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Crozet J, Denneval A, Brosse M, Pelascini E, Pasquer A, Robert M. Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Is Intrathoracic Migration of the Sleeve of High Incidence? Obes Surg 2024:10.1007/s11695-024-07341-y. [PMID: 38976187 DOI: 10.1007/s11695-024-07341-y] [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: 12/12/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Conversion of SG to Roux-en-Y gastric bypass (RYGB) is increasing. Intrathoracic migration of the sleeve (ITM) often seems associated and is increasingly reported. MATERIAL AND METHODS Patients who underwent a conversion of SG to RYGB from August 2013 to December 2022 were included. Two groups were compared: patients operated on for weight loss failure (WLF gp) and those operated on for gastroesophageal reflux disease (GERD gp). Demographic data, the incidence of ITM, weight loss outcomes, resolution of symptoms, and morbidity were analyzed. RESULTS Fifty-nine patients were included with an average follow-up of 32 months: 46 patients in the GERD gp (78%) were compared to 13 patients (22%) in the WLF gp. Groups were comparable regarding age and gender, but BMI and commodities were significantly higher in the WLF gp. In the GERD gp, on preoperative gastroscopy, 30% had a esophagitis, 48% had an ITM which required a posterior crural closure versus no esophagitis (p=0.02) and 23% of ITM in the WLF gp (p=0.11). Conversion led to 93% of GERD symptom improvement. In the WLF gp, mean TWL% was 15.3%, significantly greater than in the GERD gp (TWL% = 4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups. CONCLUSION The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of ITM was high requiring a surgical treatment with a very good efficacy on symptoms. Weight loss results were disappointing.
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Affiliation(s)
- Jessica Crozet
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France.
- University Claude Bernard Lyon 1, Lyon, France.
| | - Axel Denneval
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Matthias Brosse
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Elise Pelascini
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
| | - Arnaud Pasquer
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Lyon, France
| | - Maud Robert
- Department of Digestive Surgery, Centre of Bariatric Surgery, University Hospital of Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
- Specialized centre of obesity, University Hospital of Lyon, Hospices Civils de Lyon, Pierre Bénite, France
- University Claude Bernard Lyon 1, Lyon, France
- Carmen lab, INSERM Unit, 1060, Bron, France
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Livingston EH, Zelicha H, Dutson EP, Li Z, Maciejewski ML, Chen Y. Generalizability of Randomized Clinical Trial Outcomes for Diabetes Control Resulting From Bariatric Surgery. ANNALS OF SURGERY OPEN 2024; 5:e414. [PMID: 38911638 PMCID: PMC11192007 DOI: 10.1097/as9.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/11/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To assess the external validity of randomized controlled trials (RCTs) of bariatric surgical treatment on diabetes control. Background Multisite RCTs provide the strongest evidence supporting clinical treatments and have the greatest internal validity. However, characteristics of trial participants may not be representative of patients receiving treatment in the real world. There is a need to assess how the results of RCTs generalize to all contemporary patient populations undergoing treatments. Methods All patients undergoing sleeve gastrectomy at University of California Los Angeles (UCLA) between January 8, 2018 and May 19, 2023 had their baseline characteristics, weight change, and diabetes control compared with those enrolled in the surgical treatment and medications potentially eradicate diabetes efficiently (STAMPEDE) and diabetes surgery study (DSS) RCTs of bariatric surgery's effect on diabetes control. Weight loss and diabetes control were compared between UCLA patients who did and did not fit the entry criteria for these RCTs. Results Only 65 (17%) of 387 patients with diabetes fulfilled the eligibility criteria for STAMPEDE, and 29 (7.5%) fulfilled the criteria for DSS due to being older, having higher body mass index, and lower HbA1c. UCLA patients experienced slightly less weight loss than patients in the RCTs but had similar diabetes control. The 313 (81%) patients not eligible for study entry into either RCT had similar long-term diabetes control as those who were eligible for the RCTs. Conclusions Even though only a very small proportion of patients undergoing bariatric surgery met the eligibility criteria for the 2 major RCTs, most patients in this contemporary cohort had similar outcomes. Diabetes outcomes from STAMPEDE and DSS generalize to most patients undergoing bariatric surgery for diabetes control.
