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Yang W, Zalin A, Nelson M, Bonanomi G, Smellie J, Shotliff K, Efthimiou E, Greener V. Bariatric surgery in individuals with human immunodeficiency virus and type 2 diabetes: a case series. J Med Case Rep 2019; 13:146. [PMID: 31072397 PMCID: PMC6509847 DOI: 10.1186/s13256-019-2078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/10/2019] [Indexed: 11/22/2022] Open
Abstract
Background The efficacy and safety of bariatric surgery have not been fully elucidated in patients affected with human immunodeficiency virus. Although adjustable gastric banding and sleeve gastrectomy are starting to be used in patients with human immunodeficiency virus, there are limited descriptions of the outcomes of type 2 diabetes mellitus in individuals who are human immunodeficiency virus positive and undergoing these procedures. Case presentation We have evaluated retrospectively three patients who underwent adjustable gastric banding or sleeve gastrectomy, the effect in weight reduction and glycemic control as well as its impact on human immunodeficiency virus management. Case 1 (adjustable gastric banding), a 58-year-old Caucasian male, achieved 19% total weight loss, Case 2, a 33-year-old Caucasian male (sleeve gastrectomy) lost 25%, and Case 3, a 48-year-old Caucasian female (sleeve gastrectomy), lost 14% postoperation. In terms of type 2 diabetes mellitus, Case 2 achieved complete remission according to American Diabetes Association criteria, while Case 1 would also have achieved remission were it not for the continuation of metformin postoperatively. Insulin requirements and pill burden were markedly reduced in Case 3 after sleeve gastrectomy, although lack of remission was predictable given the longevity of type 2 diabetes mellitus and preoperative insulin dosage. In all three cases, human immunodeficiency virus status did not appear to be affected by the bariatric surgery which was supported by the postoperative stable CD4 count and undetectable viral load. Conclusions Bariatric surgery is a safe and effective treatment modality in patients who are human immunodeficiency virus positive with obesity and type 2 diabetes mellitus.
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Affiliation(s)
- Wei Yang
- Bariatric Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK. .,Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK.
| | - Anjali Zalin
- Diabetes and Endocrinology, Diabetes and Metabolism, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
| | - Mark Nelson
- HIV Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
| | - Gianluca Bonanomi
- Bariatric Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
| | - James Smellie
- Endocrine and Thyroid Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
| | - Kevin Shotliff
- Endocrinology and Bariatric Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
| | - Evangelos Efthimiou
- Bariatric Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
| | - Veronica Greener
- Bariatric Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London, SW10 9NH, UK
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Kim G, Tan CS, Tan KW, Lim SPY, So JBY, Shabbir A. Sleeve Gastrectomy and Roux-En-Y Gastric Bypass Lead to Comparable Changes in Body Composition in a Multiethnic Asian Population. J Gastrointest Surg 2019; 23:445-450. [PMID: 30187324 DOI: 10.1007/s11605-018-3920-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/06/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Changes in body composition after bariatric surgery such as a sustained loss of body fat are often associated with an inevitable loss of fat free mass. This can contribute to an undesirable disturbance in resting metabolic rate and weight maintenance. Our aim was to study changes in body composition in a multiethnic Asian cohort following bariatric surgery and to identify differences between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. METHODS A retrospective review of prospectively collected data on 295 patients who underwent either laparoscopic sleeve gastrectomy (256 patients) or laparoscopic Roux-en-Y gastric bypass (39 patients) was performed. Body composition variables were measured with the analyzer, GAIA 359 PLUS, which included the parameters; total body weight, body mass index, excess weight, basal metabolic rate, fat-free mass, fat mass, and total body water. RESULTS There were no statistical differences in gender, ethnicity, age, weight, height, and body mass index between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. At each time point (6, 12, 24, and 36 months) post-operation, there was no significant differences in % total body weight loss, basal metabolic rate, fat mass, fat percentage, and total body water between sleeve gastrectomy and bypass patients. There was significant difference (p < 0.05) in fat free mass only at 3 years post-operation, with sleeve gastrectomy patients having 9.79 kg less fat-free mass than bypass patients. However, after multivariate analysis, we found no statistically significant differences. CONCLUSION Sleeve gastrectomy and gastric bypass seemed to give similar changes to body composition.
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Affiliation(s)
- Guowei Kim
- University Surgical Cluster, National University Health System, Level 8 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kah Wei Tan
- University Surgical Cluster, National University Health System, Level 8 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Serene P Y Lim
- University Surgical Cluster, National University Health System, Level 8 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jimmy B Y So
- University Surgical Cluster, National University Health System, Level 8 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Asim Shabbir
- University Surgical Cluster, National University Health System, Level 8 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Njei B, McCarty TR, Sharma P, Lange A, Najafian N, Ngu JN, Ngomba VE, Echouffo-Tcheugui JB. Bariatric Surgery and Hepatocellular Carcinoma: a Propensity Score-Matched Analysis. Obes Surg 2018; 28:3880-3889. [PMID: 30069863 PMCID: PMC6219901 DOI: 10.1007/s11695-018-3431-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The association between obesity and rising incidence of hepatocellular carcinoma (HCC) in the USA has been documented; however, the role of bariatric surgery remains less clear. AIM To evaluate the cross-sectional association of prior-bariatric surgery and HCC. METHODS The United States Nationwide Inpatient Sample (NIS) database was queried from 2004 to 2014 for discharges with a diagnosis of morbid obesity. Primary outcomes of interest were HCC and in-hospital mortality rate. Secondary outcomes were length of stay and cost. Baseline characteristics were balanced using propensity score matching (PSM). Using Poisson and logistic regressions, adjusted HCC prevalence ratio (PR) and mortality odds ratio (OR) were derived in patients with prior-bariatric surgery compared to those without bariatric surgery. RESULTS Of the 2,881,414 patients included in our study, 267,082 (9.3%) underwent bariatric surgery. From 2004 to 2014, there was a threefold increase in age-adjusted prevalence of HCC from 27 per 100,000 to 72 per 100,000 (PTrend < 0.001). After PSM, 230,956 patients with prior-bariatric surgery were matched with 230,956 patients without bariatric surgery. Prior-bariatric surgery was associated with lower prevalence of HCC (PR 0.11; 95% CI, 0.03-0.48; P < 0.001). In-hospital mortality was also lower for patients with surgery (OR 0.22; 95% CI, 0.20-0.26; P < 0.001). The occurrence of HCC added $18,840 extra cost, increased mean length of stay by 2 (95% CI; 1-3) days, and increased risk of death by 65% (aOR 1.65; 95% CI 1.18-2.29). CONCLUSION In this nationwide study of morbidly obese patients, prior-bariatric surgery was associated with a lower prevalence of HCC and lower in-patient mortality.
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Affiliation(s)
- Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.
| | - Thomas R McCarty
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Prabin Sharma
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Andrew Lange
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Nilofar Najafian
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius N Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Valmy E Ngomba
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Sharma P, McCarty TR, Ngu JN, O’Donnell M, Njei B. Impact of bariatric surgery in patients with HIV infection: a nationwide inpatient sample analysis, 2004-2014. AIDS 2018; 32:1959-1965. [PMID: 30157083 PMCID: PMC6126912 DOI: 10.1097/qad.0000000000001915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite rising rates of obesity among patients with HIV, the potential role for weight loss surgery in this population remains less clear. The primary aim of this study was to evaluate the role of bariatric surgery on relevant clinical outcomes among hospitalized obese patients with HIV. DESIGN Retrospective analysis using the United States Nationwide Inpatient Sample database from 2004 to 2014. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared with those without bariatric surgery. PATIENTS Patients with discharge co-diagnoses of morbid obesity and HIV. INTERVENTION Bariatric surgery. MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality. Secondary outcomes included renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, gastrointestinal strictures, micronutrient deficiency, length of stay, and hospitalization costs. RESULTS Among 7803 patients with discharge diagnoses of HIV and morbid obesity, 346 patients (4.4%) had bariatric surgery. The proportion of bariatric surgery in obese patients with HIV initially declined by -0.10% per year from 2004 to 2009 (Ptrend < 0.05), then increased at an annual rate of +0.33% from 2012 to 2014 (Ptrend < 0.05). On multivariable analysis, bariatric surgery did not influence mortality (P = 0.98). Bariatric surgery was associated with decreased risk for renal failure, respiratory failure, and sepsis (all P < 0.001). However, bariatric surgery increased the risk for postoperative strictures (IRR 2.5; 95% CI 1.5-4.5; P = 0.001). CONCLUSION Though initially underutilized, bariatric surgery in morbidly obese HIV patients is increasing and appears to be well tolerated and effective in significantly reducing life-threatening morbidity.
