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El Ansari W, El-Menyar A, El-Ansari K, Al-Ansari A, Lock M. Cumulative Incidence of Venous Thromboembolic Events In-Hospital, and at 1, 3, 6, and 12 Months After Metabolic and Bariatric Surgery: Systematic Review of 87 Studies and Meta-analysis of 2,731,797 Patients. Obes Surg 2024; 34:2154-2176. [PMID: 38602603 PMCID: PMC11127857 DOI: 10.1007/s11695-024-07184-7] [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: 12/28/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Systematic review/meta-analysis of cumulative incidences of venous thromboembolic events (VTE) after metabolic and bariatric surgery (MBS). Electronic databases were searched for original studies. Proportional meta-analysis assessed cumulative VTE incidences. (PROSPERO ID:CRD42020184529). A total of 3066 records, and 87 studies were included (N patients = 4,991,683). Pooled in-hospital VTE of mainly laparoscopic studies = 0.15% (95% CI = 0.13-0.18%); pooled cumulative incidence increased to 0.50% (95% CI = 0.33-0.70%); 0.51% (95% CI = 0.38-0.65%); 0.72% (95% CI = 0.13-1.52%); 0.78% (95% CI = 0-3.49%) at 30 days and 3, 6, and 12 months, respectively. Studies using predominantly open approach exhibited higher incidence than laparoscopic studies. Within the first month, 60% of VTE occurred after discharge. North American and earlier studies had higher incidence than non-North American and more recent studies. This study is the first to generate detailed estimates of the incidence and patterns of VTE after MBS over time. The incidence of VTE after MBS is low. Improved estimates and time variations of VTE require longer-term designs, non-aggregated reporting of characteristics, and must consider many factors and the use of data registries. Extended surveillance of VTE after MBS is required.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, 3050, Doha, Qatar.
- College of Medicine, Qatar University, Doha, Qatar.
- Department of Clinical Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kareem El-Ansari
- Faculty of Medicine, St. George's University, Saint George's, Grenada
| | | | - Merilyn Lock
- Department of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Gokce N, Karki S, Dobyns A, Zizza E, Sroczynski E, Palmisano JN, Mazzotta C, Hamburg NM, Pernar LI, Carmine B, Carter CO, LaValley M, Hess DT, Apovian CM, Farb MG. Association of Bariatric Surgery With Vascular Outcomes. JAMA Netw Open 2021; 4:e2115267. [PMID: 34251443 PMCID: PMC8276087 DOI: 10.1001/jamanetworkopen.2021.15267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Bariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood. OBJECTIVES To identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvascular and macrovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal cohort included 307 individuals who underwent bariatric surgery. Participants were enrolled in the bariatric weight loss program at Boston Medical Center, a large, multi-ethnic urban hospital, with presurgical and postsurgical assessments. Data were collected from December 11, 2001 to August 27, 2019. Data were analyzed in September 2019. EXPOSURE Bariatric surgery. MAIN OUTCOMES AND MEASURES Flow-mediated dilation (FMD) and reactive hyperemia (RH) (as measures of macrovascular and microvascular function, respectively) and clinical variables were measured preoperatively at baseline and at least once postoperatively within 12 months of the bariatric intervention. RESULTS A total of 307 participants with obesity (mean [SD] age, 42 [12] years; 246 [80%] women; 199 [65%] White; mean [SD] body mass index, 46 [8]) were enrolled in this study. Bariatric surgery was associated with significant weight loss and improved macrovascular and microvascular function across subgroups of sex, race, and traditional metabolic syndrome (mean [SD] pre- vs postsurgery weight: 126 [25] kg vs 104 [25] kg; P < .001; mean [SD] pre- vs postsurgery FMD: 9.1% [5.3] vs 10.2% [5.1]; P < .001; mean [SD] pre- vs postsurgery RH: 764% [400] vs 923% [412]; P < .001). Factors associated with change in vascular phenotype correlated most strongly with adiposity markers and several metabolic variables depending on vascular territory (eg, association of weight change with change in RH: estimate, -3.2; 95% CI, -4.7 to -1.8; association of hemoglobin A1c with change in FMD: estimate, -0.5; 95% CI, -0.95 to -0.05). While changes in macrovascular function among individuals with metabolically healthy obesity were not observed, the addition of biomarker assessment using high-sensitivity C-reactive protein plasma levels greater than 2 mg/dL identified participants with seemingly metabolically healthy obesity who had low-grade inflammation and achieved microvascular benefit from weight loss surgery. CONCLUSIONS AND RELEVANCE The findings of this study suggest that bariatric intervention is associated with weight loss and favorable remodeling of the vasculature among a wide range of individuals with cardiovascular risk. Moreover, differences in arterial responses to weight loss surgery by metabolic status were identified, underscoring heterogeneity in physiological responses to adiposity change and potential activation of distinct pathological pathways in clinical subgroups. As such, individuals with metabolically healthy obesity represent a mixed population that may benefit from more refined phenotypic classification.
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Affiliation(s)
- Noyan Gokce
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Shakun Karki
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Alyssa Dobyns
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Elaina Zizza
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Emily Sroczynski
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Joseph N. Palmisano
- Department of Public Health, Boston University School of Medicine, Boston, Massachusetts
| | - Celestina Mazzotta
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Naomi M. Hamburg
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Luise I. Pernar
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Brian Carmine
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Cullen O. Carter
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Michael LaValley
- Department of Public Health, Boston University School of Medicine, Boston, Massachusetts
| | - Donald T. Hess
- Department of General Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Caroline M. Apovian
- Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Melissa G. Farb
- Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
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Lazebnik LB, Golovanova EV, Alekseenko SA, Bueverov AO, Plotnikova EY, Dolgushina AI, Ilchenko LY, Ermolova TV, Tarasova LV, Lee ED, Tsyganova YV, Akhmedov VA, Ageeva EA, Losev VM, Kupriyanova IN, Serikova SN, Korochanskaya NV, Vologzhanina LG, Zimmerman YS, Sas EI, Zhuravel SV, Okovitiy SV, Osipenko MF, Radchenko VG, Soldatova GS, Sitkin SI, Seliverstov PV, Shavkuta GV, Butova EN, Kozhevnikova SA. Russian Consensus “Hyperammonemia in Adults” (Version 2021). EXPERIMENTAL AND CLINICAL GASTROENTEROLOGY 2021:97-118. [DOI: 10.31146/1682-8658-ecg-187-3-97-118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Justification Given the large number of reports on the peculiarities of liver lesions during the Sars-Cov-2 infection [1], a team of experts who participated in the 23rd Congress of the Scientific Society of Gastroenterologists of Russia and 15 National Congress of Therapists of November 19, 2020 decided to make additions to the Russian Consensus of “Hyperammonemia in Adults” published early 2020 [2, 3].
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Affiliation(s)
- L. B. Lazebnik
- “Moscow State University of Medicine and Density n. a. A. I. Evdokimov”
| | - E. V. Golovanova
- “Moscow State University of Medicine and Density n. a. A. I. Evdokimov”
| | | | - A. O. Bueverov
- I. M. Sechenov first Moscow state medical university (Sechenov university); Moscow regional research and clinical Institute of M. F. Vladimirsky
| | - E. Yu. Plotnikova
- Federal State Budgetary Institution of Higher Education Kemerovo state medical University of the Ministry of health of Russia
| | - A. I. Dolgushina
- “South-Ural State Medical University” of the Ministry of Health of Russia
| | - L. Yu. Ilchenko
- Pirogov Russian National Research Medical University (RNRMU)
| | - T. V. Ermolova
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation
| | - L. V. Tarasova
- BI of HE “The Surgut State University”; “The Chuvashian State University”
| | - E. D. Lee
- Multifocal Medicine Center of The Central Bank of Russian Federation
| | | | - V. A. Akhmedov
- “Omsk State Medical University” of the Ministry of Health
| | | | | | - I. N. Kupriyanova
- “Ural state medical University” of the Ministry of health of the Russian Federation
| | - S. N. Serikova
- State Budgetary Institution of Health Care “Region Clinic Hospital Nr 2” Health Ministry of Krasnodar Region
| | - N. V. Korochanskaya
- State Budgetary Institution of Health Care “Region Clinic Hospital Nr 2” Health Ministry of Krasnodar Region
| | - L. G. Vologzhanina
- “Perm State Medical University named E. A. Wagner” of the Ministry of Health of Russia
| | - Ya. S. Zimmerman
- “Perm State Medical University named E. A. Wagner” of the Ministry of Health of Russia
| | - E. I. Sas
- Military Medical Academy named after S. M. Kirov
| | - S. V. Zhuravel
- “Moscow State University of Medicine and Density n. a. A. I. Evdokimov”; Scientific Research Institute of Emergency Medicine of N. V. Sklifosovskiy of Healthcare Department of Moscow
| | - S. V. Okovitiy
- Saint Petersburg State Chemical Pharmaceutical University (SPCPA)
| | - M. F. Osipenko
- Public budgetary educational institution of higher education “Novosibirsk State Medical University” of the Ministry of Healthcare of the Russia
| | | | | | - S. I. Sitkin
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation; Federal Medical and Biological Agency “State Research Institute of Highly Pure Biopreparations”
| | - P. V. Seliverstov
- North- Western state medical University named after I. I. Mechnikov, Ministry of health of the Russian Federation
| | - G. V. Shavkuta
- Rostov State Medical University of the Ministry of Health of Russia
| | - E. N. Butova
- Rostov State Medical University of the Ministry of Health of Russia
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Mellinger JL, Shedden K, Winder GS, Fernandez AC, Lee BP, Waljee J, Fontana R, Volk ML, Blow FC, Lok ASF. Bariatric surgery and the risk of alcohol-related cirrhosis and alcohol misuse. Liver Int 2021; 41:1012-1019. [PMID: 33529460 PMCID: PMC8204517 DOI: 10.1111/liv.14805] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/29/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Bariatric surgery is common, but alcohol misuse has been reported following these procedures. We aimed to determine if bariatric surgery is associated with increased risk of alcohol-related cirrhosis (AC) and alcohol misuse. METHODS Retrospective observational analysis of obese adults with employer-sponsored insurance administrative claims from 2008 to 2016. Subjects with diagnosis codes for bariatric surgery were included. Primary outcome was risk of AC. Secondary outcome was risk of alcohol misuse. Bariatric surgery was divided into before 2008 and after 2008 to account for patients who had a procedure during the study period. Cox proportional hazard regression models using age as the time variable were used with interaction analyses for bariatric surgery and gender. RESULTS A total of 194 130 had surgery from 2008 to 2016 while 209 090 patients had bariatric surgery prior to 2008. Age was 44.1 years, 61% women and enrolment was 3.7 years. A total of 4774 (0.07%) had AC. Overall risk of AC was lower for those who received sleeve gastrectomy and laparoscopic banding during the study period (HR 0.4, P <.001; HR 0.43, P =.02) and alcohol misuse increased for Roux-en-Y and sleeve gastrectomy recipients (HR 1.86 and 1.35, P <.001, respectively). In those who had surgery before 2008, women had increased risk of AC and alcohol misuse compared to women without bariatric surgery (HR 2.1 [95% CI: 1.79-2.41] for AC; HR 1.98 [95% CI 1.93-2.04]). CONCLUSIONS Bariatric surgery is associated with a short-term decreased risk of AC but potential long-term increased risk of AC in women. Post-operative alcohol surveillance is necessary to reduce this risk.