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Affiliation(s)
| | - Hila Zelicha
- From the Department of Surgery, UCLA School of Medicine, Los Angeles, CA
| | - Erik P. Dutson
- From the Department of Surgery, UCLA School of Medicine, Los Angeles, CA
| | - Zhaoping Li
- Division of Clinical Nutrition, UCLA School of Medicine, Los Angeles, CA
- Department of Medicine, VA Greater Los Angeles Health System, Los Angeles, CA
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
| | - Yijun Chen
- From the Department of Surgery, UCLA School of Medicine, Los Angeles, CA
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Weinberg L, Scurrah N, Neal-Williams T, Zhang W, Chen S, Slifirski H, Liu DS, Armellini A, Aly A, Clough A, Lee DK. The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study. BMC Surg 2023; 23:335. [PMID: 37924061 PMCID: PMC10625241 DOI: 10.1186/s12893-023-02246-6] [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: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Antiemetic and analgesic oral premedications are frequently prescribed preoperatively to enhance recovery after laparoscopic sleeve gastrectomy. However, it is unknown whether these medications transit beyond the stomach or if they remain in the sleeve resection specimen, thereby negating their pharmacological effects. METHODS A retrospective cohort study was performed on patients undergoing laparoscopic sleeve gastrectomy and receiving oral premedication (slow-release tapentadol and netupitant/palonosetron) as part of enhanced recovery after bariatric surgery program. Patients were stratified into the Transit group (premedication absent in the resection specimen) and Failure-to-Transit group (premedication present in the resection specimen). Age, sex, body mass index, and presence of diabetes were compared amongst the groups. The premedication lead time (time between premedications' administration and gastric specimen resection), and the premedication presence or absence in the specimen was evaluated. RESULTS One hundred consecutive patients were included in the analysis. Ninety-nine patients (99%) were morbidly obese, and 17 patients (17%) had Type 2 diabetes mellitus. One hundred patients (100%) received tapentadol and 89 patients (89%) received netupitant/palonosetron. One or more tablets were discovered in the resected specimens of 38 patients (38%). No statistically significant differences were observed between the groups regarding age, sex, diabetes, or body mass index. The median (Q1‒Q3) premedication lead time was 80 min (57.8‒140.0) in the Failure-to-Transit group and 119.5 min (85.0‒171.3) in the Transit group; P = 0.006. The lead time required to expect complete absorption in 80% of patients was 232 min (95%CI:180‒310). CONCLUSIONS Preoperative oral analgesia and antiemetics did not transit beyond the stomach in 38% of patients undergoing laparoscopic sleeve gastrectomy. When given orally in combination, tapentadol and netupitant/palonosetron should be administered at least 4 h before surgery to ensure transition beyond the stomach. Future enhanced recovery after bariatric surgery guidelines may benefit from the standardization of premedication lead times to facilitate increased absorption. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry; number ACTRN12623000187640; retrospective registered on 22/02/2023.
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Affiliation(s)
- Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Australia.
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia.
