1
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Clapp B, Portela R, Sharma I, Nakanishi H, Marrero K, Schauer P, Halfdanarson TR, Abu Dayyeh B, Kendrick M, Ghanem OM. Risk of non-hormonal cancer after bariatric surgery: meta-analysis of retrospective observational studies. Br J Surg 2022; 110:24-33. [PMID: 36259310 DOI: 10.1093/bjs/znac343] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obesity is associated with an increased incidence of at least 13 types of cancer. Although bariatric surgery has been associated with a reduced risk of hormonal cancers, data for non-hormonal cancers are scarce. The aim of this study was to evaluate the effect of bariatric surgery on the incidence of non-hormonal cancers. METHODS Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles between 1984 and 2018, following the PRISMA system. Meta-analysis was conducted using a random-effect model with subgroup analysis by procedure and cancer type. RESULTS From 2526 studies screened, 15 were included. There were a total of 18 583 477 patients, 947 787 in the bariatric group and 17 635 690 in the control group. In comparison to the non-surgical group, the bariatric group had a lower incidence of cancer (OR .65 (95 per cent c.i. 0.53 to 0.80); P < 0.002). In the subgroup analysis, Roux-en-Y gastric bypass and sleeve gastrectomy were associated with decreased risk of developing cancer, while no difference was observed with adjustable gastric banding. When evaluated by cancer type, liver (OR 0.417 (95 per cent c.i. 0.323 to 0.538)), colorectal (OR 0.64 (95 per cent c.i. 0.49 to 0.84)), kidney and urinary tract cancer (OR 0.77 (95 per cent c.i. 0.72 to 0.83)), oesophageal (OR 0.60 (95 per cent c.i. 0.43 to 0.85)), and lung cancer (OR 0.796 (95 per cent c.i. 0.45 to 0.80)) also presented a lower cancer incidence in the bariatric group. CONCLUSION Bariatric surgery is related to an almost 50 per cent reduction in the risk of non-hormonal cancers.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, Texas, USA
| | - Ray Portela
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ishna Sharma
- Department of Surgery, University of Connecticut, Farmington, Connecticut, USA
| | | | - Katie Marrero
- Department of Surgery, Carle Foundation Hospital General Surgery Residency, Champaign, Illinois, USA
| | - Philip Schauer
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | | | - Barham Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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2
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus report: Definition and interpretation of remission in type 2 diabetes. Diabet Med 2022; 39:e14669. [PMID: 34460965 DOI: 10.1111/dme.14669] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | | | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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3
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. J Clin Endocrinol Metab 2022; 107:1-9. [PMID: 34459898 PMCID: PMC8825709 DOI: 10.1210/clinem/dgab585] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Indexed: 11/19/2022]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c < 6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Correspondence: Matthew C. Riddle, Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR, USA. E-mail:
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, U.K
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King’s College London, London, U.K
| | - Philip Schauer
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
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4
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetologia 2021; 64:2359-2366. [PMID: 34458934 DOI: 10.1007/s00125-021-05542-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks vs benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed 'remission' as the most appropriate descriptive term, and HbA1c <48 mmol/mol (6.5%) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Philip Schauer
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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5
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Riddle MC, Cefalu WT, Evans PH, Gerstein HC, Nauck MA, Oh WK, Rothberg AE, le Roux CW, Rubino F, Schauer P, Taylor R, Twenefour D. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care 2021; 44:dci210034. [PMID: 34462270 PMCID: PMC8929179 DOI: 10.2337/dci21-0034] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 02/03/2023]
Abstract
Improvement of glucose levels into the normal range can occur in some people living with diabetes, either spontaneously or after medical interventions, and in some cases can persist after withdrawal of glucose-lowering pharmacotherapy. Such sustained improvement may now be occurring more often due to newer forms of treatment. However, terminology for describing this process and objective measures for defining it are not well established, and the long-term risks versus benefits of its attainment are not well understood. To update prior discussions of this issue, an international expert group was convened by the American Diabetes Association to propose nomenclature and principles for data collection and analysis, with the goal of establishing a base of information to support future clinical guidance. This group proposed "remission" as the most appropriate descriptive term, and HbA1c <6.5% (48 mmol/mol) measured at least 3 months after cessation of glucose-lowering pharmacotherapy as the usual diagnostic criterion. The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.