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Affiliation(s)
- Jessica L. Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI
| | | | | | | | - Jennifer Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Robert Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Michael L. Volk
- Transplantation Institute, Loma Linda University Health, Loma Linda CA
| | - Frederic C. Blow
- Department of Psychiatry, Ann Arbor, MI,VA Center for Clinical Management Research (CCMR), Ann Arbor, MI
| | - Anna SF Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
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Skulsky SL, Dang JT, Switzer NJ, Sharma AM, Karmali S, Birch DW. Higher Edmonton Obesity Staging System scores are independently associated with postoperative complications and mortality following bariatric surgery: an analysis of the MBSAQIP. Surg Endosc 2020; 35:7163-7173. [PMID: 33155074 DOI: 10.1007/s00464-020-08138-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Bariatric surgery is an evidence-based approach for sustained weight loss in patients with severe obesity. The most common procedures in North America are the laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The Edmonton Obesity Staging System (EOSS) is a tool that assigns patients a score of 0 to 4 according to their obesity-related comorbidities and functional status. Previous research demonstrates that increasing EOSS score is associated with overall non-operative mortality risk. OBJECTIVE We sought to assess the association of the EOSS with major 30-day postoperative complications following LSG or LRYGB. METHODS Primary LSG or LRYGB patients were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Patients were assigned EOSS scores according to their comorbidities and functional limitations extracted from the database. Multivariable logistic regression analysis was conducted to evaluate the relationship between EOSS score, age, sex, BMI, type of procedure, or operative time with 30-day major complications. RESULTS From 2015 to 2017, 430,238 patients (79.4% female) who underwent primary LSG or LRYGB were identified. The relative frequencies of patients by EOSS score were: 0 and 1 (23.9%), 2 (62.8%), 3 (10.5%), and 4 (2.9%). Mean preoperative BMI was 45.4 (SD 7.9) kg/m2 and mean age was 44.6 (SD 12.0) years. The overall 30-day major complication rate was 3.5%. EOSS 2, 3, and 4 were significantly associated with major complications. The strongest associations with major complications were EOSS 4 (OR 2.30; 95% CI 2.11-2.51, p < 0.001) and LRYGB versus LSG (OR 2.03; 95% CI 1.97-2.11, p < 0.001). EOSS 3 and 4 were most strongly associated with death. CONCLUSION Higher EOSS scores are independently associated with 30-day major postoperative complications and mortality. The EOSS provides utility in staging patients and identifying those at greater risk of postoperative complications.
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Affiliation(s)
- Samuel L Skulsky
- Department of Surgery, University of Ottawa, Loeb Research Building, 725 Parkdale Avenue, Office WM150B, Ottawa, ON, K1Y 4E9, Canada.
| | - Jerry T Dang
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Zheng X, Zhang J, Wang L, Sang Q, Zhu B, Zhang N, Sun Z. Case Report: an Unusual Complex Internal Hernia After Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:1833-1835. [PMID: 33078339 DOI: 10.1007/s11695-020-05060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Jianlu Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Bin Zhu
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China.
| | - Zhipeng Sun
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Tieyi Road, Haidian Distinct, Beijing, 100038, China.
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Sleeve gastrectomy-induced endocrine changes in the remnant stomachs of premenopausal and postmenopausal rats: role of the estrogen receptors. Surg Obes Relat Dis 2020; 17:193-207. [PMID: 33011072 DOI: 10.1016/j.soard.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/02/2020] [Accepted: 08/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although alterations in the plasma levels of leptin, glucagon-like peptide-1, and gastrin were linked with bariatric surgery outcomes, gastric production of these peptides was not elucidated before. OBJECTIVE The aim was to evaluate the impact of estrogen depletion and estrogen receptors (ERs) on sleeve gastrectomy (SG)-induced alterations in gastric hormone production, gastric mucosal integrity, and bone mass. SETTING Physiology Research Lab at the University. METHODS Female Sprague-Dawley rats underwent ovariectomy or sham operation (control), and 2 months later SG or sham SG was performed. Rats received either nonselective agonist 17 β, ER-α agonist, ER-β agonist, or vehicle for 3 weeks. Trunk blood and gastric tissues were collected for biochemical measurements, while histopathologic examination was performed in gastric and femur samples. RESULTS In the presence of intact ovaries, SG-induced weight loss was accompanied by reductions in the gastric synthesis of leptin and gastrin, while gastric glucagon-like peptide-1 was additionally decreased when SG was performed at the postmenopausal state. SG elevated the depleted serum estradiol levels of menopause, implicating a beneficial effect, but the occurrence of severe gastric mucosal injury was triggered. On the other hand, using ER agonists upregulated gastrin-expressing cells, ameliorated gastric injury, and improved bone loss. CONCLUSIONS SG, either at premenopausal or postmenopausal state, resulted in considerable loss in bone mass, along with reductions in the gastric levels of gastrin and leptin. Functional status of the ovaries needs to be taken into consideration when monitoring the outcomes of SG, and ER agonists could be of value in controlling SG-induced complications.
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Clapp B, Harper B, Barrientes A, Wicker E, Alvara C, Tyroch A. The MBSAQIP is going viral! 194 hits and still going strong. Surg Obes Relat Dis 2020; 16:1401-1406. [DOI: 10.1016/j.soard.2020.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/01/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
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Double-balloon enteroscopy for diagnostic and therapeutic ERCP in patients with surgically altered gastrointestinal anatomy: a systematic review and meta-analysis. Surg Endosc 2020; 35:18-36. [DOI: 10.1007/s00464-020-07893-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/05/2020] [Indexed: 12/19/2022]
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Hardy KL, Stark R, Small KH, Kenkel JM. An Alternative Treatment of Pseudogynecomastia in Male Patients After Massive Weight Loss. Aesthet Surg J Open Forum 2020; 2:ojaa013. [PMID: 33791640 PMCID: PMC7780471 DOI: 10.1093/asjof/ojaa013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There has been an increase in body contouring procedures following massive weight loss (MWL), including male breast reduction procedures. Treating male chest deformity after MWL using standard mastopexy techniques often leads to suboptimal results. OBJECTIVES The authors describe a technique to treat pseudogynecomastia using a modified elliptical excision and nipple-areola complex (NAC) transposition on a thinned inferior dermal pedicle as an alternative to conventional techniques. METHODS A retrospective chart review from January 2011 to January 2019 identified a total of 14 male patients who underwent excision of pseudogynecomastia using the described technique. RESULTS Patients were characterized by age, method of weight loss, pre-weight loss body mass index (BMI), post-weight loss BMI, total weight loss, grade of pseudogynecomastia, and concurrent procedures performed. Patients were followed for a period ranging from 3 months to 1.5 years (average, 8.1 months). Pre-weight loss BMI and post-weight loss BMI averaged 52.0 kg/m2 and 29.6 kg/m2, respectively. The average weight lost was 79.72 kg and the average total amount of tissue removed was 2615 g. All patients had concurrent procedures with an average operative time of 274 minutes. Four out of 14 patients (28.6%) experienced minor complications, which included asymmetry, delayed wound healing, seroma, and hyperpigmentation. There were no wound infections, hematomas, flap necrosis, or dysesthesia. CONCLUSIONS Due to several cosmetic advantages and low complication profile, our technique using a modified elliptical excision and NAC transfer on an inferior dermal pedicle is an attractive option for treating male chest deformity after MWL. LEVEL OF EVIDENCE 4
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Affiliation(s)
| | | | | | - Jeffrey M Kenkel
- Corresponding Author: Dr Jeffrey M. Kenkel, Professor and Chair, Department of Plastic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA. E-mail: ; Twitter: @drkenkel
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Hjorth S, Näslund I, Andersson-Assarsson JC, Svensson PA, Jacobson P, Peltonen M, Carlsson LMS. Reoperations After Bariatric Surgery in 26 Years of Follow-up of the Swedish Obese Subjects Study. JAMA Surg 2020; 154:319-326. [PMID: 30601881 DOI: 10.1001/jamasurg.2018.5084] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Importance Bariatric surgery is an established treatment for obesity, but knowledge on the long-term incidence of revisional surgery is scarce. Objective To determine the incidence and type of revisional surgery after bariatric surgery in 26 years of follow-up of participants in the Swedish Obese Subjects (SOS) study. Design, Setting, and Participants The SOS study is a prospective nonrandomized controlled study comparing bariatric surgery (banding, vertical banded gastroplasty [VBG], and gastric bypass [GBP]) with usual care. The bariatric surgeries in the SOS study were conducted at 25 public surgical departments in Sweden. Men with body mass index values of 34 or higher and women with body mass indexes of 38 or higher were recruited to the surgery group of the SOS study between September 1, 1987, and January 31, 2001, and follow-up continued until December 31, 2014. Data analysis occurred from November 2016 to April 2018. Interventions Banding, VBG, or GBP. Main Outcomes and Measures Revisional surgeries, analyzed using data from questionnaires, hospital records, and the Swedish National Patient register through December 31, 2014. Results A total of 2010 participants underwent surgery. The age range was 37 to 60 years. A total of 376 participants underwent banding (18.7%), while 1365 had VBG (67.9%) and 266 had GBP (13.2%). During a median follow-up of 19 years, 559 participants (27.8%) underwent first-time revisional surgery, including 354 conversions to other bariatric procedures (17.6%), 114 corrective surgeries (5.6%), and 91 reversals to normal anatomy (4.5%). Revisional surgeries (conversions, corrective surgery, and reversals) were common after banding (153 of 376 [40.7%]) and VBG (386 of 1365 [28.3%]) but relatively rare after GBP (20 of 266 [7.5%]). Patients who had banding and VBG primarily underwent conversions to GBP or reversals. Incidence of reversals was 5 times higher after banding than after VBG (40.7% vs 7.5%; unadjusted hazard ratio, 5.19 [95% CI, 3.43-7.87]; P < .001). Corrective surgeries were equally common irrespective of the index surgery (72 of 1365 patients who had VBG [5.3%]; 23 of 376 patients who had banding [6.1%]; 19 of 266 patients who had GBP [7.1%]). Revisional surgery indications, including inadequate weight loss, band-associated complications (migration, stenosis, and slippage), staple-line disruptions, and postsurgical morbidity, varied depending on index surgery subgroup. Most corrections occurred within the first 10 years, whereas conversions and reversals occurred over the entire follow-up period. Conclusions and Relevance Corrective surgeries occur mainly within the first 10 years and with similar incidences across all 3 surgical subgroups, but indications varied. Conversions (mainly to GBP) and reversals occurred after many years and were most frequent after banding and VBG, reflecting a higher overall revisional surgery demand after these operations.
