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Giannopoulos S, AbuHasan Q, Connors JDN, Athanasiadis DI, Hilgendorf W, Gardiner R, Martine V, Baumgartner TC, Stefanidis D. Patients' perspectives on weight recurrence after bariatric surgery: a single-center survey. Surg Endosc 2024; 38:2252-2259. [PMID: 38409612 DOI: 10.1007/s00464-023-10664-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: 07/30/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Weight recurrence (WR) affects nearly 20% of patients after bariatric surgery and may decrease its benefits, affecting patients' quality of life negatively. Patient perspectives on WR are not well known. OBJECTIVES Assess patient needs, goals, and preferences regarding WR treatment. SETTING Single MBSAQIP-accredited academic center, and online recruitment. METHODS An 18-item, web-based survey was distributed to adults seeking treatment for WR after a primary bariatric surgery (PBS), in addition to online recruitment, between 2021 and 2023. Survey items included somatometric data, questions about the importance of factors for successful weight loss, procedure decision-making, and treatment expectations. RESULTS Fifty-six patients with > 10% increase from their nadir weight were included in the study. Patients had initially undergone Roux-en-Y gastric bypass (62.5%), sleeve gastrectomy (28.6%), adjustable gastric banding (3.6%), or other procedures (5.3%). When assessing their satisfaction with PBS, 57.1% were somewhat/extremely satisfied, 33.9% somewhat/extremely dissatisfied, while 8.9% were ambivalent. Patients considered the expected benefits (for example, weight loss) as the most important factor when choosing a treatment option for WR. Patient goals included "feeling good about myself" (96.4% very/extremely important), "being able to resume activities I could not do before" (91% very/extremely important), and "improved quality of life" and "-life expectancy" (> 90% very/extremely important). Finally, RBS, lifestyle modification with peer support, and anti-obesity medication were ranked as first treatment options for WR by 40%, 38.8%, and 29.8% of the respondents, respectively. CONCLUSIONS Patients considered weight loss as the most important factor when choosing treatment modality for WR, with RBS and lifestyle changes being preferred over weight-loss medications. Large prospective randomized trials are needed to counsel this patient population better.
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Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Qais AbuHasan
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Jill D Nault Connors
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios I Athanasiadis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - William Hilgendorf
- General Surgery, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Robin Gardiner
- Indiana University Health North Hospital, Carmel, IN, USA
| | - Victoria Martine
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Timothy C Baumgartner
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, Indianapolis, IN, 46202, USA.
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Huynh M, Tjandra R, Helwa N, Okasha M, El-Falou A, Helwa Y. Continuous pH monitoring using a sensor for the early detection of anastomotic leaks. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1128460. [PMID: 37275781 PMCID: PMC10235488 DOI: 10.3389/fmedt.2023.1128460] [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] [Received: 12/20/2022] [Accepted: 05/04/2023] [Indexed: 06/07/2023] Open
Abstract
Anastomotic leaks (AL) and staple line leaks are a serious post-operative complication that can develop following bariatric surgery. The delay in the onset of symptoms following a leak usually results in reactive diagnostics and treatment, leading to increased patient morbidity and mortality, and a clinical and economic burden on both the patient and the hospital. Despite support in literature for pH as a biomarker for early detection of AL, the current methods of pH detection require significant clinician involvement and resources. Presented here is a polyaniline (PANI)-based pH sensor that can be connected inline to surgical drains to continuously monitor peritoneal secretion in real time for homeostatic changes in pH. During this study, the baseline peritoneal fluid pH was measured in two pigs using the PANI sensor and verified using a benchtop pH probe. The PANI sensor was then utilized to continuously monitor the changes in the pH of peritoneal effluent, as a gastric leak was simulated. The inline sensors were able to detect the resulting local changes in drainage pH within 10 min of leak induction. The successful implementation of this sensor in clinical practice can both enable high efficiency continuous monitoring of patient status and drastically decrease the time required to detect AL, thus potentially decreasing the clinical and economic burden incurred by gastric leaks.
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Affiliation(s)
- Michelle Huynh
- FluidAI Medical, Kitchener, ON, Canada
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Mohamed Okasha
- FluidAI Medical, Kitchener, ON, Canada
- Department of Chemistry, University of Waterloo, Waterloo, ON, Canada
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Hanipah ZN, Rubino F, Schauer PR. Remission with an Intervention: Is Metabolic Surgery the Ultimate Solution? Endocrinol Metab Clin North Am 2023; 52:65-88. [PMID: 36754498 DOI: 10.1016/j.ecl.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Long-term remission of type 2 diabetes following lifestyle intervention or pharmacotherapy, even in patients with mild disease, is rare. Long-term remission following metabolic surgery however, is common and occurs in 23% to 98% depending on disease severity and type of surgery. Remission after surgery is associated with excellent glycemic control without reliance on pharmacotherapy, improvements in quality of life, and major reductions in microvascular and macrovascular complications. For patients with type 2 diabetes, early intervention with metabolic surgery, when beta cell function still remains intact, provides the greatest probability of long-term remission as high as 90% or more.
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Affiliation(s)
- Zubaidah Nor Hanipah
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London; Bariatric and Metabolic Surgery King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
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Belle S, Kouladouros K, Kähler G. [Management of Endoscopic Complications after Bariatric Surgery: Focus on Current Endoscopic Therapy]. Zentralbl Chir 2022; 147:539-546. [PMID: 36479650 DOI: 10.1055/a-1962-6910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In bariatric surgery, complications are rare. Most of the complications can be managed by endoscopy. Rare complications impose a challenge in everyday clinical work. To optimally treat the complications and to minimise the harm to the patient it is important to implement complication management. This review gives an overview of relevant bariatric complications and endoscopic therapy strategies, focusing on published literature of the last five years. This manuscript could be a starting point for complication management in the clinic.
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Affiliation(s)
- Sebastian Belle
- Zentrale Interdisziplinäre Endoskopie (ZIE), Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Konstantinos Kouladouros
- Chirurgie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Georg Kähler
- Chirurgie, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
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5
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Du S, Jiang X, Guo A, Zuo K, Zhang T. Clinical Application of Early Warning Scoring Based on BiLSTM-Attention in Emergency Obstetric Preexamination and Triage. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6274230. [PMID: 35340245 PMCID: PMC8942667 DOI: 10.1155/2022/6274230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Maternity is a special category of population and the criteria for emergency prescreening cannot be directly applied to adults. Therefore, a set of criteria for grading maternal conditions should be established. In this paper, we have combined the semantic analysis technique of BiLSTM-Attention neural network and fuzzy defect risk assessment method, to develop a hybrid approach, to preprocess the text of emergency obstetric prescreening information. Furthermore, we have used word2vec to characterize the word embedding vector and highlight the features related to the degree of defects of emergency obstetric prescreening information through the attention mechanism and obtain the semantic feature vector of the warning information. BiLSTM-Attention neural network has the dual advantages of extracting bidirectional semantic information and giving weight to important judgment information which has effectively improved the semantic understanding accuracy. Experimental tests and application analysis show that the judgment model which is based on proposed method has accurately classified and graded the defects of emergency obstetric prescreening alerts. Additionally, the accuracy and microaverage value are used as evaluation indexes.
