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Berro C, Pendolino AL, Foletto M, Facciolo MC, Maculan P, Prevedello L, Giuntoli DG, Scarpa B, Pavan C, Andrews PJ, Ottaviano G. Olfactory and Gustatory Function before and after Laparoscopic Sleeve Gastrectomy. ACTA ACUST UNITED AC 2021; 57:medicina57090913. [PMID: 34577836 PMCID: PMC8466191 DOI: 10.3390/medicina57090913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/09/2023]
Abstract
Background and Objectives: Bariatric surgery is the gold standard for the treatment of morbid obesity, and current evidence suggests that patients undergoing surgery can show changes in their sense of taste and smell. However, no definitive conclusions can be drawn given the heterogeneity of the studies and the contrasting results reported in the literature. Materials and Methods: We enrolled 18 obese patients undergoing laparoscopic sleeve gastrectomy (LSG) and 15 obese controls. At baseline (T0) and 6 months after enrollment/surgery (T1), both groups underwent Sniffin’ Sticks and whole mouth test. Post-operative qualitative taste variations were also analyzed and SNOT-22, VAS for taste and smell, and MMSE were administered. Results: An improvement in the olfactory threshold was observed in the treatment group (p = 0.03) at 6 months. At multivariate analysis, the olfactory threshold differences observed correlated with MMSE (p = 0.03) and T0 gustatory identification (p = 0.01). No changes in sense of taste were observed between the two groups at 6 months, even though nine subjects in the treatment group reported a worsening of taste. This negatively correlated with age (p < 0.001), but a positive marginal correlation was observed with the olfactory threshold difference between T0 and T1 (p = 0.06). Conclusions: Olfaction can improve after LSG, and this seems to be the consequence of an improved olfactory threshold. Although we did not observe any change in gustatory identification, food’s pleasantness worsened after bariatric surgery.
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Affiliation(s)
- Cecilia Berro
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35128 Padova, Italy; (C.B.); (M.C.F.); (D.G.G.); (G.O.)
| | - Alfonso Luca Pendolino
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK;
- Ear Institute, University College London, London WC1X 8EE, UK
- Correspondence:
| | - Mirto Foletto
- Centre for Mechanics of Biological Materials, University of Padova, 35128 Padova, Italy;
- IFSO Bariatric Centre of Excellence, Padova University Hospital, 35128 Padova, Italy;
| | - Maria Cristina Facciolo
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35128 Padova, Italy; (C.B.); (M.C.F.); (D.G.G.); (G.O.)
| | - Pietro Maculan
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Luca Prevedello
- IFSO Bariatric Centre of Excellence, Padova University Hospital, 35128 Padova, Italy;
| | - Diletta Giulia Giuntoli
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35128 Padova, Italy; (C.B.); (M.C.F.); (D.G.G.); (G.O.)
| | - Bruno Scarpa
- Department of Statistical Sciences and Department of Mathematics Tullio Levi-Civita, University of Padova, 35128 Padova, Italy;
| | - Chiara Pavan
- Department of Psychiatry, University of Padua, 35128 Padua, Italy;
| | - Peter J. Andrews
- Department of ENT, Royal National ENT & Eastman Dental Hospitals, London WC1E 6DG, UK;
- Ear Institute, University College London, London WC1X 8EE, UK
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section, University of Padova, 35128 Padova, Italy; (C.B.); (M.C.F.); (D.G.G.); (G.O.)
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Abstract
Laparoscopic sleeve gastrectomy (SG) is currently the most commonly performed standalone bariatric procedure worldwide. Gastric staple line leakage is the feared immanent complication of the operation, which is difficult to treat and often persists. This article presents the endoscopic treatment options for complications after laparoscopic SG, particularly the treatment of gastric staple line leakage. Most important for a successful treatment is the understanding of the underlying pathophysiological causes, the exact surgical comprehension of the procedure and advanced endoscopic skills. The choice of endoscopic intervention depends on the available strategies as well as on the skills of the executing endoscopist. Currently, internal drainage seems to be the most expedient method.
