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Shahabi Shahmiri S, Safari S, Sheikhbahaei E, Fathi M, Moosavi D, Daryabari SN, Pazouki A, Parmar CD, Kermansaravi M. Midterm outcomes of one anastomosis gastric bypass for patients with BMI < 35 kg/m 2 from a large single center. Surg Endosc 2024; 38:3940-3947. [PMID: 38844728 DOI: 10.1007/s00464-024-10928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is gaining more attention in patients with severe obesity and recently is used for patients with body mass index (BMI) < 35 kg/m2. In this 5-year single center experience we aim to report our outcomes of using OAGB for patients with BMI < 35 kg/m2. METHODS This is a retrospective analysis of prospectively collected data recorded in to our national obesity registry database. Variables including age, sex, weight, BMI, any associated disease, blood levels of metabolic markers, nutrients, and vitamins before and after surgery were extracted and analyzed. RESULTS 173 patients with mean age and BMI of 41 ± 10 years and 33 ± 1 kg/m2 underwent OAGB and at least one of the obesity-associated medical problems was found in 88 (50.5%) of them preoperatively. The mean duration of surgery and length of hospital stay were 60.7 ± 7.4 min and 1.3 ± 1.4 days. 78% and 70% of patients had available data at 24 and 60 months, respectively. The mean BMI was 23.9 ± 2.2 kg/m2 1 year after surgery and each year after that till 5 years was 24 ± 2, 24.4 ± 2.6, 25.1 ± 2.7, and 25.5 ± 2.7 kg/m2. Significant improvement in levels of fasting blood glucose, lipid profile, and liver enzymes were observed. CONCLUSION OAGB for BMI < 35 kg/m2 has significant effects in weight loss, helps remit diabetes and hypertension in the majority of cases, improves lipid profile, and has no increased burden of postoperative problems or deficiency in nutritional factors rather than what is known and predictable.
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Affiliation(s)
- Shahab Shahabi Shahmiri
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram (Hazrat-e Rasool) University Hospital, School of Medicine, Iran University of Medical Sciences, Mansouri St., Niyayesh St., Sattarkhan Ave., Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Rasool-e Akram (Hazrat-e Rasool) University Hospital, Tehran, Iran
| | - Shiva Safari
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Minimally Invasive Surgery and Obesity Research Center, Alzahra University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fathi
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram (Hazrat-e Rasool) University Hospital, School of Medicine, Iran University of Medical Sciences, Mansouri St., Niyayesh St., Sattarkhan Ave., Tehran, Iran.
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Rasool-e Akram (Hazrat-e Rasool) University Hospital, Tehran, Iran.
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Delaram Moosavi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Nooredin Daryabari
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Firoozgar University-Affiliated Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram (Hazrat-e Rasool) University Hospital, School of Medicine, Iran University of Medical Sciences, Mansouri St., Niyayesh St., Sattarkhan Ave., Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Rasool-e Akram (Hazrat-e Rasool) University Hospital, Tehran, Iran
| | | | - Mohammad Kermansaravi
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram (Hazrat-e Rasool) University Hospital, School of Medicine, Iran University of Medical Sciences, Mansouri St., Niyayesh St., Sattarkhan Ave., Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Rasool-e Akram (Hazrat-e Rasool) University Hospital, Tehran, Iran
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Shahabi Shahmiri S, Sheikhbahaei E, Davarpanah Jazi A, Zefreh H, Yang W, Valizadeh R, Ribeiro R, Kermansaravi M. Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass. Obes Surg 2024; 34:2634-2649. [PMID: 38735966 DOI: 10.1007/s11695-024-07240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND In this systematic review, we aim to evaluate the reasons and outcomes behind remnant gastrectomy with or after gastric bypass procedures. RESULTS A total of 66 studies examining 1918 patients were included in this study with 70% of female predominance. Twenty studies reported RGB on 1751 patients and 46 studies reported remnant gastrectomy after gastric bypass in 167 patients. The most common etiology of RGB was related to the in situ remnant stomach neoplasia in 10 studies on 981 patients; mostly for preventive intentions in high prevalence areas. Remnant gastrectomy after gastric bypass was performed to treat a complication such as GGF, retrograde bile reflux gastritis, cancer mostly adenocarcinoma. Studies revealed that RGB has similar weight loss in comparison to standard Roux-en-Y gastric bypass.
