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Pinho Costa M, Santos-Sousa H, Oliveira CR, Amorim-Cruz F, Bouça R, Barbosa E, Carneiro S, Sousa-Pinto B. The Metabolic Effects and Effectiveness of the Different Reconstruction Methods used in Gastric Cancer Surgery: A Systematic Review and Meta-Analysis. Sci Rep 2024; 14:23477. [PMID: 39379429 PMCID: PMC11461857 DOI: 10.1038/s41598-024-72456-2] [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: 06/15/2024] [Accepted: 09/06/2024] [Indexed: 10/10/2024] Open
Abstract
Gastric Cancer (GC) is the fifth most common cancer worldwide. Early stages of GC began being detected, giving rise to a new concern, Quality of Life. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HBP), and body mass index (BMI) reduction rate and to provide an overview of recent research on oncometabolic surgery (OS). We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y reconstruction, and residual stomach on T2DM, HBP, and BMI reduction rate. Heterogeneity was assessed using the I2 statistics. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95% CI) [1.27; 1.62]) and 1.3 (95% CI [1.00; 1.69]), respectively. Compared with the Billroth II group, Roux-en-Y reconstruction had significantly greater T2DM remission after gastrectomy (RR = 1.19; 95% CI [1.08; 1.31]), while HBP showed no significant differences. Regarding the improvement of HBP, total gastrectomy was significantly superior to subtotal gastrectomy (95% CI [1.01; 2.64]). A trend towards Roux-en-Y Esophagojejunostomy as the best option for T2DM remission was observed (95% CI [0.98; 2.77]; p = 0.06). Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Further research is needed to assess the impact of OS on metabolic diseases.
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Affiliation(s)
- Maria Pinho Costa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- ULS São João, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- ULS São João, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Carolina Rodrigues Oliveira
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Senhora da Oliveira Hospital, ULS Alto Ave, Rua dos Cutileiros, 4835-044, Guimarães, Portugal
| | - Filipe Amorim-Cruz
- ULS São João, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Raquel Bouça
- Instituto de Medicina Molecular João Lobo Antunes, Edifício Egas Moniz, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Elisabete Barbosa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- ULS São João, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Silvestre Carneiro
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- ULS São João, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS - Center for Health Technologies and Services Research, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
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Bharatselvam S, Schwenger KJP, Ghorbani Y, Fischer SE, Jackson TD, Okrainec A, Allard JP. Assessing clinical and metabolic responses related to hyperlipidemia, MASLD and type 2 diabetes: sleeve versus RYGB. Nutrition 2024; 126:112530. [PMID: 39111098 DOI: 10.1016/j.nut.2024.112530] [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: 04/03/2024] [Revised: 06/28/2024] [Accepted: 07/11/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVE Both Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are effective at inducing weight loss, but more information is needed on their comparative effectiveness at improving clinical/biochemical outcomes related to the presence of hyperlipidemia, metabolic dysfunction-associated steatotic liver disease (MASLD), or type 2 diabetes (T2D) at baseline. Here we aimed to assess this in real-world practice. METHODS This is a prospective cross-sectional and cohort study of 142 patients who underwent RYGB or LSG as per clinical practice. Clinical/biochemical data were collected at baseline, prior to surgery and 12 months post-bariatric surgery. Liver biopsy was performed during surgery to diagnose MASLD. The main outcome was 12-month changes in lipid parameters, mainly total cholesterol, between types of surgery. RESULTS A TOTAL OF: 107 participants underwent RYGB and 35 underwent LSG. Both groups were similar at baseline except for a higher proportion of males and waist circumference in the LSG group. At 12 months postsurgery, RYGB versus LSG resulted in a significantly lower body mass index, triglycerides, total cholesterol, and low-density lipoprotein. However, alanine aminotransferase was significantly lower in those who underwent LSG. In subgroup analyses RYGB was superior at improving lipid-related parameters in those with hyperlipidemia, whereas LSG was superior at reducing alanine aminotransferase in those with MASLD. CONCLUSIONS RYGB versus LSG leads to greater reductions in body mass index and lipid parameters, especially in those with hyperlipidemia, whereas LSG showed greater improvements in liver enzymes in those with MASLD.
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Affiliation(s)
| | | | - Yasaman Ghorbani
- Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sandra E Fischer
- Toronto General Hospital, University Health Network, Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Timothy D Jackson
- Division of Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Allan Okrainec
- Division of Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Johane P Allard
- Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Canada.
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Sabah SA, Haddad EA. The Utilization of Bariatric Surgery in Patients With and Without Diabetes: Results from the Second Kuwait National Bariatric Surgery Database Report. Bariatr Surg Pract Patient Care 2024; 19:20-27. [DOI: 10.1089/bari.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Affiliation(s)
- Salman Al Sabah
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
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Al-Kubaisy M, Azzam MI, Toubasi A, Al-Ani A, Mafrachi B, Al-Ani H, Bashir A, Haddad A. Glycemic Status Following Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in Patients Without Diabetes: A Systematic Review and Meta-Analysis. Bariatr Surg Pract Patient Care 2023; 18:201-212. [DOI: 10.1089/bari.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Affiliation(s)
| | | | - Ahmad Toubasi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Baraa Mafrachi
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Hashim Al-Ani
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad Bashir
- Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
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Vargas CM, Gómez D, Madrigal V, Guilbert L, Sepúlveda EM, Rodríguez FM, Zerrweck C. Women with Anemia Refractory to Oral Iron Treatment Following Bariatric Surgery: a Short-Term Analysis. Obes Surg 2023; 33:846-850. [PMID: 36602723 DOI: 10.1007/s11695-022-06447-5] [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: 08/12/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Iron deficiency and anemia are common after bariatric surgery. Women have a higher risk of developing such long-term complications. Though oral supplementation is indicated, intravenous iron therapy is required in some cases. METHODS This retrospective study included patients who underwent bariatric surgery between 2012 and 2018. Postoperative anemia patients receiving parental iron therapy were assessed during the first 24 months. Their baseline characteristics, surgery type, and laboratory test results were analyzed. A follow-up analysis included a subgroup of women with and without gynecological disorders. Patients with vitamin B12 or folic acid deficiencies were excluded. RESULTS Six hundred eleven (63.3%) met the inclusion criteria: 525 underwent gastric bypass, of which 79.6% were women. Overall, postoperative anemia was 28.9% (24.5% related to gastric bypass), especially among women (84%). Anemia refractory to oral iron therapy was observed in 12.9% of patients. All the patients requiring iron infusions (n = 54) were women, and half of them (51.8%) reported abnormal uterine bleeding. Postsurgical hemogram values were significantly lower in patients with abnormal uterine bleeding (despite the same number of infusions) than in those without gynecological disorders; 89.2% of these women had preoperative anemia. CONCLUSION Anemia is frequent in bariatric surgery patients despite supplementation. Women undergoing gastric bypass with a history of gynecological disorders are prone to require more iron infusions. Consulting with the patient about a higher risk is important, and probably knowing the plan or including the opinion of an OBGYN to determine as a team the assessment, treatment, and prognosis.
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Affiliation(s)
- César M Vargas
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Dalio Gómez
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Violeta Madrigal
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Lizbeth Guilbert
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Fátima M Rodríguez
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico
| | - Carlos Zerrweck
- The Obesity Clinic, Hospital General Tláhuac, Avenida La Turba #655, Col. Villa Centroamericana Y del Caribe, Del. Tláhuac, 13250, Mexico City, Mexico.
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Alkharaiji M, Anyanwagu U, Crabtree T, Gordon J, Idris I. Clinical cost evaluation and health benefits of post-bariatric intervention for patients with type 2 diabetes living in the UK. Clin Obes 2021; 11:e12486. [PMID: 34569163 DOI: 10.1111/cob.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
To assess associated healthcare costs and risk of developing obesity-related comorbidities among patients with type 2 diabetes with severe obesity and receiving insulin treatment, following bariatric surgery (BS). A retrospective cohort study was conducted from a UK electronic primary care database. Propensity score matching (1:1) was performed for BS with non-BS cohort. Follow-up was over 5 years (694 person-years), comparing drug utilization with clinical cost differences, such as visits to General practitioners (GPs), hospitalization, and laboratory use. Cox proportional regression was used to compute differences in the risk of obesity-related comorbidities and chi-square analysis to explore differences in insulin independency and diabetes remission proportions during follow-up. Eighty patients who received BS were matched to 80 non-BS (N = 160). The baseline mean age was 48.3 years (SD: 12.9) (61% female), and body mass index was 39.3 kg/m2 (SD: 9.3). During follow-up, antidiabetic drug cost was significantly lower in the BS group than in the non-BS (median cost/person [£]: 527.77 [interquartile range (IQR): 1196.11] vs. 1564.13 [IQR: 1576.01]; p < 0.001). Overall, aggregate cost analysis showed a significant total healthcare cost reduction in the BS group (median cost/person [£]: 1597.96 [IQR: 2631.84] vs. 2440.12 [IQR: 2242.95]; p = 0.050). BS significantly protected against obesity-related comorbidities compared with the non-BS (adjusted hazard ratio: 0.56; 95% confidence interval: 0.32-0.96; p = 0.036) and increased insulin independency throughout all follow-up points: at year 5: 48.1% versus 28.9%; p = 0.044, respectively. While BS shows evidence of cost efficiency, cost saving was not identified. The efficiency is evident by the protective effect against crude obesity-related comorbidities associated with increased insulin independency.
