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Formal Nutritional Education Improves Weight Loss in Bariatric Patients Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 26:2952-2960. [PMID: 27179519 DOI: 10.1007/s11695-016-2216-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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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Tewksbury C, Williams NN, Dumon KR, Sarwer DB. Preoperative Medical Weight Management in Bariatric Surgery: a Review and Reconsideration. Obes Surg 2017; 27:208-214. [PMID: 27761723 DOI: 10.1007/s11695-016-2422-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bariatric surgery is the most robust treatment for extreme obesity. The impact of preoperative medical weight management sessions designed, in theory, with the primary goal of promoting preoperative weight loss, is unclear. This paper reviews studies that have investigated the relationship between preoperative weight loss and bariatric surgical outcomes, both with respect to postoperative weight loss and complications. We conclude that the most robust of preoperative interventions has not been implemented or evaluated in a manner which would conclusively assess the value of this element of care. We offer a reconsideration of the role of preoperative medical weight management and provide recommendations for future research in this area.
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Affiliation(s)
- Colleen Tewksbury
- Penn Metabolic and Bariatric Surgery Program, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 4th Floor Silverstein, Philadelphia, PA, 19104, USA.
- Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA.
| | - Noel N Williams
- Penn Metabolic and Bariatric Surgery Program, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 4th Floor Silverstein, Philadelphia, PA, 19104, USA
| | - Kristoffel R Dumon
- Penn Metabolic and Bariatric Surgery Program, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 4th Floor Silverstein, Philadelphia, PA, 19104, USA
| | - David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
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Small-Volume, Fast-Emptying Gastric Pouch Leads to Better Long-Term Weight Loss and Food Tolerance After Roux-en-Y Gastric Bypass. Obes Surg 2017; 28:693-701. [DOI: 10.1007/s11695-017-2922-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Farias G, Netto BDM, Bettini SC, Dâmaso AR, de Freitas ACT. Neuroendocrine regulation of energy balance: Implications on the development and surgical treatment of obesity. Nutr Health 2017; 23:131-146. [PMID: 28838280 DOI: 10.1177/0260106017719369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger-satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure. OBJECTIVE This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries. CONCLUSIONS According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.
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Affiliation(s)
- Gisele Farias
- 1 Department of Surgery, Universidade Federal do Paraná, UFPR, Curitiba-Pr, Brazil
| | | | - Solange Cravo Bettini
- 3 Federal University of Paraná (UFPR), Gastrointestinal Surgery Service of Hospital de Clínicas, Curitiba-PR, Brazil
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Andrew B, Alley JB, Aguilar CE, Fanelli RD. Barrett’s esophagus before and after Roux-en-Y gastric bypass for severe obesity. Surg Endosc 2017; 32:930-936. [DOI: 10.1007/s00464-017-5768-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022]
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Joosten SA, Hamilton GS, Naughton MT. Impact of Weight Loss Management in OSA. Chest 2017; 152:194-203. [DOI: 10.1016/j.chest.2017.01.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/15/2017] [Accepted: 01/21/2017] [Indexed: 02/05/2023] Open
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Patel JJ, Mundi MS, Hurt RT, Wolfe B, Martindale RG. Micronutrient Deficiencies After Bariatric Surgery: An Emphasis on Vitamins and Trace Minerals [Formula: see text]. Nutr Clin Pract 2017; 32:471-480. [PMID: 28609642 DOI: 10.1177/0884533617712226] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a worldwide epidemic with a disproportionate increase in grade III obesity. Bariatric surgery offers an attractive option for sustained weight loss compared with traditional methods such as exercise and diet. Micronutrient deficiencies are common and clinically significant after bariatric surgery. These deficiencies are related to a combination of patient and surgical variables. A thorough understanding of specific micronutrient deficiencies is necessary for early recognition and optimal management. The purpose of this review is to describe indications, outcomes, and types of bariatric procedures, risk factors, and mechanisms for micronutrient deficiencies, as well as outline specific vitamin and trace element deficiencies after bariatric surgery.
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Affiliation(s)
- Jayshil J Patel
- 1 Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Manpreet S Mundi
- 2 Division of Endocrinology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Bruce Wolfe
- 4 Division of Bariatric Surgery, Oregon Health Sciences University, Portland, Oregon, USA
| | - Robert G Martindale
- 5 Division of General Surgery, Oregon Health Sciences University, Portland, Oregon, USA
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Resende CMM, Durso DF, Borges KBG, Pereira RM, Rodrigues GKD, Rodrigues KF, Silva JLP, Rodrigues EC, Franco GR, Alvarez-Leite JI. The polymorphism rs17782313 near MC4R gene is related with anthropometric changes in women submitted to bariatric surgery over 60 months. Clin Nutr 2017; 37:1286-1292. [PMID: 28579220 DOI: 10.1016/j.clnu.2017.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/20/2017] [Accepted: 05/15/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluate whether the polymorphism rs17782313 near MC4R gene influences long-term outcomes after bariatric surgery. METHODS The rs16782313 polymorphism was genotyped in 217 individuals undergoing bariatric surgery and analyzed in detail in 141 women. Data for comorbidities, BMI, excess weight loss (EWL), and body composition were obtained before and during 60 months after surgery. RESULTS The risk allele was found in 65 (47%) of the 141 women. Pre-surgical body weight and BMI were higher in carriers of the rs17782313 polymorphism (CC + CT group) than in non-carriers (TT group) (p = 0.039 and 0.047, respectively). The number of women who acquired surgical success (EWL > 50%), was lower in CC + CT group compared to TT group (p = 0.015). The minimum BMI seen during the 60 months of follow-up was higher in CC + CT group compared to TT group (p = 0.028). The number of women who presented BMI < 30 kg/m2 (no longer classified as obesity) after 24 months of surgery was inferior in CC + CT group (6 out 35 patients - 17%) than in TT group (19 out 49 patients - 37%, p = 0.043). Moreover, the number of patients maintaining BMI > 35 kg/m2 were higher carriers (18 out 35 patients - 51%) compare to non-carriers (16 out 49 patients - 32%, p = 0.045). CONCLUSION Women with extreme obesity carrying rs17782313 MC4R polymorphism present a higher pre-surgical BMI, are more unlikely to reach non-obesity BMI (<30 kg/m2) and tend to maintain a BMI > 35 kg/m2 that characterize treatment failure.
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Affiliation(s)
| | - Danielle Fernandes Durso
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | - Karina Braga Gomes Borges
- Departamento de Análises Clínicas de Toxicológicas - FAFAR, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rafaela Messias Pereira
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
| | | | - Kathryna Fontana Rodrigues
- Departamento de Análises Clínicas de Toxicológicas - FAFAR, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - José Luiz Padilha Silva
- Departamento de Estatística, ICEX, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Gloria Regina Franco
- Departamento de Bioquimica e Imunologia - ICB, Universidade Federal de Minas, Belo Horizonte, MG, Brazil
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Abstract
Sleeve gastrectomy, gastric bypass, gastric banding, and duodenal switch are the most common bariatric procedures performed worldwide. Ninety-five percent of bariatric operations are performed with minimally invasive laparoscopic technique. Perioperative morbidities and mortalities average around 5% and 0.2%, respectively. Long-term weight loss averages around 15% to 25% or about 80 to 100 lbs (40-50 kg). Comorbidities, including type 2 diabetes, hypertension, dyslipidemia, sleep apnea, arthritis, gastroesophageal reflux disease, and nonalcoholic fatty liver disease, improve or resolve after bariatric surgery.
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Affiliation(s)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44022, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, UPM-Serdang, 43400 Serdang, Selangor, Malaysia
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44022, USA.
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Sood A, Hakim DN, Hakim NS. Consequences of Recipient Obesity on Postoperative Outcomes in a Renal Transplant: A Systematic Review and Meta-Analysis. EXP CLIN TRANSPLANT 2016. [PMID: 27015529 DOI: 10.6002/ect.2015.0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. MATERIALS AND METHODS We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m(2). All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m(2)). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. RESULTS We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). CONCLUSIONS Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.
