401
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Liu Q, Wang S, Wei M, Huang X, Cheng Y, Shao Y, Xia P, Zhong M, Liu S, Zhang G, Hu S. Improved FGF21 Sensitivity and Restored FGF21 Signaling Pathway in High-Fat Diet/Streptozotocin-Induced Diabetic Rats After Duodenal-Jejunal Bypass and Sleeve Gastrectomy. Front Endocrinol (Lausanne) 2019; 10:566. [PMID: 31543863 PMCID: PMC6728857 DOI: 10.3389/fendo.2019.00566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/02/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: Bariatric surgery can profoundly improve glucose and lipid metabolism in diabetic rats. Fibroblast growth factor 21 (FGF21) is an important hormone with multiple metabolic beneficial effects. Alteration in serum FGF21 level after bariatric surgery has been reported with conflicting results. Here, we investigated the effect of bariatric surgeries on FGF21 expression and sensitivity. Methods: We performed duodenal-jejunal bypass (DJB), sleeve gastrectomy (SG) and sham surgery in diabetic rats induced by high fat diet and streptozotocin. Metabolic parameters, including body weight, food intake, glucose tolerance, and lipid profiles, were monitored. FGF21 levels in both serum and liver were measured after surgery. FGF21 signaling pathway including FGF receptor 1 (FGFR1), β-klotho (KLB), and phosphorylated extracellular signal-regulated kinase 1/2 (ERK1/2) was detected in the liver and white adipose tissue (WAT). We also determined FGF21 sensitivity post-operatively by acute recombinant human FGF21 injection. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were conducted immediately after FGF21 injection. Serum triglyceride (TG) and non-esterified fatty acid (NEFA) were measured and the mRNA levels of early growth response 1 (Egr1) and c-Fos in the liver and WAT were detected after FGF21 injection. Results: Improvements in glucose tolerance, insulin sensitivity, and lipid profiles were observed after bariatric surgeries along with ameliorated lipid metabolism in the liver and WAT. Serum and hepatic FGF21 levels decreased in both DJB and SG groups. FGFR1 and phosphorylated ERK1/2 levels increased in both DJB and SG groups 8 weeks after surgery. The expression of KLB was downregulated only in the WAT after DJB and SG. Significant alteration of OGTT and ITT were observed after acute FGF21 administration in DJB and SG groups. Serum TG and NEFA in DJB and SG groups also decreased after FGF21 administration. And increased mRNA levels of Egr1 and c-Fos were detected in the liver and WAT after DJB and SG surgeries. Conclusions: DJB and SG surgeries can downregulate hepatic expression of FGF21, restore FGF21 signaling pathway and improve FGF21 sensitivity in high-fat diet/streptozotocin-induced diabetic rats.
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Affiliation(s)
- Qiaoran Liu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Shuo Wang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Huang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yugang Cheng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yi Shao
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Pingtian Xia
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Mingwei Zhong
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
- *Correspondence: Sanyuan Hu
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402
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Medina DA, Li T, Thomson P, Artacho A, Pérez-Brocal V, Moya A. Cross-Regional View of Functional and Taxonomic Microbiota Composition in Obesity and Post-obesity Treatment Shows Country Specific Microbial Contribution. Front Microbiol 2019; 10:2346. [PMID: 31681211 PMCID: PMC6812679 DOI: 10.3389/fmicb.2019.02346] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/26/2019] [Indexed: 02/05/2023] Open
Abstract
Gut microbiota has been shown to have an important influence on host health. The microbial composition of the human gut microbiota is modulated by diet and other lifestyle habits and it has been reported that microbial diversity is altered in obese people. Obesity is a worldwide health problem that negatively impacts the quality of life. Currently, the widespread treatment for obesity is bariatric surgery. Interestingly, gut microbiota has been shown to be a relevant factor in effective weight loss after bariatric surgery. Since that the human gut microbiota of normal subjects differs between geographic regions, it is possible that rearrangements of the gut microbiota in dysbiosis context are also region-specific. To better understand how gut microbiota contribute to obesity, this study compared the composition of the human gut microbiota of obese and lean people from six different regions and showed that the microbiota compositions in the context of obesity were specific to each studied geographic location. Furthermore, we analyzed the functional patterns using shotgun DNA metagenomic sequencing and compared the results with other obesity-related metagenomic studies, we observed that microbial contribution to functional pathways were country-specific. Nevertheless, our study showed that although microbial composition of obese patients was country-specific, the overall metabolic functions appeared to be the same between countries, indicating that different microbiota components contribute to similar metabolic outcomes to yield functional redundancy. Furthermore, we studied the microbiota functional changes of obese patients after bariatric surgery, by shotgun metagenomics sequencing and observed that changes in functional pathways were specific to the type of obesity treatment. In all, our study provides new insights into the differences and similarities of obese gut microbiota in relation to geographic location and obesity treatments.
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Affiliation(s)
- Daniel A. Medina
- Laboratorio de Biotecnología Aplicada, Facultad de Medicina Veterinaria, Universidad San Sebastián, Puerto Montt, Chile
- *Correspondence: Daniel A. Medina,
| | - Tianlu Li
- Chromatin and Disease Group, Cancer Epigenetics and Biology Programme (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Epigenetics and Immune Disease Group, Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain
| | - Pamela Thomson
- Departamento de Ingeniería Química y Bioprocesos, Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandro Artacho
- Genomics and Health Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)-Salud Pública, Valencia, Spain
| | - Vicente Pérez-Brocal
- Genomics and Health Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)-Salud Pública, Valencia, Spain
| | - Andrés Moya
- Genomics and Health Area, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO)-Salud Pública, Valencia, Spain
- Integrative Systems Biology Institute, University of Valencia, CSIC, Valencia, Spain
- Biomedical Research Centre Network for Epidemiology and Public Health (CIBEResp), Madrid, Spain
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403
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Aron-Wisnewsky J, Prifti E, Belda E, Ichou F, Kayser BD, Dao MC, Verger EO, Hedjazi L, Bouillot JL, Chevallier JM, Pons N, Le Chatelier E, Levenez F, Ehrlich SD, Doré J, Zucker JD, Clément K. Major microbiota dysbiosis in severe obesity: fate after bariatric surgery. Gut 2019; 68:70-82. [PMID: 29899081 PMCID: PMC7143256 DOI: 10.1136/gutjnl-2018-316103] [Citation(s) in RCA: 258] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Decreased gut microbial gene richness (MGR) and compositional changes are associated with adverse metabolism in overweight or moderate obesity, but lack characterisation in severe obesity. Bariatric surgery (BS) improves metabolism and inflammation in severe obesity and is associated with gut microbiota modifications. Here, we characterised severe obesity-associated dysbiosis (ie, MGR, microbiota composition and functional characteristics) and assessed whether BS would rescue these changes. DESIGN Sixty-one severely obese subjects, candidates for adjustable gastric banding (AGB, n=20) or Roux-en-Y-gastric bypass (RYGB, n=41), were enrolled. Twenty-four subjects were followed at 1, 3 and 12 months post-BS. Gut microbiota and serum metabolome were analysed using shotgun metagenomics and liquid chromatography mass spectrometry (LC-MS). Confirmation groups were included. RESULTS Low gene richness (LGC) was present in 75% of patients and correlated with increased trunk-fat mass and comorbidities (type 2 diabetes, hypertension and severity). Seventy-eight metagenomic species were altered with LGC, among which 50% were associated with adverse body composition and metabolic phenotypes. Nine serum metabolites (including glutarate, 3-methoxyphenylacetic acid and L-histidine) and functional modules containing protein families involved in their metabolism were strongly associated with low MGR. BS increased MGR 1 year postsurgery, but most RYGB patients remained with low MGR 1 year post-BS, despite greater metabolic improvement than AGB patients. CONCLUSIONS We identified major gut microbiota alterations in severe obesity, which include decreased MGR and related functional pathways linked with metabolic deteriorations. The lack of full rescue post-BS calls for additional strategies to improve the gut microbiota ecosystem and microbiome-host interactions in severe obesity. TRIAL REGISTRATION NUMBER NCT01454232.
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Affiliation(s)
- Judith Aron-Wisnewsky
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France,Assistance Publique Hôpitaux de Paris, APHP, Nutrition department, CRNH Ile de France, Pitié-Salpêtrière Hospital, Paris France
| | - Edi Prifti
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France,IRD, Sorbonne Université, UMMISCO, Unité de modélisation Mathématique et Informatique des Systèmes Complexes, 32 Avenue Henri Varagnat, 93143 Bondy Cedex, France
| | - Eugeni Belda
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France
| | - Farid Ichou
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France
| | - Brandon D Kayser
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France
| | - Maria Carlota Dao
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France
| | - Eric O Verger
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France
| | - Lyamine Hedjazi
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France
| | - Jean-Luc Bouillot
- Assistance Publique Hôpitaux de Paris, APHP, Visceral surgery department of Ambroise Paré, Paris, France
| | - Jean-Marc Chevallier
- Assistance Publique Hôpitaux de Paris, APHP, Visceral surgery department of HEGP; Paris, France
| | - Nicolas Pons
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France
| | | | - Florence Levenez
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France
| | - Stanislav Dusko Ehrlich
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy-en-Josas, France
| | - Joel Doré
- MGP MetaGénoPolis, INRA, Université Paris-Saclay, 78350 Jouy en Josas, France,AgroParisTech, UMR1319 MICALIS, Jouy-en-Josas, France
| | - Jean-Daniel Zucker
- Institute of Cardiometabolism and Nutrition, ICAN, Integromics and metabolomics platform, Paris, France,IRD, Sorbonne Université, UMMISCO, Unité de modélisation Mathématique et Informatique des Systèmes Complexes, 32 Avenue Henri Varagnat, 93143 Bondy Cedex, France
| | - Karine Clément
- Sorbonne Université, INSERM, NutriOmics team, ICAN, F-75013, Paris, France,Assistance Publique Hôpitaux de Paris, APHP, Nutrition department, CRNH Ile de France, Pitié-Salpêtrière Hospital, Paris France
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404
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Iannelli A, Treacy P, Sebastianelli L, Schiavo L, Martini F. Perioperative complications of sleeve gastrectomy: Review of the literature. J Minim Access Surg 2019; 15:1-7. [PMID: 29737316 PMCID: PMC6293679 DOI: 10.4103/jmas.jmas_271_17] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Sleeve gastrectomy (SG) has known a spectacular rise worldwide during the last decade. The absence of digestive anastomosis simplifies the surgical technique, reducing anastomosis-related complications such as fistula, stricture and marginal ulcer. Furthermore, the respect for digestive continuity preserves the functions of pylorus, that regulates gastric emptying, and duodenum, where calcium, B vitamins and iron are absorbed. Despite the multiple advantages, SG also has specific complications such as bleeding, stenosis, portal thrombosis and leak. The staple line leak at the oesophagogastric junction is the most feared complication and its prevention remains difficult, as the involved mechanisms have been only partially elucidated. Its management is long and requires a multidisciplinary technical platform including Intensive Care Unit, digestive endoscopy and interventional radiology as well as a specialised surgeon. The aim of this review is to explain in detail the perioperative complications of SG, their prevention and treatment, referring to the most recent available literature.
