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Cuva D, Parikh M, Brown A, Somoza E, Saunders JK, Park J, Lipman J, Einersen P, Chui P. BE-CALM: a clinical score to predict weight loss after conversion from sleeve gastrectomy to Roux-en-Y gastric bypass. Surg Endosc 2025; 39:1050-1055. [PMID: 39681676 DOI: 10.1007/s00464-024-11460-z] [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: 08/19/2024] [Accepted: 12/01/2024] [Indexed: 12/18/2024]
Abstract
BACKGROUND Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be indicated for patients due to insufficient weight loss or weight regain. OBJECTIVES To assess weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients. SETTING University Hospital. METHODS Retrospective review of patients who underwent conversion from SG to RYGB from 2015 to 2022 was performed, assessing pre-and post-operative weights for each procedure. RESULTS 114 patients were included (84% female, pre-SG BMI 49.3 ± 10.2). Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6-58.2] ± 10.1%), %EWL of 56.8%([13.3-97.3] ± 16.4%), and total body weight regain of 53.9%([0.0-144.4] ± 31.3%). Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, leveling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m2 increase yielded 0.8% greater %TBWL [95% CI 0.5-1%, p < 0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9-7.1%, p < 0.0001). Conversely, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5-5.7%, p < 0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB. CONCLUSIONS Conversion from SG to RYGB is effective for further weight loss. Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after SG demonstrate the most effective weight loss post-conversion.
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Affiliation(s)
- Dylan Cuva
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Manish Parikh
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Avery Brown
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA.
| | - Eduardo Somoza
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - John K Saunders
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Julia Park
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Jeffrey Lipman
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Peter Einersen
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
| | - Patricia Chui
- Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA
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Cornejo J, Zevallos A, Sarmiento J, Shojaeian F, Mokhtari-Esbuie F, Adrales G, Li C, Sebastian R. Increased staple line leak rates following re-sleeve: analysis comparing re-sleeve versus Roux-en-Y gastric bypass conversion and primary sleeve gastrectomy. Surg Endosc 2024; 38:5368-5376. [PMID: 39037465 DOI: 10.1007/s00464-024-11046-9] [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: 04/20/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Sleeve gastrectomy is the most common bariatric procedure and its long-term complications include inadequate weight loss, weight regain, and de novo GERD, often requiring revisional surgery. Revisions, notably re-sleeve and conversion to Roux-en-Y gastric bypass (RYGB), are frequently performed, but safety data is limited. Herein, we used the MBSAQIP database to compare 30 day outcomes of primary sleeve gastrectomy (SG) with re-sleeve (RS) and SG to RYGB conversion. METHODS Patients who underwent primary SG, RS, and SG to RYGB conversion within the MBSAQIP data registry from January 1, 2020 to December 31, 2022 were included in this study. Using Propensity Score Matching analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30 day postoperative outcomes and bariatric-specific complications between primary SG and RS (analysis 1) and between RS and SG to RYGB conversion (analysis 2). RESULTS A total of 302,961 were included. The matched cohorts in analysis 1 (n = 1630) and analysis 2 (n = 1633) had similar pre-operative characteristics. Propensity-matched outcomes in analysis 1 showed that patients in the RS group had significantly higher staple line leak (1.3% vs. 0.1%, p < 0.001) when compared to primary SG. Similarly, longer operative times (90.16 ± 51.90 min vs. 68.32 ± 37.54 min, p < 0.001) and higher rates of readmissions (5.5% vs. 2.1%, p < 0.001), reoperations (2.3% vs. 0.6%, p < 0.001), interventions (2.5% vs. 0.4%, p < 0.001) were found in those who underwent RS. In analysis 2, RS showed higher leak rates (1.3% vs. 0.5%, p = 0.015) when compared to conversion from SG to RYGB. CONCLUSION The RS group has a higher risk of staple line leaks compared to primary SG and conversion from SG to RYGB. In our study, there was a 2.6-fold increase in staple line leak after re-sleeve compared to RYGB conversion and a 13-fold increase compared to primary SG.
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Affiliation(s)
- Jorge Cornejo
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Alba Zevallos
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Joaquin Sarmiento
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Fatemeh Shojaeian
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Gina Adrales
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Christina Li
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Raul Sebastian
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA.
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Parmar C, Abi Mosleh K, Aeschbacher P, Halfdanarson TR, McKenzie TJ, Rosenthal RJ, Ghanem OM. The feasibility and outcomes of metabolic and bariatric surgery prior to neoplastic therapy. Surg Obes Relat Dis 2024; 20:717-728. [PMID: 38594091 DOI: 10.1016/j.soard.2024.02.008] [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: 11/09/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is a potent intervention for addressing obesity-related medical conditions and achieving sustainable weight loss. Beyond its conventional role, MBS has demonstrated potential to serve as a transitional step for patients requiring various interventions. However, the implications of MBS in the context of neoplasia remain understudied. OBJECTIVES To explore the feasibility of MBS as a possible attempt to reduce surgical and treatment risks in patients with benign tumors or low-grade cancers. SETTING Multicenter review from twelve tertiary referral centers spanning 8 countries. METHODS A retrospective review of patients with a diagnosis of primary neoplasia, deemed inoperable or high-risk due to obesity, and receiving primary MBS prior to neoplastic therapy. Data encompassed baseline characteristics, neoplasia characteristics, MBS outcomes, and neoplastic therapy outcomes. RESULTS Thirty-seven patients (median age 52 years, 75.7% female, median BMI of 49.1 kg/m2) were included. There were 9 distinct organs of origin of primary neoplasia, with the endometrium (43.2%) being the most common, followed by the pancreas, colon, kidney and breast. Sleeve gastrectomy (SG) was the most commonly performed MBS procedure (78.4%), with no MBS-related complications or mortalities reported over an average of 4.3 ± 3.9 years. Thirty-one patients (83.8%) eventually underwent neoplastic surgery, with a mean BMI decrease from 49.9 kg/m2 to 39.7 kg/m2 at surgery over an average of 5.8 ± 4.8 months. There were 2 (6.7%) documented mortalities associated with neoplastic surgical intervention. CONCLUSIONS This study highlights the potential feasibility of employing MBS prior to neoplastic therapy in patients with low-grade, less aggressive neoplasms in the context of obesity. This underscores the importance of providing a personalized, case-to-case multidisciplinary approach in the management of these patients.
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Affiliation(s)
- Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK; University College London, London, UK
| | | | - Pauline Aeschbacher
- Department of General Surgery and Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | | | | | - Raul J Rosenthal
- Department of General Surgery, Bariatric and Metabolic Institute, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Deffain A, Denis R, Pescarus R, Garneau PY, Atlas H, Studer AS. Single Anastomosis Duodeno-Ileal bypass (SADI-S) as Primary or Two-Stage Surgery: Mid-Term Outcomes of a Single Canadian Bariatric Center. Obes Surg 2024; 34:1207-1216. [PMID: 38363495 DOI: 10.1007/s11695-024-07095-7] [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: 11/08/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Compare primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) and two-stage SADI after sleeve gastrectomy (SG) in terms of weight loss, reduction/remission of comorbidities, and morbidity. METHODS Retrospective study including 179 patients treated laparoscopically between 2016 and 2020. A 50Fr bougie was used for the SG in the primary SADI-S (group 1) and 36/40Fr for the two-stage procedure (group 2). The duodeno-ileal anastomosis was performed at 250 cm from the ileocecal valve and at least 2 cm after the pylorus. RESULTS Mean age was 44.1 years old, and there were 148 women and 31 men. There were 67 (37.4%) patients in group 1 and 112 (62.6%) in group 2, with 67% completing the 4-year follow-up. Mean preoperative body mass index (BMI) was 51.1 kg/m2 and 44.6 kg/m2 for groups 1 and 2, respectively. Preoperative comorbidities were obstructive sleep apnea, hypertension, type 2 diabetes, and dyslipidemia in 103 (57.5%), 93 (52%), 65 (36.3%), and 58 (32.4%) of cases. At 4 years postoperatively, excess weight loss (EWL) was 67.5% in group 1 and 67% in group 2 (p = 0.1005). Both groups had good comorbidity remission rates. Early postoperative morbidity rate was 10.4% in group 1 and 3.6% in group 2. In group1, there were mostly postoperative intra-abdominal hematomas managed conservatively (n = 4). Two revisional surgeries were needed for duodeno-ileal anastomosis leaks. Postoperative gastroesophageal reflux disease (GERD), daily diarrhea, vitamin, and protein levels were similar in both groups. CONCLUSION Both types of strategies are efficient at short and mid-term outcomes. Preoperative criteria will inform surgeon decision between a primary and a two-stage strategy.
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Affiliation(s)
- Alexis Deffain
- Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada.
| | - Ronald Denis
- Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada
| | - Radu Pescarus
- Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada
| | - Pierre Y Garneau
- Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada
| | - Henri Atlas
- Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada
| | - Anne-Sophie Studer
- Department of Bariatric, Robotic and Minimally Invasive Surgery, CIUSSS Nord-de-L'Ile-de-Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin Ouest Montréal, Québec, H4J 1C5, Canada
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Nakanishi H, Mosleh KA, Al-Kordi M, Farsi S, Chaudhry S, Marrero K, Scott Davis S, Kermansaravi M, Parmar C, Clapp B, Ghanem OM. One Anastomosis Gastric Bypass as Revisional Surgery Following Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:429-441. [PMID: 38198098 DOI: 10.1007/s11695-024-07056-0] [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: 10/30/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Although sleeve gastrectomy (SG) is the most performed metabolic and bariatric surgery (MBS) worldwide, some patients require conversional procedures due to weight recurrence or late complications. Recently, one-anastomosis gastric bypass (OAGB) gained popularity as a viable option to address those problems. The aim of this meta-analysis is to assess the safety and efficacy of conversional OAGB after primary SG in the management of patients with obesity. METHODS Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to February 2023 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42023403528). RESULTS From 1,117 studies screened, twenty studies met the eligibility criteria, with a total of 1,057 patients with obesity undergoing conversional OAGB after primary SG. The mean age ranged from 28.2 to 49.5 years, and 744 patients (75.2%) were women. At one year after revisional OAGB, the pooled mean percent excess weight loss (%EWL) was 65.2% (95%CI: 56.9, 73.4, I2 = 97%). The pooled mean %EWL after conversional OAGB was 71.1% (95%CI: 62.2, 80.0, I2 = 90%) at two years and 71.6% (95%CI: 61.0, 82.2, I2 = 50%) at five years. Additionally, resolution rates of diabetes and hypertension were 65.4% (95%CI: 0.522, 0.785, I2 = 65%) and 58.9% (95%CI: 0.415, 0.762, I2 = 89%), respectively. CONCLUSIONS Our meta-analysis demonstrated OAGB as an effective conversional procedure after primary SG in terms of weight loss and obesity-associated medical problems for selected patients. Despite the promising results, further randomized controlled studies with larger sample sizes and more extended follow-up periods are necessary to determine if the OAGB is the best conversional surgery after SG.