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Affiliation(s)
- Anshuman Sood
- From the Royal College of Surgeons in Ireland, Dublin, Ireland
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Kothari SN, Borgert AJ, Kallies KJ, Baker MT, Grover BT. Long-term (>10-year) outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 13:972-978. [PMID: 28223086 DOI: 10.1016/j.soard.2016.12.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the "gold standard" for weight loss surgery. Long-term data are limited, and reporting methods for LRYGB outcomes vary in the literature. In addition, follow-up compliance within bariatric centers is poor due to insurance and access to care issues, making long-term follow-up evaluation difficult. OBJECTIVE Evaluate long-term LRYGB outcomes using standard outcome reporting definitions. SETTING Integrated multispecialty health system. METHODS A retrospective review of our institution's prospective bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015. Data were defined according to the 2015 Standards for Outcome Reporting. RESULTS During the study period, 1402 patients underwent primary LRYGB; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m2, respectively. Early complications included anastomotic leak (0.2%), venous thromboembolism (0.6%), surgical site infections (1.4%), and urinary tract infections (1.6%). The 30-day readmission rate was 3.5%. There were no 30-day mortalities. Follow-up weight data were available for>70% of eligible patients through 12 years postoperative. The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79% and 30.1 kg/m2, respectively. Remission of diabetes, dyslipidemia, and hypertension were observed through 8 years postoperatively. CONCLUSION This is the first report of long-term (>10-year) outcomes from a single integrated health system using the 2015 Standards for Outcome Reporting. LRYGB results in significant, sustained weight loss and durable improvement and remission of obesity-related co-morbidities. Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up.
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Affiliation(s)
- Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
| | - Andrew J Borgert
- Department of Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Kara J Kallies
- Department of Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Matthew T Baker
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Brandon T Grover
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
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Bova C, Fox E, Alencar M, Kerksick C. Nutritional Challenges and Strategies for the Bariatric Patient and How Fitness Professionals Can Provide Support. Strength Cond J 2016. [DOI: 10.1519/ssc.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gregorio VD, Lucchese R, Vera I, Silva GC, Silva A, Moraes RCC. THE ALCOHOL CONSUMPTION IS AMENDED AFTER BARIATRIC SURGERY? AN INTEGRATIVE REVIEW. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 29Suppl 1:111-115. [PMID: 27683790 PMCID: PMC5064260 DOI: 10.1590/0102-6720201600s10027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/03/2016] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery has been an alternative when conservative methods of weight loss fail. Patients undergoing bariatric surgery have an increased risk of up to 6.5% of problems related to alcohol Objective: Integrative review out to analyze the change of alcohol consumption in this public Method: Database was accessed from June of 2015 to January of 2016 by searching "bariatric surgery" AND "alcoholism", and their Portuguese equivalents. ScienceDirect, PubMed, Lilacs and Medline, besides manual search, were searched. To be included, the paper should have been published between 2005-2016 and related to bariatric surgery and alcoholism. Theses, dissertations, unpublished papers, case reports and theoretical studies were excluded, and a database was subsequently composed Results: In 2005 there was only a review of change in alcohol metabolism in patients undergoing bariatric surgery. There were no publications in 2006. In 2007, only one study was published, and it did not meet the inclusion criteria. In 2010, there was an increase of 13% in publications and of 20% in 2012, reaching 40% in 2013 Conclusion: The prevalence and incidence of alcohol consumption in relation to the postoperative time was six months to three years with higher incidence for follow-up treatment by men. Roux-en-Y gastric bypass showed greater association with increased consumption of alcohol during the postoperative period. Alcohol consumption proved to be essential to be faced in bariatric surgery.
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Affiliation(s)
| | - Roselma Lucchese
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
| | - Ivânia Vera
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
| | - Graciele C Silva
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
| | - Andrecia Silva
- Universidade Federal de Goiás (Federal Univesity of Goiás), Goiânia, GO Brazil
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Veziant J, Raspado O, Entremont A, Joris J, Pereira B, Slim K. Large-scale implementation of enhanced recovery programs after surgery. A francophone experience. J Visc Surg 2016; 154:159-166. [PMID: 27638322 DOI: 10.1016/j.jviscsurg.2016.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery program (ERP) has now surpassed the stage of clinical research in certain specialties and currently poses the problematic of large-scale implementation. The goal of this study was to report the experience during the first year of implementation in three French-speaking countries. MATERIAL AND METHODS This is a prospective study in which 67 healthcare centers, all registered in the Grace-Audit databank, participated. Included were patients undergoing colorectal (CRS), bariatric (BS) and orthopedic hip and knee surgery (OS), performed within an ERP. The main endpoints were duration of hospital stay, postoperative morbidity, the degree of compliance with the elements of the ERP, the relation between the extent of application of the elements and postoperative hospital stay, and finally the completeness of data inclusions in the databank. RESULTS A total of 1904 patients were included in the Grace-Audit databank between January 1, 2015 and January 31, 2016, undergoing CRS (n=490), BS (n=431), and OS (n=983). The mean implementation rate was 83.7±10.0% for CRS, 75.0±23.7% for BS, and 83.5±14.9% for OS. The duration of hospital stay was 6.5 days for CRS, 2.6 days for BS and 3.4 days for OS. Overall postoperative morbidity (onset of postoperative undesirable event), surgical morbidity (superficial or deep organ space surgical site complications such as bleeding, infection or defective healing) and readmission rates were 20.6%, 7.5%, and 5.7% for CRS; 2.5%, 1.4%, and 1.6% for BS and 2.9%, 0.2%, and 2% for OS, respectively. A statistically significant relationship was found between the degree of compliance of the elements of ERP and the duration of hospital stay for CRS and BS; hospital stay was reduced when at least 15 of the 22 elements of the program were applied (P<0.001). The patients included in the Grace-Audit databank represented less than 20% of the patients undergoing operation in the same establishments during the study period for all three specialties. CONCLUSIONS This study shows that large-scale ERPs are feasible and safe in French-speaking countries. Nonetheless, although encouraging, these preliminary results highlight that implementation must be improved in specialties such as bariatric surgery and that more complete data collection is needed.
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Affiliation(s)
- J Veziant
- Service de chirurgie digestive, CHU Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France
| | - O Raspado
- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France; Infirmerie protestante, 69300 Caluire, France
| | - A Entremont
- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France
| | - J Joris
- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France; Service d'anesthésie et de réanimation, CHU de Liège, 4000 Liège, Belgium
| | - B Pereira
- Département de statistiques, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Estaing, 63003 Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France.
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- Groupe francophone de réhabilitation améliorée après chirurgie, 63110 Beaumont, France
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Silva JS, Chaves GV, Stenzel AP, Pereira SE, Saboya CJ, Ramalho A. Improvement of anthropometric and biochemical, but not of vitamin A, status in adolescents who undergo Roux-en-Y gastric bypass: a 1-year follow up study. Surg Obes Relat Dis 2016; 13:227-233. [PMID: 27865810 DOI: 10.1016/j.soard.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/14/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to describe anthropometric, biochemical, co-morbidity, and vitamin A nutritional status in severely obese adolescents before and 30, 180, and 365 days after Roux-en-Y gastric bypass (RYGB). SETTING Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. METHODS Sixty-four adolescents (15-19 years old) with a body mass index≥40 kg/m2 were enrolled in a prospective follow-up study. Vitamin A status was evaluated before surgery (T0), and 30 (T30), 180 (T180), and 365 (T365) days after surgery, applying biochemical and functional indicators. Anthropometric measures, lipid profile, glycemia, and basal insulin also were assessed. No patients were lost during follow-up. RESULTS Before surgery, 26.6% of the sample group experienced vitamin A deficiency (VAD). Serum retinol levels dropped significantly 30 days after surgery and then returned to basal levels. There was a significant increase in the prevalence of β-carotene deficiency and night blindness throughout the postsurgery period. A significant reduction in blood glucose, insulin resistance, lipid profile, and anthropometric parameters was observed. CONCLUSION The finding that oral daily supplementation with 5000 IU retinol acetate failed to reverse VAD and night blindness after RYGB is highly significant. We recommend assessment of VAD and night blindness in extremely obese adolescents before and after RYGB. We further recommend monitoring for an additional 180 days (for VAD) and 365 days (for night blindness) after surgery, with particular attention to daily supplementation needs.
