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Leyaro B, Howie L, McMahon K, Ali A, Carragher R. Weight loss outcomes and associated factors after metabolic bariatric surgery: Analysis of routine clinical data in Scotland. Am J Surg 2025; 241:116151. [PMID: 39719776 DOI: 10.1016/j.amjsurg.2024.116151] [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: 09/12/2024] [Revised: 12/03/2024] [Accepted: 12/16/2024] [Indexed: 12/26/2024]
Abstract
BACKGROUND Bariatric surgery is a cornerstone intervention for individuals with severe obesity, offering substantial and sustainable weight loss. METHODS This retrospective cohort study included 186 patients with obesity and Type2 diabetes who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2009 and 2020 at University Hospital Ayr. Optimal clinical response weight loss was defined as excess weight loss (%EWL) ≥50 % or total weight loss (%TWL) ≥20 %. RESULTS At 2-years post-surgery, 43.6 % achieved ≥50 %EWL, and 44.1 % achieved ≥20%TWL, with 31.8 % maintaining this at 5-years. Depending on the definition used, between 11.2 % and 45.9 % of patients experienced recurrent weight gain. BMI had significant positive association with %TWL but negative with %EWL (p < 0.05). RYGB had significantly higher %TWL compared to SG (p < 0.05). CONCLUSION Most patients experienced weight loss which was maintained over time, however recurrent weight gain was noted. Pre-surgery BMI was significantly associated with weight changes.
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Affiliation(s)
- Beatrice Leyaro
- School of Computing, Engineering and Physical Sciences, University of West of Scotland, Scotland, UK; Institute of Public Health: Epidemiology and Biostatistics Department, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania.
| | - Lyz Howie
- School of Health and Life Sciences, University of the West of Scotland, Scotland, UK
| | - Kevin McMahon
- Department of General & Upper GI Surgery, University Hospital Ayr, Ayr, Scotland, UK
| | - Abdulmajid Ali
- Department of General & Upper GI Surgery, University Hospital Ayr, Ayr, Scotland, UK
| | - Raymond Carragher
- School of Computing, Engineering and Physical Sciences, University of West of Scotland, Scotland, UK
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Petry C, Minuzzi RK, Dos Santos FS, Semmelmann AL, Bassols GF, Lima JFSP. Evaluation of the Impact of Functional Hypogonadism in Body Composition and Weight Loss in Men Undergoing Bariatric Surgery. Obes Surg 2025; 35:224-230. [PMID: 39661243 DOI: 10.1007/s11695-024-07626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 12/03/2024] [Accepted: 12/06/2024] [Indexed: 12/12/2024]
Abstract
INTRODUCTION Obesity and hypogonadism are linked in a vicious cycle: low testosterone levels favor weight gain and adiposity induces hypogonadism. We aimed to investigate if low levels of testosterone in pre-operative of bariatric surgery impacts postoperative weight loss (WL) and body composition (BC). MATERIAL AND METHODS A prospective, observational study included male patients who qualified for bariatric surgery. Patients underwent clinical evaluation, hormonal evaluation and assessment of body composition measured by dual energy X-ray absorptiometry in both pre-operative and postoperative periods. RESULTS We evaluated 36 patients, mean age 37.1±10.2 years, weight 131.3±14.3 kg and BMI 44.4±4.95 kg/m2. Considering total testosterone (TT) <264 mg/dL and free testosterone <6.5 mg/dL (when TT was borderline), hypogonadism was found in 18 patients (50%). Among the 20 patients who underwent the total evaluation in the pre-operative period, the excess of weight was greater in hypogonadal men (58.1±1.,6 vs 51.1±13.5 kg) as well as the body fat percentage (BFP) (46.1±4.3 vs 45.1±4.5%), however, without statistical significance. After surgery, TT returned to normal in all hypogonadal patients, and patients showed similar WL and BFP. Regarding the relationship between visceral fat and testosterone, it was observed a moderate correlation between the change in TT levels and the reduction in visceral fat. CONCLUSIONS Although frequently observed, low levels of TT in the pre-operative period do not impact post-surgical outcomes, in terms of WL or BC. The normalization of TT levels in the postoperative period is probably due to the gonadal function improvement provided by the WL after bariatric surgery.
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Affiliation(s)
- Carolina Petry
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
- Graduate Program in Pathology, Porto Alegre, Brazil.
| | - Ricardo Kunde Minuzzi
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Pathology, Porto Alegre, Brazil
| | - Felipe Souza Dos Santos
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
- Undergraduate Course of Biomedicine, Porto Alegre, Brazil
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Kim J, Ben-Umeh KC, Kelley J, Davidson LE, Hashibe M, Smith K, Richards N, Adams T. Long-Term Cancer Outcomes Following Bariatric Surgery: A Comparative Analysis of Surgical Procedures. Cancers (Basel) 2024; 16:3730. [PMID: 39594685 PMCID: PMC11591725 DOI: 10.3390/cancers16223730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/31/2024] [Accepted: 11/03/2024] [Indexed: 11/28/2024] Open
Abstract
Background/Objectives: Metabolic and bariatric surgery (MBS) is known to reduce cancer risk. However, the association between specific bariatric procedures and cancer incidence is not well-studied. This study examined the association between four different MBS procedures and cancer incidence. Methods: Bariatric surgery registry data were linked with statewide cancer registry data from 1979 to 2018. The study included 27,092 adult subjects (aged ≥ 18 years old at surgery) who underwent MBS (BMI ≥ 30 kg/m2 at surgery) from 1979 to 2017. Cancer records were linked to MBS patient records, resulting in 1547 cancer cases. Cox proportional hazards regression was used to examine the association between MBS procedure types and cancer incidence. Results: Of all patients, 75% underwent Roux-en-Y gastric bypass (RYGB), 9% adjustable gastric banding (AGB), 10% sleeve gastrectomy (SG), and 6% duodenal switch (BPD-DS). The overall cancer incidence during the follow-up period was 6.4% for RYGB, 4.6% for AGB, 1.6% for SG, and 5.9% for BPD-DS. The mean follow-up duration from surgery to cancer incidence or censoring was 167 months (standard deviation = 121 months). Compared to RYGB, patients who underwent AGB (Hazard Ratio [HR] = 1.26, p = 0.03) and BPD-DS (HR = 1.91, p < 0.01) had a significantly higher hazard of developing cancer, while SG (HR = 1.17, p = 0.33) showed no significant difference. Conclusions: These findings suggest that AGB and BPD-DS may be associated with higher cancer risks compared to RYGB. Additional large population studies are needed to better understand the long-term cancer risks and mechanisms associated with different MBS types.
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Affiliation(s)
- Jaewhan Kim
- Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA;
| | - Kenechukwu C. Ben-Umeh
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT 84112, USA;
| | - Joshua Kelley
- Department of Physical Therapy, University of Utah, Salt Lake City, UT 84108, USA;
| | - Lance E. Davidson
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84602, USA;
| | - Mia Hashibe
- Division of Public Health, University of Utah, Salt Lake City, UT 84108, USA;
| | - Ken Smith
- Department of Family Studies & Population Science, University of Utah, Salt Lake City, UT 84112, USA;
| | | | - Ted Adams
- Division of Epidemiology, University of Utah, Salt Lake City, UT 84108, USA;
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Forester G, Steffen KJ, Heinberg LJ, Wonderlich JA, Murray MF, Stanley TB, Dougherty EN, Olson M, Crosby RD, Bond DS, Gunstad J. Examining the bidirectional longitudinal associations between body mass index and episodic memory following bariatric surgery. Surg Obes Relat Dis 2024; 20:1065-1071. [PMID: 39256112 DOI: 10.1016/j.soard.2024.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/26/2024] [Accepted: 08/03/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND The relationship between obesity and episodic memory (i.e., conscious memory for specific events) is hypothesized to be bidirectional. Indeed, studies have shown that metabolic and bariatric surgery (MBS) is associated with episodic memory improvement, and better memory is associated with better postsurgical weight-loss outcomes. However, direct tests of the hypothesized bidirectional association between episodic memory and body mass index (BMI) in MBS are lacking, as few studies have employed repeated, prospective assessments of memory in conjunction with bidirectional modeling techniques. OBJECTIVES The present study used latent change score analysis to examine the bidirectional longitudinal associations between episodic memory and BMI in the 2 years following MBS. SETTING University hospital; public practice. METHODS Episodic memory function and BMI were assessed in adults prior to MBS, and at 1, 6, 12, 18, and 24-months postsurgery. RESULTS A total of 124 participants (41% lost at 2-year follow-up) showed, on average, favorable weight-loss and episodic memory outcomes following MBS. Crucially, presurgery episodic memory predicted initial change in BMI at 1-month postsurgery, and postsurgery episodic memory at 1- and 6-months predicted change in BMI at 6- and 12-months postsurgery. No evidence was found for pre- and postsurgery BMI predicting changes in episodic memory. CONCLUSIONS Results supported a unidirectional prospective relationship between episodic memory and weight change following MBS, such that better memory pre- and postsurgery predicted improved weight-loss outcomes. These findings highlight the likely importance of episodic memory function for weight change and support the potential benefit of targeting memory processes to improve weight-loss outcomes.
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Affiliation(s)
- Glen Forester
- Center for Biobehavioral Research, Sanford Research; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences.
| | - Kristine J Steffen
- Center for Biobehavioral Research, Sanford Research; Department of Pharmaceutical Sciences, North Dakota State University
| | - Leslie J Heinberg
- Department of Psychiatry and Psychology, Cleveland Clinic Lerner College of Medicine
| | - Joseph A Wonderlich
- Center for Biobehavioral Research, Sanford Research; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
| | - Matthew F Murray
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | | | | | - Megan Olson
- Center for Biobehavioral Research, Sanford Research
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
| | - Dale S Bond
- Departments of Surgery and Research, Hartford Hospital/Hartford Healthcare
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Lucocq J, Homyer K, Geropoulos G, Thakur V, Stansfield D, Joyce B, Drummond G, Tulloh B, de Beaux A, Lamb PJ, Robertson AG. Long-Term Weight Loss and Comorbidity Resolution of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass and the Impact of Preoperative Weight Loss on Overall Outcome. Surg Laparosc Endosc Percutan Tech 2024; 34:466-471. [PMID: 39364879 DOI: 10.1097/sle.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 07/15/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND The impact of preoperative weight loss on long-term weight loss outcomes and comorbidity resolution in both laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are poorly reported. Understanding this relationship is necessary to guide surgeons toward appropriate procedure and patient selection. The present study investigates long-term weight loss outcomes and comorbidity resolution following LSG and LRYGB and investigates the effect of preoperative variables on long-term outcomes. METHODS All patients who underwent LSG and LRYGB (2008-2022) in a tertiary referral centre were followed up prospectively. From 2010, a 12-week intensive preoperative information course (IPIC) became standard practice to optimize preoperative weight loss. Excess weight loss outcomes (EWL≥50% and ≥70%) were compared between LSG and LRYGB using multivariate logistic regression and the effect of preoperative weight loss on weight loss and comorbidity resolution, improvement, and exacerbation were reported. RESULTS A total of 319 patients (median age: 49 y; M:F, 75:244) were included (158 LSG: 161 LRYGB). During follow-up, 260 (81.5%) and 163 patients (51.1%) achieved EWL≥50% and ≥70%, respectively. Those with sustained EWL≥50% and EWL≥70% at the end of follow-up were more likely to have underwent a LRYGB versus a LSG (59.6% vs. 40.4%, P=0.002; 61.7% vs. 38.3%, P<0.001). IPIC and higher preoperative weight loss (HR: 2.59 to 3.72, P<0.001) increased rates of EWL≥50% and EWL70% for both procedures. Improvement or resolution of type-2 diabetes were significant (72.7%), but up to 27.3% of patients developed or suffered an exacerbation of a psychiatric illness. CONCLUSIONS Excess weight loss outcomes are similar for LSG and LRYGB but LRYGB results in higher rates of sustained excess weight loss during long-term follow-up. Preoperative weight loss improves long-term weight loss. Comorbidity resolution is significant but rates of psychiatric illness exacerbation are high following metabolic and bariatric surgery.
