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Crozet J, Denneval A, Brosse M, Pelascini E, Pasquer A, Robert M. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Is Intrathoracic Migration of the Sleeve of High Incidence? Obes Surg 2024:10.1007/s11695-024-07341-y. [PMID: 38976187 DOI: 10.1007/s11695-024-07341-y] [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: 12/12/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Conversion of SG to Roux-en-Y gastric bypass (RYGB) is increasing. Intrathoracic migration of the sleeve (ITM) often seems associated and is increasingly reported. MATERIAL AND METHODS Patients who underwent a conversion of SG to RYGB from August 2013 to December 2022 were included. Two groups were compared: patients operated on for weight loss failure (WLF gp) and those operated on for gastroesophageal reflux disease (GERD gp). Demographic data, the incidence of ITM, weight loss outcomes, resolution of symptoms, and morbidity were analyzed. RESULTS Fifty-nine patients were included with an average follow-up of 32 months: 46 patients in the GERD gp (78%) were compared to 13 patients (22%) in the WLF gp. Groups were comparable regarding age and gender, but BMI and commodities were significantly higher in the WLF gp. In the GERD gp, on preoperative gastroscopy, 30% had a esophagitis, 48% had an ITM which required a posterior crural closure versus no esophagitis (p=0.02) and 23% of ITM in the WLF gp (p=0.11). Conversion led to 93% of GERD symptom improvement. In the WLF gp, mean TWL% was 15.3%, significantly greater than in the GERD gp (TWL% = 4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups. CONCLUSION The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of ITM was high requiring a surgical treatment with a very good efficacy on symptoms. Weight loss results were disappointing.
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Affiliation(s)
- Jessica Crozet
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France.
- University Claude Bernard Lyon 1, Lyon, France.
| | - Axel Denneval
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Matthias Brosse
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Elise Pelascini
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
| | - Arnaud Pasquer
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Maud Robert
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Lyon, France
- Carmen lab, INSERM Unit, 1060, Bron, France
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2
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Thaher O, Wollenhaupt F, Croner RS, Hukauf M, Stroh C. Evaluation of the effect of sleeve gastrectomy versus Roux-en-Y gastric bypass in patients with morbid obesity: multicenter comparative study. Langenbecks Arch Surg 2024; 409:156. [PMID: 38730065 PMCID: PMC11087333 DOI: 10.1007/s00423-024-03341-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed techniques in bariatric surgery. The aim of this study is to compare two surgical procedures in terms of weight loss and the development of comorbidities such as type II diabetes mellitus T2D, arterial hypertension, sleep apnea (OSAS), and gastroesophageal reflux disease (GERD). METHODS Data from the German Bariatric Surgery Registry (GBSR) from 2005 to 2021 were used. 1,392 RYGB and 1,132 SG primary surgery patients were included. Minimum age 18 years; five-year follow-up data available. Tests were performed with a 5% significance level. RESULTS Loss of follow-up 95.41% within five years. Five years after surgery, the RYGB showed significant advantages in terms of excess weight loss (%EWL 64.2% vs. 56.9%) and remission rates of the studied comorbidities: hypertension (54.4% vs. 47.8%), OSAS (64.5% vs. 50.1%), and GERD (86.1% vs. 66.9%). Compared to the pre-test, individuals diagnosed with insulin-dependent T2D showed significant improvements with RYGB over a five-year period (remission rate: 75% vs. 63%). In contrast, non-insulin-dependent T2D showed no significant difference between the two approaches (p = 0.125). CONCLUSION Both surgical procedures resulted in significant weight loss and improved comorbidities. However, the improvement in comorbidities was significantly greater in patients who underwent RYGB than in those who underwent SG, suggesting that the RYGB technique is preferable. Nevertheless, RYGB requires a high degree of surgical skill. Therefore, acquiring expertise in the technical facets of the surgery is essential to achieving favorable outcomes.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Friederike Wollenhaupt
- Department for Pediatrics and Adolescent Medicine, Asklepios Klinikum Heidberg, Tangstedter Landstraße 400, 22417, Hamburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research mbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße Des Friedens 122, 07548, Gera, Germany
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Adil MT, Perera M, Whitelaw D, Jambulingam P, Al-Taan O, Munasinghe A, Rashid F, Riaz A, Jain V, Askari A. Systematic Review and Meta-analysis of the Effects of Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy on Dyslipidemia. Obes Surg 2024; 34:967-975. [PMID: 38240941 DOI: 10.1007/s11695-023-07022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
The aim of this meta-analysis was to compare the effects of LRYGB and LSG on dyslipidemia. Studies comparing the effects of LRYGB and LSG on dyslipidemia with follow-up of 12 months or more were included. Twenty-four studies comprising seven RCTs and 17 comparative observational studies were included. Meta-analysis of RCTs (n=487) showed that improvement/resolution of dyslipidemia was better after LRYGB (68.5%, n=161/235) compared to LSG (48.4%, n=122/252). Patients undergoing LRYGB were more than twice as likely to experience improvement/resolution in dyslipidemia compared to those undergoing LSG (OR 2.28, 95% CI 1.21-4.29, p=0.010). Both LRGYB and LSG appears effective in improving dyslipidemia at >12 months after surgery; however, this improvement is more than twice higher after LRYGB compared to LSG.
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Affiliation(s)
- Md Tanveer Adil
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK.
| | - Minali Perera
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Douglas Whitelaw
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Periyathambi Jambulingam
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Omer Al-Taan
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Aruna Munasinghe
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Farhan Rashid
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Amjid Riaz
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Vigyan Jain
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
| | - Alan Askari
- Department of Bariatric & Upper GI Surgery, Luton & Dunstable Hospital, Bedfordshire Hospitals NHS Foundation Trust, Lewsey Road, Luton, LU4 0DZ, UK
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García-Honores L, Caballero-Alvarado J, Bustamante-Cabrejos A, Lozano-Peralta K, Zavaleta-Corvera C. LAPAROSCOPIC SLEEVE GASTRECTOMY VERSUS LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR WEIGHT LOSS IN OBESE PATIENTS: WHICH IS MORE EFFECTIVE? A SYSTEMATIC REVIEW AND META-ANALYSIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1782. [PMID: 38088727 PMCID: PMC10712920 DOI: 10.1590/0102-672020230064e1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS To determine if LSG is more effective than RYLGB for weight loss. METHODS A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
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Affiliation(s)
- Laura García-Honores
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
| | - Jose Caballero-Alvarado
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Regional Hospital of Trujillo, Department of surgery - Trujillo, La Libertad, Peru
| | - Alexander Bustamante-Cabrejos
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Alta Complejidad Virgen de la Puerta Hospital, Department of surgery - Trujillo, La Libertad, Peru
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AlObaid A, Alhudaib A, Ntyl S, Alharbi N. Sleeve gastrectomy on a patient with situs Inversus: A case report. Int J Surg Case Rep 2023; 106:108241. [PMID: 37086504 PMCID: PMC10154726 DOI: 10.1016/j.ijscr.2023.108241] [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: 09/06/2022] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Bariatric surgery is one of the methods used to treat obesity. Performing Laparoscopic Sleeve Gastrectomy (LSG) on patients with Situs Inversus Totals (SIT) could be very challenging and has no standard protocol yet. The aim of this case report is to describe our experience in performing laparoscopic sleeve gastrectomy in situs inversus patients. The article has been reported in line with the SCARE criteria. CASE PRESENTATION Our patient is a 33-year-old woman with a body mass index (BMI) of 45 kg/m2, known case of polycystic ovarian syndrome (PCOS) and secondary infertility. She was admitted to the hospital for LSG for weight reduction surgery. Preoperative investigations showed that the patient had SIT. Subsequently, we successfully performed LSG on this patient without intraoperative or postoperative complications. The patient was discharged home two days post-operation and given a follow-up appointment after two weeks. CASE DISCUSSION Literature review states that SIT occurs once in 10,000 to 50,000 births. Therefore, it can serve as a challenge when performing any operation such as LSG. CONCLUSION A good understanding and a well-planned approach prior to any surgery will ease the performance of the procedure and lead to better outcomes for the patient post-operation.
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Affiliation(s)
- Abdulhakeem AlObaid
- King Abdullah Bin Abdulaziz University Hospital, General Surgery Department, Princess Nourah University, Riyadh, Saudi Arabia
| | - Abdullah Alhudaib
- King Abdullah Bin Abdulaziz University Hospital, General Surgery Department, Princess Nourah University, Riyadh, Saudi Arabia.
| | - Sondous Ntyl
- King Abdullah Bin Abdulaziz University Hospital, General Surgery Department, Princess Nourah University, Riyadh, Saudi Arabia.
| | - Najla Alharbi
- King Abdullah Bin Abdulaziz University Hospital, General Surgery Department, Princess Nourah University, Riyadh, Saudi Arabia.