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Affiliation(s)
- Mohammed Alkharaiji
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- Department of Public Health, College of Health Sciences, The Saudi Electronic University, Riyadh, Saudi Arabia
| | - Uchenna Anyanwagu
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Thomas Crabtree
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Jason Gordon
- HEOR Consulting Ltd, Singleton Court Business Park, Wonastow Rd, Monmouth, UK
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton, Derby, UK
| | - Iskandar Idris
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton, Derby, UK
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Remission of Type II Diabetes Mellitus 1-Year Postoperative Following One Anastomosis Gastric Bypass in Correlation with ABCD, DiaRem, and DRS Scores. Obes Surg 2021; 32:450-456. [PMID: 34780027 DOI: 10.1007/s11695-021-05793-0] [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: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) is a debilitating chronic illness. Roux en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) present a potential solution to type II DM. Several scoring systems predict DM remission as ABCD score, DiaRem score, and diabetes remission score (DRS). STUDY DESIGN This was a retrospective study that included 138 patients with DM and underwent OAGB. BMI, HbA1C, insulin, and oral hypoglycemics need were recorded pre- and postoperatively with calculation of ABCD, DiaRem, and DRS scores. Effects of OAGB on DM were observed and correlated with the scoring systems to detect their sensitivity and specificity. RESULTS Age, preoperative, and postoperative BMI were 47.38 ± 7.632, 45.096 ± 4.465, and 31.173 ± 3.799 respectively. The preoperative and stimulated C-peptides were 3.357 ± 0.995 and 4.158 ± 0.897 ng/ml respectively. The preoperative and postoperative HbA1C were 7.396 ± 0.743% and 6.564 ± 0.621% respectively. Patients with complete remission were 32 patients (23.2%) and with partial remission were 46 patients (33.3%) adding to 56.5% considered in remission. There was significant decrease of BMI, HbA1C, insulin, and oral hypoglycemic use postoperatively. Receiver operator characteristics (ROC) curve showed that ABCD, DiaRem, and DRS scores had AUC of 0.853 with cut-off > 5, 0.921 with cut-off ≤ 8, and 0.805 with cut-off ≤ 8 respectively. The DiaRem score had the highest AUC followed by ABCD score then DRS score. CONCLUSION OAGB significantly reduced BMI and HbA1C values 1 year postoperatively with 56.5% DM remission. DiaRem score had more remission predictive value following OAGB than ABCD and DRS scores especially when ≤ 8 with 90.6% sensitivity and 83% specificity.
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Alagiakrishnan K, Halverson T. Holistic perspective of the role of gut microbes in diabetes mellitus and its management. World J Diabetes 2021; 12:1463-1478. [PMID: 34630900 PMCID: PMC8472496 DOI: 10.4239/wjd.v12.i9.1463] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/24/2021] [Accepted: 08/13/2021] [Indexed: 02/06/2023] Open
Abstract
The gut microbiota (GM) plays a role in the development and progression of type 1 and type 2 diabetes mellitus (DM) and its complications. Gut dysbiosis contributes to the pathogenesis of DM. The GM has been shown to influence the efficacy of different antidiabetic medications. Intake of gut biotics, like prebiotics, probiotics and synbiotics, can improve the glucose control as well as the metabolic profile associated with DM. There is some preliminary evidence that it might even help with the cardiovascular, ophthalmic, nervous, and renal complications of DM and even contribute to the prevention of DM. More large-scale research studies are needed before wide spread use of gut biotics in clinical practice as an adjuvant therapy to the current management of DM.
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Affiliation(s)
| | - Tyler Halverson
- Department of Medicine, University of Alberta, Edmonton T6G 2G3, Alberta, Canada
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Tan SYT, Syn NL, Lin DJ, Lim CH, Ganguly S, Ong HS, Tan JTH, Lee PC. Centile Charts for Monitoring of Weight Loss Trajectories After Bariatric Surgery in Asian Patients. Obes Surg 2021; 31:4781-4789. [PMID: 34363141 DOI: 10.1007/s11695-021-05618-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Following bariatric surgery, accurate charting of weight loss and regain is crucial. Various preoperative factors affect postoperative weight loss, including age, sex, ethnicity, and surgical type. These are not considered by current weight loss metrics, limiting comparison of weight loss outcomes between patients or centers and across time. METHODS Patients (n=1022) who underwent sleeve gastrectomy (n=809) and gastric bypass (n=213) from 2008 to 2020 in a single center were reviewed. Weight loss outcomes (% total weight loss) were measured for 60 months postoperatively. Longitudinal centile lines were plotted using the post-estimation predictions of quantile regression models, adjusted for type of procedure, sex, ethnicity, and baseline BMI. RESULTS Median regression showed that %TWL was 1.0% greater among males than females (β = +1.1, 95% CI: +0.6 to +1.7, P = <0.0001). Participants who underwent SG had less %TWL compared to GB (β = -1.3, 95% CI: -1.9 to -0.8, P < 0.0001). There was a trend towards less %TWL among the Indian and Malay participants compared to Chinese. Age and diabetes were not significant predictors. Reference centile charts were produced for the overall cohort, as well as specific charts adjusted for type of bariatric procedure, sex, ethnicity, and baseline BMI. CONCLUSION Centile charts provide a clinically relevant method for monitoring of weight trajectories postoperatively and aid in realistic and personalised goal setting, and the early identification of "poor responders". This is the first study to present post-bariatric surgery centile charts for an Asian cohort.
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Affiliation(s)
- Sarah Ying Tse Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daryl J Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Tian Hui Tan
- Department of Upper Gastrointestinal & Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
- Obesity Centre, Outram Community Hospital SGH, Specialist Outpatient Clinic SingHealth Tower, Level 3, 10 Hospital Blvd, Singapore, 168582, Singapore.
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Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut-Liver Axis. Nutrients 2021; 13:nu13082649. [PMID: 34444807 PMCID: PMC8399840 DOI: 10.3390/nu13082649] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Weight loss is a therapeutic solution for many metabolic disorders, such as obesity and its complications. Bariatric surgery aims to achieve lasting weight loss in all patients who have failed after multiple dietary attempts. Among its many benefits, it has been associated with the regression of non-alcoholic fatty liver disease (NAFLD), which is often associated with obesity, with evidence of substantial improvement in tissue inflammation and fibrosis. These benefits are mediated not only by weight loss, but also by favorable changes in systemic inflammation and in the composition of the gut microbiota. Changes in microbial metabolites such as short-chain fatty acids (SCFAs), capable of acting as endocrine mediators, and bile acids (BAs) as well as modifications of the gut-brain axis, are among the involved mechanisms. However, not all bariatric surgeries show beneficial effects on the liver; those leading to malabsorption can cause liver failure or a marked worsening of fibrosis and the development of cirrhosis. Nevertheless, there are still many unclear aspects, including the extent of the benefits and the magnitude of the risks of bariatric surgery in cirrhotic patients. In addition, the usefulness and the safety of these procedures in patients who are candidates to or who have undergone liver transplant need solid supporting evidence. This paper aims to review literature data on the use of bariatric surgery in the setting of chronic liver disease.
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Bariatric Surgery in Patients with Cirrhosis: Careful Patient and Surgery-Type Selection Is Key to Improving Outcomes. Obes Surg 2021; 30:3444-3452. [PMID: 32285332 DOI: 10.1007/s11695-020-04583-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Previous reports suggest an increased mortality in cirrhotic patients undergoing bariatric surgery (BS). With advancements in management of BS, we aim to study the trends, outcomes, and their predictors in patients with cirrhosis undergoing BS. MATERIALS AND METHODS A retrospective study was performed using the National Database from 2008 to 2013. Outcomes of BS in patients with cirrhosis were studied. In-hospital mortality, length of stay, and cost of care were compared between patients with no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC). Multivariable logistic regression analysis was performed to study the predictors of mortality. RESULTS Of the 558,017 admissions of patients who underwent BS during the study period, 3086 (0.55%) had CC and 103 (0.02%) had DC. An upward trend of vertical sleeve gastrectomy (VSG) utilization was seen during the study period. On multivariate analysis, mortality in CC was comparable with those in NC (aOR 1.88; CI 0.65-5.46); however, it was higher in DC (aOR 83.8; CI 19.3-363.8). Other predictors of mortality were older age (aOR 1.06; CI 1.04-1.08), male (aOR 2.59; CI 1.76-3.81), Medicare insurance (aOR 1.93; CI 1.24-3.01), lower income (aORs 0.44 to 0.55 for 2nd to 4th income quartile vs. 1st quartile), > 3 Elixhauser Comorbidity Index (aOR 5.30; CI 3.45-8.15), undergoing Roux-en-Y gastric bypass as opposed to VSG (aOR 3.90; CI 1.79-8.48), and centers performing < 50 BS per year (aOR 5.25; CI 3.38-8.15). Length of stay and hospital cost were also significantly higher in patients with cirrhosis as compared with those with NC. CONCLUSION Patients with compensated cirrhosis can be considered for bariatric surgery. However, careful selection of patients, procedure type, and volume of surgical center is integral in improving outcomes and healthcare utilization in patients with cirrhosis undergoing BS.