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Affiliation(s)
- James Lucocq
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, UK
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Jefferies RS, Ward MA, Shabbir R, Farias DA, Ogola GO, Leeds SG. Magnetic sphincter augmentation vs subtotal gastrectomy with Roux-en-Y reconstruction for the treatment of postsleeve gastrectomy gastroesophageal reflux disease. J Gastrointest Surg 2024; 28:1682-1686. [PMID: 39152086 DOI: 10.1016/j.gassur.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Obesity affects more than one-third of Americans and can be treated with bariatric surgery, most commonly sleeve gastrectomy (SG). SG has been shown to increase the incidence of gastroesophageal reflux disease (GERD) in some patients, which can be refractory to medical management. Surgical options for post-SG GERD include magnetic sphincter augmentation (MSA) and subtotal gastrectomy with Roux-en-Y reconstruction (SGRY). A comparative analysis of MSA and SGRY for post-SG GERD was performed to evaluate postoperative outcomes. METHODS A retrospectively maintained prospectively gathered database from 2018 to 2023 was used to identify patients who underwent MSA or SGRY for the indication of GERD after SG. Differences among patient characteristics; GERD assessments, including the health-related quality of life (HRQL) questionnaire and the reflux symptom index (RSI); and procedure outcomes were collected and analyzed according to surgery type. RESULTS A total of 92 patients (85 females and 7 males) met the inclusion criteria. The study included 17 patients in the MSA group, 71 patients in the SGRY group, and 4 patients who underwent both procedures. The average preoperative body mass index (BMI) of all patients was 33.3. Compared with patients who underwent MSA, those who underwent SGRY presented with higher BMI (29.4 vs 34.2, respectively; P = .013), preoperative GERD-HRQL (35 vs 52, respectively; P = .046), and RSI (14 vs 28, respectively; P = .017). Postoperatively, patients who underwent SGRY demonstrated a higher decrease in mean postoperative DeMeester score than those who underwent MSA (44.2 vs 13.9, respectively; P = .040), with 22 patients (50%) in the SGRY group vs 10 patients (20%) in the MSA group achieving normalization. CONCLUSION Although MSA remains a viable surgical alternative, our study indicated that SGRY can produce better symptom control and decrease acid exposure compared with MSA in patients with post-SG GERD.
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Affiliation(s)
- Rachel S Jefferies
- Department of Clinical Research Management, The University of North Texas Health and Science Center, Fort Worth, TX, United States
| | - Marc A Ward
- Department of Surgery, Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, United States; Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, United States; Department of Surgery, Texas A&M School of Medicine, College Station, TX, United States
| | - Rehma Shabbir
- Department of Surgical Research, Research Institute, Baylor Scott & White Health, Dallas, TX, United States
| | - Daylon A Farias
- Department of Clinical Research Management, The University of North Texas Health and Science Center, Fort Worth, TX, United States
| | - Gerald O Ogola
- Department of Surgical Research, Research Institute, Baylor Scott & White Health, Dallas, TX, United States
| | - Steven G Leeds
- Department of Surgery, Center for Advanced Surgery, Baylor Scott & White Health, Dallas, TX, United States; Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, United States; Department of Surgery, Texas A&M School of Medicine, College Station, TX, United States.
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Lane J, Holmberg D, Thorell A, Burden AM, Furniss D, Burkard T. The association of bariatric surgery and carpal tunnel syndrome: A propensity score-matched cohort study. J Plast Reconstr Aesthet Surg 2024; 97:245-255. [PMID: 39173576 DOI: 10.1016/j.bjps.2024.07.015] [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: 07/04/2023] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES To test the hypothesis that weight loss following bariatric surgery is associated with a reduced risk of developing carpal tunnel syndrome (CTS) compared with obese patients who do not undergo bariatric surgery. METHODS We performed a cohort study using data from the Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery from 2006 to 2019 were propensity score (PS)-matched to up to 2 obese bariatric surgery-free patients ("unexposed patients"). Cox proportional hazard regression was used to calculate hazard ratios (HR) with 95% confidence intervals (CIs) to compare the incidence of CTS among bariatric surgery patients to obese unexposed patients both overall and divided by subgroups of age, sex, bariatric surgery type, and duration of follow-up. RESULTS In total, 40,619 bariatric surgery patients were PS-matched to 63,540 obese unexposed patients who did not undergo surgery. Bariatric surgery was not associated overall with CTS (HR 0.98, 95% CI 0.91-1.05). There was a 23% decreased risk of CTS incidence observed within >1-3 years after bariatric surgery (HR 0.77, 95% CI 0.68-0.88). Decreased CTS risks were observed among bariatric surgery patients aged 18-34 years (HR 0.87, 95% CI 0.74-1.01) and those who underwent sleeve gastrectomy (HR 0.81, 95% CI 0.63-1.03), but these risks did not reach significance level compared with obese unexposed patients. However, there was a 20% increased CTS risk after 6 years (HR 1.20, 95% CI 1.05-1.36). CONCLUSION Our results suggest that marked weight does not have a lasting impact on the reduction of CTS incidence.
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Affiliation(s)
- Jennifer Lane
- Barts Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dag Holmberg
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Thorell
- Department of Clinical Science, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Andrea M Burden
- ETH Zurich, Institute for Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Theresa Burkard
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK; ETH Zurich, Institute for Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Zurich, Switzerland.
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Horváth L, Mráz M, Jude EB, Haluzík M. Pharmacotherapy as an Augmentation to Bariatric Surgery for Obesity. Drugs 2024; 84:933-952. [PMID: 38970626 PMCID: PMC11343883 DOI: 10.1007/s40265-024-02029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 07/08/2024]
Abstract
A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.
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Affiliation(s)
- Luděk Horváth
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Miloš Mráz
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne and University of Manchester, Manchester, United Kingdom.
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Lucocq J, Hughes C, Homyer K, Thakur V, Stansfield D, Geropoulos G, Joyce B, Drummond G, de Beaux A, Tulloh B, Lamb PJ, Robertson AG. Predicting Inadequate Weight Loss After Bariatric Surgery: Derivation and Validation of a Four Factor Model. Obes Surg 2024; 34:2991-2998. [PMID: 38981957 DOI: 10.1007/s11695-024-07383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Weight loss following bariatric surgery is variable and predicting inadequate weight loss is required to help select patients for bariatric surgery. The aim of the present study was to determine variables associated with inadequate weight loss and to derive and validate a predictive model. METHODS All patients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastrectomy (2008-2022) in a tertiary referral centre were followed up prospectively. Inadequate weight loss was defined as excess weight loss (EWL) < 50% by 24 months. A top-down approach was performed using multivariate logistic regression and then internally validated using bootstrapping. Patients were categorised into risk groups. RESULTS A total of 280 patients (median age, 49 years; M:F, 69:211) were included (146 LSG; 134 LRYGB). At 24 months, the median total weight loss was 30.9% and 80.0% achieved EWL ≥ 50% by 24 months. Variables associated with inadequate weight loss were T2DM (OR 2.42; p = 0.042), age 51-60 (OR 1.93, p = 0.006), age > 60 (OR 4.93, p < 0.001), starting BMI > 50 kg/m² (OR 1.93, p = 0.037) and pre-operative weight loss (OR 3.51; p = 0.036). The validation C-index was 0.75 (slope = 0.89). Low, medium and high-risk groups had a 4.9%, 16.7% and 44.6% risk of inadequate weight loss, respectively. CONCLUSIONS Inadequate weight loss can be predicted using a four factor model which could help patients and clinicians in decision-making for bariatric surgery.
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Affiliation(s)
- James Lucocq
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK.
| | - Conor Hughes
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Kate Homyer
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Vikram Thakur
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Daniel Stansfield
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Georgios Geropoulos
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Brian Joyce
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Gillian Drummond
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Andrew de Beaux
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Bruce Tulloh
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Peter J Lamb
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Andrew G Robertson
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
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Murray MF, Pearl ES, Zelenak L, Hamann A, Sehgal M, Braciszewski JM, Carlin AM, Miller-Matero LR. COVID-19-Related Increases in Depressive and Anxious Symptoms Are Associated with Maladaptive Eating Among Patients up to 4 years Post-bariatric Surgery. Obes Surg 2024; 34:2580-2586. [PMID: 38839635 PMCID: PMC11338285 DOI: 10.1007/s11695-024-07326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Depressive and anxious symptoms and maladaptive eating behaviors fluctuate with stressful events for patients seeking bariatric surgery. These associations are less clear for patients postoperatively. Using the COVID-19 pandemic as a frame, we examined associations between changes in depressive and anxious symptoms and maladaptive eating behaviors between up to four years postoperatively. METHODS Participants (N = 703) who underwent surgery between 2018 and 2021 completed web-based questionnaires between 2021 and 2022. Demographic and surgical data were obtained from electronic health records. Participants reported whether depressive and anxious symptoms increased or were stable/decreased during the COVID-19 pandemic, and completed eating behavior measures. RESULTS Many participants reported increased depressive (27.5%) and anxious (33.7%) symptoms during the COVID-19 pandemic. Compared to those who reported stable or decreased symptoms, these participants were as follows: (1) more likely to endorse presence of binge, loss-of-control, graze, and night eating; (2) reported higher emotional eating in response to anger and frustration, depression, and anxiety; and (3) reported higher driven and compulsive eating behaviors. Frequency of binge, loss-of-control, graze, and night eating episodes did not differ between groups (e.g., increased vs. stable/decreased anxious symptoms) among participants who endorsed any episodes. CONCLUSION A large portion of the sample reported increased depressive and anxious symptoms during the COVID-19 pandemic, and these increases were associated with maladaptive eating behaviors. Depressive and anxious symptoms and eating behaviors should be assessed postoperatively as significant stressors may be associated with increased distress and maladaptive eating behaviors that can affect postoperative outcomes. Postoperative interventions may be useful at simultaneously targeting these concerns.
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Affiliation(s)
- Matthew F Murray
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA.
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S Maryland Ave MC3077, Chicago, IL, 60637, USA.
| | - Elise S Pearl
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
| | - Logan Zelenak
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Department of Surgery, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Monica Sehgal
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
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11
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Ministrini S, Padro T. MicroRNA in cardiometabolic health and disease: The perspectives of sex, gender and personalised medicine. Eur J Clin Invest 2024; 54:e14223. [PMID: 38623918 DOI: 10.1111/eci.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Personalized medicine represents a novel and integrative approach that focuses on an individual's genetics and epigenetics, precision medicine, lifestyle and exposures as key players of health status and disease phenotypes. METHODS In this narrative review, we aim to carefully discuss the current knowledge on gender disparities in cardiometabolic diseases, and we consider the sex- specific expression of miRNAs and their role as promising tool in precision medicine. RESULTS Personalised medicine overcomes the restricted care of patient based on a binomial sex approach, by enriching itself with a holistic and dynamic gender integration. Recognized as a major worldwide health emergency, cardiometabolic disorders continue to rise, impacting on health systems and requiring more effective and targeted strategies. Several sex and gender drivers might affect the onset and progression of cardiometabolic disorders in males and females at multiple levels. In this respect, distinct contribution of genetic and epigenetic mechanisms, molecular and physiological pathways, sex hormones, visceral fat and subcutaneous fat and lifestyle lead to differences in disease burden and outcomes in males and females. CONCLUSIONS Sex and gender play a pivotal role in precision medicine because the influence the physiology of each individual and the way they interact with environment from intrauterine life.
