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Markus A, Henrik BJ, Benedikt R, Alexander H, Thomas B, Clemens S, Jan-Hendrik E. Endoscopic vacuum therapy in salvage and standalone treatment of gastric leaks after bariatric surgery. Langenbecks Arch Surg 2021; 407:1039-1046. [PMID: 34787705 PMCID: PMC9151560 DOI: 10.1007/s00423-021-02365-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/18/2021] [Indexed: 12/24/2022]
Abstract
Introduction Gastric leaks constitute some of the most severe complications after obesity surgery. Resulting peritonitis can lead to inflammatory changes of the stomach wall and might necessitate drainage. The inflammatory changes make gastric leak treatment difficult. A common endoscopic approach of using stents causes the problem of inadequate leak sealing and the need for an external drainage. Based on promising results using endoscopic vacuum therapy (EVT) for esophageal leaks, we implemented this concept for gastric leak treatment after bariatric surgery (Ahrens et al., Endoscopy 42(9):693–698, 2010; Schniewind et al., Surg Endosc 27(10):3883–3890, 2013). Methods We retrospectively analyzed data of 31 gastric leaks after bariatric surgery. For leak therapy management, we used revisional laparoscopy with suturing and drainage. EVT was added for persistent leaks in sixteen cases and was used in four cases as standalone therapy. Results Twenty-one gastric leaks occurred in 521 sleeve gastrectomies (leakage rate 4.0%), 9 in 441 Roux-en-Y gastric bypasses (leakage rate 2.3%), and 1 in 12 mini-bypasses. Eleven of these gastric leaks were detected within 2 days after bariatric surgery and successfully treated by revision surgery. Sixteen gastric leaks, re-operated later than 2 days, remained after revision surgery, and EVT was added. Without revision surgery, we performed EVT as standalone therapy in 4 patients with late gastric leaks. The EVT healing rate was 90% (18 of 20). In 2 patients with a late gastric leak in sleeve gastrectomy, neither revisional surgery, EVT, nor stent therapy was successful. EVT patients showed no complications related to EVT during follow-up. Conclusion EVT is highly beneficial in cases of gastric leaks in obesity surgery where local peritonitis is present. Revisional surgery was unsuccessful later than 2 days after primary surgery (16 of 16 cases). EVT shows a similar healing rate to stent therapy (80–100%) but a shorter duration of treatment. The advantages of EVT are endoscopic access, internal drainage, rapid granulation, and direct therapy control. In compartmentalized gastric leaks, EVT was successful as a standalone therapy without external drainage. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02365-9.
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Affiliation(s)
- Ahrens Markus
- Department of Surgery, St. Vinzenz Hospital Dinslaken, Dinslaken, Germany.
- Department of General, Thorax, Transplant and Paediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Beckmann Jan Henrik
- Department of General, Thorax, Transplant and Paediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Reichert Benedikt
- Department of General, Thorax, Transplant and Paediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Hendricks Alexander
- Department of General, Thorax, Vascular and Transplant Surgery, University Hospital Rostock, Rostock, Germany
| | - Becker Thomas
- Department of General, Thorax, Transplant and Paediatric Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Schafmayer Clemens
- Department of General, Thorax, Vascular and Transplant Surgery, University Hospital Rostock, Rostock, Germany
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Al-Kurd A, Grinbaum R, Abubeih A, Mizrahi I, Kupietzky A, Lourie NEE, Mazeh H, Beglaibter N. Results of conversion of gastric banding to gastric bypass in patients between 50 and 60 years of age are similar to those observed in younger patients. Am J Surg 2019; 217:745-749. [DOI: 10.1016/j.amjsurg.2018.12.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/25/2018] [Accepted: 12/31/2018] [Indexed: 12/15/2022]
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Pirini F, Rodriguez-Torres S, Ayandibu BG, Orera-Clemente M, Gonzalez-de la Vega A, Lawson F, Thorpe RJ, Sidransky D, Guerrero-Preston R. INSIG2 rs7566605 single nucleotide variant and global DNA methylation index levels are associated with weight loss in a personalized weight reduction program. Mol Med Rep 2017; 17:1699-1709. [PMID: 29138870 PMCID: PMC5780113 DOI: 10.3892/mmr.2017.8039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/17/2017] [Indexed: 12/27/2022] Open
Abstract