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Affiliation(s)
- Prabin Sharma
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Thomas R. McCarty
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius N. Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Michael O’Donnell
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Pinto-Bastos A, Conceição E, de Lourdes M, Arrojado F, Brandão I, Machado PPP. Psychological and Behavioral Aspects of Primary and Reoperative Surgery: a 6-Month Longitudinal Study. Obes Surg 2018; 28:3984-3991. [PMID: 30105661 DOI: 10.1007/s11695-018-3452-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Problematic eating behaviors and general psychopathology have been associated with poor weight loss after bariatric surgery. However, little is known about how these aspects impact weight loss outcomes for the increasing number of patients undergoing reoperative surgeries. This study compares disordered eating and weight-related outcomes before and 6 months after surgery in patients undergoing primary (P-Group) and reoperative bariatric surgery (R-Group). METHODS This longitudinal study assessed 122 P-Group and 116 R-Group patients before and 6 months after surgery. The assessment included the eating disorder examination diagnostic items, and a set of self-report measures assessing eating disorder symptomatology, grazing, depression, anxiety, and negative urgency. RESULTS Preoperatively, no differences were found between the R- and P-Groups in terms of disordered eating-related variables (except for shape concern, which was higher for the R-Group). At 6 months after surgery, the R-Group revealed significantly higher values for restraint (F(1,219) = 5.84, p = 0.016), shape (F(1,219) = 5.59, p = 0.019), weight concerns (F(1,219) = 13.36, p = 0.000), depression (F(1,219) = 7.17, p = 0.008), anxiety (F(1,219) = 6.94, p = - 0.009), and compulsive grazing (F(1,219) = 6.13, p = 0.014). No significant pre- or post-surgery predictors of weight loss were found for the P-Group (χ2 = 0.70, p = 0.872). In the R-Group, post-surgery anxiety (Waldχ2(1) = 6.19, p = 0.01) and the post-surgery number of days with grazing in the previous month (Waldχ2(1) = 3.90, p = 0.04) were significant predictors of weight loss. CONCLUSION At 6 months after surgery, the R-Group presented more problematic eating and general psychological distress, which may put these patients at greater risk of poorer long-term weight outcomes.
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Affiliation(s)
- Ana Pinto-Bastos
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Eva Conceição
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal.
| | - Marta de Lourdes
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Filipa Arrojado
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
| | - Isabel Brandão
- Faculty of Medicine, University of Porto, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo P P Machado
- School of Psychology, University of Minho, Campus Gualtar, 4010-057, Braga, Portugal
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Billeter AT, de la Garza Herrera JR, Scheurlen KM, Nickel F, Billmann F, Müller-Stich BP. MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol 2018; 179:R77-R93. [PMID: 29764908 DOI: 10.1530/eje-18-0009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Katharina M Scheurlen
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Gribben JL, Ilonzo N, Neifert S, Michael Leitman I. Predictors of Reoperation and Failure to Rescue in Bariatric Surgery. JSLS 2018; 22:JSLS.2017.00074. [PMID: 29472758 PMCID: PMC5814103 DOI: 10.4293/jsls.2017.00074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives Morbidity and mortality have been shown to increase several-fold in patients who have undergone bariatric surgery and returned to the operating room after their initial procedures. Failure-to-rescue (FTR) analyses allow for an understanding of patient management and outcomes that is more distinguished than assessments of adverse occurrences and mortality rates alone. The objective of this study was to assess failure to rescue (FTR) and the characteristics and outcomes of patients undergoing reoperation after laparoscopic gastric bypass (LGBP) and laparoscopic sleeve gastrectomy (LSG). Methods The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) participant data files were accessed to identify patients >18 years of age who underwent LGBP and LSG from 2011 through 2015. Patients were further classified into 3-day reoperation and nonreoperation cohorts. Patient demographics, comorbidities, and baseline health characteristics were collected. Pertinent outcomes, complications, and FTR were analyzed. Results A total of 96,538 patients were included. Of those, 1,850 (1.92%) returned to the operating room, and 94,688 (98.08%) did not. Patients who underwent reoperation had a greater likelihood of having any complication (72.20% vs. 51.29%; P < .0001) and had a higher overall mortality rate (1.46% vs. 0.10%, P < .0001). The FTR rates were 2.01% in the reoperation group and 0.14% in the nonreoperation group (P < .0001). Conclusion Patients who undergo LGBP and LSG and have reoperations are at higher risk of developing complications with subsequent mortality.
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Affiliation(s)
- Jeanie L Gribben
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Ilonzo
- Department of Surgery, Mount Sinai St. Luke's, New York, New York, USA
| | - Sean Neifert
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Charalampakis V, Seretis C, Daskalakis M, Fokoloros C, Karim A, Melissas J. The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up. Surg Obes Relat Dis 2018; 14:1652-1658. [PMID: 30072237 DOI: 10.1016/j.soard.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/05/2018] [Accepted: 06/17/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up. OBJECTIVES To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome. SETTING Bariatric Unit, University Hospital of Heraklion, Greece. METHODS Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded. RESULTS A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m2 completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from -.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study. CONCLUSIONS Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome.
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Affiliation(s)
- Vasileios Charalampakis
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece; Department of General Surgery, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom.
| | - Charalampos Seretis
- Department of General Surgery, George Elliot Hospital, Nuneaton, United Kingdom
| | - Markos Daskalakis
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece; Upper GI Unit, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Christos Fokoloros
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
| | - Ahmed Karim
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - John Melissas
- Bariatric Unit, Heraklion University Hospital, University of Crete, Crete, Greece
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Abstract
Nearly 160 million Americans are overweight, obese, or morbidly obese. Morbid obesity and its numerous comorbidities are threats to a person's health. Moreover, hospitalized individuals living with adiposity-based chronic conditions are at risk for certain immobility hazards. Many individuals who are morbidly obese look to metabolic surgery as a means for achieving sustainable weight loss. This article addresses critical care needs of people living with excess weight or weight maldistribution, along with specific needs of those undergoing metabolic surgery.
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Affiliation(s)
- Cheryl Holsworth
- Cheryl Holsworth is Senior Specialist Bariatric Surgery, Sharp Memorial Hospital, San Diego, California. Susan Gallagher is Senior Clinical Advisor, Celebration Institute Inc, 8790 Skyline Lane, Conroe, TX 77302
| | - Susan Gallagher
- Cheryl Holsworth is Senior Specialist Bariatric Surgery, Sharp Memorial Hospital, San Diego, California. Susan Gallagher is Senior Clinical Advisor, Celebration Institute Inc, 8790 Skyline Lane, Conroe, TX 77302
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Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients. Surg Obes Relat Dis 2018; 14:603-610. [DOI: 10.1016/j.soard.2018.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/19/2018] [Accepted: 02/10/2018] [Indexed: 01/07/2023]
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Weight Loss and Comorbidity Resolution 3 Years After Bariatric Surgery—an Indian Perspective. Obes Surg 2018; 28:2712-2719. [DOI: 10.1007/s11695-018-3218-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sleeve Gastrectomy and Roux-en-Y Gastric Bypass lead to Comparable Changes in Body Composition after Adjustment for Initial Body Mass Index. Obes Surg 2018; 26:1932-3. [PMID: 27129803 DOI: 10.1007/s11695-016-2212-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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63
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Mandeville Y, Van Looveren R, Vancoillie PJ, Verbeke X, Vandendriessche K, Vuylsteke P, Pattyn P, Smet B. Moderating the Enthusiasm of Sleeve Gastrectomy: Up to Fifty Percent of Reflux Symptoms After Ten Years in a Consecutive Series of One Hundred Laparoscopic Sleeve Gastrectomies. Obes Surg 2018; 27:1797-1803. [PMID: 28190216 DOI: 10.1007/s11695-017-2567-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become a popular one-stage bariatric procedure with a proven efficacy on weight loss. However, the relationship between LSG and gastroesophageal reflux disease (GERD) remains a subject of debate. The objective is to determine the long-term effect of LSG on weight loss and reflux disease. METHODS A retrospective analysis of 100 consecutive patients who underwent an LSG between January 2005 and March 2009 was performed. The effect of LSG on weight evolution and the relationship between preoperative and postoperative GERD symptoms and PPI dependency was analyzed. RESULTS A mean follow-up of 8.48 years (range 6.1-10.3) was achieved. We observed a long-term % excess weight loss (%EWL) of 60%. A significant increase in reflux symptoms and use of PPIs was seen. Seventeen percent suffered from reflux disease preoperatively versus 50% at the end of the postoperative follow-up (RR = 2.5882, 95% CI [1.6161-4.1452], p value = 0.0001). The chance of developing de novo reflux after LSG was 47.8% (32/67). Reflux disease was present in 7 of the 26 patients who underwent a secondary Roux-en-Y gastric bypass (RYGB). In four of these seven patients, reflux disease disappeared completely after the secondary RYGB (57.1%). CONCLUSIONS A satisfactory long-term effect on weight loss was achieved. However, a significant increase in GERD and PPI dependency after LSG was noted. New onset GERD was seen in more than 40% of the study population. Conversion to RYGB is a good option in patients with refractory reflux disease after LSG.
