1
|
Changes in Antihypertensive Medication Following Bariatric Surgery. Obes Surg 2022; 32:1312-1324. [PMID: 35083703 DOI: 10.1007/s11695-022-05893-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postoperatively. Roux-en-Y gastric bypass was the most studied surgical approach followed by Laparoscopic Sleeve Gastrectomy. Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the mean number of antihypertensive medications decreased by approximately one. In almost a third of the studies, over 75% of participants experienced hypertension remission. All articles aside from two reported a decrease in systolic BP, with about 40% reporting a decrease of ≥ 10 mm Hg.
Collapse
|
2
|
Serin SO, Sisik A, Basak F. Relationship between monocyte-to-high-density lipoprotein cholesterol ratio and excess weight loss in laparoscopic sleeve gastrectomy. Biomark Med 2021; 15:1367-1375. [PMID: 34514845 DOI: 10.2217/bmm-2021-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The present study evaluates the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and the percentage of excess weight loss (%EWL) in patients undergoing laparoscopic sleeve gastrectomy. Method: This prospective cohort study evaluated 125 patients who underwent laparoscopic sleeve gastrectomy. The MHR before and at 6 months after surgery were compared in patients with <50 and ≥50 %EWL. Results: The MHR was lower in patients with a %EWL of <50 than in patients with a %EWL of ≥50 (p = 0.019). The decrease in the MHR at postoperative 6 months was more remarkable in patients with a %EWL of ≥50 (p < 0.001). Conclusion: The present study suggests that MHR decreased more remarkably at postoperative 6 months in patients with high %EWL, predicting a decrease in cardiovascular risk.
Collapse
Affiliation(s)
- Sibel Ocak Serin
- Department of Internal Medicine, University of Health Sciences, Umraniye Training & Research Hospital, Istanbul, 34760, Turkey
| | - Abdullah Sisik
- Department of General Surgery, University of Health Sciences, Umraniye Training & Research Hospital, Istanbul, 34760, Turkey
| | - Fatih Basak
- Department of General Surgery, University of Health Sciences, Umraniye Training & Research Hospital, Istanbul, 34760, Turkey
| |
Collapse
|
3
|
Keleidari B, Mahmoudie M, Anaraki AG, Shahraki MS, Jamalouee SD, Gharzi M, Mohtashampour F. Six month-follow up of laparoscopic sleeve gastrectomy. Adv Biomed Res 2016; 5:49. [PMID: 27110546 PMCID: PMC4817394 DOI: 10.4103/2277-9175.178786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/10/2014] [Indexed: 11/25/2022] Open
Abstract
Background: The rising prevalence of obesity in today populations has led obese individuals to seek medical interventions. Aside from special diets, routine exercise and in some cases, medical treatment, most of the obese patients, favoring those with morbid or super obesity can benefit from bariatric surgery to lose weight. Laparoscopic sleeve gastrectomy (LSG) is relatively new method to limit the compliance of stomach. The consequent quick satiety during each meal results in gradual weight loss in patients. We investigated the efficacy and safety of this method among a group of our patients. Materials and Methods: This cross-sectional study was conducted in Isfahan, Iran, from January 2012 to January 2013. Thirty-five cases of obesity that had undergone LSG were enrolled and their baseline data of weight, body mass index (BMI), blood sugar, lipid profile, liver function indexes and blood pressure were collected. The patients were followed up for 6 months. The 6-month results were analyzed. Results: There was significant reduction in BMI, weight, blood sugar, blood pressure, liver enzymes and lipid profile components (P < 0.05), except for alkaline phosphatase (ALP) (P = 0.3). The average of excess weight loss percentage after 6 months was 69.2 ± 20.9%. No mortality occurred. Two of the patients had micro anastomotic leaks that were treated with nonoperative management. A case of gross leakage was treated with tube jejunostomy. Conclusion: Our study confirmed the efficacy and safety of LSG as a single surgical intervention for body weight reduction in morbidly and super obese patients.
