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Sadiku F, Alceste D, Serra M, Hehl SJ, Gero D, Thalheimer A, Bueter M, Widmer J. Comparative analysis of linear- and circular-stapled gastrojejunostomies in Roux-en-Y gastric bypass: a focus on postoperative morbidity using the comprehensive complication index. Langenbecks Arch Surg 2024; 409:120. [PMID: 38602565 PMCID: PMC11009775 DOI: 10.1007/s00423-024-03303-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE The linear-stapled (LSA) and the circular-stapled anastomosis (CSA) are the two most commonly performed techniques for the gastrojejunostomy (GJ) during laparoscopic Roux-en-Y gastric bypass (RYGB). This study compared the outcome after both techniques with special focus on postoperative morbidity using the comprehensive complication index (CCI). METHODS Five hundred eighty-eight patients operated between 01/2010 and 12/2019 were included in the final analysis and divided in two cohorts according to the surgical technique of the GJ (LSA (n = 290) or CSA (n = 298)). Before 09/2016, the CSA was exclusively performed for the GJ, while after 09/2016, the LSA was solely used. RESULTS The mean CCI for patients with Clavien-Dindo complication grade ≥ 2 within the first 90 days after RYGB was 31 ± 9.1 in the CSA and 25.7 ± 6.8 in the LSA group (p < 0.001), both values still below the previously published benchmark cutoff (≤ 33.73). The C-reactive Protein (CRP)-levels on postoperative days (POD) 1 and 3 as well as the use of opioids on POD 1 were significantly higher in the CSA- than in the LSA-group (all p < 0.001). There were significantly more internal herniations in the CSA group during the first 24 postoperative months (p < 0.001). CONCLUSION Patients after RYGB with CSA were found to have higher CCI values during the first 90 PODs compared to patients in which the LSA was applied. To achieve optimal outcomes in terms of patient morbidity, the LSA seems to be the superior technique for GJ in RYGB.
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Affiliation(s)
- Floni Sadiku
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniela Alceste
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
| | - Michele Serra
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
| | - Stefanie Josefine Hehl
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland.
- Department of Surgery, Maennedorf Hospital, Maennedorf Zurich, Zurich, Switzerland.
| | - Jeannette Widmer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8006, Zurich, Switzerland
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Steinert RE, Mueller M, Serra M, Lehner-Sigrist S, Frost G, Gero D, Gerber PA, Bueter M. Effect of inulin on breath hydrogen, postprandial glycemia, gut hormone release, and appetite perception in RYGB patients: a prospective, randomized, cross-over pilot study. Nutr Diabetes 2024; 14:9. [PMID: 38448413 PMCID: PMC10918168 DOI: 10.1038/s41387-024-00267-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Large intestinal fermentation of dietary fiber may control meal-related glycemia and appetite via the production of short-chain fatty acids (SCFA) and the secretion of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY). We investigated whether this mechanism contributes to the efficacy of the Roux-en-Y gastric bypass (RYGB) by assessing the effect of oligofructose-enriched inulin (inulin) vs. maltodextrin (MDX) on breath hydrogen (a marker of intestinal fermentation), plasma SCFAs, gut hormones, insulin and blood glucose concentrations as well as appetite in RYGB patients. METHOD Eight RYGB patients were studied on two occasions before and ~8 months after surgery using a cross-over design. Each patient received 300 ml orange juice containing 25 g inulin or an equicaloric load of 15.5 g MDX after an overnight fast followed by a fixed portion snack served 3 h postprandially. Blood samples were collected over 5 h and breath hydrogen measured as well as appetite assessed using visual analog scales. RESULTS Surgery increased postprandial secretion of GLP-1 and PYY (P ≤ 0.05); lowered blood glucose and plasma insulin increments (P ≤ 0.05) and reduced appetite ratings in response to both inulin and MDX. The effect of inulin on breath hydrogen was accelerated after surgery with an increase that was earlier in onset (2.5 h vs. 3 h, P ≤ 0.05), but less pronounced in magnitude. There was, however, no effect of inulin on plasma SCFAs or plasma GLP-1 and PYY after the snack at 3 h, neither before nor after surgery. Interestingly, inulin appeared to further potentiate the early-phase glucose-lowering and second-meal (3-5 h) appetite-suppressive effect of surgery with the latter showing a strong correlation with early-phase breath hydrogen concentrations. CONCLUSION RYGB surgery accelerates large intestinal fermentation of inulin, however, without measurable effects on plasma SCFAs or plasma GLP-1 and PYY. The glucose-lowering and appetite-suppressive effects of surgery appear to be potentiated with inulin.
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Affiliation(s)
- R E Steinert
- Department of Surgery and Transplantation, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland.
| | - M Mueller
- Department of Surgery and Transplantation, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - M Serra
- Department of Surgery and Transplantation, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - S Lehner-Sigrist
- Department of Surgery and Transplantation, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - G Frost
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - D Gero
- Department of Surgery and Transplantation, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - P A Gerber
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich (USZ) and University of Zurich (UZH), Zürich, Switzerland
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Peterli R, Hurme S, Bueter M, Grönroos S, Helmiö M, Salminen P. Standardized Assessment of Metabolic Bariatric Surgery Outcomes: Secondary Analysis of 2 Randomized Clinical Trials. JAMA Surg 2024; 159:306-314. [PMID: 38055284 PMCID: PMC10701667 DOI: 10.1001/jamasurg.2023.6254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/03/2023] [Indexed: 12/07/2023]
Abstract
Importance A standardized definition and reporting of metabolic bariatric surgery (MBS) outcomes is not available for actual clinical practice and science. Objective To assess the feasibility of using a clinically relevant and feasible MBS outcome score (Swiss-Finnish Bariatric Metabolic Outcome Score [SF-BARI Score]). Design, Setting, and Participants This assessment of a bariatric surgery outcome score is based on the secondary analysis of merged 5-year individual patient data (N = 457) of 2 large randomized clinical trials (Swiss SM-BOSS [Swiss Multicenter Bypass or Sleeve Study], conducted from January 2007 to November 2011, and Finnish SLEEVEPASS [Laparoscopic Gastric Bypass Vs Sleeve Gastrectomy to Treat Morbid Obesity], conducted from March 2008 until June 2010) that compared laparoscopic sleeve gastrectomy with laparoscopic Roux-en-Y gastric bypass in the treatment of severe obesity. This secondary analysis was performed from January 2022 to January 2023. Main Outcomes and Measures The main outcome was the feasibility of the SF-BARI Score and the SF-BARI Score QOL (quality of life) as tools to assess MBS outcomes. The score includes percentage of total weight loss (%TWL), 4 obesity-related comorbidities (type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea), complications, and QOL, if available. Results Among the 457 included patients, 323 (70.7%) were female and 134 (29.3%) were male, and the mean (SD) age was 45.6 (10.7) years. Outcomes for the SF-BARI Score were available for 435 patients (95.2%) at 1 year and 398 patients (87.1%) at 5 years and for SF-BARI Score QOL in 289 (63.2%) patients at 1 year and 318 patients (69.6%) at 5 years. The SF-BARI Score was correlated with both the SF-BARI Score QOL (r = 0.96; 95% CI, 0.95-0.96; P < .001) and %TWL (r = 0.86; 95% CI, 0.84-0.89; P < .001) and with the Bariatric Analysis and Reporting Outcome System (r = 0.59; 95% CI, 0.51-0.65; P < .001). Score outcomes were categorized as excellent, very good, good, fair, and suboptimal response. There was a statistically significant difference in scores at 1 vs 5 years (4.0; 95% CI, 1.4-6.6; P = .003), and the gastric bypass group had a higher score compared with the sleeve gastrectomy group (7.4; 95% CI, 3.4-11.5; P < .001). Conclusions and Relevance These findings indicate that this metabolic bariatric surgery outcome score is a simple, relevant, and feasible composite tool to define and measure MBS outcomes, enabling standardized reporting. Trial Registration ClinicalTrials.gov Identifiers: NCT00356213 (SM-BOSS) and NCT00793143 (SLEEVEPASS).
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Affiliation(s)
- Ralph Peterli
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Claraunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Saija Hurme
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
| | - Sofia Grönroos
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Mika Helmiö
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
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Widmer J, Eden J, Abbassi F, Angelico R, Rössler F, Müllhaupt B, Dutkowski P, Bueter M, Schlegel A. How best to combine liver transplantation and bariatric surgery?-Results from a global, web-based survey. Liver Int 2024; 44:566-576. [PMID: 38082500 DOI: 10.1111/liv.15791] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND AND AIMS Obesity is a growing healthcare challenge worldwide and a significant risk factor for liver failure as seen with non-alcoholic steatohepatitis (NASH). Combining metabolic-bariatric surgery (MBS) with liver transplantation (LT) appears as attractive strategy to treat both, the underlying liver disease and obesity. However, there is an ongoing debate on best timing and patient selection. This survey was designed to explore the current treatment practice for patients with NASH and obesity worldwide. METHODS A web-based survey was conducted in 2022 among bariatric and LT surgeons, and hepatologists from Europe, North and South America and Asia. RESULTS The survey completion rate was 74% (145/196). The average respondents were 41-50 years (38%), male (82.1%) and had >20 years of clinical experience (42.1%). Centres with a high LT-caseload for NASH were mainly located in the USA and United Kingdom. Almost 30% have already performed a combination of LT with MBS and 49% plan to do it. A majority of bariatric surgeons prefer MBS before LT (77.2%), whereas most of LT surgeons (52%) would perform MBS during LT. Most respondents (n = 114; 80%) favour sleeve gastrectomy over other bariatric techniques. One third (n = 42; 29.4%) has an established protocol regarding MBS for LT candidates. CONCLUSION The most experienced centres doing LT for NASH are in the USA and United Kingdom with growing awareness worldwide. Overall, a combination of MBS and LT has already been performed by a third of respondents. Sleeve gastrectomy is the bariatric technique of choice-preferably performed either before or during LT.
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Affiliation(s)
- Jeannette Widmer
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Janina Eden
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Fariba Abbassi
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Roberta Angelico
- HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Fabian Rössler
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Beat Müllhaupt
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Dutkowski
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Andrea Schlegel
- Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Zurich, Switzerland
- Transplantation Center, Digestive Disease and Surgery Institute and Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centre of Preclinical Research, Milan, Italy
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Giudicelli G, Gero D, Romulo L, Chirumamilla V, Iranmanesh P, Owen CK, Bauerle W, Garcia A, Lucas L, Mehdorn AS, Pandey D, Almuttawa A, Cabral F, Tiwari A, Lambert V, Pascotto B, De Meyere C, Yahyaoui M, Haist T, Scheffel O, Robert M, Nuytens F, Azagra S, Kow L, Prasad A, Vaz C, Vix M, Bindal V, Beckmann JH, Soussi D, Vilallonga R, El Chaar M, Wilson EB, Ahmad A, Teixeira A, Hagen ME, Toso C, Clavien PA, Puhan M, Bueter M, Jung MK. Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy. Br J Surg 2024; 111:znad374. [PMID: 37981863 PMCID: PMC10771137 DOI: 10.1093/bjs/znad374] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 10/21/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer.
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Affiliation(s)
- Guillaume Giudicelli
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Lind Romulo
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Vasu Chirumamilla
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Pouya Iranmanesh
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Wayne Bauerle
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Amador Garcia
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lisa Lucas
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Anne-Sophie Mehdorn
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Dhananjay Pandey
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Abdullah Almuttawa
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
- Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Abhishek Tiwari
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Virginia Lambert
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Beniamino Pascotto
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | | | - Marouan Yahyaoui
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Haist
- Department of General and Visceral Surgery, Asklepios Paulinen Klinik, Wiesbaden, Germany
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Maud Robert
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | | | - Santiago Azagra
- General and Minimally Invasive (Laparoscopic and Robotic) Surgery Department, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Lilian Kow
- Adelaide Bariatric Centre, Department of Surgery, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Arun Prasad
- Department of Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Carlos Vaz
- Robotic Surgery Unit, Cuf Tejo Hospital, Lisbon, Portugal
| | - Michel Vix
- Department of Endocrine and Digestive Surgery, Strasbourg University Hospital – IRCAD, Strasbourg, France
| | - Vivek Bindal
- Institute of Minimal Access, Bariatric and Robotic Surgery, Max Super Speciality Hospital, Delhi NCR, India
| | - Jan H Beckmann
- Department of General, Abdominal, Thoracic, Transplantation and Paediatric Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
- Kurt Semm Centre for Laparoscopic and Robot Assisted Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Soussi
- Department of Endocrine and Digestive Surgery, University Hospital of Poitiers, Poitiers, France
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maher El Chaar
- Department of Surgery, Division of Bariatric Surgery, St. Luke’s University Health Network, Bethlehem, Pennsylvania, USA
| | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Arif Ahmad
- Bariatric and Robotic Center of Excellence, Mather Northwell Hospital Health, Port Jefferson, New York, USA
| | - Andre Teixeira
- Department of Surgery, Orlando Health, University of Central Florida, Orlando, Florida, USA
| | - Monika E Hagen
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Minoa K Jung
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
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Schultes B, Ernst B, Hallschmid M, Bueter M, Meyhöfer SM. The 'Behavioral Balance Model': A new perspective on the aetiology and therapy of obesity. Diabetes Obes Metab 2023; 25:3444-3452. [PMID: 37694802 DOI: 10.1111/dom.15271] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
Obesity is a debilitating disease of global proportions that necessitates refined, concept-driven therapeutic approaches. Policy makers, the public and even health care professionals, but also individuals with obesity harbour many misconceptions regarding this disease, which leads to prejudice, negative attitudes, stigmatization, discrimination, self-blame, and failure to provide and finance adequate medical care. Decades of intensive, successful scientific research on obesity have only had a very limited effect on this predicament. We propose a science-based, easy-to-understand conceptual model that synthesizes the complex pathogenesis of obesity including biological, psychological, social, economic and environmental aspects with the aim to explain and communicate better the nature of obesity and currently available therapeutic modalities. According to our integrative 'Behavioral Balance Model', 'top-down cognitive control' strategies are implemented (often with limited success) to counterbalance the increased 'bottom-up drive' to gain weight, which is triggered by biological, psycho-social and environmental mechanisms in people with obesity. Besides offering a deeper understanding of obesity, the model also highlights why there is a strong need for multimodal therapeutic approaches that may not only increase top-down control but also reduce a pathologically increased bottom-up drive.