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Affiliation(s)
- Matthew C Riddle
- Division of Endocrinology, Diabetes, & Clinical Nutrition, Department of Medicine, Oregon Health & Science University, Portland, OR
| | - William T Cefalu
- Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, U.K
| | - Hertzel C Gerstein
- Population Health Research Institute and Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michael A Nauck
- Diabetes Division, Katholisches Klinikum Bochum gGmbH, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - William K Oh
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy E Rothberg
- Department of Internal Medicine, Michigan Medicine, and Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, U.K
| | | | - Roy Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K
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6
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Kashyap SR, Kheniser K, Aminian A, Schauer P, Le Roux C, Burguera B. Double-blinded, randomized, and controlled study on the effects of canagliflozin after bariatric surgery: A pilot study. Obes Sci Pract 2020; 6:255-263. [PMID: 32523714 PMCID: PMC7278903 DOI: 10.1002/osp4.409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/25/2022] Open
Abstract
Setting Bariatric surgery is indicated for patients diagnosed with obesity and type 2 diabetes. Many patients achieve type 2 diabetes remission soon after bariatric surgery. Even though most maintain good glycemic control, remission is not maintained in all patients, and as a result, some patients may relapse. Type 2 diabetes relapse is common in patients who regain weight; weight regain is prevalent 1 to 2 years after surgery. Additional pharmacotherapy may be required to aid bariatric surgery in fostering weight loss and reducing blood glucose levels. Objectives The purpose of this clinical trial was to determine the effects of canagliflozin in participants who initially achieved type 2 diabetes remission but subsequently relapsed. Methods The double‐blinded, randomized, and prospective study recruited participants (n = 16) roughly 3 years after bariatric surgery. The participants were followed for 6 months. Results Body mass index (−1.24 kg/m2) and body weight (−3.7 kg) were significantly reduced with canagliflozin therapy versus placebo. There were improvements in body fat composition as denoted by reductions in android (−3.00%) and truncal (−2.67%) fat. Also, there were differences in blood glucose and hemoglobin A1C at 6 months. Conclusion After bariatric surgery, canagliflozin improved weight loss and glycemic outcomes in participants with type 2 diabetes. Canagliflozin also facilitated improvements in body fat composition.
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Affiliation(s)
| | - Karim Kheniser
- Endocrinology and Metabolism Institute Cleveland Clinic Cleveland Ohio
| | - Ali Aminian
- Bariatric and Metabolic Institute Cleveland Clinic Cleveland Ohio
| | - Philip Schauer
- Bariatric and Metabolic Institute Cleveland Clinic Cleveland Ohio
| | - Carel Le Roux
- Diabetes Complications Research Centre, Conway Institute University College Dublin Dublin Ireland.,Investigative Science Imperial College London London UK
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7
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Donnellan E, Wazni OM, Elshazly M, Kanj M, Hussein AA, Baranowski B, Kochar A, Trulock K, Aminian A, Schauer P, Jaber W, Saliba WI. Impact of Bariatric Surgery on Atrial Fibrillation Type. Circ Arrhythm Electrophysiol 2020; 13:e007626. [DOI: 10.1161/circep.119.007626] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Obesity is an independent risk factor for atrial fibrillation (AF) and is associated with a higher AF burden. Recently, weight loss has been found to be associated with a significant reversal in AF type. Bariatric surgery (BS) is associated with reductions in inflammation, left atrial and ventricular remodeling, sleep apnea, blood pressure, and improved glycemic control, all of which may reduce AF burden. In this study, we sought to determine the impact of BS on AF type.
Methods:
We studied AF type before and after BS in 220 morbidly obese patients (body mass index, ≥40 kg/m
2
). All patients underwent extended outpatient cardiac rhythm monitoring within 12 months of BS and at least 1 year after BS.
