Sequelas da cirurgia bariátrica

​Estima-se que o excesso de peso seja responsável por 500,000 mortes ao ano nos EUA.[1]Ward ZJ, Willett WC, Hu FB, et al. Excess mortality associated with elevated body weight in the USA by state and demographic subgroup: a modelling study. EClinicalMedicine. 2022 Jun;48:101429. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00159-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/35516446?tool=bestpractice.com Na Inglaterra e na Escócia, estima-se que 23% de todas as mortes sejam atribuídas ao sobrepeso ou obesidade.[2]Ho FK, Celis-Morales C, Petermann-Rocha F, et al. Changes over 15 years in the contribution of adiposity and smoking to deaths in England and Scotland. BMC Public Health. 2021 Feb 11;21(1):169. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10167-3 http://www.ncbi.nlm.nih.gov/pubmed/33568116?tool=bestpractice.com A incidência de obesidade classe III (índice de massa corporal [IMC] de 40 ou mais) está crescendo rapidamente e isso resultou em um aumento drástico das cirurgias bariátricas no mundo inteiro.A cirurgia bariátrica (também conhecida como cirurgia metabólica) demonstrou reduzir substancialmente as taxas de mortalidade por todas as causas entre adultos com obesidade, em comparação com o tratamento não cirúrgico da obesidade.[3]Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021 May 15;397(10287):1830-41. http://www.ncbi.nlm.nih.gov/pubmed/33965067?tool=bestpractice.com Estudos demonstraram que crianças e adolescentes com obesidade classe III beneficiam da cirurgia para perda de peso.[4]NHS England. Clinical Commissioning Policy: Obesity surgery for children with severe complex obesity. April 2017. https://www.england.nhs.uk https://www.england.nhs.uk/commissioning/spec-services/npc-crg/group-e/e02 O mecanismo de ação da cirurgia bariátrica para obesidade não é completamente compreendido atualmente, mas parece incluir restrição do volume gástrico, má absorção e alterações hormonais.​[5]Beckman LM, Beckman TR, Earthman CP. Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc. 2010 Apr;110(4):571-84. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284064 http://www.ncbi.nlm.nih.gov/pubmed/20338283?tool=bestpractice.com ​​[6]Balsiger BM, Poggio JL, Mai J, et al. Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity. J Gastrointest Surg. 2000 Nov-Dec;4(6):598-605. http://www.ncbi.nlm.nih.gov/pubmed/11307094?tool=bestpractice.com

As recomendações relativas ao limiar do IMC para a cirurgia bariátrica diferem entre as diretrizes.[7]National Institute for Health and Care Excellence (NICE). Obesity: identification, assessment and management. Jul 2023​ [internet publication]. https://www.nice.org.uk/guidance/cg189 [8]Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg. 2023 Jan;33(1):3-14. https://link.springer.com/article/10.1007/s11695-022-06332-1 http://www.ncbi.nlm.nih.gov/pubmed/36336720?tool=bestpractice.com [9]Welbourn R, Hopkins J, Dixon JB, et al. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev. 2018 Jan;19(1):14-27. https://onlinelibrary.wiley.com/doi/10.1111/obr.12601 http://www.ncbi.nlm.nih.gov/pubmed/29024367?tool=bestpractice.com [10]Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc. 2020 Jun;34(6):2332-58. https://link.springer.com/article/10.1007/s00464-020-07555-y http://www.ncbi.nlm.nih.gov/pubmed/32328827?tool=bestpractice.com ​​ A American Society of Metabolic and Bariatric Surgery e a International Federation for the Surgery of Obesity and Metabolic Disorders recomendam a cirurgia bariátrica para indivíduos com IMC ≥35 kg/m² com ou sem comorbidades, ou para indivíduos com IMC entre 30.0 e 34.9 kg/m² que não alcançam uma perda de peso durável e o manejo das comorbidades, apesar na terapia não cirúrgica ideal.[8]Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg. 2023 Jan;33(1):3-14. https://link.springer.com/article/10.1007/s11695-022-06332-1 http://www.ncbi.nlm.nih.gov/pubmed/36336720?tool=bestpractice.com A cirurgia bariátrica também é uma opção de tratamento para pacientes com diabetes do tipo 2 e IMC >30 kg/m² que não alcançam perda de peso durável e o manejo das comorbidades, apesar da terapia não cirúrgica ideal.[11]American Diabetes Association Professional Practice Committee; 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of care in diabetes–2024. Diabetes Care. 2024 January 1; 47 (Suppl 1): S145–57. https://diabetesjournals.org/care/article/47/Supplement_1/S145/153942/8-Obesity-and-Weight-Management-for-the-Prevention [8]Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery. Obes Surg. 2023 Jan;33(1):3-14. https://link.springer.com/article/10.1007/s11695-022-06332-1 http://www.ncbi.nlm.nih.gov/pubmed/36336720?tool=bestpractice.com Em indivíduos asiáticos, o limiar de IMC é menor devido a diferenças na composição corporal e no risco cardiometabólico.[11]American Diabetes Association Professional Practice Committee; 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: standards of care in diabetes–2024. Diabetes Care. 2024 January 1; 47 (Suppl 1): S145–57. https://diabetesjournals.org/care/article/47/Supplement_1/S145/153942/8-Obesity-and-Weight-Management-for-the-Prevention

Após a cirurgia bariátrica, é possível que os pacientes compareçam a clínicas, prontos-socorros ou hospitais diferentes daqueles onde foram operados. Assim, torna-se necessário o conhecimento das complicações comuns.[12]Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. American Society for Metabolic and Bariatric Surgery position statement on emergency care of patients with complications related to bariatric surgery. Surg Obes Relat Dis. 2010 Mar 4;6(2):115-7. http://www.ncbi.nlm.nih.gov/pubmed/20189469?tool=bestpractice.com ​ O abdome com adiposidade central pode ser difícil de examinar, podendo mascarar sinais típicos de sepse.É essencial prestar muita atenção aos sinais vitais, aos achados do exame físico e a qualquer mudança em relação à evolução pós-operatória esperada.