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Affiliation(s)
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Cited by Other Article(s) |
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1
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Thobie A, Menahem B, Pouchucq C, Bouvier V, Alves A, Dejardin O. Comparison between total weight loss and other metrics after bariatric surgery using a multilevel mixed-effects linear regression model. Surg Endosc 2024; 38:3684-3690. [PMID: 38777893 DOI: 10.1007/s00464-024-10883-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Several tools are used to assess postoperative weight loss after bariatric surgery, including the percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess body mass index (BMI) loss (%EBMIL). A repeated series of measurements should be considered to assess weight loss as accurately as possible. This study aimed to test weight loss metrics. METHODS Data were obtained from a prospective database of patients with obesity who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2016 and 2017 in a French tertiary referral bariatric center. A multilevel mixed-effects linear regression model with repeated measures was used to analyze repeated weight measurements over time. RESULTS A total of 435 patients underwent LRYGB (n = 266) or LSG (n = 169). At 2 years, the average %EWL, %EBMIL, and %TWL were 56.8%, 61.3%, and 26.6%, respectively. Patients who underwent LSG experienced lower weight loss (β: - 4233 in %TWL model, β: - 6437 in %EWL model, and β: - 6989 in %EBMIL model) than those who underwent LRYGB. In multivariate mixed analysis, preoperative BMI was not significantly associated with %TWL at 2 years (β, - 0.09 [- 0.22-0.03] p = 0.1). Preoperative BMI was negatively associated with both %EWL (β, - 1.61 [- 1.84-- 1.38] p < 0.0001) and %EBMIL (β, - 1.91 [- 2.16-- 1.66] p < 0.0001). CONCLUSION This is the first study to assess %TWL use for postoperative weight measurement, using a multilevel mixed-effects linear regression model %TWL is the measure of choice to assess weight loss following bariatric surgery.
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Affiliation(s)
- Alexandre Thobie
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
- UMR INSERM 1086 'ANTICIPE', Caen, France
- Registre Des Tumeurs Digestives du Calvados, Caen, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
- UMR INSERM 1086 'ANTICIPE', Caen, France
- Registre Des Tumeurs Digestives du Calvados, Caen, France
| | - Camille Pouchucq
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
| | - Véronique Bouvier
- UMR INSERM 1086 'ANTICIPE', Caen, France
- Registre Des Tumeurs Digestives du Calvados, Caen, France
- Department of Research, University Hospital of Caen, Avenue de La Côte de Nacre, 14032, Caen Cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
- UMR INSERM 1086 'ANTICIPE', Caen, France
- Registre Des Tumeurs Digestives du Calvados, Caen, France
| | - Olivier Dejardin
- UMR INSERM 1086 'ANTICIPE', Caen, France.
- Department of Research, University Hospital of Caen, Avenue de La Côte de Nacre, 14032, Caen Cedex, France.
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2
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Cohen RV, Petry TB. How to address weight regain after bariatric surgery in an individualized way. Rev Endocr Metab Disord 2023; 24:993-1002. [PMID: 37171756 DOI: 10.1007/s11154-023-09806-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
Bariatric surgery is the most effective obesity treatment. As a chronic and progressive disease, weight loss response to surgery will vary individually. Thus, insufficient weight loss or regain can happen after surgery, but they lack a standard definition. There are different mechanisms underlying weight regain and/or insufficient weight loss, such as genetics, maladaptive eating behaviors, and the inadequate choice of index operations, among others. Patients with weight regain or insufficient weight loss should be submitted to an individualized and comprehensive evaluation by a multidisciplinary team. This may help identify the causes and direct the appropriate treatment individually. Options for patients with insufficient weight loss and/or weight regain following bariatric surgery include repair of postoperative complications, conversion into another operation, endoscopic therapies with inconsistent outcomes, and dietary/behavioral counseling. Revision and conversion surgeries have higher complication rates than primary operations. Although there is no standard pharmacological regimen for that indication, the new agents seem efficient and safe to promote the loss of the regained weight and even be adjunctive to selected patients before they reach the plateau. This review aims to summarize the knowledge of the best approach for patients with weight regain/insufficient weight loss and suggests an algorithm to customize the approach and therapeutic options after bariatric surgery.
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Affiliation(s)
- Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, São Paulo, Brazil.
| | - Tarissa Bz Petry
- Center for the Treatment of Obesity and Diabetes, Hospital Alemao Oswaldo Cruz, São Paulo, Brazil
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3
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Yang C, Kessler M, Taebi N, Hetjens M, Reissfelder C, Otto M, Vassilev G. Remote Follow-up with a Mobile Application Is Equal to Traditional Outpatient Follow-up After Bariatric Surgery: the BELLA Pilot Trial. Obes Surg 2023:10.1007/s11695-023-06587-2. [PMID: 37081252 PMCID: PMC10119000 DOI: 10.1007/s11695-023-06587-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Medical follow-up after bariatric surgery is recommended. However, the compliance was poor. This study aimed to evaluate the feasibility of a smartphone-based fully remote follow-up (FU) program for patients after bariatric surgery. METHODS In the interventional group, patients were followed up using a smartphone application (app), through which questionnaires were sent regularly. Participants in the control group underwent standard FU at the outpatient clinic every three months. After 12 months, all the participants were evaluated at an outpatient clinic. RESULTS Between August 2020 and March 2021, 44 and 43 patients in the interventional and control groups, respectively, were included in the analysis after three patients were lost to FU, and three withdrew their informed consent because they wished for more personal contact with medical caregivers. After 12 months, total weight loss (TWL), %TWL, and percentage of excess weight loss (%EWL) did not differ between groups. There were no significant differences in the complication rates, including surgical complications, malnutrition, and micronutrition deficiency. The parameters of bioelectrical impedance analysis and quality of life did not differ between the groups. Vitamins and minerals in serum were similar in both groups except for calcium, which was significantly higher in the interventional group (2.52 mmol/L vs. 2.35 mmol/L, p = 0.038). CONCLUSION Fully remote FU with a smartphone application is at least as effective as traditional in-person FU in an outpatient clinic after bariatric surgery. Through remote FU, patients can save time and medical professionals may have more resources for patients with more severe problems.
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Affiliation(s)
- Cui Yang
- Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Mia Kessler
- Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niki Taebi
- Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Hetjens
- Department of Biomedical Informatics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Georgi Vassilev
- Department of Surgery, Medical Faculty Mannheim, University Medicine Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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4
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Lu G, Dong Z, Huang B, Hu S, Cai S, Hu M, Hu R, Wang C. Determination of weight loss effectiveness evaluation indexes and establishment of a nomogram for forecasting the probability of effectiveness of weight loss in bariatric surgery: a retrospective cohort. Int J Surg 2023; 109:850-860. [PMID: 36974733 PMCID: PMC10389379 DOI: 10.1097/js9.0000000000000330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The purpose of this research was to determine the index that contributes the most to assessing the effectiveness of weight loss 1 year following bariatric surgery and to implement it as the clinical outcome to develop and confirm a nomogram to predict whether bariatric surgery would be effective. METHODS Patient information was extracted from the Chinese Obesity and Metabolic Surgery Database for this retrospective study. The most contributing weight loss effectiveness evaluation index was created using canonical correlation analysis (CCA), and the predictors were screened using logistic regression analysis. A nomogram for estimating the likelihood of effectiveness of weight loss was constructed, and its performance was further verified. RESULTS Information was obtained for 540 patients, including 30 variables. According to the CCA, ≥25 percentage total weight loss was found to be the most correlated with patient information and contribute the most as a weight loss effectiveness evaluation index. Logistic regression analysis and nomogram scores identified age, surgical strategy, abdominal circumference, weight loss history, and hyperlipidemia as predictors of effectiveness in weight loss. The prediction model's discrimination, accuracy, and clinical benefit were demonstrated by the consistency index, calibration curve, and decision curve analysis. CONCLUSIONS The authors determined a 25 percentage total weight loss as an index for weight loss effectiveness assessment by CCA and next established and validated a nomogram, which demonstrated promising performance in predicting the probability of effectiveness of weight loss in bariatric surgery. The nomogram might be a valuable tool in clinical practice.
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Affiliation(s)
- Guanhua Lu
- Departments of Metabolic and Bariatric Surgery
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, Guangdong Province, China
| | - Zhiyong Dong
- Departments of Metabolic and Bariatric Surgery
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, Guangdong Province, China
| | - Biao Huang
- Departments of Metabolic and Bariatric Surgery
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, Guangdong Province, China
| | - Songhao Hu
- Departments of Metabolic and Bariatric Surgery
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, Guangdong Province, China
| | - Shenhua Cai
- Department of Thyroid, Mammary and Vascular Surgery, The First Affiliated Hospital of Sun Yat-sen University
| | - Min Hu
- Hepatobiliary Surgery, The First Affiliated Hospital of Jinan University
| | - Ruixiang Hu
- Departments of Metabolic and Bariatric Surgery
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, Guangdong Province, China
| | - Cunchuan Wang
- Departments of Metabolic and Bariatric Surgery
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, Guangdong Province, China
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5
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Reporting Weight Loss 2021: Position Statement of the Dutch Society for Metabolic and Bariatric Surgery (DSMBS). Obes Surg 2021; 31:4607-4611. [PMID: 34283377 DOI: 10.1007/s11695-021-05580-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 01/20/2023]
Abstract
Prevailing recommendations on reporting weight loss after bariatric and metabolic surgery are not evidence-based. They promote the outcome metric percentage excess weight loss (%EWL), sometimes indicated as percentage excess body mass index loss (%EBMIL). Many studies proved that this popular outcome measure, in contrast to other weight loss metrics, is inaccurate and error-sensitive when comparing weight loss within and between studies. It is inappropriate for assessing poor weight loss response and weight regain as well. The percentage (total) weight loss metric is the best alternative. The Dutch Society for Metabolic and Bariatric Surgery (DSMBS) recommends to stop using the %EWL (or %EBMIL) metric as primary outcome measure in all cases and calls on the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to propagate this evidence-based recommendation.
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Artero EG, Ferrez-Márquez M, Torrente-Sánchez MJ, Martínez-Rosales E, Carretero-Ruiz A, Hernández-Martínez A, López-Sánchez L, Esteban-Simón A, Romero Del Rey A, Alcaraz-Ibáñez M, Rodríguez-Pérez MA, Villa-González E, Barranco-Ruiz Y, Martínez-Forte S, Castillo C, Gómez Navarro C, Aceituno Cubero J, Reyes Parrilla R, Aparicio Gómez JA, Femia P, Fernández-Alonso AM, Soriano-Maldonado A. Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial. Obes Surg 2021; 31:4227-4235. [PMID: 34268680 PMCID: PMC8458203 DOI: 10.1007/s11695-021-05559-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 12/04/2022]
Abstract
Background Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies. Purpose The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity. Material and Methods The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7–14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery. Conclusion The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery. Trial Registration EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018.