Collapse
Affiliation(s)
- Behrouz Keleidari
- Department of General Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Mahmoudie
- Department of General Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Ghanei Anaraki
- Department of General Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Sayadi Shahraki
- Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samira Dvashi Jamalouee
- Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Gharzi
- Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnoosh Mohtashampour
- Department of Laparascopic Surgery, Isfahan Minimally Invasive Surgery and Obesity Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
4
|
Lau RG, Kumar S, Hall CE, Palaia T, Rideout DA, Hall K, Brathwaite CE, Ragolia L. Roux-en-Y gastric bypass attenuates the progression of cardiometabolic complications in obese diabetic rats via alteration in gastrointestinal hormones. Surg Obes Relat Dis 2015; 11:1044-53. [PMID: 25980330 DOI: 10.1016/j.soard.2014.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/10/2014] [Accepted: 12/05/2014] [Indexed: 01/20/2023]
|
5
|
Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg 2014; 23:1994-2003. [PMID: 23955521 DOI: 10.1007/s11695-013-1030-z] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bariatric surgery is effective in the management of type 2 diabetes (T2D) and obesity; however, it is not clear whether Roux-en-Y gastric bypass (GBP) or sleeve gastrectomy (SG) is the most effective procedure. This review compared T2D remission and weight loss in patients with T2D after GBP or SG. All human SG or GBP studies published in English between 1 Jan 2007 and 30 April 2012 reporting on BMI and T2D outcomes were included. Analyses were performed separately for the most frequent distinct time points reported after surgery. A total of 21 prospective (three randomised control trials) and 12 retrospective studies, involving 1375 patients met eligibility criteria. T2D remission defined by hemoglobin A1c of <6.5 % for GBP and SG respectively was 67 and 56 % at 3 months, 76 and 68 % at 12 months, and 81 and 80 % at 36 months. Greater percent excess BMI loss occurred at 12 months (72.5 % after GBP and 66.7 % after SG) compared with 3 months (45.9 % after GBP and 25.9 % after SG). There was no significant difference in either T2D remission or weight loss with GBP compared with SG. Both GBP and SG result in similar early remission of T2D in 67 and 56 % of patients at 3 months respectively with modest additional T2D remission with time, although weight loss with both procedures increase substantially between 3 and 12 months post-operatively. Further randomised controlled trials comparing SG and GBP in patients with T2D using comparable definitions of diabetes remission with long-term follow-up are needed to evaluate relative benefits.
Collapse
Affiliation(s)
- Shelley Yip
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand,
| | | | | |
Collapse
|
6
|
Lopez J, Vilallonga R, Targarona EM, Balague C, Enriquez L, Rivera R, Balibrea JM, Perez-Ochoa F, Rodriguez K, Baeza M, Reyes A. Can LigaSure™ be used to perform sleeve gastrectomy? – Tensile strength and histological changes. MINIM INVASIV THER 2013; 23:144-51. [DOI: 10.3109/13645706.2013.875924] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
7
|
Desiderio J, Trastulli S, Scalercio V, Mirri E, Grandone I, Cirocchi R, Penzo J, Santoro A, Redler A, Boselli C, Noya G, Fatati G, Parisi A. Effects of laparoscopic sleeve gastrectomy in patients with morbid obesity and metabolic disorders. Diabetes Technol Ther 2013; 15:1004-9. [PMID: 23984802 DOI: 10.1089/dia.2013.0162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSES Obesity and its correlation with other pathological conditions determine the onset of the metabolic syndrome, which exposes the patient to a higher risk of major cardiovascular complications. Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical procedure that appears to influence both the reduction of fat mass and the action of some gastrointestinal hormones. PATIENTS AND METHODS Between January 2011 and July 2013, 23 patients with morbid obesity underwent LSG and follow-up. In the evaluation of patients, the criteria for metabolic syndrome given by the International Diabetes Federation were followed. A multidisciplinary team of experts evaluated patients before surgery and in subsequent scheduled postoperative visits at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months. Anthropometric and metabolic parameters were analyzed. RESULTS The mean excess weight loss was 8.57±3.02%, 17.65±6.40%, 25.47±7.90%, 33.76±9.27%, 41.83±10.71%, 46.02±13.90%, 52.60±14.05%, 58.48±16.07%, and 62.59±21.29% at 7, 30, 60, and 90 days and 4, 5, 6, 9, and 12 months, respectively. In the same observational period there was an excellent improvement of metabolic indices. None of the patients previously taking prescribed hypoglycemic drugs restarted therapy. Mean fasting plasma glucose significantly decreased compared with the preoperative values. Blood pressure had a statistically significant improvement. Modification in the lipid profile was more variable. During the period of observation 22 of 23 patients reported in this study did not fit the criteria for metabolic syndrome. CONCLUSIONS Morbid obesity and related diseases may benefit from a surgical approach in selected patients. Randomized controlled trials are needed to evaluate the role of LSG.
Collapse
Affiliation(s)
- Jacopo Desiderio
- 1 Department of Digestive Surgery, St. Maria Hospital , Terni, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Ruiz-Tovar J, Oller I, Tomas A, Llavero C, Arroyo A, Calero A, Martinez-Blasco A, Calpena R. Midterm Impact of Sleeve Gastrectomy, Calibrated with a 50-Fr Bougie, on Weight Loss, Glucose Homeostasis, Lipid Profiles, and Comorbidities in Morbidly Obese Patients. Am Surg 2012. [DOI: 10.1177/000313481207800937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bariatric surgery has been shown to be effective in achieving and maintaining weight change and reducing obesity-related comorbidities. Recent reports have shown that sleeve gastrectomy could have similar resolution rates of the metabolic syndrome than Roux-Y bypass after a short-term follow-up of 1 year. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. There is little mid- and long-term information available about the evolution of these comorbidities with this procedure and with calibration of the sleeve with a 50-Fr bougie. A retrospective study of all the morbidly obese patients undergoing laparoscopic sleeve gastrectomy, calibrated with a 50-Fr bougie, as bariatric procedure between October 2007 and September 2009 was performed. Mean excessive body mass index loss was 76.9 per cent after 1 year and 79.9 per cent after 2 years. After surgery, 83.3 per cent of patients with Type 2 diabetes mellitus discontinued their hypoglycemic medication at 1 month. All the patients with hypertension discontinued antihypertensive drugs at 6 months. One hundred per cent of patients with hypertriglyceridemia discontinued their hypolipidemic drugs at 3 months. Glucose levels decreased significantly 3 months after surgery (mean reduction of 24.7 mg/dL; 95% confidence interval [CI], 8.8 to 40.7; P = 0.003). Triglyceride levels decreased 3 months after surgery (mean reduction of 54.4 mg/dL; 95% CI, 22.8 to 86.1; P = 0.004). High-density lipoprotein (HDL) cholesterol increased significantly after 12 months (increase of 16.7 mg/dL; 95% CI, 11.7 to 21.7; P < 0.001). The changes observed were maintained 24 months after surgery. Sleeve gastrectomy, calibrated with a 50-Fr bougie, significantly reduced glucose and triglyceride levels and the cardiovascular risk predictor triglyceride/HDL ratio and increased HDL levels after surgery and maintained them under normal ranges for at least 2 years.
