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Khalooeifard R, Rahmani J, Ghoreishy SM, Tavakoli A, Najjari K, Talebpour M. Evaluate the Effects of Different Types of Preoperative Restricted Calorie Diets on Weight, Body Mass Index, Operation Time and Hospital Stay in Patients Undergoing Bariatric Surgery: a Systematic Review and Meta Analysis Study. Obes Surg 2024; 34:236-249. [PMID: 38052747 DOI: 10.1007/s11695-023-06973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
Previous studies investigated low-calorie diets (LCD), very-low-calorie diets (VLCD), and very-low-calorie ketogenic diets (VLCKD) in relation to weight loss and outcomes for bariatric surgery patients. However, the overall effects of these diets on various outcomes remain unclear. This study aimed to assess the impact of preoperative restricted calorie diets on weight, body mass index (BMI), operation time (OT), and hospital stay (HS) in bariatric surgery patients. Seventeen articles were analyzed, revealing the highest weight loss (-8.62) and BMI reduction (-5.75) with VLCKD. Due to insufficient data, the impact of these diets on OT and HS could not be determined. Further interventional studies are required to determine the ideal preoperative diet that achieves optimal weight loss, patient compliance, tolerance, acceptance, and surgical outcomes.
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Affiliation(s)
- Razieh Khalooeifard
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mojtaba Ghoreishy
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Aryan Tavakoli
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosrow Najjari
- Advanced Minimally Invasive Surgery Fellowship, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Talebpour
- Advanced Minimally Invasive Surgery Fellowship, Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Carr P, Keighley T, Petocz P, Blumfield M, Rich GG, Cohen F, Soni A, Maimone IR, Fayet-Moore F, Isenring E, Marshall S. Efficacy and safety of endoscopic sleeve gastroplasty and laparoscopic sleeve gastrectomy with 12+ months of adjuvant multidisciplinary support. BMC PRIMARY CARE 2022; 23:26. [PMID: 35123409 PMCID: PMC8817771 DOI: 10.1186/s12875-022-01629-7] [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: 06/03/2021] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
Background The laparoscopic sleeve gastrectomy (LSG) and the incisionless endoscopic sleeve gastroplasty (ESG) weight loss procedures require further investigation of their efficacy, safety and patient-centered outcomes in the Australian setting. Methods The aim was to examine the 6- and 12-month weight loss efficacy, safety, and weight-related quality of life (QoL) of adults with obesity who received the ESG or LSG bariatric procedure with 12+ months of adjuvant multidisciplinary pre- and postprocedural support. Data were from a two-arm prospective cohort study that followed patients from baseline to 12-months postprocedure from a medical center in Queensland. Percent excess weight loss (%EWL) was the primary outcome. Secondary outcomes were body composition (fat mass, fat-free mass, android:gynoid ratio, bone mineral content) via dual energy X-ray absorptiometry, weight-related QoL, lipid, glycemic, and hepatic biochemistry, and adverse events. Results 16 ESG (19% attrition; 81.2% female; aged:41.4 (SD: 10.4) years; BMI: 35.5 (SD: 5.2) kg/m2) and 45 LSG (9% attrition; 84.4% female; aged:40.4 (SD: 9.0) years; BMI: 40.7 (SD: 5.6) kg/m2) participants were recruited. At 12-months postprocedure, ESG %EWL was 57% (SD: 32%; p < 0.01) and LSG %EWL was 79% (SD: 24%; p < 0.001). ESG and LSG cohorts improved QoL (19.8% in ESG [p > 0.05]; 48.1% in LSG [p < 0.05]), liver function (AST: − 4.4 U/L in ESG [p < 0.05]; − 2.7 U/L in LSG [p < 0.05]), HbA1c (− 0.5% in ESG [p < 0.05]; − 0.1% in LSG [p < 0.05]) and triglycerides (− 0.6 mmol/L in ESG [p > 0.05]; − 0.4 mmol/L in LSG [P < 0.05]) at 12-months. Both cohorts reduced fat mass (p < 0.05). The ESG maintained but LSG decreased fat-free mass at 6-months (p < 0.05); and both cohorts lost fat-free mass at 12-months (p < 0.05). There were no adverse events directly related to the procedure. The ESG reported 25% mild-moderate adverse events possibly related to the procedure, and the LSG reported 27% mild-severe adverse events possibly related to the procedure. Conclusions In this setting, the ESG and LSG were safe and effective weight loss treatments for obese adults alongside multidisciplinary support. Patients who elected the ESG maintained fat-free mass at 6-months but both cohorts lost fat-free mass at 12-months postprocedure. Patients who elected the LSG had large and significant improvements to weight-related quality of life. Further well-powered studies are required to confirm these findings. Trial registration This study was registered prospectively at the Australia New Zealand Clinical Trials Registry on 06/03/2018, Registration Number ACTRN12618000337279. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01629-7.