Results:
There was a significant reduction in body mass index following BS from 49.7±9 to 37.2±9 kg/m
2
. Weight loss was the greatest in the gastric bypass group with a mean percentage weight loss of 25% compared with 19% in patients who underwent sleeve gastrectomy and 16% following gastric banding (
P
<0.0001). Significant reductions in CRP (C-reactive protein), NT-proBNP (N-terminal pro-B-type natriuretic peptide), HbA1C (glycated hemoglobin), and systolic blood pressure were observed in all 3 groups. Reversal of AF type occurred in 71% of patients following gastric bypass, 56% of patients who underwent sleeve gastrectomy, and 50% of patients following gastric banding (
P
=0.004). On Cox proportional hazards analyses, percentage weight loss was significantly associated with AF reversal (
P
=0.0002).
Conclusions:
BS is associated with significant reductions in weight, inflammatory markers, blood pressure, and AF type, and the beneficial effects appear to be the greatest in those undergoing gastric bypass surgery. This study further exemplifies the importance of weight loss and risk factor modification in AF management.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | | | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | | | | | - Kevin Trulock
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ali Aminian
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Philip Schauer
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
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8
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Rogula T, Koprivanac M, Janik MR, Petrosky JA, Nowacki AS, Dombrowska A, Kroh M, Brethauer S, Aminian A, Schauer P. Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches? Obes Surg 2019; 28:2589-2596. [PMID: 29637410 PMCID: PMC6132787 DOI: 10.1007/s11695-018-3228-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/31/2022]
Abstract
Objective The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. Summary Background Data The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques. Methods Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS). Results The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS. Conclusions TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques. Electronic supplementary material The online version of this article (10.1007/s11695-018-3228-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomasz Rogula
- University Hospital Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | - Michał Robert Janik
- University Hospital Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warszawa, Poland.
| | - Jacob A Petrosky
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amy S Nowacki
- Department of Quantitative Health Sciences in the Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Matthew Kroh
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stacy Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Philip Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Aminian A, Zajichek A, Arterburn D, Brethauer S, Nissen S, Schauer P, Kattan M. A101 Individualized Diabetes Complications Risk Scores: Future Risk of Diabetes End-Organ Complications with and without Metabolic Surgery. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Aleassa E, Keith C, Aminian A, Schauer P. A219 Positive Effects of Bariatric Surgery on Idiopathic Intracranial Hypertension. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Aminian A, Kashyap S, Cummings DE, Cherla D, Schauer P, Vangoitsenhoven R. A126 Presence of liver steatosis is associated with greater diabetes remission after gastric bypass surgery. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Donnellan E, Wazni O, Kanj M, Hussein A, Baranowski B, Lindsay B, Aminian A, Jaber W, Schauer P, Saliba W. Outcomes of Atrial Fibrillation Ablation in Morbidly Obese Patients Following Bariatric Surgery Compared With a Nonobese Cohort. Circ Arrhythm Electrophysiol 2019; 12:e007598. [DOI: 10.1161/circep.119.007598] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 11/16/2022]
Abstract
Background:
Morbid obesity is associated with unacceptable high recurrence rates following atrial fibrillation ablation. The role of risk-factor modification including weight loss and improved glycemic control in reducing arrhythmia recurrence following ablation has been highlighted in recent years. In this study, we compared arrhythmia recurrence rates in morbidly obese patients who underwent prior bariatric surgery (BS) with those of nonobese patients following atrial fibrillation ablation in addition to morbidly obese patients who did not undergo BS.
Methods:
This was a single-center observational cohort study. We matched 51 morbidly obese patients [body mass index ≥40 kg/m
2
] who had undergone prior BS in a 2:1 manner with 102 nonobese patients and 102 morbidly obese patients without prior BS on the basis of age, sex, and timing of atrial fibrillation ablation. Our primary outcome of interest was arrhythmia recurrence.
