ABSTRACT BACKGROUND: Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited. OBJECTIVE: To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity. DESIGN AND SETTING: Observational, analytical, and retrospective cohort study. Tertiary-level university hospital. METHODS: This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures. RESULTS: No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001). CONCLUSION: Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss. BACKGROUND oneanastomosis one anastomosis (OAGB limited OBJECTIVE RouxenY Roux en Y (RYGB obesity SETTING Observational analytical Tertiarylevel Tertiary level hospital METHODS surgery eGFR, , (eGFR) Collaboration oneyear procedures RESULTS sex obesityassociated conditions 0.007 0007 0 007 0.026. 0026 0.026 . 026 0.026) 103.9 1039 103 9 (103. 2 1161 116 116. 13.3 133 13 3 1024 102 4 102. 1132 113 113. 0001 001 0.001 respectively. respectively respectively) 162 16 16.2 167 7 16. 263 26 26.3 0.3. 03 0.3 0.3) 0.001. 0.001) CONCLUSION procedure (eGFR 0.00 000 00 002 0.02 02 103. 10 (103 13. 26. 0. 0.0 (10 (1 (

ABSTRACT BACKGROUND: The association of gastric plication with fundoplication is a reliable option for the treatment of individuals with obesity associated with gastroesophageal reflux disease. AIMS: To describe weight loss, endoscopic, and gastroesophageal reflux disease-related outcomes of gastric plication with fundoplication in individuals with mild obesity. METHODS: A retrospective cohort study was carried out, enrolling individuals who underwent gastric plication with fundoplication at a tertiary private hospital from 2015–2019. Data regarding perioperative and weight loss outcomes, endoscopic and 24-hour pH monitoring findings, and gastroesophageal reflux disease-related symptoms were analyzed. RESULTS: Of 98 individuals, 90.2% were female. The median age was 40.4 years (IQR 32.1–47.8). The median body mass index decreased from 32 kg/m2 (IQR 30,5–34) to 29.5 kg/m2 (IQR 26.7–33.9) at 1–2 years (p<0.05); and to 27.4 kg/m2 (IQR 24.1–30.6) at 2–4 years (p=0.059). The median percentage of total weight loss at 1–2 years was 7.8% (IQR −4.1–14.7) and at 2–4 years, it was 16.4% (IQR 4.3–24.1). Both esophageal and extra-esophageal symptoms showed a significant reduction (p<0.05). A significant decrease in the occurrence of esophagitis was observed (p<0.01). The median DeMeester score decreased from 30 (IQR 15.1–48.4) to 1.9 (IQR 0.93–5.4) (p<0.0001). CONCLUSIONS: The gastric plication with fundoplication proved to be an effective and safe technique, leading to a significant and sustained weight loss in addition to endoscopic and clinical improvement of gastroesophageal reflux disease. BACKGROUND disease AIMS diseaserelated related METHODS out 20152019 2015 2019 2015–2019 24hour hour 24 findings analyzed RESULTS 9 902 90 2 90.2 female 404 40 4 40. IQR 32.1–47.8. 321478 32.1–47.8 . 1 47 8 32.1–47.8) 3 kgm2 kgm kg m2 m kg/m 30,5–34 30534 5 34 295 29 29. 26.7–33.9 267339 26 7 33 12 1– p<0.05 p005 p 0 05 (p<0.05) 274 27 27. 24.1–30.6 241306 6 2– p=0.059. p0059 p=0.059 059 (p=0.059) 78 7.8 −4.1–14.7 41147 14 164 16 16.4 4.3–24.1. 43241 4.3–24.1 4.3–24.1) extraesophageal extra p<0.05. p<0.01. p001 p<0.01 01 (p<0.01) 15.1–48.4 151484 15 48 19 1. 0.93–5.4 09354 93 p<0.0001. p00001 p<0.0001 0001 (p<0.0001) CONCLUSIONS technique 2015201 201 2015–201 90. 32147 32.1–47. 30,5–3 3053 26.7–33. 26733 p<0.0 p00 (p<0.05 24.1–30. 