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Affiliation(s)
- Prudence Carr
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Tim Keighley
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Peter Petocz
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Michelle Blumfield
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Graeme G Rich
- Bariatric Gastroenterologist & Director, Bariatrics Australia, Sydney Adventist Hospital, Wahroonga, Australia
| | - Felicity Cohen
- Weightloss Solutions Australia, Varsity Lakes, Queensland, Australia
| | - Asha Soni
- Weightloss Solutions Australia, Varsity Lakes, Queensland, Australia
| | | | - Flavia Fayet-Moore
- Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Skye Marshall
- Department of Science, Nutrition Research Australia, Level 10, 20 Martin Place, Sydney, New South, Wales. .,Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia.
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Complications nutritionnelles de la chirurgie de l’obésité : prévalence, prévention, traitement. Revue systématique de littérature. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Jackson C, Snyder J, Crooks VA, Lavergne MR. Exploring isolation, self-directed care and extensive follow-up: factors heightening the health and safety risks of bariatric surgery abroad among Canadian medical tourists. Int J Qual Stud Health Well-being 2019; 14:1613874. [PMID: 31084487 PMCID: PMC6522967 DOI: 10.1080/17482631.2019.1613874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: This article explores first-hand accounts of Canadian bariatric patients’ experiences of seeking and obtaining weight loss surgery abroad through the practice of medical tourism. While researchers have identified many of the challenges and associated health and safety risks imposed on patients by engaging in medical tourism generally, little is known about the specific challenges experienced by Canadians seeking bariatric surgery abroad.Method: To better understand these challenges, we conducted thematic analysis on interviews conducted with 20 former Canadian bariatric tourists.Results: Our analysis illuminated three key challenges Canadians face in obtaining bariatric care: (1) stigma and isolation from friends, family and medical professionals; (2) self-directed navigation of domestic and destination health care systems; and (3) challenges with obtaining adequate follow-up care in Canada.Conclusions: While these challenges identified by participants may occur in other forms of medical tourism, it appears that these challenges are occurring simultaneously in cases of bariatric tourism by Canadians. These challenges appear to work in conjunction to heighten the health and safety risks potential Canadian bariatric tourists may be exposed to. Unless structural changes occur to increase domestic availability of bariatric surgery, Canadians are likely to continue seeking this care abroad.
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Affiliation(s)
- Carly Jackson
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Jeremy Snyder
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Valorie A Crooks
- b Department of Geography , Simon Fraser University , Burnaby , British Columbia , Canada
| | - M Ruth Lavergne
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
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Gastric leak after laparoscopic sleeve gastrectomy: management with endoscopic double pigtail drainage. A systematic review. Surg Obes Relat Dis 2019; 15:1414-1419. [PMID: 31023576 DOI: 10.1016/j.soard.2019.03.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 01/28/2023]
Abstract
Gastric leak remains the main complication after sleeve gastrectomy, but there are no standardized guidelines for its treatment. Good results have been reported using endoscopic double-pigtail stent. To estimate its effectiveness, we carried out this systematic review. Eleven eligible articles were identified by searching PubMed, Embase, and Cochrane Library databases. A total of 385 patients met the inclusion criteria. The pooled proportion of successful leak closures by using double pigtail drainage was 83.41%. The proportion of successful leak closures by using double pigtail drainage by experienced operators as first-line treatment was 84.71%. Our review suggested that double-pigtail stent could be a valid approach to manage the postbariatric gastric leak, with low rate of complications and a good tolerance by patients. More high-quality studies with large samples sizes should be undertaken to better evaluate and compare the variety of techniques available.
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Jackson C, Snyder J, Crooks VA, Lavergne MR. "I didn't have to prove to anybody that I was a good candidate": a case study framing international bariatric tourism by Canadians as circumvention tourism. BMC Health Serv Res 2018; 18:573. [PMID: 30029651 PMCID: PMC6053718 DOI: 10.1186/s12913-018-3385-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 07/12/2018] [Indexed: 01/28/2023] Open
Abstract
Background Medical tourism is a practice where patients travel internationally to purchase medical services. Medical tourists travel abroad for reasons including costly care, long wait times for care, and limited availability of desired procedures stemming from legal and/or regulatory restrictions. This paper examines bariatric (weight loss) surgery obtained abroad by Canadians through the lens of ‘circumvention tourism’ – typically applied to cases of circumvention of legal barriers but here applied to regulatory circumvention. Despite bariatric surgery being available domestically through public funding, many Canadians travel abroad to obtain these surgeries in order to circumvent barriers restricting access to this care. Little, however, is known about why these barriers push some patients to obtain these surgeries abroad and the effects of this circumvention. Methods Semi-structured phone interviews were conducted with 20 former Canadian bariatric tourists between February and May of 2016. Interview questions probed patients’ motivations for seeking care abroad, as well as experiences with attempting to obtain care domestically and internationally. Interviews were digitally recorded, transcribed verbatim, and then thematically analyzed. Results Three key barriers to access were identified: (1) structural barriers resulting in limited locally available options; (2) strict body mass index cut-off points to qualify for publicly-funded surgery; and (3) the extended wait-time and level of commitment required of the mandatory pre-operative program in Canada. It was not uncommon for participants to experience a combination, if not all, of these barriers. Conclusions Collectively, these barriers restricting domestic access to bariatric care in Canada may leave Canadian patients with a sense that their health care system is not adequately addressing their specific health care needs. In circumventing these barriers, patients may feel empowered in their health care opportunities; however, significant concerns are raised when patients bypass protections built into the health system. Given the practical limitations of a publicly funded health care system, these barriers to care are likely to persist. Health professionals and policy makers in Canada should consider these barriers in the future when examining the implications medical tourism for bariatric surgery holds for Canadians.
