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Jense MTF, Meuwissen N, Galal AM, De Witte E, Fransen S, Broos PPHL, Greve JWM, Boerma EJG. Convincing 10-Year Follow-up Results of the Banded Roux-en-Y Gastric Bypass. Obes Surg 2024; 34:1286-1294. [PMID: 38393455 PMCID: PMC11026224 DOI: 10.1007/s11695-024-07113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Several studies have shown the positive effect on weight loss of the banded Roux-en-Y gastric bypass (BRYGB). Thus far, studies describing the 10-year post-operative results are scarce. Therefore, the aim of this study was to describe the weight loss results, effect on associated medical problems, and complication rates during 10 years of follow-up after BRYGB. METHOD Data were collected from patients who underwent laparoscopic BRYGB with a non-adjustable silicone gastric ring between January 2011 and March 2013. All patients were included when found to be eligible according to the IFSO criteria. RESULTS One hundred forty-nine patients were included, 110 received a primary BRYGB and 39 received a conversional BRYGB. The primary BRYGB group consisted of 68% female patients with a mean BMI of 44.5 kg/m2 and a mean age of 46 years old. The conversional group consisted of 77% females and had a mean BMI of 34.8 kg/m2 and a mean age of 48 years. At 10-year follow-up, 67.1% of the data was available. Ten-year post-operative 30% total weight loss was seen in the primary group, and 7% in the conversional group. In 10 years, 23% of the patients had complications of which half were ring-related. CONCLUSION The addition of a silicon ring to the Roux-en-Y gastric bypass may result in substantial and stable weight loss maintenance 10 years post-operative. Furthermore, the number of patients with long-term complications was low and the number of associated medical problems was significantly reduced.
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Affiliation(s)
- Marijn T F Jense
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands.
- Research Institute NUTRIM, Faculty of Health, Medicine and Life Sciences at Maastricht University, Maastricht, The Netherlands.
| | - Nina Meuwissen
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Abdelrahman M Galal
- General Surgery Department, Sohag Faculty of Medicine, Sohag University Hospitals, Sohag, Egypt
| | - Evelien De Witte
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
| | - Sofie Fransen
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
| | - Pieter P H L Broos
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
| | - Jan Willem M Greve
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
- Research Institute NUTRIM, Faculty of Health, Medicine and Life Sciences at Maastricht University, Maastricht, The Netherlands
| | - Evert-Jan G Boerma
- Bariatric Surgery at Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419 XZ, Heerlen, The Netherlands
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van Dam KAM, Jense MTF, de Witte E, Fransen S, Boerma EJG, Greve JWM. Laparoscopic Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Gives Better Result Compared to an Open Approach. Obes Surg 2023:10.1007/s11695-023-06574-7. [PMID: 37043139 DOI: 10.1007/s11695-023-06574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Vertical banded gastroplasty (VBG) has a relatively high failure rate in the long run, requiring revisional surgery in 30-65%. A common conversion option is to Roux-en-Y gastric bypass (RYGB), which can be performed laparoscopically or open. Current literature contains small cohorts and inconclusive results. Therefore, we set out to compare our series of open and laparoscopic VBG to RYGB conversions. METHODS All conversions performed between 1996 and 2020 were included. Patients were divided into 3 groups based on conversion indication: weight recurrence (group 1), excessive weight loss (group 2), and eating/pouch difficulties (group 3). The primary outcome was postoperative complications according to the Clavien-Dindo (CD) classification. Secondary outcome was %total weight loss (%TWL) 1 to 5 years after revisional surgery. RESULTS We included 205 patients (84.9% female) of whom 105 underwent laparoscopic and 100 open VBG to RYGB conversion. Twenty-three short-term complications occurred in the laparoscopic group, with 16 > CD3a. In the open group, 33 complications occurred with 12 > CD3a. Overall complications were 33.3% in laparoscopic and 64% in open patients. There were no significant differences between the laparoscopic and open group in BMI (p = 0.76) and %TWL (p = 0.694) after 5 years. After 5 years, lost to follow-up was 97% in the open group. Twenty-eight percent of patients who reached follow-up in the laparoscopic group had available data. CONCLUSIONS We demonstrate that the overall complication rate is lower in the laparoscopic group compared to the open group. Regarding BMI, an improvement was achieved in both groups after 5 years.
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Affiliation(s)
- Kayleigh A M van Dam
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands.
| | - Marijn T F Jense
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Evelien de Witte
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Sofie Fransen
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Evert-Jan G Boerma
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
| | - Jan Willem M Greve
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, PC, Heerlen, The Netherlands
- Dutch Obesity Clinic South, John F, Kennedylaan 301, 6419, XZ, Heerlen, The Netherlands
- NUTRIM, Maastricht University Medical Center, Maastricht, The Netherlands
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Jense MTF, Palm-Meinders IH, Sanders B, Boerma EJG, Greve JWM. The Swallowable Intragastric Balloon Combined with Lifestyle Coaching: Short-Term Results of a Safe and Effective Weight Loss Treatment for People Living with Overweight and Obesity. Obes Surg 2023:10.1007/s11695-023-06573-8. [PMID: 37012502 DOI: 10.1007/s11695-023-06573-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Some patients with overweight or obesity are not eligible for surgery according to international guidelines or do not wish a surgical intervention. For these patients, different treatment options are being explored. In this study, we examined the effectiveness of the swallowable intragastric balloon (IB) combined with lifestyle coaching, in patients living with overweight and obesity. METHOD A retrospective data study was conducted on patients with a swallowable IB placement between December 2018 and July 2021, combined with a 12-month coaching program. Before balloon placement, patients underwent multidisciplinary screening. The IB was swallowed and filled with fluid once in the stomach and naturally excreted around 16 weeks. RESULTS A total of 336 patients, 71.7% female, were included with a mean age of 45.7 (±11.7) years. Mean baseline weight and BMI were 107.54 (±19.16) kg and 36.1 (±5.02) kg/m2. After 1 year, the mean total weight loss was 11.0% (±8.4). The mean placement duration was 13.1 (±2.82) min, and in 43.7%, a stylet was used to facilitate placement. The most common symptoms were nausea (80.4%) and gastric pain (80.3%). In the majority of patients, complaints were resolved within a week. The early deflation of the balloon occurred in 8 patients (2.4%) of which one showed symptoms suggesting a gastric outlet obstruction. CONCLUSION Given the low rate of long-term complaints while providing a positive effect on weight loss, we conclude that the swallowable intragastric balloon, combined with lifestyle coaching, is a safe and effective treatment option for patients living with overweight and obesity.
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Affiliation(s)
- Marijn T F Jense
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, Heerlen, PC, Netherlands.
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419, Heerlen, XZ, Netherlands.
- Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Inge H Palm-Meinders
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419, Heerlen, XZ, Netherlands
| | - Boy Sanders
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419, Heerlen, XZ, Netherlands
| | - Evert-Jan G Boerma
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, Heerlen, PC, Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419, Heerlen, XZ, Netherlands
| | - Jan Willem M Greve
- Bariatric Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419, Heerlen, PC, Netherlands
- Dutch Obesity Clinic South, John F. Kennedylaan 301, 6419, Heerlen, XZ, Netherlands
- Maastricht University Medical Center, Maastricht, The Netherlands
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Bonouvrie DS, van de Pas KGH, Janssen L, Leclercq WKG, Greve JWM, van Dielen FMH. Safety of bariatric surgery in the elderly: results from the Dutch National Registry. Surg Obes Relat Dis 2023; 19:335-343. [PMID: 36481353 DOI: 10.1016/j.soard.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/17/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The increased human life expectancy and prevalence of obesity lead to more elderly people with obesity. As the popularity of bariatric surgery continues to grow, more elderly persons apply for bariatric surgery. However, because of the potentially higher surgical risk in elderly patients, bariatric surgery has been performed in small numbers. Moreover, the literature so far has shown controversial results. OBJECTIVE To determine the safety of bariatric surgery in elderly patients in terms of 2-year morbidity and mortality. SETTING Dutch nationwide mandatory registry for bariatric surgery. METHODS A population-based retrospective cohort study. Elderly patients (aged ≥65 years) who received primary bariatric surgery between January 2015 and January 2020 were compared with the general bariatric surgical population (aged 18-65 years). RESULTS Of 49,553 patients, 838 elderly patients (1.7%) were included. An intraoperative complication was registered in 1.2% of the elderly patients and 1.1% of the nonelderly patients (P = .814). A severe short-term complication (≤30 days) was registered in 38 elderly patients (4.5%) and 1071 nonelderly patients (2.2%) (P < .001). The short-term mortality rates were .2% and .1%, respectively (P = .173). Bleeding was the most reported short-term complication. Significantly more nonelderly patients had a follow-up visit; 560 elderly patients (66.8%) versus 34,975 nonelderly patients (71.8%) (P = .002). The severe midterm complication rate (>30 days to ≤2 years) was significantly higher in nonelderly patients (3.7% versus 1.6%; P = .008). CONCLUSIONS Bariatric surgery in elderly patients is safe in terms of perioperative outcome, mortality, and midterm complication rate. However, elderly patients experienced twice as many severe short-term complications. Bariatric surgery in elderly patients should be recommended on a case-by-case basis.
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Affiliation(s)
- Daniëlle S Bonouvrie
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Kelly G H van de Pas
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | - Wouter K G Leclercq
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | - Jan Willem M Greve
- Maastricht University Medical Center and Faculty of Health, Medicine and Life Sciences, Research School NUTRIM, Maastricht, The Netherlands; Department of Surgery, Zuyderland Hospital, Heerlen/Sittard-Geleen, The Netherlands
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Akpinar EO, Ghaferi AA, Liem RSL, Bonham AJ, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Predicting serious complication risks after bariatric surgery: external validation of the Michigan Bariatric Surgery Collaborative risk prediction model using the Dutch Audit for Treatment of Obesity. Surg Obes Relat Dis 2023; 19:212-221. [PMID: 36274015 DOI: 10.1016/j.soard.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/14/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risk-prediction tools can support doctor-patient (shared) decision making in clinical practice by providing information on complication risks for different types of bariatric surgery. However, external validation is imperative to ensure the generalizability of predictions in a new patient population. OBJECTIVE To perform an external validation of the risk-prediction model for serious complications from the Michigan Bariatric Surgery Collaborative (MBSC) for Dutch bariatric patients using the nationwide Dutch Audit for Treatment of Obesity (DATO). SETTING Population-based study, including all 18 hospitals performing bariatric surgery in the Netherlands. METHODS All patients registered in the DATO undergoing bariatric surgery between 2015 and 2020 were included as the validation cohort. Serious complications included, among others, abdominal abscess, bowel obstruction, leak, and bleeding. Three risk-prediction models were validated: (1) the original MBSC model from 2011, (2) the original MBSC model including the same variables but updated to more recent patients (2015-2020), and (3) the current MBSC model. The following predictors from the MBSC model were available in the DATO: age, sex, procedure type, cardiovascular disease, and pulmonary disease. Model performance was determined using the area under the curve (AUC) to assess discrimination (i.e., the ability to distinguish patients with events from those without events) and a graphical plot to assess calibration (i.e., whether the predicted absolute risk for patients was similar to the observed prevalence of the outcome). RESULTS The DATO validation cohort included 51,291 patients. Overall, 986 patients (1.92%) experienced serious complications. The original MBSC model, which was extended with the predictors "GERD (yes/no)," "OSAS (yes/no)," "hypertension (yes/no)," and "renal disease (yes/no)," showed the best validation results. This model had a good calibration and an AUC of .602 compared with an AUC of .65 and moderate to good calibration in the Michigan model. CONCLUSION The DATO prediction model has good calibration but moderate discrimination. To be used in clinical practice, good calibration is essential to accurately predict individual risks in a real-world setting. Therefore, this model could provide valuable information for bariatric surgeons as part of shared decision making in daily practice.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands; Dutch Obesity Clinic, The Hague & Gouda, The Netherlands
| | - Aaron J Bonham
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands; Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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Akmaz B, Hameleers A, Boerma EG, Vliegen RFA, Greve JWM, Meesters B, Stoot JHMB. Hiatal hernia recurrences after laparoscopic surgery: exploring the optimal technique. Surg Endosc 2023:10.1007/s00464-023-09907-w. [PMID: 36781470 DOI: 10.1007/s00464-023-09907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/21/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION The recurrence rate of hiatal hernia (HH) after laparoscopic surgery with crural repair and Nissen or Toupet fundoplication is high (< 25-42%). HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS) or mesh placement but the effect in the long-term (> 1 year) is still unclear. We determined the recurrence rate of HH after surgery and established whether the use of reinforcement techniques could reduce long-term recurrence rates. METHODS In this retrospective cohort study patients were included if they underwent a laparoscopic fundoplication in this hospital between 2012 and 2019. HH was measured with computed tomography and baseline patient characteristics and surgical details were collected. Primary outcomes were recurrence of symptoms and re-intervention, secondary outcome was effect of surgical reinforcement techniques. Statistical analyses comprised chi-square tests, Mann-Whitney U tests and uni- and multivariable logistic regression analyses. RESULTS In total, 307 patients were included, 206 women and 101 men. During primary surgery, 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Use of VMS during primary surgery was significantly associated with fewer recurrences (OR = 0.34, p = 0.048), corrected for confounding factors. Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in five patients (1.6%). Mesh and VMS were used more during secondary and tertiary surgery. CONCLUSION The recurrence rate among HH patients in this cohort study was 20.8% with a mean follow-up time of 6 years. Secondary surgery was performed in 17.6% of the patients. In future, the use of VMS might lead to fewer recurrences after primary laparoscopic repair of HH.