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Affiliation(s)
| | | | | | | | | | | | - Paul Pattyn
- AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium
| | - Bart Smet
- AZ Delta Ziekenhuis, Wilgenstraat 2, Roeselare, Belgium
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Nickel F, Schmidt L, Sander J, Tapking C, Bruckner T, Müller-Stich BP, Fischer L. Patient Perspective in Obesity Surgery: Goals for Weight Loss and Improvement of Body Shape in a Prospective Cohort Study. Obes Facts 2018; 11:466-474. [PMID: 30537759 PMCID: PMC6341368 DOI: 10.1159/000493372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/26/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Obesity surgery provides sustainable weight loss, improvement of comorbidities, and improved quality of life (QOL). There is few evidence on the patient perspective and goals. This study compared expected and achieved weight loss, body shape, and QOL. METHODS Patients completed the Moorehead-Ardelt QOL questionnaire (MAQOL) and questionnaires on actual and expected weight loss and body shape, comorbidities, and goals of obesity surgery preoperatively and within 24 months postoperatively. RESULTS 44 patients completed questionnaires pre- and postoperatively. BMI, MAQOL and comorbidities significantly improved postoperatively. Patients' expected weight loss goal corresponded to a postoperative BMI of 32.6 ± 5.6 kg/m2 and was not different from their achieved BMI within 24 months after surgery (33.9 ± 6.3 kg/m2, p = 0.276). Self-reported body shape improved but did not reach preoperatively expected goals. During the weight loss period, patients adapted their weight loss and body shape goals to higher levels. Patients attributed a higher part of their success in weight loss to surgery postoperatively (79.5 ± 22.0 vs. 89.1 ± 18.4%, p = 0.028). CONCLUSION Patients lost as much weight as they had expected and later modified the goals to even greater weight loss. Body shape improved but did not reach expected levels. QOL improved independently from weight loss and body shape. Patients attributed successful weight loss predominantly to surgery.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany,
| | - Lukas Schmidt
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Sander
- Obesity Clinic, Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Christian Tapking
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Beat-Peter Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General and Visceral Surgery, Hospital Mittelbaden, Baden-Baden, Germany
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Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy on Morbidly Obese, Super-Obese, and Super-Super Obese Patients for the Treatment of Morbid Obesity. Obes Surg 2017; 28:1484-1491. [DOI: 10.1007/s11695-017-3053-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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66
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Preoperative and Postoperative Assessments of Biochemical Parameters in Patients with Severe Obesity Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 28:2261-2271. [PMID: 29116560 DOI: 10.1007/s11695-017-3007-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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67
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Impact of Bariatric Surgery on Outcomes of Patients with Inflammatory Bowel Disease: a Nationwide Inpatient Sample Analysis, 2004–2014. Obes Surg 2017; 28:1015-1024. [PMID: 29047047 DOI: 10.1007/s11695-017-2959-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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68
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Díaz-Tobarra M, Cassinello Fernández N, Jordá Gómez P, Nofal MN, Alfonso Ballester R, Ortega Serrano J. One-Stage vs Two-Stage Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients with Body Mass Index >55 Kg/m 2; 5-YEAR FOLLOW UP. Obes Surg 2017; 27:955-960. [PMID: 27722822 DOI: 10.1007/s11695-016-2411-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgical strategies in patients with BMI > 55 kg/m2 are not well established. OBJECTIVES The objective of this study is to compare the long term results and complications of 1- vs. 2-stage laparoscopic "Roux-en-Y″ gastric bypass (LRYGB) for patients with BMI > 55 kg/m2. METHODS Retrospective review of the complications and outcomes, between January 2007 and January 2010, for patients with a BMI > 55 kg/m2 who underwent directly a LRYGB (1-stage) or a LRYGB as a 2nd stage of a laparoscopic sleeve gastrectomy (LSG). RESULTS Twenty-four patients were enrolled (no patient was lost during the 5-year follow-up). In the 1-stage LRYGB group, two patients had grade II complications according to Clavien-Dindo classification. In the 2-stage LRYGB group, complications of the first and the second surgery were summed. There were no differences between the two groups despite being heterogenous (more men with a higher BMI in the 2-stage group). There was a statistically significant difference in the final BMI in 1-stage LRYGB group compared to the 2-stage LRYGB group (34.46 ± 6.29 vs. 40.40 ± 3.47; p = 0.01, respectively) and in percentage of excess of BMI loss (%EBMIL; 69.80 ± 19.96 vs. 54.54 ± 13.93; p = 0.04, respectively). CONCLUSIONS In patients with a BMI > 55 kg/m2, both 1- and 2-stage LRYGB give good long-term results. If feasible, a 1-stage LRYGB obtains a better percentage of excess of BMI loss but if not possible, the strategy of initially performing a laparoscopic sleeve gastrectomy followed by a LRYGB is safe and there were no differences in complications.
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Affiliation(s)
- María Díaz-Tobarra
- Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain
| | - Norberto Cassinello Fernández
- Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain. .,Servicio Cirugía General y Aparato Digestivo, Hospital Clínico Universitario, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.
| | - Pablo Jordá Gómez
- Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain
| | - Mohammad Nebih Nofal
- Bariatric and Metabolic Surgery Unit, Hospital Clínico Universitario, Valencia, Spain
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McCarty TR, Echouffo-Tcheugui JB, Lange A, Haque L, Njei B. Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004-2012. Surg Obes Relat Dis 2017; 14:74-80. [PMID: 29055669 DOI: 10.1016/j.soard.2017.09.511] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 08/17/2017] [Accepted: 09/09/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bariatric surgery in eligible morbidly obese individuals may improve liver steatosis, inflammation, and fibrosis; however, population-based data on the clinical benefits of bariatric surgery in patients with nonalcoholic fatty liver disease (NAFLD) are lacking. OBJECTIVES To assess the relationship between bariatric surgery and clinical outcomes in hospitalized patients with NAFLD. SETTING United States inpatient care database. METHODS The Nationwide Inpatient Sample database was queried from 2004 to 2012 with co-diagnoses of NAFLD and morbid obesity. Hospitalizations with a history of prior bariatric surgery (Roux-en-Y gastric bypass, gastric band, and sleeve gastrectomy) were also identified. The primary outcome was in-hospital mortality. Secondary outcomes included cirrhosis, myocardial infarction, stroke, and renal failure. Poisson regression was used to derive adjusted incidence risk ratios for clinical outcomes in patients with prior bariatric surgery compared with those without bariatric surgery. RESULTS Among 45,462 patients with a discharge diagnosis of NAFLD and morbid obesity, 18,618 patients (41.0%) had prior bariatric surgery. There was a downward trend in bariatric surgery procedures (percent annual change of -5.94% from 2004 to 2012). In a multivariable analysis, prior bariatric surgery was associated with decreased inpatient mortality compared with no bariatric surgery (incidence risk ratios = .08; 95% confidence interval, .03-.20, P<.001). Prior bariatric surgery was also associated with decreased incidence risk ratios for cirrhosis, myocardial infarction, stroke, and renal failure (all P<.001). CONCLUSIONS Prior bariatric surgery is associated with decreased in-hospital morbidity and mortality in morbidly obese NAFLD patients. Despite this, the proportion of NAFLD patients with bariatric surgery has declined from 2004 to 2012.
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Affiliation(s)
- Thomas R McCarty
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Andrew Lange
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Lamia Haque
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut; Investigative Medicine Program, Yale Center of Clinical Investigation, New Haven, Connecticut.
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Kafalı ME, Şahin M, Ece İ, Acar F, Yılmaz H, Alptekin H, Ateş L. The effects of bariatric surgical procedures on the improvement of metabolic syndrome in morbidly obese patients: Comparison of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass. Turk J Surg 2017; 33:142-146. [PMID: 28944323 DOI: 10.5152/turkjsurg.2017.3865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/12/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in terms of weight loss, metabolic parameters, and postoperative complications. MATERIAL AND METHODS Data on patients who underwent laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy with a diagnosis of morbid obesity between January 2012 and June 2014 were retrospectively evaluated. Patients were compared in terms of age, sex, body mass index, duration of operation, American Society of Anesthesiologists score, perioperative complications, length of hospital stay, and long term follow-up results. RESULTS During the study period, 91 patients (45 laparoscopic Roux-en-Y gastric bypass and 46 laparoscopic sleeve gastrectomy) underwent bariatric surgery. There was no difference between the two groups in terms of preoperative patient characteristics. Both groups showed statistically significant weight loss and improvement in co-morbidities when compared with the preoperative period. Weight loss and improvement in metabolic parameters were similar in both groups. The duration of operation and hospital stay was longer in the laparoscopic Roux-en-Y gastric bypass group. Furthermore, the rate of total complications was significantly lower in the laparoscopic sleeve gastrectomy group. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective method with a significantly lower complication rate and length of hospital stay than laparoscopic Roux-en-Y gastric bypass, with similar improvement rates in metabolic syndrome.