Single nucleotide polymorphisms associated with lipid metabolism and energy balance are implicated in the weight loss response caused by nutritional interventions. Diet-induced weight loss is also associated with differential global DNA methylation. DNA methylation has been proposed as a predictive biomarker for weight loss response. Personalized biomarkers for successful weight loss may inform clinical decisions when deciding between behavioral and surgical weight loss interventions. The aim of the present study was to investigate the association between global DNA methylation, genetic variants associated with energy balance and lipid metabolism, and weight loss following a non-surgical weight loss regimen. The present study included 105 obese participants that were enrolled in a personalized weight loss program based on their allelic composition of the following five energy balance and lipid metabolism-associated loci: Near insulin-induced gene 2 (INSIG2); melanocortin 4 receptor; adrenoceptor β2; apolipoprotein A5; and G-protein subunit β3. The present study investigated the association between a global DNA methylation index (GDMI), the allelic composition of the five energy balance and lipid metabolism-associated loci, and weight loss during a 12 month program, after controlling for age, sex and body mass index (BMI). The results demonstrated a significant association between the GDMI and near INSIG2 locus, after adjusting for BMI and weight loss, and significant trends were observed when stratifying by gender. In conclusion, a combination of genetic and epigenetic biomarkers may be used to design personalized weight loss interventions, enabling adherence and ensuring improved outcomes for obesity treatment programs. Precision weight loss programs designed based on molecular information may enable the creation of personalized interventions for patients, that use genomic biomarkers for treatment design and for treatment adherence monitoring, thus improving response to treatment.
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Affiliation(s)
- Francesca Pirini
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, I‑47014 Meldola, Italy
| | | | - Bola Grace Ayandibu
- Department of Otolaryngology, School of Medicine, Johns Hopkins University, Baltimore, MD 21231, USA
| | - María Orera-Clemente
- Genetic Laboratory, University General Hospital Gregorio Marañón, 28007 Madrid, Spain
| | | | - Fahcina Lawson
- Department of Otolaryngology, School of Medicine, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Roland J Thorpe
- Johns Hopkins University Centre for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - David Sidransky
- Department of Otolaryngology, School of Medicine, Johns Hopkins University, Baltimore, MD 21231, USA
| | - Rafael Guerrero-Preston
- Department of Otolaryngology, School of Medicine, Johns Hopkins University, Baltimore, MD 21231, USA
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Lewis M, Netz U, Mizrahi S, Avinoah E, Gal D, Perry ZH. Do Male Patients Benefit from Laparoscopic Adjustable Gastric Banding More than Female Patients? A Retrospective Cohort Study. Obes Surg 2017; 28:760-766. [PMID: 28861730 DOI: 10.1007/s11695-017-2916-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Clinical trials in the field of bariatrics, and specifically laparoscopic adjustable gastric banding (LAGB), have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results, and specifically quality of life (QOL) parameters, have not been addressed sufficiently. The aim of our study was to examine the long-term gender association with outcome of LAGB including the impact on QOL. METHODS A retrospective cohort study of patients who underwent LAGB between 2006 and 2014 by a single surgeon was conducted. Data were collected from the hospital registry and a telephone interview that included a standardized questionnaire. Outcomes including BMI reduction, evolution of comorbidities, complications, reoperations, and QOL were compared according to the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS Included were 114 males and 127 females, with a mean age of 38.2 years at surgery, and an average post-surgery follow-up of 6.5 years. Similar BMI reduction (p = 0.68) and perioperative complication rates (p = 0.99) were observed. Males had a greater improvement in comorbidities (p < 0.001), less band slippage (p = 0.006), underwent fewer reoperations (p = 0.02), and reported higher QOL scores (p = 0.02) than females. The total BAROS score was significantly higher for males than females (p < 0.001). CONCLUSIONS LAGB surgery results in better outcomes for male than female patients as measured by the BAROS, despite a similar BMI reduction. Gender-specific outcomes should be taken into consideration in optimizing patient selection and preoperative patient counseling.