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Affiliation(s)
- Bernd Schultes
- Metabolic Center St. Gallen, friendlyDocs Ltd, St. Gallen, Switzerland
| | - Barbara Ernst
- Metabolic Center St. Gallen, friendlyDocs Ltd, St. Gallen, Switzerland
| | - Manfred Hallschmid
- Department of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen (IDM), Tübingen, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Sebastian M Meyhöfer
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
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Ghafoor S, Tognella A, Stocker D, Hötker AM, Kaniewska M, Sartoretti T, Euler A, Vonlanthen R, Bueter M, Alkadhi H. Diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. Hernia 2023; 27:1253-1261. [PMID: 37410196 PMCID: PMC10533612 DOI: 10.1007/s10029-023-02830-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Inguinal hernias are mainly diagnosed clinically, but imaging can aid in equivocal cases or for treatment planning. The purpose of this study was to evaluate the diagnostic performance of CT with Valsalva maneuver for the diagnosis and characterization of inguinal hernias. METHODS This single-center retrospective study reviewed all consecutive Valsalva-CT studies between 2018 and 2019. A composite clinical reference standard including surgery was used. Three blinded, independent readers (readers 1-3) reviewed the CT images and scored the presence and type of inguinal hernia. A fourth reader measured hernia size. Interreader agreement was quantified with Krippendorff's α coefficients. Sensitivity, specificity, and accuracy of Valsalva-CT for the detection of inguinal hernias was computed for each reader. RESULTS The final study population included 351 patients (99 women) with median age 52.2 years (interquartile range (IQR), 47.2, 68.9). A total of 381 inguinal hernias were present in 221 patients. Sensitivity, specificity, and accuracy were 85.8%, 98.1%, and 91.5% for reader 1, 72.7%, 92.5%, and 81.8% for reader 2, and 68.2%, 96.3%, and 81.1% for reader 3. Hernia neck size was significantly larger in cases correctly detected by all three readers (19.0 mm, IQR 13, 25), compared to those missed by all readers (7.0 mm, IQR, 5, 9; p < 0.001). Interreader agreement was substantial (α = 0.723) for the diagnosis of hernia and moderate (α = 0.522) for the type of hernia. CONCLUSION Valsalva-CT shows very high specificity and high accuracy for the diagnosis of inguinal hernia. Sensitivity is only moderate which is associated with missed smaller hernias.
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Affiliation(s)
- S Ghafoor
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - A Tognella
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Stocker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A M Hötker
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Kaniewska
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - T Sartoretti
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A Euler
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - R Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - H Alkadhi
- Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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8
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Gero D, Müller V, File B, Bueter M, Widmer J, Thalheimer A. Attitudes of primary care physicians toward bariatric surgery: a free word association networks analysis. Surg Obes Relat Dis 2023; 19:1177-1186. [PMID: 37393117 DOI: 10.1016/j.soard.2023.05.015] [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: 01/05/2023] [Revised: 05/01/2023] [Accepted: 05/06/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Primary care physicians (PCPs) hold major responsibility in referring patients with obesity eligible for bariatric surgery (BS). OBJECTIVE The aim was to explore PCPs' mental representation of BS in order to identify barriers and catalysts of BS referral practices. SETTING Switzerland. METHODS A total of 3526 PCPs were invited to participate in an online survey. PCPs were asked to write the first 5 words that came to their mind about the term "bariatric surgery." Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Mental representation network was constructed based on co-occurrence of associations, using validated data-driven methodology. RESULTS In all, 216 PCPs completed the study (response rate: 6.13%). Respondents were aged 55 ± 9.8 years, had an equal sex distribution, and practiced mainly in urban settings. Three mental representations of BS emerged: indication-focused (most frequent associations: "obesity," "diabetes"), treatment-focused ("gastric bypass," "weight loss"), and outcome-focused ("complications," "challenging follow-up"). The emotional label "interested" was used significantly more frequently in the treatment-focused group. Comparison of PCPs among mental modules showed that those with a treatment-focused mindset referred patients for BS most frequently and were significantly more willing to follow up with postbariatric patients (χ2 = 17.8, P = .022). CONCLUSIONS PCPs think about BS along 3 mental representations, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confidence in performing postbariatric follow-up was identified as catalyst of BS referral. Access to optimal care for patients with obesity may be improved accordingly.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
| | - Vanessa Müller
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Bálint File
- Wigner Research Centre for Physics, Budapest, Hungary
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Surgery, Männedorf Hospital, Männedorf, Switzerland.
| | - Jeannette Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
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9
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Serra M, Alceste D, Hauser F, Hulshof PJM, Meijer HAJ, Thalheimer A, Steinert RE, Gerber PA, Spector AC, Gero D, Bueter M. Assessing daily energy intake in adult women: validity of a food-recognition mobile application compared to doubly labelled water. Front Nutr 2023; 10:1255499. [PMID: 37810925 PMCID: PMC10556674 DOI: 10.3389/fnut.2023.1255499] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Accurate dietary assessment is crucial for nutrition and health research. Traditional methods, such as food records, food frequency questionnaires, and 24-hour dietary recalls (24HR), have limitations, such as the need for trained interviewers, time-consuming procedures, and inaccuracies in estimations. Novel technologies, such as image-based dietary assessment apps, have been developed to overcome these limitations. SNAQ is a novel image-based food-recognition app which, based on computer vision, assesses food type and volume, and provides nutritional information about dietary intake. This cross-sectional observational study aimed to investigate the validity of SNAQ as a dietary assessment tool for measuring energy and macronutrient intake in adult women with normal body weight (n = 30), compared to doubly labeled water (DLW), a reference method for total daily energy expenditure (TDEE). Energy intake was also estimated using a one-day 24HR for direct comparison. Bland-Altman plots, paired difference tests, and Pearson's correlation coefficient were used to assess agreement and relationships between the methods. SNAQ showed a slightly higher agreement (bias = -329.6 kcal/day) with DLW for total daily energy intake (TDEI) compared to 24HR (bias = -543.0 kcal/day). While both SNAQ and 24HR tended to underestimate TDEI, only 24HR significantly differed from DLW in this regard (p < 0.001). There was no significant relationship between estimated TDEI and TDEE using SNAQ (R2 = 27%, p = 0.50) or 24HR (R2 = 34%, p = 0.20) and there were no significant differences in energy and macronutrient intake estimates between SNAQ and 24HR (Δ = 213.4 kcal/day). In conclusion, these results indicate that SNAQ provides a closer representation of energy intake in adult women with normal body weight than 24HR when compared to DLW, but no relationship was found between the energy estimates of DLW and of the two dietary assessment tools. Further research is needed to determine the clinical relevance and support the implementation of SNAQ in research and clinical settings. Clinical trial registration: This study is registered on ClinicalTrials.gov with the unique identifier NCT04600596 (https://clinicaltrials.gov/ct2/show/NCT04600596).
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Affiliation(s)
- Michele Serra
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - Daniela Alceste
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - Florian Hauser
- Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - Paul J. M. Hulshof
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Harro A. J. Meijer
- Centre for Isotope Research (CIO), Energy and Sustainability Research Institute Groningen, University of Groningen, Groningen, Netherlands
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Robert E. Steinert
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Philipp A. Gerber
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - Alan C. Spector
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL, United States
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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10
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Wölnerhanssen BK, Meyer-Gerspach AC, Nussbaumer R, Sauter M, Thumshirn M, Bueter M, Vetter D, Gubler C, Morell B, Jell A, Vieth M, Beglinger C, Peterli R, Fox M. Prospective clinical cohort study: low incidence of Barrett esophagus but high rate of reflux disease at 5-year follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:707-715. [PMID: 36990881 DOI: 10.1016/j.soard.2023.02.012] [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: 03/24/2022] [Revised: 11/10/2022] [Accepted: 02/04/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease seems more frequent after laparoscopic sleeve gastrectomy (LSG) than Roux-en-Y gastric bypass (LRYGB). Retrospective case series have raised concerns about a high incidence of Barrett esophagus (BE) after LSG. OBJECTIVE This prospective clinical cohort study compared the incidence of BE ≥5 years after LSG and LRYGB. SETTING St. Clara Hospital, Basel, and University Hospital, Zürich, Switzerland. METHODS Patients were recruited from 2 bariatric centers where preoperative gastroscopy is standard practice and LRYGB is preferred for patients with preexisting gastroesophageal reflux disease. At follow-up ≥5 years after surgery, patients underwent gastroscopy with quadrantic biopsies from the squamocolumnar junction and metaplastic segment. Symptoms were assessed using validated questionnaires. Wireless pH measurement assessed esophageal acid exposure. RESULTS A total of 169 patients were included, with a median 7.0 ± 1.5 years after surgery. In the LSG group (n = 83), 3 patients had endoscopically and histologically confirmed de novo BE; in the LRYGB group (n = 86), there were 2 patients with BE, 1 de novo and 1 preexisting (de novo BE, 3.6% versus 1.2%; P = .362). At follow-up, reflux symptoms were reported more frequently by the LSG group than by the LRYGB group (51.9% versus 10.5%). Similarly, moderate-to-severe reflux esophagitis (Los Angeles grade B-D) was more common (27.7% versus 5.8%) despite greater use of proton pump inhibitors (49.4% versus 19.7%), and pathologic acid exposure was more frequent in patients who underwent LSG than in patients who underwent LRYGB. CONCLUSIONS After at least 5 years of follow-up, a higher incidence of reflux symptoms, reflux esophagitis, and pathologic esophageal acid exposure was found in patients who underwent LSG compared with patients who underwent LRYGB. However, the incidence of BE after LSG was low and not significantly different between the 2 groups.
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Affiliation(s)
- Bettina K Wölnerhanssen
- St. Clara Research Ltd., Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Anne C Meyer-Gerspach
- St. Clara Research Ltd., Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Rahel Nussbaumer
- St. Clara Research Ltd., Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Visceral Surgery, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Matthias Sauter
- Department of Gastroenterology, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital, Basel, Switzerland; Department of Gastroenterology, University Hospital, Zürich, Switzerland
| | - Miriam Thumshirn
- Department of Gastroenterology, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital, Basel, Switzerland
| | - Marco Bueter
- Department of Visceral Surgery, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland; Department of Visceral and Transplantation Surgery, University Hospital, Zürich, Switzerland
| | - Diana Vetter
- Department of Visceral and Transplantation Surgery, University Hospital, Zürich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology, University Hospital, Zürich, Switzerland
| | - Bernhard Morell
- Department of Gastroenterology, University Hospital, Zürich, Switzerland
| | - Alissa Jell
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael Vieth
- Institute for Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Bayreuth, Germany
| | - Christoph Beglinger
- St. Clara Research Ltd., Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Ralph Peterli
- Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Visceral Surgery, Clarunis University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Mark Fox
- Department of Gastroenterology, University Hospital, Zürich, Switzerland; Laboratory and Clinic for Motility Disorders and Functional Digestive Diseases, Klinik Arlesheim, Arlesheim, Switzerland
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11
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Gero D, Bueter M. Post-bariatric changes in ingestive behavior: Shift in macronutrient preferences in rats and dynamic adaptation of the within-meal microstructure in humans. Physiol Behav 2023; 263:114113. [PMID: 36764423 DOI: 10.1016/j.physbeh.2023.114113] [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: 12/18/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
This invited review is based on a presentation given at the Annual Meeting of the Society for the Study of Ingestive Behavior in July 2022 and provides the summary of two recent studies on changes in ingestive behavior following bariatric surgery (BS). First, long-term changes in daily absolute and relative macronutrient intake are reported in a rodent model of Roux-en-Y gastric bypass (RYGB). Rats undergoing RYGB progressively decreased their daily calorie- and daily fat intake compared to their preoperative baseline and to the intake of sham operated animals. Second, postbariatric changes in the within-meal ingestive microstructure are portrayed, based on longitudinal data collected in RYGB patients using a drinkometer. The post-RYGB meal size showed a dynamic adjustment process, with the highest decrease in the early postoperative phase, followed by a steady convalescence up to 1-year, at which point the meal size of RYGB patients became comparable to the normal weight adults'. Results are contextualized and contrasted to recent reports on the effect of BS on taste and food choices and consumption. The showcased evidence supports the role of ingestive adaptation and learning in the achievement of reduced calorie intake after RYGB, both in humans and in rodents. The reorganized upper-gastrointestinal anatomy supposedly leads to increased postingestive caloric sensibility, which might be an important behavioral mediator of decreased postbariatric meal size and consequent weight loss.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Surgery, Männedorf Hospital, Männedorf, Switzerland.
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12
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Renold C, Deferm NP, Hauser R, Gerber P, Bueter M, Thalheimer A, Gero D. The Effect of a Multifaceted Intervention Including Classroom Education and Bariatric Weight Suit Use on Medical Students' Attitudes toward Patients with Obesity. Obes Facts 2023; 16:381-391. [PMID: 36977399 PMCID: PMC10427925 DOI: 10.1159/000530405] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION Weight bias refers to negative attitudes toward individuals because of their weight. Evidence-based strategies to successfully reduce weight bias in medical students are lacking. The purpose of this study was to investigate the impact of a multifaceted intervention on medical students' attitudes toward patients with obesity. METHODS Third and fourth year medical students (n = 79), who enrolled in an 8-week graduate course focusing on the various epidemiologic, physiological, and clinical aspects of obesity, including a gamification task with bariatric weight suits (BWSs), were asked to complete the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale questionnaire pre- and post-course. The inclusion period was between September 2018 and June 2021 and covered 4 consecutive groups of students. RESULTS The overall NEW Attitudes Scale scores did not change significantly pre- versus post-intervention (pre-course: 19.59, post-course: 24.21, p value = 0.24). However, the subgroup of 4th year medical students showed a significant improvement in their attitudes (pre-course: 16.4, post-course: 26.16, p value = 0.02). The Thurstone rating of 9 out of 31 individual survey items changed significantly from pre- to post-course with a moderate strength (Cramer's V >0.2), including 5 items showing weight bias reduction. The disagreement with the statement "overweight/obese individuals lack willpower" increased from 37 to 68%. CONCLUSION These findings suggest that in medical students with a low level of weight bias at baseline, a semester course on obesity combined with BWS use affects only a limited number of items of the NEW Attitudes Scale questionnaire. The sensitization of medical students to weight stigma has the potential to improve quality of healthcare for patients with obesity.