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Affiliation(s)
- Stefano Ministrini
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Teresa Padro
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain
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12
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Lucocq J, Thakur V, Geropoulos G, Stansfield D, Irvine L, Duxbury M, de Beaux AC, Tulloh B, Wallace B, Joyce B, Harrow L, Drummond G, Lamb PJ, Robertson AG. Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11 years results from a tertiary referral centre. Surg Endosc 2024; 38:2689-2698. [PMID: 38519610 DOI: 10.1007/s00464-024-10791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Outcomes of long-term (5-10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery. METHODS Data were collected prospectively from a bariatric center (2008-2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%. RESULTS Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5-11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up. CONCLUSIONS IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up.
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Affiliation(s)
- James Lucocq
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Vikram Thakur
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Georgios Geropoulos
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Daniel Stansfield
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Laura Irvine
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Mhairi Duxbury
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew C de Beaux
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Bruce Tulloh
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Beverley Wallace
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Brian Joyce
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Lisa Harrow
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Gillian Drummond
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Peter J Lamb
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew G Robertson
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK.
- Department of Clinical Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK.
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13
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Muscogiuri G, Verde L, Vetrani C, Barrea L, Savastano S, Colao A. Obesity: a gender-view. J Endocrinol Invest 2024; 47:299-306. [PMID: 37740888 PMCID: PMC10859324 DOI: 10.1007/s40618-023-02196-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE There is a growing awareness of the importance of understanding gender differences in obesity. The aim of this short review was to revise the current evidence on anthropometric characteristics and nutritional and pharmacological aspects of obesity from a gender perspective. METHODS A literature search within PubMed was performed. Selected publications related to obesity and gender differences were reviewed. RESULTS The prevalence of obesity among men is higher than in women, but women have a higher percentage of body fat content compared to men, and gender appears to be an important factor in the manifestation of central (android) or peripheral (gynoid) obesity. In addition, while in most clinical trials, women are still underrepresented, in clinical registration trials of anti-obesity drugs, women are commonly up-represented and gender-specific analysis is uncommon. Considering that adipose tissue is one of the factors affecting the volume of distribution of many drugs, mainly lipophilic drugs, gender differences might be expected in the pharmacokinetics and pharmacodynamics of anti-obesity drugs. Indeed, although Liraglutide 3 mg, a long-acting glucagon-like peptide-1 receptor agonist, and naltrexone/bupropion display lipophilic properties, currently, a gender-dose adjustment for both these drugs administration is not recommended. In addition, despite that predicted responders to treatment offer substantial opportunities for efficient use, especially of expensive new therapies, such as anti-obesity drugs, data on gender differences to identify early responders to both these have not yet been investigated. Finally, bariatric surgery gender disparity reflects healthcare practices. Weight loss similar, but differing effects: women need more correction and face psychology challenges; men have worse physiology and fewer comorbidity improvements. CONCLUSION Gender differences exist in obesity prevalence and phenotype, body fat distribution, drug efficacy, clinical trial representation, and different secondary effects of bariatric surgery. Gender is an important variable in obesity analysis.
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Affiliation(s)
- G Muscogiuri
- Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy.
| | - L Verde
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - C Vetrani
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento Di Scienze Umanistiche, Centro Direzionale, Università Telematica Pegaso, Via PorzioIsola F2, 80143, Naples, Italy
| | - L Barrea
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento Di Scienze Umanistiche, Centro Direzionale, Università Telematica Pegaso, Via PorzioIsola F2, 80143, Naples, Italy
| | - S Savastano
- Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Diabetologia E Andrologia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
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McClelland PH, Jawed M, Kabata K, Zenilman ME, Gorecki P. Long-term outcomes following laparoscopic Roux-en-Y gastric bypass: weight loss and resolution of comorbidities at 15 years and beyond. Surg Endosc 2023; 37:9427-9440. [PMID: 37676323 DOI: 10.1007/s00464-023-10366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold-standard bariatric procedure with proven efficacy in morbidly obese populations. While the short-term benefits of LRYGB have been well-documented, durable weight loss and long-term resolution of obesity-related comorbidities have been less clearly described. METHODS This single-center study prospectively reports weight loss and comorbidity resolution in patients undergoing LRYGB between August 2001 and September 2007 with at least 15-year follow-up. Data were collected at the time of surgery; 1, 3, 6, and 12 months postoperatively; and then annually thereafter. RESULTS A total of 486 patients were included in this analysis. Patients were predominantly female (88.7%), and the median age was 36.0 [IQR 29.0-45.0] years. Patients were ethnically diverse, including Black/African American (43.6%), White/Caucasian (35.0%), Hispanic (18.3%), and other backgrounds (3.1%). Mean preoperative weight and body mass index were 133.0 ± 21.9 kg and 48.4 ± 6.5 kg/m2, and the median number of comorbidities was 6.0 [IQR 4.0-7.0]. Follow-up rates at 1, 5, 10, and 15 years were 75.3%, 37.2%, 35.2%, and 18.9%, respectively. On average, maximum percentage total weight loss (%TWL) occurred 2 years postoperatively (- 36.2 ± 9.5%), and ≥ 25% TWL was consistently achieved at 1, 5, 10, and 15-year time intervals (- 28.0 ± 13.0% at 15 years). Patients with comorbidities experienced improvement or resolution of their conditions within 1 year, including type 2 diabetes mellitus (83/84, 98.8%), obstructive sleep apnea (112/116, 96.6%), hypertension (142/150, 94.7%), and gastroesophageal reflux disease (217/223, 97.3%). Rates of improved/resolved comorbidities remained consistently high through at least 10 years after surgery. CONCLUSIONS LRYGB provides durable weight loss for at least 15 years after surgery, with stable average relative weight loss of approximately 25% from baseline. This outcome corresponds with sustainable resolution of obesity-related comorbidities for at least 10 years after the initial operation.
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Affiliation(s)
- Paul H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Mohsin Jawed
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Krystyna Kabata
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Michael E Zenilman
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Piotr Gorecki
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
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15
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Abdalla TSA, Giannou AD, Abdalla ASA, Izbicki JR, Dupreé A, Mann O, Wolter S. The Effect of Non-Alcoholic Fatty Liver Disease on Weight Loss and Resolution of Obesity-Related Disorders After Bariatric Surgery. World J Surg 2023; 47:3281-3288. [PMID: 37747548 PMCID: PMC10694115 DOI: 10.1007/s00268-023-07153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Patients undergoing bariatric surgery have a high incidence of non-alcoholic fatty liver disease (NAFLD). However, the effect of NAFLD or non-alcoholic steatohepatitis (NASH) on the weight loss and resolution of obesity-related disorders is a matter of debate. METHODS In this study, we compare the long-term outcomes after bariatric with the presence of NAFLD in the liver biopsy at the time of surgery. RESULTS The follow-up was available for 226 out of 288 patients. The mean follow-up time was 24.9 (± 13.6) months. The baseline histology showed that 112 patients (38.9%) had no NASH, 70 (24.3%) were borderline, and 106 (36.8%) had NASH. At follow-up, the mean BMI dropped from (52 ± 10.2) to (36.6 ± 8) kg/m 2. Excess weight loss (EWL) was similar in all NAFLD groups. Type 2 diabetes mellitus dropped from 35.7 to 11.4%, hypertension from 65.6 to 36.7%, hyperlipidemia from 62.3 to 33%, and obstructive sleep apnea from 37.5 to 14.9%. Only hyperlipidemia was significantly associated with NASH compared to the groups with no NASH or borderline NASH (p value = 0.002 and p value = 0.04, respectively) during the first two years of follow-up. CONCLUSION The beneficial effects of bariatric surgery are evident across all patients with NAFLD. Patients with NASH have comparable outcomes regarding weight loss and resolution of obesity-related comorbidities.
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Affiliation(s)
- Thaer S A Abdalla
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Anastasios D Giannou
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Ahmed S A Abdalla
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Anna Dupreé
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
| | - Stefan Wolter
- Department of General, Visceral and Thoracic Surgery, At the University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251, Hamburg, Germany
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16
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Pereira SS, Guimarães M, Monteiro MP. Towards precision medicine in bariatric surgery prescription. Rev Endocr Metab Disord 2023; 24:961-977. [PMID: 37129798 PMCID: PMC10492755 DOI: 10.1007/s11154-023-09801-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 05/03/2023]
Abstract
Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.
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Affiliation(s)
- Sofia S Pereira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Marta Guimarães
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220, Santa Maia da Feira, Portugal
| | - Mariana P Monteiro
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal.
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal.
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17
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Mela V, Agüera Z, Alvarez-Bermudez MD, Martín-Reyes F, Granero R, Sánchez-García A, Oliva-Olivera W, Tomé M, Moreno-Ruiz FJ, Soler-Humanes R, Fernández-Serrano JL, Sánchez-Gallegos P, Martínez-Moreno JM, Sancho-Marín R, Fernández-Aranda F, García-Fuentes E, Tinahones FJ, Garrido-Sánchez L. The Relationship between Depressive Symptoms, Quality of Life and miRNAs 8 Years after Bariatric Surgery. Nutrients 2023; 15:4109. [PMID: 37836393 PMCID: PMC10574314 DOI: 10.3390/nu15194109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: There are conflicting results on whether weight loss after bariatric surgery (BS) might be associated with quality of life (QoL)/depressive symptomatology. We aim to determine whether BS outcomes are associated with QoL/depressive symptomatology in studied patients at the 8-year follow-up after BS, as well as their relationship with different serum proteins and miRNAs. (2) Methods: A total of 53 patients with class III obesity who underwent BS, and then classified into "good responders" and "non-responders" depending on the percentage of excess weight lost (%EWL) 8 years after BS (%EWL ≥ 50% and %EWL < 50%, respectively), were included. Basal serum miRNAs and different proteins were analysed, and patients completed tests to evaluate QoL/depressive symptomatology at 8 years after BS. (3) Results: The good responders group showed higher scores on SF-36 scales of physical functioning, role functioning-physical, role functioning-emotional, body pain and global general health compared with the non-responders. The expression of hsa-miR-101-3p, hsa-miR-15a-5p, hsa-miR-29c-3p, hsa-miR-144-3p and hsa-miR-19b-3p were lower in non-responders. Hsa-miR-19b-3p was the variable associated with the response to BS in a logistic regression model. (4) Conclusions: The mental health of patients after BS is limited by the success of the intervention. In addition, the expression of basal serum miRNAs related to depression/anxiety could predict the success of BS.