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Affiliation(s)
- Antonio Iannelli
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice; Inserm, U1065, Team 8 "Hepatic Complications of Obesity"; University of Nice Sophia Antipolis, Nice, France
| | - Patrick Treacy
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Lionel Sebastianelli
- Digestive Surgery Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France
| | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli"; IX Division of General Surgery, Vascular Surgery and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
| | - Francesco Martini
- Digestive and Bariatric Surgery Unit, Joseph Ducuing Hospital, Toulouse, France
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405
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Parretti HM, Hughes CA, Jones LL. 'The rollercoaster of follow-up care' after bariatric surgery: a rapid review and qualitative synthesis. Obes Rev 2019; 20:88-107. [PMID: 30345630 DOI: 10.1111/obr.12764] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/26/2018] [Accepted: 08/09/2018] [Indexed: 12/15/2022]
Abstract
Benefits of bariatric surgery for obesity related comorbidities are well established. However, in the longer term, patients can become vulnerable to procedure specific problems, experience weight regain and continue to need monitoring and management of comorbidities. Effective longer term follow-up is vital due to these complex needs post-surgery. Current guidance recommends annual long-term follow-up after bariatric surgery. However, attendance can be low, and failure to attend is associated with poorer outcomes. Understanding patients' experiences and needs is central to the delivery of effective care. This rapid review has synthesized the current qualitative literature on patient experiences of healthcare professional (HCP) led follow-up from 12 months after bariatric surgery. A recurring theme was the need for more and extended follow-up care, particularly psychological support. Enablers to attending follow-up care were patient self-efficacy as well as HCP factors such as a non-judgemental attitude, knowledge and continuity of care. Barriers included unrealistic patient expectations and perceived lack of HCP expertise. Some preferences were expressed including patient initiated access to HCPs and more information preoperatively to prepare for potential post-surgery issues. Insights gained from this work will help identify areas for improvement to care in order to optimize longer term outcomes.
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Affiliation(s)
- H M Parretti
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - C A Hughes
- Fakenham Weight Management Services, Fakenham, Norfolk, UK.,University of East Anglia, Norwich, Norfolk, UK
| | - L L Jones
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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406
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Alkandari A, Ashrafian H, Sathyapalan T, Darzi A, Holmes E, Athanasiou T, Atkin SL, Gooderham NJ. Bariatric Surgery Modulates Urinary Levels of MicroRNAs Involved in the Regulation of Renal Function. Front Endocrinol (Lausanne) 2019; 10:319. [PMID: 31164867 PMCID: PMC6536704 DOI: 10.3389/fendo.2019.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Obesity and diabetes cause chronic kidney disease with a common pathophysiology that is characterized by the accumulation of collagen in the extracellular matrix. Recent evidence has implicated the epithelial-to-mesenchymal transition (EMT) as a key step in this pathology with regulation by microRNAs. Weight loss leads to improvements in renal function; therefore, this study hypothesized that bariatric-surgery aided weight loss would lead to changes in urinary microRNAs involved in the regulation of renal function. Materials and methods: Twenty-four bariatric patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy donated urine pre-operatively and at 2-6 months and 1-2 years post-operatively. Urine samples were also obtained from 10 healthy weight and 7 morbidly obese non-surgical controls. Expression levels of kidney microRNAs were assessed in urine and the function of microRNAs was assessed through the in vitro transfection of HK-2 cells, a kidney proximal tubule cell line. Results: Levels of miR 192, miR 200a, and miR 200b were upregulated in urine following bariatric surgery. This increase was consistent across surgical type and diabetes status and was maintained and enhanced with time. Bariatric surgery alters urinary miR 192 expression from levels seen in morbidly obese patients to levels seen in healthy weight control patients. In mechanistic studies, the transfection of miR 192 in HK-2 cells increased miR 200a expression and decreased ZEB2, a key transcriptional promoter of kidney fibrosis. Conclusions: Bariatric surgery increased miR 192 and miR 200 urinary levels, key anti-fibrotic microRNAs that could contribute to a renal-protective mechanism and may be of value as urinary biomarkers following surgery. These findings suggest that urinary microRNAs may represent potential novel biomarkers for obesity-associated renal function.
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Affiliation(s)
- Abdullah Alkandari
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Dasman Diabetes Institute, Kuwait City, Kuwait
- *Correspondence: Abdullah Alkandari
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes, and Metabolism, Hull York Medical School, Kingston upon Hull, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Elaine Holmes
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Stephen L. Atkin
- Weill Cornell Medical College Qatar, Qatar Foundation, Doha, Qatar
| | - Nigel J. Gooderham
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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407
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Schürner AM, Manzini G, Bueter M, Schadde E, Beck-Schimmer B, Schläpfer M. Perioperative surgery- and anaesthesia-related risks of laparoscopic Roux-en-Y gastric bypass - a single centre, retrospective data analysis. BMC Anesthesiol 2018; 18:190. [PMID: 30545308 PMCID: PMC6293573 DOI: 10.1186/s12871-018-0654-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022] Open
Abstract
Background Conservative obesity treatment often leads to limited results. Bariatric surgery is highly efficient, but the candidates are at risk of developing perioperative complications. Bariatric outcomes have been well described in the past, but there are only few reports of perioperative outcomes. The aim of this study was to evaluate the incidence of anaesthetic and surgical complications of Roux-en-Y bypass. Methods Data of all adult patients, who underwent primary Roux-en-Y gastric bypass surgery between 1/2006 and 12/2013 at the University Hospital Zurich were analysed. Using our clinical database, anaesthetic and surgical complications during the first 30 days after surgery were analysed and risk factors determined by multivariate analysis. Results Seven hundred eleven patients (72% female, median age 40 years) were analysed. Overall, surgical complications occurred in 34% patient, while complications attributable to anaesthesia occurred in 37%. Post-operative nausea and vomiting (PONV) were observed in 34%, intubation-related complications in 4%, and delayed extubation in 2% of our patients. Within the first 30 days after surgery, 22% of the patients presented with an infection. Gastrointestinal complications were found in 8%, and bleeding complications in 3%. Anaesthesia complications were less common in older patients and in patients anaesthetized with a volatile anaesthetic. Severe complications were more common in patients with a lower body mass index (BMI) and with longer surgery. The risk to develop a postoperative infection was higher in diabetic patients. Conclusion Roux-en-Y bariatric surgery has few anaesthetic complications, the most common is PONV. PONV is more common in younger patients and not more common with volatile anaesthetics. Major complications are overall rare and occur in patients with lower BMI and longer surgery, likely reflecting more difficult procedures. Electronic supplementary material The online version of this article (10.1186/s12871-018-0654-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna M Schürner
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Giulia Manzini
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Department of Surgery, Cantonal Hospital Olten, Baslerstrasse 150, 4600, Olten, Switzerland
| | - Marco Bueter
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Erik Schadde
- Institute of Physiology, University Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Rush University Medical Center, 1653 W. Congress Pkwy, Chicago, IL, 60612-3244, USA.,Department of Surgery, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Beatrice Beck-Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.,Institute of Physiology, University Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Department of Anaesthesiology, University of Illinois at Chicago, 1740 West Taylor Street Suite 3200W, MC 515, Chicago, IL, 60612, USA
| | - Martin Schläpfer
- Institute of Anaesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. .,Institute of Physiology, University Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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408
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Puzziferri N, Wolfe BM. PCORnet Bariatric Surgery Outcomes: Strength in Numbers. Ann Intern Med 2018; 169:806-807. [PMID: 30383123 DOI: 10.7326/m18-2819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nancy Puzziferri
- University of Texas Southwestern Medical Center, Dallas, Texas (N.P.)
| | - Bruce M Wolfe
- Oregon Health & Science University, Portland, Oregon (B.M.W.)