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Affiliation(s)
- Hayato Nakanishi
- St George's University of London, London, SW17 0RE, UK
- University of Nicosia Medical School, University of Nicosia, 2417, Nicosia, Cyprus
| | | | | | - Soroush Farsi
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Shahrukh Chaudhry
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL, USA
| | - S Scott Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital NHS Trust, London, UK
- University College London, London, UK
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
- Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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O'Laughlin M, Cornejo J, Zevallos A, Coker A, Schweitzer M, Adrales G, Li C, Sebastian R. Laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass conversion versus primary Roux-en-Y gastric bypass: a propensity score matching analysis. Surg Endosc 2023; 37:7947-7954. [PMID: 37433912 DOI: 10.1007/s00464-023-10261-0] [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: 04/04/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Secondary bariatric surgery rates have increased, accounting for approximately 19% of the total bariatric cases in the last years, most commonly conversion of sleeve gastrectomy to gastric bypass. Using the MBSAQIP, we evaluate the outcomes of this procedure compared to the primary RYGB surgery. METHODS The new variable, conversion of sleeve gastrectomy to RYGB in the 2020 and 2021 MBSAQIP database was analyzed. Patients who underwent primary laparoscopic RYGB and those who underwent laparoscopic sleeve gastrectomy to RYGB conversion were identified. Using Propensity Score Matching analysis, the cohorts were matched for 21 preoperative characteristics. We then compared 30-day outcomes and bariatric-specific complications between primary RYGB and conversion from sleeve gastrectomy to RYGB. RESULTS There were 43,253 primary RYGB procedures performed and 6,833 conversions from sleeve gastrectomy to RYGB. The matched cohorts (n = 5912) for the two groups have similar pre-operative characteristics. Propensity-matched outcomes showed that conversion from sleeve gastrectomy to RYGB was associated with more readmissions (6.9% vs 5.0%, p < 0.001), interventions (2.6% vs 1.7%, p < 0.001), conversion to open (0.7% vs 0.2%, p < 0.001), length of stay (1.79 ± 1.77 days vs 1.62 ± 1.66 days, p < 0.001), and operative time (119.16 ± 56.82 min vs 138.27 ± 66.00, p < 0.001). There were no significant differences in mortality (0.1% vs 0.1%, p = 0.405), and bariatric-specific complications such as anastomotic leak (0.5% vs 0.4%, p = 0.585), intestinal obstruction (0.1% vs 0.2%, p = 0.808), internal hernia (0.2% vs 0.1%, p = 0.285) or anastomotic ulcer (0.3% vs 0.3%, p = 0.731) rates. CONCLUSION Conversion from sleeve gastrectomy to RYGB is a safe and feasible operation with reasonable outcomes compared with primary RYGB.
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Affiliation(s)
- Michael O'Laughlin
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Jorge Cornejo
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Alba Zevallos
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Alisa Coker
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Gina Adrales
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Christina Li
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Raul Sebastian
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA.
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Saux P, Bauvin P, Raverdy V, Teigny J, Verkindt H, Soumphonphakdy T, Debert M, Jacobs A, Jacobs D, Monpellier V, Lee PC, Lim CH, Andersson-Assarsson JC, Carlsson L, Svensson PA, Galtier F, Dezfoulian G, Moldovanu M, Andrieux S, Couster J, Lepage M, Lembo E, Verrastro O, Robert M, Salminen P, Mingrone G, Peterli R, Cohen RV, Zerrweck C, Nocca D, Le Roux CW, Caiazzo R, Preux P, Pattou F. Development and validation of an interpretable machine learning-based calculator for predicting 5-year weight trajectories after bariatric surgery: a multinational retrospective cohort SOPHIA study. Lancet Digit Health 2023; 5:e692-e702. [PMID: 37652841 DOI: 10.1016/s2589-7500(23)00135-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/04/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Weight loss trajectories after bariatric surgery vary widely between individuals, and predicting weight loss before the operation remains challenging. We aimed to develop a model using machine learning to provide individual preoperative prediction of 5-year weight loss trajectories after surgery. METHODS In this multinational retrospective observational study we enrolled adult participants (aged ≥18 years) from ten prospective cohorts (including ABOS [NCT01129297], BAREVAL [NCT02310178], the Swedish Obese Subjects study, and a large cohort from the Dutch Obesity Clinic [Nederlandse Obesitas Kliniek]) and two randomised trials (SleevePass [NCT00793143] and SM-BOSS [NCT00356213]) in Europe, the Americas, and Asia, with a 5 year follow-up after Roux-en-Y gastric bypass, sleeve gastrectomy, or gastric band. Patients with a previous history of bariatric surgery or large delays between scheduled and actual visits were excluded. The training cohort comprised patients from two centres in France (ABOS and BAREVAL). The primary outcome was BMI at 5 years. A model was developed using least absolute shrinkage and selection operator to select variables and the classification and regression trees algorithm to build interpretable regression trees. The performances of the model were assessed through the median absolute deviation (MAD) and root mean squared error (RMSE) of BMI. FINDINGS 10 231 patients from 12 centres in ten countries were included in the analysis, corresponding to 30 602 patient-years. Among participants in all 12 cohorts, 7701 (75·3%) were female, 2530 (24·7%) were male. Among 434 baseline attributes available in the training cohort, seven variables were selected: height, weight, intervention type, age, diabetes status, diabetes duration, and smoking status. At 5 years, across external testing cohorts the overall mean MAD BMI was 2·8 kg/m2 (95% CI 2·6-3·0) and mean RMSE BMI was 4·7 kg/m2 (4·4-5·0), and the mean difference between predicted and observed BMI was -0·3 kg/m2 (SD 4·7). This model is incorporated in an easy to use and interpretable web-based prediction tool to help inform clinical decision before surgery. INTERPRETATION We developed a machine learning-based model, which is internationally validated, for predicting individual 5-year weight loss trajectories after three common bariatric interventions. FUNDING SOPHIA Innovative Medicines Initiative 2 Joint Undertaking, supported by the EU's Horizon 2020 research and innovation programme, the European Federation of Pharmaceutical Industries and Associations, Type 1 Diabetes Exchange, and the Juvenile Diabetes Research Foundation and Obesity Action Coalition; Métropole Européenne de Lille; Agence Nationale de la Recherche; Institut national de recherche en sciences et technologies du numérique through the Artificial Intelligence chair Apprenf; Université de Lille Nord Europe's I-SITE EXPAND as part of the Bandits For Health project; Laboratoire d'excellence European Genomic Institute for Diabetes; Soutien aux Travaux Interdisciplinaires, Multi-établissements et Exploratoires programme by Conseil Régional Hauts-de-France (volet partenarial phase 2, project PERSO-SURG).
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Affiliation(s)
- Patrick Saux
- Université de Lille, Inria, CNRS, Centrale Lille, UMR 9189 - CRIStAL, France
| | - Pierre Bauvin
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1190-EGID, Lille, France
| | - Violeta Raverdy
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1190-EGID, Lille, France
| | - Julien Teigny
- Université de Lille, Inria, CNRS, Centrale Lille, UMR 9189 - CRIStAL, France
| | - Hélène Verkindt
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1190-EGID, Lille, France
| | - Tomy Soumphonphakdy
- Université de Lille, Inria, CNRS, Centrale Lille, UMR 9189 - CRIStAL, France
| | - Maxence Debert
- Université de Lille, Inria, CNRS, Centrale Lille, UMR 9189 - CRIStAL, France
| | - Anne Jacobs
- Nederlandse Obesitas Kliniek, Huis Ter Heide, Netherlands
| | - Daan Jacobs
- Nederlandse Obesitas Kliniek, Huis Ter Heide, Netherlands
| | | | - Phong Ching Lee
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Division of Surgery, Singapore General Hospital, Singapore
| | - Johanna C Andersson-Assarsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lena Carlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Per-Arne Svensson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Florence Galtier
- Endocrinology Department, CHU de Montpellier, University of Montpellier, Montpellier, France; Clinical Investigation Center 1411, INSERM, CHU de Montpellier, University of Montpellier, Montpellier, France
| | | | | | | | - Julien Couster
- Centre Hospitalier Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Marie Lepage
- Centre Hospitalier Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Erminia Lembo
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Ornella Verrastro
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Maud Robert
- Department of Digestive Surgery, Center of Bariatric Surgery, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland; Department of Surgery, University of Turku, Turku, Finland
| | - Geltrude Mingrone
- Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Ralph Peterli
- University of Basle, Basle, Switzerland; Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital Basle, Basle, Switzerland
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Carlos Zerrweck
- Clínica Integral de Cirugía para la Obesidad y Enfermedades Metabólicas, Hospital General Tláhuac, Mexico City, Mexico
| | - David Nocca
- Department of Digestive Surgery, CHU de Montpellier, University of Montpellier, Montpellier, France
| | | | - Robert Caiazzo
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1190-EGID, Lille, France
| | - Philippe Preux
- Université de Lille, CNRS, Inria, Centrale Lille, UMR 9189 - CRIStAL, Lille, France.
| | - François Pattou
- Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1190-EGID, Lille, France.
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8
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Pérez Corzo HJ, Verboonen Sotelo JS, Romero Manzano J, Salgado Salas RE, Esparza I. Laparoscopic Sleeve Gastrectomy (LSG) in a Patient With Situs Inversus Totalis (SIT): A Case Report. Cureus 2023; 15:e40873. [PMID: 37492846 PMCID: PMC10363578 DOI: 10.7759/cureus.40873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Obesity is associated with several preventable health issues, such as diabetes mellitus and hypertension. Bariatric surgery has shown potential in treating obesity. Laparoscopic sleeve gastrectomy (LSG) is one of several bariatric surgical techniques gaining popularity as a primary procedure. Situs inversus totalis (SIT) is an uncommon hereditary abnormality that can present challenges in laparoscopic surgery due to the mirror-image anatomy. We present the case of a 54-year-old female with a body mass index (BMI) of 54.36 kg/m2. She was diagnosed with SIT and had no other known diseases, medication use, or allergies. We performed a conventional LSG, modifying the original trocar port positions to match the anatomy. LSG is a safe and effective procedure for patients with SIT. Preoperative diagnosis can help reduce the risk of complications by facilitating proper surgical planning.
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Affiliation(s)
| | | | | | | | - Isaac Esparza
- Bariatric Surgery, Obesity Goodbye Center, Tijuana, MEX
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9
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Hany M, Torensma B, Zidan A, Agayby ASS, Ibrahim M, Shafie ME, Sayed IE. Comparison of Sleeve Volume Between Banded and Non-banded Sleeve Gastrectomy: Midterm Effect on Weight and Food Tolerance-a Retrospective Study. Obes Surg 2023; 33:406-417. [PMID: 36508154 PMCID: PMC9889434 DOI: 10.1007/s11695-022-06404-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sleeve dilatation after laparoscopic sleeve gastrectomy (LSG) causes weight regain (WR). Banded sleeve gastrectomy (BSG) was proposed to prevent dilatation and reduce WR. METHODS A retrospective cohort study on patients who underwent BSG and LSG and completed 4 years of follow-up from 2016 to 2021 was included. Body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), and FT scores were calculated at 1, 2, 3, and 4 years. The sleeve volume was estimated at 6 months, 1 year, and 4 years. Multi-variate analysis was conducted to assess correlations between covariates. WR was calculated as weight gain > 10%, > 10 kg above the nadir, or BMI increase of ≥ 5 kg/m 2 above the nadir. RESULTS This study included LSG 1279 patients and BSG 132 patients. Mean %EWL at 1 year was 83.87 ± 17.25% in LSG vs. 85.71 ± 7.92% in BSG and was 83.47 ± 18.87% in LSG and 85.54 ± 7.48% in BSG at 4 years. Both had significant weight loss over time (p. < 0.001) with no significant main effect of surgery (p.0.438). Mean sleeve volume at 6 months was 102.32 ± 9.88 ± 10.28 ml in LSG vs. 101.89 ± 10.019 ml in BSG and at 4 years was 580.25 ± 112.25 ml in LSG vs. 157.94 ± 12.54 ml in BSG (p. < 0.001). WR occurred in 136 (10.6%) and 4 (3.1%) (p.0.002) in LSG and BSG patients, 90 (7%) vs. zero (0%) (p.0.002) and 31 (2.4%) vs. zero (0%) (p.0.07) using the > 10%, > 10 kg increase above the nadir and the ≥ 5 kg/m 2 BMI increases above the nadir formulas, respectively. CONCLUSION BSG had significantly lower sleeve volume, significantly lower WR, and significantly lower FT scores than LSG after 4 years from surgery; however, volume changes were not correlated with weight loss.
