Santoro Sérgio, Velhote Manoel Carlos Prieto, Malzoni Carlos Eduardo, Milleo Fábio Quirino, Klajner Sidney, Campos Fábio Guilherme
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Sao Paulo Med J. 2006 Jul 6;124(4):192-7. doi: 10.1590/s1516-31802006000400004.
Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach.
Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná.
The technique included vertical (sleeve) gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum), i.e. the lower limit for normal adults. The operations on 100 patients are described.
The mean follow-up was nine months (range: one to 29 months). The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m2, respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7% of patients, all of them resolved without sequelae. There was no mortality.
This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1) and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.
大多数减肥手术技术本质上都包含非生理性特征，如吻合口或束带变窄，或消化道节段切除，尤其是十二指肠切除。这可能会引发症状或并发症。本文旨在报告一种采用生理和进化方法治疗病态肥胖的新手术技术的初步结果。
病例系列描述，研究地点为圣保罗的以色列人阿尔伯特·爱因斯坦医院、军事警察医院以及巴拉那州蓬塔格罗萨的维森蒂诺医院。
该技术包括垂直（袖状）胃切除术、网膜切除术和肠切除术，保留了3米小肠（起始空肠和大部分回肠），这是正常成年人的下限。本文描述了对100例患者实施的手术。
平均随访时间为9个月（范围：1至29个月）。在1、2、4、6和12个月时，体重指数的平均降低值分别为4.3、6.1、8.1、10.1和10.7kg/m²。所有患者均表示出现了早饱现象。合并症有显著改善，尤其是糖尿病。7%的患者出现手术并发症，所有并发症均无后遗症地得到解决。无死亡病例。
该手术创建了比例缩小的胃肠道，其基本功能未受损害，且胃腔大小能适应高热量饮食。它消除了胃饥饿素、纤溶酶原激活物抑制剂-1（PAI-1）和抵抗素的产生来源，并使更多营养物质进入远端肠道，产生了理想的代谢结果。患者无需营养支持或药物治疗。该手术操作简单且安全。