Results:
From the time of BS to ablation, BS was associated with a significant reduction in body mass index (47.6±9.3 to 36.7±7;
P
<0.0001), glycated hemoglobin (6.7±1.5 to 5.8±0.6;
P
<0.0001), and systolic blood pressure (145±13 to 118±11;
P
<0.0001). During a mean follow-up of 29±13 months following ablation, recurrent arrhythmia occurred in 10/51 (20%) patients in the BS group compared with 25/102 (24.5%) patients in the nonobese group and 56 (55%) patients in the non-BS morbidly obese group (
P
<0.0001). No procedural complications were observed in the BS group.
Conclusions:
Bariatric surgery is associated with a reduction in arrhythmia recurrence following atrial fibrillation ablation in morbidly obese patients to those of nonobese patients. Morbidly obese patients should be considered for BS before atrial fibrillation ablation.
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Affiliation(s)
- Eoin Donnellan
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Mohamed Kanj
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ayman Hussein
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | | | - Bruce Lindsay
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Ali Aminian
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Wael Jaber
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Philip Schauer
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
| | - Walid Saliba
- Department of Cardiovascular Medicine, Cleveland Clinic, OH
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13
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Connor E, Maurer K, Cooper K, Schauer P, Rose P, Michener C, Jernigan A. Referral to a weight loss specialist is associated with long-term weight control in endometrial cancer survivors: Long-term follow-up of a prospective cohort study. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.03.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Burguera B, Schauer P, Kahan S. What to Offer the 99% of Patients With Severe Obesity Who Do Not Undergo Bariatric Surgery? Mayo Clin Proc 2019; 94:957-960. [PMID: 31171134 DOI: 10.1016/j.mayocp.2018.11.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/27/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Bartolome Burguera
- Department of Endocrinology, Endocrinology and Metabolism Institute, Cleveland Clinic, OH; National Diabetes and Obesity Research Institute, Tradition, MS.
| | - Philip Schauer
- Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Scott Kahan
- George Washington University School of Medicine, Washington, DC; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Rogula T, Leifer D, Petrosky JA, Liu X, Janik M, Zeer V, Fiedorczuk P, Baczek J, Schauer P. Stapler-Less Robotic Partial Gastrectomy: a Safety and Feasibility Experimental Study. Obes Surg 2018; 29:721-728. [DOI: 10.1007/s11695-018-03634-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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16
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Aminian A, Meister K, Khorgami Z, Satava ME, Schauer P, Brethauer S. Clinical Significance of Perioperative Hyperglycemia in Bariatric Surgery: Evidence for Better Perioperative Glucose Management. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Karas L, Hanipah ZN, Meister K, Antoine H, Javier Birriel T, Schauer P, Brethauer S, Aminian A. BMI-based thromboprophylactic dosing of enoxaparin after bariatric surgery could be sub-optimal: Evidence for dosage adjustment by anti-Factor Xa in high-risk patients. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Aminian A, Punchai S, Hanipah ZN, Schauer P, Brethauer S. Bariatric Surgery as a First Line Treatment of Type 2 Diabetes in Patients with Obesity Class I and II: 89% Diabetes Remission in Long-term Follow-up. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aminian A, Daigle C, Tu C, Petrick A, Morton J, Schauer P, Brethauer S. Which Postoperative Complications Matter Most after Bariatric Surgery? Prioritizing Quality Improvement Efforts to Improve National Outcomes. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Hanipah ZN, Punchai S, Augustin T, Brethauer S, Schauer P, Aminian A. Impact of early post-bariatric surgery acute kidney injury on long-term renal function. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Hanipah ZN, Punchai S, Brethauer S, Schauer P, Aminian A. Development of De Novo Diabetes in Long-term Follow-up after Bariatric Surgery. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Aminian A, Clemence S, Alberts J, Schauer P, Brethauer S. Bariatric Surgery Decision-Making Calculator: A Novel Mobile App for Evidence-Based Clinical Practice. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Sacks J, Mulya A, Fealy C, David Mosinski J, Pagadala M, Dan O, Schauer P, Brethauer S, Kirwan JP. Increased Mitochondrial Fusion and Biogenesis in the Liver of Obese Rats Following Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Aminian A, Hanipah ZN, Punchai S, Mackey J, Brethauer S, Schauer P. Long-Term Effects of Bariatric Surgery in Patients with Insulin-Treated Type 2 Diabetes: 44% at Glycemic Target without Insulin use. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Singh T, Kochhar GS, Goh GB, Schauer P, Brethauer S, Kroh M, Aminian A, Lopez R, Dasarathy S, McCullough AJ. Safety and efficacy of bariatric surgery in patients with advanced fibrosis. Int J Obes (Lond) 2016; 41:443-449. [PMID: 27881858 DOI: 10.1038/ijo.2016.212] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/07/2016] [Accepted: 11/13/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bariatric surgery is performed safely in non-alcoholic fatty liver disease (NAFLD) patients with minimal fibrosis (stage 1-2). However, the safety and potential benefits of bariatric surgery for NAFLD with advanced fibrosis (stage 3-4) remain unclear. This study was designed to compare the safety and efficacy of bariatric surgery in patients with biopsy proven advanced fibrosis to those with minimal fibrosis. METHODS All patients who underwent bariatric surgery between 2005 and 2014 and had evidence of NAFLD with fibrosis score 3-4 (advanced fibrosis) based on the staging system defined by Kleiner et al. on intraoperative liver biopsy were included and compared with patients who had fibrosis score 1-2 (minimal fibrosis). The groups were compared for length of hospital stay after bariatric surgery and incidence of postoperative complications over a follow-up period of 1 year. An improvement in hepatic function tests before and 1 year after surgery was used as a parameter to evaluate for NAFLD improvement. RESULTS Ninety-nine patients with F3-4 (group 1) and 198 patients with F1-2 (group 2) were included. Mean age (51.9 vs 50.1 years) and body mass index (46.4 vs 46.5 kg m-2) were similar in the two groups. Median serum aspartate aminotransferase (43 vs 30 U l-1; normal 10-40 U l-1) and alanine aminotransferase (40.5 vs 34 U l-1; normal 10-50 U l-1) were significantly higher in group 1 and improved 1 year after surgery. Median length of hospital stay after surgery was higher in group 1 than that in group 2 (4 days vs 3 days; P-value=0.002). The proportion of patients developing postoperative complications over 1 year was similar in both groups (36.4% vs 32.8%; P-value=0.54). CONCLUSIONS Advanced fibrosis does not increase the risk of developing postoperative complications in medically optimized patients undergoing bariatric surgery. Improvement in serum transaminase levels suggests a reduction in hepatic necroinflammatory activity following bariatric surgery.
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Affiliation(s)
- T Singh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Gastroenterology, Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, Cleveland, OH, USA
| | - G S Kochhar
- Department of Gastroenterology, Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, Cleveland, OH, USA
| | - G B Goh
- Department of Gastroenterology, Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, Cleveland, OH, USA
| | - P Schauer
- Department of Bariatric Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S Brethauer
- Department of Bariatric Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - M Kroh
- Department of Bariatric Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A Aminian
- Department of Bariatric Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - R Lopez
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - S Dasarathy
- Department of Gastroenterology, Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, Cleveland, OH, USA.,Department of Pathobiology, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - A J McCullough
- Department of Gastroenterology, Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University Cleveland, Cleveland, OH, USA.,Department of Pathobiology, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