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409
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Arterburn D, Wellman R, Emiliano A, Smith SR, Odegaard AO, Murali S, Williams N, Coleman KJ, Courcoulas A, Coley RY, Anau J, Pardee R, Toh S, Janning C, Cook A, Sturtevant J, Horgan C, McTigue KM. Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study. Ann Intern Med 2018; 169:741-750. [PMID: 30383139 PMCID: PMC6652193 DOI: 10.7326/m17-2786] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness. OBJECTIVE To compare weight loss and safety among bariatric procedures. DESIGN Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: NCT02741674). SETTING 41 health systems in the National Patient-Centered Clinical Research Network. PARTICIPANTS 65 093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures. INTERVENTION 32 208 Roux-en-Y gastric bypass (RYGB), 29 693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures. MEASUREMENTS Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events. RESULTS Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44 978 (84%), 20 783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI, 25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics. LIMITATION Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data. CONCLUSION Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Ana Emiliano
- Rockefeller University, New York, New York (A.E.)
| | - Steven R Smith
- The Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida (S.R.S.)
| | - Andrew O Odegaard
- University of California, Irvine, School of Medicine, Irvine, California (A.O.O.)
| | - Sameer Murali
- Kaiser Permanente Southern California, Pasadena, California (S.M., K.J.C.)
| | - Neely Williams
- Community Partners' Network, Nashville, Tennessee (N.W.)
| | - Karen J Coleman
- Kaiser Permanente Southern California, Pasadena, California (S.M., K.J.C.)
| | - Anita Courcoulas
- University of Pittsburgh, Pittsburgh, Pennsylvania (A.C., K.M.M.)
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Roy Pardee
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Sengwee Toh
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.)
| | - Cheri Janning
- Duke Clinical & Translational Science Institute, Durham, North Carolina (C.J.)
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Jessica Sturtevant
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.)
| | - Casie Horgan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.)
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410
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Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J, Buchwald H, Scopinaro N. IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg 2018; 28:3783-3794. [PMID: 30121858 DOI: 10.1007/s11695-018-3450-2] [Citation(s) in RCA: 616] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), being a Federation of 62 national societies, is the ideal network to monitor the number and type of procedures at a global level. The IFSO survey, enriched with a special section on revisional procedures, aims to report the number and types of bariatric procedures performed worldwide in 2016 and analyzes the surgical trends from 2008 to 2016. METHODS The 2016 IFSO Survey form was emailed to all IFSO societies. Each Society was requested to indicate the number and type of bariatric procedures performed in the country. Trend analyses from 2008 to 2016 were also performed. RESULTS The total number of bariatric/metabolic procedures performed in 2016 was 685,874; 634,897 (92.6%) of which were primary and 50,977 were revisional (7.4%). Among the primary interventions, 609,897 (96%) were surgical and 25,359 (4%) were endoluminal. The most performed primary surgical bariatric/metabolic procedure was sleeve gastrectomy (SG) (N = 340,550; 53.6%), followed by Roux-en-Y gastric bypass (N = 191,326; 30.1%), and one-anastomosis gastric bypass (N = 30,563; 4.8%). CONCLUSIONS In 2016, there was an increase in the total number both of surgical and endoluminal bariatric/metabolic procedures. Revisional procedures represent about 7% of the total bariatric interventions. SG remains the most performed surgical procedure in the world.
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Affiliation(s)
- Luigi Angrisani
- General and Endoscopic Surgery Unit, "S. Giovanni Bosco" Hospital, Via Filippo Maria Briganti, 255, Naples, Italy.
| | - A Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - P Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - A Vitiello
- General and Endoscopic Surgery Unit, "S. Giovanni Bosco" Hospital, Via Filippo Maria Briganti, 255, Naples, Italy
| | - K Higa
- Advanced Laparoscopy Surgery Associates, Fresno Heart and Surgical Hospital, Fresno, CA, USA
- Fresno Medical Education Program, University of California, San Francisco, San Francisco, CA, USA
| | - J Himpens
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - H Buchwald
- Departments of Surgery and Biomedical Engineering, University of Minnesota, Minneapolis, MN, 55455, USA
| | - N Scopinaro
- Department of Surgery, University of Genoa, School of Medicine, Genoa, Italy
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411
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Ring Madsen L, Espersen R, Rejnmark L, Richelsen B. Effect of calcium citrate vs calcium carbonate on elevated parathyroid hormone after Roux-en-Y gastric bypass. A double-blinded, randomized trial. Clin Endocrinol (Oxf) 2018; 89:734-741. [PMID: 30107042 DOI: 10.1111/cen.13836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/08/2018] [Accepted: 08/12/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Following Roux-en-Y gastric bypass (RYGB), elevated parathyroid hormone (PTH) levels potentially harmful to bone health are commonly observed. Owing to assumed superior absorption, calcium citrate is often recommended over calcium carbonate following RYGB for the treatment of elevated PTH. We aimed to investigate the impact of either calcium carbonate or calcium citrate (1200 mg elementary calcium) in patients with elevated PTH levels following RYGB. DESIGN Clinical, double-blinded, randomized controlled trial of a 12-week duration at a Danish University Hospital. PATIENTS AND MEASUREMENTS Thirty-nine (no drop out) RYGB operated patients with elevated PTH levels (PTH > 6.9 pmol/L) and normal plasma levels of calcium and 25-hydroxyvitamin D were randomized to either calcium carbonate or calcium citrate (1200 mg elementary calcium/daily). We assessed change in PTH as the primary outcome. RESULTS The effect of the two calcium formulations on change in PTH was comparable and neutral: -1.9% (calcium citrate) vs +0.9% (calcium carbonate), P = 0.680. Compared to the carbonate-treated group, the following bone turnover markers decreased significantly in the citrate-treated group: procollagen I N-terminal propeptide (-16.6% vs -3.2%, P = 0.021), osteocalcin (-17.2% vs -4.3%, P = 0.007) and bone-specific alkaline phosphatase (-5.9% vs 3.7%, P = 0.027) and remained significantly decreased after multivariable adjustment. CONCLUSION Increasing the dose of calcium supplementation in RYGB operated patients with slightly elevated PTH levels does not normalize PTH levels, regardless of the type of supplement. Our results do not support recommending supplementation with calcium citrate over calcium carbonate in RYGB patients.
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Affiliation(s)
- Lene Ring Madsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rasmus Espersen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjørn Richelsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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412
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Axelsson KF, Werling M, Eliasson B, Szabo E, Näslund I, Wedel H, Lundh D, Lorentzon M. Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study. J Bone Miner Res 2018; 33:2122-2131. [PMID: 30011091 DOI: 10.1002/jbmr.3553] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/13/2018] [Accepted: 07/07/2018] [Indexed: 12/20/2022]
Abstract
Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38,971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31,213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation 1-year postsurgery was investigated. During a median follow-up time of 3.1 (interquartile range [IQR], 1.7 to 4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (hazard ratio [HR] 1.26; 95% CI, 1.05 to 1.53; and HR 1.32; 95% CI, 1.18 to 1.47; respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Kristian F Axelsson
- Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden.,Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Malin Werling
- Department of Gastrosurgical Research & Education, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Szabo
- Department of Surgery. Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery. Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Hans Wedel
- Health Metrics, Sahlgrenska Academin, University of Gothenburg, Gothenburg, Sweden
| | - Dan Lundh
- School of Bioscience, University of Skövde, Skövde, Sweden
| | - Mattias Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
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413
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Koch TR, Shope TR, Camilleri M. Current and future impact of clinical gastrointestinal research on patient care in diabetes mellitus. World J Diabetes 2018; 9:180-189. [PMID: 30479683 PMCID: PMC6242723 DOI: 10.4239/wjd.v9.i11.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/12/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
The worldwide rise in the prevalence of obesity supports the need for an increased interaction between ongoing clinical research in the allied fields of gastrointestinal medicine/surgery and diabetes mellitus. There have been a number of clinically-relevant advances in diabetes, obesity, and metabolic syndrome emanating from gastroenterological research. Gastric emptying is a significant factor in the development of upper gastrointestinal symptoms. However, it is not the only mechanism whereby such symptoms occur in patients with diabetes. Disorders of intrinsic pacing are involved in the control of stomach motility in patients with gastroparesis; on the other hand, there is limited impact of glycemic control on gastric emptying in patients with established diabetic gastroparesis. Upper gastrointestinal functions related to emptying and satiations are significantly associated with weight gain in obesity. Medications used in the treatment of diabetes or metabolic syndrome, particularly those related to pancreatic hormones and incretins affect upper gastrointestinal tract function and reduce hyperglycemia and facilitate weight loss. The degree of gastric emptying delay is significantly correlated with the weight loss in response to liraglutide, a glucagon-like peptide-1 analog. Network meta-analysis shows that liraglutide is one of the two most efficacious medical treatments of obesity, the other being the combination treatment phentermine-topiramate. Interventional therapies for the joint management of obesity and diabetes mellitus include newer endoscopic procedures, which require long-term follow-up and bariatric surgical procedure for which long-term follow up shows advantages for individuals with diabetes. Newer bariatric procedures are presently undergoing clinical evaluation. On the horizon, combination therapies, in part directed at gastrointestinal functions, appear promising for these indications. Ongoing and future gastroenterological research when translated to care of individuals with diabetes mellitus should provide additional options to improve their clinical outcomes.
