REDUÇÃO DE COMORBIDADES DEVIDO A PROCEDIMENTOS INVASIVOS VOLTADOS PARA PERDA PONDERAL
DOI:
https://doi.org/10.56238/arev8n5-030Palavras-chave:
Cirurgia Bariátrica, Comorbidade, Síndrome MetabólicaResumo
A obesidade constitui um desafio global de saúde pública, estando intrinsecamente ligada a comorbidades metabólicas e cardiovasculares que reduzem a qualidade de vida. Esta revisão sistemática, baseada na análise de 140 artigos publicados entre 2020 e 2024, avalia o impacto a longo prazo da cirurgia bariátrica — especificamente o Bypass Gástrico e a Gastrectomia Vertical — na remissão destas condições. As evidências demonstram que, além da perda de peso sustentada, os procedimentos promovem melhorias significativas na hipertensão arterial, dislipidemia e esteatose hepática, bem como taxas elevadas de remissão da diabetes tipo 2 e recuperação da função renal. Observou-se também uma redução substancial nos custos com medicação para síndrome metabólica. Contudo, a eficácia duradoura destas intervenções enfrenta barreiras críticas, nomeadamente o reganho ponderal e o surgimento de transtornos psiquiátricos e alimentares no período pós-operatório. Conclui-se, portanto, que o sucesso clínico da cirurgia bariátrica depende imperativamente de um acompanhamento multidisciplinar contínuo para mitigar recidivas e garantir a manutenção dos benefícios metabólicos alcançados.
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1. LAPEÑA-RODRÍGUEZ, M. et al. Excellent Results in Terms of Weight Loss and Type 2 Diabetes Control are Maintained 20 Years after Roux-en- Y Gastric Bypass. Journal of Gastrointestinal Surgery, v. 27, n. 11, p. 2580–2582, 18 jan. 2024. DOI: https://doi.org/10.1007/s11605-023-05734-5
2. VAN DER LAAN, L. et al. Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity- score matched analysis. Surgery for Obesity and Related Diseases, 5 out. 2024. DOI: https://doi.org/10.1016/j.soard.2024.09.009
3. ABU DAYYEH, B. K. et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet (London, England), v. 400, n. 10350, p. 441–451, 6 ago. 2022. DOI: https://doi.org/10.1016/S0140-6736(22)01280-6
4. SHARAIHA, R. Z. et al. Five-Year Outcomes of Endoscopic Sleeve Gastroplasty for the Treatment of Obesity. Clinical Gastroenterology and Hepatology, v. 19, n. 5, p. 1051-1057.e2, 1 maio 2021. DOI: https://doi.org/10.1016/j.cgh.2020.09.055
5. POLJO, A. et al. Role of sleeve gastrectomy in improving metabolic syndrome: an overview. Updates in Surgery, 25 nov. 2024. DOI: https://doi.org/10.1007/s13304-024-02038-4
6. FELSENREICH, D. M. et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases, v. 12, n. 9, p. 1655–1662, nov. 2016. DOI: https://doi.org/10.1016/j.soard.2016.02.021
7. OUTÓN, S. et al. Presión arterial central en la obesidad mórbida y tras la cirugía bariátrica. Nefrología, v. 40, n. 3, p. 217–222, maio 2020. DOI: https://doi.org/10.1016/j.nefro.2019.09.004
8. KHOSROW NAJJARI et al. Laparoscopic gastric plication: A long- term follow-up and comparison of outcomes in severe vs. non-severe obesity. The American journal of surgery, v. 228, p. 102–106, 1 fev. 2024. DOI: https://doi.org/10.1016/j.amjsurg.2023.08.005
9. CRANE, J. D. et al. The Impact of Bariatric Surgery on Coronary Microvascular Function Assessed Using Automated Quantitative Perfusion CMR. JACC. Cardiovascular imaging, 1 ago. 2024.
