Arquivos Brasileiros De Cirurgia Digestiva[JOURNAL]
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200 papers
Repercussions of bariatric surgery on bone mineral density: a comparative analysis between Roux-en-Y gastric bypass and sleeve gastrectomy.
Fradique BNSS, Costa AS, Antunes MC … +3 more , Rodrigues ATDS, Santa-Cruz F, Ferraz ÁAB
Arq Bras Cir Dig · 2026 · PMID 41637335 · Publisher ↗
BACKGROUND: Malabsorption of micronutrients including calcium and vitamin D may lead to pathological bone fractures in the late postoperative period of bariatric surgery. AIMS: The aim of this study was to evaluate the e...
BACKGROUND: Malabsorption of micronutrients including calcium and vitamin D may lead to pathological bone fractures in the late postoperative period of bariatric surgery. AIMS: The aim of this study was to evaluate the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on bone mineral density (BMD) and calcium and vitamin D intake after 3 years of surgery. METHODS: Cross-sectional study that included 66 patients in the late postoperative period of bariatric surgery to analyze their BMD. Anthropometric and demographic data were collected, and a 24-hour recall questionnaire was carried out to assess food consumption patterns. BMD was assessed by bone densitometry of the femur and spine, and the values were expressed as z-scores. RESULTS: The mean age was 40.1 years, 86.4% were female. RYGB was performed in 60.3% and SG in 39.7%. There was no significant difference between the techniques when comparing anthropometry, body composition, and food consumption patterns. There was a positive correlation, after RYGB, between femoral z-score, calcium and vitamin D intake, and multivitamin supplementation. A total of 12.7% of the sample had compromised bones, and among these, 87.5% underwent RYGB, 100% had inadequate consumption of calcium and vitamin D, and 12.5% were in menopause. CONCLUSIONS: A small percentage of the sample showed bone loss after RYGB and SG. The type of surgery was not a significant factor in changing BMD. However, all those affected had a low intake of calcium and vitamin D.
Prognostic and predictive value of AXL and C-MET in patients with rectal cancer.
Ribas CAPM, N Doelken E, Tripathi S … +7 more , Polat B, Lissner R, Böeldicke T, Ribas-Filho JM, Malafaia O, Gasser M, Waaga-Gasser AM
Arq Bras Cir Dig · 2026 · PMID 41563267 · Full text
BACKGROUND: Rectal cancer remains a significant clinical challenge with demand for conclusive biomarkers, essential in prognostication and therapy monitoring of neoadjuvant and adjuvant treatment strategies. AIMS: The ai...
BACKGROUND: Rectal cancer remains a significant clinical challenge with demand for conclusive biomarkers, essential in prognostication and therapy monitoring of neoadjuvant and adjuvant treatment strategies. AIMS: The aim of the study was to evaluate AXL and cellular mesenchymal-epithelial transition factor (C-MET) biomarkers for cancer stem cells and to correlate them with clinicopathological characteristics and patient outcome data with respect to neoadjuvant chemoradiotherapy. METHODS: Serum levels of soluble surface markers AXL and C-MET were retrospectively analyzed in 164 rectal cancer patients with additional immunofluorescent analyses of their primary tumor tissues. RESULTS: Kaplan-Meier analysis confirmed the prognostic significance of Union for International Cancer Control stages, but with no significant correlation between investigated markers with patient age, gender, or tumor stage. In contrast, tumor tissues demonstrated stage-dependently increased marker expression. While AXL was detected at low levels, C-MET exhibited a bimodal distribution, with elevated levels seen in most patients, particularly post-neoadjuvant therapy and non-significantly in the subgroup with poorer response to neoadjuvant therapy (p=0.074). CONCLUSIONS: AXL serum levels in the rectal cancer cohort were significantly different from healthy subjects but did not correlate with tumor stage or survival during and after neoadjuvant/adjuvant therapy. Soluble C-MET levels in the blood, influenced by neoadjuvant chemoradiotherapy, may serve as a predictive marker for treatment response.
Weight loss and self-perceived quality of life following laparoscopic Roux-en-Y gastric bypass: is it important?
Castro GRA, Macedo LD, Ferri JVV … +5 more , Vulcanis IB, Andrade DP, Sadowski JA, Bastos ELS, Marchesini JCD
Arq Bras Cir Dig · 2026 · PMID 41538507 · Full text
BACKGROUND: Weight loss (WL) is the most commonly used datum to measure the results of metabolic and bariatric surgery. The amount of WL is generally directly and proportionally associated with the improvement in quality...