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Affiliation(s)
| | - Mustafa Şahin
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - İlhan Ece
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Fahrettin Acar
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Hüseyin Yılmaz
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Hüsnü Alptekin
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
| | - Leyla Ateş
- Department of General Surgery, Selçuk University School of Medicine, Konya, Turkey
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Casillas RA, Kim B, Fischer H, Zelada Getty JL, Um SS, Coleman KJ. Comparative effectiveness of sleeve gastrectomy versus Roux-en-Y gastric bypass for weight loss and safety outcomes in older adults. Surg Obes Relat Dis 2017; 13:1476-1483. [DOI: 10.1016/j.soard.2017.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 01/07/2023]
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72
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Madeira T, do Carmo I, Bicha Castelo H, Santos O. Self-Regulation of Weight After Sleeve Gastrectomy. Behav Modif 2017; 42:231-248. [PMID: 28845694 DOI: 10.1177/0145445517724540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is recognized as the most effective method for achieving relevant weight loss in subjects with severe obesity. However, there is insufficient knowledge about weight self-regulation and quality of motivation in these patients. The main goal of this study was to characterize the association between the percentage of excess weight loss (%EWL) and the motivation to manage weight, at least 1 year after sleeve gastrectomy (SG). This is an observational longitudinal retrospective study. All patients corresponding to predefined inclusion criteria who underwent SG from January 2008 to July 2010 at a main general hospital were invited. A version of the Treatment Self-Regulation Questionnaire (TSRQ) was used to assess patients' quality of motivation: TSRQ concerning continuing the weight self-management program. Clinical data were collected from patients' records. Overall, 81 patients participated (16 men and 65 women, 25-64 years old). The average body mass index was significantly reduced from 45.3 ± 7.0 kg/m2 preoperatively to 32.7 ± 6.9 kg/m2 postoperatively. Autonomous self-regulation was higher than externally controlled self-regulation, regarding motives to keep managing weight after SG. Postoperatively, %EWL correlated negatively with external self-regulation. SG was found to be associated with the quality of motivation for losing weight. External motivations were associated with worse results. These findings support the importance of multiprofessional teams in the assessment and treatment of patients, aiming for the promotion of weight self-regulation after bariatric surgery.
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Affiliation(s)
- Teresa Madeira
- 1 Instituto de Saúde Ambiental, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa.,2 Faculdade de Medicina, Universidade de Lisboa
| | | | | | - Osvaldo Santos
- 1 Instituto de Saúde Ambiental, Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa.,2 Faculdade de Medicina, Universidade de Lisboa
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Disse E, Pasquer A, Pelascini E, Valette PJ, Betry C, Laville M, Gouillat C, Robert M. Dilatation of Sleeve Gastrectomy: Myth or Reality? Obes Surg 2017; 27:30-37. [PMID: 27334645 DOI: 10.1007/s11695-016-2261-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The success of longitudinal sleeve gastrectomy (LSG) is perceived as being potentially limited by dilatation of the remaining gastric tube during the follow-up. The aim of this prospective study was to determine the incidence and the characteristics of sleeve dilatation during the first post-operative year. MATERIALS AND METHODS Gastric volumetry using 3D gastric computed tomography with gas expansion was performed in 54 successive subjects who underwent an LSG for morbid obesity at 3 and 12 months following surgery. Total gastric volume, volume of the gastric tube and the antrum, and diameter of the gastric tube were assessed after multiplanar reconstructions. An increase of at least 25 % of the total gastric volume was considered as sleeve dilatation. Percentage of excess BMI loss (%EBMIL) and daily caloric intakes were recorded during the first 18 months. RESULTS Sixty-one percent of the subjects experienced sleeve dilatation 1 year after surgery. The gastric tube was mainly involved in the sleeve dilatation process (+91 %). Sleeve dilatation occurred especially in subjects with smaller total gastric volume at baseline (189 vs 236 ml, p = 0.02). Daily caloric intake was similar between the groups at each point of the follow-up. No difference concerning %EBMIL was observed between the groups during the 18 months of follow-up. CONCLUSIONS Sleeve dilatation occurred in more than 50 % of the patients. Dilatation was not necessarily linked to an increase of daily caloric intake and insufficient weight loss during the first 18 months following surgery. Small LSG at baseline is at higher risk of dilatation.
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Sleeve Gastrectomy: Correlation of Long-Term Results with Remnant Morphology and Eating Disorders. Obes Surg 2017; 27:2845-2854. [PMID: 28508273 DOI: 10.1007/s11695-017-2713-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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75
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Perrone F, Bianciardi E, Ippoliti S, Nardella J, Fabi F, Gentileschi P. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years. Updates Surg 2017; 69:101-107. [PMID: 28266000 DOI: 10.1007/s13304-017-0426-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most widely used bariatric procedures nowadays. The aim of this study was to compare long-term results on weight loss and comorbidities improvement for both procedures. A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 underwent LSG and 142 underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range 60-96). LSG showed greater effectiveness in percentage of excess weight loss (%EWL) at 180 days and at 1 year of follow-up. Instead, at 5th year follow-up LRYGB and LSG showed similar %EWL values (72.34 versus 70.26). LSG group showed a lack of weight loss in patients from 3 to 5 years after surgery, whereas LRYGB group patients maintained an effective weight loss during the entire follow-up period. In LSG group both length of stay and operative time were found to be shorter. LRYGB showed better effectiveness in type 2 diabetes mellitus (T2DM) resolution rate. None of the two techniques has proven to be clearly better than the other on a long-term follow-up analysis, except for the LRYGB better results in T2DM healing. According to our findings, in LSG Group after 3 years the weight remains stable.
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Affiliation(s)
- Federico Perrone
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy.
| | - Emanuela Bianciardi
- Psychiatric Unit, Department of System Medicine, University of Rome, Tor Vergata, Rome, Italy
| | | | | | | | - Paolo Gentileschi
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy.,Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy
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Staple Line Leak After Primary Sleeve Gastrectomy—Risk Factors and Mid-term Results: Do Patients Still Benefit from the Weight Loss Procedure? Obes Surg 2017; 27:1780-1788. [PMID: 28078641 DOI: 10.1007/s11695-017-2543-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Neylan CJ, Kannan U, Dempsey DT, Williams NN, Dumon KR. The Surgical Management of Obesity. Gastroenterol Clin North Am 2016; 45:689-703. [PMID: 27837782 DOI: 10.1016/j.gtc.2016.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the United States, more than one-third of the population is obese. Currently, bariatric surgery is the best known treatment for obesity, and multiple meta-analyses have shown bariatric surgery to be more effective for treating obesity than diet and exercise or pharmacologic treatment. The modern era of bariatric surgery began in 2005, which is defined by a drastic increase in the use of laparoscopy. Bariatric surgery has the potential to improve obesity-related comorbidities, such as type 2 diabetes, cardiovascular disease, and sleep apnea. The effect of bariatric surgery on weight loss and comorbidities varies by the type of procedure.
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Affiliation(s)
- Christopher J Neylan
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Umashankkar Kannan
- Department of Surgery, Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Molina López A, Sabench Pereferrer F, Vives Espelta M, Bonada Sanjaume A, Blanco Blasco S, Raga Carceller E, Hernández González M, Sánchez Marín A, Salas Salvadó J, Del Castillo Déjardin D. Usefulness of Baltasar's expected body mass index as an indicator of bariatric weight loss surgery. Obes Surg 2016; 26:2712-2717. [PMID: 27039101 DOI: 10.1007/s11695-016-2163-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Determining the best indicator to report weight loss takes on special relevance following bariatric surgery. Our objective is to apply a method proposed by Baltasar et al. to express weight loss results following bariatric surgery. MATERIALS AND METHODS Anthropometric data were collected from 265 patients who had undergone Sleeve gastrectomy (SG, n = 172) and Roux-en-Y gastric bypass (RYGBP, n = 93) with a 2-year follow-up period. Initial BMI was calculated as well as BMI 2 years after, percentage of excess BMI loss (PEBMIL), expected BMI (EBMI), and corrected PEBMIL. RESULTS In SG group, average BMI 2 years after surgery fell within a 95 % CI of expected BMI, with an average BMI of 31.58 ± 4.05 kg/m2 in 35-45 BMI group, an average BMI of 33.62 ± 4.96 kg/m2 in 45-55 BMI group, and an average BMI of 37.40 ± 5.93 kg/m2 in 55-65 BMI group. In RYGBP group, average BMI 2 years after the surgery was below than average expected BMI (28.76 ± 3.20 kg/m2 in 35-45 BMI group and 29.71 ± 3.30 kg/m2 in 45-55 BMI group). Results are considered excellent for the group with an initial BMI of above 45 kg/m2. CONCLUSIONS EBMI is a good weight loss indicator, mainly when 95 % CI is taken into account. EBMI is consistent with the results obtained 2 years after surgery in our patients who underwent SG and RYGBP. Corrected PEBMIL is a good indicator for expressing the percentage of BMI loss and offers more realistic values than conventional formula with a cut-off point of 25 points.