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Affiliation(s)
- Virginia Mela
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Zaida Agüera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
- Departament d’Infermeria de Salut Pública, Salut Mental i Maternoinfantil, Escola d’Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Maria D. Alvarez-Bermudez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Flores Martín-Reyes
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | - Roser Granero
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ana Sánchez-García
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Wilfredo Oliva-Olivera
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Monica Tomé
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29009 Malaga, Spain;
| | - Francisco J. Moreno-Ruiz
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain;
| | - Rocío Soler-Humanes
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain; (R.S.-H.); (J.L.F.-S.)
| | - Jose L. Fernández-Serrano
- Unidad de Gestión Clínica de Cirugía General y Digestiva, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain; (R.S.-H.); (J.L.F.-S.)
| | - Pilar Sánchez-Gallegos
- Department of Surgical Specialities, Biochemistry and Immunology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain; (P.S.-G.); (J.M.M.-M.); (R.S.-M.)
| | - Jose M. Martínez-Moreno
- Department of Surgical Specialities, Biochemistry and Immunology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain; (P.S.-G.); (J.M.M.-M.); (R.S.-M.)
| | - Raquel Sancho-Marín
- Department of Surgical Specialities, Biochemistry and Immunology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain; (P.S.-G.); (J.M.M.-M.); (R.S.-M.)
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge, 08907 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Eduardo García-Fuentes
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Francisco J. Tinahones
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Department of Medicine and Dermatology, Faculty of Medicine, University of Malaga, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
| | - Lourdes Garrido-Sánchez
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Malaga, Spain; (V.M.); (M.D.A.-B.); (F.M.-R.); (A.S.-G.); (W.O.-O.); (L.G.-S.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28029 Madrid, Spain; (Z.A.); (R.G.); (F.F.-A.)
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Valezi AC, Campos ACL, Bahten LCV. BRAZILIAN MULTI-SOCIETY POSITION STATEMENT ON EMERGING BARIATRIC AND METABOLIC SURGICAL PROCEDURES. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1759. [PMID: 37729276 PMCID: PMC10510373 DOI: 10.1590/0102-672020230041e1759] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 09/22/2023]
Abstract
This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.
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Verras GI, Mulita F, Pouwels S, Parmar C, Drakos N, Bouchagier K, Kaplanis C, Skroubis G. Outcomes at 10-Year Follow-Up after Roux-en-Y Gastric Bypass, Biliopancreatic Diversion, and Sleeve Gastrectomy. J Clin Med 2023; 12:4973. [PMID: 37568375 PMCID: PMC10419540 DOI: 10.3390/jcm12154973] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Morbid obesity is a well-defined chronic disease, the incidence of which is constantly rising. Surgical treatment of morbid obesity has produced superior outcomes compared to conventional weight loss measures. Currently, there is a gap in the literature regarding long-term outcomes. Our single-institution, retrospective cohort study aims to evaluate weight loss outcomes, comorbidity reduction, and adverse effects at 10 years following Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Sleeve Gastrectomy (SG). MATERIALS AND METHODS We included all consecutive patients with 10-year follow-up records operated on within our institution. The comparison was carried out on the average percentage of weight and BMI loss. Nausea and vomiting were evaluated through self-reporting Likert scales. Diabetes resolution and nutritional deficiencies were also evaluated. RESULTS A total of 490 patients from 1995 up to 2011 were included in our study. Of these, 322 underwent RYGB, 58 underwent long-limb BPD, 34 underwent laparoscopic RYGB with fundus excision, 47 underwent laparoscopic SG, and 29 underwent laparoscopic RYGB as a revision of prior SG. RYGB and BPD were significantly associated with higher percentages of weight loss (37.6% and 37.5%), but were not found to be independent predictors of weight loss. Nausea and vomiting were associated with SG and laparoscopic RYGB with fundus excision, more so than the other operations. No differences were observed regarding diabetes resolution and nutritional deficiencies. CONCLUSIONS Longer follow-up reports are important for the comparison of outcomes between different types of bariatric operations. BPD and RYGB resulted in superior weight loss, with no observed differences in diabetes resolution and adverse outcomes.
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Affiliation(s)
- Georgios-Ioannis Verras
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Sjaak Pouwels
- Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, 47805 Krefeld, Germany;
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, 5022 Tiburg, The Netherlands
| | - Chetan Parmar
- The Wittington Hospital NHS Trust, London N19 5NF, UK;
| | - Nikolas Drakos
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Konstantinos Bouchagier
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Charalampos Kaplanis
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - George Skroubis
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
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Nascimento IMCD, Padilha BM, Araujo MLD, Silva PCD, Noronha GAD, Cabral PC, Ferraz ÁAB. VITAMIN D LEVELS AND LIPID PROFILE IN PATIENTS UNDERGOING BARIATRIC SURGERY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1753. [PMID: 37531473 PMCID: PMC10379289 DOI: 10.1590/0102-672020230035e1753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/01/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Vitamin, mineral, and metabolic deficiencies occur in the postoperative period of bariatric surgery, in the short and long term, and are worrisome intercurrences. AIMS To evaluate the association of serum vitamin D levels with the lipid profile in obese patients undergoing bariatric surgery. METHODS Case series of patients assisted from 2010 to 2018, in a private hospital of medium and high complexity, who underwent bariatric surgery using sleeve gastrectomy or Roux-en-Y gastric bypass techniques, monitored by the same surgeon. Sociodemographic, clinical, laboratory, and anthropometric data were collected preoperatively and at 6, 12, and 24 months after surgery. RESULTS A total of 156 individuals, mostly female (75.6%) were monitored. The most frequent comorbidities were hepatic steatosis (76.3%) and hypertension (48.27). Regarding preoperative vitamin D levels, only 18.9% of the population had a satisfactory level (≥30 ng/mL). There was a reduction in weight and an improvement in the lipid profile after surgery. Significant correlations were observed between the lipid profile and vitamin D concentration only in the sample submitted to the Roux-en-Y gastric bypass technique: negative correlation between total cholesterol and vitamin D two years after surgery; positive correlation between triglycerides and vitamin D one year after surgery; and negative correlation between high-density lipoprotein and vitamin D two years post-surgery. CONCLUSIONS It is essential to routinely monitor vitamin D levels and lipid profile pre- and postoperatively in order to avoid damage associated with this vitamin deficiency.
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21
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Barrea L, Verde L, Schiavo L, Sarno G, Camajani E, Iannelli A, Caprio M, Pilone V, Colao A, Muscogiuri G. Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery. Nutrients 2023; 15:nu15081907. [PMID: 37111126 PMCID: PMC10142118 DOI: 10.3390/nu15081907] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients' suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143 Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Gerardo Sarno
- San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
- Faculté de Medicine, Université Côte d'Azur, 06000 Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", 06204 Nice, France
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, 00166 Rome, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
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Köhler H, Bollenbach IA, Gruner-Labitzke K, Bollenbach JN, Böker C, Markov V, Kröger C. Improvement of Work Ability After Weight Loss Surgery: Results of a Longitudinal Study of Patients Suffering from Extreme Obesity Before and 4 Years After Bariatric Surgery. Obes Surg 2023; 33:1347-1355. [PMID: 36935471 DOI: 10.1007/s11695-023-06548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Body mass index (BMI) is directly associated with employment status. Our longitudinal prospective study is aimed at ascertaining whether work ability index (WAI) 4 years after surgery remains improved, such as 1 year after surgery, or changes and whether socio-demographic or psycho-social factors influence changes in work ability. MATERIALS AND METHODS 197 bariatric surgery candidates were recruited. Data on demographic and psycho-social characteristics were collected prior to surgery (t1) and at 6 (t2), 12 (t3), and 48 months (t4). Change effects over time in the WAI and BMI were investigated using a repeated-measures analysis of variance (ANOVA). A hierarchical multiple regression analysis was calculated to predict socio-demographic and psychosocial characteristics at t1 on WAI at t4. RESULTS Not only a significant increase in WAI was observed between t1 and t2 and between t3 and t4 but also a significant decrease between t2 and t4. BMI reduction was significant between t1 and t2 and t3 and t4, respectively. There was no significant interaction effect of BMI reduction 4 years after surgery on decreased work ability from t2 to t4. The hierarchical multiple regression analysis revealed an association of WAI scores at t1 on WAI scores at t4 only. CONCLUSIONS Work ability 4 years after surgery remained significantly improved compared to the values at t1-t3 assessment. Since work ability was the only predictor at t1, findings might indicate the use of psycho-social measures post bariatric surgery to increase work ability. There was no association between work ability and other socio-demographic or psycho-social factors.
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Affiliation(s)
- Hinrich Köhler
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany
| | - Ioana A Bollenbach
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany.
| | - Kerstin Gruner-Labitzke
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany
| | - Jan N Bollenbach
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany
| | - Clara Böker
- Department of General, Visceral, Vascular and Bariatric Surgery, Klinikum Nordstadt, 30167, Hannover, Germany
| | - Valentin Markov
- Department of Psychology, University of Hildesheim, 31141, Hildesheim, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, 31141, Hildesheim, Germany
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McClelland PH, Kabata K, Gorecki W, Jano A, Zenilman ME, Gorecki P. Long-term weight loss after bariatric procedures for morbidly obese adolescents and youth: a single-institution analysis with up to 19-year follow-up. Surg Endosc 2023; 37:2224-2238. [PMID: 35879574 DOI: 10.1007/s00464-022-09434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity is a public health concern among adolescents and young adults. Bariatric surgery is the most effective treatment for morbid obesity and has been increasingly utilized in young patients. Long-term outcomes data for bariatric surgery in this age group are limited. METHODS This is a single-institution, prospective analysis of 167 patients aged 15-24 years who underwent one of three laparoscopic bariatric procedures between 2001 and 2019: Roux-en-Y gastric bypass (LRYGB, n = 71), adjustable gastric banding (LAGB, n = 22), and sleeve gastrectomy (LSG, n = 74). Longitudinal weight and body mass index (BMI) measurements were compared to evaluate patterns of weight loss. RESULTS All operations were completed laparoscopically using the same clinical pathways. Patients were predominantly female (82.6%), had a median age of 22.0 [Q1-Q3 20.0-23.0] years, and had a mean presurgical BMI of 48.5 ± 6.5 kg/m2 (range 38.4-68.1 kg/m2). All procedures produced significant weight loss by 1 year, peak weight loss by 2 years, and modest weight regain after 5 years. Mean percent weight/BMI losses at 5 years for LRYGB, LAGB, and LSG were - 36.7 ± 10.8%, - 14.5 ± 15.3%, and - 25.1 ± 13.4%, respectively (p < 0.001). LRYGB patients were most likely to achieve ≥ 25% weight loss at 1, 3, and 5 years and maintained significant average weight loss for more than 15 years after surgery. Reoperations were procedure-specific, with LAGB, LRYGB, and LSG having the highest, middle, and lowest reoperation rates, respectively (40.9% vs. 16.9% vs. 5.4%, p < 0.001). CONCLUSION All procedures provided significant and durable weight loss. LRYGB patients achieved the best and most sustained weight loss. LSG patients experienced second-best weight loss between 1 and 5 years, with lowest chance of reoperation. LAGB patients had the least weight loss and the highest reoperation rate. Compared to other factors, type of bariatric procedure was independently predictive of successful weight loss over time. More studies with long-term follow-up are needed.