BACKGROUND: Weight loss (WL) is the most commonly used datum to measure the results of metabolic and bariatric surgery. The amount of WL is generally directly and proportionally associated with the improvement in quality of life (QoL), as the greater the former, the greater the perception of well-being. AIMS: To assess the relationship between the amount of weight lost after laparoscopic Roux-en-Y gastric bypass (LRYGB) and self-perceived improvement in quality of life (QoL). METHODS: The medical records of patients who underwent LRYGB between January 2017 and December 2019 with a minimum follow-up of 3 years were analyzed. The data obtained in the subgroups made up according to percentage of total weight loss (%TWL), age, and time elapsed since surgery were compared with the self-perceived QoL by the Short Form Survey 36 (SF-36) questionnaire. RESULTS: A total of 95 individuals (71.6% women) with an average age of 45 years and an average postoperative (PO) follow-up of 61.1 months were enrolled. The mean pre- and postoperative weight was 114 kg and 73.4 kg, respectively, and the mean %TWL was 35.6%. According to the comparison between the data from the medical records and the self-perceived QoL assessment, D1 (physical functioning) was the best scoring domain, while D3 (pain) was the worst. There was a significant improvement of the D4 (general health) domain in patients with %TWL greater than 30% (p<0.05), D7 (role emotional), and D8 (mental health) domains in patients older than 45 years (p<0.05) and better results in D7 (role emotional) domain in patients over 5 years after surgery (p<0.05). CONCLUSIONS: Greater weight loss and age and longer time after surgery showed important self-perceived improvement in QoL after LRYGB in some assessment domains, both physical and emotional.
Validity of scoring system for palliative care in oncology: CODETM - "Care of the dying evaluation". Is it important in assessing the end-of-life process?
Oliveira TM, Passarini JN, Haugen DF … +2 more , Mayland CR, Lopes LR
Arq Bras Cir Dig · 2026 · PMID 41538506 · Full text
BACKGROUND: Patients with advanced cancer experience a range of distressing symptoms. Palliative care (PC) emerges as an essential area to be implemented by health systems in the care of patients with irreversible diseas...
BACKGROUND: Patients with advanced cancer experience a range of distressing symptoms. Palliative care (PC) emerges as an essential area to be implemented by health systems in the care of patients with irreversible diseases and beyond therapeutic possibilities. AIMS: To compare the perception of caregivers of patients in palliative care offered by two public hospitals using the CODETM questionnaire; to determine the score obtained by the questionnaire and its usefulness in the evaluation of the palliative care offered. METHODS: The post-death questionnaire "Care of the Dying Evaluation" (CODETM) was applied to the family members who accompanied the patients in the last days, assessing the perception of the quality of care provided to the patient and the level of support to the family. RESULTS: No statistical difference in demographics. Participants who received palliative care had higher scores in the score, as well as in the ward and ICU unit compared to the emergency unit. The predictive cut-off value for adequate palliative care practice was 97 points, corresponding to 78.6% of the score. CONCLUSIONS: There was no statistical difference between the caregivers' perception of the care offered to patients between the two hospitals, being worse in the emergency unit. The cut-off value was 78.6% and was considered adequate and the CODETM questionnaire was a useful tool in the evaluation of palliative care offered by hospitals to patients and can be applied to propose improvements in palliative care. Therefore, there is a need for an instrument that can constantly classify and qualify the care provided to patients and their families in order to offer dignified, comprehensive and humanized care, as proposed by the CODETM questionnaire.
Preoperative glycemic response to a very low-calorie diet predicts long-term type 2 diabetes remission after bariatric surgery.
Bortolan MFFT, DE Cleva R, Ferreira L … +2 more , Pajecki D, Santo MA
Arq Bras Cir Dig · 2025 · PMID 41417301 · Full text
BACKGROUND: Obesity and type 2 diabetes mellitus are highly prevalent conditions with a significant public health impact, highlighting the need for effective management strategies. Bariatric surgery is widely recognized...
BACKGROUND: Obesity and type 2 diabetes mellitus are highly prevalent conditions with a significant public health impact, highlighting the need for effective management strategies. Bariatric surgery is widely recognized for promoting sustained weight loss and high rates of type 2 diabetes mellitus remission. AIMS: This study investigated the preoperative blood glucose response to a very low-calorie diet as a functional predictor of type 2 diabetes mellitus remission following Roux-en-Y gastric bypass. METHODS: 198 participants who followed a very low-calorie diet (600 kcal/day) during the preoperative period were included, with glycemic response monitoring. RESULTS: Complete remission of type 2 diabetes mellitus occurred in 66.7% of patients. Two years after surgery, patients with blood glucose levels below 143 mg/dL on the second day of the very low-calorie diet had a higher likelihood (over 70%) of achieving complete remission type 2 diabetes mellitus in the late postoperative period. CONCLUSIONS: Preoperative capillary blood glucose levels demonstrated good specificity in predicting remissions. These findings reinforce the clinical utility of early glycemic control as a valuable indicator for predicting the success of surgical treatment for type 2 diabetes mellitus.
Tumor budding in gastric adenocarcinoma: prognostic value and association with clinicopathological markers.
Bacha D, Kammoun N, Troudi B … +3 more , Attia M, Lahmar-Boufaroua A, Ben-Slama S
Arq Bras Cir Dig · 2025 · PMID 41417300 · Full text
BACKGROUND: The analysis of tumor budding (TB) and its prognostic value in gastric adenocarcinoma (GA) has been the focus of several studies, with inconsistent results. This parameter is not included in gastric prognosti...