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Affiliation(s)
- Alicia Molina López
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
| | - Fàtima Sabench Pereferrer
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
| | - Margarida Vives Espelta
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
- Surgery Service of Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain
| | | | - Santiago Blanco Blasco
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
- Surgery Service of Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain
| | - Esther Raga Carceller
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
- Surgery Service of Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain
| | - Mercè Hernández González
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
- Surgery Service of Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain
| | - Antonio Sánchez Marín
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain
- Surgery Service of Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain
| | - Jordi Salas Salvadó
- Unit of Nutrition, Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain
| | - Daniel Del Castillo Déjardin
- Surgery Unit of the Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Tarragona, Spain.
- Surgery Service of Sant Joan University Hospital. IISPV, Reus, Tarragona, Spain.
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Abstract
PURPOSE OF REVIEW Obesity is a worldwide epidemic, having profound effects on Western populations. Bariatric surgery has long been employed to treat obesity and its related comorbidities. Over time, researchers have amassed significant data to support bariatric surgery in the pursuit of treating diabetes mellitus. This review serves to introduce the most recent findings and their relation to the various bariatric surgical options as bariatric surgery will continue to cement itself in the treatment paradigm of diabetes mellitus. RECENT FINDINGS Numerous studies performed in the past 10 years have demonstrated the improvement or cessation of diabetes with bariatric surgical intervention. In comparing the vertical sleeve gastrectomy and Roux-en-Y gastric bypass, data demonstrate a more beneficial response of diabetes to the Roux-en-Y gastric bypass, and an even further exaggerated response with the biliopancreatic diversion/duodenal switch. The benefit has long been established, but what causes the improvement in diabetes mellitus after bariatric surgery? Recent data suggest a decrease in circulating bile salts as well as changes to inflammatory markers and circulating cytokines. Furthermore, tailoring of existing surgical procedures has led to the development of the SIPS procedure, and its benefit is demonstrated in bypassing a large portion of intestine while eliminating an enteroenterostomy, helping to reduce short gut syndrome and resultant diarrhea. SUMMARY The surgical climate within the bariatric field is changing and will continue to do so in the future. As the understanding of the causes or mechanisms in which bariatric surgery improves metabolic disorders becomes more evident, the process of individualizing care for specific patients will become more prevalent.
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Twells LK, Gregory DM, Midodzi WK, Dillon C, Kovacs CS, MacDonald D, Lester KK, Pace D, Smith C, Boone D, Murphy R. The Newfoundland and Labrador Bariatric Surgery Cohort Study: Rational and Study Protocol. BMC Health Serv Res 2016; 16:618. [PMID: 27793212 PMCID: PMC5086068 DOI: 10.1186/s12913-016-1869-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/20/2016] [Indexed: 12/19/2022] Open
Abstract
Background In Canada, there has been a disproportionate increase in adults with Class II (BMI 35.0–39.9 kg/m2) or Class III obesity (BMI ≥ 40 kg/m2) affecting 9 % of Canadians with increases projected. Individuals affected by severe obesity (BMI ≥ 35) are at increased risk of high blood pressure, cardiovascular disease, diabetes, cancer, impaired quality of life, and premature mortality. Bariatric surgery is the most effective treatment for severe obesity. Laparoscopic sleeve gastrectomy (LSG), a relatively new type of bariatric surgery, is growing in popularity as a treatment. The global prevalence of LSG increased from 0 to 37.0 % between 2003 and 2013. In Canada and the US, between 2011 and 2013, the number of LSG surgeries increased by 244 % and LSG now comprises 43 % of all bariatric surgeries. Since 2011, Eastern Health, the largest regional health authority in Newfoundland and Labrador (NL), Canada has performed approximately 100 LSG surgeries annually. Methods A population-based prospective cohort study with pre and post surgical assessments at 1, 3, 6, 12, 18, 24 months and annually thereafter of patients undergoing LSG. This study will report on short - to mid-term (2–4 years) outcomes. Patients (n = 200) followed by the Provincial Bariatric Surgery Program between 19 and 70 years of age, with a BMI between 35.0 and 39.9 kg/m2 and an obesity-related comorbidity or with a BMI ≥ 40 kg/m2 are enrolled. The study is assessing the following outcomes: 1) complications of surgery including impact on nutritional status 2) weight loss/regain 3) improvement/resolution of comorbid conditions and a reduction in prescribed medications 4) patient reported outcomes using validated quality of life tools, and 5) impact of surgery on health services use and costs. We hypothesize a low complication rate, a marked reduction in weight, improvement/resolution of comorbid conditions, a reduction in related medications, improvement in quality of life, and a decrease in direct healthcare use and costs and indirect costs compared to pre-surgery. Discussion Limited data on the impact of LSG as a stand-alone procedure on a number of outcomes exist. The findings from this study will help to inform evidence-based practice, clinical decision-making, and the development of health policy.
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Affiliation(s)
- Laurie K Twells
- School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada. .,Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada.
| | - Deborah M Gregory
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - William K Midodzi
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - Carla Dillon
- School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - Christopher S Kovacs
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - Don MacDonald
- Research and Evaluation, Newfoundland and Labrador Centre for Health Information, 70 O'Leary Avenue, St. John's, NL, A1B 2C7, Canada
| | - Kendra K Lester
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - David Pace
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - Chris Smith
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - Darrell Boone
- Faculty of Medicine, Memorial University, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
| | - Raleen Murphy
- Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL, A1B 3 V6, Canada
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81
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Hancı D, Altun H, Altun H, Batman B, Karip AB, Serin KR. Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients. Obes Surg 2016; 26:558-62. [PMID: 26138692 DOI: 10.1007/s11695-015-1784-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. METHOD A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. RESULTS Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). CONCLUSIONS Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Deniz Hancı
- Ear Nose and Throat Clinic, Liv Hospital, Ulus, Istanbul, Turkey
| | - Huseyin Altun
- Ear Nose and Throat Clinic, Yunus Emre Hospital, Uskudar, Istanbul, Turkey
| | - Hasan Altun
- General Surgery Clinic, Liv Hospital, Ulus, Istanbul, Turkey.
