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De Maio F, Boru CE, Velotti N, Capoccia D, Santarelli G, Verrastro O, Bianco DM, Capaldo B, Sanguinetti M, Musella M, Raffaelli M, Leonetti F, Delogu G, Silecchia G. Short-term gut microbiota's shift after laparoscopic Roux-en-Y vs one anastomosis gastric bypass: results of a multicenter randomized control trial. Surg Endosc 2024:10.1007/s00464-024-11154-6. [PMID: 39294316 DOI: 10.1007/s00464-024-11154-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/04/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Roux-en-Y (RYGB) and one anastomosis gastric bypass (OAGB) represent two of the most used bariatric/metabolic surgery (BMS) procedures. Gut microbiota (GM) shift after bypass surgeries, currently understated, may be a possible key driver for the short- and long-term outcomes. METHODS Prospective, multicenter study enrolling patients with severe obesity, randomized between OAGB or RYGB. Fecal and blood samples were collected, pre- (T0) and 24 months postoperatively (T1). GM was determined by V3-V4 16S rRNA regions sequencing and home-made bioinformatic pipeline based on Qiime2 plugin and R packages. OBJECTS To compare OAGB vs RYGB microbiota profile at T1 and its impact on metabolic and nutritional status. RESULTS 54 patients completed the study, 27 for each procedure. An overall significant variation was detected in anthropometric and serum nutritional parameters at T1, with a significant, similar decrease in overall microbial alpha and beta diversity observed in both groups. An increase in relative abundances of Actinobacteria and Proteobacteria and a reduction of Bacteroidetes, no significant changes in Firmicutes and Verrucomicrobia, with an increase of the Firmicutes/Bacteroidetes ratio were observed. CONCLUSIONS BMS promotes a dramatic change in GM composition. This is the first multicenter, RCT evaluating the impact of OAGB vs Roux-en-Y bypass on GM profile. The bypass technique per se did not impact differently on GM or other examined metabolic parameters. The emergence of slightly different GM profile postoperatively may be related to clinical conditions or may influence medium or long-term outcomes and as such GM profile may represent a biomarker for bariatric surgery's outcomes.
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Affiliation(s)
- Flavio De Maio
- Dipartimento Di Scienze Di Laboratorio E Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristian Eugeniu Boru
- General Surgery Division, Sant'Andrea Hospital, Department of Medical Surgical Sciences and Translational Medicine and Department of Medical-Surgical Sciences and Biotechnologies, University "La Sapienza" of Rome, Via Di Grottarossa N. 1035, 00189, Rome, Italy.
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Danila Capoccia
- General Surgery Division, Sant'Andrea Hospital, Department of Medical Surgical Sciences and Translational Medicine and Department of Medical-Surgical Sciences and Biotechnologies, University "La Sapienza" of Rome, Via Di Grottarossa N. 1035, 00189, Rome, Italy
| | - Giulia Santarelli
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ornella Verrastro
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Delia Mercedes Bianco
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, University of Naples ''Federico II", Naples, Italy
| | - Maurizio Sanguinetti
- Dipartimento Di Scienze Di Laboratorio E Infettivologiche, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mario Musella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Frida Leonetti
- General Surgery Division, Sant'Andrea Hospital, Department of Medical Surgical Sciences and Translational Medicine and Department of Medical-Surgical Sciences and Biotechnologies, University "La Sapienza" of Rome, Via Di Grottarossa N. 1035, 00189, Rome, Italy
| | - Giovani Delogu
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
- Mater Olbia Hospital, Olbia, Italy
| | - Gianfranco Silecchia
- General Surgery Division, Sant'Andrea Hospital, Department of Medical Surgical Sciences and Translational Medicine and Department of Medical-Surgical Sciences and Biotechnologies, University "La Sapienza" of Rome, Via Di Grottarossa N. 1035, 00189, Rome, Italy
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Friedman DN, Chou JF, Clark JM, Moskowitz CS, Ford JS, Armstrong GT, Mubdi NZ, McDonald A, Nathan PC, Sklar CA, Ramanathan LV, Robison LL, Oeffinger KC, Tonorezos ES. Exercise and QUality Diet after Leukemia: A Randomized Weight Loss Trial among Adult Survivors of Childhood Leukemia in the Childhood Cancer Survivor Study. Cancer Epidemiol Biomarkers Prev 2024; 33:1158-1166. [PMID: 38652494 PMCID: PMC11371536 DOI: 10.1158/1055-9965.epi-23-1601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/02/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Obesity is prevalent in childhood cancer survivors and interacts with cancer treatments to potentiate risk for cardiovascular (CV) death. We tested a remote weight-loss intervention trial that was effective among adults with CV risk factors in a cohort of adult survivors of childhood acute lymphoblastic leukemia (ALL) with overweight/obesity. METHODS In this phase III efficacy trial, survivors of ALL enrolled in the Childhood Cancer Survivor Study with a body mass index ≥25 kg/m2 were randomized to a remotely delivered weight-loss intervention versus self-directed weight loss, stratified by history of cranial radiotherapy. The primary endpoint was the difference in weight loss at 24 months in an intent-to-treat analysis. Analyses were performed using linear mixed-effects models. RESULTS Among 358 survivors (59% female; median attained age: 37 years; IQR: 33-43 years), the baseline mean (SD) weight was 98.6 kg (24.0) for the intervention group (n = 181) and 94.9 kg (20.3) for controls (n = 177). Adherence to the intervention was poor; 15% of individuals in the intervention group completed 24/30 planned coaching calls. Weight at 24 months was available for 274 (77%) participants. After controlling for cranial radiotherapy, sex, race/ethnicity, and age, the mean (SE) change in weight from baseline to 24 months was -0.4 kg (0.8) for the intervention group and 0.2 kg (0.6) for control participants (P = 0.59). CONCLUSIONS A remote weight-loss intervention that was successful among adults with CV conditions did not result in significant weight loss among adult survivors of childhood ALL. IMPACT Future interventions in this population must be tailored to the unique needs of survivors to encourage engagement and adherence. See related In the Spotlight, p. 1147.
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Affiliation(s)
- Danielle N Friedman
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeanne M Clark
- Johns Hopkins University Schools of Medicine and Public Health, Baltimore, Maryland
| | - Chaya S Moskowitz
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Jennifer S Ford
- Hunter College and The Graduate Center, City University of New York, New York, New York
| | | | - Nidha Z Mubdi
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aaron McDonald
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Charles A Sklar
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Lakshmi V Ramanathan
- Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | | | | | - Emily S Tonorezos
- National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Yamamoto PA, Vozmediano V, Cristofoletti R, Jiang J, Schmittgen TD, de Gaitani CM, Kemp R, Sankarankutty AK, Dos Santos JS, Salgado Junior W, de Moraes NV. Rerouting cardiovascular management following gastric bypass surgery: Dose optimization of carvedilol using population-based analysis. Br J Clin Pharmacol 2024; 90:2223-2235. [PMID: 38852609 DOI: 10.1111/bcp.16129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
AIMS A population-based pharmacokinetic (PK) modeling approach (PopPK) was used to investigate the impact of Roux-en-Y gastric bypass (RYGB) on the PK of (R)- and (S)-carvedilol. We aimed to optimize carvedilol dosing for these patients utilizing a pharmacokinetic/pharmacodynamic (PK/PD) link model. METHODS PopPK models were developed utilizing data from 52 subjects, including nonobese, obese, and post- RYGB patients who received rac- carvedilol orally. Covariate analysis included anthropometric and laboratory data, history of RYGB surgery, CYP2D6 and CYP3A4 in vivo activity, and relative intestinal abundance of major drug- metabolizing enzymes and transporters. A direct effect inhibitory Emax pharmacodynamic model was linked to the PK model of (S)- carvedilol to simulate the changes in exercise- induced heart rate. RESULTS A 2-compartmental model with linear elimination and parallel first-order absorptions best described (S)-carvedilol PK. RYGB led to a twofold reduction in relative oral bioavailability compared to nonoperated subjects, along with delayed absorption of both enantiomers. The intestinal ABCC2 mRNA expression increases the time to reach the maximum plasma concentration. The reduced exposure (AUC) of (S)-carvedilol post-RYGB corresponded to a 33% decrease in the predicted area under the effect curve (AUEC) for the 24-hour β-blocker response. Simulation results suggested that a 50-mg daily dose in post-RYGB patients achieved comparable AUC and AUEC to 25-mg dose in nonoperated subjects. CONCLUSION Integrated PK/PD modeling indicated that standard dosage regimens for nonoperated subjects do not provide equivalent β-blocking activity in RYGB patients. This study highlights the importance of personalized dosing strategies to attain desired therapeutic outcomes in this patient cohort.
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Affiliation(s)
- Priscila Akemi Yamamoto
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Valvanera Vozmediano
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Rodrigo Cristofoletti
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Jinmai Jiang
- Cancer Genetics Research Complex, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Thomas D Schmittgen
- Cancer Genetics Research Complex, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | - Rafael Kemp
- School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | | | | | - Wilson Salgado Junior
- School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Natalia Valadares de Moraes
- Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, FL, USA
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Zhao S, Fu Y, Zhou J, Sun L, Li R, Tian Z, Cheng Y, Wang J, Wang W, Wang D. Comparing the Efficacy of Robotic Versus Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Obes Surg 2024; 34:3493-3505. [PMID: 39042305 DOI: 10.1007/s11695-024-07413-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has emerged as the predominant metabolic bariatric surgery. With a growing number of studies evaluating the feasibility of robotic sleeve gastrectomy (RSG), it becomes imperative to ascertain whether the outcomes of both techniques are comparable. This study endeavors to synthesize existing evidence and juxtapose the surgical outcomes of LSG and RSG. METHODS We collected articles comparing LSG and RSG published between 2011 and 2024. The compiled data included author names, study duration, sample size, average age, gender distribution, geographical location, preoperative body mass index (BMI), bougie diameter, duration of hospitalization, surgical duration, readmission rates, conversion rates, costs, postoperative percentage of excess weight loss (%EWL), postoperative BMI, mortality rates, and complications. RESULTS We incorporated 21 articles. Both the RSG and LSG cohorts exhibited comparable rates of readmission, conversion, mortality, and incidence of complications (p > 0.05). Moreover, the efficacy of weight loss was similar between RSG and LSG. Nonetheless, RSG was linked to longer operative duration (WMD, -27.50 minutes; 95% confidence interval [CI], -28.82 to -26.18; p < 0.0001), prolonged hospitalization (WMD, -0.15 days; 95% CI, -0.25 to -0.04; p = 0.006), and elevated expenses (WMD, -5830.9 dollars; 95% CI, -8075.98 to -3585.81; p < 0.0001). CONCLUSIONS While both RSG and LSG demonstrated positive postoperative clinical outcomes, RSG patients experienced extended hospital stays, longer operative times, and increased hospitalization costs compared to LSG patients. Using the robotic platform for sleeve gastrectomy (SG) in patients with obesity did not appear to offer any clear benefits.
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Affiliation(s)
- Shuai Zhao
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Yayan Fu
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Jiajie Zhou
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Ruiqi Li
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Zhen Tian
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Yifan Cheng
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Jie Wang
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
| | - Daorong Wang
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Jeon SM, Kwon Y, Kim D, Hwang J, Heo Y, Park S, Kwon JW. Discontinuation of blood pressure-lowering, glucose-lowering, and lipid-lowering medications after bariatric surgery in patients with morbid obesity: a nationwide cohort study in South Korea. Surg Obes Relat Dis 2024; 20:840-848. [PMID: 38631926 DOI: 10.1016/j.soard.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/05/2024] [Accepted: 03/02/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Limited evidence exists on the patterns of medication use for hypertension, diabetes mellitus (DM), and dyslipidemia after bariatric surgery among Asian patients. OBJECTIVES To investigate the patterns in the use of blood pressure-lowering, glucose-lowering, and lipid-lowering medications following BS in Korean patients with morbid obesity. SETTING This study is a retrospective cohort study using the Health Insurance Review and Assignment claims database of South Korea (from 2019 to 2021). METHODS We included patients who underwent BS between 2019 and 2020 in South Korea. We evaluated the treatment patterns of blood pressure-lowering, glucose-lowering, and lipid-lowering medications at 3-month intervals for 1-year following BS, including medication use, individual medication classes, and the number of medications prescribed. Furthermore, we estimated remission rates for each disorder based on patient characteristics by defining patients who discontinued their medications for at least 2 consecutive quarters as remission. RESULTS A total of 3810 patients were included in this study. For 1-year following BS, a marked decrease in the number of patients using blood pressure-lowering, glucose-lowering, and lipid-lowering medications was observed. The most remarkable decrease occurred in glucose-lowering medications, which decreased by approximately -75.1% compared with that at baseline. This tendency was consistently observed when analyzing both the number of medications prescribed and the specific medication classes. Regarding remission rates, patients who were female, younger, and received the biliopancreatic diversion-duodenal switch as their BS showed a relatively higher incidence of remission than other groups. CONCLUSIONS BS was associated with a decrease in the use of medications for hypertension, diabetes mellitus (DM), and dyslipidemia.
