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Almasi MH, Barzin M, Khalaj A, Mahdavi M, Valizadeh M, Hosseinpanah F. Safety and efficacy of sleeve gastrectomy in non-diabetic individuals with class I vs. class II obesity: a matched controlled experiment from Tehran Obesity Treatment Study (TOTS). Surg Endosc 2024:10.1007/s00464-024-11240-9. [PMID: 39289225 DOI: 10.1007/s00464-024-11240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/29/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND This study aimed to evaluate the 3-year outcomes of sleeve gastrectomy in non-diabetic individuals with class I obesity. METHODS A total of 78 participants with class I obesity and 78 participants with class II obesity, matched in terms of age, sex (93.6% female), and the rates of dyslipidemia and hypertension, were included in this prospective cohort study. Follow-up data, including metabolic features, body composition, nutritional characteristics, and surgery complications, were gathered at the baseline and 6, 12, 24, and 36 months post-bariatric surgery. Micronutrient deficiencies and comorbidities (hypertension and dyslipidemia) were evaluated in both groups using conditional logistic regression analysis, and Clavien-Dindo classification was used to compare surgical complications. RESULTS Baseline characteristics of the participants in both groups were similar (n = 78, mean age: 36.4 ± 8.5). The two groups were also comparable in terms of weight loss, cardiovascular risk factors, and remission of obesity-related comorbidities 3 years following sleeve gastrectomy. Overall values of Δ total weight loss (TWL)%, Δ excess weight loss (EWL)%, and β (95% CI) were - 1.86 (1.19), and - 2.56 (4.5) with a P value of 0.118 and 0.568, respectively. The occurrence of surgical complications and undesirable outcomes were also similar between the two study groups. CONCLUSION Bariatric surgery is an effective and safe method to achieve weight loss and alleviate cardiovascular risk factors and obesity-related comorbidities in non-diabetic individuals with class I and class II obesity.
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Affiliation(s)
- Minoo Heidari Almasi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Alireza Khalaj
- Department of Surgery, Faculty of Medicine, Tehran Obesity Treatment Center, Shahed University, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Pieretti G, Gubitosi A, Mazzarella V, Cimmino M, Lanzano G, Grella R, Ferraro G, Grella E. The use of Fibrin Sealants in Reducing Drain Output in Abdominoplasty: Is it Useful? JPRAS Open 2024; 41:166-172. [PMID: 39040145 PMCID: PMC11261249 DOI: 10.1016/j.jpra.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/02/2024] [Indexed: 07/24/2024] Open
Abstract
Background Abdominoplasty is a common surgical procedure in which excess abdominal skin and fat are reduced to improve body contouring. Fibrin sealant has been proposed to reduce postsurgical bleeding and exudation. In this study, we evaluated whether there was a significant statistical difference in surgical output between the use of fibrin glue and its nonuse in abdominoplasty surgery, specifically in reducing bleeding and exudation. Material and methods A retrospective chart review of 68 postbariatric abdominoplasty patients (58 females, 10 males) was performed. We divided the patients into Group A (30 cases, 44%), in which we used fibrin sealant, and Group B (38 cases, 56%), in which we did not use fibrin glue. We calculated the total amount of liquid in suction drainages until the day of their removal. Statistical analysis included the independent t-test with a significance level of 0.05. Results The average drainage output in Group A was 620.0 ± 375.0 mL, whereas in Group B, it was 500.0 ± 290.0 mL. Results indicate an insignificant correlation between the use of fibrin glue and the amount of liquid in the surgical drains (t = 1.52, p = 0.13). The result is not significant at p <.05 according to the independent t-test. Conclusion The use of fibrin sealant surely has a high value in all surgical branches to reduce postoperative complications, but in our study, we did not find any advantages in its use for reducing surgical drain output in abdominoplasty patients.
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Affiliation(s)
- G. Pieretti
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - A. Gubitosi
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - V. Mazzarella
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - M. Cimmino
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - G. Lanzano
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - R. Grella
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - G.A. Ferraro
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
| | - E. Grella
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgery and Dental Specialities, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia, 80138 Naples, Italy
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Yousefi R, Ben-Porat T, Marques Vieira A, Lavoie KL, Bacon SL. Who gains the most quality-of-life benefits from metabolic and bariatric surgery: findings from the prospective REBORN cohort study. Surg Obes Relat Dis 2024:S1550-7289(24)00787-1. [PMID: 39304457 DOI: 10.1016/j.soard.2024.08.029] [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: 02/18/2024] [Revised: 06/22/2024] [Accepted: 08/17/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Prioritizing patients for metabolic and bariatric surgery (MBS) based on their potential postoperative benefits is essential. OBJECTIVES To examine changes in quality of life (QoL) during the initial postoperative year among patients with diverse eligibility statuses and determine which group experiences greater benefits. SETTING Center intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de- Montréal (CIUSSS-NIM), Canada. METHODS We categorized patients into 3 groups based on obesity class and the presence of comorbidities: Group 1 (obesity class II without comorbidities, n = 28); Group 2 (obesity class II with comorbidities, n = 36); and Group 3 (obesity class III, n = 460). QoL (Short-Form QoL questionnaire [SF-12]) and anthropometrics were measured at 6 months before, and 6 and 12 months after surgery. RESULTS Repeated measures mixed models revealed a significant main effect of time (P < .001) and an interaction between time and group for the physical component of QoL (P = .007). These indicated consistent improvements across time in all groups, with the greatest benefits seen in Group 3 relative to Group 1. There were no interactions between time and group for the mental components of QoL (P = .402). There were significant interaction effects for weight and BMI (P's < .001), with Group 3 losing more weight than Groups 1 or 2. CONCLUSIONS All groups that underwent MBS had improvements in the physical aspects of QoL and weight over time, even those who have traditionally not be considered eligible for MBS (i.e., Group 1). This provides a starting point to explore the importance of not excluding patients due to their weight and comorbidity status and setting comprehensive eligibility criteria encompassing all patients who might benefit from MBS, beyond just weight loss.
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Affiliation(s)
- Reyhaneh Yousefi
- Montréal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Québec, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, Québec, Canada
| | - Tair Ben-Porat
- Montréal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Québec, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, Québec, Canada
| | - Ariany Marques Vieira
- Montréal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Québec, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, Québec, Canada
| | - Kim L Lavoie
- Montréal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Simon L Bacon
- Montréal Behavioural Medicine Centre (MBMC), Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Québec, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, Québec, Canada.
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Moize V, Laferrère B, Shapses S. Nutritional Challenges and Treatment After Bariatric Surgery. Annu Rev Nutr 2024; 44:289-312. [PMID: 38768613 DOI: 10.1146/annurev-nutr-061121-101547] [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] [Indexed: 05/22/2024]
Abstract
Bariatric surgery is an important weight loss tool in individuals with severe obesity. It is currently the most effective long-term weight loss treatment that lowers obesity-related comorbidities. It also has significant physiological and nutritional consequences that can result in gastrointestinal complications and micronutrient deficiencies. After gastric bypass, clinical events that negatively affect nutritional status include malabsorption, dumping syndrome, kidney stones, altered intestinal bile acid availability, bowel obstruction, ulcers, gastroesophageal reflux, and bacterial overgrowth. Risk factors for poor nutritional status and excessive loss of lean body mass and bone include reduced dietary quality and inadequate intake, altered nutrient absorption, and poor patient compliance with nutrient supplementation. There are unique concerns in adolescents, older individuals, and individuals who become pregnant postoperatively. With careful management, health-care professionals can assist with long-term weight loss success and minimize the risk of acute and long-term nutrition complications after bariatric surgery.
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Affiliation(s)
- Violeta Moize
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
- Obesity Unit, Hospital Clinic Barcelona and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Blandine Laferrère
- Nutrition and Obesity Research Center, Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sue Shapses
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Nutritional Sciences and New Jersey Institute for Food, Nutrition, and Health, Rutgers University, New Brunswick, New Jersey, USA;
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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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Benaiges D, Goday A, Casajoana A, Flores-Le Roux JA, Fitó M, Pozo OJ, Serra C, Pera M, Llauradó G, Climent E, Villatoro M, Lazaro I, Castañer O, Pedro-Botet J. Short-term effects of gastric bypass versus sleeve gastrectomy on high LDL cholesterol: The BASALTO randomized clinical trial. Cardiovasc Diabetol 2024; 23:205. [PMID: 38879559 PMCID: PMC11180388 DOI: 10.1186/s12933-024-02296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/04/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND There has been a substantial increase in the use of laparoscopic sleeve gastrectomy (SG) to treat morbid obesity despite observational evidence demonstrating the superiority of Roux-en-Y gastric bypass (RYGB) for reducing low-density lipoprotein (LDL) cholesterol. The main aim was to ascertain whether high LDL cholesterol levels should be considered when selecting the most appropriate surgical procedure for each patient (RYGB or SG). METHODS In this single-center, randomized clinical trial using intention-to-treat analysis, 38 patients with severe obesity and elevated levels of LDL cholesterol were randomly assigned to undergo RYGB or SG. The primary outcome was LDL cholesterol remission at 12 months, defined as LDL cholesterol < 3.36 nmol/l without lipid-lowering medications. Secondary outcomes included changes in weight, other comorbidities, qualitative lipoprotein traits, cholesterol esters, glycoproteins, cholesterol absorption and synthesis metabolites and complications. RESULTS Intention-to-treat analysis revealed that LDL cholesterol remission occurred in 66.6% of RYGB patients compared to 27.8% of SG patients (p = 0.019). Among patients completing follow-up, RYGB demonstrated superior remission (80.0% vs. 29.4%, p = 0.005). Exclusive benefits of RYGB included a reduction in large, medium, and small LDL particles. Cholesterol absorption markers showed differential behavior after both techniques: campesterol (Δ -15.2 µg/mg, 95% CI -30.2 to -0.1) decreased after RYGB, and sitosterol (Δ 21.1 µg/mg, 95% CI 0.9 to 41.2), cholestanol (Δ 30.6 µg/mg, 95% CI 14.8 to 57.9) and campesterol (Δ 18.4 µg/mg, 95% CI 4.4 to 32.3) increased after SG. No differences in weight loss, cholesterol esters, glycoproteins, cholesterol synthesis metabolites or postoperative complications were observed between techniques. CONCLUSION In conclusion, RYGB is superior to SG in terms of short-term of high LDL cholesterol remission. Furthermore, RYGB also led to a greater improvement in lipoprotein parameters that confer an atherogenic profile. Therefore, the presence of elevated levels of LDL cholesterol should be considered when determining the optimal bariatric surgery procedure for each patient. TRIAL REGISTRATION Clinicaltrials.gov number, NCT03975478).
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Affiliation(s)
- David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain.
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain.
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain.
- Consorci Sanitari de l'Alt Penedès i Garraf, Vilafranca del Penedès, Spain.
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain.
| | - Albert Goday
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
- Department of Medicine, Universitat Autònoma de Barcelona. Plaça Cívica, Bellaterra, Barcelona, 08193, Spain
| | - Anna Casajoana
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- Esophago-Gastric and Bariatric Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Juana A Flores-Le Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
| | - Montserrat Fitó
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Oscar J Pozo
- Applied Metabolomics Research Group, Neurosciences Research Program, IMIM (Hospital del Mar Research Institute), Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Carme Serra
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Manuel Pera
- Esophago-Gastric and Bariatric Surgery Unit, Department of Surgery, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
| | - Elisenda Climent
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
| | - Montserrat Villatoro
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
| | - Iolanda Lazaro
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Olga Castañer
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- CiberOBN. Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
- Ciber Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Avenida Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, Barcelona, 08003, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Dr. Aiguader, 80, Barcelona, 08003, Spain
- Department of Medicine, Universitat Autònoma de Barcelona. Plaça Cívica, Bellaterra, Barcelona, 08193, Spain
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Pujol-Rafols J, Carmona-Maurici J, Felsenreich DM, Shikora SA, Prager G, Di Lorenzo N, De Luca M, Uyanik O, Mazzarella M, D'Arco S, Angrisani L, Pardina E, Balibrea JM. Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines. Obes Surg 2024; 34:1395-1404. [PMID: 38472706 DOI: 10.1007/s11695-024-07142-3] [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: 12/19/2023] [Revised: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). AIM To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. METHODS All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. RESULTS Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. CONCLUSIONS Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.