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Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 30:664-672. [PMID: 31724116 DOI: 10.1007/s11695-019-04235-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures. OBJECTIVES We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG. METHODS Medline, Embase, The Cochrane Library, and NHS Evidence were searched for English language RCTs comparing RYGB with SG and assessed weight loss and/or comorbidity resolution at 5 years. RESULTS Five studies were included in the final analysis. Meta-analysis demonstrates a significantly greater percentage excess weight loss in patients undergoing RYGB compared with SG (65.7% vs 57.3%, p < 0.0001). Resolution of diabetes was seen in 37.4% and 27.5% after RYGB and SG respectively. There was no significant difference between RYGB and SG in rates of resolution or improvement of diabetes. Similarly, HbA1C levels were not significantly different between the two procedures. Resolution of dyslipidaemia was more common after RYGB (68.6% vs 55.2%, p = 0.0443). Remission of gastro-oesophageal reflux occurred in 60.4% in the RYGB group in contrast to 25.0% in the SG group (p = 0.002). CONCLUSIONS Both RYGB and SG result in sustained weight loss and comorbidity control at 5 years. RYGB resulted in greater %EWL, improved dyslipidaemia outcomes and a lower incidence of postoperative gastro-oesophageal reflux disease (GORD).
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Huang C, Wang Q, Zhang Q, Zhou B, Lin J, Meng H. Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Bone Mineral Density in Zucker Diabetic Fatty Rats: A Short-Term Comparative Study. Obes Facts 2021; 14:178-189. [PMID: 33662956 PMCID: PMC8138275 DOI: 10.1159/000514426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While bariatric surgery could result in weight loss as well as glycaemia improvement, the short-term impact on bone health in a high glycemic environment following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remains intriguing. OBJECTIVE The aim of this study was to compare the short-term effects of RYGB and SG procedures on bone health in Zucker diabetic fatty (ZDFfa/fa) rats. METHODS Thirty age-matched male ZDFfa/fa rats were randomized into RYGB, SG, and sham groups after establishment of the diabetic model. Body weight, blood glucose, bone mineral density (BMD), the level of bone turnover markers (BTM), vitamin D, and serum calcium and phosphorus were measured 4 weeks after the operation. RESULTS The RYGB procedure brought about lower blood glucose, BMD, serum calcium and phosphorus levels, as well as a relatively higher bone turnover rate and 1,25(OH)2VD level, compared to the SG and sham groups, while the influences of the SG procedure were not significant. 25(OH)VD demonstrated no significant difference among the 3 groups. CONCLUSIONS Despite its excellent ability to provide short-term glycemic control, the RYGB procedure could led to more severe impairment of bone health compared to the SG procedure. Bone health should be procured after bariatric surgery, especially with the RYGB procedure. Early detection of BMD and BTM may help to avoid deterioration of bone.
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Affiliation(s)
- Cheng Huang
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China
| | - Qiong Wang
- Department of Nephrology, Beijing Hospital, Beijing, China
| | - Qin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Biao Zhou
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jun Lin
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hua Meng
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
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Primary laparoscopic sleeve gastrectomy versus gastric bypass: a propensity-matched comparison of 30-day outcomes. Surg Obes Relat Dis 2021; 17:1369-1382. [PMID: 33741294 DOI: 10.1016/j.soard.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for obesity. There is uncertainty regarding rates of adverse outcomes between the most common methods: laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). OBJECTIVES To compare rates of readmission, reoperation, intervention, unplanned intensive care unit (ICU) admission, all-cause and procedure-related mortality, and postoperative complications at 30 days between LRYGB and LSG. SETTING Retrospective, observational, multicenter registry. METHODS We identified 611,619 patients from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry between January 1, 2015, and December 31, 2018 (447,326 [73.1%] LSG; 164,293 [26.9%] LRYGB). RESULTS Adverse events were more common after LRYGB (readmission: 3% with LSG versus 5.9% with LRYGB [P < .001; odds ratio {OR}, LSG/LRYGB = .489]; intervention: .9% with LSG versus 2.4% with LRYGB [P < .001; OR, LSG/LRYGB = .357]; reoperation: .8% with LSG versus 2.3% with LRYGB [P < .001; OR, LSG/LRYGB = .363]; unplanned ICU admission: .52% with LSG versus 1.1% with LRYGB [P < .001; OR, LSG/LRYGB = .454]; all-cause mortality: .07% with LSG versus .15% with LRYGB [P < .001; OR, LSG/LRYGB = .489]; procedure-related mortality: .04% with LSG versus .08% with LRYGB [P < .001; OR, LSG/LRYGB = .446]; Clavien-Dindo I: .20% with LSG versus .63% with LRYGB [P < .001; OR, LSG/LRYGB = .317]; Clavien-Dindo II: .70% with LSG versus 1.3% with LRYGB [P < .001; OR, LSG/LRYGB = .527]; Clavien-Dindo III: 3.3% with LSG versus 6.6% with LRYGB [P < .001; OR, LSG/LRYGB = .481]; Clavien-Dindo IV: .36% with LSG versus .76% with LRYGB [P < .001; OR, LSG/LRYGB = .466]; and Clavien-Dindo V: .07% with LSG versus .15% with LRYGB [P < .001; OR, LSG/LRYGB = .488]). Surgery type was among the strongest independent predictors of adverse events, and LRYGB conferred higher adjusted odds of all adverse outcomes (all-cause mortality: OR, LRYGB/LSG = 1.791 [P < .001]; procedure-related mortality: OR, LRYGB/LSG = 1.979 [P < .001]; readmission: OR, LRYGB/LSG = 1.921 [P < .001]; unplanned ICU admission: OR, LRYGB/LSG = 1.870 [P < .001]; intervention: OR, LRYGB/LSG = 2.662 [P < .001]; reoperation: OR, LRYGB/LSG = 2.646 [P < .001]; and Clavien-Dindo grade: OR, LRYGB/LSG = 2.007 [P < .001]). CONCLUSION The rates of 30-day adverse outcomes are lower after LSG compared with after LRYGB. LRYGB independently conferred increased odds of adverse outcomes compared with LSG, and surgery type was among the strongest predictors of adverse outcomes.
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Ece I, Yilmaz H, Yormaz S, Çolak B, Calisir A, Sahin M. The Short-Term Effects of Transit Bipartition with Sleeve Gastrectomy and Distal-Roux-en-Y Gastric Bypass on Glycemic Control, Weight Loss, and Nutritional Status in Morbidly Obese and Type 2 Diabetes Mellitus Patients. Obes Surg 2021; 31:2062-2071. [PMID: 33409969 DOI: 10.1007/s11695-020-05212-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to compare the postoperative metabolic and nutritional outcomes after transit bipartition with sleeve gastrectomy (TB-SG) and distal-Roux-en-Y gastric bypass (D-RYGB). MATERIALS AND METHODS A retrospective evaluation was made of 109 morbidly obese patients who underwent TB-SG or D-RYGB. Primary outcomes included metabolic variables such as glycemic control and serum lipid levels, and secondary outcomes consisted of nutritional deficiencies and weight loss after surgical procedures. RESULTS During the study period, 83 and 26 patients underwent D-RYGB and TB-SG, respectively. The preoperative characteristics and nutritional status of the groups were similar. D-RYGB resulted in significantly higher weight loss rates in the first 3 months, but the percentage of excess weight loss (EWL %) was not different in the 12-month follow-up period. Although D-RYGB provided faster glycemic control due to early weight loss, there was no difference between the two groups. At the end of the follow-up period, the TB-SG was associated with significantly less deficiency of vitamin D, vitamin B12, iron, and folic acid. Anastomosis leakage was more common in the D-RYGB technique. The overall complication rates of the groups were similar. CONCLUSION TB-SG is a safe and effective alternative to D-RYGB for the treatment of obesity-related metabolic disorders with fewer nutritional deficiencies.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey.
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Bayram Çolak
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
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16
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Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication. Obes Surg 2021; 31:1733-1744. [PMID: 33398627 DOI: 10.1007/s11695-020-05192-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5 years. MATERIAL AND METHODS Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. RESULTS Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5 years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p = 0.001. At 5 years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p < 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p = 0.008, and the GLP-1 AUC at 1 month (OR 7.229), p = 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up. CONCLUSIONS Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5 years.
