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Remmel S, Noom M, Sandstrom R, Mhaskar R, Diab ARF, Sujka JA, Docimo S, DuCoin CG. Preoperative comorbidities as a predictor of EBWL after bariatric surgery: a retrospective cohort study. Surg Endosc 2024; 38:2770-2776. [PMID: 38580757 DOI: 10.1007/s00464-024-10785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION The purpose of this study is to investigate the impact of preoperative comorbidities, including depression, anxiety, type 2 diabetes mellitus, obstructive sleep apnea, hypothyroidism, and the type of surgery on %EBWL (percent estimated body weight loss) in patients 1 year after bariatric surgery. Patients who choose to undergo bariatric surgery often have other comorbidities that can affect both the outcomes of their procedures and the postoperative period. We predict that patients who have depression, anxiety, diabetes mellitus, obstructive sleep apnea, or hypothyroidism will have a smaller change in %EBWL when compared to patients without any of these comorbidities. METHODS AND PROCEDURES Data points were retrospectively collected from the charts of 440 patients from March 2012-December 2019 who underwent a sleeve gastrectomy or gastric bypass surgery. Data collected included patient demographics, select comorbidities, including diabetes mellitus, obstructive sleep apnea, hypothyroidism, depression, and anxiety, and body weight at baseline and 1 year postoperatively. Ideal body weight was calculated using the formula 50 + (2.3 × height in inches over 5 feet) for males and 45.5 + (2.3 × height in inches over 5 feet) for females. Excess body weight was then calculated by subtracting ideal body weight from actual weight at the above forementioned time points. Finally, %EBWL was calculated using the formula (change in weight over 1 year/excess weight) × 100. RESULTS Patients who had a higher baseline BMI (p < 0.001), diabetes mellitus (p = 0.026), hypothyroidism (p = 0.046), and who had a laparoscopic sleeve gastrectomy rather than Roux-en-Y gastric bypass (p < 0.001) had a smaller %EBWL in the first year after bariatric surgery as compared to patients without these comorbidities at the time of surgery. Controversially, patients with anxiety or depression (p = 0.73) or obstructive sleep apnea (p = 0.075) did not have a statistically significant difference in %EBWL. CONCLUSION A higher baseline BMI, diabetes mellitus, hypothyroidism, and undergoing laparoscopic sleeve gastrectomy may lead to lower %EBWL in the postoperative period after bariatric surgery. At the same time, patients' mental health status and sleep apnea status were not related to %EBWL. This study provides new insight into which comorbidities may need tighter control in order to optimize weight loss outcomes after bariatric surgery.
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Affiliation(s)
- Shelby Remmel
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA
| | - Madison Noom
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA
| | - Reagan Sandstrom
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Abdul-Rahman Fadi Diab
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Joseph Adam Sujka
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Salvatore Docimo
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Christopher Garnet DuCoin
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL, 33602, USA.
- Division of Gastrointestinal Surgery, Tampa General Hospital, Tampa, FL, USA.
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Fiorotti AM, Gomes ACA, Bortoli AM, de Brito BB, Nunes KZ, Haraguchi FK, Bolsoni-Lopes A. Dynamic Changes in Adiponectin and Resistin Drive Remission of Cardiometabolic Risk Biomarkers in Individuals with Obesity Following Bariatric Surgery. Pharmaceuticals (Basel) 2024; 17:215. [PMID: 38399430 PMCID: PMC10893494 DOI: 10.3390/ph17020215] [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: 12/21/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
The remission of obesity-related diseases following bariatric surgery appears to result from the reorganization of metabolic and hormonal pathways involving adipokines. This study aimed to investigate the relationship between changes in body adiposity and serum adipokine levels, as well as the association between variations in adiponectin or resistin levels and cardiometabolic risk blood biomarkers before and after Roux-en-Y gastric bypass. A longitudinal and prospective study was conducted with bariatric surgery patients. Anthropometric, body composition and blood biochemical parameters were measured before and at 2 and 6 months post-surgery. The data were analyzed using ANOVA, Pearson or Spearman correlation, and simple linear regression with a significance level of p < 0.05. Among 36 mostly female patients aged 30 to 39 years, significant reductions in body weight (-26.8%), fat mass (-50%), waist circumference (-18%) and waist-to-height ratio (-22%) were observed post-surgery. Serum adiponectin levels increased (+107%), while resistin (-12.2%), TNF-α (-35%), and PAI-1 (-11.1%) decreased. Glucose, insulin, CRP, cholesterol, LDL-c, triglycerides, and vitamin D also decreased. Waist circumference variation showed a positive correlation with PAI-1 and TNF-α and a negative correlation with adiponectin. The total fat mass showed a positive correlation with PAI-1. Adiponectin variation correlated negatively with glucose, resistin, and CRP but positively with HDL-c. Resistin showed a positive correlation with insulin and CRP. In conclusion, 6 months post-bariatric surgery, reducing abdominal adiposity had a more significant impact on serum adipokine levels than total fat mass. Adiponectin increase and resistin decrease acted as endocrine mediators driving the remission of cardiometabolic risk biomarkers in individuals with obesity following Roux-en-Y gastric bypass.
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Affiliation(s)
| | | | | | | | | | | | - Andressa Bolsoni-Lopes
- Postgraduate Program in Nutrition and Health, Health Sciences Center, Federal University of Espirito Santo, Vitoria 29047-105, Brazil (A.C.A.G.); (A.M.B.); (B.B.d.B.); (K.Z.N.); (F.K.H.)
