Avaliação de medidas do lobo esquerdo do fígado, relacionando-as com a dificuldade de acesso para cirurgias bariátricas

Abstract

There are several studies showing increased weight of the world’s population. Obesity is today responsible for more deaths than malnutrition worldwide. This growth, especially in morbid obesity, resulted in the increase of bariatric surgery. According to the 1991 consensus of the NIH (National Institute of American Health), bariatric surgery was considered to be the only effective treatment for these patients who were not successful with previous clinical treatment Like any surgical procedure, bariatric surgery presents conditions that hinder their achievement. Several authors emphasize the difficulty of an enlarged and fatty liver to the surgeon during laparoscopy. Due to this need to be able to assess the dimensions of the hepatic left lobe, various techniques through imaging methods have been developed. Among the methods used, the ultrasound has the advantages of not emitting ionizing radiation, low cost and wide availability. Despite these advantages, there are still no criteria for evaluating hepatic size with a focus on bariatric surgery, that is, the dimensions of the liver are not taken into account the gastric esophagus transition. The aim of the present study is to determine the relationship of left liver lobe measurements and eventual limitation offered by the liver to the intraoperative period of bariatric surgery. For this, special liver measurements were performed using anatomical landmarks of particular interest for bariatric surgery and comparing with eventual transoperative limitation offered by the liver. Methods: Eighty patients underwent preoperative US to evaluate the size of the left lobe of the liver, 24-48 hours prior to LRYGBP (laparoscopic Roux-en-Y gastric by-pass) or LSG (sleeve gastrectomy). These measures were made in the traditional way and using specific anatomical landmarks. It was possible to obtain all measures in seventy-nine patients and the results were then compared with the intraoperative findings, classified by the surgeon as liver easily removable or removable with difficulty. Results: There was no significant differences in the traditional measures of the left lobe (p = 0.83). In several measures proposed by this study, there were statistically significant differences between the groups with and without difficulty in removing the liver. Between this new measures, the ones that better separated the two groups were obtained in the following measures: LLL (p <0.001, ES=1.11, AUC=0.74), LLlong x LLL (p=0.13, AS=1.12, AUC=0.74) and the multiplication of the three measures (p=0.019, ES=1.14, AUC=0.73). Conclusions: The measures proposed were related to the intraoperative difficulty to remove the liver and access the Angle of His in bariatric surgeries by videolaparoscopy.