ABSTRACT Background: Among the 2.0 billion overweight individuals in the world, Brazil ranks fifth in the number of obese people, therefore requiring treatment options for obesity. Aim: The aim of this study was to compare the percentage of total body weight loss (%TWL), change in body mass index (BMI), percentage of excess weight loss (%EWL), incidence of reflux esophagitis, and occurrence of Barrett's esophagus in obese patients undergoing gastric bypass (Roux-en-Y gastric bypass [RYGB]) and sleeve gastrectomy (SG), both techniques by videolaparoscopy. Methods: The study included 100 consecutive patients who underwent RYGB and SG techniques, totaling 200 patients, and were followed up for 60 months, from June 2013 to July 2018. Results: The frequency of gastroesophageal reflux disease (GERD) was lower in RYGB patients (p<0.05). At 60 months, the %EWL was 77.4±13.3 kg (RYGB) versus 80.5±17.5 kg (SG) (p<0.05). The BMI data were statistically significantly different between groups after 5 years (28.5±3.9 kg/m2 in RYGB and 31.9±5.3 kg/m2 in SG groups, p<0.05). During the follow-up, the RYGB showed higher %EWL compared to the SG (at 60 months, 80.1% vs. 59.1%, respectively, p<0.05). The %TWL was 30% for the RYGB and 19.7% for the SG (p<0.05). The RYGB had a lower frequency of reflux esophagitis and Barrett's esophagus. Conclusions: The RYGB technique showed greater absolute weight loss, %TWL, BMI reduction, and %EWL in higher obesity classes compared to the SG technique. Additionally, RYGB had a lower frequency of reflux esophagitis and Barrett's esophagus.

RESUMO Racional: Dentre os 2,0 bilhões de indivíduos com sobrepeso no mundo, O Brasil ocupa o quinto lugar em número de obesos, portanto, necessitando de opções de tratamento para obesidade. Objetivos: Comparar a porcentagem de perda de peso corporal total, alteração do índice de massa corporal (IMC), a porcentagem de perda de excesso de peso (%PEP), incidência de esofagite de refluxo e a ocorrência esôfago de Barrett em obesos submetidos às técnicas de bypass gástrico (RYGB) e a gastrectomia vertical (GV) por videolaparoscopia. Métodos: Foram incluídos no estudo 100 pacientes consecutivos submetidos às técnicas RYGB e o LSG, totalizando 200 pacientes, seguidos durante 60 meses, de junho de 2013 a julho de 2018. Resultados: A frequência de doença do refluxo gastroesofágico (DRGE) registrada foi menor em pacientes submetidos à RYGB (p < 0,05). Aos 60 meses, a perda absoluta de peso foi de 77,4±13,3 kg (RYGB) versus 80,5±17,5 (GV) (p<0,05). Os dados do IMC foram, após 5 anos, 28,5 ± 3,9 kg/m2 no RYGB e 31,9 ± 5,3 kg/m2 nos grupos GV, p<0,05. A técnica RYGB mostrou maiores %PEP em comparação à técnica GV (aos 60 meses, 80,1% vs. 59,1%, respectivamente, p<0,05). A porcentagem de perda do peso total (%PEP) foi de 30% para à técnica RYGB e 19,7% para a GV (p<0,05). A técnica RYGB teve menor frequência de esofagite de refluxo e esôfago de Barrett. Conclusões: A técnica RYGB mostrou maior perda de peso absoluta, porcentagem de perda de peso corporal total, redução do IMC e %PEP em comparação à técnica GV; além de menor frequência de esofagite de refluxo e esôfago de Barrett.

ABSTRACT Purpose: Vasoplegia, or vasoplegic shock, is a syndrome whose main characteristic is reducing blood pressure in the presence of a standard or high cardiac output. For the treatment, vasopressors are recommended, and the most used is norepinephrine. However, new drugs have been evaluated, and conflicting results exist in the literature. Methods: This is a systematic review of the literature with meta-analysis, written according to the recommendations of the PRISMA report. The SCOPUS, PubMed, and ScienceDirect databases were used to select the scientific articles included in the study. Searches were conducted in December 2022 using the terms “vasopressin,” “norepinephrine,” “vasoplegic shock,” “postoperative,” and “surgery.” Meta-analysis was performed using Review Manager (RevMan) 5.4. The endpoint associated with the study was efficiency in treating vasoplegic shock and reduced risk of death. Results: In total, 2,090 articles were retrieved; after applying the inclusion and exclusion criteria, ten studies were selected to compose the present review. We found no significant difference when assessing the outcome mortality comparing vasopressin versus norepinephrine (odds ratio = 1.60; confidence interval 0.47–5.50), nor when comparing studies on vasopressin versus placebo. When we analyzed the length of hospital stay compared to the use of vasopressin and norepinephrine, we identified a shorter length of hospital stay in cases that used vasopressin; however, the meta-analysis did not demonstrate statistical significance. Conclusions: Considering the outcomes included in our study, it is worth noting that most studies showed that using vasopressin was safe and can be considered in managing postoperative vasoplegic shock.