Introduction: Bariatric surgery is a procedure to reduce weight in the long term in patients with obesity. The objective of this study was to evaluate ghrelin levels and weight reduction according to the type of bariatric surgery, comparing the single anastomosis bypass and the sleeve-forming gastrectomy. Materials and Method: Cohort study that included 50 patients with obesity, 22 Mini-Bypass and 28 gastric sleeve. Body weight and ghrelin concentrations were evaluated in the presurgical stage, on day 7 and in months 1, 3 and 6 after surgery. Results: Of the total of patients, 86% had > 50% excess weight loss (PEPP) at 6 months. The concentration of ghrelin decreased within the first week of the intervention. At 6 months, greater reduction of ghrelin was observed in patients with gastric sleeve (4636 ± 2535 vs 1340 ± 1001 pg/mL, p < 0.0001). The PEPP in patients with Mini-Bypass was superior, compared to gastric sleeve. Conclusion: The comparison between the techniques indicated that, after 6 months of post-surgical evolution, patients with Mini-Bypass had a greater reduction in body weight and ghrelin levels, compared to the gastric sleeve group. Ghrelin concentration is a variable that participates in weight control; however, the type of surgical approach is probably more related to weight loss in these patients.

Resumen Objetivo: La cirugía bariátrica es un procedimiento para disminuir de peso a largo plazo en pacientes con obesidad. El objetivo de este estudio fue evaluar los niveles de ghrelina y la reducción del peso de acuerdo al tipo de cirugía bariátrica, comparando el bypass de una sola anastomosis y la gastrectomía formadora de manga. Materiales y Métodos: Estudio de cohorte que incluyó a 50 pacientes con obesidad, 22 mini-bypass y 28 mangas gástricas. Se evaluó el peso corporal y las concentraciones de ghrelina en la etapa prequirúrgica, en el día 7 y en los meses 1, 3 y 6 después de la cirugía. Resultados: Del total de pacientes, el 86% presentaron > 50% pérdida del exceso de peso (PEPP) a los 6 meses. La concentración de ghrelina disminuyó desde la primera semana en el grupo total de participantes. A los 6 meses, se observó mayor reducción de ghrelina en los pacientes con la manga gástrica (4.636 ± 2.535 vs 1.340 ± 1.001 pg/mL, p < 0,0001). El PEPP en pacientes con mini-bypass fue superior, en comparación con manga gástrica. Conclusiones: La comparación entre las técnicas indicó que, a los 6 meses de evolución posquirúrgica, los pacientes con mini-bypass presentaron mayor reducción de peso corporal y del nivel de ghrelina, en comparación con el grupo de manga gástrica. La concentración de ghrelina es una variable que participa en el control de peso; sin embargo, el tipo de abordaje quirúrgico probablemente tiene mayor relación con la pérdida de peso en estos pacientes.

Abstract Introduction: Obesity is associated with multiple comorbidities such as dyslipidemia. Objective: To analyze the changes in lipid parameters in patients undergoing bariatric surgery procedures. Material and methods: Longitudinal study in patients undergoing bariatric surgery in 2016. Post-procedure changes were recorded. Results: 66 patients were included. Gastric sleeve was performed in 33.3%, Roux-en-Y gastric bypass (RYGB) in 22.7% and an anastomosis bypass in 43.9%. Initial weight of 122 ± 26.9 kg and initial BMI of 46.72 ± 8.7 kg/m2. Atherogenic dyslipidemia (AD) occurred in 83.3%. Significant differences were found in all the variables studied at the year of follow-up; no difference between the different techniques in weight: p = 0.674, %EBWL: p = 0.420, TGC: p = 0.287 and c-HDL: p = 0.432; if in the changes of CT (p = 0.0001) and c-LDL (p = 0.01). When evaluating the indexes, a significant difference was found in all at the beginning and at 12 months of follow-up (p = 0.001); no difference between the techniques studied. With respect to AD, significant improvement was observed at one year follow-up (p = 0.05) with remission in 74%. Conclusions: Bariatric surgery is associated with improvement of the different lipid parameters, with remission of AD in most patients regardless of the type of procedure performed.