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García-Honores L, Caballero-Alvarado J, Bustamante-Cabrejos A, Lozano-Peralta K, Zavaleta-Corvera C. LAPAROSCOPIC SLEEVE GASTRECTOMY VERSUS LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR WEIGHT LOSS IN OBESE PATIENTS: WHICH IS MORE EFFECTIVE? A SYSTEMATIC REVIEW AND META-ANALYSIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1782. [PMID: 38088727 PMCID: PMC10712920 DOI: 10.1590/0102-672020230064e1782] [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: 03/14/2023] [Accepted: 08/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS To determine if LSG is more effective than RYLGB for weight loss. METHODS A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
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Affiliation(s)
- Laura García-Honores
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
| | - Jose Caballero-Alvarado
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Regional Hospital of Trujillo, Department of surgery - Trujillo, La Libertad, Peru
| | - Alexander Bustamante-Cabrejos
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Alta Complejidad Virgen de la Puerta Hospital, Department of surgery - Trujillo, La Libertad, Peru
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Abu-Rumaileh M, Haddad RA, Yosef M, Esfandiari NH, Kraftson A, Khairi S, Lager C, Bushman J, Khalatbari S, Tincopa M, Varban O, Bozadjieva-Kramer N, Oral EA. Impact of Nonalcoholic Fatty Liver Disease (NAFLD) on Weight Loss After Bariatric Surgery. Obes Surg 2023; 33:3814-3828. [PMID: 37940737 DOI: 10.1007/s11695-023-06865-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: 08/30/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Obesity and associated comorbidities, such as NAFLD, impose a major healthcare burden worldwide. Bariatric surgery remains the most successful approach for sustained weight loss and the resolution of obesity-related complications. However, the impact of preexisting NAFLD on weight loss after bariatric surgery has not been previously studied. The goal of this study is to assess the impact of preexisting NAFLD on weight loss outcomes up to 5 years after weight loss surgery. RESEARCH DESIGN AND METHODS Data from the Michigan Bariatric Surgery Cohort (MI-BASiC) was extracted to examine the effect of baseline NAFLD on weight loss outcomes. The cohort included a total of 714 patients older than 18 years of age undergoing gastric bypass (GB; 380 patients) or sleeve gastrectomy (SG; 334 patients) at the University of Michigan between January 2008 and November 2013. Repeated measure analysis was used to determine if preexisting NAFLD was a predictor of weight loss outcomes up to 5 years post-surgery. RESULTS We identified 221 patients with an established clinical diagnosis of NAFLD at baseline. Multivariable repeated measure analysis with adjustment for covariates shows that patients with preexisting NAFLD had a significantly lower percentage of total and excess weight loss compared to patients without preexisting NAFLD. Furthermore, our data show that baseline dyslipidemia is an indicator of the persistence of NAFLD after bariatric surgery. CONCLUSIONS Our data show that patients' body weight loss in response to bariatric surgery is impacted by factors such as preexisting NAFLD. Additionally, we show that NAFLD may persist or recur in a subset of patients after surgery, and thus careful continued follow-up is recommended.
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Affiliation(s)
| | - Raad A Haddad
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC 25-3696, Ann Arbor, MI, 48109, USA
- Division of Endocrinology, Diabetes, and Metabolic Diseases, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Matheos Yosef
- Biostatistics Core, Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC 25-3696, Ann Arbor, MI, 48109, USA
| | - Andrew Kraftson
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC 25-3696, Ann Arbor, MI, 48109, USA
| | - Shafaq Khairi
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC 25-3696, Ann Arbor, MI, 48109, USA
| | - Corey Lager
- Bronson Diabetes and Endocrinology, Homer Stryker, MD School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Jordan Bushman
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC 25-3696, Ann Arbor, MI, 48109, USA
- Beaumont Hospital, Corewell Health, Farmington Hills, MI, USA
- Beaumont Hospital, Corewell Health, Rochester Hills, MI, USA
| | - Shoukoufeh Khalatbari
- Biostatistics Core, Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Monica Tincopa
- Division of Gastroenterology and Hepatology, University of California at San Diego, La Jolla, CA, USA
| | - Oliver Varban
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Henry Ford Health, Department of Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Nadejda Bozadjieva-Kramer
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
- Veterans Affairs Ann Arbor Healthcare System, Veterans Affairs, Ann Arbor, MI, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Medicine, University of Michigan Medical School, 2800 Plymouth Road, NCRC 25-3696, Ann Arbor, MI, 48109, USA.
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Dolan RD, Jirapinyo P, Maahs ED, Thompson CC. Endoscopic closure versus surgical revision in the management of gastro-gastric fistula following Roux-en-Y gastric bypass. Endosc Int Open 2023; 11:E629-E634. [PMID: 37397860 PMCID: PMC10310440 DOI: 10.1055/a-2037-4764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/09/2022] [Indexed: 07/04/2023] Open
Abstract
Background and study aims Gastro-gastric fistulae (GGF) occur in 1.3 % to 6 % of Rouxy-en-Y gastric bypass (RYGB) patients and can be associated with abdominal pain, reflux, weight regain and onset of diabetes. Endoscopic and surgical treatments are available without prior comparisons. The study aim was to compare endoscopic and surgical treatment methods in RYGB patients with GGF. Patients and methods A retrospective matched cohort study of RYGB patients who underwent endoscopic closure (ENDO) or surgical revision (SURG) for GGF. One-to-one matching was performed based on age, sex, body mass index and weight regain. Patient demographics, GGF size, procedural details, symptoms and treatment-related adverse events (AEs) were collected. A comparison of symptom improvement and treatment-related AEs was performed. Fisher's Exact, t -test and Wilcoxon Rank Sum tests were performed. Results Ninety RYGB patients with GGF (45 ENDO, 45 matched SURG) were included. GGF symptoms included weight regain (80 %), gastroesophageal reflux disease (71 %) and abdominal pain (67 %). At 6 months, the ENDO and SURG groups experienced 0.59 % and 5.5 % total weight loss (TWL) ( P = 0.0002). At 12 months, the ENDO and SURG groups experienced 1.9 % and 6.2 % TWL ( P = 0.007). Abdominal pain improved in 12 (52.2 %) ENDO and 5 (15.2 %) SURG patients at 12 months ( P = 0.007). Diabetes and reflux resolution rates were similar between groups. Treatment-related AEs occurred in four (8.9 %) ENDO and 16 (35.6 %) SURG patients ( P = 0.005), of which none and eight (17.8%), respectively, were serious ( P = 0.006). Conclusions Endoscopic GGF treatment produces greater improvement in abdominal pain and fewer overall and serious treatment-related AEs. However, surgical revision appears to yield greater weight loss.