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Affiliation(s)
- Maor Lewis
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Uri Netz
- Department of Surgery A, Soroka University Medical Center, PO Box 151, 64101, Beer-Sheva, Israel.
| | - Solly Mizrahi
- Department of Surgery A, Soroka University Medical Center, PO Box 151, 64101, Beer-Sheva, Israel
| | - Eliezer Avinoah
- Department of Surgery A, Soroka University Medical Center, PO Box 151, 64101, Beer-Sheva, Israel
| | - Doron Gal
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Zvi H Perry
- Department of Surgery A, Soroka University Medical Center, PO Box 151, 64101, Beer-Sheva, Israel
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Sanchez Santos R, Corcelles R, Vilallonga Puy R, Delgado Rivilla S, Ferrer JV, Foncillas Corvinos J, Masdevall Noguera C, Socas Macias M, Gomes P, Balague Ponz C, de Tomas Palacios J, Ortiz Sebastian S, Sanchez Pernaute A, Puche Pla JJ, Sabench Pereferrer F, Abasolo Vega J, Suñol Sala X, Garcia Navarro A, Duran Escribano C, Cassinello Fernandez N, Perez N, Gracia Solanas JA, Garcia-Moreno Nisa F, Hernández Matias A, Valentí Azcarate V, Perez Folques JE, Navarro Garcia I, Dominguez-Adame Lanuza E, Martinez Cortijo S, González Fernández J. Prognostic factors of weight loss after sleeve gastrectomy: Multi centre study in Spain and Portugal. Cir Esp 2017; 95:135-142. [PMID: 28325497 DOI: 10.1016/j.ciresp.2017.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/31/2017] [Accepted: 02/06/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has become a technique in its own right although a selective or global indication remains controversial. The weight loss data at 5 years are heterogeneous. The aim of the study is to identify possible prognostic factors of insufficient weight loss after SG. METHODS A SG retrospective multicenter study of more than one year follow-up was performed. Failure is considered if EWL>50%. Univariate and multivariate study of Cox regression were performed to identify prognostic factors of failure of weight loss at 1, 2 and 3 years of follow up. RESULTS A total of 1,565 patients treated in 29 hospitals are included. PSP per year: 70.58±24.7; 3 years 69.39±29.2; 5 years 68.46±23.1. Patients with EWL<50 (considered failure): 17.1% in the first year, 20.1% at 3 years, 20.8% at 5 years. Variables with influence on the weight loss failure in univariate analysis were: BMI>50kg/m2, age>50years, DM2, hypertension, OSA, heart disease, multiple comorbidities, distance to pylorus> 4cm, bougie>40F, treatment with antiplatelet agents. The reinforcement of the suture improved results. In multivariate study DM2 and BMI are independent factors of failure. CONCLUSION The SG associates a satisfactory weight loss in 79% of patients in the first 5 years; however, some variables such as BMI>50, age>50, the presence of several comorbidities, more than 5cm section of the pylorus or bougie>40F can increase the risk of weight loss failure.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pedro Gomes
- Hospital Geral, Centro Hospitalar Univertario Coimbra, Coimbra, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | - Nieves Perez
- Hospital Virgen de los Lirios, Alcoy (Alicante), España
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Kemaloğlu Öz T, Ünal Dayı Ş, Seyit H, Öz A, Ösken A, Atasoy I, Yıldız U, Özpamuk Karadeniz F, İpek G, Köneş O, Alış H. The effects of weight loss after sleeve gastrectomy on left ventricular systolic function in men versus women. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:492-499. [PMID: 27119820 DOI: 10.1002/jcu.22361] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/21/2016] [Accepted: 03/25/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To evaluate and compare the effects of weight lost after sleeve gastrectomy on left ventricular (LV) systolic function using both two-dimensional speckle tracking (2D-STE) and three-dimensional echocardiography (3DE) in men versus women. METHODS In 53 obese patients referred for sleeve gastrectomy, 2D-STE and 3DE were performed prior to and 6 months after surgery. RESULTS The study included 53 obese patients (62.3% female; mean age 36.8 ± 10.7 years). Six months after surgery, all patients demonstrated a significant decrease in body mass index, body weight, blood pressure, heart rate, LV end-diastolic dimension, myocardial wall thickness, LV mass, LV mass index, LV mass/height(2.7) , LV end-diastolic volume, LV end-systolic volume, and stroke volume as well as an increase in SV index and ejection fraction. There was no significant difference in measured variables between men and women at baseline or postsurgery, except for baseline LV end-diastolic dimension, and baseline and after surgery LV mass, LV mass index, and LV mass/height(2.7) , which were all significantly higher in men. CONCLUSIONS Sleeve gastrectomy improves LV systolic function and contributes to reverse LV remodeling in both genders. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:492-499, 2016.