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Affiliation(s)
- Jacqueline Souza Silva
- Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ana Paula Stenzel
- Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Silvia Elaine Pereira
- Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos José Saboya
- Surgical Clinic, Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andréa Ramalho
- Department of Social and Applied Nutrition, Center for Research on Micronutrients, Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Shantavasinkul PC, Omotosho P, Corsino L, Portenier D, Torquati A. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis 2016; 12:1640-1645. [PMID: 27989521 DOI: 10.1016/j.soard.2016.08.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. OBJECTIVES This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. SETTING An academic medical center in the United States. METHODS A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. RESULTS Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (P<.001). Average weight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (P<.001). Time elapsed since RYGB was significantly longer in the WR group (WR 6.0±2.4 years versus SWL 3.3±1.8 years; P<.001; range 2-12 yr). Patients in the WR group were significantly younger (WR 42.3±9.8 yr versus SWL 45.7±10.8 years; P<.001), had fewer co-morbidities, and were less likely to have type 2 diabetes with insulin dependence preoperatively. Univariate analysis found that older age, male gender, having hypertension, dyslipidemia, and insulin-treated type 2 diabetes were all factors associated with sustained weight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. CONCLUSION The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB.
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Affiliation(s)
- Prapimporn Chattranukulchai Shantavasinkul
- Division of Nutrition and Biochemical Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Center for Weight Loss and Bariatric Surgery, Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Philip Omotosho
- Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Leonor Corsino
- Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, NC
| | - Dana Portenier
- Center for Weight Loss and Bariatric Surgery, Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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69
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Molin Netto BD, Earthman CP, Farias G, Landi Masquio DC, Grotti Clemente AP, Peixoto P, Bettini SC, von Der Heyde ME, Dâmaso AR. Eating patterns and food choice as determinant of weight loss and improvement of metabolic profile after RYGB. Nutrition 2016; 33:125-131. [PMID: 27474230 DOI: 10.1016/j.nut.2016.05.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Significant changes in the preference for different dietary components have been observed after Roux-en-Y gastric bypass (RYGB). The aim of this study was to evaluate the early post-RYGB changes in quality of eating patterns and their relationship to weight loss and metabolic parameters. METHODS The sample was composed of 41 extremely obese individuals undergoing RYGB. Dietary data were collected using a validated food frequency questionnaire in Brazil. A food intake evaluation was conducted with a focus on the frequency of consumption (≥4 times/wk) of markers for healthy eating and markers for unhealthy eating. Furthermore, anthropometric and metabolic markers were collected before surgery and 6 mo post-RYGB. RESULTS Compared with baseline, the postsurgery body mass index was reduced by 12.9 kg/m2, corresponding to an excess weight loss of 63.5%. Blood glucose, insulin, ferritin, cholesterol, low-density lipoprotein-cholesterol, triacylglycerol (TG), and hemoglobin were reduced 6 mo after RYGB (P < 0.05). The consumption frequency of many foods defined as unhealthy decreased after surgery (e.g., from 15.4% to 5.1% for pizza and 18% to 0% for hamburger), and some healthy food increased (e.g., from 0% to 5.1% for fish and from 0% to 25.6% for plain yogurt). There was a decrease in the frequency of individuals who reported consuming fruit and vegetables. Conversely, insulin, glucose, and TG levels were positively associated with intake of chocolates/truffles and ice cream/sundaes. CONCLUSION Participants in the present study appeared to develop a healthier dietary pattern by 6 mo after RYGB. These results show that a healthier dietary pattern is associated with a significant improvement of metabolic profile and weight loss.
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Affiliation(s)
- Bárbara Dal Molin Netto
- Postgraduate Program of Nutrition, Universidade Federal de São Paulo - Escola Paulista de Medicina - UNIFESP-EPM. Post Graduate Program in Nutrition, São Paulo, SP, Brazil.
| | - Carrie P Earthman
- Department of Food Science and Nutrition, University of Minnesota - Twin Cities, Minneapolis, MN
| | - Gisele Farias
- Bariatric Surgery Service of Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Deborah Cristina Landi Masquio
- Postgraduate Program of Nutrition, Universidade Federal de São Paulo - Escola Paulista de Medicina - UNIFESP-EPM. Post Graduate Program in Nutrition, São Paulo, SP, Brazil
| | - Ana Paula Grotti Clemente
- Postgraduate Program of Nutrition, Universidade Federal de São Paulo - Escola Paulista de Medicina - UNIFESP-EPM. Post Graduate Program in Nutrition, São Paulo, SP, Brazil
| | - Priscilla Peixoto
- Undergraduate in Nutrition, Federal University of Paraná, Curitiba, PR, Brazil
| | - Solange Cravo Bettini
- Bariatric Surgery Service of Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | | | - Ana R Dâmaso
- Postgraduate Program of Nutrition, Universidade Federal de São Paulo - Escola Paulista de Medicina - UNIFESP-EPM. Post Graduate Program in Nutrition, São Paulo, SP, Brazil.
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Mangieri CW, Strode MA, Sherman WE, Pierotti ML, Faler BJ, Choi YU. Institutional Improvement in Weight Loss after Laparoscopic Sleeve Gastrectomy. Am Surg 2016. [DOI: 10.1177/000313481608200521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) is a recent addition to the bariatric surgery armamentarium. It has been demonstrated to be an efficacious stand-alone bariatric procedure in regard to weight loss. This study evaluates the progress of our initial experience with LSG. Retrospective review of prospective data from 2008 to 2010. Compared data between our first operative year of experience with LSG (2008) and our third year of experience (2010). Data compared for up to three years postoperatively. End points were percentage of excess body weight loss (%EWL) and percentage of excess body mass index loss (%EBL). Institutional improvement in %EWL and %EBL rates as our collective experience increased with LSG. Mean increase in %EWL of 14 per cent and mean increase of %EBL of 22 per cent. In our first year performing LSG the institutional weight loss was <50 per cent EWL, which is often cited as a benchmark level for “success” after bariatric surgery. By our third year of experience with LSG we achieved an institutional weight loss >50 per cent EWL. Institutional improvement in weight loss results with LSG as the collective experience increased. Several factors could have contributed to this observation to include a surgical men-torship program and the institution of formal nutritional education. This study demonstrates that institutional experience is a significant factor in weight loss results with LSG.
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Affiliation(s)
- Christopher W. Mangieri
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Matthew A. Strode
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - William E. Sherman
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Matthew L. Pierotti
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Byron J. Faler
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Yong U. Choi
- Department of General Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia
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71
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Alfonsson S, Sewall A, Lidholm H, Hursti T. The Meal Pattern Questionnaire: A psychometric evaluation using the Eating Disorder Examination. Eat Behav 2016; 21:7-10. [PMID: 26722817 DOI: 10.1016/j.eatbeh.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Meal pattern is an important variable in both obesity treatment and treatment for eating disorders. Momentary assessment and eating diaries are highly valid measurement methods but often cumbersome and not always feasible to use in clinical practice. The aim of this study was to design and evaluate a self-report instrument for measuring meal patterns. METHOD The Pattern of eating item from the Eating Disorder Examination (EDE) interview was adapted to self-report format to follow the same overall structure as the Eating Disorder Examination Questionnaire. The new instrument was named the Meal Patterns Questionnaire (MPQ) and was compared with the EDE in a student sample (n=105) and an obese sample (n=111). RESULTS The individual items of the MPQ and the EDE showed moderate to high correlations (rho=.63-89) in the two samples. Significant differences between the MPQ and EDE were only found for two items in the obese sample. The total scores correlated to a high degree (rho=.87/.74) in both samples and no significant differences were found in this variable. DISCUSSION The MPQ can provide an overall picture of a person's eating patterns and is a valid way to collect data regarding meal patterns. The MPQ may be a useable tool in clinical practice and research studies when more extensive instruments cannot be used. Future studies should evaluate the MPQ in diverse cultural populations and with more ecological assessment methods.
