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Beck RH, Afrooz I, Suhail Masalawala M, Watad R, Al Shaban T, Deeb A. Characteristics of adolescents referred for bariatric surgery in Abu Dhabi, United Arab Emirates. Front Pediatr 2024; 12:1297251. [PMID: 38523841 PMCID: PMC10957758 DOI: 10.3389/fped.2024.1297251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
About a third of children and adolescents are overweight or obese in the United Arab Emirates, and referrals for metabolic and bariatric surgery (MBS) are now common. Despite excellent evidence that MBS should be considered in adolescents with severe obesity, it remains a management approach of last resort in many cases. Baseline, real-world data on adolescent patients living with obesity referred for surgery, their characteristics, and how these relate to current and future referral policy are important to ensure best practice. Here we examined the demographic, anthropometric, and clinical characteristics of adolescents referred for MBS over a three-year period to Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Ninety-two adolescents living with obesity were recruited: 54.3% were female, the average age was 16.3 ± 2.4 years, and 88.0% of patients had a first-degree relative with a history of obesity and 62% a family history of bariatric surgery. The average BMI was 47.7 ± 10.5, and the average percentage of the 95th percentile BMI was 169.5 ± 38.8%. Complications of obesity (hypertension, type 2 diabetes and prediabetes, dyslipidemia, and liver function abnormalities) were common. Our analysis highlights that there exists a mismatch between the profiles of patients referred for MBS, local guidelines, and international best practice in decision-making for referral to MBS services. While many adolescents in the UAE seem to enjoy family support and experience in the surgical management of obesity, local guidelines need updating to reflect changes in the definitions of obesity, thresholds for referral, and to remove unnecessary developmental stage barriers to increase the window for personalized surgical management.
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Affiliation(s)
- Reem Hassan Beck
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Imrana Afrooz
- Clinical Trial Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Rama Watad
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Talat Al Shaban
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Chang PC, Huang IYW, Liu SD, Huang CK, Lin TE, Jhou HJ, Chen PH, Chang TW. Perioperative Dexmedetomidine Infusion Improves Perioperative Care of Bariatric-Metabolic Surgery: A Single Center Experience with Meta-Analysis. Obes Surg 2024; 34:416-428. [PMID: 38177557 DOI: 10.1007/s11695-023-07036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study aims to determine the effects of perioperative dexmedetomidine infusion (PDI) on Asian patients undergoing bariatric-metabolic surgery (BMS), focusing on the need for pain medications and management of postoperative nausea and vomiting (PONV), and to investigate the association with these variables, including patients' characteristics and BMS data. MATERIALS AND METHODS A retrospective review of prospectively collected data was conducted in an Asian weight management center from August 2016 to October 2021. A total of 147 native patients with severe obesity were enrolled. All patients were informed of the full support of perioperative pain medications for BMS. The pain numeric rating scale scores, events of PONV, needs for pain medications, and the associated patients' characteristics were analyzed. A p-value of < 0.05 was considered statistically significant. Furthermore, to verify the effects of perioperative usage of dexmedetomidine for BMS, a systematic review with meta-analysis of currently available randomized control trials was performed. RESULTS Among the 147 enrolled patients, 107 underwent laparoscopic sleeve gastrectomy and 40 underwent laparoscopic Roux-en-Y gastric bypass. PDI has been used as an adjunct multimodal analgesia for BMS in our institution since June 2017 (group D; n = 114). In comparison with those not administered with perioperative dexmedetomidine (group C; n = 33), lower pain numeric rating scale scores (2.52 ± 2.46 vs. 4.27 ± 2.95, p = 0.007) in the postanesthesia care unit, fewer PONV (32.46% vs. 51.52%; p = 0.046), and infrequent needs of additional pain medications (19.47% vs. 45.45%; p = 0.003) were observed in group D. Multivariable analysis demonstrated that type II diabetes mellitus was correlated with the decreased need of pain medications other than PDI (p = 0.035). Moreover, dexmedetomidine seemed to have a better analgesic effect for patients with longer surgical time based on our meta-analysis. CONCLUSION Based on our limited experience, PDI could be a practical solution to alleviate pain and PONV in Asian patients undergoing BMS. Moreover, it might reduce the need for rescue painkillers with better postoperative pain management for patients with type II diabetes mellitus or longer surgical time.
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Affiliation(s)
- Po-Chih Chang
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, 804, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
- Weight Management Cente, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan
- Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Ivy Ya-Wei Huang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Nursing, Kaohsiung Medical University Hospital/ Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Sian-De Liu
- Department of Pharmacy, New Taipei Municipal TuCheng Hospital (Built and Operated By Chang Gung Medical Foundation), New Taipei City, 236, Taiwan
| | - Chih-Kun Huang
- Body Science and Metabolic Disorders International Medical Center, China Medical, University Hospital, Taichung City, Taiwan
| | - Tsun-En Lin
- Department of Nursing, Kaohsiung Medical University Hospital/ Kaohsiung Medical University, Kaohsiung City, Taiwan
- Specialist Nursing Office, Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Wei Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Weight Management Cente, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan.
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Weitzner ZN, Kim KH, Kim Y, Seo KW, Choi YS, Dutson EP. Comparison of Eastern and Western patients undergoing bariatric surgery at two US and Korean institutions: a retrospective analysis of differing bariatric patient populations. Surg Endosc 2024; 38:129-135. [PMID: 37934296 DOI: 10.1007/s00464-023-10549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/15/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Currently, there are differences in both demographics and indications for bariatric surgery between Eastern and Western countries. We compared postoperative outcomes between Korean and American bariatric programs in order to assess how bariatric surgery differently affects these populations. METHODS We enrolled 540 patients who underwent bariatric surgery at University of California, Los Angeles (UCLA) and 85 patients who underwent surgery at Kosin University Gospel Hospital (KUGH) between January 2019 and December 2020. We compared demographics, complications, weight loss, and metabolic parameters between these groups. RESULTS There was a difference in age between the UCLA and KUGH patient groups (44.3 years vs 37.6 years, P < 0.01). Frequencies of T2DM and OSA were also different (4.2% vs 50.6%, 34.1% vs 85.9% P < 0.01. Length of hospital stay varied (1.55 days vs 6.68 days, P < 0.01), but there was no difference in operating time and complications. There was no difference in percent of excess weight loss between the two groups at 6 months (29.7 vs 33.8, P = 0.13). Hepatic steatosis index (HSI) was higher in the UCLA group both before (54.2 vs 51.5, P < 0.01) and after (44.4 vs 40.0, P = 0.02) surgery. LSG was the most frequently performed operation, and robotic surgery and revisions were performed only in the UCLA program. CONCLUSION There were differences in age, BMI, length of stay, and choice of operation between Korean and American bariatric patients. Also, there were differences in the degree of fatty liver disease using HSI and liver enzymes before and after surgery. There was no significant differences in operation time and complications. These findings suggest differences in bariatric practices and reactions to bariatric surgery in Eastern and Western settings.
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Affiliation(s)
- Zachary N Weitzner
- Department of Surgery, UCLA Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, 72-239 CHS, BOX 956904, Los Angeles, CA, 90095, USA
| | - Ki Hyun Kim
- Department of Surgery, College of Medicine, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea
| | - Yoonhong Kim
- Department of Surgery, College of Medicine, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea
| | - Kyung Won Seo
- Department of Surgery, College of Medicine, Kosin University, 262 Gamcheon-ro, Seo-gu, Busan, 49267, Republic of Korea.
| | - Young Sik Choi
- Department of Internal Medicine, College of Medicine, Kosin University, Busan, Republic of Korea
| | - Erik P Dutson
- Department of Surgery, UCLA Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, 72-239 CHS, BOX 956904, Los Angeles, CA, 90095, USA.
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Lu G, Hu R, Dong Z, Wang J, Yang W, Wang C. Bibliometric and Correlation Analysis of Bariatric Surgery Researches in Asia-Pacific from 2000 to 2021. Obes Facts 2023; 16:484-496. [PMID: 37598680 PMCID: PMC10601626 DOI: 10.1159/000533152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Bariatric surgery has grown in popularity over the past two decades, especially in the Asia-Pacific. Correspondingly, researchers' interest in this field has also increased. This study aims to perform a bibliometric analysis of publications from Asia-Pacific represented by the International Federation for the Surgery of Obesity and Metabolic Disorders Asia-Pacific Chapter (IFSO-APC) and investigate the relevant factors that might affect the publications. METHODS The search terms for bariatric surgery were searched in Web of Science focusing on the period 2000-2021. Bibliometric analysis was performed after screening the search results. Univariate and multivariate regression analyses were performed on the number of publications and corresponding indicators obtained from official agencies. RESULTS A total of 9,547 publications in IFSO-APC were retrieved, of which China had the largest number with 2,782 publications. Authors and journals with major contributions were listed. The authors' or affiliations' cooperation networks mainly were limited to domestic. "Bariatric surgery" was the most frequent keyword with 2,063 times and also the largest cluster. "Morbid obesity" was the strongest citation bursts. Multivariate analysis found that the number of publications in each country/region was associated with body mass index ≥25 kg/m2, gross domestic product, and total population. CONCLUSION Generally, Asia-Pacific represented by IFSO-APC scientific publications on bariatric surgery has grown significantly in the last two decades, but cooperation between countries/regions should be strengthened. "Morbid obesity" is the focus and frontier of research in this field.