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Affiliation(s)
- Stephan Hjorth
- Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Per-Arne Svensson
- Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,The Institute of Health and Care Sciences, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Peter Jacobson
- Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Markku Peltonen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Lena M S Carlsson
- Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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12
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Trends in Bariatric Surgery: a 5-Year Analysis of the Israel National Bariatric Surgery Registry. Obes Surg 2020; 30:1761-1767. [DOI: 10.1007/s11695-020-04426-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Niu A, Carpenter TO, Grams JM, Bozorgmehri S, Tommasini SM, Schafer AL, Canales BK. High dose vitamin D supplementation does not rescue bone loss following Roux-en-Y gastric bypass in female rats. Bone 2019; 127:172-180. [PMID: 31226531 PMCID: PMC6708762 DOI: 10.1016/j.bone.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/26/2019] [Accepted: 06/17/2019] [Indexed: 01/30/2023]
Abstract
Postoperative bone loss and increased fracture risk associated with Roux-en-Y gastric bypass (RYGB) have been attributed to vitamin D/calcium malabsorption and resultant secondary hyperparathyroidism (HPT). Adequate vitamin D supplementation (VDS), particularly in an older female population, reduces incidence of secondary HPT but the effect on bone loss and fracture risk remains unclear. To investigate whether VDS corrects the RYGB bone phenotype, 41 obese adult female rats were randomized to RYGB with 1000 IU (R1000) or 5000 IU (R5000) vitamin D/kg food or a sham surgical procedure with either paired (PF) or ad libitum (AL) feeding. Bone turnover markers, urinary calcium/creatinine ratio (CCR), and serum calciotropic and gut hormones were assessed throughout a 14-week postoperative period. Femurs were analyzed by micro-computed tomography (μCT), three-point bending test, and histomorphometry. 1000 IU animals had low 25‑hydroxyvitamin D (25(OH)D), high serum parathyroid hormone (PTH), and very low urine CCR levels. 5000 IU corrected the 25(OH)D and secondary HPT but did not increase urine CCR or serum levels of 1,25‑dihydroxyvitamin D (1,25(OH)D) significantly between RYGB groups. Compared to sham animals at 14 weeks, RYGB animals had significantly higher serum osteocalcin (OCN) and C-terminal telopeptide (CTX) levels. The gut hormone peptide tyrosine tyrosine hormone (PYY) was higher in the RYGB groups, and leptin was lower. μCT and biomechanical testing revealed RYGB females had decreased cortical and trabecular bone volume and weaker, stiffer bone than controls. Histomorphometry showed decreased bone volume and increased osteoid volume with increased mineral apposition rate in RYGB compared to controls. No differences in bone phenotype were identified between 1000 IU and 5000 IU groups, and osteoclast numbers were comparable across all four groups. Thus, in our model, 5000 IU VDS corrected vitamin D deficiency and secondary HPT but did not rescue RYGB mineralization rate nor the osteomalacia phenotype. Longer studies in this model are required to evaluate durability of these detrimental effects. Our findings not only underscore the importance of lifelong repletion of both calcium and vitamin D but also suggest that additional factors affect skeletal health in this population.
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Affiliation(s)
- Aidi Niu
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Thomas O Carpenter
- Department of Pediatrics, Endocrine Section, Yale University School of Medicine, New Haven, CT, United States of America
| | - Jayleen M Grams
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States of America; Department of Surgery, Birmingham VA Medical Center, Birmingham, AL, United States of America
| | - Shahab Bozorgmehri
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, FL, United States of America
| | - Steven M Tommasini
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT 06520, United States of America
| | - Anne L Schafer
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System and University of California, San Francisco, CA, United States of America
| | - Benjamin K Canales
- Department of Urology, North Florida/South Georgia Veterans Affairs Medical Center and University of Florida, Gainesville, FL, United States of America.
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Rogers AM. Comment on: Bariatric surgery outcomes in patients on home oxygen therapy: an analysis of the MBSAQIP database. Surg Obes Relat Dis 2019; 15:1580-1581. [PMID: 31506205 DOI: 10.1016/j.soard.2019.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Ann M Rogers
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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15
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Nonfatal Hyperammonemic Encephalopathy as a Late Complication of Roux-en-Y Gastric Bypass. Case Rep Gastrointest Med 2019; 2019:9031087. [PMID: 31355019 PMCID: PMC6632496 DOI: 10.1155/2019/9031087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is the most common weight loss procedure performed in the US. Gastric bypass–related hyperammonemia (GaBHA) is a potentially fatal entity, characterized by encephalopathy associated with hyperammonemia and various nutritional deficiencies, which can present at variable time intervals after RYGB. Twenty-five cases of hyperammonemic encephalopathy after bariatric surgery have been previously reported in the literature. We describe the case of a 48-year-old Hispanic woman with no prior history of liver disease, presenting with nonfatal hyperammonemic encephalopathy as a late postoperative complication 20 years after undergoing a RYGB. Hyperammonemic encephalopathy in the absence of known hepatic dysfunction presents a diagnostic dilemma. An early diagnosis and intervention are crucial to decrease morbidity and mortality.
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Abstract
Bariatric surgery is recognized as a highly effective therapy for obesity but it does carry a risk of short term and long term complications since it results in a permanent alteration of the patient's anatomy. We present a case of 45-year-old female presented with a macular rash on extremities and facial rash from a rehabilitation center after having been discharged a month earlier from a revision surgery on her gastric bypass for anastomotic bleeding. She progressively became lethargic with Magnetic Resonance Imaging (MRI) of the brain showed symmetrically restricted diffusion concerning for hypoxic injury. Her ammonia levels were at 142 micromoles per liter (mmol/L) at the initial check which worsened to 432 mmol/L over a few days, despite treatment. Laboratory investigation later revealed her to be deficient in zinc along with many essential and nonessential amino acids. Supplemental nutrition was initiated, specifically fortifying her parenteral feeds with the essential amino acid combinations that were found deficient on testing. This lead to a slow but progressive improvement in encephalopathy. This case highlights the importance of understanding the short and long term complications of bariatric surgery. Although neurological complications are rare with peripheral neuropathy being the most common one, hyperammonemic encephalopathy is a very severe complication, with incompletely understood mechanisms and predispositions, frequently resulting in failure of recognition and subsequent delays in intervention.
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Affiliation(s)
- Prathik Krishnan
- Pulmonary Critical Care, State University of New York Upstate Medical University, Syracuse, USA
| | - Poornima Ramadas
- Hematology Oncology, State University of New York Upstate Medical University, Syracuse, USA
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17
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Common bile duct dilation after bariatric surgery. Surg Endosc 2018; 33:2531-2538. [DOI: 10.1007/s00464-018-6546-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/15/2018] [Indexed: 12/26/2022]
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18
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Postoperative Care Fragmentation Is Associated with Increased 30-Day Mortality after Bariatric Surgery. Obes Surg 2018; 28:3795-3800. [DOI: 10.1007/s11695-018-3419-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Biörserud C, Shams K, Elander A, Fagevik Olsén M. Self-image after bariatric surgery and its relationship to gender, excess skin and health-related quality of life. J Plast Surg Hand Surg 2018; 52:288-293. [PMID: 29957078 DOI: 10.1080/2000656x.2018.1481860] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: There is limited knowledge about self-image in relation to excess skin after bariatric surgery. The aim of this study was therefore to explore self-image after massive weight loss and its relationship to gender, weight loss, discomfort regarding excess skin and health-related quality of life. Methods: Eighteen months after obesity surgery, 131 patients filled in questionnaires about self-image (Som jag ser mig själv), excess skin (Sahlgrenska Excess Skin Questionnaire, SESQ) and quality of life (EQ-5D and SF-36). In addition, maximal ptosis was measured on their abdomen, arms and thighs. Results: There were no differences in self-image or quality of life between the genders. Participants who scored low discomfort on SESQ had a significantly better overall self-image, in all subscales, compared to those with high discomfort scores (p < .05). They also had a significantly higher quality of life on the EQ-5D VAS (p = .045). Correlations were low, if any, between self-image, excess skin, quality of life and ptosis. There were moderate correlations between the SESQ score and the self-image subscore 'physical well-being', and in self-image and quality-of-life scores. Conclusions: Self-image is lower among those who experience a high degree of discomfort of excess skin after bariatric surgery. Its correlation to weight loss, measured excess skin and quality of life is weak.