| | - Nick Scurrah
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | | | - Wendell Zhang
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Sharon Chen
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Hugh Slifirski
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - David S Liu
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
- General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia
| | | | - Ahmad Aly
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Anthony Clough
- Department of Surgery, Box Hill Hospital, Box Hill, Australia
- Melbourne Centre for Bariatric Surgery, Melbourne, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Zhu X, Zhou G, Gu X, Jiang X, Huang H, You S, Zhang G. Comparing bariatric surgery and medical therapy for obese adolescents with type 2 diabetes. Asian J Surg 2023; 46:4337-4343. [PMID: 36369137 DOI: 10.1016/j.asjsur.2022.10.079] [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: 03/21/2022] [Revised: 10/16/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Mounting evidence in recent years has demonstrated that the number of obese adolescents has continued to rise. Obese adolescents are more likely to be diagnosed with type 2 diabetes, which causes additional harm. This study aimed to compare the clinical outcomes of bariatric surgery and medical treatment. METHODS We conducted a multicenter, nonrandomized, retrospective study on 202 obese adolescents with type 2 diabetes who received surgery or medical treatment in three hospitals from 2017 to 2019. We analyzed the effects of surgery and medical treatment in terms of weight loss, glycemic control and the remission of type 2 diabetes. Propensity score matching was conducted to balance the confounding factors. RESULTS Among the 202 adolescents, 109 adolescents underwent surgery, and the remaining 93 adolescents received nonsurgical treatment. Both in the entire cohort and in the propensity-score matching cohort, the mean body mass index (BMI) and total weight in the surgery group notably decreased. Similarly, the effect of surgery on glycemic control (with respect to HBG, HbA1c, HOMA-IR) was superior to that of medical treatment. In the surgery group, the remission rate of diabetes was 76.1% in the entire cohort and 80.5% in the matched group, which was significantly higher than that in the control group (6.5% and 5.7%, respectively). In addition, LRYGB had better effects on weight loss and glycemic control than LSG. CONCLUSION Bariatric surgery is more effective in the control of weight loss and type 2 diabetes than medical treatment. The effects between different types of bariatric surgeries remain to be further investigated, and longer follow-up times are needed.
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Affiliation(s)
- Xinqiang Zhu
- Department of General Surgery, Suining People's Hospital, No.2 Bayi West Road, Xuzhou, 221200, China
| | - Gang Zhou
- Department of Gastrointestinal Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, NO.169 Hushan Road, Nanjing, 211100, China
| | - Xingwei Gu
- Department of General Surgery, The People's Hospital of Danyang Affiliated Danyang Hospital of Nantong University, Danyang, 212300, Jiangsu Province, China
| | - Xuetong Jiang
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 Huanghe South Road, Suqian, 223800, China
| | - Hailong Huang
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 Huanghe South Road, Suqian, 223800, China
| | - Sainan You
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, No.138 Huanghe South Road, Suqian, 223800, China
| | - Gong Zhang
- Department of Gastrointestinal Pancreatic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, NO.169 Hushan Road, Nanjing, 211100, China.
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Wildisen A, Peterli R, Werder G, Mueller B, Schuetz P, Kaegi-Braun N, Kutz A. Rate of Cardiovascular Events and Safety Outcomes Seven Years Following Gastric Bypass Versus Sleeve Gastrectomy. ANNALS OF SURGERY OPEN 2023; 4:e286. [PMID: 37601481 PMCID: PMC10431536 DOI: 10.1097/as9.0000000000000286] [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: 10/17/2022] [Accepted: 04/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective The study aimed to assess major adverse cardiovascular events (MACEs), complications requiring revision surgery, and bariatric conversion surgery 7 years after gastric bypass (GB) and sleeve gastrectomy (SG) using real-world data. Background GB and SG both result in weight loss and improved cardiometabolic health. Whether the long-term rate of MACE differs between the 2 bariatric procedures is unclear. Methods In this population-based retrospective cohort study, we used inhospital National Health Registry data from January 2012 to December 2018. Patients undergoing GB were 1:1 propensity score-matched with patients who had SG. The primary outcome was the incidence of MACE, defined as acute myocardial infarction, ischemic stroke, cardiac arrest, or hospitalization for heart failure. Secondary outcomes encompassed individual MACE components, postoperative complications, and the need for bariatric conversion surgery. Results Among 5240 propensity score-matched pairs, the incidence rate per 1000 person-years of MACE was 2.8 among patients undergoing GB and 3.2 among those undergoing SG (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.62-1.37). Single components of MACE were not different between both groups. Patients after GB had a higher risk of long-term postoperative complications requiring a revision surgery compared with those after SG (HR, 3.53 [95% CI, 2.78-4.49]). Bariatric conversion surgery was less frequently performed among patients undergoing GB compared with patients undergoing SG (HR, 0.09 [95% CI, 0.06-0.13]). Conclusions In this study, the performance of GB versus SG was associated with a similar risk of MACE. While postoperative complications were more frequent among patients undergoing GB, patients following SG had a higher probability of bariatric conversion surgery.