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Affiliation(s)
- J Pujol-Rafols
- Metabolic and Bariatric Surgery Unit (UCOM), Clínica Mi Tres Torres and Hospital HM Delfos, Barcelona, Spain.
| | - J Carmona-Maurici
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - D M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - S A Shikora
- Harvard Medical School, Department of Surgery Brigham and Women's Hospital, Boston, MA, USA
| | - G Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - N Di Lorenzo
- Dept. of Surgical Sciences, Università di Roma Tor Vergata, Roma, Italy
| | - M De Luca
- Department of Surgery, Rovigo Hospital, Italy
| | - O Uyanik
- Department of General and Digestive Surgery, Hospital Consorci Alt Penedes i Garraf, Hospital Residencia Sant Camil, Sant Pere de Ribes, Barcelona, Spain
| | | | - S D'Arco
- IFSO Headquarters, Naples, Italy
| | - L Angrisani
- Department of Public Health, Federico II" University of Naples, Naples, Italy
| | - E Pardina
- Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - J M Balibrea
- Endocrine, Metabolic and Bariatric Surgery Unit, Department of Surgery, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
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Alsabani MH, Alenezi FK, Alotaibi BA, Alotaibi AA, Olayan LH, Aljurais SF, Alarfaj N, Alkhurbush D, Almuhaisen G, Alkhmies L, Al Harbi MK. Ratios of Neutrophils and Platelets to Lymphocytes as Predictors of Postoperative Intensive Care Unit Admission and Length of Stay in Bariatric Surgery Patients: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:753. [PMID: 38792936 PMCID: PMC11123009 DOI: 10.3390/medicina60050753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: This study aimed to investigate the role of the pre- and postoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in predicting intensive care unit (ICU) admission and postoperative length of stay (LOS) in bariatric surgery. Materials and Methods: We retrospectively analysed 96 patients who underwent bariatric surgery at our institution. The NLR and PLR were calculated in the pre- and postoperative stages. Changes in pre- and postoperative hematological ratios were compared using the Wilcoxon signed-rank test. The optimal cutoff values and area under the curve (AUC) for each ratio were calculated using receiver operating characteristic (ROC) analysis. Multivariate linear regression analysis was used to assess the relationship between each ratio and the postoperative LOS after adjusting for age, sex, and American Society of Anesthesiologists (ASA) score. Results: The median age of our patients was 35.50 years, and 54.2% were male. The preoperative NLR showed a significant increase from 1.44 to 6.38 postoperatively (p < 0.001). The PLR increased from 107.08 preoperatively to 183.58 postoperatively, p < 0.001). ROC analysis showed that the postoperative NLR was a moderate to high predictor of ICU admission (AUC = 0.700, optimal cutoff point = 5.987). The postoperative PLR had less predictive power for ICU admission (AUC = 0.641, optimal cutoff point = 170.950). Ratios that had a statistically significant relationship with the postoperative LOS were the preoperative NLR (standardized β [95% CI]: 0.296 [0.115-0.598]), postoperative NLR (0.311 [0.034-0.161]), and postoperative PLR (0.236 [0.000-0.005]). Conclusions: The NLR and PLR demonstrated an independent relationship with the postoperative LOS after bariatric surgery and the predictive ability of ICU admission. Both ratios might be useful as simple markers to predict patient outcome after surgery.
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Affiliation(s)
- Mohmad H. Alsabani
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
| | - Faraj K. Alenezi
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
| | - Badi A. Alotaibi
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Ahmed A. Alotaibi
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
| | - Lafi H. Olayan
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
| | - Saleh F. Aljurais
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
| | - Najd Alarfaj
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
| | - Deem Alkhurbush
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
| | - Ghaida Almuhaisen
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
| | - Lena Alkhmies
- Anesthesia Technology Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia; (F.K.A.); .; (L.H.O.); (S.F.A.); (N.A.); (D.A.); (G.A.); (L.A.)
| | - Mohammed K. Al Harbi
- King Abdullah International Medical Research Centre, Riyadh 11481, Saudi Arabia; (B.A.A.); (M.K.A.H.)
- Department of Anesthesia, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
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Dargent J. Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project. Sci Rep 2024; 14:1252. [PMID: 38218989 PMCID: PMC10787753 DOI: 10.1038/s41598-024-51441-9] [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: 05/10/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021-March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.
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Affiliation(s)
- Jerome Dargent
- Polyclinique de Rillieux, 65 Rue des Contamines, 69140, Rillieux-la-Pape, France.
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10
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Kermansaravi M, Valizadeh R, Shahsavan M, Adel Maleknia S, Eghbali F, Pazouki A, Shahmiri SS. Metabolic and bariatric surgery in patients with class I obesity; a two-year follow-up. BMC Surg 2024; 24:6. [PMID: 38172751 PMCID: PMC10765846 DOI: 10.1186/s12893-023-02295-x] [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: 09/21/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Patients with class I obesity may need metabolic and bariatric surgery (MBS) in the presence of obesity-associated medical problems, but MBS in this class of obesity is under debate. This study aimed to investigate the efficacy and safety of MBS in patients with class I obesity. METHODS AND MATERIALS This study was a historical cohort carried out on 112 patients with class I obesity with body mass index (BMI) of 30-35 kg/m2 with a 24-month follow-up underwent MBS at Rasoul-e-Akram Hospital. The required data were extracted through the Iran National Obesity Surgery Database. The data required for the study consisted of demographic information such as age, gender, and obesity-associated medical problems like type-2 diabetes mellitus (T2DM), hypertension, obstructive sleep apnea, and dyslipidemia before surgery, 6, 12, and 24 months after surgery. RESULTS Mean age of the patients was 38.10 ± 10.04 years; mean BMI was 32.96 ± 1.35 kg/m2 and 83.9% (n = 94) of patients were female. Out of 18 patients with T2DM, 11 patients (61.11%) had complete remission and seven patients (38.88%) had partial remission. Obstructive sleep apnea, hypertension, dyslipidemia, and gastroesophageal reflux disease were observed in 18 (16.07%), 23 (20.53%), 43 (38.39%), and 13 patients (11.60%) before surgery and resolved at 24-month follow-up. Post-operative complications during the 24-month follow-up were checked to assess safety and there were no De novo gastroesophageal reflux disease, intolerance, leakage, pulmonary thromboembolism, deep vein thrombosis, incisional hernia, hypoalbuminemia (Albumin < 3.5 g/dl), excessive weight loss (BMI < 18.5 kg/m2) at any time during 24-months follow-ups and mortality. Early complications occurred as splenic injury in one case (0.89%), wound infection in one patient (0.89%), and extra-luminal bleeding in 10 (8.92%) after surgery, without any mortality. CONCLUSION MBS is safe and effective in class I obesity and can be considered in selected patients with obesity-associated medical problems.
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Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
| | | | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyyed Adel Maleknia
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Foolad Eghbali
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
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11
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Jackson TN, Cox BP, Grinberg GG, Yenumula PR, Lim RB, Chow GS, Khorgami Z. National usage of bariatric surgery for class I obesity: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis 2023; 19:1255-1262. [PMID: 37438232 DOI: 10.1016/j.soard.2023.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 04/10/2023] [Accepted: 05/14/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND National and international consensus statements, as well as the National Institutes of Health (NIH), support the use of bariatric surgery for the treatment of class I obesity. Despite this, most payors within the United States limit reimbursement to the outdated 1991 NIH guidelines or a similar adaptation. OBJECTIVES This study aimed to determine the safety of bariatric surgery in patients with lower BMI compared with standard patients, as well as determine U.S. utilization of bariatric surgery in class I obesity in 2015-2019. SETTING A retrospective analysis was performed of the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass patients were divided into body mass index cohorts: class I obesity (<35 kg/m2) and severe obesity (≥35 kg/m2). Differences in preoperative patient selection and postoperative outcomes were established, and frequency trends were delineated. RESULTS Analysis included 760,192 surgeries with 8129 (1%) for patients with class I obesity. The patients with class I obesity were older, more commonly female, and with lower American Society of Anesthesiologists (ASA) class, but with higher rates of type 2 diabetes, hyperlipidemia, and gastroesophageal reflux disease (P < .05). Variation was found for operative time, length of stay, 30-day readmission, and composite morbidity. Minimal annual variation was found for bariatric surgeries performed for patients with class I obesity. CONCLUSIONS The short-term safety of bariatric surgery in patients with class I obesity was corroborated by this study. Despite consensus statements and robust support, rates of bariatric surgery in patients with class I obesity have failed to increase and remain limited to 1%. This demonstrates the impact of the outdated 1991 NIH guidelines regarding access to care for these potentially life-saving surgeries.
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Affiliation(s)
- Theresa N Jackson
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California.
| | - Bradley P Cox
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Gary G Grinberg
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Panduranga R Yenumula
- Department of Bariatric Surgery, Kaiser Permanente South Sacramento Medical Center, Sacramento, California
| | - Robert B Lim
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Geoffrey S Chow
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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12
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Alqahtani AR, Alqahtani O, Amro N, Al Qahtani A, Elahmedi M, Abdurabu H, Boutros A, Abdo N, Ebishi A, Awil A, Aldarwish A. Long-term outcomes of laparoscopic sleeve gastrectomy in those with class I obesity: safety, efficacy, and quality of life. Surg Obes Relat Dis 2023; 19:1135-1141. [PMID: 37076319 DOI: 10.1016/j.soard.2023.03.005] [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: 10/04/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Class I obesity carries significant morbidity and mortality risk similar to higher grades of obesity, and persons with class I obesity have a high risk of progression to class II and III obesity. While bariatric surgery has made strides in safety and efficacy, it remains inaccessible for persons with class I obesity (body mass index [BMI] of 30-35 kg/m2). OBJECTIVES To assess safety, weight loss durability, co-morbidity resolution, and quality of life after laparoscopic sleeve gastrectomy (LSG) in persons with class I obesity. SETTING Multidisciplinary medical center that specializes in obesity management. METHODS A longitudinal prospective single-surgeon registry was queried for data pertaining to persons with class I obesity who underwent primary LSG. Primary endpoint was weight loss. Secondary endpoints included change in obesity-related co-morbidities, adverse events, and post hoc analysis of symptoms of gastroesophageal reflux disease (GERD) and Bariatric Analysis and Reporting Outcome System results. Follow-up was divided into short- (1-3 yr), intermediate- (4-7 yr), and long-term (8-12 yr). We evaluated percent excess weight loss (%EWL) using linear mixed models adjusting for age, sex, years since operation, and baseline BMI. Least-squares means estimates and 95% confidence intervals (CI) were generated. RESULTS Of 13,863 bariatric procedures, a total of 1851 patients were included. Mean baseline BMI, age, and male:female ratio were 32.6 ± 2.1 kg/m2, 33.7 ± 9.2 years, and 1:5, respectively. Adjusted mean %EWL (95% CI) at short-, intermediate-, and long-term follow-up were 111% (95% CI, 91%-131%), 110% (95% CI, 89%-131%), and 141% (95% CI, 57%-225%), respectively. Of 195 patients with type 2 diabetes, 59% experienced complete remission, and of 168 patients with hypertension, 43% experienced complete remission. Being on oral antidiabetes medication was a significant predictor of sustained remission compared with being on insulin or combination therapy (P < .001). Sixty-nine patients had symptoms of GERD before surgery, which improved in 55 (79.7%). Thirty-three patients developed de novo symptoms of GERD. The average Bariatric Analysis and Reporting Outcome System score was 4.5 ± 1.7, with 83% of participants rating their quality of life after surgery as good, very good, or excellent. CONCLUSION Those with class I obesity who undergo LSG experience normalization of weight, sustained remission of co-morbidity, and good quality of life without significant risk of morbidity or mortality.