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Affiliation(s)
- C Stier
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacherstr. 2, 97080, Würzburg, Deutschland.
- Medizinische Klinik und Poliklinik I, Universitätsklinik Würzburg, Würzburg, Deutschland.
| | - C Corteville
- Klinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinik Würzburg, Oberdürrbacherstr. 2, 97080, Würzburg, Deutschland
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Jahn U, Schubert T, Schlepp S, Deuber HJ. [Metabolic surgery or conservative measures as therapy of obese type 2 diabetics?]. Wien Med Wochenschr 2016; 167:234-244. [PMID: 27921198 DOI: 10.1007/s10354-016-0532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/08/2016] [Indexed: 11/30/2022]
Abstract
After bariatric surgery there are some favourable effects on comorbidities of obesity as glucose and lipid metabolism besides weight loss. Therefore surgical measures targeting at improvement of such metabolic disorders especially diabetes type 2 has been called "metabolic surgery". The complexity of its underlying metabolic mechanisms is not yet clear, but restriction of energy and weight loss (maintenance) seem to be the cornerstones.Risks of these procedures which are drawn of the established methods of bariatric surgery are reported to be relatively low in qualified centers. Being an elective operation special focus has to be set on mortality and morbidity, numbers of therapeutic failure and redo-surgery. Multiple irreversible and not seldom severe, potentially life-threatening consequences of bariatric surgery require consequent interdisciplinary postsurgery care and therapy throughout the whole life, especially substitution therapy of deficiencies due to post-operative malassimilation, if necessary. Little is known about long term consequences of modified anatomy and function of digestive system caused by surgery, and there may be a delay of (many) years until manifestation of clinical problems.Obese diabetics (BMI ≥ 35 kg/m2) should primarily be treated conservatively in an "individualized" way. Metabolic surgery should not be considered earlier than failure of the conservative approach has to be stated (in this case as an "ultima ratio" in well defined trials). A broader use of metabolic surgery beyond this narrow frame is not yet supported by long-term evidence-based data showing its value and safety.
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Thalheimer A. [Bariatric surgery - who is suitable?]. MMW Fortschr Med 2016; 158:85-92. [PMID: 27757861 DOI: 10.1007/s15006-016-8850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A Thalheimer
- Adipositaszentrum der RoMed Kliniken, Chirurgie, Harthauser Straße 16, D-83043, Bad Aibling, Deutschland.
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Abstract
BACKGROUND Neither hormone levels nor malabsorption alone fully explains the distinct weight loss after bariatric surgery in morbidly obese patients. Postoperatively, patients regularly report a change in the sense of taste and the development of food aversions. Hedonic and sensory components like olfactory and gustatory stimuli significantly affect appetite and flavour. METHODS We prospectively analysed the orthonasal olfactory and gustatory function with psychophysical testing in 44 patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) or adjustable gastric banding (AGB) and in 23 healthy controls. RESULTS About 22.7 % of morbidly obese patients were hyposmic, showing significantly lower threshold-discrimination-identification (TDI) scores (p = 0.009) with decreased discrimination and identification ability. In addition, 22.7 % of patients were tested to be limited in gustatory function, with significantly lower taste strip test (TST) scores (p = 0.003). Six months after surgery, olfactory and gustatory function was not different when compared to healthy controls. CONCLUSIONS Due to obesity, patients frequently show impaired olfactory and gustatory function. Six months after laparoscopic bariatric surgery, both chemosensory functions improve. The TDI test is an appropriate tool to measure olfactory function in obese patients.