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Affiliation(s)
- Mohamed Hany
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt ,Consultant of Bariatric Surgery at Madina Women’s Hospital (IFSO Center of Excellence), Alexandria, Egypt
| | - Bart Torensma
- grid.10419.3d0000000089452978Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ahmed Zidan
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt
| | - Ann Samy Shafiq Agayby
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt
| | - Mohamed Ibrahim
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt
| | - Mohamed El Shafie
- grid.7155.60000 0001 2260 6941Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Iman El Sayed
- grid.7155.60000 0001 2260 6941Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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10
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Mahdy T, Gado W, Emile S. Single Anastomosis Sleeve Ileal (SASI) Bipartition. OBESITY, BARIATRIC AND METABOLIC SURGERY 2023:867-881. [DOI: 10.1007/978-3-030-60596-4_98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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11
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Plamper A, Lingohr P, Nadal J, Trebicka J, Brol MJ, Woestemeier A, Schmitz SMT, Alizai PH, Neumann UP, Ulmer TF, Rheinwalt KP. A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg 2023; 27:47-55. [PMID: 36376721 PMCID: PMC9877051 DOI: 10.1007/s11605-022-05515-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) has become increasingly accepted in bariatric surgery and meanwhile represents the third most common procedure worldwide. While it shows promising weight loss results and comorbidity resolution, questions about issues such as reflux or nutritional deficiencies (ND) persist in the long term. On the other hand, the most frequently performed sleeve gastrectomy (SG) has to accept growing criticism regarding long-term results and reflux issues. There is a particular lack of long-term comparative data for both procedures. This study presents our long-term experience. METHODS We evaluated OAGB and SG patients retrospectively comparing for weight loss and resolution of comorbidities as well as perioperative and long-term complications in a follow-up period of 5 years. RESULTS Nine hundred eleven OAGB and 241 SG were included in the study. OAGB had a shorter operation time and hospital stay. Overall complication rate did not differ in both groups. Ulcers were more frequent in OAGB (7.7% vs. 1.7%, p = 0.001), whereas insufficient weight loss (IWL)/weight regain (WR) proved to be more prevalent in SG (25.7% vs. 6.4%, p < 0.001). The same held true for reflux (17.8% vs. 8.3%, p < .001). On the other hand, ND were more common in OAGB (20.0% vs. 12.0%, p = 0.005). Revisional surgery was more often indicated after SG. Analysis by linear mixed model showed that OAGB achieved a lower BMI/higher loss of BMI. Improvement of T2DM (94.6% vs. 85.2%, p = 0.008) and sleep apnea (88.8% vs. 78.8%, p = 0.01) was superior in OAGB. CONCLUSIONS OAGB had a superior effect on weight loss as well as improvement of T2DM and sleep apnea. Furthermore, long-term problems such as IWL/WR and reflux were more related to SG. On the other hand, a malabsorptive procedure such as OAGB showed a higher risk for ND. Our findings support the available data in the literature.
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Affiliation(s)
- Andreas Plamper
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Philipp Lingohr
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jennifer Nadal
- grid.15090.3d0000 0000 8786 803XInstitute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Jonel Trebicka
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Maximilian J. Brol
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Anna Woestemeier
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sophia M.-T. Schmitz
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick H. Alizai
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P. Neumann
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom F. Ulmer
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Karl P. Rheinwalt
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
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12
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Muacevic A, Adler JR, Alghamdi H, S. AlOtaibi A, Alshareef K, Alzahrani KM. Quality of Life and Body Mass Index Changes Three Years After Laparoscopic Sleeve Gastrectomy in Taif City, Saudi Arabia. Cureus 2022; 14:e32754. [PMID: 36686102 PMCID: PMC9851730 DOI: 10.7759/cureus.32754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Background Obesity has become a major global health challenge, and its prevalence has tripled in the last four decades. Impaired quality of life (QoL) is a strong incentive for severely obese patients to seek help. Sleeve gastrectomy (SG) is the most frequently practiced bariatric procedure worldwide. This study aimed to investigate the QoL and changes in body weight three years post laparoscopic SG. Methods A cross-sectional, observational study was performed in outpatient clinics in Taif city, Saudi Arabia. The study included 147 adult patients who underwent SG at least three years before inclusion in the study. Data were collected using a questionnaire designed based on the validated Bariatric quality of life (BQL) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQoL) surveys. Results All patients were suffering from class I, class II, or class III obesity before undergoing SG. Three years post-surgery, 72.8% reached their normal weight or were overweight (P<0.001). The mean± SD BMI (45± 7.0 kg/m2) significantly decreased to 26.8± 4.6 kg/m2 (P<0.001). Most of the participants (78.2%) achieved an excess weight loss percent (EWL%) of 75% or more. The mean± SD BQL score was 45.5± 5.2 points and the median (IQR) GERD-HRQoL score was 7 (15). Higher EWL% was significantly associated with a higher BQL score (P=0.041). Conclusions The current study revealed a better quality of life among patients experiencing higher rates of excess weight loss percent (EWL%) after three years of sleeve gastrectomy as compared to other patients.
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13
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Poddar E, Shrestha S, Pathak N, Khadka DS, Poudel D, Khadayat R, Pandey S, Ranjan R, Khanal S, Koirala DP. Sleeve gastrectomy for multiple gastric perforations in a preterm: A case report. Clin Case Rep 2022; 10:e6541. [PMID: 36439389 PMCID: PMC9684683 DOI: 10.1002/ccr3.6541] [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: 05/30/2022] [Revised: 09/25/2022] [Accepted: 10/15/2022] [Indexed: 11/27/2022] Open
Abstract
Neonatal gastric perforation (NGP) is a rare life-threatening condition among preterm infants. NGP can occur secondary to necrotizing enterocolitis, distal obstruction, or as a result of gastric tube insertion. Sleeve gastrectomy can be a possible therapeutic option for multiple neonatal gastric perforations.
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Affiliation(s)
- Elisha Poddar
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Suraj Shrestha
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Niharika Pathak
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | | | - Diptee Poudel
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Ramesh Khadayat
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Shailendra Pandey
- Department of Critical Care MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Ritika Ranjan
- Maharajgunj Medical CampusInstitute of MedicineKathmanduNepal
| | - Surendra Khanal
- Department of Critical Care MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Dinesh Prasad Koirala
- Department of General SurgeryPediatric Surgery UnitTribhuvan University Teaching HospitalKathmanduNepal
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14
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Indja B, Chan DL, Talbot ML. Hiatal reconstruction is safe and effective for control of reflux after laparoscopic sleeve gastrectomy. BMC Surg 2022; 22:347. [PMID: 36131312 PMCID: PMC9490990 DOI: 10.1186/s12893-022-01800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gastroesophageal reflux is a known complication following laparoscopic sleeve gastrectomy (LSG) as anatomical changes predispose to reduced lower esophageal sphincter pressure and development of hiatus hernia. The mainstay of surgical management has been Roux-en-Y gastric bypass (RYGB) which is not without risk. Hiatus hernia repair (HHR) with surgical reattachment of the oesophagus to the crura, recreating the phreno-esophageal ligament is a simple procedure specifically targeting a number of anatomical changes responsible for reflux in this population. Methods We conducted a single centre retrospective analysis of adult patients with post-sleeve reflux refractory to medical treatment, managed with either HHR, RYGB or One-anastomosis Duodenal switch (OADS). PPI use and symptoms of reflux were assessed at early and mid-term time points via validated questionnaires.
Results 99 patients were included, of these the surgical procedure was HHR alone in 58, RYGB in 29 and OADS in 12. At early follow-up control of reflux symptoms was achieved in 72.4% after HHR, 82.1% after RYGB and 100% after OADS with no significant difference between groups (p = 0.09). At mid-term followup (median 10 months IQR 7–21) there was no significant difference in the presence of symptomatic reflux as determined by post-op Visick score nor a difference in PPI use. The GerdQ score was significantly lower after OADS as compared to HHR and RYGB (4.6 ± 2.3 vs 7.7 ± 2.2 vs 8.7 ± 3.5, p = 0.006). Conclusion HHR with reconstruction of the phreno-esophageal ligament is a safe and effective procedure for patients with reflux after LSG, that avoids more complex operations such as RYGB and OADS and their associated long-term sequelae.
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Affiliation(s)
- Ben Indja
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,Department of Surgery, St George Hospital, Sydney, NSW, Australia. .,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia.
| | - Daniel L Chan
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia.,Department of Surgery, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.,Upper GI Surgery, St George Private Hospital, Suite 3, Level 5, 1 South, Sydney, NSW, 2217, Australia
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15
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How safe is adolescent bariatric surgery? An analysis of short-term outcomes. J Pediatr Surg 2022; 57:1654-1659. [PMID: 34593239 DOI: 10.1016/j.jpedsurg.2021.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of childhood obesity in the U.S. has tripled over the last three decades. However, fewer than 1% of children with severe obesity undergo surgical weight loss interventions each year. MATERIALS AND METHODS All patients age 10 to 19 years old who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2015 through 2018 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database were included in this retrospective cohort analysis. The primary outcomes were mortality and overall complications. Procedural trends, readmission and reoperation rates were also examined using a multivariate regression model. RESULTS Patients had a mean BMI of 47.3 kg/m2 and 80.0% were either 18 or 19 years old (n = 4,051). There were two reported deaths. Reoperation within 30 days occurred in 1.1% of patients, readmission in 3.5%, and complications in 1.2%. Among all readmissions, primary reasons included nausea/vomiting or nutritional depletion (41.3%) and abdominal pain (16.3%). RYGB was associated with higher odds for readmission (p = 0.006) and complications (p = 0.005). Higher BMI and younger age were not associated with an increased likelihood to experience poorer outcomes. The proportion of patients undergoing SG increased yearly over RYGB from 73.9% in 2015 to 84.3% in 2018. CONCLUSIONS Bariatric surgery appears to be low risk for adolescents and SG has become the operation of choice. More research on early consideration of surgical therapy in adolescents with severe obesity is needed given the safety profile. LEVEL OF EVIDENCE III.
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16
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Amirbeigi A, Abbaslou F, Elyasinia F. Laparoscopic sleeve gastrectomy in a patient with Situs Inversus Totalis: A case report and literature review. Ann Med Surg (Lond) 2022; 79:104101. [PMID: 35860141 PMCID: PMC9289484 DOI: 10.1016/j.amsu.2022.104101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/25/2022] [Accepted: 06/25/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction & Importance: Laparoscopic sleeve gastrectomy (LSG) is a widely accepted and effective bariatric surgery for achieving weight loss in patients with extreme obesity. Performing this surgical procedure in patients with congenital anatomical changes including situs inversus (SI) is a challenge for the surgical team. In this condition, the orientation of intra-abdominal organs is the mirror image of those in normal populations. Case presentation Herein, we present a 29-year-old female with situs inversus totalis who successfully underwent an LSG surgery with proper weight loss post-operatively and no early and late complications. Clinical discussion By reviewing the literature for patients with SI undergoing the same procedure, all patients achieved significant weight loss. Three out of nineteen cases experienced complications which were controlled without significant morbidity or mortality. Conclusion: we concluded that LSG will be a safe and effective surgery for the treatment of extreme obesity in SI patients, if the condition is diagnosed preoperatively.
Performing laparoscopic sleeve gastrectomy (LSG) in patients with situs inversus (SI) is a challenge for the surgical team. SI should be diagnosed prior to surgery to avoid prolonged surgery and lack of expertise. LSG will be a safe and effective surgery for the treatment of extreme obesity in SI patients.