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Affiliation(s)
- Guanhua Lu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Ruixiang Hu
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Zhiyong Dong
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
| | - Jianxue Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Guangdong-Hong Kong-Macao Joint University Laboratory of Metabolic and Molecular Medicine, The University of Hong Kong and Jinan University, Guangzhou, China
- Jinan University Institute of Obesity and Metabolic Disorders, Guangzhou, China
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Yin X, Guo X, Liu Z, Wang J. Advances in the Diagnosis and Treatment of Non-Alcoholic Fatty Liver Disease. Int J Mol Sci 2023; 24:ijms24032844. [PMID: 36769165 PMCID: PMC9917647 DOI: 10.3390/ijms24032844] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 02/05/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease that affects approximately one-quarter of the global adult population, posing a significant threat to human health with wide-ranging social and economic implications. The main characteristic of NAFLD is considered that the excessive fat is accumulated and deposited in hepatocytes without excess alcohol intake or some other pathological causes. NAFLD is a progressive disease, ranging from steatosis to non-alcoholic steatohepatitis (NASH), cirrhosis, hepatocellular carcinoma, liver transplantation, and death. Therefore, NAFLD will probably emerge as the leading cause of end-stage liver disease in the coming decades. Unlike other highly prevalent diseases, NAFLD has received little attention from the global public health community. Liver biopsy is currently considered the gold standard for the diagnosis and staging of NAFLD because of the absence of noninvasive and specific biomarkers. Due to the complex pathophysiological mechanisms of NAFLD and the heterogeneity of the disease phenotype, no specific pharmacological therapies have been approved for NAFLD at present, although several drugs are in advanced stages of development. This review summarizes the current evidence on the pathogenesis, diagnosis and treatment of NAFLD.
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Affiliation(s)
- Xunzhe Yin
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
| | - Xiangyu Guo
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
| | - Zuojia Liu
- State Key Laboratory of Electroanalytical Chemistry, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun 130022, China
- Correspondence: (Z.L.); (J.W.)
| | - Jin Wang
- Department of Chemistry and Physics, Stony Brook University, Stony Brook, New York, NY 11794-3400, USA
- Correspondence: (Z.L.); (J.W.)
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6
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Susanto H, Sugiharto, Taufiq A, Pranoto A, Dwi Trijoyo Purnomo J. Dynamic alteration of plasma levels of betatrophin in younger female onset obesity post acute moderate-intensity exercise training. Saudi J Biol Sci 2023; 30:103546. [PMID: 36624736 PMCID: PMC9823226 DOI: 10.1016/j.sjbs.2022.103546] [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: 06/07/2022] [Revised: 11/19/2022] [Accepted: 12/17/2022] [Indexed: 12/25/2022] Open
Abstract
Obesity is a global metabolic disease anchored by a lack of physical activity lipid disturbances. Hitherto, betatrophin is a potential liver-derived hormone that regulates lipid metabolism. A total of 26 selected onset obese individuals (BMI range ± 28-31) were enrolled in this study and given moderate-intensity exercise. Importantly, our data show that acute moderate-intensity interval exercise (MIIE) and acute moderate-intensity continue to exercise (MICE) for 40 min significantly decrease the plasma level of full-length betatrophin respectively (174.18 ± 48.19 ng/mL; 182.31 ± 52.69 ng/mL), compared to the placebo (283.97 ± 32.23 ng/mL) post 10 min and 6 h exercise treatment (p ≤ 0.05). The plasma level of betatrophin was significantly and negatively correlated with BMI (r = - 0.412, p = 0.037), fasting blood glucose (r = - 0.390, p = 0.049), and positively correlated with VO2max (r = 0.456, p = 0.019). In addition, the linear and ordinal logistic regression analysis shows that betatrophin, is a potential predictor for BMI [estimate value = 0.995, p = 0.037 and OR (95 % CI) = 0.992 (0.0984-1.00), p = 0,048]. In summary, our data demonstrate that the circulating levels of betatrophin were decreased after acute moderate-intensity exercise training.
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Affiliation(s)
- Hendra Susanto
- Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang, Malang, East Java 65145, Indonesia,Corresponding author at: Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang, Semarang No. 5 Street, Malang, East Java 65145, Indonesia.
| | - Sugiharto
- Department of Sports Science, Faculty of Sports Science, Universitas Negeri Malang, Malang, East Java 65145, Indonesia
| | - Ahmad Taufiq
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang, Malang, East Java 65145, Indonesia
| | - Adi Pranoto
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java 60132, Indonesia
| | - Jerry Dwi Trijoyo Purnomo
- Department of Statistics, Faculty of Science and Data Analytics, Institut Teknologi Sepuluh Nopember, Surabaya, East Java 60117, Indonesia
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Tham KW, Abdul Ghani R, Cua SC, Deerochanawong C, Fojas M, Hocking S, Lee J, Nam TQ, Pathan F, Saboo B, Soegondo S, Somasundaram N, Yong AML, Ashkenas J, Webster N, Oldfield B. Obesity in South and Southeast Asia-A new consensus on care and management. Obes Rev 2023; 24:e13520. [PMID: 36453081 PMCID: PMC10078503 DOI: 10.1111/obr.13520] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.
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Affiliation(s)
- Kwang Wei Tham
- Singapore Association for the Study of Obesity, Singapore
| | | | - Sioksoan C Cua
- Division of Pediatric Endocrinology, Philippine General Hospital, Metro Manila, Philippines.,Department of Pediatrics, Chinese General Hospital, Cardinal Santos Medical Center, Manila Doctors Hospital, Metro Manila, Philippines
| | | | - Mia Fojas
- Department of Biochemistry and Molecular Biology, University of the Philippines College of Medicine, Manila, Philippines
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.,Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Boden Initiative, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - June Lee
- Upper Gastrointestinal and Bariatric Surgery, Department of Surgery, Changi General Hospital, Singapore
| | - Tran Quang Nam
- Department of Endocrinology, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Faruque Pathan
- Department of Endocrinology, Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | - Banshi Saboo
- Dia Care Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Sidartawan Soegondo
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.,Diabetes Connection and Care, Eka Hospitals, Jakarta, Indonesia
| | | | - Alice M L Yong
- Department of Internal Medicine, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam
| | | | | | - Brian Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
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Li Z, Daniel S, Fujioka K, Umashanker D. Obesity among Asian American people in the United States: A review. Obesity (Silver Spring) 2023; 31:316-328. [PMID: 36695056 PMCID: PMC10108164 DOI: 10.1002/oby.23639] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 01/26/2023]
Abstract
Standard measures of obesity, i.e., body weight and BMI, suggest that Asian American people have a lower obesity prevalence than other racial groups in the United States. However, Asian American people face a unique challenge in their pattern of adiposity with central obesity, which raises the risk for multiple comorbidities, such as type 2 diabetes, metabolic syndrome, and cardiovascular disease, at a lower BMI compared with other populations. Several organizations recommend lower BMI cutoffs for obesity in Asian people (BMI ≥25.0 or ≥27.5 kg/m2 ) instead of the standard ≥30.0 kg/m2 threshold. The risks of obesity and related comorbidities in this population are further influenced by diet, physical activity, perceptions of health, and access to information and therapies. Asian-specific parameters for assessing obesity should become a standard part of clinical practice. Asian American people should equally be offered subgroup-specific tailored interventions owing to heterogeneity of this population. Access to medications and surgery should be improved, in part by updating US indications for therapies to reflect race-specific obesity thresholds and through inclusion of Asian American people of all subtypes with lower BMI values in clinical trials.
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Affiliation(s)
- Zhaoping Li
- Center for Human Nutrition, UCLA, Los Angeles, California, USA
| | | | - Ken Fujioka
- Scripps Clinic Del Mar, San Diego, California, USA
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Effect of Dexmedetomidine Compared to Remifentanil During Bariatric Surgery on Postoperative Nausea and Vomiting: a Retrospective Study. Obes Surg 2022; 32:3368-3374. [PMID: 35976557 DOI: 10.1007/s11695-022-05894-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/31/2021] [Accepted: 01/11/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) occurs frequently after bariatric surgery and is a major cause of adverse outcomes. This retrospective study investigated whether opioid-restricted total intravenous anesthesia using dexmedetomidine as a substitute for remifentanil can reduce PONV in bariatric surgery. MATERIALS AND METHODS The electronic medical records of adult patients who underwent laparoscopic bariatric surgery between January and December 2019 were reviewed. The patients were divided into two groups according to the agents used for anesthesia: Group D, propofol and dexmedetomidine; Group R, propofol and remifentanil. RESULTS A total of 134 patients were included in the analyses. The frequency of postoperative nausea was significantly lower in Group D than that in Group R until 2 h after discharge from the postanesthesia care unit (PACU) (P = 0.005 in the PACU, P = 0.010 at 2 h after PACU discharge) but failed to significantly reduce the overall high incidence rates of 60.5% and 65.5%, respectively (P = 0.592). Postoperative pain score was significantly lower in Group D until 6 h after PACU discharge. The rates of rescue antiemetic and analgesic agent administration in the PACU were significantly lower in Group D than those in Group R. CONCLUSION Opioid-restricted total intravenous anesthesia using dexmedetomidine reduces postoperative nausea, pain score, antiemetic, and analgesic requirements in the immediate postoperative period after bariatric surgery.