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Affiliation(s)
| | - Omar Alqahtani
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nizar Amro
- New You Medical Center, Riyadh, Saudi Arabia
| | - Awadh Al Qahtani
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Nael Abdo
- New You Medical Center, Riyadh, Saudi Arabia
| | | | - Amal Awil
- New You Medical Center, Riyadh, Saudi Arabia
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13
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Shahmiri SS, Parmar C, Yang W, Lainas P, Pouwels S, DavarpanahJazi AH, Chiappetta S, Seki Y, Omar I, Vilallonga R, Kassir R, Abbas SI, Bashir A, Singhal R, Kow L, Kermansaravi M. Bariatric and metabolic surgery in patients with low body mass index: an online survey of 543 bariatric and metabolic surgeons. BMC Surg 2023; 23:272. [PMID: 37689633 PMCID: PMC10492360 DOI: 10.1186/s12893-023-02175-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/29/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) in patients with low body mass index patients is a topic of debate. This study aimed to address all aspects of controversies in these patients by using a worldwide survey. METHODS An online 35-item questionnaire survey based on existing controversies surrounding MBS in class 1 obesity was created by 17 bariatric surgeons from 10 different countries. Responses were collected and analysed by authors. RESULTS A total of 543 bariatric surgeons from 65 countries participated in this survey. 52.29% of participants agreed with the statement that MBS should be offered to class-1 obese patients without any obesity related comorbidities. Most of the respondents (68.43%) believed that MBS surgery should not be offered to patients under the age of 18 with class I obesity. 81.01% of respondents agreed with the statement that surgical interventions should be considered after failure of non-surgical treatments. CONCLUSION This survey demonstrated worldwide variations in metabolic/bariatric surgery in patients with class 1 obesity. Precise analysis of these results is useful for identifying different aspects for future research and consensus building.
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Affiliation(s)
- Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
- Iran National Centre of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
| | - Chetan Parmar
- Consultant Surgeon and Head of Department, Whittington Hospital, London, UK
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Panagiotis Lainas
- Department of Surgery, Metropolitan Hospital, HEAL Academy, Athens, Greece
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands
| | - Amir Hossein DavarpanahJazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
- Iran National Centre of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Islam Omar
- Wirral University Teaching Hospital, Birkenhead, UK
| | - Ramon Vilallonga
- Obesity and Metabolic Surgery Unit, Vall Hebron Campus Hospital, Barcelona, Spain
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Syed Imran Abbas
- Director Obesity & Metabolic Surgery Clinic, Iranian Hospital Dubai, UAE. CEO & Founder of GLR International, Dubai, UAE
| | | | - Rishi Singhal
- Consultant Bariatric & Upper GI Surgeon, Birmingham Heartlands Hospital, University Hospital Birmingham, UK. Honorary Senior Lecturer, University of Birmingham, Medical Director, Healthier Weight, Birmingham, UK
| | - Lilian Kow
- Flinders University South Australia, Adelaide, Australia
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Centre of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
- Iran National Centre of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran.
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14
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Alessandris R, Moroso F, Michelotto M, Fassan M, Angerilli V, Callegari L, Foletto M. Preoperative endoscopy and pathology report of the specimen to be recommended in sleeve gastrectomy? Pathologica 2023; 115:90-96. [PMID: 37017300 PMCID: PMC10463000 DOI: 10.32074/1591-951x-781] [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: 05/23/2022] [Accepted: 12/12/2022] [Indexed: 04/06/2023] Open
Abstract
Objective Preoperative upper gastrointestinal endoscopy (UGIE) and postoperative histopathological examination (HPE) of resected specimens are still controversial issues in bariatric surgery. Methods A retrospective review of prospectively collected laparoscopic sleeve gastrectomies (SG) performed at our institution for morbid obesity was carried out. All patients underwent pre-operative UGIE with biopsy, post-operative HPE and conventional post-operative follow-up. Results From January 2019 through January 2021 we performed a total of 501 laparoscopic SG. A total of 12 (2.4%) neoplasms were found, 2 evident at preoperative UGIE, 4 detected during operation, and 6 at HPE. Eight of these 12 cases had some malignant potential and 5 would not have been detected without HPE of the specimen. The most significant unexpected case was a fundic gland type adenocarcinoma in a 64-year-old female with severe obesity. Conclusion On the basis of our clinical experience, we recommend both preoperative endoscopic assessment and postoperative HPE of the specimen to provide the best available treatment to these patients.
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Affiliation(s)
- Remo Alessandris
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Federico Moroso
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Mauro Michelotto
- Surgical Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
- Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Valentina Angerilli
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Linda Callegari
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
| | - Mirto Foletto
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Bariatric Unit, University of Padua, Padua, Italy
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15
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Symmetric three-port laparoscopic Roux-en-Y gastric bypass: a novel technique that is safe, effective, and feasible. Surg Today 2023; 53:702-708. [PMID: 36737497 DOI: 10.1007/s00595-022-02629-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/21/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Single-incision laparoscopic surgery (SILS) has been validated as a safe approach for bariatric surgery. However, as the utilization of SILS in bariatric surgery is still limited by its disadvantages, this study analyzes the outcomes of symmetric three-port laparoscopic Roux-en-Y gastric bypass (STLGB). METHODS The medical records of patients who underwent STLGB between January 2018 and February 2021 were analyzed retrospectively using an institutional database. The patients were divided into four groups according to their baseline body mass index (BMI). The primary endpoints were operative time, length of stay, complication rate, and weight loss 12 months after surgery. RESULTS We analyzed the records of 101 patients who underwent STLGB. There was a slight predominance of women (n = 61; 60.4%). The mean operative time was 97.16 ± 38.79 min and the length of stay in the hospital after surgery was 2.79 ± 1.4 days. One patient (0.99%) suffered a gastrojejunal anastomosis leak within 30 days of surgery. There were no significant differences in LOS, complication rate, or cosmetic score among the four groups. The mean BMI reduction was 8.67 kg/m2 and the % total weight loss (%TWL) was 24.37%. Weight loss measured 12 months after surgery was significantly different among the four groups. CONCLUSIONS STLGB is safe, effective, and feasible for all kinds of patients. It is reproducible with standardization of the procedure.
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Wu JX, He Q, Zhou Y, Xu JY, Zhang Z, Chen CL, Wu YH, Chen Y, Qin LQ, Li YH. Protective effect and mechanism of lactoferrin combined with hypoxia against high-fat diet induced obesity and non-alcoholic fatty liver disease in mice. Int J Biol Macromol 2023; 227:839-850. [PMID: 36563804 DOI: 10.1016/j.ijbiomac.2022.12.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Obesity is a global epidemic, it can induce glucose and lipid metabolism disorder and non-alcoholic fatty liver disease (NAFLD). This study explored a new way to control weight and improve fatty liver, namely, living in hypoxia environment and supplement with lactoferrin (Lf). Sixty male C57BL/6J mice were divided into six groups, namely, control, hypoxia, high-fat diet, hypoxia + high-fat diet, hypoxia + high-fat diet + low dose Lf intervention, and hypoxia + high-fat diet + high-dose Lf intervention. Mice in the hypoxia treatment groups were treated with approximately 11.5 % oxygen for 6 h every day for 8 weeks. Results showed that interventions combining Lf and hypoxia treatments showed better effect against obesity and NAFLD than hypoxia treatment alone. The interventions controlled weight gain in mice, improved glucolipid metabolism in mice. The combination intervention reduced cholesterol absorption by reducing the level of hydrophobic bile acids, and elevating the level of hydrophilic bile acids. Gut microbiota analysis revealed that the combination intervention considerably elevated short chain fatty acids (SCFAs)-producing bacteria level, and reduced the Desulfovibrionaceae_unclassified level. Thus, Lf combined with hypoxia intervention effectively prevents obesity and NAFLD by restoring gut microbiota composition and bile acid profile.
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Affiliation(s)
- Jiang-Xue Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China
| | - Qian He
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China
| | - Yan Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China
| | - Jia-Ying Xu
- State Key Laboratory of Radiation Medicine and Protection, School of Radiation Medicine and Protection, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China
| | - Zheng Zhang
- Center of Child Health Management, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Cai-Long Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China; Center of Child Health Management, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yun-Hsuan Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China
| | - Yun Chen
- Food Science School, Guangdong Pharmaceutical University, Zhongshan, Guangdong, China
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China.
| | - Yun-Hong Li
- Department of Nutrition and Food Hygiene, School of Public Health, Suzhou Medical college of Soochow University, Suzhou, Jiangsu, China.
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17
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Hampton L, Mocanu V, Verhoeff K, Birch DW, Karmali S, Switzer NJ. Asian race is not associated with increased 30-day serious complications or mortality: a MBSAQIP analysis of 594 837 patients. Surg Endosc 2023; 37:3893-3900. [PMID: 36720752 DOI: 10.1007/s00464-023-09898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/16/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION With expansion of bariatric surgery indications to include Asian patients with diabetes and body mass index (BMI) ≥ 27.5, or BMI ≥ 32.5, it is important to characterize Asian patient population undergoing bariatric surgery and assess their postoperative outcomes. METHODS This retrospective study analyzed the 2015-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All patients undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) who self-reported as Asian or White race were included. The primary outcomes were to characterize the Asian race population in North American and to identify if Asian race was associated with serious complications or mortality at 30 days. RESULTS Overall, 594,837 patients met inclusion, with 4229 self-reporting Asian racial status. Patients of Asian race were younger (41.8 vs 45.5 years, p < 0.001) and had a lower BMI (42.8 vs 44.7 kg/m2 p < 0.001) than White patients. They were also more likely to have insulin dependent diabetes (10.9% vs 8.2%, p < 0.001), have received prior cardiac surgery (10.0% vs 1.2% p < 0.001), and suffer from renal insufficiency (1.0% vs 0.5%, p < 0.001). There were no significant differences between rates of RYGB (28.3% vs 28.9%, p = 0.4) and mean operative duration (87.7 vs 87.5 min, p = 0.7). Additionally, there were no differences in 30 day outcomes including leak (0.5% vs 0.5%, p = 0.625), bleeding (1.2% vs 1.0%, p = 0.1), serious complications (3.4% vs 3.5%, p = 0.6), or mortality (0.1% vs 0.1%, p = 0.7) and after confounder control, Asian race was not independently associated with serious complications (OR 1.0, CI 0.9-1.2, p = 0.7), or mortality (OR 1.1, CI 0.3-3.3, p = 0.1). CONCLUSIONS Despite the increased metabolic burden of Asian patients, no differences in 30-day outcomes compared to White patients occurs. This data supports evidence suggesting these patients may safely undergo bariatric surgery independent of their increased metabolic burden.
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Affiliation(s)
- Lauren Hampton
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Noah J Switzer
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
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18
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Qin ZH, Yang X, Zheng YQ, An LY, Yang T, Du YL, Wang X, Zhao SH, Li HH, Sun CK, Sun DL, Lin YY. Quality evaluation of metabolic and bariatric surgical guidelines. Front Endocrinol (Lausanne) 2023; 14:1118564. [PMID: 36967766 PMCID: PMC10035593 DOI: 10.3389/fendo.2023.1118564] [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: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To evaluate the quality of surgical guidelines on bariatric/metabolic surgery. METHODS Four independent reviewers used the AGREE II (The Appraisal of Guidelines for Research and Evaluation II) tool to assess the methodological quality of the included guidelines and conducted a comparative analysis of the main recommendations for surgical methods of these guidelines. RESULTS Nine surgical guidelines were included in this study. Five articles with AGREE II scores over 60% are worthy of clinical recommendation. The field of rigor of development was relatively low, with an average score of 50.82%. Among 15 key recommendations and the corresponding best evidence in the guidelines, only 4 key recommendations were grade A recommendations. CONCLUSIONS The quality of metabolic and bariatric guidelines is uneven, and there is much room for improvement.