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17
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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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Alizadeh RF, Li S, Gambhir S, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Bypass for Patients with Metabolic Syndrome: An MBSAQIP Analysis. Am Surg 2020. [DOI: 10.1177/000313481908501007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32–1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46–0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53–0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43–0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55–0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Shiri Li
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Sahil Gambhir
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Marcelo W. Hinojosa
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Brian R. Smith
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Michael J. Stamos
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Ninh T. Nguyen
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
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19
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Madadi F, Jawad R, Mousati I, Plaeke P, Hubens G. Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis. Obes Surg 2020; 29:4066-4076. [PMID: 31655953 DOI: 10.1007/s11695-019-04199-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The sleeve gastrectomy (SG) has gained popularity which has resulted in a rising number of patients with T2DM to undergo this procedure. This systematic review and meta-analysis aimed to compare the long-term effects of SG on T2DM remission with remission seen after Roux-en-Y gastric bypass (RYGB) or gastric banding (GB). METHODS A literature search was performed in PubMed and Cochrane Library using the following search terms: 'sleeve gastrectomy', 'diabetes', 'gastric bypass' and 'gastric banding'. Studies published between January 2000 and April 2018, and with following inclusion criteria were selected for this review: BMI ≥ 35 kg/m2, age ≥ 18 years, follow-up ≥ 1 year, T2DM. Data was statistically analysed using a random-effects model and results were expressed as odds ratio with 95% confidence interval. RESULTS After exclusion, 35 out of an initial 748 studies, consisting of 18 138 T2DM patients, remained for inclusion. Of these patients, 2480 underwent a SG. The remaining patients underwent a RYGB (n = 10,597) or GB (n = 5061). One year postoperatively, SG patients reached significantly (OR 0.71, p = 0.003) less T2DM remission than RYGB. After stratifying for different criteria for remission, RYGB still tended to result in higher remission rates, but the difference was not statistically significant. Beyond 1 year of follow-up, the difference between RYGB and SG in terms of T2DM remission decreased. SG was superior to the GB (OR 2.17, p = 0.001) after 1 year of follow-up. CONCLUSION This review demonstrates important remission of T2DM following SG. Nevertheless, as remission was significantly more often observed following RYGB surgery, the latter procedure remains the gold standard for reaching T2DM remission in patients with concurrent obesity.
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Affiliation(s)
- Ferdous Madadi
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium. .,Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Rami Jawad
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Ismail Mousati
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Philip Plaeke
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Guy Hubens
- Department of Abdominal Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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20
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Komaei I, Currò G, Mento F, Cassaro G, Lazzara C, Barbera A, Ammendola M, Alibrandi A, Navarra G. Gastric Histopathologic Findings in South Italian Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Is Histopathologic Examination of All Resected Gastric Specimens Necessary? Obes Surg 2020; 30:1339-1346. [PMID: 31713151 DOI: 10.1007/s11695-019-04272-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up. MATERIALS AND METHODS Clinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings. RESULTS Chronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000). CONCLUSION Histopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.
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Affiliation(s)
- Iman Komaei
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Giuseppe Currò
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy.
- Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy.
| | - Federica Mento
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Gabriele Cassaro
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Claudio Lazzara
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Adalberto Barbera
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Michele Ammendola
- Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
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21
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Abdelbaki TN, El-Sayes I, Talha A, Sharaan MA. Weight Loss and Diabetes Control Following Laparoscopic Sleeve Gastrectomy. J Laparoendosc Adv Surg Tech A 2020; 30:383-388. [PMID: 31971865 DOI: 10.1089/lap.2019.0680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Tamer N. Abdelbaki
- General Surgery Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Islam El-Sayes
- General Surgery Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Ahmed Talha
- General Surgery Department, Medical Research Institute, Alexandria, Egypt
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22
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Wang L, Wang J, Jiang T. Effect of Laparoscopic Sleeve Gastrectomy on Type 2 Diabetes Mellitus in Patients with Body Mass Index less than 30 kg/m 2. Obes Surg 2020; 29:835-842. [PMID: 30536018 DOI: 10.1007/s11695-018-3602-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has been proved to be the most effective treatment strategy for the treatment of type 2 diabetes mellitus (T2DM) with a body mass index ≥ 30 kg/m2 achieving high remission rates. However, there are few clinical studies on the treatment of T2DM patients with a body mass index less than 30 kg/m2 by LSG. This study aims to study the effect of LSG on type 2 diabetes mellitus(T2DM) in patients with a body mass index (BMI) less than 30 kg/m2. METHODS The clinical data of 25 patients with type 2 diabetes mellitus (T2DM) and body mass index 23.23-29.97 kg/m2 who were treated by LSG at the Department of Bariatric and Metabolic Surgery in China-Japan Union Hospital of Jilin University from May 2016 to May 2017 were retrospectively analyzed. The changes of fasting plasma glucose, glycosylated hemoglobin, insulin resistance index, body weight, body mass index, waist circumference, blood pressure, heart rate, blood lipids, and uric acid were analyzed at 3 months, 6 months, and 12 months after operation, respectively. All the clinical data were analyzed by SPSS 22.0. They were tested with a single-sample K-S test to determine whether they were normal distribution data. The normal distribution data were analyzed by a matched t test, and the Mann-Whitney test was used to examine skewed data. RESULTS All patients (9 males, 16 females) with a median age of 57(24~65) years were treated successfully by laparoscopic sleeve gastrectomy. The median duration of type 2 diabetes mellitus was 10(0~20)years. The preoperative fasting plasma glucose, glycosylated hemoglobin, body weight, body mass index, and waist circumference were 10.32 ± 2.66 mmol/L,8.20 ± 1.47%,76.54 ± 10.02 kg,27.92 ± 1.72 kg/m2, and 99.88 ± 5.38 cm, respectively. The meaning fasting plasma glucose was 7.26 ± 1.36 mmol/L, 6.90 ± 1.07 mmol/L, and 6.62 ± 0.97 mmol/L, respectively, at 3, 6, and 12 months after operation. The mean HbAlc in the same observation intervals was 6.88 ± 1.23%,6.54 ± 1.02%, and 6.51 ± 0.89%, respectively. The body weight was 62.18 ± 8.38 kg,59.07 ± 8.58 kg, and 58.62 ± 8.53 kg, respectively. The corresponding body mass index was 22.56 ± 1.56 kg/m2, 21.35 ± 1.58 kg/m2, and 21.24 ± 1.86 kg/m2, respectively. The waist circumference was 82.84 ± 5.10 cm,78.60 ± 5.21 cm, and 76.92 ± 5.21 cm, respectively. The complete remission rates of type 2 diabetes mellitus were 40%, 60%, and 68%, respectively, at 3, 6, and 12 months after operation. The complete remission rates for insulin resistance index were 52.4%, 80%, and 80%, postoperatively, at 3, 6, and 12 months, respectively. The complete remission rates of hypertension were 22.2%, 50%, and 75%,respectively, at 3,6, and 12 months after operation. The complete remission rates of hypertriglyceridemia were 66.7%, 66.7%, and 100%,and the complete remission rates of hypercholesterolemia were 41.7%, 60%, and 100%;the abnormal elevations of plasma cholesterol in two patients with normal cholesterol before operation were significantly higher, postoperatively, at 3 monthsand 6 months, respectively. The complete remission rates of hyperuricemia were 37.5%, 33.3%, and 100% in the same observation period, respectively. The abnormal elevations of uric acid in two patients with normal uricemia before operation were significantly higher at postoperative 3 months. CONCLUSION LSG has a significant effect on patients with type 2 diabetes mellitus whose BMI less than 30 kg/m2 in a short time, but its long-term effectiveness needs to be further followed up.
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Affiliation(s)
- Lun Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Jinfa Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China
| | - Tao Jiang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun, 130033, China.
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23
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Gu J, Vergis A. Diabetes improvement and bariatric surgery-review of laparoscopic Roux-en-Y gastric bypass vs. laparoscopic vertical sleeve gastrectomy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:S10. [PMID: 32309414 PMCID: PMC7154331 DOI: 10.21037/atm.2020.01.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are globally escalating major health care issues. For both obesity and T2DM management, it has been well established that bariatric surgery is superior to lifestyle and medical management alone. Over the past two decades, the introduction of laparoscopic vertical sleeve gastrectomy (LVSG) has seen a marked rise in usage, and combined with laparoscopic Roux-en-Y gastric bypass (LRYGB), these two procedures represent more than 80% of all bariatric surgeries globally. However, the differences in effectiveness between these two procedures have been less clearly defined. This article will serve as a focused review of the literature comparing LRYGB and LVSG for T2DM management. Based on our review, we believe that both procedures are very effective at improving T2DM care, especially compared with conventional medical management. However, there may be a modest benefit to be had by using LRYGB over LVSG.
