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Allum M, Buckley A, Suliman SGI, Suliman M, Hamdan K, Al Hadad M. Outcomes Following Metabolic Bariatric Surgery at a Single Center in the United Arab Emirates. Diabetes Metab Syndr Obes 2025; 18:249-260. [PMID: 39901918 PMCID: PMC11789772 DOI: 10.2147/dmso.s499361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 01/10/2025] [Indexed: 02/05/2025] Open
Abstract
Introduction While the benefits of metabolic bariatric surgery (MBS) are well described, only few studies have been published from the Gulf region, where the impact of regional patient characteristics on outcomes remains poorly understood. Methods Data were reviewed for patients attending metabolic follow-up three or more months after primary MBS at our center in the UAE from 2016 to 2022. Total weight loss (TWL), status of type 2 diabetes (T2D), hyperlipidemia, and hypertension were assessed following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Results Of 2851 included patients, 62.6% were female and 94.0% Emirati. Pre-operatively, mean age was 34.2 ±0.2 years, median BMI was 41.0 (IQR 37.8-45.2) kg/m2; 92.5% had SG and 7.5% RYGB. %TWL (95% confidence interval) for RYGB was 31.2% (30.0-32.5), 30.9% (29.0-32.9) and 28.4% (23.0-33.8) at 1, 3 and 5 years. Following SG, %TWL was 29.9% (29.5-30.3), 25.8% (25.0-26.7) and 23.4% (21.6-25.2) for the same intervals. The proportion of total operated patients included was 60.2%, 43.7% and 33.8% respectively. Men lost more weight than women 12 months after SG, with mean %TWL of 32.5% (31.8-33.2) vs 28.4% (27.9-28.9) respectively. T2D remission (HbA1c <6.5% without diabetes medications) after SG was 61.9% (179/289) at 1 year and 40.9% (18/44) at 5 years. RYGB favored T2D remission over SG at 12 months, OR=2.272 (1.152-4.65). There was no difference between procedures for hypertension status, although remission from hyperlipidemia was higher 1 year after RYGB at 41.8% (23/55) compared to SG 16.4% (78/475) (p<0.001). Conclusion In this young Emirati cohort, RYGB was associated with more weight loss and favored T2D and hyperlipidemia remission over SG. Women lost less weight than men after SG. Weight recurrence from 1 to 5 years after SG was greater than the international average. Further research is required to explain these differences and improve outcomes.
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Affiliation(s)
- Matthew Allum
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Adam Buckley
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Sara G I Suliman
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Mohamed Suliman
- Department of Endocrinology, Imperial College London Diabetes Centre, Abu Dhabi, United Arab Emirates
| | - Khaled Hamdan
- Department of Bariatric and Metabolic Surgery, Healthpoint Hospital, Abu Dhabi, United Arab Emirates
| | - Mohamed Al Hadad
- Department of Bariatric and Metabolic Surgery, Healthpoint Hospital, Abu Dhabi, United Arab Emirates
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Alhroot M, Hassanat R, Albadaina A, Alqaisi Q, Altamimi A, Aldaileh M, Alsardia Y, Alqaisi M, Rawashdeh E, Al-Shawabkeh A. The Risk of Leakage and Bleeding After Using the Ezisurg Endostapler Technique for Bariatric Surgery. Cureus 2024; 16:e75695. [PMID: 39811224 PMCID: PMC11729792 DOI: 10.7759/cureus.75695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Obesity is a growing global health issue, with a prevalence rate of 28.8% in Jordan. Bariatric surgery is the most effective treatment for morbid obesity, yet complications such as postoperative bleeding and leakage remain significant concerns. This study evaluates the safety and effectiveness of the Ezisurg endostapler (Ezisurg Medical, Shanghai, China) in laparoscopic bariatric surgery by assessing the prevalence of these complications. METHODS A retrospective, single-center study was conducted at King Hussein Medical Hospital, Amman, Jordan. Records of 400 consecutive patients who underwent laparoscopic bariatric surgery between September 2023 and August 2024 were reviewed. Intraoperative assessment of leakage was conducted using CT scans with methylene blue test, while postoperative leakage was evaluated through Gastrografin testing and abdominal CT scans. Bleeding was assessed according to the Bleeding Academic Research Consortium (BARC) criteria. Data on patient demographics, procedure types, intraoperative and postoperative complications, and outcomes were systematically collected. Qualitative variables were summarized through frequencies and percentages, while quantitative variables were described with measures of median and interquartile range (IQR). A p-value of <0.05 was considered statistically significant. RESULTS A total of 400 patients, predominantly women (80%), with a median age of 34.0 years and a median body mass index (BMI) of 43.0 kg/m² were included. Around two-thirds of patients underwent laparoscopic sleeve gastrectomy (LSG), and the other third underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). The median operation time was 96 minutes. Postoperative complications occurred in 10 patients (3.6%), including bleeding in five patients (1.25%) and leakage in three patients (0.75%). Five (1.25%) patients had postoperative bleeding, of which two were treated conservatively and three required surgical reoperation, two at the trocar site and one at the stapler line. CONCLUSIONS The Ezisurg endostapler showed low rates of postoperative bleeding (1.25%) and leakage (0.75%), highlighting its safety and effectiveness in laparoscopic bariatric surgery. Multicenter studies and long-term follow-ups are recommended to confirm these findings, evaluate cost-effectiveness, and explore patient-specific risk factors to further improve outcomes.
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Affiliation(s)
- Mohammad Alhroot
- Department of Surgery, King Hussein Medical Hospital, Amman, JOR
| | - Ramadan Hassanat
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Alaa Albadaina
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Qasem Alqaisi
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Ashraf Altamimi
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Mohammad Aldaileh
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Yousef Alsardia
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Majed Alqaisi
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
| | - Eyad Rawashdeh
- Department of General Surgery, Jordanian Royal Medical Services, Amman, JOR
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Salas-Parra RD, Smolkin C, Choksi S, Pryor AD. Bariatric Surgery: Current Trends and Newer Surgeries. Gastrointest Endosc Clin N Am 2024; 34:609-626. [PMID: 39277294 DOI: 10.1016/j.giec.2024.06.005] [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] [Indexed: 09/17/2024]
Abstract
Bariatric surgery has evolved and gained in popularity as it has been recognized as the most sustainable and effective treatment for obesity and related diseases. These related diseases are significant causes of obesity related morbidity and mortality. Most bariatric procedures incorporate some component of gastric restriction with or without intestinal bypass, but the full mechanism of these procedures has yet to be elucidated. The most popular surgical procedure remains the sleeve gastrectomy over the last 10 years, while gastric bypass is also still commonly performed. We have also seen growth in revisional bariatric surgery and novel surgical procedures.
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Affiliation(s)
- Ruben D Salas-Parra
- Department of Surgery, Long Island Jewish Medical Center and North Shore University Hospital, Northwell, New Hyde Park, NY, USA
| | - Caroline Smolkin
- Department of Surgery, Long Island Jewish Medical Center and North Shore University Hospital, Northwell, New Hyde Park, NY, USA
| | - Sarah Choksi
- Department of Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Aurora Dawn Pryor
- Long Island Jewish Medical Center, Northwell Health; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 240-05 76th Avenue, Suite B-241, New Hyde Park, NY 11040, USA.
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De Luca M, Silverii A, Zese M, Galasso G, Bellini R, Carbonelli MG, Cataldo R, Cerbone M, Chianelli M, Gregoris FC, Conigliaro R, Cuttica CM, de Werra C, Di Simone M, Docimo L, Musella M, Gagliardi G, Angrisani L, Di Lorenzo N, Boskoski I, Genco A, Raffaelli M, Anderloni A, Casella G, Galloro G, Goracci A, Lorenzoni V, Manta R, Marzullo P, Medea G, Navarra G, Ortenzi M, Paolini B, Piazza L, Porri D, Rahimi F, Rugolotto S, Pontesilli G, Sarnelli G, Sessa L, Zani I, Zappa MA, Bandini G, Ragghianti B, Monami M. Upcoming Italian clinical practice guidelines on endoscopic bariatric treatment of overweight and obesity: design and methodological aspects. Updates Surg 2024; 76:1865-1877. [PMID: 38985376 DOI: 10.1007/s13304-024-01843-1] [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: 12/05/2023] [Accepted: 04/05/2024] [Indexed: 07/11/2024]
Abstract
Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal-jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m2 and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications.
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Affiliation(s)
- Maurizio De Luca
- Surgery Unit, Azienda ULSS5 Polesana, Ospedale di Rovigo, Rovigo, Italy
| | | | - Monica Zese
- Surgery Unit, Azienda ULSS5 Polesana, Ospedale di Rovigo, Rovigo, Italy.
| | - Giovanni Galasso
- Endoscopy Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | | | - Rita Cataldo
- Research Unit of Anesthesia and Intensive Care, Università Campus Bio Medico di Roma e Fondazione Policlinico, Rome, Italy
| | | | - Marco Chianelli
- Unit of Endocrinology, Ospedale Regina Apostolorum Albano, Rome, Italy
| | | | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit_AOU-Modena, Modena, Italy
| | | | | | - Massimo Di Simone
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ludovico Docimo
- Division of General, Oncologic, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Gagliardi
- AULSS 5 Polesana, Anesthesiology, Intensive Care and Pain Medicine, Rovigo, Italy
| | | | | | - Ivo Boskoski
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Alfredo Genco
- Department of Obesity Surgery, Policlinico Umberto I, Rome, Italy
| | - Marco Raffaelli
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Andrea Anderloni
- Department of Gastroenterology and Endoscopy, IRCCS San Matteo Pavia, Pavia, Italy
| | | | - Giuseppe Galloro
- Digestive Surgical Endoscopy Unit, University of Naples, Naples, Italy
| | - Arianna Goracci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | - Raffaele Manta
- UOC di Gastroenterologia ed Endoscopia Digestiva, Ospedali Riuniti di Livorno, Livorno, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | | | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Monica Ortenzi
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Barbara Paolini
- Dietology, UOSA Dietetical and Clinical Nutrition, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Luigi Piazza
- UOC Chirurgia Generale e d'Urgenza, Arnas Garibaldi, Catania, Italy
| | | | - Farnaz Rahimi
- Clinical Nutrition Unit, Molinette University Hospital of Turin, Turin, Italy
| | | | | | - Giovanni Sarnelli
- Unit of Digestive and Nutritional Pathophysiology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Luca Sessa
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Iris Zani
- Amici Obesi ONLUS Milano, 20128, Milan, Italy
| | | | - Giulia Bandini
- Division of Internal Medicine, Careggi University Hospital, Florence, Italy
| | | | - Matteo Monami
- Diabetology, Careggi University Hospital, Florence, Italy
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Jawhar N, Abi Mosleh K, Bartosiak KZ, Hage K, Kennel KA, Mundi MS, Kendrick ML, Ghanem OM. Comprehensive outcomes after Roux-en-Y gastric bypass with a near-complete 15-year follow-up. Surgery 2024; 176:586-594. [PMID: 38769035 DOI: 10.1016/j.surg.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/23/2024] [Accepted: 02/25/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass has a well-established safety and efficacy profile in the short and mid-term. Long-term outcomes remain limited in the literature, especially for follow-up periods of >10 years. The purpose of the study is to evaluate the long-term durability and safety of laparoscopic Roux-en-Y gastric bypass over a near-complete 15-year follow-up. METHODS This is a single-center retrospective cohort study of patients who underwent primary laparoscopic Roux-en-Y gastric bypass between 2008 and 2009 with ≥14-year follow-up. Data collected and analyzed were weight loss, obesity-related medical condition resolution and recurrence, weight recurrence, complication rate, and mortality rate. RESULTS A total of 264 patients were included. Patients were predominantly female (81.8%), and the mean age and preoperative body mass index were 48.5 ± 12.2 years and 44.9 ± 7.3 kg/m2, respectively. The maximum mean percentage total weight loss achieved at 1 year was 31.5% ± 5.7% and was consistently >20% throughout follow-up. Sustained resolution of obesity-related medical conditions was achieved with a remission rate of 60.8% for type 2 diabetes mellitus, 46.7% for denoted dyslipidemia, and 40% for hypertension. Obesity-related medical condition recurrence was observed with a recurrence rate of 24.1% for type 2 diabetes mellitus, 17.9% for hypertension, and 14.8% for denoted dyslipidemia. Significant factors associated with weight loss were maximum percentage total weight loss and preoperative type 2 diabetes mellitus. Over 15 years, the weight recurrence rate was 51.1%, with predictors of higher preoperative body mass index and preoperative type 2 diabetes mellitus. CONCLUSION Laparoscopic Roux-en-Y gastric bypass provides sustainable weight loss over a 15-year period, with consistent long-term weight-loss outcomes and resolution of obesity-related medical conditions sustained for ≥10 years after surgery.