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Affiliation(s)
- Timothy R Koch
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Timothy R Shope
- Center for Advanced Laparoscopic General and Bariatric Surgery, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC 20010, United States
| | - Michael Camilleri
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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414
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Magro DO, Cazzo E, Kotze PG, Vasques ACJ, Martinez CAR, Chaim EA, Geloneze B, Pareja JC, Coy CSR. Glucose Metabolism Parameters and Post-Prandial GLP-1 and GLP-2 Release Largely Vary in Several Distinct Situations: a Controlled Comparison Among Individuals with Crohn's Disease and Individuals with Obesity Before and After Bariatric Surgery. Obes Surg 2018; 28:378-388. [PMID: 28776152 DOI: 10.1007/s11695-017-2851-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aims to compare the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 among individuals with Crohn's disease (CD), obese individuals before and after bariatric surgery, and healthy controls. METHODS This an exploratory cross-sectional study that involved five groups of patients (two groups of individuals with CD-active and inactive), bariatric patients (pre- and post-surgery, who were their own controls), and a distinct separated control group of healthy volunteers. C-reactive protein (CRP) levels and the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 curves were assessed and compared. RESULTS The pre-RYGB group presented significantly higher levels of CRP than the post-RYGB (p = 0.001) and the control group (p = 0.001). The inactive CD group presented a higher post-prandial GLP-1 area under the curve (AUC) than the pre-RYGB group (p = 0.009). The post-RYGB group presented significantly higher AUCs of GLP-2 than the pre-RYGB group (p < 0.0001), both inactive and active CD groups (p < 0.0001 in both situations), and the control group (p = 0.002). The pre-RYGB group presented a significantly higher AUC of glucose than the post-RYGB (p = 0.02) and both active and inactive CD groups (p = 0.019 and p = 0.046, respectively). The pre-RYGB group presented a significantly higher AUC of insulin than the control (p = 0.005) and both CD groups (p < 0.0001). CONCLUSIONS Obesity is associated with an inflammatory state comparable to the one observed in CD; inflammation may also be enrolled in the blockade of GLP-2. CD individuals present a more incretin-driven pattern of glucose metabolism, as a way to prevent hypoglycemia and compensate the carbohydrate malabsorption and GLP-2 blockade.
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Affiliation(s)
- Daniéla Oliveira Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil.
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Ana Carolina Junqueira Vasques
- Research Laboratory of Metabolism and Diabetes (LIMED), Gastrocentro, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carlos Augusto Real Martinez
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Bruno Geloneze
- Research Laboratory of Metabolism and Diabetes (LIMED), Gastrocentro, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Carlos Pareja
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Cláudio Saddy Rodrigues Coy
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
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415
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Cazzo E, Pareja JC, Chaim EA, Coy CSR, Magro DO. Glucagon-Like Peptides 1 and 2 Are Involved in Satiety Modulation After Modified Biliopancreatic Diversion: Results of a Pilot Study. Obes Surg 2018; 28:506-512. [PMID: 28808865 DOI: 10.1007/s11695-017-2875-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND This paper aimed to evaluate the influence of modified biliopancreatic diversion (BPD) on the levels of GLP-1 and GLP-2 and correlate them with satiety regulation. METHODS This is a pilot prospective cohort study that evaluated six mildly obese individuals with type 2 diabetes mellitus, which underwent modified BPD and were followed-up for 12 months. Levels of GLP-1 and GLP-2 after a standard meal tolerance test were determined and correlated with satiety scores obtained by means of a visual analogue scale (VAS). RESULTS There were significant changes in BMI (33 ± 2.2 versus 26.3 ± 2.2 kg/m2; p < 0.001), HbA1c (7.9 ± 1.6 versus 5.8 ± 1.2%; p = 0.026), total cholesterol (172.3 ± 11.1 versus 134.7 ± 16.1 mg/dL; p < 0.001), LDL-c (103.3 ± 13 versus 64.6 ± 12.2 mg/dL; p < 0.001), and postprandial GLP-2 (972.7 ± 326.2 versus 1993.2 ± 1024.7; p = 0. 044). None of the scores obtained in the VAS significantly changed after surgery. After surgery, there were significant correlations of VAS scores and GLP-1 levels in question 01 ("how hungry do you feel?"; R = -0.928; p = .008) and GLP-2 levels in questions 02 ("how full do you feel?" R = 0.943; p = 0.005) and 04 ("how much do you think you can eat now? R = -0.829; p = 0.042). CONCLUSIONS Modified BPD does not lead to significant changes in satiety evaluated by the VAS; different aspects of satiety regulation are correlated with the postprandial levels of GLP-1 (hunger feeling) and GLP-2 (satiation feeling and desire to eat) 1 year after modified BPD, signaling a specific postoperative gut hormone-related modulation of appetite.
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Affiliation(s)
- Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, CEP, Campinas, SP, 13085-000, Brazil.
| | - José Carlos Pareja
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, CEP, Campinas, SP, 13085-000, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, CEP, Campinas, SP, 13085-000, Brazil
| | - Cláudio Saddy Rodrigues Coy
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, CEP, Campinas, SP, 13085-000, Brazil
| | - Daniéla Oliveira Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, Cidade Universitaria Zeferino Vaz, CEP, Campinas, SP, 13085-000, Brazil
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416
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Benaiges D, Climent E, Goday A, Julià H, Flores-Le Roux JA, Pedro-Botet J. Mid-term results of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy compared-results of the SLEEVEPASS and SM-BOSS trials. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:S83. [PMID: 30613658 DOI: 10.21037/atm.2018.10.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Paseo Marítimo, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Elisenda Climent
- Department of Endocrinology and Nutrition, Hospital del Mar, Paseo Marítimo, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Paseo Marítimo, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Helena Julià
- Department of Endocrinology and Nutrition, Hospital del Mar, Paseo Marítimo, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Paseo Marítimo, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Paseo Marítimo, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
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417
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Lindeman KG, Greenblatt LB, Rourke C, Bouxsein ML, Finkelstein JS, Yu EW. Longitudinal 5-Year Evaluation of Bone Density and Microarchitecture After Roux-en-Y Gastric Bypass Surgery. J Clin Endocrinol Metab 2018; 103:4104-4112. [PMID: 30219833 PMCID: PMC6194805 DOI: 10.1210/jc.2018-01496] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/10/2018] [Indexed: 12/13/2022]
Abstract
CONTEXT Bone health declines in the initial years after Roux-en-Y gastric bypass (RYGB), but long-term skeletal effects are unclear. OBJECTIVE To document longitudinal changes in bone mineral density (BMD) and microarchitecture 5 years after RYGB. DESIGN, SETTING, AND PARTICIPANTS Prospective 5-year observational study of 21 adults with severe obesity receiving RYGB at an academic medical center. MAIN OUTCOME MEASURES Spine and hip areal BMD were measured by dual-energy X-ray absorptiometry, and trabecular volumetric BMD (vBMD) of the spine was assessed by quantitative CT (QCT). We measured vBMD and microarchitecture of the distal radius and tibia by high-resolution peripheral QCT in a subset of subjects. Serum type I collagen C-terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (P1NP) were also measured. RESULTS Areal BMD declined by -7.8% ± 7.6% at the spine and -15.3% ± 6.3% at the total hip by 5 years after RYGB (P ≤ 0.001), although the rate of bone loss slowed in later years. Trabecular spine vBMD decreased by -12.1% ± 12.3% by 5 years (P ≤ 0.001). At peripheral sites, vBMD continued to decrease steadily throughout 5 years, with parallel declines in cortical and trabecular microarchitecture, leading to decreases in estimated failure load of -20% and -13% at the radius and tibia, respectively (P < 0.001). Five years after RYGB, CTX and P1NP were 150% and 34% above baseline (P < 0.001 and P = 0.017, respectively). CONCLUSIONS Sustained high-turnover bone loss and bone microarchitectural deterioration occur in the 5 years after RYGB. Adults receiving RYGB warrant assessment of bone health.
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Affiliation(s)
| | | | - Caroline Rourke
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Joel S Finkelstein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Elaine W. Yu, MD, MMSc, Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, Thier 1051, Boston, Massachusetts 02114. E-mail:
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418
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Bang KB, Shin HD. Endoscopic treatment of surgery or procedure-related gastrointestinal bleeding. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2018. [DOI: 10.18528/gii180031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ki Bae Bang
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Deok Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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419
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Willmer M, Salzmann-Erikson M. 'The only chance of a normal weight life': A qualitative analysis of online forum discussions about bariatric surgery. PLoS One 2018; 13:e0206066. [PMID: 30359394 PMCID: PMC6201906 DOI: 10.1371/journal.pone.0206066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background The only effective weight loss treatment for severe obesity is bariatric surgery, with Roux-en-Y gastric bypass being the most common method. Patients often have unrealistic expectations of surgery and expect a “miracle cure” even though the procedure requires major lifelong lifestyle changes. Most patients access information about the procedure online, and come into contact with others who have had the surgery. Objective The objective of this study was to describe shared values, feelings, and thoughts among visitors to a web-based forum for those undergoing bariatric surgery. Methods In this cross-sectional observation study using qualitative contents analysis, the material consisted of an online discussion forum thread about bariatric surgery, with 498 posts. These were saved in a document, read and re-read. Through coding of meaningful units of text, themes were established. Results Four themes were constructed during data analysis: a) A new life—anticipating dramatic changes of body and mind; b) Negotiating the system and playing the waiting game; c) A means to an end—managing the pre-operative diet; and d) Managing the attitudes of others. Posters described the process of bariatric surgery as a journey, riddled with roadblocks, setbacks and trials, but also with joy and expectations of a new life. Conclusion Professionals who encounter this group should be aware of their need for support throughout the process, and investigate the possibility of both pre- and postoperative support groups, either online or face-to-face. The results also show that the posters on the forum had very high, and often unrealistic, expectations on how the surgery would change their lives. It is important for those who encounter this group before surgery to be aware of this tendency and to take measures to ensure that patients undergo the surgery with realistic expectations.