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Affiliation(s)
- Soo Min Jeon
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju, South Korea
| | - Yeongkeun Kwon
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea; Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
| | - Dohyang Kim
- Department of Statistics, Daegu University, Gyeongbuk, South Korea
| | - Jinseub Hwang
- Department of Statistics, Daegu University, Gyeongbuk, South Korea
| | - Yoonseok Heo
- Department of Surgery, Inha University College of Medicine, Incheon, South Korea
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, South Korea; Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, South Korea
| | - Jin-Won Kwon
- BK21 FOUR Community-Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, South Korea.
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Alamri AM, Alsareii SA, Isaway NA, Alshaiban SH, Alyami SY, Alsaid MT. The Impact of Bariatric Surgery on Weight Reduction and the Resolution of Comorbidities in Older Geriatric Populations of Saudi Arabia: A Retrospective Study. Cureus 2024; 16:e69349. [PMID: 39282480 PMCID: PMC11398708 DOI: 10.7759/cureus.69349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2024] [Indexed: 09/19/2024] Open
Abstract
Background Obesity is a significant health concern among older adults, leading to various comorbidities and reduced quality of life. Bariatric surgery (BS) has emerged as a potential intervention, but its efficacy in geriatric populations, particularly in Saudi Arabia, is not well-established. Aims This retrospective study aims to evaluate the impact of BS on weight reduction and comorbidity resolution in Saudi Arabian geriatric populations. Methods A retrospective cohort study was conducted at King Khalid Hospital, Saudi Arabia, involving geriatric patients aged 60 and above who underwent BS between January 2018 and December 2022. Data were collected from medical records and analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate regression analysis. Results The study included a total of 26 patients with a mean age of 64 years. Of these, 18 (69.3%) were females, while eight (30.7%) were males, and 23 (87%) underwent sleeve gastrectomy (SG), while three (13%) had Roux-en-Y gastric bypass (RYGB). Preoperative comorbidities majorly included diabetes (17, 35.42%), hypertension (11, 22.92%), and anemia (four, 8.33%). The average body mass index (BMI) of the patients decreased significantly from 45.12 to 37.29 at three months and further to 31.36 at six months post surgery. Total weight loss (TWL) was 19.92% at three months and 35.15% at six months, while the percentage of excess weight loss (%EWL) was 33.42% at three months and 57.85% at six months. Results also showed a significant reduction in the number of comorbidities postoperatively. A significant association with gender, preoperative weight, and preoperative height at three and six months and a significant association with preoperative BMI and comorbidity status at six months were recorded. Conclusion The study suggests that bariatric surgery is effective in achieving significant weight loss and improving comorbidities in geriatric patients. Few demographic and clinical features affect the outcome of the weight loss.
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Affiliation(s)
| | - Saeed A Alsareii
- Department of Surgery, College of Medicine, Najran University, Najran, SAU
| | - Nadia A Isaway
- Department of Surgery, College of Medicine, Najran University, Najran, SAU
| | - Saleh H Alshaiban
- Department of Surgery, College of Medicine, Najran University, Najran, SAU
| | - Saleh Y Alyami
- Department of Medicine, College of Medicine, Najran University, Najran, SAU
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Castellanos LD, Anselmetti P, Acosta G AJ, Tomey D, Araujo-Contreras R, Puche E, Elzein S, Graham Y, Mahawar K, Marshall S, Abou-Mrad A, Oviedo RJ. The role of metabolic and bariatric surgery on the obesity pandemic in Latin America: A review of current practices and future directions. Obes Rev 2024; 25:e13793. [PMID: 38885965 DOI: 10.1111/obr.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/07/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
Latin America faces a significant public health challenge due to the high prevalence of obesity and its associated diseases. Metabolic and bariatric surgery is effective and safe to treat obesity when other treatments fail; however, its implementation in Latin America remains unsatisfactory. This review explores the current status, challenges, and innovations of metabolic and bariatric surgery in Latin America. We searched peer-reviewed journals in English and Spanish for relevant articles published between 1998 and 2023. We found that more than 20% of the Latin American population is affected by obesity. Unfortunately, only a limited number of patients have access to metabolic and bariatric surgery due to high cost, limited availability, and shortage of specialists. The review found that ongoing clinical trials are being conducted in Brazil, Mexico, Chile, and Venezuela, indicating some regional progress. However, published studies remain low in number compared with other regions. Furthermore, we summarized the clinical outcomes, risks, and perioperative assessments associated with metabolic and bariatric surgery. We discussed potential strategies to enhance the availability and affordability of this intervention. This review emphasizes the significance of metabolic and bariatric surgery in addressing the obesity pandemic, specifically for Latin America, and proposes directions for future research and innovation.
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Affiliation(s)
| | | | | | - Daniel Tomey
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Emiro Puche
- School of Medicine, Universidad Francisco de Miranda, Coro, Venezuela
| | - Steven Elzein
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Yitka Graham
- Helen McArdle Nursing and Care Research Institute, Sunderland, UK
| | - Kamal Mahawar
- Department of Surgery, University of Sunderland, Sunderland, UK
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland Australia; Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, Queensland, Australia; and Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Adel Abou-Mrad
- Centre Hospitalier Universitaire d'Orléans, Loire, France
| | - Rodolfo J Oviedo
- Nacogdoches Center for Metabolic & Weight Loss Surgery, Nacogdoches, Texas, USA
- Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, Texas, USA
- Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas, USA
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Messineo L, Bakker JP, Cronin J, Yee J, White DP. Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments. Sleep Med Rev 2024; 78:101996. [PMID: 39244884 DOI: 10.1016/j.smrv.2024.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 08/13/2024] [Accepted: 08/23/2024] [Indexed: 09/10/2024]
Abstract
Despite the commonly-accepted paradigm that patients with obstructive sleep apnea (OSA) also invariably have obesity, OSA prevalence extends beyond obesity. This necessitates a reevaluation of screening strategies, biomarkers of increased OSA risk, and heightened awareness among healthcare providers about the array of OSA treatments for diverse adult populations. While obesity contributes importantly to OSA pathogenesis, there is substantial evidence that non-anatomical factors also play a crucial role, especially in patients who do not have obesity. In recent years, notwithstanding the recognition of diverse contributors to OSA pathogenesis, research has frequently focused on weight reduction to address OSA. Insights from past experiences with bariatric surgery in OSA serve as a lens to anticipate potential outcomes of emerging anti-obesity pharmacotherapies. Pharmacological alternatives, particularly incretin agonists, exhibit promise in weight reduction and OSA improvement, but encounter obstacles such as potential side effects and high costs. With this comprehensive narrative review, we delve into the complex epidemiological and pathophysiological connections between OSA and obesity. Additionally, we emphasize the importance of a multifaceted approach to OSA treatment, recognizing that while weight management is crucial, there is a need for comprehensive strategies that go beyond traditional weight-centric perspectives.
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Affiliation(s)
- Ludovico Messineo
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA.
| | - Jessie P Bakker
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | | | | | - David P White
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
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Petcka NL, Fay K, Hall C, Mou D, Stetler J, Srinivasan JK, Patel AD, Lin E, Scott Davis S. Full esophageal mobilization during hiatal hernia repair with concomitant sleeve gastrectomy improves postoperative reflux symptoms for patients with preexisting reflux. Surg Endosc 2024:10.1007/s00464-024-11193-z. [PMID: 39198289 DOI: 10.1007/s00464-024-11193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/17/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Hiatal hernia repair (HHR) performed concurrently with vertical sleeve gastrectomy (VSG) has been shown to improve postoperative gastroesophageal reflux disease (GERD). However, data on the optimal extent of esophageal mobilization during repair are lacking. Mobilization techniques for HHR during VSG include partial (PM) or full (FM) mobilization of the esophagus. We hypothesize that patients who undergo full mobilization will be less likely to develop postoperative reflux. METHODS A single-institution retrospective review of all patients who underwent a VSG with a HHR between 2014 and 2021 was conducted. The primary outcome was postoperative reflux symptoms defined by diagnosis in the medical record, utilization of anti-reflux medications, and GERD health-related quality of life (GERD-HRQL) scores obtained via patient surveys. RESULTS There were 190 patients included with 80 patients (42.1%) undergoing PM and 110 (57.9%) undergoing FM. Rates of preoperative reflux were similar between the two groups (47.5% vs. 51.8%; p = 0.55). During the GERD-HRQL survey, there were 114 patients (60.0%) contacted with a participation rate of 91.2% (104 patients). Patients with preoperative reflux who underwent PM were found to have a higher rate of reported postoperative reflux (90.0% vs. 62.5%; p = 0.03) and higher GERD-HRQL scores (16.40 ± 9.95 vs. 10.84 ± 9.01; p = 0.04). Patients without preoperative reflux did not have a significant difference in reported reflux (55.0% vs. 51.7%; p = 0.82) or GERD-HRQL scores (12.35 ± 14.14 vs. 9.93 ± 9.46; p = 0.25). CONCLUSION Our study found that postoperative GERD was higher in patients with preexisting reflux who underwent partial esophageal mobilization during concurrent hiatal hernia repair with vertical sleeve gastrectomy. In patients without preoperative GERD, our data suggest that postoperative reflux symptoms are not dependent on the extent of esophageal mobilization during hiatal hernia repair with vertical sleeve gastrectomy.
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Affiliation(s)
- Nicole L Petcka
- Emory University School of Medicine, Atlanta, GA, USA.
- Office of Surgical Education, H100 Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Katherine Fay
- Emory University School of Medicine, Atlanta, GA, USA
| | - Carrie Hall
- Emory University School of Medicine, Atlanta, GA, USA
| | - Danny Mou
- Emory University School of Medicine, Atlanta, GA, USA
| | - Jamil Stetler
- Emory University School of Medicine, Atlanta, GA, USA
- Emory Department of Surgery, Division of General and GI Surgery, Atlanta, GA, USA
| | - Jahnavi K Srinivasan
- Emory University School of Medicine, Atlanta, GA, USA
- Emory Department of Surgery, Division of General and GI Surgery, Atlanta, GA, USA
| | - Ankit D Patel
- Emory University School of Medicine, Atlanta, GA, USA
- Emory Department of Surgery, Division of General and GI Surgery, Atlanta, GA, USA
| | - Edward Lin
- Emory University School of Medicine, Atlanta, GA, USA
- Emory Department of Surgery, Division of General and GI Surgery, Atlanta, GA, USA
| | - S Scott Davis
- Emory University School of Medicine, Atlanta, GA, USA
- Emory Department of Surgery, Division of General and GI Surgery, Atlanta, GA, USA
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10
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Bracha M, Jaroch A, Falkowski A, Zwierko B, Szwed M, Michalik M, Borkowska A, Szwed K, Kozakiewicz M. Elevated Interleukin-6 Is Associated with Successful Weight Loss 3 Months Postlaparoscopic Sleeve Gastrectomy. Obes Surg 2024:10.1007/s11695-024-07468-y. [PMID: 39180618 DOI: 10.1007/s11695-024-07468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Bariatric surgery poses an ever-increasing importance in the effective and long-lasting treatment of obesity, a condition strongly associated with inflammation and increased risk of other diseases and health problems. In obesity-related inflammation, maintaining a balance between pro-inflammatory and anti-inflammatory cytokines is crucial. In this study, we examined early effects of laparoscopic sleeve gastrectomy (LSG) on inflammatory and anti-inflammatory cytokines in obese patients, and assessed their effect on postoperative weight loss. MATERIALS AND METHODS This prospective cohort study was conducted from September 2022 till June 2023. Fifty obese adults were enrolled for LSG. All patients underwent assessments of body measurements, as well as levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and TNF-alpha at baseline and 3 months postsurgery. We developed a decision tree model to predict the success of weight loss. RESULTS At 3 months postsurgery, patients lost 18.9 ± 6.9 kg of excess body weight. A significant decrease was observed for IL-10 (p < 0.0001), simultaneously with a significant increase in IL-6 (p < 0.0001). We found that high IL-6 (> 1.169 pg/mL) levels could contribute to an effective weight loss among patients with a baseline BMI less than 47.46 kg/m2. CONCLUSION Study revealed that 3 months after bariatric surgery, inflammation persists, and its markers significantly influence postoperative weight loss, as indicated by BMI range. Distinct behaviors of IL-10 and IL-6 in relation to obesity underline the necessity of considering individual cytokine profiles when evaluating bariatric surgery outcomes.