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Affiliation(s)
- Russell D. Dolan
- Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Ethan D. Maahs
- Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Christopher C. Thompson
- Division of Gastroenterology, Hepatology and Endoscopy. Brigham and Women’s Hospital, Boston, Massachusetts, United States
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Scott AW, Leslie DB, Ikramuddin S, Dutta N, Amateau SK, Wise ES. The Case for Bariatric Surgery in Patients with Class 1 Obesity. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00355-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Kraftson A, Cain-Nielsen AH, Lockwood A, Luo Y, Buda C, Lager C, Esfandiari NH, Oral E, Varban OA. Predicting Early Weight Loss Failure Using a Bariatric Surgery Outcomes Calculator and Weight Loss Curves. Obes Surg 2022; 32:3932-3941. [PMID: 36253661 DOI: 10.1007/s11695-022-06294-4] [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: 03/31/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT Weight loss after bariatric surgery can be accurately predicted using an outcomes calculator; however, outliers exist that do not meet the 1 year post-surgery weight projections. OBJECTIVE Our goal was to determine how soon after surgery these outliers can be identified. DESIGN We conducted a retrospective cohort study. SETTING, PATIENTS, AND INTERVENTION Using a bariatric surgery outcomes calculator formulated by the Michigan Bariatric Surgery Collaborative (MBSC), predicted weight loss at 1 year post-surgery was calculated on all patients who underwent primary bariatric surgery at a single-center academic institution between 2006 and 2015 who also had a documented 1-year follow-up weight (n = 1050). MAIN OUTCOME MEASURES Weight loss curves were compared between high, low, and non-outliers as defined by their observed-to-expected (O:E) weight loss ratio based on total body weight loss (TBWL) %. RESULTS Mean predicted weight loss for the study group was 39.1 ± 9.9 kg, while mean actual weight loss was 39.7 ± 17.1 kg resulting in a mean O:E 1.01 (± 0.35). Based on analysis of the O:E ratios at 1 year post-surgery, the study group was sub-classified. Low outliers (n = 188, O:E 0.51) had significantly lower weight loss at 2 months (13.1% vs 15.6% and 16.5% TBWL, p < 0. 001) and at 6 months (19% vs 26% and 30% TBWL, p < 0.001) when compared to non-outliers (n = 638, O:E 1.00) and high outliers (n = 224, O:E 1.46), respectively. CONCLUSIONS Weight loss curves based on individually calculated outcomes can help identify low outliers for additional interventions as early as 2 months after bariatric surgery.
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Affiliation(s)
- Andrew Kraftson
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 24 Frank Lloyd Wright Drive, Suite G 1500, Ann Arbor, MI, 48105, USA.
| | - Anne H Cain-Nielsen
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Amy Lockwood
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Yingying Luo
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 24 Frank Lloyd Wright Drive, Suite G 1500, Ann Arbor, MI, 48105, USA
| | - Colleen Buda
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Corey Lager
- Bronson Diabetes and Endocrinology Center, Ann Arbor, MI, USA
| | - Nazanene H Esfandiari
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 24 Frank Lloyd Wright Drive, Suite G 1500, Ann Arbor, MI, 48105, USA
| | - Elif Oral
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, 24 Frank Lloyd Wright Drive, Suite G 1500, Ann Arbor, MI, 48105, USA
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Tan MM, Jin X, Taylor C, Low AK, Le Page P, Martin D, Li A, Joseph D, Kormas N. Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia. J Clin Med 2022; 11:4466. [PMID: 35956083 PMCID: PMC9369852 DOI: 10.3390/jcm11154466] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3−12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0−82.0%) and hypertension (73.7−82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.
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Affiliation(s)
- Michelle M.C. Tan
- Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
- Diabetes, Metabolism & Obesity Translational Research Unit, Camden Hospital, South Western Sydney Local Health District, Camden, NSW 2570, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Xingzhong Jin
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Institute of Bone and Joint Research, Kolling Institute, The University of Sydney, St Leonards, NSW 2064, Australia
| | - Craig Taylor
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
| | - Adrian K. Low
- Department of Orthopaedic Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia;
| | - Philip Le Page
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
| | - David Martin
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
- Hepatobiliary & Upper GIT Surgery Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Ang Li
- Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia;
- NHMRC Centre of Research Excellence in Healthy Housing, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - David Joseph
- Upper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia; (C.T.); (P.L.P.); (D.M.); (D.J.)