| | - Burcin Batman
- General Surgery Clinic, Liv Hospital, Ulus, Istanbul, Turkey
| | - Aziz Bora Karip
- General Surgery Clinic, Fatih Sultan Mehmet Education and Research Hospital, Atasehir, Istanbul, Turkey
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82
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Nickel F, Probst P, Fischer L. Would you unblind the patient? A case of incidental T1 N0 R0 GIST in a randomized controlled trial of sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity. Surg Obes Relat Dis 2016; 12:e83-e85. [PMID: 27692910 DOI: 10.1016/j.soard.2016.08.496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/22/2016] [Accepted: 08/28/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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83
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Nickel F, Schmidt L, Bruckner T, Büchler MW, Müller-Stich BP, Fischer L. Influence of bariatric surgery on quality of life, body image, and general self-efficacy within 6 and 24 months-a prospective cohort study. Surg Obes Relat Dis 2016; 13:313-319. [PMID: 28029597 DOI: 10.1016/j.soard.2016.08.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND It has been proven that bariatric surgery affects weight loss. Patients with morbid obesity have a significantly lower quality of life (QOL) and body image compared with the general population. OBJECTIVE To evaluate QOL, body image, and general self-efficacy (GSE) in patients with morbid obesity undergoing bariatric surgery within clinical parameters. SETTINGS Monocentric, prospective, longitudinal cohort study. METHODS Patients completed the short form 36 (SF-36) for QOL, body image questionnaire, and GSE scale 3 times: before surgery and within 6 months and 24 months after surgery. Influence of gender, age, and type of procedure, either laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass, were analyzed. RESULTS Thirty patients completed the questionnaires before and within 6 and 24 months after surgery. SF-36 physical summary score improved significantly from 34.3±11.0 before surgery to 46.0±10.4 within 6 months (P<.001) and to 49.8±8.2 within 24 months (P<.001) after surgery. SF-36 mental summary score improved significantly from 42.1±14.7 before surgery to 52.3±8.4 within 6 months (P<.001) and to 48.4±12.2 within 24 months (P<.001) after surgery. There were no significant differences between gender, age, and type of operation. Body image and GSE improved significantly after bariatric surgery (P<.001), and both correlated to the SF-36 mental summary score. CONCLUSION QOL, body image, and GSE improved significantly within 6 months and remained stable within 24 months after bariatric surgery. Improvements were independent of gender, age, and type of operation. Mental QOL was influenced by body image and GSE.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lukas Schmidt
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat-Peter Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
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85
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Bekheit M, Abdel-Baki TN, Gamal M, Abdel-Salam W, Samir M, ElKayal E, Katri K. Influence of the Resected Gastric Volume on the Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2016; 26:1505-1510. [PMID: 26602213 DOI: 10.1007/s11695-015-1981-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relation between the resected gastric volume and the weight loss after laparoscopic sleeve gastrectomy appears conflicting in the literature. Both the residual and the resected volumes represent the total gastric volume, and if the weight loss is related to one of the two volumes, it should be related to the other. While some reports indicate that the weight loss is related to the resected gastric volume, others state that the weight loss is not related to the residual volume. The aim is to investigate the influence of the resected gastric volume on the weight loss after surgery. METHODS The study included 287 consecutive patients. Gastrectomy was performed encroaching over a 38-Fr calibrating tube all the way to the angle of His. Filling volume of the resected stomach, with tap water, was measured. Patients were analyzed into group 1 with BMI ≤50 kg/m(2) and group 2 >50 kg/m(2). RESULTS Females represented 74 % of cases. Mean age was 32.9 ± 9.5 years; preoperative BMI = 48.7 ± 7.9 kg/m(2). The mean resected gastric volume was 1525 ± 408 ml, and it was significantly lower in females compared to that in males (1443 ± 311 vs 1824 ± 502 ml, p < 0.001). Data were analyzed in two groups: group 1 with BMI ≤5050 kg/m(2) and group 2 >50 kg/m(2). Both groups were similar in preoperative BMI (p = 0.399) and excess weight percent (EW%) (p = 0.33). Group 2 had a resected gastric volume (1663 ± 424.7 ml) greater than that of group 1 (1440 ± 347 ml; p < 0.001). The percentage of excess weight loss (EWL%) was 57.9 ± 14.5 % at 6 months (62.7 ± 13.5 % vs 48.34 ± 11.29 %, p < 0.001), 77 ± 19 % at 12 months (84 ± 19.6 % vs 68 ± 14.2 %, p = 0.001), 76.6 ± 7.4 % at 18 months (79.7 ± 4.8 vs 74.7 ± 8.2 %, p = 0.5), and 75.8 ± 11.5 % at 24 months (81.7 ± 11.17 vs 70 ± 11 %, p = 0.8) (group 1 vs group 2, respectively). At 12 months, 86 % patients achieved more than 50 % EWL% (100 % of group 1 vs 60 % of group 2). Preoperative BMI correlated with resected gastric volume (r = 0.239, p = 0.004). In multiple regression, the initial BMI was a predictor of EWL% at 6 and 12 months (r partial = -0.65, p < 0.0001) while the resected gastric volume was not. CONCLUSIONS The resected gastric volume is related to the total gastric volume when the technique is standardized and the residual volume is calibrated using a consistent technique. It is not in itself a predictor of weight loss, but it is related to the initial BMI which predicts the weight loss.
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Affiliation(s)
- Mohamed Bekheit
- Department of Surgery, El Kabbary General Hospital, Alexandria, Egypt.
- U1193 INSERM, University of Paris-XI, Paris, France.
| | | | - Mostafa Gamal
- Department of Surgery, Louran Hospital, Alexandria, Egypt
| | - Wael Abdel-Salam
- HBP Surgery Unit, Department of Surgery, University of Alexandria, Alexandria, Egypt
| | - Mohamed Samir
- Department of Surgery, Medical Research Institute, University of Alexandria, Alexandria, Egypt
| | - ElSaied ElKayal
- HBP Surgery Unit, Department of Surgery, University of Alexandria, Alexandria, Egypt
| | - Khaled Katri
- HBP Surgery Unit, Department of Surgery, University of Alexandria, Alexandria, Egypt
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86
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van Rutte P, Nienhuijs SW, Jakimowicz JJ, van Montfort G. Identification of technical errors and hazard zones in sleeve gastrectomy using OCHRA : "OCHRA for sleeve gastrectomy". Surg Endosc 2016; 31:561-566. [PMID: 27287912 DOI: 10.1007/s00464-016-4997-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The sleeve gastrectomy is an example of minimally invasive surgery. It is important to determine the critical steps of the procedure in order to reduce complications and increase safety and efficiency. OBJECTIVE The aim of this study was to detect the key elements of the sleeve gastrectomy and find the potential hazard zones of the procedure. SETTING Bariatric department of a large teaching hospital in the Netherlands. METHODS A prospective clinical observation study was performed including 60 sleeve gastrectomy procedures. An expert panel determined the key steps, and two experts assessed the procedures systematically for technical errors according to the principles of Observational Clinical Human Reliability Assessment (OCHRA). RESULTS A total of 213 technical errors have been made, and the majority were made during mobilization of the greater curvature and during stapling of the stomach. In 44.6 %, errors had consequences and 96 additional actions were performed. There was a significant correlation between errors during opening of the lesser sac and postoperative complications, and between repositioning of the stapler and postoperative complications. CONCLUSIONS In this study, the 13 key steps of the SG were defined, and OCHRA was considered a valuable assessment tool for surgical performance and potential hazard zones. Most consequential errors are made during dissection of the greater curvature and during stapling of the stomach. Errors during the start of mobilization of the greater curvature and repositioning of the stapler lead to longer duration of the procedure and are associated with a higher risk of postoperative complications.
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Affiliation(s)
- Pwj van Rutte
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - S W Nienhuijs
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - J J Jakimowicz
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,Technical University of Delft, Delft, The Netherlands
| | - G van Montfort
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Mangieri CW, Strode MA, Sherman WE, Pierotti ML, Faler BJ, Choi YU. Institutional Improvement in Weight Loss after Laparoscopic Sleeve Gastrectomy. Am Surg 2016. [DOI: 10.1177/000313481608200521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is a recent addition to the bariatric surgery armamentarium. It has been demonstrated to be an efficacious stand-alone bariatric procedure in regard to weight loss. This study evaluates the progress of our initial experience with LSG. Retrospective review of prospective data from 2008 to 2010. Compared data between our first operative year of experience with LSG (2008) and our third year of experience (2010). Data compared for up to three years postoperatively. End points were percentage of excess body weight loss (%EWL) and percentage of excess body mass index loss (%EBL). Institutional improvement in %EWL and %EBL rates as our collective experience increased with LSG. Mean increase in %EWL of 14 per cent and mean increase of %EBL of 22 per cent. In our first year performing LSG the institutional weight loss was <50 per cent EWL, which is often cited as a benchmark level for “success” after bariatric surgery. By our third year of experience with LSG we achieved an institutional weight loss >50 per cent EWL. Institutional improvement in weight loss results with LSG as the collective experience increased. Several factors could have contributed to this observation to include a surgical men-torship program and the institution of formal nutritional education. This study demonstrates that institutional experience is a significant factor in weight loss results with LSG.
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Affiliation(s)
- Christopher W. Mangieri
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Matthew A. Strode
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - William E. Sherman
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Matthew L. Pierotti
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Byron J. Faler
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Yong U. Choi
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
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88
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Shah N, Greenberg JA, Leverson G, Statz AK, Jolles SA, Funk LM. Weight loss after bariatric surgery: a propensity score analysis. J Surg Res 2016; 202:449-54. [DOI: 10.1016/j.jss.2016.01.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/04/2016] [Accepted: 01/29/2016] [Indexed: 01/07/2023]
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Vuolo G, Voglino C, Tirone A, Colasanto G, Gaggelli I, Ciuoli C, Ferrara F, Marrelli D. Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg 2016; 30:48-55. [PMID: 27109203 DOI: 10.1016/j.ijsu.2016.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a worldwide surgical procedure for morbid obesity. However patients selection is still anecdotal. The aim of this study is to analyse clinical and anthropometric parameters correlated with LSG and to check the validity of this procedure for different categories of obese patients. METHODS Two-hundred one consecutive patients were submitted to LSG as a primary bariatric procedure between 2008 and 2014. One year follow-up was completed in 159 patients. Smaller groups of patients completed 2 and 3 years follow-up (78, 46 patients respectively). Median preoperative body mass index (BMI) was 45.4 kg/m2 (range: 34.8-73.8); 135 patients (80%) had one or more comorbidities. Potential correlations between age, gender, preoperative BMI, preoperative excess weight, early excess weight loss (EWL) and 1 and 3 year-EWL were investigated. RESULTS All procedures were regularly completed with laparoscopic approach without conversion to laparotomy. Postoperative complications occurred in six patients (3.7%); no postoperative mortality was observed. Median one-year BMI and EWL were 32.8 kg/m2 and 55.34%, respectively. Three year-EWL was significantly influenced by age, and early EWL. A complete normalization of glycemic levels after the three-year follow-up was also observed in high percentage of diabetic patients. In patients with preoperative BMI>50 kg/m2 we observed most failure cases in terms of EWL and the worst metabolic results. CONCLUSIONS Our experience indicates that LSG is a safe procedure with satisfactory three-year late weight loss in patients with preoperative BMI <50 kg/m2. Promising results, in terms of improvements of comorbidities, were also observed. These results make LSG one of the most attractive first stage surgical procedure for morbid obesity.