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Affiliation(s)
- Mikaela Willmer
- Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
- * E-mail:
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420
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Efficiency and risks of laparoscopic conversion of omega anastomosis gastric bypass to Roux-en-Y gastric bypass. Surg Endosc 2018; 33:2572-2582. [DOI: 10.1007/s00464-018-6552-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 10/17/2018] [Indexed: 12/13/2022]
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421
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Botha J, Nielsen MH, Christensen MH, Vestergaard H, Handberg A. Bariatric surgery reduces CD36-bearing microvesicles of endothelial and monocyte origin. Nutr Metab (Lond) 2018; 15:76. [PMID: 30386406 PMCID: PMC6199798 DOI: 10.1186/s12986-018-0309-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background Bariatric surgery is a widely adopted treatment for obesity and its secondary complications. In the past decade, microvesicles (MVs) and CD36 have increasingly been considered as possible biomarkers for obesity, the metabolic syndrome (MetSy), type 2 diabetes mellitus (T2DM). Thus, the purpose of this study was to investigate how weight loss resulting from bariatric surgery affects levels of specific MV phenotypes and their expression of CD36 scavenger receptor. Additionally, we hypothesised that subjects with MetSy had higher baseline concentrations of investigated MV phenotypes. Methods Twenty individuals undergoing Roux-en-Y gastric bypass surgery were evaluated before and 3 months after surgery. MVs were characterised by flow cytometry at both time points and defined as lactadherin-binding particles within a 100-1000 nm size gate. MVs of monocyte (CD14) and endothelial (CD62E) origin were defined by cell-specific markers, and their expression of CD36 was investigated. Results Following bariatric surgery, subjects incurred an average BMI reduction (delta) of − 8.4 ± 1.4 (p < 0.0001). Significant reductions were observed for the total MVs (− 66.55%, p = 0.0017) and MVs of monocyte (− 36.11%, p = 0.0056) and endothelial (− 40.10%, p = 0.0007) origins. Although the bulk of CD36-bearing MVs were unaltered, significant reductions were observed for CD36-bearing MVs of monocyte (− 60.04%, p = 0.0192) and endothelial (− 54.93%, p = 0.04) origin. No differences in levels of MVs were identified between subjects who presented with MetSy at baseline (n = 13) and those that did not (n = 7). Conclusion Bariatric surgery resulted in significantly altered levels of CD36-bearing MVs of monocyte and endothelial origin. This likely reflects improvements in ectopic fat distribution, plasma lipid profile, low-grade inflammation, and oxidative stress following weight loss. Conversely, however, the presence of MetSy at baseline had no impact on MV phenotypes. Electronic supplementary material The online version of this article (10.1186/s12986-018-0309-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaco Botha
- 1Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark.,2Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark
| | - Morten Hjuler Nielsen
- 1Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - Maja Høegh Christensen
- 1Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - Henrik Vestergaard
- 3Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, SUND, University of Copenhagen, Panum, Mærsk tårnet, Bygning 7, 8. Etage, DK-2200 Copenhagen N, Denmark
| | - Aase Handberg
- 1Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark.,2Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark
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422
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Rayman S, Goldenshluger M, Goitein O, Dux J, Sakran N, Raziel A, Goitein D. Conversion for failed adjustable gastric banding warrants hiatal scrutiny for hiatal hernia. Surg Endosc 2018; 33:2231-2234. [PMID: 30341651 DOI: 10.1007/s00464-018-6509-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/11/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Failure or complications following laparoscopic adjustable gastric banding (LAGB) may necessitate band removal and conversional surgery. Band position and band-induced chronic vomiting create ideal conditions for de novo hiatal hernia (HH) formation. HH presence impedes and complicates conversional surgery by obscuring crucial anatomical landmarks and hindering precise gastric sleeve or pouch formation. The aim of this study was to evaluate the incidence of a HH in patients with an LAGB undergoing conversion compared to patients undergoing primary bariatric surgery (BS). METHODS Retrospective review of consecutive BS performed between 2010 and 2015. Data collected included demographics, anthropometrics, comorbidities, previous BS, preoperative and intra-operative HH detection, operation time, perioperative complications and length of hospital stay. RESULTS During the study period, 2843 patients (36% males) underwent BS. Of these, 2615 patients (92%) were "primary" (no previous BS-control group), 197 (7%) had a previous LAGB (study group), and 31 (1%) had a different previous BS and were excluded. Reasons for conversion included weight regain, band intolerance and band-related complications. Mean age and body mass index were similar between the study and the control groups. HH was preoperatively diagnosed by upper gastrointestinal (UGI) fluoroscopy in 9.1% and 9.0% of the LAGB and control groups (p = NS), respectively. However, HH was detected intra-operatively in 20.3% and 7.3%, respectively (p < 0.0001). CONCLUSIONS Preoperative diagnosis of a HH by UGI fluoroscopy for patients who have undergone LAGB is unreliable. Intra-operative hiatal exploration is highly recommended in all cases of conversional BS after LAGB.
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Affiliation(s)
- Shlomi Rayman
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Goldenshluger
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Goitein
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Dux
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery A, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - David Goitein
- Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Israel.
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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423
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Ohta M, Seki Y, Wong SKH, Wang C, Huang CK, Aly A, Baijal M, Al-Sabah S, Udomsawaengsup S, Heo YS, Althuwaini SS, Celik A, El-Hadidi N, Sargsyan D, Gee T, Rao J, Wiradisuria ER, Oliveros E, Kitano S, Kasama K. Bariatric/Metabolic Surgery in the Asia-Pacific Region: APMBSS 2018 Survey. Obes Surg 2018; 29:534-541. [PMID: 30306499 DOI: 10.1007/s11695-018-3539-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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424
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Second-stage duodenal switch for sleeve gastrectomy failure: A matched controlled trial. Surg Obes Relat Dis 2018; 14:1570-1579. [DOI: 10.1016/j.soard.2018.05.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/24/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
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425
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Park YS, Ahn SH, Park DJ, Kim HH. Effectiveness of Sleeve Gastrectomy for Metabolic Surgery in Korea. J Obes Metab Syndr 2018; 27:131-133. [PMID: 31089554 PMCID: PMC6504201 DOI: 10.7570/jomes.2018.27.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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426
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Cheng Y, Huang X, Wu D, Liu Q, Zhong M, Liu T, Zhang X, Zhang G, Hu S, Liu S. Sleeve Gastrectomy with Bypass of Proximal Small Intestine Provides Better Diabetes Control than Sleeve Gastrectomy Alone Under Postoperative High-Fat Diet. Obes Surg 2018; 29:84-92. [DOI: 10.1007/s11695-018-3520-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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427
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Randomized controlled trial of monopolar cautery versus clips for staple line bleeding control in Roux-en-Y gastric bypass. Int J Surg 2018; 58:52-56. [PMID: 30240771 DOI: 10.1016/j.ijsu.2018.09.007] [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] [Received: 05/16/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line. OBJECTIVES The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass. SETTING University hospital. METHODS A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined. RESULTS A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay. CONCLUSIONS In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.
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428
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The effects of provider-prescribed obesogenic drugs on post-laparoscopic sleeve gastrectomy outcomes: a retrospective cohort study. Int J Obes (Lond) 2018; 43:1154-1163. [PMID: 30242239 PMCID: PMC6428627 DOI: 10.1038/s41366-018-0207-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/31/2018] [Accepted: 08/04/2018] [Indexed: 12/19/2022]
Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) is one of the most commonly performed bariatric procedures and has proven effective in providing weight loss. However, considerable variance has been noted in the degree of weight loss. Physician prescription practices may be negatively affecting weight loss post-LSG and, thus, contributing to the broad range of weight loss outcomes. The aim of our study was to determine whether commonly prescribed obesogenic medications negatively affect weight loss outcomes post-LSG. Subjects/Methods: This single center retrospective cohort study performed at a University hospital included 323 patients (≥18 years) within University California, San Diego Healthcare System who underwent LSG between 2007 and 2016. We identified a list of 32 commonly prescribed medications that have weight gain as a side effect. We compared the percent excess weight loss (%EWL) of patients divided into two groups based on post-LSG exposure to obesogenic medications. A linear regression model was used to analyze %EWL at 12 months post-LSG while controlling for age, initial body mass index (BMI), and use of leptogenic medications. Results: 150 patients (Meds group) were prescribed obesogenic medications within the one-year post-LSG follow up period, whereas 173 patients (Control group) were not prescribed obesogenic medications. The Meds group lost significantly less weight compared to the Control group (%EWL ± SEM at 12 months 53.8 ± 2.4 n=78, 65.0 ± 2.6, n=84 respectively, P = 0.002). This difference could not be attributed to differences in age, gender, initial BMI, co-morbidities, or prescription of leptogenic medications between the two groups. Conclusions: The use of provider-prescribed obesogenic medications was associated with worse weight loss outcomes post-LSG. Closer scrutiny of patient medications may be necessary to help improve outcomes of weight loss treatments.
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429
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Wei JH, Chou RH, Huang PH, Lee WJ, Chen SC, Lin SJ. Metabolic surgery ameliorates cardiovascular risk in obese diabetic patients: Influence of different surgical procedures. Surg Obes Relat Dis 2018; 14:1832-1840. [PMID: 30473417 DOI: 10.1016/j.soard.2018.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/29/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, bariatric surgery was found to have therapeutic potential for the treatment of type 2 diabetes (T2D) in severely obese patients (body mass index [BMI] ≥35 kg/m2) and to reduce cardiovascular disease (CVD) risk and mortality. However, the benefit of CVD risk reduction after metabolic surgery in nonseverely obese T2D patients (BMI <35 kg/m2) remained to be proven. OBJECTIVE To evaluate the CVD risk after metabolic surgery in T2D patients using The UK Prospective Diabetes Study score. SETTING Tertiary referral general hospital, Taiwan, Republic of China. METHODS Outcomes of 392 patients (235 women and 147 men) who had undergone sleeve gastrectomy (87) or gastric bypass (305) for treatment of T2D with 1-year follow-up were assessed. Data were prospectively collected for study, and cerebral and coronary heart disease risk was calculated by using The UK Prospective Diabetes Study risk engine. Outcomes of patients who had undergone different surgical procedures were assessed. RESULTS One year after surgery, weight and glycemic control with complete and partial remission of T2D were significant in most of the patients. The 10-year coronary heart disease risk and fatal coronary heart disease risk were also reduced from 8.8% to 4.6% and from 4.6% to 2.1%, respectively (both P < .001). Similar CVD risk reduction was seen in both patients with BMI ≥35 and BMI <35. Multivariable analysis confirmed that surgical procedure of sleeve gastrectomy was a negative independent predictor of CVD risk reduction after metabolic surgery. CONCLUSION The present study confirms the efficacy of metabolic surgery for the T2D treatment and reduction of CVD risk up to 50% 1 year after surgery. Gastric bypass surgery has more power on CVD risk reduction than sleeve gastrectomy.