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Affiliation(s)
- Shahab Shahabi Shahmiri
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-e Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool University Hospital, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive and Bariatric Surgery Research Center of Rasool-e Akram University Hospital, Iran University of Medical Sciences, Manaouri St., Niyayesh St., Sattar Khan St., Tehran, Iran
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Davarpanah Jazi
- Minimally Invasive and Bariatric Surgery Research Center of Rasool-e Akram University Hospital, Iran University of Medical Sciences, Manaouri St., Niyayesh St., Sattar Khan St., Tehran, Iran.
| | - Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- The State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Rui Ribeiro
- Hospital Lusiadas Amadora Metabolic Surgery Unit and General Surgery Department Coordinator, Amadora, Portugal
| | - Mohammad Kermansaravi
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-e Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool University Hospital, Tehran, Iran
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Kermansaravi M, Shahmiri SS, Kow L, Gawdat K, Abbas SI, Aly A, Bashir A, Bhandari M, Haddad A, ElFawal MH, Inam A, Kasama K, Kim SH, Kular KS, Lakdawala M, Layani LA, Lee WJ, Pazouki A, Prasad A, Safadi B, Wang C, Yang W, Adib R, Jazi AHD, Shabbir A. Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey. Obes Surg 2024; 34:2054-2065. [PMID: 38662251 DOI: 10.1007/s11695-024-07239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts. BACKGROUND The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications. METHODS The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024. RESULTS Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36-40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications. CONCLUSION The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Khaled Gawdat
- Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Ahmad Aly
- Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
- University of Melbourne, Melbourne, Australia
| | - Ahmad Bashir
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Ashraf Haddad
- Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan
| | | | - Atif Inam
- Metabolic, Thoracic & General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | | | | | | | - Wei-Jei Lee
- Medical Weight Loss Center, China Medical University Hsinchu Hospital, Zhubei, Taiwan
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Cunchuan Wang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Reza Adib
- The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Asim Shabbir
- National University of Singapore, Singapore, Singapore
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Davarpanah Jazi AH, Shahabi S, Sheikhbahaei E, Tolone S, Skalli ME, Kabir A, Valizadeh R, Kermansaravi M. A systematic review and meta-analysis on GERD after OAGB: rate, treatments, and success. Expert Rev Gastroenterol Hepatol 2023; 17:1321-1332. [PMID: 38148703 DOI: 10.1080/17474124.2023.2296992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION This review aims to investigate the gastroesophageal reflux disease (GERD) as one of the important concerns for both surgeons and patients after one anastomosis gastric bypass (OAGB). METHOD PubMed, Scopus, Embase, Web of Science, and Cochrane were reviewed by the end of the 2021 with keywords relating to GERD, OAGB, and their equivalents. Data regarding OAGB, number of patients with GERD, treatment for GERD, endoscopy findings, the interval between GERD and OAGB were retrieved by two independent investigators. The primary effect/effect size measure was prevalence. RESULTS 40 studies examining 17,299 patients were included revealing that 2% of patients experience GERD following OAGB. Reflux after revisional OAGB is six times higher than primary OAGB. Despite being unclear, medical and surgical treatments for GERD after OAGB were used in 60% and 41% of patients with estimated success rate of 85% and 100%, respectively. CONCLUSION Based on how GERD was identified after OAGB, its rate ranged from 0 to 55%; the pooled rate of 2% is near to Roux-en-Y gastric bypass. GERD symptoms can be mild to be tolerated without medical treatment, moderate that respond to acid-reducing agents, or severe enough that are categorized as interactable and would need a surgical intervention.
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Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mehdi El Skalli
- Centre Hospitalier Universitaire Montpellier, Université de Montpellier 1, Montpellier, France
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram University Hospital, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity (IFSO), Hazrat-E Rasool University Hospital, Tehran, Iran
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Zefreh H, Amani-Beni R, Sheikhbahaei E, Farsi F, Ahmadkaraji S, Barzin M, Darouei B, Khalaj A, Shahabi S. What About My Weight? Insufficient Weight Loss or Weight Regain After Bariatric Metabolic Surgery. Int J Endocrinol Metab 2023; 21:e136329. [PMID: 38666043 PMCID: PMC11041817 DOI: 10.5812/ijem-136329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 04/28/2024] Open
Abstract
Context This review study aimed to investigate the definition, etiology, risk factors (RFs), management strategy, and prevention of insufficient weight loss (IWL) and weight regain (WR) following bariatric metabolic surgery (BMS). Evidence Acquisition Electronic databases were searched to retrieve relevant articles. The inclusion criteria were English articles with adult participants assessing the definition, prevalence, etiology, RFs, management strategy, and prevention of IWL/WR. Results Definition: The preferred definition for post-BMS IWL/WR are the terms "Lack of maintenance of total weight loss (TWL)>20%" and "weight change in percentage compared to nadir weight or weight loss". Prevalence: The exact prevalence of IWL/WR is still being determined due to the type of BMS and various definitions. Etiology: Several mechanisms, including hormonal/metabolic, dietary non-adherence, physical inactivity, mental health, and anatomic surgical failure, are possible etiologies of post-BMS IWL/WR. Risk factors: Preoperative body mass index (BMI), male gender, psychiatric conditions, comorbidities, age, poor diet, eating disorders, poor follow-ups, insufficient physical activity, micronutrients, and genetic-epigenetic factors are the most important RFs. Management Strategy: The basis of treatment is lifestyle interventions, including dietary, physical activity, psychological, and behavioral therapy. Pharmacotherapy can be added. In the last treatment line, different techniques of endoscopic surgery and revisional surgery can be used. Prevention: Behavioral and psychotherapeutic interventions, dietary therapy, and physical activity therapy are the essential components of prevention. Conclusions Many definitions exist for WR, less so for IWL. Etiologies and RFs are complex and multifactorial; therefore, the management and prevention strategy is multidisciplinary. Some knowledge gaps, especially for IWL, exist, and these gaps must be filled to strengthen the evidence used to guide patient counseling, selection, and improved outcomes.