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Barrea L, Verde L, Schiavo L, Sarno G, Camajani E, Iannelli A, Caprio M, Pilone V, Colao A, Muscogiuri G. Very Low-Calorie Ketogenic Diet (VLCKD) as Pre-Operative First-Line Dietary Therapy in Patients with Obesity Who Are Candidates for Bariatric Surgery. Nutrients 2023; 15:nu15081907. [PMID: 37111126 PMCID: PMC10142118 DOI: 10.3390/nu15081907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/24/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Bariatric surgery is currently the most effective method for achieving long-term weight loss and reducing the risk of comorbidities and mortality in individuals with severe obesity. The pre-operative diet is an important factor in determining patients' suitability for surgery, as well as their post-operative outcomes and success in achieving weight loss. Therefore, the nutritional management of bariatric patients requires specialized expertise. Very low-calorie diets and intragastric balloon placement have already been studied and shown to be effective in promoting pre-operative weight loss. In addition, the very low-calorie ketogenic diet has a well-established role in the treatment of obesity and type 2 diabetes mellitus, but its potential role as a pre-operative dietary treatment prior to bariatric surgery has received less attention. Thus, this article will provide a brief overview of the current evidence on the very low-calorie ketogenic diet as a pre-operative dietary treatment in patients with obesity who are candidates for bariatric surgery.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143 Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Gerardo Sarno
- San Giovanni di Dio e Ruggi D'Aragona University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
| | - Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
| | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
- Faculté de Medicine, Université Côte d'Azur, 06000 Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", 06204 Nice, France
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166 Rome, Italy
- Laboratory of Cardiovascular Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele, 00166 Rome, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Complex Operative Unit of General and Emergency Surgery and Bariatric Centre of Excellence SICOB, University of Salerno, 84081 Salerno, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
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Varvoglis DN, Sanchez-Casalongue M, Baron TH, Farrell TM. "Orphaned" Stomach-An Infrequent Complication of Gastric Bypass Revision. J Clin Med 2022; 11:7487. [PMID: 36556106 PMCID: PMC9782235 DOI: 10.3390/jcm11247487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
While generally safe, bariatric operations have a variety of possible complications. We present an uncommon complication after gastric bypass revision, namely the creation of an "orphaned" segment of remnant stomach that was left inadvertently in discontinuity, leading to recurrent intra-abdominal abscesses. Sinogram ultimately proved the diagnosis, and the issue was successfully treated using a combination of surgical and endoscopic methods to control the abscess and to allow internal drainage.
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Affiliation(s)
- Dimitrios N. Varvoglis
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | | | - Todd H. Baron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Timothy M. Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Guglielmi V, Campanelli M, Bianciardi E, Benavoli D, Colangeli L, D'Adamo M, Sbraccia P, Gentileschi P. Bariatric surgery for metabolic unhealthy obesity (MUO) during the COVID era: short-term results of a high-volume center. Eat Weight Disord 2022; 27:3119-3124. [PMID: 35852766 PMCID: PMC9294774 DOI: 10.1007/s40519-022-01438-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE During the coronavirus disease 19 (COVID-19) outbreak, most public hospitals worldwide have been forced to postpone a major part of bariatric surgery (BS) operations with unfavorable consequences for weight and obesity complications. The aim of this study was to evaluate the effectiveness and safety of laparoscopic BS on subjects with metabolically unhealthy obesity (MUO) during COVID-19 pandemic in a high-volume Italian center. METHODS Between March 2020 and January 2021, all patients with MUO submitted to laparoscopic BS (sleeve gastrectomy [SG], one anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) were enrolled according to the ATP III Guidelines, with a minimum follow-up of 3 months. RESULTS In the study period, 210 patients with MUO underwent laparoscopic BS (77 RYGB, 85 SG and 48 OAGB) in our obesity referral center. Postoperative major complications occurred in 4 patients (1.9%) with zero mortality. At 9-month follow-up, a total weight loss (TWL) of 28.2 ± 18.4, 26.1 ± 23.1 and 24.5 ± 11.3% (p = 0.042) was observed in RYGB, OAGB and SG groups, respectively. The rate of comorbidity resolution was very similar for all type of surgeries (p = 0.871). Only two cases of postoperative SARS-CoV-2 infection were registered (0.9%) and both cases resolved with medical therapy and observation. CONCLUSION Among the patients studied, all surgical techniques were safe and effective for MUO during the COVID era. This group of patients is at high risk for general and SARS-CoV-2-related mortality and therefore should be prioritized for BS. LEVEL OF EVIDENCE Level III, single-center retrospective cohort study.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy. .,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy.
| | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Domenico Benavoli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
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9
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Toniolo I, Berardo A, Foletto M, Fiorillo C, Quero G, Perretta S, Carniel EL. Patient-specific stomach biomechanics before and after laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:7998-8011. [PMID: 35451669 PMCID: PMC9028903 DOI: 10.1007/s00464-022-09233-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity has become a global epidemic. Bariatric surgery is considered the most effective therapeutic weapon in terms of weight loss and improvement of quality of life and comorbidities. Laparoscopic sleeve gastrectomy (LSG) is one of the most performed procedures worldwide, although patients carry a nonnegligible risk of developing post-operative GERD and BE. OBJECTIVES The aim of this work is the development of computational patient-specific models to analyze the changes induced by bariatric surgery, i.e., the volumetric gastric reduction, the mechanical response of the stomach during an inflation process, and the related elongation strain (ES) distribution at different intragastric pressures. METHODS Patient-specific pre- and post-surgical models were extracted from Magnetic Resonance Imaging (MRI) scans of patients with morbid obesity submitted to LSG. Twenty-three patients were analyzed, resulting in forty-six 3D-geometries and related computational analyses. RESULTS A significant difference between the mechanical behavior of pre- and post-surgical stomach subjected to the same internal gastric pressure was observed, that can be correlated to a change in the global stomach stiffness and a minor gastric wall tension, resulting in unusual activations of mechanoreceptors following food intake and satiety variation after LSG. CONCLUSIONS Computational patient-specific models may contribute to improve the current knowledge about anatomical and physiological changes induced by LSG, aiming at reducing post-operative complications and improving quality of life in the long run.
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Affiliation(s)
- Ilaria Toniolo
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Alice Berardo
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Padova, Italy.
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
| | - Mirto Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
- Bariatric Surgery Unit, Azienda Ospedaliera, University of Padova, Padova, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University of Sacred Heart of Rome, Rome, Italy
| | - Silvana Perretta
- IHU Strasbourg, Strasbourg, France
- IRCAD France, Strasbourg, France
- Department of Digestive and Endocrine Surgery, NHC, Strasbourg, France
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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10
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Colangeli L, Gentileschi P, Sbraccia P, Guglielmi V. Ketogenic Diet for Preoperative Weight Reduction in Bariatric Surgery: A Narrative Review. Nutrients 2022; 14:nu14173610. [PMID: 36079867 PMCID: PMC9460892 DOI: 10.3390/nu14173610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Bariatric surgery (BS) is the most effective treatment in reducing weight and the burden of comorbidities in patients with severe obesity. Despite the overall low mortality rate, intra- and post-operative complications remains quite common. Weight loss before BS reduces surgical risk, but studies are inconclusive regarding which is the best approach to apply. In this review, we summarize the current evidence on the effect of a ketogenic diet (KD) before BS. All studies agree that KD leads to considerable weight loss and important improvements in terms of surgical risk, but populations, interventions and outcomes are very heterogeneous. KD appears to be a safe and effective approach to induce weight loss before BS. However, randomized controlled trials with better-defined dietary protocols and homogeneous outcomes are necessary in order to draw firm conclusions.
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Affiliation(s)
- Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Obesity Medical Center, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Obesity Medical Center, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Obesity Medical Center, Policlinico Tor Vergata, 00133 Rome, Italy
- Correspondence:
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11
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Salman AA, Salman MA, Aon MH, Mahdy RE, Abdallah A, Shemy GG, Hassan AM, Amin FAS, Labib S. Impact of Weight Loss on the Severity of Albuminuria in Obese Diabetic Patients Undergoing Laparoscopic Sleeve Gastrectomy and One-Anastomosis Gastric Bypass. Int J Gen Med 2022; 15:6405-6413. [PMID: 35957758 PMCID: PMC9359793 DOI: 10.2147/ijgm.s365113] [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: 03/04/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
Aim To examine the effect of weight-loss induced bariatric procedures on albuminuria levels among diabetic patients suffering from obesity. Methods Adults patients who suffer from morbid obesity and type 2 diabetes mellitus (T2DM) were included in a prospective cohort study. Subjects were scheduled to undergo laparoscopic sleeve gastrectomy (LSG) or one-anastomosis gastric bypass (OAGB). The albumin-to-creatinine ratio (ACR) was adopted to assess the degree of albuminuria. Microalbuminuria was determined as a ratio of >2.5-30 mg/mmol and >3.5-30 mg/mmol for males and females, respectively, while macroalbuminuria was diagnosed when the ACR exceeded >30 mg/mmol. Results The mean uACR decreased significantly from 20.95±16.89 to 9.92±12.69mg/mmol in LSG cohort (p <0.001), and from 19.52±16.65 to 9.34±11.77mg/mmol in the OAGB cohort, with no statistically considerable differences between both cohorts at the end of follow-up (p = 0.78). Twelve months after the procedures, the percentages of cases with microalbuminuria decreased significantly to 23.8% and 23.9%, respectively (p < 0.001); likewise, the percentages of cases with macroalbuminuria significantly decreased to 7.9% and 7.5% in the LSG and OAGB groups, respectively (p < 0.001). There were no statistically considerable differences between LSG and OAGB regarding the percentages of patients with micro or macroalbuminuria at the end of follow-up. Besides, there were no significant associations between the degree of weight loss and improvement (p = 0.959) or remission (p = 0.73) of microalbuminuria. Conclusion Bariatric surgery significantly reduced the severity of albuminuria 1-year after the procedure, with no preference for one procedure over the other.
