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Teke E, Güneş Y, Çoruhlu B, Esen Bulut N, Fersahoglu MM, Ergin A, Sancak S. Effects of laparoscopic sleeve gastrectomy on thyroid hormones and relationship between metabolic parameters and long-term total weight loss. Surg Endosc 2024; 38:1807-1812. [PMID: 38291160 DOI: 10.1007/s00464-024-10693-2] [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: 11/04/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Bariatric surgery has significant effects on metabolic parameters and hormone levels. However, the specific impact of laparoscopic sleeve gastrectomy (LSG) on thyroid hormones and other metabolic parameters remains unclear. This study aimed to investigate the short and long-term effects of LSG on thyroid hormone levels, HbA1c, and other metabolic parameters. METHODS A total of 619 euthyroid patients without a history of thyroid disease or thyroid hormone replacement therapy were included in the study. Patients with diabetes were excluded from the study. Preoperative, 1-year postoperative, and 5-year postoperative levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), HbA1c, and other metabolic parameters were recorded and analyzed. RESULTS LSG resulted in significant weight loss and improvements in metabolic parameters. At 1 year postoperatively, there were significant reductions in BMI, HbA1c, TSH, fT3, and triglyceride levels, while fT4 levels increased. A statistically significant negative correlation was found between preoperative HbA1c level and percentage of total weight loss (%TWL) value at the fifth postoperative year. Additionally, a statistically significant negative correlation was found between the 5-year change in TSH and %TWL. CONCLUSION Being the first study to predict long-term total weight loss based on preoperative HbA1c, it is significant. This finding has important implications for personalized patient management and could aid clinicians in identifying individuals who may benefit most from sleeve gastrectomy as a treatment modality. This is valuable in that it emphasizes multidisciplinary work, including the endocrinologist and dietician.
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Affiliation(s)
- Emre Teke
- General Surgery Department, Haydarpaşa Numune Training and Research Hospital, Tıbbiyecaddesi No:23, Üsküdar, 34668, Istanbul, Turkey.
| | - Yasin Güneş
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Bedirhan Çoruhlu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Nuriye Esen Bulut
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Mehmet Mahir Fersahoglu
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Anıl Ergin
- General Surgery Department, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
| | - Seda Sancak
- Department of Endocrinology and Metabolic Diseases, Fatih Sultan Mehmet Training and Research Hospital, İçerenköy Mahallesi, Hastane Sokak, No:1/8, Ataşehir, 34752, Istanbul, Turkey
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Tish S, Corcelles R. The Art of Sleeve Gastrectomy. J Clin Med 2024; 13:1954. [PMID: 38610719 PMCID: PMC11012326 DOI: 10.3390/jcm13071954] [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: 02/16/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile.
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Affiliation(s)
- Shahed Tish
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA;
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Grant D, Peeler C, Rudasill J, Lazar C, Bodkin A, Criswell SL. The presence of H. pylori in laparoscopic sleeve gastrectomy specimens is associated with increased mucosal thickness, presence of secondary follicles, increased chronic inflammation, and intestinal metaplasia. J Histotechnol 2024; 47:5-12. [PMID: 37823587 DOI: 10.1080/01478885.2023.2265601] [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: 05/11/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Helicobacter pylori is putatively present in over half of the global human population and is recognized as a carcinogenic agent that increases the likelihood of infected patients developing gastric adenocarcinoma or gastric lymphoma. Although there are several means for testing for H. pylori, the gold standard remains the invasive histologic evaluation. The current most popular form of bariatric surgery is the laparoscopic sleeve gastrectomy (LSG) and is the only bariatric surgery which supplies a specimen for histologic evaluation. While non-invasive testing is effective in diagnosing and monitoring H. pylori infection, histological examination of biopsies and resections is the only way to grade chronic inflammation and evaluate specimens for additional pathologies such as intestinal metaplasia. The investigators evaluated 203 sequential LSG specimens collected from a major metropolitan hospital over the period of one year. Specimens were processed to paraffin, stained with hematoxylin and eosin, alcian blue, and immunohistochemistry to determine the presence of H. pylori, chronic inflammation, presence of secondary lymphoid follicles in the mucosa, mucosal thickness, and presence of intestinal metaplasia. Statistical analyses demonstrated a significant positive correlation among all factors examined. The overall positivity rate of H. pylori in LSG specimens was 18.2% but ranged from 6.9-23.8% depending on whether the treating clinician performed routine pre-surgical endoscopy. The presence of H. pylori was associated with a higher average chronic inflammation grade, intestinal metaplasia, thicker mucosa, and presence of lymphoid follicles with germinal centers in the mucosa.
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Affiliation(s)
- Danielle Grant
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Chelsea Peeler
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - JoAnna Rudasill
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cynthia Lazar
- Department of Pathology, Methodist University Hospital, Memphis, TN, USA
| | - Amanda Bodkin
- Department of Pathology, Methodist Le Bonheur Germantown Hospital, Germantown, TN, USA
| | - Sheila L Criswell
- Department of Diagnostic and Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
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Gerges WB, Omar ASM, Shoka AA, Hamed MA, Abdelrahim HS, Makram F. ReSleeve or revisional one anastomosis gastric bypass for failed primary sleeve gastrectomy with dilated gastric tube: a retrospective study. Surg Endosc 2024; 38:787-798. [PMID: 38057540 PMCID: PMC10830658 DOI: 10.1007/s00464-023-10609-6] [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: 10/11/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) has been increasingly performed due to weight loss failure (WLF). Many revisional procedures have been proposed after primary laparoscopic sleeve gastrectomy (pLSG) failure, including ReSleeve gastrectomy (ReLSG), and laparoscopic one anastomosis gastric bypass (LOAGB). Choosing the RBS post-pLSG failure represents a challenge. WLF without gastric tube (GT) dilation is undoubtedly converted to a malabsorptive procedure, but the presence of GT dilation makes it more difficult to select a RBS. This study aimed to compare two relatively simple revisional procedures after pLSG failure with dilated GT to help decision making on which procedure better done to which patient. METHODS Data of 52 patients who completed one year follow-up (FU) after their RBS (ReLSG: 27 or LOAGB: 25) for their failed pLSG were collected, assessed, correlated to weight loss (WL) and compared. RESULTS Mean operative time was 97 ± 18.4 min. with revisional LOAGB (RLOAGB) and 62 ± 11 min. with ReLSG. Six patients (11.5%) had seven postoperative procedure-specific complications. Significant hemorrhage occurred in three patients. Two cases of leakage were encountered with each procedure. LOAGB Patients had lower mean final weight (76.2 ± 10.5 vs 85.3 ± 13), lower mean Final BMI (26.4 ± 2.5 vs 29.7 ± 2.9) and higher mean percentage of excess weight loss (EWL%) (83.6 ± 13.5% vs 60.29 ± 14.6%). All RLOAGB patients and 77.8% of ReLSG patients had EWL% > 50%. RLOAGB patients had higher EWL% compared to ReLSG (p < 0.001). Insufficient WL (IWL) patients had higher EWL% compared to weight regain (WR) patients (p = 0.034). CONCLUSION Both procedures (RLOAGB and ReLSG) were relatively safe and effective in terms of WL. RLOAGB led to higher WL compared to ReLSG in all types of patients despite higher Caloric intake. IWL patients had more WL compared to WR patients. WL was not related to GT dilation type. Large-scale longer-FU studies are still needed. TRIAL REGISTRATION PACTR202310644487566 (retrospectively registered).
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Affiliation(s)
- Wadie Boshra Gerges
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ahmed S M Omar
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Ain Shoka
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Hossam S Abdelrahim
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Fady Makram
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Hossain N, Kaur V, Mahran M, Quddus A, Mukhopadhyay S, Shah A, Agrawal S. Intra-operative Tranexamic Acid Administration Significantly Decreases Incidence of Postoperative Bleeding Without Increasing Venous Thromboembolism Risk After Laparoscopic Sleeve Gastrectomy: a Retrospective Cohort Study of Over 400 Patients. Obes Surg 2024; 34:396-401. [PMID: 38168716 DOI: 10.1007/s11695-023-07021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND There is evidence that tranexamic acid (TXA) reduces surgical bleeding and is widely used in trauma, obstetrics and other specialties. This practice is less well-established in laparoscopic sleeve gastrectomy (LSG) due to concerns surrounding venous thromboembolism (VTE); equally postoperative bleeding is a serious complication often requiring re-operation. METHODS This retrospective cohort study compared 30-day outcomes following primary LSG in patients receiving intra-operative TXA (March 2020-July 2022) to those who did not (March 2011-March 2020). The primary outcome was postoperative bleeding (Hb < 9 g/dL) requiring transfusion or re-operation. Secondary outcomes were incidence of VTE, serious postoperative complications (Clavien-Dindo > grade 3) and death. Patients underwent standardised-protocol LSG without staple line re-enforcement under a single surgeon within the independent sector (private practice). TXA 1 g intravenous was administered immediately after a methylene blue leak test, prior to extubation. RESULTS TXA group had 226 patients and non-TXA group had 192 patients. Mean age was 40.5 ± 10.3 and 39.1 ± 9.8 years, respectively. In the TXA group, no postoperative bleeds [versus 3 (1.6%) in non-TXA group, p = 0.0279] occurred. One staple line leak (0.4%) occurred in the TXA group compared to zero in the non-TXA group (p = ns). There was no VTE or death. CONCLUSIONS This is the largest cohort study of intra-operative TXA in primary LSG to date, which demonstrates significant decrease in postoperative bleeding without increasing VTE risk. The authors recommend administration of TXA immediately following leak test, or removal of bougie to maximise efficacy. Data of TXA in LSG is awaited from the randomised controlled PATAS trial.
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Affiliation(s)
- Naveed Hossain
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Vasha Kaur
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Mostafa Mahran
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Abdul Quddus
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Santanu Mukhopadhyay
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Akshat Shah
- Department of Anaesthesia, Homerton University Hospital, Homerton Row, London, E9 6SR, UK
| | - Sanjay Agrawal
- Department of Bariatric Surgery, Homerton University Hospital, Homerton Row, London, E9 6SR, UK.
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Almukainzi M, AlQahtani R, Alanazi R, Alamri R, Alayed H. Insight of the Biopharmaceutical Implication of Sleeve Gastrectomy on Levothyroxine Absorption in Hypothyroidism Patients. Obes Surg 2024; 34:192-197. [PMID: 38091193 DOI: 10.1007/s11695-023-06970-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE The growing rate of obesity led to an increased number of bariatric surgeries (BS) as a treatment option for obesity. The gastrointestinal tract (GIT) changes following BS can impact many drugs' absorption. Levothyroxine (LT4) is a synthetic thyroxine (T4) replacement used commonly as tablets to manage hypothyroidism disorder, which is more prevalent among patients with obesity. This study aims to examine the LT4 oral tablet form therapy after sleeve gastrectomy. MATERIALS AND METHODS A retrospective cohort study was conducted in multi-center. The LT4 doses and TSH and T4 levels were compared before and after BS. The post-surgery readings were categorized into three periods: (one to three months), (four to six months), and (> six ) months after surgery. ANOVA test was used for analysis. RESULTS A total of 14374 patients who underwent BS from (1/2019 to 3/2022) were screened for eligibility, and n = 101 participants matched the inclusion criteria. The TSH and T4 were not statistically significant differences before and after surgery (P-values of 0.4864 and 0.5970, respectively). However, the doses significantly differed before and after surgery in all the follow-up time point periods (P < 0.002). CONCLUSION The LT4 required doses significantly reduced after sleeve gastrectomy, which can be related to the improved endogenous thyroid production in patients with obesity. However, the abnormality of the GIT induced by the sleeve gastrectomy may affect the exogenous LT4 absorption. Using liquid forms of LT4 while monitoring the thyroid function parameters can optimize the treatment after the procedure.