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Graphical abstract
- Enrique G Artero
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain.
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- Manuel Ferrez-Márquez
- General and Bariatric Surgery Unit, Torrecárdenas University Hospital, Almería, Spain.,Hospital Mediterráneo, Almería, Spain
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- Elena Martínez-Rosales
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Alejandro Carretero-Ruiz
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Laura López-Sánchez
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Alba Esteban-Simón
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Manuel Alcaraz-Ibáñez
- Department of Education and Health Research Centre, University of Almería, Almería, Spain
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- Manuel A Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Emilio Villa-González
- PROFITH Promoting Fitness and Health through Physical Activity Research Group, Department of Physical and Sports Education, Faculty of Education and Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Melilla, Spain
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- Yaira Barranco-Ruiz
- PROFITH Promoting Fitness and Health through Physical Activity Research Group, Department of Physical and Sports Education, Faculty of Education and Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Melilla, Spain
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- Sonia Martínez-Forte
- Obstetrics and Gynecology Unit, Torrecárdenas University Hospital, Almería, Spain
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- Carlos Castillo
- Department of Economics and Business, SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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- Pedro Femia
- Department of Statistics and Operations Research, Faculty of Medicine, University of Granada, Granada, Spain
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- Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences; SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería, Almería, Spain
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7
Muraca E, Oltolini A, Binda A, Pizzi M, Ciardullo S, Manzoni G, Zerbini F, Bianconi E, Cannistraci R, Perra S, Pizzi P, Lattuada G, Perseghin G, Villa M. Metabolic and Psychological Features are Associated with Weight Loss 12 Months After Sleeve Gastrectomy.
J Clin Endocrinol Metab 2021;
106:e3087-e3097. [PMID:
33705552 DOI:
10.1210/clinem/dgab161]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT
Laparoscopic sleeve gastrectomy (LSG) is a recognized effective procedure of bariatric surgery, but a poor response in weight loss may still represent a clinical problem. To date there are no validated predictors useful to better perform patient selection.
OBJECTIVE
To establish the association of baseline anthropometric, metabolic, and psychologic features with the percent total weight loss (%TWL) and percent excess weight loss (%EWL) 12 months after surgery.
DESIGN
Retrospective longitudinal analysis of a set of data about obese patients attending the outpatient service of a single obesity center from June 2016 to June 2019.
PATIENTS
A total of 106 obese patients underwent LSG with presurgery evaluation and follow-up at 12 months after surgery.
MAIN OUTCOME
Weight loss 12 months after LSG.
RESULTS
Patients who achieved a %TWL higher than the observed median (≥34%) were younger, with a lower fasting plasma glucose and glycated hemoglobin, with a lower prevalence of hypertension and with a lower score in the impulsiveness scale, compared with patients with a %TWL < 34%. Similar findings were found when %EWL was considered. Multivariable stepwise regression analysis showed that younger age, lower impulsiveness, higher-than-normal urinary free cortisol, and lower HbA1c were associated with higher %TWL, explaining about 31.5% of the weight loss.
CONCLUSION
Metabolic and psychologic features at baseline were independently associated with weight loss and explained a non-negligible effect on the response to LSG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and postsurgical follow-up protocols in candidates for LSG.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Alice Oltolini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Alberto Binda
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
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- Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
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- Stefano Ciardullo
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
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- Giuseppina Manzoni
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Francesca Zerbini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Eleonora Bianconi
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Rosa Cannistraci
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
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- Silvia Perra
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
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- Guido Lattuada
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
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- Gianluca Perseghin
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
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- Matteo Villa
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
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8
Tu Y, Bao Y, Zhang P. Metabolic surgery in China: present and future.
J Mol Cell Biol 2021;
13:mjab039. [PMID:
34240190 PMCID:
PMC8697345 DOI:
10.1093/jmcb/mjab039]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Obesity and its related complications comprise a serious public health problem worldwide, and obesity is increasing in China. Metabolic surgery is a new type of treatment with unique advantages in weight loss and obesity-related metabolic complications. The pathogenesis of obesity is complex and not yet fully understood. Here, we review the current efficacy and safety of metabolic surgery, as well as recent progress in mechanistic studies and surgical procedures in China. The exciting and rapid advances in this field provide new opportunities for patients with obesity and strike a balance between long-term effectiveness and safety.
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Affiliation(s)
- Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
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- Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
- Department of Endocrinology and Metabolism, Jinshan
District Central Hospital of Shanghai Sixth People's
Hospital, Shanghai 201599, China
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- Pin Zhang
- Department of Bariatric and Metabolic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s
Hospital, Shanghai 200233, China
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9
Beisani M, Sabench Pereferrer F, Vilallonga R, González López Ó, Molina López A, Del Castillo Dejardin D, García Ruiz de Gordejuela A, Fort López-Barajas JM, Armengol Carrasco M. Seeking an Initial-Weight-Independent Metric in a Mediterranean Cohort of Gastric Bypass Patients: the %AWL Revisited.
Obes Surg 2021;
31:1524-1532. [PMID:
33398625 DOI:
10.1007/s11695-020-05154-3]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND
Most relative weight-loss metrics follow the formula "Weight loss(%) = 100 · (Initial BMI - Final BMI) / (Initial BMI-a)," where a is the reference point that defines the metric. The percentage of total weight loss (%TWL, a = 0) and percentage of excess weight loss (%EWL, a = 25) are influenced by a patient's initial weight. Recently, the percentage of alterable weight loss metric (%AWL, a = 13) has been reported to produce initial-weight-independent outcomes.
OBJECTIVES
This study aimed to replicate the methodology used for %AWL determination in a Mediterranean cohort of bariatric patients.
SETTINGS
Multicenter study in 10 large hospitals in Spain.
METHODS
Two large prospective databases were retrospectively searched for all primary laparoscopic gastric bypass patients with 2 years of follow-up. Outcomes at nadir were expressed and analyzed with 26 different metrics (a from 0 to 25), looking for the metric whose outcomes produced (1) the lowest coefficient of variation, (2) no differences between initially lighter and heavier patients, and (3) no correlation with patients' initial BMI.
RESULTS
A cohort of 1793 patients was stratified into 4 gender-age groups: younger women (YW, n = 733), older women (OW, n = 674), younger men (YM, n = 197), and older men (OM, n = 189). The calculations suggested an optimal reference point of 18 kg/m2, defining a new metric (percentage of Mediterranean alterable weight loss, %MAWL). When %TWL, %EWL, %AWL, and %MAWL were tested on the whole sample, only %MAWL produced initial-weight-independent results.
CONCLUSIONS
In our Mediterranean cohort of patients, a reference point of 18 (and not 13) yielded initial-weight-independent outcomes.
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Affiliation(s)
- Marc Beisani
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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- Fàtima Sabench Pereferrer
- General and Digestive Surgery Department, Pere Virgili Health's Institute, Faculty of Medicine, University Hospital of Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Spain
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- Ramón Vilallonga
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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- Óscar González López
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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- Alicia Molina López
- General and Digestive Surgery Department, Pere Virgili Health's Institute, Faculty of Medicine, University Hospital of Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Spain
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- Daniel Del Castillo Dejardin
- General and Digestive Surgery Department, Pere Virgili Health's Institute, Faculty of Medicine, University Hospital of Sant Joan de Reus, Avinguda del Doctor Josep Laporte, 2, 43204, Reus, Spain
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- Amador García Ruiz de Gordejuela
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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- José Manuel Fort López-Barajas
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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- Manel Armengol Carrasco
- General and Digestive Surgery Department, Vall d'Hebron University Campus, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
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10
Vennapusa A, Panchangam RB, Kesara C, Chivukula T. Response: Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14).
J Obes Metab Syndr 2020;
29:327-329. [PMID:
33380578 PMCID:
PMC7789021 DOI:
10.7570/jomes20132]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Amar Vennapusa
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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- Charita Kesara
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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- Tejaswi Chivukula
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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11
Park JY. Letter: Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity (J Obes Metab Syndr 2020;29:208-14).
J Obes Metab Syndr 2020;
29:325-326. [PMID:
33328356 PMCID:
PMC7789017 DOI:
10.7570/jomes20123]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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12
Clapp B, Harper B, Barrientes A, Wicker E, Alvara C, Tyroch A. The MBSAQIP is going viral! 194 hits and still going strong.
Surg Obes Relat Dis 2020;
16:1401-1406. [DOI:
10.1016/j.soard.2020.06.006]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/01/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
13
A total weight loss of 25% shows better predictivity in evaluating the efficiency of bariatric surgery.
Int J Obes (Lond) 2020;
45:396-403. [DOI:
10.1038/s41366-020-00690-5]
[Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/23/2020] [Accepted: 09/16/2020] [Indexed: 12/17/2022]
14
Santonicola A, Gagliardi M, Asparago G, Carpinelli L, Angrisani L, Iovino P. Anhedonia and functional dyspepsia in obese patients: Relationship with binge eating behaviour.
World J Gastroenterol 2020;
26:2632-2644. [PMID:
32523316 PMCID:
PMC7265144 DOI:
10.3748/wjg.v26.i20.2632]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/09/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND
Obese patients (Ob) with a binge eating disorders (BED) behavior pattern have a higher prevalence of postprandial distress syndrome (PDS) compared to Ob without a BED behavior pattern, while an increase of PDS has been described in Ob after sleeve gastrectomy (SG). Hedonic response to a meal is dissociable from satiation in healthy subjects. Anhedonia is the lowered ability to experience pleasure. There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms.
AIM
To assess the relationship among anhedonia, BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG.
METHODS
Eighty-one Ob without SG, 45 Ob with SG and 55 healthy controls (HC) were studied. All subjects fulfilled the binge eating scale (BES) to investigate BED, the validated 14 items Snaith-Hamilton pleasure scale (SHAPS) to assess Anhedonia as well as the Beck Depression Inventory-II (BDI II) and State Trait Anxiety Inventory (STAI) questionnaires to screen for depression and anxiety. All patients underwent a standardized questionnaire investigating the intensity-frequency scores (0-6) of upper gastrointestinal symptoms and were diagnosed for the presence of functional dyspepsia (FD) and its subtypes according to ROME IV criteria.