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Affiliation(s)
- Carlo Renold
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nathalie Phyllis Deferm
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Renward Hauser
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Philipp Gerber
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
| | - Andreas Thalheimer
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Surgery, Männedorf Hospital, Männedorf, Switzerland
| | - Daniel Gero
- Faculty of Medicine, University of Zurich, Zurich, Switzerland,
- Department of Surgery and Transplantation, University Hospital Zurich, University of Zurich, Zurich, Switzerland,
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13
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Schmidt MT, Studer M, Kunz A, Studer S, Bonvini JM, Bueter M, Kook L, Haile SR, Pregernig A, Beck-Schimmer B, Schläpfer M. There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial. BMC Anesthesiol 2023; 23:41. [PMID: 36747148 PMCID: PMC9900199 DOI: 10.1186/s12871-023-01982-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 01/09/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Carbon dioxide (CO2) increases cerebral perfusion. The effect of CO2 on apnea tolerance, such as after anesthesia induction, is unknown. This study aimed to assess if cerebral apnea tolerance can be improved in obese patients under general anesthesia when comparing O2/Air (95%O2) to O2/CO2 (95%O2/5%CO2). METHODS In this single-center, single-blinded, randomized crossover trial, 30 patients 18-65 years, with body mass index > 35 kg/m2, requiring general anesthesia for bariatric surgery, underwent two apneas that were preceded by ventilation with either O2/Air or O2/CO2 in random order. After anesthesia induction, intubation, and ventilation with O2/Air or O2/CO2 for 10 min, apnea was performed until the cerebral tissue oxygenation index (TOI) dropped by a relative 20% from baseline (primary endpoint) or oxygen saturation (SpO2) reached 80% (safety abortion criterion). The intervention was then repeated with the second substance. RESULTS The safety criterion was reached in all patients before cerebral TOI decreased by 20%. The time until SpO2 dropped to 80% was similar in the two groups (+ 6 s with O2/CO2, 95%CI -7 to 19 s, p = 0.37). Cerebral TOI and PaO2 were higher after O2/CO2 (+ 1.5%; 95%CI: from 0.3 to 2.6; p = 0.02 and + 0.6 kPa; 95%CI: 0.1 to 1.1; p = 0.02). CONCLUSION O2/CO2 improves cerebral TOI and PaO2 in anesthetized bariatric patients. Better apnea tolerance could not be confirmed.
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Affiliation(s)
- Marc T. Schmidt
- grid.412004.30000 0004 0478 9977Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Sandro Studer
- grid.412004.30000 0004 0478 9977Clinical Trials Center, University Hospital Zurich, Zurich, Switzerland
| | - John M. Bonvini
- grid.412004.30000 0004 0478 9977Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- grid.412004.30000 0004 0478 9977Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Lucas Kook
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University Zurich, Zurich, Switzerland
| | - Sarah R. Haile
- grid.7400.30000 0004 1937 0650Epidemiology, Biostatistics and Prevention Institute, University Zurich, Zurich, Switzerland
| | - Andreas Pregernig
- grid.412004.30000 0004 0478 9977Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Beck-Schimmer
- grid.412004.30000 0004 0478 9977Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland ,grid.185648.60000 0001 2175 0319Department of Anesthesiology, University of Illinois at Chicago, Chicago, USA ,grid.7400.30000 0004 1937 0650Institute of Physiology, Zurich Center for Integrative Human Physiology, University Zurich Irchel, Zurich, Switzerland
| | - Martin Schläpfer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. .,Institute of Physiology, Zurich Center for Integrative Human Physiology, University Zurich Irchel, Zurich, Switzerland.
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14
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Boonchaya‐anant P, Bueter M, Gubler C, Gerber PA. Sustained weight loss after duodenal-jejunal bypass liner treatment in patients with body mass index below, but not above 35 kg/m 2 : A retrospective cohort study. Clin Obes 2023; 13:e12561. [PMID: 36239531 PMCID: PMC10078000 DOI: 10.1111/cob.12561] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 01/19/2023]
Abstract
Previous data from short term studies have shown an efficacy of the duodenal-jejunal bypass liner (DJBL) for weight loss. However, less data is available regarding weight change after device removal and possible predictors for weight loss. This is a retrospective chart review of all patients who had DJBL inserted at the University Hospital Zurich between December 2012 and June 2015. A total of 27 patients had DJBL insertion. The median BMI at baseline was 38.5 (34.0-42.2) kg/m2 . In the 24 patients with DJBL treatment >3 months (failed implantation or early removal due to side effects in 3 patients), the mean duration of implantation was 42.9 ± 13.1 weeks. During the treatment, the mean total body weight loss (%TBWL) was 15.0 ± 8.3%. Fifteen patients had long-term follow-up data available (mean duration of follow-up 4.0 ± 0.9 years). The mean weight change was 12.7 ± 12.8 kg, corresponding with a mean % weight regain of 13.3 ± 13.3%. Five patients (33.3%) subsequently underwent bariatric surgery. In patients with class I obesity (BMI <35 kg/m2 at baseline), 4 out of 6 (66.7%) had a stable weight or only a weight regain <7%. In contrast, no patient with BMI >35 kg/m2 at baseline was able to keep weight regain below 7%. DJBL is an effective treatment for obesity, but substantial weight regain occurs during long-term follow up after the device removal, in particular in patients with BMI > 35 kg/m2 .
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Affiliation(s)
- Patchaya Boonchaya‐anant
- Department of Endocrinology, Diabetology and Clinical NutritionUniversity Hospital Zurich (USZ) and University of Zurich (UZH)ZurichSwitzerland
- Hormonal and Metabolic Disorders Research Unit, Excellence Center for Diabetes, Hormone, and Metabolism, Department of MedicineFaculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross SocietyBangkokThailand
| | - Marco Bueter
- Department of Visceral and Transplantation SurgeryUniversity Hospital Zurich (USZ) and University of Zurich (UZH)ZurichSwitzerland
| | - Christoph Gubler
- Department of Gastroenterology and HepatologyUniversity Hospital Zurich (USZ) and University of Zurich (UZH)ZurichSwitzerland
| | - Philipp A. Gerber
- Department of Endocrinology, Diabetology and Clinical NutritionUniversity Hospital Zurich (USZ) and University of Zurich (UZH)ZurichSwitzerland
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15
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Auf der Maur I, Gero D, Kampmann G, Prediger T, Schopf S, Peters J, Widmer J, Deerberg-Wittram J, Köhler-Hohmann C, Bueter M, Thalheimer A. [Healthcare cost reimbursement without application-Experiences of a German bariatric service]. Chirurgie (Heidelb) 2022; 93:1082-1088. [PMID: 35904583 PMCID: PMC9592636 DOI: 10.1007/s00104-022-01690-z] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Only a small proportion of patients with morbid obesity in Germany have access to the currently most effective treatment, bariatric surgery. A major reason for this is the restrictive attitude of health insurance companies regarding the reimbursement of costs. OBJECTIVE To record the postoperative rate of cost coverage by health insurance companies without the currently common preoperative application for morbidly obese patients who received a guideline-indicated bariatric surgery. METHODS The process of postoperative reimbursement was evaluated through a prospective database over a 2-year period. Cases of primary reimbursement were correlated with respect to age, BMI, comorbidities and membership of a specific health insurance company. Rejected coverage cases were followed up for further advocacy and social court process. RESULTS A total of 188 patients underwent bariatric surgery as indicated in the guidelines without prior application. Primary cost coverage was achieved in 76.6% (n = 144). There was no correlation with BMI, comorbidities or health insurance affiliation. Patients over 40 years of age were significantly more likely to be covered for costs. For patients without postoperative cost coverage, an out of court settlement was reached in 7 cases, 8 cases were heard by the social courts and 29 cases were still being processed by lawyers. CONCLUSION Despite the relatively high rate of primary cost coverage, this analysis also shows the restrictive attitude of the health insurance companies regarding bariatric surgery with corresponding economic pressure on the service providers. The consistent implementation of application-free surgery seems necessary to increase the political pressure on health insurers and social courts.
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Affiliation(s)
- Isabel Auf der Maur
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Daniel Gero
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz
| | - Gesa Kampmann
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz
| | - Tobias Prediger
- Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Klinik Bad Aibling, Bad Aibling, Deutschland
| | - Stefan Schopf
- Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Klinik Bad Aibling, Bad Aibling, Deutschland
| | - Jutta Peters
- Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Klinik Bad Aibling, Bad Aibling, Deutschland
| | - Jeannette Widmer
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | | | - Christel Köhler-Hohmann
- arztundklinikrecht.de/Dr. iur. Christel Köhler-Hohmann, Rechtsanwältin - Fachanwältin für Medizinrecht, Gilching bei München, Deutschland
| | - M Bueter
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz
| | - Andreas Thalheimer
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz.
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz.
- University Hospital Zurich: UniversitatsSpital Zurich, Zürich, Schweiz.
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16
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Saarinen I, Grönroos S, Hurme S, Peterli R, Helmiö M, Bueter M, Strandberg M, Wölnerhanssen BK, Salminen P. Validation of the Individual Metabolic Surgery Score for Bariatric Procedure Selection in the Merged Data of Two Randomized Clinical Trials (SLEEVEPASS and SM-BOSS). Surg Obes Relat Dis 2022; 19:522-529. [PMID: 36503734 DOI: 10.1016/j.soard.2022.10.036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/06/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND LSG and LRYGB are globally the most common bariatric procedures. IMS score categorizes T2D severity (mild, moderate, and severe) based on 4 independent preoperative predictors of long-term remission as follows: T2D duration, number of diabetes medications, insulin use, and glycemic control. IMS score has not been validated in a randomized patient cohort. OBJECTIVES To assess the feasibility of individualized metabolic surgery (IMS) score in facilitating procedure selection between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for patients with severe obesity and type 2 diabetes (T2D). SETTING Merged individual patient-level 5-year data of 2 large randomized clinical trials (SLEEVEPASS and SM-BOSS [Swiss Multicenter Bypass or Sleeve Study]). METHODS IMS score was calculated for study patients and its performance was analyzed. RESULTS One hundred thirty-nine out of 155 patients with T2D had available preoperative data to calculate IMS score as follows: mild stage (n = 41/139), moderate stage (n = 77/139), severe stage (n = 21/139). At 5 years, 135 (87.1%, 67 LSG/68 LRYGB) were available for follow-up and 121 patients had both pre- and postoperative data. Diabetes remission rates according to preoperative IMS score were as follows: mild stage 87.5% (n = 14/16) after LSG and 85.7% (n = 18/21) after LRYGB (P = .999), moderate stage 42.9% (n = 15/35) and 45.2% (n = 14/31) (P = .999), and severe stage 18.2% (n = 2/11) and 0% (n = 0/7) (P = .497), respectively. The T2D remission rate varied significantly between the stages as follows: mild versus moderate odds ratio (OR) 8.3 (95% CI, 2.8-24.0; P < .001), mild versus severe OR 52.2 (95% CI 9.0-302.3; P < .001), and moderate versus severe OR 6.3 (95% CI, 1.3-29.8; P = .020). CONCLUSIONS In our study, remission rates of T2D were not statistically different after LSG and LRYGB among all patients and among patients with mild, moderate, and severe diabetes stratified by the IMS score. However, the study may be underpowered to detect differences due to small number of patients in each subgroup. IMS score seemed to be useful in predicting long-term T2D remission after bariatric surgery.
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17
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Ross RC, Akinde YM, Schauer PR, le Roux CW, Brennan D, Jernigan AM, Bueter M, Albaugh VL. The role of bariatric and metabolic surgery in the development, diagnosis, and treatment of endometrial cancer. Front Surg 2022; 9:943544. [PMID: 36117808 PMCID: PMC9470773 DOI: 10.3389/fsurg.2022.943544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 12/13/2022] Open
Abstract
The obesity pandemic continues to contribute to a worsening burden of disease worldwide. The link between obesity and diseases such as diabetes, cardiovascular disease, and cancer has been well established, yet most patients living with obesity remain untreated or undertreated. Metabolic and bariatric surgery is the most effective and durable treatment for obesity, is safe, and may have a protective benefit with respect to cancer incidence. In this review, an overview of the link between obesity, metabolic surgery, and cancer is discussed with emphasis on indications for endometrial cancer, the malignancy most strongly associated with obesity. Considerable evidence from retrospective and prospective cohort studies supports a decreased risk of endometrial cancer in patients with obesity who undergo bariatric surgery compared with nonsurgical controls. Survivors of endometrial cancer are at increased risk of poor health outcomes associated with obesity, and women with endometrial cancer are more likely to die of cardiovascular disease and other obesity-related illnesses than of the malignancy itself. Recent advances in anticancer drug therapies have targeted pathways that may also be therapeutically altered with metabolic surgery. Metabolic surgery has significant potential to enter the treatment paradigm for endometrial cancer, and gynecologic oncologist visits present an opportunity to identify patients who may benefit the most.
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Affiliation(s)
- Robert C. Ross
- Translational and Integrative Gastrointestinal and Endocrine Research Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Yetunde M. Akinde
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Philip R. Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Carel W. le Roux
- School of Medicine, St. Vincent's University Hospital and University College Dublin, Dublin, Ireland
| | - Donal Brennan
- UCD Gynecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin, Ireland
| | - Amelia M. Jernigan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Marco Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Vance L. Albaugh
- Translational and Integrative Gastrointestinal and Endocrine Research Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
- Correspondence: Vance L. Albaugh
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18
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Müller V, Gero D, File B, Widmer J, Thalheimer A, Bueter M. Attitudes of primary care physicians towards bariatric surgery in Switzerland – a free-word association networks analysis. Br J Surg 2022. [DOI: 10.1093/bjs/znac175.001] [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: 11/13/2022]
Abstract
Abstract
Objective
Primary care physicians (PCP) have a major responsibility in identifying patients with obesity eligible for bariatric surgery (BS). The aim was to explore PCPs’ attitudes towards BS in order to map potential barriers of referral.
Methods
3526 PCPs in Switzerland were invited to participate in an online survey. PCPs were asked to write the first 5 words coming to their mind about the term “bariatric surgery”. Additionally, they had to pick 2 emotions that best described each provided association. Demographic data and obesity-related referral patterns were collected. Cognitive representation network was constructed based on co-occurrence of associations, using validated data-driven methodology.
Results
216 PCPs completed the study. Respondents were aged 55±9.8 years, had an equal gender distribution and practiced mainly in urban setting (Table 1). The majority of PCPs refer either often (31%) or sometimes (41%) patients for BS, while 7% never refer patients to BS, even if eligibility criteria are met. The PCPs’ overall satisfaction with BS was high (88.5%)(Fig. 1). PCPs could be categorized in 3 subgroups based on their cognitive representation of BS: a) indication-focused (most frequent associations: “obesity”, ”diabetes”/most frequent emotion: “worrying”), b) treatment-focused (“gastric bypass”, “weight loss”/“interested”), and c) risk vs. benefit-focused (“complications”, “challenging follow-up”, “success”/“alert”) (Fig. 2&3). There were no relevant demographic or practice related differences between PCPs in the 3 cognitive modules. PCPs with a treatment-focused mindset had a significantly better knowledge of current guidelines on indications of BS (χ2=17.1, P=0.029) and referred in average 5 patients/year, x2 more than PCPs belonging to the other cognitive modules.