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Affiliation(s)
- Song Du
- Department of Emergency, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu, China
| | - Xue Jiang
- Department of Obstetrics and Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, China
| | - AiLing Guo
- Department of Critical Care, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, China
| | - Kun Zuo
- Department of Emergency, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, Gansu, China
| | - Ting Zhang
- Department of Obstetrics and Gynecology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou 730050, China
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Srinivasan M, Thangaraj SR, Arzoun H, Thomas SS, Mohammed L. The Impact of Bariatric Surgery on Cardiovascular Risk Factors and Outcomes: A Systematic Review. Cureus 2022; 14:e23340. [PMID: 35371868 PMCID: PMC8938230 DOI: 10.7759/cureus.23340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/20/2022] [Indexed: 12/04/2022] Open
Abstract
Obesity and its complications are increasing in today's era, with cardiovascular health being one of the most significant obesity-related comorbidities. Hypertension in obesity is considered one of the major causes of death and disability due to their negative repercussions on cardiovascular health. Bariatric surgery is an approved therapeutic modality for obese people in classes II and III who have a body mass index (BMI) of more than 35 kg/m2 and 40 kg/m2, respectively. These weight loss surgeries are procedures that alter metabolism by causing weight reduction and altering gastrointestinal physiology, thereby considerably decreasing cardiometabolic risk factors that have been poorly understood to date. The purpose of this review is to explore the impact of bariatric surgery on reducing cardiac risk factors, in turn protecting the heart from succumbing to premature death. A literature search was done in the following databases: PubMed, Google Scholar, and PubMed Central (PMC). The studies taken into account for this review were observational studies published between 2016 and 2021 in the English language, where the quality was assessed using relevant quality appraisal methodologies. Finally, 10 reports were selected as definitive studies. Upon extensive evaluation of the final studies, it can be concluded that bariatric surgery results in significant weight loss, which lowers metabolic syndrome prevalence, cardiovascular risk factors, and major adverse cardiovascular events, particularly acute coronary events, and a favorable improvement in cardiac structure and function, altogether steering to reduced mortality due to cardiovascular diseases in obese patients. It is also worth noting that, while metabolic surgery can help patients with various metabolic comorbidities, the impact on individuals with hypertension is still debatable. Although the studies show significant effects on the cardiovascular system, these were only observational studies in geographically dispersed locations where each patient's lifestyle patterns and motivational levels could vary. Since real-world data are not fully explored due to the limited randomized controlled trials, it is suggested that further human trials on a larger scale be conducted to provide an even more factual conclusion.
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Affiliation(s)
- Mirra Srinivasan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Santhosh Raja Thangaraj
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hadia Arzoun
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Siji S Thomas
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Amin A, Khoury NC, Lacayo M, Kostanyan S. Copper Deficiency-Induced Neuropathy After Bariatric Surgery Disguised as Demyelinating Disease: A Case Report. Cureus 2022; 14:e22705. [PMID: 35386142 PMCID: PMC8967068 DOI: 10.7759/cureus.22705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/21/2022] Open
Abstract
Neuropathy may arise from many different etiologies - from diabetes and nerve compression to viral infections and chemotherapy side effects; many patients suffer from neuropathic symptoms. While some etiologies produce irreversible neuropathy, others, such as vitamin and mineral deficiencies, lead to a possibly reversible disease process once treated. General clinicians should strive for early and prompt diagnosis of copper deficiency neuropathy whenever possible, especially in patients with normal vitamin B12 levels who present with a subacute gait disorder or prominent sensory ataxia. We present a case of a 73-year-old female with a surgical history of Roux-en-Y gastric bypass (RYGB) 20 years prior, who presented with difficulty with ambulation due to sensory ataxia and bilateral, ascending, sensory neuropathy, who was diagnosed with acquired copper deficiency-induced myeloneuropathy.
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García Ruiz de Gordejuela A, Ibarzabal A, Osorio J. Bariatric Surgery and Solid-Organ Transplantation. Transplant Proc 2022; 54:87-90. [PMID: 34973842 DOI: 10.1016/j.transproceed.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Abstract
Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant. Bariatric surgery is the most effective available weight loss procedure. Bariatric surgery can be helpful for the treatment of some conditions, such as nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, which may lead to transplant, and weight loss can improve or even reverse them. In other cases, morbid obesity is a limitation to accessing a transplant program, so bariatric surgery can serve as a conduit to transplant. After transplant, obesity and obesity-related comorbidities can be a significant health problem that may be treated, as in patients without a transplant, with bariatric surgery. There are some specific conditions and issues to be considered in patients with end-stage solid-organ disease who are candidates for bariatric surgery, such as increased morbidity and mortality. After transplant, immunosuppressant regimens and technical limitations may be also significant.
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Affiliation(s)
- Amador García Ruiz de Gordejuela
- Bariatric Surgery Unit, General Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Clinic Hospital Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Osorio
- Bariatric Surgery Unit, General Surgery Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Endo Y, Ohta M, Kawamura M, Fujinaga A, Nakanuma H, Watanabe K, Kawasaki T, Masuda T, Hirashita T, Inomata M. Gastric Wall Thickness and Linear Staple Height in Sleeve Gastrectomy in Japanese Patients with Obesity. Obes Surg 2021; 32:349-354. [PMID: 34783958 DOI: 10.1007/s11695-021-05758-3] [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: 07/20/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a standard procedure due to its low complication rates and favorable outcomes. However, limited data are available regarding the optimal size of linear staplers in relation to gastric wall thickness (GWT). METHODS Between August 2016 and December 2020, we performed LSG in 70 patients with an average age, body weight, and body mass index of 42 years, 107 kg, and 40 kg/m2, respectively. We measured the GWT at the antrum, body, and fundus using resected specimens. We used an endo-linear stapler, and the closed staple height (CSH) was 1.75 mm. RESULTS We found that the average GWT at the antrum was significantly thicker than the GWT at the body and fundus. There was a statistically significant relationship between body weight and the GWT at the antrum and body and obstructive sleep apnea and the GWT at the body. The average CSH/GWT ratios were 0.55, 0.62, and 0.90 at the antrum, body, and fundus, respectively. However, in 20 patients (29%), the CSH/GWT ratio at the fundus area was ≥ 1.0, and only preoperative body weight was a significant predictor for a CSH/GWT ratio of ≥ 1.0. CONCLUSION A light body weight may be related to a CSH/GWT ratio of ≥ 1.0 at the fundus.
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Affiliation(s)
- Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan.,Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Hiroaki Nakanuma
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Kiminori Watanabe
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita, 879-5593, Japan
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Evaluating the Pharmacoeconomic Impact of Nutrient Supplementation Post-operatively on Patients Receiving Roux-Y Gastric Bypass vs. Biliopancreatic Diversion with Duodenal Switch. Obes Surg 2021; 31:2434-2443. [PMID: 33730334 PMCID: PMC8113208 DOI: 10.1007/s11695-021-05268-2] [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: 07/07/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 11/15/2022]
Abstract
Background Without the needed medical support, bariatric surgery can be associated with post-operative malnutrition and associated nutrient deficiencies. We aimed to evaluate the cost difference of perioperative infusion requirements and TPN between GBP and BPD-DS. Methods All patients undergoing GBP or BPD-DS procedures between August 2015 and June 2018 were included. Information was collected to standardize the nutritional information into two categories: (1) oral supplementation and standard intravenous infusions, as predicted costs forming part of preoperative quote and (2) infusions prescribed for malnutrition, based on blood biochemistry, caterized as unexpected costs. Results A total of 573 patients over 3 years (GBP 60%, BPD-DS 40%) were included in the analysis. The average predicted costs from oral supplementation for both surgery groups and prophylactic infusions for BPD-DS were GBP (46.90USD) vs. BPD-DS (154.13 USD) (p-value = NS). Unexpected costs for infusions to correct nutritional deficiencies were GBP (199.14 USD) vs. BPD-DS (127.29 USD) (p-value = NS). TPN incidence rate was GBP (2.1%) and BPD-DS (12.7%) (p-value < 0.001) and admission rate per patient was GBP (0.9) and BPD-DS (0.63) (p-value < 0.05). Costs for acquiring TPN were GBP (153.58 USD) vs. BPD-DS (268.76 USD). Total unexpected costs were GBP (352.72 USD) vs. BPD-DS (396.05 USD) (p-value = NS). Conclusion Nutrient deficiencies are known to occur within both GBP and BPD-DS surgeries, even up to 3 years. The admission rate/patient, requiring TPN, was higher in the GBP group, indicating that BPD-DS surgery can be efficient and cost-effective with holistic and multitherapeutic post-surgery care. BPD-DS procedures should be reserved for centers with a comprehensive and experienced multidisciplinary team enforcing stringent follow-up regimes.