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Affiliation(s)
- May Almukainzi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia.
| | - Reem AlQahtani
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Rimah Alanazi
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Rawan Alamri
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Hajar Alayed
- Pharmaceutical Care, Dr. Suliman AlHabib Medical Group, Riyadh, Saudi Arabia
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Graceffa P, Melatti P, Callari C, Granata A. Endoluminal Rescue Management in a Complete Dehiscence of the Gastric Sleeve Suture Line. Obes Surg 2023; 33:3710-3711. [PMID: 37782405 DOI: 10.1007/s11695-023-06838-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Pietro Graceffa
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, 90123, Palermo, Italy.
| | - Piera Melatti
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, 90123, Palermo, Italy
| | - Cosimo Callari
- Center of Excellence in Bariatric Surgery, Buccheri La Ferla Hospital, 90123, Palermo, Italy
| | - Antonino Granata
- Interventional Endoscopic Unit, Buccheri La Ferla Hospital, 90123, Palermo, Italy
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Znamirowski P, Kołomańska M, Mazurkiewicz R, Tymchyshyn O, Nawacki Ł. GERD as a Complication of Laparoscopic Sleeve Gastrectomy for the Treatment of Obesity: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:1243. [PMID: 37623493 PMCID: PMC10455448 DOI: 10.3390/jpm13081243] [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: 04/11/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The incidence of obesity is increasing in developed societies, and surgical treatment is one treatment option. The most common surgical treatment for obesity is laparoscopic sleeve gastrectomy (LSG). Gastroesophageal reflux disease (GERD) is a complication of both obesity and the surgical treatment of obesity. MATERIALS AND METHODS In this study, the PubMed database was searched using the keywords "GERD" and "bariatric surgery", and 987 papers published between 1 July 2017 and 30 June 2022 were retrieved. RESULTS Nine papers met the inclusion criteria and were included in the meta-analysis. The articles were analyzed for the de novo occurrence of GERD after the treatment of its symptoms, the occurrence of erosive esophagitis, and Barrett's esophagus. In addition, interesting conclusions are presented from the papers that did not meet the inclusion criteria but shed light on the pathophysiology of GERD in obese patients undergoing LSG. CONCLUSION In conclusion, the authors draw attention to the need for endoscopic surveillance in patients undergoing LSG, even in the absence of clinical signs of GERD.
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Affiliation(s)
| | | | | | | | - Łukasz Nawacki
- Collegium Medicum, The Jan Kochanowski University, 25-369 Kielce, Poland
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Soroceanu RP, Timofte DV, Danila R, Timofeiov S, Livadariu R, Miler AA, Ciuntu BM, Drugus D, Checherita LE, Drochioi IC, Ciofu ML, Azoicai D. The Impact of Bariatric Surgery on Quality of Life in Patients with Obesity. J Clin Med 2023; 12:4225. [PMID: 37445261 DOI: 10.3390/jcm12134225] [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: 05/20/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Obesity has become a widespread health problem influencing people's health, general well-being, and healthcare costs. It also represents an important risk factor for multiple comorbidities and malignancies. OBJECTIVES the primary objective of this study was to provide notable insights to healthcare professionals regarding the management of patients with obesity, to highlight the effectiveness of bariatric surgical methods in losing excess weight, and to establish the relationship between weight loss and changes in quality of life (QoL). MATERIAL AND METHODS our study evaluated the QoL of 76 patients following bariatric surgery at different postoperative stages using the 36-Item Short Form Survey (SF-36) and The World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaires. RESULTS regarding the type of bariatric procedure performed, out of the 76 respondents, 39.47% underwent gastric bypass surgery (RYGB), 56.57% underwent sleeve gastrectomy (LSG), and only 3.94% underwent single anastomosis duodeno-ileal switch (SADI-S). Pertaining to the SF-36 questionnaire, the lowest average scores were found in the energy/fatigue subscales and in the limitations due to mental health, which remained consistent across surgery types with a significant decrease in the SADI-S group. Concerning the WHOQOL-BREF questionnaire, the lowest mean scores were found in the environment (15.03 ± 2.37) and social relations (16.08 ± 2.22) subscales, whilst the highest average scores were in physical health (16.30 ± 2.03) and mental health (16.57 ± 2.16). CONCLUSIONS the findings revealed that whilst bariatric surgery significantly improved physical health, it resulted in a decrease in mental health scores. Consequently, the study emphasizes the importance of adopting a holistic approach to managing obesity that considers improving both physical and mental health outcomes.
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Affiliation(s)
- Radu Petru Soroceanu
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Daniel Vasile Timofte
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Radu Danila
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Sergiu Timofeiov
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Roxana Livadariu
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ancuta Andreea Miler
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Bogdan Mihnea Ciuntu
- Department of Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Surgery, "St. Spiridon" County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Daniela Drugus
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Ilie Cristian Drochioi
- Department of Oral and Maxillofacial Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihai Liviu Ciofu
- Department of Oral and Maxillofacial Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Doina Azoicai
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Wakamatsu K, Oshiro T, Kitahara N, Moriyama Y, Nabekura T, Hashi K, Hayashi K, Saiki A, Okazumi S. Feasibility of Laparoscopic Sleeve Gastrectomy for Patients with Obesity and Disorders of Intellectual Development: a Single Institutional Experience. Obes Surg 2023; 33:1327-1332. [PMID: 36943609 PMCID: PMC10156847 DOI: 10.1007/s11695-023-06543-0] [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] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Owing to their difficulty following clinical advice for procedural safety and ideal surgical outcomes, bariatric and metabolic surgery (BMS) for patients with disorders of intellectual development (DID) is concerning. Studies reporting the feasibility of BMS for this population remain scarce. This study aims to clarify the feasibility of laparoscopic sleeve gastrectomy (LSG) for patients with clinically severe obesity and DID. METHODS A retrospective analysis of a single institutional prospective database collected from 2010 to 2022 was performed. The Wechsler Adult Intelligence Scale (WAIS) was used to measure intellectual ability before LSG. A multidisciplinary team approach was implemented to give special support and care to patients with DID. Patients were categorized into groups according to their WAIS scores. LSG outcomes were statistically compared between the DID and average intellectual ability groups. RESULTS Using the WAIS to measure intellectual ability among patients who underwent LSG, we identified 14 patients with DID (IQ score: < 69, mean IQ: 63.4) and 71 with average intellectual ability (IQ score: 90-109, mean IQ: 98.9). Operative outcomes were comparable between the groups as follows: operation time (DID: 163 ± 41 min, average intelligence: 162 ± 30 min), hospital stay (DID: 4 [4-5] days, average intelligence: 5 [4-6] days), and total comorbidities (DID: 7.1%, average intelligence: 8.4%). No reoperations were performed, and no mortalities were observed. CONCLUSIONS With medical and social support and care, performing LSG on patients with clinically severe obesity and DID is safe, with good short-term results.
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Affiliation(s)
- Kotaro Wakamatsu
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Takashi Oshiro
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan.
| | - Natsumi Kitahara
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Yuuki Moriyama
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Taiki Nabekura
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Kozue Hashi
- Department of Neuropsychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Karin Hayashi
- Department of Psychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Atsuhito Saiki
- Center of Diabetes, Endocrine and Metabolism, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
| | - Shinichi Okazumi
- Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan
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Soroceanu RP, Timofte DV, Maxim M, Platon RL, Vlasceanu V, Ciuntu BM, Pinzariu AC, Clim A, Soroceanu A, Silistraru I, Azoicai D. Twelve-Month Outcomes in Patients with Obesity Following Bariatric Surgery-A Single Centre Experience. Nutrients 2023; 15:nu15051134. [PMID: 36904134 PMCID: PMC10005116 DOI: 10.3390/nu15051134] [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: 02/09/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND As obesity rates continue to rise worldwide, many surgeons consider bariatric procedures as a possible cure for the upcoming obesity pandemic. Excess weight represents a risk factor for multiple metabolic disorders, especially for type 2 diabetes mellitus (T2DM). There is a strong correlation between the two pathologies. The aim of this study is to highlight the safety and short-term results of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB, laparoscopic gastric plication (LGP) and intragastric balloon (IGB) as methods used in the treatment of obesity. We followed the remission or amelioration of comorbidities, tracked metabolic parameters, weight loss curves and hoped to outline the profile of the obese patient in Romania. METHODS The target population of this study was represented by patients (n = 488) with severe obesity who qualified for the metabolic surgery criteria. Starting from 2013 to 2019, patients underwent four types of bariatric procedures and were subsequently monitored over the course of 12 months in the 3rd Surgical Clinic at "Sf. Spiridon" Emergency Hospital Iași. Descriptive evaluation indicators, as well as those of analytical evaluation were used as statistical processing methods. RESULTS A significant decrease in body weight was recorded during monitoring and was more pronounced for patients who underwent LSG and RYGB. T2DM was identified in 24.6% of patients. Partial remission of T2DM was present in 25.3% of cases, and total remission was identified in 61.4% of patients. Mean blood glucose levels, triglycerides, LDL and total cholesterol levels decreased significantly during monitoring. Vitamin D increased significantly regardless of the type of surgery performed, while mean levels of vitamin B12 decreased significantly during monitoring. Post-operative intraperitoneal bleeding occurred in 6 cases (1.22%) and a reintervention for haemostasis was required. CONCLUSIONS All procedures performed were safe and effective methods of weight loss and improved associated comorbidities and metabolic parameters.
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Affiliation(s)
- Radu Petru Soroceanu
- Department of Surgery I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- 3rd Surgical Unit, Department of Surgery, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Daniel Vasile Timofte
- Department of Surgery I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- 3rd Surgical Unit, Department of Surgery, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Madalina Maxim
- Department of Surgery I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- 3rd Surgical Unit, Department of Surgery, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Razvan Liviu Platon
- Department of Surgery I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- 3rd Surgical Unit, Department of Surgery, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Vlad Vlasceanu
- 3rd Surgical Unit, Department of Surgery, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Bogdan Mihnea Ciuntu
- Department of Surgery I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- 2nd Surgical Unit, Department of Surgery, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Alin Constantin Pinzariu
- Department of Morpho-Functional Sciences II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (A.C.P.); (A.S.)
| | - Andreea Clim
- Department of Morpho-Functional Sciences II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andreea Soroceanu
- “Socola” Institute of Psychiatry, 700282 Iasi, Romania
- Correspondence: (A.C.P.); (A.S.)
| | - Ioana Silistraru
- Department of Social Work, Journalism, Public Relations and Sociology, Faculty of Social Sciences and Humanities, Lucian Blaga University, 550024 Sibiu, Romania
| | - Doina Azoicai
- Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
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Walędziak M, Różańska-Walędziak AM. Bariatric surgery and menopause. Prz Menopauzalny 2022; 21:242-5. [PMID: 36704766 DOI: 10.5114/pm.2022.116885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/29/2022] [Indexed: 01/29/2023]
Abstract
Introduction Menopause is a process that affects hormonal levels and metabolic processes in women. The decline in oestrogen levels can predispose to the development of type 2 diabetes mellitus and obesity. Material and methods The study group included 614 women with a history of bariatric surgery, who were divided into 2 groups according to their menopausal status. The purpose of the study was to assess the influence of menopausal status on the effects of bariatric surgery in terms of weight loss. Results The percentage of estimated weight loss (%EWL), total weight loss (TWL), percentage of total weight loss (%TWL), and change in body mass index (BMI) after bariatric surgery are lower in postmenopausal than in premenopausal women. Conclusions Menopause can be considered as a factor influencing the efficacy of bariatric surgery, with lower effects in postmenopausal women.
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Kural A, Khan I, Seyit H, Caglar TR, Toklu P, Vural M. Changes in the gut microbiota of morbidly obese patients after laparoscopic sleeve gastrectomy. Future Microbiol 2021; 17:5-15. [PMID: 34877878 DOI: 10.2217/fmb-2021-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: Permanent treatment of morbid obesity with medication or diet is nearly impossible. Laparoscopic sleeve gastrectomy (LSG) is becoming a widely accepted treatment option. This study profiled and compared gut microbiota composition before and after LSG. Methods & results: A total of 54 stool samples were collected from 27 morbidly obese individuals before and after LSG. The gut microbiota was profiled with 16S amplicon sequencing. After LSG, patients demonstrated a significant decrease (p < 0.001) in BMI and an increase in bacterial diversity. An increased Firmicutes/Bacteroidetes ratio was also noticed after LSG. The families Prevotellaceae and Veillonellaceae predominated in preoperative samples but were markedly lowered after LSG. A marked increase in Akkermansia, Alistipes, Streptococcus, Ruminococcus and Parabacteroides was observed after LSG. Conclusion: In addition to lowering BMI, LSG remodeled gut microbiota composition.