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Affiliation(s)
- Jeffrey Gu
- Community Health and Epidemiology, Department of General Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, Rady College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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24
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Laparoscopic Sleeve Gastrectomy Is Associated with Lower 30-Day Morbidity Versus Laparoscopic Gastric Bypass: an Analysis of the American College of Surgeons NSQIP. Obes Surg 2019; 28:3567-3572. [PMID: 30014238 DOI: 10.1007/s11695-018-3396-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) has rapidly gained popularity as a single-stage operation for the treatment of morbid obesity, as patients undergoing LSG have been shown to achieve similar weight loss and resolution of obesity-related comorbidities in comparison to those undergoing Roux-en-Y gastric bypass (RYGB), the "gold standard" bariatric operation. Although LSG poses fewer technical challenges than RYGB, little is known about differences in short-term outcomes among patients undergoing LSG and RYGB. We hypothesized that LSG is associated with lower 30-day risk-adjusted serious morbidity. METHODS Preoperative characteristics and 30-day outcomes from the American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP) Participant Use Files (PUF) 2010-2014 were selected for all patients who underwent LSG or RYGB. Descriptive comparisons were performed using chi-square and Wilcoxon's rank-sum tests as appropriate. The primary outcome was a risk-adjusted composite measure of 30-day serious morbidity and mortality. RESULTS We analyzed records for 47,982 (42.0%) and 66,380 (58.0%) patients undergoing LSG and RYGB, respectively. On univariate analysis, LSG patients had a lower rate of organ space infection (0.45% vs. 0.68%, p < 0.001), lower rate of bleeding requiring transfusions (1.00% vs. 1.60%, p < 0.001), lower rate of sepsis (0.34% vs. 0.49%, p < 0.001), and septic shock (0.12% vs. 0.22%, p < 0.001) and required fewer unplanned reoperations (1.34% vs. 2.56%, p < 0.001) than RYGB patients. Both groups had similar rates of deep venous thrombosis (0.33% vs. 0.28%, p = 0.15) and pulmonary embolism (0.17% vs. 0.21%, p = 0.15). Mortality was lower among LSG patients (0.09% vs. 0.14%, p = 0.01). On multivariate analysis, RYGB was associated with higher risk-adjusted 30-day serious morbidity than LSG (odds ratio 1.61; 95% CI 1.52-1.71, p < 0.001). Older age, female gender, higher BMI, and insulin-dependent diabetes were also associated with risk of serious morbidity (C-statistic = 0.60). CONCLUSION Serious morbidity following bariatric surgery is uncommon; however, LSG may be associated with modest protection from adverse 30-day outcomes in comparison to RYGB. Our conclusion is limited by the difference in baseline risk factors of the populations studied.
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25
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Akbari K, Som R, Sampson M, Abbas SH, Ramus J, Jones G. The Effect of Bariatric Surgery on Patients with HIV Infection: a Literature Review. Obes Surg 2019; 28:2550-2559. [PMID: 29948874 DOI: 10.1007/s11695-018-3319-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obesity among human immunodeficiency virus (HIV)-infected individuals is on the rise. Bariatric procedures such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) alter the GI tract. Whether this alteration has any impact on the absorption of highly active antiretroviral therapy (HAART), thus affecting HIV disease markers such as CD4 cell count or viral load (VL), is not yet known. We conducted this review to look into the outcomes of bariatric surgery procedures, RYGB, SG and adjustable gastric band (AGB) and its effects on the CD4 cell counts and VL and HAART therapy. A literature search was conducted between January and April 2017, by two independent reviewers, using Pubmed and Google Scholar. The terms 'bariatric surgery and HIV', 'obesity surgery and HIV', 'gastric bypass surgery and HIV', 'sleeve gastrectomy and HIV' and 'gastric band and HIV' were used to retrieve available research. Of the 49 papers reviewed, only 12 reported the outcomes of patients with HIV undergoing bariatric surgery and were therefore included in this review. Six papers assessed patients undergoing RYGB only (N = 18), 3 papers reported on SG only (N = 18) and 3 papers reported on case mix, including 7 cases of RYGB, 4 cases of SG and 11 cases of AGB. Data is limited; however, based on the available data, bariatric surgery is safe in HIV-infected individuals and does not have any adverse impact on HIV disease progress. Additionally, there was no difference in HIV-related outcomes between SG and RYGB.
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Affiliation(s)
- Khalid Akbari
- Oxford School of Surgery, Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN, UK.
| | - Robin Som
- Department of Upper GI and Minimal Access Surgery, King's College Hospital, London, UK
| | | | - Syed Hussain Abbas
- Oxford School of Surgery, Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN, UK
| | - James Ramus
- Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN, UK
| | - Greg Jones
- Royal Berkshire Hospital, Craven Road, Reading, RG1 5AN, UK
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26
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Alsumali A, Eguale T, Bairdain S, Samnaliev M. Cost-Effectiveness Analysis of Bariatric Surgery for Morbid Obesity. Obes Surg 2019; 28:2203-2214. [PMID: 29335933 DOI: 10.1007/s11695-017-3100-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND In the USA, three types of bariatric surgeries are widely performed, including laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic adjustable gastric banding (LAGB). However, few economic evaluations of bariatric surgery are published. There is also scarcity of studies focusing on the LSG alone. Therefore, this study is evaluating the cost-effectiveness of bariatric surgery using LRYGB, LAGB, and LSG as treatment for morbid obesity. METHODS A microsimulation model was developed over a lifetime horizon to simulate weight change, health consequences, and costs of bariatric surgery for morbid obesity. US health care prospective was used. A model was propagated based on a report from the first report of the American College of Surgeons. Incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained were used in the model. Model parameters were estimated from publicly available databases and published literature. RESULTS LRYGB was cost-effective with higher QALYs (17.07) and cost ($138,632) than LSG (16.56 QALYs; $138,925), LAGB (16.10 QALYs; $135,923), and no surgery (15.17 QALYs; $128,284). Sensitivity analysis showed initial cost of surgery and weight regain assumption were very sensitive to the variation in overall model parameters. Across patient groups, LRYGB remained the optimal bariatric technique, except that with morbid obesity 1 (BMI 35-39.9 kg/m2) patients, LSG was the optimal choice. CONCLUSION LRYGB is the optimal bariatric technique, being the most cost-effective compared to LSG, LAGB, and no surgery options for most subgroups. However, LSG was the most cost-effective choice when initial BMI ranged between 35 and 39.9 kg/m2.
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Affiliation(s)
- Adnan Alsumali
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, 02115, USA.
| | - Tewodros Eguale
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, 02115, USA.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Sigrid Bairdain
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Mihail Samnaliev
- Department of Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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The Comparative Effect of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on 10-Year and Lifetime Atherosclerotic Cardiovascular Disease Risk. Obes Surg 2019; 29:3111-3117. [DOI: 10.1007/s11695-019-03948-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Liu N, Cusack MC, Venkatesh M, Pontes AL, Shea G, Svoboda DC, Greenberg JA, Lidor AO, Funk LM. 30-Day Outcomes After Intraoperative Leak Testing for Bariatric Surgery Patients. J Surg Res 2019; 242:136-144. [PMID: 31077945 DOI: 10.1016/j.jss.2019.04.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 02/21/2019] [Accepted: 04/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intraoperative testing of anastomoses and staples lines is commonly performed to minimize the risk of postoperative leaks in bariatric surgery, but its impact is unclear. The aim of this study was to determine the association between leak testing and 30-d postoperative leak, bleed, reoperation, and readmission rates for patients undergoing laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB). METHODS This is a retrospective observational study utilizing 2015-2016 data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Postoperative outcomes were compared using χ2 test. Multivariable logistic regression was used to identify factors associated with 30-d outcomes. RESULTS We included 237,081 patients. Leak testing was performed on 73.0% and 92.1% of LSG and RYGB patients, respectively. LSG was associated with lower rates of leak, bleed, reoperation, and readmission than RYGB. On multivariable analysis, intraoperative leak testing was associated with increased rates of postoperative leak for LSG and RYGB (OR 1.48 and 1.90, respectively) and lower rates of bleed for LSG (OR 0.76). There were no significant associations between leak testing and rates of reoperation or readmission. CONCLUSIONS Use of intraoperative leak testing was not associated with improved outcomes for either LSG or RYGB. A prospective trial investigating leak testing is warranted to better elucidate its impact.