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Affiliation(s)
- Marietta Bracha
- Department of Geriatrics, Division of Biochemistry and Biogerontology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85626, Bydgoszcz, Poland.
| | - Alina Jaroch
- Department of Clinical Neuropsychology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85094, Bydgoszcz, Poland
| | - Adrian Falkowski
- Department of Probability Theory and Stochastic Analysis, Faculty of Mathematics and Computer Science, Nicolaus Copernicus University in Torun, 87100, Torun, Poland
| | - Beata Zwierko
- Department of Clinical Neuropsychology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85094, Bydgoszcz, Poland
| | - Magdalena Szwed
- Department of Clinical Neuropsychology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85094, Bydgoszcz, Poland
| | - Maciej Michalik
- Department of General and Minimally Invasive Surgery, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85168, Bydgoszcz, Poland
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85094, Bydgoszcz, Poland
| | - Krzysztof Szwed
- Department of Clinical Neuropsychology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85094, Bydgoszcz, Poland
| | - Mariusz Kozakiewicz
- Department of Geriatrics, Division of Biochemistry and Biogerontology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85626, Bydgoszcz, Poland
- The Mazovian Academy in Plock, 09402, Plock, Poland
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11
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Samuels JM, English W, Birdwell KA, Feurer ID, Shaffer D, Geevarghese SK, Karp SJ. Medical and Surgical Weight Loss as a Pathway to Renal Transplant Listing. Am Surg 2024:31348241275714. [PMID: 39152619 DOI: 10.1177/00031348241275714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Abstract
PURPOSE Severe obesity is a barrier to listing for kidney transplantation due to concern for poor outcomes. This study aims to compare bariatric surgery with medical weight loss as a means of achieving weight loss and subsequent listing for renal transplant. We hypothesize that bariatric surgery will induce greater frequency of listing for transplant within 18 months of study initiation. MATERIALS AND METHODS We performed a randomized study of metabolic bariatric surgery (MBS) vs medical weight loss (MM) in patients on dialysis with a body mass index (BMI) of 40-55 kg/m2. The primary outcome was suitability for renal transplant within 18 months of initiating treatment. Secondary outcomes included weight loss, mortality, and complications. RESULTS Twenty patients enrolled, only 9 (5 MBS, 4 MM) received treatment. Treated groups did not differ in age, gender, or race (P ≥ .44). There was no statistically significant difference in the primary endpoint: 2 MBS (40%) and 1 MM (25%) listed for transplant ≤18 months (P = 1.00). With additional time, 100% MBS and 25% MM patients achieved listing status (P = .048); 100% of MBS and 0 MM received kidney transplants to date (P = .008). Weight, weight loss, and BMI trajectories differed between the groups (P ≤ .002). One death from COVID-19 occurred in the MM group, and 1 MBS patient had a myocardial infarction 3.75 years after baseline evaluation. CONCLUSION These results suggest MBS is superior to MM in achieving weight loss prior to listing for kidney transplantation. Larger studies are needed to ensure the safety profile is acceptable in patients with ESRD undergoing bariatric surgery.
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Affiliation(s)
- Jason M Samuels
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wayne English
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly A Birdwell
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Irene D Feurer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Shaffer
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil K Geevarghese
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth J Karp
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Krietenstein L, Koschker AC, Miras AD, Kollmann L, Gruber M, Dischinger U, Haubitz I, Fassnacht M, Warrings B, Seyfried F. Characteristics of Patients Lost to Follow-up after Bariatric Surgery. Nutrients 2024; 16:2710. [PMID: 39203846 PMCID: PMC11357598 DOI: 10.3390/nu16162710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
After bariatric surgery lifelong follow-up is recommended. Evidence of the consequences and reasons for being lost to follow-up (LTFU) is sparse. In this prospective study follow-up data of all patients who underwent bariatric surgery between 2008 and 2017 at a certified obesity centre were investigated. LTFU patients were evaluated through a structured telephone interview. Overall, 573 patients (female/male 70.9%/29.1%), aged 44.1 ± 11.2 years, preoperative BMI 52.1 ± 8.4 kg/m2 underwent bariatric surgery. Out of these, 33.2% had type 2 diabetes mellitus and 74.4% had arterial hypertension. A total of 290 patients were LTFU, of those 82.1% could be reached. Baseline characteristics of patients in follow-up (IFU) and LTFU were comparable, but men were more often LTFU (p = 0.01). Reported postoperative total weight loss (%TWL) and improvements of comorbidities were comparable, but %TWL was higher in patients remaining in follow-up for at least 2 years (p = 0.013). Travel issues were mentioned as the main reason for being LTFU. A percentage of 77.6% of patients reported to regularly supplement micronutrients, while 71.0% stated regular monitoring of their micronutrient status, mostly by primary care physicians. Despite comparable reported outcomes of LTFU to IFU patients, the duration of the in-centre follow-up period affected %TWL. There is a lack of sufficient supplementation and monitoring of micronutrients in a considerable number of LTFU patients.
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Affiliation(s)
- Laura Krietenstein
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Ann-Cathrin Koschker
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany; (A.-C.K.); (U.D.); (M.F.)
| | | | - Lars Kollmann
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Maximilian Gruber
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Ulrich Dischinger
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany; (A.-C.K.); (U.D.); (M.F.)
| | - Imme Haubitz
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany; (A.-C.K.); (U.D.); (M.F.)
| | - Bodo Warrings
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Centre for Mental Health, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
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13
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Moize V, Laferrère B, Shapses S. Nutritional Challenges and Treatment After Bariatric Surgery. Annu Rev Nutr 2024; 44:289-312. [PMID: 38768613 DOI: 10.1146/annurev-nutr-061121-101547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcers, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery.
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Affiliation(s)
- Violeta Moize
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Obesity Unit, Hospital Clinic Barcelona and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Blandine Laferrère
- Nutrition and Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sue Shapses
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Nutritional Sciences and New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, New Jersey, USA;
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14
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Almuallem S, Ali AK, Vourtzoumis P, Demyttenaere S, Court O, Andalib A. Validation of the Individualized Metabolic Surgery score in predicting long-term remission of diabetes after duodenal switch-type procedures. Diabetes Obes Metab 2024; 26:3200-3206. [PMID: 38725101 DOI: 10.1111/dom.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/13/2024] [Accepted: 04/23/2024] [Indexed: 07/10/2024]
Abstract
AIM To validate the Individualized Metabolic Surgery (IMS) score and assess long-term remission of type 2 diabetes (T2D) after duodenal switch (DS)-type procedures in patients with obesity. In addition, to help guide metabolic procedure selection for those patients categorized as having severe T2D. MATERIALS AND METHODS This is a retrospective single cohort study of all patients with T2D and severe obesity, who underwent DS-type procedures at a single institution from December 2010 to December 2018. Study endpoints included validating the IMS score in our cohort and evaluating the impact of DS-type procedures on long-term (≥ 5 years) remission of T2D, especially in patients with severe disease. A receiver operator characteristic curve was used to assess the accuracy of the IMS score using the area under the curve (AUC). RESULTS The study cohort included 30 patients with complete baseline and long-term glycaemic data after their index DS-type surgery. Twelve patients (40%) were classified with severe T2D, and the distribution of IMS-based severity groups was similar between our cohort and the original IMS study (P = .42). IMS scores predicted long-term T2D remission with AUC = 0.77. Patients with IMS-based severe diabetes achieved significantly higher long-term remission after DS-type procedures compared with gastric bypass and/or sleeve gastrectomy from the original IMS study (42% vs. 12%; P < .05). CONCLUSIONS The IMS score properly classifies the severity of T2D in our study cohort and adequately predicts its long-term remission after DS-type procedures. While T2D remission decreases with more severe IMS scores, long-term remission remains high after DS-type procedures among patients with severe disease.
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Affiliation(s)
- Sultan Almuallem
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Abdulaziz Karam Ali
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Phil Vourtzoumis
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Sebastian Demyttenaere
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Olivier Court
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
| | - Amin Andalib
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Canada
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15
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Hsu JL, Ismail S, Hodges MM, Agala CB, Farrell TM. Bariatric surgery: trends in utilization, complications, conversions and revisions. Surg Endosc 2024; 38:4613-4623. [PMID: 38902405 PMCID: PMC11289040 DOI: 10.1007/s00464-024-10985-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) increased in popularity after 2010 but recent data suggest it has concerning rates of gastroesophageal reflux and need for conversions. This study aims to evaluate recent trends in the utilization of bariatric procedures, associated complications, and conversions using an administrative claims database in the United States. METHODS We included adults who had bariatric procedures from 2000 to 2020 with continuous enrollment for at least 6 months in the MarketScan Commercial Claims and Encounters database. Index bariatric procedures and subsequent revisions or conversions were identified using CPT codes. Baseline comorbidities and postoperative complications were identified with ICD-9-CM and ICD-10 codes. Cumulative incidences of complications were estimated at 30-days, 6-months, and 1-year and compared with stabilized inverse probability of treatment weighted Kaplan-Meier analysis. RESULTS We identified 349,411 bariatric procedures and 5521 conversions or revisions. The sampled SG volume appeared to begin declining in 2018 while Roux-en-Y gastric bypass (RYGB) remained steady. Compared to RYGB, SG was associated with lower 1-year incidence [aHR, (95% CIs)] for 30-days readmission [0.65, (0.64-0.68)], dehydration [0.75, (0.73-0.78)], nausea or vomiting [0.70, (0.69-0.72)], dysphagia [0.55, (0.53-0.57)], and gastrointestinal hemorrhage [0.43, (0.40-0.46)]. Compared to RYGB, SG was associated with higher 1-year incidence [aHR, (95% CIs)] of esophagogastroduodenoscopy [1.13, (1.11-1.15)], heartburn [1.38, (1.28-1.49)], gastritis [4.28, (4.14-4.44)], portal vein thrombosis [3.93, (2.82-5.48)], and hernias of all types [1.36, (1.34-1.39)]. There were more conversions from SG to RYGB than re-sleeving procedures. SG had a significantly lower 1-year incidence of other non-revisional surgical interventions when compared to RYGB. CONCLUSIONS The overall volume of bariatric procedures within the claims database appeared to be declining over the last 10 years. The decreasing proportion of SG and the increasing proportion of RYGB suggest the specific complications of SG may be driving this trend. Clearly, RYGB should remain an important tool in the bariatric surgeon's armamentarium.
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Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of Toledo College of Medicine and Life Sciences, Mail Stop 1095, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Sherin Ismail
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Maggie M Hodges
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chris B Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Timothy M Farrell
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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16
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Abu-Abeid A, Dvir N, Lessing Y, Eldar SM, Lahat G, Keidar A, Yuval JB. Primary Versus Revisional Bariatric and Metabolic Surgery in Patients with a Body Mass Index ≥ 50 kg/m 2-90-Day Outcomes and Risk of Perioperative Mortality. Obes Surg 2024; 34:2872-2879. [PMID: 38879725 PMCID: PMC11289037 DOI: 10.1007/s11695-024-07310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Bariatric and metabolic surgery (BMS) is an effective treatment for patients with severe obesity. Patients with higher body mass index (BMI) and patients undergoing revisional surgery have a higher rate of major complications. This study purpose is to evaluate perioperative outcomes of patients with BMI ≥ 50 kg/m2. MATERIALS AND METHODS A retrospective analysis of patients with a BMI ≥ 50 kg/m2 undergoing BMS between 2015 and 2023 was conducted. A comparative analysis was performed between patients undergoing primary versus revisional surgery. RESULTS A total of 263 patients were included in the study. Primary procedures were performed in 220 patients (83.7%) and revisional procedures in 43 patients (16.3%). BMS included one anastomosis gastric bypass (n = 183), sleeve gastrectomy (n = 63), and other procedures (n = 17). Mean BMI was 54.6 with no difference between groups. There was no difference in baseline characteristics except the revisional group was older (44.8 ± 9.6 versus 39 ± 13 years; p = 0.006), had higher rates of gastroesophageal reflux disease (21% vs 7.3%; p = 0.005), and fatty liver disease (74% vs 55%; p = 0.02). There was perioperative mortality in three cases (1.1%) with no significant difference between groups. Leak rates were higher, and length of stay (LOS) was longer in the revisional group (4.6% vs 0.45%; p = 0.018 and 2.9 vs 3.7; p = 0.006, respectively). CONCLUSION Revisional BMS in patients with a BMI ≥ 50 kg/m2 is associated with increased leak rates and LOS. Mortality rate is 1.1% and is insignificantly different between groups. Further prospective and large-scale studies are needed to clarify the optimal surgical approach to patients with extreme BMI including revisional surgery.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel.