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Affiliation(s)
- Alessia Wildisen
- Division of Endocrinology, Diabetes and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gabriela Werder
- Department of Visceral Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nina Kaegi-Braun
- Division of Endocrinology, Diabetes and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Laparoscopic Sleeve Gastrectomy versus Laparoscopic Roux-en-Y Gastric Bypass: An Analysis of Weight Loss Using a Multilevel Mixed-Effects Linear Model. J Clin Med 2023; 12:jcm12062132. [PMID: 36983135 PMCID: PMC10051768 DOI: 10.3390/jcm12062132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Regarding weight loss outcomes, the results published after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y (LRYGB) are conflicting. At this time, no clear evidence exists that outcomes from LSG are similar to those for LRYGB. The main objective of this study was to compare the percent of total weight loss (%TWL) between LRYGB and LSG over the first 2 years using a multilevel mixed-effects linear regression. Methods: Data were collected from a prospectively maintained database of patients who underwent primary laparoscopic bariatric surgery from January 2016 to December 2017 at a French accredited bariatric center. The medical records of 435 consecutive patients were analyzed. %TWL was calculated at each follow-up surgical consultation and used as a repeated outcome variable in our models to assess the long-term %TWL. Due to this hierarchical structure of the data (%TWL at each visit = level 1) within patients (level 2), a multilevel linear regression adjusted for age, sex, preoperative BMI and comorbidities was used. Results: Among the medical records of 435 consecutive patients included, 266 patients underwent LRYGB and 169 underwent LSG. The average %TWL at 2 years was 31.7% for the LRYGB group and 25.8% for the LSG group. The final multivariate model showed that, compared with LRYGB, LSG was associated with a decreased %TWL at over 2 years of follow-up (β: −4.01; CI95%: −5.47 à −2.54; p ≤ 0.001). Conclusion: This observational study suggests that compared with LRYGB, LSG was associated with a decreased %TWL at 2 years using a multilevel model. Further studies are required to confirm the results observed with this statistical model.
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Gamba FP, Siqueira BS, Tsuchiya RS, Tanaka TM, Grassiolli S. Impact of Roux-en-Y Gastric Bypass and Vertical Gastrectomy on weight loss: a retrospective and longitudinal study in the State of Paraná, Brazil. Rev Col Bras Cir 2023; 50:e20233431. [PMID: 36790229 PMCID: PMC10519702 DOI: 10.1590/0100-6991e-20233431-en] [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: 07/27/2022] [Accepted: 09/09/2022] [Indexed: 02/08/2023] Open
Abstract
AIM to compare the impact of Roux's Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) techniques on body weight reduction over 1 and 5 years after bariatric surgery in obese patients in the state of Paraná. METHODS longitudinal and retrospective study, conducted between January 2010 and December 2013, with 737 patients of both sexes submitted to RYGB or SG and evaluated in the preoperative, 1 and 5 years after bariatric surgery (BS). Age, height, body weight, Body Mass Index (BMI), biochemical and pressure parameters were recorded. RESULTS of the total of patients, men represented lower frequency, were slightly older, with higher body weight, BMI and worse metabolic and pressure conditions than women in pre-BS (p<0.05). Regardless of sex, RYGB and SG were effective in promoting body weight reduction and BMI in 1 and 5 years after BS; the RYGB technique had greater impact on these variables in both sexes (p<0.05). The highest percentage of lost weight was observed in women who underwent the RYGB technique in the first year after BS. Five years after BS, the RYGB technique promoted a higher rate of body weight reduction in men and women compared to the SG technique (p<0.05). CONCLUSION regardless of sex, the RYGB technique promotes a higher degree of body weight reduction and BMI over time compared to the SG; having its biggest impacts in the 1 year after BS, especially in women.