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Affiliation(s)
- Alev Kural
- Dr Sadi Konuk Research & Training Hospital, University of Health Sciences Bakırköy, Istanbul, Turkey
| | - Imran Khan
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau, People's Republic of China
| | - Hakan Seyit
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau, People's Republic of China
| | - Tuba R Caglar
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau, People's Republic of China
| | - Pınar Toklu
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau, People's Republic of China
| | - Meltem Vural
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science & Technology, Macau, People's Republic of China
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Allatif REA, Mannaerts GHH, Al Afari HST, Hammo AN, Al Blooshi MS, Bekdache OA, Alawadhi O, Isied SH, Hamid S, Shikora SA. Concomitant Cholecystectomy for Asymptomatic Gallstones in Bariatric Surgery-Safety Profile and Feasibility in a Large Tertiary Referral Bariatric Center. Obes Surg 2021. [PMID: 34791618 DOI: 10.1007/s11695-021-05798-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Obesity is a risk factor for gallstone formation, which can be exacerbated by bariatric surgery-induced rapid weight loss. Current guidelines do not recommend concomitant cholecystectomy (CC) for asymptomatic gallstones during the bariatric surgery procedure. However, long-term follow-up studies have shown that the incidence of post-bariatric surgery symptomatic gallstones necessitating therapeutic cholecystectomy increases to 40%. Therefore, some surgeons advocate simultaneous cholecystectomy during the bariatric surgery for asymptomatic individuals. This study aims to evaluate the safety of performing cholecystectomy for asymptomatic gallstones during the bariatric procedure. METHODS Data from a consecutive series of patients that underwent primary laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB) or conversion of LSG to a LRYGB with or without concomitant cholecystectomy for asymptomatic gallstones between Jan 2010 and Dec 2017 were retrieved from the database. The primary endpoint was the complication rate. Secondary endpoints were the surgical operating room time (ORT) and the length of hospital stay (LOS). RESULTS Out of the 2828 patients who were included, 120 patients underwent a concomitant cholecystectomy during their bariatric procedure (LSG or LRYGB) for asymptomatic gallbladder stones and were compared to the 2708 remaining patients who only had bariatric surgery. None of the concomitant cholecystectomy patients developed a gallbladder-related complication. There was no significant increase in the rate of minor or major complications between the CC groups and the non-CC groups (LSG: 6.7% vs. 3.2%, p=0.132; LRYGB: 0% vs. 2.3%, p =0.55; and conversion of LSG to LRYGB: 20% vs. 7.1%, p = 0.125, respectively). In addition, there was no significant increase in the length of hospital stay (1.85 ±4.19 days vs. 2.24 ±1.82, p=0.404) for LSG group and (1.75 ±2.0 vs. 2.3 ±2.1, p=0.179) for LRYGB group. Adding the cholecystectomy to the bariatric procedure only added an average of 23 min (min) (27 min when added to LSG and 18 min when added to LRYGB). CONCLUSION As one of the largest series reviewing concomitant cholecystectomy in bariatric surgery, this study showed that in skilled laparoscopic bariatric surgical hands, concomitant cholecystectomy during bariatric surgery is safe and prevents potential future gallstone-related complications. Long-term large prospective randomized trials are needed to further clarify the recommendation of prophylactic concomitant cholecystectomy during bariatric surgery.
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Znamirowski P, Bryk P, Lewitowicz P, Kozieł D, Głuszek S. GERD-A Burning Problem after Sleeve Gastrectomy? Int J Environ Res Public Health 2021; 18:10829. [PMID: 34682573 DOI: 10.3390/ijerph182010829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/26/2022]
Abstract
Background: Surgical treatment is the most effective method of treatment for obesity; and laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery. Objective: The aim of the study was evaluation of the frequency of occurrence and the degree of progression of changes characteristic of GERD in patients who had undergone LSG in clinical; endoscopic; and microscopic images in the obtained bioptats; and an attempt to correlate the results obtained with the effectiveness of bariatric treatment. Materials and Method: The anonymized clinical data concerning 214 patients who had undergone LSG were collected from the database. Invitations for check-up examinations were distributed, to which 37 patients responded. Two patients were excluded from the study. In 35 patients after LSG check-up clinical examination, bariatric endoscopy (BE) and bariatric microscopy (BM) were performed on bioptats collected from the site of the gastro-esophageal junction; and 3 specimens collected at 2 cm intervals from the Z-line. The study was performed according to the standard protocol. Results: In the analyzed group, clinical symptoms of GERD occurred in 12 patients (34.5%), including 10 females and 2 males. The symptom reported by all patients was retrosternal pain/burning (heartburn). In BE, foci of ectopic mucosa in the epicardial part of the esophagus were found in 16 patients (14 F and 2 M). No correlation was observed between the analyzed parameters and the occurrence of the above-mentioned changes. In BM, only in three patients were the changes described as normal esophageal mucosa; while in another three, as foci of intestinal metaplasia, Barrett’s esophagus. In this group no foci of dysplasia were found. In eight patients, the changes were described as inflammatory. In ten patients from this group, microscopic changes occurred without clinical symptoms of the disease. Conclusions: GERD is an important clinical problem in patients after LSG; therefore; the problem of occurrence or exacerbation of symptoms of the disease should be discussed with the patient during qualification for bariatric surgery. The bariatric effectiveness of LSG does not correlate with the occurrence of the symptoms of GERD after the procedure. However; the lack of clinical symptoms of the disease does not mean the lack of its occurrence. Therefore; the endoscopic check-up after LSG should be routinely performed. During the qualification for LSG screening, histopathologic examinations of the esophagus may be useful for the assessment of the microscopic symptoms of GERD in oligosymptomatic patients; and exclusion of rare pathologies of the esophagus (e.g., eosinophilic esophagitis), which may complicate post-operative course.
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Gomes-Rocha SR, Costa-Pinho AM, Pais-Neto CC, de Araújo Pereira A, Nogueiro JPM, Carneiro SPR, Santos-Sousa HMTF, Lima-da-Costa EJ, Bouça-Machado R, Preto JR. Roux-en-Y Gastric Bypass Vs Sleeve Gastrectomy in Super Obesity: a Systematic Review and Meta-Analysis. Obes Surg 2021; 32:170-185. [PMID: 34642872 DOI: 10.1007/s11695-021-05745-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 06/08/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are safe procedures that may present sub-optimal results in superobesity (SO). A meta-analysis was performed aiming to summarize the available evidence on weight loss (primary outcome) and comorbidities resolution of LRYGB and LSG in patients with SO (BMI ≥ 50 kg/m2). From the 16 included studies, 7 integrated the meta-analysis. LRYGB showed a significantly higher weight loss at 6 to 12-months, but not after 24 months and a higher dyslipidemia resolution at 12 months. When compared with LSG, LRYGB achieved better weight loss after 6 and 12 months and higher dyslipidemia resolution after 1 year. There were no significant differences for resolution of the other co-morbidities studied.
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Affiliation(s)
- Sofia Raquel Gomes-Rocha
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - André Manuel Costa-Pinho
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4099-001, Porto, Portugal.
| | | | - André de Araújo Pereira
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Surgery Department, São João University Medical Center, 4099-001, Porto, Portugal
| | - Jorge Pedro Martins Nogueiro
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Surgery Department, São João University Medical Center, 4099-001, Porto, Portugal
| | - Silvestre Porfírio Ramos Carneiro
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Surgery Department, São João University Medical Center, 4099-001, Porto, Portugal
| | - Hugo Miguel Teixeira Ferraz Santos-Sousa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4099-001, Porto, Portugal
| | - Eduardo Jorge Lima-da-Costa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4099-001, Porto, Portugal
| | | | - John Rodrigues Preto
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, 4099-001, Porto, Portugal
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Abstract
Background: Although numerous studies outside the United States (U.S.) have explored weight loss and comorbidity resolution among patients with class I obesity (body mass index [BMI] 30–34.9 kg/m2) after metabolic surgery, few U.S.-based studies have been conducted. Objective: Our aim was to compare weight loss and comorbidity resolution among U.S. patients with class I obesity, who underwent laparoscopic sleeve gastrectomy (LSG) versus Roux-en-Y gastric bypass (RYGB). Methods: Weight loss and comorbidity data among only patients with class I obesity, who underwent LSG or RYGB, were examined. Between April 2009 and April 2017, 1215 metabolic surgeries were performed with 30 patients meeting the inclusion criteria (17 LSG and 13 RYGB). Results: Percent total weight loss (%TWL) for LSG peaked at 12 months (20.85%), while RYGB %TWL peaked at 18 months (21.65%). Percent excess weight loss (%EWL) peaked at 12 months after LSG (83.59%) and 18 months after RYGB (98.29%). Overall follow-up was 56.3%, 36.7%, and 43.3% at 12, 18, and 24 months. LSG and RYGB were both successful with regard to resolution of medical comorbidities at 12 months. Conclusion: RYGB and LSG appear to have similar, successful outcomes among U.S. patients with class I obesity for weight loss and comorbidity resolution.
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Affiliation(s)
- Dustin Baldwin
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa Sanchez-Johnsen
- Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Roberto Bustos
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alberto Mangano
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mario Masrur
- Department of Surgery, Division of General, Minimally Invasive and Robotics, University of Illinois at Chicago, Chicago, Illinois, USA
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van Rijswijk AS, van Olst N, Schats W, van der Peet DL, van de Laar AW. What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review. Obes Surg 2021; 31:3833-47. [PMID: 34002289 DOI: 10.1007/s11695-021-05394-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
Percentage total weight loss (%TWL) might be better than percentage excess weight loss to express weight loss in bariatric surgery. In this systematic review, performed according to the PRISMA statement, results of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are assessed in %TWL. A total of 13,426 studies were screened and 49 included, reporting data of 24,760 patients. The results show that, despite limiting data, LRYGB is favorable over LSG in terms of weight loss in short-term follow-up. Although recent guidelines recommend to use %TWL when reporting outcome in bariatric surgery, this study shows that there is still insufficient quality data in %TWL, especially on LSG. The use of %TWL as the primary outcome measure in bariatric surgery should be encouraged.
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Salman MA, Mikhail HMS, Abdelsalam A, Abdallah A, Elshafey HE, Abouelregal TE, Omar MG, Elkassar H, Ahmed RA, Atallah M, Shaaban HED, Abdellatif Z, Elkholy S, Salman AA. Acceleration of Gastric Emptying and Improvement of GERD Outcome After Laparoscopic Sleeve Gastrectomy in Non-diabetic Obese Patients. Obes Surg 2021; 30:2676-2683. [PMID: 32200446 DOI: 10.1007/s11695-020-04547-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/29/2022]
Abstract
PURPOSE Obesity has become a pandemic nowadays. Bariatric surgery is increasingly performed to manage obesity. Currently, laparoscopic sleeve gastrectomy (LSG) is a widely accepted procedure given its feasibility and efficacy. Previous studies revealed conflicting results regarding the change of gastric emptying following sleeve gastrectomy. The primary aim of the present study is to assess gastric motor function by gastric emptying scintigraphy in a cohort of non-diabetic patients undergoing laparoscopic sleeve gastrectomy (LSG) for treatment of severe obesity. METHODS This prospective observational study included 100 obese, non-diabetic patients attending the surgery clinic at Cairo University Hospitals and Al Azhar University Hospitals. LSG was performed following a standardized protocol, with no complications observed. All patients had gastric emptying scintigraphy done through a standard semisolid meal (250 kcal), marked with 0.5 mCiTc 99, pre-operatively and 3 months after LSG. RESULTS The mean age was 38.71 years (9.2) and males comprised 57% of the cohort. The body mass index, low-density lipoproteins, and glycated hemoglobin declined significantly at 3-month postsurgery. The scintigraphy study revealed a significantly reduced percent retention at equivalent time points 3 months after LSG. In addition, the percent of patients suffering from GERD decreased significantly after LSG. CONCLUSION Gastric emptying becomes faster after LSG in morbidly obese non-diabetic patients. GERD symptoms improve after surgery.
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Affiliation(s)
| | | | - Ahmed Abdelsalam
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdallah
- General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam E Elshafey
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | | | - Mahmoud Gouda Omar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hesham Elkassar
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mohamed Atallah
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | - Zeinab Abdellatif
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Shaimaa Elkholy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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20
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Gerges WB, Omran H, Makram F. Conversion of laparoscopic sleeve gastrectomy after weight loss failure into laparoscopic one anastomosis gastric bypass: short-term safety and efficacy and effect of indications on outcome. Surg Endosc 2021. [PMID: 33625589 DOI: 10.1007/s00464-021-08374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Revisional surgery after failed laparoscopic sleeve gastrectomy (LSG) is growing and laparoscopic one anastomosis gastric bypass (LOAGB) has been proposed as a revisional procedure due to its combined restrictive and malabsorptive effects. The aim is to study short-term complications and weight loss (WL) results of the revisional LOAGB after LSG for the two-weight loss failure (WLF) types [insufficient weight loss (IWL) and weight regain (WR)] and to assess the possible effects of these two types of failure and gastric tube anatomy on the final outcome. METHODS The data of 28 patients who completed 1-year follow-up for their revisional LOAGB after their failed LSG were assessed and statistically correlated to leakage and one year WL results. RESULTS Operative time was 96 ± 17.4 min. Leakage occurred in 2 patients (7.1%); the small number of leak patients does not allow statistical analysis for leakage. Percentage of excess weight loss (%EWL) at one year was 79.0 ± 14.4%; percentage of total weight loss (%TWL) was 31.7 ± 6.4%. %EWL was 84.2 ± 13.1 with IWL and 73.0 ± 13.9 with WR (P = 0.036). %TWL was 35.0 ± 5.2 with IWL and 27.8 ± 5.5 with WR (P = 0.001). %TWL at persistent fundus, diffusely dilated, and nondilated stomach were 38.98 ± 4.57, 31.3 ± 5.33, and 28.54 ± 5.91, respectively (P = 0.006). CONCLUSION LOAGB is a highly effective and safe procedure as a revision after LSG with WLF. Patients with IWL and patients with persistent fundus lost more weight than those with WR and those with diffuse stomach dilation or nondilation, respectively.