Resumen Introducción: La obesidad se asocia a múltiples comorbilidades como la dislipidemia. Objetivo: Analizar los cambios en los parámetros lipídicos en pacientes sometidos a procedimientos de cirugía bariátrica. Material y métodos: Estudio longitudinal en pacientes sometidos a cirugía bariátrica en 2016. Se registraron los cambios posteriores al procedimiento. Resultados: Se incluyeron 66 pacientes. Se realizó manga gástrica en 33.3%, bypass en Y de Roux en 22.7% y bypass de una anastomosis en 43.9%. Peso inicial de 122 ± 26.9 kg e IMC inicial de 46.72 ± 8.7 kg/m2. Se presentó dislipidemia aterogénica (DA) en 83.3%. Se encontraron diferencias significativas en todas las variables estudiadas al año de seguimiento; sin diferencia entre las diferentes técnicas en peso: p = 0.674, %EPP: p = 0.420, TGC: p = 0.287 y c-HDL: p = 0.432; si en los cambios de CT (p = 0.0001) y c-LDL (p = 0.01). Al evaluar los índices, en todos se encontró diferencia significativa al inicio y a los 12 meses de seguimiento (p = 0.001) sin diferencia entre las técnicas estudiadas. Con respecto a la DA, se observó mejoría significativa al año de seguimiento (p = 0.05) con remisión en 74%. Conclusiones: La cirugía bariátrica se asocia a mejoría de los diferentes parámetros lipídicos con remisión de la DA en la mayoría de los pacientes independientemente del tipo de procedimiento realizado.

RESUMO Racional: A obesidade é um grande problema de saúde. Bypass gástrico com uma anastomose (OAGB) é operação de perda de peso restritiva e disabsortiva que carrega as mesmas características do bypass gástrico em Y-de-Roux em seu status de mecanismo de perda de peso, mas seus resultados permanecem controversos. Objetivo: Descrever a técnica e os resultados do OAGB e seus efeitos na perda de peso e na remissão de comorbidades. Método: Revisão retrospectiva de todos os pacientes que foram submetidos a OAGB de janeiro de 2017 a janeiro de 2018. As características basais dos pacientes foram registradas. O acompanhamento de rotina foi de 1, 3, 6 e 12 meses. Resultados: Um total de 51 pacientes foi submetido a OAGB-HGM. A idade média foi de 43,8±9,3 anos, o peso médio foi de 125±31 e o IMC médio de 55,8±12 kg/m2. Em relação às comorbidades, 64,7% apresentavam diabete melito tipo 2 (DM2), 43,1% hipertensão arterial sistêmica (HAS) e 51% dislipidemia. O IMC diminuiu para 48,4±1,3 a 31±4,4 em 12 meses (p=0,0001) e a redução média foi de 65% de perda de excesso de peso (EWL) em 12 meses de seguimento. Houve melhora nos valores do colesterol total (CT) (p=0,348); triglicéridos (TGC) (p=0,0001); LDL (p=0,06), HDL (p=0,029) e A1C (p=0,405). A remissão do DM2 ao seguimento de 12 meses após a operação foi de 57% (p=0,124), remissão da HAS 37% (p=0,040) e remissão da dislipidemia de 43% (p=0,967). Conclusões: OAGB-HGM é procedimento comumente realizado e seguro. Resultados de curto prazo parecem promissores; no entanto, o acompanhamento em longo prazo é necessário para avaliar as complicações e possíveis efeitos nutricionais

ABSTRACT Background: Obesity is a major health problem. One anastomosis-gastric bypass (OAGB) is a restrictive and malabsorptive weight loss surgery that carries the same characteristics of Roux-en-Y gastric bypass in its status as a weight loss mechanism; but, its results remain controversial. Aim: To describe the technique and outcomes of OAGB and its effects on weight loss and remission of comorbidities. Methods: Retrospective review of all patients who underwent OAGB procedure from January 2017 to January 2018. Patients’ baseline characteristics were recorded. The routine in follow-up were at 1, 3, 6 and 12 months. Results: A total of 51 patients underwent OAGB. The mean age was 43.8±9.3 years, mean weight was 125±31 and mean BMI was 55.8±12 kg/m2. With regard to comorbidities, 64.7% had type 2 diabetes mellitus (T2DM), 43.1% systemic arterial hypertension (SAH) and 51% dyslipidemia. The BMI decreased for 48.4±1.3 to 31±4.4 at 12 months (p=0.0001) and we obtained an average decreased of 65% excess weight loss (EWL) at 12 months of follow-up. There was improvement in the values of total cholesterol (CT) (p=0.348); triglycerides (TGC) (p=0.0001); LDL (p=0.06), HDL (p=0.029) and A1C (p=0.405). Remission of T2DM al 12 months follow-up after surgery was 57% (p=0.124), remission of SAH 37% (p=0.040) and remission of dyslipidemia of 43% (p=0.967). Conclusions: OAGB is a commonly performed and safe procedure. Short term results appear promising; however, long-term follow-up is necessary to evaluate complications and possible nutritional effects.