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Affiliation(s)
- Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Kurt A Kennel
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Manpreet S Mundi
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Kukla A, Sahi SS, Navratil P, Benzo RP, Smith BH, Duffy D, Park WD, Shah M, Shah P, Clark MM, Fipps DC, Denic A, Schinstock CA, Dean PG, Stegall MD, Kudva YC, Diwan TS. Weight Loss Surgery Increases Kidney Transplant Rates in Patients With Renal Failure and Obesity. Mayo Clin Proc 2024; 99:705-715. [PMID: 38702124 PMCID: PMC11714774 DOI: 10.1016/j.mayocp.2024.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To describe the outcomes of kidney transplant (KT) candidates with obesity undergoing sleeve gastrectomy (SG) to meet the criteria for KT. METHODS Retrospective analysis was conducted of electronic medical records of KT candidates with obesity (body mass index >35 kg/m2) who underwent SG in our institution. Weight loss, adverse health events, and the listing and transplant rates were abstracted and compared with the nonsurgical cohort. RESULTS The SG was performed in 54 patients; 50 patients did not have surgery. Baseline demographic characteristics were comparable at the time of evaluation. Mean body mass index ± SD of the SG group was 41.7±3.6 kg/m2 at baseline (vs 41.5±4.3 kg/m2 for nonsurgical controls); at 2 and 12 months after SG, it was 36.4±4.1 kg/m2 and 32.6±4.0 kg/m2 (P<.01 for both). In the median follow-up time of 15.5 months (interquartile range, 6.4 to 23.9 months), SG was followed by active listing (37/54 people), and 20 of 54 received KT during a median follow-up time of 20.9 months (interquartile range, 14.7 to 28.3 months) after SG. In contrast, 14 of 50 patients in the nonsurgical cohort were listed, and 5 received a KT (P<.01). Three patients (5.6%) experienced surgical complications. There was no difference in overall hospitalization rates and adverse health outcomes, but the SG cohort experienced a higher risk of clinically significant functional decline. CONCLUSION In KT candidates with obesity, SG appears to be effective, with 37% of patients undergoing KT during the next 18 months (P<.01). Further research is needed to confirm and to improve the safety and efficacy of SG for patients with obesity seeking a KT.
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Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
| | - Sukhdeep S Sahi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Pavel Navratil
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Roberto P Benzo
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dustin Duffy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Walter D Park
- Department of Cardiovascular Surgery Research, Mayo Clinic, Rochester, MN
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Pankaj Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Matthew M Clark
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - David C Fipps
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie A Schinstock
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | - Yogish C Kudva
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Tayyab S Diwan
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
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Leang YJ, Mayavel N, Yang WTW, Kong JCH, Hensman C, Burton PR, Brown WA. Robotic versus laparoscopic gastric bypass in bariatric surgery: a systematic review and meta-analysis on perioperative outcomes. Surg Obes Relat Dis 2024; 20:62-71. [PMID: 37730445 DOI: 10.1016/j.soard.2023.08.007] [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: 04/25/2023] [Revised: 07/22/2023] [Accepted: 08/05/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Robotic-assisted surgery has emerged as a compelling approach to bariatric surgery. However, current literature has not consistently demonstrated superior outcomes to laparoscopic bariatric surgery to justify its higher cost. With its mechanical advantages, the potential gains from the robotic surgical platform are likely to be apparent in more complex cases such as gastric bypass, especially revisional cases. OBJECTIVE This systematic review and meta-analysis aimed to summarize the literature and evaluate the peri-operative outcomes of patients with obesity undergoing robotic gastric bypass versus laparoscopic gastric bypass surgery. SETTING Systematic review. METHODS A literature search of Embase, Medline, Pubmed, Cochrane library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies comparing outcomes of robotic and laparoscopic gastric bypass for obesity were included. RESULTS Twenty-eight eligible studies comprised a total of 82,155 patients; 9051 robotic bypass surgery (RBS) versus 73,104 laparoscopic bypass surgery (LBS) were included. All included studies compared Roux-en-Y gastric bypass. RBS was noted to have higher reoperation rate within 30 days (4.4% versus 3.4%; odds ratio 1.31 [95% CI, 1.04-1.66]; P = .027; I2 = 43.5%) than LBS. All other endpoints measured (complication rate, anastomotic leak, anastomotic stricture, surgical site infections, hospital readmission, length of stay, operative time, conversion rate and mortality) did not show any difference between RBS and LBS. CONCLUSION This systematic review and meta-analysis showed that there was no significant difference in key outcome measures in robotic versus laparoscopic gastric bypass. RBS was associated with a slightly higher reoperation rate and there was no reduction in overall complication rate with the use of robotic platform.
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Affiliation(s)
- Yit J Leang
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia.
| | - Naveen Mayavel
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wilson T W Yang
- Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Joseph C H Kong
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Chrys Hensman
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Paul R Burton
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Oesophago-gastric and Bariatric Unit, Department of General Surgery, The Alfred Hospital, Melbourne, Australia
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Elsaigh M, Awan B, Shabana A, Sohail A, Asqalan A, Saleh O, Szul J, Khalil R, Elgohary H, Marzouk M, Alasmar M. Comparing Safety and Efficacy Outcomes of Gastric Bypass and Sleeve Gastrectomy in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52796. [PMID: 38389648 PMCID: PMC10883263 DOI: 10.7759/cureus.52796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Sleeve Gastrectomy (SG) could be done by the removal of a big portion of the stomach, leading to reduced amounts of food taken as a result of the smaller stomach size. In contrast, Roux-en-Y Gastric Bypass (RYGB) can be done by creating a small stomach pouch and rerouting a part of the small intestine, employing combined mechanisms of restriction and malabsorption to limit food intake and modify nutrient absorption. Our aim is to identify the most effective and safest surgical intervention for individuals with both Type 2 Diabetes Mellitus (T2DM) and obesity, considering both short and long-term outcomes. We will assess participants undergoing either SG or RYGB to determine the optimal surgical approach. We made a thorough search of PubMed, Cochrane Library, Scopus, and Web of Science databases up to November 2023. Our focus was on randomized controlled trials (RCTs) comparing the safety and efficacy of RYGB and SG in T2DM regarding any extractable data. We excluded studies of other designs, such as cohorts, case reports, case series, reviews, in vitro studies, postmortem analyses, and conference abstracts. Utilizing Review Manager 5.4, we performed a meta-analysis, combining risk ratios (RR) with a 95% confidence interval (CI) conducted for binary outcomes, while mean with SD and 95% CI are pooled for the continuous ones. The total number of participants in our study is 4,148 patients. Our analysis indicates superior outcomes in the group undergoing RYGB surgery compared to the SG group (RR = 0.76, 95% (CI) (0.66 to 0.88), P = 0.0002). The pooled data exhibited homogeneity (P = 0.51, I2 = 0%) after employing the leave-one-out method. For the 1-3 year period, six studies involving 332 patients with T2DM yielded non-significant results (RR = 0.83, 95% CI (0.66 to 1.06), P = 0.14) with homogeneity (P = 0.24, I2 = 28%). Conversely, the 5-10 year period, with six studies comprising 728 DM patients, demonstrated significant results (RR = 0.69, 95% CI (0.56 to 0.85), P = 0.14) and homogeneity (P = 0.84, I2 = 0%). In terms of total body weight loss, our findings indicate significantly higher weight loss with RYGB (mean difference (MD) = -6.13, 95% CI (-8.65 to -3.6), P > 0.00001). However, pooled data exhibited considerable heterogeneity (P > 0.00001, I2 = 93%). Subgroup analyses for the 1-3 year period (five studies, 364 DM patients) and 5-10 year period (six studies, 985 DM patients) also revealed significant differences favoring RYGB, with heterogeneity observed in both periods (1-3 years: P > 0.00001, I2 = 95%; 5-10 years: P = 0.001, I2 = 75%). RYGB demonstrated significant long-term improvement in diabetes remission and superior total body weight loss compared to SG. While no notable differences were observed in other efficacy outcomes, safety parameters require further investigation. no significant distinctions were found in any of the safety outcomes: hypertension (HTN), high-density lipoprotein (HDL), hyperlipidemia, fasting blood glucose, vomiting, low-density lipoprotein (LDL), and total cholesterol. Further research is essential to comprehensively assess safety outcomes for both surgical approaches.