RESULTS
Ob without SG who were positive for BED had a 4.7 higher risk of FD compared to Ob without SG who were negative for BED (OR: 4.7; 95.0%CI 1.23-18.24; P = 0.02). STAI-Y2 scores were significantly higher in Ob without SG positive for BED (42.2 ± 1.5 vs Ob negative for BED: 39.6 ± 1 .0, P = 0.04), while SHAPS scores and BDI II did not differ in the two groups (1.16 ± 1.30 vs 0.89 ± 1.02, P = 0.49). A lower prevalence of BED (BES > 17: 11.4% vs 40.7%, P = 0.001) and BDI-II (6.8 ± 1.2 vs 13.8 ± 1.9, P = 0.005) was reported in Ob with SG than Ob without SG, on the contrary total mean scores of STAI-Y1 and STAI-Y2 were significantly higher in Ob with SG than Ob without SG. Thirty-five percent of Ob with SG fulfilled the diagnosis of FD. SHAPS mean scores and the prevalence of anhedonia did not differ among the two groups (18.2 vs 8.1%, P = 0.2). Fifty-four percent of Ob with SG achieved surgical success excess weight loss > 50%. Excess weight loss was negatively related to SHAPS total mean scores [adjusted B: -7. 099 (95%CI: -13.91 to -0.29), P = 0.04].
CONCLUSION
Ob without SG showed a higher prevalence of PDS, mood disorders and anxiety when positive for BE behavior compared to those negative for BE behavior, whereas no differences were found in SHAPS score. Ob with SG showed a higher prevalence of PDS compared to Ob without SG. Concerning psychological aspect, BED and depression are less frequent in the Ob with SG, while both state and trait anxiety are significantly higher. Moreover, the more an Ob with SG is anhedonic, less surgical success was achieved.
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Affiliation(s)
- Antonella Santonicola
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
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- Mario Gagliardi
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
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- Giovanni Asparago
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
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- Luna Carpinelli
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
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- Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples 80100, Italy
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- Paola Iovino
- Gastroenterology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi 84081, Salerno, Italy
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15
Non-responders After Gastric Bypass Surgery for Morbid Obesity: Peptide Hormones and Glucose Homeostasis.
Obes Surg 2020;
29:4008-4017. [PMID:
31338735 DOI:
10.1007/s11695-019-04089-8]
[Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION
About 20% of patients operated with Roux-en-Y gastric bypass (RYGBP) experience poor long-term weight result. This study compared levels of leptin and gut hormones in long-term weight responders with non-responders after RYGBP. In a subgroup analysis, hormone levels were assessed in T2DM (type 2 diabetes mellitus) and normoglycemic participants.
METHODS
Insulin, glucose, leptin, acyl-ghrelin, total PYY, active GLP-1, and GIP were measured during an oral glucose tolerance test (OGTT) in post-RYGBP subjects: 22 non-responders (BMI 40.6 ± 6.0 kg/m2 after an excess BMI loss [EBMIL] of 26.0 ± 15.9%) and 18 responders (BMI 29.5 ± 3.5 kg/m2 after an EBMIL of 74.9 ± 18.2%). Subjects were matched for preoperative age, BMI, and years of follow-up. Measures of glucose homeostasis were calculated, and body composition was measured.
RESULTS
Fat mass-adjusted fasting leptin correlated negatively with %EBMIL (r = - 0.57, p < 0.01). Non-responders presented higher levels of leptin during the OGTT. Leptin decreased and ghrelin returned to baseline levels earlier in non-responders. Despite having higher insulin resistance than responders, non-responders demonstrated similar OGTT responses of GLP-1, GIP, and PYY. T2DM participants demonstrated lower GLP-1 levels than normoglycemic participants of similar weight.
CONCLUSION
Fasting leptin is associated with weight result after RYGBP, and hormonal responses to a glucose oral load might work towards promoting obesity in long-term non-responders after RYGBP. Poor long-term weight result and glycemic status after RYGBP are each associated with differences in peptide hormone levels.
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16
Monpellier VM, de Vries CEE, Janssen IMC, van der Beek ESJ, Mink van der Molen AB, Hoogbergen MM, van der Lei B. The BAPRAS screening tool for reimbursement in a postbariatric population.
J Plast Reconstr Aesthet Surg 2020;
73:1159-1165. [PMID:
32173244 DOI:
10.1016/j.bjps.2020.02.002]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 11/29/2019] [Accepted: 02/09/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION
Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool.
METHODS
In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes.
RESULTS
Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m2 versus 30.4 kg/m2, p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales.
CONCLUSIONS
Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS.
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Affiliation(s)
- V M Monpellier
- Nederlandse Obesitas Kliniek, Huis ter Heide, the Netherlands; Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands.
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- C E E de Vries
- Department of Surgery, OLVG West, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
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- I M C Janssen
- Nederlandse Obesitas Kliniek, Huis ter Heide, the Netherlands; Nederlandse Obesitas Kliniek West, Haaglanden Medical Centre, Den Haag, the Netherlands
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- E S J van der Beek
- Department of Plastic Surgery, University Medical Centre of Groningen, the Netherlands
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- A B Mink van der Molen
- Department of Plastic Surgery, University Medical Centre of Utrecht, Utrecht, the Netherlands; Department of Plastic Surgery, Sint Antonius Hospital, Nieuwegein, the Netherlands
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- M M Hoogbergen
- Department of Plastic Surgery, Catharina Hospital, Eindhoven, the Netherlands
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- B van der Lei
- Nederlandse Obesitas Kliniek, Huis ter Heide, the Netherlands; Department of Plastic Surgery, University Medical Centre of Groningen, the Netherlands; Bergman Clinics, Hilversum, the Netherlands
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17
Análisis de la pérdida ponderal a medio plazo después del bypass gastroyeyunal en Y de Roux y de la gastrectomía vertical: propuesta de gráficos de percentiles del porcentaje de peso total perdido para su uso en la práctica clínica diaria.
Cir Esp 2020;
98:72-78. [DOI:
10.1016/j.ciresp.2019.09.008]
[Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/14/2019] [Accepted: 09/24/2019] [Indexed: 12/21/2022]
18
Metabolic syndrome after Roux-en-Y gastric bypass in patients with morbid obesity: Five years of follow-up, a before and after study.
Int J Surg 2019;
74:5-10. [PMID:
31874260 DOI:
10.1016/j.ijsu.2019.12.019]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/19/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND
Metabolic syndrome (MetS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse prevalence and evolution of MetS in patients suffering from morbid obesity, before and after bariatric surgery, during a follow-up period of 5 years.
METHODS
A before-after study was carried out including 156 patients with MetS. The definition of metabolic syndrome according to the Joint Interim Statement (JIS) definition was used. Demographic, as well as anthropometric, biochemical, and clinical analyses were assessed before, as well as 2 and 5 years after performing laparoscopic Roux-en-Y gastric bypass (RYGB).
RESULTS
High BMI (100%), elevated blood pressure (78%) and low levels of high density lipoprotein (70%) were the most prevalent criteria for MetS. The percentage of people with MetS decreased significantly to 48.9% at 2 years and 24.1% at 5 years. The weight was also significantly reduced at 2 years, although at 5 years a rebound effect is already observed. Percentage of total weight loss (%TWL) and excess BMI loss (%EBMIL) were. 49.7 ± 19.4% and 68.2 ± 18.9%, respectively, at 2 years and 29.3 ± 11.6% and 62.0 ± 24.9 at 5 years, both presenting significant differences (p < 0.001).
CONCLUSION
RYGB in obese patients is associated with a significant improvement of MetS and its comorbidities. Insufficient weight loss is the main factor related to the prevalence of MetS.
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19
Vilallonga R, Pereira-Cunill JL, Morales-Conde S, Alarcón I, Breton I, Domínguez-Adame E, Ferrer JV, Ruiz-de-Gordejuela AG, Goday A, Lecube A, García-Almenta EM, Rubio MÁ, Tinahones FJ, García-Luna PP. A Spanish Society joint SECO and SEEDO approach to the Post-operative management of the patients undergoing surgery for obesity.
Obes Surg 2019;
29:3842-3853. [PMID:
31342249 DOI:
10.1007/s11695-019-04043-8]
[Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE
Bariatric surgery is the method of choice for the management or treatment of obesity. Bariatric surgery brings about several physiological changes in the body and is associated with set of complications. The aim of this study is to provide guidelines on post bariatric surgery management based on consensus by the Spanish society for Obesity Surgery (Sociedad Española de Cirugía de la Obesidad) (SECO) and the Spanish Society for the Study of Obesity (Sociedad Española para el Estudio de la Obesidad) (SEEDO).
METHOD
The boards proposed seven experts from each society. The experts provided the evidence and a grade of recommendation on the selected topics based on systematic reviews/meta-analysis. A list of clinical practical recommendations levels of evidence and grades of these recommendations was derived from the consensus statements from the members of these societies.
RESULTS
Seventeen topics related to post-operative management were reviewed after bariatric surgery. The experts came with 47 recommendations and statements. The mean number of persons voting at each statement was 54 (range 36-76).
CONCLUSION
In this consensus, we have designed a set of guidelines to be followed while managing patients after bariatric surgery. Expertise and knowledge of the clinicians are required to convey suitable considerations to the post-bariatric patients. There should also be extensive follow-up plans for the bariatric surgery patients.
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Affiliation(s)
- R Vilallonga
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain.
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- J L Pereira-Cunill
- Clinical Nutritión Unit, Endocrinology and Nutrition Service, University Hospital "Virgen del Rocío", Seville, Spain
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- S Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
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- I Alarcón
- Unit of Innovation in Minimally Invasive Surgery, Department of Surgery, University Hospital "Virgen del Rocío", Hospital Quironsalud Sagrado Corazón, University of Sevilla, Sevilla, Spain
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- I Breton
- Unidad de Nutrición Clínica y Dietética del Servicio de Endocrinología y Nutrición del Hospital Gregorio Marañón, Madrid, Spain
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- E Domínguez-Adame
- UGC Cirugía General y Aparato Digestivo, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, Spain
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- A Garcia Ruiz-de-Gordejuela
- Endocrine, metabolic and bariatric Unit, General Surgery Department, Hospital Vall d'Hebron, Center of Excellence for the EAC-BC, Universitat Autònoma de Barcelona, Barcelona, Spain
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- A Goday
- Servicio de Endocrinología, Hospital del Mar de Barcelona, Departament de Medicina, CIBERobn, ISCIII, Universitat Autònoma de Barcelona, Barcelona, Spain
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- A Lecube
- Servicio deEndocrinología y Nutrición, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida (UdL), Avda. Rovira Roure, 80 25198, Lleida, Spain
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- E Martín García-Almenta
- Unidad Cirugía Esófago-Gástrica, Metabólica y Bariátrica, Hospital Clínico San Carlos, Madrid, Spain
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- M Á Rubio
- Servicio de Endocrinología y Nutrición, Hospital Clínico San Carlos, Idissc, Facultad de Medicina, Universidad Complutense, Madrid, Spain
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- F J Tinahones
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria de Malaga, Málaga, Spain
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- P P García-Luna
- Unidad de Nutrición Clínica y de la Unidad de Obesidad Mórbida (Unidad de Gestión de Endocrinología y Nutrición, UGEN), Hospital Universitario Virgen del Rocío, Seville, Spain
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21
The Impact of Preoperative BMI (Obesity Class I, II, and III) on the 12-Month Evolution of Patients Undergoing Laparoscopic Gastric Bypass.