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Mumena WA, Kutbi HA. Factors Associated with Dietary Intake and Changes in Nutritional Status Following Bariatric Surgery Among Saudi Adults. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2019.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Walaa A. Mumena
- Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Hebah A. Kutbi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc 2021; 35:4069-4084. [PMID: 33650001 DOI: 10.1007/s00464-021-08329-w] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To systematically review the literature to assess the incidence and risk factors of weight regain (WR) after bariatric surgery. Bariatric surgery is the most effective intervention for sustained weight loss of morbidly obese patients, but WR remains a concern. MATERIALS AND METHODS A PRISMA compliant systematic literature review was performed using the PubMed database, Embase and the Cochrane Library in July of 2019. Studies that reported ≥ 10% WR after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were included. The Newcastle-Ottawa scale (NOS) was used for assessing study quality. RESULTS Out of 2915 retrieved abstracts, 272 full papers were reviewed, and 32 studies included (25 of high and 7 of fair quality) reporting weight outcomes on 7391 RYGB and 5872 SG patients. 17.6% (95% CI 16.9-18.3) had a WR ≥ 10%. Risk factors related with WR fell into 5 categories, namely anatomical, genetic, dietary, psychiatric, and temporal. Specifically, gastrojejunal stoma diameter, gastric volume following sleeve, anxiety, time after surgery, sweet consumption, emotional eating, portion size, food urges, binge eating, loss of control/disinhibition when eating, and genetics have been positively associated with WR while postprandial GLP-1, eagerness to change physical activity habits, self-esteem, social support, fruit and zinc consumption, HDL, quality of life have been negatively associated. CONCLUSION At least 1 in 6 patients after bariatric surgery had ≥ 10% WR. This review identified several factors related to WR that can be used to counsel patients preoperatively and direct postoperative strategies that minimize WR risk.
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Peterson CJ, Klasen J, Delko T, Schneider R. Mechanical colon obstruction due to the alimentary limb after Roux-en-Y gastric bypass: a case report. J Med Case Rep 2021; 15:43. [PMID: 33531056 PMCID: PMC7856760 DOI: 10.1186/s13256-020-02645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Small bowel obstruction is a known and potentially lethal complication after gastric bypass surgery, in both the early and the late postoperative course. Colon or large bowel obstruction, on the other hand, seems to be rare after gastric bypass surgery and thus is not routinely considered. Case presentation We present the case of a 21-year old morbidly obese caucasian patient who underwent laparoscopic Roux-en-Y gastric bypass surgery and developed an early severe transverse colon obstruction due to compression of the transverse colon by the antecolic alimentary limb. Emergency revisional surgery showed a short and tense alimentary limb mesentery and possibly tight closure of Petersen’s space contributing to the compression. Through opening of Petersen’s space and mobilization of alimentary limb mesentery, decompression was achieved, and the patient fully recovered. Conclusions This is a rare case of colon obstruction caused by direct compression of the transverse colon by the antecolic alimentary limb. We propose that a combination of short tense alimentary limb mesentery and perhaps tight closure of Petersen’s space was responsible for the obstruction in this case. Surgeons and treating physicians need to be aware of such rare causes of early postoperative bowel obstruction and take these into consideration when evaluating patients.
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Affiliation(s)
- Caspar Joyce Peterson
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, 4002, Basel, Switzerland
| | - Jennifer Klasen
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, 4002, Basel, Switzerland
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, 4002, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, 4002, Basel, Switzerland.
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Tobón GJ, Ospina FE, Suso JP, Posso-Osorio I, Echeverri AF, Muñoz-Buitrón E, Martínez JD, Castaño GL, Agualimpia A, Bonilla-Abadía F, Dorado E, Cañas CA. Autoantibodies production and immunological abnormalities after bariatric surgery. J Transl Autoimmun 2020; 2:100024. [PMID: 32743510 PMCID: PMC7388363 DOI: 10.1016/j.jtauto.2019.100024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 12/26/2022] Open
Abstract
Objective Bariatric surgery is a widely used procedure for the treatment of obesity. Our aim is to describe the main immunological changes in patients who undergo bariatric surgery. Methods A prospective study was conducted within a cohort of patients undergoing bariatric surgery and without previous evidence of systemic or organ-specific autoimmune diseases in whom 3 blood samples were collected – one day before surgery (Time 0), and 5 (Time 1) and 10 months (Time 2) after surgery. Results Thirty four obese patients underwent surgery (Time 0):30(88.24%) were women, mean age 38.3 years. When comparing Time 0 and Time 2, there were statistically significant changes in CD4+T cell count, with an increase from 1074/mL(IQR:860–1316) to 1217.5/mL(IQR:838–1510),p = 0.0002. The CD4/CD8 ratio increased from 2.2(IQR: 1.7–2.7) to 2.4(1.8–2.8), p = 0.0001. As for humoral variables, the C3 fraction of complement decreased from 164 ± 40.6 mg/dL to 112.4 ± 31.4 mg/dL(p < 0.001) and C4 decreased from 29.3 ± 10.1 mg/dL to 22.5 ± 7.1(p = 0.0009) at Time 2. Four patients with negative ANAs at baseline, showed positive ANAs at Time 2.One patient developed anti-citrullinated peptide antibodies >200 IU/mL at Time 2. Conclusions Patients undergoing bariatric surgery show immunological changes which might eventually lead to develop an autoimmune disease.
Bariatric surgery is beneficial in treatment of obesity, although little is known about impact of significant weight loss in the immune system. Bariatric surgery may induce antinuclear antibodies positivity. Bariatric surgery may induce changes in T lymphocytes population.
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Affiliation(s)
- Gabriel J Tobón
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.,Laboratory of Immunology, Fundación Valle Del Lili, Cali, Colombia
| | - Fabio E Ospina
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.,Center for Clinical Research, Fundación Valle Del Lili, Cali, Colombia
| | - Juan Pablo Suso
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.,Center for Clinical Research, Fundación Valle Del Lili, Cali, Colombia
| | - Iván Posso-Osorio
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.,Center for Clinical Research, Fundación Valle Del Lili, Cali, Colombia
| | - Andrés F Echeverri
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Evelyn Muñoz-Buitrón
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia.,Center for Clinical Research, Fundación Valle Del Lili, Cali, Colombia
| | | | | | - Andrés Agualimpia
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Fabio Bonilla-Abadía
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
| | - Evelyn Dorado
- Department of Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Carlos A Cañas
- Grupo de Investigación en Reumatologia, Autoinmunidad y Medicina Traslacional (GIRAT), Fundación Valle Del Lili and Universidad Icesi, Cali, Colombia
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Hasan NA, Freije A, Abualsel A, Al-Saati H, Perna S. Effect of Bariatric Surgery on Weight Loss, Nutritional Deficiencies, Postoperative Complications and Adherence to Dietary and Lifestyle Recommendations: A retrospective cohort study from Bahrain. Sultan Qaboos Univ Med J 2020; 20:e344-e351. [PMID: 33110651 PMCID: PMC7574803 DOI: 10.18295/squmj.2020.20.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/05/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the effect of bariatric surgery on degree of weight loss, as well as the prevalence of nutritional deficiencies, postoperative complications and adherence to dietary and lifestyle recommendations in a cohort of patients from Bahrain. METHODS This retrospective cohort study took place between March and September 2018 at two hospitals in Bahrain. All adult patients who had undergone bariatric surgery between 2012-2017 were included. Sociodemographic and clinical information was collected from the patients' medical records and during phone interviews. RESULTS A total of 341 patients participated in the study. The mean age was 39.82 ± 9.95 years and 67.7% were female. There was a significant relationship between postoperative body mass index and both the type of surgery and time since surgery (P = 0.025 and 0.008, respectively). While type of surgery had no significant effect on percent of excess weight loss (EWL) or percent of total weight loss (TWL), time since surgery significantly affected both of these weight loss measures (P = 0.006 and 0.001, respectively). Biochemical tests revealed haemoglobin, mean corpuscular volume, 25-hydroxy vitamin D, ferritin and iron deficiencies. Commonly reported complications included hair loss (59.5%), flatulence/abdominal pain (39.3%), dry skin (34.3%) and gastroesophageal reflux disease (33.1%). The level of adherence to dietary and lifestyle recommendations was high to moderate. CONCLUSION Bariatric surgery was effective in accelerating EWL and TWL; however, it also resulted in complications such as nutritional deficiencies and gastrointestinal side-effects.