- Hepatobiliary & Upper GIT Surgery Department, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Nic Kormas
- Department of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, Australia
- Diabetes, Metabolism & Obesity Translational Research Unit, Camden Hospital, South Western Sydney Local Health District, Camden, NSW 2570, Australia
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Čolak D, Cmok Kučič A, Pintar T, Gašpirc B, Gašperšič R. Periodontal and systemic health of morbidly obese patients eligible for bariatric surgery: a cross-sectional study. BMC Oral Health 2022; 22:174. [PMID: 35562737 PMCID: PMC9107195 DOI: 10.1186/s12903-022-02207-0] [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: 10/15/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background In obese patients, periodontitis might be associated with deprived systemic health. Edmonton obesity staging system (EOSS) is a new tool for classification of obesity that considers the metabolic, physical, and psychological health. The cross-sectional study aimed to evaluate the periodontal status of morbidly obese patients eligible for bariatric surgery and the association between periodontitis, obesity-related comorbidities, and EOSS. Methods Morbidly obese patients eligible for bariatric surgery underwent detailed periodontal examination and were divided into the periodontitis group (PG) and the non-periodontitis group (NPG). The medical and demographic data were obtained from medical files, while behavioural data were obtained by the interview. Descriptive statistics and simple statistical tests were used to summarise the characteristics of the sample and the differences between PG and NPG. The logistic regression models were used to calculate the association (odds ratio (OR)) between periodontitis and obesity-related diseases and EOSS. Results The study included 79 patients, with an average BMI of 44.6 kg/m2 (SD = 7.2). The prevalence of periodontitis was 65% (CI 95% 53%-75%). PG patients (n = 51) were older, more often smokers and were more often hypertensive than NPG patients (n = 28) (p < 0.05). Hypertension was positively associated with periodontitis with adjusted OR 3.98 (95% CI 1.23–12.8; p = 0.021)) and age with adjusted OR 1.06, (95% CI 1.01–1.13; p = 0.038)), while other tested conditions (diabetes, dyslipidaemia, and smoking habits) did not show significant association with periodontitis. Periodontitis did not correlate with EOSS or other obesity-related comorbidities (p > 0.05). Conclusion The morbidly obese patients eligible for bariatric surgery show a high prevalence of periodontitis and, therefore, are advised to be examined by a dentist before undergoing surgery. They have higher odds of hypertension but not of other obesity-related diseases or higher stages of EOSS. The medical personnel should raise awareness among obese patients on the potential association of poor periodontal health with hypertension. Trial registration NCT04653714. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02207-0.
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Affiliation(s)
- Dejana Čolak
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia. .,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Alja Cmok Kučič
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Boris Gašpirc
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Hrvatski trg 6, 1000, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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10
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Howard R, Chao GF, Yang J, Thumma JR, Arterburn DE, Telem DA, Dimick JB. Medication Use for Obesity-Related Comorbidities After Sleeve Gastrectomy or Gastric Bypass. JAMA Surg 2022; 157:248-256. [PMID: 35019988 PMCID: PMC8756362 DOI: 10.1001/jamasurg.2021.6898] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Sleeve gastrectomy and gastric bypass are the most common bariatric surgical procedures in the world; however, their long-term medication discontinuation and comorbidity resolution remain unclear. OBJECTIVE To compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications up to 5 years after sleeve gastrectomy or gastric bypass. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study of adult Medicare beneficiaries who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis used instrumental-variable survival analysis to estimate the cumulative incidence of medication discontinuation and restart. Data analyses were performed from February to June 2021. EXPOSURES Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. MAIN OUTCOMES AND MEASURES The primary outcome was discontinuation of diabetes, hypertension, and hyperlipidemia medication for any reason. Among patients who discontinued medication, the adjusted cumulative incidence of restarting medication was calculated up to 5 years after discontinuation. RESULTS Of the 95 405 patients included, 71 348 (74.8%) were women and the mean (SD) age was 56.6 (11.8) years. Gastric bypass compared with sleeve gastrectomy was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30 588 patients with diabetes medication use and diagnosis at the time of surgery (74.7% [95% CI, 74.6%-74.9%] vs 72.0% [95% CI, 71.8%-72.2%]), 52 081 patients with antihypertensive medication use and diagnosis at the time of surgery (53.3% [95% CI, 53.2%-53.4%] vs 49.4% [95% CI, 49.3%-49.5%]), and 35 055 patients with lipid-lowering medication use and diagnosis at the time of surgery (64.6% [95% CI, 64.5%-64.8%] vs 61.2% [95% CI, 61.1%-61.3%]). Among the subset of patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. Specifically, the 5-year cumulative incidence of medication restart was lower after gastric bypass compared with sleeve gastrectomy among 19 599 patients who discontinued their diabetes medication after surgery (30.4% [95% CI, 30.2%-30.5%] vs 35.6% [95% CI, 35.4%-35.9%]), 21 611 patients who discontinued their antihypertensive medication after surgery (67.2% [95% CI, 66.9%-67.4%] vs 70.6% [95% CI, 70.3%-70.9%]), and 18 546 patients who discontinued their lipid-lowering medication after surgery (46.2% [95% CI, 46.2%-46.3%] vs 52.5% [95% CI, 52.2%-52.7%]). CONCLUSIONS AND RELEVANCE Findings of this study suggest that, compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication. Long-term trials are needed to explain the mechanisms and factors associated with differences in medication discontinuation and comorbidity resolution after bariatric surgery.
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Affiliation(s)
- Ryan Howard
- Department of Surgery, University of Michigan, Ann Arbor,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Grace F. Chao
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor,Veterans Affairs Ann Arbor, Ann Arbor, Michigan,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jie Yang
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Jyothi R. Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | | | - Dana A. Telem
- Department of Surgery, University of Michigan, Ann Arbor,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor,Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Justin B. Dimick
- Department of Surgery, University of Michigan, Ann Arbor,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor,Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
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11
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Thaher O, Hukauf M, Stroh C. Propensity Score Matching Sleeve Gastrectomy vs. Gastric Bypass with 5 Years of Follow-Up. Obes Surg 2021; 31:5156-5165. [PMID: 34515946 DOI: 10.1007/s11695-021-05706-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Beginning January 1, 2005, bariatric surgery cases were examined with the help of the quality assurance study for operative medicine. All data were registered and analyzed prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg, Germany. The comparative study focuses on perioperative morbidity, complications, and remission of obesity-associated diseases after gastric bypass (RYGB) and sleeve gastrectomy (SG) at 5-year follow-up. MATERIALS AND METHODS Data collection includes patients of full age who underwent SG or RYGB surgery between 2005 and 2017. The bougie is limited to 33-40 French for SG. The Roux-en-Y length for RYGB is set to 120-180 cm, and the biliodigestive length is set to 40-60 cm. Outcome criteria are perioperative morbidity, postoperative and intraoperative complications, and remission on comorbidities. RESULTS Between 2005 and 2017, 64,349 patients were enrolled in German Bariatric Surgery Registry (GBSR). Primary operations that were performed were 56.328. Out of 24,146 RYGB and 24,085 SG procedures, 922 patients had a complete 5-year follow-up. These are 342 SG patients and 580 patients with RYGB. A matching was realized for n = 285 (83.3%) patient pairs based on age, BMI, gender, ASA, and comorbidities. A significant disadvantage was identified for the SG procedure regarding reflux disease compared with RYGB (36.3% vs. 8.10%; p < 0.001). There were no significant disadvantages in terms of BMI reduction [14.92 in the RYGB and 14.50 in the SG (p = 0.437)] and %EWL [60.32 in the RYGB and 58.98 in the SG (p = 0.504)]. This also applies to the remission of NIDDM, IDDM, hypertension, and sleep apnea; no significant differences were found. CONCLUSION The results of the study show significant findings for gastroesophageal reflux. In terms of complications and obesity-associated diseases, no significant disadvantages between both treatments were found. RYGB and SG had comparable postoperative morbidity rates. The two surgical methods are legitimate bariatric procedures. However, there is a need for further evaluation to optimize patient selection in the coming years.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring, 40, 44625, Herne, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany.