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Affiliation(s)
- Jih-Hua Wei
- Cardiovascular Division, Internal Medicine Department, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China; Department of Nutrition and Health Sciences, School of Healthcare Management, Kai-Nan University, Taoyuan, Taiwan, Republic of China; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Ruey-Hsing Chou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Division of Cardiology, Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Po-Hsun Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Division of Cardiology, Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China.
| | - Shu-Chun Chen
- Department of Nutrition and Health Sciences, School of Healthcare Management, Kai-Nan University, Taoyuan, Taiwan, Republic of China
| | - Shing-Jong Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Division of Cardiology, Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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430
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Huang X, Liu T, Zhong M, Cheng Y, Hu S, Liu S. Predictors of glycemic control after sleeve gastrectomy versus Roux-en-Y gastric bypass: A meta-analysis, meta-regression, and systematic review. Surg Obes Relat Dis 2018; 14:1822-1831. [PMID: 30385071 DOI: 10.1016/j.soard.2018.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022]
Abstract
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most commonly performed bariatric procedures globally. However, it remains controversial which procedure provides better glycemic control. To identify predictors of glycemic control after SG versus RYGB, a systematic search of PubMed, EMBASE, and the Cochrane Library was conducted up to January 2017 for comparative studies with both SG and RYGB arms for the treatment of type 2 diabetes (T2D). A meta-analysis and systematic review was performed to evaluate glycemic control after SG versus RYGB with both short- and long-term follow-up. A meta-regression was performed to evaluate impacts of clinical indicators on glycemic control after SG versus RYGB. A total of 17 comparative studies involving 1160 patients were included. SG and RYGB achieved similar diabetic remission rates with both short- and long-term follow-up. However, SG provided lower endpoint glycosylated hemoglobin (A1C) after 1-year follow-up (mean deviation = .17, 95% confidence interval .03-.31, P = .02). When adjusted by baseline A1C, SG and RYGB provided similar percent delta A1C with 1-, 2-, 3-, and 5-year follow-up. The baseline body mass index, duration of T2D, preoperative fasting plasma glucose, and preoperative A1C had predictive value for glycemic control after SG, but only duration of T2D and preoperative A1C were correlated with that after RYGB. These findings showed that the choice of procedure between SG and RYGB predicts no better glycemic control. However, more factors should be considered when SG is recommended to a given patient with diabetes.
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Affiliation(s)
- Xin Huang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Teng Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Mingwei Zhong
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Yugang Cheng
- Cheeloo College of Medicine of Shandong University, Jinan, People's Republic of China
| | - Sanyuan Hu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Shaozhuang Liu
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
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431
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Walędziak M, Różańska-Walędziak A, Janik MR, Paśnik KW, Kowalewski PK. Macroscopic Evaluation of Gastric Specimens After Laparoscopic Sleeve Gastrectomy-an Optimum Screening Test for Incidental Pathologies? Obes Surg 2018; 29:28-31. [PMID: 30187420 PMCID: PMC6320350 DOI: 10.1007/s11695-018-3485-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers’ concern, the point of histological exam of each resected tissue may be questioned. Material/Methods We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination. Results In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4–99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6–99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95–99.9%, p < 0.0001). Conclusions During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.
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Affiliation(s)
- Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland.
| | | | - Michał R Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| | - Krzysztof W Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| | - Piotr K Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
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432
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Physical and Mental Impact of Laparoscopic Sleeve Gastrectomy on the Surgeon: French vs. American Positions. A Randomized and Controlled Study. Obes Surg 2018; 29:137-142. [PMID: 30187419 DOI: 10.1007/s11695-018-3496-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the physical and mental impact on the primary surgeon, by the patient's and surgical staff's dispositions at the operating table, during laparoscopic vertical sleeve gastrectomy. MATERIALS AND METHODS This is a randomized and controlled study that included 18 laparoscopic sleeve gastrectomy procedures performed by two surgeons in a private and academic hospital. The cases were randomized for the American or French position. After surgery, the National Aeronautics and Space Administration - Task Load Index (NASA-TLX) and the Body Part Discomfort (BPD) scales were applied to the primary surgeon. RESULTS An increased workload and more discomfort were reported when using the French position. The NASA-TLX was 28 ± 8 vs. 57 ± 18 (p = 0.001), and the BPD was 2 vs. 8 (p = 0.001). CONCLUSIONS The American position resulted in a lower physical and mental impact on the surgeon when performing a laparoscopic sleeve gastrectomy.
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433
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Marjanovic G, Seifert G, Läßle C, Nenova G, Höppner J, Fichtner-Feigl S, Fink JM. [The German snowball effect : An increasing aftercare problem in bariatric treatment]. Chirurg 2018; 90:293-298. [PMID: 30182266 DOI: 10.1007/s00104-018-0722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The surgical treatment of obesity in Germany is a rapidly developing field which is strictly controlled by national guidelines. OBJECTIVE Depiction of the burden on obesity centers by the exponential increase in numbers of patients following bariatric treatment. METHODS In a retrospective study the numbers of outpatients at this university obesity center (founded 2007) were descriptively analyzed. Outpatient visits were documented annually and divided into two groups: primary visit and follow-up visit. The frequency of bariatric operations as well as their acceptance/cost coverage by health insurances were evaluated. RESULTS Overall 318 patients were seen in 2007: 156 primary and 162 follow-up visits. The health insurance rejection rate for cost coverage was 16.8%. There were 1691 outpatient visits in 2016 (2016 vs. 2007: +532%), of which 487 (+312%) were primary and 1204 (+743%) follow-up visits. The health insurance rejection rate dropped to 1.8%, while the frequency of operations increased nearly tenfold. CONCLUSION With the increasing acceptance of bariatric surgery, a relatively low number of specialized centers have to deal with an exponentially rising follow-up frequency. In consideration of the extent of the obesity epidemic an adequate follow-up constitutes a socioeconomic problem, which can only be solved in an interdisciplinary setting under structural integration.
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Affiliation(s)
- G Marjanovic
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland.
| | - G Seifert
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - C Läßle
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - G Nenova
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - J Höppner
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - S Fichtner-Feigl
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - J M Fink
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Hugstetterstraße 55, 79106, Freiburg, Deutschland
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434
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Felsenreich DM, Langer FB, Prager G. Weight Loss and Resolution of Comorbidities After Sleeve Gastrectomy: A Review of Long-Term Results. Scand J Surg 2018; 108:3-9. [PMID: 30187823 DOI: 10.1177/1457496918798192] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS: Laparoscopic sleeve gastrectomy (SG) has massively increased in numbers over the last decade and is the most frequently performed bariatric procedure worldwide today. The aim of this review is to evaluate SG in terms of weight loss and resolution of comorbidities, based on data gained from the latest long-term studies available. MATERIAL AND METHODS: This review includes the results of any long-term studies on SG available at this point as well as a selection of short- and mid-term studies. RESULTS: There are only a handful of studies on sleeve gastrectomy with long-term follow-up available at this point. Conversion rates in these long-term studies amount to up to one-third of their cohorts; however, excess weight loss in patients maintaining their sleeve is over 50%. Results on the resolution of comorbidities vary among the studies available today. SUMMARY: Sleeve gastrectomy is a valid bariatric method but one has to be aware of its limitations.