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Affiliation(s)
- Nawal A. Hasan
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
| | - Afnan Freije
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
| | | | - Hani Al-Saati
- Department of Surgery, Salmania Medical Complex, Manama, Bahrain
| | - Simone Perna
- Department of Biology, College of Science, University of Bahrain, Zallaq, Bahrain
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16
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Hanipah ZN, Schauer PR. Bariatric Surgery as a Long-Term Treatment for Type 2 Diabetes/Metabolic Syndrome. Annu Rev Med 2020; 71:1-15. [DOI: 10.1146/annurev-med-053117-123246] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Metabolic surgery is increasingly becoming recognized as a more effective treatment for patients with type 2 diabetes (T2D) and obesity as compared to lifestyle modification and medical management alone. Both observational studies and clinical trials have shown metabolic surgery to result in sustained weight loss (20–30%), T2D remission rates ranging from 23% to 60%, and improvement in cardiovascular risk factors such as hypertension and dyslipidemia. Metabolic surgery is cost-effective and relatively safe, with perioperative risks and mortality comparable to low-risk procedures such as cholecystectomy, hysterectomy, and appendectomy. International diabetes and medical organizations have endorsed metabolic surgery as a standard treatment for T2D with obesity.
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Affiliation(s)
- Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor 43400, Malaysia
| | - Philip R. Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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17
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Gupta A, Shah MM, Kalaskar SN, Kroh M. Late postoperative bleeding after Roux-en-Y gastric bypass: management and review of literature. BMJ Case Rep 2018; 11:11/1/e226271. [PMID: 30567217 DOI: 10.1136/bcr-2018-226271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Gastrointestinal (GI) bleeding is a catastrophic complication of gastric bypass. Bleeding can occur during the early or late phase after the operation. Though bleeding after gastric bypass is infrequent, late bleeding is exceedingly rare. We present two patients with late bleeding following Roux-en-Y gastric bypass (RYGB). The first patient, a 65-year-old woman, presented with life-threatening upper GI bleeding almost 5 years after laparoscopic RYGB. The second patient, a 62-year-old woman, presented with upper GI bleeding after almost 14 years following RYGB. Both, due to an eroding marginal ulcer. We discuss here the management of a rare and catastrophic complication of late GI bleeding and review the various reports in the literature describing the late bleeding as a complication of gastric bypass. Late GI bleeding after RYGB presents a diagnostic and interventional challenge. High index of suspicion and adequate management strategies may lessen morbidity and mortality.
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Affiliation(s)
- Alisha Gupta
- General Internal Medicine and Geriatrics, Northwestern University, Chicago, Illinois, USA
| | - Mihir M Shah
- Surgical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sudhir N Kalaskar
- General Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matthew Kroh
- General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Marek RJ, Steffen KJ, Flum DR, Pomp A, Pories WJ, Rubin JP, Wolfe BM, Mitchell JE. Psychosocial functioning and quality of life in patients with loose redundant skin 4 to 5 years after bariatric surgery. Surg Obes Relat Dis 2018; 14:1740-1747. [DOI: 10.1016/j.soard.2018.07.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 04/17/2018] [Accepted: 07/25/2018] [Indexed: 11/16/2022]
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19
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Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates. Obes Surg 2018; 29:252-261. [DOI: 10.1007/s11695-018-3515-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Takemoto E, Andrea SB, Wolfe BM, Nagel CL, Boone-Heinonen J. Weighing in on Bariatric Surgery: Effectiveness Among Medicaid Beneficiaries-Limited Evidence and Future Research Needs. Obesity (Silver Spring) 2018; 26:463-473. [PMID: 29464910 DOI: 10.1002/oby.22059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/09/2017] [Accepted: 09/12/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In the general population, bariatric surgery is well documented as the most effective obesity treatment for sustained weight loss and remission of comorbidities. Characterization of the patient populations most likely to benefit from surgical intervention is needed, but the heterogeneity of treatment effects across payer groups has not been reviewed. METHODS A systematic review of published studies focusing on bariatric surgery outcomes among Medicaid beneficiaries was conducted. By using PubMed and Scopus, this study searched for studies that quantitatively compared clinical or social bariatric surgery outcomes for United States adult Medicaid recipients and commercially insured patients. RESULTS Of the 568 titles reviewed, 21 met inclusion criteria. Weight loss and the remission of comorbidities at 1 or 2 years postoperatively were similar between groups despite differences in baseline health status. Short-term health care utilization and mortality outcomes were worse in Medicaid recipients; for instance, Medicaid patients had an average length of stay that was 2 days longer and experienced three more deaths in the first postoperative year. CONCLUSIONS The critical research gaps in the evidence base needed to improve treatment guidelines for Medicaid patients undergoing bariatric surgery include an understanding of the causes of the baseline health differences and how these differences contribute to postoperative outcomes.
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Affiliation(s)
- Erin Takemoto
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | | | - Bruce M Wolfe
- Department of Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Corey L Nagel
- OHSU-PSU School of Public Health, Portland, Oregon, USA
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21
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Lee DJ, Elias GJB, Lozano AM. Neuromodulation for the treatment of eating disorders and obesity. Ther Adv Psychopharmacol 2018; 8:73-92. [PMID: 29399320 PMCID: PMC5788100 DOI: 10.1177/2045125317743435] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/24/2017] [Indexed: 12/25/2022] Open
Abstract
Eating disorders and obesity adversely affect individuals both medically and psychologically, leading to reduced life expectancy and poor quality of life. While there exist a number of treatments for anorexia, morbid obesity and bulimia, many patients do not respond favorably to current behavioral, medical or bariatric surgical management. Neuromodulation has been postulated as a potential treatment for eating disorders and obesity. In particular, deep brain stimulation and transcranial non-invasive brain stimulation have been studied for these indications across a variety of brain targets. Here, we review the neurobiology behind eating and eating disorders as well as the current status of preclinical and clinical neuromodulation trials for eating disorders and obesity.
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Affiliation(s)
- Darrin J Lee
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University of Toronto, 399 Bathurst St., West Wing 4-431, Toronto, ON M5T 2S8, Canada
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22
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Guerron AD, Ortega CB, Portenier D. Anastomotic Leak Following Gastric Bypass. COMPLICATIONS IN BARIATRIC SURGERY 2018:77-84. [DOI: 10.1007/978-3-319-75841-1_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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23
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Samczuk P, Ciborowski M, Kretowski A. Application of Metabolomics to Study Effects of Bariatric Surgery. J Diabetes Res 2018; 2018:6270875. [PMID: 29713650 PMCID: PMC5866882 DOI: 10.1155/2018/6270875] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/30/2017] [Accepted: 01/28/2018] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery was born in the 1950s at the University of Minnesota. From this time, it continues to evolve and, by the same token, gives new or better possibilities to treat not only obesity but also associated comorbidities. Metabolomics is also a relatively young science discipline, and similarly, it shows great potential for the comprehensive study of the dynamic alterations of the metabolome. It has been widely used in medicine, biology studies, biomarker discovery, and prognostic evaluations. Currently, several dozen metabolomics studies were performed to study the effects of bariatric surgery. LC-MS and NMR are the most frequently used techniques to study main effects of RYGB or SG. Research has yield many interesting results involving not only clinical parameters but also molecular modulations. Detected changes pertain to amino acid, lipids, carbohydrates, or gut microbiota alterations. It proves that including bariatric surgery to metabolic surgery is warranted. However, many molecular modulations after those procedures remain unexplained. Therefore, application of metabolomics to study this field seems to be a proper solution. New findings can suggest new directions of surgery technics modifications, contribute to broadening knowledge about obesity and diseases related to it, and perhaps develop nonsurgical methods of treatment in the future.