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12
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Central Noradrenergic Neurotransmission and Weight Loss 6 Months After Gastric Bypass Surgery in Patients with Severe Obesity. Obes Surg 2021; 31:4868-4876. [PMID: 34414548 PMCID: PMC8490257 DOI: 10.1007/s11695-021-05657-7] [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: 05/08/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022]
Abstract
Purpose Roux-en-Y gastric bypass (RYGB) surgery is currently the most efficient treatment to achieve long-term weight loss in individuals with severe obesity. This is largely attributed to marked reductions in food intake mediated in part by changes in gut-brain communication. Here, we investigated for the first time whether weight loss after RYGB is associated with alterations in central noradrenaline (NA) neurotransmission. Materials and Methods We longitudinally studied 10 individuals with severe obesity (8 females; age 43.9 ± 13.1 years; body mass index (BMI) 46.5 ± 4.8 kg/m2) using (S,S)-[11C]O-methylreboxetine and positron emission tomography to estimate NA transporter (NAT) availability before and 6 months after surgery. NAT distribution volume ratios (DVR) were calculated by volume-of-interest analysis and the two-parameter multilinear reference tissue model (reference region: occipital cortex). Results The participants responded to RYGB surgery with a reduction in BMI of 12.0 ± 3.5 kg/m2 (p < 0.001) from baseline. This was paralleled by a significant reduction in DVR in the dorsolateral prefrontal cortex (pre-surgery 1.12 ± 0.04 vs. post-surgery 1.07 ± 0.04; p = 0.019) and a general tendency towards reduced DVR throughout the brain. Furthermore, we found a strong positive correlation between pre-surgery DVR in hypothalamus and the change in BMI (r = 0.78; p = 0.01). Conclusion Reductions in BMI after RYGB surgery are associated with NAT availability in brain regions responsible for decision-making and homeostasis. However, these results need further validation in larger cohorts, to assess whether brain NAT availability could prognosticate the outcome of RYGB on BMI. Graphical abstract ![]()
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13
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Wijngaarden LH, Reiber BMM, Yousufzai F, Demirkiran A, Klaassen RA. Resizing a large pouch after laparoscopic Roux-en-Y gastric bypass: comparing the effect of two techniques on weight loss. Surg Endosc 2021; 36:3495-3503. [PMID: 34374871 DOI: 10.1007/s00464-021-08671-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insufficient weight loss or weight regain has many causes including a large gastric pouch. A large gastric pouch may be due to the surgical technique or can be patient related (dilation). Resizing the gastric pouch may lead to additional weight loss. Currently, there is no gold standard for the revisional surgical technique. Therefore this study was performed to determine which surgical technique for revisional bariatric surgery (BS) has superior outcomes in terms of weight loss: sleeve resection of the gastrojejunostomy and gastric pouch (SGP), or resection of the gastrojejunostomy with resizing of the pouch and creation of a new anastomosis (RGJ). METHODS All patients who underwent revisional BS for insufficient weight loss or weight regain as a result of an enlarged pouch after LRYGB from April 2014 to June 2018 in our hospitals were included in this observational cohort study. Outcomes were measured in percentage total weight loss (%TWL). RESULTS A total of 37 patients who underwent SGP and 21 patients who underwent RGJ as revisional BS were included in this study. The median body mass index before revisional BS was 37.6 kg/m2 versus 35.7 kg/m2 (SGP vs RGJ, respectively, P = 0.115). There was no significant difference in %TWL between the two cohorts 1 and 2 years after revisional BS, respectively; SGP 14.5% vs RGJ 11.0%, P = 0.885 and SGP 12.3% vs RGJ 10.8%, P = 0.604. Comparing %TWL based on weight at LRYGB, there was also no significant difference two years after revisional BS (SGP 22.0% vs RGJ 22.2%, P = 0.885). The average use of surgical disposables for the SGP technique were lower compared to the RGJ technique. CONCLUSIONS Resizing a large pouch leads to additional weight loss. Both techniques have comparable outcomes in terms of weight loss. However, based on average surgical costs, the SGP technique may be preferable.
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Affiliation(s)
- L H Wijngaarden
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - B M M Reiber
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - F Yousufzai
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - A Demirkiran
- Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - R A Klaassen
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
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14
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Čolak D, Gašperšič R, Kučič AC, Pintar T, Gašpirc B. The effect of bariatric surgery on periodontal health: systematic review and meta-analyses. Arch Med Sci 2021; 17:1118-1127. [PMID: 34336041 PMCID: PMC8314405 DOI: 10.5114/aoms/135880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/18/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION We aimed to determine whether periodontal health deteriorates after bariatric surgery (BS). METHODS A search was performed in Medline and Embase, for prospective cohort studies with data on change in periodontal parameters after BS. Meta-analysis was performed with available data. RESULTS The results of 4 included studies consistently show significant (p < 0.05) worsening of bleeding on probing (4.21% (95% CI: 0.32, 8.11)), clinical attachment loss (0.16 mm (95% CI: 0.05, 0.27)), periodontal pocket depth (PPD) (0.14 mm (95% CI: 0.06, 0.23)) and percentage of PPD 4-5 mm: 1.72% (95% CI: 0.11, 3.34) 6 months after BS, but no change after 12 months. CONCLUSIONS BS may have a transient negative effect on periodontal health.