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Affiliation(s)
- S Alfonsson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden.
| | - A Sewall
- Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden
| | - H Lidholm
- Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden
| | - T Hursti
- Department of Psychology, Uppsala University, Box 1225, 751 42 Uppsala, Sweden
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Musfeldt D, Levinson A, Nykiel J, Carino G. Lithium toxicity after Roux-en-Y bariatric surgery. BMJ Case Rep 2016; 2016:bcr2015214056. [PMID: 26994048 PMCID: PMC4800199 DOI: 10.1136/bcr-2015-214056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 01/06/2023] Open
Abstract
A 61-year-old woman with medical history significant for morbid obesity, type II diabetes mellitus, nephrogenic diabetes insipidus and bipolar disorder, had been stable on lithium carbonate therapy for several years. She had undergone a Roux-en-Y bypass surgery and, at the time of her surgery, her lithium level was found to be 0.61 mEq/L on a maintenance dose of 600 mg orally twice per day. She was discharged 8 days postoperatively on the same lithium dose, but presented to the emergency department 12 days postoperatively with signs of lithium toxicity. Her lithium level was elevated to 1.51 mEq/L and she was treated for lithium toxicity with supportive care and, ultimately, reduction of her lithium dose. Clinicians should be aware that dramatic and poorly understood changes in drug absorption may occur after bariatric surgery.
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Affiliation(s)
- Deanna Musfeldt
- Department of Critical Care Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Andrew Levinson
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Jennifer Nykiel
- Department of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
| | - Gerardo Carino
- Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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73
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Assessment of contraceptive needs in women undergoing bariatric surgery. Contraception 2016; 94:74-7. [PMID: 26939526 DOI: 10.1016/j.contraception.2016.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate documentation of contraception and counseling in women planning to undergo bariatric surgery. STUDY DESIGN Chart review of 1012 women ages 18-45years presenting for bariatric surgery evaluation. Data on socio-demographic variables, documented contraceptive method, preconception counseling, gynecology referrals and postoperative pregnancies were collected. RESULTS The charts of only 272 women (26.9%) contained documentation of a contraceptive method; the most common was oral contraceptives (n=132, 48.5%). Sixteen pregnancies were identified in the first 18months postoperatively. CONCLUSIONS Currently, the documentation of contraceptive counseling is lacking in clinical practice. Measures to enhance provider and patient awareness of these issues will improve patient care. IMPLICATIONS Pregnancy planning and documentation of perioperative contraceptive use in women undergoing bariatric surgery are suboptimal, placing these women at risk of unintended pregnancies. Future research should delineate the best practices in contraceptive provision in this high-risk population of women.
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74
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Sakhaee K, Poindexter J, Aguirre C. The effects of bariatric surgery on bone and nephrolithiasis. Bone 2016; 84:1-8. [PMID: 26679435 PMCID: PMC4827266 DOI: 10.1016/j.bone.2015.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/13/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022]
Abstract
The impact of bariatric surgery on cardiovascular and diabetic complications associated with an improvement in survival has overshadowed the adverse skeletal health and development of kidney stone disease in this population. All longitudinal based studies in the literature reporting the incidence of bone fractures or kidney stones following bariatric surgery were reviewed. Moreover, all publications over the past decade which assessed changes in bone mineral density and bone quality, or explored underlying pathophysiologic mechanisms of bone and kidney stone disease were carefully reviewed. This review provides sufficient data to support that osteoporotic fractures and kidney stone disease are associated with Roux-en-Y gastric bypass surgery. However, due to the limited data available to date, no definitive conclusion could yet be drawn whether sleeve gastrectomy or adjustable gastric banding is associated with bone fractures and kidney stones. Bariatric surgery has emerged as the most effective and sustained treatment for weight reduction. This treatment modality has been recognized to diminish the risk of cardiovascular morbidity and mortality and ameliorate diabetes mellitus complications. The derangement in mineral metabolism has emerged as a major complication following bariatric surgery.
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Affiliation(s)
- Khashayar Sakhaee
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - John Poindexter
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Crystal Aguirre
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States
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Bilge H, Yigitbas H, Ercetin C, Celebi F, Yavuz E, Solmaz A, Gulcicek OB, Arici S, Tokocin M, Ozcinar B, Kutanis R. Effect of Laparoscopic Greater Curve Plication on Glucose and Lipid Metabolism in Turkish Obese Subjects. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Huseyin Bilge
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Hakan Yigitbas
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Candas Ercetin
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Fatih Celebi
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Erkan Yavuz
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ali Solmaz
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Osman Bilgin Gulcicek
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sinan Arici
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Merve Tokocin
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Beyza Ozcinar
- Department of General Surgery, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Riza Kutanis
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Treacy PJ, Chatfield MD, Bessell J. Is Gastric Banding Appropriate in Indigenous Or Remote-Dwelling Persons? Obes Surg 2015; 26:1728-34. [DOI: 10.1007/s11695-015-1993-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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77
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Rodrigues GK, Resende CM, Durso DF, Rodrigues LA, Silva JLP, Reis RC, Pereira SS, Ferreira DC, Franco GR, Alvarez-Leite J. A single FTO gene variant rs9939609 is associated with body weight evolution in a multiethnic extremely obese population that underwent bariatric surgery. Nutrition 2015; 31:1344-50. [DOI: 10.1016/j.nut.2015.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/21/2015] [Accepted: 05/14/2015] [Indexed: 01/31/2023]
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Nutritional Status, Body Composition, and Bone Health in Women After Bariatric Surgery at a University Hospital in Rio de Janeiro. Obes Surg 2015; 26:1517-24. [DOI: 10.1007/s11695-015-1910-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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79
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Changes in nutrients and food groups intake following laparoscopic Roux-en-Y gastric bypass (RYGB). Obes Surg 2015; 24:1926-32. [PMID: 24748474 DOI: 10.1007/s11695-014-1259-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Serial changes in dietary intake, including specific food groups and nutrients during the first year following Roux-en-Y gastric bypass (RYGB) are of interest due to surgically induced alterations in meal size, food intolerances present after surgery, and potential nutrient deficiencies. To help improve the nutritional health of surgical patients, this study's purpose was to examine changes in macro- and micronutrients, food groups, and selected foods during 12 months of follow-up in post-RYGB individuals. METHODS RYGB patients (n = 17) completed 4-day food records at baseline (prior to surgery) and then at 3 weeks, 3 months, 6 months, and 12 months after surgery. Mean daily intake was determined at each time for energy intake, macro- and micronutrients, food groups, and selected foods in targeted food groups. RESULTS A dramatic decrease in mean (± SEM) daily energy intake occurred--2,150 ± 165 kcal at baseline vs. 649 ± 40 kcal at 3 weeks; energy intake continually increased to a high of 1,307 ± 129 kcal by 12 months. More than 50 % of patients had low intake of vitamins D, E, C, folate, and calcium, magnesium, and potassium at 12 months. Servings from vegetables, grains, fats, and sweetened beverages were lower, whereas, meats, dairy, fruits, and sweets showed only small, transient changes following surgery. CONCLUSIONS The reduction in energy intake following RYGB is from selected food groups and not solely a reduction in portion sizes across the diet. The lower intake of micronutrients indicates potential risk for deficiencies unless supplements are used. These findings can help in the clinical management of surgical patients to improve nutritional health.
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80
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Variations in oral vitamin and mineral supplementation following bariatric gastric bypass surgery: a national survey. Obes Surg 2015; 25:648-55. [PMID: 25403775 DOI: 10.1007/s11695-014-1425-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bariatric surgery (including gastric bypass) is associated with long-term deficiencies in vitamins and minerals, which may have deleterious effects on physiology. The American Association of Clinical Endocrinologists' (AACE) guidelines regarding post-operative vitamin supplementation have recently been endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Supplements have cost implications. Non-branded multivitamins may have similar compositions to branded multivitamins, but at a lower cost. This study assesses multivitamin supplementation following bariatric gastric bypass in England against AACE guidelines. It also examines the composition and cost of branded and non-branded multivitamins. METHODS Micronutrient amounts in common multivitamin preparations were obtained from product literature. Costs were collected from a standard retailer. To determine vitamin prescribing patterns, the 37 NHS hospitals performing bariatric gastric bypasses in England were contacted. Practice was assessed against AACE guidelines. RESULTS All non-branded multivitamins met AACE guidelines for composition. Most had similar compositions to branded multivitamins, and all were cheaper. There was no standard practice regarding post-operative supplementation among the 35 responding hospitals. Only 7/35 (20%) hospitals followed the guidance for two-tablet doses of multivitamins. Immediately post-operatively, 25/35 (71%) hospitals administered calcium carbonate and vitamin D (none recommended calcium citrate, as recommended by AACE to improve absorption), and only 9/35 (26%) hospitals recommended iron to all patients. CONCLUSION Most non-branded multivitamins are lower cost alternatives to branded multivitamins, with similar compositions. The AACE recommendation for two-tablet doses of multivitamins is not being met by most English centres. Calcium and iron supplementation is also inadequate.