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Ohta M, Ahn SM, Seki Y, Yang W, Wong SKH, Udomsawaengsup S, Hamdorf JM, Khaitan M, Kosai NR, Wang W, Lee J, Rudiman R, Wijeratne T, Oliveros E, Wang C, Kasama K. Ten Years of Change in Bariatric/Metabolic Surgery in the Asia-Pacific Region with COVID-19 Pandemic: IFSO-APC National Reports 2021. Obes Surg 2022; 32:2994-3004. [PMID: 35773552 PMCID: PMC9245878 DOI: 10.1007/s11695-022-06182-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022]
Abstract
Background On November 25, 2021, the IFSO-Asia–Pacific Chapter (IFSO-APC) Virtual Meeting 2021 was held online, and the representatives from the Asia–Pacific region presented 10 years of change in bariatric/metabolic surgery and the influence of COVID-19 in the special session of “IFSO-APC National Reports 2010–2020”. We herein report the summarized data. Methods National bariatric/metabolic surgery data, which included the data of 2010 and 2020, were collected from the representatives using a questionnaire that consisted of 10 general questions. At the congress, the data were calculated and summarized. Results Thirteen of the 14 national societies responded to the survey. From 2010 to recent years, the populations of individuals with obesity (BMI ≥ 30 kg/m2) and individuals with diabetes both significantly increased. Eight countries and regions expanded the lower limit of criteria for bariatric surgery by 2–5 kg/m2 (BMI), and 5 countries newly established criteria for metabolic surgery in the last ten years. Sixty-nine percent of the countries currently run public health insurance systems, which doubled from 2010. The number of bariatric surgeons and institutions increased more than threefold from 2010. In 2010, 2019, and 2020, surgeons in IFSO-APC societies performed 18,280, 66,010, and 49,553 bariatric/metabolic surgeries, respectively. Due to the COVID pandemic, restriction policies significantly reduced access to surgery in South and Southeast Asian countries. The biggest changes included increased numbers of bariatric surgeons and institutions, operation numbers, public insurance coverage, raising awareness, and national registry systems. Conclusion For the last 10 years, bariatric/metabolic surgery has rapidly grown in the Asia–Pacific region.
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Affiliation(s)
- Masayuki Ohta
- Research Center for GLOBAL and LOCAL Infectious Diseases, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. .,Departments of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Japan.
| | - Soo Min Ahn
- Department of Pediatric Surgery, Severance Obesity Surgery Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Simon Kin-Hung Wong
- Division of Upper Gastrointestinal & Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Suthep Udomsawaengsup
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jeffrey M Hamdorf
- Clinical Training and Evaluation Centre, Medical School, The University of Western Australia, Crawley, Australia
| | - Manish Khaitan
- Nobesity Bariatric Center, KD Hospital, Ahmedabad, India
| | - Nik Ritza Kosai
- Minimally Invasive Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Weu Wang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - June Lee
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | - Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Thejana Wijeratne
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayawardenepura, Nugegoda, Sri Lanka
| | - Edward Oliveros
- Institute of Surgery, St. Luke's Medical Center, Manila, Philippines
| | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
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11
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Reference Values for Weight Loss During 1 Year After Sleeve Gastrectomy: a Multicenter Retrospective Study in Japan. Obes Surg 2022; 32:2672-2681. [PMID: 35696050 DOI: 10.1007/s11695-022-06125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION This study aimed to provide reference values for the percentage total weight loss during 1 year after laparoscopic sleeve gastrectomy associated with primary response in Japan. METHODS This multicenter retrospective study comprised 248 patients with severe obesity who underwent laparoscopic sleeve gastrectomy at five institutions in Japan. A percentage total weight loss < 20% at 1 year was defined as primary non-response. Parsimonious predictive models were developed based on the results of multiple regression analyses. A receiver operating characteristic curve analysis was used to assess the discriminative performance for primary non-response. RESULTS The median age, initial body mass index, and percentage total weight loss at 1 year were 41 years, 41.4 kg/m2, and 30.1%, respectively. There were 28 (11.3%) primary non-responders. For discriminating primary non-responders, the areas under the receiver operating characteristic curve of the parsimonious model and actual percentage of total weight loss at 3 months after laparoscopic sleeve gastrectomy were 0.846 and 0.803, respectively. Cutoffs for the predicted percentage total weight loss using the model and actual value of percentage total weight loss at 3 months attaining 80% sensitivity were 30% and 22%, and those attaining 98% specificity were 22% and 15%, respectively. CONCLUSIONS Reference values for the percentage total weight loss at 3 months were obtained using the predictive model and actual value of percentage total weight loss at 3 months. Patients at risk for primary non-response can be determined at 3 months with these values, which can help in considering earlier interventions.
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12
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Oh TJ, Lee H, Cho YM. East Asian perspectives in metabolic and bariatric surgery. J Diabetes Investig 2022; 13:756-761. [PMID: 35029061 PMCID: PMC9077716 DOI: 10.1111/jdi.13748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
The prevalence of diabetes and obesity continues to rise in East Asia. As the risk of diabetes increases at a lower body mass index (BMI) in East Asians than in Europeans, the threshold of BMI values for metabolic and bariatric surgery (MBS) is lower in East Asians. MBS is considered upon reaching a BMI of 27.5 kg/m2 and is recommended at a BMI of ≥ 32.5 kg/m2 , depending on the status of glucose homeostasis. The most commonly performed MBS in East Asia is sleeve gastrectomy, followed by Roux-en-Y gastric bypass (RYGB). Because the incidence of gastric cancer is higher in East Asia than in other regions, concerns regarding surveillance for gastric cancer might be related to a preference for sleeve gastrectomy over RYGB in this region. Even though there is a paucity of data on direct comparisons of the efficacy of MBS among different ethnic groups, the degree of weight reduction in East Asians is not inferior to other ethnic groups. Moreover, studies suggest that the diabetes remission rate in East Asians seemed to be higher than in other ethnic groups. Future studies involving multiethnic groups are necessary to identify possible ethnic differences in diabetes remission and to determine the appropriate BMI threshold for MBS according to ethnicity.
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Affiliation(s)
- Tae Jung Oh
- Department of Internal MedicineSeoul National University College of Medicine and Seoul National University Bundang HospitalSeongnamKorea
| | - Hyuk‐Joon Lee
- Department of SurgerySeoul National University HospitalSeoulKorea
| | - Young Min Cho
- Department of Internal MedicineSeoul National University College of Medicine and Seoul National University HospitalSeoulKorea
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13
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Otake R, Seki Y, Kasama K, Yokoyama R, Kurokawa Y, Tani M. Long-term Impact of Laparoscopic Sleeve Gastrectomy on Drug Costs of Japanese Patients with Obesity and Type 2 Diabetes Mellitus. Obes Surg 2022; 32:1831-1841. [PMID: 35362916 DOI: 10.1007/s11695-022-06036-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery in Japan, and it is the only such procedure covered by national health insurance. The long-term cost of bariatric surgery in Japan has not yet been analyzed. We aimed to evaluate the long-term impact of LSG on the drug treatment costs of patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS We retrospectively analyzed data from 230 patients who had undergone LSG at our institution for their obesity and T2DM between 2007 and 2018. The clinicopathological data included age, sex, body mass index (BMI), as well as preoperative and postoperative medications for T2DM, hypertension, and dyslipidemia. We then calculated the drug treatment costs for T2DM, hypertension, and dyslipidemia before and after LSG; and we evaluated the remission rates of these obesity-related diseases. RESULTS The median preoperative body weight and BMI of the 230 patients who underwent LSG were 115 kg and 40.6 kg/m2, respectively. Preoperative drug treatment costs per month per patient for T2DM, hypertension, and dyslipidemia were ¥3795 (¥0-40285), ¥3269 (¥0-14577), and ¥1428 (¥0-19464). Post-operation, the median drug treatment costs for all these diseases became nil. The remission rates of T2DM, hypertension, and dyslipidemia 5 years after LSG were 82.8%, 50%, and 43.8%, respectively. In Japan, the cost of an LSG operation corresponds to 4.75 years of median drug costs to treat T2DM and hypertension. CONCLUSION In the long term, LSG in Japan is effective both physically and cost-wise for patients with obesity and T2DM.
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Affiliation(s)
- Reiko Otake
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.,Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Renzo Yokoyama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Department of Surgery, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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14
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Najah H, Duffillot C, Gronnier C, Lescarret B, Saubusse E, Collet D, Gatta-Cherifi B, Montsaingeon-Henry M. Guideline compliance in bariatric surgery: a French nationwide study. Surg Obes Relat Dis 2021; 18:620-627. [PMID: 35065888 DOI: 10.1016/j.soard.2021.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/30/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Strict adherence to guidelines with a comprehensive preoperative assessment and rigorous follow-up are essential to improve postoperative and long-term outcomes of bariatric surgery (BS). OBJECTIVES To investigate the trends in BS in France and to assess the compliance to guidelines in people with obesity before and after BS. SETTING University Hospital of Bordeaux, France. METHODS Data on patients who were admitted for a primary BS procedure in France between January 1 and April 1, 2014, were extracted from the French national health insurance system database. Data on patients' characteristics, preoperative assessment, hospitalization, and postoperative follow-up, including medical consultations, laboratory tests, and drug consumption, during the year preceding and the 2 years after BS were collected. RESULTS Most of the 11,824 patients (60.4%) had sleeve gastrectomy. Rates of reimbursement for preoperative consultations with general practitioners, digestive surgeons, and endocrinologists or internists were 94.5%, 89.2%, and 63%, respectively. Laboratory tests for nutritional and obesity-related co-morbidity evaluations were performed in 94.3% and 91.4%, respectively. Rates of consultation with general practitioners, digestive surgeons, and endocrinologists or internists dropped from 93.1%, 91.2%, and 29.2%, respectively, the first year to 88.4%, 50.3%, and 20%, respectively, the second year after BS (P < .001). Reimbursements for vitamin, iron, and calcium supplementation dropped from 66.6%, 24.9%, and 21%, respectively, the first year to 52.1%, 19.3%, and 11.7%, respectively, the second year after BS (P < .001). CONCLUSION Overall compliance with guidelines is improving. While preoperative medical assessment is nearly optimal, efforts still should be made in order to improve long-term follow-up in general and patient adherence to micronutrient supplementation in particular.