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Affiliation(s)
| | | | - Mohamed H Aon
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Reem Ezzat Mahdy
- Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Abdallah
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Galal Shemy
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Ahmed M Hassan
- General Surgery Department, Faculty of Medicine, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | | | - Safa Labib
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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12
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Nutritional Status after Roux-En-Y (Rygb) and One Anastomosis Gastric Bypass (Oagb) at 6-Month Follow-Up: A Comparative Study. Nutrients 2022; 14:nu14142823. [PMID: 35889780 PMCID: PMC9324253 DOI: 10.3390/nu14142823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 02/06/2023] Open
Abstract
Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two effective bariatric surgical procedures with positive outcomes in terms of weight loss, comorbidities remission, and adverse events profiles. OAGB seems to carry a higher risk of malnutrition, but existing data are controversial. The aim of this study is to objectively evaluate and compare malnutrition in patients undergoing RYGB and OAGB. Methods: Retrospective monocentric study of obese patients undergoing RYGB or OAGB between the 15 September 2020 and the 31 May 2021. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score and compared between groups. The primary outcome was the mean CONUT score at 6 months. The secondary outcomes included the incidence of malnutrition, comorbidities, including hypertension, insulin resistance and type II diabetes mellitus, and weight loss. Results: 78 patients were included: 30 underwent RYGB and 48 underwent OAGB. At 6-Month Follow-Up there was no difference between groups in the mean CONUT score nor in incidence of malnutrition. In both groups, the nutritional status significantly worsened 6 months after surgery (preoperative and postoperative score of 0.48 ± 0.9 and 1.38 ± 1.5; p = 0.0066 for RYGB and of 0.86 ± 1.5 and 1.45 ± 1.3; p = 0.0422 for OAGB). Type II Diabetes mellitus (DMII) and hypertension remission were significant in the OAGB group with a 100% relative remission in the DMII-OAGB group (p = 0.0265), and a 67% relative remission in the hypertension-OAGB group (p = 0.0031). Conclusions: No difference in nutritional status has been detected between patients undergoing RYGB or OAGB at the 6-Month Follow-Up. Both procedures may have significant mal-absorptive effects leading to decline in nutritional status. OAGB may be more efficacious in inducing DMII and hypertension remission. Larger prospective studies dedicated specifically to nutritional status after gastric bypass are needed to confirm the impact of different bypass procedures on nutritional status.
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13
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Sensi B, Beomonte Zobel L, Forte V, Alicata F, Procaccini C, Pavoncello D, Arcudi C, Bianciardi E, Gentileschi P. Internal herniation of small bowel through the minimizer ring after banded one anastomosis gastric bypass: Case report with diagnosis and management of a rare complication. Obes Res Clin Pract 2022; 16:349-352. [DOI: 10.1016/j.orcp.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
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14
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Gao D, Sun L, Wang N, Shi Y, Song J, Liu X, Yang Q, Su Z. Impact of 30° Reserve Trendelenburg Position on Lung Function in Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy. Front Surg 2022; 9:792697. [PMID: 35284476 PMCID: PMC8907616 DOI: 10.3389/fsurg.2022.792697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to evaluate the impact of patients' positioning before and after intubation with mechanical ventilation, and after extubation on the lung function and blood oxygenation of patients with morbid obesity, who had a laparoscopic sleeve gastrectomy. Methods Patients with morbid obesity (BMI ≥ 30 kg/m2, ASA I – II grade) who underwent laparoscopic sleeve gastrectomy at our hospital from June 2018 to January 2019 were enrolled in this prospective study. Before intubation, after intubation with mechanical ventilation, and after extubation, arterial blood was collected for blood oxygenation and gas analysis after posturing the patients at supine position or 30° reverse Trendelenburg position (30°-RTP). Results A total of 15 patients with morbid obesity were enrolled in this self-compared study. Pulmonary shunt (Qs/Qt) after extubation was significantly lower at 30°-RTP (18.82 ± 3.60%) compared to that at supine position (17.13 ± 3.10%, p < 0.01). Patients' static lung compliance (Cstat), during mechanical ventilation, was significantly improved at 30°-RTP (36.8 ± 6.7) compared to that of those in a supine position (33.8 ± 7.3, p < 0.05). The PaO2 and oxygen index (OI) before and after intubation with mechanical ventilation were significantly higher at 30°-RTP compared to that at supine position, and in contrast, the PA−aO2 before and after intubation with mechanical ventilation was significantly reduced at 30°-RTP compared to that at supine position. Conclusion During and after laparoscopic sleeve gastrectomy, patients with morbid obesity had improved lung function, reduced pulmonary shunt, reduced PA−aO2 difference, and increased PaO2 and oxygen index at 30°-RTP compared to that supine position.
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Affiliation(s)
- Dengyu Gao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lu Sun
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ning Wang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yubo Shi
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianli Song
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaoying Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qiyao Yang
- Education Centre, China Medical Tribun, Beijing, China
| | - Zhenbo Su
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Zhenbo Su
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15
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Clinical Impact of Mediterranean Diet Adherence before and after Bariatric Surgery: A Narrative Review. Nutrients 2022; 14:nu14020393. [PMID: 35057574 PMCID: PMC8781914 DOI: 10.3390/nu14020393] [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: 12/23/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
The population suffering from obesity is rapidly increasing all over the world. Bariatric surgery has shown to be the treatment of choice in patients with severe obesity. A Mediterranean diet has long been acknowledged to be one of the healthiest dietary patterns associated with a lower incidence of many chronic diseases. The aim of the present narrative review is to summarize the existing research on the clinical impact of a Mediterranean diet before and after bariatric surgery, focusing on its effects on weight loss and improvement in comorbidities. Although the current knowledge is limited, this information could add value and emphasize the importance of adopting a Mediterranean diet before and after bariatric surgery.
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16
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Fat-Free Mass and Skeletal Muscle Mass Gain Are Associated with Diabetes Remission after Laparoscopic Sleeve Gastrectomy in Males but Not in Females. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020978. [PMID: 35055799 PMCID: PMC8776008 DOI: 10.3390/ijerph19020978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/25/2022]
Abstract
Besides massive body weight loss, laparoscopic sleeve gastrectomy (LSG) causes massive lean mass, including fat-free mass (FFM) and skeletal muscle mass (SM) that present higher metabolic rates in males. This study examines sex differences in FFM and SM changes of type 2 diabetes (T2D) remission at 12 months post-LSG. This cohort study recruited 119 patients (53.7% females) with T2D and obesity (body mass index 42.2 ± 7.0 kg/m2) who underwent LSG. Fat-mass (FM) loss was higher in males than in females (−12.8 ± 6.2% vs. −9.9 ± 5.0%, p = 0.02) after one-year post-operation. Regardless of the weight-loss difference, males had higher FFM and SM gain than did females (12.8 ± 8.0 vs. 9.9 ± 5.0% p = 0.02 and 6.5 ± 4.3% vs. 4.9 ± 6.2%, p = 0.03, respectively). Positive correlations of triglyceride reduction with FM loss (r = 0.47, p = 0.01) and SM gain (r = 0.44, p = 0.02) over 12 months post-operation were observed in males who achieved T2D remission. The T2D remission rate significantly increased 16% and 26% for each additional percentage of FFM and SM gain one year after LSG, which only happened in males. Increased FFM and SM were remarkably associated with T2D remission in males, but evidence lacks for females.