10. OKIDA, L. F. et al. Bariatric surgery is associated with reduced admission for aortic dissection: a nationwide case-control analysis. Surgery for Obesity and Related Diseases, v. 17, n. 9, p. 1603–1610, 15 maio 2021. DOI: https://doi.org/10.1016/j.soard.2021.05.015
11. ARJONILLA SAMPEDRO, M. E. et al. Impact of ponderal loss after bariatric surgery on the cardiac structure and function. Medicina Clínica (English Edition), v. 159, n. 3, p. 109–115, ago. 2022. DOI: https://doi.org/10.1016/j.medcle.2022.07.007
12. MOREIRA, S. M. B. P. et al. Roux-en-Y Gastric Bypass Improves Adiponectin to Leptin Ratio and Inflammatory Profile in Severely Obese Women with and without Metabolic Syndrome: A Randomized Controlled Trial. Nutrients, v. 15, n. 15, p. 3312, 26 jul. 2023. DOI: https://doi.org/10.3390/nu15153312
13. BLANCHARD, C. et al. Roux-en-Y gastric bypass, but not sleeve gastrectomy, decreases plasma PCSK9 levels in morbidly obese patients. Diabetes & Metabolism, v. 46, n. 6, p. 480–487, 4 fev. 2020. DOI: https://doi.org/10.1016/j.diabet.2020.01.003
14. FREY, S. et al. Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study. Annales d Endocrinologie, v. 81, n. 1, p. 44–50, 1 fev. 2020.
15. HOSSEININASAB, A. et al. The long-term impact of bariatric surgery on psoriasis symptoms and severity: a prospective observational study. Surgery for Obesity and Related Diseases, v. 20, n. 12, p. 1208–1213, 23 jul. 2024. DOI: https://doi.org/10.1016/j.soard.2024.07.011
16. ALEMRAJABI, M. et al. Effects of weight loss after bariatric surgery on the median and ulnar nerves conduction studies. The American Journal of Surgery, v. 225, n. 4, p. 753–757, 18 nov. 2022. DOI: https://doi.org/10.1016/j.amjsurg.2022.11.020
17. SUN, W. Y. L. et al. Idiopathic intracranial hypertension and bariatric surgery: a systematic review. Canadian Journal of Surgery, v. 63, n. 2, p. E123– E128, 1 mar. 2020 DOI: https://doi.org/10.1503/cjs.016616
18. SARMIENTO-COBOS, M. et al. Decreased Liver Volume after Bariatric Surgery and its Positive Impact on Liver Function Tests and Lipid Profile. Surgery for Obesity and Related Diseases, 19 dez. 2024 DOI: https://doi.org/10.1016/j.soard.2024.12.015
19. KWAK, M. et al. Bariatric surgery is associated with reduction in non- alcoholic steatohepatitis and hepatocellular carcinoma: A propensity matched analysis. The American Journal of Surgery, v. 219, n. 3, p. 504–507, 16 set. 2019. DOI: https://doi.org/10.1016/j.amjsurg.2019.09.006
20. GARCÍA RUIZ DE GORDEJUELA, A.; IBARZABAL, A.; OSORIO, J. Bariatric Surgery and Solid-Organ Transplantation. Transplantation Proceedings, v. 54, n. 1, p. 87–90, 29 dez. 2021.