Conclusion
PCPs in Switzerland approve the efficacy of BS, but show reservation to refer eligible patients systematically. PCPs think about BS along 3 cognitive schemes, and the treatment-focused attitude was coupled with the highest willingness to refer eligible patients for BS. Confident knowledge of current indications of BS was the only significant factor that distinguished PCPs with a treatment-focused attitude. Strengthening the collaboration in therapeutic decision-making between PCPs and BS centers has the potential to improve access to optimal care for patients with obesity.
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Affiliation(s)
- V Müller
- Faculty of Medicine, University of Zurich , Zurich, Switzerland
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
| | - D Gero
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
- Hospital of Männedorf Departement of Surgery, , Männedorf, Switzerland
| | - B File
- Department of Physics, Wigner Research Center of Physics , Budapest, Hungary
| | - J Widmer
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
- Hospital of Männedorf Departement of Surgery, , Männedorf, Switzerland
| | - M Bueter
- Department of Surgery and Transplant, University Hospital Zurich , Zurich, Switzerland
- Hospital of Männedorf Departement of Surgery, , Männedorf, Switzerland
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19
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Gerdes S, Burger R, Liesch G, Freitag B, Serra M, Vonlanthen R, Bueter M, Thalheimer A. Results of robotic TAPP and conventional laparoscopic TAPP in an outpatient setting: a cohort study in Switzerland. Langenbecks Arch Surg 2022; 407:2563-2567. [PMID: 35608687 PMCID: PMC9468071 DOI: 10.1007/s00423-022-02552-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/17/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022]
Abstract
Purpose Recently, robotic surgery has been increasingly performed in hernia surgery. Although feasibility and safety of robot-assisted inguinal hernia repair in an inpatient setting have been already shown, its role in outpatient hernia surgery has not yet been investigated. Thus, this study aimed to compare robot-assisted TAPP (r-TAPP) and conventional laparoscopic TAPP (l-TAPP) in an outpatient setting. Methods A prospective database of patients with inguinal hernia treated by l-TAPP or r-TAPP in an outpatient setting during a 1-year period was analyzed in a comparative cohort study. All patients underwent a check-up appointment with their surgeon within 3 days and 6 weeks postoperatively. Data on surgical time, perioperative complications, and postoperative pain were collected. Pain was recorded by using a Verbal Rating Scale (VRS). Results Overall, outpatient laparoendoscopic inguinal hernia repair was performed in 58 patients (29 l-TAPP; 29 r-TAPP). Mean age was 57 years (21–81), mean BMI 24.5 kg/m2 (19–33) with no differences between both groups. Most patients reported none or only a low postoperative pain level in both groups (89.6% in l-TAPP group; 100% in r-TAPP), while there was a trend for less pain after r-TAPP. In both groups, there was one case of postoperative hematoma, which was successfully treated by conservative means. No other complications occurred during follow-up in either group and there was no 30-day-readmission, no unplanned overstay or any 30-day mortality in the cohort. Conclusion Robot-assisted inguinal hernia surgery can be safely performed in an outpatient setting with a tendency to less pain when compared to the conventional laparoscopic technique. Cost-effectiveness and cost-coverage of outpatient robot-assisted inguinal hernia surgery must be further investigated in times of limited health cost resources and diagnosis-related medical reimbursements.
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Affiliation(s)
- Stephan Gerdes
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Reint Burger
- Department of Surgery, Spital Männedorf, Asylstrasse 10, CH-8708, Männedorf, Switzerland
| | - Georg Liesch
- Department of Surgery, Spital Männedorf, Asylstrasse 10, CH-8708, Männedorf, Switzerland
| | - Barbara Freitag
- Department of Surgery, Spital Männedorf, Asylstrasse 10, CH-8708, Männedorf, Switzerland
| | - Michele Serra
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - René Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland.,Department of Surgery, Spital Männedorf, Asylstrasse 10, CH-8708, Männedorf, Switzerland
| | - Andreas Thalheimer
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland. .,Department of Surgery, Spital Männedorf, Asylstrasse 10, CH-8708, Männedorf, Switzerland.
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20
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Serra M, File B, Alceste D, Raguz I, Gero D, Thalheimer A, Widmer J, Ismaeil A, Steinert RE, Spector AC, Bueter M. Burst-pause criterion derivation for drinkometer measurements of ingestive behavior. MethodsX 2022; 9:101726. [PMID: 35620756 PMCID: PMC9127353 DOI: 10.1016/j.mex.2022.101726] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
Abstract
The drinkometer is a promising device for the study of ingestive behavior of liquid meals in humans. It can be used to investigate behavior in different target populations. However, ingestive behavior has a great variability across study participants. Therefore, a new analytical approach is required for the extraction and analysis of drinkometer-derived data that could account for this variability. We developed an optimized protocol to predict an optimal burst-pause criterion (PC) for the extraction of PC-dependent microstructural parameters of ingestive behavior. These describe the microstructure of bursts, while PC-independent parameters describe the microstructure of sucks. Therefore, a PC is required to analyze separately two physiologically different parts of behavior. To accomplish this burst-pause criterion derivation (BPCD), a Gaussian Mixture Model (GMM) was built for estimation of two probability density functions (PDFs). These model the distribution of inter-suck intervals (ISIs) and inter-burst intervals (IBIs), respectively. The PC is defined at the intersection point of the two density functions. A Kaplan-Meier (KM) survival analysis was performed for post-hoc verification of the fit of the predicted optimal PC to the ISI distribution. In this protocol paper, we present a walkthrough of the data analysis of drinkometer-derived data for the measurement of microstructure of ingestive behavior based on previous results published by our group [1].•Standardization of the burst-pause criterion derivation for drinkometer measurements of ingestive behavior.•All codes are publicly available in a repository.•The method can be easily adapted to studies with larger sample size or more than one study stimulus.
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Affiliation(s)
- Michele Serra
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Bálint File
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
- Wigner Research Centre for Physics, Budapest, Hungary
| | - Daniela Alceste
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Ivana Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Jeannette Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Aiman Ismaeil
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Robert E. Steinert
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Alan C. Spector
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, FL, USA
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
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21
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Ismaeil A, Gero D, Boyle CN, Alceste D, Taha O, Spector AC, Lutz TA, Bueter M. Early Postoperative Exposure to High-Fat Diet Does Not Increase Long-Term Weight Loss or Fat Avoidance After Roux-en-Y Gastric Bypass in Rats. Front Nutr 2022; 9:834854. [PMID: 35495960 PMCID: PMC9044042 DOI: 10.3389/fnut.2022.834854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Bariatric surgery alters food preferences in rats and reportedly decreases desire to consume high-fat high-sugar food in humans. The aim of this study was to investigate whether early post-operative exposure to high-fat food could increase body weight loss after Roux-en-Y gastric bypass (RYGB) by triggering fat avoidance. Methods Male Wistar rats underwent either RYGB (n = 15) or sham-operations (n = 16). Preoperatively a standardized 4-choice cafeteria diet [dietary options: low-fat/low-sugar (LFLS), low-fat/high-sugar (LFHS), high-fat/low-sugar (HFLS), high-fat/high-sugar (HFHS)] was offered. First, each option was available for 4 days, thereafter rats were offered the 4 options simultaneously for 3 days preoperatively. Post-surgery, 8 rats in the RYGB- and 8 in the sham-group were exposed to a high-fat content diet (Oatmeal + 30% lard, OM+L) for 10 days, while 7 RYGB rats and 8 sham-rats received OM alone. From the 11th postoperative day, the 4-choice cafeteria diet was reintroduced for 55-days. The intake of all available food items, macronutrients and body weight changes were monitored over 8 weeks. Main outcomes were long-term body-weight and daily change in relative caloric intake during the postoperative cafeteria period compared to the preoperative cafeteria. Results During the first 12 days of postoperative cafeteria access, RYGB-rats exposed to OM+L had a higher mean caloric intake per day than RYGB rats exposed to OM alone (Δ10 kCal, Padj = 0.004), but this difference between the RYGB groups disappeared thereafter. Consequently, in the last 33 days of the postoperative cafeteria diet, the mean body weight of the RYGB+OM+L group was higher compared to RYGB+OM (Δ51 g, Padj < 0.001). RYGB rats, independently from the nutritional intervention, presented a progressive decrease in daily consumption of calories from fat and increased their daily energy intake mainly from non-sugar carbohydrates. No such differences were detected in sham-operated controls exposed to low- or high fat postoperative interventions. Conclusion A progressive decrease in daily fat intake over time was observed after RYGB, independently from the nutritional intervention. This finding confirms that macronutrient preferences undergo progressive changes over time after RYGB and supports the role of ingestive adaptation and learning. Early postoperative exposure to high-fat food failed to accentuate fat avoidance and did not lead to superior weight loss in the long-term.
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Affiliation(s)
- Aiman Ismaeil
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- Department of General Surgery, Aswan University Hospital, Aswan, Egypt
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christina N. Boyle
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Daniela Alceste
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Osama Taha
- Department of Plastic Surgery, Assiut University Hospital, Asyut, Egypt
| | - Alan C. Spector
- Program in Neuroscience, Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Thomas A. Lutz
- Institute of Veterinary Physiology, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
- *Correspondence: Marco Bueter,
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22
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Plath L, Burger R, Bueter M, Thalheimer A. Two cases of an internal hernia after laparoscopic sigmoid resection. BMJ Case Rep 2022; 15:15/4/e249468. [PMID: 35393282 PMCID: PMC8990697 DOI: 10.1136/bcr-2022-249468] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Two patients with a laparoscopic resection of the sigmoid colon in their surgical history were diagnosed with an internal hernia because of a mesenteric gap underneath the descending neocolon. While the first case demonstrated a strongly symptomatic patient with a closed-loop obstruction of the small bowel, the second case was less obvious and correct diagnosis was achieved after a few weeks by finally performing a diagnostic laparoscopy. Since internal hernias after laparoscopic sigmoid resection are a rare complication and as presented in the second case can display very unspecific symptoms, the surgeon’s awareness is not immediately raised towards it. Therefore, an asymptomatic internal hernia bears a constant risk of a life-threatening outcome allowing to recommend an initial closure of the mesenteric gap. In both cases, successful treatment was achieved by surgery and intraoperatively closing the remaining mesenteric gap. Subsequently recovery and follow-up were uneventful.
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Affiliation(s)
- Liane Plath
- Surgery, Spital Männedorf AG, Maennedorf, Switzerland
| | - Reint Burger
- Surgery, Spital Männedorf AG, Maennedorf, Switzerland
| | - Marco Bueter
- Surgery, Spital Männedorf AG, Maennedorf, Switzerland.,Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Surgery, Spital Männedorf AG, Maennedorf, Switzerland.,Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
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23
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Widmer J, Gero D, Sommerhalder B, Alceste D, Raguz I, Serra M, Vonlanthen R, Bueter M, Thalheimer A. Online survey on factors influencing patients' motivation to undergo bariatric surgery. Clin Obes 2022; 12:e12500. [PMID: 34878217 PMCID: PMC9285963 DOI: 10.1111/cob.12500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/15/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
Abstract
Given the worldwide increasing prevalence of severe obesity and considering the amount of scientific evidence demonstrating the beneficial effects of bariatric surgery (BS), it is surprising that only a fraction of patients with obesity undergo BS. We therefore conducted an anonymized online survey among individuals with a history of BS to understand factors influencing the deciding process leading to BS. Respondents were recruited on a voluntary basis from obesity-related social media groups between April and June 2020. The self-designed, non-validated questionnaire consisted of 20 questions and was open to any participants with a history of BS. Of 851 participants who started the survey, 665 completed the questionnaire (completion rate of 78.1%). Five years after BS, still 70% of the survey-participants were very satisfied or satisfied with the surgical result. However, the majority (73.3%) would have undergone BS earlier. The main motivation to choose BS was related to health status or quality of life. Important characteristics for a bariatric surgeon to obtain patients' trust are "taking time and listen" (74.7%), empathy (64%) and sympathy (56%). Post-operative satisfaction with the surgical outcome was high and long-lasting in this large cohort of BS patients. However, most participants would retrospectively have undergone BS earlier. The main reason to choose BS as treatment for their obesity were impaired physical health or reduced quality of life. Nearby location to patients' residence and availability of surgeons with empathy were decisive motives for bariatric centre selection.