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17
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Anselmo A, Siragusa L, Sensi B, Bacchiocchi G, Pellicciaro M, Manzia TM, Gentileschi P, Tisone G. High-priority liver transplantation and simultaneous sleeve gastrectomy in MELD 32 end-stage liver disease: a case report with long-term follow-up. Obes Res Clin Pract 2022; 16:91-94. [PMID: 35016856 DOI: 10.1016/j.orcp.2022.01.001] [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: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Morbid obesity is a worldwide epidemic closely linked to Non-Alcoholic Fatty Liver Disease (NAFLD), an ever more relevant indication for Liver Transplantation (LT). Obesity affects an increasing number of LT recipients, but the ideal management of these patients remain unclear. Bariatric surgery (BS) in LT setting is challenging but feasible, although the debate is still open about the best timing of bariatric surgery. Herein we report a case of high-priority LT and simultaneous sleeve gastrectomy (SG) in an obese young adult. CASE REPORT A 45 years old man with morbid obesity (BMI 46 kg/m2) and severe NAFLD-related end-stage liver disease (ESLD) underwent simultaneous LT and sleeve gastrectomy (SG) in an emergency setting, due to a MELD score of 32. He had substantial weight loss during long-term follow-up and enjoyed resolution of diabetes and hypertension. At 4 years follow-up, he has normal allograft function with appropriate immunosuppressant blood levels and no ultrasound evidence of steatosis. CONCLUSION In selected patients, combined LT and SG present several advantages in terms of transplant outcomes, weight loss and resolution of obesity-related comorbidities. In addition, it can be performed in the high-priority setting in case of severe ESLD with good results in the short- and long-term.
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Affiliation(s)
| | - Leandro Siragusa
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Bruno Sensi
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | - Giuseppe Tisone
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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18
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Campanelli M, Bianciardi E, Benavoli D, Bagaglini G, Lisi G, Gentileschi P. Laparoscopic Banded One Anastomosis Gastric Bypass: A Single-Center Series. J Obes 2022; 2022:4942052. [PMID: 35132363 PMCID: PMC8817855 DOI: 10.1155/2022/4942052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Laparoscopic one anastomosis gastric bypass (LOAGB) is a relatively new procedure for the treatment of morbid obesity and related comorbidities. On average, this procedure results in good postoperative weight loss with a low complication rate. Recent publications suggest that dumping syndrome and weight regain might be reduced by placing a silicone ring over the gastric pouch during the procedure, so called laparoscopic banded one anastomosis gastric bypass (LBOAGB). METHODS 86 patients undergoing LBOAGB between 2018 and 2020 were enrolled in this retrospective study. Hospital records were used to assess weight loss, comorbidity resolution, and any complications either in the short or medium term. RESULTS 54 Female and 32 male patients were included with a mean age of 43 years (25-64), preoperative body mass index of 42 kg/m2 (35-49), and preoperative weight of 114 kg (86-162). Thirty-four patients presented with type 2 diabetes (39.5%), 42 patients (49%) diagnosed with hypertension, 24 presented with OSAS (28%), and 21 (24%) hypercholesterolaemia patients were included. In total, 36 patients were diagnosed with multiple comorbidities. The operative data showed an average operative time of 48 minutes with 3.4% of patients suffering from early (minor) complications and 2.3% with a late (minor) complication. One patient required reoperation due to intra-abdominal bleeding. The median length of hospital stay was 2.5 days. Median follow-up was 18 months (5-36). In that period, no patient required ring removal or conversion to Roux-en-Y gastric bypass surgery. Food intolerance/vomiting was present in 1 patient (1.1%), bile reflux was present in 1 patient (1.1%), and no stomal ulcers were observed. Mean % excess weight loss at 12 and 24 months was 72% and 80%, respectively. Fifty-two out of 86 patients (60%) had a complete resolution of comorbidities. A CONUT score >2 (mild malnutrition) was found in 40% of patients, while a CONUT score 0-1 was found in 60% of patients. CONCLUSION LBOAGB shows promising results in terms of safety and efficacy in the short term. Further prospective studies will be required to evaluate the consistency of the results in the long term.
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Affiliation(s)
- Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
| | - Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Domenico Benavoli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
| | - Giulia Bagaglini
- General Surgery Residency School, University of Rome “Tor Vergata”, Rome, Italy
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome 00144, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
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The Effects of Bariatric Surgery and Gastrectomy on the Absorption of Drugs, Vitamins, and Mineral Elements. Pharmaceutics 2021; 13:pharmaceutics13122111. [PMID: 34959391 PMCID: PMC8708306 DOI: 10.3390/pharmaceutics13122111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/17/2022] Open
Abstract
Bariatric surgery, which is an effective treatment for obesity, and gastrectomy, which is the primary treatment method for gastric cancer, alter the anatomy and physiology of the digestive system. Weight loss and changes in the gastrointestinal tract may affect the pharmacokinetic parameters of oral medications. Both bariatric and cancer patients use drugs chronically or temporarily. It is important to know how surgery affects their pharmacokinetics to ensure an effective and safe therapy. The Cochrane, PubMed, and Scopus databases were searched independently by two authors. The search strategy included controlled vocabulary and keywords. Studies show that bariatric surgery and gastrectomy most often reduce the time to maximum plasma concentration (tmax) and decrease the maximum plasma concentration (Cmax) in comparison with the values of these parameters measured in healthy volunteers. Vitamin and mineral deficiencies are also observed. The effect depends on the type of surgery and the properties of the drug. It is recommended to use the drugs that have been tested on these groups of patients as it is possible to monitor them.
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20
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Dolo PR, Yao L, Shao Y, Widjaja J, Li C, Zhu X. The effect of sleeve ablation of gastric mucosa on body weight and glucose homeostasis in Sprague-Dawley rat model. Surg Obes Relat Dis 2021; 17:1984-1994. [PMID: 34479813 DOI: 10.1016/j.soard.2021.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/25/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The gastric mucosa is an important endocrine organ, most of which is resected in sleeve gastrectomy (SG). The effect of removing most of the gastric mucosa has not been studied. OBJECTIVE To assess the effect of ablating the gastric mucosa (an area proportional to that in SG), on obesity and diabetes in a rat model. SETTING The Affiliated Hospital of Xuzhou Medical University in Xuzhou Jiangsu, P. R. China. METHODS Among 34 fatty Sprague-Dawley rats, 26 randomly received low-dose streptozotocin (STZ) to induce diabetes and then were randomly assigned to gastric mucosa ablation (GMA, n = 10), sleeve gastrectomy (SG, n = 8), and sham (n = 8) groups. The remaining normal fatty rats were assigned to the non-diabetic gastric mucosa ablation (nGMA, n = 8) group. In the GMA groups, the gastric mucosa was thermally ablated using electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed meal tolerance test (MMTT) were repeated at designated time points postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded. RESULTS Fasting ghrelin concentration and area under curve (AUC) decreased significantly (P < .05) in the GMA groups and the SG group after surgery. Gastrin concentration remained unchanged in SG but decreased significantly in the GMA groups after surgery. Significantly increased GLP-1 AUC was found in the GMA groups and the SG group postoperatively. The decrease in fasting blood glucose did not differ significantly between the diabetic GMA and SG groups after surgery. Glucose AUC during OGTT in both SG and diabetic GMA groups was decreased significantly from the preoperative level, but the decreased glucose AUC in the SG group was significantly greater (P < .05). The decrease in body weight and food intake in the SG group was significantly greater than in the GMA groups. CONCLUSION Ablation of most of the gastric mucosa along the greater curvature is effective in weight loss and glycemic control in a rodent model.
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Affiliation(s)
- Ponnie Robertlee Dolo
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Libin Yao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Yong Shao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Jason Widjaja
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Chao Li
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China
| | - Xiaocheng Zhu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Jiangsu, P. R. China; Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou Jiangsu, P. R. China.
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21
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Gentileschi P, Bianciardi E, Benavoli D, Campanelli M. Metabolic surgery for type II diabetes: an update. Acta Diabetol 2021; 58:1153-1159. [PMID: 34003378 PMCID: PMC8316162 DOI: 10.1007/s00592-021-01722-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/15/2021] [Indexed: 01/14/2023]
Abstract
Bariatric operations have been documented in clinical trials to promote remission or dramatic improvement of Type II Diabetes Mellitus and related comorbidities. Herein we review randomized trials and meta-analyses published during the last 20 years on the results of bariatric/metabolic surgery in obese patients with type 2 diabetes with the aim of highlighting the scientific evidence available. Several studies and RCTs in the last 20 years have showed outstanding results of bariatric/metabolic surgery on Type II diabetes and comorbidities in patients with either BMI > 35 kg/m2 or BMI < 35 kg/m2. They have established that bariatric procedures are superior to non-surgical interventions for inducing weight loss and amelioration of type 2 diabetes, even in patients with a BMI between 30 and 35 kg/m2. The physiopatologic changes that improve glucose homeostasis after bariatric surgery remain unclear but glycemic control is improved after sleeve gastrectomy, duodenal-jejunal bypass, Roux-en-Y gastric bypass, gastric banding, One Anastomosis Gastric Bypass, and biliopancreatic diversion. Nevertheless, it is suggested that the various gastrointestinal procedures may have different effects and mechanisms of action. Metabolic surgery will help integrate knowledge and multidisciplinary expertise to provide a combination of conservative and surgical treatments for Type II diabetes. These treatments must be considered as complementary options and not alternative strategies, with the same goal of controlling diabetes and achieving cure.