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Biter LU, Gadiot RPM, Grotenhuis BA, Dunkelgrün M, van Mil SR, Zengerink HJJ, Smulders JF, Mannaerts GHH. The Sleeve Bypass Trial: a multicentre randomized controlled trial comparing the long term outcome of laparoscopic sleeve gastrectomy and gastric bypass for morbid obesity in terms of excess BMI loss percentage and quality of life. BMC OBESITY 2015; 2:30. [PMID: 26316928 PMCID: PMC4550059 DOI: 10.1186/s40608-015-0058-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 06/16/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Obesity is an increasing disease worldwide. Bariatric surgery is the only effective therapy to induce sufficient long-term weight loss for morbidly obese patients. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold standard surgical technique. Laparoscopic Sleeve Gastrectomy (LSG) is a new promising bariatric procedure which has the advantage of maintaining an intact gastrointestinal tract. The aim of this study is to evaluate the efficiency of both techniques. Our hypothesis is that LSG has a similar percentage excess BMI loss (%EBMIL) after 5 years compared to LRYGB. METHODS/DESIGN The Sleeve Bypass Trial is a randomized multicentre clinical trial: patients eligible for bariatric surgery are randomized to either LSG or LRYGB. Patients with a body mass index (BMI) ≥ 40 kg/m(2) or BMI 35 kg/m(2) with obesity related comorbidity (T2 DM, sleep apnoea, hypertension) are eligible for randomization. At randomization patients are stratified for centre, sex, T2 DM and BMI ≥ 50 kg/m(2). A total number of 620 patients will be enrolled and equally (1:1) randomized to both treatment arms. Only surgeons experienced in both operation techniques will participate in the Sleeve Bypass trial. The primary endpoint is the 5-year weight loss (%EBMIL) of LSG and LRYGB. Secondary endpoints are resolution of obesity related comorbidity, complications, revision bariatric surgery and quality of life (QOL) defined in various questionnaires. DISCUSSION Long-term %EBMIL between the two treatment strategies used to be in favour of LRYGB, but more recent results throughout the world show similar %EBMIL in both techniques. If weight loss is comparable, obesity-related comorbidity and QOL after bariatric procedures should be taken into account when deciding on which surgical technique is to be preferred for certain subgroups in the future. TRIAL REGISTRATION Dutch Trial Register: NTR 4741.
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Affiliation(s)
- L. Ulas Biter
- />Department of Surgery, St. Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Ralph P. M. Gadiot
- />Department of Surgery, St. Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Martin Dunkelgrün
- />Department of Surgery, St. Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Stefanie R. van Mil
- />Department of Surgery, St. Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - J. Frans Smulders
- />Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
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Lao WL, Malone DC, Armstrong EP, Voellinger D, Somers S, Jin J, Dreyer N, Globe D. Effect of adjustable gastric banding on quality of life and weight loss in the Helping Evaluate Reduction in Obesity (HERO) registry study: 2 year analysis. Curr Med Res Opin 2015; 31:1451-60. [PMID: 26154653 DOI: 10.1185/03007995.2015.1059802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This report from the Helping Evaluate Reduction in Obesity (HERO) Study investigated weight loss, health-related quality of life (HRQOL), and factors predictive of HRQOL improvement during a 2 year period following Lap-Band AP implantation (post-LBAP). RESEARCH DESIGN AND METHODS This prospective, observational study included patients with 1 and 2 year follow-up data post-LBAP (N = 585). Changes in body mass index (BMI), percentage of weight loss (%WL), excess weight loss (%EWL) and HRQOL (Impact of Weight on Quality of Life [IWQOL]-Lite measure), and differences between <30% EWL and ≥30% EWL subgroups were assessed at 1 and 2 years post-LBAP. Multiple linear regression examined association of %EWL groups with IWQOL-Lite scores controlling for age, gender, region (US vs outside US), household income, employment status, and comorbidities. RESULTS Most patients were female (80.2%) and from the US (64.8%); overall mean (SD) age was 43.6 (11.28) years and 65.8% of patients had ≥30% EWL at year 2. At 2 years post-LBAP, mean %EWL was 43.5%; %EWL was 12.4% in the <30% EWL group and 59.6% in ≥30% EWL group (P ≤ 0.0001). Changes in IWQOL total and subscores were significantly greater in ≥30% EWL versus <30% EWL patients (all P < 0.0005) at years 1 and 2; Self-Esteem and Physical subscores had the largest changes. Multiple regression analysis showed that patients with ≥30% EWL had clinically meaningful improvements in HRQOL compared with patients having <30% EWL (P ≤ 0.001). Similarly, US patients and females had a clinically significant change in IWQOL score versus their counterparts (P ≤ 0.001). Conversely, income, comorbidities and employment status were not significant predictors of change in IWQOL scores at year 2. CONCLUSIONS These results support and extend findings regarding the effectiveness of LBAP for weight loss and illustrate the importance of ≥30% EWL as a significant factor in predicting clinically significant improvement in HRQOL 1 and 2 years post-LBAP. CLINICAL TRIAL REGISTRATION NCT00953173.
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Affiliation(s)
- W-L Lao
- a a University of Arizona , Tucson , AZ , USA
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Comparison of weight loss and body composition changes in morbidly obese Taiwanese patients with different bariatric surgeries: a 1-year follow-up study. Obes Surg 2015; 24:572-7. [PMID: 24222534 DOI: 10.1007/s11695-013-1115-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study investigated the impacts of two different bariatric surgeries on the body composition of morbidly obese patients in Taiwan. Also, the differences in body composition changes between genders were compared. METHODS In total, 198 patients who underwent bariatric surgery were included, with 130 receiving a sleeve gastrectomy (SG) and 68 receiving adjusted gastric banding (AGB). The weight and body composition were measured by bioelectrical impedance. Follow-up examinations were performed at subsequent visits after surgery and at 1 year. Only 81 SG and 40 AGB patients continued follow-up for the entire 12 months. RESULTS All patients experienced significant weight loss beginning from 3 months after surgery. Compared to patients with AGB, SG patients had a greater extent of body mass index (BMI) loss, whereas a greater muscle weight percentage increase was found compared to AGB patients. Female patients had a higher body fat mass and lower muscle weight percentage and BMI than did males. There were no differences in changes in BMI, or percentages of body fat and muscle mass between male and female patients for 12 months after surgery. However, the waist/hip ratio (WHR) decrement and percentage of excess weight loss (ExWL%) were significantly greater in female than male patients with both bariatric surgeries. CONCLUSIONS These findings suggest that although females had greater extents of WHR decrement and ExWL% than male patients with both surgical procedures, patients who received SG had higher BMI changes and body fat losses than SGB patients regardless of differences in the gender distribution.