Obes Surg 2019;
28:3095-3101. [PMID:
29725974 DOI:
10.1007/s11695-018-3281-1]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND
Whether or not the initial body mass index (BMI) influences weight loss and comorbidities improvement after bariatric surgery continues to be a matter of debate. The main reason for this is a lack of studies including obesity class I.
METHODS
Retrospective study with patients submitted to gastric bypass at a single institution. They were classified based on initial BMI (obesity class I, II, and III), and a comparative analysis of their metabolic profile (glucose, HbA1c%, C-peptide, insulin and diabetes medication), lipid profile (triglycerides, total cholesterol, HDL, LDL), and clinical data (systolic/diastolic blood pressure and cardiovascular risk) was performed at 0 and 12 months. Diabetes remission and weight loss were also analyzed.
RESULTS
Two-hundred and twenty patients were included (23 in group 1, 113 in group 2, and 84 in group 3). Initial weight, BMI, and number of patients with T2DM were statistically different in group 1; other parameters were homogenous. At 12 months, every group had similar improvement of the metabolic profile, excepting serum insulin. Diabetes remission was 57.9, 61.1, and 60% for group 1, 2, and 3. For weight loss, there were differences between groups when using BMI and percentage of excess weight loss, but not with percentage of total weight loss. The non-metabolic and clinical data improved without differences, except for total cholesterol and LDL.
CONCLUSIONS
The metabolic, lipid, and clinical profiles associated with obesity present similar improvement 1 year after laparoscopic gastric bypass, despite different baseline BMI. Diabetes remission and percentage of total weight loss were also similar.
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22
Is Pre-operation Social Connectedness Associated with Weight Loss up to 2 Years Post Bariatric Surgery?
Obes Surg 2019;
28:3524-3530. [PMID:
30043144 DOI:
10.1007/s11695-018-3378-6]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND
To date, little attention has been paid to supportive relationships as factors contributing to weight loss from bariatric surgery.
MATERIAL AND METHODS
This prospective study examined whether total percentage weight loss (%TWL) at 3, 12 and 24 months post-surgery varies by distinct aspects of pre-surgery social support (received emotional and practical support and contact with friends and family) in a sample of bariatric surgery candidates (n = 182). These associations were tested with linear regression models adjusted for gender, age, ethnicity, employment status, self-esteem, mastery and time elapsed since the day of surgery.
RESULTS
One hundred fifty-four participants underwent a bariatric procedure, and all but seven provided weight loss data at least at one occasion. Emotional support and contact with friends were positively associated with %TWL at 3, 12 and 24 months, and the magnitude of these associations was large. For instance, in the fully adjusted models, %TWL at 24 months increased by 2.36% (SE 1.17, p = 0.048) with each increase of one standard deviation in emotional support and was higher by 9.23% (SE 4.31, p = 0.035) for participants who reported seeing 1-5 friends per month compared with those who saw none. There was some evidence for a positive association between practical support and %TWL at 3 and 12 months post-surgery.
CONCLUSION
Supportive relationships are important contributors to weight loss from bariatric surgery. If replicated in future studies, these findings could inform clinical care and interventions aimed at improving support systems of bariatric surgery candidates.
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23
van de Laar AW, van Rijswijk AS, Kakar H, Bruin SC. Sensitivity and Specificity of 50% Excess Weight Loss (50%EWL) and Twelve Other Bariatric Criteria for Weight Loss Success.
Obes Surg 2019;
28:2297-2304. [PMID:
29484610 DOI:
10.1007/s11695-018-3173-4]
[Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND
Criteria for bariatric weight loss success are numerous. Most of them are arbitrary. None of them is evidence-based. Our objective was to determine their sensitivity and specificity.
METHODS
Thirteen common bariatric weight loss criteria were compared to a benchmark reflecting the gold standard in bariatric surgery. We used an elaborate baseline BMI-independent weight loss percentile chart, based on retrospective data after laparoscopic Roux-en-Y gastric bypass (LRYGB), performed between 2007 and 2017. Percentile curves p31.6 (patients' expectation), p25 (interquartile range), p15.9 (1 standard deviation (SD) below median), and p10.9 (surgeons' goal) were used as possible cutoff for success to determine true or false positive and negative results beyond 1 year.
RESULTS
We operated 4497 primary LRYGB patients, with mean follow-up 22 (± 1 SD 19; range 0-109) months, 3031 patients with last result ≥ 1 year, 518 ≥ 5 years. For all four cutoff percentile curves for success, specificities were low (2-72%) for criteria < 35 body mass index (BMI), ≥ 25percentage excess BMI loss (%EBMIL), ≥ 50%EBMIL, ≥ 15 percentage total weight loss (%TWL), ≥ 20%TWL, ≥ 25 percentage excess weight loss (%EWL), and high (83-96%) for < 30 BMI. No criterion had > 80% specificity and sensitivity for a cutoff above p15.9. For p15.9, they were both > 80% for criteria ≥ 10 BMI reduction and ≥ 50%EWL, both > 90% for ≥ 25%TWL and ≥ 35 percentage alterable weight loss (%AWL). All criteria had high sensitivities for all cutoff percentile curves (87-100%), except < 30 BMI (65-78%).
CONCLUSIONS
For the first time, common bariatric criteria for weight loss success were systematically validated. Most criteria recognized success very well (high sensitivities), but ≥ 15%TWL, ≥ 20%TWL, < 35BMI, ≥ 25%EWL, ≥ 25%EBMIL, and ≥ 50%EBMIL left too many poor responders unnoticed (low specificities). Bariatric weight loss success is best assessed by comparing results to percentile curve 1 SD below median (p15.9) in a bariatric baseline BMI-independent weight loss percentile chart. Criteria ≥ 35%AWL and ≥ 25%TWL came close to that curve, both with > 90% sensitivity and specificity. Among others, criterion ≥ 50%EBMIL did not.
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Affiliation(s)
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- A S van Rijswijk
- MC Slotervaart Hospital, Louwesweg 6, 1066EC, Amsterdam, The Netherlands
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- H Kakar
- University of Amsterdam, Spui 21, 1012WX, Amsterdam, The Netherlands
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- S C Bruin
- MC Slotervaart Hospital, Louwesweg 6, 1066EC, Amsterdam, The Netherlands
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24
Musella M, Bruni V, Greco F, Raffaelli M, Lucchese M, Susa A, De Luca M, Vuolo G, Manno E, Vitiello A, Velotti N, D'Alessio R, Facchiano E, Tirone A, Iovino G, Veroux G, Piazza L. Conversion from laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) to one anastomosis gastric bypass (OAGB): preliminary data from a multicenter retrospective study.
Surg Obes Relat Dis 2019;
15:1332-1339. [PMID:
31272866 DOI:
10.1016/j.soard.2019.05.026]
[Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/19/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure, while laparoscopic adjustable gastric banding (LAGB) has been for a decade one of the most popular interventions for weight loss. After LSG and LAGB, some patients may require a second surgery due to weight regain or late complications. One anastomosis gastric bypass (OAGB) is a promising bariatric procedure, which provides effective long-term weight loss and has a favorable effect on type 2 diabetes.
OBJECTIVES
To retrospectively analyze data from 10 Italian centers on conversion from LAGB and LSG to OAGB.
SETTING
High-volume centers for bariatric surgery.
METHODS
Prospectively collected data from 10 high-volume centers were retrospectively reviewed. Body mass index (BMI), percentage of excess BMI loss, reasons for redo, remission from co-morbidities (hypertension, diabetes, gastroesophageal reflux, and dyslipidemia), and major complications were recorded.
RESULTS
Three hundred patients were included in the study; 196 patients underwent conversion from LAGB to OAGB and 104 were converted from LSG. BMI was 45.1 ± 7 kg/m2 at the time of first intervention, 41.8 ± 6.3 kg/m2 at redo time, and 30.5 ± 5.5 kg/m2 at last follow-up appointment. Mean percentage of excess BMI loss was 13.2 ± 28.2 at conversion and 73.4 ± 27.5 after OAGB. Remission rates from hypertension, diabetes, gastroesophageal reflux, and dyslipidemia were 40%, 62.5%, 58.7% and 52%, respectively. Mean follow-up was 20.8 (range, 6-156) months and overall complications rate was 8.6%.
CONCLUSION
Our data show that OAGB is a safe and effective revisional procedure after failed restrictive bariatric surgery.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, Naples, Italy.
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- Francesco Greco
- Bariatric Surgery Unit, Fondazione Poliambulanza, Brescia, Italy
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- Marco Raffaelli
- Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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- Marcello Lucchese
- Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
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- Antonio Susa
- Bariatric Surgery Unit, Gruppo San Donato, Milan, Italy
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- Giuseppe Vuolo
- Department of Surgical Sciences, Bariatric Surgery Unit, University of Siena, Siena, Italy
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- Emilio Manno
- General and Endocrine Surgery, AORN "A. Cardarelli", Naples, Italy
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- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, Naples, Italy
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- Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples "Federico II" University, Naples, Italy
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- Enrico Facchiano
- Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, Florence, Italy
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- Andrea Tirone
- Department of Surgical Sciences, Bariatric Surgery Unit, University of Siena, Siena, Italy
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- Giuseppe Iovino
- General and Endocrine Surgery, AORN "A. Cardarelli", Naples, Italy
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- Gastone Veroux
- General and Emergency Surgery, ARNAS "G, Garibaldi", Catania, Italy
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- Luigi Piazza
- General and Emergency Surgery, ARNAS "G, Garibaldi", Catania, Italy
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25
van de Laar AW, Nienhuijs SW, Apers JA, van Rijswijk AS, de Zoete JP, Gadiot RP. The Dutch bariatric weight loss chart: A multicenter tool to assess weight outcome up to 7 years after sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.