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Affiliation(s)
- Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | | | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy.
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Bianciardi E, Imperatori C, Innamorati M, Fabbricatore M, Monacelli AM, Pelle M, Siracusano A, Niolu C, Gentileschi P. Measuring Knowledge, Attitudes, and Barriers to Medication Adherence in Potential Bariatric Surgery Patients. Obes Surg 2021; 31:4045-4054. [PMID: 34212345 PMCID: PMC8397664 DOI: 10.1007/s11695-021-05485-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bariatric surgery is an effective treatment for the obesity epidemic, but the poor attendance and adherence rates of post-surgery recommendations threaten treatment effectiveness and health outcomes. Preoperatively, we investigated the unique contributions of clinical (e.g., medical and psychiatric comorbidities), sociodemographic (e.g., sex, age, and educational level), and psychopathological variables (e.g., binge eating severity, the general level of psychopathological distress, and alexithymia traits) on differing dimensions of adherence in a group of patients seeking bariatric surgery. METHODS The final sample consisted of 501 patients (346 women). All participants underwent a full psychiatric interview. Self-report questionnaires were used to assess psychopathology, binge eating severity, alexithymia, and three aspects of adherence: knowledge, attitude, and barriers to medical recommendations. RESULTS Attitude to adherence was associated with alexithymia (β = -2.228; p < 0.001) and binge eating disorder (β = 0.103; p = 0.047). The knowledge subscale was related to medical comorbidity (β = 0.113; p = 0.012) and alexithymia (β = -2.256; p < 0.001); with age (β = 0.161; p = 0.002) and psychiatric comorbidity (β =0.107; p = 0.021) manifesting in the barrier subscale. CONCLUSION We demonstrated that alexithymia and psychiatric and eating disorders impaired adherence reducing attitude and knowledge of treatment and increasing the barriers. Both patient and doctor can benefit from measuring adherence prior to surgery, with a qualitative approach shedding light on the status of adherence prior to the postsurgical phase when the damage regarding adherence is, already, done. Graphical Abstract.
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Affiliation(s)
- Emanuela Bianciardi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
- , Rome, Italy.
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | | | - Martina Pelle
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata", Rome, Italy
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Valente M, Campanelli M, Benavoli D, Arcudi C, Riccó M, Bianciardi E, Gentileschi P. Safety and Outcomes of Laparoscopic Sleeve Gastrectomy in a General Surgery Residency Program. JSLS 2021; 25:JSLS.2020.00063. [PMID: 33879991 PMCID: PMC8035819 DOI: 10.4293/jsls.2020.00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: With the escalation of surgical treatment of morbid obesity, there is a growing interest in the training of bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) gained popularity both as a first-stage approach and as a stand-alone procedure. Objectives: The aim of this study was to assess detectable differences in LSG with intra-operative resident involvement. Methods: We reviewed obese patients, who had undergone LSG between January 1, 2017 and January 31, 2020. Collected data reported demographic factors, operative time, postoperative complications, and outcomes. Results: Among 313 patients who met the inclusion criteria, 94 were men and 219 were women. The procedures were performed either by an expert bariatric surgeon (group 1), or a general surgery resident (group 2), respectively in 228 and 85 cases. Mean operative time of the first group was 65.3 ± 18.8 minutes, while it was 74.3 ± 17.2 among trainees (p < 0.001). Perioperative complications were diagnosed in 13 patients (10 in group 1 and 3 in group 2). Mean excess body weight loss after 12 months was 87.7 ± 28.2% in the first group and 81.1 ± 31.6% in the residents group. Between the two groups, we found no differences in the incidence of perioperative complications and in surgical outcomes. Trainee involvement was associated with increased operative time, with no correlation with a worse postoperative course. Conclusions: Residents can safely perform LSG in referral centers under the supervision of an expert bariatric surgeon. Trainee involvement is not related to increased leak rate, nor to suboptimal short-term outcome.
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Affiliation(s)
- Marina Valente
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Domenico Benavoli
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Claudio Arcudi
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | | | | | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
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Laparoscopic sleeve gastrectomy for morbid obesity and Klinefelter syndrome: clinical report on two patients, with long-term follow-up. Eat Weight Disord 2021; 26:1685-1690. [PMID: 32654003 DOI: 10.1007/s40519-020-00951-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Klinefelter syndrome (KS) can appear as a wide spectrum of clinical manifestations, with no guidelines for appropriate treatment. We present the first study of bariatric surgery (BS) with a 48-month follow-up, for the management of two patients affected by obesity and KS. CASES PRESENTATION The first patient was a 32-year-old man with diagnosis of Klinefelter mosaicism (46 XY/47, XXY), Body Mass Index (BMI) of 50 kg/m2, metabolic syndrome and Binge Eating Disorder (BED). He underwent a Laparoscopic Sleeve Gastrectomy (LSG) with weight loss (BMI = 38 kg/m2) and improvements to his metabolic profile at 48 months. The second patient was a 44-year-old man with KS (47, XXY), BMI of 49 kg/m2, Obstructive Sleep Apnea Syndrome and BED. He underwent a banded LSG. After 48 months, he showed a satisfactory weight loss (BMI = 32 kg/m2) and amelioration of comorbidities. CONCLUSION In patients with KS, LSG demonstrated long-term beneficial effects for weight loss and amelioration of comorbidities. An interdisciplinary approach is mandatory, since it leads to adherence to follow-up programs and mental health well-being.
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Laparoscopic Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy for Type 2 Diabetes Mellitus in Nonseverely Obese Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Obes Surg 2021; 30:1660-1670. [PMID: 31912466 DOI: 10.1007/s11695-019-04378-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, randomized controlled trials (RCTs) have indicated that bariatric surgery in nonseverely obese patients with a body mass index (BMI) less than 35 kg/m2 might be even superior to medical therapy with regard to type 2 diabetes mellitus (T2DM) remission, but the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) in nonseverely obese patients has not been conclusively determined. The objective of this study is to compare LRYGB versus LSG for T2DM in nonseverely obese patients. METHODS A meta-analysis identifying RCTs evaluating LRYGB versus LSG for T2DM in nonseverely obese patients was conducted. The primary outcome was T2DM remission. Additional analyses comprised percent excess weight loss (%EWL), BMI, waist circumference, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum lipid level, medication use, quality of life, and adverse events. RESULTS Four RCTs concerning total 296 patients were included. T2DM remission rate and %EWL were of no difference between the two bariatric procedures. LRYGB was associated with lower BMI, waist circumference, low-density lipoprotein, and higher high-density lipoprotein than LSG. However, HbA1c, FPG, total cholesterol, and triglyceride were not significantly different between the two surgical groups. The medication use and quality of life were improved in both two groups. The gastroesophageal reflux diseases of LRYGB group were less than that of LSG group. Dumping syndromes were noted more frequently in the LRYGB group. CONCLUSIONS Both LRYGB and LSG have comparative effect on resolving T2DM in nonseverely obese patients at midterm follow-up. Further RCTs should address the potential risks and long-term effects of LRYGB and LSG in nonseverely obese patients.
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Termine P, Boru CE, Iossa A, Ciccioriccio MC, Campanelli M, Bianciardi E, Gentileschi P, Silecchia G. Transhiatal Migration After Laparoscopic Sleeve Gastrectomy: Myth or Reality? A Multicenter, Retrospective Study on the Incidence and Clinical Impact. Obes Surg 2021; 31:3419-3426. [PMID: 33834373 DOI: 10.1007/s11695-021-05340-x] [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: 01/09/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Only anecdotally reported, intrathoracic migration (ITM) represents an unacknowledged complication after sleeve gastrectomy (LSG) contributing to gastroesophageal reflux disease (GERD) development, both recurrent and de novo. The primary endpoint of this study was to evaluate the incidence of postoperative ITM ≥ 2 cm; the secondary endpoint was to determine the relationships between ITM, GERD, endoscopic findings, and percentage of patients requiring surgical revision. MATERIALS AND METHODS A retrospective, multicenter study on prospective databases was conducted, analyzing LSGs performed between 2013 and 2018. Inclusion criteria consisted of primary operation; BMI ranging 35-60 kg/m2; age 18-65 years; minimum follow-up 24 months; and postoperative UGIE, excluding concomitant hiatal hernia repair. Esophageal manometry and 24-h pH-metry were indicated, based on postoperative questionnaires and UGIE; patients with GERD due to ITM, and non-responders to medical therapy, were converted to R-en-Y gastric bypass (RYGB). RESULTS An ITM ≥ 2cm was postoperatively diagnosed in 94 patients (7% of 1337 LSGs), after mean 24.16 ± 13.6 months. Postoperative esophagitis was found in 29 patients vs. 15 initially (p=0.001), while GERD was demonstrated in 75 (vs. 20 preoperatively, p< 0.001). Fifteen patients (16%) underwent revision to RYGB with posterior cruroplasty. Seventeen patients with severe GERD presented improvement of endoscopic findings and clinical symptoms as a result of conservative therapy. CONCLUSIONS ITM after LSG is not a negligible complication and represents an important pathogenic factor in the development or worsening of GERD. Postoperative UGIE plays a fundamental role in the diagnosis of esophageal mucosal lesions.