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Affiliation(s)
- Paulina Samczuk
- Clinical Research Centre, Medical University of Białystok, Białystok, Poland
| | - Michal Ciborowski
- Clinical Research Centre, Medical University of Białystok, Białystok, Poland
| | - Adam Kretowski
- Clinical Research Centre, Medical University of Białystok, Białystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Białystok, Poland
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24
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Nor Hanipah Z, Schauer PR. Master’s Program Bariatric Pathway: Roux-En-Y Gastric Bypass. THE SAGES MANUAL OF BARIATRIC SURGERY 2018:33-50. [DOI: 10.1007/978-3-319-71282-6_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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25
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Marchesi DG, Ciriaco JGM, Miguel GPS, Batista GAP, Cabral CP, Fraga LC. Does the Attention Deficit Hyperactivity Disorder interfere with bariatric surgery results? ACTA ACUST UNITED AC 2017; 44:140-146. [PMID: 28658332 DOI: 10.1590/0100-69912017002006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 01/09/2023]
Abstract
Objective to analyze possible negative effects of Attention Deficit Hyperactivity Disorder (ADHD) on the success of bariatric surgery. Methods we evaluated forty patients undergoing bariatric surgery and with regular post-operative follow-up of at least one year. To all, we applied the questionnaire advocated in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association for ADHD, as well as analyzed their postoperative data. Results fifteen (38%) patients presented a positive questionnaire for ADHD. Patients with ADHD presented higher BMI than patients without the disorder (45.8 vs. 40.9 kg/m2, p=0.017), and the difference remained in all postoperative stages. There was no statistically significant difference in surgery success (33.3% x 66.7%, p=0.505) or in BMI reduction (30.71% x 31.88%, p=0.671) one year after the procedure. Conclusion ADHD patients have a higher BMI. However, the presence of ADHD does not influence the success of bariatric surgery and the reduction of BMI.
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Affiliation(s)
- Doglas Gobbi Marchesi
- - Federal University of Espírito Santo, Department of Surgical Clinics, Vitória, Espírito Santo State, Brazil
| | | | | | | | - Camila Pereira Cabral
- - Federal University of Espírito Santo, Department of Surgical Clinics, Vitória, Espírito Santo State, Brazil
| | - Larissa Carvalho Fraga
- - Federal University of Espírito Santo, Department of Surgical Clinics, Vitória, Espírito Santo State, Brazil
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26
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Abstract
Sleeve gastrectomy, gastric bypass, gastric banding, and duodenal switch are the most common bariatric procedures performed worldwide. Ninety-five percent of bariatric operations are performed with minimally invasive laparoscopic technique. Perioperative morbidities and mortalities average around 5% and 0.2%, respectively. Long-term weight loss averages around 15% to 25% or about 80 to 100 lbs (40-50 kg). Comorbidities, including type 2 diabetes, hypertension, dyslipidemia, sleep apnea, arthritis, gastroesophageal reflux disease, and nonalcoholic fatty liver disease, improve or resolve after bariatric surgery.
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Affiliation(s)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44022, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, UPM-Serdang, 43400 Serdang, Selangor, Malaysia
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44022, USA.
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27
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Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients. Surg Obes Relat Dis 2017; 13:514-521. [DOI: 10.1016/j.soard.2016.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 02/05/2023]
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28
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Ramada Faria GF, Nunes Santos JM, Simonson DC. Quality of life after gastric sleeve and gastric bypass for morbid obesity. Porto Biomed J 2017; 2:40-46. [PMID: 32258584 DOI: 10.1016/j.pbj.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023] Open
Abstract
Highlights Quality-of-life measures improve as early as 3 months after bariatric surgery.There is wide variability in reporting that renders direct comparisons difficult.The available comparisons between RYGB and sleeve gastrectomy could not detect any difference.Improvement in PRO measures might be related to weight loss.Larger and better designed studies are required to achieve discrimination in PRO measures. Background Obesity is associated with reduced quality-of-life (QoL), which generally improves after bariatric surgery. The differential effect of each type of surgery (gastric sleeve [SG] and gastric bypass [RYGB]) on QoL is not yet fully understood. Objectives To understand which of these surgeries offers greatest improvement in QoL and patient satisfaction. Methods Systematic literature search on Pubmed in July 2014. Relevant articles were selected in a step-wise approach. The 2482 titles were scanned for relevance and 191 were selected for abstract reviewing; and 88 papers were selected for full text analysis. Results Only 5 papers compared the 2 techniques and only 17 more had retrievable data either on SG or RYGB. The reports were very heterogeneous, preventing a direct comparison of patient reported outcomes (PRO) among studies.Improved results have been reported as early has 3 months and SF-36 scores were improved in all domains in medium to long-term. The question remains whether the improvement in QoL is related to the weight loss and which factors are associated with improved patients' perceptions. Conclusions There is wide heterogeneity in the reporting of PRO measures after bariatric surgery, but data is consistent with a significant improvement after both surgeries.Larger and better-designed studies are required to understand if there are significant differences in the quality of life after SG or RYGB.
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Affiliation(s)
- Gil Filipe Ramada Faria
- Department of Surgery, Unidade de Investigação em Cirurgia Digestiva e Metabólica, Centro Hospitalar do Porto, Hospital de Sto António, Portugal.,Center for Health Technology and Services Research (CINTESIS), Instituto de Ciências Biomédicas de Abel Salazar, Portugal
| | - Jorge Manuel Nunes Santos
- Department of Surgery, Unidade de Investigação em Cirurgia Digestiva e Metabólica, Centro Hospitalar do Porto, Hospital de Sto António, Portugal.,Instituto de Ciências Biomédicas de Abel Salazar, Portugal
| | - Donald C Simonson
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, United States
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29
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Abstract
Diet, exercise, cognitive behavioral therapy and pharmacotherapy are some of the means of assisting patients to lose weight, with bariatric surgery being the most effective. Over the last two decades, the increased awareness of the systemic benefits of bariatric surgery, as well as the improved safety and the wider use of the laparoscopic approach, has made bariatric surgery flourish. In the United Kingdom, the adjustable gastric band (10%), vertical sleeve gastrectomy (37%) and Roux-en-Y gastric bypass (45%) are the three most common procedures. Obesity-associated mortality and co-morbidities such as type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, renal dysfunction and depression improve significantly with bariatric surgery. The mechanisms of weight loss extend beyond restriction and malabsorption and include changes in hunger and satiety, food preferences, and possibly energy expenditure. Despite its safety and efficacy, bariatric surgery is underutilized as less than 1% of adults with obesity receive it. In view of the evolution of obesity into a global threat, access to bariatric surgery should be increased, whilst developing safer and less invasive weight loss treatments.
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Affiliation(s)
- E Panteliou
- a Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism , Imperial College London , London , UK
| | - A D Miras
- a Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism , Imperial College London , London , UK
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30
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Bencsath K, Jammoul A, Aminian A, Shimizu H, Fisher CJ, Schauer PR, Rae-Grant A, Brethauer SA. Outcomes of Bariatric Surgery in Morbidly Obese Patients with Multiple Sclerosis. J Obes 2017; 2017:1935204. [PMID: 28299203 PMCID: PMC5337361 DOI: 10.1155/2017/1935204] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/13/2017] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
Obesity is common in patients with multiple sclerosis (MS); however, safety and efficacy of bariatric surgery in this population remain unclear. A database of 2,918 was retrospectively reviewed, yielding 22 (0.75%) severely obese patients with MS who underwent bariatric surgery. Sixteen surgical patients with complete follow-up data were matched to a nonsurgical control group of MS patients, based on age, BMI, MS subtype, and length of follow-up. MS relapse rates and trends in the timed twenty-five foot walk test (T25FW) were compared. In the surgical group (gastric bypass n = 19, sleeve gastrectomy n = 3), preoperative BMI was 46.5 ± 7.2 Kg/m2 and average excess weight was 60.4 kg. Follow-up data was collected at 59.0 ± 29.8 months. There were two major and four minor complications. Five patients required readmission and there were no mortalities. Percent excess weight loss was 75.5 ± 27.0%. In the 16 patients with follow-up data, patients who underwent bariatric surgery were significantly faster on the T25FW compared to the nonsurgical population. In conclusion, bariatric surgery is relatively safe and effective in achieving weight loss in patients with MS. In addition, surgery may help patients maintain ambulation. Findings support the need for further studies on bariatric surgery and disease-specific outcomes in this population.