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Affiliation(s)
- Tuğba Kemaloğlu Öz
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey.
| | - Şennur Ünal Dayı
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Hakan Seyit
- Bakırköy Dr. Sadi konuk Training and Research Hospital, General Surgery Department, Turkey
| | - Ayhan Öz
- Şişli Hamidiye Etfal Training and Research Hospital, General Surgery Department, Turkey
| | - Altuğ Ösken
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Işıl Atasoy
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Ufuk Yıldız
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Fatma Özpamuk Karadeniz
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Göktürk İpek
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Cardiology Department, Turkey
| | - Osman Köneş
- Bakırköy Dr. Sadi konuk Training and Research Hospital, General Surgery Department, Turkey
| | - Halil Alış
- Bakırköy Dr. Sadi konuk Training and Research Hospital, General Surgery Department, Turkey
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Stroh C, Köckerling F, Volker L, Frank B, Stefanie W, Christian K, Christiane B, Thomas M. Results of More Than 11,800 Sleeve Gastrectomies: Data Analysis of the German Bariatric Surgery Registry. Ann Surg 2016; 263:949-55. [PMID: 26727093 DOI: 10.1097/sla.0000000000001559] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (SG) is an upcoming procedure in bariatric surgery and is currently performed worldwide. Staple line leakage, as the most frequent and most feared complication, is still a major concern. METHODS Since 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary SG within a 7-year period were considered for analysis. RESULTS Using the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005, and December 31, 2013. Staple line leak rate decreased from 6.5% to 1.4%. Male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate. CONCLUSIONS Owing to the growing experience a constant decrease in the leakage rate after SG has been observed. Staple line disruption may still lead to sepsis, multiorgan dysfunction, and increased mortality. The results of the current study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.
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Affiliation(s)
- Christine Stroh
- *SRH Municipal Hospital Gera, Gera, Germany †Vivantes Hospital Berlin, Berlin, Germany ‡Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany §StatConsult Magdeburg, Magdeburg, Germany ¶Institute of Quality Assurance at Otto-von Guericke University Magdeburg, Magdeburg, Germany
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Vuolo G, Voglino C, Tirone A, Colasanto G, Gaggelli I, Ciuoli C, Ferrara F, Marrelli D. Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg 2016; 30:48-55. [PMID: 27109203 DOI: 10.1016/j.ijsu.2016.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a worldwide surgical procedure for morbid obesity. However patients selection is still anecdotal. The aim of this study is to analyse clinical and anthropometric parameters correlated with LSG and to check the validity of this procedure for different categories of obese patients. METHODS Two-hundred one consecutive patients were submitted to LSG as a primary bariatric procedure between 2008 and 2014. One year follow-up was completed in 159 patients. Smaller groups of patients completed 2 and 3 years follow-up (78, 46 patients respectively). Median preoperative body mass index (BMI) was 45.4 kg/m2 (range: 34.8-73.8); 135 patients (80%) had one or more comorbidities. Potential correlations between age, gender, preoperative BMI, preoperative excess weight, early excess weight loss (EWL) and 1 and 3 year-EWL were investigated. RESULTS All procedures were regularly completed with laparoscopic approach without conversion to laparotomy. Postoperative complications occurred in six patients (3.7%); no postoperative mortality was observed. Median one-year BMI and EWL were 32.8 kg/m2 and 55.34%, respectively. Three year-EWL was significantly influenced by age, and early EWL. A complete normalization of glycemic levels after the three-year follow-up was also observed in high percentage of diabetic patients. In patients with preoperative BMI>50 kg/m2 we observed most failure cases in terms of EWL and the worst metabolic results. CONCLUSIONS Our experience indicates that LSG is a safe procedure with satisfactory three-year late weight loss in patients with preoperative BMI <50 kg/m2. Promising results, in terms of improvements of comorbidities, were also observed. These results make LSG one of the most attractive first stage surgical procedure for morbid obesity.