Surg Obes Relat Dis 2019;
15:200-210. [DOI:
10.1016/j.soard.2018.11.024]
[Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/07/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
26
Eilenberg M, Langer FB, Beer A, Trauner M, Prager G, Staufer K. Significant Liver-Related Morbidity After Bariatric Surgery and Its Reversal-a Case Series.
Obes Surg 2018;
28:812-819. [PMID:
28965313 PMCID:
PMC5803276 DOI:
10.1007/s11695-017-2925-x]
[Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background
Nonalcoholic fatty liver disease (NAFLD) occurs in up to 80% of patients with obesity. Current data suggest an improvement of NAFLD after established bariatric procedures.
Objectives
This study investigated liver function impairment after Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB).
Setting
University Hospital, Bariatric Surgery Unit
Methods
In this single-center case series, consecutive in- and outpatients after bariatric surgery who presented with severe liver dysfunction from March 2014 to February 2017 were included and followed until March 2017.
Results
In total, 10 patients (m:f = 2:8; median age 48 years, range 22–66 years) were included. Liver dysfunction occurred after a median postoperative time of 15 months (range 2–88 months). Median %excess weight loss at that time was 110.6% (range 85.2–155.5%). Liver steatosis/fibrosis occurred in 70%, cirrhosis in 30% of patients, and led to fatigue (90%), ascites (70%), hepatic encephalopathy (30%), and upper gastrointestinal bleeding (20%). Elevation of transaminases, impairment of coagulation parameters, thrombocytopenia, and hypoalbuminemia were present in 70, 80, 70, and 100%, respectively. In eight patients, lengthening of the alimentary/common limb led to an improvement or complete remission of symptoms. In one patient, liver transplantation was required, one patient deceased due to septic shock and decompensated liver disease.
Conclusions
Severe liver dysfunction may also occur after bariatric procedures such as OAGB and RYGB. A comprehensive, meticulous follow-up for early identification of postoperative liver impairment should be aspired. Bypass length reduction led to a fast improvement in all patients.
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Affiliation(s)
- Magdalena Eilenberg
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
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- Felix B Langer
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
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- Andrea Beer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
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- Michael Trauner
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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- Gerhard Prager
- Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria
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- Katharina Staufer
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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27
High cardiovascular risk patients benefit more from bariatric surgery than low cardiovascular risk patients.
Surg Endosc 2018;
33:1626-1631. [DOI:
10.1007/s00464-018-6437-0]
[Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/05/2018] [Indexed: 12/25/2022]
28
Ruffault A, Vaugeois F, Barsamian C, Lurbe I Puerto K, Le Quentrec-Creven G, Flahault C, Naudé AJ, Ferrand M, Rives-Lange C, Czernichow S, Carette C. Associations of lifetime traumatic experience with dysfunctional eating patterns and postsurgery weight loss in adults with obesity: A retrospective study.
Stress Health 2018;
34:446-456. [PMID:
29602207 DOI:
10.1002/smi.2807]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 02/02/2023]
Abstract
This study aimed to examine the associations of lifetime traumatic experience with presurgery and postsurgery eating pathology and postoperative weight loss in a sample of adult bariatric surgery patients using electronic medical record (EMR) data. Presurgery lifetime exposure to traumatic event, presurgery and postsurgery dysfunctional eating patterns, and post-operative total and excess weight losses were extracted from electronic medical records of 200 adult bariatric surgery patients in 2013 and 2014. Logistic regression analyses were conducted. During their lifetime, 60.5% of the patients (81.5% women, age = 44.4 ± 11.5 years; BMIpre = 44.9 ± 5.5 kg/m2 ) reported that they were exposed to a traumatic event. Before surgery, trauma exposure was associated with impulsive, compulsive, or restrictive eating patterns (OR = 2.40), overeating or disturbed eating (OR = 1.55), and grazing or night eating behaviours (OR = 1.72). After surgery, trauma exposure was associated with lower total weight loss at 6 (OR = 2.06) and 24 months (OR = 2.06), and to overeating or disturbed eating (OR = 1.53) 12 months after surgery. Bariatric surgery candidates with a history of trauma exposure could benefit from closer medical, dietetic, and/or psychological follow-up care to avoid insufficient postoperative weight loss as well as reappearance of dysfunctional eating patterns after surgery.
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Affiliation(s)
- Alexis Ruffault
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes, Boulogne-Billancourt, France
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- Fanny Vaugeois
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes, Boulogne-Billancourt, France
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- Charles Barsamian
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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- Kàtia Lurbe I Puerto
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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- Gérane Le Quentrec-Creven
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes, Boulogne-Billancourt, France
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- Cécile Flahault
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Université Paris Descartes, Boulogne-Billancourt, France
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- Anne-Jeanne Naudé
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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- Margot Ferrand
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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- Claire Rives-Lange
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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- Sébastien Czernichow
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France.,INSERM UMS 011, Population-based cohorts, Villejuif, France
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- Claire Carette
- Service de Nutrition, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
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29
Arevalo A, Pacheco R, Salgado CM, van Loon S, Boer AK, Vieira SM, Kaymak U, Sousa JMC. Fuzzy Classification of Bariatric Post-surgery Effectiveness.
2018 IEEE INTERNATIONAL CONFERENCE ON FUZZY SYSTEMS (FUZZ-IEEE) 2018:1-8. [DOI:
10.1109/fuzz-ieee.2018.8491643]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
30
Smith OJ, Hachach-Haram N, Greenfield M, Bystrzonowski N, Pucci A, Batterham RL, Hashemi M, Mosahebi A. Body Contouring Surgery and the Maintenance of Weight-Loss Following Roux-En-Y Gastric Bypass: A Retrospective Study.
Aesthet Surg J 2018;
38:176-182. [PMID:
29040424 DOI:
10.1093/asj/sjx170]
[Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND
Bariatric surgery leads to significant weight loss with reduced morbidity and mortality. However, excess skin as a consequence of weight loss represents a major problem, impacting upon patient's functionality with potential negative effects on weight loss.
OBJECTIVES
We evaluated the effect of body-contouring surgery on weight-loss maintenance following bariatric surgery.
METHODS
We undertook a retrospective analysis of patients undergoing Roux-en-Y gastric bypass (RYGB) +/- body-contouring surgery (BC). The control group (n = 61) received RYGB, the test group (n = 30) received RYGB+BC 12 to 18 months after bariatric surgery. Each RYGB+BC patient was matched to two control patients for age, sex, glycaemic status, and weight on day of surgery. Per cent weight loss (%WL) was calculated at 3, 6, 12, 24, 36, 48, and 60 months post-RYGB for both groups.
RESULTS
The %WL was similar at 3, 6, and 12 months post-RYGB. At 24 months, %WL was 35.6% in the RYGB+BC group and 30.0% in the RYGB group (P < 0.05). At 36 months, the RYGB+BC group maintained their weight loss (%WL 33.0%), in contrast, the RYGB gained weight (%WL = 27.3%, P < 0.05). This trend continued (RYGB+BC vs RYGB) at 48 months (%WL 30.8% vs 27.0%) and at 60 months (%WL 32.2% vs 22.7%, P < 0.05).
CONCLUSIONS
Our results suggest patients who undergo body contouring after bariatric surgery are able to lose significantly more weight and maintain weight loss at five years of follow up compared to those undergoing bariatric surgery alone.
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Affiliation(s)
- Oliver J Smith
- NIHR Academic Clinical Fellow in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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- Nadine Hachach-Haram
- Specialty Registrars in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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- Nicki Bystrzonowski
- Specialty Registrars in Plastic Surgery, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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- Andrea Pucci
- Consultant Obesity Physician, Centre for Obesity Research, Department of Medicine, University College, London, UK
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- Rachel L Batterham
- Professor of Obesity, Diabetes, and Endocrinology, Centre for Obesity Research, Department of Medicine, University College, London, UK
- UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College, London, UK
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- Majid Hashemi
- Consultant Upper GI and Bariatric Surgeon, UCLH Bariatric Centre for Weight Management and Metabolic Surgery, University College, London, UK
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- Afshin Mosahebi
- Consultant Plastic, Reconstructive and Aesthetic Surgeon, Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
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31
Carbajo MA, Jiménez JM, Luque-de-León E, Cao MJ, López M, García S, Castro MJ. Evaluation of Weight Loss Indicators and Laparoscopic One-Anastomosis Gastric Bypass Outcomes.
Sci Rep 2018;
8:1961. [PMID:
29386655 PMCID:
PMC5792492 DOI:
10.1038/s41598-018-20303-6]
[Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/16/2018] [Indexed: 01/30/2023] Open
Abstract
Mini-gastric bypass/One-anastomosis gastric bypass (MGB-OAGB) is an effective bariatric technique for treating overweight and obesity, controlling and improving excess-weight-related comorbidities. Our study evaluated OAGB characteristics and resulting weight evolution, plus surgical success criteria based on various excess weight loss indicators. A prospective observational study of 100 patients undergoing OAGB performed by the same surgical team (two-year follow-up). Surgical characteristics were: surgery duration, associated complications, bowel loop length, hospital stay, and weight loss at 6 postoperative points. 100 patients were treated (71 women, 29 men); mean initial age was 42.61 years and mean BMI, 42.61 ± 6.66 kg/m2. Mean surgery duration was 97.84 ± 12.54 minutes; biliopancreatic loop length was 274.95 ± 23.69 cm. Average hospital stay was 24 hours in 98% of patients; no surgical complications arose. Weight decreased significantly during follow-up (P < 0.001). Greatest weight loss was observed at 12 months postsurgery (68.56 ± 13.10 kg). Relative weight loss showed significant positive correlation, with greatest weight loss at 12 months and %excess BMI loss > 50% achieved from the 3-month follow-up in 92.46% of patients. OAGB seems to be effective in treating obesity, with short hospital stays. Relative weight loss correlates optimally with absolute outcomes, but both measures should be used to evaluate surgical results.
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Affiliation(s)
- Miguel A Carbajo
- Centre of Excellence for the Study and Treatment of Diabetes and Obesity, Valladolid, Spain.
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- Jose M Jiménez
- Centre of Excellence for the Study and Treatment of Diabetes and Obesity, Valladolid, Spain. .,Nursing Faculty, University of Valladolid, Valladolid, Spain. .,Endocrinology and Clinical Nutrition Research Centre (ECNRC), University of Valladolid, Valladolid, Spain. .,Castilla-León Regional Healthcare Management (Sacyl), Valladolid, Spain.