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Affiliation(s)
- Natalie Liu
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Meghan C Cusack
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Manasa Venkatesh
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Anisa L Pontes
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Grace Shea
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Dillon C Svoboda
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Anne O Lidor
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
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Khattab A, Sperling MA. Obesity in Adolescents and Youth: The Case for and against Bariatric Surgery. J Pediatr 2019; 207:18-22. [PMID: 30626484 DOI: 10.1016/j.jpeds.2018.11.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ahmed Khattab
- Division of Pediatric Endocrinology, Rutgers-Robert Wood Johnson Medical School, Child Health Institute of New Jersey, New Brunswick, NJ; Division of Pediatric Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark A Sperling
- Division of Pediatric Endocrinology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Gray KD, Moore MD, Bellorin O, Abelson JS, Dakin G, Zarnegar R, Pomp A, Afaneh C. Increased Metabolic Benefit for Obese, Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy. Obes Surg 2018; 28:636-642. [PMID: 28852955 DOI: 10.1007/s11695-017-2904-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients. MATERIALS AND METHODS Retrospective review was conducted of all patients age 60 years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014. RESULTS A total of 134 patients who underwent LSG (n = 65) or LRYGB (n = 69) were identified. Groups were similar with respect to age (64 years, range 60-75 years), BMI (44.0 ± 6.1), and ASA score (91% ≥ ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p = 0.75). Median follow-up was 39 months (IQR 14-64 months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p = 0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36 months was 26.9 ± 9.0% in the LSG group and 23.9 ± 9.3% in the LRYGB group, p = 0.24. CONCLUSIONS Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.
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Affiliation(s)
- Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Maureen D Moore
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Omar Bellorin
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Jonathan S Abelson
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Gregory Dakin
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Alfons Pomp
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA
| | - Cheguevara Afaneh
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 1300 York Ave. A1027, New York, NY, 10065, USA. .,, 525 E 68th St, Box 294, New York, NY, 10021, USA.
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Dong Z, Islam SMS, Yu AM, Qu R, Guan B, Zhang J, Hong Z, Wang C. Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis. BMC Surg 2018; 18:73. [PMID: 30223815 PMCID: PMC6142391 DOI: 10.1186/s12893-018-0406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis. METHODS We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis. RESULTS In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m2 to < 35 kg/m2 in Asia. CONCLUSIONS Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m2, and that LSG is the most commonly performed surgical procedure for this in Asia.
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Affiliation(s)
- Zhiyong Dong
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630 China
| | | | - Ashley M. Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rui Qu
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630 China
| | - Bingsheng Guan
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630 China
| | - Junchang Zhang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630 China
| | - Zhao Hong
- Robert H Lurie Medical Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 USA
| | - Cunchuang Wang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630 China
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Laparoscopic Roux-en-Y gastric bypass is as safe as laparoscopic sleeve gastrectomy. Results of a comparative cohort study. Ann Med Surg (Lond) 2018; 35:38-43. [PMID: 30275949 PMCID: PMC6161416 DOI: 10.1016/j.amsu.2018.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/19/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022] Open
Abstract
Background A meta-analysis and six randomized controlled trials show higher 30-day complication rates with laparoscopic Roux-en-Y gastric bypass (LRYGB) than with laparoscopic sleeve gastrectomy (LSG). Aim To identify any difference in 30-day outcomes of patients treated with LRYGB or LSG when a standardized technique and identical post-operative protocol was followed with all procedures being conducted either by or under the supervision of a single consultant surgeon who had significant experience in bariatric surgery prior to commencing independent practice. Methods A prospectively collected database of all patients under primary LRYGB or LSG, between March 2010 and February 2017, was analyzed. Data on demographics, length-of-stay (LOS), conversion to open, 30-day complications and mortality were reviewed. Results Over a seven-year period, 485 patients (LRYGB-279 and LSG-206) were included. There were no significant demographic differences and no difference in the pre-operative risk scoring [American Society of Anesthesiologists (ASA) and obesity surgery mortality risk score (OSMRS)] between the groups. There was no significant difference between the groups in terms of LOS (p = 0.275), complications (p = 0.920), re-admissions (p = 0.593) or re-operations (p = 0.366) within 30-days. There were no conversions to open or in-patient mortality in either group. Conclusions Unlike previous studies, we found no difference in early complication rates between LRYGB and LSG in a comparable cohort when performed by a surgeon with sufficient experience in bariatric surgery.
Low complication rates with both procedures. Most complications were minor (Clavien-Dindo ≤ IIIa). LRYGB is as safe as SG in the early post-operative period when performed by a surgeon with adequate experience. Bariatric fellowships play an important role in ensuring optimal outcomes.
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Goh GBB, Schauer PR, McCullough AJ. Considerations for bariatric surgery in patients with cirrhosis. World J Gastroenterol 2018; 24:3112-3119. [PMID: 30065557 PMCID: PMC6064959 DOI: 10.3748/wjg.v24.i28.3112] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/17/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease (NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery. Bariatric surgeons may encounter, either expectedly or unexpectedly, patients with non-alcoholic steatohepatitis (NASH) and NASH related cirrhosis more frequently. As such, the issues and considerations surrounding their medical care/surgery warrant careful deliberation to ensure the best outcomes. These considerations include severity of cirrhosis, liver synthetic function, portal hypertension and the impact of surgical factors. This review explores these considerations comprehensively and emphasizes the best approach to managing cirrhotic patients in the context of bariatric surgery.
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Affiliation(s)
- George Boon-Bee Goh
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169608, Singapore
- Duke-NUS Graduate Medical School, Singapore 169608, Singapore
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Arthur J McCullough
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH 44195, United States
- Department of Pathobiology, Cleveland Clinic, Cleveland, OH 44195, United States
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Hayoz C, Hermann T, Raptis DA, Brönnimann A, Peterli R, Zuber M. Comparison of metabolic outcomes in patients undergoing laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy - a systematic review and meta-analysis of randomised controlled trials. Swiss Med Wkly 2018; 148:w14633. [PMID: 30035801 DOI: 10.57187/smw.2018.14633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bariatric surgery is the most effective treatment for morbid obesity and is known to have beneficial effects on glycaemic control in patients with type 2 diabetes mellitus (T2DM) and in diabetes prevention. The preferred type of surgery and mechanism of action is, however, unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effects of laparoscopic roux-en-Y gastric bypass (RYGB) with those of sleeve gastrectomy (SG) on metabolic outcome, with a special focus on glycaemic control. METHODS A literature search of the Medline, Pubmed, Cochrane, Embase and SCOPUS databases was performed in November 2014 for RCTs comparing RYGB with SG in overweight and obese patients with or without T2DM. The primary outcome was improvement in postoperative glycaemic control. Secondary outcomes included weight-related and lipid metabolism parameters. Synthesis of these data followed established statistical procedures for meta-analysis. RESULTS Sixteen RCTs with a total of 1132 patients with overweight or obesity were included in the analysis. When compared with patients who underwent SG, those who underwent RYGB showed no difference after 12 months in mean fasting blood glucose (mean difference [MD] -6.22 mg/dl, 95% confidence interval [CI] -17.27 to 4.83; p <0.001). However, there was a better outcome with RYGB, with lower mean fasting glucose levels at 24 months (MD -16.92 mg/dl, 95% CI -21.67 to -12.18), 36 months (MD -5.97mg/dl, 95% CI -9.32 to -2.62) and at 52 months (MD -15.20 mg/dl, 95% CI -27.35 to -3.05) mg/dl; p = 0.010) and lower mean glycated haemoglobin (HbA1 at 12 months (MD -0.47%, 95% CI -0.73 to -0.20%; p <0.001) and at 36 months postoperatively compared to SG. Fasting insulin levels and HOMA indices showed no difference at any stage of follow-up. In the subgroup including only diabetic patients HbA1c showed lower levels at 12 months (MD -0.46%, 95% CI-0.73 to -0.20%). No difference was found for the fasting insulin at baseline and after 12 months. Similarly, when compared to SG, patients that underwent RYGB had lower low-density lipoproteins at 12 months. This effect was lost at 36 months. Patients undergoing RYGB also had lower triglycerides at 12 months and at 52 months, lower cholesterol at 60 months and an improvement of BMI at 52 months postoperatively. BMI values at 12 months and low-density lipoprotein levels at 12 and 36 months were lower for diabetic patients only, as in the overall analysis. CONCLUSION Based on this meta-analysis, RYGB is more effective than SG in improving weight loss and short- and mid-term glycaemic and lipid metabolism control in patients with and without T2DM. Therefore, unless contraindicated, RYGB should be the first choice to treat patients with obesity and T2DM and/or dyslipidaemia.
