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Shu J, Zhu T, Xiong S, Liu T, Zhao Y, Huang X, Liu S. Sex dimorphism in the effect and predictors of weight loss after sleeve gastrectomy. Front Endocrinol (Lausanne) 2024; 14:1333051. [PMID: 38269248 PMCID: PMC10806568 DOI: 10.3389/fendo.2023.1333051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Background No sex-specific guidelines for surgical anti-obesity strategies have been proposed, partially due to the controversy regarding sex-related differences in weight loss after bariatric metabolic surgery. Objectives To explore sex dimorphism in the effect and predictors of weight loss after sleeve gastrectomy (SG), thereby providing clinical evidence for the sex-specific surgical treatment strategy. Methods In a prospective cohort design, participants scheduled for SG at an affiliated hospital between November 2020 and January 2022 were assessed for eligibility and allocated to the Male or Female group with a 1-year follow-up after surgery. The primary outcome was the sex difference in the weight-loss effect after SG indicated by both percentage of total weight loss (TWL%) and excess weight loss (EWL%). The secondary outcome was the analysis of sex-specific preoperative predictors of weight loss after SG based on univariate and multivariate analyses. Independent predictors were obtained to construct a nomogram model. The discrimination, calibration, and clinical utility of the nomogram were based on receiver operating characteristic curve, concordance index, calibration curve, and decision curve analysis, respectively. Results Ninety-five male and 226 female patients were initially included. After propensity score matching by baseline body mass index (BMI), 85 male and 143 female patients achieved comparable TWL% and EWL% for 1 year after SG. For male patients, baseline BMI, area under the curve for insulin during oral glucose tolerance test, and progesterone were independent predictors of weight loss after SG. Baseline BMI, age, thyroid stimulating hormone, and Self-Rating Anxiety Scale score were independent predictors for female patients. Conclusion No obvious sex difference is detected in the weight-loss effect after SG. Sex dimorphism exists in the predictors of weight loss after SG. Further research with long-term and a multicenter design is needed to confirm the predictive model.
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Affiliation(s)
- Jiaxin Shu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Tao Zhu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Sisi Xiong
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Teng Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yian Zhao
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
- Department of Surgery, First Clinical College, Shandong University, Jinan, China
| | - Xin Huang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shaozhuang Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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Casas-Tapia C, Araujo-Castillo RV, Saavedra-Tafur L, Bert-Dulanto A, Piscoya A, Casas-Lucich A. Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI≥35kg/m 2 after vertical gastrectomy. Cir Esp 2020; 98:328-335. [PMID: 32000981 DOI: 10.1016/j.ciresp.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 11/22/2019] [Accepted: 12/01/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. METHODS Retrospective cohort including patients ≥18 years old with BMI≥35kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. RESULTS Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038). CONCLUSIONS There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.