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Affiliation(s)
- Carly Jackson
- Simon Fraser University, Blusson Hall 10516, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Jeremy Snyder
- Simon Fraser University, Blusson Hall 10516, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Valorie A Crooks
- Simon Fraser University, Blusson Hall 10516, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - M Ruth Lavergne
- Simon Fraser University, Blusson Hall 10516, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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Elbahrawy A, Bougie A, Loiselle SE, Demyttenaere S, Court O, Andalib A. Medium to long-term outcomes of bariatric surgery in older adults with super obesity. Surg Obes Relat Dis 2018; 14:470-476. [DOI: 10.1016/j.soard.2017.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/10/2017] [Accepted: 11/04/2017] [Indexed: 01/06/2023]
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Lorenzo D, Guilbaud T, Gonzalez JM, Benezech A, Dutour A, Boullu S, Berdah S, Bège T, Barthet M. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc 2018; 87:429-437. [PMID: 28750839 DOI: 10.1016/j.gie.2017.07.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/19/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Fistulas after sleeve gastrectomy are major adverse events of bariatric surgery. The endoscopic management strategy evolved from closure to internal drainage after 2013. The main objective of our study was to evaluate and compare these different approaches. METHODS This retrospective study included all patients treated for fistulas after sleeve gastrectomy in a referral center. Closure management was defined as initial treatment that used a covered metal stent and/or endoclips. Internal drainage management was defined as initial treatment by nasocystic drain and/or a double-pigtail stent. RESULTS A total of 100 patients (women N = 78, mean [± standard deviation {SD}] age 42 ± 12 years) were included between 2007 and 2015. The mean (± SD) delay between sleeve gastrectomy and the first endoscopy was 82 ± 125 days. The overall success of endoscopic treatment was 86% within 6 ± 27 months. Two patients died. The primary success of internal drainage and closure management occurred in 19 of 22 (86%) and 49 of 77 (63%) patients, respectively. Among patients in failure for closure management, 22 had secondary internal drainage (18 being successful). Success of initial management was significantly higher for internal drainage (P = .043). Factors associated with failure of closure management were in multivariable analysis: collection >5 cm (P = .013). Factors associated with a time >6 months for achieving leakage closure were in multivariable analysis: reoperation before endoscopy (P = .044) and purulent flow at endoscopy (P = .043). CONCLUSIONS Endoscopic management of fistulas after sleeve gastrectomy was successful in 86% of cases. In cases of collections >5 cm, internal drainage should be proposed first. Surgical reintervention before endoscopy delays treatment success.
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Affiliation(s)
- Diane Lorenzo
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Théophile Guilbaud
- Department of Visceral Surgery, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Jean Michel Gonzalez
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Alban Benezech
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Anne Dutour
- Department of Endocrinology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Sandrine Boullu
- Department of Endocrinology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Stéphane Berdah
- Department of Visceral Surgery, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Thierry Bège
- Department of Visceral Surgery, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Aix Marseille Univ-APHM-Hôpital Nord, Marseille, France
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Maïmoun L, Lefebvre P, Jaussent A, Fouillade C, Mariano-Goulart D, Nocca D. Body composition changes in the first month after sleeve gastrectomy based on gender and anatomic site. Surg Obes Relat Dis 2017; 13:780-787. [PMID: 28283436 DOI: 10.1016/j.soard.2017.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/03/2017] [Accepted: 01/06/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) induces acute weight loss, but its impact on the very early postoperative changes in body composition (BC) is less clear. OBJECTIVES This longitudinal study examined the BC changes in the first month after SG according to gender and anatomic site. METHODS BC (lean tissue mass [LTM] and fat mass [FM]) were determined by dual-energy x-ray absorptiometry in 41 obese patients (33 women, 80.5%) just before SG and 1 month later. SETTING University hospital of Montpellier, France. RESULTS One month after SG, mean weight loss was -9.8±2.6 kg, with a significant decrease in LTM and FM (kg) ranging from -7.3% to 9.5%, depending on site. FM (kg) loss in men exceeded that in women at whole body, upper limbs, and trunk. FM (%) and the LTM/FM ratio decreased only in the trunk in men and the lower limbs in women, but the gender difference was only observed for the trunk. In women, age was positively correlated with relative FM variation (% and kg) in the lower limbs and negatively correlated with LTM and LTM/FM. In men, weight was negatively correlated with the relative LTM and FM (kg) variations in the upper limbs. CONCLUSION SG induces acute weight loss, but this loss comprises losses in both FM and LTM. Because excessive LTM loss can have deleterious consequences, preventive strategies should be implemented soon after bariatric surgery. The specific changes in BC are highlighted according to gender and anatomic site.