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Affiliation(s)
- B Akmaz
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - A Hameleers
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - E G Boerma
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - R F A Vliegen
- Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - J W M Greve
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - B Meesters
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands
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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Weight recurrence after Sleeve Gastrectomy versus Roux-en-Y gastric bypass: a propensity score matched nationwide analysis. Surg Endosc 2023:10.1007/s00464-022-09785-8. [PMID: 36745232 DOI: 10.1007/s00464-022-09785-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Literature remains scarce on patients experiencing weight recurrence after initial adequate weight loss following primary bariatric surgery. Therefore, this study compared the extent of weight recurrence between patients who received a Sleeve Gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB) after adequate weight loss at 1-year follow-up. METHODS All patients undergoing primary RYGB or SG between 2015 and 2018 were selected from the Dutch Audit for Treatment of Obesity. Inclusion criteria were achieving ≥ 20% total weight loss (TWL) at 1-year and having at least one subsequent follow-up visit. The primary outcome was ≥ 10% weight recurrence (WR) at the last recorded follow-up between 2 and 5 years, after ≥ 20% TWL at 1-year follow-up. Secondary outcomes included remission of comorbidities at last recorded follow-up. A propensity score matched logistic regression analysis was used to estimate the difference between RYGB and SG. RESULTS A total of 19.762 patients were included, 14.982 RYGB and 4.780 SG patients. After matching 4.693 patients from each group, patients undergoing SG had a higher likelihood on WR up to 5-year follow-up compared with RYGB [OR 2.07, 95% CI (1.89-2.27), p < 0.01] and less often remission of type 2 diabetes [OR 0.69, 95% CI (0.56-0.86), p < 0.01], hypertension (HTN) [OR 0.75, 95% CI (0.65-0.87), p < 0.01], dyslipidemia [OR 0.44, 95% CI (0.36-0.54), p < 0.01], gastroesophageal reflux [OR 0.25 95% CI (0.18-0.34), p < 0.01], and obstructive sleep apnea syndrome (OSAS) [OR 0.66, 95% CI (0.54-0.8), p < 0.01]. In subgroup analyses, patients who experienced WR after SG but maintained ≥ 20%TWL from starting weight, more often achieved HTN (44.7% vs 29.4%), dyslipidemia (38.3% vs 19.3%), and OSAS (54% vs 20.3%) remission compared with patients not maintaining ≥ 20%TWL. No such differences in comorbidity remission were found within RYGB patients. CONCLUSION Patients undergoing SG are more likely to experience weight recurrence, and less likely to achieve comorbidity remission than patients undergoing RYGB.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands
- Dutch Obesity Clinic, The Hague & Gouda, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
- Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Akmaz B, Hameleers A, Boerma EG, Vliegen RFA, Greve JWM, Meesters B, Stoot JHMB. OC-067 HIATAL HERNIA RECURRENCES AFTER LAPAROSCOPIC SURGERY: EXPLORING CONTRIBUTING SURGICAL FACTORS. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
The recurrence rate of hiatus hernia (HH) is high after laparascopic surgery (25–42%). HH repair can be reinforced by means of additional ventral sutures, pledgets or mesh placement. We determined the recurrence rate of HH after surgery and established whether lower long-term recurrence rates can be achieved with reinforcement techniques.
Methods
Patients were included in this retrospective cohort study if they underwent a laparoscopic fundoplication in our hospital between 2012–2019. HH was measured on CT scans and patient files were reviewed.
Results
In total, 307 patients were included, 206 women and 101 men. Pre-operatively, 102 patients were diagnosed with type III HH and 68 patients with type IV HH. The median transverse diameter of the HH was 3.2 cm. 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of ventral sutures in 132 patients, pledgets in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in 5 patients (1.6%). Use of pledgets during primary surgery (OR=0.34, p=0.048) was significantly associated with fewer recurrences, corrected for confounding factors. Use of ventral sutures and mesh were not significantly associated with reduced recurrence rates.
Conclusions
The recurrence rate among HH patients in our hospital was 20.8% with a mean follow-up time of 6 years. In future, the use of pledgets might lead to fewer recurrences after primary laparoscopic repair of HH.
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Affiliation(s)
- B Akmaz
- Department of Surgery, Zuyderland Medical Center , Heerlen , Netherlands
| | - A Hameleers
- Department of Surgery, Zuyderland Medical Center , Heerlen , Netherlands
| | - E G Boerma
- Department of Surgery, Zuyderland Medical Center , Heerlen , Netherlands
| | - R F A Vliegen
- Department of Radiology, Zuyderland Medical Center , Heerlen , Netherlands
| | - J W M Greve
- Department of Surgery, Zuyderland Medical Center , Heerlen , Netherlands
| | - B Meesters
- Department of Surgery, Zuyderland Medical Center , Heerlen , Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center , Heerlen , Netherlands
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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Hospital Variation in Preference for a Specific Bariatric Procedure and the Association with Weight Loss Performance: a Nationwide Analysis. Obes Surg 2022; 32:3589-3599. [PMID: 36100807 DOI: 10.1007/s11695-022-06212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Hospitals performing a certain bariatric procedure in high volumes may have better outcomes. However, they could also have worse outcomes for some patients who are better off receiving another procedure. This study evaluates the effect of hospital preference for a specific type of bariatric procedure on their overall weight loss results. METHODS All hospitals performing bariatric surgery were included from the nationwide Dutch Audit for Treatment of Obesity. For each hospital, the expected (E) numbers of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB) were calculated given their patient-mix. These were compared with the observed (O) numbers as the O/E ratio in a funnel plot. The 95% control intervals were used to identify outlier hospitals performing a certain procedure significantly more often than expected given their patient-mix (defined as hospital preference for that procedure). Similarly, funnel plots were created for the outcome of patients achieving ≥ 25% total weight loss (TWL) after 2 years, which was linked to each hospital's preference. RESULTS A total of 34,558 patients were included, with 23,154 patients completing a 2-year follow-up, of whom 79.6% achieved ≥ 25%TWL. Nine hospitals had a preference for RYGB (range O/E ratio [1.09-1.53]), with 1 having significantly more patients achieving ≥ 25%TWL (O/E ratio [1.06]). Of 6 hospitals with a preference for SG (range O/E ratio [1.10-2.71]), one hospital had significantly fewer patients achieving ≥ 25%TWL (O/E ratio [0.90]), and from two hospitals with a preference for OAGB (range O/E ratio [4.0-6.0]), one had significantly more patients achieving ≥ 25%TWL (O/E ratio [1.07]). One hospital had no preference for any procedure but did have significantly more patients achieving ≥ 25%TWL (O/E ratio [1.10]). CONCLUSION Hospital preference is not consistently associated with better overall weight loss results. This suggests that even though experience with a procedure may be slightly less in hospitals not having a preference, it is still sufficient to achieve similar weight loss outcomes when surgery is provided in centralized high-volume bariatric institutions.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6229 HX, Maastricht, the Netherlands.
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, the Netherlands
- Dutch Obesity Clinic, The Hague & Gouda, the Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Jan Willem M Greve
- Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6229 HX, Maastricht, the Netherlands
- Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
- Dutch Obesity Clinic South, Heerlen, the Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
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10
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Romaen IFL, Jense MTF, Palm-Meinders IH, de Witte E, Fransen SAF, Greve JWM, Boerma EJG. Higher Preoperative Weight loss Is Associated with Greater Weight Loss up to 12 Months After Bariatric Surgery. Obes Surg 2022; 32:2860-2868. [PMID: 35788954 DOI: 10.1007/s11695-022-06176-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prior research suggested presurgical weight loss is associated with greater total weight loss, resulting in a more effective bariatric intervention. We aimed to assess whether preoperative weight loss is a predictor for total weight loss, and which patient factors are associated with successful weight loss. METHODS All patients (N = 773) that underwent primary bariatric surgery between June 2017 and August 2019 were included in this single-center retrospective study. Outcome measures were preoperative weight loss (%preopWL) and total weight loss (%TWL) up to 1 year postoperatively. Patients were divided into 4 groups based on quartiles of %preopWL. RESULTS Total weight loss after 1, 6, and 12 months for the upper quartile was 16.9%, 33.4%, and 37.8%, and for the lower quartile 11.8%, 28.9%, and 35.2%, respectively (p < 0.001). Seven hundred fourteen patients (92.4%) were available for the 1-year follow-up. Preoperative weight loss was not associated with the incidence of complications. Independent factors predicting increased %preopWL were mandated preoperative weight loss program (MWP) (p < 0.001), older age (p = 0.005), weight measurement in the week before surgery (p = 0.031), and non-diabetic status (p = 0.010). Predictors for superior %TWL were MWP (p = 0.014), younger age (p = 0.001), non-diabetic status (p = 0.005), female gender (p = 0.001), higher Body Mass Index (p = 0.006), and banded gastric bypass (p = 0.001). CONCLUSION Higher preoperative weight loss is associated with persisting greater weight loss up to at least 12 months post-surgery. In order to optimize preoperative weight loss, we recommend extra preoperative support to younger and diabetic patients. We advise nutritional counseling and additional weight measurement in the week before surgery.
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Affiliation(s)
- Ine F L Romaen
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
| | - Marijn T F Jense
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
| | | | - Evelien de Witte
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands
| | - Sofie A F Fransen
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands
| | - Jan Willem M Greve
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands
- Research School, NUTRIM University of Maastricht, 6229 ER, Maastricht, the Netherlands
| | - Evert-Jan G Boerma
- Surgical Department, Zuyderland Medical Center, 6419 PC, Heerlen/Sittard, the Netherlands.
- Dutch Obesity Clinic South, 6419 XZ, Heerlen, the Netherlands.