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Affiliation(s)
- Zi-Han Qin
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ya-Qi Zheng
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li-Ya An
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Yang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yu-Lu Du
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiao Wang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shu-Han Zhao
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hao-Han Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheng-Kai Sun
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Da-Li Sun, ; Yue-Ying Lin,
| | - Yue-Ying Lin
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- *Correspondence: Da-Li Sun, ; Yue-Ying Lin,
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19
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 173] [Impact Index Per Article: 173.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, New South Wales, Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
- Division of Pediatric Surgery, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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20
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2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022; 18:1345-1356. [PMID: 36280539 DOI: 10.1016/j.soard.2022.08.013] [Citation(s) in RCA: 236] [Impact Index Per Article: 118.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
Major updates to 1991 National Institutes of Health guidelines for bariatric surgery.
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21
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Holmes S, Sarma S, Campbell S, Azab A, Qiang J, Mukerji G. Gaps in Referral to Bariatric Surgery for Patients With Type 2 Diabetes Seen in Endocrinology Clinics. Can J Diabetes 2022; 46:835-842.e1. [PMID: 36088215 DOI: 10.1016/j.jcjd.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES One-third of adults in Canada are overweight and 26.8% experience obesity. Bariatric surgery confers effective weight loss and reduces obesity-related complications, including type 2 diabetes, but remains an underutilized treatment. Our objective in this study was to determine whether a gap exists in bariatric program referrals for patients with type 2 diabetes seen in endocrinology clinics at an ambulatory tertiary care hospital in Toronto, Canada. METHODS A retrospective chart review was conducted of 843 consecutive patients with type 2 diabetes in endocrinology clinics between January 1, 2015 and December 31, 2020. Inclusion criteria were age ≥18 years, type 2 diabetes and body mass index (BMI)>35 kg/m2. Exclusion criteria were recent active cancer, uncontrolled psychiatric disease or active substance use disorder within 6 months of the initial visit. Referrals to bariatric surgery were assessed within a 5-year follow-up period and compared with baseline referral rates from the Ontario Bariatric Network (OBN). An online survey of 48 endocrinologists in Toronto, Ontario, was also conducted to assess physician-level barriers to referral. RESULTS The proportion of patients with class II obesity (BMI>35 kg/m2) and type 2 diabetes meeting the eligibility criteria for bariatric referral was 4.6% (n=38). A documented discussion about bariatric surgery occurred with 7 (18.0%) of these eligible patients, and 1 patient (2.6%) was referred for surgery. Aside from surgical referrals, only 2.6% of eligible patients were referred to cognitive-behavioural therapy, 36.8% were initiated on obesity pharmacotherapy and 42.1% were referred to a dietitian. Baseline OBN data demonstrated that most surgical referrals (n=6,360) were from family physicians (65.0%) and only 8.8% were from a medical specialist. Eight percent of surveyed endocrinologists reported that they discussed bariatric surgery with at least half of their eligible patients. The most frequent barrier to discussing bariatric surgery during visits was time constraints. Physicians identified that simplifying the referral process and providing bariatric surgery handouts would be helpful interventions to improve referral rates. CONCLUSIONS Our gap analysis demonstrated a low bariatric surgery referral rate by tertiary care endocrinologists. Our study also identified a large gap in the appropriate treatment of obesity with poor utilization of behavioural, lifestyle and pharmacotherapy practices. As obesity and diabetes rates increase, better education, training and knowledge translation will be necessary to overcome weight bias and prioritize obesity management.
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Affiliation(s)
- Sheila Holmes
- Division of Endocrinology and Metabolism, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shohinee Sarma
- Division of Endocrinology and Metabolism, Sinai Leadership Centre for Diabetes, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sara Campbell
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Abdulrahman Azab
- Division of Endocrinology and Metabolism, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Judy Qiang
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Division of Endocrinology and Metabolism, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.
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22
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Yao G, Aierken A, Li T, Cao X, Apaer S, Anweier N, Wu J, Fulati X, Zhang YF, Tuerxunmaimaiti A, Tuxun T. The influence of geometric algebra in surgical practice of sleeve gastrectomy-single center experience. Medicine (Baltimore) 2022; 101:e30783. [PMID: 36316944 PMCID: PMC9622570 DOI: 10.1097/md.0000000000030783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Laparoscopic surgery could be considered as an art of geometric algebra. However, very little is studied in the context of bariatric surgery. The current study aims to explore the possible influence concept of geometric algebra on the surgical process in the overweight and obese patients in the setting of laparoscopic sleeve gastrectomy (LSG). During the study period, clinical data of subjects who underwent LSG was retrospectively analyzed. Parameters examined include body mass index (BMI), umbilical-xiphoidal interval (U-X) and umbilical-fundus (U-F) interval. In this study, LSG was performed via central view approach (C) and left view approach (L). In both groups, the body surface projection points of viewing hole (V), main and accessory operating holes (O1 and O2) and surface display of fundus (F) were connected to form a geometric figure. The accessibility of the surgical instrument into the fundus, the need for elongated instruments and related intra- and post-operative parameters were noted. The overweight and obese subjects showed a significant increased U-X and U-F interval compared to the non-obese subjects. The length of both U-X and U-F interval were correlated with the BMI. The geometric figure is quite different between L and C approach with significant increase of area of quadrangle. Significant longer O1-F, O2-F and V-F interval was calculated in C approach of patients and thus the elongated instruments were frequently required. The integration of the concept geometric algebra with the proper selection of troca may provide a better surgical experience and smooth surgical process.
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Affiliation(s)
- Gang Yao
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Amina Aierken
- Health Management Institute, Xinjiang Medical University, Urumqi, China
| | - Tao Li
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xinling Cao
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shadika Apaer
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Nuerzhatijaing Anweier
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jing Wu
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiapukaiti Fulati
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yun-Fei Zhang
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudushalamu Tuerxunmaimaiti
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tuerhongjiang Tuxun
- Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- *Correspondence: Tuerhongjiang Tuxun, Department of Liver & Laparoscopic Surgery, Center of Digestive and Vascular Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China (e-mail: )
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23
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Elnabil-Mortada A, Elmaleh HM, Ackroyd R, Khaled RA. Effectiveness and Safety of Laparoscopic Sleeve Gastrectomy for Weight Loss in Mild Obesity: Prospective Cohort Study with 3-Year Follow-up. Obes Surg 2022; 32:1918-1925. [PMID: 35201570 PMCID: PMC8867692 DOI: 10.1007/s11695-022-05958-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/24/2022] [Accepted: 02/02/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Patients with mild obesity especially in absence of associated medical problems (OAMP) are commonly managed by non-surgical approaches. Laparoscopic sleeve gastrectomy (LSG) has proved itself to be effective and it is now the most performed weight loss procedure. We aimed to study the effectiveness and safety of LSG for weight loss in mild obesity. METHODS A prospective cohort study. Group A; BMI (30-34.9 kg/m2), and group B; BMI ≥ 40 or BMI ≥ 35 with OAMP. Demographic data, perioperative complications, % excess weight loss (EWL), % total weight loss (TWL), nutritional profile, and evolution of OAMP were recorded and statistically analyzed. RESULTS A total of 250 patients, with 80 patients (32%) in group A, and 170 (68%) in group B. The majority were female. The mean preoperative weight, BMI, and excess weight were 90.1 ± 9.52, 32.7 ± 1.4, and 21.5 ± 4.9 in group A, and 129.88 ± 26.12, 47.8 ± 8.2, and 62.3 ± 23.6 kg in group B respectively. The low BMI group had significantly lower OAMP, with higher pre-LSG non-surgical procedures rate. Overall post-operative morbidity rate was significantly higher in group B. %TWL was significantly lower in low BMI group. Nutritional profile was within the normal range in both groups at 3-year follow-up. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective weight loss solution for mild obesity with better outcome than for higher BMI. Further studies are warranted to reconsider NIH's statement for medicolegal aspects, and for matching the current changes in bariatric surgery practice, safety evidence, and patients' demand.
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Affiliation(s)
- Ahmed Elnabil-Mortada
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Haitham M Elmaleh
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Roger Ackroyd
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rabbah A Khaled
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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24
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Climent E, Oliveras A, Pedro-Botet J, Goday A, Benaiges D. Bariatric Surgery and Hypertension. J Clin Med 2021; 10:jcm10184049. [PMID: 34575161 PMCID: PMC8467380 DOI: 10.3390/jcm10184049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022] Open
Abstract
A clear pathogenetic association exists between obesity and arterial hypertension, becoming even more evident in subjects with severe obesity. Bariatric surgery has proved to be the most effective treatment for severe obesity, with its benefits going beyond weight loss. The present review aimed to determine the effects of bariatric surgery on arterial hypertension evident in short- and long-term follow-ups. Moreover, the differences between surgical techniques regarding hypertension remission are described as well as the possible pathophysiologic mechanisms involved. In addition, the effects of bariatric surgery beyond blood pressure normalization are also analyzed, including those on target organs and cardiovascular morbidity and mortality.
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Affiliation(s)
- Elisenda Climent
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Anna Oliveras
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Nephrology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Area of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28029 Madrid, Spain
| | - Juan Pedro-Botet
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Albert Goday
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, 28029 Madrid, Spain
| | - David Benaiges
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Consorci Sanitari de l’Alt Penedès i Garraf, 08720 Vilafranca del Penedès, Spain
- Correspondence: ; Tel.: +34-93-248-3902; Fax: +34-93-248-3254
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25
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Ricciardi C, Gubitosi A, Lanzano G, Parisi S, Grella E, Ruggiero R, Izzo S, Docimo L, Ferraro G, Improta G. Health technology assessment through the six sigma approach in abdominoplasty: Scalpel vs electrosurgery. Med Eng Phys 2021; 93:27-34. [PMID: 34154772 DOI: 10.1016/j.medengphy.2021.05.019] [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: 09/04/2020] [Revised: 05/11/2021] [Accepted: 05/25/2021] [Indexed: 12/30/2022]
Abstract
Abdominoplasty is a surgical procedure conducted to reduce excess abdominal skin and fat and improve body contouring. Despite being commonly performed, it is associated with a risk of complications such as infection, seroma, haematoma and wound dehiscence. To reduce the incidence of complications, different methods are used to create the abdominal flap, i.e., incision with a scalpel or electrosurgery. In this study, health technology assessment (HTA) using the Six Sigma methodology was conducted to compare these incision techniques in patients undergoing abdominoplasty. Two consecutively enroled groups of patients (33 in the scalpel group and 35 in the electrosurgery group) who underwent surgery at a single institution, the University of Campania "Luigi Vanvitelli", were analysed using the drain output as the main outcome for comparison of the incision techniques. While no difference was found regarding haematoma or seroma formation (no cases in either group), the main results also indicate a greater drain output (p-value<0.001) and a greater incidence of dehiscence (p-value=0.056) in patients whose incisions were made through electrosurgery. The combination of HTA and the Six Sigma methodology was useful to prove the possible advantages of creating skin incisions with a scalpel in full abdominoplasty, particularly a significant reduction in the total drain output and a reduction in wound healing problems, namely, wound dehiscence, when compared with electrosurgery, despite considering two limited and heterogeneous groups.