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Affiliation(s)
- Laurent Maïmoun
- Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier (UM), Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), U1046 INSERM, UMR9214 CNRS, University of Montpellier, Montpellier, France.
| | - Patrick Lefebvre
- Departement d'Endocrinology, Diabetes, Nutrition, Hôpital Lapeyronie, CHRU, Montpellier, France
| | - Audrey Jaussent
- Unité de recherche clinique, biostatistiques et épidémiologie, Département de l'Information Médicale, CHRU, Montpellier, France
| | - Clémence Fouillade
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHRU, Montpellier, France
| | - Denis Mariano-Goulart
- Service de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier et Université Montpellier (UM), Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles (PhyMedExp), U1046 INSERM, UMR9214 CNRS, University of Montpellier, Montpellier, France
| | - David Nocca
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHRU, Montpellier, France
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LaRocca CJ, Beilman GJ, Birch M. A Case of Pseudocholinesterase Deficiency Resulting From Malnutrition. ACTA ACUST UNITED AC 2016; 7:112-4. [PMID: 27467903 DOI: 10.1213/xaa.0000000000000362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pseudocholinesterase deficiencies occur because of both genetic and acquired factors. We present the case of a patient with a history of bariatric surgery and severe malnutrition who subsequently developed prolonged neuromuscular blockade after succinylcholine administration. She had markedly decreased pseudocholinesterase levels at the time of the incident, but her motor function returned to normal with supportive care. After aggressive nutritional support over multiple weeks, her pseudocholinesterase levels drastically improved. For those patients in a poor nutritional state who experience an unexpected episode of apnea or prolonged neuromuscular blockade, practitioners must always consider malnutrition-induced pseudocholinesterase deficiency as a possible etiology.
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Affiliation(s)
- Christopher J LaRocca
- From the Departments of *Surgery and †Anesthesiology, University of Minnesota, Minneapolis, Minnesota
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Groven KS, Glenn NM. The experience of regaining weight following weight loss surgery: A narrative-phenomenological exploration. Health Care Women Int 2016; 37:1185-1202. [PMID: 27249448 DOI: 10.1080/07399332.2016.1195386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Weight loss surgery (WLS) is gaining ground as the most effective treatment against obesity. In the literature, however, we see a divide among individuals who have undergone WLS based on the amount of weight lost and maintained: successful and unsuccessful patients. In this article, we focus on the notion of unsuccessful patients-exploring the accounts of three women who have regained weight following WLS. In doing so, we endeavor to better understand how weight regain has meaning, and its impact and implications for the lives of individuals who undergo WLS. The findings reveal how weight-regain stories are easily silenced, buried beneath social, cultural, and institutional/medical narratives of successful weight loss and transformation. People who have such experiences may feel reticent to reveal them and in doing so increase their own suffering, therefore leaving the popular narratives unchallenged.
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Affiliation(s)
- Karen Synne Groven
- a Institute of Health and Society , University of Oslo , Oslo , Norway.,b Institute of Physiotherapy , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Nicole M Glenn
- c Institut de Recherche en Santé Publique , Department of Social and Preventive Medicine, School of Public Health, Université de Montréal , Montréal , Québec , Canada
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12
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Leonetti F, Campanile FC, Coccia F, Capoccia D, Alessandroni L, Puzziello A, Coluzzi I, Silecchia G. Very low-carbohydrate ketogenic diet before bariatric surgery: prospective evaluation of a sequential diet. Obes Surg 2015; 25:64-71. [PMID: 25005809 DOI: 10.1007/s11695-014-1348-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We evaluated the effectiveness of a sequential diet regimen termed the obese preoperative diet (OPOD) in morbidly obese patients with and without type 2 diabetes mellitus (T2DM) scheduled for laparoscopic bariatric surgery. METHODS Fifty patients (body mass index 53.5 ± 8.4 kg/m(2)) scheduled for bariatric surgery, including 14 with T2DM, were prospectively enrolled and followed the OPOD regimen: a very low-calorie ketogenic diet for 10 days, followed by a very low-calorie diet for 10 days, and then a low-calorie diet for 10 days. Patients were evaluated at baseline (T0) and after 10 days (T1), 20 days (T2), and 30 days (T3). RESULTS Body weight, body mass index, waist circumference, and neck circumference were significantly lower at T1, T2, and T3 than at T0 in the 48 patients who completed the OPOD. Two patients discontinued the OPOD after 4-7 days. In patients with T2DM, fasting plasma glucose levels decreased significantly, enabling reduction of diabetic medications. Plasma and urine ketone levels increased at T1 but were all <1 mmol/L, and hunger decreased during the diet period. CONCLUSIONS OPOD, including 10 days of a VLCKD, was safe and effective in morbidly obese patients, and it seems to be promising in morbidly obese patients with and without T2DM scheduled for laparoscopic bariatric surgery.