BACKGROUND: The analysis of tumor budding (TB) and its prognostic value in gastric adenocarcinoma (GA) has been the focus of several studies, with inconsistent results. This parameter is not included in gastric prognostic classifications or standardized pathological reports. AIMS: To evaluate TB in GA and its prognostic significance through survival analysis, in addition to investigating the association between TB and clinicopathological markers that are considered prognostic factors for this type of cancer. METHODS: This retrospective study covers a period of ten years, from January 2008 to December 2017. It included patients who underwent surgery for GA. TB evaluation followed the 2016 consensus guidelines for colorectal cancer, with three grades: Bd1 (0-4 buds), Bd2 (5-9 buds), and Bd3 (10 or more buds). Additionally, a two-grade classification system was employed, distinguishing between low-grade budding (fewer than 10 buds) and high-grade budding (10 or more buds). RESULTS: TB was classified as low-grade in 69% of the cases and high-grade in 31%. High-grade TB was significantly correlated with perineural invasion (HR [hazard ratio]: 2.98, 95%CI [95% confidence interval] 1.04-8.53, p=0.004), stages III and IV (HR 4.04, 95%CI 1.27-12.83, p=0.01), and mortality (HR 3.65, 95%CI 1.24-10.74, p=0.02). It was an independent prognostic factor for recurrence-free survival (RFS) (p=0.005, p<0.05). CONCLUSIONS: We have demonstrated that TB prognostic and predictive value in GA is significant, particularly regarding patient survival.
Predictive factors for histological response to neoadjuvant therapy in gastric adenocarcinomas.
Bacha D, Boudrigua N, Mallek I … +5 more , Chammem S, Attia M, Gharbi L, Lahmar A, Ben-Slama S
Arq Bras Cir Dig · 2025 · PMID 41417299 · Full text
BACKGROUND: Perioperative chemotherapy is the standard curative treatment for resectable gastric adenocarcinoma, significantly improving both overall and recurrence-free survival. The histological response to neoadjuvant...
BACKGROUND: Perioperative chemotherapy is the standard curative treatment for resectable gastric adenocarcinoma, significantly improving both overall and recurrence-free survival. The histological response to neoadjuvant therapy is a critical prognostic factor, commonly assessed through grading systems such as Mandard's tumor regression grade (TRG). AIMS: The aim of the study was to identify predictive factors for histological response to neoadjuvant therapy in gastric adenocarcinoma. METHODS: A retrospective study was performed on patients with gastric adenocarcinoma who underwent surgery following neoadjuvant chemotherapy, from 2015 to 2020. The histological response was evaluated using Mandard TRG, which includes five grades (1-5), based on the proportion of residual viable tumor cells and fibrosis. Grades 1-3 were considered a response, and Grades 4 and 5 were considered no response. Students' t-test, chi-squared test, and multivariate logistic regression were used, with significance set at p<0.05. RESULTS: Forty patients were included (male-to-female ratio 2.64, mean age 63 years). Histological response (TRG 1-3) was observed in 48%, while 52% showed no response (TRG 4-5). Univariate analysis showed significant correlations between histological response and tumor size >38 mm (p=0.03), differentiation (p=0.02), parietal wall invasion, absence of nodal involvement (both p<0.001), pathological tumor, node, and metastasis stage (p<0.001), and absence of vascular and perineural invasion (both p=0.001). Multivariate analysis identified parietal wall invasion (odds ratio=2.351, p=0.022) and absence of lymph node metastases (odds ratio=1.491, p=0.01) as independent predictive factors. CONCLUSIONS: Parietal wall invasion and absence of nodal metastases are predictive of histological response to neoadjuvant therapy in gastric adenocarcinoma.
Gastric sleeve and gastric bypass: changes in weight after two-year follow-up - which is more effective?
Freire AR, Kreimer F, Lima DSC … +3 more , Calado CKM, Silva SAD, Burgos MGPA
Arq Bras Cir Dig · 2025 · PMID 41370427 · Full text
BACKGROUND: Bariatric surgery is currently the gold standard for the treatment of obesity. However, weight recurrence varies among the different surgical methods. AIMS: To compare changes in weight one and two years afte...
BACKGROUND: Bariatric surgery is currently the gold standard for the treatment of obesity. However, weight recurrence varies among the different surgical methods. AIMS: To compare changes in weight one and two years after bariatric surgery considering the gastric bypass and gastric sleeve methods. METHODS: A cross-sectional study was conducted at a hospital with adults of both sexes followed up for two years after surgery. Anthropometric, sociodemographic, clinical, and lifestyle characteristics were analyzed. RESULTS: A total of 184 patients, predominantly women (82.1%), were assessed (136 submitted to gastric sleeve and 48 to gastric bypass). Good adherence to the multivitamin, but not to diet or physical activity, was verified in both groups. The percentages of weight loss and excess weight loss were higher in the gastric bypass group (one year after surgery: p<0.001 and p=0.010, respectively; two years after surgery: p<0.001 and p<0.001, respectively). Average weight gain was 2.37 kg and higher after gastric sleeve (p=0.042), whereas no difference between methods was found for the percentage of weight recurrence. Weight loss and recurrence at the two-year follow-up were influenced by diet in both groups. The percentage of weight loss was higher after gastric bypass one and two years after surgery. Weight recurrence was higher after the gastric sleeve method, without interfering with the surgical success of the technique. CONCLUSIONS: We verified greater efficacy in the gastric bypass technique in terms of weight loss at 12 and 24 months postoperatively. Weight recurrence was found 24 months after both methods, especially in the gastric sleeve group, without constituting surgical failure.