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel.
| | - Nadav Dvir
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Yonatan Lessing
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
| | - Jonathan Benjamin Yuval
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6, Weizman St., 6423906, Tel- Aviv, Israel
- Tel Aviv University, The Faculty of Medical & Health Sciences, Tel- Aviv, Israel
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17
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Kumar K, Bhawana F, Vandna F, Pirya F, Kumari P, Sawlani A, Sara S, Simran F, Kumar A, Deepa F, Gul A. Interactions Between Gastroesophageal Reflux Disease and Diabetes Mellitus: A Systematic Review of Pathophysiological Insights and Clinical Management Strategies. Cureus 2024; 16:e66525. [PMID: 39246980 PMCID: PMC11380927 DOI: 10.7759/cureus.66525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
This systematic review elucidates the complex interplay between gastroesophageal reflux disease (GERD) and diabetes mellitus, integrating findings from various studies to highlight pathophysiological connections and effective clinical management strategies. Our examination reveals that mechanisms such as delayed gastric emptying and autonomic neuropathy significantly contribute to the exacerbation of GERD symptoms in diabetic patients, influencing clinical outcomes and treatment efficacy. The review underscores the necessity of multidisciplinary approaches in treating these comorbid conditions and advocates for therapeutic strategies that simultaneously address GERD and diabetes, such as the use of prokinetic agents and tailored surgical interventions like laparoscopic Roux-en-Y gastric bypass. This synthesis advances our understanding and proposes a foundation for future research and clinical practice, aiming to improve the quality of life and treatment outcomes for affected patients. This work contributes significantly to gastroenterology and endocrinology, providing a comprehensive resource for clinicians and researchers alike.
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Affiliation(s)
- Kishor Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Karachi, PAK
| | - Fnu Bhawana
- Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Fnu Vandna
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Fnu Pirya
- Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Pirya Kumari
- Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, PAK
| | - Anjlee Sawlani
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sara Sara
- Internal Medicine, Northern Lincolnshire and Goole NHS Foundation Trust, Goole, GBR
| | - Fnu Simran
- Internal Medicine, Chandka Medical College, Larkana, PAK
| | - Ankash Kumar
- Internal Medicine, Northern Lincolnshire and Goole NHS Foundation Trust, Goole, GBR
- Internal Medicine, Liaquat University of Medical and Health Sciences, Karachi, PAK
| | - Fnu Deepa
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Ali Gul
- General Surgery, Nishtar Medical University, Multan, PAK
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18
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Vuagniaux A, Barberá-Carbonell B, Dayer A, Mantziari S, Suter M. Meticulous Closure of Mesenteric Defects Effectively Reduces the Incidence of Internal Hernia After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:2806-2813. [PMID: 38902480 PMCID: PMC11289074 DOI: 10.1007/s11695-024-07306-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Internal hernia (IH) after Roux-Y gastric bypass (RYGB) can lead to extended small bowel ischemia if it not recognized and treated promptly. The aim of this study is to show whether improvement in mesenteric defect (MD) closure reduces the incidence of IH. PATIENTS AND METHODS Retrospective analysis of prospectively collected data from our database including all patients who underwent laparoscopic RYGB between 1999 and 2015. The usual technique was a retrocolic/retrogastric RYGB. We divided patients in four groups according to the closure technique for MD and compared incidences of IH between groups. All patients had at least 8 years of follow-up. RESULTS A total of 1927 patients (1497 females/460 males, mean age of 41.5 ± 11 years) were operated. A retrocolic/retrogastric RYGB was performed in 1747 (90.7%) and an antecolic RYGB in 180 patients. Mean duration of follow-up was 15 (8-24) years. 111 patients (5.8%) developed IH, the majority through the jejunojejunostomy (JJ, 3.7%) and Petersen (1.7%) defects. With improvement of closure technique, the incidence decreased over time, from 12.9% in the group with separate sutures to 1.05% in the most recent group with running non-absorbable sutures and an additional purse-string at the JJ defect (p < 0.0001). CONCLUSION Meticulous closure of MD during RYGB is a very important step that significantly reduces the IH risk after RYGB, even with a retrocolic/retrogastric anatomy. Using running non absorbable braided sutures and an additional purse-string suture at the JJ is the most effective technique, but a small IH risk persists. A high index of suspicion remains necessary in patients who present with acute abdominal pain after RYGB.
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Affiliation(s)
- Aurélie Vuagniaux
- Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | | | - Anna Dayer
- Department of Surgery, Riviera-Chablais Hospital, Centre Médico-Chirurgical de L'Obésité Riviera-Chablais, Rte Des Tilles 6A, 1847, Rennaz, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland.
- Department of Surgery, Riviera-Chablais Hospital, Centre Médico-Chirurgical de L'Obésité Riviera-Chablais, Rte Des Tilles 6A, 1847, Rennaz, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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19
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Liang B, Yang Y, Wang Z. A commentary on 'Personal versus therapist perioperative music intervention: a randomized controlled trial'. Int J Surg 2024; 110:5230-5231. [PMID: 38767573 PMCID: PMC11326024 DOI: 10.1097/js9.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Biao Liang
- Department of Anorectal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
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20
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Lei Y, Lei X, Chen G, Wang Z, Song H, Feng X, Wu Y, Jia V, Hu J, Tian Y. Update on comparison of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass: a systematic review and meta-analysis of weight loss, comorbidities, and quality of life at 5 years. BMC Surg 2024; 24:219. [PMID: 39080707 PMCID: PMC11288029 DOI: 10.1186/s12893-024-02512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/24/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) are the two most commonly performed bariatric surgeries for the treatment of obesity. This meta-analysis was performed with the aim of summarizing the available evidence on weight loss, remission of comorbidities, and quality of life in LRYGB and LSG, complementing the current literature. METHODS We searched PubMed, EMBASE and the Cochrane Library from January 2012 to June 2023 for randomized controlled trials and non-randomized interventional studies. We finally selected 18 eligible studies. RESULTS LRYGB resulted in greater weight loss compared with LSG at 5 years [WMD= -7.65 kg/m², 95% confidence interval (CI) -11.54 to -3.76, P = 0.0001], but there exists high heterogeneity with I²=84%. Resolution rate of type 2 diabetes mellitus (T2D) (OR = 0.60, 95%Cl 0.41-0.87, p = 0.007) and dyslipidemia (OR = 0.44, 95%Cl 0.23-0.84, p = 0.01) was higher in the LRYGB group than that in the LSG group at 5 years. There was no difference between LRYGB and LSG for remission of hypertension, and obstructive sleep apnea. No differences were observed in the QoL after LRYGB or LSG. Morbidity was lower in the LSG group (WMD = -0.07, 95% CI: -0.13, -0.02, P = 0.01) than in the LRYGB group. No statistically significant difference was found in mortality between the two procedures. CONCLUSION At 5 years after surgery, LRYGB resulted in greater weight loss and achieved better remission rate of T2D and dyslipidemia than LSG. However, LSG has a lower morbidity rate than that of LRYGB.
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Affiliation(s)
- Yu Lei
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
- Clinical Research Group, Grade 2020 in Department of Clinical Medicine, North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Xiyan Lei
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
- Clinical Research Group, Grade 2021 in Department of Clinical Medicine, North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Guobiao Chen
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Zhenhong Wang
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Honghua Song
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
- Clinical Research Group, Grade 2020 in Department of Clinical Medicine, North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Xingtong Feng
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
- Clinical Research Group, Grade 2021 in Department of Clinical Medicine, North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Yanzhi Wu
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
- Clinical Research Group, Grade 2020 in Department of Clinical Medicine, North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China
| | - Victor Jia
- School of Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Yunhong Tian
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College(University), Nanchong, 637000, Sichuan, China.
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21
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Puttarajappa CM, Smith KJ, Ahmed BH, Bernardi K, Lavenburg LM, Hoffman W, Molinari M. Economic evaluation of weight loss and transplantation strategies for kidney transplant candidates with obesity. Am J Transplant 2024:S1600-6135(24)00446-5. [PMID: 39084464 DOI: 10.1016/j.ajt.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024]
Abstract
Novel antiobesity medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), have expanded weight loss (WL) options for kidney transplantation (KT) candidates with obesity beyond lifestyle modifications and bariatric surgery. However, varying effectiveness, risk profiles, and costs make strategy choices challenging. To aid decision-making, we used a Markov model to examine the cost-effectiveness of different WL strategies over a 10-year horizon. A target WL of 15% of total body weight was used for the base case scenario, and we compared these strategies to a "liberal" KT strategy of transplanting candidates with obesity. Outcomes included costs (2023 US dollars), quality-adjusted life years, and incremental cost-effectiveness ratios. In analysis, a liberal KT strategy was favored over lifestyle modifications and GLP-1RAs. Among WL strategies, bariatric surgery was the most effective and cost the least, whereas lifestyle modification had the highest cumulative costs and was the least effective. Compared to liberal KT, bariatric surgery costs $45 859 per quality-adjusted life year gained. GLP-1RAs were favored over bariatric surgery only when drug costs were below $5000 per year (base cost $12 077). In conclusion, for KT candidates with obesity, a liberal KT strategy and bariatric surgery are preferred over lifestyle modifications alone and GLP-1RAs based on outcomes and cost-effectiveness.
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Affiliation(s)
- Chethan M Puttarajappa
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Kenneth J Smith
- Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bestoun H Ahmed
- Department of Surgery, Bariatric and Minimally Invasive and Bariatric Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karla Bernardi
- Department of Surgery, Bariatric and Minimally Invasive and Bariatric Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Linda-Marie Lavenburg
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Hoffman
- Transplant Nephrology, University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pennsylvania, USA
| | - Michele Molinari
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Pažusis M, Gerasimovič G, Petereit R, Gudaitytė R, Maleckas A. GERD after Roux-en-Y Gastric Bypass: Prevalence and Risk Factors Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1221. [PMID: 39202502 PMCID: PMC11356576 DOI: 10.3390/medicina60081221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/21/2024] [Accepted: 07/26/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: The prevalence of GERD is increasing among individuals with obesity, and RYGB is an effective procedure to control GERD and obesity. However, some patients continue to have GERD after RYGB. The aim of this study was to investigate the prevalence and the risk factors for GERD after RYGB. Material and Methods: This prospective study included 180 RYGB patients followed for an average of 12.2 (0.6) years. In total, 126 (70%) patients agreed to participate and provided data on their weight, GERD symptoms, and filled the GERD-HRQL, TFEQ-18, and GSRS questionnaires. Results: The average age before surgery was 42.7 (10.5) years, and BMI was 45.2 (6.4) kg/m2. Moreover, 128 (71.1%) were females, and preoperative GERD was diagnosed in 74 (41.1%) patients. At the 12-year follow-up, the mean %EBMIL and %TWL was 60.37 and 25.73, respectively. The median %WR was 18.0 (39.0). Postoperative GERD was present in 30 (23.8%) patients, of whom 12 (40%) continued to have GERD symptoms and 18 (60%) developed de novo GERD. The GERD-HRQL score significantly decreased from 3.0 (9.0) at baseline to 2.0 (5.0) (p = 0.028) at 12 years. GSRS Diarrhea and Indigestion scores increased significantly from 1.33 (0.67) to 1.5 (2.42) (p < 0.001) and from 2.0 (1.25) to 2.25 (1.25) (p < 0.001), respectively. No change in the cognitive restraint score was observed. Uncontrolled eating and emotional eating scores decreased from 51.85 (22.22) to 40.74 (33.33) (p < 0.001) and from 44.44 (44.44) to 33.33 (22.22) (p < 0.001), respectively. In the multivariate analysis, %WR > 11 (OR = 3.22, p = 0.029) and GSRS Diarrhea score (OR = 3.21, p = 0.027) were significant predictors of GERD 12 years after RYGB. Conclusions: RYGB was an effective procedure to control GERD; however, 23.8% had persistent or de novo GERD after 12 years. The independent risk factors associated with GERD after RYGB were weight regain and GSRS Diarrhea score.