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Abstract
BACKGROUND Dumping syndrome is a common complication after surgery of the upper gastrointestinal tract with symptoms ranging from mild gastrointestinal discomfort and moderate vasomotor disturbances, to severe hyperinsulinemic hypoglycemia. Due to the increasing number of bariatric procedures being performed worldwide, bariatric surgery has become the most common cause for this disease entity. OBJECTIVE The aim of this review is to highlight the evidence for the physiological mechanisms contributing to dumping syndrome after the two most common bariatric surgery procedures, Roux-en-Y gastric bypass and sleeve gastrectomy, to discuss technical aspects of the procedures underlying the development of the syndrome, patient-related predictive factors and other differential diagnoses, together with diagnostic and therapeutic algorithms.
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Ordemann J, Elbelt U, Menenakos C. [Procedure selection and technique of metabolic surgery]. Chirurg 2014; 85:969-74. [PMID: 25348419 DOI: 10.1007/s00104-014-2798-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Metabolic surgery is becoming an impressive therapeutic option for type 2 diabetes mellitus and other metabolic diseases. Compared to conservative therapy bariatric procedures, such as gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion, seem to achieve significantly higher remission rates and improvements in blood glucose metabolism. Recent studies describe additional effect mechanisms which go beyond the assumed mechanisms of restriction and malabsorption. The results in the current literature suggest that gastric bypass and sleeve gastrectomy provide the best metabolic risk-benefit profiles. Gastric banding and biliopancreatic diversion can only be recommended in specific cases.
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Affiliation(s)
- J Ordemann
- Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland,
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Does bariatric surgery change olfactory perception? Results of the early postoperative course. Int J Colorectal Dis 2014; 29:253-60. [PMID: 24276075 DOI: 10.1007/s00384-013-1795-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Changes of food preference toward foods with low caloric density have been demonstrated after bariatric surgery and may contribute to sustained body weight loss. It has been hypothesized that olfactory perception as an integral part of food selection might be altered after bariatric surgery. METHODS Sniffin' Sticks® were used to investigate the olfactory perception of morbidly obese patients undergoing either Roux-en-Y gastric bypass (RYGB, n = 15) or sleeve gastrectomy (SG, n = 15) before 1, 6, 12, and 24 weeks after surgery. Obese patients without surgical intervention served as controls (CG, n = 12). Results are presented using the testing odor threshold, discrimination, and identification score (TDI; higher scores indicate better olfactory perception). Body weight loss was recorded. RESULTS Initial BMI of the SG group (56.04 ± 7.096 kg m(-2)) was higher compared to the BMI of the RYGB (48.71 ± 6.49 kg m(-2)) and CG (50.35 ± 6.78 kg m(-2)); p = 0.011. Body weight loss among the surgical groups was not different (p = 0.011) while controls did not lose weight. Mean baseline TDI scores were significantly lower in the SG group 27.1 ± 3.9 vs. 32.6 ± 3.6 (RYGB) and 32.1 ± 5.3 (CG), respectively, whereas there were after 24 weeks no changes in RYGB and CG patients; the TDI score in the SG group increased significantly to 31.1 ± 3.5 (p < 0.01). CONCLUSIONS Our data suggest that a substantial body weight loss per se does not affect olfactory perception. However, our results point towards improved olfactory perception after sleeve gastrectomy but not Roux-en-Y gastric bypass.
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Muschart X, Blommaert D. Syncope secondary to obesity? J Cardiovasc Electrophysiol 2013; 24:1296-8. [PMID: 23889903 DOI: 10.1111/jce.12220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/27/2022]
Abstract
The frequency of obesity is increasing worldwide. The relationship between obesity and mortality is known. Bariatric surgery is well established in the treatment of morbid obesity to reduce weight permanently. Bariatric procedures are effective and influencing associated comorbidities. Adjustable gastric banding is a popular and effective bariatric operation in Europe for more than 10 years. Classic complications of gastric banding are known, but here we describe one more example. In this study, we report the case of a patient with gastric banding who presented with syncope after a meal.
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Affiliation(s)
- Xavier Muschart
- Department of Cardiology, Mont-Godinne University Hospital, Yvoir, Belgium
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