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11
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Jense MTF, Palm-Meinders IH, Sigterman-Nelissen R, Boerma EJG, Liem RSL, Swank DJ, Greve JWM. The Benefits of Banded over Non-banded Roux-en-Y Gastric Bypass in Patients with Morbid Obesity: a Multi-center Study. Obes Surg 2022; 32:1856-1863. [PMID: 35366739 PMCID: PMC9072269 DOI: 10.1007/s11695-022-06024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
Background
Roux-en-Y gastric bypass (RYGB) has proven to be an effective treatment for obesity with excellent long-term results, even though weight regain can occur. A method to improve the results of RYGB and minimize chance of weight regain is banded RYGB. Better sustained weight loss is also related to higher remission of comorbidities. The aim of this study was to evaluate the effect of banded and non-banded RYGB on long-term weight loss results and comorbidities. Method A retrospective comparative data study was performed. Patients who underwent a primary RYGB between July 2013 and December 2014 and followed a 5-year follow-up program in the Dutch Obesity Clinic were included. Comorbidities were assessed during screening and follow-up. Results The study included 375 patients with mean weight and body mass index (BMI) of 128.9 (± 21.2) kg and 44.50 (± 5.72) kg/m2. Of this group, 184 patients underwent RYGB and 191 banded RYGB. During follow-up (3 months, 1–5 years) % Total Weight Loss (%TWL) was superior in the banded group (32.6% vs 27.6% at 5 years post-operative, p < 0.001). Complication rates in both groups were similar. Comorbidity improvement or remission did not significantly differ between the two groups (p = 0.14–1.00). After 5 years of follow-up, 79 patients (20.5%) were lost to follow-up. Conclusion Banded RYGB does show superior weight loss compared to non-banded RYGB. No difference in effect on comorbidity improvement or remission was observed. Since complication rates are similar, while weight loss is significantly greater, we recommend performing banded RYGB over non-banded RYGB. Graphical abstract ![]()
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12
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Akpinar EO, Nienhuijs SW, Liem RS, Greve JWM, Marang- van de Mheen PJ. Conversion to RYGB versus OAGB after a failed primary gastric band: matched nationwide study. Surg Obes Relat Dis 2022; 18:948-956. [DOI: 10.1016/j.soard.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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13
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Plat VD, Kasteleijn A, Greve JWM, Luyer MDP, Gisbertz SS, Demirkiran A, Daams F. Esophageal Cancer After Bariatric Surgery: Increasing Prevalence and Treatment Strategies. Obes Surg 2021; 31:4954-4962. [PMID: 34494230 PMCID: PMC8490213 DOI: 10.1007/s11695-021-05679-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/02/2022]
Abstract
Purpose The number of bariatric procedures has increased exponentially over the last 20 years. On the background of ever-increasing incidence of esophageal malignancies, the altered anatomy after bariatric surgery poses challenges in treatment of these cancers. In this study, an epidemiological estimate is presented for the future magnitude of this problem and treatment options are described in a retrospective multicenter cohort. Methods The number of bariatric procedures, esophageal cancer incidence, and mortality rates of the general population were used for epidemiological estimates. A retrospective multicenter cohort was composed; patients were treated in three large oncological centers with a high upper gastrointestinal cancer caseload. Consecutive patients with preceding bariatric surgery who developed esophageal cancer between 2014 and 2019 were included. Results Approximately 3200 out of 6.4 million post bariatric surgery patients are estimated to have developed esophageal cancer between 1998 and 2018 worldwide. In a multicenter cohort, 15 patients with esophageal cancer or Barrett’s esophagus and preceding bariatric surgery were identified. The majority of patients had a history of Roux-en-Y gastric bypass (46.7%) and had an adenocarcinoma of the distal esophagus (60%). Seven patients received curative surgical treatment, five of whom are still alive at last follow-up (median follow-up 2 years, no loss to follow-up). Conclusion Based on worldwide data, esophageal cancer development following bariatric surgery has increased over the past decades. Treatment of patients with esophageal cancer after bariatric surgery is challenging and requires a highly individualized approach in which optimal treatment and anatomical limitations are carefully balanced. Graphical abstract ![]()
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Affiliation(s)
- Victor D Plat
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7075, 1007 MB, Amsterdam, The Netherlands
| | - Anne Kasteleijn
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7075, 1007 MB, Amsterdam, The Netherlands
| | - Jan Willem M Greve
- Department of Gastrointestinal Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center Maastricht, Maastricht, The Netherlands
| | - Misha D P Luyer
- Department of Gastrointestinal Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Suzanne S Gisbertz
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7075, 1007 MB, Amsterdam, The Netherlands
| | - Ahmet Demirkiran
- Department of Gastrointestinal Surgery, Rode Kruis Hospital, Beverwijk, The Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7075, 1007 MB, Amsterdam, The Netherlands.
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14
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Kolen AM, Romeijn MM, Holthuijsen DDB, Janssen L, Greve JWM, Leclercq WKG, van Dielen FMH. Current preoperative strategies applied in the Dutch bariatric centers: A national survey. Clin Obes 2021; 11:e12461. [PMID: 34028197 PMCID: PMC8365720 DOI: 10.1111/cob.12461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
There is no consensus about the optimal management of patients undergoing bariatric surgery. This study aimed to identify current weight loss goals prior to bariatric surgery, as well as aimed to explore preoperative strategies related to diet, nutritional supplements and physical activity. An online survey was distributed among bariatric surgeons and dietitians in all 18 Dutch bariatric centers. This survey included the following four domains: weight loss, diet, nutritional supplements and physical activity. For the analyses one answer per center was used, either the most common answer or the answer given by the most expert responder. All 18 centers reported at least one response. Preoperative weight loss was requested in 28% of the centers, whereas 61% desired a stable weight or weight loss, and 11% had no requests. A preoperative diet was routinely recommended in 78% of the centers and on indication (ie, depending on baseline weight and/or comorbidity status) in 22%. The most frequently prescribed diet was a low-energy diet (800-1500 kcal/day) in 44% of the centers. Nutritional supplements were recommended in 78% of the centers. Physical activity with low intensity was recommended in 83% of the centers, while physical exercise training with mid- to high-intensity was recommended in 72%. Inconsistent responses within centers were observed in 56% of the questions. The current bariatric practice within the Netherlands shows high variability and inconsistencies in preoperative management. Consensus-building and standardization of strategies should be promoted in the future.
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Affiliation(s)
- Aniek M. Kolen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marleen M. Romeijn
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Daniëlle D. B. Holthuijsen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Loes Janssen
- Department of SurgeryMáxima Medical CenterVeldhovenThe Netherlands
| | - Jan Willem M. Greve
- Research School NUTRIM, Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
- Department of SurgeryZuyderland Medical CenterHeerlenThe Netherlands
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15
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Romeijn MM, van Hoef S, Janssen L, van de Pas KGH, van Dielen FMH, Luijten AAPM, Göttgens KWA, Greve JWM, Leclercq WKG. Correction to: Comparison of Linear Versus Circular-Stapled Gastroenterostomy in Roux-en-Y Gastric Bypass: a Nationwide Population-Based Cohort Study. Obes Surg 2021; 31:3588-3589. [PMID: 33990850 PMCID: PMC8496587 DOI: 10.1007/s11695-021-05474-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Marleen M Romeijn
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. .,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Stijn van Hoef
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Kelly G H van de Pas
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Kevin W A Göttgens
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jan Willem M Greve
- Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
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16
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Romeijn MM, van Hoef S, Janssen L, van de Pas KGH, van Dielen FMH, Luijten AAPM, Göttgens KWA, Greve JWM, Leclercq WKG. Comparison of Linear versus Circular-Stapled Gastroenterostomy in Roux-en-Y Gastric Bypass: A Nationwide Population-Based Cohort Study. Obes Surg 2021; 31:3579-3587. [PMID: 33905068 PMCID: PMC8270800 DOI: 10.1007/s11695-021-05436-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/10/2021] [Accepted: 04/13/2021] [Indexed: 01/13/2023]
Abstract
Background When performing a Roux-en-Y gastric bypass (RYGB), the gastroenterostomy can be constructed with a circular stapled or linear stapled technique. The size of the gastroenterostomy depends on the stapling method and this may affect weight loss outcomes. The aim of this study was to examine the impact of the stapling technique on weight loss outcomes after RYGB. Methods This is a nationwide population-based cohort study of patients that received a RYGB. Data were derived from the Dutch Audit of Treatment of Obesity. Primary outcome was the impact of stapling technique on the rate of non-response defined as significant weight regain (≥20% of a patients’ lost weight) 2–4 years post-surgery, after initial successful weight loss (≥20% total weight loss, TWL). Secondary outcomes were the rate of response, defined as successful weight loss (≥20% TWL) within 1.5 years post-surgery, the incidence of complications and the progression of comorbidities. Results In a cohort of 12,468 patients, non-response was equally distributed between both groups (circular 18.0% vs. linear 17.6%). No differences in response rate (circular 97.0% vs. linear 96.5%) or %TWL were observed up to 4 years post-surgery. Patients in the circular stapled group experienced more complications, specifically major bleedings (2.4% vs. 1.2%; p=0.002) within 30 days postoperatively. No differences were found in deteriorated comorbidities, neither in de novo developed comorbidities. Conclusion When comparing stapling technique in RYGB, weight loss outcomes did not differ during a 4-year follow-up period. The linear stapled gastroenterostomy could pose an advantage due to its lower complication rate. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05436-4.
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Affiliation(s)
- Marleen M Romeijn
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. .,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Stijn van Hoef
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Kelly G H van de Pas
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.,Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Kevin W A Göttgens
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Jan Willem M Greve
- Research School NUTRIM, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
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17
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Akpinar EO, Marang-van de Mheen PJ, Nienhuijs SW, Greve JWM, Liem RSL. National Bariatric Surgery Registries: an International Comparison. Obes Surg 2021; 31:3031-3039. [PMID: 33786743 PMCID: PMC8175300 DOI: 10.1007/s11695-021-05359-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/05/2021] [Accepted: 03/16/2021] [Indexed: 01/23/2023]
Abstract
Introduction Pooling population-based data from all national bariatric registries may provide international real-world evidence for outcomes that will help establish a universal standard of care, provided that the same variables and definitions are used. Therefore, this study aims to assess the concordance of variables across national registries to identify which outcomes can be used for international collaborations. Methods All 18 countries with a national bariatric registry who contributed to The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Global Registry report 2019 were requested to share their data dictionary by email. The primary outcome was the percentage of perfect agreement for variables by domain: patient, prior bariatric history, screening, operation, complication, and follow-up. Perfect agreement was defined as 100% concordance, meaning that the variable was registered with the same definition across all registries. Secondary outcomes were defined as variables having “substantial agreement” (75–99.9%) and “moderate agreement” (50–74.9%) across registries. Results Eleven registries responded and had a total of 2585 recorded variables that were grouped into 250 variables measuring the same concept. A total of 25 (10%) variables have a perfect agreement across all domains: 3 (18.75%) for the patient domain, 0 (0.0%) for prior bariatric history, 5 (8.2%) for screening, 6 (11.8%) for operation, 5 (8.8%) for complications, and 6 (11.8%) for follow-up. Furthermore, 28 (11.2%) variables have substantial agreement and 59 (23.6%) variables have moderate agreement across registries. Conclusion There is limited uniform agreement in variables across national bariatric registries. Further alignment and uniformity in collected variables are required to enable future international collaborations and comparison. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05359-0.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands. .,Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands.,Dutch Obesity Clinic South, Heerlen, Netherlands
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands.,Dutch Obesity Clinic, The Hague, Netherlands
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18
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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study. Surg Obes Relat Dis 2021; 17:1349-1358. [PMID: 33762128 DOI: 10.1016/j.soard.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery among patients with obesity and type 2 diabetes (T2D) can induce complete remission. However, it remains unclear whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has better T2D remission within a population-based daily practice. OBJECTIVES To compare patients undergoing RYGB and SG on the extent of T2D remission at the 1-year follow-up. SETTING Nationwide, population-based study including all 18 hospitals in the Netherlands providing metabolic and bariatric surgery. METHODS Patients undergoing RYGB and SG between October 2015 and October 2018 with 1 year of complete follow-up data were selected from the mandatory nationwide Dutch Audit for Treatment of Obesity (DATO). The primary outcome is T2D remission within 1 year. Secondary outcomes include ≥20% total weight loss (TWL), obesity-related co-morbidity reduction, and postoperative complications with a Clavien-Dindo (CD) grade ≥III within 30 days. We compared T2D remission between RYGB and SG groups using propensity score matching to adjust for confounding by indication. RESULTS A total of 5015 patients were identified from the DATO, and 4132 (82.4%) had completed a 1-year follow-up visit. There were 3350 (66.8%) patients with a valid T2D status who were included in the analysis (RYGB = 2623; SG = 727). RYGB patients had a lower body mass index than SG patients, but were more often female, with higher gastroesophageal reflux disease and dyslipidemia rates. After adjusting for these confounders, RYGB patients had increased odds of achieving T2D remission (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.14-2.1; P < .01). Groups were balanced after matching 695 patients in each group. After matching, RYGB patients still had better odds of T2D remission (OR, 1.91; 95% CI, 1.27-2.88; P < .01). Also, significantly more RYGB patients had ≥20%TWL (OR, 2.71; 95% CI, 1.96-3.75; P < .01) and RYGB patients had higher dyslipidemia remission rates (OR, 1.96; 95% CI, 1.39-2.76; P < .01). There were no significant differences in CD ≥III complications. CONCLUSION Using population-based data from the Netherlands, this study shows that RYGB leads to better T2D remission rates at the 1-year follow-up and better metabolic outcomes for patients with obesity and T2D undergoing bariatric surgery in daily practice.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands; Dutch Obesity Clinic, The Hague, Netherlands
| | | | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands; Dutch Obesity Clinic South, Heerlen, Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
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Simons N, Bijnen M, Wouters KAM, Rensen SS, Beulens JWJ, van Greevenbroek MMJ, ’t Hart LM, Greve JWM, van der Kallen CJH, Schaper NC, Schalkwijk CG, Stehouwer CDA, Brouwers MCGJ. The endothelial function biomarker soluble E-selectin is associated with nonalcoholic fatty liver disease. Liver Int 2020; 40:1079-1088. [PMID: 31960587 PMCID: PMC7317803 DOI: 10.1111/liv.14384] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Plasma soluble E-selectin (sE-selectin) is a frequently used biomarker of systemic endothelial dysfunction. The present study explored the relationship between nonalcoholic fatty liver disease (NAFLD) and plasma sE-selectin levels. METHODS Expression of E-selectin in liver, visceral adipose tissue (VAT) and muscle was studied in relation to plasma sE-selectin in severely obese individuals (n = 74). The course of hepatic E-selectin expression in relation to hepatic steatosis and inflammation was examined in C57BL/6J LDLR-/- mice on a Western-type diet. The relationship between biomarkers of NAFLD, that is, plasma aminotransferase (ALT) and NAFLD susceptibility genes (rs738409 [PNPLA3] and rs1260326 [GCKR]), and plasma sE-selectin was studied in the combined CODAM (n = 571) and Hoorn (n = 694) studies. RESULTS E-selectin expression in liver, not VAT or muscle, was associated with plasma sE-selectin in severely obese individuals (β = 0.26; 95% CI: 0.05-0.47). NAFLD severity was associated with hepatic E-selectin expression (P = .02) and plasma sE-selectin (P = .003). LDLR-/- mice on a Western-type diet displayed increased hepatic E-selectin expression that followed the same course as hepatic inflammation, but not steatosis. In the CODAM study, plasma ALT was associated with plasma sE-selectin, independent of potential confounders (β = 0.25; 95% CI: 0.16-0.34). Both rs738409 and rs1260326 were associated with higher plasma sE-selectin in the combined CODAM and Hoorn studies (P = .01 and P = .004 respectively). CONCLUSIONS NAFLD and related markers are associated with higher expression of hepatic E-selectin and higher levels of plasma sE-selectin. Further studies are required to investigate the role of E-selectin in the pathogenesis of NAFLD and the applicability of sE-selectin as a plasma biomarker of NAFLD/NASH.