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Affiliation(s)
- Paul H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Krystyna Kabata
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Wojciech Gorecki
- Department of Pediatric Surgery, Jagiellonian University Medical College, University Children's Hospital of Krakow, Krakow, Poland
| | - Antalya Jano
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Michael E Zenilman
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Piotr Gorecki
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
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Varvoglis DN, Lipman JN, Li L, Sanchez-Casalongue M, Zhou R, Duke MC, Farrell TM. Gastric Bypass Versus Sleeve Gastrectomy: Comparison of Patient Outcomes, Satisfaction, and Quality of Life in a Single-Center Experience. J Laparoendosc Adv Surg Tech A 2023; 33:155-161. [PMID: 36106945 DOI: 10.1089/lap.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) is the most common primary bariatric operation performed in the United States. Its relative technical ease, combined with a decreased risk for anatomic and malabsorptive complications make LSG an attractive option compared to laparoscopic gastric bypass (LGB) for many patients and surgeons. However, emerging evidence for progressive gastroesophageal reflux disease (GERD) after LSG, and the inferior weight loss in many studies, suggests that the enthusiasm for LSG requires reassessment. We hypothesized that patient satisfaction and quality of life (QoL) may be lower after LSG compared to LGB because of these differences. Methods: We distributed a survey querying weight-loss outcomes, complications, foregut symptoms, QoL, and overall satisfaction to patients who underwent bariatric operations at our institution between 2000 and 2020 and who had electronic mail contact information available. Mean follow-up was 2.75 ± 2.41 years for LGB patients and 3.37 ± 2.18 (P = .021) years for LSG patients. We compared these groups for weight-loss outcomes, changes in foregut symptoms, gastrointestinal QoL, postbariatric QoL, and overall satisfaction using appropriate statistical tests. Results: Among 323 respondents, 126 underwent LGB and 197 underwent LSG. LGB patients had larger body mass index (BMI) reduction than LSG patients (-17.16 ± 9.07 kg/m2 versus -14.87 ± 7.4 kg/m2, P = .023). LGB patients reported less reflux (P = .003), with decreased heartburn (P < .0001) and regurgitation (P = .0027). However, a greater proportion of LGB patients reported at least one complication (P = .025). Despite this, more LGB patients reported satisfaction (92.86%) than LSG patients (73.6%). Conclusion: LGB patients are significantly more likely to be satisfied than LSG patients. Factors contributing to the higher level of satisfaction include less GERD and better BMI decrease.
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Affiliation(s)
- Dimitrios N Varvoglis
- Department of Surgery and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey N Lipman
- Department of Surgery and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lang Li
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Manuel Sanchez-Casalongue
- Department of Surgery and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Randal Zhou
- Department of Surgery, Yale University, New Haven, Connecticut, USA
| | - Meredith C Duke
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy M Farrell
- Department of Surgery and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Sleeve Gastrectomy: Does the Amount of Stomach Removed Matter? Obes Surg 2023; 33:469-474. [PMID: 36474099 DOI: 10.1007/s11695-022-06383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Data regarding the associations between percent weight loss and the volume and weight of stomach resected during sleeve gastrectomy (SG) are mixed. The purpose of this study was to evaluate the effect of the size and volume of stomach removed during laparoscopic SG on percent total body weight lost (%TBWL). METHODS An observational case series study was performed on 67 patients for 1 year after SG at a single university-affiliated, tertiary care hospital. Data were collected on demographics, medical history, and %TBWL at 3, 6, and 12 months post-operatively. Pearson's correlation matrices and multiple linear regression analyses were performed. RESULTS Most patients (88.1%) were female with a mean age of 44 years. The mean volume of stomach resected was 1047.0 cubic centimeters, and the median weight resected was 123.0 g. Follow-up data were available for 44 patients at 1-year post-operation. There was no association between the volume and weight of stomach resected and %TBWL at 1-year post-operation; however, greater %TBWL was associated with younger patient age (r = - 0.525, p < 0.001). CONCLUSION One year after SG, no associations between %TBWL and the volume and weight of stomach resected were observed.
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Courtney MJ, Carr WRJ, Mahawar K. Laparoscopic Roux-en-Y Gastric Bypass: Weight Loss Outcomes. OBESITY, BARIATRIC AND METABOLIC SURGERY 2023:377-387. [DOI: 10.1007/978-3-030-60596-4_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Varvoglis DN, Sanchez-Casalongue M, Baron TH, Farrell TM. "Orphaned" Stomach-An Infrequent Complication of Gastric Bypass Revision. J Clin Med 2022; 11:7487. [PMID: 36556106 PMCID: PMC9782235 DOI: 10.3390/jcm11247487] [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: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
While generally safe, bariatric operations have a variety of possible complications. We present an uncommon complication after gastric bypass revision, namely the creation of an "orphaned" segment of remnant stomach that was left inadvertently in discontinuity, leading to recurrent intra-abdominal abscesses. Sinogram ultimately proved the diagnosis, and the issue was successfully treated using a combination of surgical and endoscopic methods to control the abscess and to allow internal drainage.
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Affiliation(s)
- Dimitrios N. Varvoglis
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | | | - Todd H. Baron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Timothy M. Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Singh P, Adderley NJ, Subramanian A, Gokhale K, Hazlehurst J, Singhal R, Bellary S, Tahrani AA, Nirantharakumar K. Glycemic outcomes in patients with type 2 diabetes after bariatric surgery compared with routine care: a population-based, real-world cohort study in the United Kingdom. Surg Obes Relat Dis 2022; 18:1366-1376. [PMID: 36123295 DOI: 10.1016/j.soard.2022.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/30/2022] [Accepted: 08/01/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Clinical trials have shown that bariatric surgery (BS) is associated with better glycemic control and diabetes remission in patients with type 2 diabetes (T2D) compared with routine care. OBJECTIVE We conducted a real-world population-based study examining the impact of BS on glycemic control and medications in patients with T2D. SETTING AND METHODS This was a retrospective, matched, controlled cohort study conducted between January 1, 1990, and January 31, 2018, using IQVIA Medical Research Data, a primary care electronic records database. Adults with body mass index (BMI) ≥30 kg/m2 and T2D who had BS (surgical) were matched for age, sex, BMI, and diabetes duration to two controls (with T2D and no BS). RESULTS A total of 1126 patients in the surgical group and 2219 patients in the control group were analyzed. Mean (standard deviation) age was 50.0 (9.3) years, 67.6% were women, baseline glycocylated hemoglobin (HbA1C) was 7.8% (1.7 mmol/mol), and diabetes duration was 4.7 years (range, 2.0-8.4 years). Over a median (interquartile range) follow-up of 3.6 years (1.7-5.9 years), a higher proportion of patients in the surgical group achieved an HbA1C of ≤6.0% than the control group (65.8% versus 22.8%). The surgical group showed a decrease in mean HbA1C of 1.5% (95% confidence interval [CI]: 1.4%-1.7%), 1.4% (1.2%-1.5%), and 1.3% (1.1%-1.5%) at 1-, 2-, and 3-year follow-up, respectively, whereas HbA1C increased in the control group. The proportion of patients receiving glucose-lowering medications decreased in the surgical group (92.2% to 66.5%) but increased in the control group (85.3% to 90.2%). CONCLUSION BS is associated with significant improvement in glycemic control, achievement of normal HbA1C levels, and reduced need for glucose-lowering therapy in patients with T2D.
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Affiliation(s)
- Pushpa Singh
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan Hazlehurst
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rishi Singhal
- Department of Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| | - Srikanth Bellary
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom
| | - Krishnarajah Nirantharakumar
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom; Midlands Health Data Research, Birmingham, United Kingdom.
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Finze A, Otto M, Reissfelder C, Blank S. [Therapeutic Options for Regaining Weight after Bariatric Surgery]. Zentralbl Chir 2022; 147:547-555. [PMID: 36479651 DOI: 10.1055/a-1957-5570] [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
PURPOSE The purpose of this article is to create an overview of diagnostic and therapeutic options for weight regain (WR) and insufficient weight loss (IWL) after bariatric surgery (BS). With increasing popularity of BS, WR is becoming more relevant. METHODS We combined recent literature on WR and IWL with personal experience to suggest possible proceedings if WR or IWL is diagnosed. RESULTS If an anatomical-pathological cause can be detected, surgical therapy is the most effective. If WR or IWL is idiopathic, a multimodal therapeutic concept is necessary for sufficient therapeutic success. Depending on the initial BS, a combination of lifestyle intervention, medication and surgical therapy seems most effective. CONCLUSIONS Extensive diagnostic testing is necessary prior to any surgical intervention. In idiopathic WR after Roux-en-Y Gastric Bypass (RYGB), we suggest lengthening the biliopancreatic limb and shortening the common channel. After Sleeve-Gastrectomy (SG), we currently see RYGB as most effective in patients with gastroesophageal reflux disease (GERD) and SADI-S as a feasible option if no GERD is present.
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Affiliation(s)
- Alida Finze
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Mirko Otto
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | | | - Susanne Blank
- Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
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Fadel MG, Fehervari M, Lairy A, Das B, Alyaqout K, Ashrafian H, Khwaja H, Efthimiou E. Clinical outcomes of single-stage versus two-stage laparoscopic Roux-en-y gastric bypass in the management of obesity (BMI ≥ 50 kg/m 2): a retrospective cohort study. Langenbecks Arch Surg 2022; 407:3349-3356. [PMID: 36050499 DOI: 10.1007/s00423-022-02664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with obesity, BMI ≥ 50 kg/m2, can be a challenging operation. Weight loss with intra-gastric balloon (IGB) insertion prior to LRYGB may improve operative outcomes. METHODS Between June 2000 and June 2020, patients with a BMI ≥ 50 kg/m2 underwent either IGB insertion followed by LRYGB (two-stage group), or LRYGB as the definitive bariatric procedure (single-stage group) in our institution. The two-stage procedure was adopted for high risk individuals. Primary outcome measures were percentage total weight loss (%TWL) at 24 months, length of stay and postoperative morbidity. Propensity score analysis was used to account for differences between groups. RESULTS A total of 155 (mean age 42.9 years ± 10.60; mean BMI 54.6 kg/m2 ± 4.53) underwent either the two-stage (n = 30) or single-stage procedure (n = 125) depending on preoperative fitness. At 6 months following LRYGB, there was a significant difference in %TWL between the groups in a matched analysis (11.9% vs 23.7%, p < 0.001). At 24 months, there was no difference in %TWL (32.0% vs 34.7%, p = 0.13). Median hospital stay following LRYGB was 2.0 (1-4) days with the two-stage vs 2.0 (0-14) days for the single-stage approach (p = 0.75). There was also no significant difference in complication rates (p = 0.058) between the two groups. CONCLUSIONS There was no difference in weight loss after one or two-stage procedures in the treatment of patients with a BMI ≥ 50 kg/m2 super obesity in a propensity score weighted analysis at 24 months. Length of stay and perioperative complications were similar for high risk patients; however, the two-stage approach was associated with delayed weight loss. Single-stage management is recommended for moderate risk patients, particularly with significant metabolic disorders, whilst two-stage approach is a safe and feasible pathway for high risk individuals.
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Affiliation(s)
- Michael G Fadel
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK.