21. LASSAILLY, G. et al. Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis. Gastroenterology, v. 159, n. 4, p. 1290-1301.e5, 1 out. 2020. DOI: https://doi.org/10.1053/j.gastro.2020.06.006
22. FUNES, D. R. et al. Changes in renal blood flow after surgically induced weight loss: can bariatric surgery halt the progression of chronic kidney disease? Surgery for Obesity and Related Diseases, v. 20, n. 5, p. 439–444, 25 nov. 2023. DOI: https://doi.org/10.1016/j.soard.2023.11.013
23. GARCÍA RUIZ DE GORDEJUELA, A.; IBARZABAL, A.; OSORIO, J. Bariatric Surgery and Solid-Organ Transplantation. Transplantation Proceedings, v. 54, n. 1, p. 87–90, 29 dez. 2021. DOI: https://doi.org/10.1016/j.transproceed.2021.11.008
24. MACHADO, F. P. et al. Weight Loss Through Bariatric Surgery in Men Presents Beneficial Effects on Sexual Function, Symptoms of Testosterone Deficiency, and Hormonal Profile. Sexual Medicine, v. 9, n. 4, p. 100400, ago. 2021. DOI: https://doi.org/10.1016/j.esxm.2021.100400
25. YANG, Ming; LIU, Shuai ; ZHANG, Chunye. The Related Metabolic Diseases and Treatments of Obesity. Healthcare, v. 10, n. 9, p. 1616–1616, 2022 DOI: https://doi.org/10.3390/healthcare10091616
26. ANEJA, A. Hypertension and Obesity. Recent Progress in Hormone Research, v. 59, n. 1, p. 169–205, 1 jan. 2004. DOI: https://doi.org/10.1210/rp.59.1.169
27. CHOBANIAN, A. V. et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, v. 42, n. 6, p. 1206–1252, dez. 2003. DOI: https://doi.org/10.1161/01.HYP.0000107251.49515.c2
28. BLONDE, Lawrence; UMPIERREZ, Guillermo E; REDDY, S Sethu; et al. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan—2022 Update. Endocrine Practice, v. 28, n. 10, p. 923–1049, 2022.
29. KOUROSH SARKHOSH et al. The Impact of Sleeve Gastrectomy on Hypertension: A Systematic Review. Obesity Surgery, v. 22, n. 5, p. 832–837, 15 fev. 2012. DOI: https://doi.org/10.1007/s11695-012-0615-2
30. SALMINEN, P. et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA, v. 319, n. 3, p. 241–254, 16 jan. 2018. DOI: https://doi.org/10.1001/jama.2017.20313
31. CAVARRETTA, E. et al. Cardiac Remodeling in Obese Patients After Laparoscopic Sleeve Gastrectomy. World Journal of Surgery, v. 37, n. 3, p. 565– 572, 19 dez. 2012. DOI: https://doi.org/10.1007/s00268-012-1874-8
32. VOGLINO, C. et al. Cardiovascular Benefits and Lipid Profile Changes 5 Years After Bariatric Surgery: A Comparative Study Between Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Journal of Gastrointestinal Surgery, v. 24, n. 12, p. 2722–2729, 16 dez. 2019.
33. RUSSYAN MARK MABEZA et al. Bariatric surgery improves outcomes of hospitalizations for acute heart failure: a contemporary, nationwide analysis. Surgery for Obesity and Related Diseases, v. 19, n. 7, p. 681–687, 1 jul. 2023. DOI: https://doi.org/10.1016/j.soard.2022.12.027
34. AMGAD MENTIAS et al. Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population. v. 79, n. 15, p. 1429–1437, 1 abr. 2022.
35. FREY, S. et al. Improvement in arterial stiffness (pOpmètre®) after bariatric surgery. Results from a prospective study. Annales d Endocrinologie, v. 81, n. 1, p. 44–50, 1 fev. 2020. DOI: https://doi.org/10.1016/j.ando.2020.01.002
36. AMGAD MENTIAS et al. Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population. v. 79, n. 15, p. 1429–1437, 1 abr. 2022. DOI: https://doi.org/10.1016/j.jacc.2022.01.047
37. VOGLINO, C. et al. Cardiovascular Benefits and Lipid Profile Changes 5 Years After Bariatric Surgery: A Comparative Study Between Sleeve Gastrectomy and Roux-en-Y Gastric Bypass. Journal of Gastrointestinal Surgery, v. 24, n. 12, p. 2722–2729, 16 dez. 2019. DOI: https://doi.org/10.1007/s11605-019-04482-9
38. FARIAS, G. et al. Impact of dietary patterns according to NOVA food groups: 2 y after Roux-en-Y gastric bypass surgery. Nutrition, v. 74, p. 110746, jun. 2020. DOI: https://doi.org/10.1016/j.nut.2020.110746
39. LULAS BITER et al. Long-term effect of sleeve gastrectomy vs Roux- en-Y gastric bypass in people living with severe obesity: a phase III multicentre randomised controlled trial (SleeveBypass). The Lancet Regional Health - Europe, v. 38, p. 100836–100836, 1 mar. 2024. DOI: https://doi.org/10.1016/j.lanepe.2024.100836
40. SCHAUER, P. R. et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. New England Journal of Medicine, v. 366, n. 17, p. 1567–1576, 26 abr. 2012.
