FLAVIO MASATO KAWAMOTO

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 4 Citação(ões) na Scopus
    C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass
    (2021) CLEVA, Roberto de; KAWAMOTO, Flavio; BORGES, Georgia; CAPRONI, Priscila; CASSENOTE, Alex Jones Flores; SANTO, Marco Aurelio
    OBJECTIVES: Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS: We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770 (R)) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS: The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION: Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.
  • conferenceObject
    ANALYSIS OF LIVER FUNCTION IN THE OBESE PATIENT AND ITS CORRELATION WITH METABOLIC COMORBIDITIES NASH and bariatric surgery
    (2019) SILVA, M. B. D. B. E.; MESQUITA, G. H. A. D.; MOTA, F. C.; KAWAMOTO, F. M.; DANTAS, A. C. B.; MARSON, A. G.; MATSUDA, M.; ANDRAUS, W.; SANTO, M. A.
  • bookPart 1 Citação(ões) na Scopus
    Surgical options in type 2 diabetes
    (2015) PAJECKI, D.; RICCIOPPO, D.; KAWAMOTO, F.; SANTO, M. A.
    The onset of type 2 diabetes is characterized by a nonreversible complex cycle that includes severe deleterious effects on glucose metabolism. Obesity, but mainly visceral adipose tissue accumulation, is an important factor in this process. The goals of diabetes management in clinical practice, despite the improvement over the years, are often not met. In the last 20 years, based on observations of bariatric surgery series that have shown great improvement of type 2 Diabetes in morbid obese patients, metabolic surgery has emerged as a therapeutic possibility. In 2011 the International Diabetes Federation released its position statement mentioning that bariatric surgery was an accepted option for T2DM patients with BMI > 35 kg/m2 and might be considered an alternative therapy for patients with BMI ≤ 35 kg/m2 who do not respond to standard medical therapy. Metabolic/bariatric surgery includes the application of conventional bariatric procedures (Roux-en-Y gastric bypass, biliopancreatic diversion, sleeve gastrectomy) and the introduction of new procedures (ileal interposition, intestinal bipartition) designed with the specific aim of having metabolic effects, irrespective of causing massive weight loss. The reversal of T2DM occurs due to mechanisms such as the increase in insulin sensitivity associated with an improvement in beta-cell function, including recovering the first phase of insulin secretion. This recovery is a consequence of the increase of GLP-1 production, and change in circulating bile acids. Remission of diabetes is observed on the first postoperative days after the operation. © Springer International Publishing Switzerland 2015.
  • article 24 Citação(ões) na Scopus
    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, Ivan
    OBJECTIVES: 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.
  • 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.
  • article 13 Citação(ões) na Scopus
    EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment
    (2013) SANTO, Marco Aurelio; PAJECKI, Denis; RICCIOPPO, Daniel; CLEVA, Roberto; KAWAMOTO, Flavio; CECCONELLO, Ivan
    Context 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.
  • conferenceObject
    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, I
    Introduction 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, I
    Introduction 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
    LAPAROSCOPIC SLEEVE GASTRECTOMY AFTER LIVER TRANSPLANTATION - VL.071
    (2014) PAJECKI, D.; SANTO, M.; JOAQUIM, H. D.; KAWAMOTO, F.; CESCONETTO, D.; MACACARI, R.; ANDRAUS, W.; D'ALBUQUERQUE, L. C.; CECCONELLO, I.
  • bookPart
    Avaliação e preparo do paciente para cirurgia bariátrica e metabólica
    (2016) PAJECKI, Denis; OLIVEIRA, Daniel Riccioppo Cerqueira Ferreira de; SANTO, Marco Aurelio; KAWAMOTO, Flavio