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Affiliation(s)
- Haythem Najah
- Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
| | - Coralie Duffillot
- Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | | | | | - Denis Collet
- Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Blandine Gatta-Cherifi
- Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
| | - Maud Montsaingeon-Henry
- Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France
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15
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Asokkumar R, Lim CH, Tan AS, Lee PC, Eng A, Tan J, Lopez-Nava G, Ganguly S, Chang J, Khor C. Safety and early efficacy of endoscopic sleeve gastroplasty (ESG) for obesity in a multi-ethnic Asian population in Singapore. JGH Open 2021; 5:1351-1356. [PMID: 34950778 PMCID: PMC8674547 DOI: 10.1002/jgh3.12680] [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: 10/06/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/06/2022]
Abstract
Background and Aim Endoscopic sleeve gastroplasty (ESG) is an alternative nonsurgical treatment option for obesity. However, most studies on the utility and efficacy of ESG are derived from the Western population. It is unknown if ESG elicits similar results in Asians with different fat distribution, sociocultural customs, and dietary practices. Our study aims to assess the safety and efficacy of ESG among a multi-ethnic Asian population. Methods We reviewed 35 patient records who underwent primary ESG for obesity at our unit. We followed a U-shaped suture pattern. Our primary outcome was to assess technical feasibility and safety. The secondary outcome was to determine the percentage total body weight loss (TBWL) at the last follow-up. Results The mean ± SD age and body mass index were 43.6 ± 11.3 years and 34 ± 4.9 kg/m2, respectively. The majority were female (57%) and of Chinese ethnicity (51%). The procedure was technically successful in all patients. We used an average of five sutures (range, 4-7), and the mean ± SD procedure time was 65 ± 10 min. No major complications occurred, and the average length of stay was 1 day. Twenty-one patients completed 3 months of follow-up, and 10 patients 6 months. The mean ± SD TBWL at 3 and 6 months were 14.5 ± 4.8% and 16.2 ± 4.9%, respectively. We observed improvement in diabetes mellitus (87%), fatty liver (86%), and hypertension (58%) during the follow-up. Conclusion ESG is a safe and effective option for promoting weight loss in a multi-ethnic Asian population. ESG-induced weight loss may improve obesity-related comorbidities.
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Affiliation(s)
- Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology Singapore General Hospital Singapore Singapore.,Duke-NUS Graduate Medical School Singapore Singapore
| | - Chin Hong Lim
- Duke-NUS Graduate Medical School Singapore Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery Singapore General Hospital Singapore Singapore
| | - Ai Shan Tan
- Department of Nutrition and Dietetics Singapore General Hospital Singapore Singapore
| | - Phong Ching Lee
- Duke-NUS Graduate Medical School Singapore Singapore.,Department of Endocrinology Singapore General Hospital Singapore Singapore
| | - Alvin Eng
- Duke-NUS Graduate Medical School Singapore Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery Singapore General Hospital Singapore Singapore
| | - Jeremy Tan
- Duke-NUS Graduate Medical School Singapore Singapore.,Department of Upper Gastrointestinal and Bariatric Surgery Singapore General Hospital Singapore Singapore
| | | | - Sonali Ganguly
- Duke-NUS Graduate Medical School Singapore Singapore.,Department of Endocrinology Singapore General Hospital Singapore Singapore
| | - Jason Chang
- Department of Gastroenterology and Hepatology Singapore General Hospital Singapore Singapore.,Duke-NUS Graduate Medical School Singapore Singapore
| | - Christopher Khor
- Department of Gastroenterology and Hepatology Singapore General Hospital Singapore Singapore.,Duke-NUS Graduate Medical School Singapore Singapore
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16
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Yap RV, Eleazar PJ, Roble Ii VM, Rosello DE. Bariatric Surgery in Cebu, Philippines: Current Status and Initial Experience With Laparoscopic Sleeve Gastrectomy. Cureus 2021; 13:e18953. [PMID: 34815899 PMCID: PMC8605933 DOI: 10.7759/cureus.18953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background The prevalence of obesity in the Philippines has increased more than three-fold over the last two decades. However, bariatric surgery has not been widely adopted yet in the country. Local data mainly on laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (RYGB) are limited as well. We report for the first time our experience with laparoscopic sleeve gastrectomy (LSG) and present the current local status of bariatric surgery in Cebu, Philippines. Patients and methods This is a retrospective study of all patients 18 years old and above who underwent LSG in a single, private, tertiary institution during the period 2009 - 2019. Our primary endpoint was weight loss after LSG. Secondary endpoint was postoperative complications. Results Thirty-three patients (mean age 40.9 ± 14.5 years) underwent LSG. Baseline weight and BMI were 112.6 ± 29 kg and 41.3 ± 8.6, respectively. The mean operative duration was 201 ± 72.9 minutes. The were no open conversions with minimal morbidity. Mean hospital stay was 3.7 ± 0.9 days. The postoperative mean weight and BMI after one year were 68.9 ± 17 kg and 26.6 ± 6, respectively. Overall, mean excess weight loss (EWL) was 61.9 ± 44.1 % at a median follow-up of 5.4 months. Significant weight loss was noted after the third month. Conclusion LSG is a safe and effective method in producing weight loss. It can be a definitive treatment option as local prevalence of obesity is increasing in the Philippines. However, access to and the practice of bariatric surgery remains limited in the country. A collaboration among private and government stakeholders is essential.
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Affiliation(s)
- Ralph Victor Yap
- Department of Surgery, Cebu Doctors' University Hospital, Cebu, PHL
| | | | - Vincent Matthew Roble Ii
- Department of Surgery, Section of Minimally Invasive Surgery, Cebu Doctors' University Hospital, Cebu, PHL
| | - Don Edward Rosello
- Department of Surgery, Section of Minimally Invasive Surgery, Cebu Doctors' University Hospital, Cebu, PHL
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17
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Yamaguchi T, Tanaka S, Ishihara N, Saiki A, Tatsuno I. A Survey of Bariatric/Metabolic Surgery as a Treatment Option for Patients with Severe Obesity and Type 2 Diabetes in Japan. Obes Surg 2021; 32:926-929. [PMID: 34687409 DOI: 10.1007/s11695-021-05762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Takashi Yamaguchi
- Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan.
| | - Sho Tanaka
- Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan
| | - Noriko Ishihara
- Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrinology and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura City, Chiba, 285-8741, Japan.,Chiba Prefecture University of Health Sciences, 2-10-1, Wakaba, Mihama-ku, Chiba City, 261-0014, Japan
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18
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Yap RV, Eleazar PJ, Roble II VM, Rosello DE. Bariatric Surgery in Cebu, Philippines: Current Status and Initial Experience With Laparoscopic Sleeve Gastrectomy. Cureus 2021. [DOI: https:/doi.org/10.7759/cureus.18953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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19
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Jabbour J, Awada D, Naim N, Al-Jawaldeh A, Haidar Ahmad H, Mortada H, Hoteit M. Impact of Bariatric Surgery on the Healthy Eating Index, Binge Eating Behavior and Food Craving in a Middle Eastern Population: A Lebanese Experience. Healthcare (Basel) 2021; 9:healthcare9111416. [PMID: 34828462 PMCID: PMC8621850 DOI: 10.3390/healthcare9111416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022] Open
Abstract
Even though bariatric surgeries (BS) are on the rise in Lebanon and the Middle East, the changes in diet quality, binge eating, and food cravings in this region are poorly studied peri-operatively. This cross-sectional study aimed to assess binge eating behaviors, food craving and the Healthy Eating Index (HEI) in Lebanese patients who underwent BS in a duration that exceeds 6 months. Evaluation included a dietary assessment of usual diet preoperatively and postoperatively. It included the collection of information on sociodemographic, anthropometric and surgical variables, as well as the administration of dietary recalls and questionnaires to calculate the HEI score, the Binge Eating Scale (BES) and the Food Craving Inventory (FCI). Participants (n = 60) were mostly females (85%) who had undergone sleeve gastrectomy (90%), with a mean duration since BS of 2.4 ± 1.8 years. Despite improvements in their HEI scores, 97% of the participants remained in the worst category. The frequency of participants in the severe BES category dropped markedly postoperatively from 78% to 5% (p < 0.01). Food craving followed a similar trend, with scores dropping from 50 ± 36 pre-surgery to 30 ± 25 post surgery (p < 0.01). Weight regain, prevalent among 40% of participants, was predicted by BES. Despite the improvement in BES and FCI, HEI improvement remained shy. Future interventions should validate findings in other countries and assess means for optimizing HEI scores among BS patients in the Middle East region.
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Affiliation(s)
- Jana Jabbour
- Nutrition Department, School of Health Sciences, Modern University for Business and Sciences, Beirut 6573, Lebanon;
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
| | - Dalia Awada
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
| | - Nour Naim
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
| | - Ayoub Al-Jawaldeh
- Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon; (D.A.); (N.N.)
| | - Houssein Haidar Ahmad
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt;
| | - Hussein Mortada
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Faculty of Science, Lebanese University, Zahle 6573, Lebanon
- Correspondence: (H.M.); (M.H.)
| | - Maha Hoteit
- PHENOL Research Group (Public Health Nutrition Program-Lebanon), Faculty of Public Health, Lebanese University, Beirut 6573, Lebanon
- Faculty of Science, Lebanese University, Zahle 6573, Lebanon
- Correspondence: (H.M.); (M.H.)