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Hamdi A, Julien C, Brown P, Woods I, Hamdi A, Ortega G, Fullum T, Tran D. Midterm outcomes of revisional surgery for gastric pouch and gastrojejunal anastomotic enlargement in patients with weight regain after gastric bypass for morbid obesity. Obes Surg 2015; 24:1386-90. [PMID: 24634099 DOI: 10.1007/s11695-014-1216-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reoperative surgery for the morbidly obese has become increasingly common due to postoperative weight regain. There are limited studies evaluating the effectiveness of revisional surgery. This study evaluates the weight loss outcomes of revisional surgery over a 2-year period at our University Hospital, USA. Of the 412 patients who underwent laparoscopic bariatric surgery between June 2009 and June 2011, we identified 25 patients who had Roux-en-Y gastric bypass (RYGB) originally, who underwent laparoscopic revisional surgery for weight regain. Preoperative and postoperative data were reviewed. Statistical analysis was performed using paired t test. This study includes 0 male and 25 female patients with an average age of 42 (range min to max: 28-58), mean original body mass index (BMI) of 54.6 kg/m(2) (r = 37.3-80.7), average lowest BMI achieved of 32.2 (r = 20.1-50.9), and average BMI at the time of revision of 41.0 kg/m(2) (r = 29.5-60.7, standard deviation (SD) = 8.5). All laparoscopic revisions consisted of resizing the gastric pouch by resection and recreating the gastrojejunostomy. Average hospital length of stay was 1.28 days (r = 1-4). Perioperative morbidity was 8 %; one patient developed a trocar site hernia which required repair, and another suffered postoperative bleeding requiring transfusion. There was no mortality. Postoperative BMI averages at 3, 6, 9, 12, and 24 months were 35.0 (SD = 7.15), 34.7 (SD = 4.26), 36.2 (SD = 7.63), 33.0 (SD = 6.58), and 44.2 (SD = 12.87), respectively. Statistically significant weight loss was achieved at 3 [t (10) = 6.74, p < 0.05], 6 [t (7) = 4.69, p < 0.05], 9 [t (9) = 2.94, p < 0.05], and 12 [t (6) = 3.78, p < 0.05] months. However, there was no statistically significant weight loss at 24 months postoperatively [t (4) = -0.16, p > 0.05]. Laparoscopic revisional bariatric surgery can be performed with significant weight loss up to 1 year postoperatively. However, additional studies are required to evaluate longer-term success.
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85
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Ewang-Emukowhate M, Harrington DJ, Botha A, McGowan B, Wierzbicki AS. Vitamin K and other markers of micronutrient status in morbidly obese patients before bariatric surgery. Int J Clin Pract 2015; 69:638-42. [PMID: 25496224 DOI: 10.1111/ijcp.12594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Micronutrient deficiencies occur in morbidly obese patients. The aim of this study was to assess vitamin deficiencies prior to bariatric surgery including vitamin K about which there is little data in this population. METHODS A prospective assessment of 118 consecutive patients was performed. Clinical allied with haematological and biochemical variables were measured. Micronutrients measured included vitamins K1 , PIVKA-II (protein-induced in vitamin K absence factor II), vitamin D, vitamin B12 (holotranscobalamin), iron, transferrin and folate. RESULTS Patients were aged 49 ± 11 [mean (SD, standard deviation)] years, body mass index (BMI) 50 ± 8 kg/m(2), 66% female and 78% Caucasian. Hypertension was present in 47% and type 2 diabetes in 32%. Vitamin D supplements had been prescribed in 8%. Micronutrient insufficiencies were found for vitamin K (40%), vitamin D (92%) and vitamin B12 (25%), and also iron (44%) and folate (18%). Normocalcaemic vitamin D insufficiency with secondary hyperparathyroidism was present in 18%. Iron and transferrin levels were associated with age, sex and estimated glomerular filtration rate. Vitamin K levels were associated with age, and inversely with BMI and diabetes mellitus; and PIVKA-II with smoking, triglycerides and liver function markers. Vitamin D levels were associated with statin use and prescription of supplements and inversely with BMI. Vitamin B12 levels were associated with ethnicity and HbA1c. CONCLUSION Micronutrient status shows differing relationships with age, gender and BMI. Vitamin K insufficiency was present in 40% and not related to deficiencies in other vitamins or micronutrients. Vitamin D and vitamin K supplementation should be considered prebariatric surgery in patients with diabetes or severe insulin resistance.
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Affiliation(s)
- M Ewang-Emukowhate
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, St Thomas' Hospital, London, UK
| | - D J Harrington
- Nutristasis Unit, Viapath, Guy's & St Thomas' Hospitals, St Thomas' Hospital, London, UK
| | - A Botha
- Department of Upper Gastrointestinal Surgery, Guy's & St Thomas' Hospitals, St Thomas' Hospital, London, UK
| | - B McGowan
- Department of Diabetes & Endocrinology, Guy's & St Thomas' Hospitals, St Thomas' Hospital, London, UK
| | - A S Wierzbicki
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, St Thomas' Hospital, London, UK
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86
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Patients with psychiatric comorbidity can safely undergo bariatric surgery with equivalent success. Surg Endosc 2015; 30:251-8. [DOI: 10.1007/s00464-015-4196-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/26/2015] [Indexed: 12/19/2022]
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Indications and limitations of bariatric intervention in severely obese children and adolescents with and without nonalcoholic steatohepatitis: ESPGHAN Hepatology Committee Position Statement. J Pediatr Gastroenterol Nutr 2015; 60:550-61. [PMID: 25591123 DOI: 10.1097/mpg.0000000000000715] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD), which is one of the most common causes of chronic liver disease worldwide. The present best treatment for NAFLD and nonalcoholic steatohepatitis (NASH) is weight reduction through lifestyle modification. Because of frustrating inefficiency of such a therapeutic approach, bariatric surgery is increasingly performed in adolescents as an alternative option for weight reduction. Standards of care and consensus for indications are, however, scarce. We explore the indications and limitations of bariatric surgery in children with severe obesity with and without NASH and aim to provide guidance for the exceptional indications for adolescents with extreme obesity with major comorbidity that may benefit from these controversial interventions. Present evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation, and fibrosis in NASH. Uncomplicated NAFLD is not an indication for bariatric surgery. Roux-en-Y gastric bypass is considered a safe and effective option for adolescents with extreme obesity, as long as an appropriate long-term follow-up is provided. Laparoscopic adjustable gastric banding has not been approved by the Food and Drug Administration for use in adolescents and therefore should be considered investigational. Finally, sleeve gastrectomy and other types of weight loss surgery that have grown increasingly common in adults, still need to be considered investigational. Temporary devices may be increasingly being used in pediatrics; however, future studies, including a long-term risk analysis of patients who undergo surgery, are much needed to clarify the exact indications for bariatric surgery in adolescents.
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88
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McGrice M, Don Paul K. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions. Diabetes Metab Syndr Obes 2015; 8:263-74. [PMID: 26150731 PMCID: PMC4485844 DOI: 10.2147/dmso.s57054] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2-10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments.
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Affiliation(s)
- Melanie McGrice
- Nutrition Plus Enterprises, Melbourne, VIC, Australia
- Correspondence: Melanie McGrice, Nutrition Plus Enterprises, PO Box 9064, South Yarra, Melbourne, VIC 3141, Australia, Tel +61 1300 438 550, Email
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90
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Lester EB, Gerstein LH, Nicholas DR, Hilgendorf WA. Adoption of Recommended Eating Behaviors Following Bariatric Surgery: Predicting Group Membership. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eric B. Lester
- Counseling Psychology and Guidance Services, Ball State University, Teachers College, Muncie, Indiana
| | - Lawrence H. Gerstein
- Counseling Psychology and Guidance Services, Ball State University, Teachers College, Muncie, Indiana
| | - Donald R. Nicholas
- Counseling Psychology and Guidance Services, Ball State University, Teachers College, Muncie, Indiana
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91
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Gómez V, Bhalla R, Heckman MG, Florit PTK, Diehl NN, Rawal B, Lynch SA, Loeb DS. Routine Screening Endoscopy before Bariatric Surgery: Is It Necessary? Bariatr Surg Pract Patient Care 2014; 9:143-149. [PMID: 25516819 DOI: 10.1089/bari.2014.0024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Routine esophagogastroduodenoscopy (EGD) prior to bariatric surgery has not been consistently shown to change the management of the patient. A study was performed to estimate the proportion of patients undergoing bariatric surgery evaluation who had abnormal findings on preoperative EGD that resulted in alteration of management and, second, to evaluate potential risk factors for occurrence of abnormal findings on the EGD. Methods: An observational, retrospective study in which all 232 patients who were cleared to undergo bariatric surgery and who underwent preoperative EGD between 2006 and 2013 were included at a single tertiary dedicated bariatric center for weight loss management. Abnormal findings on screening EGD and medical or surgical management alteration based on the EGD findings were reviewed. Results: Abnormal findings on screening EGD were found in 143 patients (61.6%). Thirty-five patients had medical management altered (15.1%), while four patients (1.7%) had surgical management altered. Being aged >55 years and the presence of gastroesophageal reflux disease were associated with occurrence of an abnormal finding on screening EGD. Conclusions: While abnormalities on preoperative EGD are often found in patients undergoing bariatric surgery evaluation, rarely do the findings change surgical management. Alternative methods for screening for common GI conditions should be considered in appropriate patients.