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Affiliation(s)
- Nynke Simons
- Department of Internal MedicineDivision of Endocrinology and Metabolic DiseasesMaastricht University Medical CenterMaastrichtThe Netherlands,Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Mitchell Bijnen
- Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Kristiaan A. M. Wouters
- Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Sander S. Rensen
- Department of General SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Joline W. J. Beulens
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center – location VUmcthe Amsterdam Public Health Research Institute AmsterdamAmsterdamThe Netherlands,Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marleen M. J. van Greevenbroek
- Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Leen M. ’t Hart
- Department of Epidemiology and BiostatisticsAmsterdam University Medical Center – location VUmcthe Amsterdam Public Health Research Institute AmsterdamAmsterdamThe Netherlands,Department of Cell and Chemical BiologyLeiden University Medical CenterLeidenThe Netherlands,Department of Biomedical Data SciencesSection Molecular EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Jan Willem M. Greve
- Department of General SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands,NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of General SurgeryZuyderland Medical CenterHeerlenThe Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Nicolaas C. Schaper
- Department of Internal MedicineDivision of Endocrinology and Metabolic DiseasesMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,CAPHRI School for Public Health and Primary CareMaastricht UniversityMaastrichtThe Netherlands
| | - Casper G. Schalkwijk
- Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
| | - Coen D. A. Stehouwer
- Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineDivision of General Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Martijn C. G. J. Brouwers
- Department of Internal MedicineDivision of Endocrinology and Metabolic DiseasesMaastricht University Medical CenterMaastrichtThe Netherlands,Department of Internal MedicineDivision of General Internal MedicineLaboratory for Metabolism and Vascular MedicineMaastricht University Medical CenterMaastrichtThe Netherlands,CARIM School for Cardiovascular DiseasesMaastricht UniversityMaastrichtThe Netherlands
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20
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van Rijn S, Betzel B, de Jonge C, van Dijk DPJ, Janssen IM, Berends FJ, Bouvy ND, Greve JWM. The Effect of 6 and 12 months Duodenal-Jejunal Bypass Liner Treatment on Obesity and Type 2 Diabetes: a Crossover Cohort Study. Obes Surg 2019; 28:1255-1262. [PMID: 29110244 PMCID: PMC5968053 DOI: 10.1007/s11695-017-2997-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The aim of this research was to study the duodenal-jejunal bypass liner (DJBL) treatment for obesity and type 2 diabetes mellitus (T2DM) in patients after dietary treatment in a cross-over design. BACKGROUND DJBL treatment has been proven effective for treatment of obesity and T2DM. However, data on safety and efficacy of a 12-month DJBL treatment is limited. METHODS In 2014, our research group reported on a multicenter randomized clinical trial. Patients were randomized to DJBL or dietary treatment (control group). Twenty-eight patients crossed over after their dietary treatment and received up to 12 months of DJBL treatment. Patient visits were conducted at baseline, during DJBL treatment (1 week, 1-6, 9, 12 months) and 6 months after removal of the liner. Patients underwent a standard physical examination, blood sampling, assessment of adverse events, nutritional and diabetes counseling, and a standardized meal tolerance test. RESULTS Of the 28 patients included in this study, 24 patients completed 6 months of treatment. Eighteen patients were extended to 12 months of DJBL treatment; 13 patients completed this treatment period. After 6 months of DJBL treatment, a significant increase in excess weight loss (EWL) and decrease in weight, BMI, HbA1c, fasting glucose, cholesterol, HDL and LDL improved significantly. After 12 months of DJBL treatment, these parameters stabilized. CONCLUSIONS The DJBL is an effective, minimally invasive treatment option. Even after successful treatment with dietary restrictions, the DJBL is still capable of significantly reducing weight and improving cardiovascular and type 2 diabetes mellitus parameters in obese patients.
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Affiliation(s)
- Selwyn van Rijn
- Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bark Betzel
- Department of General Surgery, Rijnstate Medical Center, Arnhem, The Netherlands
| | - Charlotte de Jonge
- Department of General Surgery, Zuyderland Medical Center, Heerlen-Sittard, The Netherlands
| | - David P J van Dijk
- Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ignace M Janssen
- Department of General Surgery, Rijnstate Medical Center, Arnhem, The Netherlands
| | - Frits J Berends
- Department of General Surgery, Rijnstate Medical Center, Arnhem, The Netherlands
| | - Nicole D Bouvy
- Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem M Greve
- Department of General Surgery, Zuyderland Medical Center, Heerlen-Sittard, The Netherlands. .,, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
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21
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Mahawar KK, Himpens JM, Shikora SA, Ramos AC, Torres A, Somers S, Dillemans B, Angrisani L, Greve JWM, Chevallier JM, Chowbey P, De Luca M, Weiner R, Prager G, Vilallonga R, Adamo M, Sakran N, Kow L, Lakdawala M, Dargent J, Nimeri A, Small PK. The first consensus statement on revisional bariatric surgery using a modified Delphi approach. Surg Endosc 2019; 34:1648-1657. [PMID: 31218425 DOI: 10.1007/s00464-019-06937-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/12/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) constitutes a possible solution for patients who experience an inadequate response following bariatric surgery or significant weight regain following an initial satisfactory response. This paper reports results from the first modified Delphi consensus-building exercise on RBS. METHODS We created a committee of 22 recognised opinion-makers with a special interest in RBS. The committee invited 70 RBS experts from 27 countries to vote on 39 statements concerning RBS. An agreement amongst ≥ 70.0% experts was regarded as a consensus. RESULTS Seventy experts from twenty-seven countries took part. There was a consensus that the decision for RBS should be individualised (100.0%) and multi-disciplinary (92.8%). Experts recommended a preoperative nutritional (95.7%) and psychological evaluation (85.7%), endoscopy (97.1%), and a contrast series (94.3%). Experts agreed that Roux-Y gastric bypass (RYGB) (94.3%), One anastomosis gastric bypass (OAGB) (82.8%), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) (71.4%) were acceptable RBS options after gastric banding (84.3%). OAGB (84.3%), bilio-pancreatic diversion/duodenal switch (BPD/DS) (81.4%), and SADI-S (88.5%) were agreed as consensus RBS options after sleeve gastrectomy. lengthening of bilio-pancreatic limb was the only consensus RBS option after RYGB (94.3%) and OAGB (72.8%). CONCLUSION Experts achieved consensus on a number of aspects of RBS. Though expert opinion can only be regarded as low-quality evidence, the findings of this exercise should help improve the outcomes of RBS while we develop robust evidence to inform future practice.
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Affiliation(s)
- Kamal K Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
| | | | - Scott A Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Almino C Ramos
- Gastro-Obeso-Center Metabolic Optimisation Institute, Sao Paulo, Brazil
| | - Antonio Torres
- Hospital Clinico San Carlos, Complutense University, Madrid, Spain
| | - Shaw Somers
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Luigi Angrisani
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Jan Willem M Greve
- Zuyderland Medical Center, Heerlen, The Netherlands.,The Netherlands and Maastricht University (MUMC+), Maastricht, The Netherlands
| | | | - Pradeep Chowbey
- Max Institute of Minimal Access Metabolic and Bariatric Surgery, Max Hospital, Saket, New Delhi, India
| | | | - Rudolf Weiner
- Clinic Obesity Surgery, Sana-Klinikum Offenbach, Offenbach, Germany
| | | | | | - Marco Adamo
- University College London Hospital, London, UK
| | | | - Lilian Kow
- Flinders Private Hospital, Adelaide, Australia
| | | | | | | | - Peter K Small
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK
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22
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van Nierop FS, de Jonge C, Kulik W, Bouvy N, Schaap FG, Olde Damink SW, Rensen S, Romijn JA, Greve JWM, Soeters MR. Duodenal-jejunal lining increases postprandial unconjugated bile acid responses and disrupts the bile acid-FXR-FGF19 axis in humans. Metabolism 2019; 93:25-32. [PMID: 30658059 DOI: 10.1016/j.metabol.2018.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/21/2018] [Accepted: 12/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Placement of the duodenal-jejunal bypass liner (DJBL) leads to rapid weight loss and restoration of insulin sensitivity in a similar fashion to bariatric surgery. Increased systemic bile acid levels are candidate effectors for these effects through postprandial activation of their receptors TGR5 and FXR. We aimed to quantify postprandial bile acid, GLP-1 and FGF19 responses and assess their temporal relation to the weight loss and metabolic and hormonal changes seen after DJBL placement. METHODS We performed mixed meal testing in 17 obese patients with type 2 diabetes mellitus (DM2) directly before, one week after and 6 months after DJBL placement. RESULTS Both fasting and postprandial bile acid levels were unchanged at 1 week after implantation, and greatly increased 6 months after implantation. The increase consisted of unconjugated bile acid species. 3 hour-postprandial GLP-1 levels increased after 1 week and were sustained, whereas FGF19 levels and postprandial plasma courses were unaffected. CONCLUSIONS DJBL placement leads to profound increases in unconjugated bile acid levels after 6 months, similar to the effects of bariatric surgery. The temporal dissociation between the changes in bile acids, GLP-1 and FGF19 and other gut hormone responses warrant caution about the beneficial role of bile acids after DJBL placement. This observational uncontrolled study emphasizes the need for future controlled studies.
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Affiliation(s)
- Frederik Samuel van Nierop
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology & Metabolism Research Institute, Meibergdreef 9, Amsterdam, the Netherlands
| | - Charlotte de Jonge
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
| | - Wim Kulik
- Amsterdam UMC, University of Amsterdam, Department of Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nicole Bouvy
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
| | - Frank G Schaap
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Steven W Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands; Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany.; Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sander Rensen
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands
| | - Johannes A Romijn
- Amsterdam UMC, University of Amsterdam, Department of Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan Willem M Greve
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, the Netherlands; Department of General Surgery, Zuyderland Medical Center, Heerlen-Sittard, the Netherlands
| | - Maarten R Soeters
- Amsterdam UMC, University of Amsterdam, Department of Endocrinology and Metabolism, Amsterdam Gastroenterology & Metabolism Research Institute, Meibergdreef 9, Amsterdam, the Netherlands.