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Affiliation(s)
- Mohamed Elsaigh
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Bakhtawar Awan
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Ahmed Shabana
- Bariatric and General Surgery, Shifa Hospital, Cairo, EGY
| | - Azka Sohail
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Ahmad Asqalan
- Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Omnia Saleh
- Surgery, Brigham and Women's Hospital, Boston, USA
| | - Justyna Szul
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Rana Khalil
- General and Emergency Surgery, Newcastle University Hospitals and Kasralainy Medical School, Cairo University, Cairo, EGY
| | - Hatem Elgohary
- General and Emergency Surgery, Helwan University, Cairo, EGY
| | - Mohamed Marzouk
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Mohamed Alasmar
- General and Emergency Surgery, Salford Royal Hospital, University of Manchester, Manchester, GBR
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9
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Aderinto N, Olatunji G, Kokori E, Olaniyi P, Isarinade T, Yusuf IA. Recent advances in bariatric surgery: a narrative review of weight loss procedures. Ann Med Surg (Lond) 2023; 85:6091-6104. [PMID: 38098582 PMCID: PMC10718334 DOI: 10.1097/ms9.0000000000001472] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/25/2023] [Indexed: 12/17/2023] Open
Abstract
Bariatric surgery has emerged as a highly effective option for individuals with obesity, offering significant and sustainable weight loss outcomes. This surgical approach involves various procedures that alter the anatomy of the gastrointestinal tract, leading to reduced food intake and nutrient absorption. Established procedures such as sleeve gastrectomy, gastric bypass, adjustable gastric banding, and biliopancreatic diversion with duodenal switch have proven track records. In contrast, emerging options like intragastric balloons, AspireAssist devices, and endoscopic sleeve gastroplasty show promise but require further investigation. Numerous studies have highlighted the remarkable benefits of bariatric surgery, not only in weight loss but also in the resolution of obesity-related comorbidities and significant improvements in quality of life. However, successful outcomes rely on a multidisciplinary approach, encompassing preoperative evaluation, patient selection, comprehensive postoperative care, nutritional support, and psychological counseling. Regular follow-up and adherence to postsurgical recommendations are crucial for sustained weight loss and positive long-term results. As bariatric surgery continues to evolve, tailored procedures based on individual needs and ongoing research hold the potential for even more refined and effective approaches. Through this ongoing advancement, bariatric surgery is poised to offer improved patient outcomes, transforming lives for those grappling with the challenges of obesity.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
| | | | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | - Peter Olaniyi
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Oyo State
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10
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Alsayed Hasan M, Schwartz S, McKenna V, Ing R. An Imbalance of Pathophysiologic Factors in Late Postprandial Hypoglycemia Post Bariatric Surgery: A Narrative Review. Obes Surg 2023; 33:2927-2937. [PMID: 37530920 DOI: 10.1007/s11695-023-06758-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
With a rise in obesity and more patients opting for bariatric surgery, it becomes crucial to understand associated complications like postprandial hypoglycemia (PPH). After bariatric surgery, significant changes are seen in insulin sensitivity, beta cell function, glucagon-like peptide 1 (GLP-1) levels, the gut microbiome, and bile acid metabolism. And in a small subset of patients, exaggerated imbalances in these functional and metabolic processes lead to insulin-glucose mismatch and hypoglycemia. The main treatment for PPH involves dietary modifications. For those that do not respond, medications or surgical interventions are considered to reverse some of the imbalances. We present a few case reports of patients that safely tolerated GLP-1 agonists. However, larger randomized control trials are needed to further characterize PPH and understand its treatment.
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Affiliation(s)
- Marah Alsayed Hasan
- Department of Internal Medicine, Main Line Health System/Lankenau Medical Center, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA.
| | - Stanley Schwartz
- Affiliate, Main Line Health System, Emeritus, University of Pennsylvania, 100 E Lancaster Ave, Wynnewood, PA, 19096, USA
| | - Victoria McKenna
- Main Line Health Bariatric Surgery - Bryn Mawr, 830 Old Lancaster Road Suite 300, Bryn Mawr, PA, 19010, USA
| | - Richard Ing
- Bariatric Center of Bryn Mawr Hospital, Main Line Health System, Bryn Mawr Medical Building North, 830 Old Lancaster Road, Bryn Mawr, PA, 19010, USA
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11
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Tabesh MR, Eghtesadi M, Abolhasani M, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline. Obes Surg 2023; 33:2557-2572. [PMID: 37389806 DOI: 10.1007/s11695-023-06703-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/18/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.
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Affiliation(s)
| | - Maryam Eghtesadi
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran
| | - Maryam Abolhasani
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports and Exercise Medicine Department, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Tehran, 14395-578, Iran.
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12
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Sridhar A, Khan D, Elliott JA, Naughton V, Flatt PR, Irwin N, Moffett CR. RYGB surgery has modest effects on intestinal morphology and gut hormone populations in the bypassed biliopancreatic limb but causes reciprocal changes in GLP-2 and PYY in the alimentary limb. PLoS One 2023; 18:e0286062. [PMID: 37228045 DOI: 10.1371/journal.pone.0286062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
Roux-en-Y gastric-bypass (RYGB) induced alterations in intestinal morphology and gut-cell hormone expression profile in the bypassed biliopancreatic-limb (BPL) versus the alimentary-limbs (AL) are poorly characterised. This pilot study has therefore explored effects following RYGB in high-fat-diet (HFD) and normal-diet (ND) rats. Female Wistar rats (4-week-old) were fed HFD or ND for 23-weeks prior to RYGB or sham surgeries. Immunohistochemical analysis of excised tissue was conducted three-weeks post-surgery. After RYGB, intestinal morphology of the BPL in both HFD and ND groups was unchanged with exception of a small decrease in villi width in the ND-RYGB and crypt depth in the HFD-RYGB group. However, in the AL, villi width was decreased in ND-RYGB rats but increased in the HFD-RYGB group. In addition, crypt depth decreased after RYGB in the AL of HFD rats. GIP positive cells in either limb of both groups of rats were unchanged by RYGB. Similarly, there was little change in GLP-1 positive cells, apart from a small decrease of numbers in the villi of the BPL in HFD rats. RYGB increased GLP-2 cell numbers in the AL of ND-RYGB rats, including in both crypts and villi. This was associated with decreased numbers of cells expressing PYY in the AL of ND-RYGB rats. The BPL appears to maintain normal morphology and unchanged enteroendocrine cell populations despite being bypassed in RYGB-surgery. In contrast, in the AL, villi area is generally enhanced post-RYGB in ND rats with increased numbers of GLP-2 positive cells and decreased expression of PYY.
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Affiliation(s)
- Ananyaa Sridhar
- Biomedical Sciences Research Institute, School of Biomedical Sciences, Ulster University, Coleraine, N. Ireland, United Kingdom
| | - Dawood Khan
- Biomedical Sciences Research Institute, School of Biomedical Sciences, Ulster University, Coleraine, N. Ireland, United Kingdom
| | - Jessie A Elliott
- Department of Surgery, Trinity Centre for Health Sciences and St. James's Hospital, Dublin, Ireland
| | - Violetta Naughton
- Biomedical Sciences Research Institute, School of Biomedical Sciences, Ulster University, Coleraine, N. Ireland, United Kingdom
| | - Peter R Flatt
- Biomedical Sciences Research Institute, School of Biomedical Sciences, Ulster University, Coleraine, N. Ireland, United Kingdom
| | - Nigel Irwin
- Biomedical Sciences Research Institute, School of Biomedical Sciences, Ulster University, Coleraine, N. Ireland, United Kingdom
| | - Charlotte R Moffett
- Biomedical Sciences Research Institute, School of Biomedical Sciences, Ulster University, Coleraine, N. Ireland, United Kingdom
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13
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Noria SF, Shelby RD, Atkins KD, Nguyen NT, Gadde KM. Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment. Curr Diab Rep 2023; 23:31-42. [PMID: 36752995 PMCID: PMC9906605 DOI: 10.1007/s11892-023-01498-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE OF REVIEW Although bariatric surgery is the most effective treatment of severe obesity, a proportion of patients experience clinically significant weight regain (WR) with further out from surgery. The purpose of this review is to summarize the prevalence, predictors, and causes of weight regain. RECENT FINDINGS Estimating the prevalence of WR is limited by a lack of consensus on its definition. While anatomic failures such as dilated gastric fundus after sleeve gastrectomy and gastro-gastric fistula after Roux-en-Y gastric bypass can lead to WR, the most common causes appear to be dysregulated/maladaptive eating behaviors, lifestyle factors, and physiological compensatory mechanisms. To date, dietary, supportive, behavioral, and exercise interventions have not demonstrated a clinically meaningful impact on WR, and there is limited evidence for pharmacotherapy. Future studies should be aimed at better defining WR to begin to understand the etiologies. Additionally, there is a need for non-surgical interventions with demonstrated efficacy in rigorous randomized controlled trials for the prevention and reversal of WR after bariatric surgery.
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Affiliation(s)
- Sabrena F Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio State University, N718 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Rita D Shelby
- Department of Plastic and Reconstructive Surgery, University of Miami, Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Katelyn D Atkins
- Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine, 3800 W Chapman Ave, Orange, CA, 92868, USA
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14
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de Oliveira VL, Bestetti AM, Trasolini RP, de Moura EGH, de Moura DTH. Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations. World J Gastroenterol 2023; 29:1173-1193. [PMID: 36926665 PMCID: PMC10011956 DOI: 10.3748/wjg.v29.i7.1173] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/21/2023] Open
Abstract
Post-surgical leaks and fistulas are the most feared complication of bariatric surgery. They have become more common in clinical practice given the increasing number of these procedures and can be very difficult to treat. These two related conditions must be distinguished and characterized to guide the appropriate treatment. Leak is defined as a transmural defect with communication between the intra and extraluminal compartments, while fistula is defined as an abnormal communication between two epithelialized surfaces. Traditionally, surgical treatment was the preferred approach for leaks and fistulas and was associated with high morbidity with significant mortality rates. However, with the development of novel devices and techniques, endoscopic therapy plays an increasingly essential role in managing these conditions. Early diagnosis and endoscopic therapy initiation after clinical stabilization are crucial to success since clinical success rates are higher for acute leaks and fistulas when compared to late and chronic leaks and fistulas. Several endoscopic techniques are available with different mechanisms of action, including direct closure, covering/diverting or draining. The treatment should be individualized by considering the characteristics of both the patient and the defect. Although there is a lack of high-quality studies to provide standardized treatment algorithms, this narrative review aims to provide a summary of the current scientific evidence and, based on this data and our extensive experience, make recommendations to help choose the best endoscopic approach for the management of post-bariatric surgical leaks and fistulas.
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Affiliation(s)
- Victor Lira de Oliveira
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Alexandre Moraes Bestetti
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Roberto Paolo Trasolini
- Division of Gastroenterology, Hepatology and Endoscopy, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 021115, United States
| | - Eduardo Guimarães Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
| | - Diogo Turiani Hourneaux de Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403010, Brazil
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15
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Unique long-term simultaneous complications of conventional Roux-en-Y gastric bypass after 27 years: A case report. Int J Surg Case Rep 2022; 101:107787. [PMID: 36434869 PMCID: PMC9685287 DOI: 10.1016/j.ijscr.2022.107787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION We report a case of late concomitant complications caused by conventional Roux-en-Y gastric bypaas and its managements. PRESENTATION OF CASE A 62-year-old male presented 27 years after conventional gastric bypass Y-de-Roux (BGYR) with, sudden, moderate intensity abdominal pain, nausea, biliary vomiting and hyporexia. Persistent abdominal pain was constant, so a thoracoabdominal tomography was requested by the surgeon. It confirmed the presence of intestinal intussusception associated with lithiasis and cholecystitis. The patient reported having lost 45 kg since the BGYR. He goes to the operating room for definitive management. DISCUSSION The etiology of post-BGYR intussusception is largely unknown, and multiple hypotheses have been created, such as the iatrogenic stitch created by the suture line in the entero-enteric anastomosis and the most common pattern found is antegrade. The use of contrasted CT as the most reliable diagnostic method. CONCLUSION The importance of taking into account the possible complications existing in bariatric patients and their frequency gives us the opportunity to suspect and detect them in time and in the most cases the management must be surgical.