Standardized approach to small bowel bleeding in a hierarchical healthcare network with varying levels of complexity.
Carvalho RP, Gama-Cunha G, Martinez EZ … +1 more , Santos JSD
Arq Bras Cir Dig · 2025 · PMID 41370426 · Full text
BACKGROUND: The systematized approach to patients with small bowel bleeding (SBB) can reduce risks and costs for both patients and the Unified Health System (SUS). AIM: Evaluate the evolution of the systematized approach...
BACKGROUND: The systematized approach to patients with small bowel bleeding (SBB) can reduce risks and costs for both patients and the Unified Health System (SUS). AIM: Evaluate the evolution of the systematized approach to SBB in a regulated, hierarchically organized healthcare network of varying complexity. METHODS: Analysis of the medical records of patients with SBB treated at a tertiary, public, and teaching hospital in two distinct periods: before the implementation of a specialized service and algorithm for SBB (2001-2014, group without algorithm-GSA) and after the establishment of a trained, dedicated team, availability of capsule endoscopy and enteroscopy (2015-2023, group with algorithm-GCA). Demographic, clinical, and care-related data from 184 patient records were collected and entered into the REDCap platform. Additionally, a cost analysis was conducted. RESULTS: Among the 184 patients, 82 (45%) were in the GSA group and 102 (55%) in the GCA group. The average number of specific exams per patient was 7.19 in GSA and 6.37 in GCA (p=0.02, p<0.05). Blood transfusions were performed in 64 patients (78.05%) in GSA and 68 patients (66.67%) in GCA (p=0.05). The average time to reach diagnosis was 309.9 weeks in GSA and 75.37 weeks in GCA (p<0.01). The average hospital stay was 7.57 weeks in GSA and 2.55 weeks in GCA (p<0.01). In GSA, 19 patients (23.2%) died due to SBB, while in GCA only six did (5.9%) (p=0.001, p<0.05). The average cost was higher compared to GCA (p<0.01). CONCLUSIONS: The results of organizing a reference service for SBB care support are sufficient to subsidize the planning of services and regional healthcare networks.
Brazilian consensus- and evidence-based recommendations in the diagnosis and treatment of pancreatic exocrine insufficiency in patients after digestive surgeries. Position paper of six brazilian medical societies of surgery.
Montagnini AL, Bernardo WM, Kassab P … +16 more , Quireze Junior C, Oliveira CVC, Diniz AL, Pinheiro RN, Oliveira AF, Portari Filho P, Ravanini GAG, Forones NM, Pertille MFK, Valezi AC, Dantas ACB, Marzinotto MAN, Figueira ER, Jukemura J, Ribeiro Junior U, Herman P
Arq Bras Cir Dig · 2025 · PMID 41337569 · Full text
BACKGROUND: Exocrine pancreatic insufficiency (EPI) is a condition characterized by reduced exocrine secretion, leading to decreased food digestion, and digestive tract surgeries can be a cause. Postoperative "de novo" E...
BACKGROUND: Exocrine pancreatic insufficiency (EPI) is a condition characterized by reduced exocrine secretion, leading to decreased food digestion, and digestive tract surgeries can be a cause. Postoperative "de novo" EPI is defined as the onset of digestive symptoms following surgeries, which show significant improvement after the initiation of pancreatic enzyme replacement therapy (PERT). The diagnosis of postoperative EPI may be delayed due to mild or nonspecific symptoms, both in pancreatic surgeries and in upper abdominal surgeries. AIMS: The aim of this study was to conduct a systematic review on the diagnosis and treatment of "de novo" EPI related to digestive surgeries, in collaboration with the development of a consensus among the main surgical societies in Brazil. METHODS: The steering committee developed 10 questions related to two areas of interest: diagnosis and treatment. A systematic review was conducted for each of the domains. The evidence was assessed for quality using the GRADEpro tool. Recommendations were formulated for each of the questions. The final report was reviewed by representatives of the surgical societies for the consolidation and approval of the recommendations through a modified Delphi system. RESULTS: "De novo" EPI should be considered in case of the onset of postoperative digestive symptoms. Diagnostic methods vary in complexity of execution, with varying sensitivity and specificity in the postoperative condition. Fecal Elastase-1 (FE-1) has limited value in diagnosing EPI in the postoperative setting. PERT can be initiated based on clinical suspicion, and there is no difference in approach regarding the type of surgery performed. PERT should be started at the appropriate dose for the intensity of symptoms and adjusted up or down according to symptom control. Proper treatment of EPI leads to symptom improvement and an increase in quality of life. PERT should be maintained as long as patients have a favorable clinical response. CONCLUSIONS: The recommendations encompass the diagnosis and treatment of "de novo" EPI and can serve as a basis for the establishment of educational programs led by the participating surgical societies.