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Affiliation(s)
- D M Felsenreich
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - F B Langer
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - G Prager
- Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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O’Brien R, Johnson E, Haneuse S, Coleman KJ, O’Connor PJ, Fisher DP, Sidney S, Bogart A, Theis MK, Anau J, Schroeder EB, Arterburn D. Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study. Ann Intern Med 2018; 169:300-310. [PMID: 30083761 PMCID: PMC6759803 DOI: 10.7326/m17-2383] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Bariatric surgery improves glycemic control in patients with type 2 diabetes mellitus (T2DM), but less is known about microvascular outcomes. Objective To investigate the relationship between bariatric surgery and incident microvascular complications of T2DM. Design Retrospective matched cohort study from 2005 to 2011 with follow-up through September 2015. Setting 4 integrated health systems in the United States. Participants Patients aged 19 to 79 years with T2DM who had bariatric surgery (n = 4024) were matched on age, sex, body mass index, hemoglobin A1c level, insulin use, diabetes duration, and intensity of health care use up to 3 nonsurgical participants (n = 11 059). Intervention Bariatric procedures (76% gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) compared with usual care. Measurements Adjusted Cox regression analysis investigated time to incident microvascular disease, defined as first occurrence of diabetic retinopathy, neuropathy, or nephropathy. Results Median follow-up was 4.3 years for both surgical and nonsurgical patients. Bariatric surgery was associated with significantly lower risk for incident microvascular disease at 5 years (16.9% for surgical vs. 34.7% for nonsurgical patients; adjusted hazard ratio [HR], 0.41 [95% CI, 0.34 to 0.48]). Bariatric surgery was associated with lower cumulative incidence at 5 years of diabetic neuropathy (7.2% for surgical vs. 21.4% for nonsurgical patients; HR, 0.37 [CI, 0.30 to 0.47]), nephropathy (4.9% for surgical vs. 10.0% for nonsurgical patients; HR, 0.41 [CI, 0.29 to 0.58]), and retinopathy (7.2% for surgical vs. 11.2% for nonsurgical patients; HR, 0.55 [CI, 0.42 to 0.73]). Limitation Electronic health record databases could misclassify microvascular disease status for some patients. Conclusion In this large, multicenter study of adults with T2DM, bariatric surgery was associated with lower overall incidence of microvascular disease (including lower risk for neuropathy, nephropathy, and retinopathy) than usual care. Primary Funding Source National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
- Rebecca O’Brien
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Karen J. Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - David P. Fisher
- The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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437
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Fahmy MH, Sarhan MD, Salman MA, Fathy E. Gastro-Esophageal Reflux Disease After Laparoscopic Mini-Gastric Bypass and Roux-en-Y Gastric Bypass: Is There a Difference? Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed Hassan Fahmy
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Diaa Sarhan
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Ehab Fathy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Montastier E, Chalret du Rieu M, Tuyeras G, Ritz P. Long-term nutritional follow-up post bariatric surgery. Curr Opin Clin Nutr Metab Care 2018; 21:388-393. [PMID: 29979242 DOI: 10.1097/mco.0000000000000490] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Bariatric surgery is an effective treatment for classes II and III obesity and its associated diseases. However, many important long-term outcomes of bariatric surgery are still poorly understood, such as neurological and psychological complications, bone health, and so on. This review summarizes the current evidence and expert opinions on nutritional care in the long-term postoperative period. RECENT FINDINGS In the first section, we will provide an update of the main long-term complications: risk of anaemia, risk of bone fracture, neurological and psychological complications, and risk of developing Barrett's oesophagus after sleeve gastrectomy. We will also examine the current strategies used to increase weight loss or reduce weight regain. As adherence to long-term follow-up has been shown to decrease over time, the second section aims to identify all measures that improve follow-up rates, to get the maximum benefit from bariatric surgery, while minimizing long-term adverse effects and complications. SUMMARY There is still a significant level of uncertainty regarding the best clinical practices for maintaining the health benefits provided by bariatric surgery. The role of family physician in postsurgery care needs to be clearly defined. More effort is needed to improve psychological care, behaviour management, and therapeutic patient education after bariatric surgery. A more patient-centred approach should probably be considered.
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Affiliation(s)
- Emilie Montastier
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital
- University of Toulouse, UMR1048, Paul Sabatier University
- French National Institute of Health and Medical Research (INSERM), UMR1048, Obesity Research Laboratory, Institute of Metabolic and Cardiovascular Diseases (I2MC)
| | - Mael Chalret du Rieu
- Department of General and Gastrointestinal Surgery, Toulouse University Hospital
| | - Géraud Tuyeras
- Department of General and Gastrointestinal Surgery, Toulouse University Hospital
| | - Patrick Ritz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital
- University of Toulouse, UMR1027, Paul Sabatier University, Toulouse, France
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Huang X, Liu S, Wu D, Cheng Y, Han H, Wang K, Zhang G, Hu S. Facilitated Ca 2+ homeostasis and attenuated myocardial autophagy contribute to alleviation of diabetic cardiomyopathy after bariatric surgery. Am J Physiol Heart Circ Physiol 2018; 315:H1258-H1268. [PMID: 30141985 DOI: 10.1152/ajpheart.00274.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bariatric surgery has been reported to relieve diabetic cardiomyopathy (DCM) effectively. However, the mechanisms remain largely unknown. To determine the effects of bariatric surgery on DCM via modulation of myocardial Ca2+ homeostasis and autophagy, sleeve gastrectomy (SG), duodenal-jejunal bypass (DJB), and sham surgeries were performed in diabetic rats induced by high-fat diet and a low dose of streptozotocin. Cardiac remodeling was assessed by a series of morphometric and histological analyses. Transthoracic echocardiography and hemodynamic measurements were performed to determine cardiac function. Ca2+ homeostasis was evaluated by measuring Ca2+ transients with fura-2 AM in isolated ventricular myocytes along with detection of the abundance of Ca2+ regulatory proteins in the myocardium. Myocardial autophagic flux was determined by expression of autophagy-related proteins in the absence and presence of chloroquine. Both SG and DJB surgery alleviated DCM morphologically and functionally. Ca2+ transients exhibited a significantly higher amplitude and faster decay after SG and DJB, which could be partially explained by increased expression of ryanodine receptor 2, sarco(endo)plasmic reticulum Ca2+-2ATPase, 12.6-kDa FK506-binding protein, and hyperphosphorylation of phospholamban. In addition, a lower level of light chain 3B and higher level of p62 were detected after both SG and DJB, which was not reversed by chloroquine treatment and associated with activated mammalian target of rapamycin and attenuated AMP-activated protein kinase signaling pathway. Collectively, these results provided evidence that bariatric surgery could alleviate DCM effectively, which may result, at least in part, from facilitated Ca2+ homeostasis and attenuated autophagy, suggesting a potential choice for treatment of DCM when properly implemented. NEW & NOTEWORTHY The present study is the first to investigate the modulation of myocardial Ca2+ homeostasis and autophagy after bariatric surgery and to examine its effects on diabetic cardiomyopathy. Bariatric surgery could facilitate myocardial Ca2+ homeostasis and attenuate myocardial autophagy, contributing to the alleviation of cardiomyopathy morphologically and functionally in a diabetic rat model.
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Affiliation(s)
- Xin Huang
- Department of General Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Shaozhuang Liu
- Department of General Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China.,State Key Laboratory of Diabetes and Obesity Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Dong Wu
- State Key Laboratory of Diabetes and Obesity Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Yugang Cheng
- State Key Laboratory of Diabetes and Obesity Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Haifeng Han
- Department of General Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Kexin Wang
- Department of General Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Guangyong Zhang
- Department of General Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
| | - Sanyuan Hu
- Department of General Surgery, Qilu Hospital of Shandong University , Jinan , People's Republic of China
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440
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Pujol Rafols J, Al Abbas AI, Devriendt S, Guerra A, Herrera MF, Himpens J, Pardina E, Peinado-Onsurbe J, Ramos A, Ribeiro RJDS, Safadi B, Sanchez-Aguilar H, de Vries C, Van Wagensveld B. Roux-en-Y gastric bypass, sleeve gastrectomy, or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study. Surg Obes Relat Dis 2018; 14:1659-1666. [PMID: 30236443 DOI: 10.1016/j.soard.2018.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND To date, laparoscopic adjustable gastric banding remains the third most commonly performed surgical procedure for weight loss. Some patients fail to get acceptable outcomes and undergo revisional surgery at rates ranging from 7% to 60%. Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and sleeve gastrectomy (SG) are among the most common salvage options for failed laparoscopic adjustable gastric banding. OBJECTIVE To compare the outcomes of converting failed laparoscopic adjustable gastric banding to RYGB, OAGB, or SG. METHODS Data collected from 7 experienced bariatric centers around the world were retrospectively collected, reviewed, and analyzed. Final body mass index (BMI), change in BMI, percentage excess BMI loss, and major complications with particular attention to leaks, hemorrhage, and mortality were reported. RESULTS Of 1219 patients analyzed, 74% underwent RYGB, 16% underwent OAGB, and 10% underwent SG after banding failure. The mean age was 38 years (±10 yr), and 82% of patients were women. The mean follow-up was 33 months. The follow-up rate was 100%, 87%, and 52% at 1, 3, and 5 years, respectively. At the latest follow-up, percentage excess BMI loss >50% was achieved by 75% of RYGB, 85% of OAGB, and 67% of SG patients. Postoperative complications occurred in 13% of patients after RYGB, 5% after OAGB, and 15% after SG. CONCLUSION Our data show that it is possible to achieve or maintain significant weight loss with an acceptable complication rate with all 3 surgical options.
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Affiliation(s)
| | - Amr I Al Abbas
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Stefanie Devriendt
- AZ Sint Blasius, Dendermonde, Belgium and CHIREC Hospitals, Brussels, Belgium
| | | | - Miguel F Herrera
- Instituto Nacional de Nutrición. Centro Médico ABC, México City, México
| | - Jacques Himpens
- AZ Sint Blasius, Dendermonde, Belgium and CHIREC Hospitals, Brussels, Belgium
| | - Eva Pardina
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Julia Peinado-Onsurbe
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Almino Ramos
- GastroObeso-Center - Advanced Institute In Bariatric And Metabolic Surgery, Sao Paulo, Brazil
| | | | - Bassem Safadi
- American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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441
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Changes in the lipid profile 5 years after bariatric surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:1099-1105. [DOI: 10.1016/j.soard.2018.05.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/23/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023]
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442
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Engebretsen KV, Blom-Høgestøl IK, Hewitt S, Risstad H, Moum B, Kristinsson JA, Mala T. Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study. Scand J Gastroenterol 2018; 53:917-922. [PMID: 30231804 DOI: 10.1080/00365521.2018.1489892] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate. MATERIAL AND METHODS Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years. RESULTS During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate. CONCLUSIONS We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.