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Atabey M, Aykota MR, Özel Mİ, Arslan G. Short-term changes and correlations of plasma spexin, kisspeptin, and galanin levels after laparoscopic sleeve gastrectomy. Surg Today 2021; 51:651-658. [PMID: 33555434 DOI: 10.1007/s00595-021-02240-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the circulating levels of spexin, kisspeptin, galanin, and the correlations between these peptides after laparoscopic sleeve gastrectomy (LSG). METHODS The plasma levels of the spexin, kisspeptin, and galanin and metabolic parameters (body mass index, weight loss, % excess weight loss, body fat, fasting glucose, HbA1C, and cholesterol levels) were measured (baseline, 1 month, and 3 months) and correlated in thirty adult individuals with obesity (22 female and 8 male) after LSG. RESULTS The body mass index (BMI), body fat, fasting glucose, total and low-density lipoprotein cholesterol decreased, while high-density lipoprotein cholesterol and % EWL (excess weight loss) increased at 3 months after surgery. The plasma spexin levels increased at 3 months, kisspeptin levels increased at 1 month and stabilized afterward, and galanin levels decreased at 3 months after LSG. Significant correlations were found between metabolic parameters with spexin, kisspeptin, and galanin. In addition, spexin and kisspeptin were negatively correlated with galanin, while spexin was positively correlated with kisspeptin. CONCLUSIONS The biochemical data reveal evidence that LSG causes an increase in the levels of spexin, and kisspeptin and a decrease in galanin levels. Our findings, therefore, suggest a possible interaction between these novel peptides, which have potential roles in obesity and glucose metabolism.
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Affiliation(s)
- Mustafa Atabey
- Department of General Surgery, Faculty of Medicine, University of Biruni, Istanbul, Turkey.
| | - Muhammed Raşid Aykota
- Department of General Surgery, Faculty of Medicine, University of Pamukkale, Denizli, Turkey
| | - Mehmet İlker Özel
- Department of General Surgery, Şarkışla Public Hospital, Sivas, Turkey
| | - Gökhan Arslan
- Department of Physiology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey
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22
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Skulsky SL, Dang JT, Switzer NJ, Sharma AM, Karmali S, Birch DW. Higher Edmonton Obesity Staging System scores are independently associated with postoperative complications and mortality following bariatric surgery: an analysis of the MBSAQIP. Surg Endosc 2020; 35:7163-7173. [PMID: 33155074 DOI: 10.1007/s00464-020-08138-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Bariatric surgery is an evidence-based approach for sustained weight loss in patients with severe obesity. The most common procedures in North America are the laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The Edmonton Obesity Staging System (EOSS) is a tool that assigns patients a score of 0 to 4 according to their obesity-related comorbidities and functional status. Previous research demonstrates that increasing EOSS score is associated with overall non-operative mortality risk. OBJECTIVE We sought to assess the association of the EOSS with major 30-day postoperative complications following LSG or LRYGB. METHODS Primary LSG or LRYGB patients were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Patients were assigned EOSS scores according to their comorbidities and functional limitations extracted from the database. Multivariable logistic regression analysis was conducted to evaluate the relationship between EOSS score, age, sex, BMI, type of procedure, or operative time with 30-day major complications. RESULTS From 2015 to 2017, 430,238 patients (79.4% female) who underwent primary LSG or LRYGB were identified. The relative frequencies of patients by EOSS score were: 0 and 1 (23.9%), 2 (62.8%), 3 (10.5%), and 4 (2.9%). Mean preoperative BMI was 45.4 (SD 7.9) kg/m2 and mean age was 44.6 (SD 12.0) years. The overall 30-day major complication rate was 3.5%. EOSS 2, 3, and 4 were significantly associated with major complications. The strongest associations with major complications were EOSS 4 (OR 2.30; 95% CI 2.11-2.51, p < 0.001) and LRYGB versus LSG (OR 2.03; 95% CI 1.97-2.11, p < 0.001). EOSS 3 and 4 were most strongly associated with death. CONCLUSION Higher EOSS scores are independently associated with 30-day major postoperative complications and mortality. The EOSS provides utility in staging patients and identifying those at greater risk of postoperative complications.
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Affiliation(s)
- Samuel L Skulsky
- Department of Surgery, University of Ottawa, Loeb Research Building, 725 Parkdale Avenue, Office WM150B, Ottawa, ON, K1Y 4E9, Canada.
| | - Jerry T Dang
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Arya M Sharma
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Aldriweesh MA, Aljahdali GL, Shafaay EA, Alangari DZ, Alhamied NA, Alradhi HA, Yaqoub AS, El-Boghdadly S, Aldibasi OS, Adlan AA. The Incidence and Risk Factors of Cholelithiasis Development After Bariatric Surgery in Saudi Arabia: A Two-Center Retrospective Cohort Study. Front Surg 2020; 7:559064. [PMID: 33195385 PMCID: PMC7641899 DOI: 10.3389/fsurg.2020.559064] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Rapid weight loss after bariatric surgery is a known risk factor for cholelithiasis development. This study aimed to estimate the incidence of cholelithiasis following bariatric surgery among morbidly obese patients who underwent bariatric surgery. Methods: This is a retrospective cohort study of all morbidly obese patients who underwent bariatric surgery in King Abdulaziz Medical City (Riyadh, Saudi Arabia) or King Abdulaziz Hospital (Al Ahsa, Saudi Arabia) between January 2015 and December 2018. Patients with a history of cholecystectomy or previous bariatric surgery were excluded. We estimated the incidence rate of cholelithiasis among the cohort. We also examined the associated risk factors of cholelithiasis development. Results: The study cohort contained 490 patients (38.7% males; 61.43% females) with a mean age of 36.87 ± 11.44 years. Most patients (58.54%) were followed up for 12 months. The incidence of cholelithiasis post-operation was 6.53% (n = 32). The average period of cholelithiasis formation was 12-24 months. The percentage of total weight loss (TWL%) was significantly associated with the development of cholelithiasis post-operatively. Conclusion: A significant association was found between weight loss following bariatric surgery and the incidence of cholelithiasis. Gender, age, and comorbidities were not associated with the formation of cholelithiasis. We recommend regular follow-up appointments with thorough patient education about gradual weight loss to reduce the risk of developing cholelithiasis.
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Affiliation(s)
- Mohammed A Aldriweesh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ghadeer L Aljahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Edi A Shafaay
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Dalal Z Alangari
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nawaf A Alhamied
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hadeel A Alradhi
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amirah S Yaqoub
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami El-Boghdadly
- Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Omar S Aldibasi
- College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdallah A Adlan
- Department of Bioethics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Singla V, Aggarwal S, Aggarwal S, Gupta M, Singh D. Correlation of weight loss with residual gastric volume on computerized tomography in patients undergoing sleeve gastrectomy: A systematic review. Clin Obes 2020; 10:e12394. [PMID: 32767720 DOI: 10.1111/cob.12394] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/08/2020] [Accepted: 07/07/2020] [Indexed: 12/19/2022]
Abstract
Laparoscopic Sleeve gastrectomy (LSG) is the most commonly performed bariatric surgical procedure worldwide. There is wide variation however in post-operative weight loss on long term follow-up, and residual gastric volume (RGV) is believed to be an important variable. Multiple studies have correlated RGV as assessed by Computerized Tomography volumetry with excess weight loss (EWL%) following LSG, but definite consensus is lacking. This article systematically reviews the published studies in English literature to ascertain whether any correlation exists between the RGV and EWL% following LSG. Ten studies were included in this review, and significant differences were noted in the technique of RGV assessment, and timing of RGV and EWL% assessment. Five studies found a statistically significant correlation between the RGV and EWL%. One study found a correlation which did not reach statistical significance. Two additional studies reported that the resected volume rather than RGV correlated with the EWL%. Meta-analysis of studies reporting correlation between RGV and EWL% showed that up to 26.3% (95% CI: 5.1%-56.1%) of variability in EWL% can be explained by variations in RGV. A lower RGV is likely to result in a better post-operative weight loss following LSG. There is need for standardization of technique and timing of RGV assessment.
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Affiliation(s)
- Vitish Singla
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Aggarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehul Gupta
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Singh
- Department of Surgical disciplines, All India Institute of Medical Sciences, New Delhi, India
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Diaz-Lara C, Curtis C, Romero M, Palazón-Bru A, Diez-Tabernilla M, Oller I, Arroyo A, Lacueva FJ. Tolerance to Specific Foods After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:3891-3897. [PMID: 32710369 DOI: 10.1007/s11695-020-04732-9] [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: 02/15/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We assessed the degree of tolerance to different types of food after LSG to provide specific useful advice concerning food intake to these patients during the first postoperative year. METHODS A specific questionnaire measuring tolerance to 59 types of food was completed in postoperative months 1, 3, 6, 9, and 12 in a prospective consecutive cohort of patients who underwent LSG. An ordinal score of tolerance based on the median (Me) and a cumulative link ordinal model (CLOM) analyzing temporal variability in oral tolerance to each type of food were used. Foods with Me values of 3 points or higher and CLOM values of approximately 80% or higher were considered well tolerated. RESULTS Sixty-five patients were included in the study. The questionnaire was completed in the first, third, sixth, ninth, and twelfth months by 42 (64%), 44 (67%), 41 (63%), 41 (63%), and 39 (60%) patients, respectively. All kinds of fish were very well tolerated. Regarding meat intake, chicken, turkey, rabbit, and minced meat were well tolerated, whereas lamb, veal, and pork were not. Except for noodles and toasted bread, a poor degree of tolerance during follow-up was found for most carbohydrates. Yogurt, skimmed milk, and cottage cheese were well tolerated. A heterogeneous degree of tolerance was observed for vegetables, with cooked vegetables being well tolerated, and raw vegetables not. CONCLUSION Our study provides individual information on specific foods regarding their degree of tolerance. This information may be useful for advising patients during the first postoperative year after LSG.
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Affiliation(s)
- Carlos Diaz-Lara
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital General Universitario de Elche, Alicante, Spain
| | - Carolina Curtis
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital General Universitario de Elche, Alicante, Spain
| | - Manuel Romero
- Department of Surgery, Miguel Hernández University of Elche, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain
| | - María Diez-Tabernilla
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital General Universitario de Elche, Alicante, Spain
| | - Inmaculada Oller
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital General Universitario de Elche, Alicante, Spain
| | - Antonio Arroyo
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital General Universitario de Elche, Alicante, Spain. .,Department of Surgery, Miguel Hernández University of Elche, Alicante, Spain.
| | - Francisco Javier Lacueva
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital General Universitario de Elche, Alicante, Spain.,Department of Surgery, Miguel Hernández University of Elche, Alicante, Spain
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Abstract
INTRODUCTION There is a huge variation in weight loss outcomes between bariatric patients, possibly due to differences in caloric intake and changes in the amount physical activity. However, the association between the change in energy intake and weight loss has not yet been the subject of an extensive investigation. OBJECTIVE To explore the relationship between total energy intake and % total body weight loss (%TBWL) over a period of 4 years post-surgery. METHODS Of the 466 patients who were asked to participate, a total 135 patients were included in this study. They all underwent bariatric surgery, 54 with primary Roux-en-Y Gastric Bypass, 43 redo Roux-en-Y gastric bypass after laparoscopic gastric banding and 38 laparoscopic sleeve gastrectomy. Pre- and post-operative dietary intake and physical activity were collected for both a weekday and a weekend day. The main analysis was performed using multiple regression analyses and was adjusted for age at surgery, BMI at baseline, obstructive sleep apnoea syndrome, type of eating behaviour, change in physical activity and protein intake (g/kg body weight). RESULTS %TBWL over time, post-operative energy intake and change in physical activity did not differ between the different procedure groups (p = 0.312, p = 0.988 and p = 0.050, respectively). Change in energy intake did differ between different procedure groups (p = 0.031) and linear regression showed that this was related to total body weight loss for the fully adjusted model (β = - 0.004, p = 0.014). CONCLUSION This study showed a higher decrease in energy intake to be related with a higher %TBWL.
