weight loss (TWL) (MD = - 5.89%; 95% CI - 6.80 to - 4.97) after revisional surgery. Overall early complication rate was similar between procedures (RD = 0.04; 95% CI: - 0.05 to 0.12). Limited and heterogeneous data prevent meaningful conclusions, but the present analysis suggests that OAGB has a better TWL after revisional surgery.
- Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial)(2020) PAJECKI, Denis; DANTAS, Anna Carolina Batista; KANAJI, Ana Lumi; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; CLEVA, Roberto de; SANTO, Marco AurelioBackground: The aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population. Objectives: The aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients. Setting: University hospital, Sao Paulo, Brazil. Methods: We performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged >= 65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification. Results: A total of 36 patients, with a BMI between 35.5 and 52.8 kg/m(2) were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P=.13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P=.07). Each group had 1 readmission and there was no mortality in 90-day follow-up. Conclusions: Morbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGBin this population setting.
- Small-Volume, Fast-Emptying Gastric Pouch Leads to Better Long-Term Weight Loss and Food Tolerance After Roux-en-Y Gastric Bypass(2018) RICCIOPPO, Daniel; SANTO, Marco Aurelio; ROCHA, Manoel; BUCHPIGUEL, Carlos Alberto; DINIZ, Marcio Augusto; PAJECKI, Denis; CLEVA, Roberto de; KAWAMOTO, FlavioAnatomical and functional influences on gastric bypass (GBP) results are often poorly evaluated and not yet fully understood. The purpose of this study is to evaluate the influence of the gastric pouch volume and its emptying rate on long-term weight loss and food tolerance after GBP. Weight loss, food tolerance, pouch volumetry (V) by three-dimensional reconstruction, and pouch emptying rate by 4 h scintigraphy were evaluated in 67 patients. Cutoffs were identified for V and retention percentage (%Ret) at 1 h (%Ret1). From these parameters, the sample was categorized, looking for associations between V, %Ret, weight loss, and food tolerance, assessed by a questionnaire for quick assessment of food tolerance (SS). PO median follow-up time was 47 months; median V was 28 mL; %Ret at 1, 2, and 4 h were 8, 2, and 1%, respectively. There were associations between V <= 40 mL and higher emptying rates up to 2 h (V <= 40 mL: %Ret1 = 6, %Ret2 = 2, p = 0.009; V > 40 mL: %Ret1 = 44, %Ret2 = 13.5, p = 0.045). An association was found between higher emptying speed in 1 h and higher late weight loss (WL), represented by lower percentage of excess weight loss (%EWL) regain (p = 0.036) and higher %EWL (p = 0.033) in the group with %Ret1 <= 12%, compared to the group %Ret1 >= 25%. Better food tolerance (SS > 24), was associated with lower %Ret1 (p = 0.003). Smaller pouch size is associated with a faster gastric emptying, greater WL maintenance, and better food tolerance. These data suggest that a small pouch with rapid emptying rate is an important technical parameter for good outcomes in GBP.
- Weight Regain After Gastric Bypass: Influence of Gut Hormones(2016) SANTO, Marco Aurelio; RICCIOPPO, Daniel; PAJECKI, Denis; KAWAMOTO, Flavio; CLEVA, Roberto de; ANTONANGELO, Leila; MARCAL, Lia; CECCONELLO, IvanThe Roux-en-Y gastric bypass (RYGB) is the gold standard bariatric operation. However, a major concern in late follow-up is the substantial weight regain. Understanding the role of gastrointestinal hormone secretion in this situation is relevant. The aim of the present study was to evaluate the influence of gastrointestinal hormones comparing postprandial secretion of ghrelin, glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and leptin between patients with weight regain and those with favorable weight control. Twenty-four patients with follow-up from 27 to 59 months were divided into two groups according to sustained weight loss: group A (14 patients) had sustained weight losses, and group B (10 patients) had significant weight regain. Basal serum levels of ghrelin, GIP, GLP-1, and leptin after fasting and 30, 60, 90, and 120 min after a standard meal were measured. There was no difference in the ghrelin secretion. There was a difference in the GIP secretion, with a higher percentage increase in 30 min in group A (330 % x 192.2 %; p = 0.01). There were also differences in the GLP-1 secretion, with higher increases in absolute (p = 0.03) and percentage values after 30 min in group A (124 % x 46.5 %; p = 0.01). There was also a difference between baseline leptin values, with higher levels in group B (p = 0.02). The secretion of gut hormones in patients with weight regain after RYGB is different from that in patients with satisfactory weight outcome. After meal stimulation, reduced levels of GIP and GLP-1 may indicate the influence of gut hormones in the process of weight regain.
conferenceObject Baseline Characteristics and Benefit/Risk Assessment of Elderly Obese Patients, Candidates for Bariatric Surgery(2012) SANTO, Marco A.; PAJECKI, Denis; LUMI, Ana; RICCIOPPO, Daniel; OTSUZI, Thiago; CLEVA, Roberto de; CECCONELLO, IvanIntroduction Obesity is associated with exacerbation of the age-related decline in physical function. In the elderly, obesity is associated with loss of functionality and therefore with poor quality of life and loss of independence. Bariatric surgery in elderly people is controversial. By NIH 1991 statement, 65 years old is the age limit for patients who are candidates for surgical treatment of obesity, but in developing countries, elderly is considered as the population above 60 years. Since this population is increasing, the decision of operating is becoming a frequent concern and a big challenge for bariatric surgeons. The assessment of functionality is an important issue to evaluate the risk/benefit of the operation in this population. Objective To evaluate the baseline characteristics (co morbidities, medication use) and functionality (activities of daily living–ADL and instrumental activities of daily living-IADL) in morbid obese patients, who are candidates for bariatric surgery, with 60 years or more. Materials and Methods: Subjects from the bariatric surgery program of Hospital das Clinicas were prospectively evaluated by personal interview, chart revision and application of functionality tests (Lawton, Katz). Results Twenty six patients (18 women and 8 men) have completed the evaluation. The mean age was 64.7 years, mean weight was 121,9Kg and mean BMI was 47.9Kg/m2. All patients had hypertension, 53.8 % were diabetic, 11.5 % reported previous stroke and 30.7 % had cardiac co morbidities (which included myocardial infarction, angina, heart failure and arrhythmia). Pulmonary disease was present in 27.1 % of individuals and 73.1 % had sedentary lifestyle mostly due to pain. The prescription included 7.19 medications per patient with 57.7 % reporting regular pain medication use. With respect to functionality, 30 % and 57 % had impairment in at least one ADL and IADL, respectively. Discussion This characteristics of this population demands a structured and objective plan for the benefit/risk assessment and decision on whom of those patients should be operated and who should not. The application of functionality tests in the pre-op can be useful to separate the patients who will probably benefit of massive weight loss of those who will not. Conclusion In the study population there is a high prevalence of co morbidities, functionality impairment, sedentary lifestyle and polypharmacy.