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23
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Roebroek YGM, Paulus GF, van Mil EGAH, Vreugdenhil ACE, Winkens B, Nederkoorn C, Stehouwer CDA, Greve JWM, Bouvy ND, van Heurn LWE. Bariatric surgery in adolescents: a prospective randomized controlled trial comparing laparoscopic gastric banding to combined lifestyle interventions in adolescents with severe obesity (BASIC trial). BMC Pediatr 2019; 19:34. [PMID: 30691442 PMCID: PMC6350363 DOI: 10.1186/s12887-019-1395-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 01/04/2019] [Indexed: 01/22/2023] Open
Abstract
Background Obesity in children and adolescents is an increasing problem associated with multiple co-morbidities including metabolic and endocrine changes, cardiovascular abnormalities, and impaired quality of life. Combined lifestyle interventions are the current standard treatment for severe obesity in children. However, the medium- and long-term results of these interventions are relatively poor. Bariatric surgery shows substantial weight loss and health improvement in adults and retrospective studies in adolescents show similar outcomes. However, well-designed prospective studies in this young age group are rare. Our objectives are to determine whether combining surgery with lifestyle interventions in severely obese adolescents leads to a significant additional weight reduction compared to lifestyle interventions solely, and to assess its effect on obesity-associated co-morbidities in a prospective randomized controlled setting. Methods Patients aged 14–16 years with sex- and age-adjusted BMI > 40 kg/m2 (or > 35 kg/m2 with comorbidity) and failure to achieve weight reduction > 5% during at least one year of combined lifestyle interventions are included in this trial. Randomization determines whether laparoscopic adjustable gastric banding will be added to combined lifestyle intervention throughout the trial period. Sixty children will be included in this trial. Follow-up visits are planned at 6 months, 1,2 and 3 years. Primary endpoints are percentage of total weight loss, and change of BMI. Secondary endpoints include body composition, pubertal development, metabolic and endocrine changes, inflammatory status, cardiovascular abnormalities, non-alcoholic steatohepatitis, quality of life and changes in behaviour. Discussion This randomized controlled trial is designed to provide important information about the safety and efficacy of laparoscopic adjustable gastric banding treatment in severely obese adolescents with unsuccessful combined lifestyle interventions. The reversibility of this surgical procedure forms a strong argument to decide for gastric banding over other surgical procedures, since bariatric surgery in adolescents is still in its infancy. Trial registration The BASIC trial is registered in the register of ClinicalTrials.gov since July 2010, Identifier: NCT01172899 Electronic supplementary material The online version of this article (10.1186/s12887-019-1395-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Y G M Roebroek
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - G F Paulus
- Department of General Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - E G A H van Mil
- Department of Paediatrics, Jeroen Bosch Medical Centre, 's Hertogenbosch, The Netherlands
| | - A C E Vreugdenhil
- Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B Winkens
- Department of Methodolgy and Statistics and CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - C Nederkoorn
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - J W M Greve
- Department of General Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - L W E van Heurn
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam Medical Centre/ VU University Medical Centre, Amsterdam, The Netherlands
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24
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Bijnen M, Josefs T, Cuijpers I, Maalsen CJ, van de Gaar J, Vroomen M, Wijnands E, Rensen SS, Greve JWM, Hofker MH, Biessen EAL, Stehouwer CDA, Schalkwijk CG, Wouters K. Adipose tissue macrophages induce hepatic neutrophil recruitment and macrophage accumulation in mice. Gut 2018; 67:1317-1327. [PMID: 29074725 DOI: 10.1136/gutjnl-2016-313654] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Obesity is a risk factor for non-alcoholic steatohepatitis (NASH). This risk has been attributed to visceral adipose tissue (vAT) expansion associated with increased proinflammatory mediators. Accumulation of CD11c+ proinflammatory adipose tissue macrophages (ATM) is an important driver of vAT inflammation. We investigated the role of ATMs in hepatic inflammation during NASH development. DESIGN vAT isolated from lean, obese or ATM-depleted (using clodronate liposomes) obese mice was transplanted to lean ldlr-/- acceptor mice. Systemic and hepatic inflammation was assessed either after 2 weeks on standard chow or after 8 weeks on high cholesterol diet (HCD) to induce NASH. RESULTS Transplanting donor vAT from obese mice increased HCD-induced hepatic macrophage content compared with lean-transplanted mice, worsening liver damage. ATM depletion prior to vAT transplantation reduced this increased hepatic macrophage accumulation. On chow, vAT transplantation induced a more pronounced increase in circulating and hepatic neutrophil numbers in obese-transplanted than lean-transplanted mice, while ATM depletion prior to vAT transplantation reversed this effect. Microarray analysis of fluorescence-activated cell sorting of CD11c+ and CD11c- macrophages isolated from donor adipose tissue showed that obesity resulted in enhanced expression of neutrophil chemotaxis genes specifically in CD11c+ ATMs. Involvement of the neutrophil chemotaxis proteins, CXCL14 and CXCL16, was confirmed by culturing vAT. In humans, CD11c expression in vAT of obese individuals correlated with vAT expression of neutrophil chemotactic genes and with hepatic expression of neutrophil and macrophage marker genes. CONCLUSION ATMs from obese vAT induce hepatic macrophage accumulation during NASH development, possibly by enhancing neutrophil recruitment.
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Affiliation(s)
- Mitchell Bijnen
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - Tatjana Josefs
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands.,Department of Medicine, NYU School of Medicine, New York City, New York, USA
| | - Ilona Cuijpers
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - Constantijn J Maalsen
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - José van de Gaar
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - Maria Vroomen
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - Erwin Wijnands
- Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands.,Department of Pathology, MUMC, Maastricht, Limburg, The Netherlands
| | - Sander S Rensen
- Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands.,Department of General Surgery, MUMC, Maastricht, Limburg, The Netherlands
| | - Jan Willem M Greve
- Department of General Surgery, Atrium Medical Centre Parkstad, Heerlen, The Netherlands
| | - Marten H Hofker
- Department of Pediatrics, Molecular Genetics, UMCG, Groningen, The Netherlands
| | - Erik A L Biessen
- Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands.,Department of Pathology, MUMC, Maastricht, Limburg, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
| | - Kristiaan Wouters
- Department of Internal Medicine, MUMC, Maastricht, Limburg, The Netherlands.,Cardiovascular Research Institute Maastricht, MUMC, Maastricht, Limburg, The Netherlands
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25
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Atanasovska B, Rensen SS, van der Sijde MR, Marsman G, Kumar V, Jonkers I, Withoff S, Shiri-Sverdlov R, Greve JWM, Faber KN, Moshage H, Wijmenga C, van de Sluis B, Hofker MH, Fu J. A liver-specific long noncoding RNA with a role in cell viability is elevated in human nonalcoholic steatohepatitis. Hepatology 2017; 66:794-808. [PMID: 28073183 DOI: 10.1002/hep.29034] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 12/12/2016] [Accepted: 01/06/2017] [Indexed: 12/28/2022]
Abstract
UNLABELLED Hepatocyte apoptosis in nonalcoholic steatohepatitis (NASH) can lead to fibrosis and cirrhosis, which permanently damage the liver. Understanding the regulation of hepatocyte apoptosis is therefore important to identify therapeutic targets that may prevent the progression of NASH to fibrosis. Recently, increasing evidence has shown that long noncoding (lnc) RNAs are involved in various biological processes and that their dysregulation underlies a number of complex human diseases. By performing gene expression profiling of 4,383 lncRNAs in 82 liver samples from individuals with NASH (n = 48), simple steatosis but no NASH (n = 11), and healthy controls (n = 23), we discovered a liver-specific lncRNA (RP11-484N16.1) on chromosome 18 that showed significantly elevated expression in the liver tissue of NASH patients. This lncRNA, which we named lnc18q22.2 based on its chromosomal location, correlated with NASH grade (r = 0.51, P = 8.11 × 10-7 ), lobular inflammation (r = 0.49, P = 2.35 × 10-6 ), and nonalcoholic fatty liver disease activity score (r = 0.48, P = 4.69 × 10-6 ). The association of lnc18q22.2 to liver steatosis and steatohepatitis was replicated in 44 independent liver biopsies (r = 0.47, P = 0.0013). We provided a genetic structure of lnc18q22.2 showing an extended exon 2 in liver. Knockdown of lnc18q22.2 in four different hepatocyte cell lines resulted in severe phenotypes ranging from reduced cell growth to lethality. This observation was consistent with pathway analyses of genes coexpressed with lnc18q22.2 in human liver or affected by lnc18q22.2 knockdown. CONCLUSION We identified an lncRNA that can play an important regulatory role in liver function and provide new insights into the regulation of hepatocyte viability in NASH. (Hepatology 2017;66:794-808).
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Affiliation(s)
- Biljana Atanasovska
- Department of Pediatrics, Molecular Genetics, University Medical Center Groningen, Groningen, The Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sander S Rensen
- Department of Surgery, University Hospital Maastricht, and Nutrition and Toxicology Research Institute, University of Maastricht, Maastricht, The Netherlands
| | - Marijke R van der Sijde
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Glenn Marsman
- Department of Pediatrics, Molecular Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Vinod Kumar
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iris Jonkers
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sebo Withoff
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronit Shiri-Sverdlov
- Departments of Molecular Genetics, Molecular Cell Biology, and Population Genetics, Nutrition and Toxicology Research Institute, University of Maastricht, Maastricht, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Klaas Nico Faber
- Department of Gastroenterology and Hepatology, University of Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, Center for Liver, Digestive, and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Han Moshage
- Department of Gastroenterology and Hepatology, University of Groningen, Groningen, The Netherlands
- Department of Laboratory Medicine, Center for Liver, Digestive, and Metabolic Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cisca Wijmenga
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart van de Sluis
- Department of Pediatrics, Molecular Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Marten H Hofker
- Department of Pediatrics, Molecular Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Jingyuan Fu
- Department of Pediatrics, Molecular Genetics, University Medical Center Groningen, Groningen, The Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Walenbergh SMA, Houben T, Rensen SS, Bieghs V, Hendrikx T, van Gorp PJ, Oligschlaeger Y, Jeurissen MLJ, Gijbels MJJ, Buurman WA, Vreugdenhil ACE, Greve JWM, Plat J, Hofker MH, Kalhan S, Pihlajamäki J, Lindsey P, Koek GH, Shiri-Sverdlov R. Plasma cathepsin D correlates with histological classifications of fatty liver disease in adults and responds to intervention. Sci Rep 2016; 6:38278. [PMID: 27922112 PMCID: PMC5138820 DOI: 10.1038/srep38278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/25/2016] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic steatohepatitis (NASH) is characterized by liver lipid accumulation and inflammation. The mechanisms that trigger hepatic inflammation are poorly understood and subsequently, no specific non-invasive markers exist. We previously demonstrated a reduction in the plasma lysosomal enzyme, cathepsin D (CatD), in children with NASH compared to children without NASH. Recent studies have raised the concept that non-alcoholic fatty liver disease (NAFLD) in adults is distinct from children due to a different histological pattern in the liver. Yet, the link between plasma CatD to adult NASH was not examined. In the current manuscript, we investigated whether plasma CatD in adults correlates with NASH development and regression. Biopsies were histologically evaluated for inflammation and NAFLD in three complementary cohorts of adults (total n = 248). CatD and alanine aminotransferase (ALT) were measured in plasma. Opposite to our previous observations with childhood NASH, we observed increased levels of plasma CatD in patients with NASH compared to adults without hepatic inflammation. Furthermore, after surgical intervention, we found a reduction of plasma CatD compared to baseline. Our observations highlight a distinct pathophysiology between NASH in children and adults. The observation that plasma CatD correlated with NASH development and regression is promising for NASH diagnosis.
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Affiliation(s)
- Sofie M A Walenbergh
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Tom Houben
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Sander S Rensen
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Veerle Bieghs
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Tim Hendrikx
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Patrick J van Gorp
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Yvonne Oligschlaeger
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Mike L J Jeurissen
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Marion J J Gijbels
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Wim A Buurman
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Anita C E Vreugdenhil
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Jan Willem M Greve
- Surgery, Atrium Medical Center Parkstad, 6419PC, Heerlen, The Netherlands
| | - Jogchum Plat
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Marten H Hofker
- Pathology and Medical Biology, Molecular Genetics, Medical Biology Section, University Medical Center Groningen, 9713GZ, Groningen, The Netherlands
| | - Satish Kalhan
- Pathobiology, Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, USA
| | - Jussi Pihlajamäki
- Clinical Nutrition, University of Eastern Finland, FI-70211 Kuopio, Finland.,Clinical Nutrition and Obesity Center, Kuopio University Hospital, FI-70211 Kuopio, Finland
| | - Patrick Lindsey
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Ger H Koek
- Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
| | - Ronit Shiri-Sverdlov
- Molecular Genetics, General Surgery, Paediatrics, Pathology, Population Genetics, Human Biology, Maastricht University Medical Centre, 6200MD, Maastricht, The Netherlands
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27
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de Jonge C, Rensen SS, Verdam FJ, Vincent RP, Bloom SR, Buurman WA, le Roux CW, Bouvy ND, Greve JWM. Impact of Duodenal-Jejunal Exclusion on Satiety Hormones. Obes Surg 2015; 26:672-8. [DOI: 10.1007/s11695-015-1889-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Handgraaf HJM, Ashton D, Favretti F, Segato G, van Ramshorst B, Meesters B, Greve JWM. The Gastric Band That Is Not to Be : Efficacy, Safety and Performance of the Easyband™: a Multicenter Experience. Obes Surg 2015; 25:2239-44. [PMID: 25956149 DOI: 10.1007/s11695-015-1704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Access port problems after laparoscopic adjustable gastric banding can be significant complications. The Easyband™ is an innovative type of gastric band, whose internal diameter can be adjusted by a telemetrically activated motor. The aim of this study was to evaluate safety, efficacy and performance of the Easyband™. METHODS A total of 110 morbidly obese patients were prospectively enrolled. The Easyband™ was implanted laparoscopically by experienced bariatric surgeons in six different hospital locations. Patient characteristics, surgery details, postoperative weight loss, and complications were recorded. Follow-up lasted 2 years. RESULTS Follow-up was completed by 78.2 % of the patients. Surgeons rated 71 % of each aspect of Easyband™ implantation as "easy" or "very easy". Adjustments were successful in 91 % of the attempts. One or more adverse events occurred in 79.1 % of the patients. Thirty-six serious adverse events were reported, of which 50 % was device-related. One or more functional tests failed in 20.9 % of the devices, 8.2 % passed after a repeated test. A reintervention was necessary in 15.5 % of the patients. Mean weight loss after 2 years was 24.2 ± 14.0 kg, mean excess weight loss was 46.1 ± 24 %. CONCLUSION Excess weight loss with the Easyband™ was comparable with other gastric banding devices. Adjustment of the device was simple, non-invasive and more acceptable to patients than with a standard access port. However, a high incidence of device-related problems requiring surgical explantation occurred. The Easyband™ represents a major advance in gastric band design, but significant technical problems need to be resolved before further implants can be recommended.