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Affiliation(s)
- Louella A H M Schoemacher
- Wageningen University & Research, Wageningen, The Netherlands. .,Department of Surgery, Rijnstate Hospital & Vitalys Clinics, Postal number 1190, 6800 TA, Arnhem, The Netherlands.
| | - Abel B Boerboom
- Department of Surgery, Rijnstate Hospital & Vitalys Clinics, Postal number 1190, 6800 TA, Arnhem, The Netherlands
| | | | - Edo O Aarts
- Department of Surgery, Rijnstate Hospital & Vitalys Clinics, Postal number 1190, 6800 TA, Arnhem, The Netherlands.
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Son J, Ko CS, Park YC, Yoo MW. Portomesenteric Vein Thrombosis after Laparoscopic Sleeve Gastrectomy: A Case Report. J Metab Bariatr Surg 2020; 9:19-23. [PMID: 36686894 PMCID: PMC9847642 DOI: 10.17476/jmbs.2020.9.1.19] [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] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 01/25/2023]
Abstract
Portomesenteric vein thrombosis is an uncommon but potentially life-threatening complication associated with laparoscopic sleeve gastrectomy. We present the case of a 26-year-old male who underwent an uneventful laparoscopic sleeve gastrectomy and presented on postoperative day 14 with portomesenteric vein thrombosis. The patient was treated conservatively with IV heparinization, followed by an oral anticoagulant agent. He was discharged in stable condition without further problems. A high index of suspicion for the disease is required not to miss or delay the diagnosis of portomesenteric vein thrombosis which could lead to a fatal outcome. All patients should be screened beforehand for underlying hypercoagulability before surgery.
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Affiliation(s)
- Jimin Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Seok Ko
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | | - Moon-Won Yoo
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Coşkun M, Yardimci S, Arslantaş MK, Altun GT, Uprak TK, Kara YB, Cingi A. Subcostal Transversus Abdominis Plane Block for Laparoscopic Sleeve Gastrectomy, Is It Worth the Time? Obes Surg 2020; 29:3188-3194. [PMID: 31175560 DOI: 10.1007/s11695-019-03984-4] [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: 12/11/2022]
Abstract
BACKGROUND Obesity is a complex and multifactorial disease whose incidence has increased, making it a serious public health issue. Laparoscopic sleeve gastrectomy (LSG) is one of the most common surgical procedures that is chosen for bariatric surgery. Decreasing postoperative pain in these patients which will increase patients' compliance and quality of life will lead to better surgical results. This study aims to compare the effectiveness of trocar site infiltration versus bilateral subcostal transversus abdominis plane block (TAP) in controlling postoperative pain in patients. METHODS Forty-five consecutive patients who have undergone LSG in xxx General Surgery Department have been enrolled in the study. Patients were divided into two groups according to the surgeon's choice. The first group underwent TAP block, while the second group underwent trocar site infiltration. Patients' pain was recorded via visual analogue scale (VAS) in postoperative periods. RESULTS Twenty-nine female (69%) and 13 (31%) male patients were included in the study. Median age was 41 (18-58) and median BMI was 48 (41.1-68). When the VAS values were compared, in the TAPB group, 6th hour resting and coughing pain was statistically significantly less. Other VAS values measured while resting, coughing, and post-mobilization did not show significant differences. There were no significant differences between the groups' tramadol use. CONCLUSIONS After LSG, TAP block and trocar site infiltration yield similar pain control. Due to the faster application and fewer side effects, we concluded that trocar site infiltration should be the intervention of choice in controlling postoperative pain in LSG.
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Affiliation(s)
- Mümin Coşkun
- School of Medicine, General Surgery Department Fevzi Çakmak Mah, Marmara University, Mimar Sinan Cad No:41 Üst Kaynarca, Pendik, 34899, İstanbul, Turkey.
| | - Samet Yardimci
- Medical Park Hospital General Surgery Department Fevzi Çakmak Mahallesi, D100, Cemal Gürsel Cd. No:9, Pendik, 34899, İstanbul, Turkey
| | - Mustafa Kemal Arslantaş
- School of Medicine, Anesthesiology Department Fevzi Çakmak Mah, Marmara University, Mimar Sinan Cad No:41 Üst Kaynarca, Pendik, 34899, İstanbul, Turkey
| | - Gülbin Töre Altun
- School of Medicine, Anesthesiology Department Fevzi Çakmak Mah, Marmara University, Mimar Sinan Cad No:41 Üst Kaynarca, Pendik, 34899, İstanbul, Turkey
| | - Tevfik Kıvılcım Uprak
- School of Medicine, General Surgery Department Fevzi Çakmak Mah, Marmara University, Mimar Sinan Cad No:41 Üst Kaynarca, Pendik, 34899, İstanbul, Turkey
| | - Yalçın Burak Kara
- School of Medicine, General Surgery Department Fevzi Çakmak Mah, Marmara University, Mimar Sinan Cad No:41 Üst Kaynarca, Pendik, 34899, İstanbul, Turkey
| | - Asim Cingi
- School of Medicine, General Surgery Department Fevzi Çakmak Mah, Marmara University, Mimar Sinan Cad No:41 Üst Kaynarca, Pendik, 34899, İstanbul, Turkey
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Saafan T, El Ansari W, Bashah M. Compared to What? Is BMI Associated with Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens? Obes Surg 2020; 29:2166-2173. [PMID: 30989568 DOI: 10.1007/s11695-019-03801-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a risk for many different cancers. Laparoscopic sleeve gastrectomy (LSG) is common, and benign or pre-malignant histopathology types are reported in the removed gastric specimens. We assessed whether higher BMI was associated with certain benign or pre-malignant histopathological changes. METHOD Retrospective chart review of all primary LSG patients (N = 1555). Demographic, clinical, and LSG histopathology data were retrieved. BMI of patients with specific benign or pre-malignant conditions in their gastric specimens was compared with the BMI of the rest of the patients with abnormal histopathology specimens and also compared with the BMI of patients with normal control specimens. RESULTS Females comprised 70% of the patients. Mean BMI were 46.3 (females) and 48 (males). Normal LSG specimens comprised 52%. Most common abnormal histopathologies were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), lymphoid aggregates (2.2%), intestinal metaplasia (1.4%) and GIST (0.7%). After controlling for confounders (age, gender, H. pylori, diabetes mellitus type 2, hypertension), no significant association was observed between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies. CONCLUSION When confounders were taken into account, there appeared no significant associations between the BMI of patients with specific benign or pre-malignant histopathology compared with the BMI of the rest of the patients with abnormal histopathologies and compared to the BMI of patients with normal histopathologies of their gastric specimens. There was a very weak correlation between BMI and other covariates.
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Affiliation(s)
- Tamer Saafan
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar. .,College of Medicine, Qatar University, Doha, Qatar. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Moataz Bashah
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine, Doha, Qatar
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Yemini R, Nesher E, Carmeli I, Winkler J, Rahamimov R, Mor E, Keidar A. Bariatric Surgery Is Efficacious and Improves Access to Transplantation for Morbidly Obese Renal Transplant Candidates. Obes Surg 2020; 29:2373-2380. [PMID: 31134476 DOI: 10.1007/s11695-019-03925-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 02/06/2023]
Abstract
BACKGROUND The surgical risk of morbidly obese patients is high and even higher for kidney transplant candidates. A BMI > 35-40 kg/m2 is often a contraindication for that surgery. The safety, feasibility, and outcome of bariatric surgery for those patients are inconclusive. METHODS We conducted a retrospective chart review of prospectively collected data on morbidly obese renal transplant candidates who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between January 2009 and September 2017. The reported outcome included body weight and graft status after a mean follow-up of 47 months (range 0.5-5 years). RESULTS Twenty-four patients (8 females, 16 males, average age 54 years, average preoperative BMI 41 kg/m2 [range 35-51]) underwent LSG (n = 17) or LRYGB (n = 7). Sixteen of them (67%) proceeded to kidney transplantation. Of the 8 pre-transplant and post-bariatric surgery patients, 5 are on the waitlist, and 2 patients died (one of staple line leakage, and one from sepsis unrelated to the bariatric surgery). The average time from bariatric surgery to transplantation was 1.5 years (range 1 month to 4.3 years). The average pre-transplantation BMI was 28 kg/m2 (range 19-36). The mean percentage of excess weight loss was 66% (n = 21), and the total percentage of weight loss was 29% (n = 21). Comorbidities (type 2 diabetes, hypertension, and dyslipidemia) improved significantly following both surgical approaches. CONCLUSIONS LSG and LRYGB appear to effectively address obesity issues before kidney transplantation and improve surgical access. Morbidly obese transplant candidates would benefit from prior bariatric surgery.
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Affiliation(s)
- Renana Yemini
- Department of Surgery, Assuta Ashdod Medical Center, Ashdod, Israel. .,Ben-Gurion University, Beer-Sheva, Israel.
| | - Eviatar Nesher
- Departments of Transplant Surgery, Beilinson Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Idan Carmeli
- Department of Surgery, Assuta Ashdod Medical Center, Ashdod, Israel.,Ben-Gurion University, Beer-Sheva, Israel
| | - Janos Winkler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Departments of Nephrology, Beilinson Medical Center, Petach-Tikva, Israel
| | - Ruth Rahamimov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Departments of Nephrology, Beilinson Medical Center, Petach-Tikva, Israel
| | - Eytan Mor
- Departments of Transplant Surgery, Beilinson Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrei Keidar
- Department of Surgery, Assuta Ashdod Medical Center, Ashdod, Israel.,Ben-Gurion University, Beer-Sheva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Bariatric Clinic, Department of Surgery, Beilinson Medical Center, Petach-Tikva, Israel
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de la Cruz M, Büsing M, Dukovska R, Torres AJ, Reiser M. Short- to medium-term results of single-anastomosis duodeno-ileal bypass compared with one-anastomosis gastric bypass for weight recidivism after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2020; 16:1060-1066. [PMID: 32473786 DOI: 10.1016/j.soard.2020.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 12/27/2019] [Revised: 03/28/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Single-anastomosis duodeno-ileal bypass (SADI) and the one-anastomosis gastric bypass (OAGB) are 2 revisional procedures to address the problem of weight recidivism after laparoscopic sleeve gastrectomy (LSG). OBJECTIVES To evaluate the efficacy and safety of SADI and OAGB as revisional bariatric surgery (RBS) in initially super-obese patients (body mass index [BMI] >50 kg/m2). SETTING Academic hospital, bariatric center of excellence, Germany. METHODS Observational study of outcomes in 84 initially super-obese patients who had undergone RBS after LSG (SADI n = 42, OAGB n = 42) between July 2013 and April 2018. Follow-up examinations were performed at 1, 6, 12, 24, and 36 months after RBS. The variables analyzed included time between LSG and RBS, BMI, excess weight loss, total weight loss, operation time, and complications. RESULTS The time interval between LSG and RBS was 45.5 ± 22.8 and 43.5 ± 24.2 months for SADI and OAGB, respectively. At the time of RBS, the mean BMI was 42.8 ± 7.9 kg/m2 for SADI and 43.4 ± 9.2 kg/m2 for OAGB. The follow-up examinations rates (%) after SADI were 97.6, 92.8, 90.5, 78.6, 57.1, and 100, 97.6, 95.2, 85.7, and 59.5 after OAGB. The BMI at the follow-up examinations were 39.1 ± 7.2, 34.2 ± 6.9, 31.2 ± 5.8, 30.2 ± 5.3, 29.3 ± 5.1 for SADI, and 39.5 ± 8.1, 36.6 ± 7.4, 34.7 ± 7.9, 32.9 ± 6.3, and 31.6 ± 5.9 for OAGB. The mean operating times for SADI and OAGB were 138 ± 40 and 123 ± 39 minutes, respectively. Three patients in the SADI group and 1 patient in the OAGB group developed a major complication within the first 30 postoperative days. CONCLUSION SADI and OAGB were effective second-step procedures for further weight reduction after LSG in initially super-obese patients after short to medium follow-up. There was a trend toward higher weight loss for SADI though this did not reach statistical significance. Substantial differences concerning surgery time and complications between the 2 procedures were not observed.