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Affiliation(s)
- Dejana Čolak
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rok Gašperšič
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alja Cmok Kučič
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadeja Pintar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Slovenia
| | - Boris Gašpirc
- Department of Oral Diseases and Periodontology, Dental Clinic, University Medical Centre Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 30:664-672. [PMID: 31724116 DOI: 10.1007/s11695-019-04235-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures. OBJECTIVES We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG. METHODS Medline, Embase, The Cochrane Library, and NHS Evidence were searched for English language RCTs comparing RYGB with SG and assessed weight loss and/or comorbidity resolution at 5 years. RESULTS Five studies were included in the final analysis. Meta-analysis demonstrates a significantly greater percentage excess weight loss in patients undergoing RYGB compared with SG (65.7% vs 57.3%, p < 0.0001). Resolution of diabetes was seen in 37.4% and 27.5% after RYGB and SG respectively. There was no significant difference between RYGB and SG in rates of resolution or improvement of diabetes. Similarly, HbA1C levels were not significantly different between the two procedures. Resolution of dyslipidaemia was more common after RYGB (68.6% vs 55.2%, p = 0.0443). Remission of gastro-oesophageal reflux occurred in 60.4% in the RYGB group in contrast to 25.0% in the SG group (p = 0.002). CONCLUSIONS Both RYGB and SG result in sustained weight loss and comorbidity control at 5 years. RYGB resulted in greater %EWL, improved dyslipidaemia outcomes and a lower incidence of postoperative gastro-oesophageal reflux disease (GORD).
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16
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Dolan RD, Bazarbashi AN, Jirapinyo P, Thompson CC. Test Characteristics of Abdominal Computed Tomography for the Diagnosis of Gastro-gastric Fistula in Patients with Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2471-2476. [PMID: 33619691 DOI: 10.1007/s11695-021-05296-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Gastrogastric fistulae (GGF) occur in 1-6% of Roux-en-Y gastric bypass (RYGB) patients. Many patients undergo abdominal computed tomography (CT) as an initial test owing to its wide availability; however, CT diagnostic accuracy for GGF is unclear. Our aim was to evaluate test characteristics of abdominal CT compared to upper gastrointestinal series (UGI) and esophagogastroduodenoscopy (EGD) for diagnosing GGF using surgery as a gold standard. METHODS Retrospective review of RYGB patients who underwent abdominal CT with oral contrast within 1 year. Demographics, weight parameters, and symptoms were collected. Surgery within 1 year of the diagnostic tests was included as the gold standard comparison. Primary outcomes included CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) for GGF. RESULTS One hundred thirty-seven patients were included, where 42 (30.1%) had positive CT and 95 (69.3%) had negative CT for GGF. Compared to surgical confirmation, CT abdomen with PO contrast had sensitivity of 73.1% (59-84.4), specificity of 95.2% (88.3-98.7), PPV 90.5% (77.4-97.3), NPV of 85.1% (76.3-91.2), and DA 89.7%. UGI series had sensitivity of 58.5% (42.1-73.7), specificity of 98.8% (93.5-99.9), PPV of 96% (79.7-99.9), NPV of 82.8% (73.9-89.7), and diagnostic accuracy (DA) of 85.4%. EGD had sensitivity of 78.3% (63.6-89.1), specificity of 98.8% (93.5-99.9), PPV 97.3 (85.8-99.9), and DA 91.5%. There were no significant differences in diagnostic test characteristics among modalities. CONCLUSIONS Abdominal CT with oral contrast has similar diagnostic test characteristics to UGI and EGD at detecting GGF when using surgical diagnosis as a gold standard.
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Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Pichamol Jirapinyo
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, 02115, USA.
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17
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Primary laparoscopic sleeve gastrectomy versus gastric bypass: a propensity-matched comparison of 30-day outcomes. Surg Obes Relat Dis 2021; 17:1369-1382. [PMID: 33741294 DOI: 10.1016/j.soard.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for obesity. There is uncertainty regarding rates of adverse outcomes between the most common methods: laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). OBJECTIVES To compare rates of readmission, reoperation, intervention, unplanned intensive care unit (ICU) admission, all-cause and procedure-related mortality, and postoperative complications at 30 days between LRYGB and LSG. SETTING Retrospective, observational, multicenter registry. METHODS We identified 611,619 patients from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry between January 1, 2015, and December 31, 2018 (447,326 [73.1%] LSG; 164,293 [26.9%] LRYGB). RESULTS Adverse events were more common after LRYGB (readmission: 3% with LSG versus 5.9% with LRYGB [P < .001; odds ratio {OR}, LSG/LRYGB = .489]; intervention: .9% with LSG versus 2.4% with LRYGB [P < .001; OR, LSG/LRYGB = .357]; reoperation: .8% with LSG versus 2.3% with LRYGB [P < .001; OR, LSG/LRYGB = .363]; unplanned ICU admission: .52% with LSG versus 1.1% with LRYGB [P < .001; OR, LSG/LRYGB = .454]; all-cause mortality: .07% with LSG versus .15% with LRYGB [P < .001; OR, LSG/LRYGB = .489]; procedure-related mortality: .04% with LSG versus .08% with LRYGB [P < .001; OR, LSG/LRYGB = .446]; Clavien-Dindo I: .20% with LSG versus .63% with LRYGB [P < .001; OR, LSG/LRYGB = .317]; Clavien-Dindo II: .70% with LSG versus 1.3% with LRYGB [P < .001; OR, LSG/LRYGB = .527]; Clavien-Dindo III: 3.3% with LSG versus 6.6% with LRYGB [P < .001; OR, LSG/LRYGB = .481]; Clavien-Dindo IV: .36% with LSG versus .76% with LRYGB [P < .001; OR, LSG/LRYGB = .466]; and Clavien-Dindo V: .07% with LSG versus .15% with LRYGB [P < .001; OR, LSG/LRYGB = .488]). Surgery type was among the strongest independent predictors of adverse events, and LRYGB conferred higher adjusted odds of all adverse outcomes (all-cause mortality: OR, LRYGB/LSG = 1.791 [P < .001]; procedure-related mortality: OR, LRYGB/LSG = 1.979 [P < .001]; readmission: OR, LRYGB/LSG = 1.921 [P < .001]; unplanned ICU admission: OR, LRYGB/LSG = 1.870 [P < .001]; intervention: OR, LRYGB/LSG = 2.662 [P < .001]; reoperation: OR, LRYGB/LSG = 2.646 [P < .001]; and Clavien-Dindo grade: OR, LRYGB/LSG = 2.007 [P < .001]). CONCLUSION The rates of 30-day adverse outcomes are lower after LSG compared with after LRYGB. LRYGB independently conferred increased odds of adverse outcomes compared with LSG, and surgery type was among the strongest predictors of adverse outcomes.