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Affiliation(s)
- Alireza Amirbeigi
- Department of General Surgery, School of Medicine, Kerman University of Medical, Iran
- Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
- Corresponding author. Shahid Bahonar Hospital, Department of General Surgery, School of Medicine, Kerman University of Medical Sciences, Qaraney St, Kerman, 7613747181, Iran.
| | - Fereshteh Abbaslou
- Department of Obstetrics and Gynecology, Mirza Kuchekkhan Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fezzeh Elyasinia
- Department of General Surgery, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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17
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Sewefy AM, Atyia AM, Mohammed MM, Kayed TH, Hamza HM. Single anastomosis sleeve jejunal (SAS-J) bypass as a treatment for morbid obesity, technique and review of 1986 cases and 6 Years follow-up. Retrospective cohort. Int J Surg 2022; 102:106662. [PMID: 35568310 DOI: 10.1016/j.ijsu.2022.106662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/16/2022] [Accepted: 05/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Santoro's operation is a sleeve gastrectomy with transit bipartition. The operation aims to maintain passage to the duodenum to minimize nutritional deficiency. This procedure is rapidly changed to single anastomosis sleeve ileal (SASI) bypass. SAS-J bypass is a modification of SASI with a short biliary limb. MATERIAL AND METHODS This study is a retrospective study of prospectively collected data. The study includes a comprehensive review of 1986 patients who underwent SAS-J bypass over 6 years. The total number is used to evaluate the perioperative data. One- and two-year follow-up was used to evaluate weight loss and comorbidities; follow-up of more than 5 years was used to obtain long-term results. RESULTS In this study, 70.4% of patients were female and 29.6% were male. The mean body mass index (BMI) was 44.7. The mean age was 42 years. Regarding comorbidities, 25.8% of the patients had type 2 diabetes, 31% were hypertensive, 14.2% had sleep apnea syndrome, 6.6% had gastroesophageal reflux disease (GERD), and 39.6% had hyperlipidemia. Of the 1294 patients who complete one-year follow up, %EWL reached 87%. Blood glucose levels were normalized in 98.5% of patients, hypertension remitted in 93%, hyperlipidemia improved in 97%, SAS is improved in all cases, and GERD improved in 89% of patients. After 5 years, 94 patients' BMI decreased from 44.3 to 28.3 without significant nutritional deficiency. CONCLUSIONS Laparoscopic SAS-J bypass is an effective and simple alternative bariatric procedure at short- and long-term follow-up.
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Affiliation(s)
- Alaa M Sewefy
- Department of Surgery, Minia University Hospital, Egypt.
| | - Ahmed M Atyia
- Department of Surgery, Minia University Hospital, Egypt
| | | | - Taha H Kayed
- Department of Surgery, Minia University Hospital, Egypt
| | - Hosam M Hamza
- Department of Surgery, Minia University Hospital, Egypt
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18
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El Ansari W, Elhag W. Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study. Metab Syndr Relat Disord 2022; 20:360-366. [PMID: 35506900 DOI: 10.1089/met.2021.0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. Materials and Methods: We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample t-tests compared the observed and predicted BMI at 1 year. Results: The model comprised preoperative BMI (β = 0.757, P = 0.026) + age (β = 0.142, P < 0.0001) with adjusted R2 of 0.581 (P < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m2) +0.106 × age (years). For validation, the equation exhibited an adjusted R2 0.550 (P < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m2, P = 0.225). Conclusions: This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
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19
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Elmahdy TM, Elsherpiny WY, Barakat HB. Laparoscopic one anastomosis gastric bypass: A revisional Procedure For Failed Laparoscopic Sleeve Gastrectomy. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tamer M. Elmahdy
- Gastrointestinal and laparoscopic Surgery Unit, General Surgery Department Faculty of Medicine, Tanta University
| | - Waleed Y. Elsherpiny
- Gastrointestinal and laparoscopic Surgery Unit, General Surgery Department Faculty of Medicine, Tanta University
| | - Hossam B. Barakat
- Gastrointestinal and laparoscopic Surgery Unit, General Surgery Department Faculty of Medicine, Tanta University
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Souza MDGD, Silva LB, Ferraz ÁAB, Campos JM. ARE THERE BENEFITS IN PERFORMING GASTRO-OMENTOPEXY IN LAPAROSCOPIC VERTICAL GASTRECTOMY? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1598. [PMID: 35019118 PMCID: PMC8735264 DOI: 10.1590/0102-672020210003e1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/20/2021] [Indexed: 11/29/2022]
Abstract
Background:
Gastro-omentopexy promotes the reconnection of the stomach to the gastroesplenic and gastrocolic ligaments and constitutes an alternative for the prevention of complications in laparoscopic vertical gastrectomy.
Aim:
To demonstrate the benefits of the gastro-omentopexy technique in patients undergoing sleeve gastrectomy, with possible reduction in postoperative complications.
Methods:
Prospective, non-randomized, case series type study, consisting of a clinical population of 179 patients who underwent the technique in 2018, with follow-up between 6-12 months in the postoperative period.
Results:
From the participants 71.5% were women, aged between 30-40 years (36.3%). As for the prevalence of complications in the postoperative period, the low prevalence was evident, with emphasis on readmission (1.1%); reoperation (1.1%); wound infection (1.1%); bleeding hemorrhage (0.5%); and stricture (1.1%). However, temporary symptoms were present such as nausea/vomiting, food intolerance, epigastric pain and feeling of fullness, right after surgery.
Conclusion:
The technique promoted a significant improvement in quality of life and control of comorbidities. In addition, it was associated with a low prevalence of stenosis, and with no fistula, making the method safer.
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Affiliation(s)
- Maíra Danielle Gomes de Souza
- Postgraduate Program in Surgery, Department of Clinical Medicine, Faculty of Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, PE, Brazil
| | - Lyz Bezerra Silva
- Postgraduate Program in Surgery, Department of Clinical Medicine, Faculty of Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, PE, Brazil
| | - Álvaro A B Ferraz
- Postgraduate Program in Surgery, Department of Clinical Medicine, Faculty of Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, PE, Brazil
| | - Josemberg Marins Campos
- Postgraduate Program in Surgery, Department of Clinical Medicine, Faculty of Medicine, Center for Medical Sciences, Federal University of Pernambuco, Recife, PE, Brazil
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21
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Khan IA, K AA, Asghar M, Abbas K. Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy in Morbidly Obese and Super Obese Patients. Cureus 2021; 13:e20767. [PMID: 35111452 PMCID: PMC8794445 DOI: 10.7759/cureus.20767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/05/2022] Open
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22
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Almussallam B, Alqahtani SM, Abdo N, Maghraoui W, Fawaz M, Hachani A, Soliman SD, Elsayed M, Alsareii SA. Laparoscopic Sleeve Gastrectomy in a Patient With Situs Inversus Totalis and Kartagener Syndrome. Cureus 2021; 13:e17155. [PMID: 34532185 PMCID: PMC8435210 DOI: 10.7759/cureus.17155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 01/07/2023] Open
Abstract
Laparoscopic sleeve gastrectomy (LSG) is a widely accepted and adopted procedure to achieves weight loss in morbid obesity. Situs inversus (SI) is when the body's visceral organs are not in the normal position with reversal of anatomical orientation. Patients with obesity and SI can be challenging to diagnose and manage. We present a case of a 23-year-old male who has SI totalis with Kartagener syndrome who underwent LSG to treat morbid obesity. Furthermore, we conducted a comprehensive review of the current medical literature. We conclude that LSG can be safely performed in SI. However, it is recommended to leave such cases to more experienced surgeons. In addition, it is advisable to consider few unconventional technical operative methods before surgery. Nevertheless, more data are needed to better study LSG in SI patients, which can be difficult given the rare nature of SI.
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Affiliation(s)
- Basem Almussallam
- Department of Surgery, McMaster University, Hamilton, CAN.,Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
| | - Saad M Alqahtani
- Department of Surgery, College of Medicine, Majmaah University, Majmaah, SAU
| | - Nael Abdo
- Department of General and Bariatric Surgery, National Medical Complex (NMC) Najran Hospital, Najran, SAU
| | - Walid Maghraoui
- Department of Cardiology, National Medical Complex (NMC) Najran Hospital, Najran, SAU
| | - Mohammad Fawaz
- Department of General and Bariatric Surgery, National Medical Complex (NMC) Najran Hospital, Najran, SAU
| | - Asma Hachani
- Department of Internal Medicine/Critical Care, National Medical Complex (NMC) Najran Hospital, Najran, SAU
| | - Sally D Soliman
- Department of Internal Medicine and Pulmonology, Alexandria Police Hospital, Alexandria, EGY
| | - Mohamad Elsayed
- Department of Anaesthesia, National Medical Complex (NMC) Najran Hospital, Najran, SAU
| | - Saeed A Alsareii
- Department of Surgery, College of Medicine, Najran University, Najran, SAU
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23
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Elmaleh HM, Elnabeel Mortada A, Khaled RA. Evaluation of Anterior Phrenoesophageal Ligament Preservation During Hiatus Hernia Repair in Laparoscopic Sleeve Gastrectomy as an Anti-Reflux Measure. J Laparoendosc Adv Surg Tech A 2021; 31:507-514. [PMID: 33595363 DOI: 10.1089/lap.2021.0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure, but it had been reported to increase the incidence of gastroesophageal reflux disease (GERD) and its consequences. Some surgeons tried to decrease that by routine hiatal dissection with hiatus hernia (HH) repair. But, hiatal dissection with HH repair is considered an important risk factor for the newly emergent complication of intrathoracic sleeve migration (ITSM). We proposed a new hiatal repair technique, which is expected to improve GERD without increasing the potential for ITSM. This study aims to evaluate the results of this technique. Methods: A prospective observational study was performed at the Ain Shams University Hospital between January 2016 and December 2019. It included patients with morbid obesity and one of the following: Clinical manifestations of GERD with endoscopic evidence of HH/laxity or esophagitis. Asymptomatic HH/laxity. LSG combined and HH repair with anterior phrenoesophageal ligament (PEL) preservation was performed for all patients. Patients were followed up for 12 months. Patients were evaluated after 1 year with an upper gastrointestinal (GI) endoscopy. Results: Thirty-two patients were enrolled in our study. After 1 year, the mean excess weight loss was 63% ± 23%. The mean GERD health-related quality of life (GERD-HRQL) score dropped to 12 ± 8. GERD-HRQL scores improved in 25 of documented esophagitis patients, worsened in 2, and did not change in 2 patients. Endoscopy showed a decrease in rate and degree of esophagitis (from 28 [87.5%] preoperatively to 8 [25%] patients after 1 year of follow-up). The improvement was better in patients with grade A and B esophagitis. Two patients were converted to gastric bypass due to persistent intractable GERD symptoms with grade C esophagitis despite medical treatment. No cases of ITSM were detected. Conclusion: Anterior PEL preserving HH repair combined with LSG is a safe and feasible technique that can control GERD manifestations without interference with the technique or outcome of LSG.
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Affiliation(s)
- Haitham Mostafa Elmaleh
- Bariatric Surgery Unit, General Surgery Department, Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Ahmed Elnabeel Mortada
- Bariatric Surgery Unit, General Surgery Department, Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
| | - Rabbah Abdellateef Khaled
- Bariatric Surgery Unit, General Surgery Department, Faculty of Medicine, Ain Shams University Hospitals, Cairo, Egypt
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24
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Ramai D, Singh J, Lester J, Khan SR, Chandan S, Tartaglia N, Ambrosi A, Serviddio G, Facciorusso A. Systematic review with meta-analysis: bariatric surgery reduces the incidence of hepatocellular carcinoma. Aliment Pharmacol Ther 2021; 53:977-984. [PMID: 33721336 DOI: 10.1111/apt.16335] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 03/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Obesity is a risk factor for non-alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery. AIM To determine whether bariatric surgery reduces the risk of HCC. METHODS We performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random-effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI). RESULTS Nine studies (two abstracts and seven full texts) were included for meta-analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28-0.57) which favoured bariatric surgery, though with high heterogeneity (I2 : 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53-0.75) with moderate heterogeneity (I2 : 38%). The pooled rate/1000 person-years was 0.05 (95% CI: 0.02-0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20-0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18-0.42). CONCLUSION Bariatric surgery is associated with a decreased risk of HCC.