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- Enrique Luque-de-León
- Centre of Excellence for the Study and Treatment of Diabetes and Obesity, Valladolid, Spain
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- María-José Cao
- Nursing Faculty, University of Valladolid, Valladolid, Spain.,Endocrinology and Clinical Nutrition Research Centre (ECNRC), University of Valladolid, Valladolid, Spain
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- María López
- Nursing Faculty, University of Valladolid, Valladolid, Spain.,Castilla-León Regional Healthcare Management (Sacyl), Valladolid, Spain
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- Sara García
- Castilla-León Regional Healthcare Management (Sacyl), Valladolid, Spain
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- María-José Castro
- Centre of Excellence for the Study and Treatment of Diabetes and Obesity, Valladolid, Spain.,Nursing Faculty, University of Valladolid, Valladolid, Spain.,Endocrinology and Clinical Nutrition Research Centre (ECNRC), University of Valladolid, Valladolid, Spain
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32
Abstract
BACKGROUND
Evidence about the impact of psychological factors on weight loss after bariatric surgery is scarce. This study explores whether patients' preoperative estimate of target weight influences actual weight loss for different types of bariatric procedures.
METHODS
Patients eligible for bariatric surgery were instructed twice on how to calculate their expected target weight. They were divided into three groups based on their percentage excess weight loss (%EWL) and percentage total body weight loss (%TBWL). Weight loss 12 and 24 months after surgery was analyzed for each group and per type of surgery.
RESULTS
Six hundred fifty-six patients participated in this study. Types of surgery performed were the Roux-en-Y gastric bypass (RYGB, 75%), sleeve gastrectomy (SG, 8.1%), REDO-RYGB (12.5%), and laparoscopic adjustable gastric banding (LAGB, 4.4%). Data of 622 and 410 patients were available for analysis at 12 and 24 months, respectively. Surprisingly, 415 patients (63.3%) overestimated their expected weight loss as opposed to our calculation, based on our own historic data. One hundred thirty-four patients (20.4%) estimated their weight loss correctly and 107 patients (16.3%) underestimated their weight loss. There was a significant higher %EWL 12 months after RYGB surgery for patients who overestimated their weight loss compared to those who estimated their weight loss correctly (p = 0.001). After 24 months and for other types of procedures, no statistically significant differences were found between the three groups.
CONCLUSION
Despite instructions on how to calculate target weight, the majority of patients overestimated their weight loss. Actual %EWL 12 months after RYGB surgery might be influenced by setting a low target weight.
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33
Corcelles R, Boules M, Froylich D, Hag A, Daigle CR, Aminian A, Brethauer SA, Burguera B, Schauer PR. Total Weight Loss as the Outcome Measure of Choice After Roux-en-Y Gastric Bypass.
Obes Surg 2018;
26:1794-8. [PMID:
26803753 DOI:
10.1007/s11695-015-2022-y]
[Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND
Currently, there is no agreement on the best method to describe weight loss (WL) after bariatric surgery. The aim of this study is to evaluate short-term outcomes using percent of total body weight loss (%TWL).
METHODS
A single-institution retrospective study of 2420 patients undergoing Roux-en-Y gastric bypass (RYGB) was performed. Suboptimal WL was defined as %TWL < 20 % at 12 months.
RESULTS
Mean preoperative BMI was 46.8 ± 7.8 kg/m(2). One year after surgery, patients lost an average 14.1 kg/m(2) units of body mass index (BMI), 30.0 ± 8.5 %TWL, and 68.5 ± 22.9 %EWL. At 6 and 12 months after RYGB, mean BMI and percent excess WL (%EWL) significantly improved for all baseline BMI groups (p < 0.01, BMI; p = 0.01, %EWL), whereas mean %TWL was not significantly different among baseline BMI groups (p = 0.9). The regression analysis between each metric outcome and preoperative BMI demonstrated that preoperative BMI did not significantly correlate with %TWL at 1 year (r = 0.04, p = 0.3). On the contrary, preoperative BMI was strongly but negatively associated with the %EWL (r = -0.52, p < 0.01) and positively associated with the BMI units lost at 1 year (r = 0.56, p < 0.01). In total, 11.3 % of subjects achieved <20 %TWL at 12 months and were considered as suboptimal WL patients.
CONCLUSION
The results of our study confirm that %TWL should be the metric of choice when reporting WL because it is less influenced by preoperative BMI. Eleven percent of patients failed to achieve successful WL during the in the first year after RYGB based on our definition.
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Affiliation(s)
- Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA.,Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
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- Mena Boules
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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- Dvir Froylich
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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- Amani Hag
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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- Christopher R Daigle
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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- Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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- Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA.
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- Barto Burguera
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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- Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
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34
Sabench Pereferrer F, Molina López A, Vives Espelta M, Raga Carceller E, Blanco Blasco S, Buils Vilalta F, París Sans M, Piñana Campón ML, Hernández González M, Sánchez Marín A, Del Castillo Déjardin D. Weight Loss Analysis According to Different Formulas after Sleeve Gastrectomy With or Without Antral Preservation: a Randomised Study.
Obes Surg 2017;
27:1254-1260. [PMID:
27995517 DOI:
10.1007/s11695-016-2454-z]
[Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND
The measurement of weight loss after bariatric surgery is under constant review in order to obtain the ideal standard for reporting weight loss. Several formulas have been proposed for this purpose. Our goal is to analyse weight loss after sleeve gastrectomy, with or without antrum preservation through different measurement formulas.
METHODS
A prospective randomised study of 60 patients (30 patients with initial section at 3 cm from pylorus and 30 patients at 8 cm from the pylorus). We calculate the following variables at 3, 6 and 12 months from surgery: BMI, excess weight loss (%EWL), percentage of excess of BMI loss (%PEBMIL), expected BMI, % PEBMIL corrected by EBMI and percentage of total weight loss (%TWL).
RESULTS
Weight evolution is similar in both groups, reaching a mean BMI of 33.62 ± 4.35 and 34.48 ± 4.23 kg/m2 respectively 12 months after surgery, closer to expected BMI. TWL follows the same trend, with losses exceeding 30%, although 3 cm group is above the tables of percentiles made with our series. Regarding PEBMIL, the 3 cm group reaches 67.8% classified as excellent, while 8 cm group reaches 62.8% classified as a good result. EWL situates the best results for 3 cm group.
CONCLUSIONS
Group 3 cm obtained a lower percentage of suboptimal results using EWL. %TWL places the 3 cm group in higher percentile than 8 cm group. Through EBMI, both groups are equally effective. It is necessary to have standardised dynamic tables for each surgical technique, becoming essential elements to measure weight loss after surgery.
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Affiliation(s)
- Fàtima Sabench Pereferrer
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Alicia Molina López
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Margarida Vives Espelta
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Esther Raga Carceller
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Santiago Blanco Blasco
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Francisco Buils Vilalta
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Marta París Sans
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Maria Luisa Piñana Campón
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Mercè Hernández González
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Antonio Sánchez Marín
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain
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- Daniel Del Castillo Déjardin
- Surgery Service of Sant Joan University Hospital, Faculty of Medicine and Health Sciences, IISPV, Rovira i Virgili University, Reus, Tarragona, Spain.
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35
Nunez Lopez O, Jupiter DC, Bohanon FJ, Radhakrishnan RS, Bowen-Jallow KA. Health Disparities in Adolescent Bariatric Surgery: Nationwide Outcomes and Utilization.
J Adolesc Health 2017;
61:649-656. [PMID:
28867350 PMCID:
PMC5667551 DOI:
10.1016/j.jadohealth.2017.05.028]
[Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE
Bariatric surgery represents an appropriate treatment for adolescent severe obesity, but its utilization remains low in this patient population. We studied the impact of race and sex on preoperative characteristics, outcomes, and utilization of adolescent bariatric surgery.
METHODS
Retrospective analysis (2007-2014) of adolescent bariatric surgery using the Bariatric Outcomes Longitudinal Database, a national database that collects bariatric surgical care data. We assessed the relationships between baseline characteristics and outcomes (weight loss and remission of obesity-related conditions [ORCs]). Using the National Health and Nutrition Examination Survey and U.S. census data, we calculated the ratio of severe obesity and bariatric procedures among races and determined the ratio of ratios to assess for disparities.
RESULTS
About 1,539 adolescents underwent bariatric surgery. Males had higher preoperative body mass index (BMI; 51.8 ± 10.5 vs. 47.1 ± 8.7, p < .001) and higher rates of obstructive sleep apnea and dyslipidemia. Blacks had higher preoperative BMI (52.4 ± 10.6 vs. 47.3 ± 8.3; 48.7 ± 8.8; 48.2 ± 12.1 kg/m2; whites, Hispanics, and others, respectively p < .001) and higher rates of hypertension, obstructive sleep apnea, and asthma. Weight loss and ORCs remission rates did not differ between sexes or races after accounting for the rate of severe obesity in each racial group. White adolescents underwent bariatric surgery at a higher proportion than blacks and Hispanics (2.5 and 2.3 times higher, respectively).
CONCLUSIONS
Preoperative characteristics vary according to race and sex. Race and sex do not impact 12-month weight loss or ORC's remission rates. Minority adolescents undergo bariatric surgery at lower-than-expected rates.
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Affiliation(s)
- Omar Nunez Lopez
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
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- Daniel C Jupiter
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
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- Fredrick J Bohanon
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas
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- Ravi S Radhakrishnan
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas
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36
Espinoza J, Chen A, Orozco J, Deavenport-Saman A, Yin L. Effect of personal activity trackers on weight loss in families enrolled in a comprehensive behavioral family-lifestyle intervention program in the Federally Qualified Health Center setting: a randomized controlled trial.
Contemp Clin Trials Commun 2017;
7:86-94. [PMID:
29308436 PMCID:
PMC5753795 DOI:
10.1016/j.conctc.2017.06.004]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 06/02/2017] [Accepted: 06/10/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND
Childhood obesity continues to be a substantial problem despite major public health efforts, and disproportionately impacts children from low-income families. Digital health tools and consumer technology offer promising opportunities for interventions, but few studies have evaluated how they might be incorporated into existing interventions or used to create new types of interventions. It remains unclear which approaches would be most beneficial for underserved pediatric populations.
PURPOSE
To describe the design and rationale of a single-center randomized, controlled trial evaluating the effects of personal activity tracker (PAT) use by parents on weight-status improvement in both parents and overweight children enrolled in BodyWorks (BW), a comprehensive behavioral family-lifestyle intervention program (CBFLI), in a primary-care clinic serving a predominantly low-income Latino population.