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20
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Yap RV, Eleazar PJ, Roble II VM, Rosello DE. Bariatric Surgery in Cebu, Philippines: Current Status and Initial Experience With Laparoscopic Sleeve Gastrectomy. Cureus 2021. [DOI: https://doi.org/10.7759/cureus.18953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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21
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Chang PC, Chen KH, Jhou HJ, Chen PH, Huang CK, Lee CH, Chang TW. Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis. Sci Rep 2021; 11:15217. [PMID: 34312476 PMCID: PMC8313581 DOI: 10.1038/s41598-021-94716-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022] Open
Abstract
The standard size of bougie for laparoscopic sleeve gastrectomy (LSG) is not yet established. Therefore, a systematic review and network meta-analysis were conducted to assess the weight loss effects and associated complications of LSG for patients with morbid obesity, based on different bougie sizes. A total of 15 studies were reviewed in this systemic review and network meta-analysis (2,848 participants), including RCTs and retrospective studies in PubMed, and Embase until September 1, 2020. The effectiveness of different bougie calibration sizes was assessed based on excess weight loss (EWL), total complications, and staple line leak. Within this network meta-analysis, S-sized (≤ 32 Fr.) and M-sized (33–36 Fr.) bougies had similar effects and were associated with the highest EWL improvement among all different bougie sizes (S-sized: standardized mean difference [SMD], 10.52; 95% confidence interval [CI] − 5.59 to − 26.63, surface under the cumulative ranking curve [SUCRA], 0.78; and M-sized: SMD, 10.16; 95% CI − 3.04–23.37; SUCRA, 0.75). M-sized bougie was associated with the lowest incidence of total complications (M-sized: odds ratio, 0.43; 95% CI, 0.16–1.11; SUCRA, 0.92). Based on our network meta-analysis, using M-sized bougie (33–36 Fr.) is an optimal choice to balance the effectiveness and perioperative safety of LSG in the clinical practice.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Chih-Kun Huang
- Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Taichung City, Taiwan
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung City, 80756, Taiwan.
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22
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Inocian EP, Nolfi DA, Felicilda-Reynaldo RFD, Bodrick MM, Aldohayan A, Kalarchian MA. Bariatric surgery in the Middle East and North Africa: narrative review with focus on culture-specific considerations. Surg Obes Relat Dis 2021; 17:1933-1941. [PMID: 34332910 DOI: 10.1016/j.soard.2021.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 12/26/2022]
Abstract
There is an increasing volume of bariatric surgeries in the Middle East and North Africa (MENA), but the context of bariatric surgery in the region is not fully understood. Incorporating culture-specific considerations in the provision of care to patients who undergo bariatric surgery may help to optimize outcomes after surgery. We conducted a narrative review of published research studies on bariatric surgery in the MENA region, highlighting cultural and contextual aspects relevant to the care of bariatric surgery patients who undergo surgery in this geographic area. The authors searched the following online databases: PubMed, CINAHL, Embase, and Academic Search Elite from 2010-2020 for studies conducted in 18 countries in the MENA region. This narrative review identifies cultural-specific considerations that may affect bariatric care and outcomes in 6 domains: knowledge of bariatric surgery; mental health, body image, and quality of life; influence of family; religion and lifestyle; preoperative practices; and healthcare access. Provision of culturally congruent care may help patients to achieve the best possible outcomes after bariatric surgery. Results may inform efforts to provide safe and culture-specific care in the MENA region, as well as those who migrate or seek care in other countries. More research is warranted on this heterogeneous population to optimize postsurgery weight trajectory and psychosocial adjustment.
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Affiliation(s)
- Ergie P Inocian
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania.
| | - David A Nolfi
- Gumberg Library, Duquesne University, Pittsburgh, Pennsylvania
| | | | - Mustafa M Bodrick
- Health Academy, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Abdullah Aldohayan
- Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Ohta M, Endo Y, Fujinaga A, Kawasaki T, Watanabe K, Matsuda T, Nakanuma H, Kawamura M, Hirashita T, Masaki T, Inomata M. Predictors of early withdrawal from follow-up visits after laparoscopic sleeve gastrectomy in a Japanese institution. Surg Today 2021; 52:46-51. [PMID: 34101018 DOI: 10.1007/s00595-021-02318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative weight loss is related to postoperative adherence to follow-up after bariatric/metabolic surgery, but many patients stop attending follow-up visits early. The aim of this study was to clarify predictors of early withdrawal from follow-up after laparoscopic sleeve gastrectomy (LSG) in a Japanese institution. METHODS One hundred and fifty-three patients who underwent LSG were retrospectively included in this study. Multivariate analysis was performed to evaluate independent predictors of withdrawal from follow-up visits within 12 months after LSG among significant or nearly significant factors in the univariate analyses. The discrimination power of significant factors was estimated using area under the receiver operating characteristic curve (AUC). RESULTS Within 12 months after LSG, 25 of the 153 patients withdrew from follow-up visits. The multivariate analysis showed that age was the only significant predictor of withdrawal. The AUC for age was 0.685, and the cut-off value was < 40 years. The younger patients (< 40 years old) had a significantly higher rate of withdrawal compared with the older patients (≥ 40 years) (27.0% vs. 8.9%). CONCLUSION Older Japanese patients (≥ 40 years old) may be better candidates for LSG. We consider it significant to continue to emphasize the importance of follow-up visits in younger patients after LSG.
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Affiliation(s)
- Masayuki Ohta
- Global Oita Medical Advanced Research Center for Health, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan. .,Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kiminori Watanabe
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takashi Matsuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroaki Nakanuma
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Zeng Q, Li N, Pan XF, Chen L, Pan A. Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol 2021; 9:393-405. [PMID: 34022157 DOI: 10.1016/s2213-8587(21)00047-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 02/03/2021] [Accepted: 02/12/2021] [Indexed: 02/08/2023]
Abstract
China has one of the largest populations with obesity in the world, and obesity has become a major challenge for the country's health-care system. Current guidelines for obesity management are not adequately supported by evidence from clinical studies in Chinese populations. Effective lifestyle interventions suitable for Chinese populations are scarce, insufficient weight-loss medications have been approved by regulatory bodies, and there is low acceptance of non-lifestyle interventions (ie, medications and surgery) among both health-care providers and the general public. Large, well designed, and well implemented clinical trials are needed to strengthen the evidence base for the clinical management of obesity in China. Obesity management can be improved through use of a tiered system involving health management centres, integrated lifestyle interventions and medical treatments, strengthened obesity education and training, and use of advanced electronic health technologies. Resource mobilisation, support from major stakeholders for people with overweight or obesity, and education and changes to social norms among the wider public are also needed. National health policies should prioritise both obesity prevention and improvement of the treatment and management of obesity.
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Affiliation(s)
- Qiang Zeng
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Naishi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of the National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiong-Fei Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China.
| | - An Pan
- Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Port-sharing techniques for laparoscopic cholecystectomy and sleeve gastrectomy. Surg Today 2021; 51:1996-1999. [PMID: 34009434 DOI: 10.1007/s00595-021-02304-7] [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: 01/27/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
In Japan, the number of bariatric surgeries performed has remained low. Thus, concomitant laparoscopic cholecystectomy (LC) with laparoscopic sleeve gastrectomy (LSG) is still relatively uncommon, but is increasing. We developed new port-sharing techniques for LC and LSG, which we performed on 26 obese Japanese patients with gall bladder (GB) diseases, using the LSG trocar arrangement and one additional trocar. We performed LC first, and after exchanging a port for a liver retractor in the epigastrium, we then completed LSG. One patient with an anomalous extrahepatic bile duct required one additional port. The mean LC time was 55 min, and the transition to LSG just after LC was smooth in all the patients. One patient suffered postoperative intraperitoneal hemorrhage, which was managed conservatively. Concomitant LC with LSG using port-sharing techniques is feasible and safe for obese Japanese patients with GB diseases.
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26
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Predictive scoring system for advanced liver fibrosis in Japanese patients with severe obesity. Surg Today 2021; 51:1513-1520. [PMID: 33829335 DOI: 10.1007/s00595-021-02266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to examine the predictive scoring system of advanced liver fibrosis in severely obese Japanese patients. METHODS Seventy-two patients underwent laparoscopic sleeve gastrectomy and intraoperative liver biopsies. We classified these patients into two groups: Brunt stage ≥ 2 (advanced fibrosis) and 0/1 (none/mild fibrosis). A logistic regression analysis was performed to identify the predictors of advanced fibrosis. RESULTS Sixteen patients had advanced fibrosis, while 56 had no/mild fibrosis. The prevalence of type 2 diabetes mellitus (T2DM) in advanced fibrosis group was significantly higher than in none/mild fibrosis. An univariate analysis of the factors predicting advanced fibrosis showed significant differences in AST/ALT ratio, serum insulin levels, HOMA-IR, and type IV collagen 7S in the T2DM group. According to a multivariate analysis, type IV collagen 7S was an independent predictor and the cutoff value was 5.6 ng/mL. We created a flow chart; high risk (T2DM and type IV collagen 7S ≥ 5.6 ng/mL), moderate risk (T2DM and type IV collagen 7S < 5.6 ng/mL), and low risk (non-DM). For those at high risk, the sensitivity, specificity, positive predictive value, and negative predictive value were 56.2%, 94.4%, 75.0%, and 87.9%, respectively. CONCLUSION This classification system has the potential to accurately categorize the risk of liver fibrosis.