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Affiliation(s)
- Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Farnaz Farsi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Ahmadkaraji
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Darouei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khalaj
- Department of Surgery, School of Medicine, Tehran Obesity Treatment Center, Shahed University, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Conversion of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass: Results of a Retrospective Multicenter Study. Obes Surg 2022; 32:1842-1848. [PMID: 35212908 DOI: 10.1007/s11695-022-05963-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) may expose the patient to certain specific complications. Here, we report the results of conversion of OAGB to Roux-en-Y gastric bypass (RYGB) in terms of outcomes and weight loss. METHODS Between January 2009 and January 2019, all patients undergoing conversion of OAGB to RYGB because of complications due to OAGB (n = 23) were included. The primary efficacy endpoint was the effectiveness of converting OAGB to RYGB. The secondary endpoints were overall mortality and morbidity during the first 3 postoperative months, specific morbidity, reoperation, length of hospitalization, weight loss, and progression of comorbidities related to obesity at 2-year follow-up. RESULTS Indications for conversion were bile reflux (n = 14; 60.9%), severe malnutrition (n = 3; 13%), gastro-gastric fistula (n = 4; 17.4%), and anastomotic leak (n = 2; 8.7%). The median time interval between OAGB and conversion to RYGB was 34 months (0-158). At the time of RYGB, median body mass index (BMI) was 28.0 kg/m2 (18.2-50.7), representing a median BMI change of 14.0 (- 1.7-43.5). Fifteen surgeries (65.1%) were completed laparoscopically. Five complications (21.7%) were recorded, including 2 major ones (8.7%). Reoperation rate was 4.3% (n = 1). At 24 months of follow-up (n = 18; 78.3%), median BMI was 28.7 kg/m2 (19.4-35.4), representing a median BMI change of 19.5 (12.2-43.1). No patient complained of bile reflux or persistent malnutrition. CONCLUSION RYGB performed as revisional surgery for complications after OAGB is an effective procedure with no major weight regain at 2 years of follow-up.
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Pazouki A, Shahabi S, Sheikhbahaei E, Mokhber S, Jazi AHD, Kermansaravi M. COVID-19 Vaccination and Timing of Bariatric Surgery: Considerations and Concerns for Patients with Severe Obesity. Obes Surg 2022; 32:558-560. [PMID: 34580832 PMCID: PMC8476289 DOI: 10.1007/s11695-021-05734-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave., Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave., Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| | - Erfan Sheikhbahaei
- Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sommayeh Mokhber
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave., Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| | - Amir Hossein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave., Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| | - Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave., Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
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Pregnancy Less Than 1 Year After the Bariatric Surgery: Is It Really Safe? Obes Surg 2021; 31:2211-2218. [PMID: 33604866 DOI: 10.1007/s11695-021-05260-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The time interval between bariatric surgery and pregnancy is controversial. In this study, we report and compare the outcomes of pregnancy from two groups of bariatric surgery (BS) patients who became pregnant less than 12 months (early) and above 12 months (late) after surgery. MATERIALS AND METHODS For this retrospective study, women of reproductive age who became pregnant after BS between 2010 and 2019 were reviewed, allocated into two groups, and compared. Perinatal care was provided as standards and continued at monthly intervals by a gynecologist. Demographic data, pregnancy-related events, results of any screening tests in each trimester, the reports of all ultrasonographies, and lab data were extracted from their medical documents. Chi-square and t-test were used for analysis. RESULTS Four hundred seventy-seven out of 1046 participants were of reproductive age. 12 and 37 women were put in early and late pregnancy groups, respectively. No significant difference was observed in the rate of maternal complications, outcomes of pregnancies, and the rate of fetal and neonatal problems in pregnancies conceived during the first vs. second year postbariatric surgery. 91.6% of the patients with early pregnancy had at least one perinatal/neonatal finding. Mean neonatal birth weight was 2610 ± 152 and 2881 ± 315 g in early and late pregnancy groups, respectively. Patients with early pregnancy were not at significantly higher odds for any pregnancy-related or neonatal complications. CONCLUSION The rate of maternal, fetal, and neonatal complications in pregnancies conceived during the first vs. second postbariatric year were indifferent.
