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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Resultados iniciais da primeira série de casos brasileira de cirurgia bariátrica totalmente robótica

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) (2013)

Almino Ramos Carlos Eduardo Domene Paula Volpe Dênis Pajecki Luiz Alfredo Vieira d’Almeida

Currently, bariatric surgery is the most effective therapy for morbid obesity, and the laparoscopic approach is considered gold-standard for Roux-en-Y gastric bypass. Totally robotic Roux-en-Y gastric bypass has been proposed as a major evolution in minimally invasive bariatric surgery and its use is becoming more widespread.To provide an early report of the first Brazilian case-series of totally robotic gastric bypass and perioperative short-term outcomes.All consecutive patients who underwent totally robotic gastric bypass at two recognized centers of bariatric surgery were included. Patient demographic data, body mass index, operative times, hospital stay, complications and mortality in the 30 postoperative days were recorded. The surgeons received the same training program before the clinical procedures and all the surgeries were performed under the supervision of an experienced robotic surgeon.The surgeries were performed by five surgeons and included 68 patients (52 women - 76.5%), with a mean age of 40.5 years (range 18 to 59) and mean BMI of 41.3 (35.2 - 59.2). Total mean operative time was 158 minutes (range 90 to 230) and mean overall hospital stay was 48 h. Postoperative surgical complication rate (30 day) was 5.9%, with three minor and one major complication. There was no mortality, leak or stricture.Even with surgeons in early learning curves, the robotic approach within a well-structured training model was safe and reproducible for the surgical treatment of the morbid obesity.

Gold standard (test)

Roux-en-Y anastomosis

10.1590/s0102-67202013000600002

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Citations (12)

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

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

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.

Duodenal switch

Biliopancreatic Diversion

Sleeve gastrectomy

Clipping (morphology)

10.1590/0102-6720201600s10021

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Citations (27)

The Role of Gastrojejunostomy Size on Gastric Bypass Weight Loss

Obesity Surgery (2017)

Almino Ramos João Caetano Marchesini Eduardo Lemos de Souza Bastos Manoela Galvão Ramos Maíra Danielle Gomes de Souza

Gastric banding

10.1007/s11695-017-2686-6

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Citations (25)

Laparoscopic Total Gastrectomy for the Treatment of Post-Sleeve Chronic Unhealing Fistula

Journal of the American College of Surgeons (2017)

Almino Ramos Eduardo L.S. Bastos Manoel Galvão Neto Manoela Galvão Ramos Josemberg Marins Campos

Sleeve gastrectomy

10.1016/j.jamcollsurg.2017.07.530

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Citations (0)

Total clipless cholecystectomy by means of harmonic sealing

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

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

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.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.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.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.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.

Cystic artery

Harmonic scalpel

CLIPS

10.1590/s0102-67202015000100014

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Citations (16)

TECHNICAL ASPECTS OF 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 vertical gastrectomy indications for surgical treatment of morbid obesity have increased worldwide. Despite this increase, many aspects of surgical technique still remains in controversy.To contribute presenting surgical details in order to better realize the vertical gastrectomy technique in bariatric surgery.Technical systematization, patient preparation, positioning of the trocars, operative technique and postoperative care are presented in details.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.The surgical technique proposed here presented itself viable and facilitating the surgeon's work on difficult points of the vertical gastrectomy.

Sleeve gastrectomy

Invasive surgery

10.1590/s0102-6720201500s100018

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Citations (24)