Gastroesophageal reflux disease and the phantom of Barrett's esophagus after most-often-used bariatric procedures: are future investigations necessary?
Braghetto I, Carreño B, Hermosilla R … +1 more , Zanabria R
Arq Bras Cir Dig · 2025 · PMID 41221976 · Full text
BACKGROUND: Studies have investigated the incidence of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) after common bariatric surgeries. However, many of these studies have bias or limitations. Theref...
BACKGROUND: Studies have investigated the incidence of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) after common bariatric surgeries. However, many of these studies have bias or limitations. Therefore, it is crucial to determine the true incidence of GERD in long-term follow-ups (FUs) post-surgery. AIMS: The aim of this study was to review and summarize long-term data regarding the incidence of post-surgical GERD and BE after various bariatric procedures, discuss the characteristics of current information available, and establish the need for future studies to determine objective functional outcomes that have not yet been reported. METHODS: A narrative review was conducted using multiple electronic databases, including the review of 15 meta-analyses and over 200 articles. RESULTS: The quality of studies analyzing GERD and BE following bariatric surgery varies widely. Some papers provide detailed outcomes, while others offer limited information. The reported rate of de novo postoperative GERD development after sleeve gastrectomy varies from 4.06 to 74.7% (mean=33.8±19.1), and the incidence of BE ranges from 0.2 to 27% (mean=8.2±7.5). After Roux-en-Y gastric bypass (RYGB), similar variability is observed, with BE incidence ranging from 1.6 to 17.5% (mean=7.5±5.9). In the case of one-anastomosis gastric bypass (OAGB), scarce information is available and most reports are incomplete. The incidence of erosive esophagitis ranges from 15 to 70%, with BE incidence reported in only two papers (1-9.5%). For procedures such as single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), fundoplication-sleeve, or sleeve bipartition, few specific data are available, with most reports limited to symptoms and lacking findings such as esophagitis, hiatal hernia, or BE. CONCLUSION: This revision provides evidence that SG may indeed lead to an increased risk of BE. Numerous studies suggest that RYGB protects against BE. Other bariatric procedures must be extensively evaluated. Relatively low quality of available literature on this topic was observed; therefore, well-controlled prospective studies with long-term FUs are necessary to fully understand the effect of bariatric surgery on BE.
Global strategies for the diffusion of robotic surgery.
Tustumi F, Bolm L, Edelmuth RCL … +17 more , Maegawa FAB, Andraus W, Herman P, McKechnie T, Tsung A, Samreen S, Merkow R, D'Souza N, Zafar SN, Shimoda GM, Wolosker N, Kawaguchi Y, Tsoulfas G, Montalvo-Jave EE, Dudeja V, Khaitan PG, Khan S
Arq Bras Cir Dig · 2025 · PMID 41221975 · Full text
BACKGROUND: The global adoption of robotic surgery has advanced rapidly in high-income countries, yet its diffusion remains limited in resource-constrained settings due to financial, infrastructural, and educational barr...
BACKGROUND: The global adoption of robotic surgery has advanced rapidly in high-income countries, yet its diffusion remains limited in resource-constrained settings due to financial, infrastructural, and educational barriers. As surgical technology evolves, there is an urgent need to promote countries' equitable access to robotic platforms worldwide. AIMS: The aim of this study was to analyze global strategies employed to promote the diffusion of robotic surgery, with a particular focus on overcoming barriers in resource-limited settings, and to provide practical insights that can guide its equitable and sustainable implementation. METHODS: This study is a multinational, policy-oriented integrative review conducted under the guidance of the Research Committee of the Society for Surgery of the Alimentary Tract in the USA (SSAT). The study integrates a bibliometric analysis, a literature review, and expert insights from diverse healthcare environments. Contributions were gathered from SSAT members. RESULTS: Robotic platforms are predominantly concentrated in North America, Western Europe, and Eastern Asia, with the USA hosting nearly 60% of all installations. Research output is similarly skewed, with few countries and institutions producing most clinical trials. Key barriers to diffusion include high costs, lack of infrastructure, limited training capacity, regulatory hurdles, and resistance among surgeons. Facilitators include public-private partnerships, philanthropic support, technology transfer, simulation platforms, and curriculum integration by professional societies. CONCLUSIONS: Achieving global equity in robotic surgery requires coordinated action across research, education, clinical practice, policy, and infrastructure. Global cooperation and innovation in implementation strategies can help bridge the current disparities and promote safe, cost-effective surgical care in underserved regions, improving patient outcomes.
Management of desmoid tumors associated with familial adenomatous polyposis: a three-decade experience of a tertiary center in Brazil.
Lima AP, Leal RF, Camargo MG … +4 more , Martinez CAR, Fagundes JJ, Coy CSR, Ayrizono MLS
Arq Bras Cir Dig · 2025 · PMID 41191718 · Full text
BACKGROUND: Aggressive fibromatosis, also known as desmoid tumor (DT), is a locally aggressive myofibroblastic neoplasm originating from deep soft tissues, characterized by an infiltrative growth pattern with a tendency...