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Affiliation(s)
- Christina Biörserud
- a Department of Surgery/Gastrosurgical Research and Education , Sahlgrenska University Hospital , Gothenburg , Sweden.,b Department of Clinical Sciences/Surgery , Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden
| | - Kima Shams
- c Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
| | - Anna Elander
- d Department of Plastic Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden.,e Department of Clinical Sciences/Surgery , Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden
| | - Monika Fagevik Olsén
- a Department of Surgery/Gastrosurgical Research and Education , Sahlgrenska University Hospital , Gothenburg , Sweden.,b Department of Clinical Sciences/Surgery , Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden.,f Department of Physiotherapy , Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg University , Gothenburg , Sweden
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Thomas IA, Gaynor JJ, Joseph T, De La Cruz-Munoz N, Sageshima J, Kupin W, Chen LJ, Ciancio G, Burke GW, Mattiazzi AD, Roth D, Guerra G. Roux-en-Y gastric bypass is an effective bridge to kidney transplantation: Results from a single center. Clin Transplant 2018; 32:e13232. [PMID: 29488657 DOI: 10.1111/ctr.13232] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 12/23/2022]
Abstract
Body mass index (BMI) > 35-40 kg/m2 is often a contraindication, while Roux-en-Y gastric bypass (RYGB) is performed to enable kidney transplantation. This single-center retrospective study evaluated pre- and post-transplant outcomes of 31 morbidly obese patients with end-stage renal disease having RYGB before kidney transplantation between July 2009 and June 2014. Fourteen RYGB patients were subsequently transplanted. Nineteen recipients not having GB with a BMI ≥ 36 kg/m2 at transplantation were used as historical controls. Mean BMI (±SE) before RYGB was 43.5 ± 0.7 kg/m2 (range: 35.4-50.5 kg/m2 ); 87.1% (27/31) achieved a BMI < 35 kg/m2 . The percentage having improved diabetes/hypertension control was 29.0% (9/31); 25.8% (8/31) had complications (mostly minor) after RYGB. Among transplanted patients, blacks/Hispanics comprised 78.6% (11/14) and 84.2% (16/19) of RYGB and controls; 57.1% (8/14) and 63.2% (12/19) had a (mostly long-standing) pretransplant history of diabetes. While biopsy-proven acute rejection (BPAR) occurred significantly higher among RYGB vs control patients (6/14 vs 3/19, P = .03), patients developing T-cell BPAR were also significantly more likely to have a tacrolimus (TAC) trough level < 4.0 ng/mL within 3 weeks of T-cell BPAR (P = .0007). In Cox's model, the impact of having a TAC level < 4.0 ng/mg remained significant (P = .007) while the effect of RYGB was no longer significant (P = .13). Infections, graft, and patient survival were not significantly different. Despite obvious effectiveness in achieving weight loss, RYGB will need more careful post-transplant monitoring given the observed higher BPAR rate.
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Affiliation(s)
- Ian A Thomas
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Jeffrey J Gaynor
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Tameka Joseph
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | | | | | - Warren Kupin
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Linda J Chen
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Gaetano Ciancio
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - George W Burke
- Department of Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Adela D Mattiazzi
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - David Roth
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
| | - Giselle Guerra
- Department of Medicine, University of Miami/Jackson Memorial Hospital, Miami, FL, USA
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21
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Nagarur A, Fenves AZ. Late presentation of fatal hyperammonemic encephalopathy after Roux-en-Y gastric bypass. Proc AMIA Symp 2017; 30:41-43. [PMID: 28127128 DOI: 10.1080/08998280.2017.11929521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Worldwide, there have been <25 reported cases of hyperammonemic encephalopathy associated with Roux-en-Y gastric bypass surgery in the absence of cirrhosis. We describe a 42-year-old woman who presented with subacute but progressive neurological decline late in her postoperative course, which deteriorated despite multiple conservative and aggressive measures, including hemodialysis, in an attempt to reduce measured plasma ammonia levels. This syndrome of hyperammonemic encephalopathy represents a serious, underrecognized, and potentially treatable complication after Roux-en-Y gastric bypass.
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Affiliation(s)
- Amulya Nagarur
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew Z Fenves
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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22
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Twells LK, Driscoll S, Gregory DM, Lester K, Fardy JM, Pace D. Morbidity and health-related quality of life of patients accessing laparoscopic sleeve gastrectomy: a single-centre cross-sectional study in one province of Canada. BMC OBESITY 2017; 4:40. [PMID: 29238600 PMCID: PMC5725939 DOI: 10.1186/s40608-017-0176-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Abstract
Background In Canada, severe obesity (BMI ≥ 35 kg/m2) affects 5% or 1.2 million adults. Bariatric surgery is the only effective treatment for severe obesity, but the demand for publicly funded procedures is high and capacity limited. Little is known in Canada about the types of patients undergoing these procedures, especially laparoscopic sleeve gastrectomy (LSG). The study objective is to examine the socio-demographic profile, morbidity and HRQoL of patients accessing LSG in one Canadian province. Methods Health status and HRQoL were examined in patients (n = 195) undergoing LSG. HRQoL was assessed using the EQ-5D-3L, SF-12v2 and the Impact of Weight on Quality of Life-lite questionnaire. Results Mean age and BMI were 44 and 49 kg/m2 and most were women (82%). Pre-surgery, comorbidities were sleep apnea (65%), dyslipidemia (48%), hypertension (47%) and osteoarthritis (44%). Patients reported impaired HRQoL with 44-67% reporting problems in mobility, usual activities, pain and anxiety/depression. Physical health was impaired more than mental health. There were few socio-demographic differences between women and men, but significant differences in comorbid conditions such as sleep apnea, dyslipidemia, hypertension and gout exist (p < .05). Women reported fewer problems with self-care (9.5% vs. 25.0%, p < .05), and better overall health (VAS 61.5 vs. 52.0, p < .05) and General Health (39.3 vs. 32.9, p < .05), but greater impairment in self-esteem (27.3 vs. 44.1, p < .01) and sexual life (49.2 vs. 63.6, p < .05). Conclusions Before LSG, patients reported significant morbidity and impaired HRQoL. Although baseline characteristics were similar between men and women, gender specific differences were observed in comorbid profile and HRQoL.
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Affiliation(s)
- Laurie K Twells
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,School of Pharmacy, Memorial University, Health Sciences Centre, 300 Prince Philip Drive Newfoundland and Labrador, St. John's, A1B 3V6 Canada
| | - Shannon Driscoll
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Deborah M Gregory
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Kendra Lester
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - John M Fardy
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
| | - Dave Pace
- Faculty of Medicine, Memorial University, Medical Education Building, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada.,Eastern Health, Health Sciences Centre, 300 Prince Philip Drive, St. John's, NL A1B 3V6 Canada
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24
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Rate of Death and Complications in Laparoscopic and Open Roux-en-Y Gastric Bypass. A Meta-analysis and Meta-regression Analysis on 69,494 Patients. Obes Surg 2017; 26:1956-63. [PMID: 27189352 DOI: 10.1007/s11695-016-2231-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Morbid obesity is a life threatening condition. Currently, surgery represents the only effective and durable therapeutic option to treat it. The first aim of the study was to estimate and compare the major surgical complications and the 30-day rate of mortality between laparoscopic and open Roux-en-Y gastric bypass (LRYGB and RYGB). The second aim was to evaluate the change in outcomes, complications, and deaths, with increased experience over the time period of the review. A random effect of the meta-analysis and meta-regression was used to evaluate surgical complications (i.e., reoperation, stenosis, bleeding, surgical site infection, fistula, internal hernia, and incisional ventral hernia) and the rate of mortality after LRYGB and RYGB over time. A search of literature from 2000 to 2014 led to the selection of 17 papers. When looking at surgical techniques separately, we observed a higher rate of mortality for open surgery (death rate 0.82 %, 95 % CI = 0.49-1.23) compared to laparoscopic surgery (death rate 0.22 %, 95 % CI = 0.09-0.40). This difference resulted highly significant when the two techniques were formally compared (p < 0.001). The improving of surgery technique resulted in a mean rate of mortality reduction of 0.069 %. Laparoscopy represents the approach of choice for bariatric surgery. Contemporary reports of LRYGB show low mortality rates and progressive decline in postoperative complications. Laparoscopic bariatric surgery requires advanced laparoscopic skills, and probably an extended learning curve is not accounted for by current mortality statistics.
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25
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Anhê FF, Varin TV, Schertzer JD, Marette A. The Gut Microbiota as a Mediator of Metabolic Benefits after Bariatric Surgery. Can J Diabetes 2017; 41:439-447. [DOI: 10.1016/j.jcjd.2017.02.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 02/07/2023]
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26
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A Novel Endoscopic Technique to Diagnose Gastric Cancer in Excluded Stomach after Roux-en-Y Gastric Bypass. ACG Case Rep J 2017; 4:e36. [PMID: 28331875 PMCID: PMC5356153 DOI: 10.14309/crj.2017.36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 12/06/2016] [Indexed: 11/21/2022] Open
Abstract
Access to the bypassed portion of the stomach after Roux-en-Y gastric bypass remains a challenge. We present a case of 64-year-old woman who presented with gastric outlet obstruction. We used a novel endoscopic technique to access the bypassed stomach by creating a jejunogastrostomy using a specialized stent, which allowed the insertion of a pediatric gastroscope to examine the bypassed portion of the stomach. Stomach biopsies revealed poorly differentiated adenocarcinoma with signet cell features.