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Key Words
- Abdominoplasty
- Acronyms: BMI, body mass index
- CTQ, critical to quality
- DMAIC
- DMAIC, define, measure, analyse, improve, and control
- HTA, health technology assessment
- Health technology assessment
- K, potassium
- Na, sodium
- Six Sigma
- WBC, white blood cells
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Affiliation(s)
- C Ricciardi
- Department of Advanced Biomedical Sciences, University Hospital of Naples "Federico II", Via S. Pansini, 5, Naples 80131, Italy.
| | - A Gubitosi
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Lanzano
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Parisi
- Division of General, Min-invasive and Bariatric Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini no 5, Naples 80131 Italy
| | - E Grella
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - R Ruggiero
- Division of General, Min-invasive and Bariatric Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini no 5, Naples 80131 Italy
| | - S Izzo
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - L Docimo
- Division of General, Min-invasive and Bariatric Surgery, University of Study of Campania "Luigi Vanvitelli" Naples, via Luigi Pansini no 5, Naples 80131 Italy
| | - G Ferraro
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Improta
- Department of Public Health, University Hospital of Naples "Federico II", Naples, Italy
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Angrisani L, Santonicola A, Iovino P, Ramos A, Shikora S, Kow L. Bariatric Surgery Survey 2018: Similarities and Disparities Among the 5 IFSO Chapters. Obes Surg 2021; 31:1937-1948. [PMID: 33432483 PMCID: PMC7800839 DOI: 10.1007/s11695-020-05207-7] [Citation(s) in RCA: 246] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the last decade. METHODS All IFSO Societies were asked to fill in the IFSO survey form on how many and which surgical and endoluminal interventions have been performed in the 2018. A special section was added, asking about the existence of national guidelines for bariatric and metabolic surgery, national recommendations for preoperative gastroscopy, type of reimbursement for bariatric/metabolic surgery, including for patients with BMI < 35 kg/m2. The trend analyses from 2008 to 2018 were also performed. RESULTS Fifty-seven/65 (87.7%) IFSO Societies submitted completed forms. The American Society for Metabolic and Bariatric Surgery did not fill the IFSO survey form but provided an official report on the performed interventions. The total number of surgical and endoluminal procedures performed in 2018 in the world was 696,191. Sleeve gastrectomy (SG) remained the most commonly performed bariatric procedure (N = 386,096; 55.4%). Among the total reported bariatric/metabolic interventions, 604,223 (86.8%) were primary surgical and 29,167 (4.2%) primary endoluminal operations; 62,801 (9%) were revisional procedures. CONCLUSIONS There was only a slight increase (10.317 procedures) in the total number of the reported bariatric interventions compared to the last IFSO survey. SG continues to be the most commonly performed operation since 2014. The one anastomosis gastric bypass (OAGB), currently the third most performed procedure after SG and Roux-en-Y gastric bypass (RYGB), continues to rise in popularity worldwide.
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Affiliation(s)
- Luigi Angrisani
- Public Health Department "Federico II" University of Naples, Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Almino Ramos
- Gastro-Obeso-Center Institute, São Paulo, Brazil
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lilian Kow
- Flinders University, Adelaide, South Australia, Australia
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Zhang NJ, Fu YZ, Shan XD, Zhang N, Sun XT, Chu XH, Bi Y, Zhu DL, Feng WH. Are Chinese Patients with Type 2 Diabetes and a Body Mass Index of 27.5-32.5 kg/m 2 Suitable for Metabolic Surgery? A One-Year Post-Surgery Study. Diabetes Ther 2021; 12:1429-1444. [PMID: 33740209 PMCID: PMC8099981 DOI: 10.1007/s13300-021-01027-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/08/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to clarify the efficacy and safety of metabolic surgery in Chinese patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 27.5-32.5 kg/m2. METHODS A total of 99 patients with T2DM were enrolled in this retrospective cohort study. Of these patients, 53 had a BMI of 27.5-32.5 kg/m2 and had undergone metabolic surgery (n = 21) or were on conventional antidiabetic therapy (n = 32)]; 46 had a BMI ≥ 32.5 kg/m2 and all had undergone metabolic surgery. Primary endpoints included the triple endpoint [hemoglobin A1c < 6.5%, low-density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L, and systolic blood pressure (SBP) < 130 mmHg] and successful weight loss 1 year later. Remission of diabetes, glucose and lipid metabolism, medication usage, and adverse events were evaluated. RESULTS Of patients with BMI 27.5-32.5 kg/m2 undergoing metabolic surgery, 33.33% achieved the composite endpoints, and 100% achieved successful weight loss. This result was similar to that in patients with BMI ≥ 32.5 and better than those with BMI 27.5-32.5 kg/m2 receiving conventional antidiabetic therapy. A significant and similar reduction in BMI, waist circumference, SBP, serum LDL-C, hemoglobin A1c, and uric acid, as well as similar frequency postoperative adverse events, were confirmed in both metabolic surgery groups. Patients with BMI 27.5-32.5 kg/m2 who had undergonemetabolic surgery showed more metabolic improvement than those only receiving medications but they experienced more adverse events. CONCLUSION A BMI cutoff of 27.5 kg/m2 for metabolic surgery may be suitable for Chinese patients with T2DM.
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Affiliation(s)
- Ning-Jing Zhang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yu-Zhe Fu
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Xiao-Dong Shan
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ning Zhang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xi-Tai Sun
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xue-Hui Chu
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Bi
- Department of Endocrinology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Da-Long Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Wen-Huan Feng
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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Angrisani L, Santonicola A, Iovino P, Ramos A, Shikora S, Kow L. Bariatric Surgery Survey 2018: Similarities and Disparities Among the 5 IFSO Chapters. Obes Surg 2021. [PMID: 33432483 DOI: 10.1007/s11695-020-05207-7.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND The 2018 IFSO Survey focused on similarities and disparities in the number and types of surgical and endoluminal interventions among the IFSO chapters occurred in the last decade. METHODS All IFSO Societies were asked to fill in the IFSO survey form on how many and which surgical and endoluminal interventions have been performed in the 2018. A special section was added, asking about the existence of national guidelines for bariatric and metabolic surgery, national recommendations for preoperative gastroscopy, type of reimbursement for bariatric/metabolic surgery, including for patients with BMI < 35 kg/m2. The trend analyses from 2008 to 2018 were also performed. RESULTS Fifty-seven/65 (87.7%) IFSO Societies submitted completed forms. The American Society for Metabolic and Bariatric Surgery did not fill the IFSO survey form but provided an official report on the performed interventions. The total number of surgical and endoluminal procedures performed in 2018 in the world was 696,191. Sleeve gastrectomy (SG) remained the most commonly performed bariatric procedure (N = 386,096; 55.4%). Among the total reported bariatric/metabolic interventions, 604,223 (86.8%) were primary surgical and 29,167 (4.2%) primary endoluminal operations; 62,801 (9%) were revisional procedures. CONCLUSIONS There was only a slight increase (10.317 procedures) in the total number of the reported bariatric interventions compared to the last IFSO survey. SG continues to be the most commonly performed operation since 2014. The one anastomosis gastric bypass (OAGB), currently the third most performed procedure after SG and Roux-en-Y gastric bypass (RYGB), continues to rise in popularity worldwide.
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Affiliation(s)
- Luigi Angrisani
- Public Health Department "Federico II" University of Naples, Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Almino Ramos
- Gastro-Obeso-Center Institute, São Paulo, Brazil
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lilian Kow
- Flinders University, Adelaide, South Australia, Australia
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Baiocchi CDAF, Rocha de Sá DA. Impact of Metabolic Surgery on Type-2 Diabetes Remission. Curr Diabetes Rev 2021; 17:e121420189129. [PMID: 33319676 DOI: 10.2174/1573399817999201214224920] [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: 05/10/2020] [Revised: 09/02/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022]
Abstract
Diabetes Mellitus is characterized by numerous metabolic disorders, which have in common the serum elevation of glucose, caused for a pancreatic malfunction in insulin secretion and / or its action. It is a non-communicable disease, considered major public health problems and generalized growth worldwide, being a chronic disease, which can generate a high treatment cost. Metabolic surgery is a safe treatment, regulated by the Federal Council of Medicine and useful in treating people with BMI over 30 years of age, who are unable to control pathologies associated with obesity, primarily type 2 diabetes. The general objective of this study is to understand through a literature review the main impacts of metabolic surgery about the remission of DM 2. This present study it is an exploratory and descriptive study carried out through a literature review. Data were collected through research in virtual health databases, at the Virtual Health Library - VHL, Latin American and Caribbean Health Sciences Information System, LILACS, National Library of Medicine - MEDLINE, Scielo, USP database, PUBMED theses and books. Metabolic surgery proof be a good and effective treatment for having and maintaining good weight loss, as well as a significant clinical and metabolic improvement that extends beyond weight loss. Metabolic surgery is a satisfactory way of achieving long-term weight reduction in obese individuals, increasing survival for these patients. Obese patients with DM2 have a long-term remission of DM2 after bariatric / metabolic surgery. Therefore, it concludes that such procedure is effective in the treatment of the disease and other diseases associated with obesity.
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Evdoshenko VV, Fedenko VV, Bordan NS, Matveev NL, Tsepkovsky AS. [One-anastomosis gastric bypass with a short limb]. Khirurgiia (Mosk) 2020:37-47. [PMID: 33210506 DOI: 10.17116/hirurgia202011137] [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: 11/17/2022]
Abstract
OBJECTIVE To develop an acceptable method of surgical treatment of patients with obesity grade 1 and 2 in accordance with the following criteria: high safety, no risk or minimal risk of intestinal malabsorption, no limitations for postoperative gastrointestinal examination, no need for organ resection and surgical reversibility in case of necessity. MATERIAL AND METHODS In accordance with the above-mentioned criteria, we have modified OAGB (one-anastomosis gastric bypass). A gastric tube was formed from a lesser curvature using 33Fr stomach catheter with a length of at least 25 cm. Manual retrogastric retrocolic anastomosis in «end-to-side» fashion was performed within 20 cm from the ligament of Treitz. This type of anastomosis made it possible to preserve gastric tube length as much as possible that reduces the risk of jejunogastroesophageal reflux. RESULTS There were 16 patients (15 females and 1 male) aged 23-48 years for the period from June 2019 till March 2020. Mean weight of patients was 86.12 kg (range 62-124). Mean BMI was 35.15 kg/m2 (ranged 21.96-39.62). In 6 months after surgery, all patients achieved normal BMI. Man BMI dropped to 23.8 kg/m2. Minimal excessive weight loss was 81.8%, maximal excessive weight loss - 125%. Control esophagogastroduodenoscopy was performed in 5 patients after 6 months and later. During retrograde duodenoscopy, we visualized major duodenal papilla in all cases using a flexible endoscope with standard optic system. CONCLUSION The proposed modification of one-anastomosis gastric bypass with a short limb is a safe and effective procedure in bariatric surgery. This surgery ensures postoperative diagnostic and therapeutic endoscopic procedures in all parts of stomach and duodenum. This method could be recommended for surgical treatment of patients with obesity grade 1 and 2 after additional clinical trials and analysis of long-term results.
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Affiliation(s)
- V V Evdoshenko
- JSC Institute of Plastic and Cosmetic Surgery, Moscow, Russian Federation.,Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - V V Fedenko
- JSC Institute of Plastic and Cosmetic Surgery, Moscow, Russian Federation
| | - N S Bordan
- JSC Institute of Plastic and Cosmetic Surgery, Moscow, Russian Federation.,Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - N L Matveev
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - A S Tsepkovsky
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Alves LB, Mattiello R, Todescatto AD, Sarria EE, Mottin CC, Padoin AV. Bariatric patient's body composition: An option to BMI? Clin Nutr ESPEN 2020; 40:121-124. [PMID: 33183524 DOI: 10.1016/j.clnesp.2020.10.004] [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: 06/04/2017] [Revised: 09/12/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery is one of the best treatments for obesity. This indication includes an evaluation of body mass index (BMI) that does not consider the body composition of an individual. AIM To determine the body composition of bariatric surgery candidates. METHODS Patients treated at a tertiary care centre for obesity were evaluated. Body composition was measured by bioelectrical impedance analysis (BIA). All measures of BIA and surgical indication were analysed. RESULTS We evaluated 407 subjects, 87 (21.4%) men, with a mean age of 36 years. In men with indications for bariatric surgery, the mean ± SD body fat percentage (%BF) was 45.1 ± 5.39%, and the mean ± SD visceral fat area was 243.6 ± 33.79 cm2. In women with indications for bariatric surgery, the mean ± SD %BF was 50.7 ± 3.3%, and the mean ± SD visceral fat area was 241.7 ± 24.77 cm2. CONCLUSION This study showed different body compositions between men and women and parameters of %BF and visceral fat area evaluated by BIA.
