Biópsia hepática em cunha ou com agulha em cirurgia bariátrica convencional

• Ano de defesa: 2005
• Autor(a) principal: Padoin, Alexandre Vontobel
• Orientador(a): Silva, Jefferson Luis Braga da
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; CIRURGIA BARIÁTRICA; OBESIDADE MÓRBIDA; FÍGADO - DOENÇAS
• Link de acesso: http://hdl.handle.net/10923/4490

Background: Morbidly obese patients, despite normal laboratory tests and no clinical evidence of disease, present high prevalence of hepatic histological changes. Hepatic biopsy is able to define diagnosis, staging and to assess the evolution (follow-up) of hepatic disease, thus helping to define clinical management. There is no agreement on which biopsy technique provides better material for analysis. Considering that subcapsular fibrosis is a common finding, sampling from more profound sites is necessary in order to achieve an adequate histological assessment. Methods: This is a transversal study of 264 consecutive morbidly obese patients, submitted to open Roux and Y gastric bypass between July 2001 and September 2004, in which a transoperatory liver biopsy was taken. The first 107 were wedge biopsies and the last 157 were needle biopsies. The histological degree of steatosis, presence of fibrosis and adequacy of material from the different biopsy techniques were compared. Results: The degree of steatosis of both sampling techniques showed no statistical difference (p=0. 132). The presence of fibrosis in wedge biopsies (46. 1% fibrosis, n: 41) was significantly higher than in needle biopsies (13. 7% fibrosis, n: 20), p<0. 001. As expected, sample size of needle biopsies was smaller than the obtained by the wedge technique (p < 0. 001), but there was no difference in the quality of material obtained (p=0. 95). Conclusion: Needle biopsies were as effective as wedge biopsies to assess the degree of steatosis in morbidly obese patients. The presence of subcapsular fibrosis in needle biopsies was lower than in wedge biopsies, suggesting an adequate tissue sampling through a less invasive technique.