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27
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Wesp JA, Duke MC, Farrell TM. Single-Incision Laparoscopic Sleeve Gastrectomy: Yes or No? J Laparoendosc Adv Surg Tech A 2017; 27:227-228. [PMID: 28170289 DOI: 10.1089/lap.2017.29015.tmf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julie Ann Wesp
- UNC Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Meredith C Duke
- UNC Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Timothy M Farrell
- UNC Department of Surgery, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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28
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Skelin M, Lucijanić T, Amidžić Klarić D, Rešić A, Bakula M, Liberati-Čizmek AM, Gharib H, Rahelić D. Factors Affecting Gastrointestinal Absorption of Levothyroxine: A Review. Clin Ther 2017; 39:378-403. [PMID: 28153426 DOI: 10.1016/j.clinthera.2017.01.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/23/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Levothyroxine (LT4) is a drug with a narrow therapeutic index, applied in small amounts (micrograms), which makes interactions in the absorption phase clinically significant. The main aim of this article was to review and present the latest information on factors that affect the gastrointestinal absorption of this drug. METHODS Relevant data were collected by using the MEDLINE, PubMed, EMBASE, Web of Science, Science Direct, and Scopus databases with the key words levothyroxine and absorption. Searches were not limited to specific publication types, study designs, dates, or languages. The reports were highly variable in the amount of information provided regarding study design and methods. Because of the heterogeneity of studies, no statistical analysis was performed. FINDINGS Many gastrointestinal disorders, such as celiac disease, atrophic gastritis, lactose intolerance, and Helicobacter pylori infection, may impede the absorption of levothyroxine. During treatment of these disorders, it is necessary to monitor serum thyroid-stimulating hormone and free T4 values to reduce the risk of developing iatrogenic hyperthyroidism. Soybeans and coffee have the greatest impact on the reduction of absorption, whereas vitamin C has the ability to increase it. Conversely, the effect of dietary fiber on the absorption of LT4 is not yet fully understood; further research is needed on this topic. A decrease in the absorption of LT4 is established and clinically significant when administered concomitantly with cholestyramine, colesevelam, lanthanum, calcium carbonate, calcium citrate, calcium acetate, iron sulfate, ciprofloxacin, aluminum hydroxide, sevelamer, or proton pump inhibitors. This effect should be taken into consideration when prescribing these drugs concomitantly with LT4. The effects of Giardia lamblia infection and the influence of orlistat, polystyrene sulfonate, raloxifene, and simethicone on absorption of LT4 have been poorly documented. For bariatric surgery, sucralfate and H2-antagonist interactions are not well founded or contradictory evidence is available regarding their existence; additional research should be conducted. IMPLICATIONS The majority of the interactions are clinically significant. They are based on the LT4 adsorption on interfering substances in the digestive tract, as well as a consequently reduced amount of the drug available for absorption. These interactions can be avoided by separating the administration of LT4 and the interfering substance.
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Affiliation(s)
- Marko Skelin
- Pharmacy Department, General Hospital Šibenik, Šibenik, Croatia
| | - Tomo Lucijanić
- Department of Endocrinology, Diabetes and Metabolic Disorders, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Arnes Rešić
- Department of Paediatrics, Children's Hospital Zagreb, Zagreb, Croatia
| | - Miro Bakula
- Department of Endocrinology, Diabetes and Metabolic Disorders, General Hospital "Sv. Duh," Zagreb, Croatia
| | - Ana-Marija Liberati-Čizmek
- Department of Endocrinology, Diabetes and Metabolic Disorders, General Hospital "Sv. Duh," Zagreb, Croatia
| | - Hossein Gharib
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Dario Rahelić
- Department of Endocrinology, Diabetes and Metabolic Disorders, Clinical Hospital Dubrava, Zagreb, Croatia
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Cai JX, Diehl DL, Kiesslich R, Storm AC, El Zein MH, Tieu AH, Hoffman A, Singh VK, Khashab MA, Okolo PI, Kumbhari V. A multicenter experience of through-the-scope balloon-assisted enteroscopy in surgically altered gastrointestinal anatomy. Surg Endosc 2016; 31:2753-2762. [PMID: 28039647 DOI: 10.1007/s00464-016-5282-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgically altered gastrointestinal anatomy poses challenges for deep enteroscopy. Current overtube-assisted methods have long procedure times and utilize endoscopes with smaller working channels that preclude use of standard accessories. A through-the-scope balloon-assisted enteroscopy (TTS-BAE) device uses standard endoscopes with a large working channel to allow metallic and plastic stent insertion. We aim to determine the efficacy and safety of TTS-BAE in patients with altered surgical anatomy. METHODS A retrospective, multicenter study of TTS-BAE in altered anatomy patients at two USA and one German institution was performed between January 2013 and December 2014. Type of anatomy, procedure indication and duration, adverse events, and target, technical, and clinical success were recorded. RESULTS A total of 32 patients (mean age 54 years, Caucasian 81.6%, female 42.1%, mean BMI 25.4 kg/m2) underwent 38 TTS-BAE procedures. Thirty-two percent of cases had a prior attempt at conventional enteroscopy which failed to reach the target site. The target was successfully reached in 23 (60.5%) cases. Of the 23 cases that reached the intended target, 22 (95.7%) achieved technical success and 21 (91.3%) achieved clinical success. The median procedure time was 43 min. Target, technical, and clinical success rates for TTS-BAE-assisted ERCP (n = 31) were 58.1, 54.8 and 54.8%. Seven self-expandable metallic stents (five biliary, two jejunal) were attempted, and all successfully deployed. Adverse events occurred in 4 (10.4%) cases, including one luminal perforation. CONCLUSION TTS-BAE is an alternative to overtube-assisted enteroscopy that is comparable in safety in patients with surgically altered anatomies. Technical success in the instances where the target had been reached was excellent. TTS-BAE confers an advantage over overtube-assisted enteroscopy as it can facilitate the deployment of self-expandable metallic stents in the biliary tree and deep small bowel.
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Affiliation(s)
- Jennifer X Cai
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA, USA
| | - Ralf Kiesslich
- Department of Internal Medicine II, HSK Hospital, Wiesbaden, Germany
| | - Andrew C Storm
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA
| | - Mohamad H El Zein
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA
| | - Alan H Tieu
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA
| | - Arthur Hoffman
- Department of Internal Medicine II, HSK Hospital, Wiesbaden, Germany
| | - Vikesh K Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA
| | - Patrick I Okolo
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA.
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, 1800 Orleans Street, Sheikh Zayed Tower 7E, Suite 7125G, Baltimore, MD, 21287, USA.
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Azran C, Wolk O, Zur M, Fine-Shamir N, Shaked G, Czeiger D, Sebbag G, Kister O, Langguth P, Dahan A. Oral drug therapy following bariatric surgery: an overview of fundamentals, literature and clinical recommendations. Obes Rev 2016; 17:1050-1066. [PMID: 27335140 DOI: 10.1111/obr.12434] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is the most effective solution for severe obesity and obesity with comorbidities, and the number of patients going through bariatric surgery is rapidly and constantly growing. The modified gastrointestinal anatomy of the patient may lead to significant pharmacokinetic alterations in the oral absorption of drugs after the surgery; however, because of insufficient available literature and inadequate awareness of the medical team, bariatric surgery patients may be discharged from the hospital with insufficient instructions regarding their medication therapy. In this article, we aim to present the various mechanisms by which bariatric surgery may influence oral drug absorption, to provide an overview of the currently available literature on the subject, and to draw guidelines for the recommendations bariatric surgery patients should be instructed before leaving the hospital. To date, and until more robust data are published, it is essential to follow and monitor patients closely for safety and efficacy of their medication therapies, both in the immediate and distant time post-surgery.
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Affiliation(s)
- Carmil Azran
- Clinical Pharmacy, Herzliya Medical Center, Herzliya, Israel
| | - Omri Wolk
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moran Zur
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noa Fine-Shamir
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gad Shaked
- Department of Surgery B, Soroka University Medical Center, Beer Sheva, Israel
| | - David Czeiger
- Department of Surgery B, Soroka University Medical Center, Beer Sheva, Israel
| | - Gilbert Sebbag
- Department of Surgery B, Soroka University Medical Center, Beer Sheva, Israel
| | - Olga Kister
- Institute of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Johannes Gutenberg-University, Mainz, Germany
| | - Peter Langguth
- Institute of Pharmacy, Biopharmaceutics and Pharmaceutical Technology, Johannes Gutenberg-University, Mainz, Germany
| | - Arik Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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31
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Fallahi P, Ferrari SM, Ruffilli I, Ragusa F, Biricotti M, Materazzi G, Miccoli P, Antonelli A. Advancements in the treatment of hypothyroidism with L-T4 liquid formulation or soft gel capsule: an update. Expert Opin Drug Deliv 2016; 14:647-655. [PMID: 27552635 DOI: 10.1080/17425247.2016.1227782] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The most recent advance concerning levothyroxine (L-T4) therapy is the development of novel oral formulations: the liquid preparation, and the soft gel capsule. Areas covered: This review evaluates the most recent clinical studies about these new formulations. The liquid formulation has been shown to overcome: the food and beverages intereference with L-T4 tablets absorption, caused by food or coffee at breakfast; malabsorption induced by the increased gastric pH, resulting from atrophic gastritis, or due to proton-pump inhibitors; and malabsorption after bariatric surgery. The use of liquid L-T4 has been studied also in pregnancy, newborns and infants, suggesting a better bioequivalence than tablets. Finally, liquid L-T4 is more active than tablets in the control of thyroid-stimulating hormone (TSH) in hypothyroid patients without malabsorption, drug interference, or gastric disorders, leading to a hypothesized higher absorption of liquid L-T4 also in these patients. Few studies have evaluated soft gel L-T4 with promising results in patients with malabsorption related to coffee or gastritis. Expert opinion: Liquid L-T4 (and soft gel capsules) are more active than the tablet L-T4 in the control of TSH in hypothyroid patients with gastric disorders, malabsorption, or drug interference, but also in patients without absorption disorders.