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Affiliation(s)
- Giuseppe Vuolo
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Costantino Voglino
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Andrea Tirone
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Giuseppina Colasanto
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Ilaria Gaggelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Francesco Ferrara
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
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Bužga M, Maresova P, Seidlerova A, Zonča P, Holéczy P, Kuča K. The influence of methods of bariatric surgery for treatment of type 2 diabetes mellitus. Ther Clin Risk Manag 2016; 12:599-605. [PMID: 27143901 PMCID: PMC4841116 DOI: 10.2147/tcrm.s96593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The constantly growing incidence of obesity represents a risk of health complications for individuals, and is a growing economic burden for health care systems and society. The aim of this study was to evaluate the efficacy of bariatric surgery, specifically laparoscopic greater curve plication, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, in patients with type 2 diabetes mellitus. The effect of bariatric surgery on the changes in blood pressure before, and 12 months after, surgery and in pharmacotherapy in the 12 months after surgery was analyzed. For achieving this purpose, 74 patients from the Obesity and Surgery Department of Vitkovice Hospital in Ostrava in the Czech Republic, were monitored. They were operated in 2011 and 2012. The Bonferroni method was used to test hypotheses about the impact of surgery on blood pressure and pharmacotherapy. One year after the surgery, systolic and diastolic blood pressure values decreased, both with no statistically significant difference between surgery types. Improvement was observed in 68% of cases, with 25% of patients discontinuing pharmacotherapy entirely.
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Affiliation(s)
- Marek Bužga
- Research Obesity Center, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petra Maresova
- Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
| | - Adela Seidlerova
- Research Obesity Center, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Zonča
- Research Obesity Center, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavol Holéczy
- Research Obesity Center, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kamil Kuča
- Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic; Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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91
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Goal-directed program after sleeve gastrectomy improves weight loss. Surg Obes Relat Dis 2016; 12:518-521. [PMID: 26944549 DOI: 10.1016/j.soard.2015.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 11/01/2015] [Accepted: 11/14/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of our study is to determine if a goal-directed program improves weight loss after sleeve gastrectomy. METHODS Our goal-directed program involves setting excess weight loss targets at fixed intervals after sleeve gastrectomy. We identified patients in 3 bariatric centers between April 2010 and July 2013 and compared the center that has a goal-directed weight loss program (goal-directed program) with the other 2 centers (standard program). RESULTS A total of 211 patients were included, with 129 patients in the goal-directed weight loss program. The 2 groups were similar in terms of gender distribution, ethnicity distribution, age, and preoperative weight, preoperative body mass index, and surgical technique. The follow-up rates at 3, 6, 9, and 12 months for patients in the goal-directed program was 84.5%, 75.2%, 59.7%, and 82.2%, respectively, compared with 65.9%, 68.3%, 51.2%, and 68.3% for the standard program. The percentage total weight loss at 3, 6, 9, and 12 months was 17.1%, 23.3%, 26.8%, and 28.6%, respectively, for the goal-directed program, compared with 15.3%, 21.8%, 24.4%, and 25.4%, respectively, for the standard program. The mean excess weight loss at 3, 6, 9, and 12 months were 40%, 54%, 62%, and 67%, respectively, for the goal-directed program group, and 36%, 50%, 54%, and 55%, respectively, for the standard program, where statistical significance (P<.005) was achieved at 12 months. CONCLUSION Our results suggest that a goal-directed protocol may improve weight loss outcomes after laparoscopic sleeve gastrectomy.
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Alvarez V, Carrasco F, Cuevas A, Valenzuela B, Muñoz G, Ghiardo D, Burr M, Lehmann Y, Leiva MJ, Berry M, Maluenda F. Mechanisms of long-term weight regain in patients undergoing sleeve gastrectomy. Nutrition 2016; 32:303-8. [PMID: 26611808 DOI: 10.1016/j.nut.2015.08.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/20/2015] [Accepted: 08/23/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Weight regain after bariatric surgery may be associated with behavioral, metabolic, or mechanical factors alone or in combination. The aim of this study was to investigate which factors are related to weight regain in the long-term after sleeve gastrectomy (SG). METHODS A retrospective case-control study with 40 patients undergoing SG (32 women, 8 men; age 42.9 ± 10.7 y; preoperative body mass index 35 ± 2.8 kg/m(2)), was performed. Patients were grouped according percentile->50% (cases) or <50% (controls)-of weight regain (%WR cutoff: 25% of weight loss). Weight history, anthropometry, glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), thyroid-stimulating hormone, resting energy expenditure, body composition, dietary survey, psychological test, and physical activity were recorded. Residual gastric capacity was estimated using a radiologic method. RESULTS (MEDIAN [P25-P75]): The evaluation was conducted 38.5 mo (34-41 mo) after SG. Percent weight regain ranged from 2.7% to 129.2% (25.4% [13-37.1]). Patients in the higher %WR group had a greater residual gastric volume (252.7 ± 108.4 versus 148.5 ± 25.3; P < 0.05) and the estimated volume was significantly correlated with %WR (r = 0.673; P = 0.023). Significantly higher body mass index (P = 0.001), resting energy expenditure (P = 0.04), fasting insulin (P = 0.01), and HOMA-IR (P = 0.02) were observed in the higher %WR group. A higher fat intake and a trend toward higher total energy intake were observed in the group with greater %WR. Clinical or borderline levels of anxiety were more frequently observed in the higher %WR group (70% versus 30%; P = 0.01). CONCLUSIONS Results from the present study demonstrated that the most important factor associated with long-term weight regain after SG was residual gastric volume. Additional prospective studies with larger numbers of patients are necessary to confirm our results.
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Affiliation(s)
| | - Fernando Carrasco
- Department of Nutrition, Clinica Las Condes, Santiago, Chile; Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Ada Cuevas
- Department of Nutrition, Clinica Las Condes, Santiago, Chile
| | - Barbara Valenzuela
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Giselle Muñoz
- Department of Nutrition, Clinica Las Condes, Santiago, Chile
| | - Daniela Ghiardo
- Department of Nutrition, Clinica Las Condes, Santiago, Chile
| | - Maria Burr
- Department of Nutrition, Clinica Las Condes, Santiago, Chile
| | - Yael Lehmann
- Department of Nutrition, Clinica Las Condes, Santiago, Chile
| | - Maria J Leiva
- Department of Nutrition, Clinica Las Condes, Santiago, Chile
| | - Marcos Berry
- Department of Surgery, Clinica Las Condes, Santiago, Chile
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93
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Obeidat F, Shanti H, Mismar A, Albsoul N, Al-Qudah M. The Magnitude of Antral Resection in Laparoscopic Sleeve Gastrectomy and its Relationship to Excess Weight Loss. Obes Surg 2016; 25:1928-32. [PMID: 25744305 DOI: 10.1007/s11695-015-1642-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the effect of antral resection on weight loss and complications after laparoscopic sleeve gastrectomy (LSG). METHODS This was a retrospective study of the prospectively collected data of patients who underwent LSG at Jordan University Hospital from February 2011 to February 2012. Patients were divided into two groups based on antral resection: group A underwent a 6-cm antral resection, and group B underwent a 2-cm antral resection. The percentage of excess weight loss (%EWL) was calculated at 3, 6, 12, and 24 months postoperatively. RESULTS One hundred and ten patients were included in the study, all of whom completed at least 24 months of follow-up (mean follow-up, 33 months). Their mean body mass index was 46.1 ± 7.9 kg/m(2). In group A, the mean %EWL was 38.1 ± 14.1, 54.9 ± 19.9, 65.6 ± 22.8, and 66.8 ± 28.4% at 3, 6, 12, and 24 months, respectively. However, in group B, the mean %EWL was 42.1 ± 13.4, 63.8 ± 19.8, 80.0 ± 22.1, and 81.5 ± 22.9% at 3, 6, 12, and 24 months, respectively. Patients in group B experienced statistically significant greater weight loss than patients in group A. Statistically significant greater weight regain was seen in group A. Group A had a higher incidence of reflux symptoms (six patients; 11%) than group B (four patients; 7.1%). CONCLUSIONS Radical antral resection in association with LSG safely potentiates the restrictive effect achieved and may result in greater and better maintained weight loss.