- Imperial College London, London, UK.
| | - Matyas Fehervari
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Ali Lairy
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | | | - Khaled Alyaqout
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait
| | - Hutan Ashrafian
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Haris Khwaja
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Evangelos Efthimiou
- Department of Bariatric and Metabolic Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
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Dias de Castro Heredia ML, Weydmann G, Kops NL, Martins GP, Bizarro L, Friedman R. Conscious and pre-conscious attentional bias to food images in patients subjected to Roux-en-Y gastric bypass. Appetite 2022; 175:106057. [PMID: 35460810 DOI: 10.1016/j.appet.2022.106057] [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: 11/10/2020] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022]
Abstract
Attentional bias (AB) to food after bariatric surgery might be a cognitive marker for weight regain. The visual probe task (VPT) is commonly used to capture AB at automatic, pre-conscious, and conscious orientation of attention. The aim of this study was to investigate how the preoperative BMI of patients submitted to Roux-en-Y gastric bypass (RYGB) impacts AB to food. We assessed patients who had preoperative BMI>50 (n = 28) or preoperative BMI<50 (n = 31) months after the RYGB procedure. Participants underwent clinical, psychological, and VPT evaluations. In VPT, pairs of food and matching non-food images were shown for 100 ms, 500 ms or 2000 ms and AB for food was assessed for each exposure time. A significant AB to food was observed at 2000 ms for all patients in this study, suggesting that the overall sample were consciously orienting their attention toward food cues after surgery, a finding that might be relevant for understanding weight control. When groups with preoperative BMI higher and lower than 50 kg/m2 were compared, a significant difference on AB to food stimuli at 500 ms was observed, controlling for excess weight lost since surgery and postoperative time. Subjects with preoperative BMI>50 had a positive and reliable AB to food while subjects with preoperative BMI<50 had a negative AB. This suggests that food stimuli have a higher incentive salience even after surgery for those with BMI>50, which might explain why subjects with higher preoperative weight have higher risks for weight regain. These results may indicate that RYGB can impact incentive salience for food cues in a differential manner, increasing conscious AB in all patients and decreasing pre-conscious AB only in those with BMI<50 kg/m2.
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Affiliation(s)
| | - Gibson Weydmann
- Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Natália Luiza Kops
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Gianluca Pioli Martins
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lisiane Bizarro
- Programa de Pós-Graduação em Psicologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Rogério Friedman
- Programa de Pós-Graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Division of Endocrinology and Metabolism, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Maus U, Schultz K, Vay C. Skelettale Auswirkungen bariatrischer Chirurgie. OSTEOLOGIE 2022; 31:153-161. [DOI: 10.1055/a-1910-3123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
ZusammenfassungBei zunehmender Prävalenz der Adipositas sind in Deutschland ca. 54% der Bevölkerung übergewichtig oder adipös, wobei mit steigendem Übergewicht das Risiko für weitere Erkrankungen, wie z. B. Diabetes mellitus Typ 2, Herzinsuffizienz, arterielle Hypertonie u. a. stark ansteigt. Die Reduktion des Körpergewichtes ist daher aus verschiedenen Gesichtspunkten anzustreben. Viele Patientinnen und Patienten mit Adipositas haben bereits vor einer möglichen Operation einen Mangel an Vitamin D und Calcium und zeigen in Laboruntersuchungen entsprechende Defizite. Die konservative Behandlung der Adipositas aus Ernährungs-, Bewegung- und Verhaltenstherapie bildet die Basis der möglichen Therapiemaßnahmen. Bei Versagen der konservativen Behandlungsoptionen ergibt sich ab einem Body-Mass-Index (BMI) von über 40 kg/m2 die Indikation zur operativen Therapie, ab einem BMI von 50 kg/m2 besteht unter bestimmten Voraussetzungen die primäre Indikation zur Durchführung einer bariatrisch-chirurgischen Maßnahme. Zu den in Deutschland am häufigsten empfohlenen operativen Verfahren, die in der Regel laparoskopisch durchgeführt werden, gehören weiterhin die Implantation eines Magenbands, die Bildung eines Magenschlauchs (Gastric-sleeve-Resektion), die Anlage eines proximalen Roux-en-Y-Magenbypass oder eines Omega-loop-Magenbypass. Neben der angestrebten Reduktion des Übergewichtes durch ihre restriktiven wie malabsorptiven Wirkungen führen diese OP-Methoden in unterschiedlichem Ausmaß zu Veränderungen des Kalzium-Stoffwechsels u. a. mit Hypocalcämie, Vitamin-D-Defizit und Erhöhung des Serum-Parathormons, was in einem erhöhten Frakturrisiko, Veränderungen der Knochendichte und der Mikroarchitektur des Knochens münden kann. In der Nachsorge nach bariatrischen Operationen sind daher eine ausreichende Supplementierung verschiedener Vitamine, Mineralien und Spurenelemente, die regelmäßige Kontrolle der Laborparameter und der Knochendichte sowie ein angepasstes körperliches Training wichtig. Aus osteologischer Sicht kommt bei diagnostizierter Osteoporose insbesondere eine intravenöse antiresorptive Therapie in Betracht.
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Affiliation(s)
- Uwe Maus
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Katharina Schultz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Christian Vay
- Klinik für Allgemein – und Viszeralchirurgie, Uniklinik Düsseldorf, Düsseldorf, Germany
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Song Y, Ni Z, Li Y, Li Z, Zhang J, Guo D, Yuan C, Zhang Z, Li Y. Exploring the landscape, hot topics, and trends of bariatric metabolic surgery with machine learning and bibliometric analysis. Ther Adv Gastrointest Endosc 2022; 15:26317745221111944. [PMID: 35923214 PMCID: PMC9340401 DOI: 10.1177/26317745221111944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background This study aimed to analyze the landscape of publications on bariatric metabolic surgery through machine learning and help experts and scholars from various disciplines better understand bariatric metabolic surgery's hot topics and trends. Methods In January 2021, publications indexed in PubMed under the Medical Subject Headings (MeSH) term 'Bariatric Surgery' from 1946 to 2020 were downloaded. Python was used to extract publication dates, abstracts, and research topics from the metadata of publications for bibliometric evaluation. Descriptive statistical analysis, social network analysis (SNA), and topic modeling with latent Dirichlet allocation (LDA) were used to reveal bariatric metabolic surgery publication growth trends, landscape, and research topics. Results A total of 21,798 records of bariatric metabolic surgery-related literature data were collected from PubMed. The number of publications indexed to bariatric metabolic surgery had expanded rapidly. Obesity Surgery and Surgery for Obesity and Related Diseases are currently the most published journals in bariatric metabolic surgery. The bariatric metabolic surgery research mainly included five topics: bariatric surgery intervention, clinical case management, basic research, body contour, and surgical risk study. Conclusion Despite a rapid increase in bariatric metabolic surgery-related publications, few studies were still on quality of life, psychological status, and long-term follow-up. In addition, basic research has gradually increased, but the mechanism of bariatric metabolic surgery remains to be further studied. It is predicted that the above research fields may become potential hot topics in the future.
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Affiliation(s)
- Yancheng Song
- Department of Gastrointestinal Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenni Ni
- School of Information Management, Wuhan
University, Wuhan, China
| | - Yi Li
- Department of Gastrointestinal Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaopeng Li
- Department of Gastrointestinal Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian Zhang
- Department of Colorectal Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dong Guo
- Department of Gastrointestinal Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chentong Yuan
- Department of Gastrointestinal Surgery, The
Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhuoli Zhang
- Department of Radiological Sciences, University
of California Irvine, Irvine, CA, USA
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Buzza AFB, Machado CA, Pontes F, Sampaio LG, Contador JS, Sampaio CL, Radominski RB, Boguszewski CL, Borba VZC. Prevalence of sarcopenia in women at stable weight phase after Roux-en-Y gastric bypass. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:362-371. [PMID: 35657128 PMCID: PMC9832848 DOI: 10.20945/2359-3997000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
Abstract
Objective Evaluating the prevalence of sarcopenia in women submitted to bariatric surgery - Roux-en-Y gastric bypass. Design: Observational, cross-sectional study. Subjects and methods Women (18-65 years old) who underwent bariatric surgery (BG) ≥ 2 years and reached stable weight ≥ 6 months, were investigated. Control group (CG) comprised non-operated matched women with obesity. Body composition was determined through dual-energy X-ray absorptiometry. Low lean mass (LLM) was defined as appendicular lean mass index (ALM kg/height m2) < 5.5 kg/m2. Physical strength was assessed through dynamometer and sit-to-stand test (SST), whereas performance was assessed through 4-m gait speed and Short Physical Performance Battery Tests (SPPB). Sarcopenia was diagnosed in the presence of LLM and low strength. Results One-hundred and twenty women (60 in each group, 50 ± 9.7 years old) were investigated. All anthropometric and body composition parameters were lower in BG than in CG, whereas strength and performance were similar between groups. Women with reduced strength presented high total fat mass and low physical activity level (p < 0.005). LLM was observed in 35% of BG and in 18.3% of CG (p = 0.04), whereas sarcopenia was diagnosed in 28.3% of BG and in 16.6% of CG (p = 0.12). Sarcopenic women in BG had better performance both in SST (p = 0.001) and SPPB (p = 0.004). Total lean mass (OR:1.41, 95% CI [1.18; 1.69], p < 0.001) and obesity (OR: 38.2 [2.27; 644.12], p < 0.001) were associated with sarcopenia in the multivariate analysis. Conclusion Despite great weight loss, sarcopenia prevalence did not increase in BG and its presence was influenced by total lean mass and obesity.
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Affiliation(s)
- Andreia Fabiana Bueno Buzza
- Departamento de Clínica Médica, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, PR, Brasil,
| | - Cristina Aquino Machado
- Centro de Ciências da Saúde da Faculdade de Medicina da Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Felipe Pontes
- Centro de Ciências da Saúde da Faculdade de Medicina da Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Letícia Guadanhim Sampaio
- Centro de Ciências da Saúde da Faculdade de Medicina da Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | - Carolina Labigalini Sampaio
- Centro de Ciências da Saúde da Faculdade de Medicina da Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Rosana Bento Radominski
- Departamento de Clínica Médica, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, PR, Brasil
| | - Cesar Luiz Boguszewski
- Departamento de Clínica Médica, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, PR, Brasil
| | - Victoria Zeghbi Cochenski Borba
- Departamento de Clínica Médica, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR), Curitiba, PR, Brasil
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Burkard T, Holmberg D, Wretenberg P, Thorell A, Hügle T, Burden AM. The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis: Propensity score-matched cohort studies. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100249. [DOI: 10.1016/j.ocarto.2022.100249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/20/2022] [Indexed: 11/28/2022] Open
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Balla A, Corallino D, Quaresima S, Palmieri L, Meoli F, Cordova Herencia I, Paganini AM. Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study. Front Surg 2022; 9:906133. [PMID: 35693301 PMCID: PMC9178117 DOI: 10.3389/fsurg.2022.906133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/11/2022] [Indexed: 01/17/2023] Open
Abstract
Aims Indocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate. Methods Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m2 (CI, 95% 36 to 49.3 kg/m2) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures. Results Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case. Conclusions ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.
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Poole M, Fasola L, Zevin B. Management of Complications After Bariatric Surgery: a Survey of Comfort and Educational Needs of General Surgeons in Ontario, Canada. Obes Surg 2022; 32:2407-2416. [PMID: 35503158 PMCID: PMC9063615 DOI: 10.1007/s11695-022-06095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
Purpose Approximately 10% of patients develop complications after bariatric surgery. These patients often present to their local general surgeon rather than the hospital where the primary bariatric operation was performed. The objective of this study was to conduct a survey of general surgeons in Ontario, Canada, to explore their confidence and educational needs regarding management of surgical complications post-bariatric surgery. Materials and Methods A 40-item survey was created and piloted with community and academic general surgeons. It was disseminated by mail in August 2020 to general surgeons in Ontario who take acute care surgery call. Bariatric surgeons and surgeons who do not take acute care surgery call were excluded. Results A total of 138/715 (19.3%) eligible surgeons completed the survey. Of the respondents, 63/112 (54.3%) had no exposure to bariatric surgery during residency or fellowship. A total of 72/108 (66.7%) respondents agreed that management of complications after bariatric surgery should be within the skillset of a general surgeon; however, 28/108 (25.9%) were not confident managing these complications. Seventy-one of 108 (65.7%) respondents were interested in additional continuing professional development (CPD) resources regarding management of these complications. Hands-on workshops, online resources, and live webinars were the most preferred educational formats for such CPD resources, with 67.1% of participants willing to commit 1–3 h and 42.9% willing to pay >$100 for such CPD resources. Conclusions One-quarter of general surgeons in Ontario, Canada, were not comfortable managing complications after bariatric surgery; however, the majority of surgeons were interested in additional CPD resources on this topic. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-06095-9.