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Affiliation(s)
- Pietro Termine
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Cristian Eugeniu Boru
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy.
| | - Angelo Iossa
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Maria Chiara Ciccioriccio
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, and "Tor Vergata" University of Rome, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, and "Tor Vergata" University of Rome, Rome, Italy
| | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
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Hu Z, Sun J, Li R, Wang Z, Ding H, Zhu T, Wang G. A Comprehensive Comparison of LRYGB and LSG in Obese Patients Including the Effects on QoL, Comorbidities, Weight Loss, and Complications: a Systematic Review and Meta-Analysis. Obes Surg 2021; 30:819-827. [PMID: 31834563 PMCID: PMC7347514 DOI: 10.1007/s11695-019-04306-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To systematically and comprehensively evaluate the differences between laparoscopic Roux-en-Y gastric bypass (LRYGB) versus sleeve gastrectomy (LSG) in obese patients. Methods A systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018. The meta-analysis was performed by the RevMan 5.3 software. Results Twenty-three articles with 7443 patients were included. In short term (< 3 years), LRYGB was superior to LSG in terms of improving comorbidities (T2D, odds ratio (OR) 1.93, 1.06–3.52, P < 0.05, hypertension, OR 1.59, 1.08–2.34, P < 0.05, dyslipidemia, OR 1.61, 1.05–2.46, P < 0.05), but there were no differences in the midterm and long term. Quality of life (QoL) after bariatric surgery was included, but no differences were observed in the QoL after LRYGB or LSG (gastrointestinal quality of life index (GIQLI) and Moorehead–Ardelt quality of life questionnaire (M-A-Q), P > 0.05). LRYGB achieved a higher EWL% than LSG (after 3 years, WMD 5.48, 0.13–10.84. P < 0.05; after 5 years, WMD 4.55, 1.04–8.05, P < 0.05) in long term, but no significant differences were found during 0.25- to 2.0-year follow-up. The rate of early and late complications was much higher in LRYGB than in LSG (early complications, OR = 2.11, 95% CI = 1.53–2.91, P < 0.001; late complications, OR = 2.60, 95% CI = 1.93–3.49, P < 0.001). Conclusions This meta-analysis showed that LRYGB was more effective than LSG in comorbidities’ resolution or improvement in short term. For weight loss, LRYGB had better long-term effects than LSG. In addition, no differences were observed in the quality of life after LRYGB or LSG. LRYGB was associated with more complications than LSG. Electronic supplementary material The online version of this article (10.1007/s11695-019-04306-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhihao Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Junfeng Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Ruixin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Zhuoyin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Hengxuan Ding
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Tianyu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Guojun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
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Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 30:664-672. [PMID: 31724116 DOI: 10.1007/s11695-019-04235-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures. OBJECTIVES We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG. METHODS Medline, Embase, The Cochrane Library, and NHS Evidence were searched for English language RCTs comparing RYGB with SG and assessed weight loss and/or comorbidity resolution at 5 years. RESULTS Five studies were included in the final analysis. Meta-analysis demonstrates a significantly greater percentage excess weight loss in patients undergoing RYGB compared with SG (65.7% vs 57.3%, p < 0.0001). Resolution of diabetes was seen in 37.4% and 27.5% after RYGB and SG respectively. There was no significant difference between RYGB and SG in rates of resolution or improvement of diabetes. Similarly, HbA1C levels were not significantly different between the two procedures. Resolution of dyslipidaemia was more common after RYGB (68.6% vs 55.2%, p = 0.0443). Remission of gastro-oesophageal reflux occurred in 60.4% in the RYGB group in contrast to 25.0% in the SG group (p = 0.002). CONCLUSIONS Both RYGB and SG result in sustained weight loss and comorbidity control at 5 years. RYGB resulted in greater %EWL, improved dyslipidaemia outcomes and a lower incidence of postoperative gastro-oesophageal reflux disease (GORD).
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Toolabi K, Golzarand M, Farid R. Laparoscopic Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy in Terms of Efficacy and Safety: a Comparative Study During 11-Year Experience. Obes Surg 2021; 31:2489-2496. [PMID: 33686580 DOI: 10.1007/s11695-021-05313-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE This cohort study was designed to compare the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) for the management of morbid obesity during the 11-year experience. MATERIALS AND METHODS This study was conducted between July 2006 and August 2019. Annually we recorded data about the weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of weight loss (%WL), weight regain, and postoperative complications into a prospectively collected database. RESULTS A total of 1146 patients (LRYGB=396 and LSG=750) aged >18 years old were included in the study. Over the first 7 years after surgery, the weight loss rate was significantly higher in the LRYGB-treated group than the LSG-treated group, and weight regain was significantly lower in the LRYGB-treated group in comparison with the LSG-treated group. Our results revealed that statistically, but not clinically, the efficacy of LRYGB and LSG is equivalent in terms of %WL, %EWL, and weight regain within 8 years and more. Besides, there were no significant differences in surgery-related mortality and severe complications between the two procedures. CONCLUSION Our study's results indicated that the clinical efficacy of LRYGB in the management of obesity is better than LSG during the 11-year experience. But the differences in weight loss and weight regain were not statistically relevant at 8 years and more after the surgery. Also, a comparison of severe complications did not indicate significant differences between the two groups.
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Affiliation(s)
- Karamollah Toolabi
- Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 42, Arabi St., Yemen St., Chamran Exp, Tehran, Iran. .,Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roya Farid
- Department of Social Sciences and Health, Durham University, Durham, UK
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Bianciardi E, Raimondi G, Samela T, Innamorati M, Contini LM, Procenesi L, Fabbricatore M, Imperatori C, Gentileschi P. Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study. Front Endocrinol (Lausanne) 2021; 12:662252. [PMID: 34025579 PMCID: PMC8131828 DOI: 10.3389/fendo.2021.662252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven's Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.
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Affiliation(s)
- Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- *Correspondence: Emanuela Bianciardi,
| | - Giulia Raimondi
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Tonia Samela
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Lorenzo Maria Contini
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Leonardo Procenesi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
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Hauters P, Dubart JW, Desmet J, Degolla R, Roumain M, Malvaux P. Ten-year outcomes after primary vertical sleeve gastrectomy for morbid obesity: a monocentric cohort study. Surg Endosc 2020; 35:6466-6471. [PMID: 33140154 DOI: 10.1007/s00464-020-08137-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the 10-year outcomes after sleeve gastrectomy (SG). Primary end-points were the long-term weight loss and the need for conversion and one of the secondary end-points was the incidence of gastroesophageal reflux (GERD). MATERIALS AND METHODS Between 2006 and 2008, 40 consecutive patients had a primary SG. A retrospective analysis of our database and telephone interview of patients who defaulted clinic follow-up was conducted. Success of surgery was defined as percentage of excess weight loss (%EWL) > 50% and no need for conversion. RESULTS Thirty-four patients (85%) achieved a 10-year follow-up. There were 11 men and 23 women with a mean preoperative body mass index (BMI) of 44 ± 4 kg/m2 and a mean age of 42 ± 8 years. Optimal weight loss was reached after a follow-up of 12 months: the mean BMI was 31 ± 5 kg/m2 and %EWL 70 ± 21%. A progressive weight regain was observed over time. With a median follow-up of 11 years (range 7-12), the mean BMI and %EWL were respectively 36 ± 8 kg/m2 (p < 0.005) and 42 ± 37% (p < 0.001). With a median delay of 9 years (range 7-9), 6 patients (18%) were converted to gastric bypass because of weight regain. On total, SG was successful only in 14 patients (41%). Success rate was particularly high in patients who had a 1-year %EWL > 75%: 10/12 (83%) vs. 4/22 (17%) (p < 0.001). Those 12 patients were only characterized by a lower preoperative BMI: 41 ± 2 vs. 45 ± 4 (p < 0.002). Besides, 22 patients (65%) had long-term GERD requiring medical treatment: the incidence of de novo GERD was 41% (6/14) and of persisting GERD 80% (16/20). CONCLUSIONS Our 10-year success rate after SG was 41% and the incidence of GERD 65%. SG should preferably be proposed to selected patients. Patients with low preoperative BMI and without preoperative symptoms of GERD appeared as the best candidates for SG.