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18
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Hauters P, Dubart JW, Desmet J, Degolla R, Roumain M, Malvaux P. Ten-year outcomes after primary vertical sleeve gastrectomy for morbid obesity: a monocentric cohort study. Surg Endosc 2020; 35:6466-6471. [PMID: 33140154 DOI: 10.1007/s00464-020-08137-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the 10-year outcomes after sleeve gastrectomy (SG). Primary end-points were the long-term weight loss and the need for conversion and one of the secondary end-points was the incidence of gastroesophageal reflux (GERD). MATERIALS AND METHODS Between 2006 and 2008, 40 consecutive patients had a primary SG. A retrospective analysis of our database and telephone interview of patients who defaulted clinic follow-up was conducted. Success of surgery was defined as percentage of excess weight loss (%EWL) > 50% and no need for conversion. RESULTS Thirty-four patients (85%) achieved a 10-year follow-up. There were 11 men and 23 women with a mean preoperative body mass index (BMI) of 44 ± 4 kg/m2 and a mean age of 42 ± 8 years. Optimal weight loss was reached after a follow-up of 12 months: the mean BMI was 31 ± 5 kg/m2 and %EWL 70 ± 21%. A progressive weight regain was observed over time. With a median follow-up of 11 years (range 7-12), the mean BMI and %EWL were respectively 36 ± 8 kg/m2 (p < 0.005) and 42 ± 37% (p < 0.001). With a median delay of 9 years (range 7-9), 6 patients (18%) were converted to gastric bypass because of weight regain. On total, SG was successful only in 14 patients (41%). Success rate was particularly high in patients who had a 1-year %EWL > 75%: 10/12 (83%) vs. 4/22 (17%) (p < 0.001). Those 12 patients were only characterized by a lower preoperative BMI: 41 ± 2 vs. 45 ± 4 (p < 0.002). Besides, 22 patients (65%) had long-term GERD requiring medical treatment: the incidence of de novo GERD was 41% (6/14) and of persisting GERD 80% (16/20). CONCLUSIONS Our 10-year success rate after SG was 41% and the incidence of GERD 65%. SG should preferably be proposed to selected patients. Patients with low preoperative BMI and without preoperative symptoms of GERD appeared as the best candidates for SG.
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Affiliation(s)
- P Hauters
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium.
| | - J-W Dubart
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - J Desmet
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - R Degolla
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - M Roumain
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - P Malvaux
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
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Stenberg E, Cao Y, Marsk R, Sundbom M, Jernberg T, Näslund E. Association between metabolic surgery and cardiovascular outcome in patients with hypertension: A nationwide matched cohort study. PLoS Med 2020; 17:e1003307. [PMID: 32931494 PMCID: PMC7491727 DOI: 10.1371/journal.pmed.1003307] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension, together with obesity, is a leading cause of mortality and disability. Whilst metabolic surgery offers remission of several metabolic comorbidities, the effect for patients with hypertension remains controversial. The objective of the present study was to evaluate the effect of metabolic surgery on cardiovascular events and mortality on patients with morbid obesity (body mass index [BMI] ≥ 35 kg/m2) and hypertension. METHODS AND FINDINGS We conducted a matched cohort study of 11,863 patients with morbid obesity and pharmacologically treated hypertension operated on with metabolic surgery and a matched non-operated-on control group of 26,199 subjects with hypertension (matched by age, sex, and area of residence) of varied matching ratios from 1:1 to 1:9, using data from the Scandinavian Obesity Surgery Register (SOReg), the Swedish National Patient Registers (NPR) for in-hospital and outpatient care, the Swedish Prescribed Drug Register, and Statistics Sweden. The main outcome was major adverse cardiovascular event (MACE), defined as first occurrence of acute coronary syndrome (ACS) event, cerebrovascular event, fatal cardiovascular event, or unattended sudden cardiac death. The mean age in the study group was 52.1 ± 7.46 years, with 65.8% being women (n = 7,810), and mean BMI was 41.9 ± 5.43 kg/m2. MACEs occurred in 379 operated-on patients (3.2%) and 1,125 subjects in the control group (4.5%). After adjustment for duration of hypertension, comorbidities, and education, a reduction in risk was seen in the metabolic surgery group (adjusted hazard ratio [HR] 0.73, 95% confidence intervals [CIs] 0.64-0.84, P < 0.001). The surgery group had lower risk for ACS events (adjusted HR 0.52, 95% CI 0.41-0.66, P < 0.001) and a tendency towards lower risk for cerebrovascular events (adjusted HR 0.81, 95% CI 0.63-1.01, P = 0.060) compared with controls. The main limitations with the study were the lack of information on BMI and history of smoking in the control group and the nonrandomised study design. CONCLUSION Metabolic surgery on patients with morbid obesity and pharmacologically treated hypertension was associated with lower risk for MACEs and all-cause mortality compared with age- and sex-matched controls with hypertension from the general population.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- * E-mail:
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Richard Marsk
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tomas Jernberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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20
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Gu L, Huang X, Li S, Mao D, Shen Z, Khadaroo PA, Ng DM, Chen P. A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. BMC Surg 2020; 20:30. [PMID: 32050953 PMCID: PMC7014764 DOI: 10.1186/s12893-020-00695-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are two representative bariatric surgeries. This study aimed to compare the effects of the LSG and LRYGB based on high-quality analysis and massive amount of data. Methods For this study databases of PubMed, Web of Science, EBSCO, Medline, and Cochrane Library were searched for articles published until January 2019 comparing the outcomes of LSG and LRYGB. Results This study included 28 articles. Overall, 9038 patients (4597, LSG group; 4441, LRYGB group) were included. The remission rate of type 2 diabetes mellitus (T2DM) in the LRYGB group was superior to that in the LSG group at the 3-years follow-up. Five-year follow-up results showed that LRYGB had an advantage over LSG for the percentage of excess weight loss and remission of T2DM, hypertension, dyslipidemia, and abnormally low-density lipoprotein. Conclusions In terms of the long-term effects of bariatric surgery, the effect of LRYGB was better than of LSG.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China
| | - Xiaojing Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shengnan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zefeng Shen
- Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | | | - Derry Minyao Ng
- Medical College of Ningbo University, Hangzhou, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China.