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Affiliation(s)
- Poupak Fallahi
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | | | - Ilaria Ruffilli
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Francesca Ragusa
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - Marco Biricotti
- b Department of Surgical, Medical, Molecular Pathology and Critical Area , University of Pisa , Pisa , Italy
| | - Gabriele Materazzi
- b Department of Surgical, Medical, Molecular Pathology and Critical Area , University of Pisa , Pisa , Italy
| | - Paolo Miccoli
- b Department of Surgical, Medical, Molecular Pathology and Critical Area , University of Pisa , Pisa , Italy
| | - Alessandro Antonelli
- a Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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Jans G, Matthys C, Bel S, Ameye L, Lannoo M, Van der Schueren B, Dillemans B, Lemmens L, Saey JP, van Nieuwenhove Y, Grandjean P, De Becker B, Logghe H, Coppens M, Roelens K, Loccufier A, Verhaeghe J, Devlieger R. AURORA: bariatric surgery registration in women of reproductive age - a multicenter prospective cohort study. BMC Pregnancy Childbirth 2016; 16:195. [PMID: 27473473 PMCID: PMC4966861 DOI: 10.1186/s12884-016-0992-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 07/19/2016] [Indexed: 12/28/2022] Open
Abstract
Background The expansion of the obesity epidemic is accompanied with an increase in bariatric procedures, in particular in women of reproductive age. The weight loss induced by the surgery is believed to reverse the negative impact of overweight and obesity on female reproduction, however, research is limited to in particular retrospective cohort studies and a growing number of small case-series and case-(control) studies. Methods/design AURORA is a multicenter prospective cohort study. The main objective is to collect long-term data on reproductive outcomes before and after bariatric surgery and in a subsequent pregnancy. Women aged 18–45 years are invited to participate at 4 possible inclusion moments: 1) before surgery, 2) after surgery, 3) before 15 weeks of pregnancy and 4) in the immediate postpartum period (day 3–4). Depending on the time of inclusion, data are collected before surgery (T1), 3 weeks and 3, 6, 12 or x months after surgery (T2-T5) and during the first, second and third trimester of pregnancy (T6-T8), at delivery (T9) and 6 weeks and 6 months after delivery (T10-T11). Online questionnaires are send on the different measuring moments. Data are collected on contraception, menstrual cycle, sexuality, intention of becoming pregnant, diet, physical activity, lifestyle, psycho-social characteristics and dietary supplement intake. Fasting blood samples determine levels of vitamin A, D, E, K, B-1, B-12 and folate, albumin, total protein, coagulation parameters, magnesium, calcium, zinc and glucose. Participants are weighted every measuring moment. Fetal ultrasounds and pregnancy course and complications are reported every trimester of pregnancy. Breastfeeding is recorded and breast milk composition in the postpartum period is studied. Discussion AURORA is a multicenter prospective cohort study extensively monitoring women before undergoing bariatric surgery until a subsequent pregnancy and postpartum period. Trial registration Retrospectively registered (July 2015 - NCT02515214)
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Affiliation(s)
- Goele Jans
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Christophe Matthys
- Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sarah Bel
- Scientific Institute of Public Health, Department of Public Health and Surveillance, Unit Surveys, Lifestyle and Chronic Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Lieveke Ameye
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias Lannoo
- Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bart Van der Schueren
- Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bruno Dillemans
- Department of Abdominal Surgery, St-Jan Hospital Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Luc Lemmens
- Department of Abdominal Surgery, St-Nikolaas Hospital, Moerlandstraat 1, 9100, St-Niklaas, Belgium
| | - Jean-Pierre Saey
- Medicosurgical unit for metabolic diseases, CHR Mons Hainaut, 5 avenue Baudouin de Constantinople, 7000, Mons, Belgium
| | - Yves van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Pascale Grandjean
- Department of Obstetrics and Gynecology, CHR Mons Hainaut, 5 avenue Baudouin de Constantinople, 7000, Mons, Belgium
| | - Ben De Becker
- Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Oosterveldlaan 24, 2610, Wilrijk, Belgium
| | - Hilde Logghe
- Department of Obstetrics and Gynecology, St-Lucas Hospital Bruges, St-Lucaslaan 29, 8310, Bruges, Belgium
| | - Marc Coppens
- Department of Obstetrics and Gynecology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium
| | - Kristien Roelens
- Department of Obstetrics and Gynecology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Anne Loccufier
- Department of Obstetrics and Gynecology, St-Jan Hospital Bruges, Ruddershove 10, 8000, Bruges, Belgium
| | - Johan Verhaeghe
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Roland Devlieger
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital Wilrijk, Oosterveldlaan 24, 2610, Wilrijk, Belgium.,Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Hopkins J, Welbourn R. The importance of national registries/databases in metabolic surgery: the UK experience. Surg Obes Relat Dis 2016; 12:1178-85. [DOI: 10.1016/j.soard.2016.02.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
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34
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Primeaux SD, de Silva T, Tzeng TH, Chiang MC, Hsia DS. Recent advances in the modification of taste and food preferences following bariatric surgery. Rev Endocr Metab Disord 2016; 17:195-207. [PMID: 27245858 DOI: 10.1007/s11154-016-9365-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is a large body of evidence indicating that bariatric surgery provides durable weight loss and health benefits to patients who are obese and have comorbidities such as type 2 diabetes (T2D). However, there are still many questions related to mechanisms of metabolic improvement, predictors of success/failure, and long term consequences, which need to be answered. More recently, there has been a particular interest in the modulation of taste and food preferences that occurs after bariatric surgery and how this affects weight loss in different individuals. Animal models as well as human studies have shed some light on the role of taste in changing food preferences and how these changes may affect weight loss after surgery. The goal of this review is to discuss the physiological and behavioral consequences of bariatric surgery as a treatment for obesity and T2D, with particular emphasis on recent studies describing bariatric surgery-induced modifications in taste perception and food preferences.
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Affiliation(s)
- Stefany D Primeaux
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB 7159D, New Orleans, LA, 70112, USA.
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA.
| | - Taniya de Silva
- Department of Internal Medicine-Endocrinology, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Tony H Tzeng
- Department of Physiology, LSU Health Sciences Center, 1901 Perdido Street, MEB 7159D, New Orleans, LA, 70112, USA
| | - Monica C Chiang
- Department of Internal Medicine-Endocrinology, LSU Health Sciences Center, New Orleans, LA, 70112, USA
| | - Daniel S Hsia
- Joint Diabetes, Endocrinology & Metabolism Program, Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
- Department of Internal Medicine-Endocrinology, LSU Health Sciences Center, New Orleans, LA, 70112, USA
- Pennington Biomedical Research Center, Baton Rouge, LA, 70808, USA
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Hedenbro JL, Näslund E, Boman L, Lundegårdh G, Bylund A, Ekelund M, Laurenius A, Möller P, Olbers T, Sundbom M, Ottosson J, Näslund I. Formation of the Scandinavian Obesity Surgery Registry, SOReg. Obes Surg 2016; 25:1893-900. [PMID: 25703826 DOI: 10.1007/s11695-015-1619-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity surgery is expanding, the quality of care is ever more important, and learning curve assessment should be established. A large registry cohort can show long-term effects on obesity and its comorbidities, complications, and long-term side effects of surgery, as well as changes in health-related quality of life (QoL). Sweden is ideally suited to the task of data collection and audit, with universal use of personal identification numbers, nation-wide registries permitting cross-matching to analyze causes of death, in-hospital care, and health-related absenteeism. METHOD In 2004, the Scandinavian Obesity Surgery Registry (SOReg) was initiated and government financing secured. A project group created a national database covering all public as well as private hospitals. Data entry was to be made online, operative definitions of comorbidity were formed, and complication severity scored. Several forms of audit were devised. RESULTS After pilot studies, the system has been running in its present form since 2007. Since 15 January 2013, SOReg covers all bariatric surgery centers in Sweden. The number of operations in the database exceeded 40,000 (March 2014), with a median follow-up of 2.94 years. Audit shows that >98% of data are correct. All results are publicized annually on the Internet. COMMENTS Using this systematic approach, it has been possible to cover >99% of all bariatric surgery, cross-matching our data with nation-wide registries for in-hospital care, cause of death, and permitting regular nation-wide audit. Several scientific studies have used, or are using, what seems to be the most comprehensive database in obesity surgery.
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Affiliation(s)
- J L Hedenbro
- Department of Surgery, Lund University, Lund, Sweden,
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36
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Allan PJ, Stevens P, Abraham A, Paine P, Farrer K, Teubner A, Carlson G, Lal S. Outcome of intestinal failure after bariatric surgery: experience from a national UK referral centre. Eur J Clin Nutr 2016; 70:772-8. [DOI: 10.1038/ejcn.2016.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 10/08/2015] [Accepted: 10/17/2015] [Indexed: 12/27/2022]
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Johnson EE, Simpson AN, Harvey JB, Simpson KN. Bariatric surgery implementation trends in the USA from 2002 to 2012. Implement Sci 2016; 11:21. [PMID: 26897023 PMCID: PMC4761154 DOI: 10.1186/s13012-016-0382-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/12/2016] [Indexed: 11/21/2022] Open
Abstract
Background Many beneficial health care interventions are either not put into practice or fail to diffuse over time due to complex contextual factors that affect implementation and diffusion. Bariatric surgery is an example of an effective intervention that recently experienced a plateau and decrease in rates, with minimal documented justification for this trend. While there are conceptual models that provide frameworks of general innovation implementation and diffusion, few studies have tested these models with data to measure the relative effects of factors that affect diffusion of specific health care interventions. Methods A literature review identified factors associated with implementation and diffusion of health care innovations. These factors were utilized to construct a conceptual model of diffusion to explain changes in bariatric surgery over time. Six data sources were used to construct measures of the study population and factors in the model that may affect diffusion of surgery. The population included obese and morbidly obese patients from 2002 to 2012 who had bariatric surgery in 15 states. Multivariable models were used to identify environmental, population, and medical practice factors that facilitated or impeded diffusion of bariatric surgery over time. Results It was found that while bariatric surgery rates increased over time, the speed of growth in surgeries, or diffusion, slowed. Higher cumulative number of surgeries and higher proportion of the state population in age group 50–59 slowed surgery growth, but presence of Medicare centers of excellence increased the speed of surgery diffusion. Over time, the factors affecting the diffusion of bariatric surgery fluctuated, indicating that diffusion is affected by temporal and cumulative effects. Conclusions The primary driver of diffusion of bariatric surgery was the extent of centers of excellence presence in a state. Higher cumulative surgery rates and higher proportions of older populations in a state slowed diffusion. Surprisingly, measures of the presence of champions were not significant, perhaps because these are difficult to measure in the aggregate. Our results generally support the conceptual model of diffusion developed from the literature, which may be useful for examining other innovations, as well as for designing interventions to support rapid diffusion of innovations to improve health outcomes and quality of care.