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Affiliation(s)
- Matas Pažusis
- Department of Surgery, Medical Academy, Lithuanian University of Health Science, 44307 Kaunas, Lithuania; (M.P.); (G.G.); (R.G.)
| | - Gabrielė Gerasimovič
- Department of Surgery, Medical Academy, Lithuanian University of Health Science, 44307 Kaunas, Lithuania; (M.P.); (G.G.); (R.G.)
| | - Rūta Petereit
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Science, 44307 Kaunas, Lithuania;
| | - Rita Gudaitytė
- Department of Surgery, Medical Academy, Lithuanian University of Health Science, 44307 Kaunas, Lithuania; (M.P.); (G.G.); (R.G.)
| | - Almantas Maleckas
- Department of Surgery, Medical Academy, Lithuanian University of Health Science, 44307 Kaunas, Lithuania; (M.P.); (G.G.); (R.G.)
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
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23
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Chandan S, Khan SR, Deliwala SS, Dahiya DS, Mohan BP, Ramai D, Saghir SM, Dhindsa BS, Kassab LL, Facciorusso A, Nandipati K, Yang D, Adler DG. Risk of De Novo Barrett's Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Studies with Long-Term Follow-Up. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00669-4. [PMID: 39059544 DOI: 10.1016/j.cgh.2024.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND & AIMS Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures worldwide. Gastroesophageal reflux disease (GERD) is a major concern in patients undergoing SG and is a risk factor for Barrett's esophagus (BE). We conducted a systematic review and meta-analysis to assess the incidence of and analyze predictive factors for post-SG BE. METHODS A comprehensive literature search was conducted in April 2024, for studies reporting on incidence of BE, erosive esophagitis (EE), and hiatal hernia (HH) post-SG. Primary outcomes were post-SG pooled rates of de novo BE, EE, GERD symptoms, proton pump inhibitor use, and HH. Meta-regression analysis was performed to assess if patient and post-SG factors influenced the rates of post-SG BE. RESULTS Nineteen studies with 2046 patients (79% females) were included. Mean age was 42.2 years (standard deviation, 11.1) and follow-up ranged from 2 to 11.4 years. The pooled rate of de novo BE post-SG was 5.6% (confidence interval, 3.5-8.8). Significantly higher pooled rates of EE (risk ratio [RR], 3.37], HH (RR, 2.09), GER/GERD symptoms (RR, 3.32), and proton pump inhibitor use (RR, 3.65) were found among patients post-SG. GER/GERD symptoms post-SG positively influenced the pooled BE rates, whereas age, sex, body mass index, post-SG EE, and HH did not. CONCLUSIONS Our analysis shows that SG results in a significantly increased risk of de novo BE and higher rates of EE, proton pump inhibitor use, and HH. Our findings suggest that clinicians should routinely screen patients with SG for BE and future surveillance intervals should be followed as per societal guidelines.
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Affiliation(s)
- Saurabh Chandan
- Center for Interventional Endoscopy, Advent Health, Orlando, Florida
| | - Shahab R Khan
- Department of Internal Medicine, Brigham's & Women Hospital, Boston, Massachusetts
| | - Smit S Deliwala
- Department of Gastroenterology, Emory University, Atlanta, Georgia
| | - Dushyant S Dahiya
- Division of Gastroenterology Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, Kansas
| | | | - Daryl Ramai
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah
| | - Syed M Saghir
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska
| | - Banreet S Dhindsa
- Department of Gastroenterology, NYU Langone Medical Center, New York, New York
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Kalyana Nandipati
- Division of Surgery, Gastroenterology, Creighton University School of Medicine, Omaha, Nebraska
| | - Dennis Yang
- Center for Interventional Endoscopy, Advent Health, Orlando, Florida
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado.
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24
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Lucocq J, Hughes C, Homyer K, Thakur V, Stansfield D, Geropoulos G, Joyce B, Drummond G, de Beaux A, Tulloh B, Lamb PJ, Robertson AG. Predicting Inadequate Weight Loss After Bariatric Surgery: Derivation and Validation of a Four Factor Model. Obes Surg 2024:10.1007/s11695-024-07383-2. [PMID: 38981957 DOI: 10.1007/s11695-024-07383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Weight loss following bariatric surgery is variable and predicting inadequate weight loss is required to help select patients for bariatric surgery. The aim of the present study was to determine variables associated with inadequate weight loss and to derive and validate a predictive model. METHODS All patients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastrectomy (2008-2022) in a tertiary referral centre were followed up prospectively. Inadequate weight loss was defined as excess weight loss (EWL) < 50% by 24 months. A top-down approach was performed using multivariate logistic regression and then internally validated using bootstrapping. Patients were categorised into risk groups. RESULTS A total of 280 patients (median age, 49 years; M:F, 69:211) were included (146 LSG; 134 LRYGB). At 24 months, the median total weight loss was 30.9% and 80.0% achieved EWL ≥ 50% by 24 months. Variables associated with inadequate weight loss were T2DM (OR 2.42; p = 0.042), age 51-60 (OR 1.93, p = 0.006), age > 60 (OR 4.93, p < 0.001), starting BMI > 50 kg/m² (OR 1.93, p = 0.037) and pre-operative weight loss (OR 3.51; p = 0.036). The validation C-index was 0.75 (slope = 0.89). Low, medium and high-risk groups had a 4.9%, 16.7% and 44.6% risk of inadequate weight loss, respectively. CONCLUSIONS Inadequate weight loss can be predicted using a four factor model which could help patients and clinicians in decision-making for bariatric surgery.
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Affiliation(s)
- James Lucocq
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK.
| | - Conor Hughes
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Kate Homyer
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Vikram Thakur
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Daniel Stansfield
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Georgios Geropoulos
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Brian Joyce
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Gillian Drummond
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Andrew de Beaux
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Bruce Tulloh
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Peter J Lamb
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
| | - Andrew G Robertson
- Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, UK
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25
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Adenuga AT, Salu IK, Bello UM, Okaro A. Obesity and the Need for Bariatric Surgery in Nigeria: A Review. Niger Postgrad Med J 2024; 31:207-212. [PMID: 39219342 DOI: 10.4103/npmj.npmj_157_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024]
Abstract
Obesity was mainly regarded as a disease of developed countries, but currently there is a growing rise in the population of patients with obesity in developing countries of Africa. A body mass index of 30 kg/m2 or higher is regarded as obesity, and this may be associated with comorbidities such as metabolic and cardiovascular diseases, orthopaedic and psychiatric conditions, and cancer. There is conclusive scientific evidence that shows that obesity is caused by complex psychosocial, genetic and environmental factors. Diet and exercise are not effective as sole management of severe obesity. Bariatric surgery is the most cost-effective definitive treatment for all classes of obesity, and the associated weight reduction causes improvement or complete resolution of obesity-associated comorbidity, improves the quality of life and reduces all-cause mortality. It is estimated that about 15% of adults in Nigeria are obese, and in the year 2023, it was reported that only 214 bariatric procedures were done locally, with 134 (62.6%) being gastric balloon insertions, 75 (35.1%) primary weight loss surgeries and 5 revisional surgeries (2.3%). In this article, we discussed the existing weight loss options in Nigeria, the current state of bariatric surgery and the need to improve the practice of bariatric surgery for obese Nigerians and complications of obesity.
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Affiliation(s)
| | | | | | - Abuchi Okaro
- Department of Surgery, Euracare Hospital, Lagos, Nigeria
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26
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Dantas ACB, Coutinho JL, de Meira JD, De Moura DTH, Pajecki D, Santo MA. Lots of reflux, but no Barrett: real-world data on the incidence of gastroesophageal reflux on routine endoscopic follow-up more than 5 years after sleeve gastrectomy. J Gastrointest Surg 2024; 28:1177-1178. [PMID: 38705371 DOI: 10.1016/j.gassur.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Jorge Landivar Coutinho
- Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - José Donizeti de Meira
- Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Diogo Turiani Hourneaux De Moura
- Serviço de Endoscopia Gastrointestinal, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Denis Pajecki
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariatrica e Metabolica, Disciplina de Cirurgia do Aparelho Digestivo e Coloproctologia, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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27
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Ng PC. Comment on: Long-term results of conversion of RYGB to biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2024; 20:e1-e2. [PMID: 38755081 DOI: 10.1016/j.soard.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Peter C Ng
- UNC Rex Healthcare, Raleigh, North Carolina
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Kupietzky A, Dodi O, Cohen N, Dover R, Maden A, Mazeh H, Grinbaum R, Mizrahi I. Similar Rates of Symptomatic Marginal Ulcers After One-Anastomosis-Gastric Bypass Compared to Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:2331-2337. [PMID: 38789681 DOI: 10.1007/s11695-024-07298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE One-anastomosis-gastric-bypass (OAGB) has become a common bariatric procedure worldwide. Marginal ulcers (MU) are a significant non-immediate complication of gastric bypass surgeries. There seems to be concern among surgeons that MU are more common after OAGB compared with Roux-en-Y gastric bypass (RYGB) due to the constant and extensive exposure of the anastomosis to bile. The aim of this study was to compare the incidence, presentation, and management of MU between the two surgeries. MATERIALS AND METHODS A retrospective study of prospectively collected data was performed to include all consecutive patients between 2010 and 2020, who underwent elective OAGB or RYGB at our institution. Patients diagnosed with symptomatic MU were identified. Factors associated with this complication were assessed and compared between the two surgeries. RESULTS Symptomatic MU were identified in 23/372 OAGB patients (6.2%) and 35/491 RYGB patients (7.1%) (p = 0.58). Time to ulcer diagnosis was shorter in OAGB patients (12 ± 11 vs. 22 ± 17 months, p < 0.01). Epigastric pain was the common symptom (78% OAGB vs. 88.5% RYGB, p = 0.7) and approximately 15% of ulcers presented with perforation upon admission (17% vs.11.4%, p = 0.7). Re-operation was required in 5/23 OAGB (21.7%) and 6/36 RYGB (17%) patients (p = 0.11) while the rest of the patients were managed non-operatively. CONCLUSIONS The risk of developing a marginal ulcer is similar between patients who underwent OAGB and RYGB. Patients diagnosed with MU following OAGB tend to present earlier; however, the clinical presentation is similar to RYGB patients. The management of this serious complication seems to be associated with acceptable outcomes with comparable operative and non-operative approaches.
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Affiliation(s)
- Amram Kupietzky
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Omri Dodi
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noa Cohen
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roi Dover
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ata Maden
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Haggi Mazeh
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Grinbaum
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ido Mizrahi
- Department of Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Samuels JM, Albaugh VL, Yu D, Chen Y, Williams DB, Spann MD, Wang L, Flynn CR, English WJ. Sex- and operation-dependent effects on 5-year weight loss results of bariatric surgery. Surg Obes Relat Dis 2024; 20:687-694. [PMID: 38462409 PMCID: PMC11228959 DOI: 10.1016/j.soard.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Weight loss response after bariatric surgery is highly variable, and several demographic factors are associated with differential responses to surgery. Preclinical studies demonstrate numerous sex-specific responses to bariatric surgery, but whether these responses are also operation dependent is unknown. OBJECTIVE To examine sex-specific weight loss outcomes up to 5 years after laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). SETTING Single center, university, United States. METHODS Retrospective, observational cohort study including RYGB (n = 5057) and vertical SG (n = 2041) patients from a single, academic health center. Percentage total weight loss (TWL) over time was examined with generalized linear mixed models to determine the main and interaction effects of surgery type on weight loss by sex. RESULTS TWL demonstrated a strong sex-by-procedure interaction, with women having a significant advantage with RYGB compared with SG (adjusted difference at 5 yr: 8.0% [95% CI: 7.5-8.5]; P < .001). Men also experienced greater TWL over time with RYGB or SG, but the difference was less and clinically insignificant (adjusted difference at 5 yr: 2.9% [2.0-3.8]; P < .001; P interaction between sex and procedure type = .0001). Overall, women had greater TWL than men, and RYGB patients had greater TWL than SG patients (adjusted difference at 5 yr: 3.1% [2.4-3.2] and 6.9% [6.5-7.3], respectively; both P < .0001). Patients with diabetes lost less weight compared with those without (adjusted difference at 5 yr: 3.0% [2.7-3.2]; P < .0001). CONCLUSIONS Weight loss after bariatric surgery is sex- and procedure-dependent. There is an association suggesting a clinically insignificant difference in weight loss between RYGB and SG among male patients at both the 2- and 5-year postsurgery time points.