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Affiliation(s)
- Letícia Biscaino Alves
- Center for Obesity and Metabolic Syndrome, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil; Post-Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil.
| | - Rita Mattiello
- Post-Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil.
| | | | - Edgar E Sarria
- Pediatric Department, School of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.
| | - Cláudio Corá Mottin
- Center for Obesity and Metabolic Syndrome, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil; Post-Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil.
| | - Alexandre Vontobel Padoin
- Center for Obesity and Metabolic Syndrome, Hospital São Lucas - Pontifícia Universidade Católica Do Rio Grande Do Sul (PUCRS), Porto Alegre, RS, Brazil; Post-Graduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil.
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Behrens E, Poggi L, Aparicio S, Martínez Duartez P, Rodríguez N, Zundel N, Ramos Cardoso A, Camacho D, López-Corvalá JA, Vilas-Bôas ML, Laynez J. COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery. Obes Surg 2020; 30:4519-4528. [PMID: 32827292 PMCID: PMC7442889 DOI: 10.1007/s11695-020-04910-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 pandemic varies greatly and has different dynamics in every country, city, and hospital in Latin America. Obesity increases the risk of SARS-CoV-2 infection, and it is one of the independent risk factors for the most severe cases of COVID-19. Currently, the most effective treatment against obesity available is bariatric and metabolic surgery (BMS), which further resolves or improves other independent risk factors like diabetes and hypertension. OBJECTIVE Provide recommendations for the resumption of elective BMS during COVID-19 pandemic. METHOD This document was created by the IFSO-LAC Executive Board and a task force. Based on data collected from a survey distributed to all IFSO-LAC members that obtained 540 responses, current evidence available, and consensus reached by other scientific societies. RESULTS The resumption of elective BMS must be a priority maybe similar to oncological surgery, when hospitals reach phase I or II, treating obesity patients in a NON-COVID area, avoiding inadvertent intrahospital contagion from healthcare provider, patients, and relatives. Same BMS indication and types of procedures as before the pandemic. Discard the presence of SARS-CoV-2 within 72 h prior to surgery. Continues laparoscopic approach. The entire team use N95 mask. Minimum hospital stays. Implement remote visits for the follow-up. CONCLUSION Resumption of elective BMS is crucial because it is not only a weight loss operation but also resolves or improves comorbidities and appears to be an immune restorative procedure of obese patients in the medium term, offering them the same probability of contracting COVID-19 as the regular population.
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Affiliation(s)
- Estuardo Behrens
- NEW LIFE CENTER, 10 calle 2-45 zona 14. Of. 1202, Guatemala City, Guatemala
- Bariatric and Metabolic Institute of Guatemala, Guatemala City, Guatemala
| | - Luis Poggi
- Department of Surgery Clinica Anglo Americana, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Peruvian Academy of Surgery, Lima, Peru
| | | | | | - Nelson Rodríguez
- Department of Bariatric Surgery, Hospital Puerta de Hierro Andares, Guadalajara, Mexico
| | | | | | - Diego Camacho
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467 USA
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Şen O, Çalıkoğlu İ, Özgen G, Türkçapar AG, Yerdel MA. Sleeve gastrectomy in class 1 obesity: Assessment of operative outcomes. Surg Obes Relat Dis 2020; 17:170-176. [PMID: 32988747 DOI: 10.1016/j.soard.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The risk/benefit ratio of sleeve gastrectomy (SG), especially in patients without type 2 diabetes (T2D), is unknown for patients with class 1 obesity. OBJECTIVES Assessment of operative outcomes of SG in class 1 obesity. SETTING Private practice. METHODS Candidates for a primary SG with body mass index 30-35 kg/m2 after 5 years of unsuccessful dieting were included after informed consent was obtained. Participants who did not complete 3-month follow-up and those who underwent modified SGs were excluded. Data and complications were recorded prospectively. Patients were followed up at 3, 6, and 12 months and yearly thereafter. Definition of presence and remission of T2D and insulin resistance were set according to guidelines. Effects on weight loss parameters were evaluated with Wilcoxon signed-rank test. RESULTS Between 2012 and 2020, 143 consecutive SGs were performed in patients with class 1 obesity without conversion, leak, mortality, or a venous event. Two were lost to follow-up. In 141 participants, 2 bleedings and 1 colon perforation occurred (2.1% rate for acute life-threatening events). During a mean follow-up of 25.9 months; 1 case of functional stenosis and 4 cases of de novo symptomatic cholelithiasis clinically became evident in different patients, all requiring reoperation. Therefore a 5.6% rate of major complications were identified at 2 years. The benefit on weight loss was immediate and permanent (P < .001). T2D and insulin resistance were in remission in 100% and 98.1% of participants at 1 year, respectively. CONCLUSION The 5.6% major complication rate reflects a minimum because more de novo symptomatic gallstones and stenosis are yet to occur or overlooked. Additionally, this excludes patients with de novo reflux and malnutrition, dissatisfaction issues, or recidivism. Caution is required to freely operate on patients with class 1 obesity with no co-morbidity. Evidence-based outcome data are lacking to balance the reported risks.
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Affiliation(s)
- Ozan Şen
- İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey; Türkçapar Bariatrics, İstanbul, Turkey
| | - İsmail Çalıkoğlu
- İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey
| | - Görkem Özgen
- İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey
| | | | - Mehmet Ali Yerdel
- İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey.
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Brunaldi VO, Farias GFA, de Rezende DT, Cairo-Nunes G, Riccioppo D, de Moura DTH, Santo MA, de Moura EGH. Argon plasma coagulation alone versus argon plasma coagulation plus full-thickness endoscopic suturing to treat weight regain after Roux-en-Y gastric bypass: a prospective randomized trial (with videos). Gastrointest Endosc 2020; 92:97-107.e5. [PMID: 32217111 DOI: 10.1016/j.gie.2020.03.3757] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS A significant number of patients regain weight after Roux-en-Y gastric bypass. Ablation with argon plasma coagulation (APC) plus endoscopic full-thickness suturing (FTS-APC) and ablation alone have been reported for treating weight regain when associated with gastrojejunostomy (GJ) dilation. However, comparative controlled data are still lacking. METHODS This was a pilot single-center open-label randomized trial comparing the effectiveness and safety of APC alone versus FTS-APC for transoral outlet reduction. Patients with at least 20% weight regain from the nadir, and GJ ≥15 mm were considered eligible. The primary outcome was percentage total weight loss (%TWL) at 12 months. Secondary outcomes were the incidence of adverse events, amelioration of metabolic laboratory parameters, and improvement in quality of life and eating behavior. RESULTS Forty patients meeting the eligibility criteria were enrolled from October 2017 to July 2018. Technical and clinical success rates were similar between the groups. At 12 months, the mean %TWL was 8.3% ± 5.5% in the APC alone group versus 7.5% ± 7.7% in the FTS-APC group (P = .71). The pre-revisional % solid gastric retention at 1 hour positively correlated with the probability of achieving ≥10% TWL at 12 months. Both groups experienced significant reductions in low-density lipoprotein and triglyceride levels at 12 months, and improvement in eating behavior and quality of life at 3 months. There were 2 cases of stenoses (1 from each group), which were successfully treated with endoscopic balloon dilation. CONCLUSION APC alone is similar to FTS-APC in terms of technical and clinical outcomes within 1 year of follow-up. (Clinical trial registration number: NCT03094936.).
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Affiliation(s)
- Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil; Center for Gastrointestinal Endoscopy, Surgery and Anatomy Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Galileu Ferreira Ayala Farias
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Tavares de Rezende
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Gabriel Cairo-Nunes
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Riccioppo
- Bariatric and Metabolic Surgery Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Marco Aurelio Santo
- Bariatric and Metabolic Surgery Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
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Wang HH, Lee DK, Liu M, Portincasa P, Wang DQH. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr 2020; 23:189-230. [PMID: 32483543 PMCID: PMC7231748 DOI: 10.5223/pghn.2020.23.3.189] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Abstract
BACKGROUND Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. METHODS A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. RESULTS The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. CONCLUSIONS Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.
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Wilbrink J, Bernards N, Mujagic Z, van Avesaat M, Pijls K, Klaassen T, van Eijk H, Nienhuijs S, Stronkhorst A, Wilms E, Troost F, Masclee A. Intestinal barrier function in morbid obesity: results of a prospective study on the effect of sleeve gastrectomy. Int J Obes (Lond) 2019; 44:368-376. [PMID: 31819200 DOI: 10.1038/s41366-019-0492-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 10/31/2019] [Accepted: 11/17/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Obesity has been associated with impaired intestinal barrier function. It is not known whether bariatric surgery leads to changes in intestinal barrier function. We hypothesized that obesity is associated with disturbances in gastrointestinal barrier function, and that after bariatric surgery barrier function will improve. METHODS Prospective single center study in which we assessed segmental gut permeability by urinary recovery of a multisugar drink in 27 morbidly obese (BMI 43.3 ± 1.1 kg/m2) and 27 age and gender matched lean subjects (BMI 22.9 ± 0.43 kg/m2). Fecal calprotectin, SCFAs, plasma cytokines, and hsCRP were assessed as inflammatory and metabolic markers. Comparisons: (a) morbidly obese subjects vs. controls and (b) 2 and 6 months postsleeve vs. presleeve gastrectomy (n = 14). In another group of 10 morbidly obese and 11 matched lean subjects colonic and ileal biopsies were obtained in order to measure gene transcription of tight junction proteins. RESULTS Gastroduodenal permeability (urinary sucrose recovery) was significantly increased in obese vs. lean controls (p < 0.05). Small intestinal and colonic permeability (urinary recovery of lactulose/L-rhamnose and sucralose/erythritol, respectively) in obese subjects were not significantly different from controls. Morbidly obese subjects had a proinflammatory systemic and intestinal profile compared with lean subjects. After sleeve gastrectomy BMI decreased significantly (p < 0.001). Postsleeve gastroduodenal permeability normalized to values that do not differ from lean controls. CONCLUSIONS Gastroduodenal permeability, but not small intestinal or colonic permeability, is significantly increased in morbidly obese patients. After sleeve gastrectomy, gastroduodenal permeability normalized to values in the range of lean controls. Thus, the proximal gastrointestinal barrier is compromised in morbid obesity and is associated with a proinflammatory intestinal and systemic profile.
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Affiliation(s)
- Jennifer Wilbrink
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands. .,Department of Gastroenterology-Hepatology, Catharina Hospital, Eindhoven, The Netherlands. .,Department of Gastroenterology-Hepatology, Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
| | - Nienke Bernards
- Department of Gastroenterology-Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Zlatan Mujagic
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Mark van Avesaat
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Kirsten Pijls
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Tim Klaassen
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Hans van Eijk
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Simon Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Arnold Stronkhorst
- Department of Gastroenterology-Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Ellen Wilms
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Freddy Troost
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Ad Masclee
- Division of Gastroenterology-Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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Ooi GJ, Earnest A, Doyle L, Laurie C, Wentworth JM, Sikaris K, le Roux CW, Burton PR, O'Brien PE, Brown WA. Detailed Description of Change in Serum Cholesterol Profile with Incremental Weight Loss After Restrictive Bariatric Surgery. Obes Surg 2019; 28:1351-1362. [PMID: 29159554 DOI: 10.1007/s11695-017-3015-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Dyslipidemia affects up to 75% of morbidly obese individuals and is a key driver of cardiovascular disease. Weight loss is an established strategy to improve metabolic risk, including dyslipidemia. We aimed to determine weight loss goals for resolution of serum lipid abnormalities, by measuring improvements during progressive weight loss in obese individuals. METHODS We performed a prospective cohort study of obese individuals with the metabolic syndrome undergoing adjustable gastric banding. Lipid levels were monitored monthly for 9 months, then three monthly until 24 months. RESULTS There were 101 participants included, age 47.4 ± 10.9 years with body mass index 42.6 ± 5.9 kg/m2. At 24 months, total body weight loss (TBWL) was 18.3 ± 7.9%. This was associated with significant improvements in high-density lipoprotein (HDL) (1.18 vs 1.47, p < 0.001), triglyceride (2.0 vs 1.4, p < 0.001), and total cholesterol to HDL ratio (TC:HDL) (4.6 vs 3.6, p < 0.001). Over this time, progressive and linear improvements in HDL, triglycerides, and TC:HDL were seen with incremental weight loss (observed at 2.5% TBWL intervals). Significant improvements occurred after a threshold weight loss of 7.5-12.5% TBWL was achieved, with odds ratio (OR) 1.48-2.50 for normalization. These odds improved significantly with increasing weight loss (OR 18.2-30.4 with > 25% TBWL). Despite significant weight loss, there was no significant change in low-density lipoprotein (LDL). CONCLUSION Significant improvements in triglycerides, HDL, and TC:HDL occur after 7.5-12.5% TBWL, with ongoing benefit after greater weight loss. LDL needs to be addressed independently, as this was not observed to respond to weight loss alone. TRIAL REGISTRATION NUMBER Australian Clinical Trials Registry (ACTRN12610000049077).