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Affiliation(s)
- Henricus J M Handgraaf
- Department of Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - David Ashton
- Healthier Weight Centres, 22 Upper Wimpole Street, London, W1G 6NB, UK.
| | - Franco Favretti
- Department of Surgery, San Bortolo Regional Hospital, Viale Ferdinando Rodolfi, 37, Vicenza, 36100, Italy.
| | - Gianni Segato
- Department of Surgery, San Bortolo Regional Hospital, Viale Ferdinando Rodolfi, 37, Vicenza, 36100, Italy.
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, P.O. Box 2500, Nieuwegein, 3430EM, The Netherlands.
| | - Berry Meesters
- Department of Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - Jan Willem M Greve
- Department of Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
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29
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Plat J, Hendrikx T, Bieghs V, Jeurissen MLJ, Walenbergh SMA, van Gorp PJ, De Smet E, Konings M, Vreugdenhil ACE, Guichot YD, Rensen SS, Buurman WA, Greve JWM, Lütjohann D, Mensink RP, Shiri-Sverdlov R. Protective role of plant sterol and stanol esters in liver inflammation: insights from mice and humans. PLoS One 2014; 9:e110758. [PMID: 25356831 PMCID: PMC4214692 DOI: 10.1371/journal.pone.0110758] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 09/23/2014] [Indexed: 01/22/2023] Open
Abstract
The inflammatory component of non-alcoholic steatohepatitis (NASH) can lead to irreversible liver damage. Therefore there is an urgent need to identify novel interventions to combat hepatic inflammation. In mice, omitting cholesterol from the diet reduced hepatic inflammation. Considering the effects of plant sterol/stanol esters on cholesterol metabolism, we hypothesized that plant sterol/stanol esters reduces hepatic inflammation. Indeed, adding plant sterol/stanol esters to a high-fat-diet reduced hepatic inflammation as indicated by immunohistochemical stainings and gene expression for inflammatory markers. Finally, adding sterol/stanol esters lowered hepatic concentrations of cholesterol precursors lathosterol and desmosterol in mice, which were highly elevated in the HFD group similarly as observed in severely obese patients with NASH. In vitro, in isolated LPS stimulated bone marrow derived macrophages desmosterol activated cholesterol efflux whereas sitostanol reduced inflammation. This highly interesting observation that plant sterol/stanol ester consumption leads to complete inhibition of HFD-induced liver inflammation opens new venues in the treatment and prevention of hepatic inflammation.
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Affiliation(s)
- Jogchum Plat
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
- * E-mail: (JP); (RSS)
| | - Tim Hendrikx
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Veerle Bieghs
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Mike L. J. Jeurissen
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sofie M. A. Walenbergh
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Patrick J. van Gorp
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Els De Smet
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Maurice Konings
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Anita C. E. Vreugdenhil
- Department of Pediatrics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Yasmin Dias Guichot
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Sander S. Rensen
- Department of General Surgery, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Wim A. Buurman
- Department of General Surgery, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jan Willem M. Greve
- Department of General Surgery, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
- Atrium Medical Center Parkstad, Heerlen, the Netherlands
| | - Dieter Lütjohann
- Institute of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
| | - Ronald P. Mensink
- Department of Human Biology, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
- * E-mail: (JP); (RSS)
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30
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Segers FM, Verdam FJ, de Jonge C, Boonen B, Driessen A, Shiri-Sverdlov R, Bouvy ND, Greve JWM, Buurman WA, Rensen SS. Complement alternative pathway activation in human nonalcoholic steatohepatitis. PLoS One 2014; 9:e110053. [PMID: 25299043 PMCID: PMC4192551 DOI: 10.1371/journal.pone.0110053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 09/08/2014] [Indexed: 01/07/2023] Open
Abstract
The innate immune system plays a major role in the pathogenesis of nonalcoholic steatohepatitis (NASH). Recently we reported complement activation in human NASH. However, it remained unclear whether the alternative pathway of complement, which amplifies C3 activation and which is frequently associated with pathological complement activation leading to disease, was involved. Here, alternative pathway components were investigated in liver biopsies of obese subjects with healthy livers (n = 10) or with NASH (n = 12) using quantitative PCR, Western blotting, and immunofluorescence staining. Properdin accumulated in areas where neutrophils surrounded steatotic hepatocytes, and colocalized with the C3 activation product C3c. C3 activation status as expressed by the C3c/native C3 ratio was 2.6-fold higher (p<0.01) in subjects with NASH despite reduced native C3 concentrations (0.94±0.12 vs. 0.57±0.09; p<0.01). Hepatic properdin levels positively correlated with levels of C3c (rs = 0.69; p<0.05) and C3c/C3 activation ratio (rs = 0.59; p<0.05). C3c, C3 activation status (C3c/C3 ratio) and properdin levels increased with higher lobular inflammation scores as determined according to the Kleiner classification (C3c: p<0.01, C3c/C3 ratio: p<0.05, properdin: p<0.05). Hepatic mRNA expression of factor B and factor D did not differ between subjects with healthy livers and subjects with NASH (factor B: 1.00±0.19 vs. 0.71±0.07, p = 0.26; factor D: 1.00±0.21 vs. 0.66±0.14, p = 0.29;). Hepatic mRNA and protein levels of Decay Accelerating Factor tended to be increased in subjects with NASH (mRNA: 1.00±0.14 vs. 2.37±0.72; p = 0.22; protein: 0.51±0.11 vs. 1.97±0.67; p = 0.28). In contrast, factor H mRNA was downregulated in patients with NASH (1.00±0.09 vs. 0.71±0.06; p<0.05) and a similar trend was observed with hepatic protein levels (1.12±0.16 vs. 0.78±0.07; p = 0.08). Collectively, these data suggest a role for alternative pathway activation in driving hepatic inflammation in NASH. Therefore, alternative pathway factors may be considered attractive targets for treating NASH by inhibiting complement activation.
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Affiliation(s)
- Filip M. Segers
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Froukje J. Verdam
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Charlotte de Jonge
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, the Netherlands
| | - Bas Boonen
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Ann Driessen
- Department of Pathology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Genetics and Cell Biology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nicole D. Bouvy
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jan Willem M. Greve
- Department of Surgery, Atrium Medical Centre Parkstad, Heerlen, the Netherlands
| | - Wim A. Buurman
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Sander S. Rensen
- Department of General Surgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- * E-mail:
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31
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Mathus-Vliegen EMH, Greve JWM. Obesity and the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2014; 28:531-2. [PMID: 25194172 DOI: 10.1016/j.bpg.2014.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 01/31/2023]
Affiliation(s)
- E M H Mathus-Vliegen
- Department of Gastroenterology & Hepatology, Academic Medical Centre University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - J W M Greve
- Atrium Medical Centre, Henry Dunantstraat 5, 6419 CX Heerlen, The Netherlands; Orbis Medical Centre, Sittard, The Netherlands
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32
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Gaens KHJ, Goossens GH, Niessen PM, van Greevenbroek MM, van der Kallen CJH, Niessen HW, Rensen SS, Buurman WA, Greve JWM, Blaak EE, van Zandvoort MA, Bierhaus A, Stehouwer CDA, Schalkwijk CG. Nε-(carboxymethyl)lysine-receptor for advanced glycation end product axis is a key modulator of obesity-induced dysregulation of adipokine expression and insulin resistance. Arterioscler Thromb Vasc Biol 2014; 34:1199-208. [PMID: 24723555 DOI: 10.1161/atvbaha.113.302281] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Dysregulation of inflammatory adipokines by the adipose tissue plays an important role in obesity-associated insulin resistance. Pathways leading to this dysregulation remain largely unknown. We hypothesized that the receptor for advanced glycation end products (RAGE) and the ligand N(ε)-(carboxymethyl)lysine (CML) are increased in adipose tissue and, moreover, that activation of the CML-RAGE axis plays an important role in obesity-associated inflammation and insulin resistance. APPROACH AND RESULTS In this study, we observed a strong CML accumulation and increased expression of RAGE in adipose tissue in obesity. We confirmed in cultured human preadipocytes that adipogenesis is associated with increased levels of CML and RAGE. Moreover, CML induced a dysregulation of inflammatory adipokines in adipocytes via a RAGE-dependent pathway. To test the role of RAGE in obesity-associated inflammation further, we constructed an obese mouse model that is deficient for RAGE (ie, RAGE(-/-)/Leptr(Db-/-) mice). RAGE(-/-)/Leptr(Db-/-) mice displayed an improved inflammatory profile and glucose homeostasis when compared with RAGE(+/+)/Leptr(Db-/-) mice. In addition, CML was trapped in adipose tissue in RAGE(+/+)/Leptr(Db-/-) mice but not in RAGE(-/-)/Leptr(Db-/-). RAGE-mediated trapping in adipose tissue provides a mechanism underlying CML accumulation in adipose tissue and explaining decreased CML plasma levels in obese subjects. Decreased CML plasma levels in obese individuals were strongly associated with insulin resistance. CONCLUSIONS RAGE-mediated CML accumulation in adipose tissue and the activation of the CML-RAGE axis are important mechanisms involved in the dysregulation of adipokines in obesity, thereby contributing to the development of obesity-associated insulin resistance.
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Affiliation(s)
- Katrien H J Gaens
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Gijs H Goossens
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Petra M Niessen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Marleen M van Greevenbroek
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Carla J H van der Kallen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Hans W Niessen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Sander S Rensen
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Wim A Buurman
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Jan Willem M Greve
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Ellen E Blaak
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Marc A van Zandvoort
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Angelika Bierhaus
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Coen D A Stehouwer
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.)
| | - Casper G Schalkwijk
- From the Department of Internal Medicine and the Laboratory of Metabolism and Vascular Medicine (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., C.D.A.S., C.G.S.), Cardiovascular Research Institute Maastricht (K.H.J.G., P.M.N., M.M.v.G., C.J.H.v.d.K., M.A.v.Z., C.D.A.S., C.G.S.), Department of Human Biology (G.H.G., E.E.B.), NUTRIM School for Nutrition, Toxicology, and Metabolism (G.H.G., S.S.R., W.A.B., J.W.M.G., E.E.B.), Department of General Surgery (S.S.R., W.A.B., J.W.M.G.), and Department of Biomedical Engineering (M.A.v.Z.), Maastricht University Medical Center, Maastricht, The Netherlands; Department of Pathology and Cardiac Surgery, Institute for Cardiovascular Research, Vrije Universiteit Medical Center, Amsterdam, The Netherlands (H.W.N.); and Department of Medicine and Clinical Chemistry, University of Heidelberg, Heidelberg, Germany (A.B.).