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16
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Nathanson AL, Thompson SK. Stomal diameter in laparoscopic gastric bypass: surgical dogma put to the test! ANZ J Surg 2022; 92:2772-2773. [DOI: 10.1111/ans.18009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew L. Nathanson
- Oesophago‐Gastric Surgery Unit Flinders Medical Centre Bedford Park South Australia Australia
| | - Sarah K. Thompson
- Oesophago‐Gastric Surgery Unit Flinders Medical Centre Bedford Park South Australia Australia
- College of Medicine & Public Health Flinders University Bedford Park South Australia Australia
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17
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Eghbali F, Bahardoust M, Pazouki A, Barahman G, Tizmaghz A, Hajmohammadi A, Karami R, Hosseini-Baharanchi FS. Predictors for weight loss after Roux-en-Y gastric bypass: the trend and associated factors for weight loss. BMC Surg 2022; 22:310. [PMID: 35953797 PMCID: PMC9367149 DOI: 10.1186/s12893-022-01760-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Historically, Roux-en-Y gastric bypass (RYGB) has been considered the gold standard of bariatric surgery (BS). This procedure acts as a mixed restrictive and malabsorptive operation. METHODS This retrospective cohort study included 410 morbidly obese patients (BMI > 40 kg/m2 or BMI > 35 kg/m2 along with at least one major comorbidity) who underwent primary laparoscopic RYGB surgery from 2009 to 2015 by a single surgery team. The patients were 18 years and older with at least 12 months of follow-up. Total weight loss (%TWL) and comorbidity resolution were compared in short-term (12 months) and mid-term (12-60 months) follow-ups. The primary and secondary outcomes were evaluating the effect of Roux-en-Y on weight loss and control of comorbidities, respectively. RESULTS The mean ± SD age, weight, and BMI at surgery were 40.1 ± 10.58 years, 123.32 ± 19.88 kg, and 45.78 ± 5.54 kg/m2, respectively, and 329 (80%) were female, and 62 (15%) had T2DM. %TWL was significantly higher in T2DM patients 9 months postoperatively and after that. Patients with lower BMI (< 50 kg/m2) at surgery and non-diabetic patients had a significantly lower %TWL over a short- and long-term follow-up (P < 0.001). CONCLUSIONS BS remains the most efficacious and durable weight loss treatment. However, a proportion of patients will experience insufficient weight loss following BS.
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Affiliation(s)
- Foolad Eghbali
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, 1449614535, Iran.
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gelayol Barahman
- Medical Doctor, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Adnan Tizmaghz
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Hajmohammadi
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Karami
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, 1449614535, Iran.
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18
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Stumpf O, Lange V, Rosenthal A, Lefering R, Paasch C. A 30 mm sized gastrojejunostomy may lead to a lower rate of therapy failure in comparison to a 45 mm sized gastrojejunostomy following laparoscopic Roux-en-Y gastric bypass. Ann Med Surg (Lond) 2022; 78:103787. [PMID: 35734741 PMCID: PMC9206935 DOI: 10.1016/j.amsu.2022.103787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Oliver Stumpf
- Center of Obesity and Metabolic Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Berlin, Germany
| | - Volker Lange
- Center of Obesity and Metabolic Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Berlin, Germany
| | - Anke Rosenthal
- Obesity Outpatient Clinic, Bismarckstraße 101, 10625, Berlin, Germany
| | - Rolf Lefering
- IFOM-Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Cologne, Germany
| | - Christoph Paasch
- Department of General Surgery, University Hospital Brandenburg an der Havel, Hochstraße 29, 14770, Brandenburg an der Havel, Germany
- Faculty of Medicine, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Corresponding author. University Hospital Brandenburg an der Havel, Medizinische Hochschule Brandenburg Theodor Fontane, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
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19
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Kalmar CL, Park BC, Kassis S, Higdon KK, Perdikis G. Functional panniculectomy vs cosmetic abdominoplasty: Multicenter analysis of risk factors and complications. J Plast Reconstr Aesthet Surg 2022; 75:3541-3550. [PMID: 35705442 DOI: 10.1016/j.bjps.2022.04.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/12/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Amidst the rising trend of bariatric surgical procedures being performed across the country and around the world, patients seeking functional panniculectomy after massive weight loss represent a different population than those seeking cosmetic abdominoplasty. The purpose of this study was to determine whether certain complications are more likely to occur in patients undergoing functional panniculectomy, as well as identify risk factors that are implicated in the occurrence of adverse events. METHODS Retrospective cohort study was conducted of patients undergoing cosmetic abdominoplasty and functional panniculectomy in North America between 2015 and 2019 using the National Surgical Quality Improvement Program database sponsored by the American College of Surgeons. Comorbidities and postoperative complications between these two cohorts were analyzed with appropriate statistics. RESULTS During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n = 6397) patients undergoing functional panniculectomy and 42.6% (n = 4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty (p < .001). Overall adverse events (p < .001), medical complications (p = .047), surgical complications (p < .001), related readmission (p < .001), and related reoperation (p < .001) were significantly higher in patients undergoing functional panniculectomy. Surgical complications significantly higher in functional panniculectomy included superficial incisional infection (p < .001), deep incisional infection (p < .001), organ/space infection (p < .001), dehiscence (p = .003), and bleeding requiring transfusion (p = .003). CONCLUSIONS Patients undergoing functional panniculectomy are significantly more likely to have comorbidities and experience postoperative wound infection, dehiscence, sepsis, bleeding, related readmission, and related reoperation.
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Affiliation(s)
- Christopher L Kalmar
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Benjamin C Park
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Salam Kassis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kent K Higdon
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Galen Perdikis
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
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20
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Appetite Changes in Weight Regain and Weight Maintenance After Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:1-12. [PMID: 35441332 DOI: 10.1007/s11695-022-06061-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) surgery produces significant weight loss. However, a number of patients experience weight regain years after surgery. Factors driving weight regain after surgical interventions are currently being explored. Our objective was to investigate appetite-related measures associated with weight regain after RYGB surgery. MATERIALS AND METHODS Using a cross-sectional design, 29 participants (49.6 ± 9.1 years of age; current BMI 32.4 ± 4.7 kg/m2, 43.6 ± 8.9 months post-RYGB) were stratified into tertiles according to weight regain per month after nadir (weight maintenance (WM), n = 9; low weight regain (LWR), n = 10; and high weight regain (HWR), n = 10). The average weight regain was, by design, significantly different between the groups (WM = 2.2 ± 2.5 kg; LWR = 10.0 ± 3.4 kg; HWR = 14.9 ± 6.3 kg regained, p < 0.05). Appetite (visual analog scales), olfactory performance ("sniffin sticks"), eating behaviors (Three Factor Eating Questionnaire), food reward (Leeds Food Preference Questionnaire), and appetite-related hormones (ghrelin, PYY, GLP-1 and leptin) were measured fasting and in response to a standardized test meal. RESULTS Dietary restraint was significantly higher than clinical cutoffs in WM and LWR (p < 0.05). As expected, significant time effects were noted for ghrelin, PYY, and GLP-1, but there were no group differences. CONCLUSION The results suggest that appetite-related outcomes are similar across individuals who have maintained weight loss and experienced regain following RYGB.
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21
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Purich K, Mocanu V, Joy J, Verhoeff K, Dang J, Switzer NJ, Birch DW, Karmali S. The Impact of Metabolic and Bariatric Surgeon Status on Outcomes After Bariatric Surgery: a Retrospective Cohort Study Using the MBSAQIP Database. Obes Surg 2022; 32:1944-1953. [PMID: 35349044 DOI: 10.1007/s11695-022-06028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/13/2022] [Accepted: 03/18/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Differences between complication rates of bariatric surgeries performed by general surgeons (GS) versus those performed by metabolic and bariatric surgeons (MBS) are poorly understood. METHODS We analyzed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database focusing on RYGB and SG procedures between 2016 and 2019. Our primary objective was to evaluate trends in the number of bariatric procedures performed by GS and MBS. Secondary objectives were assessing for differences in 30-day mortality and the incidence of serious complications. Differences between groups were evaluated by chi-squared analysis for categorical data and ANOVA tests for continuous data. A multivariable logistic regression was performed to determine the influence of subspecialized training on the incidence of serious complications and 30 day mortality. RESULTS A total of 622,079 patients were analyzed, 15,485 were operated on by GS (2.5%, mean age 44.7 years, mean BMI 45.2 kg/m2), while 606,594 procedures were performed by MBS (97.5%, mean age 44.4 years, mean BMI 45.2 kg/m2). The proportion of procedures being completed by the GS group decreased from n=4662, 3.2% in 2016, to n=3414, 2.1% in 2019. After adjusting for comorbidities, MBS patients did not have differences in death at 30 days (OR 1.26 [0.67-2.38], p=0.467) or serious complications (OR 0.97 [0.89-1.06], p=0.554). CONCLUSION The majority of bariatric procedures are being completed by MBS with the proportion completed by GS decreasing. We found no difference in the number of serious complications and 30-day mortality rates across the MBS and GS groups. Graphical abstract.
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Affiliation(s)
- Kieran Purich
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Joshua Joy
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jerry Dang
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.,Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
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22
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Dudash M, Saeed K, Wang S, Johns A, Colonie R, Falvo A, Horsley R, Gabrielsen J, Petrick AT, Parker DM. A comparative evaluation of robotic and laparoscopic Roux-en-Y gastric bypass: a critical evaluation on the impact of postoperative pain and opioid requirements. Surg Endosc 2022; 36:7700-7708. [PMID: 35199202 DOI: 10.1007/s00464-022-09124-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/07/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The benefits of minimally invasive surgery using laparoscopy on postoperative pain and opioid use are well established. Our goal was to determine whether patients who underwent Roux-en-Y gastric bypass using a robotic approach (RA-RYGB) had lower postoperative pain and required less opioids than those undergoing laparoscopic Roux-en-Y gastric bypass (L-RYGB). Secondary outcomes evaluated included length of stay, operative time, and readmissions. METHODS AND PROCEDURES This was a retrospective cohort study from a tertiary academic medical center. Patients who underwent L-RYGB or RA-RYGB between 5/1/2018 and 10/31/2019 were included. Cases with concomitant hernia repair, chronic opioid use, and those who did not receive a TAP block or multimodal pain control were excluded. Baseline demographics were compared. Inpatient and outpatient opioid use in Morphine Milligram Equivalents (MME) and pain scores (10-point Likert scale) were compared. RESULTS There were 573 RY patients included (462 L-RYGB; 111 RA-RYGB). Median and maximum inpatient pain scores were similar for L-RYGB and RA-RYGB (3.0 vs 3.1, p = 0.878; 7.0 vs 7.0, p = 0.688). Median inpatient opioid use and maximum single day use were similar for L-RYGB and RA-RYGB (40.0 MME vs. 42.0 MME, p = 0.671; 30.0 MME vs 30.0 MME, p = 0.648). Both the outpatient prescribing of opioids (50.2% vs. 42.3%, p = 0.136) and outpatient opioid MME at 2 weeks (L-RYGB 30.0 MME vs. 33.8 MME, p = 0.854) were comparable between cohorts. Patient reported pain at 2-week follow-up was significantly higher for RA-RYGB (68.1%) than L-RYGB (55.6%) (p = 0.030). RA-RYGB had a higher rate of 30-day readmission and longer operative times compared to the L-RYGB (6.3% vs 13.5%, p = 0.010; 144.5 vs 200.0 min, p < 0.001). CONCLUSION This study identified no benefit for postoperative pain or opioid requirements in patients undergoing RA-RYGB compared to L-RYGB. The RA-RYGB group was significantly more likely to report pain at the two-week follow-up.
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Affiliation(s)
- Mark Dudash
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Kashif Saeed
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Shengxuan Wang
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Alicia Johns
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Ryan Colonie
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Alexandra Falvo
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Ryan Horsley
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Jon Gabrielsen
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - Anthony T Petrick
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA
| | - David M Parker
- Department of General Surgery, Geisinger Medical Center, 100 N. Academy Ave, MC 21-69, Danville, PA, 17822, USA.