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Affiliation(s)
- Meredith Poole
- Department of Surgery, Juravinski Hospital, McMaster University, Room B3-143, 711 Concession Street East, Hamilton, Ontario, L8V 1C3, Canada
| | - Laurie Fasola
- Department of Surgery, Kingston General Hospital, Queen's University, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada
| | - Boris Zevin
- Department of Surgery, Kingston General Hospital, Queen's University, 76 Stuart Street, Burr 2, Kingston, ON, K7L 2V7, Canada.
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Hinnen C, Hermens M. A Lifestyle Group Intervention Aimed at Losing Sufficient Weight After Laparoscopic Roux-en-Y Gastric Bypass May Be Helpful for a Small Group of Patients. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chris Hinnen
- Leids University Medical Center, Leiden, The Netherlands
| | - Mark Hermens
- Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Ospanov O, Yeleuov G, Fursov A, Yelembayev B, Fursov R, Sergazin Z, Mustafin A. A laparoscopic one anastomosis gastric bypass with wrapping versus nonwrapping fundus of the excluded part of the stomach to treat obese patients (FundoRingOAGB trial): study protocol for a randomized controlled trial. Trials 2022. [PMID: 35392958 DOI: 10.1186/s13063-022-06252-6.pmid:35392958;pmcid:pmc8991694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Laparoscopic one anastomosis gastric bypass (LOAGB) is a simple variation of gastric bypass and has gained worldwide popularity with clinical outcomes similar to laparoscopic Roux-en-Y gastric bypass (LRYGB) for weight loss and management of comorbidities. However, biliary reflux to the esophagus negates the benefits of LOAGB. In addition, weight gain after LOAGB and after LRYGB is a major problem in bariatric surgery. The aim of this article is to describe the design and protocol of a randomized controlled trial comparing the outcomes of two methods of LOAGB: experimental method with wrapping versus standard method nonwrapping fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB. METHODS The study was designed as a single-center prospective, interventional, randomized controlled trial. Masking: None (open label). Allocation: randomized. Enrollment: 100 obese patients. The relevant ethics committee approved the trial protocol. The endpoints (body mass index, bile reflux in the esophagus, other reflux symptoms) will be assessed presurgery and postsurgery (12, 24, and 36 months postoperatively). DISCUSSION With its 3-year follow-up time, this RCT will provide important data on the impact of wrapping the fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB. TRIAL REGISTRATION ClinicalTrials.gov NCT04834635 . Registered on 8 April 2021.
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Affiliation(s)
- Oral Ospanov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan.
| | - Galymzhan Yeleuov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Alexandr Fursov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Bakhtiyar Yelembayev
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Roman Fursov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Zhenis Sergazin
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Adil Mustafin
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
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Ospanov O, Yeleuov G, Fursov A, Yelembayev B, Fursov R, Sergazin Z, Mustafin A. A laparoscopic one anastomosis gastric bypass with wrapping versus nonwrapping fundus of the excluded part of the stomach to treat obese patients (FundoRingOAGB trial): study protocol for a randomized controlled trial. Trials 2022; 23:264. [PMID: 35392958 PMCID: PMC8991694 DOI: 10.1186/s13063-022-06252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/29/2022] [Indexed: 01/14/2023] Open
Abstract
Background Laparoscopic one anastomosis gastric bypass (LOAGB) is a simple variation of gastric bypass and has gained worldwide popularity with clinical outcomes similar to laparoscopic Roux-en-Y gastric bypass (LRYGB) for weight loss and management of comorbidities. However, biliary reflux to the esophagus negates the benefits of LOAGB. In addition, weight gain after LOAGB and after LRYGB is a major problem in bariatric surgery. The aim of this article is to describe the design and protocol of a randomized controlled trial comparing the outcomes of two methods of LOAGB: experimental method with wrapping versus standard method nonwrapping fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB. Methods The study was designed as a single-center prospective, interventional, randomized controlled trial. Masking: None (open label). Allocation: randomized. Enrollment: 100 obese patients. The relevant ethics committee approved the trial protocol. The endpoints (body mass index, bile reflux in the esophagus, other reflux symptoms) will be assessed presurgery and postsurgery (12, 24, and 36 months postoperatively). Discussion With its 3-year follow-up time, this RCT will provide important data on the impact of wrapping the fundus of the excluded part of the stomach to prevent weight regain and biliary reflux after LOAGB. Trial registration ClinicalTrials.govNCT04834635. Registered on 8 April 2021.
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Affiliation(s)
- Oral Ospanov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan.
| | - Galymzhan Yeleuov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Alexandr Fursov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Bakhtiyar Yelembayev
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Roman Fursov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Zhenis Sergazin
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Adil Mustafin
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Nur-Sultan, Kazakhstan
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Hu S, Huang B, Loi K, Chen X, Ding Q, Luo L, Wang C, Yang W. Patients with Prader-Willi Syndrome (PWS) Underwent Bariatric Surgery Benefit more from High-Intensity Home Care. Obes Surg 2022; 32:1631-1640. [PMID: 35288862 DOI: 10.1007/s11695-022-05999-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term weight loss effect of bariatric surgeries for patients with Prader-Willi Syndrome (PWS) remains controversial since factors like postoperative home care intensity may impact the outcome. The aim of this study was to evaluate the role of home care intensity on long-term weight loss effect of bariatric surgery in patients with PWS. METHODS This was a prospective observational study on patients with PWS undergoing bariatric surgery and patients were enrolled from July 2015 to December 2016. Detailed information of patients' weight and behaviors was recorded by caregivers postoperatively. The intensities of home care applied to patients were classified into four categories (high, moderate, low, and very low) according to the records. RESULTS Six cases (3 males, 3 females) were enrolled in this study with LSG (n = 2), RYGB (n = 3), and LSG-DJB (n = 1) as their primary operation. The mean BMI of these participants was 46.78 ± 11.63 kg/m2, and the mean age was 17.66 ± 6.59 years. All patients had at least 5 years of follow-ups, and the %EWL were 51.57 ± 23.36%, 64.54 ± 18.97%, 35.34 ± 36.53%, 19.45 ± 41.78%, and - 4.74 ± 71.50% in the half, first, second, third, and fifth year after surgery respectively. Two patients with high-intensity home care achieved a %EWL of 70.57 ± 8.86% in the fifth year after surgery. CONCLUSIONS Overall long-term weight loss of bariatric surgery for patients with PWS was not found through the follow-ups. Two patients with high-intensity home care maintained weight loss at the fifth-year follow-up, suggesting a pivotal role of high-intensity home care in long-term outcomes of bariatric surgery in patients with PWS.
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Affiliation(s)
- Songhao Hu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China.,Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China.,Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
| | - Biao Huang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China.,Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China.,Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China
| | - Ken Loi
- Department of Upper GI and Bariatric Surgery, St George Public and Private Hospital, University of NSW, Sydney, Australia
| | - Xiaomei Chen
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China
| | - Qinyu Ding
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China
| | - Lan Luo
- General Surgery Department of Jihua Hospital affiliated to Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China. .,Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China. .,Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China.
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, No. 613, Huangpu Avenue West, Guangzhou, Guangdong, China. .,Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China. .,Laboratory of Metabolic and Molecular Medicine, Guangdong-Hong Kong-Macao Joint University, Guangzhou, China.
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Mahajan UV, Ojukwu DI, Azagury DE, Safer DL, Cunningham T, Halpern CH. Can responsive deep brain stimulation be a cost-effective treatment for severe obesity? Obesity (Silver Spring) 2022; 30:338-346. [PMID: 35088556 DOI: 10.1002/oby.23324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A first-in-human responsive deep brain stimulation (rDBS) trial (NCT03868670) for obesity is under way, which is based on promising preclinical evidence. Given the upfront costs of rDBS, it is prudent to examine the success threshold for cost-effectiveness compared with laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Efficacy and safety data on LRYGB and safety data on rDBS were collected for established indications through a literature search. The success threshold was defined as minimum BMI reduction. Treatment costs were calculated via Medicare national reimbursement data. RESULTS LRYGB had a mean BMI reduction of 13.75 kg/m2 . Based on adverse events, LRYGB was a less-preferred health state (overall adverse event utility of 0.96 [0.02]) than rDBS (0.98 [0.01]), but LRYGB ($14,366 [$6,410]) had a significantly lower treatment cost than rDBS ($29,951 [$4,490]; p < 0.0001). Therefore, for rDBS to be cost-effective compared with LRYGB, the multiple models yielded a success threshold range of 13.7 to 15.2 kg/m2 . CONCLUSIONS This study established a preliminary efficacy success threshold for rDBS to be cost-effective for severe obesity, and results from randomized controlled trials are needed. This analysis allows for interpretation of the economic impact of advancing rDBS for obesity in light of ongoing trial results and suggests an attainable threshold is needed for cost-effectiveness.
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Affiliation(s)
- Uma V Mahajan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Disep I Ojukwu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Dan E Azagury
- Section of Minimally Invasive and Bariatric Surgery, Department of General Surgery, Stanford University Medical Center, Stanford, California, USA
| | - Debra L Safer
- Stanford Adult Eating and Weight Disorders Program, Department of Psychiatry, Stanford University Medical Center, Stanford, California, USA
| | - Tricia Cunningham
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Promoting Weight Loss Success Following Bariatric Surgery Through Telehealth. TOP CLIN NUTR 2022. [DOI: 10.1097/tin.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Oliveira GS, Vieira FT, Lamarca F, Lima RM, Carvalho KMB, Dutra ES. Resistance Training Improves Muscle Strength and Function, Regardless of Protein Supplementation, in the Mid- to Long-Term Period after Gastric Bypass. Nutrients 2021; 14:14. [PMID: 35010889 PMCID: PMC8746810 DOI: 10.3390/nu14010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022] Open
Abstract
Inadequate protein intake and low levels of physical activity are common long-term sequelae after bariatric surgery and can negatively affect muscle strength (MS) and physical function (PF). The study investigated the effects of resistance training with or without protein supplementation on MS and PF. The study, which involved a 12-week controlled trial (n = 61) of individuals 2-7 years post-Roux-en-Y gastric bypass (RYGB), comprised four groups: whey protein supplementation (PRO; n = 18), maltodextrin placebo (control [CON]; n = 17), resistance training combined with placebo (RTP; n = 11), and resistance training combined with whey protein supplementation (RTP+PRO; n = 15). An isokinetic dynamometer was used to measure MS (peak torque at 60°/s and 180°/s). PF was measured with the 30-s sit-to-stand (30-STS), 6-min walk (6-MWT), and timed up-and-go (TUG) tests. There were improvements in the absolute and relative-to-bodyweight peak torque at 60°/s and 180°/s, TUG, 6-MWT and 30-STS in the RTP and RTP+PRO groups, but not in the CON and PRO groups. Changes in MS were significantly correlated with changes in PF between the pre- and post-intervention periods. A supervised resistance training program, regardless of protein supplementation, improved MS and PF in the mid-to-long-term period after RYGB and can lead to clinical benefits and improved quality of life.