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Affiliation(s)
- Firas Obeidat
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan,
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94
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Timucin Aydin M, Aras O, Karip B, Memisoglu K. Staple Line Reinforcement Methods in Laparoscopic Sleeve Gastrectomy: Comparison of Burst Pressures and Leaks. JSLS 2016; 19:JSLS.2015.00040. [PMID: 26175554 PMCID: PMC4487958 DOI: 10.4293/jsls.2015.00040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Objectives: Laparoscopic sleeve gastrectomy is a technically simple and popular bariatric operation with acceptable results. However, leaks can occur in long staple lines, for which various reinforcement methods are used. We compared nonreinforced stapling in laparoscopic sleeve gastrectomy with 3 staple line reinforcement methods: suturing, absorbable buttressing material, and fibrin glue. Methods: From March 1 until September 30, 2014, 118 patients with body mass index >40 kg/m2 underwent sleeve gastrectomy and were enrolled in 4 groups, depending on the type of reinforcement used. The resected stomach specimens were treated with the same methods of reinforcement as used in the surgeries in the corresponding patients and then insufflated until a burst occurred. The burst pressures of the resected stomach specimens and adverse postoperative events were recorded. Results: Five postoperative leaks occurred in the reinforcement groups (fibrin glue, 2; absorbable buttresses, 2; sutures, 1); no leaks were evident in the no-reinforcement group. Suturing afforded the highest burst pressure and took the longest to perform of the methods. There was no correlation between the leaks and burst pressures. All of the leaks occurred in the proximal fundus in the resected stomach specimens and in the affected patients. Discussion: Although most surgeons use additional reinforcement on long staple lines in sleeve gastrectomy, there is no consensus about its necessity. We did not show any benefit of such reinforcement methods over proper stapling technique alone. Conclusion: Laparoscopic sleeve gastrectomy without staple line reinforcement is safe and avoids additional costs for reinforcement materials.
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Affiliation(s)
- M Timucin Aydin
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Orhan Aras
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Bora Karip
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Kemal Memisoglu
- Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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95
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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96
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Altun H, Hanci D, Altun H, Batman B, Serin RK, Karip AB, Akyuz U. Improved Gustatory Sensitivity in Morbidly Obese Patients After Laparoscopic Sleeve Gastrectomy. Ann Otol Rhinol Laryngol 2016; 125:536-40. [DOI: 10.1177/0003489416629162] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: The reduction in the preferences for sweet and fat containing tastes in obese patients who underwent bariatric surgery was relatively well shown; however, there are only limited data on the changes in the sensitivity of other tastes like sour, salty, and bitter. Methods: We investigated the changes in gustatory sensitivity of 52 morbidly obese patients (M/F, 22/30; age range, 19-60 years; BMI range, 32.5-63.0 kg/m2) after laparoscopic sleeve gastrectomy. The surgery was performed by the same surgeon using 5 ports technique. Gustatory sensitivity was tested preoperatively and 1 and 3 months after the surgery using standardized Taste Strips test. Results: There was a statistically significant improvement in the taste acuity to sweet, sour, salty, and bitter tastants in morbidly obese patients after the laparoscopic sleeve gastrectomy during the follow-up period of 3 months. Median whole test scores of the patients were increased from 11.5 preoperatively to 14 in the first and third months. Conclusion: In this study, we were able to show the significant improvement in gustatory sensitivity of morbidly obese patients after laparoscopic sleeve gastrectomy for the first time in literature.
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Affiliation(s)
- Huseyin Altun
- Yunus Emre Hospital, Istanbul, ENT clinic, ENT surgeon
| | - Deniz Hanci
- Okmeydani Education and Research Hospital, Istanbul, ENT Department; ENT surgeon
| | - Hasan Altun
- Liv Hospital, Istanbul, General Surgery clinic, General Surgeon
| | - Burcin Batman
- Liv Hospital, Istanbul, General Surgery clinic, General Surgeon
| | | | - Aziz Bora Karip
- FSM Education and Research Hospital, Istanbul, General surgery Clinic, General Surgeon
| | - Umit Akyuz
- FSM Education and Research Hospital, Istanbul, Gastroenterology Clinic, Gastroenterologist
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97
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Early outcomes of laparoscopic sleeve gastrectomy in a multiethnic Asian cohort. Surg Obes Relat Dis 2016; 12:330-7. [DOI: 10.1016/j.soard.2015.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/27/2015] [Accepted: 05/15/2015] [Indexed: 12/12/2022]
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98
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Khan S, Rock K, Baskara A, Qu W, Nazzal M, Ortiz J. Trends in bariatric surgery from 2008 to 2012. Am J Surg 2015; 211:1041-6. [PMID: 26762828 DOI: 10.1016/j.amjsurg.2015.10.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity is a global epidemic that has been increasing in prevalence. The only treatment method for durable weight loss is bariatric surgery. The aim of this study was to observe trends in usage and outcomes of bariatric operations used in the United States from 2008 to 2012. METHODS Analysis was performed on bariatric surgery admissions from 2008 to 2012 based off of the Nationwide Inpatient Sample database. Data were selected from using International Classification of Disease, 9th Revision codes correlating to bariatric procedures for the purpose of obesity. Annual estimates and trends were reviewed for patient demographics, procedure type, patient outcomes, and length of stay (LOS). RESULTS A total of 598,756 bariatric procedures were examined. Laparoscopic gastric bypass was the most commonly used surgical method in 2008 (58.2%). A decreasing trend in its use, and the use of laparoscopic gastric banding (LGB), was equipoised with increasing use of laparoscopic sleeve gastrectomy (LSG). Use of LSG accounted for 8.2% of procedures in 2011 and 39.6% in 2012. LGB and LSG had the lowest rates of complications, in-hospital morbidity and mortality, and the shortest LOS whereas open bypass and duodenal switch had the highest rates of complications, in-hospital morbidity and mortality, and longest LOSs. Overall rates of venous thromboembolism increased from .08% in 2008 to .215% in 2012. Respiratory complications decreased from 6.1% to 3.9%. There were no observed trends in rates of renal complications, visceral injury, bleeding, and infections. In-hospital morbidity decreased, whereas mortality rates were stable at .1%. CONCLUSIONS The utilization of bariatric procedures has reached a plateau in the United States. Changes in the composition of procedural types suggest that LSG has become a popular alternative to gastric bypass and LGB.
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Affiliation(s)
- Sohaib Khan
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Kathryn Rock
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Arunkumar Baskara
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Weikai Qu
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Munier Nazzal
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Jorge Ortiz
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA.
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99
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Erridge S, Sodergren MH, Darzi A, Purkayastha S. Natural Orifice Translumenal Endoscopic Surgery: Review of Its Applications in Bariatric Procedures. Obes Surg 2015; 26:422-8. [PMID: 26620212 PMCID: PMC4709375 DOI: 10.1007/s11695-015-1978-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review aims to summarise clinical applications of natural orifice translumenal endoscopic surgery (NOTES) in bariatric surgery. A review of data, until December 2014, was carried out regarding techniques and outcomes of bariatric NOTES procedures. Nine publications were included in the final analysis, with another six papers describing endolumenal procedures included for comparison. All NOTES studies adopted a hybrid procedure. Hybrid NOTES sleeve gastrectomy (hNSG) was described in four humans and two porcine studies. In humans, six subjects (23.1 %) were converted to conventional laparoscopic methods, and one postoperative complication (3.8 %) was reported. Mean excess weight loss was 46.6 % (range 35.2–58.9). Transvaginal-assisted sleeve gastrectomy appears feasible and safe when performed by appropriately trained professionals. However, improvements must be made to overcome current technical limitations.
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Affiliation(s)
- Simon Erridge
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK.
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100
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Sharma S, Narwaria M, Cottam DR, Cottam S. Randomized double-blinded trial of laparoscopic gastric imbrication v laparoscopic sleeve gastrectomy at a single Indian institution. Obes Surg 2015; 25:800-4. [PMID: 25428511 DOI: 10.1007/s11695-014-1497-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Currently, there is a debate whether the laparoscopic gastric imbrication (LGI) offers similar weight loss when compared to the laparoscopic sleeve gastrectomy (LSG). On the surface, they seem to offer similar-sized stomachs after the procedures are performed. We chose to perform a randomized double-blinded trial to see if similar-sized pouches result in similar types of weight loss. Our belief was that sleeve gastrectomy would offer at least a 10% better weight loss over a 3-year period. METHODS Thirty patients were randomized to one of two arms. The patients and the third party administrator following the patients were blinded as to which procedure was chosen. The surgeon had full knowledge of the patients' surgery throughout the treatment. The decision of which arm to place them was made by a single employee of the third party administrator and not shared with the employees following the patients. Patients were then followed for 3 years. RESULTS There were no differences in weight, age, or BMI preoperatively. There were no differences between the two groups at any follow-up time point from 6 months to 3 years. Follow-up was 100%. CONCLUSION Due to the large standard deviations present in both groups, there was no statistical difference between either of the groups in terms of weight loss.
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Affiliation(s)
- Sunil Sharma
- Department of Surgery, University of Florida Health at Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA,
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