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23
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Guo JY, Chen HH, Lee WJ, Chen SC, Lee SD, Chen CY. Fibroblast Growth Factor 19 and Fibroblast Growth Factor 21 Regulation in Obese Diabetics, and Non-Alcoholic Fatty Liver Disease after Gastric Bypass. Nutrients 2022; 14:nu14030645. [PMID: 35277004 PMCID: PMC8839096 DOI: 10.3390/nu14030645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Gastric bypass (GB) is an effective treatment for those who are morbidly obese with coexisting type 2 diabetes mellitus (T2DM) or non-alcoholic fatty liver disease (NAFLD). Fibroblast growth factors (FGFs) are involved in the regulation of energy metabolism. Methods: We investigated the roles of FGF 19, FGF 21, and total bile acid among those with morbidly obese and T2DM undergoing GB. A total of 35 patients were enrolled. Plasma FGF 19, FGF 21, and total bile acid levels were measured before surgery (M0), 3 months (M3), and 12 months (M12) after surgery, while the hepatic steatosis index (HSI) was calculated before and after surgery. Results: Obese patients with T2DM after GB presented with increased serum FGF 19 levels (p = 0.024) and decreased total bile acid (p = 0.01) and FGF 21 levels (p = 0.005). DM complete remitters had a higher FGF 19 level at M3 (p = 0.004) compared with DM non-complete remitters. Fatty liver improvers tended to have lower FGF 21 (p = 0.05) compared with non-improvers at M12. Conclusion: Changes in FGF 19 and FGF 21 play differential roles in DM remission and NAFLD improvement for patients after GB. Early increases in serum FGF 19 levels may predict complete remission of T2DM, while a decline in serum FGF 21 levels may reflect the improvement of NAFLD after GB.
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Affiliation(s)
- Jiun-Yu Guo
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Hsin-Hung Chen
- Department of Nutrition and Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan;
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan 330056, Taiwan;
| | - Shu-Chun Chen
- Department of Nursing, Chang-Gung Institute of Technology, Taoyuan 33303, Taiwan;
| | - Shou-Dong Lee
- Division of Gastroenterology, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei 11220, Taiwan;
| | - Chih-Yen Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
- Faculty of Medicine and Institute of Emergency and Critical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Chinese Taipei Society for the Study of Obesity, Taipei 110301, Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases, Taoyuan 333423, Taiwan
- Correspondence: ; Tel.: +886-2-28712121 (ext. 2050); Fax: +886-2-28711058
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24
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Baker BS, Bozynski CC, Leary EV, Sherwood RJ, Keeney JA, Cook JL, Duren DL. Tibial Bone Quality in Former Bariatric Surgery Patients with Osteoarthritis. Obes Surg 2021; 31:5322-5329. [PMID: 34625891 DOI: 10.1007/s11695-021-05727-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
Downstream effects of bariatric weight-loss surgery have been associated with bone resorption, potentially jeopardizing total knee arthroplasty (TKA) implant fixation/ingrowth. PURPOSE This case-control study sought to determine if TKA patients with history of bariatric surgery exhibit altered microanatomy of subchondral bone quality in the tibial plateau compared to controls. MATERIALS AND METHODS With IRB approval, 41 bone samples were evaluated from 12 former bariatric surgery patients and 10 sex-, age-, weight-, height-, and BMI-matched controls. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were completed prior to TKA. Tibial plateau osteochondral tissues were recovered during the TKA procedure, and samples from the medial and lateral plateaus were dissected into 1 × 2 cm sections, scanned using microcomputed tomography (µCT), and plastic-embedded for histologic sectioning/staining of undecalcified bone. Paired t tests with Bonferroni correction were performed to assess group differences. RESULTS Female bariatric surgery patients had reduced osteoid/total area and greater osteoclast number asymmetry than female controls (p < 0.03). No differences were noted in µCT or histologic bone parameters between bariatric and control patients when the sexes were combined. Bariatric patients self-reported worse preoperative PROMIS pain interference and physical function scores than controls (p < 0.04). CONCLUSIONS Similarities of subchondral bone between former bariatric surgery patients and matched controls indicate OA disease progression dominates the bone landscape in both patient groups.
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Affiliation(s)
- Breanne S Baker
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA
- School of Kinesiology, Applied Health, and Recreation, Oklahoma State University, Stillwater, OK, 74078, USA
| | - Chantelle C Bozynski
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA
| | - Emily V Leary
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA
| | - Richard J Sherwood
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA
- Department of Pathology and Anatomical Sciences, Craniofacial Research Center, University of Missouri, Columbia, MO, 65212, USA
| | - James A Keeney
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA
| | - James L Cook
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA
| | - Dana L Duren
- Department of Orthopaedic Surgery and Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri, Research 4th Floor, 1100 Virginia Avenue, Columbia, MO, 65212, USA.
- Department of Pathology and Anatomical Sciences, Craniofacial Research Center, University of Missouri, Columbia, MO, 65212, USA.
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25
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Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, Inagaki N, Ishigaki Y, Kasama K, Kikkawa E, Koyama H, Masuzaki H, Miyatsuka T, Nozaki T, Ogawa W, Ohta M, Okazumi S, Shimabukuro M, Shimomura I, Nishizawa H, Saiki A, Seki Y, Shojima N, Tsujino M, Ugi S, Watada H, Yamauchi T, Yamaguchi T, Ueki K, Kadowaki T, Tatsuno I. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13:1-30. [PMID: 34777929 PMCID: PMC8574153 DOI: 10.1007/s13340-021-00551-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 12/20/2022]
Abstract
Bariatric surgery has been shown to have a variety of metabolically beneficial effects for patients with type 2 diabetes (T2D), and is now also called metabolic surgery. At the 2nd Diabetes Surgery Summit held in 2015 in London, the indication for bariatric and metabolic surgery was included in the “algorithm for patients with type T2D”. With this background, the Japanese Society for Treatment of Obesity (JSTO), the Japan Diabetes Society (JDS) and the Japan Society for the Study of Obesity (JASSO) have formed a joint committee to develop a consensus statement regarding bariatric and metabolic surgery for the treatment of Japanese patients with T2D. Eventually, the consensus statement was announced at the joint meeting of the 38th Annual Meeting of JSTO and the 41st Annual Meeting of JASSO convened in Toyama on March 21, 2021. In preparing the consensus statement, we used Japanese data as much as possible as scientific evidence to consider the indication criteria, and set two types of recommendation grades, “recommendation” and “consideration”, for items for which recommendations are possible. We hope that this statement will be helpful in providing evidence-based high-quality care through bariatric and metabolic surgery for the treatment of obese Japanese patients with T2D.
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Affiliation(s)
- Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695 Japan
| | - Koutaro Yokote
- Department of Endocrinology Hematology, and Gerontology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junji Fujikura
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Karin Hayashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Yahaba, Japan
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Eri Kikkawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Nishinomiya, Hyogo Japan
| | - Hiroaki Masuzaki
- Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takehiro Nozaki
- Clinical Trial Center, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Sakura, Chiba Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hitoshi Nishizawa
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Nobuhiro Shojima
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology and Metabolism, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Satoshi Ugi
- Division of Endocrinology and Metabolism, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroaki Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, Sakura, Japan
| | - Koujiro Ueki
- Department of Molecular Diabetic Medicine, Diabetes Research Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
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26
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Metabolic profiles, energy expenditures, and body compositions of the weight regain versus sustained weight loss patients who underwent Roux-en-Y gastric bypass. Surg Obes Relat Dis 2021; 17:2015-2025. [PMID: 34635422 DOI: 10.1016/j.soard.2021.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Weight regain (WR) has been an emerging problem after Roux-en Y gastric bypass (RYGB) and little is known about the mechanisms of WR after RYGB. OBJECTIVE To evaluate the mechanisms of WR after RYGB through the postprandial gut hormones response, particularly glucagon-like peptide-1 (GLP-1), which regulates appetite control, energy expenditure, body composition, physical activities, dietary intake, and psychological factors. SETTING Duke University Medical Center, Durham, North Carolina. METHODS A cross sectional study of 34 patients who underwent RYGB at least 2 years and achieved ≥50% of excess weight loss at 1year was conducted. The subjects were categorized into WR group or sustained weight loss group, based upon whether their WR was ≥15% of postoperative lowest weight. RESULTS The WR group had less augmented postprandial GLP-1 response but exaggerated hyperinsulinemia. Postprandial peptide YY, ghrelin, and glucose were not different between group. Patients who regained weight required less weight-adjusted energy expenditure and had more percentage body fat and less percentage lean mass. The caloric intake and diet composition were comparable between groups; however, the WR group had higher depression scores, binge eating scales, and hunger rating and spent significantly less time on vigorous exercise. CONCLUSIONS The mechanisms of WR in patients who were initially successful after RYGB are complex and involved not only the role of postprandial gut hormone response but are also related to energy expenditure adaptation and body composition changes. Moreover, food preference and physical activity may play roles in weight control after bariatric surgery. Further prospective controlled trial is needed to explore the mechanisms of WR.
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27
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Abstract
The purpose of this American Society for Reproductive Medicine Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled "Obesity and reproduction: an educational bulletin" last published in 2015 (Fertil Steril 2015;104:1116-26).
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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28
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Gehle DB, Pullatt RC, Elias PS. Gastrojejunocolic fistula: case report of a rare late complication of laparoscopic Roux-en-Y gastric bypass and review of the literature. Int J Surg Case Rep 2021; 84:106152. [PMID: 34280970 PMCID: PMC8274295 DOI: 10.1016/j.ijscr.2021.106152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Laparoscopic Roux-en-Y gastric bypass (LRYGB) is known as the weight loss surgery to which other bariatric procedures are compared. While morbidity and mortality of this procedure are low, serious complications do exist which can be life-threatening and sometimes require surgical correction. CASE PRESENTATION A 63-year-old woman underwent LRYGB outside of the United States, later complicated by biliary colic treated with cholecystectomy and upper gastrointestinal bleeding secondary to H. pylori-related ulcer at her gastrojejunostomy. Following adequate treatment of the patients marginal ulcer, the patient experienced several months of progressive severe abdominal pain, frequent vomiting and diarrhea, and unintentional weight loss refractory to pharmacologic therapy. The patient underwent multiple medical and endoscopic evaluations unrevealing of an organic cause of her symptoms. At presentation, the patient was found to be profoundly weak, dehydrated and malnourished with metabolic derangements and was subsequently diagnosed with a gastrojejunocolic fistula via upper endoscopy and radiography. We provided excluded stomach gastrostomy tube feeding to the patient for three months to improve the patients nutritional status before definitive surgical correction was successfully performed. DISCUSSION Large bowel fistulas are a rare and highly morbid late complication following LRYGB and are likely secondary to marginal ulcers and/or instrumentation such as endoscopy. Surgery represents the definitive treatment. CONCLUSION LRYGB is typically a safe and effective intervention for obesity. Large bowel fistulas are rare complications following this surgery. We highlight difficulties in diagnosing and treating this condition.
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Affiliation(s)
- Daniel B Gehle
- Medical University of South Carolina College of Medicine, 96 Jonathan Lucas Street, Suite 601, MSC 617, Charleston, SC 29425, USA
| | - Rana C Pullatt
- Medical University of South Carolina, Department of Surgery, Division of Gastrointestinal and Laparoscopic Surgery, 114 Doughty Street, Charleston, SC 29425, USA
| | - Puja S Elias
- Medical University of South Carolina, Department of Medicine, Division of Gastroenterology and Hepatology, 30 Courtenay Drive, Suite 249, MSC 702, Charleston, SC 29425, USA.
