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Medas F, Moroni E, Deidda S, Zorcolo L, Restivo A, Canu GL, Cappellacci F, Calò PG, Pintus S, Fantola G. The paradox of Zeno in bariatric surgery weight loss: Superobese patients run faster than morbidly obese patients, but can't overtake them. Front Surg 2023; 10:1100483. [PMID: 36816006 PMCID: PMC9932266 DOI: 10.3389/fsurg.2023.1100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Superobesity (SO) is defined as a BMI > 50 Kg/m2, and represents the extreme severity of the disease, resulting in a challenge for the surgeons. Methods In this retrospective study we aimed to compare the outcomes of SO patients compared to morbidly obese (MO) patients. Results We included in this study 154 MO patients, with a median preoperative BMI of 40.8 kg/m2, and 19 SO patients with median preoperative BMI of 54.9 kg/m2. The MO patients underwent sleeve gastrectomy (SG) in 62 (40.3%) cases, laparoscopic Roux-and-Y gastric bypass (LRYGBP) in 85 (55.2%) cases and One-Anastomosis Gastric Bypass (OAGB) in 7 (4.5%) cases. underwent OAGB. The patients in the SO group were submitted to SG in 11 (57.9%) cases, LRYGBP in 5 (26.3%) cases, and OAGB in 3 (15.8%). At 24-month follow-up, an excess weight loss (EWL) >50% was achieved in 129 (83.8%) patients in the MO group and in 15 (78.9%) in the SO group (p = 0.53). A BMI < 35 kg/m2 was achieved in 137 (89%) patients in the MO group and from 8 (42.2%) patients in the SO group (p < 0.001). The total weight loss was significantly directly related to the initial BMI. Superobesity was identified as independent risk factor for surgical failure when considering the outcome of BMI < 35 kg/m2. Discussion Our study confirms that, although SO patients tend to gain a greater weight loss than MO patients, they less frequently achieve the desired BMI target. In this setting, it should be necessary to re-consider malabsorptive procedures as first choice.
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Affiliation(s)
- Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy,Correspondence: Fabio Medas
| | - Enrico Moroni
- Obesity Surgery Unit, Surgical Department, “ARNAS G. Brotzu” Hospital, Cagliari, Italy
| | - Simona Deidda
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Luigi Zorcolo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Angelo Restivo
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | | | | | - Stefano Pintus
- Obesity Surgery Unit, Surgical Department, “ARNAS G. Brotzu” Hospital, Cagliari, Italy
| | - Giovanni Fantola
- Obesity Surgery Unit, Surgical Department, “ARNAS G. Brotzu” Hospital, Cagliari, Italy
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Arias A, Rodríguez-Álvarez C, González-Dávila E, Acosta-Torrecilla A, Novo-Muñoz MM, Rodríguez-Novo N. Arterial Hypertension in Morbid Obesity after Bariatric Surgery: Five Years of Follow-Up, a Before-And-After Study. Int J Environ Res Public Health 2022; 19:ijerph19031575. [PMID: 35162597 PMCID: PMC8835193 DOI: 10.3390/ijerph19031575] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Arterial hypertension (HTN) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study is to analyse the prevalence and evolution of HTN and weight loss in patients suffering from morbid obesity before and after bariatric surgery, during a follow-up period of five years. METHODS A before-and-after study was carried out on severely obese patients undergoing Laparoscopic Roux-En-Y Gastric Bypass (LRYGB). Criteria for HTN diagnosis were current treatment with antihypertensive agents and/or systolic blood pressure (SBP) > 140 mmHg and/or diastolic (DBP) > 90 mmHg. HTN remission was defined as normalisation of blood pressure (BP) maintained after discontinuation of medical treatment, and HTN recurrence was considered when HTN diagnostic criteria reappeared after remission. Weight loss during the study period was evaluated for each patient, calculating excess weight loss percentage (% EWL) and BMI loss percentage (% BMIL) with reference to the baseline value. RESULTS A total of 273 patients were included in the study. HTN was present in 48.2%; 29.4% of hypertensive patients showed HTN remission two years after the surgical procedure, 30.3% of them had relapsed at five years. CONCLUSION LRYGB in obese patients is associated with a remission of HTN, and no weight loss differences were observed between the group of patients showing HTN remission at two years and the group who did not. However, differences were observed after the second follow-up year, with an increased weight loss in the remission group, which could indicate that sustained weight loss favours the control of HTN.
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Affiliation(s)
- Angeles Arias
- Department of Preventive Medicine and Public Health, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain;
- Correspondence:
| | | | - Enrique González-Dávila
- Department of Mathematics, Statistics and Operations Research, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain;
| | | | - M. Mercedes Novo-Muñoz
- Faculty of Health Sciences, Nursing Section, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain; (M.M.N.-M.); (N.R.-N.)
| | - Natalia Rodríguez-Novo
- Faculty of Health Sciences, Nursing Section, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain; (M.M.N.-M.); (N.R.-N.)
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Sun Y, Huang L, Xu L, Zhang M, Guo Y, Wang Y. The Application of a SaCoVLM TM Visual Intubation Laryngeal Mask for the Management of Difficult Airways in Morbidly Obese Patients: Case Report. Front Med (Lausanne) 2021; 8:763103. [PMID: 34869469 PMCID: PMC8637043 DOI: 10.3389/fmed.2021.763103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022] Open
Abstract
We report insertion of the SaCoVLMTM in three awake morbidly obese patients (BMI 46. 7-52.1 kg/m2). The patients were given intravenous atropine and midazolam injections after entering the operating room and then inhaled an anesthetic with 2% lidocaine atomization. After SaCoVLMTM insertion while patients were awake, when the vocal cords were visualized, controlled anesthetic induction commenced with spontaneous ventilation. The entire anesthesia induction and intubation process was completed under visualization, and no adverse events such as hypoxemia occurred. No patient had an unpleasant recall of the procedure. We conclude that the SaCoVLMTM is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.