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bucak E, Sharma G, Hanipah ZN, Punchai S, Froylich D, Aminian A, Brethauer S, Schauer P. Outcomes of RYGB in Patients with Pulmonary Fibrosis and GERD. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Heinberg L, bucak E, Marek R, Hanipah ZN, Ashton K, Lavery M, Punchai S, Sharma G, Haskins I, Froylich D, Chang J, Tammy F, Schauer P, Brethauer S. 30 Day Readmission Following Weight Loss Surgery: Can Psychological Factors Predict Non-Specific Indications for Readmission? Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Hanipah ZN, bucak E, Punchai S, Gautam S, Kroh M, Aminian A, Brethauer S, Schauer P. Early Experience with Distal Bypass for Weight Regain after Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Punchai S, Sharma G, Nor Hanipah Z, bucak E, Mulcahy M, Aminian A, Steckner K, Brethauer S, Cywinski J, Schauer P, Young J. Feasibility of Laparoscopic Sleeve Gastrectomy in patients with Left Ventricular Assist Device. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Punchai S, Hanipah ZN, Sharma G, bucak E, Kroh M, Aminian A, Schauer P. Early Experience with Duodenal Switch as a Primary or Revisional Operation. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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Punchai S, Nor Hanipah Z, Sharma G, bucak E, Froylich D, Sullivan L, Heinberg L, Schauer P, Brethauer S, Aminian A. Neurologic Manifestations of Vitamin B Deficiency after Bariatric Surgery. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Mulcahy M, Hanipah ZN, Bucak E, Sharma G, Punchai S, Steckner K, Schauer P, Brethauer S, Dweik R. Baratric Surgery in Patients with Pulmonary Hypertension. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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33
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bucak E, Nasr E, Nor Hanipah Z, Sharma G, Punchai S, Burguera B, Aminian A, Schauer P, Brethauer S, Cetin D. Impact of adjuvant pharmacotherapy on weight loss outcomes after bariatric surgery. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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35
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Viscusi E, Ding L, Bradley Phipps J, Itri L, Schauer P. Body mass index and the efficacy and safety of the needle-free fentanyl iontophoretic transdermal system in postoperative pain management: Results of a pooled analysis of six phase 3 and 3B trials. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Alsulaimy M, Punchai S, Brethauer S, Schauer P, Aminian A. The utility of diagnostic laparoscopy in post-bariatric surgery patients with chronic abdominal pain of unknown etiology. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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37
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DeMaria EJ, Schauer P, Patterson E, Nguyen NT, Jacob BP, Inabnet WB, Buchwald H. The Optimal Surgical Management of the Super Obese Patient: The Debate. Surg Innov 2016; 12:107-21. [PMID: 16034493 DOI: 10.1177/155335060501200202] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 11/16/2022]
Abstract
Optimal management of the super-obese patient (body mass index >50 kg/M2) undergoing weight loss surgery in the new era of laparoscopic treatment is more controversial than ever before. Newer laparoscopic options for treatment of the super obese, including laparoscopic adjustable gastric banding, sleeve gastrectomy, and staging of gastric bypass, are technically easier and may be safer. Concerns that weight loss may be suboptimal or that the procedures will require revision, or both, make these choices controversial. Open access/conversion for established procedures such as long-limb gastric bypass and biliopancreatic diversion with or without duodenal switch are the traditional alternatives when laparoscopic access fails or is deemed too difficult to undertake. The following debate was presented by invited experts in laparoscopic and open bariatric surgery at the 2005 Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Florida. The presenters put forth arguments for the various modern options for treatment of the super obese, which are presented in written form. Interactive audience response technology provided a mechanism for polling the audience before and after the presentations. A review of the audience's responses provides insight into the decision-making considerations of a population of laparoscopically oriented bariatric surgeons.
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Affiliation(s)
- Eric J DeMaria
- Virginia Commonwealth University, Center for Minimally Invasive Surgery, Richmond 23298-480, USA.