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Affiliation(s)
- Jeannette Widmer
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - Daniel Gero
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | | | - Daniela Alceste
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - Ivana Raguz
- Department of SurgerySpital MännedorfMännedorf
| | - Michele Serra
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - René Vonlanthen
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
| | - Marco Bueter
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
- Department of SurgerySpital MännedorfMännedorf
| | - Andreas Thalheimer
- Department of Surgery and TransplantationUniversity Hospital ZurichZurichSwitzerland
- Department of SurgerySpital MännedorfMännedorf
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24
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Alceste D, Serra M, Raguz I, Gero D, Thalheimer A, Widmer J, File B, Ismaeil A, Steinert RE, Spector AC, Bueter M. Association between microstructure of ingestive behavior and body weight loss in patients one year after Roux-en-Y gastric bypass. Physiol Behav 2022; 248:113728. [DOI: 10.1016/j.physbeh.2022.113728] [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: 09/01/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/22/2023]
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25
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Gero D, Muller X, Staiger RD, Gutschow CA, Vonlanthen R, Bueter M, Clavien PA, Puhan MA. How to Establish Benchmarks for Surgical Outcomes?: A Checklist Based on an International Expert Delphi Consensus. Ann Surg 2022; 275:115-120. [PMID: 32398485 DOI: 10.1097/sla.0000000000003931] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define a standardized methodology for establishing benchmarks for relevant outcomes in surgery. SUMMARY BACKGROUND DATA Benchmarking is an established tool to improve quality in industry and economics, and is emerging in assessing outcome values in surgery. Despite a recent 10-step approach to identify such benchmark values, a standardized and more widely agreed-on approach is still lacking. METHODS A multinational web-based Delphi survey with a focus on methodological requirements for establishing benchmarks for surgical outcomes was performed. Participants were selected among internationally renowned specialists in abdominal, vascular, and thoracic surgery. Consensus was defined as ≥70% agreement and results were used to develop a checklist to establish benchmarks in surgery. RESULTS Forty-one surgical opinion leaders from 19 countries and 5 continents were involved. Experts' response rates were 98% and 80% in rounds 1 and 2, respectively. Upon completion of the final Delphi round, consensus was successfully achieved for 26 of 36 items covering the following areas: center eligibility, validation of databases, patient cohort selection, procedure selection, duration of follow-up, statistical analysis, and publication requirements regarding center-specific outcomes. CONCLUSIONS This multinational Delphi survey represents the first expert-led process for developing a standardized approach for establishing benchmarks for relevant outcome measures in surgery. The provided consensual checklist customizes the methodology of outcome reporting in surgery and thus improves reproducibility and comparability of data and should ultimately serve to improve quality of care.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Xavier Muller
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Roxane D Staiger
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christian A Gutschow
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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26
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Goetze S, Frey K, Rohrer L, Radosavljevic S, Krützfeldt J, Landmesser U, Bueter M, Pedrioli PGA, von Eckardstein A, Wollscheid B. Reproducible Determination of High-Density Lipoprotein Proteotypes. J Proteome Res 2021; 20:4974-4984. [PMID: 34677978 DOI: 10.1021/acs.jproteome.1c00429] [Citation(s) in RCA: 6] [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] [Indexed: 12/16/2022]
Abstract
High-density lipoprotein (HDL) is a heterogeneous mixture of blood-circulating multimolecular particles containing many different proteins, lipids, and RNAs. Recent advancements in mass spectrometry-based proteotype analysis show promise for the analysis of proteoforms across large patient cohorts. In order to create the required spectral libraries enabling these data-independent acquisition (DIA) strategies, HDL was isolated from the plasma of more than 300 patients with a multiplicity of physiological HDL states. HDL proteome spectral libraries consisting of 296 protein groups and more than 786 peptidoforms were established, and the performance of the DIA strategy was benchmarked for the detection of HDL proteotype differences between healthy individuals and a cohort of patients suffering from diabetes mellitus type 2 and/or coronary heart disease. Bioinformatic interrogation of the data using the generated spectral libraries showed that the DIA approach enabled robust HDL proteotype determination. HDL peptidoform analysis enabled by using spectral libraries allowed for the identification of post-translational modifications, such as in APOA1, which could affect HDL functionality. From a technical point of view, data analysis further shows that protein and peptide quantities are currently more discriminative between different HDL proteotypes than peptidoforms without further enrichment. Together, DIA-based HDL proteotyping enables the robust digitization of HDL proteotypes as a basis for the analysis of larger clinical cohorts.
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Affiliation(s)
- Sandra Goetze
- Institute of Translational Medicine (ITM), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich 8093, Switzerland.,Swiss Multi-Omics Center (SMOC), PHRT-CPAC, ETH Zurich, Zurich 8093, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland
| | - Kathrin Frey
- Institute of Translational Medicine (ITM), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich 8093, Switzerland
| | - Lucia Rohrer
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich 8091, Switzerland
| | - Silvija Radosavljevic
- Institute for Clinical Chemistry, University Hospital Zurich, Zurich 8091, Switzerland
| | - Jan Krützfeldt
- Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich 8091, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin 12203, Germany
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich 8091, Switzerland
| | - Patrick G A Pedrioli
- Institute of Translational Medicine (ITM), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich 8093, Switzerland.,Swiss Multi-Omics Center (SMOC), PHRT-CPAC, ETH Zurich, Zurich 8093, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland
| | | | - Bernd Wollscheid
- Institute of Translational Medicine (ITM), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich 8093, Switzerland.,Swiss Multi-Omics Center (SMOC), PHRT-CPAC, ETH Zurich, Zurich 8093, Switzerland.,Swiss Institute of Bioinformatics (SIB), Lausanne 1015, Switzerland
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27
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Thalheimer A, Vonlanthen R, Ivanova S, Stoupis C, Bueter M. Mind the gap - Small bowel obstruction due to preperitoneal herniation following laparoscopic inguinal hernia repair - A case report. Int J Surg Case Rep 2021; 88:106532. [PMID: 34688071 PMCID: PMC8536528 DOI: 10.1016/j.ijscr.2021.106532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/23/2021] [Revised: 10/16/2021] [Accepted: 10/16/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Inguinal hernia repair is a very frequent operation in general and visceral surgery worldwide. The laparo-endoscopic approaches such as TAPP have gained increasing acceptance among specialists and many consider them as standard of care due to perioperative safety and excellent postoperative results. Knowledge of specific complications after minimally invasive inguinal hernia surgery, however, is important for the successful management of these patients. CASE PRESENTATION We herein present the case of a 75-year-old female patient who electively underwent laparoscopic repair of combined inguinal and femoral hernia. During the postoperative course a small bowel obstruction occurred requiring emergency re-laparoscopy revealing a preperitoneal herniation of small bowel through a peritoneal defect. CLINICAL DISCUSSION Small bowel obstruction due to preperitoneal herniation of small bowel through a peritoneal defect after laparoscopic hernia repair is extremely rare. In such cases, emergency laparoscopic revision is necessary to avoid bowel ischaemia. Adequate closure of the peritoneum during the primary procedure along with the necessary attention to detail seems mandatory to avoid preperitoneal herniation after TAPP. CONCLUSION Inadequate peritoneal closure after TAPP may lead to preperitoneal herniation of the small bowel leading to postoperative intestinal obstruction. All hernia surgeons should be aware of this rare, but potentially life-threatening complication and should close all peritoneal defects with greatest care and accuracy.
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Affiliation(s)
- Andreas Thalheimer
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland; Department of Surgery, Spital Männedorf, Männedorf, Switzerland.
| | - Rene Vonlanthen
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Silviya Ivanova
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | | | - Marco Bueter
- Department of Visceral and Transplantation Surgery, University Hospital of Zürich, Zürich, Switzerland; Department of Surgery, Spital Männedorf, Männedorf, Switzerland
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28
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Seki Y, Vonlanthen R, Widmer J, Thalheimer A, Kasama K, Himpens J, Hollyman M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures. Ann Surg 2021; 274:821-828. [PMID: 34334637 DOI: 10.1097/sla.0000000000005117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marie Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Sietske Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Ellen Deleus
- Department of General Surgery, University Hospital Leuven, Leuven, Belgium
| | - Aaron Lloyd
- Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California
| | - Emanuele Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - George Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Ivana Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andres San Martin
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Marko Kraljević
- Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Sebastien Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France
| | - Lisa Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Henna Sammalkorpi
- Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - José Luis Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Amalia Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Tom Wiggins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Ekhlas Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | | | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jeannette Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Jacques Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
- The European School of Laparoscopic Surgery, St Pierre University Hospital, Brussels, Belgium
| | - Marianne Hollyman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alec Beekley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Matias Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile
| | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Anne Juuti
- Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | | | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France
| | - Michel Suter
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Camilo Boza
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Raul Rosenthal
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Kelvin Higa
- Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California
| | - Matthias Lannoo
- Department of General Surgery, University Hospital Leuven, Leuven, Belgium
| | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dimitri A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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29
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Abstract
Background Gastroesophageal reflux disease (GERD) is strongly associated with excess body weight. Summary GERD is characterized by typical symptoms with or without mucosal damage because of retrograde flow of gastric content into the esophagus. An ineffective esophagogastric junction (EGJ) combined with anatomical abnormalities is considered to be causative. The incidence of GERD is strongly associated with excess body weight, reflecting the pathophysiological relevance of the abdominothoracic pressure gradient. Key Message Weight loss has been demonstrated to be an effective therapy for GERD combined with obesity. In cases in which surgical therapy is indicated, traditional antireflux surgery has led to equivocal results, advocating a proximal Roux-en-Y gastric bypass in these patients to correct both GERD and excess body weight.
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Affiliation(s)
- Andreas Thalheimer
- Department of Visceral and Transplant Surgery, University Hospital of Zürich, Zurich, Switzerland.,Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital of Zürich, Zurich, Switzerland.,Department of Surgery, Spital Männedorf, Männedorf, Switzerland
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30
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Gero D, File B, Alceste D, Frick LD, Serra M, Ismaeil AE, Steinert RE, Spector AC, Bueter M. Microstructural changes in human ingestive behavior after Roux-en-Y gastric bypass during liquid meals. JCI Insight 2021; 6:e136842. [PMID: 34369388 PMCID: PMC8410040 DOI: 10.1172/jci.insight.136842] [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: 02/20/2020] [Accepted: 06/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) decreases energy intake and is, therefore, an effective treatment of obesity. The behavioral bases of the decreased calorie intake remain to be elucidated. We applied the methodology of microstructural analysis of meal intake to establish the behavioral features of ingestion in an effort to discern the various controls of feeding as a function of RYGB. METHODS The ingestive microstructure of a standardized liquid meal in a cohort of 11 RYGB patients, in 10 patients with obesity, and in 10 healthy-weight adults was prospectively assessed from baseline to 1 year with a custom-designed drinkometer. Statistics were performed on log-transformed ratios of change from baseline so that each participant served as their own control, and proportional increases and decreases were numerically symmetrical. Data-driven (3 seconds) and additional burst pause criteria (1 and 5 seconds) were used. RESULTS At baseline, the mean meal size (909.2 versus 557.6 kCal), burst size (28.8 versus 17.6 mL), and meal duration (433 versus 381 seconds) differed between RYGB patients and healthy-weight controls, whereas suck volume (5.2 versus 4.6 mL) and number of bursts (19.7 versus 20.1) were comparable. At 1 year, the ingestive differences between the RYGB and healthy-weight groups disappeared due to significantly decreased burst size (P = 0.008) and meal duration (P = 0.034) after RYGB. The first-minute intake also decreased after RYGB (P = 0.022). CONCLUSION RYGB induced dynamic changes in ingestive behavior over the first postoperative year. While the eating pattern of controls remained stable, RYGB patients reduced their meal size by decreasing burst size and meal duration, suggesting that increased postingestive sensibility may mediate postbariatric ingestive behavior. TRIAL REGISTRATION NCT03747445; https://clinicaltrials.gov/ct2/show/NCT03747445. FUNDING This work was supported by the University of Zurich, the Swiss National Fund (32003B_182309), and the Olga Mayenfisch Foundation. Bálint File was supported by the Hungarian Brain Research Program Grant (grant no. 2017-1.2.1-NKP-2017-00002).
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Bálint File
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary.,Wigner Research Centre for Physics, Budapest, Hungary.,Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Daniela Alceste
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Lukas D Frick
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Michele Serra
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Aiman Em Ismaeil
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Robert E Steinert
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Alan C Spector
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, Florida, USA
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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31
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Vonlanthen R, Widmer J, Thalheimer A, Himpens J, Hollymann M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Objective
Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.
Methods
The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.
Results
Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.
Conclusion
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- D Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - S Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - E Deleus
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Lloyd
- Department of Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, USA
| | - E Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - G Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - I Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A San Martin
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - L Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - H Sammalkorpi
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - J L Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - T Tatarian
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - T Wiggins
- Bariatric and Metabolic Surgery Center, Musgrove Park Hospital, Taunton, United Kingdom
| | - E Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - J -P Goreux
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
| | - R Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - M Hollymann
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Aggarwal
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - A Beekley
- Bariatric and Metabolic Surgery Center, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - M Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - A Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Juuti
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - P Salminen
- Department of Surgery, University of Turku, Turku, Finland
| | - G Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - A Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Boza
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - R Rosenthal
- Bariatric and Metabolic Surgery Department, Cleveland Clinic Florida, Weston, USA
| | - K Higa
- Bariatric and Metabolic Surgery Center, Fresno Heart and Surgical Hospital, Fresno, USA
| | - M Lannoo
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - B Dillemans
- Department of Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - P -A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingkom
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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32
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Kraljević M, Schneider R, Wölnerhanssen B, Bueter M, Delko T, Peterli R. Different limb lengths in gastric bypass surgery: study protocol for a Swiss multicenter randomized controlled trial (SLIM). Trials 2021; 22:352. [PMID: 34011386 PMCID: PMC8136210 DOI: 10.1186/s13063-021-05313-6] [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: 08/10/2020] [Accepted: 05/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background Obesity and type 2 diabetes mellitus are reaching epidemic proportions. In morbidly obese patients, bariatric operations lead to sustained weight loss and relief of comorbidities in the majority of patients. Laparoscopic Roux-Y-gastric bypass (RYGB) is one of the most frequently performed operations, but it is still unknown why some patients respond better than others. Therefore, a number of variations of this operation have been introduced. Recent evidence suggests that a longer bypassed biliopancreatic limb (BPL) has the potential to be more effective compared to the standard RYGB with a shorter BPL length. This article describes the design and protocol of a randomized controlled trial comparing the outcome of a RYGB operation with a long versus short BPL. Methods/design The trial is designed as a multicenter, randomized, patient- and observer-blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that long BPL RYGB is superior compared to short BPL RYGB in terms of weight loss and resolution of T2DM, the study is conducted as a superiority trial. Postoperative percent total weight loss and nutritional deficiency rate are the primary endpoints, whereas morbidity, mortality, remission of obesity-related comorbidities and quality of life are secondary endpoints. Eight hundred patients, between 18 and 65 years and with a body mass index (BMI) from 35 to 60 kg/m2 who meet the regulatory rules for bariatric surgery in Switzerland, will be randomized. The endpoints and baseline measurements will be assessed pre-, intra-, and postoperatively. Discussion With its high number of patients and a 5-year follow-up, this study will answer questions about effectiveness and safety of long BPL RYGB and provide level I evidence for improvement of the standard RYGB. These findings might therefore potentially influence global bariatric surgery guidelines. Trial registration ClinicalTrials.gov NCT04219787. Registered on 7 January 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05313-6.
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Affiliation(s)
- Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | | | - Marco Bueter
- Department of Visceral Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland
| | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland.