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Affiliation(s)
- Victoria Gómez
- Department of Gastroenterology and Hepatology, Mayo Clinic , Jacksonville, Florida
| | - Rajat Bhalla
- Department of Internal Medicine, Mayo Clinic , Jacksonville, Florida
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic , Jacksonville, Florida
| | - Paul T Kröner Florit
- Department of Gastroenterology and Hepatology, Mayo Clinic , Jacksonville, Florida
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic , Jacksonville, Florida
| | - Bhupendra Rawal
- Division of Biomedical Statistics and Informatics, Mayo Clinic , Jacksonville, Florida
| | - Scott A Lynch
- Department of General Surgery, Mayo Clinic , Jacksonville, Florida
| | - David S Loeb
- Department of Gastroenterology and Hepatology, Mayo Clinic , Jacksonville, Florida
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92
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Kosanovic R, Romero RJ, Donkor C, Sarasua A, Rabaza JR, Gonzalez AM. A comparative retrospective study of robotic sleeve gastrectomy vs robotic gastric bypass. Int J Med Robot 2014; 11:275-283. [PMID: 25417602 DOI: 10.1002/rcs.1621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND The introduction of the robotic platform to bariatric surgery has brought forth a novel approach, with modifications to the standard laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LGB). The purpose of this study was to match robotic gastric bypass (RGB) vs robotic sleeve gastrectomy (RSG) and compare them to those observed with the laparoscopic platform. METHODS A retrospective data collection of RSGs and RGBs from a single institution was performed. Groups were compared. RESULTS This study included 134 RSG and 165 RGB patients. RGB has a longer surgical time (p < 0.001) and a higher incidence of long-term complications (p = 0.005) but similar lengths of hospital stay (p = 0.093), rate of perioperative complications (p = 0.487) and EWL% at 1 year of follow-up compared to RSG. CONCLUSIONS RSGs had shorter surgical times and a lower incidence of long-term complications when compared with RGBs. These results appear to be similar to those studies reporting the laparoscopic approach. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Radomir Kosanovic
- Department of General and Bariatric Surgery, South Miami Hospital, Baptist Health South Florida, Miami, FL, USA
| | - Rey Jesús Romero
- Department of General and Bariatric Surgery, South Miami Hospital, Baptist Health South Florida, Miami, FL, USA
| | - Charan Donkor
- Department of General and Bariatric Surgery, South Miami Hospital, Baptist Health South Florida, Miami, FL, USA
- Florida International University, Herbert Wertheim College of Medicine Florida, Miami, FL, USA
| | - Armando Sarasua
- Department of General and Bariatric Surgery, South Miami Hospital, Baptist Health South Florida, Miami, FL, USA
| | - Jorge Rafael Rabaza
- Department of General and Bariatric Surgery, South Miami Hospital, Baptist Health South Florida, Miami, FL, USA
- Florida International University, Herbert Wertheim College of Medicine Florida, Miami, FL, USA
| | - Anthony Michael Gonzalez
- Department of General and Bariatric Surgery, South Miami Hospital, Baptist Health South Florida, Miami, FL, USA
- Florida International University, Herbert Wertheim College of Medicine Florida, Miami, FL, USA
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93
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Verma R, Eid G, Ali M, Saber A, Pryor AD. Emerging technologies and procedures: results of an online survey and real-time poll. Surg Obes Relat Dis 2014; 11:161-8. [PMID: 25701960 DOI: 10.1016/j.soard.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/04/2014] [Accepted: 08/03/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Many new techniques and bariatric endoluminal procedures are being developed and used for the treatment of obesity. Clear guidelines or opinions of the new techniques are not readily available. The aim of this study was to gauge the level of interest and opinions of bariatric surgeons regarding these new techniques, using online and real poll surveys. METHODS The American Society for Metabolic and Bariatric Surgery (ASMBS) Emerging Technologies committee developed a questionnaire that was distributed among the membership and conducted a live poll of attendees at Obesity Week 2013. Opinions of new technologies and techniques by practitioners were assessed. RESULTS A total of 134 responses to the questionnaire were returned. Most responses (79%) expressed the belief that new bariatric techniques are needed to improve the practice of bariatric and metabolic surgery. The responses describing the effects of new procedures and technology as beneficial were (1) increased interest from patients or referring physicians (94%), (2) expanded indications for intervention (93%), and (3) lower risk intervention (96%). Nearly all respondents (90.2%) identified value in informational guidelines on new technologies and procedures, and most (88.7%) agreed that the ASMBS should coordinate clinical trials or registries to evaluate these therapies. CONCLUSION Although most bariatric and metabolic surgeons agree that new endoluminal surgical techniques are beneficial, most also are unable to offer the procedures to their patients without more clinical evidence and clear guidelines from the society.
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Affiliation(s)
- Richa Verma
- Stony Brook University Medical Center, Stony Brook, New York
| | - George Eid
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Mohamed Ali
- University of California Davis, Davis, California
| | - Alan Saber
- The Brooklyn Hospital Center, Brooklyn, New York
| | - Aurora D Pryor
- Stony Brook University Medical Center, Stony Brook, New York.
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94
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Pepino MY, Stein RI, Eagon JC, Klein S. Bariatric surgery-induced weight loss causes remission of food addiction in extreme obesity. Obesity (Silver Spring) 2014; 22:1792-8. [PMID: 24852693 PMCID: PMC4115048 DOI: 10.1002/oby.20797] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 05/09/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To test the hypotheses that bariatric surgery-induced weight loss: induces remission of food addiction (FA), and normalizes other eating behaviors associated with FA. METHODS Forty-four obese subjects (BMI= 48 ± 8 kg/m(2) ) were studied before and after ∼20% weight loss induced by bariatric surgery (25 Roux-en-Y gastric bypass, 11 laparoscopic adjustable gastric banding, and eight sleeve gastrectomy). We assessed: FA (Yale Food Addiction Scale), food cravings (Food Craving Inventory), and restrictive, emotional and external eating behaviors (Dutch Eating Behavior Questionnaire). RESULTS FA was identified in 32% of subjects before surgery. Compared with non-FA subjects, those with FA craved foods more frequently, and had higher scores for emotional and external eating behaviors (all P-values <0.01; all Cohen's d >0.8). Surgery-induced weight loss resulted in remission of FA in 93% of FA subjects; no new cases of FA developed after surgery. Surgery-induced weight loss decreased food cravings, and emotional and external eating behaviors in both groups (all P-values < 0.001; all Cohen's d ≥ 0.8). Restrictive eating behavior did not change in non-FA subjects but increased in FA subjects (P < 0.01; Cohen's d>1.1). CONCLUSION Bariatric surgery-induced weight loss induces remission of FA and improves several eating behaviors that are associated with FA.
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Affiliation(s)
- Marta Yanina Pepino
- Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St. Louis, Missouri, 63110, USA
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95
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Tack J, Deloose E. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies. Best Pract Res Clin Gastroenterol 2014; 28:741-9. [PMID: 25194187 DOI: 10.1016/j.bpg.2014.07.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 01/31/2023]
Abstract
Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.