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Affiliation(s)
- Emily E Johnson
- College of Nursing, Medical University of South Carolina, Room 414, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Annie N Simpson
- Department of Health Leadership and Management, Medical University of South Carolina, 151 Rutledge Avenue, Charleston, SC, 29425, USA.
| | - Jillian B Harvey
- Department of Health Leadership and Management, Medical University of South Carolina, 151 Rutledge Avenue, Charleston, SC, 29425, USA.
| | - Kit N Simpson
- Department of Health Leadership and Management, Medical University of South Carolina, 151 Rutledge Avenue, Charleston, SC, 29425, USA.
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Gallo AS, DuCoin CG, Berducci MA, Nino DF, Almadani M, Sandler BJ, Horgan S, Jacobsen GR. Endoscopic revision of gastric bypass: Holy Grail or Epic fail? Surg Endosc 2015; 30:3922-7. [PMID: 26675939 DOI: 10.1007/s00464-015-4699-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/18/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately 20-30 % of patients who undergo Roux-en-Y gastric bypass (RYGB) will not meet the goals of weight loss surgery. Revisional surgery is associated with higher morbidity compared to initial operative management, and results in terms of weight loss have been inconsistent. Endoscopic plication has been seen as a less invasive option, with encouraging initial results. The objective was to analyze the outcomes after Restorative Obesity Surgery, Endolumenal (ROSE) procedure. METHODS We retrospectively analyzed patients who underwent ROSE between 5/2008 and 11/2013. All patients had failure of weight loss or regain weight after RYGB. Demographics, operative data, and follow-up were recorded. RESULTS Twenty-seven patients underwent ROSE. One patient was excluded due to lack of follow-up. Twenty-five (96 %) patients were female. Mean time since initial RYGB was 11.9 ± 4.3 years. Mean initial weight and BMI were 236 ± 47 lb and 40.6 ± 8.1 kg/m(2), respectively. Mean OR time was 77 ± 30 min. Preoperative average pouch length and stoma diameter were 6.8 ± 2.3 and 2.1 ± 0.7 cm, respectively. On average, 4 ± 1.6 stitches were placed. Final pouch length and stoma diameter were 3.4 ± 1.6 (50 % reduction) and 0.86 ± 0.4 cm (61 % reduction). A total of 12 (46 %) and seven (28 %) patients underwent EGD at 3 and 12 months postoperatively. The mean pouch length and stoma diameter were 5 ± 1.9 (26.5 % reduction) and 1.2 ± 0.7 cm (42.9 % reduction) at 3 months and 6.14 ± 1.6 (10 % reduction) and 2.2 ± 1.2 cm (4.7 % increase) at 12 months, respectively. The %EWL was 8.9, 9.3, 8, 6.7, -10.7, -13.5, -5.8, -4.5 at 3, 6, 12, 24, 36, 48, 60, and 72 months, respectively. CONCLUSION Although endoscopic plication achieved the intended reduction in the pouch and stoma diameter at 3 months, these tend toward the preoperative diameter at 12 months. This anatomical failure and the lack of follow-up may explain why most patients failed to achieve sustainable weight loss.
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Affiliation(s)
- Alberto S Gallo
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. .,Baptist Health Louisville, 4001 Kresge Way Suite 200, Louisville, KY, 40207, USA.
| | - Christopher G DuCoin
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Martin A Berducci
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Diego F Nino
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Moneer Almadani
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Bryan J Sandler
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Santiago Horgan
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Garth R Jacobsen
- Minimally Invasive Surgery Department, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Revision of failed primary adjustable gastric banding to mini-gastric bypass: results in 48 consecutive patients. Updates Surg 2015; 67:433-7. [DOI: 10.1007/s13304-015-0335-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/31/2015] [Indexed: 11/26/2022]
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Abstract
Weight loss continues for extended time post-bariatric surgery; thus, discharge destination is an important factor to consider when examining outcomes of surgery. The Agency for Healthcare Research and Quality State Inpatient Database was utilized to identify patients with bariatric surgery and to determine factors associated with and predictive of home discharge. Patients that were discharged home had shorter length of stays, lower total hospital costs, fewer chronic conditions, and lower readmission rates. Factors predictive of discharge were identified. Being discharged home could be associated with characteristics vital to patient's long-term weight loss. It is imperative to focus on factors predictive of home discharge in order to reap the most beneficial outcomes of surgery.
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Affiliation(s)
- Emily E Johnson
- Department of Health Sciences and Research, Medical University of South Carolina, 77 President Street, Charleston, SC, 29425, USA,
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Trends in bariatric surgery, 2002-2012: do changes parallel the obesity trend? Surg Obes Relat Dis 2015; 12:398-404. [PMID: 26707931 DOI: 10.1016/j.soard.2015.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/09/2015] [Accepted: 07/12/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND It is well documented that bariatric surgery is an effective weight loss intervention, and bariatric procedure rates have increased over time. However, there was a period of plateau in procedure rates in the mid to late 2000s. Recent literature has not identified current trends in procedure rates or associations between bariatric surgery and population factors, such as obesity and diabetes. OBJECTIVES The purpose of this study was to determine trends in statewide rates of bariatric operations, obesity, and diabetes over an 11-year period and to determine if population factors are associated with procedure rates. SETTING Data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) were utilized to identify a study sample population of patients who underwent bariatric procedures from 2002-2012. METHODS State level population characteristics were obtained from the Behavioral Risk Factor Surveillance System and Census Bureau Data for the 11-year period. Statistical analyses determined rates of surgery, obesity, and diabetes over time, as well as associations between surgery rates and population factors. RESULTS From 2002-2012, bariatric procedure rates increased, with an exponential rise in laparoscopic surgical methods. Procedure rates reached a peak value in 2009 and then plateaued. Statewide obesity and diabetes rates increased over time, although there was no association between these population factors and procedure rates. Women had consistently higher rates of bariatric operations. CONCLUSION Although bariatric procedures are an evidenced-based effective treatment for obesity, procedure rates were not associated with the increasing obesity and diabetes rates in the United States. Further research is needed to identify factors that affect the adoption and diffusion of bariatric operations to increase diffusion of beneficial innovations and improve overall quality of care and health outcomes.
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Inamdar S, Slattery E, Sejpal DV, Miller LS, Pleskow DK, Berzin TM, Trindade AJ. Systematic review and meta-analysis of single-balloon enteroscopy-assisted ERCP in patients with surgically altered GI anatomy. Gastrointest Endosc 2015; 82:9-19. [PMID: 25922248 DOI: 10.1016/j.gie.2015.02.013] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/07/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgically altered pancreaticobiliary anatomy increases the difficulty of performing ERCP. Single-balloon enteroscopy (SBE) is a relatively new technique that can be used for ERCP in patients with surgically altered anatomy. OBJECTIVE To evaluate the therapeutic and diagnostic success of SBE-ERCP among patients with surgically altered anatomy. DESIGN/SETTING Systematic review and meta-analysis of studies involving SBE-ERCP in patients with Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure. Enteroscopy success was defined as success in reaching the papilla and/or biliary anastomosis by using SBE. Diagnostic success was defined as obtaining a cholangiogram. Procedural success was defined as the ability to provide successful intervention, if appropriate. A random-effects model was used. RESULTS A total of 461 patients underwent SBE-ERCP from 15 trials. The pooled enteroscopy, diagnostic, and procedural success rates were 80.9% (95% confidence interval [CI], 75.3%-86.4%), 69.4% (95% CI, 61.0%-77.9%), and 61.7% (95% CI, 52.9%-70.5%), respectively. There was statistical large heterogeneity for enteroscopy, diagnostic, and therapeutic success (P < .001 for all). Adverse events occurred in 6.5% (95% CI, 4.7%-9.1%) of patients. There was no evidence of publication bias in this meta-analysis. LIMITATIONS Our findings and interpretations are limited by the quantity and heterogeneity of the studies included in the analysis. CONCLUSION SBE-ERCP has high diagnostic and procedural success rates in this challenging patient population. It should be considered a first-line intervention when biliary access is required after Roux-en-Y gastric bypass, hepaticojejunostomy, or Whipple procedure.
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Affiliation(s)
- Sumant Inamdar
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA
| | - Eoin Slattery
- Department of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York, USA
| | - Divyesh V Sejpal
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA
| | - Larry S Miller
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA
| | - Douglas K Pleskow
- The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tyler M Berzin
- The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Arvind J Trindade
- Department of Medicine, Division of Gastroenterology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York, USA; The Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Fenves AZ, Shchelochkov OA, Mehta A. Hyperammonemic syndrome after Roux-en-Y gastric bypass. Obesity (Silver Spring) 2015; 23:746-9. [PMID: 25754921 DOI: 10.1002/oby.21037] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/28/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Hyperammonemic encephalopathy is an uncommon but severe complication of the Roux-en-Y gastric bypass surgery for obesity. Mechanisms underlying this complication are incompletely understood, resulting in delayed recognition and management. This study evaluated common laboratory findings and possible etiology of hyperammonemic encephalopathy after successful Roux-en-Y gastric bypass surgery. METHODS A retrospective review of 20 patients identified through our own clinical practice was conducted, with the addition of similar cases from other institutions identified through the review of literature. RESULTS Patients presenting with hyperammonemic encephalopathy after Roux-en-Y gastric bypass surgery presented with overlapping clinical and laboratory findings. Common features included: (1) weight loss following successful Roux-en-Y gastric bypass for obesity; (2) hyperammonemic encephalopathy accompanied by elevated plasma glutamine levels; (3) absence of cirrhosis; (4) hypoalbuminemia; and (5) low plasma zinc levels. The mortality rate was 50%. Ninety-five percent of patients were women. Three patients were diagnosed with proximal urea cycle disorders. One patient experienced improvement in the hyperammonemia after surgical correction of spontaneous splenorenal shunt. CONCLUSIONS Hyperammonemic encephalopathy after Roux-en-Y gastric bypass surgery is a newly recognized, potentially fatal syndrome with diverse pathophysiologic mechanisms encompassing genetic and nongenetic causes.