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Mahmoudieh M, Keleidari B, Hadipour P, Sheikhbahaei E, Chang AR, Ramtin S, Shahabi S. Comparative Effectiveness of Roux-en-Y Gastric Bypass vs. One Anastomosis Gastric Bypass on Kidney Function. Obes Surg 2021; 31:2464-2470. [PMID: 33599924 DOI: 10.1007/s11695-021-05295-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Obesity and its associated medical problems increase risk of kidney function decline while prior studies suggest that bariatric surgery may improve kidney outcomes. However, little is known about the comparative effectiveness of different types of bariatric surgery on kidney function. In this study, we compare the effects of laparoscopic one anastomosis gastric bypass (LOAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on kidney function one year after surgery. MATERIALS AND METHODS The patients' demographic, medical, and surgical data were prospectively collected and retrospectively reviewed. Type 2 diabetes mellitus, hypertension, and dyslipidemia, body mass index (BMI), and kidney function tests were obtained before and one year after surgery. Kidney function was evaluated by estimated glomerular filtration rate (eGFR) and spot urine albumin to creatinine ratio (ACR). Changes in eGFR and ACR were compared between LRYGB vs. LOAGB after adjustment for confounders (age, sex, remission of associated medical problems, preoperative BMI, and percentage of excess BMI loss) using ANCOVA model. RESULTS Both surgical techniques significantly decreased the post-surgery presence of diabetes, hypertension, and dyslipidemia (p < 0.001 for all paired comparisons). The eGFR level significantly increased and the ACR level significantly decreased in both groups (p < 0.001 for all paired comparisons before and after adjustment). However, eGFR and ACR mean differences between LRYGB and LOAGB were not significantly different after adjustment for confounding variables (p = 0.9 and 0.4, respectively). CONCLUSION Both LOAGB and LRYGB improved 1-year eGFR and ACR equally independently from weight loss and other confounders.
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Affiliation(s)
- Mohsen Mahmoudieh
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrouz Keleidari
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pedram Hadipour
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alex R Chang
- Kidney Health Research Institute, Geisinger Health, Danville, Philadelphia, PA, USA
| | - Sina Ramtin
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahab Shahabi
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Areas of Non-Consensus Around One Anastomosis/Mini Gastric Bypass (OAGB/MGB): A Narrative Review. Obes Surg 2021; 31:2453-2463. [PMID: 33598845 DOI: 10.1007/s11695-021-05276-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE One anastomosis/mini gastric bypass (OAGB/MGB) is now an established bariatric and metabolic surgical procedure with good outcomes. Despite two recent consensus statements around OAGB/MGB, there are some issues which are not accepted as consensus and need more long-term data and research. MATERIAL AND METHODS After identifying the topic of non-consensus from the two recent OAGB/MGB consensuses, PubMed, Scopus, and Cochrane were searched for articles published by November 2020. RESULTS In this study, we evaluated these non-consensus topics around OAGB/MGB and all related articles on these topics were assessed by authors to have an argument on these items. CONCLUSION There is enough evidence to include OAGB/MGB as an accepted standard bariatric and metabolic surgical procedure. However, long-term data and more research are needed to have a consensus in all aspects including these non-consensus topics.
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11
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One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) as Revisional Surgery Following Primary Restrictive Bariatric Procedures: a Systematic Review and Meta-Analysis. Obes Surg 2020; 31:370-383. [PMID: 33118133 PMCID: PMC7809003 DOI: 10.1007/s11695-020-05079-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/31/2022]
Abstract
One anastomosis gastric bypass (OAGB/MGB) has gained popularity in the past decade. International databases were searched for articles published by September 10, 2020, on OAGB/MGB as a revisional procedure after restrictive procedures. Twenty-six studies examining a total of 1771 patients were included. The mean initial BMI was 45.70 kg/m2, which decreased to 31.52, 31.40, and 30.54 kg/m2 at 1, 3, and 5-year follow-ups, respectively. Remission of type-2 diabetes mellitus (T2DM) following OAGB/MGB at 1-, 3-, and 5-year follow-up was 65.16 ± 24.43, 65.37 ± 36.07, and 78.10 ± 14.19%, respectively. Remission/improvement rate from gastroesophageal reflux disease (GERD). Also, 7.4% of the patients developed de novo GERD following OAGB/MGB. Leakage was the most common major complication. OAGB/MGB appears to be feasible and effective as a revisional procedure after failed restrictive bariatric procedures.
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