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de Jonge C, Rensen SS, D’Agnolo HMA, Bouvy ND, Buurman WA, Greve JWM. Six Months of Treatment with the Endoscopic Duodenal-Jejunal Bypass Liner Does Not Lead to Decreased Systemic Inflammation in Obese Patients with Type 2 Diabetes. Obes Surg 2013; 24:337-41. [DOI: 10.1007/s11695-013-1154-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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de Jonge C, Rensen SS, Koek GH, Joosten MF, Buurman WA, Bouvy ND, Greve JWM. Endoscopic duodenal-jejunal bypass liner rapidly improves plasma parameters of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2013; 11:1517-20. [PMID: 23920034 DOI: 10.1016/j.cgh.2013.07.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/16/2013] [Accepted: 07/15/2013] [Indexed: 02/07/2023]
Abstract
Bariatric surgery reduces nonalcoholic fatty liver disease (NAFLD). We investigated the effects of duodenal-jejunal bypass liner (DJBL), nonsurgical bariatric device, on plasma parameters of NAFLD. Seventeen obese subjects with type 2 diabetes received the DJBL for 24 weeks. Before, during, and after DJBL implantation, we determined plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase (γ-GT), albumin, caspase-cleaved cytokeratin-18 (CK-18), and liver fatty acid-binding protein (L-FABP). At baseline, subjects had increased levels of AST (35 ± 4 IU/L), ALT (54 ± 5 IU/L), and γ-GT (66 ± 14 IU/L), compared with healthy individuals; subjects' mean concentrations of caspase-cleaved CK-18 and L-FABP were 214.4 ± 35.6 U/L and 29.3 ± 2.6 ng/mL, respectively. Three months after implantation of DJBL, all NAFLD-related parameters had decreased from baseline (AST, 28 ± 3 IU/L; ALT, 32 ± 2 IU/L; γ-GT, 44 ±7 IU/L; caspase-cleaved CK-18, 140.6 ± 16.3U/L; and L-FABP, 18.2 ± 1.5 ng/mL; all P < .05). After 6 months, levels of ALT and γ-GT had further decreased (ALT, 28 ± 2 IU/L and γ-GT, 35 ± 5 IU/L), whereas levels of AST, caspase-cleaved CK-18, and L-FABP had stabilized (P = not significant). Six months after DJBLs were removed, levels of ALT (37 ± 3 IU/L), γ-GT (42 ± 5 IU/L), and caspase-cleaved CK-18 (124.5 ± 12.5U/L) were still reduced (P < .05), whereas AST and L-FABP had returned to near baseline levels (P = not significant). Therefore, in obese subjects, DJBL reduces plasma parameters of NAFLD. ClinicalTrials.gov, Number: NCT00985114.
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Affiliation(s)
- Charlotte de Jonge
- Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism Research, Maastricht University Medical Center, Maastricht, the Netherlands; Department of General Surgery, Atrium Medical Center Parkstad, Heerlen, the Netherlands
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de Jonge C, Rensen SS, Verdam FJ, Vincent RP, Bloom SR, Buurman WA, le Roux CW, Schaper NC, Bouvy ND, Greve JWM. Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes. Obes Surg 2013. [PMID: 23526068 DOI: 10.1007/s11695–013–0921–3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL). METHODS Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA1c and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment. RESULTS At 24 weeks after implantation, patients had lost 12.7 ± 1.3 kg (p < 0.01), while HbA1c had improved from 8.4 ± 0.2 to 7.0 ± 0.2 % (p < 0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 ± 0.5 vs. 9.0 ± 0.5 vs. 8.6 ± 0.5 mmol/L and 1,999 ± 85 vs. 1,536 ± 51 vs. 1,538 ± 72 mmol/L/min, both p < 0.01). In parallel, the glucagon response decreased (23,762 ± 4,732 vs. 15,989 ± 3,193 vs. 13,1207 ± 1,946 pg/mL/min, p < 0.05) and the GLP-1 response increased (4,440 ± 249 vs. 6,407 ± 480 vs. 6,008 ± 429 pmol/L/min, p < 0.01). The GIP response was decreased at week 24 (baseline-115,272 ± 10,971 vs. week 24-88,499 ± 10,971 pg/mL/min, p < 0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation. CONCLUSIONS The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.
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Affiliation(s)
- Charlotte de Jonge
- Department of General Surgery and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Verdam FJ, Dallinga JW, Driessen A, de Jonge C, Moonen EJC, van Berkel JBN, Luijk J, Bouvy ND, Buurman WA, Rensen SS, Greve JWM, van Schooten FJ. Non-alcoholic steatohepatitis: a non-invasive diagnosis by analysis of exhaled breath. J Hepatol 2013; 58:543-8. [PMID: 23142062 DOI: 10.1016/j.jhep.2012.10.030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 10/10/2012] [Accepted: 10/31/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Histological evaluation of a liver biopsy is the current gold standard to diagnose non-alcoholic steatohepatitis (NASH), but the procedure to obtain biopsies is associated with morbidity and high costs. Hence, only subjects at high risk are biopsied, leading to underestimation of NASH prevalence, and undertreatment. Since analysis of volatile organic compounds in breath has been shown to accurately identify subjects with other chronic inflammatory diseases, we investigated its potential as a non-invasive tool to diagnose NASH. METHODS Wedge-shaped liver biopsies from 65 subjects (BMI 24.8-64.3 kg/m(2)) were obtained during surgery and histologically evaluated. The profile of volatile organic compounds in pre-operative breath samples was analyzed by gas chromatography-mass spectrometry and related to liver histology scores and plasma parameters of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). RESULTS Three exhaled compounds were sufficient to distinguish subjects with (n=39) and without NASH (n=26), with an area under the ROC curve of 0.77. The negative and positive predictive values were 82% and 81%. In contrast, elevated ALT levels or increased AST/ALT ratios both showed negative predictive values of 43%, and positive predictive values of 88% and 70%, respectively. The breath test reduced the hypothetical percentage of undiagnosed NASH patients from 67-79% to 10%, and of misdiagnosed subjects from 49-51% to 18%. CONCLUSIONS Analysis of volatile organic compounds in exhaled air is a promising method to indicate NASH presence and absence. In comparison to plasma transaminase levels, the breath test significantly reduced the percentage of missed NASH patients and the number of unnecessarily biopsied subjects.
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Affiliation(s)
- Froukje J Verdam
- Department of General Surgery, Nutrition and Toxicology Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Segers FM, Verdam FJ, de Jonge C, Boonen B, Bouvy ND, Greve JWM, Buurman WA, Rensen SS. Complement alternative pathway activation is associated with severity of nonalcoholic steatohepatitis. Immunobiology 2012. [DOI: 10.1016/j.imbio.2012.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gaens KHJ, Niessen PMG, Rensen SS, Buurman WA, Greve JWM, Driessen A, Wolfs MGM, Hofker MH, Bloemen JG, Dejong CH, Stehouwer CDA, Schalkwijk CG. Endogenous formation of Nε-(carboxymethyl)lysine is increased in fatty livers and induces inflammatory markers in an in vitro model of hepatic steatosis. J Hepatol 2012; 56:647-55. [PMID: 21907687 DOI: 10.1016/j.jhep.2011.07.028] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/20/2011] [Accepted: 07/30/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Increased lipid peroxidation and inflammation are major factors in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). A lipoxidation product that could play a role in the induction of hepatic inflammation is N(ε)-(carboxymethyl)lysine (CML). The aim of the present study was to investigate the relationship between steatosis and CML and to study the role of CML in hepatic inflammation. METHODS We included 74 obese individuals, which were categorized into 3 groups according to the grade of hepatic steatosis. CML accumulation in liver biopsies was assessed by immunohistochemistry and plasma CML levels were measured by mass spectrometry. Plasma CML levels were also determined in the hepatic artery, portal, and hepatic vein of 22 individuals, and CML fluxes across the liver were calculated. Hepatocyte cell lines were used to study CML formation during intracellular lipid accumulation and the effect of CML on pro-inflammatory cytokine expression. Gene expression levels of the inflammatory markers were determined in liver biopsies of the obese individuals. RESULTS CML accumulation was significantly associated with the grade of hepatic steatosis, the grade of hepatic inflammation, and gene expression levels of inflammatory markers PAI-1, IL-8, and CRP. Analysis of CML fluxes showed no release/uptake of CML by the liver. Lipid accumulation in hepatocytes, induced by incubation with fatty acids, was associated with increased CML formation and expression of the receptor for advanced glycation endproducts (RAGE), PAI-1, IL-8, IL-6, and CRP. Pyridoxamine and aminoguanidine inhibited the endogenous CML formation and the increased RAGE, PAI-1, IL-8, IL-6, and CRP expression. Incubation of hepatocytes with CML-albumin increased the expression of RAGE, PAI-1, and IL-6, which was inhibited by an antibody against RAGE. CONCLUSIONS Accumulation of CML and a CML-upregulated RAGE-dependent inflammatory response in steatotic livers may play an important role in hepatic steatosis and in the pathogenesis of NAFLD.
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Affiliation(s)
- Katrien H J Gaens
- Department of Internal Medicine, Laboratory of Metabolism and Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Schouten R, Wiryasaputra DCMS, van Dielen FMH, van Gemert WG, Greve JWM. Influence of reoperations on long-term quality of life after restrictive procedures: a prospective study. Obes Surg 2012; 21:871-9. [PMID: 21221834 PMCID: PMC3119802 DOI: 10.1007/s11695-010-0350-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Quality of life improves after bariatric surgery. However, long-term results and the influence of reoperations are not well known. A prospective quality of life assessment before, 1 and 7 years after laparoscopic adjustable gastric banding (LAGB) and vertical banded gastroplasty (VBG) was performed in order to determine the influence of reoperations during follow-up. One hundred patients were included in the study. Fifty patients underwent VBG and 50 LAGB. Patients completed the quality of life questionnaires prior to surgery and two times during follow-up. Health-related quality of life (HRQoL) questionnaires included the Nottingham Health Profile I and II and the Sickness Impact Profile 68. Follow-up was 84% with a mean duration of 84 months (7 years). During follow-up, 65% of VBG patients underwent conversion to Roux-en-Y gastric bypass while 44% of LAGB patients underwent a reoperation or conversion. One year after the procedure, nearly all quality-of-life parameters significantly improved. After 7 years, the Nottingham Health Profile (NHP)-I domain “physical ability”, the NHP-II and the SIP-68 domains “mobility control”, “social behavior”, and “mobility range” were still significantly improved in both groups. The domains “emotional reaction”, “social isolation” (NHP-I), and “emotional stability” (SIP-68) remained significantly improved in the VBG group while this was true for the domain “energy level” (NHP-I) in the LAGB group. Both the type of procedure and reoperations during follow-up were not of significant influence on the HRQoL results. Weight loss and decrease in comorbidities were the only significant factors influencing quality of life. Restrictive bariatric surgery improves quality of life. Although results are most impressive 1 year after surgery, the improvement remains significant after long-term follow-up. Postoperative quality of life is mainly dependent on weight loss and decrease in comorbidities and not on the type of procedure or surgical complications.
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Affiliation(s)
- Ruben Schouten
- Department of Surgery, Atrium Medical Centre Parkstad, P.O. Box 4446, 6401, CX, Heerlen, The Netherlands.
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Verdam FJ, de Jonge C, Greve JWM. [Practice guideline for the treatment of morbid obesity]. Ned Tijdschr Geneeskd 2012; 156:A4630. [PMID: 22727229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The increasing prevalence of obesity and its related comorbidities represents an increasing burden for the Dutch health care and requires effective therapy. The primary treatment of obesity consists of lifestyle interventions directed at lifestyle change; in morbidly obese subjects only bariatric surgery is cost-effective in the long term, with respect to both weight loss and reduction in comorbidity. There is a new Dutch multidisciplinary practice guideline on the treatment of morbid obesity, in which the following aspects are covered: indications for surgery, pre-operative policy advice, considerations for the type of operation, and the short and long term follow-up after bariatric surgery. Patients between 18 and 65 years old are eligible for bariatric surgery if they have a BMI ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 in the presence of comorbidity. In adolescents under 18 bariatric surgery should only be performed in a research setting; in patients older than 65 years bariatric surgery can be performed exceptionally, preferably in a centre with large experience.
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Affiliation(s)
- Froukje J Verdam
- Maastricht Universitair Medisch Centrum, afd.Algemene Heelkunde, Maastricht, the Netherlands
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Abstract
Laparoscopic adjustable gastric banding (LAGB) and vertical-banded gastroplasty (VBG) are surgical treatment modalities for morbid obesity. This prospective study describes the long-term results of LAGB and VBG. One hundred patients were included in the study. Fifty patients underwent LAGB and 50 patients, open VBG. Study parameters were weight loss, changes in obesity-related comorbidities, long-term complications, re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status. From 91 patients (91%), data were obtained with a mean follow-up duration of 84 months (7 years). Weight loss [percent excess weight loss (EWL)] was significantly more after VBG compared with LAGB, 66% versus 54%, respectively. All comorbidities significantly decreased in both groups. Long-term complications after VBG were mainly staple line disruption (54%) and incisional hernia (27%). After LAGB, the most frequent complications were pouch dilatation (21%) and anterior slippage (17%). Major re-operations after VBG were performed in 60% of patients. All re-operations following were conversions to Roux-en-Y gastric bypass (RYGB). In the LAGB group, 33% of patients had a refixation or replacement of the band, and 11% underwent conversion to another bariatric procedure. There were no significant differences in weight loss between patients with or without re-interventions. No vitamin deficiencies were present after 7 years, although supplement usage was inconsistent. This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery. The failure rate of 65% after VBG is too high, and this procedure is not performed anymore in our institution. The re-operation rate after LAGB is decreasing as a result of new techniques and materials. Results of the re-operations are good with sustained weight loss and reduction in comorbidities. However, in order to achieve these results, a durable and complete follow-up after restrictive procedures is imperative.