METHODS
This study is being conducted in the AltaMed general pediatrics clinic at Children's Hospital Los Angeles. Eligible participants are families (child and adult caregiver) in which the child is between 7-18 years of age, has a BMI ≥85th percentile for age and sex, and has been referred to BW by their AltaMed pediatrician. BW consists of one weekly, two-hour session for 7 weeks. In a given cycle, the program is offered on two separate nights: Monday (Spanish) and Wednesday (English). Families self sort into one of two groups based on language preference. To ensure balanced allocation of language preference groups and prevent in-group cross contamination, block randomization is used to assign whole groups to either the intervention or control arms of the study. The control arm consists of usual care, while the intervention arm adds assigning a Fitbit PAT to the parents and training them in its proper use. Study personnel are blinded to group assignment during the analysis phase. Study outcomes include attendance rate, program completion rate, and changes in weight-status improvement, defined as change in weight and BMI for adults and change in BMI z-score for children. We hypothesize that the intervention arm will have better weight-related outcomes than the control arm. Study completion is anticipated in 2017, after the enrollment of approximately 150 families.
CONCLUSIONS
The study aim is to evaluate the effects of PATs on weight-related outcomes in overweight children and parents participating in a CBFLI. The results will be important for determining whether wearable devices are an effective addition to weight loss interventions for overweight and obese children.
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Affiliation(s)
- Juan Espinoza
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
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- Alexander Chen
- Keck School of Medicine of Keck School of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA
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- Jazminne Orozco
- USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar Street, CHP 133, Los Angeles, CA 90089, USA
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- Alexis Deavenport-Saman
- Keck School of Medicine of Keck School of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90033, USA
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- Larry Yin
- Division of General Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
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37
Sepúlveda M, Alamo M, Saba J, Astorga C, Lynch R, Guzmán H. Long-term weight loss in laparoscopic sleeve gastrectomy.
Surg Obes Relat Dis 2017;
13:1676-1681. [PMID:
28807556 DOI:
10.1016/j.soard.2017.07.017]
[Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/08/2017] [Accepted: 07/10/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION
Laparoscopic sleeve gastrectomy (LSG) has become an option as a bariatric surgical technique. There is a lack of long-term results of this procedure in the literature. The aim of this study is to present weight loss results of LSG for up to 7 years of follow-up.
METHODS
A retrospective series of patients who underwent LSG between 2008 and 2011 was examined. The primary endpoint was weight loss: percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and body mass index (BMI) were reported. Failure was defined as %EWL<50%. Multivariate analysis for weight loss was performed. The complications rate was reported.
RESULTS
A total of 148 patients met the inclusion criteria; 76.3% were female. Mean preoperative BMI was 36 ± 4 kg/m2. Mean operative time was 89.3 ± 3.2 minutes. Follow-up at 5, 6, and 7 years was 77.7%, 83.3%, and 82.2%, respectively. Mean %EWL and %TWL at 1, 3, 5, and 7 years was 93.2%, 80.7%, 70.6%, and 51.7%, and 27.2%, 23.3%, 20.4%, and 16.3%, respectively. The failure rate was 30.4% at the fifth year and 51.4% at the seventh year. High preoperative BMI was related to worse %EWL (P<0.001) but not to %TWL. Preoperative BMI<35 kg/m2 was associated with better %EWL but not with %TWL (P = 0.003). Four leaks (2.7%) and no mortalities were reported.
CONCLUSIONS
LSG is an acceptable surgical technique for weight loss, but in this series, up to one third of the patients fail at the fifth year and half fail in the seventh year. %EWL is better in patients with BMI<35 kg/m2, but this difference disappears when we express outcomes with %TWL.
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Affiliation(s)
- Matías Sepúlveda
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile.
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- Jorge Saba
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
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- Cristián Astorga
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
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- Raúl Lynch
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
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- Hernán Guzmán
- Hospital DIPRECA, Santiago, Chile; Universidad Diego Portales, Santiago, Chile
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38
Bariatric surgery in young adults: a multicenter study into weight loss, dietary adherence, and quality of life.
Surg Obes Relat Dis 2017;
13:1204-1210. [DOI:
10.1016/j.soard.2017.02.026]
[Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/31/2017] [Accepted: 02/24/2017] [Indexed: 12/27/2022]
39
Angrisani L, Vitiello A, Santonicola A, Hasani A, De Luca M, Iovino P. Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy as Revisional Procedures after Adjustable Gastric Band: 5-Year Outcomes.
Obes Surg 2017;
27:1430-1437. [PMID:
27995516 DOI:
10.1007/s11695-016-2502-8]
[Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION
In 2013, a worldwide bariatric surgery survey showed that laparoscopic adjustable gastric banding (LAGB) has been abandoned in favor of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-y gastric bypass (LRYGBP).
PURPOSE
The aim of this study was to compare results of LRYGBP and LSG performed as a revisional procedure after LAGB.
MATERIALS AND METHODS
All patients converted from LAGB to LSG or to LRYGBP from January 2007 to December 2011 were included in the study. Clinical data collected were age, gender, indications for revision, complications, body mass index (BMI), and body weight at revisional procedures. Weight loss was calculated at 1, 3, and 5 years after conversion.
RESULTS
Fifty-one patients were included in this study, 43 females and 8 males. Twenty-four patients were converted to LRYGBP (LRYGBP group) and 27 to LSG (LSG group). Indication for conversion was weight loss failure in 34 (67%) patients and band complications in 17 (33%) patients. No significant difference in age, BMI, and body weight in the two groups was found at the time of revision. One patient converted to LRYGBP had an internal hernia; one patient initially scheduled for LSG was intraoperatively converted to LRYGBP due to staple line leak. No other major perioperative complication was observed. Follow-up rate at 5 years was 84.3% (43 patients out of 51 patients) Delta-BMI and percentage of excess weight loss (%EWL) were not significantly different in the two groups at 1, 3, and 5 years (p > 0.05).
CONCLUSION
LRYGBP or LSG are feasible and effective surgical options after LAGB. Satisfactory weight loss was achieved after both procedures.
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Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
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- Antonio Vitiello
- Department of Endocrinology, Gastroenterology and Surgery, University Hospital of Naples "Federico II", Naples, Italy.
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- Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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- Ariola Hasani
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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- Maurizio De Luca
- Thoracic and Abdominal Surgery Department, Montebelluna-Treviso Hospital, Montebelluna, Italy
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- Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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40
Sabench Pereferrer F, Domínguez-Adame Lanuza E, Ibarzabal A, Socas Macias M, Valentí Azcárate V, García Ruiz de Gordejuela A, García-Moreno Nisa F, González Fernández J, Vilallonga Puy R, Vilarrasa García N, Sánchez Santos R. Quality Criteria in Bariatric Surgery: Consensus Review and Recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery.
ACTA ACUST UNITED AC 2017. [DOI:
10.1016/j.cireng.2016.09.015]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
41
Sabench Pereferrer F, Domínguez-Adame Lanuza E, Ibarzabal A, Socas Macias M, Valentí Azcárate V, García Ruiz de Gordejuela A, García-Moreno Nisa F, González Fernández J, Vilallonga Puy R, Vilarrasa García N, Sánchez Santos R. Quality criteria in bariatric surgery: Consensus review and recommendations of the Spanish Association of Surgeons and the Spanish Society of Bariatric Surgery.
Cir Esp 2017;
95:4-16. [PMID:
27979315 DOI:
10.1016/j.ciresp.2016.09.007]
[Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022]
Abstract
Bariatric surgery has proven to be highly effective in controlling obesity and metabolic syndrome; the results of this surgery are not only expressed in terms of weight loss, but also in terms of resolution of comorbidities, improved quality of life and complications. The different parameters used to measure these outcomes require uniformity and reference patterns. Therefore, it is essential to identify those indicators and quality criteria that are helpful in defining the «best practice» principles in bariatric surgery. In this regard, the Section of Obesity of the Spanish Association of Surgeons, in collaboration with the Spanish Society for Bariatric Surgery (SECO), present as an objective to identify the key points that define «quality» in this type of surgery. We describe the main indicators based on the published literature as well as the criteria for referral of the main comorbidities according to the evidence found and grades of recommendation.
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Affiliation(s)
- Fátima Sabench Pereferrer
- General and Digestive Surgery Department, University Hospital of Sant Joan, Pere Virgili Health's Institute, Faculty of Medicine, Reus (Tarragona), España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Eduardo Domínguez-Adame Lanuza
- Metabolic and Gastroesophageal Surgery Unit, Virgen de la Macarena University Hospital, Sevilla, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Ainitze Ibarzabal
- Clinical Institute of Digestive and Metabolic Diseases, Hospital Clínic de Barcelona, Barcelona, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- María Socas Macias
- General and Digestive Surgery Department, Bariatric and Gastroesophageal Surgery Innovation Unit, University Hospital Virgen del Rocío, Sevilla, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Víctor Valentí Azcárate
- Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, CIBER Pathophysiology of Obesity and Nutrition (CIBERobn), Carlos III Health's Institut, Health Research Institute of Navarra, Pamplona, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Amador García Ruiz de Gordejuela
- Bariatric Surgery Unit, Surgery Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Francisca García-Moreno Nisa
- Surgery Department, Ramón y Cajal University Hospital, Madrid, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Jesús González Fernández
- Metabolic, Bariatric and General Surgery Department, Asturias Medical Center, Oviedo, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Ramón Vilallonga Puy
- Endocrine, Metabolic and Bariatric Surgery Unit, Center of Excellence for the EAC-BC, General Surgery Department, Vall d'Hebron University Hospital, Barcelona, España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Nuria Vilarrasa García
- Endocrinology and Nutrition Department, Bellvitge University Hospital, L'Hospitalet de Llobregat (Barcelona), España; Section of Morbid Obesity, Spanish Association of Surgeons
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- Raquel Sánchez Santos
- General and Digestive Surgery Department, Complejo Hospitalario de Pontevedra, Pontevedra, España; Section of Morbid Obesity, Spanish Association of Surgeons.
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42
The longitudinal trajectory of post-surgical % total weight loss among middle-aged women who had undergone bariatric surgery.