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38
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Corcelles R, Froylich D, Boules M, Chang J, Khorgami Z, Nash D, Brethauer S, Cetin D, Burguera B, Schauer P. Inadequate weight loss after Roux-en-Y gastric bypass: a 3 arms comparative study. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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39
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Aminian A, Kirwan J, Burguera B, Kashyap S, Schauer P, Brethauer S. Bariatric Surgery in Patients with Type 1 Diabetes: A Meta-analysis of 104 Cases. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Froylich D, Corcelles R, Daigle C, Boules M, Brethauer S, Schauer P, Aminian A. Weight Loss is Higher among Patients who Undergo Body-Contouring procedures after Bariatric Surgery. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Corcelles R, Froylich D, Boules M, Hag A, Aminian A, Khorgami Z, Leslie H, Kirwan J, Brethauer S, Burguera B, Schauer P. Primary inadequate weight loss after Roux-en-y Gastric Bypass is not associated with poor metabolic outcomes. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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42
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Aminian A, Andalib A, Khorgami Z, Cetin D, Burguera B, Bartholomew J, Brethauer S, Schauer P. Who Should Get Extended Thromboprophylaxis After Bariatric Surgery? A Risk Assessment Tool to Guide Indications for Post-Discharge Pharmacoprophylaxis. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.10.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Aminian A, Kirwan J, Burguera B, Brethauer S, Schauer P. A Nationwide Safety Analysis of Bariatric Surgery In Nonmorbidly Obese Patients With Type 2 Diabetes. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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Froylich D, Corcelles R, Boules M, Brethauer S, Schauer P, Sharma G. Factors Associated with the Length of Stay in Intensive Care Unit following Bariatric Surgery. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Aminian A, Chaudhry R, Khorgami Z, Andalib A, Augustin T, Kroh M, Brethauer S, Schauer P. A Challenge Between Trainee Education and Patient Safety: Does Fellow Participation Impact Postoperative Outcomes Following Bariatric Surgery? Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Froylich D, Corcelles R, Daigle C, Kirwan J, Brethauer S, Schauer P. The Effect of Pregnancy Before or After Bariatric Surgery on Weight Loss. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Khorgami Z, Andalib A, Corcelles R, Aminian A, Brethauer S, Schauer P. Concurrent Ventral Hernia Repair in Patients Undergoing Laparoscopic Gastric Bypass and Sleeve Gastrectomy: A Case-Matched Study Utilizing the National Surgical Quality Improvement Program (Nsqip) Database. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.10.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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48
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Khorgami Z, Andalib A, Corcelles R, Aminian A, Schauer P, Brethauer S. Fast Track Bariatric Surgery: Safety of Discharge on the First Postoperative Day after Laparoscopic Gastric Bypass. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Davis M, Rodriguez J, El-Hayek K, Brethauer S, Schauer P, Zelisko A, Chand B, O'Rourke C, Kroh M. Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients. JSLS 2015; 19:e2015.00060. [PMID: 26508825 PMCID: PMC4591904 DOI: 10.4293/jsls.2015.00060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. METHODS We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. RESULTS Mean preoperative body mass index was 38.1 ± 4.9 kg/m(2). Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. CONCLUSIONS Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.
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Affiliation(s)
| | | | | | | | - Philip Schauer
- Department of Surgery, Bariatric and Metabolic Institute
| | - Andrea Zelisko
- Department of General Surgery, Akron General Medical Center, Akron, Ohio
| | - Bipan Chand
- Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Colin O'Rourke
- Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew Kroh
- Department of Surgery, Digestive Disease Institute
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50
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Chawla AS, Hsiao CW, Romney MC, Cohen R, Rubino F, Schauer P, Cremieux P. Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications. Pharmacoeconomics 2015; 33:629-641. [PMID: 26063335 DOI: 10.1007/s40273-015-0302-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite consistently supportive evidence of clinical effectiveness and economic advantages compared with currently available non-surgical obesity treatments, patient access to bariatric and metabolic surgery (BMS) is impeded. To address this gap and better understand the relationship between value and access, the objectives of this study were twofold: (i) identify the multidimensional barriers to adoption of BMS created by clinical guidelines, public policies, and health technology assessments; and, most importantly, (ii) develop recommendations for stakeholders to improve patient access to BMS. Updated public policies focused on treatment and clinical guidelines that reflect the demonstrated advantages of BMS, patient education on safety and effectiveness, updated reimbursement policies, and additional data on long-term BMS effectiveness are needed to improve patient access.
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Affiliation(s)
- Amarpreet S Chawla
- Quintiles Advisory Services, 4820, Emperor Blvd, Durham, NC, 27703, USA,
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