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Affiliation(s)
- Andrew Z Fenves
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Problematic eating behaviors among bariatric surgical candidates: a psychometric investigation and factor analytic approach. Eat Behav 2015; 16:34-9. [PMID: 25464064 DOI: 10.1016/j.eatbeh.2014.10.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/23/2014] [Accepted: 10/24/2014] [Indexed: 11/22/2022]
Abstract
Psychological factors (e.g., anxiety, depression) are routinely assessed in bariatric pre-surgical programs, as high levels of psychopathology are consistently related to poor program outcomes (e.g., failure to lose significant weight pre-surgery, weight regain post-surgery). Behavioral factors related to poor program outcomes and ways in which behavioral and psychological factors interact, have received little attention in bariatric research and practice. Potentially problematic behavioral factors are queried by Section H of the Weight and Lifestyle Inventory (WALI-H), in which respondents indicate the relevance of certain eating behaviors to obesity. A factor analytic investigation of the WALI-H serves to improve the way in which this assessment tool is interpreted and used among bariatric surgical candidates, and subsequent moderation analyses serve to demonstrate potential compounding influences of psychopathology on eating behavior factors. Bariatric surgical candidates (n =362) completed several measures of psychopathology and the WALI-H. Item responses from the WALI-H were subjected to principal axis factoring with oblique rotation. Results revealed a three-factor model including: (1) eating in response to negative affect, (2) overeating/desirability of food, and (3) eating in response to positive affect/social cues. All three behavioral factors of the WALI-H were significantly associated with measures of depression and anxiety. Moderation analyses revealed that depression did not moderate the relationship between anxiety and any eating behavior factor. Although single forms of psychopathology are related to eating behaviors, the combination of psychopathology does not appear to influence these problematic behaviors. Recommendations for pre-surgical assessment and treatment of bariatric surgical candidates are discussed.
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Roux-en-Y Near Esophagojejunostomy for Failed Antireflux Operations: Outcomes in More Than 100 Patients. Ann Thorac Surg 2014; 98:1905-11; discussion 1911-3. [DOI: 10.1016/j.athoracsur.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/07/2014] [Accepted: 07/07/2014] [Indexed: 12/12/2022]
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Zhang Y, Liu J, Yao J, Ji G, Qian L, Wang J, Zhang G, Tian J, Nie Y, Zhang YE, Gold MS, Liu Y. Obesity: pathophysiology and intervention. Nutrients 2014; 6:5153-83. [PMID: 25412152 PMCID: PMC4245585 DOI: 10.3390/nu6115153] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/21/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023] Open
Abstract
Obesity presents a major health hazard of the 21st century. It promotes co-morbid diseases such as heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Excessive energy intake, physical inactivity, and genetic susceptibility are main causal factors for obesity, while gene mutations, endocrine disorders, medication, or psychiatric illnesses may be underlying causes in some cases. The development and maintenance of obesity may involve central pathophysiological mechanisms such as impaired brain circuit regulation and neuroendocrine hormone dysfunction. Dieting and physical exercise offer the mainstays of obesity treatment, and anti-obesity drugs may be taken in conjunction to reduce appetite or fat absorption. Bariatric surgeries may be performed in overtly obese patients to lessen stomach volume and nutrient absorption, and induce faster satiety. This review provides a summary of literature on the pathophysiological studies of obesity and discusses relevant therapeutic strategies for managing obesity.
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Affiliation(s)
- Yi Zhang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Ju Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Jianliang Yao
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Gang Ji
- Xijing Gastrointestinal Hospital, the Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Long Qian
- Department of Biomedical Engineering, Peking University, Beijing 100871, China.
| | - Jing Wang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Guansheng Zhang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Jie Tian
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710071, China.
| | - Yongzhan Nie
- Xijing Gastrointestinal Hospital, the Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
| | - Yi Edi Zhang
- Department of Psychiatry & McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL 32610, USA.
| | - Mark S Gold
- Department of Psychiatry & McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL 32610, USA.
| | - Yijun Liu
- Department of Psychiatry & McKnight Brain Institute, University of Florida, 1149 South Newell Drive, Gainesville, FL 32610, USA.
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Parra MT, Riera R, Atallah ÁN, Porfirio G. Exercise after bariatric surgery for obese adults. Hippokratia 2014. [DOI: 10.1002/14651858.cd011340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maíra T Parra
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Álvaro N Atallah
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Gustavo Porfirio
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Brazilian Cochrane Centre; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
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Saurabh S, Smith JK, Pedersen M, Jose P, Nau P, Samuel I. Scheduled intravenous acetaminophen reduces postoperative narcotic analgesic demand and requirement after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2014; 11:424-30. [PMID: 25614351 DOI: 10.1016/j.soard.2014.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/02/2014] [Accepted: 09/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intravenous (i.v.) acetaminophen has the potential to reduce postoperative narcotic analgesic requirement but this has not been reported in bariatric surgery. As lower dosages could reduce undesirable narcotic side effects, we investigated the opioid-sparing effect of concomitant i.v. acetaminophen in bariatric surgery. METHODS We performed a retrospective review of our electronic medical records of laparoscopic Roux-en-Y gastric bypasses (LRYGB) performed for severe obesity between 2011 and 2013. We identified 183 patients that received scheduled i.v. acetaminophen in addition to morphine sulfate (MSO4) patient-controlled analgesia (PCA). A cohort of 229 patients from the preceding 2 years who were treated with MSO4 PCA but not acetaminophen was used as a historical control. Patient demographic characteristics and narcotic use data were extracted from electronic medical records. Student's t test or linear regression was used as appropriate (P< .05). RESULTS During the first 24-hour postoperative period after LRYGB, narcotic analgesic demand (total PCA demand including nondelivery of narcotic due to lock-out) was reduced by 25% with the concomitant use of i.v. acetaminophen (40.5 versus 30.9 average pushes; P<.05). During the same period, narcotic analgesic dosage requirement was cut down by 20% in the study group (average of 29.9 versus 24.1 mg of MSO4; P<.05). Linear regression analysis confirmed that these changes were independent of age, gender, and body mass index distribution, or type 2 diabetes mellitus. CONCLUSION Scheduled i.v. acetaminophen reduces the demand for and the requirement of narcotic analgesia after LRYGB. We provide new evidence in support of the routine use of multimodal analgesia that includes scheduled i.v. acetaminophen in the initial 24-hour period after bariatric surgery.
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Affiliation(s)
- Shireesh Saurabh
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jessica K Smith
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Mark Pedersen
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Paul Jose
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Peter Nau
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Isaac Samuel
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
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Singh S, Suresh S, McClave SA, Cave M. Treating Every Needle in the Haystack. JPEN J Parenter Enteral Nutr 2014; 39:977-85. [DOI: 10.1177/0148607114546900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/20/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Sanjeev Singh
- Department of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Swetha Suresh
- Department of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- Department Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Stephen A. McClave
- Department of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Matt Cave
- Department of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, Kentucky
- Robley Rex Louisville VAMC, Louisville, Kentucky
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Alcohol metabolism is not affected by sleeve gastrectomy. Surg Endosc 2014; 29:1088-93. [PMID: 25159638 DOI: 10.1007/s00464-014-3790-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/30/2014] [Indexed: 01/28/2023]
Abstract
INTRODUCTION It has been published that patients who underwent gastric bypass surgery have impaired alcohol metabolism, predisposing them to higher rates of intoxication and DUI arrests. Yet the impact of laparoscopic sleeve gastrectomy (LSG) on alcohol metabolism and in particular the long-term effects are still unclear. We hypothesized that LSG does not alter alcohol metabolism. METHODS A prospective cohort study of patients undergoing LSG was evaluated. Blood alcohol concentration (BAC) was extrapolated using a Breathalyzer(®). Alcohol metabolism was evaluated by determining BAC every 5 min after a single dose of alcohol (5 oz. glass of 14% v/v Malbec wine), until BAC was equal to zero. Subjects were queried about alcohol intoxication symptoms. All parameters were obtained and analyzed preoperatively and at 3 and 12 months postoperatively. RESULTS Our study consisted of 10 patients (9 female) with a mean age of 46.6 ± 2.2 years and BMI of 43.5 ± 2.2 kg/m(2). The mean percentage excess weight loss was 39.5 ± 3.3 at 3 months and 55.6 ± 4.4 at 12 months. Peak BAC at 20 min was not different at 3 months (0.068 ± 0.007, p = 0.77) or at 12 months (0.047 ± 0.008, p = 0.19) when compared to the preoperative assessment (0.059 ± 0.014). In addition, the time to BAC equal to zero was not significantly different between baseline and the follow-up values (preoperative: 70 ± 9 min, 3 months: 95 ± 18 min, and 12 months: 57 ± 8 min, (p > 0.05). Symptoms of intoxication were not significantly different in patients before and after surgery. CONCLUSIONS Our study suggests that LSG does not alter alcohol metabolism. Patients who undergo LSG do not have higher levels of intoxication following alcohol consumption and are therefore not prone to higher rates of DUI charges than the general public, in contrast to that previously reported following in patients who undergo gastric bypass surgery.
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