41. SCHAUER, P. R. et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. New England Journal of Medicine, v. 366, n. 17, p. 1567–1576, 26 abr. 2012. DOI: https://doi.org/10.1056/NEJMoa1200225
42. DAVOUDI, Z. et al. Inflammatory and metabolic markers and comorbidities remission following sleeve gastrectomy: A single center one-year cohort study. Primary care diabetes, v. 17, n. 3, p. 273–277, 7 mar. 2023. DOI: https://doi.org/10.1016/j.pcd.2023.03.001
43. LIU, Y. et al. A multi-center study on glucometabolic response to bariatric surgery for different subtypes of obesity. Frontiers in endocrinology, v. 13, p. 989202, mar. 2022. DOI: https://doi.org/10.3389/fendo.2022.989202
44. ABDALLA SALMAN, M. et al. Predictors of type-2 diabetes remission following bariatric surgery after a two-year follow up. Asian Journal of Surgery, mar. 2022. DOI: https://doi.org/10.1016/j.asjsur.2021.12.070
45. SOLEYMANI, T. et al. Bariatric surgery and COVID-19 outcomes: results from the PaTH to Health: Diabetes study. Surgery for Obesity and Related Diseases, v. 20, n. 11, p. 1039–1045, 4 jun. 2024. DOI: https://doi.org/10.1016/j.soard.2024.05.016
46. NUDOTOR, R. D. et al. Comparative Effectiveness of Roux-en Y Gastric Bypass Versus Vertical Sleeve Gastrectomy for Sustained Remission of Type 2 Diabetes Mellitus. Journal of Surgical Research, v. 261, p. 407–416, maio 2021. DOI: https://doi.org/10.1016/j.jss.2020.12.024
47. FORBES, H. et al. Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study. Surgical Endoscopy, 30 set. 2024. DOI: https://doi.org/10.1007/s00464-024-11144-8
48. CHIA, T. et al. Prescription drug usage as measure of comorbidity resolution after bariatric surgery: a population-based cohort study. Surgical Endoscopy, v. 37, n. 11, p. 8601–8610, 25 jul. 2023. DOI: https://doi.org/10.1007/s00464-023-10294-5
49. FRANCISCA, Maria; PAPELBAUM, Marcelo; ANTÔNIO, Marco; et al. Mental health and weight regain after bariatric surgery: associations between weight regain and psychiatric and eating-related comorbidities. Archives of Endocrinology and Metabolism, v. 68, 2024. DOI: https://doi.org/10.20945/2359-4292-2023-0208
50. REMMEL, Shelby; NOOM, Madison; SANDSTROM, Reagan; et al. Preoperative comorbidities as a predictor of EBWL after bariatric surgery: a retrospective cohort study. Surgical Endoscopy, v. 38, n. 5, p. 2770–2776, 2024. DOI: https://doi.org/10.1007/s00464-024-10785-z
51. 1-PAGE, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting DOI: https://doi.org/10.31222/osf.io/v7gm2_v1
52. systematic reviews. BMJ, p. n71, 29 mar. 2021.
