Manoela Galvão Ramos

Gastro Obeso Center

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Almino Ramos

Gastro Obeso Center

Eduardo Lemos de Souza Bastos

Faculdade de Medicina de Marília

Josemberg Marins Campos

Universidade Federal de Pernambuco

Manoel Galvão Neto

Faculdade de Medicina do ABC

Thales Delmondes Galvão

Gastro Obeso Center

Nestor Tadashi Suguitani BERTIN

Gastro Obeso Center

Raphael Lucena

Gastro Obeso Center

Josemberg MARINS

Universidade Federal de Pernambuco

Natán Zundel

Fundación Santa Fe de Bogotá

Mário Nora

Centro Hospitalar de Entre o Douro e Vouga E.P.E.

Cooperative Institutions

Gastro Obeso Center

Universidade Federal de Pernambuco

Kennedy Clinic Hospital

Universidade Nove de Julho

Universidade de São Paulo

D’Or Institute for Research and Education

Hospital São Paulo

Florida International University

Faculdade de Medicina do ABC

Hospital das Clínicas da Universidade Federal de Pernambuco

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Total clipless cholecystectomy by means of harmonic sealing

Figshare (2021)

Almino Ramos Manoela Galvão Ramos Manoel Galvão Neto Josemberg MARINS Eduardo Lemos de Souza Bastos

BACKGROUND: In traditional laparoscopic cholecistectomy, the cystic duct and artery are commonly closed by metallic clips just before their division. Although the placement of these clips for occluding cystic artery and duct can be considered safe, biliary leaks and bleeding may occur especially by its dislodgement. AIM: To report a prospective case-series in total clipless cholecystectomy by means of harmonic shears for closure and division of the artery and cystic duct as well removal of the gallbladder from the liver. METHODS: Was evaluate a series of 125 patients who underwent laparoscopic cholecystectomy where the sealing and division of cystic artery and duct was carried out only by harmonic shears. The intact extracted gallbladder was submitted to a reverse pressure test for assessment of the technique safety by means of CO2 insuflation. RESULTS: The most common indication for surgery was gallstones. The mean operative time was 26 min and all gallbladders were dissected intact from the liver bed. There was no mortality and the overall morbidity rate was 0.8% with no hemorrhage or leaks. The reverse pressure test showed that all specimens support at least 36-mmHg of pressure without leaking. CONCLUSION: The harmonic shears is effective and safe in laparoscopic cholecystectomy as a sole instrument for sealing and division of the artery and cystic duct. The main advantages could be related to the safety and decreased operative time.

Harmonic

10.6084/m9.figshare.14281315

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Simplified gastric bypass: 13 years of experience and 12,000 patients operated

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) (2014)

Almino Ramos Andrey Carlo Sousa SILVA Manoela Galvão Ramos Edwin Canseco Manoel Galvão Neto

BACKGROUND: Obesity is increasingly prevalent disease worldwide and bariatric surgery is the most effective treatment for the most severe cases. The Roux-en-Y gastric bypass is still the most used technique all over the world and the laparoscopic approach has been preferred by surgeons with different approaches, propositions and techniques in performing the procedure. AIM: To report the surgical aspects of the systematization and results of the simplified laparoscopic gastric bypass (Brazilian technique). METHODS: Were included all patients undergoing this procedure from January 2001 to July 2014; were described and analyzed aspects of this technique, the systematization and complications associated with the procedure. RESULTS: A total of 12,000 patients (72% women) were included, with a mean age of 43 years (14-76) and a mean BMI of 44.5 (35-90 kg/m2). Mean total operative time was 72 minutes (36-270) and the mean hospital stay was 36 hours. There were 303 cases of gastrojejunostomy stenosis (2.5%), 370 patients had gastrointestinal bleeding (3%) with only one lap revision due to a enteroanastomosis bleeding and six revisions related to intestinal obstruction caused by impacted clots in the jejunojenunostomy. Blood transfusion was needed in 32 patients (0.3%); Petersen hernia was diagnosed in 18 (0.15%) and digestive fistula in 54 (0.45%), which led to reoperation in 43 of them (67%). The overall mortality was 0.1% (fistula with sepsis=8, pulmonary thromboembolism=3; intestinal obstruction associated with sepsis=1). CONCLUSION: The simplified laparoscopic gastric bypass is a feasible and safe option with low complication rate and easy reproducibility for education and training in bariatric surgery.