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Affiliation(s)
- Geraldine J Ooi
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia. .,Department of Surgery, Alfred Hospital, Melbourne, Australia.
| | - Arul Earnest
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Lisa Doyle
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia
| | - Cheryl Laurie
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia
| | - John M Wentworth
- Walter and Eliza Hall Institute, Melbourne University, Melbourne, Australia
| | - Ken Sikaris
- Melbourne Pathology, East Melbourne, Australia
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College, Dublin, Ireland
| | - Paul R Burton
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia.,Department of Surgery, Alfred Hospital, Melbourne, Australia
| | - Paul E O'Brien
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia
| | - Wendy A Brown
- Centre for Obesity Research and Education, Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Road, Melbourne, 3181, Australia.,Department of Surgery, Alfred Hospital, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW Obesity is increasing at an alarming rate and now poses a global threat to humankind. In recent years, we have seen the emergence of medical devices to combat the obesity epidemic. These therapeutic strategies are discussed in this review dividing them into gastric and duodenal therapies. RECENT FINDINGS Traditionally, medical devices for obesity such as the intragastric balloon have focused on reducing gastric size, but more recently there has been a shift towards developing devices that modulate neural and hormonal responses to induce early satiety thus reducing oral intake. Medical devices for obesity treatment may have a role in those patients who are struggling to control their weight despite significant lifestyle modifications such as diet and exercise and who decline or are unfit for bariatric surgery. For the wider adoption and integration of these devices in the obesity treatment paradigm, more long-term efficacy and safety data from randomised controlled trials are required.
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Affiliation(s)
- Aruchuna Ruban
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
| | - Akash Doshi
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Erika Lam
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Julian P. Teare
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
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Gastroesophageal reflux disease in a patient with a BMI of 30 kg/m 2 and previous endoscopic sleeve gastroplasty: Indication for a one-anastomosis gastric bypass. Cir Esp 2019; 97:547-548. [PMID: 31387725 DOI: 10.1016/j.ciresp.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
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Turner M, Johnson AC, Lantz P. Impact of self-efficacy on risk aversion in the context of surgical weight loss decision scenarios. Clin Obes 2019; 9:e12311. [PMID: 31050137 DOI: 10.1111/cob.12311] [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: 12/05/2018] [Revised: 02/28/2019] [Accepted: 04/04/2019] [Indexed: 11/30/2022]
Abstract
Obesity is prevalent among a third of US adults and a leading indicator for many chronic diseases. Self-efficacy is important for non-surgical weight loss interventions, but there is less information about the role of self-efficacy in the candidacy phase when there are discussions of side effects and decisions for uptake. This study conducted an experiment set within an online survey assessing risk aversion towards bariatric surgery as a weight loss intervention. The survey asked about hypothetical weight loss scenarios for bariatric surgery among a national probability-based sample of US adults aged 18 years and older. Participants answered their willingness to achieve different weight loss amounts within the context of bariatric surgery in varying risk scenarios. The analysis utilized a repeated-measures linear mixed model. A three-way interaction demonstrated that participants were more willing to take risks under ideal weight loss conditions even with the risk of death, particularly when considering self-efficacy (𝛽 = 1.20, P = .05). Margin projections showed that those with lower self-efficacy were more likely to take risks overall. This trend was significant for those with a body mass index of 30 and above in scenarios presenting one's ideal weight as the outcome of bariatric surgery. Adding a measure of self-efficacy within patient assessments could identify those eligible patients who are most likely to adopt bariatric surgery, particularly among those who may have negative post-surgical outcomes due to low self-efficacy levels. Addressing self-efficacy by way of providing support resources in tandem with candidacy consultations may enhance quality of life and post-surgical outcomes.
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Affiliation(s)
- Monique Turner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Andrea C Johnson
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Paula Lantz
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan
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Navarrete Aulestia S, Leyba JL, Navarrete Llopis S, Pulgar V. One Anastomosis Gastric Bypass/Minigastric Bypass in Patients with BMI < 35 kg/m 2 and Type 2 Diabetes Mellitus: Preliminary Report. Obes Surg 2019; 29:3987-3991. [PMID: 31297740 DOI: 10.1007/s11695-019-04071-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Obesity in the world has been increasing, and the number of diabetic patients will increase by 114%, and the best treatment results are achieved through surgery. Several techniques have been described; the gastric bypass of an anastomosis (MGB/OAGB) has been gaining popularity for its simplicity and good results. We present a prospective study with this technique in 16 mild obesity patients with type 2 diabetes mellitus or peripheral insulin resistance. OBJECTIVE To evaluate weight loss as well as metabolic changes by measuring fasting glycemia and Hb A1c after 1 year of follow-up. MATERIAL AND METHODS Sixteen patients were operated on with the OAGB/MGB technique from September 2014 to January 2016, with some form of metabolic syndrome, whether DM2, RPI, HBP, or dyslipidemia, including patients in the study with a follow-up of at least 12 months. RESULTS There were 13 cases of female sex and 3 of male, average age of 42.9 years, with an average weight of 87.7 kg and BMI of 32.2 kg/m2. Metabolic values were fasting glycemia of 193.6 ± 52.9 mg/dl and HbA1c of 8.4% ± 1 (preop) and glycemia posop, 78.8 ± 7.6 mg/dl; HbA1c posop, 6.1 ± 0.2; preop weight, 87.7 ± 14 kg (69-116); weight posop, 66.8 ± 10.5 kg (49-90); BMI preop, 32.2 ± 1.8 (30-34.9); BMI posop, 25.4 ± 1.7 (21.7-27.6); percentage of excess weight lost, 87.6 ± 11.8 (70.9-100) % with 100% remission of diabetes. CONCLUSION The results show the benefits of MGB/OAGB in mild obese diabetic patients.
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Vitiello A, Angrisani L, Santonicola A, Iovino P, Pilone V, Forestieri P. Bariatric Surgery Versus Lifestyle Intervention in Class I Obesity: 7-10-Year Results of a Retrospective Study. World J Surg 2019; 43:758-762. [PMID: 30430189 DOI: 10.1007/s00268-018-4847-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgery for Obesity (IFSO) have both stated that bariatric surgery (BS) should not be denied in Class I patients. However, lifestyle intervention (LI), such as diet plus gym programs, is still considered the preferred approach for subjects with a BMI ranging from 30 to 35 kg/m2. The aim of this study was to retrospectively compare results of LI and BS in patients in Class I obesity. METHODS Retrospective analysis of prospective maintained databases of two centers for the "Interdisciplinary Treatment of Obesity" was performed. All patients in Class I obesity and follow-up >7 years were included in the study. Subjects were divided into two groups: BS group that included patients who had undergone surgery and LI group that included patients who underwent lifestyle intervention (LI). Percentage of excess body mass index loss (%EBMIL) and comorbidities remission were recorded. RESULTS Seventy-six patients were included in the study. Fifty-six subjects were submitted to surgery (BS group); 20 subjects were treated with nonsurgical approach (LI group). In BS group, 34 underwent laparoscopic adjustable gastric band, 13 laparoscopic sleeve gastrectomy (LSG), and 9 laparoscopic Roux-en-Y gastric bypass. EWL% resulted significantly higher in BS group at 1, 3, 5, 7 and 10 years (p < 0.01). CONCLUSION Bariatric surgery is more effective than LI for patients in Class I obesity. Due to its versatility, low-risk profile and high-effectiveness LSG could be the standard intervention for these patients.
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Affiliation(s)
- Antonio Vitiello
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Luigi Angrisani
- General, Laparoscopic and Emergency Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy
| | - Antonella Santonicola
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
| | - Pietro Forestieri
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Klebanoff MJ, Corey KE, Samur S, Choi JG, Kaplan LM, Chhatwal J, Hur C. Cost-effectiveness Analysis of Bariatric Surgery for Patients With Nonalcoholic Steatohepatitis Cirrhosis. JAMA Netw Open 2019; 2:e190047. [PMID: 30794300 PMCID: PMC6484583 DOI: 10.1001/jamanetworkopen.2019.0047] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Obesity is the most common risk factor for nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease that can lead to cirrhosis and hepatocellular carcinoma. Weight loss can be an effective treatment for obesity and may slow the progression of advanced liver disease. OBJECTIVE To assess the cost-effectiveness of bariatric surgery in patients with NASH and compensated cirrhosis. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation study used a Markov-based state-transition model to simulate the benefits and risks of laparoscopic sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (GB), and intensive lifestyle intervention (ILI) compared with usual care in patients with NASH and compensated cirrhosis and varying baseline weight (overweight, mild obesity, moderate obesity, and severe obesity). Patients faced varied risks of perioperative mortality and complications depending on the type of surgery they underwent. Data were collected on March 22, 2017. MAIN OUTCOMES AND MEASURES Life-years, quality-adjusted life-years (QALYs), costs (in 2017 $US), and incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS Demographic characteristics of the patient population were based on a previously published prospective study (n = 161). Patients in the model were 41.0% female, and the base case age was 54 years. Compared with usual care, SG was associated with an increase in QALYs of 0.263 to 1.180 (bounds of ranges represent overweight to severe obesity); GB, 0.263 to 1.207; and ILI, 0.004 to 0.216. Sleeve gastrectomy was also associated with an increase in life-years of 0.693 to 1.930; GB, 0.694 to 1.947; and ILI, 0.012 to 0.114. With usual care, expected life-years in overweight, mild obesity, moderate obesity, and severe obesity were 12.939, 11.949, 10.976, and 10.095, respectively. With usual care, QALY in overweight was 6.418; mild obesity, 5.790; moderate obesity, 5.186; and severe obesity, 4.577. Sleeve gastrectomy was the most cost-effective option for patients across all weight classes assessed: ICER for SG in patients with overweight was $66 119 per QALY; mild obesity, $18 716 per QALY; moderate obesity, $10 274 per QALY; and severe obesity, $6563 per QALY. A threshold analysis on the procedure cost of GB found that for GB to be cost-effective, the cost of the surgery must be decreased from its baseline value of $28 734 by $4889 for mild obesity, by $3189 for moderate obesity, and by $2289 for severe obesity. In overweight patients, GB involved fewer QALYs than SG, and thus decreasing the cost of surgery would not result in cost-effectiveness. CONCLUSIONS AND RELEVANCE Bariatric surgery could be highly cost-effective in patients with NASH compensated cirrhosis and obesity or overweight. The findings from this analysis suggest that it can inform clinical trials evaluating the effect of bariatric procedures in patients with NASH cirrhosis, including those with a lower body mass index.