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Affiliation(s)
- Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Northwell Health, Port Jefferson, NY, USA
| | - Janice Lester
- Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Nicola Tartaglia
- General Surgery Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Ambrosi
- General Surgery Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Serviddio
- Hepatology Unit, Centro C.U.R.E., Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
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25
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Jamialahmadi T, Nematy M, Bo S, Ponzo V, Jangjoo A, Goshayeshi L, Tasbandi A, Nikiforov NG, Sahebkar A. Associations between Pre-Bariatric High-Sensitivity C-Reactive Protein and Post-Surgery Outcomes. Diagnostics (Basel) 2021; 11:721. [PMID: 33919641 PMCID: PMC8073671 DOI: 10.3390/diagnostics11040721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obesity is a chronic inflammatory condition associated with increased circulating levels of C-reactive protein (CRP). Bariatric surgery has been reported to be effective in improving both inflammatory and liver status. Our aims were to elucidate the relationships between pre-surgery high sensitivity-CRP (hs-CRP) values and post-surgery weight loss and liver steatosis and fibrosis in patients with severe obesity undergoing Roux-en-Y gastric bypass. METHODS We conducted an observational prospective study on 90 individuals with morbid obesity, who underwent gastric bypass. Anthropometric indices, laboratory assessment (lipid panel, glycemic status, liver enzymes, and hs-CRP), liver stiffness and steatosis were evaluated at baseline and 6-months after surgery. RESULTS There was a significant post-surgery reduction in all the anthropometric variables, with an average weight loss of 33.93 ± 11.79 kg; the mean percentage of total weight loss (TWL) was 27.96 ± 6.43%. Liver elasticity was significantly reduced (from 6.1 ± 1.25 to 5.42 ± 1.52 kPa; p = 0.002), as well as liver aminotransferases, nonalcoholic fatty liver disease fibrosis score (NFS) and the grade of steatosis. Serum hs-CRP levels significantly reduced (from 9.26 ± 8.45 to 3.29 ± 4.41 mg/L; p < 0.001). The correlations between hs-CRP levels and liver fibrosis (elastography), steatosis (ultrasonography), fibrosis-4 index, NFS, and surgery success rate were not significant. Regression analyses showed that serum hs-CRP levels were not predictive of liver status and success rate after surgery in both unadjusted and adjusted models. CONCLUSIONS In patients with morbid obesity, bariatric surgery caused a significant decrease in hs-CRP levels, liver stiffness and steatosis. Baseline hs-CRP values did not predict the weight-loss success rate and post-surgery liver status.
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Affiliation(s)
- Tannaz Jamialahmadi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Mohsen Nematy
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Simona Bo
- Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Torino, Italy
| | - Valentina Ponzo
- Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, 10126 Torino, Italy
| | - Ali Jangjoo
- Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
- Gastroenterology and Hepatology Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Aida Tasbandi
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
| | - Nikita G. Nikiforov
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Institute of Human Morphology, 3 Tsyurupa Street, 117418 Moscow, Russia
- Laboratory of Medical Genetics, Institute of Experimental Cardiology, National Medical Research Center of Cardiology, 121552 Moscow, Russia
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 91779-48564, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 91779-48954, Iran
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad P.O. Box 91779-48564, Iran
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Abstract
BACKGROUND The Montpellier bariatric team has recently proposed some technical alternatives to decrease the rate of gastroesophageal reflux disease (GERD) after bariatric surgery and also to offer patients an alternative in case of contraindication to Roux-en-Y gastric bypass (RYGBP): the Nissen-Sleeve (N-Sleeve). OBJECTIVES We present here the results from a cohort of patients that underwent an operation with this newly designed anti-reflux bariatric procedure N-Sleeve: Nissen valve added to a standard SG. METHODS Data from a prospective, observational, and monocentric cohort. All consecutive patients presenting to the bariatric surgery department for a laparoscopic sleeve gastrectomy between 2016 and 2018 with GERD were included in the study. The fundus was stapled with a margin from the valve, and the valve was created with tissue at a distance from the greater curvature so as to avoid a double layer stapling of the stomach. RESULTS A total of 70 patients were included in the study. Ninety percent of the cohort presented with a hiatal hernia at the time of surgery. No mortality was observed during the follow-up period. Concerning GERD, 76% of all patients had preoperative esophageal syndromes, whereas 21% were asymptomatic with associated esophagitis. Grade A-C esophagitis was present in 99% of the cohort, but no Barrett's esophagus was present. Fifty-six (80%) patients used PPIs regularly. At 1 year of follow-up, one patient was still symptomatic. CONCLUSIONS Comparative trials remain necessary between N-Sleeve and standard bariatric procedures to refine the specific indications of each of them and determine the eventual role of the N-Sleeve.
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Jaruvongvanich V, Wongjarupong N, Vantanasiri K, Samakkarnthai P, Ungprasert P. Midterm Outcome of Laparoscopic Sleeve Gastrectomy in Asians: a Systematic Review and Meta-analysis. Obes Surg 2021; 30:1459-1467. [PMID: 31865553 DOI: 10.1007/s11695-019-04332-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a commonly performed bariatric surgery. Studies have suggested that LSG can provide effective and sustainable weight loss although most of them were conducted in Western populations. Our aim was to characterize the midterm outcome of LSG in Asians with obesity. METHODS MEDLINE and EMBASE were searched through August 2019 for studies that reported % total body weight loss (TBWL) and/or % excess weight loss (EWL) at 3 and/or 5 years among adult Asians with obesity who underwent LSG. Data on complications and surgical revision rate were also extracted. The pooled effect size and 95% confidence interval (CI) were calculated using a random effects model. RESULTS A total of 19 studies involving 6235 patients were included. The pooled mean %EWLs were 72.6% (95% CI 67.2-78.0, I2 = 97%); 67.1% (95% CI 61.7-72.6, I2 = 95%); and 59.1% (95% CI 48.8-69.4, I2 = 94%) at 1, 3, and 5 years, respectively. The pooled mean %TBWLs were 32.1%, 29.0%, and 25.5% at 1, 3, and 5 years, respectively. The pooled rates of revision due to gastroesophageal reflux disease and weight regain were 1.9% and 2.5%, respectively. CONCLUSIONS Our meta-analysis suggests that LSG is an effective procedure for weight reduction that offers durable response for up to 5 years among Asians with obesity. The longer-term data is needed.
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Affiliation(s)
| | - Nicha Wongjarupong
- Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
| | | | - Parinya Samakkarnthai
- Division of Endocrinology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Patompong Ungprasert
- Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sun D, Schaff HV, Nishimura RA, Geske JB, Dearani JA, Lahr BD, Ommen SR. Impact of Body Mass Index on Outcome of Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy. Ann Thorac Surg 2021; 113:519-526. [PMID: 33774005 DOI: 10.1016/j.athoracsur.2021.03.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/19/2021] [Accepted: 03/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Obesity is highly prevalent in patients with obstructive hypertrophic cardiomyopathy (HCM). In this study, we investigated the impact of body mass index (BMI) in patients undergoing septal myectomy (SM) for obstructive HCM. METHODS We reviewed 2,746 patients who underwent transaortic SM for obstructive HCM from February 1993 through September 2018. Patients were stratified into 3 groups based on BMI (normal weight < 25 kg/m2, overweight 25 to < 30 kg/m2, and obese ≥ 30 kg/m2). RESULTS Preoperatively, median left ventricular outflow tract (LVOT) gradient was 58 mmHg, and there was no difference in gradients across BMI strata (P=0.35). Obese patients had lower percentage with moderate or greater mitral valve regurgitation (45.8%) compared to normal (52.9%) and overweight (55.4%) patients (P<0.001). However, patients with higher BMI were more likely to have New York Heart Association class III/IV limitation at presentation (P<0.001). After myectomy, both anteroseptal thickness (P=0.115) and LVOT gradient (P=0.210) did not differ between groups. There were 14 (0.5%) deaths < 30 days postoperatively and the risk was similar across BMI strata (P=0.448). Model-estimated changes in average BMI at 10 years post procedure showed stratum-specific increases ranging from 0.60 to 1.56 kg/m2. During a median (IQR) follow-up of 7.2 (3.2-13.3) years, higher BMI was associated with reduced survival after adjusting for baseline covariates (P=0.001). CONCLUSIONS Septal myectomy is safe and effective in HCM patients with obesity, but risk of late mortality increased with increasing BMI. Attention to risk factor management through weight loss may improve late results after SM.
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Affiliation(s)
- Daokun Sun
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Brian D Lahr
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Hospitalizations and emergency department visits in heart failure patients after bariatric surgery. Surg Obes Relat Dis 2020; 17:489-497. [PMID: 33376053 DOI: 10.1016/j.soard.2020.11.014] [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: 08/22/2020] [Revised: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Heart failure is a disease with significant healthcare utilization and a prioritized target for readmission prevention. Although obesity is related to heart failure morbidity, the effects of bariatric surgery in obese patients with heart failure are not well studied. OBJECTIVES To evaluate the impact of bariatric surgery on hospital-based healthcare utilization for patients with heart failure. SETTING Administrative statewide database. METHODS The New York Statewide Planning and Research Cooperative System database was used to identify patients with obesity and heart failure who underwent bariatric surgery from 2005 to 2015. Emergency department (ED) visits and hospitalization records from 1 year presurgery and up to 2 years postsurgery were compared. RESULTS Our study identified 899 patients with heart failure who underwent bariatric surgery. In the year presurgery, 11.48% of patients had any ED visit or hospitalization with a primary diagnosis of heart failure. The rate decreased drastically in the first year after surgery, with only 3.70% of patients having any heart failure-related hospital visits. The rate of heart failure-related visits was also lower in the second year postsurgery (3.44%) compared with the year before surgery. The risk of heart failure-related hospital visits was lower in both the first year (odds ratio [OR], .29; 95% confidence interval [CI], .19-.43) and second year postsurgery (OR, .26; 95% CI, .17-.41; P < .0001) than in the year before surgery. CONCLUSIONS These findings suggest that bariatric interventions might be associated with decreased risks of ED visits or hospitalizations due to heart failure exacerbations in obese patients with preexisting heart failure.
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30
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Beavers KM, Greene KA, Yu EW. MANAGEMENT OF ENDOCRINE DISEASE: Bone complications of bariatric surgery: updates on sleeve gastrectomy, fractures, and interventions. Eur J Endocrinol 2020; 183:R119-R132. [PMID: 32869608 PMCID: PMC8254876 DOI: 10.1530/eje-20-0548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elaine W. Yu
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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31
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Miller-Matero LR, Hecht L, Patel S, Martens KM, Hamann A, Carlin AM. The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery. Surg Obes Relat Dis 2020; 17:384-389. [PMID: 33082073 DOI: 10.1016/j.soard.2020.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING Single bariatric center. METHODS Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Leah Hecht
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Shivali Patel
- Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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The outcomes of single anastomosis sleeve jejunal bypass as a treatment for morbid obesity (Two-year follow-up). Surg Endosc 2020; 35:5698-5704. [PMID: 32989534 DOI: 10.1007/s00464-020-08029-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 09/16/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Santoro's operation is a sleeve gastrectomy with transit bipartition. The aim of the procedure is to keep pass to the duodenum to decrease nutritional deficiency and to allow endoscopic management of obstructive jaundice. To be easier, this procedure was rapidly altered to a single anastomosis sleeve ileal bypass (SASI). In this study, we shifted the anastomosis up to the jejunum to evaluate the effect of laparoscopic single anastomosis sleeve jejunal (SASJ) bypass as a treatment for morbid obesity and related comorbidities. In addition, the effect of the SASJ procedure on nutritional deficiency was examined. METHODS In this study, 150 morbidly obese patients underwent SASJ bypass with a biliary limb length of 200-250 cm. All patients were followed up at 1, 3, 6, 12, 18, and 24 months. We evaluated all cases by assessing BMI, complications, nutritional status, and obesity-related comorbidities. RESULTS The mean age of participants was 30.6 years, and the mean body mass index (BMI) was 44.6 kg/m2. Of the patients, 35 (23.2%) had type two diabetes and 47 (31.3%) were hypertensive. Postoperative bleeding occurred in two cases (1.3%). One patient developed a gastric leak (0.7%), and five patients developed biliary gastritis (3.3%). One patient (0.7%) developed a pulmonary embolism. The %EWL reached 85% in 1 year. Normalization of blood glucose occurred within 2 months after surgery in all diabetic patients. Hypertension underwent remittance in 89% of hypertensive patients. All patients were gradually weaned from four types of multivitamin regimens to only one multivitamin regimen without apparent nutritional deficiency. CONCLUSIONS Laparoscopic SASJ bypass is an effective, safe, and simple procedure for treating morbid obesity and comorbid conditions with least nutritional deficiency. However, long-term studies are needed.