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29
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Fultang J, Chinaka U, Rankin J, Bakhshi A, Ali A. Preoperative Bariatric Surgery Predictors of Type 2 Diabetes Remission. J Obes Metab Syndr 2021; 30:104-114. [PMID: 33436532 PMCID: PMC8277586 DOI: 10.7570/jomes20084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/30/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
Obesity represents a significant proportion of the global public health burden, with the World Health Organization (WHO) estimating more than 600 million people are affected worldwide. Unfortunately, the epidemic of obesity is linked to the increased prevalence of associated metabolic diseases such as type 2 diabetes mellitus (T2DM). Bariatric surgery as an intervention has been shown to provide sustainable weight loss, and also leads to superior short- and long-term metabolic benefits including T2DM remission. Despite this added advantage conferred by bariatric surgery, emerging evidence has shown that not all patients with T2DM achieve remission postoperatively. As such, to improve patient selection and optimize preoperative counselling, research has focused on the preoperative predictors of T2DM remission following bariatric surgery. Herein, we provide a critical review of the current literature addressing preoperative predictors of T2DM remission and highlight the current gaps in the literature. The review comprised a multistage advanced electronic search of the Ovid/Medline, Embase, and Cochrane online libraries to identify available studies published over the last decade.
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Affiliation(s)
- Joshua Fultang
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Ugochukwu Chinaka
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Jean Rankin
- School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Andisheh Bakhshi
- School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
| | - Abdulmajid Ali
- Bariatric Surgery Unit, University Hospital Ayr, Ayrshire, UK.,School of Health and Life Sciences University of the West of Scotland, Ayrshire, UK
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30
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Chen G, Zhang GX, Peng BQ, Cheng Z, Du X. Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy Plus Procedures for Treatment of Morbid Obesity: Systematic Review and Meta-Analysis. Obes Surg 2021; 31:3303-3311. [PMID: 33956302 DOI: 10.1007/s11695-021-05456-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023]
Abstract
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally, but both techniques have shortcomings. Several modifications of SG (SG plus procedures) have been developed, but the efficacy of the different procedures has not been completely elucidated. In this meta-analysis, we aimed to evaluate the efficacy and safety of SG plus procedures. Out of the initially identified 2357 studies, thirteen were selected for this meta-analysis: two studies on banded sleeve gastrectomy (BSG), four studies on sleeve gastrectomy plus duodenal-jejunal bypass (SG + DJB) or sleeve gastrectomy with loop duodenal-jejunal bypass (SADJB), two studies on sleeve gastrectomy with jejunal-jejunal bypass (SG + JJB), four studies on single anastomosis duodenal-ileal switch (SADI-S), and one study on stomach intestinal pylorus-sparing surgery (SIPS). SADI-S procedure was found to achieve significantly greater percentage of excess weight loss than the RYGB. SG + DJB and SADJB achieved greater weight loss than the RYGB. Major complications were fewer with SG + JJB than with RYGB, but the difference was not significant. Overall, SG plus procedures appear to achieve better weight loss and cause fewer complications than RYGB.
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Affiliation(s)
- Gang Chen
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Gui-Xiang Zhang
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo-Qiang Peng
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong Cheng
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Du
- Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, Yaan People's Hospital, Yaan, China.
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31
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Kumar P, Yau HCV, Trivedi A, Yong D, Mahawar K. Global Variations in Practices Concerning Roux-en-Y Gastric Bypass-an Online Survey of 651 Bariatric and Metabolic Surgeons with Cumulative Experience of 158,335 Procedures. Obes Surg 2021; 30:4339-4351. [PMID: 32592015 DOI: 10.1007/s11695-020-04796-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION There is significant variation in practices concerning Roux-en-Y gastric bypass (RYGB) among bariatric surgeons, but there is currently a lack of robust data on the nature and extent of these variations. The purpose of this study was to understand global variations in practices concerning RYGB. METHODS A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms. The link was also distributed through a personnel email network of authors. RESULTS A total of 657 surgeons from 65 countries completed the survey. Crohn's disease and liver cirrhosis were considered absolute contraindications for RYGB by 427 surgeons (64.98%) and 347 surgeons (53.30%), respectively. More than 68.5% of surgeons performed routine upper GI endoscopy while 64.17% performed routine ultrasound of abdomen preoperatively. The majority of surgeons (77.70%) used the perigastric technique for Gastric pouch creation. Approximately, 79.5% used orogastric bougie. More than 70% of the respondents did not use any staple line reinforcement routinely. Only 17.67% of surgeons measured the whole small bowel length, and the majority of surgeons (86.5%) used constant length of BP limb. Approximately, 89% used constant length of alimentary limb. Approximately, 95% of surgeons preferred antecolic bypass, and more than 86% routinely closed the Petersen defect. Marginal ulcer prophylaxis was used by the majority (91.17%). Almost 95% of surgeons recommended lifelong vitamin and mineral supplements. CONCLUSION This survey identifies global variations in practices concerning RYGB. It identifies several areas for future research and consensus building.
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Affiliation(s)
- Parveen Kumar
- Sir Charles Gairdner Hospital, Nedlands, Western Australia.
| | | | | | - David Yong
- Joondalup Health Campus, Joondalup, Western Australia
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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32
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Jansen CMAH, Bonouvrie DS, Jacobs MLYE, Janssen N, Leclercq WKG, Scheltinga MRM, Roumen RMH. Chronic Abdominal Pain After Previous Bariatric Surgery: Consider the Abdominal Wall. Obes Surg 2021; 30:2942-2948. [PMID: 32337643 DOI: 10.1007/s11695-020-04629-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Up to 30% of patients who undergo bariatric surgery experience recurrent abdominal pain within 3 years after the operation. Although some causes for persisting discomfort are well known, a small portion of patients may suffer from an abdominal wall pain associated with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). Aim of the present study is to discuss incidence, clinical presentation, and treatment outcome in patients with ACNES after bariatric surgery. METHODS This retrospective observational cohort study analyzed electronically stored data of patients with ACNES having a history of bariatric surgery. All were treated for ACNES between 2011 and 2017 in a Dutch center of excellence for abdominal wall and groin pain. Success after treatment was defined as a minimal 50% drop in pain level using a Numeric Rating Scale. RESULTS A total of 49 patients (female n = 44, median age 45 (25-63) years) were identified. Four (8%) experienced long-term pain relief after just one abdominal wall infiltration with lidocaine. Ten additional patients reported success after 2-5 injections. A total of 35 unresponsive patients chose to undergo a neurectomy that was successful in 27. Therefore, this step-up approach conferred an 84% success rate. Occurrence of ACNES after bariatric surgery was estimated at 1 in 100 patients. CONCLUSION ACNES should be considered in the differential diagnosis of ongoing pain following previous bariatric surgery. A treatment regimen including abdominal wall infiltrations using an anesthetic agent or a neurectomy is successful in a vast majority of these patients.
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Affiliation(s)
- Claire M A Heukensfeldt Jansen
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Eindhoven/Veldhoven, The Netherlands.,SolviMáx, Center of Expertise for ACNES, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Daniëlle S Bonouvrie
- Obesity Center Máxima, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | - Monica L Y E Jacobs
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Eindhoven/Veldhoven, The Netherlands. .,SolviMáx, Center of Expertise for ACNES, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Centre, Eindhoven, The Netherlands.
| | - Nicky Janssen
- NUTRIM, Maastricht University, Maastricht, the Netherlands
| | - Wouter K G Leclercq
- Obesity Center Máxima, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands
| | - Marc R M Scheltinga
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Eindhoven/Veldhoven, The Netherlands.,SolviMáx, Center of Expertise for ACNES, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Eindhoven/Veldhoven, The Netherlands.,SolviMáx, Center of Expertise for ACNES, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Centre, Eindhoven, The Netherlands
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The Longitudinal Efficiency of Robotic Surgery: an MBSAQIP Propensity Matched 4-Year Comparison of Robotic and Laparoscopic Bariatric Surgery. Obes Surg 2021; 30:3706-3713. [PMID: 32495073 DOI: 10.1007/s11695-020-04712-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The objective of this study was to examine the MBSAQIP database to assess efficiency trends and perioperative outcomes in robotic bariatric surgery. METHODS Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015-2018 MBSAQIP Participant Use Data Files. Patients were propensity matched 1:1 based on sex, body mass index, assistant, and previous obesity or foregut surgery. A total of 93,802 patients were included. RESULTS Median operative times were significantly longer for both RA-SG (89 vs. 62 min; p < 0.0001) and RA-RYGB (141 vs. 105 min; p < 0.0001) compared with laparoscopic. Over the 4-year period, the difference in operative times (OR delta) between RA-SG and L-SG was unchanged while the difference in operative times between RA-RYGB and L-RYGB increased. Both robotic groups were significantly more likely to be readmitted (RA-SG p = 0.001, RA-RYGB p = 0.006). Robotic SG was more likely to have a reintervention (p = 0.018) and extended length of stay (LOS) (> 4 days) compared with laparoscopic (p = < 0.0002). No significant differences were noted in morbidity and mortality by approach. CONCLUSIONS Operative times were 30% longer for RA-SG and 25% longer for RA-RYGB when compared with laparoscopic. There was no significant improvement in OR delta for either RA-SG or RA-RYGB over the four years. Readmission rates were higher for both RA-SG and RA-RYGB. Robotic SG had a greater percentage of patients with extended LOS compared with laparoscopic. No evidence of improved efficiency for robotic bariatric surgery as defined by operative time or clinical outcomes was identified.
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Gastric Sensory and Motor Functions and Energy Intake in Health and Obesity-Therapeutic Implications. Nutrients 2021; 13:nu13041158. [PMID: 33915747 PMCID: PMC8065811 DOI: 10.3390/nu13041158] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 01/19/2023] Open
Abstract
Sensory and motor functions of the stomach, including gastric emptying and accommodation, have significant effects on energy consumption and appetite. Obesity is characterized by energy imbalance; altered gastric functions, such as rapid gastric emptying and large fasting gastric volume in obesity, may result in increased food intake prior to reaching usual fullness and increased appetite. Thus, many different interventions for obesity, including different diets, anti-obesity medications, bariatric endoscopy, and surgery, alter gastric functions and gastrointestinal motility. In this review, we focus on the role of the gastric and intestinal functions in food intake, pathophysiology of obesity, and obesity management.
