INTRODUCTION
Obesity represents a serious emerging disease with consequent negative
public health outcomes.[1] There are currently
more than 2.0 billion overweight and obese people in the world, and
Brazil is in fifth place in the world ranking, with an estimate of more
than 18.0 million people.[2]
In this scenario, bariatric surgery is more effective in weight loss and
control of comorbidities in relation to dietary procedures and
drugs.[3] Despite the good results and control of
the disease in the medium and long term, the Roux-en-Y Gastric Bypass
(RYGB) features about 20% of the patients submitted to this surgery do
not lose the desired weight in the first year or regain weight after 18
to 24 months.[3] The weight regains process can
involve several variables, highlighting the size of the gastric pouch
(GP), size of the gastrojejunal anastomosis (GJA), BMI prior to surgery,
eating habits, psychiatric disorders, problems with self-esteem and
socioeconomic conditions.[4,5]
According to the International Federation for the Surgery of Obesity and
Metabolic Disorders (IFSO) in its report published in 2015, about 86
thousand bariatric surgeries were performed in Brazil, 70.0% of which
was RYGB -type laparoscopic gastroplasty.[6] In
this sense, several studies regarding RYGB have shown significant
results, including increasing survival, reducing cardiovascular
mortality, and controlling metabolic diseases.[7-9]
In this context, the most common late complication is the recurrence of
obesity, in which the main associated factors are food error and bad
lifestyle habits associated with a sedentary lifestyle, which can cause
an increased gastric reservoir and dilation of the diameter of the GJA
and among others.[10,11] Thus, GJA above 15.0 mm
has been associated with obesity recurrence, especially when associated
with complaints of decreased satiety or early hunger due to rapid
gastric emptying.[11-13]
In this sense, the narrowing of the dilated GJA through argon plasma
coagulation (APC) in the recurrence of obesity, in patients undergoing
RYGB, presents itself as an effective and safe alternative, according to
important published works.[14-18] As a consequence
of weight gain after RYGB, abnormal anatomical findings are found in
71.2% of patients, with 58.9% presenting with GJA
dilation.[18] Therefore, APC is technically
feasible and reproducible, relatively inexpensive, and with numerous
advantages over the usual
electrocoagulation.[14-17] The complications have
a low incidence and the tissue penetration limit of 2.0 to 3.0 mm
associated with adequate coagulation allows its application in critical
areas such as the duodenum and the colon.[18]
Thus, decreasing the diameter of a dilated anastomosis can lead to a
23% reduction in excess weight on average, together with the monitoring
of a multidisciplinary team.[18] In this sense,
the recurrence of obesity is associated with decreased quality of life
and recurrence of comorbidities.[19,20]
Thus, the present study assessed the efficacy and complications of APC
therapy in treating post- RYGB weight recovery compared to a sham
control group.