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McCarty TR, Sharma P, Lange A, Ngu JN, Davis A, Njei B. Safety of Bariatric Surgery in Morbidly Obese Patients with Human Immunodeficiency Virus: A Nationwide Inpatient Sample Analysis, 2004-2014. Bariatr Surg Pract Patient Care 2020; 15:116-123. [PMID: 32939330 DOI: 10.1089/bari.2019.0065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Despite rising rates of obesity among human immunodeficiency virus (HIV)-positive individuals, the safety and tolerability of surgery in this population have not been established. The primary aim of this study was to examine the safety of bariatric surgery and rate of in-hospital postoperative complications in morbidly obese patients with HIV. Materials and Methods: The U.S. Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with codiagnoses of morbid obesity and bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospitalization costs, and multiple categories of complications, including systemic complications, surgical complications, and nutritional and behavioral complications. Results: Among 267,082 patients with discharge diagnoses of morbid obesity and bariatric surgery, 346 (0.13%) were diagnosed with HIV. On multivariable analysis, HIV did not influence in-hospital mortality (p = 0.530). HIV was not associated with increased risk of renal failure (p = 0.274), thromboembolism (p = 0.713), myocardial infarction (p = 0.635), sepsis (p = 0.757), hemorrhage (p = 0.303), or wound infection (p = 0.229). Other measured surgical complications were not significantly different (p > 0.05). Notably, HIV-positive patients had an increased risk for postoperative pneumonia (p = 0.002), pancreatitis (p = 0.049), and thiamine deficiency (p = 0.016). Conclusion: Bariatric surgery among HIV-positive patients appears to be acceptably safe with the risk of postoperative complications comparable with non-HIV patients.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Prabin Sharma
- Department of Gastroenterology and Hepatology, Yale New Haven Health-Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Andrew Lange
- Department of Gastroenterology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Julius N Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashley Davis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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Relation of Gastric Volume With Weight Loss After Sleeve Gastrectomy: Results of a Prospective Analysis. Surg Laparosc Endosc Percutan Tech 2020; 30:489-494. [PMID: 32694406 DOI: 10.1097/sle.0000000000000825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative sleeve volume (SV) is a key factor in evaluating the results of laparoscopic sleeve gastrectomy (LSG). An objective measurement of SV was obtained with 3-dimensional computed tomographic (3DCT) reconstruction. Several studies have compared SV with percent excess weight loss (%EWL), identifying an inverse relationship. We hypothesized that gastric capacity is one of the factors responsible for weight loss after LSG. OBJECTIVES Outcomes of the study were the analysis of the inverse correlation between SV and weight loss (%EWL and body mass index) at the 12-month follow-up, and evaluation of SV in the group with %EWL >50%. In addition, the failure rate was quantified in the SV >180 mL group. MATERIALS AND METHODS This is a prospective study with the collection of data. All patients who received LSG from January to December 2017 were evaluated. Computed tomography was performed on the upper abdomen at 12 months postoperatively to measure the SV using a standardized technique involving gastric distension. RESULTS A total of 42 patients were considered for 3DCT evaluation at the 12-month follow-up. A significant linear inverse relation was reported between SV and %EWL (P<0.05); a similar trend, without significant results, was reported for body mass index loss. The entire cohort was subdivided according to %EWL. A %EWL<50% presented a significantly higher mean SV (P<0.01) than %EWL >50%. SV >180 mL was powerful in predicting abnormal gastric distension. Over this value, %EWL was lower than that in the remaining group (P<0.05, 31.9% vs. 51.8%). CONCLUSIONS Our results confirmed a direct relation between SV and %EWL. Objective evaluation of gastric compliance obtained with 3DCT should be used intensively for LSG.
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Thakur U, Bhansali A, Gupta R, Rastogi A. Liraglutide Augments Weight Loss After Laparoscopic Sleeve Gastrectomy: a Randomised, Double-Blind, Placebo-Control Study. Obes Surg 2020; 31:84-92. [PMID: 32656729 DOI: 10.1007/s11695-020-04850-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Both laparoscopic sleeve gastrectomy (LSG) and liraglutide cause a significant weight loss. We evaluated the effect of liraglutide in comparison with placebo on total weight loss (TWL) and excess body weight loss (EWL) and when added in initial weight loss period after LSG in obese individuals. MATERIAL AND METHODS Participants with BMI > 30 kg/m2 undergoing LSG were randomised to receive either liraglutide (subcutaneous) in increasing does of 0.6 mg/day until maximum tolerated dose of 3.0 mg (L-L group) or placebo (L-P group) from 6 weeks post-operative until 6 months. Weight, BMI, %TWL, %EWL, HbA1c, fasting plasma glucose, HOMA-IR, resolution of type 2 diabetes mellitus, hypertension, dyslipidaemia, sleep apnea and quality of life were evaluated. Primary end point was %TWL and % EWL at post-operative 6 months. RESULTS Thirty participants underwent LSG, and 23 were randomised to receive liraglutide (n = 12) or placebo (n = 11).The mean dose of liraglutide in L-L group was 1.41 ± 0.49 mg/day. Patients in L-L group had %TWL of 28.2 ± 5.7 and %EWL of 58.7 ± 14.3 as compared with 23.2 ± 6.2 (p = 0.116) and 44.5 ± 8.6 (p = 0.043) in L-P group at 24 weeks, respectively. BMI decreased by 11.7 ± 3.5 in L-L group compared with 9.5 ± 4.0 in L-P group (p = 0.287). All patients with diabetes or pre-diabetes had resolution of dysglycemia in the L-L group as compared with 50% in L-P group. However, there was no significant difference in resolution of other obesity-related comorbidities between two groups at 24-week follow-up. CONCLUSION Liraglutide added early after LSG significantly augments weight loss from LSG in obese individuals. TRIAL REGISTRATION The study protocol was registered at clinical trials.gov.in with NCT: 04325581.
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Affiliation(s)
- Uttam Thakur
- Department of Gastro-intestinal Surgery, PGIMER, Chandigarh, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, Room-1011, Nehru Hospital Extension Block, Chandigarh, 160012, India
| | - Rajesh Gupta
- Department of Gastro-intestinal Surgery, PGIMER, Chandigarh, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, Room-1011, Nehru Hospital Extension Block, Chandigarh, 160012, India.
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McCarty TR, Thompson CC. Bariatric and Metabolic Therapies Targeting the Small Intestine. ACTA ACUST UNITED AC 2020; 22:145-153. [PMID: 32905221 DOI: 10.1016/j.tige.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The global prevalence of obesity and type 2 diabetes (T2DM) necessitates an increased reliance on effective and safe endoscopic therapies. While surgery is highly effective, endoscopic therapies may be able to reach a greater number of affected individuals and help to reduce the burden of disease worldwide. Although current endoscopic treatments entail space occupying gastric devices as well as suturing or plication, innovative, non-Food and Drug Administration (FDA) approved small bowel specific endoscopic bariatric and metabolic therapies have been developed within the last several years. Small intestine therapies include endoluminal bypass liners, duodenal mucosal resurfacing, endoscopic anastomosis systems, and restricted duodenal flow treatments. These endoscopic bariatric and metabolic therapies rely upon foregut and hindgut mechanisms to achieve weight loss and improve glucose homeostasis. This review will detail these important small bowel mechanisms and evaluates current small bowel endoscopic treatments.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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Stefura T, Kacprzyk A, Droś J, Chłopaś K, Wysocki M, Rzepa A, Pisarska M, Małczak P, Pędziwiatr M, Nowakowski M, Budzyński A, Major P. The hundred most frequently cited studies on sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2020; 15:249-267. [PMID: 32489485 PMCID: PMC7233154 DOI: 10.5114/wiitm.2019.89392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is one of the most popular bariatric operations and one of the most frequently studied areas in bariatric surgery. AIM To summarise the characteristics of the most frequently cited studies focusing on SG. MATERIAL AND METHODS We used the Web of Science database to identify all studies focused on SG published from 2000 to 2018. The term "sleeve gastrectomy" and synonyms were used to reveal the 100 most cited records. RESULTS The most frequently cited publication had 493 citations. The highest mean number of citations per year was 73.00. Studies were most frequently published in the years 2010 and 2012. Articles were most commonly published in bariatric surgery-oriented journals. CONCLUSIONS Our study indicates an increase in medical researchers' interest in the subject of SG and underlines the need to perform studies with a higher level of evidence to further analyse the outcomes and basic science behind SG.