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21
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Impact of Weight Loss on Inflammation State and Endothelial Markers Among Individuals with Extreme Obesity After Gastric Bypass Surgery: a 2-Year Follow-up Study. Obes Surg 2020; 30:1881-1890. [DOI: 10.1007/s11695-020-04411-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
PURPOSE OF REVIEW We seek to characterize the impact of bariatric surgery on diabetes mellitus by recalling its history, examining the clinical data, exploring the putative mechanisms of action, and anticipating its future. RECENT FINDINGS Results of clinical trials reveal that bariatric surgery induces remission of diabetes in 33-90% of individuals at 1-year post-treatment versus 0-39% of medically managed. Remission rates decrease over time but remain higher in surgically treated individuals. Investigations have revealed numerous actions of surgery including effects on intestinal physiology, neuronal signaling, incretin hormone secretion, bile acid metabolism, and microbiome changes. Bariatric surgery improves control of diabetes through both weight-dependent and weight-independent actions. These various mechanisms help explain the difference between individuals treated surgically vs. medically. They also explain differing effects of various bariatric surgery procedure types. Understanding how surgery affects diabetes will help optimize utilization of the therapy for both disease prevention and treatment.
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Affiliation(s)
- Alison H Affinati
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA
| | - Andrew T Kraftson
- Division of Metabolism, Endocrinology and Diabetes (MEND), Department of Internal Medicine, Michigan Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Lobby G, Suite 1500, Ann Arbor, MI, 48106-0482, USA.
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Guerreiro V, Neves JS, Salazar D, Ferreira MJ, Oliveira SC, Souteiro P, Pedro J, Magalhães D, Varela A, Belo S, Freitas P, Carvalho D. Long-Term Weight Loss and Metabolic Syndrome Remission after Bariatric Surgery: The Effect of Sex, Age, Metabolic Parameters and Surgical Technique - A 4-Year Follow-Up Study. Obes Facts 2019; 12:639-652. [PMID: 31747662 PMCID: PMC6940448 DOI: 10.1159/000503753] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/26/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities. However, the literature reports inconsistent results regarding weight loss (WL) and the resolution of comorbidities associated with obesity. OBJECTIVE We aim to evaluate long-term differences in WL between different surgical techniques and the impact of each surgical technique on metabolic parameters (type 2 diabetes mellitus [T2DM], dyslipidemia,hypertension, and metabolic syndrome). We also aim to evaluate the effect of baseline clinical characteristics in WL and in the evolution of metabolic syndrome (MetS) components. Our hypothesis is that different types of surgery have different effects on WL and the prevalence of comorbidities over time. METHODS We retrospectively evaluated WL and metabolic parameter remission (T2DM, dyslipidemia, hypertension, and MetS) during 4 years in 1,837 morbidly obese patients (females, 85%; age, 42.5 ± 10.6 years; BMI, 44.0 ± 5.8) who underwent bariatric surgery (Roux-en-Y gastric bypass [RYGB], laparoscopic sleeve gastrectomy [LSG], and laparoscopic adjustable gastric band [LAGB]). RESULTS The mean percentage of WL for RYGB, LSG, and LAGB was, respectively, 32.9 ± 8.7, 29.8 ± 9.8, and 16.2 ± 9.6 at 12 months and 30.6 ± 9.1, 22.7 ± 10.0, and 15.8 ± 10.8 at 48 months (p < 0.001), even after adjustment for baseline weight, BMI, age, and sex (p < 0.001). Women had more WL during the first 36 months (p = 0.013 and 0.007 at 12 and 36 months, respectively) and older patients had less WL compared to younger ones (p <0.001), except at 48 months. Patients with T2DM had less WL than those without diabetes after adjustment (sex, age, and surgical technique) during the same period. Patients with hypertension had less WL at 12 months (p = 0.009) and MetS at 24 months (p = 0.020) compared to those without these comorbidities. There was no significant difference regarding the presence of dyslipidemia in WL. The RYGB group showed better results for MetS resolution. CONCLUSION During the 4-year follow-up, RYGB was the surgical procedure that caused the highest WL and MetS resolution.
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Affiliation(s)
- Vanessa Guerreiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal,
- Faculty of Medicine, University of Porto, Porto, Portugal,
| | - João Sérgio Neves
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Daniela Salazar
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sofia Castro Oliveira
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Souteiro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jorge Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Daniela Magalhães
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sandra Belo
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Freitas
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
- Multidisciplinary Group for Surgical Management of Obesity, Centro Hospitalar São João, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
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