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Affiliation(s)
- Kalman Bencsath
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
- *Kalman Bencsath:
| | - Adham Jammoul
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Hideharu Shimizu
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carolyn J. Fisher
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Philip R. Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Rae-Grant
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stacy A. Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
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Marek RJ, Tarescavage AM, Ben-Porath YS, Ashton K, Heinberg LJ, Rish JM. Associations between psychological test results and failure to proceed with bariatric surgery. Surg Obes Relat Dis 2016; 13:507-513. [PMID: 27771315 DOI: 10.1016/j.soard.2016.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/22/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reasons why some patients who begin the presurgical process for bariatric surgery fail to complete the procedure are understudied. Previous research implies that psychological factors play a role. OBJECTIVES To examine whether scores from baseline psychological testing incrementally predict failure to proceed with bariatric surgery beyond demographic information in patients' medical charts and data derived from a clinical interview. SETTING Cleveland Clinic Bariatric and Metabolic Institute. METHODS The sample (n = 1160) was mainly female (72.41%), middle aged (mean age = 46.07 yr, SD = 11.70) and of Caucasian descent (65.76%). Hierarchical logistic regressions were conducted to test the incremental validity of baseline Minnesota Multiphasic Personality Inventory-2 Restructured Form scores after controlling for information gathered from the psychological interview and medical charts. Relative risk ratios were calculated to reflect the clinical utility of the results. RESULTS In total, 27.16% of patients failed to proceed with bariatric surgery after 1 year or more after a recommendation for surgery from their psychological evaluations. Psychological test scores were substantially associated with failure to proceed with surgery and significantly accounted for up to 6% of additional variance after controlling for psychological interview variables and medical chart data. Elevated scores on Minnesota Multiphasic Personality Inventory-2 Restructured Form scales, such as anxiety and substance use, identify patients at up to 2.5 times greater risk for failing to proceed with bariatric surgery. CONCLUSIONS Objective psychological test data-notably, scale scores assessing for substance abuse, anxiety, and demoralization-add to information obtained from a clinical interview and medical records in identifying patients at risk for failing to proceed with bariatric surgery.
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Affiliation(s)
- Ryan J Marek
- Department of Psychological Sciences, Kent State University, Kent, Ohio.
| | | | | | - Kathleen Ashton
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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A Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve Gastrectomy. Obes Surg 2016; 25:2360-7. [PMID: 26024735 PMCID: PMC4644197 DOI: 10.1007/s11695-015-1705-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Leaks after sleeve gastrectomy (SG) may be due to a mismatch between staple height and tissue thickness. The aim of this study was to determine the range of gastric thicknesses in three areas of stapling. Methods SG was performed using a 40-Fr suction calibration system 4 cm from the pylorus. Measurement of combined gastric walls was accomplished with an applied pressure of 8 g/mm2 on the fundus, midbody, and antrum. Results We enrolled 26 SG patients (15 women, 11 men; mean age 36.8 years). Body mass index (BMI) averaged 45.3 kg/m2 overall, 44.7 kg/m2 for males and 45.7 kg/m2 for females. Although male patients had a thicker stomach antrum than female patients (3.12 vs. 3.09 mm), the midbody (2.57 vs. 3.09 mm) and proximal areas (1.67 vs. 1.72 mm) were thicker in female patients. However, some maximum fundus thicknesses were up to 2.83 mm in females and 2.28 mm in males. Some antra were as thick as 4.07 mm in females and 5.39 mm in males. Also, men had a longer average staple line (22.95 vs. 19.90 cm). Conclusion Because of the range of gastric thicknesses, a single staple height cannot be used to appose the full range of gastric wall thicknesses without potentially causing necrosis or poor apposition. To help avoid leaks, a thickness calibration device is needed to determine correct staple height.
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Abstract
Obesity is closely associated with the development of type 2 diabetes. Many strategies have been used in the past to combat these two conditions, but very few provide for stable and durable glycemic control. Bariatric surgery has emerged as a powerful tool for treating obesity and in over 70 % of cases provides a short-term cure for diabetes. While the acute metabolic effects of surgery are striking, it remains important for us to also consider the long-term effects. This review aims to summarize the chronic or long-term metabolic and physiological effects of Roux-en-Y gastric bypass (RYGB) surgery on pancreatic function, skeletal muscle and hepatic insulin sensitivity, and gastrointestinal remodeling. An increased understanding of the current state of research in these areas can provide the basis for stimulating further research that would contribute to new treatment and management strategies for obesity and diabetes.
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Affiliation(s)
- J David Mosinski
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
- Metabolic Translational Research Center, Cleveland Clinic, Cleveland, OH, 44195, USA.
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Kassir R, Debs T, Blanc P, Gugenheim J, Ben Amor I, Boutet C, Tiffet O. Complications of bariatric surgery: Presentation and emergency management. Int J Surg 2016; 27:77-81. [DOI: 10.1016/j.ijsu.2016.01.067] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/10/2016] [Accepted: 01/21/2016] [Indexed: 01/05/2023]
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Lebel S, Dion G, Marceau S, Biron S, Robert M, Biertho L. Clinical outcomes of duodenal switch with a 200-cm common channel: a matched, controlled trial. Surg Obes Relat Dis 2016; 12:1014-1020. [PMID: 27236379 DOI: 10.1016/j.soard.2016.01.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/13/2016] [Accepted: 01/13/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) with a 100-cm common channel has been our treatment of choice for morbid obesity since the early 1990s. This procedure offers excellent long-term weight loss but can be associated with significant side effects. OBJECTIVES To assess the effect on clinical and nutritional parameters of increasing the common channel to 200 cm. SETTINGS University-affiliated tertiary care center. METHODS Patients who underwent a BPD-DS with a 200-cm common channel (study group, n = 36) were matched 1:1 for age, sex, body mass index (BMI), and main co-morbidities with patients who underwent a BPD-DS with a 100-cm common channel (control group). The strict alimentary limb was 150 cm in both groups. RESULTS The mean age was 55±9 versus 53±7 years (P = .3), with 50% women and a BMI of 49±8 kg/m(2) versus 50±6 kg/m(2) (P = .9). Follow-up rate was 97%, with a minimum follow-up of 3 years. There were no significant differences in the remission rate of major co-morbidities between the 2 groups. At 3 years, the excess weight loss was 61±22% versus 68±18% (P = .18) and the total weight loss was 33±11% versus 38±9% (P = .055) in the study group versus control group, respectively. The study group had a lower incidence of severe protein deficiency (11% versus 19%, P = .3) and hyperparathyroidism (17.1% versus 35.3%, P = .17); required a lower amount of vitamins A and D (P<.05); and had a decreased number of daily bowel movements (2.0 versus 2.9, P = .03). CONCLUSION In this population, BPD-DS with a 200-cm common channel offered similar remission rate of co-morbidities compared with standard BPD-DS. It was associated with similar weight loss at nadir, followed by a more significant weight regain. It might yield a lower rate of nutritional complications. Long-term randomized data are needed to detect other potential advantages.
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Affiliation(s)
- Stéfane Lebel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada.
| | - Geneviève Dion
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada
| | - Simon Marceau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada
| | - Simon Biron
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada
| | - Maud Robert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada
| | - Laurent Biertho
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Surgery, Division of Bariatric and General Surgery, Laval University, Quebec City, Quebec, Canada
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Controversies in perioperative anesthetic management of the morbidly obese: I am a surgeon, why should I care? Obes Surg 2015; 25:879-87. [PMID: 25726320 DOI: 10.1007/s11695-015-1635-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Over the last four decades, as the rates of obesity have increased, so have the challenges associated with its anesthetic management. In the present review, we discuss perioperative anesthesia management issues that are modifiable by the early involvement of the surgical team. We sum up available evidence or expert opinion on issues like patient positioning, postoperative analgesia, and the effect of continuous positive airway pressure (CPAP) ventilation on surgical anastomosis. We also address established predictors of higher perioperative risk and suggest possible management strategies and concerns of obese patients undergoing same day procedures. Finally, a generalized pharmacological model relevant to altered pharmacokinetics in these patients is presented.