Prev Med Rep 2016;
5:200-204. [PMID:
28070477 PMCID:
PMC5219637 DOI:
10.1016/j.pmedr.2016.12.021]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/23/2016] [Accepted: 12/26/2016] [Indexed: 01/06/2023] Open
Abstract
Middle-aged women are at a higher risk of being obese. We examined the trajectory of post-surgical % total weight loss (%TWL) among middle-aged female bariatric patients. We fitted sequential generalized estimating equations models to analyze a sample of women who received bariatric surgery in 1995–2012, aged 40–65 years at the time of surgery (N = 158,292) whose pre-operative body mass index (BMI) was ≥ 30 kg/m2 in the Bariatric Outcomes Longitudinal Database. The %TWL computed by 100% × (pre-surgery BMI − post-surgery BMI) / pre-surgery BMI showed different trajectories depending on type of surgery. For gastric banding, %TWL increased rapidly right after bariatric surgery and started to decrease around 1 year after surgery. For Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy, %TWL overall did not show remarkable changes from around 1 year after surgery. The highest increase in %TWL was observed in patients whose pre-operative BMI was 40 or higher and those who had undergone RYGB (ps < 0.001). Whereas the trajectories of %TWL among patients with sleeve gastrectomy and gastric banding did not differ much between different pre-operative BMI groups, the trajectories for RYGB were notably different between different pre-operative BMI groups (ps < 0.001). Middle-aged female bariatric patients are likely to achieve the highest %TWL if they receive RYGB and if their pre-operative BMI is 40 or higher. Further research is warranted to corroborate the present study's finding on the long-term effect of different types of bariatric surgery on %TWL among middle-aged women.
Weight loss outcomes differ between % excess weight loss and % total weight loss.
%TWL was highest among patients with preoperative BMI > 40 and RYGB procedure.
%TWL plateaued or decreased about 1 year after surgery among middle-aged females.
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43
van Wezenbeek MR, van Hout GC, Nienhuijs SW. Medical and Psychological Predictors for Long-Term Bariatric Success Using Primary Vertical-Banded Gastroplasty as a Model.
Bariatr Surg Pract Patient Care 2016. [DOI:
10.1089/bari.2016.0011]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
44
Park JY, Kim YJ. Reply to the Letter to Editor Entitled "The %EBMIL/%EWL Double-Booby Trap. A Comment on Studies that Compare the Effect of Bariatric Surgery Between Heavier and Lighter Patients".
Obes Surg 2016;
26:614-6. [PMID:
26620216 DOI:
10.1007/s11695-015-1970-6]
[Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ji Yeon Park
- Department of Surgery, National Cancer Center, Goyang, Republic of Korea
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- Yong Jin Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
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45
Angrisani L, Santonicola A, Hasani A, Nosso G, Capaldo B, Iovino P. Five-year results of laparoscopic sleeve gastrectomy: effects on gastroesophageal reflux disease symptoms and co-morbidities.
Surg Obes Relat Dis 2016;
12:960-968. [PMID:
26775051 DOI:
10.1016/j.soard.2015.09.014]
[Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/02/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) is becoming the most performed bariatric procedure; however, data available on long-term follow-up are scanty.
OBJECTIVES
The aim of the present study was to evaluate the 5-year efficacy of LSG on weight loss, gastroesophageal reflux disease (GERD) symptoms, and obesity-associated co-morbidities.
SETTING
Tertiary-care referral hospital.
METHODS
This study retrospectively analyzed 105 obese patients undergoing LSG from January 2006 to December 2009. The preoperative evaluation included demographic characteristics, evaluation of co-morbidities, a double-contrast barium swallow, and an upper-gastrointestinal endoscopy. The following data were collected at 1, 3, and 5 years after surgery: weight, improvement/remission of co-morbidities, complications, and revisional surgery.
RESULTS
According to preoperative body mass index (BMI), patients were divided into Group 1 (n = 61) with BMI≤50 kg/m(2) and Group 2 (n = 44) with BMI>50 kg/m(2). The follow-up rate was 94% after 5 years (n = 99). Delta BMI (BMI at follow-up-preoperative BMI) was significantly higher in Group 2 than in Group 1 at 1-3 years and 5 years (P<.001). Furthermore, at 5 years, Group 2 showed a significantly higher percentage total weight loss (%TWL) (26.6%±18.3% versus 33.5%±12.9%, P = .006) than Group 1, whereas percentage excess weight loss was similar (58.4%±21.8% versus 55.3%±19.5%, P = .5).Younger age at surgery and absence of postoperative GERD were associated with a better %TWL at 5 years (P<.001 and P = .03).
CONCLUSION
LSG is an effective procedure at long-term, with good weight loss outcomes and with a considerable improvement of obesity-associated co-morbidities. Younger age at surgery and absence of postoperative GERD were associated with a better %TWL at 5 years.
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Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
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- Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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- Ariola Hasani
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
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- Gabriella Nosso
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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- Brunella Capaldo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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- Paola Iovino
- Gastrointestinal Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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46
Weight-Independent Percentile Chart of 2880 Gastric Bypass Patients: a New Look at Bariatric Weight Loss Results.
Obes Surg 2016;
26:2891-2898. [DOI:
10.1007/s11695-016-2200-6]
[Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
47
Red cell distribution width is a novel biomarker that predicts excess body-mass index loss 1 year after laparoscopic Roux-en-Y gastric bypass.
Surg Endosc 2016;
30:4607-12. [PMID:
26902617 DOI:
10.1007/s00464-016-4798-9]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/03/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION
Bariatric surgery is the most effective method for producing sustained weight loss, improving obesity-associated comorbidities and reducing inflammation in the morbidly obese population. The red cell distribution width (RDW) is a novel marker of inflammation that is usually reported as part of a complete blood count. In this study, we tested our hypothesis that red cell distribution width might represent a novel biomarker predictive of excess body-mass index loss (EBMIL) following laparoscopic Roux-en-Y gastric bypass (LRYGB).
METHODS
Five hundred and forty-seven LRYGB patients included from a single institution were individually reviewed, noting both preoperative RDW and percent excess BMI loss at 6 months and 1 year post-LRYGB (%EBMIL180 and %EBMIL365, respectively). Bivariate and multivariate linear regression analysis was conducted between age, gender, initial body-mass index (BMI0) and RDW and each of the two endpoints, to assess the independence of RDW as a predictor of postoperative success.
RESULTS
The median RDW was 13.9 (13.3-14.6) %, and median EBMIL180 and EBMIL365 were 55.4 (45.2-66.7) % and 71.3 (58.9-87.8) %, respectively. After controlling for age, gender and BMI0, RDW was associated with %EBMIL365 (B = -1.4 [-2.8 to -0.002] %, P = .05), but not %EBMIL180 (B = -0.6 [-1.6 to 0.5] %, P = .30. Upon Kruskal-Wallis analysis, patients with a preoperative RDW > 15.0 % had significantly lower %EBMIL than those in the <13.0 % (P < .001) and 13.0-15.0 % (P < .01) strata.
CONCLUSIONS
RDW is predictive of EBMIL at 1 year following LRYGB. This represents a novel preoperative biomarker that may provide clinically useful prognostic information.
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48
van de Laar A, de Brauw L, Meesters E. Relationships between type 2 diabetes remission after gastric bypass and different weight loss metrics: arguments against excess weight loss in metabolic surgery.
Surg Obes Relat Dis 2016;
12:274-82. [DOI:
10.1016/j.soard.2015.07.005]
[Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 03/22/2015] [Accepted: 07/05/2015] [Indexed: 12/14/2022]
49
Wise ES, Hocking KM, Kavic SM. Prediction of excess weight loss after laparoscopic Roux-en-Y gastric bypass: data from an artificial neural network.
Surg Endosc 2016;
30:480-488. [PMID:
26017908 PMCID:
PMC4662927 DOI:
10.1007/s00464-015-4225-7]
[Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/17/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the gold standard for surgical weight loss. The success of LRYGB may be measured by excess body mass index loss (%EBMIL) over 25 kg/m(2), which is partially determined by multiple patient factors. In this study, artificial neural network (ANN) modeling was used to derive a reasonable estimate of expected postoperative weight loss using only known preoperative patient variables. Additionally, ANN modeling allowed for the discriminant prediction of achievement of benchmark 50% EBMIL at 1 year postoperatively.
METHODS
Six hundred and forty-seven LRYGB included patients were retrospectively reviewed for preoperative factors independently associated with EBMIL at 180 and 365 days postoperatively (EBMIL180 and EBMIL365, respectively). Previously validated factors were selectively analyzed, including age; race; gender; preoperative BMI (BMI0); hemoglobin; and diagnoses of hypertension (HTN), diabetes mellitus (DM), and depression or anxiety disorder. Variables significant upon multivariate analysis (P < .05) were modeled by "traditional" multiple linear regression and an ANN, to predict %EBMIL180 and %EBMIL365.
RESULTS
The mean EBMIL180 and EBMIL365 were 56.4 ± 16.5 % and 73.5 ± 21.5%, corresponding to total body weight losses of 25.7 ± 5.9% and 33.6 ± 8.0%, respectively. Upon multivariate analysis, independent factors associated with EBMIL180 included black race (B = -6.3%, P < .001), BMI0 (B = -1.1%/unit BMI, P < .001), and DM (B = -3.2%, P < .004). For EBMIL365, independently associated factors were female gender (B = 6.4%, P < .001), black race (B = -6.7%, P < .001), BMI0 (B = -1.2%/unit BMI, P < .001), HTN (B = -3.7%, P = .03), and DM (B = -6.0%, P < .001). Pearson r(2) values for the multiple linear regression and ANN models were 0.38 (EBMIL180) and 0.35 (EBMIL365), and 0.42 (EBMIL180) and 0.38 (EBMIL365), respectively. ANN prediction of benchmark 50% EBMIL at 365 days generated an area under the curve of 0.78 ± 0.03 in the training set (n = 518) and 0.83 ± 0.04 (n = 129) in the validation set.
CONCLUSIONS
Available at https://redcap.vanderbilt.edu/surveys/?s=3HCR43AKXR, this or other ANN models may be used to provide an optimized estimate of postoperative EBMIL following LRYGB.
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Affiliation(s)
- Eric S Wise
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN T2121, Nashville, TN, 37232-2730, USA.
- Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
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- Kyle M Hocking
- Department of Surgery, Vanderbilt University Medical Center, 1161 21st Ave S, MCN T2121, Nashville, TN, 37232-2730, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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- Stephen M Kavic
- Department of General Surgery, University of Maryland Medical Center, Baltimore, MD, USA
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50
van de Laar AW. The %EBMIL/%EWL Double Booby-Trap. A Comment on Studies that Compare the Effect of Bariatric Surgery Between Heavier and Lighter Patients.
Obes Surg 2015;
26:612-3. [DOI:
10.1007/s11695-015-1967-1]
[Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]