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Affiliation(s)
- Frida Leonetti
- Department of Experimental Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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13
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Emous M, Ubels FL, van Beek AP. Diagnostic tools for post-gastric bypass hypoglycaemia. Obes Rev 2015; 16:843-56. [PMID: 26315925 DOI: 10.1111/obr.12307] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 12/15/2022]
Abstract
In spite of its evident success, several late complications can occur after gastric bypass surgery. One of these is post-gastric bypass hypoglycaemia. No evidence-based guidelines exist in the literature on how to confirm the presence of this syndrome. This study aims to describe and compare the tests aimed at making a diagnosis of post-gastric bypass hypoglycaemia and to provide a diagnostic approach based upon the available evidence. A search was conducted in PubMed, Cochrane and Embase. A few questionnaires have been developed to measure the severity of symptoms in post-gastric bypass hypoglycaemia but none has been validated. The gold standard for provocation of a hypoglycaemic event is the oral glucose tolerance test or the liquid mixed meal tolerance test. Both show a high prevalence of hypoglycaemia in post-gastric bypass patients with and without hypoglycaemic complaints as well as in healthy volunteers. No uniformly established cut-off values for glucose concentrations are defined in the literature for the diagnosis of post-gastric bypass hypoglycaemia. For establishing an accurate diagnosis of post-gastric bypass hypoglycaemia, a validated questionnaire, in connection with the diagnostic performance of provocation tests, is the most important thing missing. Given these shortcomings, we provide recommendations based upon the current literature.
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Affiliation(s)
- M Emous
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F L Ubels
- Department of Endocrinology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A P van Beek
- Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.,Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lopes EC, Heineck I, Athaydes G, Meinhardt NG, Souto KEP, Stein AT. Is Bariatric Surgery Effective in Reducing Comorbidities and Drug Costs? A Systematic Review and Meta-Analysis. Obes Surg 2015; 25:1741-9. [DOI: 10.1007/s11695-015-1777-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Natvik E, Gjengedal E, Moltu C, Råheim M. Translating weight loss into agency: Men's experiences 5 years after bariatric surgery. Int J Qual Stud Health Well-being 2015; 10:27729. [PMID: 26066518 PMCID: PMC4462825 DOI: 10.3402/qhw.v10.27729] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 12/13/2022] Open
Abstract
Fewer men than women with severe obesity undergo bariatric surgery for weight loss, and knowledge about men's situation after surgery, beyond medical status, is lacking. Our aim was to explore men's experiences with life after bariatric surgery from a long-term perspective. We conducted in-depth interviews with 13 men, aged 28–60 years, between 5 and 7 years after surgery. The analysis was inspired by Giorgi's phenomenological method. We found that agency was pivotal for how the men understood themselves and their lives after surgery. Weight loss meant regaining opportunities for living and acting in unrestricted and independent daily lives, yet surgery remained a radical treatment with complex consequences. Turning to surgery had involved conceptualizing their own body size as illness, which the men had resisted doing for years. After surgery, the rapid and major weight loss and the feelings of being exhausted, weak, and helpless were intertwined. The profound intensity of the weight loss process took the men by surprise. Embodying weight loss and change involved an inevitable renegotiating of experiences connected to the large body. Having bariatric surgery was a long-term process that seemed unfinished 5 years after surgery. Restrictions and insecurity connected to health and illness persist, despite successful weight loss and embodied change. Bariatric surgery initiated a complex and long-lasting life-changing process, involving both increased capacity for agency and illness-like experiences.