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Affiliation(s)
- Giuseppe Vuolo
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Costantino Voglino
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Andrea Tirone
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Giuseppina Colasanto
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Ilaria Gaggelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Francesco Ferrara
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
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Stroh C, Weiner R, Wolff S, Knoll C, Manger T. Are There Gender-Specific Aspects in Obesity and Metabolic Surgery? Data Analysis from the German Bariatric Surgery Registry. VISZERALMEDIZIN 2015; 30:125-32. [PMID: 26288587 PMCID: PMC4513798 DOI: 10.1159/000360148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Since January 2005, the status of bariatric surgery in Germany has been examined in conjunction with a quality assurance study of the German Bariatric Surgery Registry (GBSR). All data are registered prospectively in cooperation with the Institute for Quality Assurance in Surgical Medicine at the Otto-von-Guericke University Magdeburg, Germany. Methods Data are registered in an online database. Data collection on obesity and metabolic surgery is voluntary, and was started in 2005. In addition, follow-up data are collected once a year. Results Since 2005, 8,293 sleeve gastrectomies, 10,330 Roux-en-Y gastric bypass procedures, and 3,741 gastric banding procedures have been performed in Germany, according to the data of the GBSR. Mean age and mean body mass index of female patients with gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass were significantly lower than those of male patients. The incidence of relevant comorbidities was significantly higher in male than in female patients. Conclusion Metabolic and obesity surgery is becoming more and more popular in Germany. Data from the GBSR study show significant differences in preoperative comorbidities and postoperative complication and mortality rates between male and female patients. There is a need for further evaluation of gender-specific aspects to optimize patient selection and reduce specific postoperative complications.
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Affiliation(s)
- Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, SRH Municipal Hospital, Gera, Germany ; Institute for Quality Assurance in Surgical Medicine, University Hospital, Magdeburg, Germany
| | - Rudolf Weiner
- Department of Surgery, Sachsenhausen Hospital, Frankfurt/M., Germany
| | - Stefanie Wolff
- Department of Surgery, University Hospital, Magdeburg, Germany
| | | | - Thomas Manger
- Department of General, Abdominal and Pediatric Surgery, SRH Municipal Hospital, Gera, Germany ; Institute for Quality Assurance in Surgical Medicine, University Hospital, Magdeburg, Germany
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Early post-operative complications: incidence, management, and impact on length of hospital stay. A retrospective comparison between laparoscopic gastric bypass and sleeve gastrectomy. Obes Surg 2014; 23:2004-12. [PMID: 23846474 DOI: 10.1007/s11695-013-1022-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common obesity surgeries. Their early complications may prolong hospital stay (HS). METHODS Data for patients who underwent LRYGB and LSG in our clinic from 2009 through August 2012 were collected. Early post-operative complications prolonging HS (>5 days) were retrospectively analyzed, highlighting their relative incidence, management, and impact on length of HS. RESULTS Sixty-six patients (4.9 %) after 1,345 LRYGB operations vs. 49 patients (7.14 %) after 686 LSG operations developed early complications. This difference is statistically significant (p = 0.039). Male gender percentage was significantly higher in complicated LSG group vs. complicated LRYGB group [23 patients (46.9 %) vs. 16 patients (24.2 %)] (p = 0.042). Mean BMI was significantly higher in the complicated LSG group (54.2 ± 8.3) vs. complicated LRYGB group (46.8 ± 5.7; p = 0.004). Median length of HS was not longer after complicated LSG compared with complicated LRYGB (11 vs. 10 days; p = 0.287). Leakage and bleeding were the most common complications after either procedure. Leakage rate was not higher after LSG (12 patients, 1.7 %) compared with LRYGB (22 patients, 1.6 %; p = 0.304). Bleeding rate was significantly higher after LSG (19 patients, 2.7 %) than after LRYGB (10 patients, 0.7 %; p = 0.004). Prolonged elevation of inflammatory markers was the most common presentation for complications after LSG (18 patients, 36.7 %) and LRYGB (31 patients, 46.9 %). CONCLUSIONS LSG was associated with more early complications. This may be attributed to higher BMI and predominance of males in LSG group.