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Affiliation(s)
- Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium.
| | - Eveline Deloose
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
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96
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Mercachita T, Santos Z, Limão J, Carolino E, Mendes L. Anthropometric evaluation and micronutrients intake in patients submitted to laparoscopic Roux-en-Y gastric bypass with a postoperative period of ≥ 1 year. Obes Surg 2014; 24:102-8. [PMID: 23955522 DOI: 10.1007/s11695-013-1057-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bariatric surgery is indicated as the most effective treatment for morbid obesity; the Roux-en-Y gastric bypass (RYGB) is considered the procedure of choice. However, nutritional deficiency may occur in the postoperative period as a result of reduced gastric capacity and change in nutrients absorption in the gastrointestinal tract. The prescription of vitamin and mineral supplementation is a common practice after RYGB; however, it may not be sufficient to prevent micronutrient deficiencies. The aim of this study was to quantify the micronutrient intake in patients undergoing RYGB and verify if the intake of supplementation would be enough to prevent nutritional deficiencies. METHODS The study was conducted on 60 patients submitted to RYGB. Anthropometric, analytical, and nutritional intake data were assessed preoperatively and 1 and 2 years postoperatively. The dietary intake was assessed using 24-h food recall; the values of micronutrients evaluated (vitamin B12, folic acid, iron, and calcium) were compared to the dietary reference intakes (DRI). RESULTS There were significant differences (p < 0.05) between excess weight loss at the first and second year (69.9 ± 15.3 vs 9.6 ± 62.9 %). In the first and second year after surgery, 93.3 and 94.1 % of the patients, respectively, took the supplements as prescribed. Micronutrient deficiencies were detected in the three evaluation periods. At the first year, there was a significant reduction (p < 0.05) of B12, folic acid, and iron intake. CONCLUSIONS Despite taking vitamin and mineral supplementation, micronutrient deficiencies are common after RYGB. In the second year after surgery, micronutrient intake remains below the DRI.
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Affiliation(s)
- Tânia Mercachita
- , Rua Alfredo Rebelo, Casais de Baixo, 2050-360 Azambuja, Lisbon, Portugal,
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97
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Chor J, Chico P, Ayloo S, Roston A, Kominiarek MA. Reproductive health counseling and practices: a cross-sectional survey of bariatric surgeons. Surg Obes Relat Dis 2014; 11:187-92. [PMID: 25443059 DOI: 10.1016/j.soard.2014.05.031] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/17/2014] [Accepted: 05/20/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nearly 50% of bariatric surgery patients are women of reproductive age. Both obstetric and gynecology and surgery professional guidelines recommend a delay of fertility 1-2 years postbariatric surgery. METHODS We sought to assess bariatric surgeons' perioperative reproductive counseling and contraceptive provision for women of reproductive age. We conducted a cross-sectional, national 32-question mail survey of bariatric surgeons. Survey topics included demographic factors, contraceptive counseling and provision, and method preference. Descriptive statistics were reported and Χ2 tests compared results among respondent demographic characteristics. RESULTS A total of 574 of 1,935 physicians returned surveys (30%). After excluding 41 surveys due to missing data, we analyzed 533 (27%) surveys. Mean respondent age was 48.1 years. Most respondents were male (89%), white (78%), and completed residency training ≥10 years ago (72%). The majority of respondents' bariatric surgery patients were female (77%), 63% of which were of reproductive age. Most respondents recommended that their female patients delay pregnancy 12-24 months (87%). Whereas 70% of respondents did not require preoperative contraception, 52% always required postoperative contraceptive use. Although the majority of respondents (64%) referred patients to an obstetrician-gynecologist or primary care physician to obtain contraception, 35% did not know how their female patients obtained contraception. Female respondents were more likely than male respondents to always require a medicine consultation and preoperative contraception, P<.05. CONCLUSION Despite consistently recommending a delay in pregnancy, bariatric surgeons inconsistently address perioperative contraceptive needs of women of reproductive age. These findings highlight the need for greater collaboration between bariatric surgeons and women's healthcare providers to address the reproductive health needs of women having bariatric surgery.
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Affiliation(s)
- Julie Chor
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
| | - Patricia Chico
- Department of Family Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Subhashini Ayloo
- Department of Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Alicia Roston
- Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Michelle A Kominiarek
- Department of Obstetrics and Gynecology, University of Illinois at Chicago College of Medicine, Chicago, Illinois
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98
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Hoogerboord M, Wiebe S, Klassen D, Ransom T, Lawlor D, Ellsmere J. Laparoscopic sleeve gastrectomy: perioperative outcomes, weight loss and impact on type 2 diabetes mellitus over 2 years. Can J Surg 2014; 57:101-5. [PMID: 24666447 DOI: 10.1503/cjs.024212] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an increasingly performed operation for morbid obesity worldwide. To date there has been limited experience in Canada. We report our intermediate results, assessing whether LSG can be safely performed at a Canadian academic teaching hospital and whether it is effective as a bariatric procedure and as metabolic therapy for type 2 diabetes mellitus. METHODS We performed a retrospective review of all patients who underwent LSG at our institution from Sept. 1, 2007, to June 30, 2011. RESULTS We included 166 patients (mean age 44 yr, 82% female) in our study. The mean preoperative body mass index was 49.61. At baseline, 87 (52%) patients had type 2 diabetes. For this subgroup, mean preoperative HbA1c and AC glucose were 7.6% and 8.3 mmol/L, respectively. The mean duration of surgery was 93 minutes. Major complications included 1 staple line leak (0.6%), and 2 patients required reintervention for bleeding (1.2%). The mean hospital stay was 2.6 days. Two patients required readmission (1.2%). Seven minor complications occurred (4%). Postoperative excess weight loss was 49.3% at 6 months, 54.2% at 12 months and 64.4% at 24 months. In the type 2 diabetes subgroup, resolution occurred in 78% and improvement in 7% of patients at 12 months. CONCLUSION Laparoscopic sleeve gastrectomy can be safely performed at Canadian teaching hospitals. It is effective both as a bariatric procedure and as a therapeutic intervention for type 2 diabetes mellitus.
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Affiliation(s)
| | - Shannon Wiebe
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - Dennis Klassen
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - Tom Ransom
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - Diana Lawlor
- The Department of Surgery, Dalhousie University, Halifax, NS
| | - James Ellsmere
- The Department of Surgery, Dalhousie University, Halifax, NS
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Wang B, Wong ES, Alfonso-Cristancho R, He H, Flum DR, Arterburn DE, Garrison LP, Sullivan SD. Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:253-263. [PMID: 23526126 PMCID: PMC5849067 DOI: 10.1007/s10198-013-0472-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 03/07/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE One-third of Americans are obese and an increasing number opt for bariatric surgery. This study estimates the cost-effectiveness of common bariatric surgical procedures from a healthcare system perspective. METHODS We evaluated the three most common bariatric surgical procedures in the US: laparoscopic gastric bypass (LRYGB), conventional (open) Roux-en-Y gastric bypass (ORYGB), and laparoscopic adjustable gastric banding (LAGB) compared to no surgery. The reference case was defined as a 53-year old female with body mass index (BMI) of 44 kg/m(2). We developed a two-part model using a deterministic approach for the first 5-year period post-surgery and separate empirical forecasts for the natural history of BMI, costs and outcomes in the remaining years. We used a combination of datasets including Medicare and MarketScan(®) together with estimates from the literature to populate the model. RESULTS Bariatric surgery produced additional life expectancy (80-81 years) compared to no surgery (78 years). The incremental cost-effectiveness ratios (ICERs) of the surgical procedures were US $6,600 per quality-adjusted life expectancy (QALY) gained for LRYGB, US $6,200 for LAGB, and US $17,300 for ORYGB (3 % discount rate for cost and QALYs). ICERs varied according to choice of BMI forecasting method and clinically plausible variation in parameter estimates. In most scenarios, the ICER did not exceed a threshold of US $50,000 per QALY gained.
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Affiliation(s)
- Bruce Wang
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
| | - Edwin S. Wong
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
- Northwest Center for Outcomes Research in Older Adults, VA Puget Sound, Seattle, WA
| | - Rafael Alfonso-Cristancho
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
- Surgical Outcomes Research Center, University of Washington, Seattle, WA
| | - Hao He
- Surgical Outcomes Research Center, University of Washington, Seattle, WA
| | - Davi R. Flum
- Surgical Outcomes Research Center, University of Washington, Seattle, WA
| | | | - Louis P. Garrison
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
| | - Sean D. Sullivan
- Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA
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Caring for the Postoperative Patient with Complications Presenting to the Emergency Department. Adv Emerg Nurs J 2014; 36:134-44. [DOI: 10.1097/tme.0000000000000015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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