BACKGROUND: Aggressive fibromatosis, also known as desmoid tumor (DT), is a locally aggressive myofibroblastic neoplasm originating from deep soft tissues, characterized by an infiltrative growth pattern with a tendency for local recurrence. DTs account for 0.03% of all neoplasms, and cases associated with familial adenomatous polyposis (FAP) account for 5-15% of DTs. AIMS: The aim of this study was to report the prevalence of DTs in patients operated on for FAP, describe the epidemiological profile, and evaluate the risk factors for tumor development, treatments performed, associated complications, and follow-up. METHODS: This retrospective study assessed the medical records of patients with FAP who underwent surgery between 1990 and 2021 and developed DTs during follow-up. RESULTS: In the study period, 147 patients with FAP were operated on; of these, 97 underwent total proctocolectomy with ileal-pouch anal anastomosis, 33 underwent total colectomy with ileorectal anastomosis (IRA), 14 underwent total proctocolectomy with terminal ileostomy, and three underwent total colectomy with partial proctectomy and low IRA using an ileal-pouch. A total of 26 patients (17.7%) developed DT; most were female (61.5%), were White (73.1%), and had a family history (84.6%). The most frequent complications were intestinal and ureteral obstructions. Long-term follow-up showed that six patients were free of disease, 14 were stable and undergoing drug therapy, four died due to complications of the disease, and two were lost to follow-up. CONCLUSIONS: The prevalence of DT tumor was relatively high and more commonly observed in patients with a family history of the tumor. The disease presented high rates of morbidity and mortality.
Effectiveness of bariatric surgery on body mass, biochemical parameters, and steatosis in metabolically healthy vs. unhealthy obesity.
Ito APS, Itahides LM, Ribeiro RA … +1 more , Bonfleur ML
Arq Bras Cir Dig · 2025 · PMID 41191655 · Full text
BACKGROUND: The effects of bariatric surgery in metabolically healthy obese (MHO) versus metabolically unhealthy obese (MUO) patients are underexplored in the literature. AIMS: The aim of the study was to compare the imp...
BACKGROUND: The effects of bariatric surgery in metabolically healthy obese (MHO) versus metabolically unhealthy obese (MUO) patients are underexplored in the literature. AIMS: The aim of the study was to compare the impact of bariatric surgery on weight loss, body composition, plasma biochemical parameters, and hepatic steatosis in MHO and MUO individuals. METHODS: Preoperative and 1-year postoperative medical records of 82 men and women aged 18-65 years, with body mass index >30 kg/m2, who underwent bariatric surgery from September 2021 to March 2023 were analyzed. MUO individuals were defined as those, metabolically unhealthy obese, with two metabolic syndrome risk factors, in preoperative data. RESULTS: The prevalence of MHO and MUO individuals was 22 and 78%, respectively. Preoperative neck circumference and visceral adiposity index were higher in MUO individuals. Hepatic steatosis was the most common comorbidity in both groups. After 1 year, both groups demonstrated similar benefits from bariatric surgery in reducing body weight, adiposity, and anthropometric indices. Bariatric surgery also improved blood glucose, insulin sensitivity, and dyslipidemia in MUO individuals. However, 30% of MUO individuals presented with steatosis, compared to only 5.6% of MHO individuals. This outcome was accompanied by higher plasma levels of ferritin, alanine aminotransferase, and aspartate aminotransferase in MUO individuals. CONCLUSIONS: Bariatric surgery provided similar benefits in body mass for MHO and MUO individuals. However, after 1 year, MUO individuals still exhibited elevated markers of inflammation, liver injury, and steatosis, suggesting greater residual metabolic vulnerability.
Association between constipation and inguinal hernia: a case-control study in an adult population.
Mostacero-Rojas G, Caballero-Alvarado JA, Lozano-Peralta K … +4 more , Vasquez-Paredes G, Sarmiento-Falen J, Lau-Torres VE, Zavaleta-Corvera C
Arq Bras Cir Dig · 2025 · PMID 41172449 · Full text
BACKGROUND: Inguinal hernia is the most frequently diagnosed hernia and affects approximately one-third of the male population. Several risk factors have been identified, including advanced age, limited physical activity...
BACKGROUND: Inguinal hernia is the most frequently diagnosed hernia and affects approximately one-third of the male population. Several risk factors have been identified, including advanced age, limited physical activity, smoking, and increased intra-abdominal pressure, among others. AIMS: The aim of the study was to determine whether constipation is a risk factor for inguinal hernia in the adult population. METHODS: A case-control study was conducted at the Department of Surgery of one hospital in the north of Peru, including 121 patients with a confirmed diagnosis of inguinal hernia as cases and 242 patients without such a diagnosis as controls. Inclusion and exclusion criteria were applied, and data were collected through individual interviews using a structured questionnaire that addressed clinical aspects, lifestyles, and the presence of constipation, assessed according to the Rome IV criteria. RESULTS: The results revealed significant differences between the groups of patients with and without inguinal hernia in terms of age, sex, and anthropometric characteristics. In addition, statistically significant associations were found between the presence of an inguinal hernia and type 2 diabetes, smoking, and constipation. A multivariate analysis showed that age, male sex, body mass index, high blood pressure, and constipation were significant and independent factors associated with the presence of inguinal hernia. CONCLUSIONS: Constipation is a significant risk factor for inguinal hernia in the adult population. These results support the importance of considering constipation as a risk factor in the evaluation and management of patients with inguinal hernia, highlighting the relevance of adequate clinical care in this group of patients.