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Affiliation(s)
- Jason M Samuels
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Vance L Albaugh
- Metamor Institute, Pennington Biomedical Research Center at Louisiana State University, Baton Rouge, Louisiana
| | - Danxia Yu
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Brandon Williams
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew D Spann
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lei Wang
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C Robb Flynn
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wayne J English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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30
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Barron M, Fernando DG, Atkinson SN, Kirby J, Kindel TL. Sleeve Gastrectomy Protects Against Hypertension in Rats due to Changes in the Gut Microbiome. J Surg Res 2024; 301:118-126. [PMID: 38925098 DOI: 10.1016/j.jss.2024.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/26/2024] [Accepted: 05/11/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Sleeve gastrectomy (SG), results in improvement in hypertension. We have previously published that rodent SG improves hypertension independent of weight loss associated with unique shifts in the gut microbiome. We tested if the gut microbiome directly improves blood pressure by performing fecal material transfer (FMT) from post-SG rats to surgery-naïve animals. METHODS We performed SG or Sham surgery in male, Zucker rats (n = 6-7) with obesity. Stool was collected postop from surgical donors for treatment of recipient rats. Three nonsurgical groups received daily, oral consumption of SG stool, sham stool, or vehicle alone (Nutella) for 10 wk (n = 7-8). FMT treatment was assessed for effects on body weight, food intake, oral glucose tolerance, and blood pressure. Genomic deoxyribonucleic acid of stool from donor and recipient groups were sequenced by 16S ribosomal ribonucleic acid and analyzed for diversity, abundance, and importance. RESULTS Ten weeks of SG-FMT treatment significantly lowered systolic blood pressures in surgery-naïve, recipient rats compared to vehicle treatment alone (126.8 ± 13.3 mmHg versus 151.8 ± 12.2 mmHg, P = 0.001). SG-FMT treatment also significantly altered beta diversity metrics compared to Sham-FMT and vehicle treatment. In random forest analysis, amplicon sequence variant level significantly predicted FMT group, P = 0.01. CONCLUSIONS We have found a direct link between gut microbial changes after SG and regulation of blood pressure. Future mechanistic studies are required to learn what specific gut microbial changes are required to induce improvements in obesity-associated hypertension and translation to clinical, metabolic surgery.
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Affiliation(s)
| | | | - Samantha N Atkinson
- Department of Microbiology and Immunology, Milwaukee, Wisconsin; Center for Microbiome Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John Kirby
- Department of Microbiology and Immunology, Milwaukee, Wisconsin
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Vieira de Sousa JP, Santos-Sousa H, Vieira S, Nunes R, Nogueiro J, Pereira A, Resende F, Costa-Pinho A, Preto J, Sousa-Pinto B, Carneiro S, Lima-da-Costa E. Assessing Nutritional Deficiencies in Bariatric Surgery Patients: A Comparative Study of Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy. J Pers Med 2024; 14:650. [PMID: 38929871 PMCID: PMC11204764 DOI: 10.3390/jpm14060650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Obesity is a worldwide epidemic, and bariatric surgery is considered the primary treatment for long-term weight loss and managing obesity-related health issues. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most performed procedures. Nutritional deficiencies are a significant concern following bariatric surgery and can have serious consequences. This study aims to compare the incidence of nutritional deficiencies in patients undergoing RYGB and SG. A retrospective analysis was conducted on the nutritional status of 505 consecutive patients who underwent either RYGB or SG between January and December 2019. Data were collected regarding vitamin B12, folic acid, vitamin D, calcium, PTH, magnesium, hemoglobin, iron, ferritin, and transferrin at preoperative, 6-month, and 12-month intervals post-surgery. The RYGB group showed significantly higher excess weight loss. Vitamin B12, hemoglobin, and ferritin levels were consistently higher in the SG group throughout the study. Vitamin D deficiency was prevalent, with no significant difference between the groups. Vitamin B12 deficiency was significantly more common in the RYGB group (6 months: 17.46% vs. 4.69%, p < 0.001; 12 months: 16.74% vs. 0.93%, p < 0.001). Despite differences in their mechanisms, bariatric surgeries were associated with nutritional deficiencies. It is crucial to efficiently assess, prevent, and manage these deficiencies tailored to each surgical procedure.
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Affiliation(s)
- José P. Vieira de Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - Sofia Vieira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
| | - Rita Nunes
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - André Pereira
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
| | - Bernardo Sousa-Pinto
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- CINTESIS—Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Silvestre Carneiro
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Surgery Department, São João University Medical Center, 4200-319 Porto, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (J.P.V.d.S.); (S.V.); (R.N.); (J.N.); (A.P.); (F.R.); (A.C.-P.); (B.S.-P.); (S.C.); (E.L.-d.-C.)
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4200-319 Porto, Portugal;
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Yakout A, Elli EF, Kumbhari V, Bakheet N. Endoscopic therapies for bariatric surgery complications. Curr Opin Gastroenterol 2024:00001574-990000000-00153. [PMID: 38900492 DOI: 10.1097/mog.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of endoscopic therapies for bariatric surgery complications. RECENT FINDINGS The field of interventional endoscopy now presents a range of minimally invasive procedures for addressing postbariatric complications. Lumen-opposing metal stents have emerged as a reliable solution for managing gastrojejunal strictures following Roux-en-Y gastric bypass, whether with or without associated leaks. Additionally, they serve as a conduit for performing endoscopic retrograde cholangiopancreatography (ERCP) post-RYGB via EUS-directed ERCP (EDGE). Gastric peroral endoscopic myotomy, originally designed for gastroparesis, has demonstrated effectiveness in treating postgastric sleeve stenosis, particularly the challenging helical stenosis cases. Furthermore, innovative endoscopic antireflux techniques are showing encouraging outcomes in addressing gastroesophageal reflux disease (GERD) following sleeve gastrectomy. Additionally, several modifications have been proposed to enhance the efficacy of transoral outlet reduction (TORe), originally developed to treat weight regain due to gastrojejunal anastomotic issues post-RYGB. SUMMARY Endoscopic management of bariatric surgery complications is continuously evolving. The development of new techniques and devices allows endoscopists to provide novel, minimally invasive alternatives that were not possible in the near past. Many techniques, however, are limited to expert centers because they are technically demanding, and specialized training in bariatric endoscopy is still required.
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Affiliation(s)
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Nader Bakheet
- Division of Gastroenterology and Hepatology, Department of Medicine
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Sillcox R, Bryant MK, Khandelwal S, Vierra BM, Tatum R, Yates RB, Chen JY. Prognosis of Reflux Symptom Resolution After Bariatric Surgery: How Can Preoperative Esophageal Testing Help? Obes Surg 2024:10.1007/s11695-024-07311-4. [PMID: 38867101 DOI: 10.1007/s11695-024-07311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The incidence of unresolved postoperative reflux after bariatric surgery varies considerably. Consistent perioperative patient characteristics predictive of unresolved reflux remain unknown. We leverage our institution's comprehensive preoperative esophageal testing to identify predictors of postoperative reflux. MATERIALS AND METHODS We performed a single-center retrospective review of adult patients with preoperative reflux symptoms who underwent either vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2021. All patients had pH and high-resolution manometry preoperatively. Predictors of postoperative unresolved reflux at 1 year were explored via Fisher's exact test, Kruskal Wallis test, and univariate logistic regression. RESULTS Unresolved reflux was higher in patients undergoing VSG (n = 60/129,46.5%) vs. RYGB (n = 19/98, 19.4%). Median DeMeester scores were higher (22 vs. 13, p = .07) along with rates of ineffective esophageal motility (IEM) (31.6 vs. 8.9%, p = .01) in the 19 (19.3%) patients with unresolved postoperative reflux after RYGB compared to the resolved RYGB reflux cohort. Sixty (46.5%) of VSG patients had unresolved postoperative reflux. The VSG unresolved reflux cohort had similar median DeMeester and IEM incidence to the resolved VSG group but more preoperative dysphagia (13.3% vs. 2.9%, p = .04) and higher preoperative PPI use (56.7 vs. 39.1%, p = .05). In univariate analysis, only IEM was predictive of unresolved reflux after RYGB (OR 4.74, 95% CI 1.37, 16.4). CONCLUSION Unresolved reflux was higher after VSG. Preoperative IEM predicted unresolved reflux symptoms after RYGB. In VSG patients, preoperative dysphagia symptoms and PPI use predicted unresolved reflux though lack of correlation to objective testing highlights the subjective nature of symptoms and the challenges in predicting postoperative symptomatology.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA.
| | - Mary K Bryant
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA
- Department of Surgery, Medical University of South Carolina, 30 Courtenay Drive, MSC 295, Charleston, SC, 29495, USA
| | - Saurabh Khandelwal
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA
| | - Benjamin M Vierra
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA
| | - Roger Tatum
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA
| | - Robert B Yates
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA
| | - Judy Y Chen
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA
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Dowgiałło-Gornowicz N, Lech P. The real occurrence of gastroesophageal reflux disease after sleeve gastrectomy - a prospective pH-monitoring study. Wideochir Inne Tech Maloinwazyjne 2024; 19:205-210. [PMID: 38973794 PMCID: PMC11223549 DOI: 10.5114/wiitm.2024.138521] [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: 02/14/2024] [Accepted: 03/24/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Sleeve gastrectomy (SG) is currently the most frequently performed bariatric procedure in the world. However, the occurrence of gastroesophageal reflux disease (GERD) after SG remains controversial and questionable. Aim To determine the occurrence of GERD after SG using a pH-monitoring study. Material and methods This is a prospective study involving patients undergoing SG in one surgical centre. Inclusion criteria were eligibility for bariatric surgery, no symptoms of GERD, normal gastroscopy, and pH-monitoring before the surgery. Postoperative examinations were performed 6 months after surgery. Results A total of 38 patients were analysed in the study. The mean age was 44.9 years, and the mean preoperative BMI was 42.6 kg/m2. Before surgery, all patients had normal pH values. After surgery, mean acid exposure time (AET), number of refluxes, and DeMeester score increased statistically significantly (p < 0.001). 27 (71.1%) patients each had AET > 6%, but only 9 (23.7%) reported GERD symptoms and the need for PPIs. The correlation between AET and %TWL was moderate positive, and the correlation between DeMeester score and %TWL was low positive (p = 0.011, p = 0.014, respectively). Conclusions GERD after SG seems to be a significant problem. More than two-thirds of patients had de novo GERD after SG in pH-monitoring, but only one-quarter of them required PPIs.
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Affiliation(s)
- Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive, and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Pawel Lech
- Department of General, Minimally Invasive, and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Rodbard HW, Barnard-Kelly K, Pfeiffer AFH, Mauersberger C, Schnell O, Giorgino F. Practical strategies to manage obesity in type 2 diabetes. Diabetes Obes Metab 2024; 26:2029-2045. [PMID: 38514387 DOI: 10.1111/dom.15556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
The rising phenomenon of obesity, a major risk factor for the development and progression of type 2 diabetes, is a complex and multifaceted issue that requires a comprehensive and coordinated approach to be prevented and managed. Although novel pharmacological measures to combat obesity have achieved unprecedented efficacy, a healthy lifestyle remains essential for the long-term success of any therapeutic intervention. However, this requires a high level of intrinsic motivation and continued behavioural changes in the face of multiple metabolic, psychological and environmental factors promoting weight gain, particularly in the context of type 2 diabetes. This review is intended to provide practical recommendations in the context of a holistic, person-centred approach to weight management, including evidence-based and expert recommendations addressing supportive communication, shared decision-making, as well as nutritional and pharmacological therapeutic approaches to achieve sustained weight loss.
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Affiliation(s)
| | - Katharine Barnard-Kelly
- Southern Health NHS Foundation Trust, Southampton, UK
- BHR Limited, Portsmouth, UK
- Spotlight Consultations, Fareham, UK
| | - Andreas F H Pfeiffer
- Department of Endocrinology, Diabetes and Nutrition, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Francesco Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Holst JJ, Madsbad S, Bojsen-Møller KN, Dirksen C, Svane M. New Lessons from the gut: Studies of the role of gut peptides in weight loss and diabetes resolution after gastric bypass and sleeve gastrectomy. Peptides 2024; 176:171199. [PMID: 38552903 DOI: 10.1016/j.peptides.2024.171199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
It has been known since 2005 that the secretion of several gut hormones changes radically after gastric bypass operations and, although more moderately, after sleeve gastrectomy but not after gastric banding. It has therefore been speculated that increased secretion of particularly GLP-1 and Peptide YY (PYY), which both inhibit appetite and food intake, may be involved in the weight loss effects of surgery and for improvements in glucose tolerance. Experiments involving inhibition of hormone secretion with somatostatin, blockade of their actions with antagonists, or blockade of hormone formation/activation support this notion. However, differences between results of bypass and sleeve operations indicate that distinct mechanisms may also be involved. Although the reductions in ghrelin secretion after sleeve gastrectomy would seem to provide an obvious explanation, experiments with restoration of ghrelin levels pointed towards effects on insulin secretion and glucose tolerance rather than on food intake. It seems clear that changes in GLP-1 secretion are important for insulin secretion after bypass and appear to be responsible for postbariatric hypoglycemia in glucose-tolerant individuals; however, with time the improvements in insulin sensitivity, which in turn are secondary to the weight loss, may be more important. Changes in bile acid metabolism do not seem to be of particular importance in humans.