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Comparative physiogenomic analyses of weight loss in response to 2 modes of bariatric surgery: demonstration with candidate neuropsychiatric and cardiometabolic genes. Surg Obes Relat Dis 2015; 12:369-77. [PMID: 26968501 DOI: 10.1016/j.soard.2015.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/10/2015] [Accepted: 09/23/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Surgical weight loss response is variable, with suboptimal outcomes in some patients. We hypothesized that genetic biomarkers may be related to weight change. METHODS We tested 330 single nucleotide polymorphisms (SNPs) in genes relevant to metabolic regulation in 161 patients whose decrease in body mass index (BMI), 1 year after laparoscopic adjustable gastric banding (LAGB) or Roux-en-Y gastric bypass (RYGB), was small (lowest quartile response) or large (highest quartile response). LAGB patients whose BMI decreased≤4.7 or≥10.2 units comprised groups I (n = 43) and II (n = 40), respectively. RYGB patients whose BMI decreased≤13.6 or≥19.8 units comprised groups III (n = 39) and IV (n = 39), respectively. Within each surgery, SNPs with large differences in reference allele frequency (z score>2, corresponding to values displaced 2 standard deviations [SD] from the mean for all SNPs) in low versus high quartiles, were identified. We compared reference allele frequencies, within surgical procedure, using the χ(2) test (using Bonferroni correction for multiple testing). RESULTS The mean percent excess weight losses (±SD) corresponding to groups I, II, III, and IV were: 16 (±12), 64 (±30), 55 (±16), and 75 (±17), respectively. SNPs with z score>2 were identified in genes involved in LAGB response, lipid metabolic regulation (APOE, rs439401; APOC4, rs2288911), neural processes (DRD3, rs167771; HTR3 B, rs3758987), and xeno- or endobiotic metabolism (CYP3 A4, rs12333983); and for RYGB response, in lipid transport (SCARB1, rs10846744), folate metabolism (MTHFR, rs2066470), regulation of glycolysis in immune cells (HIF1 A, rs1951795), vitamin K cycling (VKORC1, rs2359612), and xeno- or endobiotic metabolism (CYP3 A4, rs2242480). For LAGB response, APOE SNP frequencies were significantly different. CONCLUSIONS With further validation, information derived from patient DNA may be useful to predict surgical weight loss outcomes and guide selection of surgical approach.
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Marek RJ, Tarescavage AM, Ben-Porath YS, Ashton K, Merrell Rish J, Heinberg LJ. Using presurgical psychological testing to predict 1-year appointment adherence and weight loss in bariatric surgery patients: predictive validity and methodological considerations. Surg Obes Relat Dis 2015; 11:1171-81. [DOI: 10.1016/j.soard.2015.03.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/06/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022]
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Rummell CM, Heinberg LJ. Assessing marijuana use in bariatric surgery candidates: should it be a contraindication? Obes Surg 2015; 24:1764-70. [PMID: 24913244 DOI: 10.1007/s11695-014-1315-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Research has demonstrated negative effects of both alcohol and tobacco use after bariatric surgery. However, no research to date has examined effects of cannabis use after bariatric surgery, even though cannabis is the most commonly used illicit drug in the USA. Literature review reveals that many practitioners generalize from data regarding alcohol abuse to all substances. Further, many screening protocols fail to differentiate between varying levels of cannabis use. The current report aims to (1) review the relevant literature on marijuana use and its potential consequences among bariatric patients, (2) discuss relevant problems and gaps in this literature, and (3) make preliminary recommendations regarding the assessment and treatment planning of bariatric candidates who disclose marijuana use.
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Affiliation(s)
- Christina M Rummell
- Bariatric and Metabolic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/M61, Cleveland, OH, 44195, USA,
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Chatterjee R, Mitra A. An overview of effective therapies and recent advances in biomarkers for chronic liver diseases and associated liver cancer. Int Immunopharmacol 2015; 24:335-345. [PMID: 25560752 DOI: 10.1016/j.intimp.2014.12.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/12/2014] [Accepted: 12/14/2014] [Indexed: 02/07/2023]
Abstract
Chronic liver diseases (CLDs) such as hepatitis, alcoholic liver disease, nonalcoholic fatty liver, and their downstream effect cancer affect more than a billion of people around the world both symptomatically and asymptomatically. The major limitation for early detection and suitable medical management of CLDs and liver cancer is either the absent of symptoms or their similar manifestations as other diseases. This detection impediment has led to a steady increase in the number of people suffering from CLDs with an ultimate outcome of liver failure and undergoing transplantation. A better understanding of CLD pathogenesis has helped us to develop novel therapies for patients who are at greatest risk for CLD progression to the most serious disease cancer. With the discovery of aberrant molecular pathways in CLDs, it is now possible to delineate a road map for selecting targeted therapies for CLDs. Technological advances in imaging as well as the availability of several stable, sensitive, early, noninvasive biomarkers for distinguishing different stages of CLDs and cancer have greatly facilitated both drug target identification and real-time monitoring of response to therapy. Biomarkers are the most useful in clinical practice for liver diseases like hepatocellular carcinoma (HCC), which is associated with secretion of various tumor-related proteins or nucleotides in peripheral circulation. The need for the identification of CLD biomarkers remains high. This article reviews the etiologies of CLDs, the results of recent clinical trials of treatments for CLDs, and development of noninvasive methodologies for detecting CLDs and monitoring their progression toward HCC.
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Affiliation(s)
| | - Abhisek Mitra
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Stein J, Stier C, Raab H, Weiner R. Review article: The nutritional and pharmacological consequences of obesity surgery. Aliment Pharmacol Ther 2014; 40:582-609. [PMID: 25078533 DOI: 10.1111/apt.12872] [Citation(s) in RCA: 145] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/22/2013] [Accepted: 06/21/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Obesity surgery is acknowledged as a highly effective therapy for morbidly obese patients. Beneficial short-term effects on common comorbidities are practically undisputed, but a growing data pool from long-term follow-up reveals increasing evidence of potentially severe nutritional and pharmacological consequences. AIMS To assess the prevalence, causes and symptoms of complications after obesity surgery, to elucidate and compare therapy recommendations for macro- and micronutrient deficiencies, and to explore surgically-induced effects on drug absorption and bioavailability, discussing ramifications for long-term therapy and prophylaxis. METHODS PubMed, Embase and MEDLINE were searched using terms including, but not limited to, bariatric surgery, gastric bypass, obesity surgery and Roux-en-Y, coupled with secondary search terms, e.g. anaemia, micronutrients, vitamin deficiency, bacterial overgrowth, drug absorption, pharmacokinetics, undernutrition. All studies in English, French or German published January 1980 through March 2014 were included. RESULTS Macro- and micronutrient deficiencies are common after obesity surgery. The most critical, depending on surgical technique, are hypoalbuminemia (3-18%) and deficiencies of vitamins B1 (≤49%), B12 (19-35%) and D (25-73%), iron (17-45%) and zinc (12-91%). Many drugs commonly administered to obese patients (e.g. anti-depressants, anti-microbials, metformin) are subject to post-operative and/or PPI-associated changes affecting bioavailability and absorption. CONCLUSIONS Complications are associated with pre-operative and/or post-operative malnutrition or procedure-related changes in intake, absorption and drug bioavailability. The high prevalence of nutrient deficiencies after obesity surgery makes life-long nutritional monitoring and supplementation essential. Post-operative changes to drug absorption and bioavailability in bariatric patients cast doubt on the validity of standard drug dosage and administration recommendations.