Understanding risk factors for low anterior resection syndrome in a South American cohort.
Gaete MI, Jarry CI, Moreno D … +2 more , Larach JT, Bellolio F
Arq Bras Cir Dig · 2025 · PMID 41172448 · Full text
BACKGROUND: Low Anterior Resection Syndrome (LARS) is a common postoperative bowel dysfunction in patients undergoing sphincter-preserving surgery for rectal cancer. Symptoms include fecal and gas incontinence, urgency,...
BACKGROUND: Low Anterior Resection Syndrome (LARS) is a common postoperative bowel dysfunction in patients undergoing sphincter-preserving surgery for rectal cancer. Symptoms include fecal and gas incontinence, urgency, increased bowel frequency, and fragmented evacuations. LARS significantly impairs quality of life, affecting up to 90% of patients. Various factors contribute to its development, such as tumor height, extent of mesorectal excision, preoperative radiotherapy, and ileostomy. However, these factors are less studied in South American populations, where racial, cultural, and healthcare system differences may influence outcomes. AIMS: The aim of the study was to evaluate risk factors associated with LARS in a Chilean cohort of rectal cancer patients, with emphasis on cases classified as severe. METHODS: A non-concurrent prospective cohort study including patients who underwent low anterior resection between 2012 and 2021. Perioperative data collected included tumor height, surgical procedure type, preoperative radiotherapy, and protective ileostomy. Univariate and multivariate analyses were conducted to identify factors significantly associated with severe LARS, using the LARS score adapted to Chilean Spanish. RESULTS: A total of 110 patients were included, with a median follow-up of 51 months. LARS was identified in 52.7% of cases, with 29.1% classified as major. Younger age, lower tumors, total mesorectal excision, preoperative radiotherapy, and ileostomy were significantly associated with severe LARS in univariate analysis. In multivariate analysis, only younger age and preoperative radiotherapy remained as independent risk factors. CONCLUSIONS: In this Chilean cohort, nearly half of patients undergoing sphincterpreserving surgery for rectal cancer developed LARS. About one-third had the severe form, highlighting the need for targeted strategies to mitigate LARS and improve patient quality of life.
Rare occurrence of small bowel intussusception due to synchronous metastasis of renal cell carcinoma.
Aguiar MFF, Pinto RA, Ribeiro-Junior U … +2 more , Soares PC, Marques CFS
Arq Bras Cir Dig · 2025 · PMID 41172447 · Full text
BACKGROUND: Renal carcinoma is the third most common urological cancer, with 30% of patients presenting with metastases at diagnosis. Metastases to the small intestine are rare (0.7-1.1%), and their presentation as intes...
BACKGROUND: Renal carcinoma is the third most common urological cancer, with 30% of patients presenting with metastases at diagnosis. Metastases to the small intestine are rare (0.7-1.1%), and their presentation as intestinal intussusception is even more uncommon, with only a few cases reported in the literature. AIMS: The aim of the study was to present a case of stage IV clear cell renal carcinoma with a rare presentation of intestinal intussusception, leading to emergency department admission due to severe anemia and melena. METHODS: A 62-year-old man presented with melena for 2 months and a critically low hemoglobin level of 2.9 g/dL (normal range: 13.5-17.5 g/dL). Abdominal and pelvic angiotomography identified an exophytic lesion in the left kidney consistent with renal carcinoma and an approximately 16 cm ileal intussusception. RESULTS: Exploratory laparotomy revealed intestinal intussusception and a 4 cm lesion on the antimesenteric border, suspected to be a tumor. A segmental resection with primary anastomosis was performed, resulting in a favorable postoperative recovery. Histopathological and immunohistochemical analyses confirmed poorly differentiated metastatic clear cell renal carcinoma. CONCLUSIONS: This report underscores the need to consider gastrointestinal symptoms in patients with renal carcinoma, as an intestinal metastasis, although rare, is a potential complication. Synchronous metastases are even rarer and present a significant diagnostic challenge.
Surgical treatment of gastric adenocarcinoma: what factors influence the prognosis?
Naufel Junior CR, Agulham AP, Mattar BA
Arq Bras Cir Dig · 2025 · PMID 41172446 · Full text
BACKGROUND: Gastric cancer is the fifth most common cancer in the world and the fourth leading cause of deaths in oncology. AIMS: The aim of this study was to investigate the factors that affect the survival of patients...