Internal hernia

10.1590/s0102-6720201400s100002

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Citations (48)

INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) (2016)

Eduardo Arevalo VIDAL Francisco Abarca Rendón Trino Andrade Zambrano Yudoco Andrade GARCÍA Mario Ferrin VITERI

Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy.To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries.Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients.Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported.Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach.Má-rotação intestinal é rara anomalia congênita em adultos de difícil reconhecimento devido à falta de sintomas. O diagnóstico é feito geralmente incidentalmente durante procedimentos cirúrgicos ou durante autópsia.Verificar a ocorrência e reconhecimento não eventual da má-rotação intestinal durante operações bariátricas sequenciais.Retrospectivamente foram analisados os prontuários médicos de 20.000 casos de operações bariátricas de janeiro 2002 a janeiro de 2016, procurando por ocorrência de má-rotação intestinal, sua interferência na técnica operatória aplicada e a evolução imediata no pós-operatório.Foram encontrados cinco casos (0.025%) de má-rotação intestinal em homens com idades de 37, 39, 45, 49 e 52 anos e IMC de 35, 42, 49, 47 e 52 kg/m2. O paciente com IMC de 35 kg/m2 também sofria de diabete melito tipo 2. Todos os procedimentos foram realizados através de laparoscopia, sem conversões. Em um paciente não foi possível mover o jejuno para o abdome superior a fim de realizar gastrojejunostomia; foi, então, realizada gastrectomia vertical. Em outro paciente, não foi possível reconhecer totalmente a anatomia devido às aderências intestinais e foi decidido realizar bypass gástrico com anastomose única. Nenhum vazamento ou sangramento foi identificado. Não houve nenhuma complicação pós-operatória. Todos os pacientes foram liberados 72 h após o procedimento e nenhuma complicação foi notificada nos primeiros 30 dias.A cirurgia bariátrica laparoscópica pode ser realizada com sucesso em pacientes com má-rotação. Mudanças talvez sejam necessárias com relação à anomalia. Os cirurgiões devem verificar toda a condição anatômica abdominal antes de iniciar a secção gástrica.

Intestinal Malrotation

Sleeve gastrectomy

10.1590/0102-6720201600s10007

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SADI-S WITH RIGHT GASTRIC ARTERY LIGATION: TECHNICAL SYSTEMATIZATION AND EARLY RESULTS

Figshare (2019)

Jordi Pujol Gebellí Amador García-Ruiz-de-Gordejuela Almino Ramos Mário Nora Ana Marta PEREIRA

ABSTRACT Background: Bariatric surgery is performed all over the world with close to 500.000 procedures per year. The most performed techniques are Roux-en-Y gastric bypass and sleeve gastrectomy. Despite this data, the most effective procedure, biliopancreatic diversion with or without duodenal switch, represents only no more than 1.5% of the procedures. Technical complexity, morbidity, mortality, and severe nutritional adverse effects related to the procedure are the main fears that prevent most universal acceptance. Aim: To explain the technical aspects and the benefits of the SADI-S with right gastric artery ligation as an effective simplification from the original duodenal switch. Methods: Were included all patients undergoing this procedure from the November 2014 to May 2016, describing and analysing aspects of this technique, the systematization and early complications associated with the procedure. Results: A series of 67 patients were operated; 46 were women (68.7%); mean age of the group was 44 years old (33-56); and an average BMI of 53.5 kg/m2 (50-63.5). Surgical time was 115 min (80-180). A total of five patients (7.5%) had any complication and two (2.9%) had to be reoperated. There were two patients with leak, one at the duodenal stump and other at the esophagogastric angle. There was no mortality. Patients stayed at the hospital a median of 2.5 days (1-25). Conclusions: SADI-S with right gastric artery ligation is a safe procedure with few preliminary complications. The technical variations introduced to the classical duodenal switch are reproducible and may allow this procedure to be more popular. All the complications in this series were not related to the ligation of the right gastric artery.

10.6084/m9.figshare.7743455

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TECHNICAL ASPECTS OF LAPAROSCOPIC SLEEVE GASTRECTOMY

Figshare (2021)

Almino Ramos Eduardo Lemos de Souza Bastos Manoela Galvão Ramos Nestor Tadashi Suguitani BERTIN Thales Delmondes Galvão

Background : The vertical gastrectomy indications for surgical treatment of morbid obesity have increased worldwide. Despite this increase, many aspects of surgical technique still remains in controversy. Aim : To contribute presenting surgical details in order to better realize the vertical gastrectomy technique in bariatric surgery. Methods : Technical systematization, patient preparation, positioning of the trocars, operative technique and postoperative care are presented in details. Results : During 12 months were enrolled 120 patients undergoing GV according to the technique described herein. The results are published in another ABCD article (ABCD 2015;28(Supl.1):61-64) in this same volume and number. Conclusion : The surgical technique proposed here presented itself viable and facilitating the surgeon's work on difficult points of the vertical gastrectomy.