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Affiliation(s)
- Eli Natvik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Eva Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Division of Psychiatry, District General Hospital of Førde, Førde, Norway
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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16
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A Retrospective Review of the Medical Management of Hypertension and Diabetes Mellitus Following Sleeve Gastrectomy. Obes Surg 2014; 25:642-7. [DOI: 10.1007/s11695-014-1375-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Martins TDCP, Duarte TC, Mosca ERT, Pinheiro CDF, Marçola MA, De-Souza DA. Severe protein malnutrition in a morbidly obese patient after bariatric surgery. Nutrition 2014; 31:535-8. [PMID: 25701346 DOI: 10.1016/j.nut.2014.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 12/14/2022]
Abstract
The aim of this study was to describe the clinical course of a morbidly obese patient who underwent Roux-en-Y gastric bypass (RYGB) surgery and, in the late postoperative period, presented the expected loss of weight, but also presented severe protein malnutrition (PM). A patient with morbid obesity, who in March 2012, presented PM (serum albumin = 2.4 g/dL) 2 y after the completion of RYGB surgery (loss of 52.7% of usual body weight). During the hospitalization, the patient received partial volumes of commercial semi-elemental, high-protein, low-fat diet by tube feeding with gastric positioning, associated with an oral low-fat, low-sodium, and bland-consistency diet. The patient presented a temporary clinical improvement, however, outpatient monitoring identified the need for subsequent hospitalizations due to the recurrence of severe hypoalbuminemia (e.g., 1.39 g/dL), anasarca (increase of 15 kg in 79 d), and normocytic and normochromic anemia (e.g., hemoglobin 9.2 g/dL). In July 2013 the RYGB partial reversal technique was performed with a reduction of 100 cm in the Roux-en-Y arm. Seventy days after surgery, the patient was asymptomatic (albumin 3.7 g/dL), however, she presented rapid and progressive recovery of the body weight (increase of 10.3 kg in 60 d, without edema). The effective treatment of morbid obesity is still a major challenge in clinical practice. Restrictive, malabsorptive bariatric techniques are associated with nutritional deficiencies. Severe PM is rarely reported as a late postoperative complication of RYGB, however, due to the serious consequences associated with this, it requires early diagnosis and treatment.
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Affiliation(s)
- Tatiana de Castro Pereira Martins
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Thaís Castro Duarte
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Postgraduate Program in Health Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Etelvina Rocha Tolentino Mosca
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Conceição de Fátima Pinheiro
- Department of Surgery, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Maria Alzira Marçola
- Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Clinical Hospital, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Daurea Abadia De-Souza
- Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Multidisciplinary Residency Program in Clinical Nutrition, Multidisciplinary Residency in Health, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Postgraduate Program in Health Sciences, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil; Department of Internal Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
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18
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Goritz T, Duff E. Bariatric Surgery: Comprehensive Strategies for Management in Primary Care. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Iron deficiency after Roux-en-Y gastric bypass: insufficient iron absorption from oral iron supplements. Obes Surg 2014; 24:56-61. [PMID: 23918279 DOI: 10.1007/s11695-013-1042-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) may reduce the absorption of iron, but the extent to which this absorption is impeded is largely unknown. First, we determined the prevalence of iron deficiency following RYGB and explored the risk factors for its development. Second, we examined to what extent oral iron supplements are absorbed after RYGB. METHODS Monocentric retrospective study in 164 patients (123 females, 41 males; mean age 43 years) who underwent RYGB between January 2006 and November 2010 was done. Pre- and postoperative data on gender, age, BMI, serum levels of iron, ferritin, hemoglobin, vitamin B12, 25-hydroxy vitamin D, and use of proton pump inhibitors and H2 antagonists were collected. Generalized linear mixed models were used for the analysis of the data. In 23 patients who developed iron deficiency after surgery, an oral challenge test with 100 mg FeSO4 · 7H2O was performed. RESULTS Following RYGB, 52 (42.3 %) female patients and 9 male (22.0 %) patients developed iron deficiency (serum ferritin concentration ≤ 20 μg/L). The prevalence of iron deficiency was significantly higher in females than males (p = 0.0170). Young age (p = 0.0120), poor preoperative iron status (p = 0.0004), vitamin B12 deficiency (p = 0.0009), and increasing time after surgery (p < 0.0001) were also associated with iron deficiency. In the oral iron challenge test, only one patient out of 23 showed sufficient iron absorption. CONCLUSIONS Iron deficiency is extremely frequent after RYGB and is linked with different risk factors. Iron supplementation seems essential, but the effect of oral tablets may be limited as absorption of oral iron supplements is insufficient post-RYGB.
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20
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Mercachita T, Santos Z, Limão J, Carolino E, Mendes L. Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of ≥ 1 year. Obes Surg 2014; 24:102-8. [PMID: 23955522 DOI: 10.1007/s11695-013-1057-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies. METHODS The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI). RESULTS There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake. CONCLUSIONS Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.