Collapse
Affiliation(s)
- Jaime Ruiz-Tovar
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Inmaculada Oller
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Andres Tomas
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Carolina Llavero
- Department of Surgical Nursery. Hospital del Sureste, Madrid, Spain
| | - Antonio Arroyo
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Alicia Calero
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Amparo Martinez-Blasco
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| | - Rafael Calpena
- Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain
| |
Collapse
|
9
|
Abstract
BACKGROUND The clinical significance of sleeve gastrectomy (SG) as a primary bariatric intervention is still under debate. This article aims to systematically analyze excessive weight loss (EWL) in patients after SG. METHODS A systematic literature search on SG from the period January 2003 to December 2010 was performed. Data described from systematic reviews dealing with gastric bypass procedures was used as comparator. RESULTS The final study included 123 papers describing 12,129 patients. Most of the papers describe EWL at 12 months (43.9% of all papers). For SG, the maximum EWL occurred 24 and 36 months postoperatively with a mean EWL of 64.3% (minimum 46.1%, maximum 75.0%) and 66.0% (minimum 60.0%, maximum 77.5%), respectively. At 12 months, the mean EWL in patients receiving SG was significantly lower when compared to patients who underwent gastric bypass (SG 56.1%, gastric bypass 68.3%; p < 0.01, two-sided Wilcoxon test). Although patients with gastric bypass still had higher EWL rates at 24 months compared to patients after SG, these differences were not significant (SG 61.3%, gastric bypass 69.6%; p = 0.09, two-sided Wilcoxon rank-sum test). Reoperations after SG are necessary in 6.8% (range 0.7-25%) of cases with patients receiving SG as a stand alone procedure and in 9.6-28.5% of cases with patients undergoing SG as a planned first stage procedure. CONCLUSIONS SG is an effective bariatric procedure with a lasting effect on EWL. Compared with gastric bypasses, there is no difference in EWL at the time point of 24 months.
Collapse
|
10
|
Owers CE, Abbas Y, Ackroyd R, Barron N, Khan M. Perioperative optimization of patients undergoing bariatric surgery. J Obes 2012; 2012:781546. [PMID: 22829998 PMCID: PMC3398654 DOI: 10.1155/2012/781546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/05/2012] [Indexed: 01/06/2023] Open
Abstract
Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.
Collapse
Affiliation(s)
- C. E. Owers
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| | - Y. Abbas
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| | - R. Ackroyd
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| | - N. Barron
- Department of Anaesthesia, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S10 2JF, UK
| | - M. Khan
- Department of Upper GI Surgery, Sheffield Teaching Hospitals, South Yorkshire, Sheffield S5 7AU, UK
| |
Collapse
|
11
|
Abstract
The objective of this article is to systematically review the changes in insulin resistance after various types of bariatric surgical procedures. A Pubmed and EMBASE search for studies measuring insulin resistance before and after bariatric surgery was done and all original research articles from 1980 to present (2011) were included. Only the currently widely performed bariatric procedures were included. A meta-analysis of change in HOMA-IR was conducted, grouping studies with similar duration of follow-up. The percentage decrease in HOMA-IR at <=2 weeks, 1 month, 3 months, 6 months, 12 months and >16-18 months was found to be (mean ± standard error) -33.48 ± 5.78, -46.43 ± 6.99, -38.79 ± 9.64, -58.62 ± 7.38, -44.91 ± 7.98 and -67.04 ± 10.78%, respectively. RYGB (gastric bypass) and BPD (biliopancreatic diversion) produced a significant decrease in insulin resistance at 2 weeks after surgery, while LSG (sleeve gastrectomy) was strongly trending. LSG produced an earlier decrease in insulin resistance when compared to LAGB (gastric banding). RYGB, BPD and LSG produce an early decrease in insulin resistance through yet unknown mechanisms.
Collapse
Affiliation(s)
- R S Rao
- Department of Surgery, Division of Metabolic, Endocrine and Minimally Invasive Surgery, Diabetes and Bone Disease, Mount Sinai School of Medicine, 5 E. 98th St., New York, NY 10029, USA.
| | | | | |
Collapse
|