Sleeve gastrectomy

10.6084/m9.figshare.14281358

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Correlação entre cadáveres carbonizados e a dosagem da carboxihemoglobina

Revista Brasileira de Criminalística (2015)

Danielle Menezes Xavier Leonardo Dau Priscilla dos Santos Junqueira Nunes Manoela Galvão Ramos Andre Luiz Barbosa Roquette

As causas mais frequentes de óbito nos pacientes com lesões inalatórias estão relacionadas à intoxicação por monóxido de carbono (CO). A intoxicação pelo CO se dá pela falta de ar respirável, havendo substituição do oxigênio pelo CO, formando a carboxihemoglobina (COHb). A toxicidade se faz dependente de sua concentração. O artigo em questão avalia a relação da dosagem de COHb associada ao sinal de Montalti positivo, em cadáveres carbonizados, que foram encaminhados ao Instituto de Medicina Legal de Belo Horizonte (IML-BH). O objetivo é de comprovar se os cadáveres em questão vieram a óbito por asfixia ou por outro fator secundário. Para a realização da pesquisa foram feitos levantamentos de dados através de laudos necroscópicos e análises desses, os materiais analisados foram exames de espectrofotometria disponibilizados pelo IML-BH. Foi feito o levantamento dos resultados de COHb e realizado a correlação entre a COHb e o sinal de Montalti, que se mostra positivo quando encontrada fuligem na traqueia. Existiram dificuldades para estabelecer a porcentagem padrão que seria usada como referência para poder se confirmar que a intoxicação foi a causa mortis. Apesar disso, foi possível realizar as dosagens de COHb e fazer correlações dessa com: a faixa etária dos indivíduos, o nível de drogas de abuso e álcool no sangue e o local que ocorreu a carbonização. Os resultados alcançados demonstram a importância das dosagens feitas para a determinação da causa mortis do indivíduo, como fator essencial para o fechamento de laudos e investigações.

10.15260/rbc.v4i1.79

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Safe And Feasibility Of Ultra Fast-Track In Laparoscopic Gastric Bypass Surgery

Surgery for Obesity and Related Diseases (2017)

Almino Ramos Manoela Galvão Ramos Thales Delmondes Galvão Nestor Tadashi Suguitani BERTIN Raphael Lucena

Fast track

Roux-en-Y anastomosis

Gastric bypass surgery

10.1016/j.soard.2017.09.074

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MEDIUM-TERM FOLLOW-UP RESULTS WITH LAPAROSCOPIC SLEEVE GASTRECTOMY

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) (2015)

Almino Ramos Eduardo Lemos de Souza Bastos Manoela Galvão Ramos Nestor Tadashi Suguitani BERTIN Thales Delmondes Galvão

The indications for sleeve gastrectomy in the surgical treatment of morbid obesity have increased worldwide. Despite this, several aspects related to results at medium and long term remain in constant research.To present the experience of sleeve gastrectomy in a center of excellence in bariatric surgery by analyzing clinical outcomes, complications and follow-up in the medium term.The study included 120 morbidly obese patients who underwent sleeve gastrectomy and who were followed for at least 24 months. Aspects related to surgical technique, surgical complications and clinical outcome were analyzed.Seventy-five patients were women (62.5%) and the average age was 36 years. The body mass index preoperatively ranged from 35.5 to 58 kg/m2(average of 40.2 kg/m2). The length of stay ranged from 1 to 4 days (mean 2.1 days). Comorbidities observed were hypertension (19%), type 2 diabetes mellitus (6.6%), dyslipidemia (7.5%), sleep apnea (16.6%), reflux esophagitis (10%) and orthopedic diseases (7.5%). The mean body mass index and total weight loss percentage with 3, 12, 18 and 24 months were 32.2 kg/m2-19,9%; 29.5 kg/m2-26,5%; 28.2 kg/m2-30,3% and 26.9 kg/m2-32,7%, respectively. Remission of diabetes and dyslipidemia occurred in all patients. In relation to hypertension, there was improvement or remission in 86%. There were only two complications (bronchial pneumonia and dehydration), with good response to clinical treatment. There was no evidence digestive fistula and mortality was zero. Eleven patients (9.1%) had regained weighing more than 5 kg.The sleeve gastrectomy is surgical technique that has proven safe and effective in the surgical treatment of obesity and control of their comorbidities in postoperative follow-up for two years.

Dyslipidemia

Sleeve gastrectomy

10.1590/s0102-6720201500s100017

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Citations (9)

Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula

Surgery for Obesity and Related Diseases (2014)

Almino Ramos Manoela Galvão Ramos Josemberg Marins Campos Manoel Galvão Neto Eduardo Lemos de Souza Bastos

10.1016/j.soard.2014.10.021

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Citations (30)

New Closure Suture Technique to Prevent Petersen's Space Internal Hernia after Gastric Bypass