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Affiliation(s)
- Tânia Mercachita
- , Rua Alfredo Rebelo, Casais de Baixo, 2050-360 Azambuja, Lisbon, Portugal,
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21
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Hedberg J, Sundström J, Sundbom M. Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisons. Obes Rev 2014; 15:555-63. [PMID: 24666623 DOI: 10.1111/obr.12169] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/10/2014] [Accepted: 02/25/2014] [Indexed: 01/06/2023]
Abstract
Long-term weight loss after Roux-en-Y gastric bypass (RYGB) in super-obese patients has not been ideal. Biliopancreatic diversion with duodenal switch (DS) is argued to be better; however, additional side effects are feared. The aim of the present study was to determine differences in results after DS and RYGB in publications from single-centre comparisons. A systematic review of studies containing DS and RYGB performed at the same centre was performed. Outcome data were weight results, resolution of comorbid conditions, perioperative results and complications. Main outcome was difference in weight loss after DS and RYGB. Secondary outcomes were difference in resolution of comorbidities, perioperative results and complications. The final analysis included 16 studies with in total 874 DS and 1,149 RYGB operations. When comparing weight results at the longest follow-up of each study, DS yielded 6.2 (95% confidence interval 5.0-7.5) body mass index units additional weight loss compared with RYGB, P < 0.001. Operative time and length of stay were significantly longer after DS, as well as the risk for post-operative leaks, P < 0.05. DS is more effective than RYGB as a weight-reducing procedure. However, this comes at the price of more early complications and might also yield slightly higher perioperative mortality.
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Affiliation(s)
- J Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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22
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Santarpia L, Grandone I, Alfonsi L, Sodo M, Contaldo F, Pasanisi F. Long-term medical complications after malabsorptive procedures: effects of a late clinical nutritional intervention. Nutrition 2014; 30:1301-5. [PMID: 24986553 DOI: 10.1016/j.nut.2014.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/30/2013] [Accepted: 03/16/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The growing prevalence of severe obesity, combined with the failure of conservative treatments, has led to a significant spread of bariatric surgical procedures. The aim of this study was to emphasize the need of adequate presurgery patient selection and close follow-up after malabsorptive procedures for bariatric surgery. METHODS The study retrospectively evaluated 25 (20 F, 5 M; mean age 43 ± 13 y) obese patients (mean weight before intervention 134 ± 30.7 kg, body mass index 50.7 ± 10.1 kg/m(2)) attending our outpatient clinical nutrition unit for severe malabsorption and secondary malnutrition after surgical intervention that had been performed outside the regional area. RESULTS All patients received personalized dietetic indications; in 12 of 25 (48%) cases integrated by oral protein supplements and in 5 of 25 (20%) by medium chain triglycerides. According to screening exams, patients were prescribed oral/parenteral iron, vitamins A, B group, D, and folate supplementation. In 14 of 25 (56%) patients, parenteral hydration and in 4 of 25 (16%), long-term parenteral nutrition was required. Five patients required hospitalization for severely complicated protein-energy malnutrition. CONCLUSION Nutritional deficiencies are common after malabsorptive procedures for bariatric surgery; these can be present or latent before surgery, frequently going unrecognized and/or inadequately treated particularly when patients are not strictly followed up by the operating center. Despite the adequate-even intensive-intervention, clinical nutritional status moderately improved in all patients.
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Affiliation(s)
- Lidia Santarpia
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy.
| | - Ilenia Grandone
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
| | - Lucia Alfonsi
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
| | - Maurizio Sodo
- Department of Public Health, Pre and Post Transplant Surgery, Federico II University Hospital, Naples, Italy
| | - Franco Contaldo
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
| | - Fabrizio Pasanisi
- Interuniversity Research Center for Obesity and Eating Disorder CISRO, Department of Clinical Medicine and Surgery, Naples, Italy
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23
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Janero DR. Synthetic agents in the context of metabolic/bariatric surgery: expanding the scope and impact of diabetes drug discovery. Expert Opin Drug Discov 2014; 9:221-8. [DOI: 10.1517/17460441.2014.876988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- David R Janero
- Northeastern University, Bouvé College of Health Sciences, Center for Drug Discovery, Department of Pharmaceutical Sciences, and Health Sciences Entrepreneurs, 360 Huntington Avenue, 116 Mugar Life Sciences Hall, Boston, MA 02115-5000, USA ;
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24
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Tsai AG, Hosokawa P, Schoen J, Prochazka AV. Frequency of laboratory testing among gastric bypass patients. Surg Obes Relat Dis 2013; 10:340-5. [PMID: 24355327 DOI: 10.1016/j.soard.2013.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/21/2013] [Accepted: 09/08/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long-term laboratory monitoring is recommended after gastric bypass surgery to prevent the development of micronutrient deficiencies. The objective of this study was to characterize patterns of laboratory monitoring after surgery. METHODS We used a large insurance claims database to assess the frequency of laboratory testing after gastric bypass surgery. We assessed the tests recommended by an expert panel on bariatric surgery, including tests recommended routinely as well as second-line tests for specific clinical scenarios (e.g., tests for anemia when iron deficiency is not present). RESULTS With the exception of testing for diabetes, most gastric bypass patients did not undergo routine laboratory testing in the first year after their surgery, ranging from 54% (electrolytes) to 95% (zinc). However, for first-line tests, significantly more gastric bypass patients underwent testing in the first year,compared with gastric banding patients. Differences in testing frequency between gastric bypass and gastric banding patients were larger for tests of micronutrient deficiency than for common metabolic panels and complete blood counts. For second-line tests, much smaller percentages of both groups of patients underwent testing, either in the first year or after year 1. CONCLUSION Patients undergoing gastric bypass do not routinely undergo recommended laboratory tests, although they are undergoing more monitoring than gastric banding patients. Efforts must be made by patients, surgeons, and primary care providers to ensure that routine testing is done to lower the risk of adverse health outcomes.