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Abstract
BACKGROUND Each year from 2011 to 2017, fewer than 1% of eligible Americans underwent bariatric surgery to treat obesity and obesity-related comorbidities. Recent studies have suggested that a lack of knowledge within the primary care specialty about the safety and efficacy of bariatric surgery greatly affects referral. This study aimed to analyze a large cohort of primary care physicians' (PCPs) clinical perceptions regarding bariatric surgery and to identify major barriers to referral that could inform the implementation of a future educational strategy to address underutilization of bariatric surgery. STUDY DESIGN A prospective anonymous electronic survey was sent to all primary care physicians at a multicenter community-based academic hospital system between March and June of 2018, with 150 respondents, a response rate of 28%. The survey was composed of eleven questions in total, the first eight utilizing a five-point Likert scale, with answers including strongly disagree, disagree, neutral, agree, and strongly agree. The final three questions utilized freeform answers of numbers or text where appropriate. RESULTS Between 83 and 88% of PCPs responded favorably, either agree or strongly agree, to questions regarding the utility of bariatric surgery as an efficacious and valuable tool for the treatment of obesity and related comorbidities. PCPs reported an average body mass index (BMI) of 40.4 ± 5.0 kg/m2 at which bariatric surgery is a patient's best option for weight loss and an average BMI of 38.0 ± 5.6 kg/m2 at which surgery is the best option for management of comorbidities. Eighty-six percent of PCPs agree that having a BMI over 40 kg/m2 is a greater risk to a patient's long-term health than undergoing bariatric surgery. However, only 46.6% of PCPs claimed any familiarity with the NIH eligibility criteria for bariatric surgery and only 59.5% responded affirmatively that they were comfortable participating in the long-term care of a postoperative bariatric patient. The two highest reported barriers to referral for bariatric surgery together account for 40% of PCPs responses: 21.5% of PCPs report concern regarding surgical complications and/or long-term side effects as the primary barrier for referral, and 18.5% report concern for ineffective weight loss after bariatric surgery as a primary barrier to referral. CONCLUSION Results of this study indicate that despite largely positive attitudes toward the use of bariatric surgery in a patient population with obesity, primary care physicians report significant barriers to confidently referring their own patients. Further, bariatric surgery is overlooked in a large group of patients with BMIs between 35 and 40 kg/m2. Educational strategies to address these barriers should target rates of specific surgical complications and weight loss outcomes.
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36
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Bertsch T, Erbacher G. Replik auf den „Letter to Editor: Series of articles by T. Bertsch and G. Erbacher culminating in Lipoedema – myths and facts, Part 5: European Best Practice of Lipoedema – Summary of the European Lipoedema Forum Consensus“. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1302-9212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Tobias Bertsch
- Europäisches Zentrum für Lymphologie im Schwarzwald, Földiklinik
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37
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Bertsch T, Erbacher G. Erwiderung auf den Leserbrief zu Lipoedema – myths and facts Part 1 and 5. European Best Practice of Lipoedema – Summary of the European Lipoedema Consensus, Phlebologie 2020; 49: 31–49. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1250-3334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tobias Bertsch
- Europäisches Zentrum für Lymphologie, Földiklinik, Hinterzarten
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38
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Guimarães M, Pereira SS, Monteiro MP. From Entero-Endocrine Cell Biology to Surgical Interventional Therapies for Type 2 Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1307:273-297. [PMID: 32016913 DOI: 10.1007/5584_2020_480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The physiological roles of the enteroendocrine system in relation to energy and glucose homeostasis regulation have been extensively studied in the past few decades. Considerable advances were made that enabled to disclose the potential use of gastro-intestinal (GI) hormones to target obesity and type 2 diabetes (T2D). The recognition of the clinical relevance of these discoveries has led the pharmaceutical industry to design several hormone analogues to either to mitigate physiological defects or target pharmacologically T2D.Amongst several advances, a major breakthrough in the field was the unexpected observation that enteroendocrine system modulation to T2D target could be achieved by surgically induced anatomical rearrangement of the GI tract. These findings resulted from the widespread use of bariatric surgery procedures for obesity treatment, which despite initially devised to induce weight loss by limiting the systemic availably of nutrients, are now well recognized to influence GI hormone dynamics in a manner that is highly dependent on the type of anatomical rearrangement produced.This chapter will focus on enteroendocrine system related mechanisms leading to improved glycemic control in T2D after bariatric surgery interventions.
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Affiliation(s)
- Marta Guimarães
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Sofia S Pereira
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal.,Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Mariana P Monteiro
- Endocrine, Cardiovascular & Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, Porto, Portugal. .,Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.
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Selber-Hnatiw S, Sultana T, Tse W, Abdollahi N, Abdullah S, Al Rahbani J, Alazar D, Alrumhein NJ, Aprikian S, Arshad R, Azuelos JD, Bernadotte D, Beswick N, Chazbey H, Church K, Ciubotaru E, D'Amato L, Del Corpo T, Deng J, Di Giulio BL, Diveeva D, Elahie E, Frank JGM, Furze E, Garner R, Gibbs V, Goldberg-Hall R, Goldman CJ, Goltsios FF, Gorjipour K, Grant T, Greco B, Guliyev N, Habrich A, Hyland H, Ibrahim N, Iozzo T, Jawaheer-Fenaoui A, Jaworski JJ, Jhajj MK, Jones J, Joyette R, Kaudeer S, Kelley S, Kiani S, Koayes M, Kpata AJAAL, Maingot S, Martin S, Mathers K, McCullogh S, McNamara K, Mendonca J, Mohammad K, Momtaz SA, Navaratnarajah T, Nguyen-Duong K, Omran M, Ortiz A, Patel A, Paul-Cole K, Plaisir PA, Porras Marroquin JA, Prevost A, Quach A, Rafal AJ, Ramsarun R, Rhnima S, Rili L, Safir N, Samson E, Sandiford RR, Secondi S, Shahid S, Shahroozi M, Sidibé F, Smith M, Sreng Flores AM, Suarez Ybarra A, Sénéchal R, Taifour T, Tang L, Trapid A, Tremblay Potvin M, Wainberg J, Wang DN, Weissenberg M, White A, Wilkinson G, Williams B, Wilson JR, Zoppi J, Zouboulakis K, Gamberi C. Metabolic networks of the human gut microbiota. MICROBIOLOGY-SGM 2020; 166:96-119. [PMID: 31799915 DOI: 10.1099/mic.0.000853] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The human gut microbiota controls factors that relate to human metabolism with a reach far greater than originally expected. Microbial communities and human (or animal) hosts entertain reciprocal exchanges between various inputs that are largely controlled by the host via its genetic make-up, nutrition and lifestyle. The composition of these microbial communities is fundamental to supply metabolic capabilities beyond those encoded in the host genome, and contributes to hormone and cellular signalling that support the dynamic adaptation to changes in food availability, environment and organismal development. Poor functional exchange between the microbial communities and their human host is associated with dysbiosis, metabolic dysfunction and disease. This review examines the biology of the dynamic relationship between the reciprocal metabolic state of the microbiota-host entity in balance with its environment (i.e. in healthy states), the enzymatic and metabolic changes associated with its imbalance in three well-studied diseases states such as obesity, diabetes and atherosclerosis, and the effects of bariatric surgery and exercise.
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Affiliation(s)
- Susannah Selber-Hnatiw
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Tarin Sultana
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - W Tse
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Niki Abdollahi
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Sheyar Abdullah
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Jalal Al Rahbani
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Diala Alazar
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Nekoula Jean Alrumhein
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Saro Aprikian
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rimsha Arshad
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Jean-Daniel Azuelos
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Daphney Bernadotte
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Natalie Beswick
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Hana Chazbey
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Kelsey Church
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Emaly Ciubotaru
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Lora D'Amato
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Tavia Del Corpo
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Jasmine Deng
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Briana Laura Di Giulio
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Diana Diveeva
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Elias Elahie
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - James Gordon Marcel Frank
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Emma Furze
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rebecca Garner
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Vanessa Gibbs
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rachel Goldberg-Hall
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Chaim Jacob Goldman
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Fani-Fay Goltsios
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Kevin Gorjipour
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Taylor Grant
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Brittany Greco
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Nadir Guliyev
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Andrew Habrich
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Hillary Hyland
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Nabila Ibrahim
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Tania Iozzo
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Anastasia Jawaheer-Fenaoui
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Julia Jane Jaworski
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Maneet Kaur Jhajj
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Jermaine Jones
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rodney Joyette
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Samad Kaudeer
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Shawn Kelley
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Shayesteh Kiani
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Marylin Koayes
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | | | - Shannon Maingot
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Sara Martin
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Kelly Mathers
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Sean McCullogh
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Kelly McNamara
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - James Mendonca
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Karamat Mohammad
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Sharara Arezo Momtaz
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Thiban Navaratnarajah
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Kathy Nguyen-Duong
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Mustafa Omran
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Angela Ortiz
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Anjali Patel
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Kahlila Paul-Cole
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Paul-Arthur Plaisir
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | | | - Ashlee Prevost
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Angela Quach
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Aries John Rafal
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rewaparsad Ramsarun
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Sami Rhnima
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Lydia Rili
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Naomi Safir
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Eugenie Samson
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rebecca Rose Sandiford
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Stefano Secondi
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Stephanie Shahid
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Mojdeh Shahroozi
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Fily Sidibé
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Megan Smith
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Alina Maria Sreng Flores
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Anabel Suarez Ybarra
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Rebecca Sénéchal
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Tarek Taifour
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Lawrence Tang
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Adam Trapid
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Maxim Tremblay Potvin
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Justin Wainberg
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Dani Ni Wang
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Mischa Weissenberg
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Allison White
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Gabrielle Wilkinson
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Brittany Williams
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Joshua Roth Wilson
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Johanna Zoppi
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Katerina Zouboulakis
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
| | - Chiara Gamberi
- Biology Department, Concordia University, 7141 Sherbrooke St W, SP-375-09 Montreal, Quebec, H4B 1R6, Canada
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Babayiğit M, Can ME, Bulus H, Dereli N, Ozayar E, Kurtay A, Babayiğit MA, Ilhan S, Horasanli E. Prospective Randomized Trial on the Effects of Sevoflurane and Propofol on the Intraocular Pressure in Bariatric Surgery. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2020.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Münire Babayiğit
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Mehmet Erol Can
- Department of Ophthalmology, and Kecioren Training and Research Hospital, Ankara, Turkey
| | - Hakan Bulus
- Department of General Surgery, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Necla Dereli
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Esra Ozayar
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Aysun Kurtay
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | | | - Seda Ilhan
- Department of Anesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey
| | - Eyüp Horasanli
- Department of Anesthesiology and Reanimation, Yildirim Beyazit University, Ankara, Turkey
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41
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Affiliation(s)
- Tobias Bertsch
- Földi Clinic, Hinterzarten-European Center of Lymphology, Germany
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42
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Regan JA, Shah SH. Obesity Genomics and Metabolomics: a Nexus of Cardiometabolic Risk. Curr Cardiol Rep 2020; 22:174. [PMID: 33040225 DOI: 10.1007/s11886-020-01422-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Obesity is a significant international public health epidemic with major downstream consequences on morbidity and mortality. While lifestyle factors contribute, there is an evolving understanding of genomic and metabolomic pathways involved with obesity and its relationship with cardiometabolic risk. This review will provide an overview of some of these important findings from both a biologic and clinical perspective. RECENT FINDINGS Recent studies have identified polygenic risk scores and metabolomic biomarkers of obesity and related outcomes, which have also highlighted biological pathways, such as the branched-chain amino acid (BCAA) pathway that is dysregulated in this disease. These biomarkers may help in personalizing obesity interventions and for mitigation of future cardiometabolic risk. A multifaceted approach is necessary to impact the growing epidemic of obesity and related diseases. This will likely include incorporating precision medicine approaches with genomic and metabolomic biomarkers to personalize interventions and improve risk prediction.
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Affiliation(s)
- Jessica A Regan
- Department of Medicine, Duke University, Durham, NC, USA.,Duke Molecular Physiology Institute, Duke University, 300 N. Duke Street, DUMC, Box 104775, Durham, NC, 27701, USA
| | - Svati H Shah
- Department of Medicine, Duke University, Durham, NC, USA. .,Duke Molecular Physiology Institute, Duke University, 300 N. Duke Street, DUMC, Box 104775, Durham, NC, 27701, USA.