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Affiliation(s)
- P Hauters
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium.
| | - J-W Dubart
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - J Desmet
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - R Degolla
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - M Roumain
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
| | - P Malvaux
- Department of Digestive Surgery, CH Wapi, Site Notre-Dame, 9 Avenue Delmée, 7500, Tournai, Belgium
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Dolo PR, Huang K, Widjaja J, Li C, Zhu X, Yao L, Hong J. Distal gastric mucosa ablation induces significant weight loss and improved glycemic control in type 2 diabetes Sprague-Dawley rat model. Surg Endosc 2020; 34:4336-4346. [PMID: 31630290 DOI: 10.1007/s00464-019-07200-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Excluding the foregut (distal stomach and duodenum) from food transit in RYGB normalizes glucose tolerance. Excluding/removing the duodenal mucosa partly improves glycemic control. So far, the effect of excluding/removing the gastric mucosa remains unknown. OBJECTIVE To observe the effect of removing the distal gastric mucosa on glucose tolerance. METHOD Thirty fatty Sprague-Dawley rats received low-dose streptozotocin (STZ) to induce type 2 diabetes (T2D), then randomly assigned to Roux-en-Y gastric bypass (RYGB, n = 8), distal gastric mucosa removal (DGMR, n = 8), duodenal-jejunal bypass (DJB, n = 8), and Sham (n = 6) groups. In the DGMR group, the distal third of the gastric mucosa was removed by thermal ablation using an electrocautery. Rats were followed for 8 weeks postoperatively. Preoperative oral glucose tolerance test (OGTT), insulin tolerance test (ITT), and mixed-meal tolerance test (MMTT) were repeated 3 and 6 weeks postoperatively. Changes in body weight, food intake, and fasting blood glucose were also recorded. RESULTS Gastrin AUC decreased significantly (p < 0.05) in the DGMR group after surgery. A significantly increased GLP-1 AUC was found in the RYGB, DGMR, and DJB groups at week 3 and only the RYGB group at week 6 postoperatively. The improved glucose tolerance in the RYGB group was significantly greater than the improved glucose tolerance in the DGMR and DJB groups. The improved glucose tolerance 3 and 6 weeks after surgery in the DGMR group was significantly greater than the improved glucose tolerance in the DJB group. Body weight decreased significantly in the RYGB, DGMR, and DJB groups postoperatively. CONCLUSION Removing the distal gastric mucosa induced significant weight loss and improved glycemic control in T2D SD rat model. Therefore, the gastric mucosa exclusion in RYGB may be key to the weight loss and diabetes remission, which perhaps warrants a new theory.
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Affiliation(s)
- Ponnie Robertlee Dolo
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Ke Huang
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Jason Widjaja
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Chao Li
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Xiaocheng Zhu
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China. .,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.
| | - Libin Yao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
| | - Jian Hong
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China.,Institute of Digestive Diseases, Xuzhou Medical University, Xuzhou, 221006, Jiangsu, People's Republic of China
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Guraya SY, Strate T. Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus: A systematic review and meta-analysis. World J Gastroenterol 2020; 26:865-876. [PMID: 32148383 PMCID: PMC7052530 DOI: 10.3748/wjg.v26.i8.865] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus (T2DM). Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used procedures for weight loss and comorbidity resolution worldwide. However, it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure. AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients. METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution. Review manager 5.3 was used for data analysis, and the overall effect summary was represented in a forest plot. RESULTS From 1,650 titles retrieved by an initial search, we selected nine studies for this research. We found insignificant differences for T2DM resolution by LRYGB and LSG, with an odds ratio of 0.93 (95%CI: 0.64-1.35, Z statistics = 0.38, P = 0.71). Additionally, subset analyses for T2DM resolution showed insignificant differences after 24 mo (χ 2 = 1.24, df = 4, P = 0.87, overall Z effect = 0.23), 36 mo (χ 2 = 0.41, df = 2, P = 0.81, overall Z effect = 0.51), and 60 mo (χ 2 = 4.75, df = 3, P = 0.19, overall Z effect = 1.20) by LRYGB and LSG. This study reports a T2DM remission rate of 82.3% by LRYGB and 80.7% by LSG. CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up. However, long-term follow-up of 10 years is needed to further substantiate these findings.
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Affiliation(s)
- Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Tim Strate
- Department of Surgery, Reinbek Hospital, Academic Teaching Hospital of the University of Hamburg, Reinbek D-21465, Germany
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Gu L, Huang X, Li S, Mao D, Shen Z, Khadaroo PA, Ng DM, Chen P. A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. BMC Surg 2020; 20:30. [PMID: 32050953 PMCID: PMC7014764 DOI: 10.1186/s12893-020-00695-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are two representative bariatric surgeries. This study aimed to compare the effects of the LSG and LRYGB based on high-quality analysis and massive amount of data. Methods For this study databases of PubMed, Web of Science, EBSCO, Medline, and Cochrane Library were searched for articles published until January 2019 comparing the outcomes of LSG and LRYGB. Results This study included 28 articles. Overall, 9038 patients (4597, LSG group; 4441, LRYGB group) were included. The remission rate of type 2 diabetes mellitus (T2DM) in the LRYGB group was superior to that in the LSG group at the 3-years follow-up. Five-year follow-up results showed that LRYGB had an advantage over LSG for the percentage of excess weight loss and remission of T2DM, hypertension, dyslipidemia, and abnormally low-density lipoprotein. Conclusions In terms of the long-term effects of bariatric surgery, the effect of LRYGB was better than of LSG.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China
| | - Xiaojing Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shengnan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zefeng Shen
- Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | | | - Derry Minyao Ng
- Medical College of Ningbo University, Hangzhou, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China.
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Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for 5-year hypertension remission in obese patients: a systematic review and meta-analysis. J Hypertens 2020; 38:185-195. [DOI: 10.1097/hjh.0000000000002255] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Spann RA, Taylor EB, Welch BA, Grayson BE. Altered immune system in offspring of rat maternal vertical sleeve gastrectomy. Am J Physiol Regul Integr Comp Physiol 2019; 317:R852-R863. [PMID: 31692364 PMCID: PMC6962624 DOI: 10.1152/ajpregu.00230.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 12/19/2022]
Abstract
Obesity in women results in reduced fertility and increased complications during pregnancy. Vertical sleeve gastrectomy (VSG) effectively reduces weight, type 2 diabetes, and dyslipidemia, but is also associated with preterm and small-for-gestational age births. The mechanism by which VSG influences fetal development remains unknown. Here we hypothesize that previously reported immune changes during rat VSG pregnancy are reflected long term in the immune system of the offspring. Offspring of VSG and sham dams were evaluated at postnatal day (PND) 21 and PND60. At PND21, VSG pups have lower numbers of circulating B lymphocytes compared with sham pups (P < 0.05) and have lower transcription of lymphocyte marker Ptprc (P < 0.01) in the spleen, while other lymphocyte populations measured are not different. Total plasma IgG is higher (P < 0.01) and C-reactive protein is lower (P < 0.05) in VSG offspring compared with sham offspring at PND21. The central nervous system of VSG pups is also affected at PND21, having higher expression of Il1b mRNA (P < 0.05) and higher immunoreactivity of microglia marker, IBA1, in the hypothalamus. At PND60, the immune-hematological differences are not present; however, mRNA expression of Il1b is elevated (P < 0.001) in the spleen of VSG offspring along with markers of T cells. These data suggest that the immune system of VSG offspring is compromised early in life, but rebounds after weaning and may even become hyperactive. Future work is needed to determine whether the immune system of VSG offspring is capable of mounting a proper defense and whether other aspects of development are affected.
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Affiliation(s)
- Redin A Spann
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Erin B Taylor
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Bradley A Welch
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Bernadette E Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi
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Perin J, Prokopowicz G, Furtado M, Papas K, Steele KE. A Randomized Trial of a Novel Chewable Multivitamin and Mineral Supplement Following Roux-en-Y Gastric Bypass. Obes Surg 2019; 28:2406-2420. [PMID: 29500675 DOI: 10.1007/s11695-018-3177-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Vitamin and mineral deficiencies are common following Roux-en-Y gastric bypass (RYGB) and can lead to significant morbidity, but little research on the efficacy of vitamin supplementation regimens exists. We compared the efficacy and tolerability of an investigational versus a standard multivitamin regimen in patients undergoing RYGB. METHODS Fifty-six patients, aged 18 to 65, were randomized to an investigational versus a standard multivitamin. Plasma levels of vitamins A, B-12, D, E-α, E-β/γ, thiamine, folate, iron, iron-binding capacity, iron saturation, prealbumin, and parathyroid hormone (PTH) were measured at 3 and 6 months postoperatively. Proteins induced by vitamin K absence (PIVKA), beta-carotene, coenzyme Q10, and mixed tocopherols were measured at 3 months postoperatively. Primary outcomes were differences in plasma levels at 3 and 6 months. Secondary outcomes were palatability, ease of use, and adherence. RESULTS Twenty-one patients were randomized to the standard regimen and 26 to the investigational multivitamin. Nine were lost to follow-up. At 3 months, plasma levels of PTH were lower (p = 0.042), and levels of vitamin D (p = 0.033), thiamine (p = 0.009), and beta-carotene (p = 0.033) were higher in the investigational multivitamin arm compared to those in the standard regimen arm. Patients receiving the investigational multivitamin reported higher taste satisfaction than those receiving the standard regimen (p = 0.035). CONCLUSION The investigational multivitamin appears to be more effective than a standard multivitamin in maintaining therapeutic levels of clinically relevant vitamins and minerals, and was more palatable. Additional studies should be conducted to confirm these findings and refine the optimal dosing regimen. TRIAL REGISTRATION www.clinicaltrials.gov under identifier NCT01475617.