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33
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Wölnerhanssen BK, Peterli R, Hurme S, Bueter M, Helmiö M, Juuti A, Meyer-Gerspach AC, Slawik M, Peromaa-Haavisto P, Nuutila P, Salminen P. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: 5-year outcomes of merged data from two randomized clinical trials (SLEEVEPASS and SM-BOSS). Br J Surg 2021; 108:49-57. [PMID: 33640917 DOI: 10.1093/bjs/znaa011] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/03/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are both effective surgical procedures to achieve weight reduction in patients with obesity. The trial objective was to merge individual-patient data from two RCTs to compare outcomes after LSG and LRYGB. METHODS Five-year outcomes of the Finnish SLEEVEPASS and Swiss SM-BOSS RCTs comparing LSG with LRYGB were analysed. Both original trials were designed to evaluate weight loss. Additional patient-level data on type 2 diabetes (T2DM), obstructive sleep apnoea, and complications were retrieved. The primary outcome was percentage excess BMI loss (%EBMIL). Secondary predefined outcomes in both trials included total weight loss, remission of co-morbidities, improvement in quality of life (QoL), and overall morbidity. RESULTS At baseline, 228 LSG and 229 LRYGB procedures were performed. Five-year follow-up was available for 199 of 228 patients (87.3 per cent) after LSG and 199 of 229 (87.1 per cent) after LRYGB. Model-based mean estimate of %EBMIL was 7.0 (95 per cent c.i. 3.5 to 10.5) percentage points better after LRYGB than after LSG (62.7 versus 55.5 per cent respectively; P < 0.001). There was no difference in remission of T2DM, obstructive sleep apnoea or QoL improvement; remission for hypertension was better after LRYGB compared with LSG (60.3 versus 44.9 per cent; P = 0.049). The complication rate was higher after LRYGB than LSG (37.2 versus 22.5 per cent; P = 0.001), but there was no difference in mean Comprehensive Complication Index value (30.6 versus 31.0 points; P = 0.859). CONCLUSION Although LRYGB induced greater weight loss and better amelioration of hypertension than LSG, there was no difference in remission of T2DM, obstructive sleep apnoea, or QoL at 5 years. There were more complications after LRYGB, but the individual burden for patients with complications was similar after both operations.
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Affiliation(s)
- B K Wölnerhanssen
- St Clara Research Ltd, St Clara Hospital, Basle, Switzerland.,University of Basle, Basle, Switzerland
| | - R Peterli
- University of Basle, Basle, Switzerland.,Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital Basle, Basle, Switzerland
| | - S Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital, Zürich, Switzerland
| | - M Helmiö
- Department of Digestive Surgery, Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - A Juuti
- Department of Abdominal Surgery, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A C Meyer-Gerspach
- St Clara Research Ltd, St Clara Hospital, Basle, Switzerland.,University of Basle, Basle, Switzerland
| | - M Slawik
- Department of Internal Medicine and Endocrinology, St. Clara Hospital, Basle, Switzerland
| | - P Peromaa-Haavisto
- Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.,Department of Surgery, Hatanpää City Hospital, Tampere, Finland
| | - P Nuutila
- Department of Endocrinology, Turku University Hospital, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - P Salminen
- Department of Digestive Surgery, Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Department of Surgery, Satasairaala Central Hospital, Pori, Finland
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34
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Raguz I, Burger R, Vonlanthen R, Bueter M, Thalheimer A. Pitfalls of laparoscopic Re-TAPP in recurrent inguinal hernia repair-a plea for extended preoperative diagnostic. J Surg Case Rep 2021; 2021:rjab085. [PMID: 33815757 PMCID: PMC8007179 DOI: 10.1093/jscr/rjab085] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/24/2021] [Indexed: 11/14/2022] Open
Abstract
According to international guidelines, recurrent inguinal hernia should be treated by a surgical approach opposing of the primary strategy (anterior–posterior or posterior–anterior). However, recent evidence demonstrates feasibility and safety of re-laparoscopic repair of recurrent inguinal hernia after primary laparoscopy. For such a strategy, correct identification of anatomical structures is challenging, but absolutely crucial for a satisfactory postoperative result. This case of an unrecognized sliding hernia of the sigmoid colon during re-laparoscopy highlights that a precise physical examination as well as an extended preoperative radiological workup (ultrasound, computed tomography and/or magnetic resonance imaging of the abdomen and pelvis) should be considered prior to re-laparoscopy of recurrent inguinal hernia.
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Affiliation(s)
- Ivana Raguz
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Reint Burger
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Rene Vonlanthen
- Department of Visceral and Transplant Surgery, University Hospital of Zürich, Zürich, Switzerland
| | - Marco Bueter
- Department of Surgery, Spital Männedorf, Männedorf, Switzerland
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35
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Pfister D, Núñez NG, Pinyol R, Govaere O, Pinter M, Szydlowska M, Gupta R, Qiu M, Deczkowska A, Weiner A, Müller F, Sinha A, Friebel E, Engleitner T, Lenggenhager D, Moncsek A, Heide D, Stirm K, Kosla J, Kotsiliti E, Leone V, Dudek M, Yousuf S, Inverso D, Singh I, Teijeiro A, Castet F, Montironi C, Haber PK, Tiniakos D, Bedossa P, Cockell S, Younes R, Vacca M, Marra F, Schattenberg JM, Allison M, Bugianesi E, Ratziu V, Pressiani T, D'Alessio A, Personeni N, Rimassa L, Daly AK, Scheiner B, Pomej K, Kirstein MM, Vogel A, Peck-Radosavljevic M, Hucke F, Finkelmeier F, Waidmann O, Trojan J, Schulze K, Wege H, Koch S, Weinmann A, Bueter M, Rössler F, Siebenhüner A, De Dosso S, Mallm JP, Umansky V, Jugold M, Luedde T, Schietinger A, Schirmacher P, Emu B, Augustin HG, Billeter A, Müller-Stich B, Kikuchi H, Duda DG, Kütting F, Waldschmidt DT, Ebert MP, Rahbari N, Mei HE, Schulz AR, Ringelhan M, Malek N, Spahn S, Bitzer M, Ruiz de Galarreta M, Lujambio A, Dufour JF, Marron TU, Kaseb A, Kudo M, Huang YH, Djouder N, Wolter K, Zender L, Marche PN, Decaens T, Pinato DJ, Rad R, Mertens JC, Weber A, Unger K, Meissner F, Roth S, Jilkova ZM, Claassen M, Anstee QM, Amit I, Knolle P, Becher B, Llovet JM, Heikenwalder M. NASH limits anti-tumour surveillance in immunotherapy-treated HCC. Nature 2021. [PMID: 33762733 DOI: 10.1038/s41586-021-03362-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hepatocellular carcinoma (HCC) can have viral or non-viral causes1-5. Non-alcoholic steatohepatitis (NASH) is an important driver of HCC. Immunotherapy has been approved for treating HCC, but biomarker-based stratification of patients for optimal response to therapy is an unmet need6,7. Here we report the progressive accumulation of exhausted, unconventionally activated CD8+PD1+ T cells in NASH-affected livers. In preclinical models of NASH-induced HCC, therapeutic immunotherapy targeted at programmed death-1 (PD1) expanded activated CD8+PD1+ T cells within tumours but did not lead to tumour regression, which indicates that tumour immune surveillance was impaired. When given prophylactically, anti-PD1 treatment led to an increase in the incidence of NASH-HCC and in the number and size of tumour nodules, which correlated with increased hepatic CD8+PD1+CXCR6+, TOX+, and TNF+ T cells. The increase in HCC triggered by anti-PD1 treatment was prevented by depletion of CD8+ T cells or TNF neutralization, suggesting that CD8+ T cells help to induce NASH-HCC, rather than invigorating or executing immune surveillance. We found similar phenotypic and functional profiles in hepatic CD8+PD1+ T cells from humans with NAFLD or NASH. A meta-analysis of three randomized phase III clinical trials that tested inhibitors of PDL1 (programmed death-ligand 1) or PD1 in more than 1,600 patients with advanced HCC revealed that immune therapy did not improve survival in patients with non-viral HCC. In two additional cohorts, patients with NASH-driven HCC who received anti-PD1 or anti-PDL1 treatment showed reduced overall survival compared to patients with other aetiologies. Collectively, these data show that non-viral HCC, and particularly NASH-HCC, might be less responsive to immunotherapy, probably owing to NASH-related aberrant T cell activation causing tissue damage that leads to impaired immune surveillance. Our data provide a rationale for stratification of patients with HCC according to underlying aetiology in studies of immunotherapy as a primary or adjuvant treatment.
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Affiliation(s)
- Dominik Pfister
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Liver Disease Research, Global Drug Discovery, Novo Nordisk A/S, Malov, Denmark
| | | | - Roser Pinyol
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, Liver Unit, Universitat de Barcelona, Barcelona, Spain
| | - Olivier Govaere
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Matthias Pinter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Marta Szydlowska
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Revant Gupta
- Internal Medicine I, University Hospital Tübingen, Faculty of Medicine, University of Tübingen, Tübingen, Germany.,Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Mengjie Qiu
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Assaf Weiner
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Florian Müller
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ankit Sinha
- Experimental Systems Immunology Laboratory, Max-Planck Institute of Biochemistry, Munich, Germany.,Institute of Translational Cancer Research and Experimental Cancer Therapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ekaterina Friebel
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Thomas Engleitner
- Center for Translational Cancer Research (TranslaTUM), Technical University Munich, Munich, Germany.,Department of Medicine II, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Munich, Germany
| | - Daniela Lenggenhager
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, Zurich, Switzerland
| | - Anja Moncsek
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Danijela Heide
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Stirm
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan Kosla
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eleni Kotsiliti
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Valentina Leone
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Research Unit of Radiation Cytogenetics, Helmholtz Zentrum Munich, Munich, Germany
| | - Michael Dudek
- Institute of Molecular Immunology and Experimental Oncology, Technical University Munich, Munich, Germany
| | - Suhail Yousuf
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), Heidelberg, Germany.,European Center of Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Indrabahadur Singh
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Emmy Noether Research Group Epigenetic Machineries and Cancer, Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ana Teijeiro
- Cancer Cell Biology Programme, Growth Factors, Nutrients and Cancer Group, Spanish National Cancer Research Centre, CNIO, Madrid, Spain
| | - Florian Castet
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, Liver Unit, Universitat de Barcelona, Barcelona, Spain
| | - Carla Montironi
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, Liver Unit, Universitat de Barcelona, Barcelona, Spain
| | - Philipp K Haber
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dina Tiniakos
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,Department of Pathology, Aretaeion Hospita, National and Kapodistrian University of Athens, Athens, Greece
| | - Pierre Bedossa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Simon Cockell
- Bioinformatics Support Unit, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Ramy Younes
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turn, Italy
| | - Michele Vacca
- University of Cambridge Metabolic Research Laboratories, Wellcome-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Fabio Marra
- Dipartimento di Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, I. Department of Medicine, University Medical Center Mainz, Mainz, Germany
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University NHS Foundation Trust, Cambridge, UK
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastro-Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turn, Italy
| | - Vlad Ratziu
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, University Paris-Diderot, Paris, France
| | - Tiziana Pressiani
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Antonio D'Alessio
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Nicola Personeni
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ann K Daly
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Bernhard Scheiner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Katharina Pomej
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,University Medical Center Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Markus Peck-Radosavljevic
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Florian Hucke
- Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology including Centralized Emergency Department (ZAE), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Fabian Finkelmeier
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt, Germany
| | - Oliver Waidmann
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt, Germany
| | - Jörg Trojan
- Department of Gastroenterology, Hepatology and Endocrinology, University Hospital Frankfurt, Frankfurt, Germany
| | - Kornelius Schulze
- Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Wege
- Department of Internal Medicine, Gastroenterology & Hepatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Koch
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Rössler
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Siebenhüner
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sara De Dosso
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Jan-Philipp Mallm
- Division of Chromatin Networks, German Cancer Research Center (DKFZ) and Bioquant, Heidelberg, Germany
| | - Viktor Umansky
- Clinical Cooperation Unit Dermato-Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Heidelberg, Germany
| | - Manfred Jugold
- Core Facility Small Animal Imaging, German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Andrea Schietinger
- Immunology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Immunology and Microbial Pathogenesis Program, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Brinda Emu
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hellmut G Augustin
- Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), Heidelberg, Germany.,European Center of Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Hiroto Kikuchi
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Dan G Duda
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Fabian Kütting
- Department of Gastroenterology and Hepatology, University of Cologne, Cologne, Germany
| | | | - Matthias Philip Ebert
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Nuh Rahbari
- Department of Surgery at University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Henrik E Mei
- Mass Cytometry Lab, Deutsches Rheumaforschungszentrum Berlin, a Leibniz Institute, Berlin, Germany
| | - Axel Ronald Schulz
- Mass Cytometry Lab, Deutsches Rheumaforschungszentrum Berlin, a Leibniz Institute, Berlin, Germany
| | - Marc Ringelhan
- Institute of Virology, Technical University Munich/Helmholtz Zentrum Munich, Munich, Germany.,Department of Internal Medicine II, University Hospital rechts der Isar, Technical University Munich, Munich, Germany.,German Center for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Nisar Malek
- Medical University Hospital Department of Internal Medicine I, Tübingen, Germany
| | - Stephan Spahn
- Medical University Hospital Department of Internal Medicine I, Tübingen, Germany
| | - Michael Bitzer
- Medical University Hospital Department of Internal Medicine I, Tübingen, Germany
| | - Marina Ruiz de Galarreta
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amaia Lujambio
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Francois Dufour
- University Clinic for Visceral Surgery and Medicine, Inselspital, Bern, Switzerland.,Hepatology, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Thomas U Marron
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Mount Sinai Hospital, New York, NY, USA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-, Sayama, Japan
| | - Yi-Hsiang Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nabil Djouder
- Cancer Cell Biology Programme, Growth Factors, Nutrients and Cancer Group, Spanish National Cancer Research Centre, CNIO, Madrid, Spain
| | - Katharina Wolter
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen, Germany.,Cluster of Excellence 'Image Guided and Functionally Instructed Tumor Therapies' (iFIT), Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Lars Zender
- Department of Medical Oncology and Pneumology (Internal Medicine VIII), University Hospital Tübingen, Tübingen, Germany.,Cluster of Excellence 'Image Guided and Functionally Instructed Tumor Therapies' (iFIT), Eberhard-Karls University of Tübingen, Tübingen, Germany.,German Consortium for Translational Cancer Research (DKTK), Partner Site Tübingen, German Cancer Research Center (DKFZ), Tübingen, Germany
| | - Parice N Marche
- Université Grenoble Alpes, Grenoble, France.,Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Grenoble, France
| | - Thomas Decaens
- Université Grenoble Alpes, Grenoble, France.,Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Grenoble, France.,Service d'hépato-gastroentérologie, Pôle Digidune, CHU Grenoble Alpes, Grenoble, France
| | - David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK.,Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Roland Rad
- Center for Translational Cancer Research (TranslaTUM), Technical University Munich, Munich, Germany.,Department of Medicine II, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Munich, Germany
| | - Joachim C Mertens
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Achim Weber
- Department of Pathology and Molecular Pathology, University and University Hospital Zurich, Zurich, Switzerland.,Institute of Molecular Cancer Research (IMCR), University of Zurich, Zurich, Switzerland
| | - Kristian Unger
- Research Unit of Radiation Cytogenetics, Helmholtz Zentrum Munich, Munich, Germany
| | - Felix Meissner
- Experimental Systems Immunology Laboratory, Max-Planck Institute of Biochemistry, Munich, Germany
| | - Susanne Roth
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Zuzana Macek Jilkova
- Université Grenoble Alpes, Grenoble, France.,Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Grenoble, France.,Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Manfred Claassen
- Internal Medicine I, University Hospital Tübingen, Faculty of Medicine, University of Tübingen, Tübingen, Germany.,Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Quentin M Anstee
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.,Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Ido Amit
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Percy Knolle
- Institute of Molecular Immunology and Experimental Oncology, Technical University Munich, Munich, Germany
| | - Burkhard Becher
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Josep M Llovet
- Liver Cancer Translational Research Laboratory, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-Hospital Clínic, Liver Unit, Universitat de Barcelona, Barcelona, Spain. .,Mount Sinai Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
| | - Mathias Heikenwalder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Sommerhalder B, Burger R, Bueter M, Thalheimer A. An unusual reason for an inguinal swelling: De Garengeot's hernia. J Surg Case Rep 2021; 2021:rjab083. [PMID: 33777353 PMCID: PMC7984844 DOI: 10.1093/jscr/rjab083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/29/2021] [Accepted: 02/18/2021] [Indexed: 12/04/2022] Open
Abstract
We present the case of a 71-year-old female with an inguinal swelling. Intra-abdominally the appendix was found in a femoral hernia sac (De Garengeot’s hernia). A laparoscopic transabdominal preperitoneal hernia repair procedure was performed with uneventful post-operative course. Clinical presentation of this type of hernia is unspecific and often not to be distinguished from a common incarcerated hernia. Computed tomography can be helpful in obtaining a diagnosis, although the definite diagnosis is mostly found intraoperatively. As surgical options are numerous, there is no consensus on the most suitable one. A laparoscopic approach incorporates the benefit of a total abdominal overview and the possibility of standard procedures. If the appendix appears normal, the use of synthetic mesh is considered safe and an incidental appendectomy is not necessarily required.
