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Orientador(es)
Resumo(s)
A cirurgia bariátrica é a intervenção mais eficaz no tratamento da obesidade, permitindo uma perda ponderal sustentada, elevadas
taxas de remissão da diabetes mellitus tipo 2, redução do risco cardiovascular e mortalidade. Este artigo de revisão aborda as
principais técnicas cirúrgicas e enquadra os respetivos ganhos metabólicos, que se iniciam muito precocemente após cirurgia, e se
mantêm a longo prazo. Os mecanismos fisiopatológicos associados, e que extrapolam os componentes restritivo e malabsortivo
classicamente descritos, são sumariamente explanados neste artigo, e que incluem, a exclusão do intestino proximal, a chegada
precoce dos nutrientes ao intestino distal, a modulação neuroendócrina e de hormonas reguladoras do apetite, as modificações no
metabolismo dos ácidos biliares e no microbioma intestinal. Conclui-se, sublinhando que a escolha da técnica deve ser individualizada, ponderando a eficácia metabólica que pode proporcionar, face ao risco de complicações cirúrgicas e nutricionais, e sempre no âmbito de um programa multidisciplinar.
Bariatric surgery is the most e ective intervention in the treatment of obesity, allowing sustained weight loss, high rates of type 2 diabetes remission, and reduced cardiovascular risk and mortality. This review discusses the main surgical techniques and outlines the associated metabolic gains, which begin shortly after surgery and are maintained in the long term. The related pathophysiological mechanisms, which go beyond the classically described restriction and malabsorption, are briefly explained in this article and include proximal bowel exclusion, early arrival of nutrients in the distal bowel, neuroendocrine and appetite-regulating hormone modulation, and changes in bile acid metabolism and the gut microbiome. In conclusion, it is essential to emphasize that the choice of surgical technique must be individualized, considering the metabolic outcomes it can provide, the risks of surgical and nutritional complications, and always within the context of a multidisciplinary program.
Bariatric surgery is the most e ective intervention in the treatment of obesity, allowing sustained weight loss, high rates of type 2 diabetes remission, and reduced cardiovascular risk and mortality. This review discusses the main surgical techniques and outlines the associated metabolic gains, which begin shortly after surgery and are maintained in the long term. The related pathophysiological mechanisms, which go beyond the classically described restriction and malabsorption, are briefly explained in this article and include proximal bowel exclusion, early arrival of nutrients in the distal bowel, neuroendocrine and appetite-regulating hormone modulation, and changes in bile acid metabolism and the gut microbiome. In conclusion, it is essential to emphasize that the choice of surgical technique must be individualized, considering the metabolic outcomes it can provide, the risks of surgical and nutritional complications, and always within the context of a multidisciplinary program.
Descrição
Palavras-chave
HCC CIR HCC END Biomarcadores/metabolismo Cirurgia Bariátrica Diabetes Mellitus Tipo 2/cirurgia Microbioma Gastrointestinal Grelina/metabolismo Peptídeo Semelhante ao Glucagon Tipo 1/metabolismo Obesidade/cirurgia
Contexto Educativo
Citação
Rev Port Cir. 2026;59(sup. 1): 39-48
Editora
Sociedade Portuguesa de Cirurgia