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Affiliation(s)
- Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
| | - Gregory Prokopowicz
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Margaret Furtado
- American University of Antigua School of Medicine, Antigua, Antigua and Barbuda
| | | | - Kimberley E Steele
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Guraya SY, Strate T. Effectiveness of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity in achieving weight loss outcomes. Int J Surg 2019; 70:35-43. [PMID: 31408745 DOI: 10.1016/j.ijsu.2019.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are commonly performed weight loss procedures worldwide. Unfortunately, few studies have compared percentage total weight loss (%TWL) following these procedures. This research compared short-term, mid-term and long-term %TWL by LRYGB and LSG. METHODS Selected databases were searched for original articles that compared %TWL by LSG and LRYGB. Review manager 5.3 was used for data analysis. Effect summary was presented by forest plot. RESULTS A significantly better %TWL in 5 years was shown by LRYGB than LSG; pooled mean difference (MD) 1.87 (95% CI 0.27-3.48, z statistics = 2.28, p < 0.05). Subgroup analysis showed better %TWL by LRYGB than LSG at 24 months pooled MD 6.47 (95% CI 1.22-11.72, z statistics = 2.42, p < 0.05), however, better %TWL by LSG was noted after 36 months (pooled MD -0.23; 95% CI -0.39-0.06, z statistics = 2.65, p < 0.05). Finally, significantly better %TWL was noted for LRYGB at 60 months. CONCLUSION This study shows %TWL of 70.4% by LRYGB and 59.8% following LSG in at least half of patients from selected cohort. A significantly greater %TWL by LRYGB in short and long term, while higher %TWL by LSG in mid-term is reported.
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Affiliation(s)
| | - Tim Strate
- Head of the Department of Surgery, Reinbek Hospital, Academic Teaching Hospital of the University of Hamburg, Hamburger Straße 33, D-21465, Reinbek, Germany.
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Gärtner D, Stroh C, Hukauf M, Benedix F, Manger T. Sleeve gastrectomy in the German Bariatric Surgery Registry from 2005 to 2016: Perioperative and 5-year results. Surg Obes Relat Dis 2019; 15:187-193. [DOI: 10.1016/j.soard.2018.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/14/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
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Dong Z, Islam SMS, Yu AM, Qu R, Guan B, Zhang J, Hong Z, Wang C. Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis. BMC Surg 2018; 18:73. [PMID: 30223815 PMCID: PMC6142391 DOI: 10.1186/s12893-018-0406-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
Background Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis. Methods We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis. Results In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m2 to < 35 kg/m2 in Asia. Conclusions Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m2, and that LSG is the most commonly performed surgical procedure for this in Asia.
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Affiliation(s)
- Zhiyong Dong
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | | | - Ashley M Yu
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Rui Qu
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Bingsheng Guan
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Junchang Zhang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China
| | - Zhao Hong
- Robert H Lurie Medical Research Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Cunchuang Wang
- Department of Bariatric Surgery, the First Affiliated Hospital of Jinan University, No.613, Huangpu Avenue West, Guangzhou, 510630, China.
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Azagury D, Papasavas P, Hamdallah I, Gagner M, Kim J. ASMBS Position Statement on medium- and long-term durability of weight loss and diabetic outcomes after conventional stapled bariatric procedures. Surg Obes Relat Dis 2018; 14:1425-1441. [PMID: 30242000 DOI: 10.1016/j.soard.2018.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Dan Azagury
- Bariatric & Minimally Invasive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut
| | - Isam Hamdallah
- Bariatric Surgery Center, Saint Agnes Hospital, Baltimore, Maryland
| | - Michel Gagner
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida; Hôpital du Sacre Coeur, Montreal, Canada
| | - Julie Kim
- Weight Management Center, Mount Auburn Hospital, Cambridge, Massachusetts
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Changes in the lipid profile 5 years after bariatric surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:1099-1105. [DOI: 10.1016/j.soard.2018.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023]
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Abstract
PURPOSE OF REVIEW The continued success of bariatric surgery to treat obesity and obesity-associated metabolic conditions creates a need for a strong understanding of clinical nutrition both before and after these procedures. RECENT FINDINGS Surgically induced alteration of gastrointestinal physiology can affect the nutrition of individuals, especially among those who have undergone malabsorptive procedures. While uncommon, a subset of patients may develop protein-calorie malnutrition. In these cases, nutrition support should be tailored to the severity of malnutrition. Among all patients who undergo bariatric surgery, high rates of micronutrient deficiencies have been observed. To mitigate these deficiencies, empiric supplementation with multivitamins, calcium citrate, and vitamin D is generally recommended. Periodic surveillance should be performed for commonly deficient micronutrients, including thiamin (B1), folate (B9), cobalamin (B12), iron, and vitamin D. Following Roux-en-Y gastric bypass, serum levels of copper and zinc should also be monitored. In addition, lipid-soluble vitamins should be monitored following biliopancreatic diversion with/without duodenal switch.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology, Diabetes, and Bone Disease, Mount Sinai Beth Israel Medical Center, 317 East 17th St., New York, NY, 10003, USA.
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jeffrey I Mechanick
- Marie-Josee and Henry R. Kravis Center For Cardiovascular Health, Mount Sinai Heart, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Metabolic Support, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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余 浩, 戴 晓, 张 红, 黄 永, 冉 冬, 杨 园, 曾 松, 宋 志, 吴 良. [Efficacy of two bariatric surgeries in type 2 diabetic patients with a body mass index of 25-27.5]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:693-697. [PMID: 28539297 PMCID: PMC6780462 DOI: 10.3969/j.issn.1673-4254.2017.05.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the therapeutic effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG) in patients with type 2 diabetes mellitus and a low body mass index (BMI) of 25-27.5. METHODS Thirty-one type 2 diabetic patients with a BMI of 25-27.5 underwent bariatric surgeries in the General Hospital of Guangzhou Military Command between August, 2013 and August, 2015. The patients receiving LRYGB (17 cases) and SADJB-SG (14 cases) were compared for physical indexes, glucose metabolism and of pancreatic islet function at 1 year after the surgeries. RESULTS No mortality occurred in the patients after the operations. At 1 year after the operation, the patients in LRYGB group showed significant improvements in body weight, BMI, glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), oral glucose tolerance test 2 h (OGTT2h), C-peptide, fasting insulin (FINS), and postprandial 2 hour insulin (2 hPINS) (P<0.05); in SADJB-SG group, significant improvements were observed in the body weigh, BMI, HbA1c, FPG, OGTT2h, and FINS after the operation (P<0.05). The postoperative improvements in body weigh, BMI, HbA1c, FPG, OGTT2h, C-peptide, and 2hPINS were comparable between SADJB-SG group and LRYGB group (P>0.05), but the incidence of postoperative anastomotic ulcer was lower in SADJB-SG group. CONCLUSION SADJB-SG and LRYGB produce similar therapeutic effects in type 2 diabetic patients with a low BMI, but SADJB-SG is associated with a low incidence of postoperative complications and is therefore more suitable in such patients.
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Affiliation(s)
- 浩 余
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广州军区广州总医院甲状腺糖尿病外科中心,广东 广州 510000Thyroid Diabetes Surgery Center, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, China
| | - 晓江 戴
- 广州中医药大学金沙洲医院甲乳糖尿病外科,广东 广州 510000Department of Breast Diabetes Surgery, Jinshazhou Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - 红兵 张
- 广州军区广州总医院甲状腺糖尿病外科中心,广东 广州 510000Thyroid Diabetes Surgery Center, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, China
| | - 永滔 黄
- 广州中医药大学金沙洲医院甲乳糖尿病外科,广东 广州 510000Department of Breast Diabetes Surgery, Jinshazhou Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - 冬芝 冉
- 广州军区广州总医院甲状腺糖尿病外科中心,广东 广州 510000Thyroid Diabetes Surgery Center, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, China
| | - 园 杨
- 广州中医药大学金沙洲医院甲乳糖尿病外科,广东 广州 510000Department of Breast Diabetes Surgery, Jinshazhou Hospital Affiliated to Guangzhou University of Chinese Medicine, Guangzhou 510000, China
| | - 松华 曾
- 广州军区广州总医院甲状腺糖尿病外科中心,广东 广州 510000Thyroid Diabetes Surgery Center, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, China
| | - 志高 宋
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
| | - 良平 吴
- 广州军区广州总医院甲状腺糖尿病外科中心,广东 广州 510000Thyroid Diabetes Surgery Center, General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, China
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