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Affiliation(s)
- Marlon de la Cruz
- Department of Surgery, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Martin Büsing
- Department of Surgery, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Radostina Dukovska
- Department of Surgery, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Recklinghausen, Germany
| | - Antonio José Torres
- Department of Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Markus Reiser
- Department of Gastroenterology, Klinikum-Vest GmbH, Paracelsusklinik Marl, Marl, Germany.
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Assem S, Abdelbaki TN, Mohy-El Dine SH, Ketat AF, Abdelmonsif DA. SERPINE-1 Gene Methylation and Protein as Molecular Predictors of Laparoscopic Sleeve Gastrectomy Outcome. Obes Surg 2020; 30:2620-2630. [PMID: 32170551 DOI: 10.1007/s11695-020-04533-0] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND Body weight is subjected to genetic and epigenetic modifiers that might affect the success of weight loss interventions. Because of its possible complications and disparity in patients' response, identification of predictors to the outcome of bariatric surgery is indispensable. OBJECTIVES This prospective study aims to investigate serpin peptidase inhibitor type 1 (SERPINE-1) protein and gene methylation as molecular predictors to the outcome of bariatric surgery. PATIENTS AND METHODS One hundred participants were enrolled and divided to control group (n = 50) and obese patients who underwent laparoscopic sleeve gastrectomy (LSG) (n = 50). Anthropometric measurements were assessed and blood samples were collected preoperatively and 6 months postoperatively for assessment of SERPINE-1 protein and gene methylation, C-reactive protein (CRP), and homeostatic model assessment of insulin resistance (HOMA-IR). Moreover, subjects were followed for 2 years for weight loss parameters. RESULTS Patients with obesity showed high baseline SERPINE-1 protein and gene hypermethylation where LSG was followed by a drop in SERPINE-1 protein level but not gene hypermethylation. Baseline SERPINE-1 gene methylation was negatively related to postoperative weight loss and was the independent predictor to weight loss after LSG. Likewise, postoperative SERPINE-1 protein was negatively related to weight loss with independent expression from its gene methylation state. Furthermore, postoperative SERPINE-1 gene methylation correlated to CRP and HOMA-IR. CONCLUSION Baseline SERPINE-1 gene methylation might be a predictor of weight loss after LSG. Meanwhile, postoperative SERPINE-1 protein could be a predictor to weight loss maintenance after LSG. Lastly, postoperative SERPINE-1 gene methylation might serve as an index to postoperative changes in obesity-related comorbidities.
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Affiliation(s)
- Sara Assem
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Tamer N Abdelbaki
- Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Safaa H Mohy-El Dine
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amel F Ketat
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Doaa A Abdelmonsif
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. .,Molecular Biology Lab. and Nanomedicine Lab., Center of Excellence for Research in Regenerative Medicine and Applications, University of Alexandria, Alexandria, Egypt.
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Yang K, Zhang X, Zhou Y, Chen F, Shen M, Wang Y. Changes in Serum Nesfatin-1 After Laparoscopic Sleeve Gastrectomy are Associated with Improvements in Nonalcoholic Fatty Liver Disease. Diabetes Metab Syndr Obes 2020; 13:1459-1464. [PMID: 32431529 PMCID: PMC7200260 DOI: 10.2147/dmso.s246281] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a serious and widespread disease worldwide. Bariatric surgery is one of the treatments for NAFLD. Nesfatin-1 is located in the brain, periphery and plasma. We studied the relationship between nesfatin-1 changes after laparoscopic sleeve gastrectomy (LSG) and NAFLD remission. METHODS A total of 29 patients participated in the study, which collected clinical information on the patients and indicators of liver function, hepatic steatosis score and nesfatin-1 level before and after LSG. RESULTS The average BMI of the patients before surgery was 42.63±8.91 kg/m2, and the average BMI was 28.54±5.63 kg/m2 one year after surgery (p < 0.05). One year after LSG, the total weight loss percentage (TWL%) was 32.11±7.10%. The mean value of nesfatin-1 before surgery was 3.04±0.81 ng/mL, and the mean value of nesfatin-1 was 5.52±1.55 ng/mL at one year after surgery (p < 0.05). The average preoperative hepatic steatosis index (HSI) score of the patients was 52.55±9.17, and the average postoperative HSI score was 38.84±5.82 (p < 0.05). Before LSG (p < 0.05, r= -0.81) and 1 year after surgery (p < 0.05, r = -0.58), HSI and nesfatin-1 were significantly negatively correlated. Percentage of increased nesfatin-1 and percentage of decreased HSI showed positive correlation after LSG. CONCLUSION There was a negative correlation between HSI and nesfatin-1 before and after LSG, which may suggest that nesfatin-1 plays a role in NAFLD.
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Affiliation(s)
- Keyu Yang
- Department of General Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province110032, People’s Republic of China
| | - Xiaowei Zhang
- Department of General Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province110032, People’s Republic of China
| | - Yong Zhou
- Department of General Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province110032, People’s Republic of China
| | - Fu Chen
- Department of General Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province110032, People’s Republic of China
| | - Mingyang Shen
- Department of General Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province110032, People’s Republic of China
| | - Yong Wang
- Department of General Surgery, Fourth Affiliated Hospital of China Medical University, Shenyang City, Liaoning Province110032, People’s Republic of China
- Correspondence: Yong Wang Department of General Surgery, Fourth Affiliated Hospital of China Medical University, No. 4, Chongshan East Road, Huanggu District, Shenyang City, Liaoning Province110032, People’s Republic of ChinaTel +8618940259733 Email
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Kashihara H, Shimada M, Yoshikawa K, Higashijima J, Miyatani T, Tokunaga T, Nishi M, Takasu C, Hamada Y. The Effect of Laparoscopic Sleeve Gastrectomy on Obesity and Obesity-related Disease : the Results of 10 Initial Cases. J Med Invest 2019; 66:289-292. [PMID: 31656291 DOI: 10.2152/jmi.66.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/14/2022]
Abstract
Introduction : The number of patients who undergo laparoscopic sleeve gastrectomy (LSG) has been increasing. Department of Surgery, Tokushima University performed the first LSG in 2013. The aim of this study was to report the results of the initial ten cases who underwent a LSG. Patients and methods : Ten obese patients : five males and five females ; age range from thirty-three years to fifty-six years (mean age 42.2 years) ; mean body mass index (BMI) 50.3 ; five with diabetes ; nine with hypertension (HT) ; four with hyperlipidemia (HL) ; eight with sleep apnea syndrome (SAS) who underwent LSG were enrolled in this study. The data was analyzed retrospectively and included short- and long-term outcomes. Results : There were no post-operative complications in this study. The %EWL at three and six months and one year post-operative were 44.2%, 50.2% and 48.6% respectively. In three months post-operative the non-alcoholic fatty liver (NAFLD) and non-alcoholic steatohepatitis (NASH) had improved transaminase (AST/ALT), liver to spleen ratio in plain CT value. Improvements were also evident in the obesity-related diseases : diabetes 80% (4/5) ; HT 67% (6/9) ; HL 75% (3/4) ; and SAS 88% (7/8). Conclusion : LSG is a promising option for the treatment of morbid obesity and obesity-related diseases. J. Med. Invest. 66 : 289-292, August, 2019.
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Affiliation(s)
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Jun Higashijima
- Department of Surgery, Tokushima University, Tokushima, Japan
| | | | - Takuya Tokunaga
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Masaaki Nishi
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Chie Takasu
- Department of Surgery, Tokushima University, Tokushima, Japan
| | - Yasuhiro Hamada
- Department of Therapeutic nutrition, Tokushima University, Tokushima, Japan
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Blanchet MC, Frering V, Gignoux B, Matussière Y, Oudar P, Noël R, Mirabaud A. Four-Year Evolution of a Thrombophylaxis Protocol in an Enhanced Recovery After Surgery (ERAS) Program: Recent Results in 485 Patients. Obes Surg 2019; 28:2140-2144. [PMID: 29754385 PMCID: PMC6018584 DOI: 10.1007/s11695-018-3299-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
“Enhanced recovery after surgery” (ERAS) protocols may reduce morbidity, length of hospital stay (LOS), and costs. During the 4-year evolution of a bariatric ERAS protocol, we found that administration of thrombophylaxis selectively to high-risk morbidly obese patients (assessed postoperatively by Caprini score ≥ 3) undergoing omega loop gastric bypass (“mini” gastric bypass) or sleeve gastrectomy resulted in safe outcomes. Both procedures proved equally effective with this protocol. The vast majority of rapidly mobilized, low-risk patients did not appear to require antithrombotic heparin. Similar to other reported ERAS outcomes, our recent year’s results in 485 patients included a mean LOS of 1.08 ± 0.64 days (range 1–14), with 460 (95.0%) discharged on day 1 and 99.6% by day 2. There were 13 30-day complications (2.7%), two reinterventions (0.4%), and no hemorrhages.
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Affiliation(s)
- Marie-Cécile Blanchet
- Clinique de la Sauvegarde, Lyon, France. .,Espace Médico-Chirurgical, Immeuble "Trait d'Union" - Entrée A29, Av des Sources, 69009, Lyon, France.
| | | | | | | | | | - Romain Noël
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology, Clinique de la Sauvegarde, Lyon, France
| | - Alban Mirabaud
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology, Clinique de la Sauvegarde, Lyon, France
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36
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Baldwin D, Chennakesavalu M, Gangemi A. Systematic review and meta-analysis of Roux-en-Y gastric bypass against laparoscopic sleeve gastrectomy for amelioration of NAFLD using four criteria. Surg Obes Relat Dis 2019; 15:2123-2130. [PMID: 31711944 DOI: 10.1016/j.soard.2019.09.060] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) prevalence is rising worldwide, as a direct consequence of the obesity epidemic. Bariatric surgery provides proven NAFLD amelioration, although questions remain regarding whether Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG) is more effective. To answer this question, we conducted a systematic review and meta-analysis exclusively comparing RYGB and LSG for amelioration of NAFLD using 4 separate criteria: alanine transaminase, aspartate transaminase, NAFLD activity score, and NAFLD fibrosis score. Our search included 1290 initial studies, which were narrowed to 20 final studies in the meta-analysis. Overall, both RYGB and LSG significantly improved alanine transaminase, aspartate transaminase, NAFLD activity score, and NAFLD fibrosis score postoperatively. Direct comparisons of RYGB to LSG in any of the 4 criteria failed to demonstrate superiority. Our findings corroborate the current literature showing that bariatric surgery significantly improves biochemical and histologic parameters in patients with NAFLD. The novel individual comparisons of 4 criteria failed to show superiority between RYGB and LSG in ameliorating NAFLD. Despite several limitations, our study can assist clinicians by supporting the notion that RYGB and LSG may be equally efficacious in ameliorating NAFLD.
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Affiliation(s)
- Dustin Baldwin
- Department of Surgery, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mohansrinivas Chennakesavalu
- Department of Surgery, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Antonio Gangemi
- Department of Surgery, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, Illinois.