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Ohta M, Kasama K, Sasaki A, Naitoh T, Seki Y, Inamine S, Oshiro T, Doki Y, Seto Y, Hayashi H, Uyama I, Takiguchi S, Kojima K, Mori T, Inomata M, Kitagawa Y, Kitano S. Current status of laparoscopic bariatric/metabolic surgery in Japan: The sixth nationwide survey by the Japan Consortium of Obesity and Metabolic Surgery. Asian J Endosc Surg 2021; 14:170-177. [PMID: 32696619 PMCID: PMC8048478 DOI: 10.1111/ases.12836] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/30/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Laparoscopic bariatric procedures have been performed in Japan since 2000. Laparoscopic sleeve gastrectomy (LSG) has been fully covered by National Health Insurance since 2014, and it has been increasingly performed recently. The Japan Consortium of Obesity and Metabolic Surgery conducts a nationwide survey on laparoscopic bariatric/metabolic surgery every 2 years. METHODS The survey was sent by post or email to 97 Japanese institutions in January 2020. RESULTS From 2000 to 2019, a total of 3669 laparoscopic bariatric/metabolic procedures were performed in 64 institutions. The most popular procedure was LSG (n = 2866), followed by LSG with duodenojejunal bypass (LSG-DJB, n = 337) and laparoscopic Roux-en-Y gastric bypass (LRYGB, n = 280). Morbidity and reoperation rates were, respectively, 29.8% and 11.8% for LRYGB, 16.8% and 2.8% for LSG, and 13.6% and 6.6% for LSG-DJB. At 5 years after the procedures, the percentage of excess weight loss was 78% for LRYGB, 66% for LSG, and 80% for LSG-DJB. CONCLUSION This nationwide survey clearly showed that laparoscopic bariatric/metabolic surgery has been safely and effectively performed for 20 years in Japan.
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Affiliation(s)
- Masayuki Ohta
- Global Oita Medical Advanced Research Center for HealthOita UniversityYufuJapan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Akira Sasaki
- Department of SurgeryIwate Medical University School of MedicineMoriokaJapan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Susumu Inamine
- Department of SurgeryOhama Dai‐ichi HospitalOkinawaJapan
| | - Takashi Oshiro
- Department of SurgeryToho University Sakura Medical CenterSakuraJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yasuyuki Seto
- Department of Gastrointestinal SurgeryUniversity of TokyoTokyoJapan
| | - Hideki Hayashi
- Department of Frontier SurgeryChiba University Graduate School of MedicineChibaJapan
| | - Ichiro Uyama
- Department of SurgeryFujita Health University School of MedicineToyoakeJapan
| | - Shuji Takiguchi
- Department of Gastroenterological SurgeryNagoya City UniversityNagoyaJapan
| | - Kazuyuki Kojima
- First Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Toshiyuki Mori
- Department of SurgeryKyorin University School of MedicineMitakaJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineTokyoJapan
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Saiki A, Yamaguchi T, Sasaki A, Naitoh T, Matsubara H, Yokote K, Okazumi S, Ugi S, Yamamoto H, Ohta M, Ishigaki Y, Kasama K, Seki Y, Tsujino M, Shirai K, Miyazaki Y, Masaki T, Nagayama D, Tatsuno I. Background characteristics and diabetes remission after laparoscopic sleeve gastrectomy in Japanese patients with type 2 diabetes stratified by BMI: subgroup analysis of J-SMART. Diabetol Int 2021; 12:303-312. [PMID: 34150439 DOI: 10.1007/s13340-020-00487-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023]
Abstract
Aim The J-SMART study was the first national survey of Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We performed a subgroup analysis of J-SMART focusing on the differences in patient background and diabetes remission between patients with BMI 32-34.9 kg/m2 and those with higher BMI. Methods In this multi-institutional retrospective study at 10 certified bariatric institutions, 203 Japanese with type 2 diabetes (T2D) and BMI of 32 kg/m2 or higher were analyzed (mean age: 49.2 years, BMI: 43.8 kg/m2, HbA1c: 7.6%). Patients were stratified into five groups according to preoperative BMI. Results Background characteristics in BMI 32.0-34.9 group were higher adjusted HbA1c, higher visceral/subcutaneous fat area ratio, higher prevalence of diabetic retinopathy, higher frequency of insulin use and lower serum C-peptide. Although 2-year percent total weight loss (21.7%) and diabetes complete remission (CR) rate (52.4%) were lower in BMI 32.0-34.9 group, diabetes improvement rate was 81.0%, and the decrease in HbA1c and number of antidiabetic drugs were comparable or greater than those with higher BMI. Higher BMI and no insulin use were significant independent predictors of diabetes CR. No significant independent predictor was identified for diabetes improvement. Conclusion The patients with 32-34.9 kg/m2 were characterized by more severe visceral obesity, T2D and the complications, and lower intrinsic insulin secretion capacity. LSG should be considered as a treatment option for patients with BMI 32-34.9 kg/m2, to improve diabetes control.
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Affiliation(s)
- Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura-City, Chiba 285-8741 Japan
| | - Takashi Yamaguchi
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura-City, Chiba 285-8741 Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Haematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, Chiba, Japan
| | - Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | | | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Motoyoshi Tsujino
- Department of Endocrinology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kohji Shirai
- Department of Internal Medicine, Mihama Hospital, Chiba, Japan
| | | | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Daiji Nagayama
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura-City, Chiba 285-8741 Japan.,Nagayama Clinic, Tochigi, Japan
| | - Ichiro Tatsuno
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura-City, Chiba 285-8741 Japan
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Meng W, Peng R, Du L, Zheng Y, Liu D, Qu S, Xu Y, Zhang Y. Weight Loss After Laparoscopic Sleeve Gastrectomy Ameliorates the Cardiac Remodeling in Obese Chinese. Front Endocrinol (Lausanne) 2021; 12:799537. [PMID: 35126313 PMCID: PMC8815081 DOI: 10.3389/fendo.2021.799537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the impact of weight loss after laparoscopic sleeve gastrectomy (LSG) on cardiac structural and functional remodeling in obese Chinese. A total of 44 obese participants were enrolled consecutively. The physical, laboratory, electrocardiographic, and echocardiographic parameters of pre-and postoperative were recorded. The average follow-up time was 12.28 ± 5.80 months. The body mass index (BMI) of the patients with obesity was decreased from 41.6 ± 7.44 to 30.3 ± 5.73kg/m2 (P<0.001) after LSG. The systolic and diastolic blood pressure of the subjects was significantly reduced from 137.9 ± 15.7mmHg to 123.0 ± 16.0 and 83.4 ± 10.8 to 71.3 ± 11.7mmHg (P<0.001), respectively. The levels of fasting insulin and fasting blood glucose were significantly decreased (38.8 ± 32.1 to 8.43 ± 4.16 mU/L, P<0.001; 6.95 ± 2.59 to 4.64 ± 0.50mmol/L, P<0.001). Total cholesterol (TC, 4.66 ± 0.84 to 4.23 ± 0.75mmol/L, P<0.001) and triglyceride (TG, 1.92 ± 1.21 to 0.85 ± 0.30mmol/L, P<0.001) decreased significantly. Cardiovascular geometric parameters including aortic sinus diameter (ASD, 32.9 ± 2.83mm to 32.0 ± 3.10mm, P<0.05), left atrial diameter (LAD, 38.8 ± 4.03 to 36.2 ± 4.12mm, P<0.001), and interventricular septum thickness(IVS, 10.2 ± 0.93 to 9.64 ± 0.89mm, P<0.001) were significantly reduced. The ratio of weight loss (RWL) was positively correlated with the changes of LAD. The change of IVS was negatively correlated with the change of fasting blood glucose (GLU). Weight loss after LSG could effectively improve cardiac structural, but not functional, abnormality in obese Chinese.
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Affiliation(s)
- Weilun Meng
- Department of Cardiology, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
| | - Ronggang Peng
- Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Lei Du
- Department of Metabolic Surgery, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Yixing Zheng
- Department of Cardiology, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
| | - Diya Liu
- Department of Thyroid and Breast Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
- *Correspondence: Yawei Xu, ; Yi Zhang,
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Yawei Xu, ; Yi Zhang,
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Zaghloul H, Chagoury O, Elhadad S, Hayder Ahmed S, Suleiman N, Al Naama A, El Nahas K, Al Hamaq A, Charlson M, Wells MT, Al Abdulla S, Abou-Samra AB, Taheri S. Clinical and metabolic characteristics of the Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I) randomised clinical trial cohort. BMJ Open 2020; 10:e041386. [PMID: 33293319 PMCID: PMC7722827 DOI: 10.1136/bmjopen-2020-041386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Diabetes Intervention Accentuating Diet and Enhancing Metabolism-I (DIADEM-I) is the first randomised controlled trial (RCT) in the Middle East and North Africa (MENA) region testing the effectiveness of an intensive lifestyle intervention (ILI) for weight loss and diabetes remission. We report on the recruitment process and baseline characteristics of the DIADEM-I cohort based on origin (Middle East vs North Africa), and waist circumference. DESIGN DIADEM-I is an open-label randomised, controlled, parallel group RCT recruiting young individuals (18-50 years) with early type 2 diabetes (≤3 years since diagnosis) originating from MENA. Individuals from primary care were randomised to usual medical care or ILI (total dietary replacement phase using meal replacement products, followed by staged food reintroduction and physical activity support). The primary outcome is weight loss at 12 months. Other outcomes are glycaemic control and diabetes remission. SETTING Primary care, Qatar. PARTICIPANTS 147 (73% men) randomised within DIADEM-I who were included in the final trial data analysis. OUTCOME MEASURES Recruitment metrics, and baseline clinical and metabolic characteristics. RESULTS Of 1498 people prescreened, 267 (18%) were invited for screening and 209 (78%) consented. 173 (83%) were eligible. 15 (7%) withdrew before randomisation and the remaining 158 were randomised. Mean age was 42.1 (SD 5.6) years and mean body mass index was: 36.3 (5.5) kg/m2 (women) and 34.4 (5.4) kg/m2 (men). Mean diabetes duration was 1.8 (1.0) years and mean glycosylated haemoglobin (HbA1c) was 7.0% (1.30) (52.5 mmol/mol (SD 14.3)). Participants originated from 13 countries. Those from North Africa reported greater physical activity and had lower family history of diabetes. 90% of subjects were taking diabetes medications and 31% antihypertensives. Those with greater waist circumference had significantly higher insulin resistance and lower quality of life. CONCLUSION Recruitment of participants originating from the MENA region into the RCT was successful, and study participation was readily accepted. While DIADEM-I participants originated from 13 countries, there were few baseline differences amongst participants from Middle East versus North Africa, supporting generalisability of RCT results. TRIAL REGISTRATION NUMBER ISRCTN20754766; NCT03225339.