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Affiliation(s)
- Gabriela S. Oliveira
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
| | - Flávio T. Vieira
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
| | - Fernando Lamarca
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
- Department of Applied Nutrition, Federal University of the State of Rio de Janeiro, Rio de Janeiro 22290-240, Brazil
| | - Ricardo M. Lima
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
- Graduate Program in Physical Education, University of Brasília, Brasília 70910-900, Brazil
| | - Kênia M. B. Carvalho
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
| | - Eliane S. Dutra
- Graduate Program in Human Nutrition, University of Brasília, Brasília 70910-900, Brazil; (G.S.O.); (F.T.V.); (F.L.); (R.M.L.); (K.M.B.C.)
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Cooper AJ, Gupta SR, Moustafa AF, Chao AM. Sex/Gender Differences in Obesity Prevalence, Comorbidities, and Treatment. Curr Obes Rep 2021; 10:458-466. [PMID: 34599745 DOI: 10.1007/s13679-021-00453-x] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Obesity is a heterogeneous condition, yet sex/gender is rarely considered in the prevention or clinical care of this disease. This review examined and evaluated recent literature regarding the influence of sex and gender on obesity prevalence, comorbidities, and treatment in adults. RECENT FINDINGS Obesity is more prevalent in women than men in most countries, but in some countries and population subgroups, this gap is more pronounced. Several obesity-related comorbidities, including type 2 diabetes and hypertension, demonstrate sex-specific pathways. Women, compared to men, are more likely to be diagnosed with obesity and seek and obtain all types of obesity treatment including behavioral, pharmacological, and bariatric surgery. Men tend to have greater absolute weight loss, but this difference is attenuated once accounting for baseline weight. Obesity is a multifactorial condition with complex interactions among sex/gender, sociocultural, environmental, and physiological factors. More sex/gender research is needed to investigate mechanisms underlying sex/gender differences in prevalence, comorbidities, and treatment, identify ways to increase men's interest and participation in obesity treatment, and examine differences in obesity prevalence and treatments for transgender and gender non-conforming individuals.
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Affiliation(s)
- Ashley J Cooper
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Sapana R Gupta
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Ariana M Chao
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Alkharaiji M, Anyanwagu U, Crabtree T, Gordon J, Idris I. Clinical cost evaluation and health benefits of post-bariatric intervention for patients with type 2 diabetes living in the UK. Clin Obes 2021; 11:e12486. [PMID: 34569163 DOI: 10.1111/cob.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
To assess associated healthcare costs and risk of developing obesity-related comorbidities among patients with type 2 diabetes with severe obesity and receiving insulin treatment, following bariatric surgery (BS). A retrospective cohort study was conducted from a UK electronic primary care database. Propensity score matching (1:1) was performed for BS with non-BS cohort. Follow-up was over 5 years (694 person-years), comparing drug utilization with clinical cost differences, such as visits to General practitioners (GPs), hospitalization, and laboratory use. Cox proportional regression was used to compute differences in the risk of obesity-related comorbidities and chi-square analysis to explore differences in insulin independency and diabetes remission proportions during follow-up. Eighty patients who received BS were matched to 80 non-BS (N = 160). The baseline mean age was 48.3 years (SD: 12.9) (61% female), and body mass index was 39.3 kg/m2 (SD: 9.3). During follow-up, antidiabetic drug cost was significantly lower in the BS group than in the non-BS (median cost/person [£]: 527.77 [interquartile range (IQR): 1196.11] vs. 1564.13 [IQR: 1576.01]; p < 0.001). Overall, aggregate cost analysis showed a significant total healthcare cost reduction in the BS group (median cost/person [£]: 1597.96 [IQR: 2631.84] vs. 2440.12 [IQR: 2242.95]; p = 0.050). BS significantly protected against obesity-related comorbidities compared with the non-BS (adjusted hazard ratio: 0.56; 95% confidence interval: 0.32-0.96; p = 0.036) and increased insulin independency throughout all follow-up points: at year 5: 48.1% versus 28.9%; p = 0.044, respectively. While BS shows evidence of cost efficiency, cost saving was not identified. The efficiency is evident by the protective effect against crude obesity-related comorbidities associated with increased insulin independency.
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Affiliation(s)
- Mohammed Alkharaiji
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- Department of Public Health, College of Health Sciences, The Saudi Electronic University, Riyadh, Saudi Arabia
| | - Uchenna Anyanwagu
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Thomas Crabtree
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - Jason Gordon
- HEOR Consulting Ltd, Singleton Court Business Park, Wonastow Rd, Monmouth, UK
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton, Derby, UK
| | - Iskandar Idris
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton, Derby, UK
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Effectiveness and Safety of Adjustable Gastric Banding in Morbidly Obese Patients After 5 Years of Follow-up. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Obesity is a civilization disease that promotes the emergence and development of many diseases, such as type II diabetes, cardiovascular, and some cancers. It directly affects the length and quality of life. The purpose of this retrospective study was to show the short- and long-term results of weight loss after laparoscopic adjustable gastric banding (LAGB) as well as to assess the results of the procedure and the percentage of reoperations. Case series analysis included 228 subsequent patients who underwent LAGB due to obesity. In the postoperative period, there was a gradual reduction in body weight, especially in the first 24 months after surgery. After 3 years, no further weight reduction was observed, and sometimes, a slight increase in weight was observed 5 years after surgery; the trend in weight reduction over the entire time period was significant. A similar result was found for percentage of BMI loss (%BMIL) and percentage of excess body weight loss (%EWL), especially in the first 36 months after surgery. Our study confirmed the good early results and low effectiveness of laparoscopic adjustable gastric banding in the long-term treatment of pathological obesity. On the other hand, the simplicity and safety of the procedure, the minimal effects of malnutrition, the low number of early complications, and the total reversibility or conversion procedure for any other bariatric surgery are the strengths of laparoscopic adjustable gastric banding for a selected group of patients.
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Yap RV, Eleazar PJ, Roble Ii VM, Rosello DE. Bariatric Surgery in Cebu, Philippines: Current Status and Initial Experience With Laparoscopic Sleeve Gastrectomy. Cureus 2021; 13:e18953. [PMID: 34815899 PMCID: PMC8605933 DOI: 10.7759/cureus.18953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background The prevalence of obesity in the Philippines has increased more than three-fold over the last two decades. However, bariatric surgery has not been widely adopted yet in the country. Local data mainly on laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB) are limited as well. We report for the first time our experience with laparoscopic sleeve gastrectomy (LSG) and present the current local status of bariatric surgery in Cebu, Philippines. Patients and methods This is a retrospective study of all patients 18 years old and above who underwent LSG in a single, private, tertiary institution during the period 2009 - 2019. Our primary endpoint was weight loss after LSG. Secondary endpoint was postoperative complications. Results Thirty-three patients (mean age 40.9 ± 14.5 years) underwent LSG. Baseline weight and BMI were 112.6 ± 29 kg and 41.3 ± 8.6, respectively. The mean operative duration was 201 ± 72.9 minutes. The were no open conversions with minimal morbidity. Mean hospital stay was 3.7 ± 0.9 days. The postoperative mean weight and BMI after one year were 68.9 ± 17 kg and 26.6 ± 6, respectively. Overall, mean excess weight loss (EWL) was 61.9 ± 44.1 % at a median follow-up of 5.4 months. Significant weight loss was noted after the third month. Conclusion LSG is a safe and effective method in producing weight loss. It can be a definitive treatment option as local prevalence of obesity is increasing in the Philippines. However, access to and the practice of bariatric surgery remains limited in the country. A collaboration among private and government stakeholders is essential.
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Affiliation(s)
- Ralph Victor Yap
- Department of Surgery, Cebu Doctors' University Hospital, Cebu, PHL
| | | | - Vincent Matthew Roble Ii
- Department of Surgery, Section of Minimally Invasive Surgery, Cebu Doctors' University Hospital, Cebu, PHL
| | - Don Edward Rosello
- Department of Surgery, Section of Minimally Invasive Surgery, Cebu Doctors' University Hospital, Cebu, PHL
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Luna M, Pereira S, Saboya C, Cruz S, Matos A, Ramalho A. Body Composition, Basal Metabolic Rate and Leptin in Long-Term Weight Regain After Roux-en-Y Gastric Bypass Are Similar to Pre-surgical Obesity. Obes Surg 2021; 32:302-310. [PMID: 34787767 DOI: 10.1007/s11695-021-05780-5] [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: 04/19/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the relationship between body composition, basal metabolic rate (BMR), and serum concentrations of leptin with long-term weight regain after Roux-en-Y gastric bypass (RYGB) and compare it with obesity before surgery. MATERIALS AND METHODS Prospective longitudinal analytical study. Three groups were formed: individuals 60 months post RYGB, with weight regain (G1) and without it (G2), and individuals with obesity who had not undergone bariatric surgery (G3). Body fat (BF), body fat mass (BFM), visceral fat (VF), fat-free mass (FFM), skeletal muscle mass (SMM), and BMR were assessed by octapolar and multi-frequency electrical bioimpedance. Fasting serum concentrations of leptin were measured. RESULTS Seventy-two individuals were included, 24 in each group. Higher means of BF, BFM, VF, and leptin levels were observed in G1, when compared to G2 (BF: 47.5 ± 5.6 vs. 32.0 ± 8.0, p < 0.05; FBM: 47.8 ± 11.6 vs. 23.9 ± 7.0, p < 0.05; VF: 156.8 ± 30.2 vs. 96.1 ± 23.8, p < 0.05; leptin: 45,251.2 pg/mL ± 20,071.8 vs. 11,525.7 pg/mL ± 9177.5, p < 0.000). G1 and G2 did not differ in FFM, SMM, and BMR. G1 and G3 were similar according to BF, FFM, BMR, and leptin levels. Body composition, but not leptin, was correlated with %weight regain in G1 (FBM: r = 0.666, p < 0.000; BF: r = 0.428, p = 0.037; VF: r = 0.544, p = 0.006). CONCLUSION Long-term weight regain after RYGB is similar to pre-surgical obesity in body composition, BMR, and leptin concentrations, indicating relapse of metabolic and hormonal impairments associated with excessive body fat.
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Affiliation(s)
- Mariana Luna
- Postgraduate Program in Internal Medicine, Medical School, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321044-020, Brazil. .,Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil.
| | - Silvia Pereira
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Carlos Saboya
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Sabrina Cruz
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Andrea Matos
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil
| | - Andrea Ramalho
- Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Cidade Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, Rio de Janeiro, RJ, 37321941-902, Brazil.,Social Applied Nutrition Department, Micronutrients Research Center (NPqM), Institute of Nutrition, Universidade Federal Do Rio de Janeiro (UFRJ), Universitária da Universidade Federal Do Rio de Janeiro, Av. Carlos Chagas Filho, 373 - Cidade, Rio de Janeiro, RJ, 21941-902, Brazil
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Wang Y, Kassab GS. Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices. Front Physiol 2021; 12:761481. [PMID: 34777019 PMCID: PMC8585502 DOI: 10.3389/fphys.2021.761481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022] Open
Abstract
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
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Affiliation(s)
- Yanmin Wang
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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