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Affiliation(s)
- Tomasz Stefura
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Artur Kacprzyk
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Droś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Chłopaś
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Wysocki
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Anna Rzepa
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Nowakowski
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Andrzej Budzyński
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training, and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Coleman KJ, Fischer H, Arterburn DE, Barthold D, Barton LJ, Basu A, Courcoulas A, Crawford CL, Fedorka P, Kim B, Mun E, Murali S, Reynolds K, Suh K, Wei R, Yoon TK, Zane R. Effectiveness of Gastric Bypass Versus Gastric Sleeve for Cardiovascular Disease: Protocol and Baseline Results for a Comparative Effectiveness Study. JMIR Res Protoc 2020; 9:e14936. [PMID: 32249757 PMCID: PMC7171566 DOI: 10.2196/14936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/08/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background When compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission. Objective The ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety. Methods The cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018. Bariatric surgery patients were followed up for the length of their membership in the health care system. Of the patients who had at least five years of follow-up (surgery between 2009 and 2013), 85.86% (13,774/16,043) could contribute to the outcome analyses for the ENGAGE CVD cohort. Results Patients in the ENGAGE CVD cohort were 44.6 (SD 11.4) years old, mostly women (17,718/22,095; 80.19%), with 18.94% (4185/22,095) non-Hispanic black and 41.80% (9235/22,095) Hispanic, and had an average BMI of 44.3 (SD 6.9) kg/m2 at the time of surgery. When compared with patients who did not contribute data to the 5-year outcome analysis for the ENGAGE CVD cohort (2269/16,043; 14.14%), patients who contributed data (13,774/16,043; 85.86%) were older (P=.002), more likely to be women (P=.02), more likely to be non-Hispanic white (P<.001), more likely to have had an emergency department visit in the year before surgery (P=.006), less likely to have a mental illness before surgery (P<.001), and more likely to have had a CVD event at any time before surgery (P<.001). Conclusions This study had one of the largest populations of gastric sleeve patients (n=13,459). The 5-year follow-up for those patients who had surgery between 2009 and 2013 was excellent for a retrospective cohort study at 85.86% (13,774/16,043). Unlike almost any study in the literature, the majority of the ENGAGE CVD cohort was racial and ethnic minority, providing a rare opportunity to study the effects of bariatric surgery for different racial and ethnic groups, some of whom have the highest rates of severe obesity in the United States. Finally, it also used state-of-the-art statistical and econometric comparative effectiveness methods to mimic the effect of random assignment and control for sources of confounding inherent in large observational studies. International Registered Report Identifier (IRRID) RR1-10.2196/14936
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Heidi Fischer
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - David E Arterburn
- Health Research Institute, Kaiser Permanente Washington, Seattle, WA, United States
| | - Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics Institute, Department of Pharmacy, University of Washington, Seattle, WA, United States
| | - Lee J Barton
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics Institute, Department of Pharmacy, University of Washington, Seattle, WA, United States
| | - Anita Courcoulas
- Department of Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cecelia L Crawford
- Regional Nursing Research Program, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Peter Fedorka
- Department of Surgery, San Bernardino Medical Center, Kaiser Permanente Southern California, Ontario, CA, United States
| | - Benjamin Kim
- Department of Surgery, South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA, United States
| | - Edward Mun
- Department of Surgery, South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA, United States
| | - Sameer Murali
- Center for Healthy Living, San Bernardino Medical Center, Kaiser Permanente Southern California, Fontana, CA, United States
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Kangho Suh
- The Comparative Health Outcomes, Policy, and Economics Institute, Department of Pharmacy, University of Washington, Seattle, WA, United States
| | - Rong Wei
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Tae K Yoon
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Robert Zane
- Department of Surgery, South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, CA, United States
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Lu C, Li Z, Yang J, Feng L, Wang C, Shi Q. Variations in Irisin, Bone Mineral Density, Bone Mineral Content, and Body Composition After Laparoscopic Bariatric Procedures in Obese Adults. J Clin Densitom 2020; 23:244-253. [PMID: 31133501 DOI: 10.1016/j.jocd.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study was aimed to assess irisin levels in obesity (OB) and T2DM individuals and investigate the dynamic changes of irisin, bone mineral density (BMD), bone mineral content, and body composition in 19 OB patients after laparoscopic bariatric procedures, and also to evaluate the correlation of irisin, with BMD and body composition. METHODS Forty-five OB, 20 T2DM, and 20 healthy adults had been recruited. Levels of irisin were measured in all subjects. Metabolic characteristics were obtained from OB and T2DM patients. Nineteen patients were randomly assigned to be received Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) procedure and to be completed 6-month follow-up. Irisin, BMD, bone mineral content, and body composition were measured at each visit. RESULTS Significantly higher circulating irisin levels were measured in the OB group compared with T2DM and control groups. FINS, C-P, HOMA-IR, FBCI, HBCI, ALT, AST, and UA levels of OB were significantly higher than those of T2DM patients. While FBG and HbA1c of the OB were significantly lower than T2DM group. There were significant differences among circulating irisin, BMD, and body composition after laparoscopic bariatric surgery. Levels of irisin were decreased after operations including both LRYGB and LSG surgery compared with preoperation. At each time point (1, 3, and 6 months) of postoperation, there was no significant difference in percentage of total weight loss between LSG and LRYGB group. The positive correlation of irisin levels with total BMD, muscle, and fat masses were found during 6-month follow-up after surgery. CONCLUSIONS The levels of irisin were higher in OB patients. There were positive correlations of irisin levels with total BMD, muscle, and fat masses during 6-month follow-up after surgery. Irisin may be involved in the occurrence and development of obese and it is related to BMD and body composition. Both LRYGB and LSG operations could decrease the circulating levels of irisin.
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Affiliation(s)
- Chunting Lu
- Science and Education Office, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zejian Li
- Medical Centre of Stomatology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jing Yang
- Department of Internal Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Lie Feng
- Department of Endocrinology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of General Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Qiping Shi
- Department of Endocrinology, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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Madyan A, Emile SH, Abdel-Razik MA, Ellithy R, Elbanna HG, Elshobaky A. Laparoscopic Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients With Morbid Obesity: Technical Description and Short-term Outcomes. Surg Laparosc Endosc Percutan Tech 2020; 30:e13-e17. [PMID: 32032329 DOI: 10.1097/sle.0000000000000763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Morbid obesity has been recognized as a public health crisis, particularly in developed countries. Single anastomosis sleeve ileal (SASI) bypass has been introduced as a novel bariatric and metabolic procedure. The present study aimed to describe the technical steps and assess the short-term outcomes of SASI bypass in patients with super morbid obesity. PATIENTS AND METHODS Adult patients of both sexes with body mass index (BMI) ≥50 kg/m underwent SASI bypass and were followed for 12 months postoperatively. Changes in BMI, excess weight loss (EWL), and improvement in comorbidities were recorded on follow-up. RESULTS Twenty patients (17 female) of the mean age of 35.4 years were included in the study. The mean preoperative BMI (53.7±5.9) showed a significant decrease at 6 months (39.9±5.2) and then at 12 months (33.6±6) postoperatively. The mean %EWL was 44.3±7.8 at 6 months and 65.2±12.6 at 12 months. All patients with diabetes mellitus, osteoarthritis, and reflux esophagitis showed resolution at 12 months after the SASI bypass. Complications were recorded in 2 patients and no mortality was reported. CONCLUSIONS SASI bypass is an effective and safe bariatric procedure that confers significant loss of weight and improvement in medical comorbidities. As compared with previous studies on patients with lower BMI, patients with super morbid obesity attained lower %EWL but similar resolution of diabetes mellitus at 12 months after SASI bypass.
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Affiliation(s)
- Amr Madyan
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City, Egypt
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Mahdy T, Emile SH, Madyan A, Schou C, Alwahidi A, Ribeiro R, Sewefy A, Büsing M, Al-Haifi M, Salih E, Shikora S. Evaluation of the Efficacy of Single Anastomosis Sleeve Ileal (SASI) Bypass for Patients with Morbid Obesity: a Multicenter Study. Obes Surg 2020; 30:837-845. [PMID: 31734889 DOI: 10.1007/s11695-019-04296-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Single anastomosis sleeve ileal (SASI) bypass is a newly introduced bariatric and metabolic procedure. The present multicenter study aimed to evaluate the efficacy of the SASI bypass in the treatment of patients with morbid obesity and the metabolic syndrome. METHODS This is a retrospective, seven-country, multicenter study on patients with morbid obesity who underwent the SASI bypass. Data regarding patients' demographics, body mass index (BMI), percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and improvement in comorbidities at 12 months postoperatively and postoperative complications were collected. RESULTS Among 605 patients who underwent the SASI, 54 were excluded and 551 (390; 70.8% female) were included. At 12 months after the SASI, a significant decrease in the BMI was observed (43.2 ± 12.5 to 31.2 ± 9.7 kg/m2; p < 0.0001). The %TWL was 27.4 ± 13.4 and the %EWL was 63.9 ± 29.5. Among the 279 patients with type 2 diabetes mellitus (T2DM), complete remission was recorded in 234 (83.9%) patients and partial improvement in 43 (15.4%) patients. Eighty-six (36.1%) patients with hypertension, 104 (65%) patients with hyperlipidemia, 37 (57.8%) patients with sleep apnea, and 70 (92.1%) patients with GERD achieved remission. Fifty-six (10.1%) complications and 2 (0.3%) mortalities were recorded. Most complications were minor. All patients had 12 months follow-up. CONCLUSIONS The SASI bypass is an effective bariatric and metabolic surgery that achieved satisfactory weight loss and improvement in medical comorbidities, including T2DM, hypertension, sleep apnea, and GERD, with a low complication rate.
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Affiliation(s)
- Tarek Mahdy
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street Dakahlia, Mansoura, 35516, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street Dakahlia, Mansoura, 35516, Egypt.
| | - Amr Madyan
- General Surgery Department, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura University, 60 El-Gomhoria Street Dakahlia, Mansoura, 35516, Egypt
| | | | | | - Rui Ribeiro
- Clinica De Santo Antonio, Lusiadas, Amadora, Lisbon, Portugal
| | - Alaa Sewefy
- General Surgery Department, Minia Faculty of Medicine, Minia University, Minya, Egypt
| | - Martin Büsing
- Klinikum Vest, Dorstenerstr, 151, 45657, Recklinghausen, Germany
| | | | | | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Dohmen J, Praktiknjo M, Rudeloff A, Uschner FE, Klein S, Plamper A, Matthaei H, Rheinwalt KP, Wehner S, Kalff JC, Trebicka J, Lingohr P. Impact of sleeve gastrectomy and dietary change on metabolic and hepatic function in an obesity rat model - Experimental research. Int J Surg 2020; 75:139-147. [PMID: 32014594 DOI: 10.1016/j.ijsu.2020.01.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/15/2020] [Accepted: 01/26/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Sleeve gastrectomy (SG) is an effective procedure to treat morbid obesity. SG induces remission of type 2 diabetes and metabolic syndrome and improves non-alcoholic fatty liver disease (NAFLD). However, it is imperative to clarify the extent to which these beneficial effects may be attributed to SG among other concomitant changes including postoperative diet. The current study addresses this question in a rodent model of obesity by subjecting it to SG, normal diet, or a combination of the two. METHODS Male Wistar-rats were fed with either high fat diet (HF, n = 32) or received chow diet (CD, n = 8). After 15 weeks, the HF-fed rats underwent either SG or sham operation, following which they were randomised to either continue HF or switched to CD for another 6 weeks. Body weight, fasting blood glucose level, blood pressure, and adipokine expression (leptin, adiponectin, MCP-1) in the adipose tissue along with triglycerides level in the blood serum were assessed to evaluate metabolic function. Hepatic function was assessed by histological evaluation of liver fibrosis (Hydroxyproline, Sirius Red) and reverse transcription polymerase chain reaction (RT-PCR) of the inflammation marker monocyte chemoattractant protein-1 (MCP-1). RESULTS Postoperative dietary change improved adipose tissue inflammation and arterial blood pressure regardless of the surgical intervention, while SG improved hyperglycaemia, blood triglyceride levels and, regardless of the postoperative diet, hepatic inflammation and fibrosis. However, combined administration of SG with post-operative normal diet was the most effective with regard to reducing the body weight. CONCLUSION HF for 15 weeks induced obesity with metabolic syndrome and NAFLD in rats. SG and dietary intervention improved metabolic state and NAFLD; however, their combination was significantly more effective.
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Affiliation(s)
- Jonas Dohmen
- Department of Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Michael Praktiknjo
- Department of Internal Medicine I, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Anna Rudeloff
- Department of Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Frank Erhard Uschner
- Department of Internal Medicine I, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany.
| | - Sabine Klein
- Department of Internal Medicine I, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany.
| | - Andreas Plamper
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825, Cologne, Germany.
| | - Hanno Matthaei
- Department of Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Karl-Peter Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schönsteinstr. 63, 50825, Cologne, Germany.
| | - Sven Wehner
- Department of Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Jörg C Kalff
- Department of Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Jonel Trebicka
- Department of Internal Medicine I, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt Am Main, Germany; European Foundation for the Study of Chronic Liver Failure - EF Clif, Travessera de Gràcia, 11, 08021, Barcelona, Spain.
| | - Philipp Lingohr
- Department of Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Köhler H, Dorozhkina R, Gruner-Labitzke K, de Zwaan M. Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study. Obes Facts 2020; 13:166-178. [PMID: 32208386 PMCID: PMC7250322 DOI: 10.1159/000505837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is an important condition for adequate weight loss and prevention of adverse events that bariatric surgery (BS) candidates possess good specific health knowledge. There is a paucity of standardized instruments to evaluate the specific health knowledge of patients before and after BS. Therefore, we developed a 32-item multiple-choice test covering the main aspects of life which are important after BS, and investigated the correlation of specific health knowledge with health literacy, level of depression and anxiety, percentage of excess weight loss, and specific complications of BS in postoperative patients. METHODS Two groups participated in the cross-sectional study: the preoperative group (n = 109) was recruited from candidates for BS (gastric bypass or sleeve gastrectomy), the postoperative group (n = 110) was recruited from patients 12-74 months after BS (average 33 months, SD = 16.5). Both groups had completed a preoperative multimodal training program. Specific health knowledge was assessed with a newly developed knowledge questionnaire. Health literacy was evaluated with the short version of the European Health Literacy Survey (HLS-EU-Q16). The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7) were used to assess the levels of depression and anxiety. RESULTS The pre- and postoperative group did not differ with regard to the number of correctly answered questions on the knowledge questionnaire, with 75% correct answers in both groups (p = 0.059). No correlations were found with health literacy (p = 0.498) and levels of depression (preoperative group: p = 0.279; postoperative group: p = 0.242) and anxiety (preoperative group: p = 0.866; postoperative group: p = 0.119). In postoperative patients specific health knowledge was not associated with the weight loss achieved (p = 0.437). CONCLUSION The newly designed knowledge questionnaire can be useful for screening specific knowledge of BS patients at different time points.