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Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc 2019; 34:396-407. [PMID: 30993513 PMCID: PMC6946737 DOI: 10.1007/s00464-019-06782-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/04/2019] [Indexed: 12/19/2022]
Abstract
Background Staple-line leaks following laparoscopic sleeve gastrectomy (LSG) remain a concerning complication. Staple-line buttressing is largely adopted as an acceptable reinforcement but data regarding leaks have been equivocal. This study compared staple-line leaks in five reinforcement options during LSG: no reinforcement (NO-SLR), oversewing (suture), nonabsorbable bovine pericardial strips (BPS), tissue sealant or fibrin glue (Seal), or absorbable polymer membrane (APM). Methods This systematic review study of articles published between 2012 and 2016 regarding LSG leak rates aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Variables of interest included leak rates, bleeding, and complications in addition to surgical and population parameters. An independent Fisher’s exact test was used to compare the number of patients with and without leaks for the different reinforcement options. Results Of the 1633 articles identified, 148 met inclusion criteria and represented 40,653 patients. Differences in age (older in APM; p = 0.001), starting body mass index (lower in Suture; p = 0.008), and distance from pylorus (closer in BPS; p = 0.04) were observed between groups, but mean bougie size was equivalent. The overall leak rate of 1.5% (607 leaks) ranged from 0.7% for APM (significantly lower than all groups; p ≤ 0.007 for next lowest leak rate) to 2.7% (BPS). Conclusions This systematic review of staple-line leaks following LSG demonstrated a significantly lower rate using APM staple-line reinforcement as compared to oversewing, use of sealants, BPS reinforcement, or no reinforcement. Variation in surgical technique may also contribute to leak rates. Electronic supplementary material The online version of this article (10.1007/s00464-019-06782-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, 315 Place D’Youville, Suite 191, Montréal, QC H2Y 0A4 Canada
- Herbert Wertheim School of Medicine, Florida International University, Miami, FL USA
- Westmount Square Surgical Center, Westmount, QC Canada
| | - Paul Kemmeter
- Department of Surgery, Mercy Health Saint Mary’s, 2060 E Paris Ave SE #100, Grand Rapids, MI USA
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Bužga M, Marešová P, Petřeková K, Holéczy P, Kuča K. The efficacy of selected bariatric surgery methods on lipid and glucose metabolism: a retrospective 12-month study. Cent Eur J Public Health 2018; 26:49-53. [PMID: 29684298 DOI: 10.21101/cejph.a4637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 02/07/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Approximately 25% of the Czech population is currently obese. Obesity rates are expected to increase in the future. Obesity not only raises the risk of health complications for individuals, but increasing rates also represent a significant and steadily growing economic burden for healthcare systems and society as a whole. The aim of this study was to evaluate the therapeutic efficacy of three methods of bariatric surgery: laparoscopic greater curve plication (LGCP), laparoscopic sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYBG) in patients with type 2 diabetes mellitus (DM). This study examined the influence of bariatric surgery on body weight and BMI, changes in serum glucose and markers of lipid metabolism. METHODS This study evaluated outcomes in 74 patients with type 2 DM who underwent LGCP, LSG or RYGB. Patient selection followed guidelines of the International Federation for the Surgery of Obesity, i.e. BMI≥40 kg/m2 or BMI≥35 kg/m2 with associated comorbidities or BMI<35 kg/m2. For each of the procedures, the hypotheses were tested with the Bonferroni method. RESULTS Statistically significant weight loss, 20.2±9.3 kg on average, occurred by 12 months after surgery, with maximum weight reduction of 38 kg. Over the 12-month period, average fasting glycaemia decreased by 2.58 mmol/L after LGCP, by 2.01 mmol/L after LSG, and by 4.64 mmol/L after RYGB. Triacylglycerol (TGC) values decreased significantly with all procedures. The mean decrease was 1.35 mmol/L after LGCP and 1.06 mmol/L after LSG. The greatest TGC concentration decrease, 1.92 mmol/L, occurred after RYGB. Average concentrations decreased below 1.7 mmol/L. There was a statistically significant difference in body weight and BMI reduction between LGCP and LSG groups, as well as between LGCP and RYGB groups. A significant difference in the glucose decrease was observed between the LSG and RYGB groups, which can be explained by the fact that glycaemia and HbA1c levels were different between these groups prior to surgery. CONCLUSIONS The best results from the carbohydrate metabolism point reached the malabsorption method RYGB. However, the other two restrictive methods also achieved very good results. In particular, the LGCP method has not only the effect on weight reduction but also on metabolic functions and consequently points to potential healthcare expenditure savings.
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Affiliation(s)
- Marek Bužga
- Research Obesity Centre, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Petra Marešová
- Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Karin Petřeková
- Research Obesity Centre, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavol Holéczy
- Research Obesity Centre, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Kamil Kuča
- Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic.,Biomedical Research Centre, University Hospital Hradec Králové, Hradec Králové, Czech Republic
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Bevilacqua LA, Obeid NR, Spaniolas K, Bates A, Docimo S, Pryor A. Early postoperative diet after bariatric surgery: impact on length of stay and 30-day events. Surg Endosc 2018; 33:2475-2478. [PMID: 30374793 DOI: 10.1007/s00464-018-6533-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pathways for enhanced recovery after surgery (ERAS) have been shown to improve length-of-stay (LOS) and post-operative complications across various surgical fields, however there is a lack of evidence-based studies in bariatric surgery. Specifically, the value of early feeding within an ERAS program in bariatric surgery is unclear. The objective of the current study was to determine the effect of early feeding on LOS for patients who underwent primary or revisional laparoscopic sleeve gastrectomy (LSG) and Roux-en-y gastric bypass (RYGB). METHODS Retrospective single institution study of implementation of a new diet protocol in which initiation of oral intake changed from post-operative day 1 to day 0. LOS and 30-day events were compared. Patients were excluded if they were planned for 23-h stay, had significant intra-operative complications, or required reoperation within the same admission. Mann-Whitney U tests were done to compare LOS and chi-squared tests to compare 30-day events pre- and post-intervention. RESULTS A total of 244 patients were included; 84.4% were primary cases. 50.8% of cases occurred prior to early feeding implementation. Median age was 43.5 years (IQR 33-53) and majority of patients were female (78.7%). Median LOS was 32.6 (IQR 30.0-50.6). Median LOS across the whole sample was shorter in the early feeding group (36.2 vs. 31.0 h; p < 0.001). This difference remained statistically significant for primary, but not revisional cases. Post-operative events at 30 days were similar between pre- and post-intervention groups. CONCLUSIONS Early feeding the day of surgery is associated with significantly shorter LOS for patients who undergo bariatric surgery with no difference in 30-day readmissions.
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Affiliation(s)
- Lisa A Bevilacqua
- Department of Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Nabeel R Obeid
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Andrew Bates
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Salvatore Docimo
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
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Lemmens L, Van Den Bossche J, Zaveri H, Surve A. Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients. Obes Surg 2018; 28:2687-2695. [PMID: 29671124 PMCID: PMC6132784 DOI: 10.1007/s11695-018-3248-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/11/2022]
Abstract
INTRODUCTION The failure rate of the laparoscopic sleeve gastrectomy (LSG) is increasing. Gastric pouch dilation is frequently suggested to be one of the causes for the failure. The banded laparoscopic sleeve gastrectomy (BLSG) has been proposed to overcome this complication. This is the first study that reports the long-term outcome (> 5 years) of BLSG in obese and superobese patient population. MATERIALS AND METHODS One hundred and forty-seven patients (n = 51, non-banded LSG (NLSG)/n = 96, BLSG) were followed up for 5 years. Patients were evaluated for % excess weight loss (%EWL), % excess body mass index loss (%EBMIL), weight regain, BMI, and complications. Weight loss analysis was also done between banded and non-banded superobese patient populations. RESULT There was statistical significant difference between two groups at each given time point in terms of %EWL and %EBMIL. NLSG group had higher weight loss failure rate (35.2%) and weight regain (19.6%) at the 5-year follow-up compared to BLSG group (P < 0.001). There was no statistical significant difference in weight loss between obese and superobese BLSG group. The complication rates were more with BLSG group (14.5%) compared to NLSG group (9.8%); no signs of band slippage, erosion, or migration were seen. There was no mortality seen. CONCLUSION BLSG surgery was found to be safe and effective in maintaining weight loss on the long term compared to the NLSG group with low incidence of band-related problems. Additionally, the NLSG group had a higher rate of weight loss failure and weight regain at 5 years compared to the BLSG group.
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Affiliation(s)
- Luc Lemmens
- Abdominal Surgery, Campus Sint-Niklaas, AZ Nikolaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Jelmer Van Den Bossche
- Abdominal Surgery, Campus Sint-Niklaas, AZ Nikolaas, Moerlandstraat 1, 9100 Sint-Niklaas, Belgium
| | - Hinali Zaveri
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
| | - Amit Surve
- Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT 84102 USA
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Creange C, Jenkins M, Pergamo M, Fielding G, Ren-Fielding C, Schwack B. Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to sleeve gastrectomy: 5-year outcomes. Surg Obes Relat Dis 2018; 14:1531-1536. [PMID: 30449510 DOI: 10.1016/j.soard.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss. OBJECTIVE To compare the weight loss results of these 2 surgeries. SETTING University hospital, United States. METHODS A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations. RESULTS The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB = 32.93, LSG = 38.34, P = .0004), percent excess BMI lost (RYGB = 57.8%, LSG = 29.3%, P < .0001), and percent weight loss (RYGB = 23.4%, LSG = 12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P = .0022), longer operating room time (RYGB = 120.1 min versus LSG = 115.5 min, P < .0001), and longer length of stay (RYGB = 3.33 d versus LSG = 2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P = .087). CONCLUSION Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure.
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Affiliation(s)
- Collin Creange
- Department of General Surgery, NYU Langone Medical Center, New York, New York.
| | - Megan Jenkins
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - Matthew Pergamo
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - George Fielding
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | | | - Bradley Schwack
- Department of General Surgery, NYU Langone Medical Center, New York, New York
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Blanchet MC, Gignoux B, Matussière Y, Vulliez A, Lanz T, Monier F, Frering V. Experience with an Enhanced Recovery After Surgery (ERAS) Program for Bariatric Surgery: Comparison of MGB and LSG in 374 Patients. Obes Surg 2018; 27:1896-1900. [PMID: 28455803 DOI: 10.1007/s11695-017-2694-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 12/19/2022]
Abstract
BACKGROUND Strategic multidisciplinary protocols for "enhanced recovery after surgery" (ERAS) have demonstrated reductions in length of hospital stay (LOS), morbidity, and costs in conjunction with bariatric procedures. METHODS We prospectively investigated the effectiveness and safety of an ERAS protocol with laparoscopic omega loop gastric bypass ("mini" gastric bypass, MGB) and LSG in morbidly obese patients. RESULTS Average LOS was 1.24 days (range 1-14); 86.1% discharged on day 1; 96.9% by day 2, a value comparable or better than that of other ERAS studies vs standard care according to meta-analysis. Complications 2.9%; readmission 2.1%; reintervention 1.3%. CONCLUSION The program was equally safe with both procedures. Postoperative antithrombotic heparin does not appear necessary in low-risk patients. Bariatric surgical ERAS programs are evolving and not yet standardized.
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Affiliation(s)
- Marie-Cécile Blanchet
- Clinique de la Sauvegarde, Lyon, France. .,Espace Médico-Chirurgical, Immeuble ''Trait d'Union'', Entrée A29 Av des Sources, 69009, Lyon, France.
| | | | - Yann Matussière
- Clinique de la Sauvegarde, Lyon, France.,Department of Nutrition 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
| | - Alexandre Vulliez
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology - 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
| | - Thomas Lanz
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology - 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
| | - Fabienne Monier
- Clinique de la Sauvegarde, Lyon, France.,Department of anesthesiology - 29 avenue des Sources- Clinique de la Sauvegarde, 69009, Lyon, France
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Mangieri CW, Strode MA. Formal Nutritional Education Improves Weight Loss in Bariatric Patients Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2016; 26:2952-60. [PMID: 27179519 DOI: 10.1007/s11695-016-2216-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an increasingly performed procedure in the bariatric surgery armamentarium. This study evaluates our experience with LSG at Dwight D. Eisenhower Army Medical Center (DDEAMC) during the time period of 2008-2010. We found that the inclusion of formal nutritional education significantly increased our weight loss results following LSG. METHODS This is a retrospective review from our LSG caseload from 2008 to 2010. During that time, we performed 159 LSG. In our review, we performed comparative data of all operative years during 2008-2010 for up to 3 years postoperatively. Our main focus was in regard to weight loss as measured by percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess BMI loss (%EBL). We also evaluated the effect of LSG on diabetes mellitus (DM) and hypertension (HTN) postoperatively. RESULTS We found an improvement in our %EWL, %TWL, and %EBL rates in our LSG cases following the inclusion of formal nutritional education. There was a mean increase in %EWL of 15 %, %TWL of 7 %, and %EBL of 21 %, which were statistically significant, that was present at all postoperative years of follow-up. We determined the only variable that changed in our bariatric program starting in 2010 was the inclusion of formal nutritional education. We also found a statistically significant improvement in resolution of HTN with the inclusion of formal nutritional education. CONCLUSIONS The addition of formal nutritional education can enhance weight loss following bariatric surgery. We have shown a significant improvement in weight loss results following LSG with the implementation of formal nutritional education; this is the only study to our knowledge evaluating formal nutritional education and LSG.