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Affiliation(s)
| | - Reint Burger
- Department of General Surgery, Spital Männedorf, Männedorf, Switzerland
| | - Marco Bueter
- Department of General Surgery, Spital Männedorf, Männedorf, Switzerland
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Rössler F, Hübel K, Di Natale S, Oberkofler C, Gerber P, Bueter M, de Rougemont O. Sleeve gastrectomy enables simultaneous pancreas and kidney transplantation in severely obese recipients. Clin Transplant 2020; 35:e14197. [PMID: 33340422 DOI: 10.1111/ctr.14197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/08/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity adversely affects wait-listing and precludes patients with concomitant end-stage renal disease and type 1 diabetes mellitus from getting a simultaneous pancreas and kidney transplantation (SPK). OBJECTIVE To analyze safety and efficacy of laparoscopic sleeve gastrectomy (LSG) before SPK in severely obese type I diabetics. METHODS We assessed weight curve, complications, and graft function of three patients who underwent LSG before SPK. RESULTS LSG was uneventful in all patients. Body mass index dropped from 38.4 (range 35.7 - 39.9) before LSG to 28.5 (26.8 - 30.9) until SPK, with a mean loss of 25.8% (22.4 - 32.3). Interval between LSG and SPK was 364.3 (173 - 587) days. Pancreas and kidney graft function was excellent, with 100% insulin-free and dialysis-free survival over a mean follow-up of 3.6 (2.9 - 4.5) years. A1C dropped from 7% (6.3 - 8.2) before LSG to 4.9% (4.7 - 5.3) and 4.8% (4.5 - 5.1) 1 and 2 years after SPK, respectively. CONCLUSION LSG before SPK is safe and effective to enable severely obese type I diabetics to receive a lifesaving transplant. This is the first study analyzing the role of bariatric surgery before simultaneous pancreas and kidney transplantation.
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Affiliation(s)
- Fabian Rössler
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Kerstin Hübel
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Samuela Di Natale
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christian Oberkofler
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Philipp Gerber
- Department of Endocrinology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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Gero D, Schneider MA, Suter M, Peterli R, Vonlanthen R, Turina M, Bueter M. Sleeve gastrectomy or gastric bypass: a "post-code" lottery? A comprehensive national analysis of the utilization of bariatric surgery in Switzerland between 2011-2017. Surg Obes Relat Dis 2020; 17:563-574. [PMID: 33281057 DOI: 10.1016/j.soard.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/18/2020] [Revised: 10/10/2020] [Accepted: 10/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) recently became the most frequently performed bariatric surgery (BS) worldwide, overtaking the long-time standard Roux-en-Y gastric bypass (RYGB). Main indications for one or the other procedure show large inter-center variations and warrant further investigations. OBJECTIVES The aim of this study was to identify the influencers of primary BS selection in Switzerland. SETTING Switzerland. METHODS Retrospective analysis of all hospitalizations in Switzerland January 1, 2011 through December 31, 2017 with anonymized data provided by the Swiss Federal Statistical Office. BS procedures were identified based on ICD-10 and national surgical codes. Statistical analyses were performed with R. RESULTS During the study period 27,375 BS were performed. The annual BS caseload doubled over time, whereas inpatient complications decreased (∼-33%). RYGB was the prevailing procedure, although its annual proportion decreased from 80% to 70% over 7 years. Meanwhile, use of SG increased from 14% to 23%. Primary RYGB and SG had similar rates of inpatient mortality (∼.05%) and morbidity (8.0 versus 7.4%, P =.148), with the exception of higher ileus rates following RYGB (.7 versus .1%, P < .001). Patient-related factors favoring the indication of SG were male sex, extremes of age, and metabolic co-morbidities , while gastroesophageal reflux disease and private insurance-favored RYGB. Strikingly, differences between geographic regions outweighed patient-related factors in procedure selection: inhabitants of German- and Italian-speaking areas had higher likelihood (OR 4.6; 3.9, P < .001) to receive SG than those in French-speaking areas. CONCLUSION Geographic differences in primary BS procedure selection indicate a lack of objective rationales. Long-term risk-benefit and cost-effectiveness analyses are needed to assist evidence-based decision making.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marcel A Schneider
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Michel Suter
- Department of Surgery, Hopital Riviera-Chablais, Rennaz, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
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39
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Lutz TA, Bueter M, Geary N. Introduction to the special issue "bariatric surgery and appetite". Appetite 2020; 155:104810. [PMID: 32750394 DOI: 10.1016/j.appet.2020.104810] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Nori Geary
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, 10025, USA(1).
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Steinert RE, Rehman A, Souto Lima EJ, Agamennone V, Schuren FHJ, Gero D, Schreiner P, Vonlanthen R, Ismaeil A, Tzafos S, Hosa H, Vetter D, Misselwitz B, Bueter M. Roux-en-Y gastric bypass surgery changes fungal and bacterial microbiota in morbidly obese patients-A pilot study. PLoS One 2020; 15:e0236936. [PMID: 32735609 PMCID: PMC7394366 DOI: 10.1371/journal.pone.0236936] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/16/2020] [Indexed: 02/07/2023] Open
Abstract
The Roux-en-Y gastric bypass (RYGB) remains the most effective treatment for morbidly obese patients to lower body weight and improve glycemic control. There is recent evidence that the mycobiome (fungal microbiome) can aggravate disease severity in a number of diseases including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and hepatitis; moreover, a dysbiotic fungal microbiota has been reported in the obese. We characterized fungal and bacterial microbial composition in fecal samples of 16 morbidly obese patients before and three months after RYGB surgery and compared with nine healthy controls. We found that RYGB surgery induced a clear alteration in structure and composition of the gut fungal and bacterial microbiota. Beta diversity analysis revealed significant differences in bacterial microbiota between obese patients before surgery and healthy controls (P < 0.005) and a significant, unidirectional shift in RYGB patients after surgery (P < 0.001 vs. before surgery). In contrast, there was no significant difference in fungal microbiota between groups but individually specific changes after RYGB surgery. Interestingly, RYGB surgery induced a significant reduction in fungal alpha diversity namely Chao1, Sobs, and Shannon diversity index (P<0.05, respectively) which contrasts the trend for uniform changes in bacteria towards increased richness and diversity post-surgery. We did not observe any inter-kingdom relations in RYGB patients but in the healthy control cohort and there were several correlations between fungi and bacteria and clinical parameters (P<0.05, respectively) that warrant further research. Our study identifies changes in intestinal fungal communities in RYGB patients that are distinct to changes in the bacterial microbiota.
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Affiliation(s)
- Robert E. Steinert
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- * E-mail:
| | - Ateequr Rehman
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Everton Job Souto Lima
- Microbiology and Systems Biology, The Netherlands Organization for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Valeria Agamennone
- Microbiology and Systems Biology, The Netherlands Organization for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Frank H. J. Schuren
- Microbiology and Systems Biology, The Netherlands Organization for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Daniel Gero
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Phillip Schreiner
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - René Vonlanthen
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Aiman Ismaeil
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
- Department of Surgery, Aswan University, Tingar, Egypt
| | - Stefanos Tzafos
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Hanna Hosa
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Vetter
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Benjamin Misselwitz
- Division of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Marco Bueter
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
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Gero D, File B, Hinrichs N, Mueller M, Ulbert I, Somogyvári Z, Bueter M. Mental and emotional representations of "weight loss": free-word association networks in members of bariatric surgery-related social media communities. Surg Obes Relat Dis 2020; 16:1312-1320. [PMID: 32665114 DOI: 10.1016/j.soard.2020.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/18/2019] [Revised: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mindset and communication barriers may hinder the acceptance of bariatric surgery (BS) by the eligible patient population. OBJECTIVES To improve the understanding of expectations, opinions, emotions, and attitudes toward weight loss among patients with obesity. SETTING Switzerland, Germany, Austria. METHODS Survey data collected from BS-related social media communities (n = 1482). Participants were asked to write 5 words that first came to their mind about "weight loss," and to select 2 emotions, which best described their corresponding feelings. Demographic and obesity-related data were collected. Cognitive representations were constructed based on the co-occurrence network of associations, using validated data-driven methodology. RESULTS Respondents were Caucasian (98%), female (94%), aged 42.5 ± 10.1 years, current/highest lifetime body mass index = 36.9 ± 9/50.7 ± 8.7 kg/m2. The association network analysis revealed the following 2 cognitive modules: benefit-focused (health, attractiveness, happiness, agility) and procedure-focused (effort, diet, sport, surgery). Patients willing to undergo BS were more benefit-focused (odds ratio [OR] = 2.4, P = .02) and expressed more "hope" (OR = 142, P < .001). History of BS was associated with higher adherence to the procedure-focused module (OR = 2.3, P < .001), and with increased use of the emotions "gratitude" (OR = 107, P < .001), "pride" (OR = 15, P < .001), and decreased mention of "hope" (OR = .03, P < .001). CONCLUSION Patients with obesity in our study tend to think about weight loss along 2 cognitive schemes, either emphasizing its expected benefits or focusing on the process of achieving it. Benefit-focused respondents were more likely to consider BS, and to express hope rather than gratitude or pride. Novel communication strategies may increase the acceptance of BS by incorporating weight loss-related cognitive and emotional content stemming from patients' free associations.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Bálint File
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary; Wigner Research Centre for Physics, Hungarian Academy of Sciences, Budapest, Hungary
| | - Noreen Hinrichs
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Mueller
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - István Ulbert
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary; Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Zoltán Somogyvári
- Wigner Research Centre for Physics, Hungarian Academy of Sciences, Budapest, Hungary
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
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42
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Hyde KM, Blonde GD, Bueter M, le Roux CW, Spector AC. Gastric bypass in female rats lowers concentrated sugar solution intake and preference without affecting brief-access licking after long-term sugar exposure. Am J Physiol Regul Integr Comp Physiol 2020; 318:R870-R885. [PMID: 32083966 DOI: 10.1152/ajpregu.00240.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/28/2022]
Abstract
In rodents, Roux-en-Y gastric bypass (RYGB) decreases intake of, and preference for, foods or fluids that are high in sugar. Whether these surgically induced changes are due to decreases in the palatability of sugar stimuli is controversial. We used RYGB and sham-operated (SHAM) female rats to test the influence of prolonged ingestive experience with sugar solutions on the motivational potency of these stimuli to drive licking in brief-access (BA) tests. In experiment 1, RYGB attenuated intake of, and caloric preference for, 0.3 M sucrose during five consecutive, 46-h two-bottle tests (TBTs; sucrose). A second series of TBTs (5 consecutive, 46-h tests) with 1.0 M sucrose revealed similar results, except fluid preference for 1.0 M sucrose also significantly decreased. Before, between, and after the two series of TBTs, two sessions of BA tests (30 min; 10-s trials) with an array of sucrose concentrations (0 and 0.01-1.0 M) were conducted. Concentration-dependent licking and overall trial initiation did not differ between surgical groups in any test. In a similar experimental design in a second cohort of female rats, 0.6 and 2.0 M glucose (isocaloric with sucrose concentrations in experiment 1) were used in the TBTs; 0 and 0.06-2.0 M glucose were used in the BA tests. Outcomes were similar to those for experiment 1, except RYGB rats initiated fewer trials during the BA tests. Although RYGB profoundly affected intake of, and caloric preference for, sugar solutions and, with high concentrations, fluid preference, RYGB never influenced the motivational potency of sucrose or glucose to drive concentration-dependent licking in BA tests.