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Affiliation(s)
- Jens Juul Holst
- The NovoNordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Denmark.
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Denmark
| | | | - Carsten Dirksen
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Maria Svane
- Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Denmark
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Chemaly R, Ibrahim Z, Lainas P, Ghaida MA, Kassir NE, Al-Hajj G, Tayar C, Safadi B. Laparoscopic Sleeve Gastrectomy as a First Step Procedure for Oncologic Purposes: An Indication Beyond the Updated Guidelines. Obes Surg 2024; 34:2026-2032. [PMID: 38714594 DOI: 10.1007/s11695-024-07257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Obesity is a well-established risk factor for cancer. Laparoscopic sleeve gastrectomy (LSG) is established as a safe procedure providing accelerated weight loss and comorbidity improvement or remission. Additionally, it is approved as a bridging procedure for various non-oncologic surgeries, with very limited data for oncologic procedures. The aim of this study is to present a series of patients with severe obesity and concomitant cancer who underwent LSG prior to definitive oncological procedure. METHODS A retrospective review (2008-2023) was conducted in three institutions, identifying 5 patients with cancer and severe obesity who underwent LSG as bridging procedure. Variables analyzed were initial weight, initial body mass index (BMI), type of malignancy, comorbidities, interval between LSG and oncological surgery, weight and BMI before the second intervention, percentage of excess weight loss (%EWL), and postoperative morbidity and mortality. RESULTS Malignancies identified were 2 prostate cancers, 1 periampullary neuroendocrine tumor, 1 rectal cancer, and 1 renal clear cell carcinoma. Mean age of patients was 50.2 years, mean initial BMI 47.4 kg/m 2 , and mean BMI before oncological surgery 37 kg/m 2 . Mean time interval between LSG and oncological surgery was 8.3 months. Mean %EWL achieved was 45.2%. Two thromboembolic events were encountered after LSG, while none of the patients developed complications after definitive oncological treatment. The mean follow-up after oncological surgery was 61.6 months. CONCLUSION LSG can be proposed as bridging procedure before oncological surgery in meticulously selected patients. Achieved weight loss can render subsequent oncological procedures easier and safer.
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Affiliation(s)
- Rodrigue Chemaly
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon.
| | - Zeid Ibrahim
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive & Bariatric Surgery, Metropolitan Hospital, Athens, Greece
| | - Makram Abou Ghaida
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Nadim El Kassir
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Georges Al-Hajj
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital, LAU Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Claude Tayar
- Department of Surgery, Clemenceau Medical Center, Beirut, Lebanon
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Kong X, Zhang Y, Song K, He M, Xian Y, Xie X, Cheng J, Ren Y. Laparoscopic sleeve gastrectomy for premenstrual syndrome symptoms in patients with obesity. Surg Endosc 2024; 38:3106-3114. [PMID: 38622225 DOI: 10.1007/s00464-024-10819-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Premenstrual syndrome (PMS) is a pathological condition characterized by a series of abnormal physical, psychological, and behavioral symptoms. We evaluated the effectiveness of laparoscopic sleeve gastrectomy (LSG) in the treatment of patients with obesity and PMS. METHODS In this case-control study, 131 patients with obesity (BMI ≥ 27.5 kg/cm2) diagnosed with moderate-to-severe PMS from March 2018 to March 2022 were prospectively selected to undergo LSG or not at their own discretion. Participants self-reported their PMS severity using the Premenstrual Syndrome Screening Tool. Among them, 68 patients chose LSG surgery, and 63 control group patients were followed up without surgery. Data were recorded at baseline and at 3 months post-treatment. We used a multivariate analysis to assess the improvement in PMS symptoms and associated factors. RESULTS Of the 131 patients with obesity and PMS, the improvement rate of PMS in the LSG group was 57.35% (n = 39), while the improvement rate of PMS in the control group was 25.40% (n = 16). Furthermore, our study revealed that surgery is an independent factor affecting the improvement of patients with PMS. Additionally, there was a correlation between alcohol use, T2DM and obesity-related metabolic diseases, and BMI with PMS. The changes in BMI, testosterone, and estradiol(E2) levels may also contribute to the improvement of patients with obesity and PMS. CONCLUSION LSG can improve the management of obesity in patients with PMS to some extent. Changes in BMI, testosterone, and E2 may be indicative of improvement in patients with obesity and PMS.
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Affiliation(s)
- Xiangxin Kong
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China
- Institute of Hepatobiliary, Pancreatic and Gastroenterology, North Sichuan Medical College, Nanchong, 637000, China
| | - Yuan Zhang
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China
- Institute of Hepatobiliary, Pancreatic and Gastroenterology, North Sichuan Medical College, Nanchong, 637000, China
| | - Ke Song
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China
- Institute of Hepatobiliary, Pancreatic and Gastroenterology, North Sichuan Medical College, Nanchong, 637000, China
| | - Ming He
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Yin Xian
- Nanchong Psychosomatic Hospital, Nanchong, 637000, China
| | - Xing Xie
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Junming Cheng
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, South Maoyuan Road, Shunqing District, Nanchong, 637000, Sichuan, China.
- General Surgery, Xinhua Hospital, Chengdu, 610000, China.
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Wisniowski P, Samakar K, Cheng V, Hawley L, Abel S, Nguyen J, Dobrowolsky A, Martin M. Safety of redo sleeve gastrectomy as a primary revisional procedure. Surg Obes Relat Dis 2024:S1550-7289(24)00172-2. [PMID: 38871494 DOI: 10.1016/j.soard.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/01/2024] [Accepted: 04/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Insufficient weight loss after primary laparoscopic sleeve gastrectomy (LSG) occasionally requires revisional surgery. A few single-institution studies have examined the safety of redo LSG (RSG) and have shown mixed results. OBJECTIVES The aim of this study was to evaluate the safety of RSG compared with LSG over a period of 30 days. SETTING University of Southern California, United States; Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS The 2020-2021 MBSAQIP registry was used to evaluate patients who underwent RSG. Thirty-day outcomes were evaluated using univariable analysis and multivariable logistic and linear regression. RESULTS A total of 226,029 patients were reviewed, of whom 1454 (.7%) underwent RSG and 224,575 (99.3%) underwent initial LSG. Patients who underwent RSG were older (45 versus 42 yr), predominantly female (86.2% versus 81.3%), had a lower body mass index (40.0 versus 43.4), fewer co-morbidities, and greater rates of gastroesophageal reflux (38.7% versus 25.1%). They demonstrated increased overall complications (3.6% versus 2.1%, P < .001) and a longer operative time (81 versus 62 min, P < .001), but there was no difference in mortality. On multivariable analysis, patients who underwent RSG were independently associated with an increased risk of overall postoperative complications (odds ratio [OR]: 1.493, P = .018), organ space infection (OR: 6.231, P < .001), staple line leak (OR: 12.838, P < .001), pneumonia (OR: 3.85, P = .013), ventilator requirement over 48 hours (OR: 6.404, P = .035), sepsis (OR: 4.397, P = .010), septic shock (OR: 8.669, P < .001), reoperation (OR: 1.808, P = .013), readmission (OR: 2.104, P < .001), reintervention (OR: 4.435, P < .001), and longer operative times (β = 12.790, P < .001). CONCLUSIONS In this national database study, RSG was associated with increased rates of postoperative complications and a longer operative time. Although these results are concerning, further studies are required to examine long-term outcomes.
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Affiliation(s)
- Paul Wisniowski
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California.
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Vincent Cheng
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Lauren Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Stuart Abel
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - James Nguyen
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Adrian Dobrowolsky
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
| | - Matthew Martin
- Division of Upper GI and General Surgery, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, California
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Demirpolat MT, İslam MM, Ceylan EM, Aykıt F, Satır M, Güvendir Bakkaloglu I, Bacaksız ME, Yücel M, Sisik A. Effect of Histopathological Findings of Gastric Specimens Resected During Laparoscopic Sleeve Gastrectomy on Weight Loss Success: A Retrospective Analysis of 599 Patients. Cureus 2024; 16:e60881. [PMID: 38910773 PMCID: PMC11193679 DOI: 10.7759/cureus.60881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Even though there aren't enough studies on long-term outcomes, laparoscopic sleeve gastrectomy (LSG) is the most common procedure among weight loss surgeries. In this study, we aimed to evaluate the histopathological results of resected stomach specimens of patients who underwent LSG and to analyze the effect of histopathological results on weight loss success. METHODS The patients were divided into two groups according to histopathological results of the pathology specimens: abnormal (chronic active gastritis, chronic inactive gastritis, neoplasias) and normal. If the excess weight loss percentage (EWL%) values were over 70% at the end of the first year following LSG, the patients were considered successful in terms of weight loss. The groups were compared in terms of age, gender, preoperative body mass index (BMI) value, as well as postoperative first-year BMI, EWL%, total weight loss percentage (TWL%), and successful patient percentage. RESULTS A total of 599 patients were included in this study. When the patients were dichotomized according to their pathology results as normal or abnormal, 101 (%83.5) of the patients with normal pathology results had EWL% greater than 70%. On the contrary, 356 (74.5%) of the patients with abnormal pathology results had EWL% greater than 70%, and this difference was statistically significant (p=0.038). CONCLUSION Patients with normal histopathologic examination results of resected gastric specimens after LSG are more successful than the patient population with abnormal histopathologic results in terms of the percentage of patients with EWL% above 70 at the end of the first postoperative year. We recommend routine histopathologic analysis of gastric specimens after LSG in severely obese patients.
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Affiliation(s)
- Muhammed Taha Demirpolat
- General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Mehmet Muzaffer İslam
- Emergency Medicine, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Emine Maksude Ceylan
- General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Furkan Aykıt
- General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Mustafa Satır
- General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Irem Güvendir Bakkaloglu
- Pathology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Mehmet Erman Bacaksız
- General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Metin Yücel
- General Surgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
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Hsu JL, Farrell TM. Updates in Bariatric Surgery. Am Surg 2024; 90:925-933. [PMID: 38060198 DOI: 10.1177/00031348231220576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.
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Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Trujillo AB, Sagar D, Amaravadhi AR, Muraleedharan D, Malik MZ, Effa-Ababio K, Nsengiyumva M, Tesfaye T, Walędziak M, Różańska-Walędziak A. Incidence of Post-operative Gastro-esophageal Reflux Disorder in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024; 34:1874-1884. [PMID: 38483740 DOI: 10.1007/s11695-024-07163-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
Gastroesophageal reflux disease (GERD) is a common concern following laparoscopic sleeve gastrectomy (LSG). This paper aimed to assess the incidence of reflux disease following these bariatric procedures. A literature search was conducted to identify observational studies and clinical trials reporting patients developed GERD disease after LSG. Twenty-two studies included in the analysis, involve 20,495 participants, indicated that the estimated proportion of patients who developed post-surgery GERD was 0.35 (95% CI 0.30-0.41). Subgroup analysis revealed a proportion of 0.33 (95% CI 0.27-0.38) in observational studies and 0.58 (95% CI 0.39-0.75) in clinical trials. High heterogeneity was noted across studies (I2 = 98%). Sensitivity analyses and publication bias assessments were performed to enhance the robustness of the results. Our findings highlight a moderate to high risk of developing GERD following LSG surgery.