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Affiliation(s)
- Adam G Tsai
- Division of General Internal Medicine, University of Colorado, Aurora, Colorado; Anschutz Center for Health and Wellness, University of Colorado, Aurora, Colorado.
| | - Patrick Hosokawa
- Colorado Health Outcomes Program, University of Colorado, Aurora, Colorado
| | - Jonathan Schoen
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Allan V Prochazka
- Division of General Internal Medicine, University of Colorado, Aurora, Colorado; Denver VA Medical Center, Denver, Colorado
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25
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Grima M, Middleton S, Dixon J. Bariatric surgery for the treatment of severe complex obesity: An update. Nutr Diet 2013. [DOI: 10.1111/1747-0080.12068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Mariee Grima
- Clinical Obesity Research; Melbourne Victoria Australia
| | - Sonia Middleton
- Weight Assessment & Management Clinic; Melbourne Victoria Australia
| | - John Dixon
- Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2013; 20:156-60. [PMID: 23434800 DOI: 10.1097/med.0b013e32835f8a71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Savastano S, Di Somma C, Pivonello R, Tarantino G, Orio F, Nedi V, Colao A. Endocrine changes (beyond diabetes) after bariatric surgery in adult life. J Endocrinol Invest 2013; 36:267-79. [PMID: 23448968 DOI: 10.3275/8880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bariatric surgery is nowadays an effective therapeutic option for morbid obesity. Endocrinologists may thus have a growing opportunity to diagnose and treat obese patients eligible for surgery in pre- and post-operative phase. This requires a better understanding of endocrine changes caused by either obesity or weight loss surgery. Despite the large number of studies available in literature, only limited well-designed clinical trials have been performed so far to investigate changes of endocrine axes following bariatric procedures. There are still areas of unclear results such as female and male fertility, however, weight loss after bariatric surgery is considered to be associated with favorable effects on most endocrine axes. The aim of this clinical review is to overview the available literature on the effects of weight loss after bariatric surgery on the endocrine systems to suggest the most appropriate pre- and post-operative management of obese patients undergoing bariatric surgery in terms of "endocrine" health.
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Affiliation(s)
- S Savastano
- Sezione di Endocrinologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Via S. Pansini 5-80131 Naples, Italy.
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Capoccia D, Coccia F, Paradiso F, Abbatini F, Casella G, Basso N, Leonetti F. Laparoscopic gastric sleeve and micronutrients supplementation: our experience. J Obes 2012; 2012:672162. [PMID: 22545207 PMCID: PMC3321468 DOI: 10.1155/2012/672162] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/04/2012] [Indexed: 12/19/2022] Open
Abstract
Background. Laparoscopic gastric sleeve (LGS) has been recently introduced as a stand-alone, restrictive bariatric surgery. Theoretically, LGS attenuates micronutrients deficiencies and associated complications that were typically observed following malabsorptive procedures. The aim of this study was to assess some micronutrients and mineral deficiencies in patients undergoing LGS. Methods. In the period between July 2008 and April 2010, 138 obese patients (110 females and 28 males) with mean BMI 44.4 kg/m(2) ± 6.5, mean age 43.9 ± 10.9 years were enrolled and underwent LGS. Patients were followed up with routine laboratory tests and anthropometric measurements and assessed for nutritional status, as regards vitamin B12, folic acid, iron, hemoglobin, calcium, and vitamin D, every three months throughout 12 months. Results. 12 months after sleeve, patients did not show iron deficiency and/or anemia; plasma calcium levels were in the normal range without supplementation from the sixth month after the operation. Vitamin B12 and folic acid were adequately supplemented for all the follow-up period. Vitamin D was in suboptimal levels, despite daily multivitamin supplementation. Conclusion. In this study, we showed that LGS is an effective surgery for the management of morbid obesity. An adequate supplementation is important to avoid micronutrients deficiencies and greater weight loss does not require higher dosage of multivitamins.
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Affiliation(s)
- D. Capoccia
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
- *D. Capoccia:
| | - F. Coccia
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - F. Paradiso
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - F. Abbatini
- Surgical-Medical Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy
| | - G. Casella
- Surgical-Medical Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy
| | - N. Basso
- Surgical-Medical Department for Digestive Diseases, Sapienza University of Rome, Rome, Italy
| | - F. Leonetti
- Department of Clinical Sciences, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
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