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Affiliation(s)
| | | | - Lil Saavedra-Tafur
- Cirugía General, Endoscópica y Bariátrica, Clínica de Día Avendaño, Lima, Perú
| | - Aimeé Bert-Dulanto
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | - Alejandro Piscoya
- Dirección de Investigación, Universidad San Ignacio de Loyola, Lima, Perú; Servicio de Gastroenterología, Hospital Guillermo Kaelin de la Fuente, Lima, Perú
| | - Alberto Casas-Lucich
- Facultad de Ciencias de la Salud, Universidad Privada San Juan Bautista, Lima, Perú
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Giordano S, Salminen P. Laparoscopic Sleeve Gastrectomy Is Safe for Patients Over 60 Years of Age: A Meta-Analysis of Comparative Studies. J Laparoendosc Adv Surg Tech A 2020; 30:12-19. [DOI: 10.1089/lap.2019.0463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Department of Surgery, Satasairaala Central Hospital, Pori, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
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Khidir N, El-Matbouly M, Al Kuwari M, Gagner M, Bashah M. Incidence, Indications, and Predictive Factors for ICU Admission in Elderly, High-Risk Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2019; 28:2603-2608. [PMID: 29616465 DOI: 10.1007/s11695-018-3221-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity affects the elderly, leading to increased prevalence of age- and obesity-associated comorbidities. There are no guidelines for indications and risk assessment for the elderly undergoing bariatric surgery. OBJECTIVES To determine the incidence, indications, and outcomes of planned ICU admission in elderly, high-risk patients after laparoscopic sleeve gastrectomy (LSG) and to assess if preoperative risk factors for planned postoperative ICU admission in elderly patients undergoing LSG could be predicted preoperatively. METHODS Retrospective review of prospectively collected data for all patients aged ≥ 60 years who underwent LSG (2011-2016) at Hamad General Hospital in Qatar. RESULTS We followed up 58 patients aged 60-75 years for 28 ± 17 months. About 77.6% of patients were in the intermediate-risk group of the Obesity Surgery Mortality Risk Score (OS-MRS). Fourteen patients (24%) required ICU admission for 2 ± 1.2 days; all patients belonged to the American Society of Anesthesiologists (ASA) III class and intermediate to high risk on OS-MRS. There were no reported mortalities. The mean body mass index (BMI) decreased from 49 ± 10.6 to 37.6 ± 10.1 kg/m2. The number of patient comorbidities (OR, 1.43; 95% CI, 1.03-1.99) and the diagnosis of obstructive sleep apnea (OSA; OR, 7.8; 95% CI, 1.92-31.68) were associated with planned ICU admission. CONCLUSION Elderly patients undergoing LSG usually have excellent postoperative course despite the associated high risk and the required ICU admission. The number of comorbidities, diagnosis of OSA, and ASA score are possible clinically significant predictive factors for the need of post-LSG ICU admission.
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Affiliation(s)
- Nesreen Khidir
- Department of Bariatric Surgery, Hamad General Hospital, Doha, Qatar. .,HMC, P.O. Box: 3050, Doha, Qatar.
| | | | | | - Michel Gagner
- Department of Surgery, Hopital du Sacre Coeur, Montreal, Canada
| | - Moataz Bashah
- Department of Bariatric Surgery, Hamad General Hospital, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar
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Cottam S, Cottam D, Cottam A. Sleeve Gastrectomy Weight Loss and the Preoperative and Postoperative Predictors: a Systematic Review. Obes Surg 2019; 29:1388-1396. [DOI: 10.1007/s11695-018-03666-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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The Effectiveness and Safety of Sleeve Gastrectomy in the Obese Elderly Patients: a Systematic Review and Meta-Analysis. Obes Surg 2017; 26:3023-3030. [PMID: 27714526 DOI: 10.1007/s11695-016-2396-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND This systematic review was performed to compare the effectiveness and safety of SG in the obese elderly patients with the young ones. METHODS Cohort studies that compared outcomes among old and young patients who had undergone SG were included. Summary odds ratios were estimated using a random effect model. RESULTS Eleven studies were included. Old patients had a worse outcome in percentage of excess weight loss than the young ones (SMD -0.39, 95 % CI -0.55 to -0.24). No significant differences were recorded in resolution of co-morbidities: type 2 diabetes mellitus (OR 1.60, 95 % CI 0.84-3.05), hypertension (OR 1.05, 95 % CI 0.65-1.68), dyslipidemia (OR 1.38, 95 % CI 0.68-2.80), OSAS (OR 0.64, 95 % CI 0.30-1.34), or postoperative complications (OR 0.89, 95 % CI 0.51-1.55) between the elderly and the young who had undergone SG. CONCLUSIONS SG was effective for weight loss and resolution of co-morbidities with low complication rate in the obese elderly patients.