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Inaba CS, Koh CY, Sujatha-Bhaskar S, Lee Y, Pejcinovska M, Nguyen NT. The effect of hospital teaching status on outcomes in bariatric surgery. Surg Obes Relat Dis 2017; 13:1723-1727. [PMID: 28867305 PMCID: PMC6281390 DOI: 10.1016/j.soard.2017.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/05/2017] [Revised: 05/23/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies have shown conflicting effects of resident involvement on outcomes after laparoscopic bariatric surgery. Resident involvement may be a proxy for a teaching environment in which multiple factors affect patient outcomes. However, no study has examined outcomes of laparoscopic bariatric surgery based on hospital teaching status. OBJECTIVE To compare outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) between teaching hospitals (THs) and nonteaching hospitals (NTHs). SETTING Retrospective review of a national database in the United States. METHODS The Nationwide Inpatient Sample database (2011-2013) was reviewed for obese patients who underwent LRYGB or LSG. Patient demographic characteristics and outcomes were analyzed according to hospital teaching status. Primary outcome measures included risk-adjusted inpatient mortality and serious morbidity. RESULTS We analyzed 32,449 LRYGBs and 26,075 LSGs. There were 35,160 (60.1%) cases performed at THs and 23,364 (39.9%) cases performed at NTHs. At THs, the distribution of LRYGB versus LSG cases was 20,461 (58.2%) versus 14,699 (41.8%), respectively; at NTHs, the distribution was 11,988 (51.3%) versus 11,376 (48.7%), respectively. For LRYGB, there were no significant differences between THs versus NTHs in mortality (AOR 1.14; P = 0.99), but there was an increase in odds of serious morbidity at THs (AOR 1.36; P<0.001). For LSG, there were no significant differences between THs versus NTHs for mortality (AOR 1.15; P = 0.99) or serious morbidity (AOR 1.03; P = 0.99). CONCLUSIONS There is an association between THs and increased serious morbidity for LRYGB, but hospital teaching status has no effect on morbidity or mortality after LSG. Further research is warranted to elucidate the reasons for these associations.
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Affiliation(s)
- Colette S Inaba
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Christina Y Koh
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Sarath Sujatha-Bhaskar
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Yoon Lee
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Marija Pejcinovska
- Center for Statistical Consulting, University of California at Irvine, Irvine, California
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, California.
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Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis 2016; 13:170-180. [PMID: 27720197 DOI: 10.1016/j.soard.2016.08.011] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [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: 07/14/2016] [Accepted: 08/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to compare midterm and long-term weight loss and resolution of co-morbidity with laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). SUMMARY LRYGB and LSG are the most common procedures performed in bariatric surgery. However, their weight loss efficacy in the midterm and long-term has not been well compared. METHODS A meta-analysis was performed by systematically identifying comparative studies conducted until the end of June 2016 that investigated weight loss outcome and resolution of co-morbidities (type 2 diabetes mellitus, hypertension, hyperlipidemia, hypertriglyceridemia, and obstructive sleep apnea) with LRYGB and LSG in the midterm (3-5 years) and long term (≥5 years). The primary endpoint was weight loss after LRYGB versus LSG. The secondary endpoint was resolution of co-morbidities after these procedures. RESULTS Fourteen studies comprising 5264 patients were eligible. Follow-up ranged from 36 months to 75.8±8.4 months. The pooled result for weight loss outcomes did not show any significant difference in midterm weight loss (standardized mean difference = -0.03; 95% confidence interval (CI), -0.38-.33; P = .88) but a significant difference in the long-term weight loss outcome favoring LRYGB (standardized mean difference = .17; 95% CI, .05-.28; P= .005). The pooled results demonstrated no significant difference for resolution of type 2 diabetes mellitus, hypertension, hyperlipidemia, and hypertriglyceridemia. CONCLUSION Despite the insignificant difference between LRYGB and LSG in midterm weight loss, LRYGB produced better weight loss in the long-term. There was no significant difference between the 2 procedures for co-morbidity resolution.
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Affiliation(s)
- Saeed Shoar
- Department of Metabolic and Bariatric Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY.
| | - Alan A Saber
- Department of Metabolic and Bariatric Surgery, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY
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Gajbhiye R, Tirpude B, Bhanarkar H, Sanghavi A, Shamkuwar A. A Study on Role of Laparoscopic Sleeve Gastrectomy in the Management of Morbid Obesity. Indian J Surg 2016; 78:177-81. [PMID: 27358510 DOI: 10.1007/s12262-015-1334-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/26/2015] [Indexed: 12/19/2022] Open
Abstract
Obesity has assumed a pandemic and is responsible for serious medical, social, psychological, and economic implications, affecting all ages and socioeconomic groups. Hence, this prospective study was carried out to study the surgical benefits in such patients. A Prospective interventional study was carried out from June 2010 to November 2012 at IGGMC Nagpur performing laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients, and its efficacy was determined. A total of 56 patients were studied. 26 (46.42 %) being males and 30 (53.57 %) females. The maximum number of patient's, i.e., 32 (57.14 %) were in the range of BMI 40-44.99 kg/m(2) with mean BMI-43.25 kg/m(2). Mean weight was 117 kg (range 92-180 kg). Common comorbidities observed were hypertension in 43 (76.78 %), bronchial asthma in 31 (55.35 %), and diabetes in 21 (37.5 %). All patients treated with LSG had a mean operative time of 154.9 min (range 110-310 min) with 0 % leak, one conversion to open, and no mortality. Postoperative hospital stay was 3.54 days (range 3-7). Complications were minimal with prolonged vomiting seen significantly in 28 (50 %) patients. Follow up at 24 months showed mean weight 74.72 kg (68-81 kg) with mean excess weight loss of 67.71 % (62.79-71.05 %) causing a mean BMI of 28.42 kg/m(2) (26.56-30.44 kg/m(2)). It also reduced mean BP to 120.36 mmHg (110-144 mmHg) and mean fasting blood sugar to 100.63 mg/dl (80-146 mg/dl). Surgery for obesity is definitely an answer for this gift of modernization, and LSG is a safe and effective technique for achieving weight loss. Quality of life improves astonishingly and adds confidence to this mentally traumatic entity called "OBESITY".
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Oberbach A, Neuhaus J, Inge T, Kirsch K, Schlichting N, Blüher S, Kullnick Y, Kugler J, Baumann S, Till H. Bariatric surgery in severely obese adolescents improves major comorbidities including hyperuricemia. Metabolism 2014; 63:242-9. [PMID: 24332707 DOI: 10.1016/j.metabol.2013.11.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 09/12/2013] [Revised: 11/13/2013] [Accepted: 11/15/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Serum uric acid (sUA) is believed to contribute to the pathogenesis of metabolic comorbidities like hypertension, insulin-resistance (IR) and endothelial dysfunction (EDF) in obese children. The present pilot study investigated the association between sUA concentrations and loss of body weight following laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y-gastric bypass (RYGB) in severely obese adolescents. MATERIALS/METHODS 10 severely obese adolescents underwent either LSG (n=5) or RYGB (n=5). 17 normal weight, healthy, age- and gender-matched adolescents served as a normal weight peer group (NWPG). Pre- and 12 months postoperatively, sUA and relevant metabolic parameters (glucose homeostasis, transaminases, lipids) were compared. RESULTS Preoperatively, sUA was significantly elevated in patients with severe obesity compared to NWPG. Twelve months after LSG and RYGB, a significant decrease in sUA, BMI, CVD risk factors, hepatic transaminases, and HOMA-IR was observed. Reduction in SDS-BMI significantly correlated with changes in sUA. CONCLUSIONS sUA levels and metabolic comorbidities improved following bariatric surgery in severely obese adolescents. The impact of changes in sUA on long-term clinical complications of childhood obesity deserves further study.
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Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, University of Leipzig, Heart Center Leipzig, Leipzig, Germany; University of Dresden, Department of Health Sciences/Public Health, Dresden, Germany
| | - Jochen Neuhaus
- Department of Urology, University of Leipzig, Leipzig, Germany
| | - Thomas Inge
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katharina Kirsch
- Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Nadine Schlichting
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany
| | - Susann Blüher
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany; Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Leipzig, Leipzig, Germany
| | - Joachim Kugler
- University of Dresden, Department of Health Sciences/Public Health, Dresden, Germany
| | - Sven Baumann
- Helmholtz Centre for Environmental Research, Department of Metabolomics, Leipzig, Germany
| | - Holger Till
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
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Gagner M, Buchwald JN. Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis 2014; 10:713-23. [PMID: 24745978 DOI: 10.1016/j.soard.2014.01.016] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [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: 09/14/2013] [Revised: 11/28/2013] [Accepted: 01/18/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The study compared laparoscopic sleeve gastrectomy (LSG) staple-line leak rates of 4 prevalent surgical options: no reinforcement, oversewing, nonabsorbable bovine pericardial strips (BPS), and absorbable polymer membrane (APM). BACKGROUND LSG is a multipurpose bariatric/metabolic procedure with effectiveness proven through the intermediate term. Staple-line leak is a severe complication of LSG for which no definitive method of prevention has been identified. METHODS The systematic review study design was employed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement screening guidelines. Inclusion criteria centered on variables potentially relevant to LSG leak: leak rate, age, gender, calibrating bougie size, distance between pylorus and gastric transection line, overall complication rate, and mortality. Analysis of variance models were used to explore differences in select demographic and surgical technique variables characterizing each reinforcement group. An omnibus χ(2) test followed by independent Fisher's exact tests were used to compare leak rates. RESULTS There were 659 articles identified; 41 duplicates removed. Of 618 remaining articles, 324 did not meet inclusion criteria. Of the 294 remaining articles, 206 were eliminated (kin studies, those not reporting staple-line or leak incidence, those reporting discontinued products). There were 88 papers included in the analysis. Statistically significant differences were found between groups across demographic and surgical variables studied (p<0.001). There were 191 leaks in 8,920 patients; overall leak rate 2.1%. Leak rates ranged from 1.09% (APM) to 3.3% (BPS); APM leak rate was significantly lower than other groups (p< 0.05). CONCLUSION Systematic review of 88 included studies representing 8,920 patients found that the leak rate in LSG was significantly lower using APM staple-line reinforcement than oversewing, BPS reinforcement, or no reinforcement.
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Affiliation(s)
- Michel Gagner
- Department of Surgery, Hopital du Sacré Coeur, Montréal, QC, Canada.
| | - Jane N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, U.S
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Shen LN, Zhang YT, Wang Q, Xu L, Feng NP. Enhanced in vitro and in vivo skin deposition of apigenin delivered using ethosomes. Int J Pharm 2013; 460:280-8. [PMID: 24269286 DOI: 10.1016/j.ijpharm.2013.11.017] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [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: 09/19/2013] [Revised: 10/30/2013] [Accepted: 11/14/2013] [Indexed: 11/15/2022]
Abstract
The aim of this study was to develop and evaluate a novel topical delivery system for apigenin by using ethosomes. An optimal apigenin-loaded ethosome formulation was identified by means of uniform design experiments. Skin deposition and transdermal flux of apigenin loaded in ethosomes, liposomes, and deformable liposomes were compared in vitro and in vivo. The efficiency of apigenin encapsulation increased with an increase in the amount of phospholipids in ethosome formulations. Moreover, skin deposition and transdermal flux of apigenin improved with an increase in the levels of phospholipids (Lipoid S 75) and short-chain alcohols (propylene glycol and ethanol), but decreased with an increase in the ratio of propylene glycol to ethanol. Profiles of skin deposition versus time for ethosomes varied markedly between in vivo and in vitro studies compared with those of liposomes or deformable liposomes. Optimized ethosomes showed superior skin targeting both in vitro and in vivo. Moreover, they had the strongest effect on reduction of cyclooxygenase-2 levels in mouse skin inflammation induced by ultraviolet B (UVB) light. Therefore, apigenin-loaded ethosomes represent a promising therapeutic approach for the treatment of UVB-induced skin inflammation.
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Affiliation(s)
- Li-Na Shen
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yong-Tai Zhang
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Qin Wang
- Department of Oncology, Longhua Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Ling Xu
- Department of Oncology, Longhua Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
| | - Nian-Ping Feng
- Department of Pharmaceutical Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Abstract
Obesity is one of the most serious and prevalent non-communicable diseases of the 21st century. It is also a patient-centered condition in which affected individuals seek treatment through a variety of commercial, medical and surgical approaches. Considering obesity as a chronic medical disease state helps to frame the concept of using a three-stepped intensification of care approach to weight management. As a foundation, all patients should be counseled on evidence-based lifestyle approaches that include diet, physical activity and behavior change therapies. At the second tier, two new pharmacological agents, phentermine-topiramate and lorcaserin, were approved in 2012 as adjuncts to lifestyle modification. The third step, bariatric surgery, has been demonstrated to be the most effective and long-term treatment for individuals with severe obesity or moderate obesity complicated by comorbid conditions that is not responsive to non-surgical approaches. By using a medical model, clinicians can provide more proactive and effective treatments in assisting their patients with weight loss.
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Affiliation(s)
- Robert F Kushner
- Medicine Northwestern University Feinberg School of Medicine, Chicago, IL.
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