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Affiliation(s)
- Kellie M Hyde
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Ginger D Blonde
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, Florida
| | - Marco Bueter
- Division of Visceral and Transplantation Surgery, Department of Surgery, University of Zürich, Zürich, Switzerland
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Dublin, Ireland
| | - Alan C Spector
- Department of Psychology and Program in Neuroscience, Florida State University, Tallahassee, Florida
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43
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Muller MK, Gero D, Reitnauer D, Vetter D, Eshmuminov D, Hornemann T, Bueter M. The Impact of Roux-en-Y Gastric Bypass on Bone Remodeling Expressed by the P1NP/βCTX Ratio: a Single-Center Prospective Cohort Study. Obes Surg 2020; 29:1185-1194. [PMID: 30613933 DOI: 10.1007/s11695-018-03640-3] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bariatric surgery seems to decrease bone mineral density and increase the risk of fatigue fractures. P1NP (bone formation) and βCTX (bone resorption) were recently validated as reference bone turnover markers (BTM). OBJECTIVE To assess changes in bone remodeling in severely obese patients undergoing Roux-en-Y gastric bypass (RYGB) by using a new composite biomarker, the P1NP/βCTX ratio. METHODS We prospectively collected blood samples preoperatively, at 1 month and at 1 year from 114 consecutive RYGB patients from 12/2012 to 04/2014. Repeated measures ANOVA and multiple regression were used for data analysis. Cumulative incidence of fractures was assessed in 06/2018. RESULTS The P1NP/βCTX ratio decreased significantly (P < 0.001) from baseline to 1 month and 1 year (180 ± 6.6, 110 ± 4.1, and 132 ± 5.4). The 1-year P1NP/βCTX ratio did not correlate with BMI or ΔBMI, but inversely correlated with age (r = - 0.23, P = 0.014) and with hsCRP (r = - 0.26, P = 0.009), even after adjustment for age, sex, BMI, and lifestyle, and linearly correlated with albumin (r = 0.2, P = 0.037). At baseline, none of these correlations were detectable. Serum for all time-points was available from > 94% of the patients. At a median follow-up of 4.7 years, 8 patients (7.3%) had a bone fracture, all of them traumatic. CONCLUSION Following RYGB, bone remodeling increases, with a shift toward degradation. This effect seems to be weight-loss independent and shows a correlation with age, with the level of systemic inflammation, and with nutritional state. The risk of fractures should be assessed systematically in bariatric patients and measures of prevention should be improved accordingly.
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Affiliation(s)
- Markus K Muller
- Department of Surgery, Cantonal Hospital Frauenfeld, CH-8501, Frauenfeld, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Daniela Reitnauer
- Department of Surgery, Cantonal Hospital Frauenfeld, CH-8501, Frauenfeld, Switzerland
| | - Diana Vetter
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Thorsten Hornemann
- Institute of Clinical Chemistry, University and University Hospital of Zurich, CH-8091, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland.
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44
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Lutz TA, Bueter M, Geary N. Introduction to the special issue "Bariatric Surgery and Appetite". Appetite 2019; 146:104515. [PMID: 31733227 DOI: 10.1016/j.appet.2019.104515] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Thomas A Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Nori Geary
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, 10025, USA.
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Abstract
OBJECTIVE The aim of this study was to assess the quality of patient information on bariatric surgery in the internet using the modified Ensuring Quality Information for Patients (EQIP) tool. METHODS Systematic review of information on bariatric surgery in the internet by entering common search terms into five search engines. The top 100 websites of every search term and search engine were assessed using the validated EQIP tool (maximum score, 36), which entails points for content, structure, and identification data of a given website. Websites at or above the 99th percentile were analyzed separately (n = 8). RESULTS The median EQIP score of all included websites (n = 463) was 17 (IQR 15-19). While information on the medical problem, the indication for surgery, or the treatment alternatives was present in 84% of all websites, only 10% of the included websites contained adequate information on postoperative complications. Although quantitative information on incidence (37.5%) and treatment of complications (12.5%) was significantly better in the top 99th percentile websites, the content of relevant information such as occurrence and treatment of complications was still very limited. CONCLUSION The overall quality of patient information on bariatric surgery in the internet is relatively poor. Especially incidence of complications and their treatment are rarely reported even on websites with a 99th percentile EQIP score.
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Affiliation(s)
- Diana Vetter
- Department of Abdominal Surgery- and Transplantation, University Hospital of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | | | - Dimitri A Raptis
- Department of Abdominal Surgery- and Transplantation, University Hospital of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland
| | - Marco Bueter
- Department of Abdominal Surgery- and Transplantation, University Hospital of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
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46
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Jomard A, Chavez-Talavera O, Tailleux A, Bueter M, Taheri A, Wolfrum C, Lutz TA, Von Eckardstein A, Ruschitzka F, Staels B, Osto E. P729The functional relevance of bile acids in the improvement of HDL-mediated endothelial protection after bariatric surgery. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0333] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Roux-en-Y gastric bypass (RYGB) reduces cardiovascular mortality. We showed that high density lipoproteins (HDL)-mediated vasoprotection is improved early after RYGB. Circulating BAs increase upon RYGB and contribute to the weight-loss independent metabolic improvements after surgery. Bile acids (BA) are signaling molecules increasingly recognized as regulators of cardiometabolic homeostasis. BAs circulate in the blood either free or bound to albumin and HDL. The signaling role of HDL-bound BAs (HDL-BAs) is unknown. Indeed, HDL may facilitate BA delivery directly to endothelial cells where BA may synergize with HDL to promote vasoprotection.
Purpose
We studied whether RYGB changes the composition of HDL-BA and whether HDL functional properties may be modulated by specific BA bound to HDL.
Methods
HDL were isolated by ultracentrifugation from 29 morbidly obese patients before and 1 year after RYGB. The HDL-BA composition was determined by liquid chromatography-mass spectrometry (LC/MS-MS) and HDL vasoprotective properties were evaluated ex-vivo in human aortic endothelial cells (HAEC). The size and abundance of HDL particles were determined by NMR spectroscopy in plasma.
Results
The increase in total BA concentrations observed in plasma 1 year after RYGB also translated into higher concentrations (up to 25%) of BA bound to HDL. Moreover, obesity-induced HDL dysfunction was reversed after surgery, as shown by improved HDL-mediated endothelial NO production, anti-apoptotic effects and cholesterol efflux capacity. The size function analyses showed a post-operative shift towards larger HDL. After RYGB there was a remodeling of BA bound to HDL, which are either agonists of the endothelial nuclear farnesoid X receptor (FXR), e.g. chenodeoxy-CA (CDCA), cholic acid (CA) or for the membrane TGR5 receptor, e.g. deoxy-CA (DCA). The composition-function analysis revealed that among all BA subclasses, the specific enrichment in CA and in CDCA bound to HDL correlated with an improved endothelial anti-apoptotic capacity of HDL (R −0.52, p=0.006 for CA-HDL and R −0.35, p=0.07 for CDCA-HDL). Further, the exogenous loading of CA onto healthy native HDL isolated from human serum significantly enhanced their endothelial anti-apoptotic function. In the case of obese, dysfunctional, pro-apoptotic HDL, exogenous CA loading was able to restore HDL anti-apoptotic function.
Conclusion
Exogenous loading of CA restored HDL anti-apoptotic function of HDL from obese patients mimicking the beneficial remodeling of BA bound to HDL observed after RYGB. These results suggest a crucial interaction between endothelial cells and BA in the improvement of HDL's vasoprotective properties.
Acknowledgement/Funding
Swiss national Science Foundation Ambizione and PRIMA grant to EO
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Affiliation(s)
- A Jomard
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Laboratory of Translational Nutrition Biology, Zurich, Switzerland
| | | | - A Tailleux
- Institute Pasteur of Lille, Lille, France
| | - M Bueter
- University Hospital Zurich, Zurich, Switzerland
| | - A Taheri
- University of Zurich, veterinary physiology, Zurich, Switzerland
| | - C Wolfrum
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Laboratory of Translational Nutrition Biology, Zurich, Switzerland
| | - T A Lutz
- University of Zurich, veterinary physiology, Zurich, Switzerland
| | | | - F Ruschitzka
- University Hospital Zurich, Univeristy Heart Center, Zurich, Switzerland
| | - B Staels
- Institute Pasteur of Lille, Lille, France
| | - E Osto
- University Hospital Zurich, Univeristy Heart Center, Zurich, Switzerland
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Abstract
Mechanisms of bariatric and metabolic surgery Abstract. Abstract: Under the circumstances of rising numbers of patients suffering obesity and its related comorbidities, bariatric -surgery becomes a more and more important treatment option. Thereby the Roux-en-Y gastric bypass (= RYGB) and sleeve gastrectomy (= SG) are the most frequent operations performed in this field. The significant weight loss and the observed changes in food consumption cannot be explained by mechanical restriction and caloric malabsorption as initially assumed, but seem to be rather based on a complex interplay of endocrinological, neurological and behavioral mechanisms. It is thus the aim of this article to provide a short overview on the most important physiological mechanisms of bariatric and metabolic -surgery considering the available data to date.
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Affiliation(s)
- Hanna Hosa
- Bariatrische und Endokrine Chirurgie, Universitätsspital Zürich
| | - Marco Bueter
- Bariatrische und Endokrine Chirurgie, Universitätsspital Zürich
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48
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Muller MK, Gero D, Reitnauer D, Vetter D, Eshmuminov D, Hornemann T, Bueter M. Response to Letter to the Editor: The Impact of Roux-en-Y Gastric Bypass on Bone Remodeling Expressed by the P1NP/βCTX Ratio: a Single-Center Prospective Cohort Study. Obes Surg 2019; 29:3708-3709. [PMID: 31463798 DOI: 10.1007/s11695-019-04140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Markus K Muller
- Department of Surgery, Cantonal Hospital Frauenfeld, CH-8501, Frauenfeld, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Daniela Reitnauer
- Department of Surgery, Cantonal Hospital Frauenfeld, CH-8501, Frauenfeld, Switzerland
| | - Diana Vetter
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Thorsten Hornemann
- Institute of Clinical Chemistry, University and University Hospital of Zurich, CH-8091, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland.
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49
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Raselli T, Hearn T, Wyss A, Atrott K, Peter A, Frey-Wagner I, Spalinger MR, Maggio EM, Sailer AW, Schmitt J, Schreiner P, Moncsek A, Mertens J, Scharl M, Griffiths WJ, Bueter M, Geier A, Rogler G, Wang Y, Misselwitz B. Elevated oxysterol levels in human and mouse livers reflect nonalcoholic steatohepatitis. J Lipid Res 2019; 60:1270-1283. [PMID: 31113816 PMCID: PMC6602130 DOI: 10.1194/jlr.m093229] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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] [Received: 02/26/2019] [Revised: 05/19/2019] [Indexed: 02/06/2023] Open
Abstract
Nonalcoholic steatohepatitis (NASH), a primary cause of liver disease, leads to complications such as fibrosis, cirrhosis, and carcinoma, but the pathophysiology of NASH is incompletely understood. Epstein-Barr virus-induced G protein-coupled receptor 2 (EBI2) and its oxysterol ligand 7α,25-dihydroxycholesterol (7α,25-diHC) are recently discovered immune regulators. Several lines of evidence suggest a role of oxysterols in NASH pathogenesis, but rigorous testing has not been performed. We measured oxysterol levels in the livers of NASH patients by LC-MS and tested the role of the EBI2-7α,25-diHC system in a murine feeding model of NASH. Free oxysterol profiling in livers from NASH patients revealed a pronounced increase in 24- and 7-hydroxylated oxysterols in NASH compared with controls. Levels of 24- and 7-hydroxylated oxysterols correlated with histological NASH activity. Histological analysis of murine liver samples demonstrated ballooning and liver inflammation. No significant genotype-related differences were observed in Ebi2−/− mice and mice with defects in the 7α,25-diHC synthesizing enzymes CH25H and CYP7B1 compared with wild-type littermate controls, arguing against an essential role of these genes in NASH pathogenesis. Elevated 24- and 7-hydroxylated oxysterol levels were confirmed in murine NASH liver samples. Our results suggest increased bile acid synthesis in NASH samples, as judged by the enhanced level of 7α-hydroxycholest-4-en-3-one and impaired 24S-hydroxycholesterol metabolism as characteristic biochemical changes in livers affected by NASH.
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Affiliation(s)
- Tina Raselli
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Tom Hearn
- Swansea University Medical School Singleton Park, Swansea, United Kingdom
| | - Annika Wyss
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Kirstin Atrott
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Alain Peter
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Isabelle Frey-Wagner
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Marianne R Spalinger
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Ewerton M Maggio
- Institute for Surgical Pathology University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas W Sailer
- Chemical Biology and Therapeutics, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Johannes Schmitt
- Division of Hepatology Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anja Moncsek
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Joachim Mertens
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Marco Bueter
- Department of Visceral Surgery University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andreas Geier
- Division of Hepatology Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Yuqin Wang
- Swansea University Medical School Singleton Park, Swansea, United Kingdom
| | - Benjamin Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland .,Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
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50
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Reinisch KB, Zuk G, Raptis DA, Bueter M, Guggenheim M, Stasch T, Palma AF. Autologous lipotransfer for bone defects secondary to osteomyelitis: A report of a novel method and systematic review of the literature. Int Wound J 2019; 16:916-924. [PMID: 30916475 DOI: 10.1111/iwj.13119] [Citation(s) in RCA: 5] [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: 01/07/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
Autologous bone grafting is the gold standard in patients with bone defects but is associated with significant pain and donor site morbidity. Autologous lipotransfer (fat grafting or lipofilling) has become very popular in the therapy of chronic wounds. Mesenchymal stem cells from adipose tissue are known for their regenerative, reparative, and immunomodulatory effects. This case study and review evaluates the use of autologous lipotransfer for chronic osteomyelitis in a 26-year-old patient. A 26-year-old female suffering from chronic tibial osteomyelitis was initially treated with surgical debridement and antibiotics followed by lipoharvest and autologous lipofilling. MRI and computed tomography scans were performed at 2 and 6 weeks and 6 months postoperatively. A formal systematic review of clinical trials investigating autologous lipotransfer for osteomyelitis was conducted. The patient remained asymptomatic without recurrence, and the bone defect cavity showed vascularised adipose tissue after 6 weeks, with early signs of osteogenesis. The highest foot and ankle disability index was 100. The systematic review identified 266 studies after duplicates were removed. After screening for eligibility, seven manuscripts were further assessed, with none meeting the inclusion criteria. This is the first study to report the successful use of autologous lipotransfer with early signs of osteogenesis in a patient suffering from chronic osteomyelitis. Autologous lipotransfer is relatively simple, safe, and minimally invasive, making it a potential alternative to current treatments. Further research is required to assess the safety, feasibility, and efficacy of autologous fat grafting and the mechanism of osteogenesis.
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Affiliation(s)
- Katharina B Reinisch
- Department of General Surgery and Traumatology, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Grzegorz Zuk
- Department of General Surgery and Traumatology, GZO Spital Wetzikon, Wetzikon, Switzerland
| | - Dimitri A Raptis
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Merlin Guggenheim
- Department of Hand Surgery and Plastic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Tilman Stasch
- Private Practice in Plastic und Hand Surgery, Valentis Clinic, Nairobi, Kenya
| | - Adrian F Palma
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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