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Affiliation(s)
- Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Linlin Huang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Lingling Xu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
| | - Yongle Guo
- Department of Anesthesiology, Shandong First Medical University, Jinan, China
| | - Yuelan Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China.,Department of Anesthesiology, Shandong First Medical University, Jinan, China
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Wittau M, Paschke S, Kurlbaum M, Scheele J, Ly NS, Hemper E, Kornmann M, Henne-Bruns D, Bulitta JB. Population Pharmacokinetics and Target Attainment of Ertapenem in Plasma and Tissue Assessed via Microdialysis in Morbidly Obese Patients after Laparoscopic Visceral Surgery. Antimicrob Agents Chemother 2017; 61:e00952-16. [PMID: 27795367 DOI: 10.1128/AAC.00952-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/07/2016] [Indexed: 11/20/2022] Open
Abstract
Ertapenem provides broad-spectrum activity against many pathogens, and its use is relevant for the prophylaxis and treatment of infections in morbidly obese patients undergoing surgery. However, its pharmacokinetics and tissue penetration in these patients are not well defined. We assessed the population pharmacokinetics and target attainment for ertapenem in the plasma, subcutaneous tissue, and peritoneal fluid of morbidly obese patients. Six female patients (body mass index, 43.7 to 55.9 kg/m2) received 1,000 mg ertapenem as 15-min infusions at 0 and 26 h. On day 2, the unbound ertapenem concentrations in plasma, subcutaneous tissue, and peritoneal fluid were measured by microdialysis; total plasma concentrations were additionally quantified. The probability of attaining a target of an unbound ertapenem concentration above the MIC for at least 40% of the dosing interval was predicted via Monte Carlo simulations. The population pharmacokinetic model contained two disposition compartments and simultaneously described all concentrations. For unbound ertapenem, total clearance was 12.3 liters/h (coefficient of variation, 21.6% for between-patient variability) and the volume of distribution at steady state was 57.8 liters in patients with a 53-kg fat-free mass. The area under the concentration-time curve (AUC) for ertapenem was 49% lower in subcutaneous tissue and 25% lower in peritoneal fluid than the unbound AUC in plasma. Tissue penetration was rapid (equilibration half-life, <15 min) and was variable in subcutaneous tissue. Short-term ertapenem infusions (1,000 mg every 24 h) achieved robust (>90%) target attainment probabilities for MICs of up to 1 mg/liter in plasma, 0.25 to 0.5 mg/liter in subcutaneous tissue, and 0.5 mg/liter in peritoneal fluid. Ertapenem presents an attractive choice for many pathogens relevant to morbidly obese patients undergoing surgery. (This study has been registered at ClinicalTrials.gov under identifier NCT01407965.).
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Epstein NE. Prophylactic inferior vena cava filter placement prior to lumbar surgery in morbidly obese patients: Two-case study and literature review. Surg Neurol Int 2015; 6:S469-74. [PMID: 26605108 PMCID: PMC4617024 DOI: 10.4103/2152-7806.166877] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background: Preoperative “prophylactic” placement of inferior vena cava (IVC) filters in morbidly obese patients (e.g., body mass index [BMI] >40 or BMI over 35 with hypertension/diabetes) undergoing multilevel decompressive lumbar laminectomies may reduce the risk of postoperative pulmonary embolism (PE), and death. Methods: Two patients, ages 69 and 68, with morbid obesity (BMI's of 40.4 and 37.5 both with hypertension and diabetes), received prophylactic IVC filters prior to L1–S1 laminectomies. Intraoperatively and postoperatively, both received alternating compression stocking prophylaxis, and received subcutaneous heparin 5000 U q12 h 48 h after surgery until discharge; none developed deep venous thrombosis (DVT) or PE, and both filters were uneventfully removed within 3 postoperative months. Results: The spinal surgical literature largely supports the placement of IVC filters for major risk factors; obesity (BMI >40), a history of DVT/PE, cancer, fusions, hypercoagulation syndromes, pulmonary/circulatory disorders, preoperative/postoperative immobility, staged procedures (five spinal levels), combined anterior-posterior surgery, iliocaval manipulation, age >80, and prolonged surgery (e.g., >261 min vs. >8 h). Although the safety and efficacy of prophylactic IVC filters for spine surgery in patients with morbidly obesity are well substantiated, those for bariatric patients are less clear. Conclusions: Prophylactic IVC filters were successfully placed/retrieved in 2 morbidly obese patients, ages 68 and 69, undergoing L1–S1 lumbar decompressions. Although the spine surgery literature documents the safety/efficacy of prophylactic IVC filters in patients with morbid obesity, the bariatric literature still has major concerns.
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Affiliation(s)
- Nancy E Epstein
- Department of Neuroscience, Winthrop University Hospital, Mineola, New York, USA
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Bige Ö, Demir A, Saatli B, Koyuncuoğlu M, Saygılı U. Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study. J Turk Ger Gynecol Assoc 2015; 16:164-9. [PMID: 26401110 DOI: 10.5152/jtgga.2015.15128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/19/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. MATERIAL AND METHODS This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m(2) and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. RESULTS Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). CONCLUSION With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity.
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Affiliation(s)
- Özgür Bige
- Department of Obstetrics and Gynecology, Tekirdağ Star Medica Hospital, Tekirdağ, Turkey
| | - Ahmet Demir
- Clinic of Obstetrics and Gynecology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Bahadır Saatli
- Department of Obstetrics and Gynecology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Meral Koyuncuoğlu
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Uğur Saygılı
- Department of Obstetrics and Gynecology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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