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Affiliation(s)
- Hadeel Zaghloul
- Department of Medicine, Weill Cornell Medicine Qatar, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
| | - Odette Chagoury
- Department of Medicine, Weill Cornell Medicine Qatar, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- National Obesity Treatment Center, Hamad Medical Corporation, Doha, Qatar
| | - Sara Elhadad
- Department of Medicine, Weill Cornell Medicine Qatar, Doha, Qatar
| | | | - Noor Suleiman
- Department of Medicine, Weill Cornell Medicine Qatar, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- National Obesity Treatment Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Katie El Nahas
- Qatar Diabetes Association, Qatar Foundation, Doha, Qatar
| | | | - Mary Charlson
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
| | - Martin T Wells
- Department of Statistics and Data Science, Cornell University, Ithaca, United States
| | | | - Abdul Badi Abou-Samra
- Department of Medicine, Weill Cornell Medicine Qatar, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medicine Qatar, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine New York, New York, United States
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
- National Obesity Treatment Center, Hamad Medical Corporation, Doha, Qatar
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31
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Oshiro T, Kasama K, Nabekura T, Sato Y, Kitahara T, Matsunaga R, Arai M, Kadoya K, Nagashima M, Okazumi S. Current Status and Issues Associated with Bariatric and Metabolic Surgeries in Japan. Obes Surg 2020; 31:343-349. [PMID: 33170443 PMCID: PMC7808999 DOI: 10.1007/s11695-020-05056-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
Among Asian countries, laparotomic and laparoscopic bariatric surgeries were introduced in Japan after its establishment in Taiwan. However, despite high prevalence of potential patients with obesity and diabetes, the wider incorporation of surgery into treatment regimen has been stalling for decades in Japan. While the unique Japanese national health insurance system has guaranteed fair healthcare delivery, it might have worked as a barrier to the development of bariatric and metabolic surgeries (BMS). The present article reviews the status of BMS in Japan and discusses recent issues related to its use. To focus on and identify the major obstacles inhibiting the widespread use of BMS, we have comprehensively covered some major areas including the insurance system, surgical indication, accreditation and training system, original research, and national registry.
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Affiliation(s)
- Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan.
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Yu Sato
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Tomoaki Kitahara
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Rie Matsunaga
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Motoaki Arai
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Kengo Kadoya
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Makoto Nagashima
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
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Almalki OM, Soong TC, Lee WJ, Chen JC, Wu CC, Lee YC. Variation in Small Bowel Length and Its Influence on the Outcomes of Sleeve Gastrectomy. Obes Surg 2020; 31:36-42. [PMID: 32914323 DOI: 10.1007/s11695-020-04958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Small bowel length is drawing attention in the development of gastrointestinal bariatric/metabolic surgery, but the importance of the length of the small bowel in bariatric/metabolic is not clear. The present study was conducted to investigate variations in small bowel length and their clinical significance in patients undergoing laparoscopic sleeve gastrectomy (LSG). MATERIALS AND METHODS Small bowel length was measured in 620 patients diagnosed with obesity who underwent LSG between March 2014 and August 2018. Prospectively obtained demographic and clinical data were investigated, focusing on the association between small bowel length and weight loss. RESULTS Small bowel length varied widely among patients (mean 739.8 + 115.7 cm, range 380-1050 cm). Linear regression analysis revealed a significant association between small bowel length and body height, body weight, waist circumference, and serum levels of low-density lipoprotein cholesterol, hemoglobin, C-peptide, glycated hemoglobin (A1C), and gamma-glutamyl transferase (r-GT). Multivariate analysis confirmed that body height and serum A1C% levels independently predicted small bowel length in bariatric patients, strongly with body height (p < 0.001) but weakly with A1C%(p = 0.021). One-year follow-up rate was 75.3% (467/620), and small bowel length did not influence weight loss or the reduction of obesity related cardiovascular risk factors after LSG. CONCLUSION In this study, small bowel length varied widely among bariatric patients and was strongly associated with body height and weakly with serum A1C levels. Small bowel length has no significant role in weight loss or the resolution of cardiovascular risk factors after LSG.
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Affiliation(s)
- Owaid M Almalki
- Department of Surgery, College of Medicine, Taif University, Ta'if, Saudi Arabia.,Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Tien-Chou Soong
- Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan.,Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan.,College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan.
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Chun-Chi Wu
- Department of Surgery, Min-Sheng General Hospital, No. 168, Ching Kuo Road, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University, Taoyuan, Taiwan
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Moderate-Intensity Exercise and Musical Co-Treatment Decreased the Circulating Level of Betatrophin. Int J Endocrinol 2020. [DOI: 10.1155/2020/3098261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction. In general, the significant contribution of lack of physical activity is strongly correlated with lipid metabolism and metabolic disorder. Hitherto, betatrophin is a potential hormone that regulates the lipid profile in the body circulation-associated triglyceride level. This study was designed to evaluate the alteration of betatrophin levels in subject-onset hypertriglyceridemia with exercise intervention co-treated with music. Materials and Methods. A total of 60 nonprofessional athletes were enrolled in this study and given moderate-intensity exercise (MIE) combined with middle rhythm musical co-treatment. The ELISA method was applied to quantify the serum level of betatrophin in all samples. The statistical analysis was performed by applying the Kolmogorov–Smirnov normality test, one-way ANOVA, and parametric linear correlation and regression. Results. Interestingly, our data show that MIE decreased the circulating level of betatrophin combined with music (12.47 ± 0.40 ng/mL) compared with that without musical co-treatment (20.81 ± 1.16 ng/mL) and high-intensity exercise (26.91 ± 2.23 ng/mL). The plasma level of betatrophin was positively correlated with triglycerides (r = 0.316, p≤0.05), systolic blood pressure (r = 0.428, p≤0.01), HDL (r = 0.366, p≤0.05), energy expenditure (r = 0.586, p≤0.001), PGC-1α (r = 0.573, p≤0.001), and irisin (r = 0.863, p≤0.001). By contrast, the plasma level of betatrophin was negatively associated with age (r = −0.298, p≤0.05) and LDL cholesterol (r = −0.372, p≤0.05). Importantly, betatrophin is a significant predictor for energy expenditure (p≤0.001) and plasma triglyceride levels (p≤0.05). Conclusions. Our data demonstrate that betatrophin levels decreased the post-MIE and musical therapeutical combination. Therefore, betatrophin may provide a benefit as the potential biomarker of physiological performance-associated physical training.
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Five-Year Outcomes of Laparoscopic Sleeve Gastrectomy in Japanese Patients with Class I Obesity. Obes Surg 2020; 30:4366-4374. [DOI: 10.1007/s11695-020-04789-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Amiki M, Seki Y, Kasama K, Pachimatla S, Kitagawa M, Umezawa A, Kurokawa Y. Reduced-Port Sleeve Gastrectomy for Morbidly Obese Japanese Patients: a Retrospective Case-Matched Study. Obes Surg 2020; 29:3291-3298. [PMID: 31187457 DOI: 10.1007/s11695-019-03987-1] [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] [Indexed: 12/19/2022]
Abstract
BACKGROUND Reduced-port laparoscopic surgery remains controversial due to technical challenges that can lead to suboptimal outcomes, and data pertaining to operative and clinical outcomes of reduced-port sleeve gastrectomy (RPSG) vs. conventional laparoscopic sleeve gastrectomy (CLSG) are lacking. AIMS This retrospective case-matched study aimed to compare midterm (2-year) outcomes of RPSG and of CLSG. METHODS Patients included in the study had undergone laparoscopic bariatric surgery at our center between 2010 and 2017. Thirty-one consecutive female patients who underwent RPSG were compared to a sex-, age-, body mass index-matched group of 31 patients who underwent CLSG. Outcomes were evaluated and compared between groups. RESULTS Estimated blood loss volume, incidences of intraoperative and postoperative complications, and length of postoperative hospital stay did not differ significantly between the 2 groups. Operation time was significantly greater in the RPSG group than in the CLSG group (148.7 ± 22.6 vs. 120.2 ± 25.9 min, respectively; p < 0.001). Excess weight loss at 1 year was 105.9% and 109.7%, respectively (p = 0.94) and at 2 years was 101.1% and 105.3%, respectively (p = 0.64). One RPSG patient required placement of additional trocars because of bleeding from short gastric vessels, but conversion to open surgery was not required. CONCLUSIONS RPSG is feasible in carefully selected bariatric patients and results in midterm outcomes comparable to those observed after CLSG. Good cosmesis is a potential benefit of RPSG.