BACKGROUND: Gastric cancer is the fifth most common cancer in the world and the fourth leading cause of deaths in oncology. AIMS: The aim of this study was to investigate the factors that affect the survival of patients with gastric adenocarcinoma undergoing gastrectomy in a tertiary center in South Brazil. METHODS: This was a cross-sectional, observational, and retrospective study of 82 patients with gastric adenocarcinoma who underwent surgical treatment from January 2018 to August 2022. Epidemiological and prognostic factors were analyzed, such as age, sex, tumor location in the stomach, lymph node invasion, tumor extension, angiolymphatic invasion, tumor differentiation, presence of distant metastasis, compromised surgical margins, adjuvant or neoadjuvant chemotherapy, and patient survival time. RESULTS: Of the 82 patients, 41.5% died during the follow-up period, with a maximum follow-up period of 56 months. The median time to death was 22.4 months after performing the gastrectomy. Advanced age (hazard ratio [HR]=2.76; p=0.014, p<0.05), location of the tumor in the fundus of the stomach (HR=2.77; p=0.020, p>0.05), and presence of distant metastasis (HR=2.13; p=0.039) showed a significant negative impact on survival in the multivariate analysis. On the other hand, patients undergoing adjuvant (HR=5.33; p=0.001, p<0.05) or neoadjuvant (HR=3.36; p=0.006, p<0.05) chemotherapy had a positive impact. CONCLUSIONS: The present study demonstrated that survival in patients with gastric adenocarcinoma is negatively influenced by advanced age, tumor location in the fundus of the stomach, and the presence of distant metastases, in contrast to the positive impact of performing adjuvant or neoadjuvant chemotherapy.
Bariatric surgery: pre-operative comorbidities, postoperative results, and complications: a single-center retrospective cohort analysis.
Bandeira RS, Vieira KW, Trevisol BS … +2 more , Schuelter-Trevisol F, Trevisol DJ
Arq Bras Cir Dig · 2025 · PMID 41172445 · Full text
BACKGROUND: Bariatric surgery is the most effective treatment for weight loss and also promotes remission of preoperative metabolic comorbidities. AIMS: The aim of this study was to analyze preoperative comorbidities, ev...
BACKGROUND: Bariatric surgery is the most effective treatment for weight loss and also promotes remission of preoperative metabolic comorbidities. AIMS: The aim of this study was to analyze preoperative comorbidities, evaluate postoperative outcomes, and assess complications 6 months after bariatric surgery in a hospital in the state of Santa Catarina, Brazil. METHODS: A retrospective cohort study was conducted with patients who underwent bariatric surgery between 2021 and 2022 and were followed up for a period of 6 months after the procedure. RESULTS: There was a predominance of female patients (81.6%), with a mean age of 38.7 years. The preoperative prevalence of hypertension, Type 2 diabetes, dyslipidemia, and hepatic steatosis was 36.7, 22.4, 22.4, and 32.7%, respectively. The postoperative remission rates for these conditions were 55, 64, 70, and 69%, respectively. Except for diabetes, no significant differences were found between the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. There was a significant reduction in weight (p<0.01) and body mass index (BMI) (p<0.01), with no statistical differences between the RYGB and SG groups. Postoperative complications occurred in 73.5% of patients, including anemia, vitamin deficiencies, cholelithiasis, dumping syndrome, anastomotic ulcer, chronic diarrhea, and anastomotic stricture. CONCLUSIONS: The study described the preoperative comorbidity profile, postoperative outcomes, and complications with findings consistent with existing literature, except for underreporting dyslipidemia and hepatic steatosis. No statistical difference was observed between the surgical techniques performed.
Female donor gender is associated with a decrease in liver transplant survival of male recipients independent of donor and recipient anthropometrics.
Chedid MF, Prediger L, Lazzarotto-DA-Silva G … +4 more , Cronst J, DE Araujo A, Grezzana Filho TJM, Goldani LZ
Arq Bras Cir Dig · 2025 · PMID 41172444 · Full text
BACKGROUND: Data on the influence of donor gender on post-liver transplant outcomes is scarce and is lacking. AIMS: The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver t...
BACKGROUND: Data on the influence of donor gender on post-liver transplant outcomes is scarce and is lacking. AIMS: The aim of this study was to evaluate the prognostic factors of mortality in patients undergoing liver transplantation (LT) with a thorough evaluation of the influence of the donor variables. METHODS: All patients undergoing LT at a single center from December 2011 to December 2018 were included. The main outcome measure of the study was overall patient survival. The mortality predictors were evaluated using Cox regression. RESULTS: The study analyzed 202 patients, 118 (58.1%) being males, and the average age was 54.19±11.66 years. Post-LT survival for the entire cohort of 202 patients as assessed by the KaplanMeier method at 1, 3, 5, and 7 years was 81.6, 73.1, 67.6, and 63%, respectively. The only predictor of increased overall mortality was female donor gender [HR 1.918, 95%CI 1.150-3.201, p=0.013]. Weight and height differences between donor and recipient were not related to mortality (p=0.545 for weight and p=0.964 height). CONCLUSIONS: Female donor gender was associated with an increase in overall post-LT mortality, especially for male recipients, regardless of anthropometric parameters. For male patients receiving livers from female donors, infection was the most common cause of mortality, occurring in the first year following LT.
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