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.