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Affiliation(s)
- Hinrich Köhler
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany,
| | - Renata Dorozhkina
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Kerstin Gruner-Labitzke
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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Toprak SS, Gultekin Y. A combination of laparoscopic Nissen fundoplication and laparoscopic gastric plication for gastric esophageal reflux disease and morbid obesity. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2019. [DOI: 10.25083/2559.5555/4.2/81.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Riedel N, Laubner K, Lautenbach A, Schön G, Schlensak M, Stengel R, Eberl T, Dederichs F, Aberle J, Seufert J. Trends in BMI, Glycemic Control and Obesity-Associated Comorbidities After Explantation of the Duodenal-Jejunal Bypass Liner (DJBL). Obes Surg 2019; 28:2187-2196. [PMID: 29504053 DOI: 10.1007/s11695-018-3144-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A novel-approach for treatment of obesity and diabetes mellitus type 2 (T2DM) is represented by the endoscopic duodenal-jejunal bypass liner (DJBL). Recent data from the German DJBL registry provide evidence for substantial efficacy of the DJBL during the implantation period in obese patients with T2DM. However, little is known about the trends of glycemic control, BMI, and comorbidities after explantation of the DJBL, which have been investigated in the registry in this report. METHODS Patients were selected from the registry if they had a dataset at implantation, explantation, and at least one time point after explantation of the DJBL (n = 77). We also investigated a subgroup of patients with available data at least 1 year (-2 weeks) after explantation of the DJBL (n = 32). RESULTS For a mean BMI at implantation and a mean follow-up period, an increase of BMI of 2.1 kg/m2 (CI 0.8-3.2; p = 0.013) had to be expected (for HbA1c 0.3% (CI - 0.0-0.7; p = n.s.), respectively). In the subgroup analysis, HbA1c and BMI increased after explantation of the DJBL but stayed significantly below baseline levels. Meanwhile, the mean number of antidiabetic drugs slightly increased. There was deterioration seen for blood pressure and LDL cholesterol over the postexplantation period to approximately baseline levels (or higher). CONCLUSION With this data, we show that improvement of HbA1c and BMI can be partly maintained over a time of nearly 1-year postexplantation of the DJBL. However, for HbA1c, this may be biased by intensified medical treatment and effects deteriorated with time after explantation. These results suggest that implantation of the DJBL needs to be integrated in a long-term weight management program as most of other interventions in obese patients with T2DM. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02731859.
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Affiliation(s)
- Nina Riedel
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Anne Lautenbach
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Schlensak
- Department of Surgery, Schön Klinik Düsseldorf SE & Co. KG, Düsseldorf, Germany
| | | | | | - Frank Dederichs
- Department of Internal Medicine/Gastroenterology, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
- Department of Internal Medicine/Gastroenterology, Kath, Kliniken Hagen, Hagen, Germany
| | - Jens Aberle
- Department for Endocrinology and Diabetology, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, University Hospital of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
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Trends in Early Morbidity and Mortality after Sleeve Gastrectomy in Patients over 60 Years : Retrospective Review and Data Analysis of the German Bariatric Surgery Registry. Obes Surg 2019; 28:1831-1837. [PMID: 29417488 DOI: 10.1007/s11695-018-3110-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The population are getting older and obesity is growing. Laparoscopic sleeve gastrectomy (LSG) is increasingly used worldwide but is still used with skepticism in the elderly. The purpose of our analysis is to judge the security of LSG in patients older than 60 years compared to patients younger than 60 years. METHODS This retrospective review included data of all patients in Germany who underwent LSG between January 2005 and December 2016.The data were published online in the German Bariatric Surgery Registry. A total of 21,571 operations were gathered and divided into two groups: group I, patients < 60 years old; and group II, patients ≥ 60 years old. RESULTS The total number of patients and the mean body mass index of group I and group II was 19,786, 51.7 ± 9.5 kg/m2 and 1771, 49.2 ± 8.1 kg/m2, respectively. Regarding comorbidities, group II suffered statistically significantly more comorbidities than group I (p < 0.001). The general postoperative complications were 4.9% in group I and 7.8% in group II (p < 0.001). There was no significant difference in special postoperative complications (p = 0.048) and a slightly higher intraoperative complication rate in group II (2.2% vs. 1.6%, p = 0.048). Thirty-day mortality rate for group I versus II was 0.22% and 0.23% (p = 0.977), respectively. CONCLUSIONS LSG is a low-risk operation and safe surgical method with acceptable, not elevated perioperative morbidity and mortality rates in patients ≥ 60 years of age.
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Mahoney ST, Strassle PD, Farrell TM, Duke MC. Does Lower Level of Education and Health Literacy Affect Successful Outcomes in Bariatric Surgery? J Laparoendosc Adv Surg Tech A 2019; 29:1011-1015. [DOI: 10.1089/lap.2018.0806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Stephen T. Mahoney
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Paula D. Strassle
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Timothy M. Farrell
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Meredith C. Duke
- Division of General Surgery, Department of Surgery, Vanderbilt University, Nashville, Tennessee
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Burvill A, Blackham R, Hamdorf J. Laparoscopic sleeve gastrectomy in a patient with situs inversus totalis and Kartagener syndrome: an unusual surgical conundrum. BMJ Case Rep 2019; 12:e229550. [PMID: 31345831 PMCID: PMC6663256 DOI: 10.1136/bcr-2019-229550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2019] [Indexed: 01/07/2023] Open
Abstract
Kartagener syndrome is a rare autosomal recessive condition. Approximately 25% of those with situs inversus totalis suffer the syndrome. With the rising overall number and indications for bariatric surgery, this condition will be increasingly recognised. We present a case of a 25-year-old woman with SIT and Kartagener syndrome who underwent a laparoscopic sleeve gastrectomy. As with all bariatric surgery, a multidisciplinary team approach was important in managing such a case. There were considerable cognitive challenges for the surgical team both preoperatively and during the procedure. The patient tolerated the operation well and was discharged 2 days after the surgery. At 12-months follow-up, the patient had achieved 125% excess weight loss. This case illustrates that an experienced surgeon can safely perform a laparoscopic sleeve gastrectomy on a patient with situs inversus totalis.
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Affiliation(s)
- Angela Burvill
- Medical School, University of Western Australia, Crawley, Western Australia, Australia
| | - Ruth Blackham
- School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
- Hollywood Private Hospital, Western Surgical Health, Nedlands, Western Australia, Australia
| | - Jeffrey Hamdorf
- School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
- Hollywood Private Hospital, Western Surgical Health, Nedlands, Western Australia, Australia
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Neuberg M, Wuidar PA, Kohnen L, Deflines J, Kotzampassakis N, Demarche M, De Roover A. Laparoscopic Magenstrasse and Mill Gastroplasty (M&M): Midterm Results. Obes Surg 2019; 29:3212-3219. [PMID: 31254215 DOI: 10.1007/s11695-019-03965-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Magenstrasse and Mill gastroplasty (M&M) is a gastric restrictive procedure without band or stomach resection. Short-term evaluation of the laparoscopic procedure showed low morbidity and satisfactory results on weight loss. Evidence of the validity of the technique in the longer term is scarce. METHODS Data from patients who underwent M&M procedure from May 2012 to September 2015 were retrospectively reviewed. Preoperative clinical characteristics and data up to 4 years after operation were analyzed. RESULTS A total of 132 patients were included in this study with a mean age of 46 ± 13.4 years. The mean body mass index (BMI) at the time of procedure was 43 ± 4.5 kg/m2. Mean percentage of excess weight loss (%EWL) was 67, 67, 58, and 57% at 1, 2, 3, and 4 years, respectively. The remission rate for diabetes was 36%. About half of the insulin-dependent patients could stop their insulin treatment. Hypertension was resolved in 33.8% of the patients after 4 years. Incidence of vitamin and mineral deficiency was low throughout the study period, less than or equal to 3% for vitamin B12 and 1% for ferritin. Incidence of gastroesophageal reflux did not exceed 15% during the study. Over 75% of the patients reported a good or very good quality of life following the surgery. CONCLUSION These results confirm the validity of M&M as a bariatric procedure. The low incidence of vitamin deficiencies and gastroesophageal reflux might be the important asset of M&M over other existing techniques.
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Affiliation(s)
- Maud Neuberg
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium.
| | - Pierre-Arnaud Wuidar
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Laurent Kohnen
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Jenny Deflines
- Department of Diabetology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Nikos Kotzampassakis
- Department of Abdominal And Pediatric Surgery, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Martine Demarche
- Department of Abdominal And Pediatric Surgery, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Arnaud De Roover
- Department of Abdominal And Pediatric Surgery, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
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Bhandari M, Reddy M, Kosta S, Mathur W, Fobi M. Laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass: A retrospective cohort study. Int J Surg 2019; 67:47-53. [PMID: 31121327 DOI: 10.1016/j.ijsu.2019.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND There are many reports on short-term outcomes following sleeve gastrectomy, which demonstrate that it has comparable efficacy to gastric bypass. However, there are very few long-term comparative reports. This study compared the outcomes from laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB) in a cohort of patients who had surgery in 2011 with a six-year follow up. MATERIALS AND METHODS Data on patients who had either LSG or LGB at a single centre in Mohak Bariatric and Robotic Surgery Centre, Indore, M.P. India in 2011 were identified from a database of routinely collected data. This retrospective cohort was analysed for weight loss, resolution of comorbidities and nutritional status over six years. Patients who had revision operations or for whom six-year follow-up data were not available were excluded from the analysis. RESULTS 154 patients had LGB and 152 had LSG. The six-year follow up rate was 61.7% (n = 95) and 64.5% (n = 98) respectively for LGB and LSG. Percentage of excess bodyweight loss (%EWL) peaked at approximately 70% after two years in the LSG group and after three years in the LGB group. However, after six years %EWL was 61% for LGB and 50% for LSG (p = 0.001). Resolution of type-2 diabetes was more common in the LGB group compared to the LSG group (79% vs 62%, p = 0.126). Resolution of hypertension and dyslipidaemia was similar in both groups at approximately half of patients in each group for each condition. Nutrient deficiencies were found in both groups but were generally more pronounced in the LGB group. CONCLUSION LGB is a better operation for weight loss, weight loss maintenance, and resolution of type-2 diabetes than LSG. This is at the expense of an increased incidence of nutrient deficiencies. LSG appears to have greater treatment failure by six years follow up and this should be further investigated.
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Affiliation(s)
- Mohit Bhandari
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Manoj Reddy
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Susmit Kosta
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Winni Mathur
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
| | - Mathias Fobi
- Mohak Bariatric and Robotic Surgery Center, Mohak Hi-tech Specialty Hospital, Indore, M.P., India.
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