DANIEL RICCIOPPO CERQUEIRA FERREIRA DE OLIVEIRA
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Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject LIVER FUNCTION IMPROVEMENT AFTER BARIATRIC SURGERY: USING THE INDOCYANINE GREEN TEST IN THE FOLLOW-UP OF OBESE PATIENTS NASH and bariatric surgery(2019) SILVA, M. B. D. B. E.; MESQUITA, G. H. A. D.; DANTAS, A. C. B.; MOTA, F. C.; KAWAMOTO, F. M.; PAJECKI, D.; RICCIOPPO, D.; CLEVA, R. D.; ANDRAUS, W.; SANTO, M. A.; CECCONELLO, I.conferenceObject ANEMIA BEFORE AND AFTER BARIATRIC SURGERY: PREVALENCE AND EVOLUTION ON LONG-TERM FOLLOW UP(2015) SANTO, Marco; FUKUMOTO, Miwa; KANASHIRO, Newton; CURADO, Taina; DANTAS, Anna; JOAQUIM, Henrique; GARMS, Alan; RICCIOPPO, Daniel; CLEVA, Roberto; CECCONELLO, IvanconferenceObject Assessment of Body Composition in Morbid Obesity: a Comparative Study Between Body Impedance and Adiposity index Methods(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Obesity has become an epidemic public health problem. A reliable method to assess body composition and monitor the effectiveness of treatments for the morbid obesity is mandatory. However, there is still controversy as to which method to use for this purpose. Two Methods are validated in the literature, bioelectrical impedance analysis (BIA) and body adiposity index (BAI). The present study compared these methodologies. Materials & Methods We evaluated 167 patients undergoing bariatric surgery, women prevailed (82.59 %), averaging 44 years-old and mean BMI of 49.48 kg/m2. Weight, height and hip circumference were measured. Body fat (BF) was calculated by BIA and BAI. The following formulas were used: BIA: BF in kg=023.25+(0.09x resistance in ohms)+(1.00x weight in kg)-(0.08xheight in cm)+(0.13x age in years). BAI: BF% of the total weight 0 (hip circumference in centimeters/height in meters x height in meters)-18. Results The patients had an average of 53.35 % (± 5.37) of BF according to BIA, and BAI showed 50.51 % (± 13.59) of BF. There is no difference between the two Methods (p<0,05), even when stratified by BMI (BMI<45, 4550). Essa diferença variou quando o IMC foi dividido em três faixas, abaixo de 45 kg/m2 a diferença foi de 3,1 %, entre 45,1 a 49,99 kg/m2 a diferença foi de 3,78 %, acima de 50 kg/m2 a diferença foi de 1,86%. Discussion The BAI is a simple method of implementation, low cost and effective, when compared to other Methods validated for morbidly obese patients. Conclusion BAI is an effective method to assess BF, comparable to BIA, and also proved to be effective in super obese patients.conferenceObject Preoperative Weight Loss in Super Obesity: Influence on Perioperative Morbidity and Mortality in Patients undergoing Gastric Bypass(2012) SANTO, M. A.; RICCIOPPO, D.; PAJECKI, D.; KAWAMOTO, F.; MATSUDA, M.; CECCONELLO, IIntroduction Super obesity (SO) is increasing in greater proportions, and now represents 30 % of morbidly obese patients. In SO morbidity and mortality rates are greater. The preoperative weight loss in SO decreases operative time, and apparently diminishes morbidity. Based on these data, we initiated a program of preoperative weight loss for the SO. The treatment is based on hospitalization, low-calorie diet, biometrics control and physical activities, aiming to analyze weight loss and influence of weight loss in the perioperative outcome. Materials & Methods Thirty patients underwent our SO preop weight loss program, from 2006 to 2011. The mean age was 46 years, and mean BMI of 66 kg/m2 and the majority was female. All patients underwent gastric bypass after the weight loss. The average caloric intake was 5 cal/Kg/day. Results The mean weight loss was 1.9 kg/week, and after 14 weeks the mean weight loss was15.2 % of initial weight. The mean hospital stay was 21.3 weeks, and the mean weight loss was 19.7 %. All had satisfactory recovery from surgery. The mortality was null. In the last five years, from the total of 592 surgeries, 193 was performed in SO. The SO and general morbidity was 11.14 % and 20.2 %, respectively, and mortality 0.84 % and 2.07 %. Discussion In SO a preoperative weight loss is an important tool to reduce surgical risks. Hospitalization, with low-calorie diet and multidisciplinary follow-up is a safe and effective way to achieve weight loss preoperatively. Conclusion After a mean of 19,7 % of initial body weight loss, the studied group showed an important decreasing in morbimortality when compared with our previous experience. Preoperative weight loss should be encouraged in SO, and a specific program can significantly diminish surgical risks in this complex group of obeses.conferenceObject 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.
- 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 Body Composition in Morbid Obesity: Correlation Between Body Adiposity Index and Bioelectric Impedance(2013) SANTO, M.; CLEVA, R. de; PAJECKI, D.; BERNHARD, A. Biasetto; RICCIOPPO, D.; CECCONELLO, I.Introduction: Obesity has become an important public health problem. According, prevalence of morbid obesity is also growing. There is no consensus about the best method to measure body composition in morbid obesity individuals. A simple, easy, accurate, reproducible and inexpensive method is desirable. The aim of this study was to compare two methods that estimate body fat percentage (%BF), Body Adiposity Index (BAI) and Bioelectric Impedance (BI). Population and Methods: We prospectively evaluated 233 adults with indication for surgical treatment of morbid obesity at Bariatric and Metabolic Group at Hospital das Clinicas, University of Sao Paulo Medical School. All patients over eighteen years old were included after an Informed Consent and Agreement (Ethics Committee protocol number 8848). The data were collected before any intervention. Weight (Wgt) and height (Hgt) were measured in a Welmy scale. The circumferences were made with an inelastic tape-measure in a horizontal line. Waist circumference was the midpoint between the lower margin of the last palpable rib and the top of the iliac crest. Hip circumference (HC) was the maximum circumference of the buttocks. BI was made using Biodinamics equipment (model 310) with the person lies. Four electrodes were fixed in pairs in the right hand and bare feet. An electrical signal is introduced and an impedance value is obtained. This is then entered into an equation: BI= 23,25+(0,09xR)+ (1,00xWgt)-(0,08xHtg)+(0,13xYrs) (BI in kilograms of BF, R=resistance in owns, Wgt in kilograms, Htg in centimeters and age in years). BAI was determined according to the equation: BAI=(HC/Hgt x Hgt)-18 (BAI in %BF, HC in centimeters and Hgt in meters); Results: Mean age was 44±11.34 years and mean body mass index (BMI) was 49.13±7.65kg/m 2. The female prevalence was higher (78.5%) and 41.2% was super obese (BMI50kg/m 2). Mean BF was 52.15% (±6.04%) by BI and 51.49% (±8.22%) by BAI. The difference between than was 0.67% (±5.21%), interclass correlation of 0.74 (CI 95%:0.67-0.79). BAI had no significant error in women (p=0.611) and in super obese (p=0.368). A significant error was observed in men (p=0.06), in patients with BMI<50 kg/m 2 (p<0.001) and when the waist-hip ratio (WHR) was more than 1.06 (p=0,010). We observed that BAI underestimated %BF BI in men (2,44%), in patients with BMI<50 kg/m 2 (1,49%) and when the waist-hip ratio (WHR) was more than 1.06 (5,35%). Conclusion: BAI is an inexpensive and non-invasive method that was successfully used to determine BF in morbid obese adults, especially in women and super obese patients with a WHR less than 1.06.