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Stroh C, Benedix D, Weiner R, Benedix F, Wolff S, Knoll C, Manger T. Is a one-step sleeve gastrectomy indicated as a revision procedure after gastric banding? Data analysis from a quality assurance study of the surgical treatment of obesity in Germany. Obes Surg 2014; 24:9-14. [PMID: 23999964 DOI: 10.1007/s11695-013-1068-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Since 1 January 2005, the outcomes of bariatric surgeries have been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. METHODS Data are collected in an online data bank. Data collection began in 2005 for the results of gastric banding (GB) and in 2006 for sleeve gastrectomies (SGs). In addition to primary bariatric operations, data regarding the complications of revision procedures and redo operations have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany. RESULTS SGs are a popular redo operation after failed gastric banding. Using the German Bariatric Surgery Registry, we analyzed data from 137 SGs that were used in a one-step approach after GB and 37 SGs that were used in a two-step approach. Leakage rates for primary SGs dropped to 1.9 %. The incidence of leakage after a one-step SG after GB is significantly higher (4.4 %) than for a two-step approach (0 %). CONCLUSION SGs are popular procedures after failed GB in Germany, but the complication rates for one-step band removal are higher than for a two-step approach. After examining the data, we suggest performing band removal and SG as a two-step procedure. Further analysis is necessary to evaluate the optimal time period between band removal and SG. Follow-up investigations must be performed to determine if SG is an effective and safe option after GB.
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Stroh C, Groh C, Weiner R, Ludwig K, Wolff S, Kabelitz M, Manger T. Are there gender-specific aspects of gastric banding? Data analysis from the quality assurance study of the surgical treatment of obesity in Germany. Obes Surg 2014; 23:1783-9. [PMID: 23612866 DOI: 10.1007/s11695-013-0964-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Since 1 January 2005, the situation of bariatric surgery has been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. METHODS Data collection on the results of gastric banding procedures was started in 2005, and the data are registered in an online database. Follow-up data were collected once a year. Participation in the quality assurance study is voluntary. RESULTS Since 2005, 3,453 gastric banding procedures have been performed at 88 hospitals. The mean age of patients was 40.7 years, and the mean body mass index (BMI) was 45.2 kg/m2. BMI and comorbidities are significantly higher in male patients. Regarding gender-specific aspects, there are no significant differences in the perioperative complication rates. The amelioration rate of comorbidities in male patients is lower than in female patients. CONCLUSION Gastric banding in Germany is generally performed in patients with a BMI below 45 kg/m2. The perioperative complication rate is low. Data from the nationwide survey of the German Bariatric Surgery Registry show significant differences in preoperative comorbidities and their amelioration between male and female patients. There is a need for further evaluation of gender-specific aspects of gastric banding procedures to optimize patient selection, reduce specific postoperative complications, and achieve long-term effects on weight loss and remission of comorbidities.
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Affiliation(s)
- Christine Stroh
- Department of General-, Abdominal- and Pediatric Surgery, SRH Hospital Gera, Straße des Friedens 122, 07548, Gera, Germany,
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Influences of Gender on Complication Rate and Outcome after Roux-en-Y Gastric Bypass: Data Analysis of More Than 10,000 Operations from the German Bariatric Surgery Registry. Obes Surg 2014; 24:1625-33. [DOI: 10.1007/s11695-014-1252-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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