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Affiliation(s)
| | - Drishti Sagar
- Aakash Healthcare Superspeciality Hospital, Sector-3, Dwarka, Delhi, 110075, India
| | - Amoolya Rao Amaravadhi
- Internal Medicine, Malla Reddy Institute of Medical Sciences, GHMC Quthbullapur, Jeedimetla, Hyderabad, 500055, India
| | | | | | - Kofi Effa-Ababio
- University of Texas MD Anderson Cancer Center, Holcombe Boulevard, Houston, TX, 77030-4009, USA
| | | | - Tadele Tesfaye
- CareHealth Medical Practice, Jimma Road, Addis Ababa, Ethiopia
| | - Maciej Walędziak
- Department of General, Oncologic, Metabolic, and Thoracic Surgery, Military Institute of Medicine - National Research Institute, 04-141, Warsaw, Poland.
| | - Anna Różańska-Walędziak
- Department of Human Physiology and Patophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938, Warsaw, Poland
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Peromaa-Haavisto P, Luostarinen M, Juusela R, Tuomilehto H, Kössi J. Obstructive Sleep Apnea: The Effect of Bariatric Surgery After Five Years-A Prospective Multicenter Trial. Obes Surg 2024; 34:1544-1551. [PMID: 38457003 PMCID: PMC11031458 DOI: 10.1007/s11695-024-07124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The prevalence of obstructive sleep apnea (OSA) is high among the bariatric surgery candidates. Obesity is the most important individual risk factor for OSA. The aim of this study was to investigate the effect of a laparoscopic Roux-en-Y gastric bypass (LRYGB) on OSA 5 years after the surgery. PATIENTS AND METHODS In this prospective multicenter study, standard overnight cardiorespiratory recording was conducted to 150 patients at baseline prior to bariatric surgery. A total of 111 (73.3%) patients of those had OSA. Cardiorespiratory recordings at 5 years after surgery were available for 70 OSA patients. The changes in anthropometric and demographic measurements including age, weight, body mass index (BMI), and waist and neck circumference were evaluated. Also, a quality of life (QoL) questionnaire 15D administered in a baseline was controlled at 5-year follow-up visit. RESULTS At 5-year OSA was cured in 55% of patients, but moderate or severe OSA still persisted in 20% of patients after operation. Mean total AHI decreased from 27.8 events/h to 8.8 events/h (p < 0.001) at 5-year follow-up. A clinically significant difference in QoL was seen in mobility, breathing, sleeping, usual activities, discomfort and symptoms, vitality and sexual activity. The QoL total score improved more in OSA patient at 5-year follow-up. CONCLUSIONS LRYGB is an effective treatment of OSA in obese patients and the achieved beneficial outcomes are maintained at 5-year follow-up.
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Affiliation(s)
- Pipsa Peromaa-Haavisto
- Department of Surgery, Tampere University Hospital Hatanpää, PL2000, FIN-33521, Tampere, Finland.
| | | | | | | | - Jyrki Kössi
- Päijät-Häme Central Hospital, 15850, Lahti, Finland
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Lucocq J, Thakur V, Geropoulos G, Stansfield D, Irvine L, Duxbury M, de Beaux AC, Tulloh B, Wallace B, Joyce B, Harrow L, Drummond G, Lamb PJ, Robertson AG. Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11 years results from a tertiary referral centre. Surg Endosc 2024; 38:2689-2698. [PMID: 38519610 DOI: 10.1007/s00464-024-10791-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Outcomes of long-term (5-10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery. METHODS Data were collected prospectively from a bariatric center (2008-2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%. RESULTS Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5-11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up. CONCLUSIONS IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up.
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Affiliation(s)
- James Lucocq
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Vikram Thakur
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Georgios Geropoulos
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Daniel Stansfield
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Laura Irvine
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Mhairi Duxbury
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew C de Beaux
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Bruce Tulloh
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Beverley Wallace
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Brian Joyce
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Lisa Harrow
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Gillian Drummond
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Peter J Lamb
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew G Robertson
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK.
- Department of Clinical Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK.
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Liuzzo G, Patrono C. Weekly journal scan: SURMOUNTing body weight regain with tirzepatide after successful lifestyle intervention. Eur Heart J 2024; 45:1392-1394. [PMID: 38365916 DOI: 10.1093/eurheartj/ehae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Affiliation(s)
- Giovanna Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F.Vito 1, Rome 00168, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy
| | - Carlo Patrono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F.Vito 1, Rome 00168, Italy
- Center of Excellence on Ageing, CAST, 'G. d'Annunzio' University School of Medicine, Chieti, Italy
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Hamamah S, Hajnal A, Covasa M. Influence of Bariatric Surgery on Gut Microbiota Composition and Its Implication on Brain and Peripheral Targets. Nutrients 2024; 16:1071. [PMID: 38613104 PMCID: PMC11013759 DOI: 10.3390/nu16071071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Obesity remains a significant global health challenge, with bariatric surgery remaining as one of the most effective treatments for severe obesity and its related comorbidities. This review highlights the multifaceted impact of bariatric surgery beyond mere physical restriction or nutrient malabsorption, underscoring the importance of the gut microbiome and neurohormonal signals in mediating the profound effects on weight loss and behavior modification. The various bariatric surgery procedures, such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), act through distinct mechanisms to alter the gut microbiome, subsequently impacting metabolic health, energy balance, and food reward behaviors. Emerging evidence has shown that bariatric surgery induces profound changes in the composition of the gut microbiome, notably altering the Firmicutes/Bacteroidetes ratio and enhancing populations of beneficial bacteria such as Akkermansia. These microbiota shifts have far-reaching effects beyond gut health, influencing dopamine-mediated reward pathways in the brain and modulating the secretion and action of key gut hormones including ghrelin, leptin, GLP-1, PYY, and CCK. The resultant changes in dopamine signaling and hormone levels contribute to reduced hedonic eating, enhanced satiety, and improved metabolic outcomes. Further, post-bariatric surgical effects on satiation targets are in part mediated by metabolic byproducts of gut microbiota like short-chain fatty acids (SCFAs) and bile acids, which play a pivotal role in modulating metabolism and energy expenditure and reducing obesity-associated inflammation, as well as influencing food reward pathways, potentially contributing to the regulation of body weight and reduction in hedonic eating behaviors. Overall, a better understanding of these mechanisms opens the door to developing non-surgical interventions that replicate the beneficial effects of bariatric surgery on the gut microbiome, dopamine signaling, and gut hormone regulation, offering new avenues for obesity treatment.
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Affiliation(s)
- Sevag Hamamah
- Department of Basic Medical Sciences, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA 9176, USA;
| | - Andras Hajnal
- Department of Neural and Behavioral Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Mihai Covasa
- Department of Basic Medical Sciences, College of Osteopathic Medicine, Western University of Health Sciences, Pomona, CA 9176, USA;
- Department of Biomedical Sciences, College of Medicine and Biological Science, University of Suceava, 7200229 Suceava, Romania
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Al Ghareeb G, Abdoh D, Kofi M, Konswa AA. Lifestyle Interventions in a Patient Identified as Super-Super Obese With a Body Mass Index of 90.5. J Med Cases 2024; 15:55-59. [PMID: 38646420 PMCID: PMC11027765 DOI: 10.14740/jmc4194] [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: 02/16/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024] Open
Abstract
Obesity is a growing global health concern. Saudi Arabia is experiencing a higher prevalence of obesity compared to the globe. This case report focuses on a 38-year-old female with a body mass index (BMI) of 90.5 kg/m2, prediabetes, and obstructive sleep apnea who successfully underwent a lifestyle modification process resulting in remarkable weight loss. The patient's past unsuccessful attempts at weight loss had left her with a reluctance to try again initially. A multidisciplinary team collaborated to develop a management plan starting with an intensive lifestyle intervention. Lifestyle was assessed, then a structured personalized lifestyle intervention based on a plant-based diet and a gradual increase in physical activity was implemented. Over 6 months, the patient succeeded in losing 23 kg, a percent weight loss of 11.9%. An additional 5 kg was lost when liraglutide "Saxenda" was added. This case report represents the effectiveness of intensive lifestyle interventions in patients with super-super obesity for weight loss and long-term health improvement. Additional research is required to determine if the positive outcomes seen in treating a single patient can be applied to a larger population with super-super obesity. This brings up the question of whether pharmacotherapy or surgical interventions should be the primary approaches for addressing these cases, considering that surgical interventions usually involve lifestyle changes. What we already know about such cases: patients with super-super obesity often require interventions such as surgery or medication to aid in weight reduction, as they typically do not respond to lifestyle interventions alone. What this case report adds to existing knowledge: the use of lifestyle interventions proved effective in such cases as super-super obesity and delayed the need for surgical intervention even without weight reduction medications.
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Affiliation(s)
- Ghadeer Al Ghareeb
- Preventive Medicine, Lifestyle Medicine Program, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Duoaa Abdoh
- Preventive Medicine, Lifestyle Medicine Program, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mostafa Kofi
- Preventive Medicine, FCM Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ayman Afify Konswa
- Family Medicine, FCM Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Scott J, Blackhurst D, Hodgens BD, Carbonell AM, Cobb WS, Richardson ES, Dahlgren NJ, Kothari SN. Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery. J Am Coll Surg 2024; 238:551-558. [PMID: 38230854 DOI: 10.1097/xcs.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Vertical sleeve gastrectomy is the most performed bariatric operation in the US; however, a significant number of patients suffer from persistent or new-onset reflux. No consensus for objective preoperative evaluation in these patients exists. We compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. STUDY DESIGN An IRB-approved retrospective review of consecutive patients at a single institution was performed from April 2021 to December 2022. During initial consultation for bariatric surgery, a validated GERD symptom subjective survey was administered. All patients demonstrating interest in sleeve gastrectomy or had a history of reflux underwent upper endoscopy with capsule-based pH testing. RESULTS Sixty-two patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m 2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p values >0.11). CONCLUSIONS An objective method for identifying severe GERD in the preoperative assessment may aid in the decision tree for procedure selection and informed consent process. Patients with significant preoperative GERD may be at higher risk for future GERD-related sleeve complications. Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population.
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Affiliation(s)
- John Scott
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Dawn Blackhurst
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Brian D Hodgens
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Alfredo M Carbonell
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - William S Cobb
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Emily S Richardson
- University of South Carolina School of Medicine Greenville, Greenville, SC (Richardson)
| | - Nicholas Jp Dahlgren
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Shanu N Kothari
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
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Salminen P. Long-term trial outcomes of Roux-en-Y gastric bypass and one anastomosis gastric bypass: tipping the scale. Lancet Diabetes Endocrinol 2024; 12:221-222. [PMID: 38452781 DOI: 10.1016/s2213-8587(24)00066-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Paulina Salminen
- Department of Digestive Surgery, Division of Digestive Surgery and Urology, Turku University Hospital, 20520 Turku, Finland; Department of Surgery, University of Turku, Turku, Finland.
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Jense MTF, Meuwissen N, Galal AM, De Witte E, Fransen S, Broos PPHL, Greve JWM, Boerma EJG. Convincing 10-Year Follow-up Results of the Banded Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:1286-1294. [PMID: 38393455 PMCID: PMC11026224 DOI: 10.1007/s11695-024-07113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Several studies have shown the positive effect on weight loss of the banded Roux-en-Y gastric bypass (BRYGB). Thus far, studies describing the 10-year post-operative results are scarce. Therefore, the aim of this study was to describe the weight loss results, effect on associated medical problems, and complication rates during 10 years of follow-up after BRYGB. METHOD Data were collected from patients who underwent laparoscopic BRYGB with a non-adjustable silicone gastric ring between January 2011 and March 2013. All patients were included when found to be eligible according to the IFSO criteria. RESULTS One hundred forty-nine patients were included, 110 received a primary BRYGB and 39 received a conversional BRYGB. The primary BRYGB group consisted of 68% female patients with a mean BMI of 44.5 kg/m2 and a mean age of 46 years old. The conversional group consisted of 77% females and had a mean BMI of 34.8 kg/m2 and a mean age of 48 years. At 10-year follow-up, 67.1% of the data was available. Ten-year post-operative 30% total weight loss was seen in the primary group, and 7% in the conversional group. In 10 years, 23% of the patients had complications of which half were ring-related. CONCLUSION The addition of a silicon ring to the Roux-en-Y gastric bypass may result in substantial and stable weight loss maintenance 10 years post-operative. Furthermore, the number of patients with long-term complications was low and the number of associated medical problems was significantly reduced.
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Affiliation(s)
- Marijn T F Jense
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands.
- Research Institute NUTRIM, Faculty of Health, Medicine and Life Sciences at Maastricht University, Maastricht, The Netherlands.
| | - Nina Meuwissen
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Abdelrahman M Galal
- General Surgery Department, Sohag Faculty of Medicine, Sohag University Hospitals, Sohag, Egypt
| | - Evelien De Witte
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
| | - Sofie Fransen
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
| | - Pieter P H L Broos
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
| | - Jan Willem M Greve
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
- Research Institute NUTRIM, Faculty of Health, Medicine and Life Sciences at Maastricht University, Maastricht, The Netherlands
| | - Evert-Jan G Boerma
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
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