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Affiliation(s)
- K V Engebretsen
- a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.,b Department of Gastrointestinal Surgery , Vestre Viken Hospital Drammen , Drammen , Norway
| | - I K Blom-Høgestøl
- a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - S Hewitt
- a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - H Risstad
- a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - B Moum
- c Department of Gastroenterology , Oslo University Hospital and University of Oslo , Oslo , Norway
| | - J A Kristinsson
- a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - T Mala
- a Center for Morbid Obesity and Bariatric Surgery, Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.,d Department of Gastrointestinal Surgery , Oslo University Hospital , Oslo , Norway
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443
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Billeter AT, de la Garza Herrera JR, Scheurlen KM, Nickel F, Billmann F, Müller-Stich BP. MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol 2018; 179:R77-R93. [PMID: 29764908 DOI: 10.1530/eje-18-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.
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Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Katharina M Scheurlen
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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444
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Ahuja A, Tantia O, Goyal G, Chaudhuri T, Khanna S, Poddar A, Gupta S, Majumdar K. MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution. Obes Surg 2018; 28:3439-3445. [DOI: 10.1007/s11695-018-3405-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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445
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Borbély Y, Schaffner E, Zimmermann L, Huguenin M, Plitzko G, Nett P, Kröll D. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux. Surg Endosc 2018; 33:789-793. [PMID: 30003346 DOI: 10.1007/s00464-018-6344-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/06/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) has become the most frequently performed bariatric procedure to date. However, LSG is known to worsen pre-operative and result in de novo gastroesophageal reflux disease (GERD). Pre-operative evaluation reveals a high percentage of silent GERD of so far unknown influence on post-operative GERD. METHODS Prospective data of patients undergoing primary LSG between 01/2012 and 12/2015 were evaluated. Pre-operative GERD-specific evaluation consisted of validated questionnaires, upper endoscopy, 24 h-pH-manometry, and esophagograms. Patients were followed-up with questionnaires every 6 months, upper endoscopies after 1 year and 24 h-pH-metry after 2 years. Silent GERD was defined as esophagitis grade > B and/or abnormal esophageal acid exposure in absence of symptoms. LSG was performed over a 32F bougie, hiatal hernias > 1 cm were addressed with posterior hiatoplasty. Excluded were patients with hiatal hernias > 4 cm, patients with incorrect anatomy (stenosis, fundus too large) and conversion to RYGB for early leaks. RESULTS 222 patients were included. Mean follow-up was 32 ± 16 months, mean preoperative body mass index 49.6 ± 7.2 kg/m2. 116 patients (52%) presented with post-operative GERD-symptoms, of which 85 (73%) had de novo symptoms. Of those, 48 (of 85, 56%) had no preoperative GERD and 37 (of 85, 44%) silent GERD. 57 patients (26%) had neither pre- nor post-operative GERD, 7 (3%) had silent pre-operative and no postop GERD, and in 19 patients (9%) GERD was cured with LSG. 31 patients (14%) stayed symptomatic. Of 56 patients (25%) with pre-operative silent GERD, 37 (of 54, 66%) became symptomatic. CONCLUSION LSG leads to a considerable rate of post-operative GERD. De novo-GERD consist of around half of pre-operative silent GERD and completely de novo-GERD. Most patients with pre-operative silent GERD became symptomatic.
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Affiliation(s)
- Yves Borbély
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Esther Schaffner
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Lara Zimmermann
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Michael Huguenin
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Gabriel Plitzko
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Philipp Nett
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Dino Kröll
- Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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446
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Parmar CD, Mahawar KK. One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12,807 Patients. Obes Surg 2018; 28:2956-2967. [DOI: 10.1007/s11695-018-3382-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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447
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Himel AR, Cabral SA, Shaffery JP, Grayson BE. Anxiety behavior and hypothalamic-pituitary-adrenal axis altered in a female rat model of vertical sleeve gastrectomy. PLoS One 2018; 13:e0200026. [PMID: 29979735 PMCID: PMC6034810 DOI: 10.1371/journal.pone.0200026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/18/2018] [Indexed: 01/28/2023] Open
Abstract
Surgical weight loss results in a host of metabolic changes that culminate in net positive health benefit to the patients. However, the psychological impact of these surgeries has not been fully studied. On one hand, surgical weight loss has been reported to improve standard quality of life and resolution of symptoms of depression. But on the other hand, reports of self-harm and increased ER visits for self-harm suggest other psychological difficulties. Inability to handle anxiety following surgical weight loss has alarming potential ramifications for these gastric surgery patients. In the present study, we used models of diet-induced obesity and vertical sleeve gastrectomy (VSG) to ask whether anxiety behavior and hypothalamic-pituitary-adrenal (HPA) axis gene changes were affected by surgical weight loss under two diet regimens: i.e. low-fat diet (LFD) and high-fat diet (HFD). We show reduced exploratory behavior in the open field test but increased time in the open arms of the elevated plus maze. Furthermore, we show increased plasma levels of corticosterone in female VSG recipients in the estrus phase and increased levels of hypothalamic arginine-vasopressin (avp), pro-opiomelanocortin (pomc), and tyrosine hydroxylase (th). We report reduced dopamine receptor D1 (drd1) gene in prefrontal cortex (PFC) in VSG animals in comparison to Sham. Further we report diet-driven changes in stress-relevant gene targets in the hypothalamus (oxt, pomc, crhr1) and adrenal (nr3c1, nr3c2, mc2r). Taken together, these data suggest a significant impact of both surgical weight loss and diet on the HPA axis and further impact on behavior. Additional assessment is necessary to determine whether molecular and hormonal changes of surgical weight loss are the source of these findings.
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Affiliation(s)
- Alexandra R. Himel
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United Status of America
| | - Sharon A. Cabral
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United Status of America
| | - James P. Shaffery
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, United Status of America
| | - Bernadette E. Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United Status of America
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448
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Dietrich A. [Will laparoscopic sleeve gastrectomy continue to exist as a stand-alone procedure? : A procedure critical perspective]. Chirurg 2018; 89:583-588. [PMID: 29974139 DOI: 10.1007/s00104-018-0680-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sleeve gastrectomy is currently the most frequently performed bariatric procedure worldwide; however, with respect to a certain need for revisional surgery (due to reflux disease or weight regain) there is an ongoing discussion about the value of sleeve gastrectomy in terms of a stand-alone procedure. OBJECTIVE The aim of this article is to critically discuss whether sleeve gastrectomy can still be considered a stand-alone procedure. MATERIAL AND METHODS The current literature was searched for results after sleeve gastrectomy and the recommendations regarding this procedure are discussed. RESULTS Currently approximately 50% of primary bariatric procedures are sleeve gastrectomies, which has become a well-established stand-alone procedure. Sleeve gastrectomy leads to good mid-term results; however, the results of the Roux-en-Y gastric bypass are comparatively superior in terms of type 2 diabetes remission, control of preexisting or de novo reflux disease and weight loss. The mortality is comparable; however, the morbidity is lower after sleeve gastrectomy but there is a relevant rate of fistulas of the stapler suture. CONCLUSION Patients considered for sleeve gastrectomy must be informed of the procedure-specific risks, including the unforeseeable need for revision or redo surgery firstly due to weight regain or failing to reach the individual therapy target and secondly for worsening of a preexisting or de novo reflux disease.
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Affiliation(s)
- A Dietrich
- Klinik u. Poliklinik für Visceral‑, Transplantations‑, Thorax- u. Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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Cabrera A, Vives M, Molina A, París M, Raga E, Sánchez A, Sabench F, Del Castillo D. Gastric Plication and Sleeve Gastrectomy in an Experimental Model of Obesity: New Insights into Weight Loss, Intake and Metabolic Results. Obes Surg 2018; 28:3259-3267. [PMID: 29961179 DOI: 10.1007/s11695-018-3340-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Laparoscopic gastric plication (LGP) is a bariatric surgical technique based on the anatomical principles of laparoscopic sleeve gastrectomy (LSG), but its effects on the metabolic profile are still uncertain. The aim of our study is to compare the changes in weight, metabolic parameters and gastric histology following intervention by gastric plication (GP) and sleeve gastrectomy (SG) in an experimental model of obesity. METHODS To conduct the study, 32 8-week-old male Sprague-Dawley rats (Charles River®) were fattened by means of a cafeteria diet and randomly assigned to the following experimental groups: group 1: GP (n = 12); group 2: SG (n = 12) and group 3: sham (n = 8). RESULTS Unlike the SG group, the GP group attained the weight of the sham group at the end of the experiment (week 16). The GP group continued to eat more cafeteria diet than the SG group. In addition, the SG group achieved better glycaemic control than the GP group. Significantly higher plasma ghrelin levels were observed at week 16 in the GP group than in the SG group (2.29 ± 0.5 vs 1.07 ± 0.4, p < 0.05), which also occurred for the glucagon plasmatic levels (62.71 ± 36.2 vs 24.63 ± 9.3, p < 0.05). CONCLUSIONS GP is not as effective as SG and cannot be considered a metabolic surgery due to observed hormonal variations. The animals subjected to a GP continued to have a high appetite for the cafeteria diet unlike the animals submitted to an SG. Hormonal mechanisms possibly related to glucagon and ghrelin may be involved in this metabolic response.
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Affiliation(s)
- A Cabrera
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - M Vives
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - A Molina
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - M París
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - E Raga
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - A Sánchez
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain
| | - F Sabench
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain.
| | - D Del Castillo
- Surgery Service, University Hospital of Sant Joan, Faculty of Medicine, IISPV, "Rovira i Virgili" University, Reus, Tarragona, Spain.
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450
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Ortega CB, Guerron AD, Portenier D. Endoscopic Abscess Septotomy: A Less Invasive Approach for the Treatment of Sleeve Gastrectomy Leaks. J Laparoendosc Adv Surg Tech A 2018; 28:859-863. [DOI: 10.1089/lap.2017.0429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Camila B. Ortega
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Alfredo D. Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Dana Portenier
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
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