24130 p=0.05 (p=0.059 7. −4.1–14. 4114 16. 4324 4.3–24. (p<0.01 15.1–48. 15148 0.93–5. 0935 p0000 p<0.000 000 (p<0.0001 201520 20 2015–20 3214 32.1–47 30,5– 305 26.7–33 2673 p<0. p0 (p<0.0 24.1–30 2413 p=0.0 (p=0.05 −4.1–14 411 432 4.3–24 15.1–48 1514 0.93–5 093 p000 p<0.00 00 (p<0.000 20152 2015–2 321 32.1–4 30,5 26.7–3 267 p<0 (p<0. 24.1–3 241 p=0. (p=0.0 −4.1–1 41 43 4.3–2 15.1–4 151 0.93– 09 (p<0.00 2015– 32.1– 30, 26.7– p< (p<0 24.1– p=0 (p=0. −4.1– 4.3– 15.1– 0.93 32.1 26.7 (p< 24.1 p= (p=0 −4.1 4.3 15.1 0.9 32. 26. (p 24. (p= −4. 4. 15. 0. −4 −

RESUMO RACIONAL: A associação de plicatura gástrica com fundoplicatura é uma opção atrativa para o tratamento de indivíduos com obesidade associada à doença do refluxo gastroesofágico. OBJETIVOS: Descrever a evolução ponderal, clínica, endoscópica e de pHmetria após a gástrica com fundoplicatura em indivíduos com obesidade grau I e doença do refluxo gastroesofágico. MÉTODOS: Um estudo de coorte histórica foi realizado, incluindo indivíduos que realizaram gástrica com fundoplicatura em um hospital privado terciário de 2015 a 2019. Os dados sobre os resultados perioperatórios e de perda de peso, achados endoscópicos e de pHmetria de 24 horas e sintomas relacionados à doença do refluxo gastroesofágico foram analisados. RESULTADOS: Dos 98 indivíduos, 90,2% eram do sexo feminino. A idade mediana foi de 40,4 (IQR 32,1–47,8) anos. A mediana do índice de massa corporal diminuiu de 32 (IQR 30,5–34) kg/m2 para 29,5 (IQR 26,7–33,9) kg/m2 em 1–2 anos (p<0,05); de 2 a 4 anos, foi de 27,4 (IQR 24,1–30,6) kg/m2 (p=0,059). A mediana da porcentagem da perda total de peso em 1-2 anos foi de 7,8% (IQR −4,1–14,7) e em 2-4 anos, foi de 16,4% (IQR 4,3–24,1). Tanto os sintomas esofágicos quanto os extras esofágicos apresentaram redução significativa (p<0,05). Observou-se diminuição significativa na ocorrência de esofagite (p<0,01). A pontuação mediana do escore de DeMeester diminuiu de 30 (IQR 15,1–48,4) para 1,9 (IQR 0,93–5,4) (p<0,0001). CONCLUSÕES: A associação entre plicatura gástrica e fundoplicatura laparoscópica mostrou-se uma técnica eficaz e segura, levando a perda de peso significativa, bem como melhora endoscópica e clínica da doença do refluxo gastroesofágico. RACIONAL OBJETIVOS ponderal MÉTODOS realizado 201 2019 analisados RESULTADOS 9 902 90 90,2 feminino 404 40 40, IQR 32,1–47,8 321478 1 47 8 3 30,5–34 30534 5 34 kgm2 kgm kg m2 m kg/m 295 29 29, 26,7–33,9 267339 26 7 33 12 1– p<0,05 p005 p 0 05 (p<0,05) 274 27 27, 24,1–30,6 241306 6 p=0,059. p0059 p=0,059 . 059 (p=0,059) 1- 78 7,8 −4,1–14,7 41147 14 2- 164 16 16,4 4,3–24,1. 43241 4,3–24,1 4,3–24,1) p<0,05. Observouse Observou se p<0,01. p001 p<0,01 01 (p<0,01) 15,1–48,4 151484 15 48 19 1, 0,93–5,4 09354 93 p<0,0001. p00001 p<0,0001 0001 (p<0,0001) CONCLUSÕES mostrouse mostrou segura 20 90, 32,1–47, 32147 30,5–3 3053 26,7–33, 26733 p<0,0 p00 (p<0,05 24,1–30, 24130 p=0,05 (p=0,059 7, −4,1–14, 4114 16, 4324 4,3–24, (p<0,01 15,1–48, 15148 0,93–5, 0935 p0000 p<0,000 000 (p<0,0001 32,1–47 3214 30,5– 305 26,7–33 2673 p<0, p0 (p<0,0 24,1–30 2413 p=0,0 (p=0,05 −4,1–14 411 432 4,3–24 15,1–48 1514 0,93–5 093 p000 p<0,00 00 (p<0,000 32,1–4 321 30,5 26,7–3 267 p<0 (p<0, 24,1–3 241 p=0, (p=0,0 −4,1–1 41 43 4,3–2 15,1–4 151 0,93– 09 (p<0,00 32,1– 30, 26,7– p< (p<0 24,1– p=0 (p=0, −4,1– 4,3– 15,1– 0,93 32,1 26,7 (p< 24,1 p= (p=0 −4,1 4,3 15,1 0,9 32, 26, (p 24, (p= −4, 4, 15, 0, −4 −