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Affiliation(s)
| | - Kathleen E. Corey
- Gastroenterology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Sumeyye Samur
- Institute for Clinical and Economic Review, Boston, Massachusetts
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Jin G. Choi
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Lee M. Kaplan
- Gastroenterology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Jagpreet Chhatwal
- Gastroenterology Division, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital Institute for Technology Assessment, Boston
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine,Columbia University Medical Center, New York, New York
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Delgado André L, Basso-Vanelli RP, Di Thommazo-Luporini L, Angélica Ricci P, Cabiddu R, Pilon Jürgensen S, Ricardo de Oliveira C, Arena R, Borghi-Silva A. Functional and systemic effects of whole body electrical stimulation post bariatric surgery: study protocol for a randomized controlled trial. Trials 2018; 19:597. [PMID: 30382930 PMCID: PMC6211515 DOI: 10.1186/s13063-018-2844-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Background Obesity represents a major public health problem and is the fifth leading risk factor for mortality. Morbid obesity is associated with chronic systemic inflammation which increases the risk of comorbidities. Bariatric surgery (BS) is considered an effective intervention for obese patients. However, BS is associated with dietary restriction, potentially limiting physical activity. Whole-body neuromuscular electrical stimulation (WBS) could represent an innovative option for the rehabilitation of BS patients, especially during the early postoperative phase when other conventional techniques are contraindicated. WBS is a safe and effective tool to combat sarcopenia and metabolic risk as well as increasing muscle mass, producing greater glucose uptake, and reducing the proinflammatory state. Therefore, the objective of this study is to evaluate the effects of WBS on body composition, functional capacity, muscle strength and endurance, insulin resistance, and pro- and anti-inflammatory circulating markers in obese patients undergoing BS. Methods/design The present study is a randomized, double-blind, placebo-controlled, parallel groups clinical trial approved by the Ethics Committee of our Institution. Thirty-six volunteers (body mass index (BMI) > 35 kg/m2) between 18 and 45 years of age will be randomized to the WBS group (WBSG) or control (Sham) group (ShamG) after being submitted to BS. Preoperative assessments will include maximal and submaximal exercise testing, body composition, blood inflammatory markers, and quadriceps strength and endurance. The second day after discharge, body composition will be evaluated and a 6-min walk test (6MWT) will be performed. The WBS or Sham protocol will consist of 30 daily sessions for 6 consecutive weeks. Afterwards, the same assessments that were performed in the preoperative period will be repeated. Discussion Considering the important role of WBS in skeletal muscle conditioning and its value as an aid in exercise performance, the proposed study will investigate this technique as a tool to promote early rehabilitation in these patients, and as a strategy to enhance exercise capacity, weight loss, and peripheral muscle strength with positive systemic effects. The present study is still ongoing, and data will be published after its conclusion. Trial registration REBEC, RBR-99qw5h. Registered on 20 February 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2844-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Larissa Delgado André
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Renata P Basso-Vanelli
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Luciana Di Thommazo-Luporini
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Paula Angélica Ricci
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Ramona Cabiddu
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Soraia Pilon Jürgensen
- Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Claudio Ricardo de Oliveira
- Department of Medicine, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Department of Physiotherapy, Federal University of São Carlos, Rod. Washington Luís, km 235, São Carlos, São Paulo, 13565-905, Brazil.
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Aminian A, Chang J, Brethauer SA, Kim JJ. ASMBS updated position statement on bariatric surgery in class I obesity (BMI 30-35 kg/m 2). Surg Obes Relat Dis 2018; 14:1071-1087. [PMID: 30061070 DOI: 10.1016/j.soard.2018.05.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Julietta Chang
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Julie J Kim
- Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
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Brunaldi VO, Jirapinyo P, de Moura DTH, Okazaki O, Bernardo WM, Galvão Neto M, Campos JM, Santo MA, de Moura EGH. Endoscopic Treatment of Weight Regain Following Roux-en-Y Gastric Bypass: a Systematic Review and Meta-analysis. Obes Surg 2018; 28:266-276. [PMID: 29082456 DOI: 10.1007/s11695-017-2986-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) is the most commonly performed bariatric procedure. Despite its high efficacy, some patients regain part of their lost weight. Several endoscopic therapies have been introduced as alternatives to treat weight regain, but most of the articles are relatively small with unclear long-term data. To systematically assess the efficacy of endoscopic therapies for weight regain after RYGB. We searched MEDLINE, EMBASE, Scopus, Web of Science, Cochrane, OVID, CINAHL/EBSCo, LILACS/Bireme, and gray literature. Primary outcomes were absolute weight loss (AWL), excess weight loss (EWL), and total body weight loss (TBWL). Thirty-two studies were included in qualitative analysis. Twenty-six described full-thickness (FT) endoscopic suturing and pooled AWL, EWL, and TBWL at 3 months were 8.5 ± 2.9 kg, 21.6 ± 9.3%, and 7.3 ± 2.6%, respectively. At 6 months, they were 8.6 ± 3.5 kg, 23.7 ± 12.3%, and 8.0 ± 3.9%, respectively. At 12 months, they were 7.63 ± 4.3 kg, 16.9 ± 11.1%, and 6.6 ± 5.0%, respectively. Subgroup analysis showed that all outcomes were significantly higher in the group with FT suturing combined with argon plasma coagulation (APC) (p < 0.0001). Meta-analysis included 15 FT studies and showed greater results. Three studies described superficial-thickness suturing with pooled AWL of 3.0 ± 3.8, 4.4 ± 0.07, and 3.7 ± 7.4 kg at 3, 6, and 12 months, respectively. Two articles described APC alone with mean AWL of 15.4 ± 2.0 and 15.4 ± 9.1 kg at 3 and 6 months, respectively. Full-thickness suturing is effective at treating weight regain after RYGB. Performing APC prior to suturing seems to result in greater weight loss. Head-to-head studies are needed to confirm our results. Few studies adequately assess effectiveness of other endoscopic techniques.
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Affiliation(s)
- Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo Medical School, Dr. Arnaldo Av, 455, São Paulo, 01246-903, Brazil.
| | | | - Diogo Turiani H de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo Medical School, Dr. Arnaldo Av, 455, São Paulo, 01246-903, Brazil
| | - Ossamu Okazaki
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo Medical School, Dr. Arnaldo Av, 455, São Paulo, 01246-903, Brazil
| | - Wanderley M Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo Medical School, Dr. Arnaldo Av, 455, São Paulo, 01246-903, Brazil
| | - Manoel Galvão Neto
- Unit of Endoscopy-Gastro Obeso Center, Barata Ribeiro St. 237, Sao Paulo, Brazil
| | | | - Marco Aurélio Santo
- Bariatric and Metabolic Surgery Unit, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Eduardo G H de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo Medical School, Dr. Arnaldo Av, 455, São Paulo, 01246-903, Brazil
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48
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Dedov II, Mel'nichenko GA, Shestakova MV, Troshina EA, Mazurina NV, Shestakova EA, Yashkov YI, Neimark AE, Biryukova EV, Bondarenko IZ, Bordan NS, Dzgoeva FH, Ershova EV, Komshilova KA, Mkrtumyan AM, Petunina NA, Romantsova TI, Starostina EG, Strongin LG, Suplotova LA, Fadeyev VV. Russian national clinical recommendations for morbid obesity treatment in adults. 3rd revision (Morbid obesity treatment in adults). ACTA ACUST UNITED AC 2018. [DOI: 10.14341/omet2018153-70] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The presented paper is a third revision of the clinical recommendations for the treatment of morbid obesity in adults. Morbid obesity is a condition with body mass index (BMI) 40 kg / m2 or a BMI 35 kg / m2 in the presence of serious complications associated with obesity. The recommendations provide data on the prevalence of obesity, its etiology and pathogenesis, as well as on associated complications. The necessary methods for laboratory and instrumental diagnosis of obesity are described in detail. In this revision of the recommendations, the staging of prescribing conservative and surgical methods for the treatment of obesity are determined. For the first time, a group of patients with obesity and type 2 diabetes mellitus is selected, in whom metabolic surgery allows a long-term improvement in the control of glycemia or remission of diabetes mellitus.
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Berry MA, Urrutia L, Lamoza P, Molina A, Luna E, Parra F, Domínguez MJ, Alonso R. Sleeve Gastrectomy Outcomes in Patients with BMI Between 30 and 35-3 Years of Follow-Up. Obes Surg 2018; 28:649-655. [PMID: 28975492 PMCID: PMC5803286 DOI: 10.1007/s11695-017-2897-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND PURPOSE Laparoscopic sleeve gastrectomy (LSG) in patients with a BMI between 30 and 35 kg/m2 plus comorbidities has shown to be safe and effective. The purpose of this study is to describe our outcomes in this group of patients after 3 years of follow-up. MATERIALS AND METHODS Retrospective descriptive analysis of patients with initial BMI between 30 and 35 kg/m2 plus comorbidities were submitted to LSG between 2006 and 2013. We analyzed gender, age, comorbidities, BMI, total weight loss (%TWL), excess weight loss (%EWL), comorbidity resolution, morbidity, and mortality. Postoperative success was defined as %TWL over 20% and EWL% over 50% maintained for at least 1 year and comorbidity remission with no need of medication. RESULTS Of the patients, 477 underwent a LSG in the above period and 252 met inclusion criteria; 188 (75%) were female and 64 (25%) were male. Median age was 39 years (15-70). Three-year follow-up was 43.9% (111 patients). Median preoperative BMI was 32.3 kg/m2 (30-34.3). Median postoperative %TWL was 12.9, 23.2, 28.2, 24.3, and 22.1% at 1, 6, 12, 24, and 36 months, respectively. %EWL was 42.88, 77.44, 98.42, 83.2, and 75.8%. Median surgical time was 86.9 min (40-120). There was comorbidity remission at 36 months. Insulin resistance was remitted in 89.4%, dyslipidemia 52%, non-alcoholic fatty liver disease 84.6%, hypertension 75%, and GERD 65%. T2DM had 60% of complete remission and 40% improvement. There were morbidity in six patients (2.4%), two reoperations, no leaks, and no mortality. CONCLUSIONS Performing LSG in patients with grade I obesity is safe and effective. BMI should not be the only indicator to consider bariatric and metabolic surgery. We still require further studies and longer follow-up.
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Affiliation(s)
- Marcos A Berry
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile.
| | - Lionel Urrutia
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
| | - Patricio Lamoza
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
| | - Alfredo Molina
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
| | - Eduardo Luna
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
| | - Federico Parra
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
| | - María J Domínguez
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
| | - Rodrigo Alonso
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, Chile
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50
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Khalifa KA, Ansari AA, Showaiter M. Weight Loss and Glycemic Control after Sleeve Gastrectomy: Results from a Middle Eastern Center of Excellence. Am Surg 2018. [DOI: 10.1177/000313481808400231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Obesity and its associated metabolic disorders are strongly linked to both morbidity and mortality. Sleeve gastrectomy (SG) has been established as an effective means of weight loss for obese patients as well as a treatment for type 2 diabetes mellitus (T2DM). This study was designed to examine the short- and midterm outcomes of patients who underwent SG in a Middle Eastern Center of Excellence, a military training teaching hospital. The clinical outcomes of 59 patients with impaired glucose tolerance and T2DM who underwent SG between 2011 and 2014 with at least one and up to four years of follow-up were studied. Data were collected and compared, including the pre- and post-surgery measures of weight, body mass index, glycosylated hemoglobin (HbA1c), and fasting blood glucose. Complete remission was defined as a fasting blood glucose level ≤100 mg/dL, an HbA1c ≤6 mg/dL, without use of antidiabetic medications. All patients showed significant reduction in body mass index following SG. Tight glycemic control was achieved among both diabetic and prediabetic patients. In this study, 88.14 per cent of all patients (diabetic and prediabetic) achieved complete resolution from their impaired glucose tolerance and T2DM and maintained normal blood glucose and HbA1C levels from one to four years post-operatively. SG is beneficial both in terms of short- and midterm weight loss and glucose control in both diabetic and prediabetic obese patients.
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Affiliation(s)
- Khalid Al Khalifa
- Department of General Surgery, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - Ahmed Al Ansari
- Training and Education Department, Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
| | - May Showaiter
- Bahrain Defense Force Hospital, Riffa, Kingdom of Bahrain
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