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Affiliation(s)
| | | | - Dimitri Aristotle Raptis
- Department of Surgery, Cantonal Hospital Olten, Switzerland / Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Alain Brönnimann
- Department of Anaesthesia and Intensive Care, Cantonal Hospital Olten, Switzerland
| | - Ralph Peterli
- Department of Surgery, St. Claraspital, Basel, Switzerland
| | - Markus Zuber
- Department of Surgery, Cantonal Hospital Olten, Switzerland
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Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico. Obes Surg 2018; 28:3474-3483. [PMID: 29915971 DOI: 10.1007/s11695-018-3357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Alsumali A, Al-Hawag A, Samnaliev M, Eguale T. Systematic assessment of decision analytic models for the cost-effectiveness of bariatric surgery for morbid obesity. Surg Obes Relat Dis 2018; 14:1041-1059. [PMID: 29735347 DOI: 10.1016/j.soard.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/18/2022]
Abstract
Bariatric surgery among patients with morbid obesity is very effective for providing long-term weight loss and remission of obesity-related co-morbidities. However, it is very expensive and its cost effectiveness is commonly argued. Long-term cost-effectiveness evaluations of bariatric surgery have often relied on decision models. A systematic review was performed on the methodologic approaches and their quality, evaluated the quality of reporting, and summarized findings and conclusions in published cost-effectiveness models of bariatric surgery for morbid obesity. A search from different databases with an end date of October 15, 2017 was completed. The initial search for title and abstract screening resulted in 741 articles. A total of 50 articles were included for full-text review and 23 economic evaluation studies were included in the systematic review. The reporting quality scores of most articles were rated as acceptable between 61% and 100%. Most studies (89%) were modeled for adult patients with age range between 25 and 75 years old. Sixty-one percent of studies defined their health states by the existence or absence of different obesity-related co-morbidities. Eleven percent of studies took the societal perspective. Most studies (61%) used a lifetime horizon. Thirty-nine percent of studies identified the extent of weight loss as the most sensitive and influential parameter. Seventeen (74%) did not report a formal model validation. Laparoscopic Roux-en-Y gastric bypass was reported as the most cost-effective strategy most often when it compared with no treatment or medical management. While most had acceptable quality of reporting levels, several gaps in the quality of reporting and quality of methods emerged, which led to recommendations for how to improve quality in future studies.
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Affiliation(s)
- Adnan Alsumali
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts.
| | - Ali Al-Hawag
- Department of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Mihail Samnaliev
- Department of Clinical Research Center, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Tewodros Eguale
- Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
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Casajoana A, Pujol J, Garcia A, Elvira J, Virgili N, de Oca FJ, Duran X, Fernández-Veledo S, Vendrell J, Vilarrasa N. Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication. Obes Surg 2018; 27:2235-2245. [PMID: 28451931 DOI: 10.1007/s11695-017-2669-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our aim was to determine the predictive value of gut hormone changes for the improvement of type 2 diabetes (T2D) following metabolic Roux-en-Y gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP) in a randomized controlled trial. Contradictory results have been obtained regarding the role of gastrointestinal hormones (in particular GLP-1) in beneficial metabolic bariatric surgery outcomes. METHODS Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and area under the curve (AUC) of GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after surgery. RESULTS Twelve months after surgery, total weight loss percentage was higher and HbA1c lower in the mRYGB group than in the SG and GCP groups (-35.2 ± 8.1 and 5.1 ± 0.6% vs. -27.8 ± 5.4 and 6.2 ± 0.8% vs. -20.5 ± 6.8 and 6.6 ± 1.3%; p = 0.007 and p < 0.001, respectively). Moreover, GLP-1 AUC at months 1 and 12 was greater and T2D remission was higher in mRYGB (80 vs. 53.3 vs. 20%, p < 0.001). Insulin treatment (odds ratio (OR) 0.025, p = 0.018) and the increase in GLP-1 AUC from baseline to month 1 (OR 1.021, p = 0.013) were associated with T2D remission. CONCLUSIONS mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.
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Affiliation(s)
- Anna Casajoana
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Jordi Pujol
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Amador Garcia
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Jordi Elvira
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Francisco Javier de Oca
- Colorectal Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Xavier Duran
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Fernández-Veledo
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Vendrell
- Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, c/Mallafre Guasch, 4, 43007, Tarragona, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain.
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Midterm outcomes of laparoscopic sleeve gastrectomy as a stand-alone procedure in super-obese patients. Surg Obes Relat Dis 2018; 14:297-303. [DOI: 10.1016/j.soard.2017.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 11/15/2017] [Accepted: 11/15/2017] [Indexed: 12/19/2022]
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Shen SC, Tsai CY, Liao CH, Liu YY, Yeh TS, Liu KH. Learning curve of laparoscopic Roux-en-Y gastric bypass in an Asian low-volume bariatric unit. Asian J Surg 2018; 41:170-175. [PMID: 28108085 DOI: 10.1016/j.asjsur.2016.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/13/2016] [Accepted: 11/14/2016] [Indexed: 02/06/2023] Open
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Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution. Obes Surg 2018; 26:1906-11. [PMID: 26712493 DOI: 10.1007/s11695-015-2033-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to compare the results and complications among obese veterans undergoing sleeve gastrectomy and gastric bypass at a low-volume center. MATERIALS AND METHODS This is a retrospective review of bariatric procedures performed by a single surgeon from 2009-2013. Outcomes of interest were mortality, complications, and length of stay. Weight loss and comorbidity resolution were compared between sleeve gastrectomy (SG) and Roux-y gastric bypass (RYGB). Length of stay and distance traveled to receive services were analyzed. Distributed groups were compared with Student's t test. Welch's correction was used where variances were unequal via ANOVA. Complications were compared using Fisher's exact test. RESULTS Eighty-five patients (SG = 51, RYGB = 34) were analyzed. Postoperatively, patients were seen in clinic, contacted by phone or email, and their electronic health care records were reviewed. Average length of follow-up was 114.3 weeks. Mortality was 0 %. Complication rates were comparable between groups. The percent total weight loss was 22.6 % for the SG and 27.5 % for the RYGB (p = 0.02). The percent excess weight loss was 49 % for SG and 55 % for RYGB (p = 0.149). Percent excess body mass index (BMI) loss was 54 and 61 % (p = 0.197) for SG and RYGB, respectively. Comorbidity resolution was similar between groups except for diabetes which was superior for RYGB (p = 0.03). Veterans lived an average of 141.3 miles from our VA, and all 85 patients were able to be contacted for follow-up. CONCLUSIONS Despite long travel distances for high-risk veterans, bariatric surgery can be performed safely even at a low-volume VA hospital with acceptable morbidity and mortality and excellent follow-up. There was no difference in morbidity or mortality between patients undergoing SG vs RYGB.
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Guner A, Cho M, Son T, Kim HI, Noh SH, Hyung WJ. Improved glycemic control with proximal intestinal bypass and weight loss following gastrectomy in non-obese diabetic gastric cancer patients. Oncotarget 2017; 8:104605-104614. [PMID: 29262665 PMCID: PMC5732831 DOI: 10.18632/oncotarget.22262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/23/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study was to assess whether gastrectomy influences glycemic control in non-obese diabetic gastric cancer patients and to identify factors related to glucose metabolism after gastrectomy. MATERIALS AND METHODS We retrospectively analyzed changes in glucose metabolism in 238 non-obese (body mass index < 30 kg/m2) patients with type II diabetes who underwent distal gastrectomy with either gastroduodenostomy (n = 91) or gastrojejunostomy (n = 147) for stage I gastric cancer. We collected demographics, diabetes-related features, surgery-related features, and changes in glucose metabolism during follow-up. The effect of surgery on the course of diabetes was evaluated at different time points according to fasting blood glucose levels and use of diabetes-related medication. RESULTS Preoperatively, the mean body mass index was 24.3 ± 2.3. Weight, body mass index and fasting blood glucose of all patients were significantly lower compared to preoperative levels at all time points. Weight loss after 6 months and the percentage of patients whose weight loss ratio was higher than 10% after one year were greater in the gastrojejunostomy group than the gastroduodenostomy group. Overall, 88 (37%) patients showed improvement in their diabetes course at one month after surgery; 152 (64%) showed improvement after 2 years. Duration of diabetes, weight loss, and reconstruction type were associated with improvement in diabetes at different time points. At 6 months and thereafter, the percentage of patients with an improved diabetes course was highest in the gastrojejunostomy plus higher than 10% weight loss group. CONCLUSIONS Although weight loss may be associated with adverse effects of gastrectomy, postoperative weight loss in an acceptable range is a useful measure of the better glycemic control for the group of diabetic patients. Selecting gastrojejunostomy during gastrectomy and inducing acceptable weight loss after gastrectomy could be beneficial to the non-obese diabetic gastric cancer patients for improved glycemic control.
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Affiliation(s)
- Ali Guner
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of General Surgery, Karadeniz Technical University College of Medicine, Farabi Hospital, Trabzon, Turkey
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
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Roux-En-Y Gastric Bypass Vs. Sleeve Gastrectomy: Balancing the Risks of Surgery with the Benefits of Weight Loss. Obes Surg 2017; 27:154-161. [PMID: 27342739 PMCID: PMC5187368 DOI: 10.1007/s11695-016-2265-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The purpose of the study was to compare weight loss, metabolic parameters, and postoperative complications in patients undergoing Roux-en-Y gastric bypass (GB) and sleeve gastrectomy (SG). Methods We retrospectively studied 30-day postoperative complications as well as change in weight, blood pressure, cholesterol, hemoglobin, hemoglobin A1C, and creatinine from baseline to 2, 6, 12, and 24 months postoperatively in 383 patients undergoing GB and 336 patients undergoing SG at the University of Michigan from January 2008 to November 2013. For a study population which typically has high attrition rates, there were excellent follow-up rates (706/719 at 2 months, 566/719 at 6 months, 519/719 at 12 months, and 382/719 at 24 months). Results Baseline characteristics were similar in both groups except for higher weight and BMI in the SG group. The GB group experienced greater total body weight loss at 6, 12, and 24 months (41.9 vs. 34.6 kg at 24 months, p < 0.0001). Excess weight loss was 69.7 and 51.7 % following GB and SG respectively at 24 months (p < 0.0001). BP improved significantly in both groups. Surgical complication rates were greater after GB (10.1 vs. 3.5 %, p = 0.0007) with no significant difference in life-threatening or potentially life-threatening complications. Conclusions Weight loss was greater following GB compared to SG at 2 years. The risk for surgical complications was greater following GB. Surgical intervention should be tailored to surgical risk, comorbidities, and desired weight loss. Electronic supplementary material The online version of this article (doi:10.1007/s11695-016-2265-2) contains supplementary material, which is available to authorized users.