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Affiliation(s)
- Ruben Schouten
- Department of Surgery, Atrium Medical Centre, Heerlen, The Netherlands.
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Abstract
CONTEXT Type 2 diabetes mellitus (DM2) is associated with small intestinal hyperplasia and hypertrophy in rodents. Moreover, the small intestine is increasingly acknowledged to play a role in the pathophysiology of DM2. OBJECTIVE The objective of the study was to investigate the relation between plasma markers of small intestinal function and chronic hyperglycemia in man. DESIGN, SETTING, AND PARTICIPANTS We conducted a cross-sectional observational study of 40 severely obese subjects with chronic hyperglycemia and 30 severely obese subjects without chronic hyperglycemia who were indicated for bariatric surgery. MAIN OUTCOME MEASURES We assessed plasma levels of citrulline, representing small intestinal enterocyte mass, intestinal fatty acid binding protein (I-FABP), a marker of enterocyte loss, and glucagon-like peptide-2, an intestinotrophic factor, and related them to glycated hemoglobin (HbA(1c)) levels. RESULTS Plasma citrulline and I-FABP levels were both significantly elevated in subjects with chronic hyperglycemia (HbA(1c) > 6.0%) compared with subjects with a normal HbA(1c) (≤ 6.0%) (citrulline, 35 ± 2.1 μm vs. 26 ± 1.4 μm, P = 0.001; I-FABP, 140 ± 22 pg/ml vs. 69 ± 14 pg/ml, P = 0.001). Moreover, plasma citrulline and I-FABP levels correlated with HbA(1c) levels (citrulline, r(s) = 0.30, P = 0.02; I-FABP, r(s) = 0.33, P = 0.005). The I-FABP to citrulline ratio was higher in subjects with an elevated HbA(1c) (4.0 vs. 3.1, P = 0.03). Plasma glucagon-like peptide-2 levels were not related to citrulline or I-FABP levels (r(s) = 0.06, P = 0.67; r(s) 0.08, P = 0.54, respectively). CONCLUSION Chronically elevated glucose levels in obese individuals are associated with increased small intestinal enterocyte mass and increased enterocyte loss. These findings argue for the further exploration of the role of the intestine in the pathophysiology of DM2.
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Affiliation(s)
- Froukje J Verdam
- Department of General Surgery, School for Nutrition, Toxicology, and Metabolism Research Institute Maastricht, Maastricht University Medical Center, 6200 MD Maastricht, The Netherlands
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43
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van Dielen FMH, Nijhuis J, Rensen SSM, Schaper NC, Wiebolt J, Koks A, Prakken FJ, Buurman WA, Greve JWM. Early insulin sensitivity after restrictive bariatric surgery, inconsistency between HOMA-IR and steady-state plasma glucose levels. Surg Obes Relat Dis 2009; 6:340-4. [PMID: 20096645 DOI: 10.1016/j.soard.2009.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 11/01/2009] [Accepted: 11/18/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND The low-grade inflammatory condition present in morbid obesity is thought to play a causative role in the pathophysiology of insulin resistance (IR). Bariatric surgery fails to improve this inflammatory condition during the first months after surgery. Considering the close relation between inflammation and IR, we conducted a study in which insulin sensitivity was measured during the first months after bariatric surgery. Different methods to measure IR shortly after bariatric surgery have given inconsistent data. For example, the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels have been reported to decrease rapidly after bariatric surgery, although clamp techniques have shown sustained insulin resistance. In the present study, we evaluated the use of steady-state plasma glucose (SSPG) levels to assess insulin sensitivity 2 months after bariatric surgery. METHODS Insulin sensitivity was measured using HOMA-IR and SSPG levels in 11 subjects before surgery and at 26% excess weight loss (approximately 2 months after restrictive bariatric surgery). RESULTS The SSPG levels after 26% excess weight loss did not differ from the SSPG levels before surgery (14.3 +/- 5.4 versus 14.4 +/- 2.7 mmol/L). In contrast, the HOMA-IR values had decreased significantly (3.59 +/- 1.99 versus 2.09 +/- 1.02). CONCLUSION During the first months after restrictive bariatric surgery, we observed a discrepancy between the HOMA-IR and SSPG levels. In contrast to the HOMA-IR values, the SSPG levels had not improved, which could be explained by the ongoing inflammatory state after bariatric surgery. These results suggest that during the first months after restrictive bariatric surgery, HOMA-IR might not be an adequate marker of insulin sensitivity.
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Affiliation(s)
- Francois M H van Dielen
- Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Department of General Surgery, Maastricht University/University Hospital Maastricht, Maastricht, The Netherlands
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Nijhuis J, Rensen SS, Slaats Y, van Dielen FMH, Buurman WA, Greve JWM. Neutrophil activation in morbid obesity, chronic activation of acute inflammation. Obesity (Silver Spring) 2009; 17:2014-8. [PMID: 19390527 DOI: 10.1038/oby.2009.113] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recent studies show that morbid obesity is associated with activation of the innate immune response. Neutrophil activation is a fundamental process in the innate immune response. Therefore, the activation state of neutrophils in severely obese subjects and the effect of bariatric surgery on neutrophil activation was evaluated. Neutrophil activation was assessed by measuring circulating concentrations of myeloperoxidase (MPO) and calprotectin in 37 severely obese and 9 control subjects (enzyme-linked immunosorbent assay). Moreover, membrane expression of CD66b on circulating neutrophils was measured using flow cytometry in a group of seven severely obese and six control subjects. Immunohistochemical detection of MPO was performed in adipose and muscle tissue. Plasma MPO and calprotectin levels were significantly increased in severely obese subjects as compared to healthy controls, 27.1 +/- 10.8 vs. 17.3 +/- 5.5 ng/ml (P < 0.001) and 115.5 +/- 43.5 vs. 65.1 +/- 23.1 ng/ml (P < 0.001) for MPO and calprotectin, respectively. In line, CD66b expression was significantly increased in severely obese individuals, 177.3 +/- 43.7 vs. 129.7 +/- 9.2 (mean fluorescence intensity) (P < 0.01). Bariatric surgery resulted in decreased calprotectin, but MPO plasma levels remained elevated. Adipose and muscle tissue did not contain increased numbers of MPO expressing cells in severely obese individuals. These results point out that circulating neutrophils are activated to a greater extent in severely obese subjects. Our data support the finding that the innate immune system is activated in severely obese individuals. Moreover, because neutrophils have a short life span, this indicates that the chronic inflammatory condition associated with morbid obesity is characterized by a continuous activation of the innate immune system.
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Affiliation(s)
- Jeroen Nijhuis
- Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Luyer MDP, Derikx JPM, Beyaert R, Hadfoune M, van Kuppevelt TH, Dejong CHC, Heineman E, Buurman WA, Greve JWM. High-fat nutrition reduces hepatic damage following exposure to bacterial DNA and hemorrhagic shock. J Hepatol 2009; 50:342-50. [PMID: 19070388 DOI: 10.1016/j.jhep.2008.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Revised: 08/02/2008] [Accepted: 08/23/2008] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIMS Bacterial infection combined with hypotension results in exacerbation of the inflammatory response with release of interferon (IFN) gamma. This excessive inflammation may lead to development of hepatic damage and liver failure. This study investigates the effect of dietary lipids on release of IFN-gamma and development of hepatic damage following exposure to synthetic bacterial DNA (CpG-ODN) and hemorrhagic shock. METHODS Rats were exposed to CpG-ODN 18h before hemorrhagic shock. Samples were taken 4h following shock. High-fat nutrition was administered at 18h, 2h and 45min before induction of shock. RESULTS Enteral high-fat strongly reduced circulating IFN-gamma (0.2ng/ml, P<0.01) following exposure to CpG-ODN and hemorrhagic shock compared with fasted rats (2.7ng/ml). Concomitantly, plasma L-FABP was reduced (437+/-22ng/ml, P<0.01), and F-actin distribution was preserved. Furthermore, high-fat nutrition reduced apoptosis in the liver and preserved expression of the hepatoprotective protein ABIN-1. Interestingly, administration of anti-IFN-gamma antibodies was associated with reduced expression of ABIN-1. CONCLUSIONS This study shows that enteral high-fat reduces IFN-gamma and decreases CpG-enhanced liver injury following hemorrhagic shock. Administration of high-fat nutrition may be an important new therapeutic strategy to reduce liver damage in a clinical setting of bacterial infection combined with hypotension.
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Affiliation(s)
- Misha D P Luyer
- Department of Surgery, Maasland Hospital, Sittard, The Netherlands.
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46
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Abstract
Help for diabetics
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Affiliation(s)
- J W M Greve
- Department of Surgery, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - F Rubino
- Section of Gastrointestinal Metabolic Surgery, Weill Medical College of Cornell University New York Presbyterian Hospital, 525 East 68th Street, P-714 New York, NY 10065, USA
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Fried M, Hainer V, Basdevant A, Buchwald H, Dietel M, Finer N, Greve JWM, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. [Interdisciplinary European guidelines on surgery for severe obesity]. Rozhl Chir 2008; 87:468-476. [PMID: 19174948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- M Fried
- Klinické centrum pro minimálne invazivní a bariatrickou chirurgii ISCARE a Univerzita Karlova--1.lékarská fakulta, Praha, Ceská republika.
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Fried M, Hainer V, Basdevant A, Buchwald H, Deitel M, Finer N, Greve JWM, Horber F, Mathus-Vliegen E, Scopinaro N, Steffen R, Tsigos C, Weiner R, Widhalm K. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts 2008; 1:52-9. [PMID: 20054163 PMCID: PMC6444702 DOI: 10.1159/000113937] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In 2005, for the first time in European history, an extraordinary expert panel named BSCG (Bariatric Scientific Collaborative Group), was appointed through joint effort of the major European scientific societies which are active in the field of obesity management. Societies that constituted this panel were: IFSO - International Federation for the Surgery of Obesity, IFSO-EC - International Federation for the Surgery of Obesity - European Chapter, EASO - European Association for Study of Obesity, ECOG - European Childhood Obesity Group, together with the IOTF (International Obesity Task Force) which was represented during the completion process by its representative. The BSCG was composed not only of the top officers representing the respective scientific societies (four acting presidents, two past presidents, one honorary president, two executive directors), but was balanced with the presence of many other key opinion leaders in the field of obesity. The BSCG composition allowed the coverage of key disciplines in comprehensive obesity management, as well as reflecting European geographical and ethnic diversity. This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past 2 years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.
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Affiliation(s)
- Martin Fried
- Clinical Center for Minimally Invasive and Bariatric Surgery, 1st Medical Faculty, Charles University, Prague, Czech Republic.
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Heemskerk J, de Hoog DENM, van Gemert WG, Baeten CGMI, Greve JWM, Bouvy ND. Robot-assisted vs. conventional laparoscopic rectopexy for rectal prolapse: a comparative study on costs and time. Dis Colon Rectum 2007; 50:1825-30. [PMID: 17690936 PMCID: PMC2071956 DOI: 10.1007/s10350-007-9017-2] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Laparoscopic rectopexy has become one of the most advocated treatments for full-thickness rectal prolapse, offering good functional results compared with open surgery and resulting in less postoperative pain and faster convalescence. However, laparoscopic rectopexy can be technically demanding. Once having mastered dexterity, with robotic assistance, laparoscopic rectopexy can be performed faster. Moreover, it shortens the learning curve in simple laparoscopic tasks. This may lead to faster and safer laparoscopic surgery. Robot-assisted rectopexy has been proven safe and feasible; however, until now, no study has been performed comparing costs and time consumption in conventional laparoscopic rectopexy vs. robot-assisted rectopexy. METHODS Our first 14 cases of robot-assisted laparoscopic rectopexy were reviewed and compared with 19 patients who underwent conventional laparoscopic rectopexy in the same period. RESULTS Robot-assisted laparoscopic rectopexy did not show more complications. However, the average operating time was 39 minutes longer, and costs were euro 557.29 (or: dollars 745.09) higher. CONCLUSION Robot-assisted laparoscopic rectopexy is a safe and feasible procedure but results in increased time and higher costs than conventional laparoscopy.
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Affiliation(s)
- Jeroen Heemskerk
- Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands.
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