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Lemaître F, Léger P, Nedelcu M, Nocca D. Laparoscopic sleeve gastrectomy in the South Pacific. Retrospective evaluation of 510 patients in a single institution. Int J Surg 2016; 30:1-6. [DOI: 10.1016/j.ijsu.2016.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/13/2016] [Accepted: 04/05/2016] [Indexed: 02/06/2023]
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Dubnov-Raz G, Inge TH, Ben-Ami M, Pienik R, Vusiker I, Yardeni D. Body composition changes in adolescents after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2015; 12:322-9. [PMID: 26525372 DOI: 10.1016/j.soard.2015.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is a commonly used bariatric procedure in severely obese adolescents. Weight loss after SG is associated with marked changes in body composition, but factors associated with such changes have not yet been described in adolescents. OBJECTIVE To identify factors associated with changes in body weight and composition in adolescents 1 year after SG. SETTING University Hospital, Tel Hashomer, Israel. METHODS Age, sex, weight, height, preoperative body mass index (BMI), and body fat percent measured by bioimpedance were collected in 25 adolescents (16 males, 9 females, age 16.6±1.5 yr) before and 1 year after SG. Obesity-related complications, preoperative weight loss, and physical activity after surgery were also recorded. Repeated-measures analyses of variance and linear mixed model analyses were performed. RESULTS One year after SG, weight decreased by 32%, fat mass by 55%, and fat-free mass by 9% from baseline. Male participants lost significantly more weight than female participants, with larger decreases in fat mass (-65% versus -41%, P<.001) and body fat percent (-48% versus -21%, P<.001). The amount of physical activity at 1-year follow-up was also associated with larger reductions in body fat percent in both genders. Age or baseline BMI, fat mass, and fat-free mass were not associated with changes in BMI or body composition. CONCLUSION Among obese adolescents 1 year after SG, the only modifiable factor associated with larger decreases in body fat percent was physical activity. Larger studies are needed to formally identify other possible predictors of body composition changes after SG.
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Affiliation(s)
- Gal Dubnov-Raz
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Thomas H Inge
- Pediatric General & Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michal Ben-Ami
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Reut Pienik
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Irena Vusiker
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Dani Yardeni
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
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Gastric Supply Manipulation to Modulate Ghrelin Production and Enhance Vascularization to the Cardia. Surg Innov 2014; 22:5-14. [DOI: 10.1177/1553350614552734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction. Selective embolization of the left-gastric artery (LGA) reduces levels of ghrelin and achieves significant short-term weight loss. However, embolization of the LGA would prevent the performance of bariatric procedures because the high-risk leakage area (gastroesophageal junction [GEJ]) would be devascularized. Aim. To assess an alternative vascular approach to the modulation of ghrelin levels and generate a blood flow manipulation, consequently increasing the vascular supply to the GEJ. Materials and methods. A total of 6 pigs underwent a laparoscopic clipping of the left gastroepiploic artery. Preoperative and postoperative CT angiographies were performed. Ghrelin levels were assessed perioperatively and then once per week for 3 weeks. Reactive oxygen species (ROS; expressed as ROS/mg of dry weight [DW]), mitochondria respiratory rate, and capillary lactates were assessed before and 1 hour after clipping (T0 and T1) and after 3 weeks of survival (T2), on seromuscular biopsies. A celiac trunk angiography was performed at 3 weeks. Results. Mean (±standard deviation) ghrelin levels were significantly reduced 1 hour after clipping (1902 ± 307.8 pg/mL vs 1084 ± 680.0; P = .04) and at 3 weeks (954.5 ± 473.2 pg/mL; P = .01). Mean ROS levels were statistically significantly decreased at the cardia at T2 when compared with T0 (0.018 ± 0.006 mg/DW vs 0.02957 ± 0.0096 mg/DW; P = .01) and T1 (0.0376 ± 0.008mg/DW; P = .007). Capillary lactates were significantly decreased after 3 weeks, and the mitochondria respiratory rate remained constant over time at the cardia and pylorus, showing significant regional differences. Conclusions. Manipulation of the gastric flow targeting the gastroepiploic arcade induces ghrelin reduction. An endovascular approach is currently under evaluation.
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