RESUMO Racional: A obesidade pode ser tratada com a cirurgia bariátrica; porém, doenças da via biliar como colelitíase e coledocolitíase podem surgir, principalmente devido à grande perda de peso. A colangiopancreatografia retrógrada é procedimento diagnóstico e terapêutico dessas afecções, e pode ser dificultada pela alteração anatômica após a operação. Objetivos: Relatar a eficácia e a segurança da colangiopancreatografia endoscópica retrógrada assistida por videolaparoscopia nos pacientes pós-cirurgia bariátrica com derivação gástrica em Y-de-Roux. Método: Estudo retrospectivo entre 2007 e 2017. Foram coletados: idade, gênero, indicação cirúrgica, tempo de internamento, diagnóstico etiológico, taxa de sucesso terapêutico, intercorrências intra e pós-operatórias. Resultados: Sete pacientes tiveram coledocolitíase confirmada por exame de imagem, principalmente em mulheres. O intervalo entre a derivação gástrica e o procedimento endoscópico variou de 1 a 144 meses. Não houve intercorrências intraoperatórias. A canulação da papila duodenal foi obtida em 100% dos casos. A maioria dos casos de complicações foi relacionada à gastrostomia, e raramente ao procedimento endoscópico. Houve duas intercorrências pós-operatórias, um caso de dor toracoabdominal refratária às doses elevadas de morfina no mesmo dia do procedimento, além de um diagnóstico laboratorial de pancreatite aguda pós-procedimento em paciente assintomático. A permanência hospitalar máxima foi de quatro dias. Conclusão: A colangiopancreatografia retrógrada endoscópica pela gastrostomia laparoscópica é método eficaz, seguro, visto que a maioria das complicações foi relacionada à gastrostomia; ela não altera a sequência de realização da colangiopancreatografia convencional.

ABSTRACT Background: Obesity can be treated with bariatric surgery; but, excessive weight loss may lead to diseases of the bile duct such as cholelithiasis and choledocholithiasis. Endoscopic retrograde cholangiopancreatography is a diagnostic and therapeutic procedure for these conditions, and may be hampered by the anatomical changes after surgery. Aim: Report the efficacy and the safety of videolaparoscopy-assisted endoscopic retrograde cholangiopancreatography technique in patients after bariatric surgery with Roux-en-Y gastric bypass. Method: Retrospective study performed between 2007 and 2017. Data collected were: age, gender, surgical indication, length of hospital stay, etiological diagnosis, rate of therapeutic success, intra and postoperative complications. Results: Seven patients had choledocholithiasis confirmed by image exam, mainly in women. The interval between gastric bypass and endoscopic procedure ranged from 1 to 144 months. There were no intraoperative complications. The rate of duodenal papillary cannulation was 100%. Regarding complications, the majority of cases were related to gastrostomy, and rarely to endoscopic procedure. There were two postoperative complications, a case of chest-abdominal pain refractory to high doses of morphine on the same day of the procedure, and a laboratory diagnosis of acute pancreatitis after the procedure in an asymptomatic patient. The maximum hospital stay was four days. Conclusion: The experience with endoscopic retrograde cholangiopancreatography through laparoscopic gastrostomy is a safe and effective procedure, since most complications are related to the it and did not altered the sequence to perform the conventional cholangiopancreatography.