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43
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Obeidat N, AlRyalat SA, Al Oweidat K, Abu-Khalaf M, Btoush A, Al-Essa M, Obeidat Z, Obeidat M, Wahbeh A. Long-term Effects of Gastric Bypass Surgery in Patients with Obstructive Sleep Apnea. CURRENT RESPIRATORY MEDICINE REVIEWS 2020. [DOI: 10.2174/1573398x16666200206151624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Obstructive sleep apnea is a common disorder involving, intermittent
mechanical obstruction of the upper airway during sleep. Obesity is the most powerful risk factor for
obstructive sleep apnea.
Objective:
This study aimed to investigate the long-term effect of Roux-en-Y gastric bypass bariatric
surgery on patients with obstructive sleep apnea.
Methods:
This study included patients were referred for bariatric surgery (Roux-en-Y gastric bypass)
to control symptoms and complications of obesity during a 5-year period. An overnight sleep study
was performed for each patient before and after the bariatric surgery, to study its effect on different
obstructive sleep apnea-related variables.
Results:
This study included 179 patients (mean age 35.9 ± 10.7 years). The mean duration from preoperative
assessment to postoperative assessment was 2.4 ± 2.2 years. The mean change in body
mass index and weight showed a decrease of 16.0 ± 16.0 kg/m2 and48.7 ± 25.9 kg, respectively. The
apnea hypopnea index decreased by a mean of 22.6 ± 26.3 events/hour.
Conclusion:
We concluded that a decrease in the body mass index by 1 kg/m2 could predict a
decrease in the apnea hypopnea index by 0.46 events/hour. Moreover, after mean follow-up duration
of 2.4 years, 84.3% of mild and 83.3% of moderate obstructive sleep apnea patients became normal
postoperatively.
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Affiliation(s)
- Nathir Obeidat
- Department of Respiratory and Sleep Medicine, The University of Jordan, Amman, Jordan
| | | | - Khaled Al Oweidat
- Department of Respiratory and Sleep Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abu-Khalaf
- Department of Bariatric Surgery, The University of Jordan, Amman, Jordan
| | - Asma Btoush
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Al-Essa
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Zaina Obeidat
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Mohammed Obeidat
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Ayman Wahbeh
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
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44
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41:1623-1640. [PMID: 31640864 DOI: 10.1016/j.jogc.2019.03.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION Women with obesity who are pregnant or planning pregnancies. EVIDENCE Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE SOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS RECOMMENDATIONS.
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45
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Tabesh MR, Maleklou F, Ejtehadi F, Alizadeh Z. Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: a Practical Guideline. Obes Surg 2020; 29:3385-3400. [PMID: 31367987 DOI: 10.1007/s11695-019-04112-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
According to ASMBS, the rate of bariatric surgery increased from 158,000 in 2011 to 196,000 in 2015. Nevertheless, this growth in invasive techniques does not eliminate unhealthy habits, so lifestyle modification such as healthy nutrition and correct physical activity programs may improve surgical results. The objective of the present narrative review was to categorize the guidelines related to nutrition, physical activity, and supplement prescription before and after bariatric surgery. The main key words including nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y gastric bypass, sleeve gastrostomy, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google scholar. The recommendations are classified based on the type of surgery. The indications for surgery and the type of bariatric surgery are not included in this review. This review helps medical teams, including bariatric surgeons, nutritionists, and sports medicine specialists, with proper management before and after bariatric surgery.
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Affiliation(s)
| | - Faezeh Maleklou
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ejtehadi
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Alizadeh
- Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, No. 7, Ale-ahmad Highway, Opposite of the Shariati Hospital, Tehran, 14395-578, Iran.
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Butti F, Vanoni-Colombo A, Djafarrian R, Allemann P, Calmes JM, Fournier P. Roux-en-Y Gastric Bypass with Manual Intracorporeal Anastomoses in 3D Laparoscopy: Operative Technique. J Laparoendosc Adv Surg Tech A 2020; 30:879-882. [PMID: 32407156 DOI: 10.1089/lap.2020.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Bariatric surgery is the only treatment for severe obesity recognized as truly effective, and Roux-en-Y gastric bypass is one of the most frequent procedures. The aim of this study is to present a 3D laparoscopic bypass technique with intracorporal anastomosis, performed completely by hand. Methods: After positioning the patient and creating the 20 mL gastric pouch, the gastrojejunal anastomosis is performed with two continuous sutures of resorbable V-Lock 3.0. The same technique is used to do the laterolateral jejunojejunal anastomosis. All patients who have undergone the previously described procedure are included in our bariatric enhanced recovery after surgery (ERAS) protocol. Results: The combination between the by-pass ERAS protocol and the described technique reduces postoperative pain, and usually allows discharge of patients within 48 hours. Conclusions: In our experience, the technique using totally handsewn anastomosis is safe as those previously described in the literature and is cost-effective due to the use of continuous suture for the gastrojejunal and the jejunojejunal anastomoses instead of staplers.
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Affiliation(s)
- Fabio Butti
- Visceral Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,General Surgery Department, Groupement hospitalier de l'Ouest lémanique, Nyon Hospital, Nyon, Switzerland
| | - Alice Vanoni-Colombo
- Visceral Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,General Surgery Department, Groupement hospitalier de l'Ouest lémanique, Nyon Hospital, Nyon, Switzerland
| | - Reza Djafarrian
- Visceral Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre Allemann
- Clinique de La Source, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Marie Calmes
- Visceral Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Pierre Fournier
- Visceral Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,General Surgery Department, Groupement hospitalier de l'Ouest lémanique, Nyon Hospital, Nyon, Switzerland
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47
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Hajifathalian K, Sharaiha RZ. Revision of gastric bypass: What is on the menu? Gastrointest Endosc 2020; 91:1074-1077. [PMID: 32327118 DOI: 10.1016/j.gie.2020.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Kaveh Hajifathalian
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medicine
- Cornell University, New York, New York, USA
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital, Weill Cornell Medicine
- Cornell University, New York, New York, USA
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48
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Shin RD, Goldberg MB, Shafran AS, Shikora SA, Majumdar MC, Shikora SA. Revision of Roux-en-Y Gastric Bypass with Limb Distalization for Inadequate Weight Loss or Weight Regain. Obes Surg 2020; 29:811-818. [PMID: 30560312 DOI: 10.1007/s11695-018-03635-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Of patients undergoing Roux-en-Y gastric bypass (RYGB), 15-35% of patients fail to achieve "adequate" weight loss or regain significant weight. Multiple solutions have been proposed, but not well studied. We report our experience with limb distalization with lengthening the biliopancreatic (BP) limb and shortening the common channel (CC). METHODS We retrospectively reviewed data from patients undergoing laparoscopic limb distalization for excess weight loss (EWL) <50% or BMI >35 kg/m2 after RYGB from 2012 to 2017. The BP limb was lengthened and CC was shortened to 100-200 cm. Perioperative outcomes such as morbidity, weight loss, nutritional deficiencies, comorbidity remission, and operative details were analyzed. RESULTS Twenty-two patients were included. The mean BMI prior to RYGB was 54.1 ± 8.5 kg/m2 and 43.0 ± 5.5 kg/m2 prior to limb distalization. The mean follow-up was 18.3 ± 12.9 months with a mean BMI change, %EWL, and %TWL (total weight loss) of 11.8 ± 7.4 kg/m2, 62.3 ± 32.4%, and 25.4 ± 14.4%, respectively. The total mean BMI change, %EWL, and %TWL from RYGB was 22.2 ± 9.9 kg/m2, 77.8 ± 23.6%, and 40.2 ± 13.3%, respectively. Of patients with persistent comorbidities, remission rates of diabetes, hypertension, and gastroesophageal reflux disease were 100%, 17%, and 38%, respectively. The mean operative time was 132.6 ± 54.4 min and mean hospital stay was 2.2 ± 1.3 days. Overall morbidity was 27.3%. Three patients (13.6%) developed nutritional deficiencies requiring reversal surgery. CONCLUSION In patients with inadequate weight loss or weight regain after RYGB, limb distalization with lengthening of the BP limb is an effective procedure for additional weight loss and further improvement of comorbidities. Nutritional complications are a risk, but can be minimized with close follow-up and patient compliance.
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Affiliation(s)
- Reuben D Shin
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of General Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Michael B Goldberg
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of General Surgery, Crozer Keystone Health System, Upland, PA, USA
| | - Allison S Shafran
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Samuel A Shikora
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Melissa C Majumdar
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Scott A Shikora
- Department of General Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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49
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Sayadishahraki M, Rezaei MT, Mahmoudieh M, Keleydari B, Shahabi S, Allami M. Single-Anastomosis Sleeve Jejunal Bypass, a Novel Bariatric Surgery, Versus Other Familiar Methods: Results of a 6-Month Follow-up-a Comparative Study. Obes Surg 2019; 30:769-776. [PMID: 31768867 DOI: 10.1007/s11695-019-04266-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Obesity and its associated morbidities have become a significant concern all over the world. Bariatric surgery, regardless of its type, is the most effective approach for treating morbid obesity. Single-anastomosis sleeve jejunal (SASJ) bypass is a novel bariatric surgery technique and can be considered for patients with former background of severe gastroesophageal symptoms. The purpose of this research was to compare SASJ bypass outcomes with other techniques during a 6-month follow-up. METHODS This is a non-randomized clinical trial conducted on 100 patients, who underwent four types of bariatric surgery (classic Roux-en-Y bypass, SASJ bypass, omega gastric bypass, and sleeve gastrectomy), and each one of these types contained 25 cases, during the time period of 2 years from 2016 to 2018. Patients' information including age, gender, height, basal weight, body mass index (BMI), serum albumin, and hemoglobin A1C were recorded, within 1, 3, and 6 months after their surgery, and also were compared with each other. RESULTS Members of the four groups were similar due to their age, gender distribution, height, baseline BMI, hemoglobin A1C, albumin, and also excess weight (P value > 0.05); however, the sleeve gastrectomy group baseline weight was significantly higher compared with the other three groups (P value = 0.013). All of the groups significantly lost weight during this 6-month period, but the comparison between them indicated no statistical difference regarding excess weight loss, BMI, hemoglobin A1C, and albumin (P value > 0.05). The excess weight loss mean during 6 months in SASJ bypass was 34.2 ± 5.4%, which was comparable with other groups. CONCLUSIONS The weight loss trend after the SASJ bypass was similar to that of older techniques; consequently this technique can be considered for cases with particular indications due to the reversibility and also more accessible gastric follow-up studies in the SASJ approach. Further researches with longer follow-ups are strongly recommended.
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Affiliation(s)
| | | | | | | | - Shahab Shahabi
- Isfahan University of Medical Sciences, Isfahan, 8174675731, Iran
| | - Mostafa Allami
- Isfahan University of Medical Sciences, Isfahan, 8174675731, Iran
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50
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Maxwell C, Gaudet L, Cassir G, Nowik C, McLeod NL, Jacob CÉ, Walker M. Directive clinique N o 391 - Grossesse et obésité maternelle Partie 1 : Préconception et soins prénataux. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1641-1659. [PMID: 31640865 DOI: 10.1016/j.jogc.2019.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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