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Surg Obes Relat Dis 2017; 12:1144-62. [PMID: 27568469 DOI: 10.1016/j.soard.2016.05.018] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI≥40 kg/m(2)) and in those with class II obesity (BMI 35.0-39.9 kg/m(2)) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m(2) if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m(2) for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO
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Abstract
Obesity is a worldwide epidemic, and those suffering from obesity have increased morbidity and mortality rates. There are various causes of obesity and many treatment options for patients suffering from obesity, including nonsurgical treatments. However, bariatric surgery is often the best choice for optimal weight loss and the attenuation of comorbidities. Currently, laparoscopic sleeve gastrectomy is the most common type of bariatric surgery in the United States due to its technical simplicity, feasibility, and overall positive outcomes. This article discusses bariatric surgical criteria and selection, expected perioperative course, potential complications after surgery, and nursing implications for the care of bariatric patients. A case report is used to exemplify stages of surgical care and follow-up treatment for patients who undergo laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Aura Petcu
- Aura Petcu is Nurse Practitioner, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code UHS 8W, Portland, OR 97239
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Ali M, El Chaar M, Ghiassi S, Rogers AM. American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis 2017; 13:1652-1657. [PMID: 29054173 DOI: 10.1016/j.soard.2017.08.007] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/08/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Mohamed Ali
- Department of Surgery, University of California-Davis Medical Center, Sacramento, California
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, Allentown, Pennsylvania
| | - Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Ann M Rogers
- Division of Minimally Invasive and Bariatric Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania.
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Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KGMM, Zimmet PZ, Del Prato S, Ji L, Sadikot SM, Herman WH, Amiel SA, Kaplan LM, Taroncher-Oldenburg G, Cummings DE. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: a Joint Statement by International Diabetes Organizations. Obes Surg 2017; 27:2-21. [PMID: 27957699 DOI: 10.1007/s11695-016-2457-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite growing evidence that bariatric/metabolic surgery powerfully improves type 2 diabetes (T2D), existing diabetes treatment algorithms do not include surgical options. AIM The 2nd Diabetes Surgery Summit (DSS-II), an international consensus conference, was convened in collaboration with leading diabetes organizations to develop global guidelines to inform clinicians and policymakers about benefits and limitations of metabolic surgery for T2D. METHODS A multidisciplinary group of 48 international clinicians/scholars (75% nonsurgeons), including representatives of leading diabetes organizations, participated in DSS-II. After evidence appraisal (MEDLINE [1 January 2005-30 September 2015]), three rounds of Delphi-like questionnaires were used to measure consensus for 32 data-based conclusions. These drafts were presented at the combined DSS-II and 3rd World Congress on Interventional Therapies for Type 2 Diabetes (London, U.K., 28-30 September 2015), where they were open to public comment by other professionals and amended face-to-face by the Expert Committee. RESULTS Given its role in metabolic regulation, the gastrointestinal tract constitutes a meaningful target to manage T2D. Numerous randomized clinical trials, albeit mostly short/midterm, demonstrate that metabolic surgery achieves excellent glycemic control and reduces cardiovascular risk factors. On the basis of such evidence, metabolic surgery should be recommended to treat T2D in patients with class III obesity (BMI ≥40 kg/m2) and in those with class II obesity (BMI 35.0-39.9 kg/m2) when hyperglycemia is inadequately controlled by lifestyle and optimal medical therapy. Surgery should also be considered for patients with T2D and BMI 30.0-34.9 kg/m2 if hyperglycemia is inadequately controlled despite optimal treatment with either oral or injectable medications. These BMI thresholds should be reduced by 2.5 kg/m2 for Asian patients. CONCLUSIONS Although additional studies are needed to further demonstrate long-term benefits, there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with T2D and obesity. To date, the DSS-II guidelines have been formally endorsed by 45 worldwide medical and scientific societies. Health care regulators should introduce appropriate reimbursement policies.
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Affiliation(s)
| | | | - Robert H Eckel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Osland E, Yunus RM, Khan S, Alodat T, Memon B, Memon MA. Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review. Obes Surg 2017; 26:2273-84. [PMID: 26894908 DOI: 10.1007/s11695-016-2101-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures. METHODS RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures. RESULTS Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures. CONCLUSIONS This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.
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Affiliation(s)
- Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | | | - Shahjahan Khan
- School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, QLD, Australia
| | - Tareq Alodat
- Department of Basic Science, King Saud University, Riyadh, Saudi Arabia
| | - Breda Memon
- Sunnybank Obesity Centre and South East Queensland Surgery (SEQS), Suite 9, McCullough Centre, 259 McCullough Street, Sunnybank, QLD, Australia
| | - Muhammed Ashraf Memon
- School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba, QLD, Australia.
- Sunnybank Obesity Centre and South East Queensland Surgery (SEQS), Suite 9, McCullough Centre, 259 McCullough Street, Sunnybank, QLD, Australia.
- Mayne Medical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.
- Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK.
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van der Wielen N, Paulus G, van Avesaat M, Masclee A, Meijerink J, Bouvy N. Effect of Endoscopic Gastroplication on the Genome-Wide Transcriptome in the Upper Gastrointestinal Tract. Obes Surg 2017; 27:740-748. [PMID: 27620343 PMCID: PMC5306242 DOI: 10.1007/s11695-016-2356-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bariatric surgery is an effective intervention strategy in obesity, resulting in sustained weight loss and a reduction of comorbidities. Gastroplication, using the articulating circular endoscopic stapler, was recently introduced as a transoral bariatric technique. This procedure reduces gastric volume and induced 34.9 % of excess weight loss in the first year (Paulus et al. Gastrointest Endosc. 81(2):312-20, 3). The aim of the present study was to gain insight in the long-term effects and underlying mechanisms of gastroplication by investigating differences in the genome-wide gastric and duodenal transcriptome before and 1 year after intervention. METHODS Ten morbidly obese patients (BMI 39.8 ± 0.9 kg/m2 (mean ± SEM)) underwent gastroplication. Previous to the procedure and after 1 year, blood samples were taken, and mucosal biopsies were collected from the fundus, antrum and duodenum. Gene expression was measured using microarray analysis. Plasma adiponectin, HbA1c, IL-1β, IL-6, IL-7, TNF-α, IFN-γ, MCP-1, IL-8, TGF-1 and CRP levels were determined. RESULTS Downregulation of inflammatory genes and gene sets was observed in the fundus and duodenum 1 year after surgery. Gene expression of ghrelin and its activating enzyme GOAT were downregulated in the upper gastrointestinal tract. Patients showed a reduction in plasma HbA1c levels (from 6.17 ± 0.51 to 5.32 ± 0.14 %, p = 0.004) and an increase of plasma adiponectin (from 16.87 ± 3.67 to 27.67 ± 5.92 μg/ml, p = 0.002). CONCLUSIONS Individuals undergoing gastroplication displayed a downregulation of inflammatory tone in the stomach and duodenum, which coincided with improved HbA1c and adiponectin levels. The reduction of inflammatory tone in the upper gastrointestinal tract may be a consequence of an improved metabolic health status or alternatively caused by the procedure itself.
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Affiliation(s)
- Nikkie van der Wielen
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Givan Paulus
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mark van Avesaat
- Top Institute Food and Nutrition, Wageningen, The Netherlands
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht, University Medical Center, Maastricht, The Netherlands
| | - Ad Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM, Maastricht, University Medical Center, Maastricht, The Netherlands
| | - Jocelijn Meijerink
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
| | - Nicole Bouvy
- Department of General Surgery, NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
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50
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Abstract
Most metabolic effects following bariatric surgery are favorable. One area in which the consequences seem to be detrimental is on skeletal health. Mechanisms that have been cited include malabsorption of calcium and vitamin D, decrease in mechanical loading, and changes in gastrointestinal and fat-derived hormone levels. It is important that the impact of these procedures on bone metabolism is closely examined. The significance of the bone loss that occurs, and its possible effect on future fracture risk, should also be evaluated.
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Affiliation(s)
- Naina Sinha Gregory
- Division of Endocrinology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, 211 East 80th Street, New York, NY 10075, USA.
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