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Affiliation(s)
- Manabu Amiki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yosuke Seki
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
| | - Kazunori Kasama
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Srinivasulu Pachimatla
- Ramdev Rao Memorial General Hospital, Sivananda Rehabilitation Home, National Highway No. 65 Metro Pillar No. 34, Kukutpally Hyderabad, Telangana, 500072, India
| | - Michiko Kitagawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Akiko Umezawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
| | - Yoshimochi Kurokawa
- Weight loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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Abstract
BACKGROUND The aim of this study was to investigate gut inflammation and permeability in rats after duodenal-jejunal bypass (DJB) and in rats injected with a glucagon-like peptide-1 (GLP-1) receptor analog. METHODS Twelve male 16-week-old obese diabetic rats were divided into three groups: the DJB group, the sham group, and the group injected daily with a GLP-1 receptor agonist (liraglutide). Gut inflammation and the expression of tight junction protein (claudin-1) were analyzed in the three groups at 8 weeks after surgery. RESULTS The DJB group showed significantly lower levels of gut inflammatory cytokines than the liraglutide group. Claudin-1 showed stronger intensity on immunofluorescent staining in the DJB group than that in the liraglutide group. CONCLUSIONS In summary, DJB surgery might maintain gut permeability via suppression of gut inflammation.
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Umemura A, Sasaki A, Nitta H, Nikai H, Baba S, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Ishigaki Y. Prognostic factors and a new preliminary scoring system for remission of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy. Surg Today 2020; 50:1056-1064. [PMID: 32170427 DOI: 10.1007/s00595-020-01990-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/11/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the early remission rate of type 2 diabetes mellitus (T2DM) after laparoscopic sleeve gastrectomy (LSG) and establish a preliminary scoring system that predicts T2DM remission. METHODS We assessed the outcomes of 49 morbidly obese patients with T2DM who underwent LSG between 2008 and 2018. The prognostic factors for T2DM remission 1 year post-LSG were identified and an original scoring system was established. We validated our scoring system by comparing it with the individualized metabolic surgery score and the ABCD score. RESULTS The patients' mean body weight loss and percentage of excess weight loss were 34.4 kg and 59.4%, respectively, while the T2DM remission rate was 77.5%. The serum insulin level and the T2DM duration were independent predictive factors, the receiver-operating characteristic (ROC) curves for which revealed cutoff values of 12.7 ng/mL and 72 months, respectively. We set our system's score range at 0-2, whereby patients with higher scores have a good T2DM remission prognosis, as higher insulin levels, and/or shorter T2DM duration. Our scoring system had accuracy levels similar to those of the ABCD score with a simple stratification. CONCLUSION Our preliminary scoring system attains a good level of accuracy for predicting T2DM remission.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shigeaki Baba
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yasushi Ishigaki
- Division of Diabetes and Metabolism, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, 020-8505, Japan
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Amiki M, Seki Y, Kasama K, Hashimoto K, Kitagawa M, Umezawa A, Kurokawa Y. Revisional Bariatric Surgery for Insufficient Weight Loss and Gastroesophageal Reflux Disease: Our 12-Year Experience. Obes Surg 2020; 30:1671-1678. [DOI: 10.1007/s11695-019-04374-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Porat D, Markovic M, Zur M, Fine-Shamir N, Azran C, Shaked G, Czeiger D, Vaynshtein J, Replyanski I, Sebbag G, Dahan A. Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial. J Clin Med 2019; 8:jcm8111949. [PMID: 31726725 PMCID: PMC6912358 DOI: 10.3390/jcm8111949] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/03/2019] [Accepted: 11/08/2019] [Indexed: 12/22/2022] Open
Abstract
Oral drug bioavailability may be significantly altered after laparoscopic sleeve gastrectomy (LSG), the most popular bariatric procedure worldwide. Paracetamol (acetaminophen) is the post-bariatric analgesic/antipyretic drug of choice. In this work we studied and analyzed the LSG effects on systemic bioavailability and pharmacokinetics of paracetamol after oral administration of solid vs. liquid dosage form. A 4-armed, pharmacokinetic, crossover trial was performed in patients enrolled for LSG. Single paracetamol dose (500 mg), as caplet (n = 7) or syrup (n = 5), was administered before vs. 4–6 months post-LSG. Bioavailability was enhanced after LSG; in the caplet groups, average AUC0–t increased from 9.1 to 18.6 µg·h/mL with AUC0–t difference of 9.5 µg·h/mL (95% CI 4.6–14.5, p = 0.003). Cmax increased from 1.8 (95% CI 1.2–2.5) to 4.2 µg/mL (3.6–4.8) after LSG (p = 0.032). In the syrup groups, AUC0–t increased from 13.4 to 25.6 µg·h/mL, with AUC0–t difference of 12.2 µg·h/mL (95% CI 0.9–23.5, p = 0.049). Cmax changed from 5.4 (95% CI 2.5–8.4) to 7.8 µg/mL (6.1–9.6), and systemic bioavailability was complete (102%) after the surgery. Overall, decreased paracetamol exposure in obesity, with recovery to normal drug levels (caplet) or even higher (syrup) post-LSG, was revealed. In conclusion, attention to paracetamol effectiveness/safety in obesity, and after bariatric surgery, is prudent.
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Affiliation(s)
- Daniel Porat
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Milica Markovic
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Moran Zur
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Noa Fine-Shamir
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya 46140, Israel
| | - Gad Shaked
- Department of Surgery B, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - David Czeiger
- Department of Surgery B, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Julie Vaynshtein
- Department of Surgery B, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Ilya Replyanski
- Department of Surgery B, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Gilbert Sebbag
- Department of Surgery B, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Arik Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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Ugi S, Morino K, Yamaguchi T, Yamamoto H, Kaida S, Miyazawa I, Sato D, Sekine O, Fujita Y, Kashiwagi A, Tani M, Maegawa H. Preserving β-cell function is the major determinant of diabetes remission following laparoscopic sleeve gastrectomy in Japanese obese diabetic patients. Endocr J 2019; 66:817-826. [PMID: 31155539 DOI: 10.1507/endocrj.ej19-0054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Laparoscopic sleeve gastrectomy has been proven effective in treating obesity-associated type 2 diabetes mellitus (T2DM). However, reports of the effect of laparoscopic sleeve gastrectomy on glucose metabolism in Japanese obese patients with T2DM are rare. The aim of this study was to evaluate the effects of laparoscopic sleeve gastrectomy on glucose tolerance in Japanese obese patients with T2DM, and to analyze factors influencing diabetes remission after surgery. This was a retrospective analysis of data for 24 consecutive patients with T2DM who underwent laparoscopic sleeve gastrectomy. We investigated weight loss and its impact on T2DM 1 year postoperatively. We also compared baseline characteristics and postoperative factors between patients who achieved diabetes remission and patients without remission. Mean body weight loss and percent total weight loss were 23.9 kg and 23.3%, respectively. Mean hemoglobin A1c levels dropped from 7.3 ± 0.3% to 6.1 ± 0.2%, and 18 patients (75%) achieved diabetes remission 1 year postoperatively. Patients achieving remission had significantly lower hemoglobin A1c levels (p = 0.026), higher fasting C-peptide values (p < 0.001), shorter diabetes duration (p < 0.001), lower insulin requirement (p = 0.002), and higher area under the insulin response curve (p < 0.001) and insulinogenic index (p < 0.001) during oral glucose tolerance testing. In conclusion, laparoscopic sleeve gastrectomy is an effective treatment for Japanese obese patients with T2DM. Preserving insulin secretion is the major determinant of diabetes remission.
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Affiliation(s)
- Satoshi Ugi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Katsutaro Morino
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hiroshi Yamamoto
- Department of Surgery, Kohnan Hospital, Koka, Shiga 520-3321, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Itsuko Miyazawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Daisuke Sato
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Osamu Sekine
- Department of Medicine, Kusatsu General Hospital, Kusatsu, Shiga 525-8585, Japan
| | - Yukihiro Fujita
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Atsunori Kashiwagi
- Department of Medicine, Kusatsu General Hospital, Kusatsu, Shiga 525-8585, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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Abstract
OBJECTIVE This study aimed to evaluate the cost-effectiveness of bariatric surgery (BS) compared to non-surgical treatment (NST) in Korean people with morbid obesity according to comorbidities and body mass index (BMI) severity. METHODS The target cohort was people with morbid obesity, defined as BMI of ≥ 35 kg/m2, or obese people with BMI of 30-34.9 kg/m2 having obesity-related comorbidities. A decision-tree model for 1-year obesity treatment and Markov model for the rest of life were used. In the decision-tree model, the comorbidity remission rate and BMI change after 1-year treatment were decided based on a prospective clinical trial. In the Markov model, the transition probabilities were calculated considering the BMI level and age. The starting age of 20 years, a cycle length of 1 year, a time horizon of 80 years, and a 5% discount rate were applied for the base case from the healthcare system perspective. RESULTS In the base case, BS improved quality-adjusted life years (QALYs) and was the cost-effective option in total cohort (incremental cost-effectiveness ratio of BS vs. NST was 674 USD/QALY). It was shown to be cost-effective in all subgroup analyses based on BMI level. In particular, BS was a dominant alternative for the subgroup with basal BMI of 35.0-37.4 kg/m2. Various sensitivity analyses showed the robustness of results indicating the cost-effectiveness of BS. CONCLUSION BS at BMI of > 30 kg/m2 was more effective than NST for a reduction in BMI and remission of obesity-related comorbidities and was cost-effective in Korea.
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Cho EJ, Kim SM. Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center. Yonsei Med J 2019; 60:782-790. [PMID: 31347334 PMCID: PMC6660444 DOI: 10.3349/ymj.2019.60.8.782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/05/2019] [Accepted: 06/04/2019] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Although laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation. MATERIALS AND METHODS This retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities. RESULTS Between January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal. CONCLUSION During our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.
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Affiliation(s)
- Eun Jung Cho
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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