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Affiliation(s)
- J Stein
- Department of Gastroenterology and Clinical Nutrition, Sachsenhausen Hospital, Frankfurt/Main, Germany; German Obesity Center (GOC), Frankfurt-Sachsenhausen, Frankfurt/Main, Germany
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Ng J, Seip R, Stone A, Ruano G, Tishler D, Papasavas P. Ethnic variation in weight loss, but not co-morbidity remission, after laparoscopic gastric banding and Roux-en-Y gastric bypass. Surg Obes Relat Dis 2014; 11:94-100. [PMID: 25547051 DOI: 10.1016/j.soard.2014.07.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/22/2014] [Accepted: 07/27/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Demographic factors such as ethnicity may affect bariatric surgery outcomes. We examined weight loss and co-morbidities outcomes in African American, Caucasian, and Hispanic patients who underwent laparoscopic gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB). The primary aim was to investigate demographic differences in weight loss and co-morbidities outcomes. METHODS We retrospectively examined weight change and co-morbidities outcomes in our prospective database. A total of 1,903 patients underwent LAGB or RYGB between January 1, 2005 and March 31, 2012. Of those, 1828 completed their 1-year follow-up visit (9-15 mo) and had complete data. We excluded patients who were missing ethnicity information, resulting in a final cohort of 1,684 patients. Multivariate analyses and χ2 tests were used to examine demographic variables in body mass index (BMI) change, percent excess weight loss (%EWL), and remission of co-morbidities. We also examined weight loss outcomes at 2- and 3-year follow-up. RESULTS Overall, those who underwent RYGB had a lower BMI and greater %EWL at 1, 2, and 3 years compared to those who had undergone LAGB. Overall, African American patients had a higher postoperative BMI than either Caucasian or Hispanic patients. African American patients also showed less %EWL than Caucasian and Hispanic patients. When we examined within surgery type, ethnic differences between African American and Caucasian patients were present across all 3 years in RYGB, but there were no ethnic differences by year 3 in LAGB. Additionally, African American and Hispanic patients no longer differed by year 3 in RYGB and by year 2 in LAGB. There were no significant ethnic differences in remission of diabetes, hyperlipidemia, hypertension, and sleep apnea at 1 year. CONCLUSION Our study found significant ethnic differences in the postoperative BMI and %EWL, which were more pronounced in patients undergoing RYGB than LAGB at the 3-year time point. These weight loss differences did not translate to a lower rate of co-morbidities remission.
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Affiliation(s)
- Janet Ng
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Richard Seip
- Genetic Research Center, Hartford Hospital, Hartford, Connecticut
| | - Andrea Stone
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Gualberto Ruano
- Genetic Research Center, Hartford Hospital, Hartford, Connecticut
| | - Darren Tishler
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
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Ben MD, Polimeni L, Baratta F, Pastori D, Loffredo L, Angelico F. Modern approach to the clinical management of non-alcoholic fatty liver disease. World J Gastroenterol 2014; 20:8341-8350. [PMID: 25024593 PMCID: PMC4093688 DOI: 10.3748/wjg.v20.i26.8341] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/15/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common and emerging form of chronic liver disease worldwide. It includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis, which may progress to cirrhosis, liver cancer, and liver mortality. Common metabolic diseases, which are well established cardiovascular risk factors, have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. The pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver infiltration. Management of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity worldwide. First-line management focuses on lifestyle modifications. Moderate weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly recommended. Several therapeutic interventions have been proposed. These include insulin sensitizer agents, lipid lowering drugs, antioxidants such as vitamin E and supplementation of vitamin D3. However, therapeutic strategies have been largely empirical so far, and experimental trials have mostly been carried out in uncontrolled settings with small sample sizes. Metabolic conditions such as diabetes mellitus, obesity, hypertension and hyperlipidemia, should be strongly considered and a multidisciplinary approach should be personalized for individual patients. Treatment of co-morbidities should be regarded as of paramount importance in the management of these patients. The purpose of this review is to examine different approaches for the clinical management of non-alcoholic fatty liver disease.
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Lawley J. Weighing up the evidence: a meta-analysis and therapeutic audit of the treatments for obesity. ACTA ACUST UNITED AC 2014. [DOI: 10.1093/biohorizons/hzu003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Sussenbach SP, Silva EN, Pufal MA, Casagrande DS, Padoin AV, Mottin CC. Systematic review of economic evaluation of laparotomy versus laparoscopy for patients submitted to Roux-en-Y gastric bypass. PLoS One 2014; 9:e99976. [PMID: 24945704 PMCID: PMC4063755 DOI: 10.1371/journal.pone.0099976] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/20/2014] [Indexed: 12/13/2022] Open
Abstract
Background Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). Methods A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. Results In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. Conclusion This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs.
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Affiliation(s)
- Samanta Pereira Sussenbach
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Milene Amarante Pufal
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela Shan Casagrande
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Postgraduate Program in Medical Sciences: Endocrinology and Metabolism, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Port Alegre, Porto Alegre, Brazil
| | - Alexandre Vontobel Padoin
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cláudio Corá Mottin
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
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Renal outcomes of bariatric surgery in obese adults with diabetic kidney disease. J Nephrol 2014; 27:361-70. [DOI: 10.1007/s40620-014-0078-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/22/2014] [Indexed: 12/21/2022]
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Levinson R, Silverman JB, Catella JG, Rybak I, Jolin H, Isom K. Pharmacotherapy prevention and management of nutritional deficiencies post Roux-en-Y gastric bypass. Obes Surg 2014; 23:992-1000. [PMID: 23558789 DOI: 10.1007/s11695-013-0922-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Roux-en-Y gastric bypass is the most commonly performed bariatric procedure. It is associated with nutritional deficiencies due to gastric reduction, intestinal bypass, reduced caloric intake, avoidance of nutrient-rich foods, noncompliance with supplementation and poor food tolerability. Although there are multiple publications on this topic, there is a lack of consistent guidance for the healthcare practitioner caring for the bariatric patient. This article will encompass literature reviewing the pharmacotherapy approach to prevention and management of nutritional deficiencies since the American Society of Metabolic and Bariatric Surgery guidelines were published in 2008.
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SUSSENBACH S, SILVA EN, PUFAL MA, ROSSONI C, CASAGRANDE DS, PADOIN AV, MOTTIN CC. Implementing laparoscopy in Brazil's National Public Health System: the bariatric surgeons' point of view. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2014; 27 Suppl 1:39-42. [PMID: 25409964 PMCID: PMC4743517 DOI: 10.1590/s0102-6720201400s100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/08/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.
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Affiliation(s)
- Samanta SUSSENBACH
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Everton N SILVA
- Faculdade de Ceilândia da Universidade de
Brasília, Brasília, DF, Brazil
| | - Milene Amarante PUFAL
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Carina ROSSONI
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
- Centro Integrado de Tratamento à Obesidade,
Chapecó, SC, Brazil
| | - Daniela Schaan CASAGRANDE
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alexandre Vontobel PADOIN
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Cláudio Corá MOTTIN
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
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Trofa D, Smith EL, Shah V, Shikora S. Total weight loss associated with increased physical activity after bariatric surgery may increase the need for total joint arthroplasty. Surg Obes Relat Dis 2013; 10:335-9. [PMID: 24355323 DOI: 10.1016/j.soard.2013.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 09/15/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Retrospectively, our institution noticed an increased number of patients undergoing total joint arthroplasty (TJA) after bariatric surgery. Considering that bariatric surgery is a proven modality to reduce osteoarthritic pain, we sought to identify a reason some patients may later require TJA. The objective of this study was to investigate the hypothesis that rapid or increased weight loss after bariatric surgery may be a risk factor for TJA. METHODS Weight loss parameters were retrospectively assessed in 15 bariatric surgery patients who subsequently received a primary TJA and compared with matched bariatric controls. RESULTS Patients who required a TJA lost 27.9% more of their body mass index (BMI) compared with controls (P = .049). Furthermore, patients who underwent TJA 25-48 months postbariatric surgery lost 78.2% more of their BMI compared with controls (P<.001). Total knee arthroplasty patients lost 43.9% more of their BMI compared with controls (P = .02), and the difference in BMI change for total hip arthroplasty patients was not significant versus controls. CONCLUSION These results contradict the tenant that weight loss is universally protective against arthritis and merit larger prospective investigations.
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Affiliation(s)
- David Trofa
- Department of Orthopaedics, Boston, Massachusetts
| | - Eric L Smith
- Department of Orthopaedics, Boston, Massachusetts.
| | - Vivek Shah
- Department of Orthopaedics, Boston, Massachusetts
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Gelinas BL, Delparte CA, Hart R, Wright KD. Unrealistic Weight Loss Goals and Expectations Among Bariatric Surgery Candidates: The Impact on Pre- and Postsurgical Weight Outcomes. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.9999] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Bethany L. Gelinas
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Chelsea A. Delparte
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Regan Hart
- Bariatric Pre-admission Clinic, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada
| | - Kristi D. Wright
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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