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Affiliation(s)
- Fernanda Pereira Gamba
- - Universidade Estadual do Oeste do Paraná, Programa de pós-graduação em biociências e saúde - Cascavel - PR - Brasil
| | - Bruna Schumaker Siqueira
- - Universidade Estadual do Oeste do Paraná, Programa de pós-graduação em biociências e saúde - Cascavel - PR - Brasil
| | | | | | - Sabrina Grassiolli
- - Universidade Estadual do Oeste do Paraná, Programa de pós-graduação em biociências e saúde - Cascavel - PR - Brasil
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Reynolds EL, Votruba KL, Watanabe M, Banerjee M, Elafros MA, Chant E, Villegas-Umana E, Giordani B, Feldman EL, Callaghan BC. The Effect of Surgical Weight Loss on Cognition in Individuals with Class II/III Obesity. J Nutr Health Aging 2023; 27:1153-1161. [PMID: 38151865 PMCID: PMC11100299 DOI: 10.1007/s12603-023-2047-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Obesity is a global epidemic and is associated with cognitive impairment and dementia. It remains unknown whether weight loss interventions, such as bariatric surgery, can mitigate cognitive impairment. OBJECTIVES We aimed to determine the effect of surgical weight loss on cognition in individuals with class II/III obesity. DESIGN We performed a prospective cohort study of participants who underwent bariatric surgery. At baseline and two years following surgery, participants completed metabolic risk factor and neuropsychological assessments. SETTING Participants were enrolled from an academic suburban bariatric surgery clinic. PARTICIPANTS There were 113 participants who completed baseline assessments and 87 completed two-year follow-up assessments (66 in-person and 21 virtual) after bariatric surgery. The mean (SD) age was 46.8 (12.5) years and 64 (73.6%) were female. INTERVENTION Bariatric surgery. There were 77 (88.5%) participants that underwent sleeve gastrectomy and 10 (11.5%) that underwent gastric bypass surgery. MEASUREMENTS Cognition was assessed using the NIH toolbox cognitive battery (NIHTB-CB) and the Rey Auditory Verbal Learning Test (AVLT). The primary outcome was the change in NIHTB-CB fluid composite score before and after surgery. RESULTS The primary outcome, NIHTB-CB composite score, was stable following bariatric surgery (-0.4 (13.9), p=0.81,n=66). Among secondary outcomes, the NIHTB-CB dimensional card sorting test (executive function assessment), improved (+6.5 (19.9),p=0.01,n=66) while the Rey AVLT delayed recall test (memory assessment) declined (-0.24 (0.83),p=0.01,n=87) following surgery. Improvements to metabolic risk factors and diabetes complications were not associated with improvements to NIHTB-CB composite score. The other 4 NIHTB-CB subtests and Rey AVLT assessments of auditory learning and recognition were stable at follow-up. CONCLUSIONS Following bariatric surgery, the age-adjusted composite cognitive outcome did not change, but an executive subtest score improved. These results suggest that bariatric surgery may mitigate the natural history of cognitive decline in individuals with obesity, which is expected to be faster than normal aging, but confirmatory randomized controlled trials are needed. The decline in delayed recall also warrants further studies to determine potential differential effects on cognitive subtests.
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Affiliation(s)
- E L Reynolds
- Brian Callaghan, 109 Zina Pitcher Place, 4021 BSRB, Ann Arbor, MI 48104, 734-764-7205 office, 734-763-7275 fax,
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GAMBA FERNANDAPEREIRA, SIQUEIRA BRUNASCHUMAKER, TSUCHIYA RICARDOSHIGUEO, TANAKA TOMAZMASSAYUKI, GRASSIOLLI SABRINA. O impacto do Bypass Gástrico em Y de Roux e da Gastrectomia Vertical na perda de peso: um estudo retrospectivo e longitudinal no Estado do Paraná, Brasil. Rev Col Bras Cir 2023. [DOI: 10.1590/0100-6991e-20233431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
RESUMO Objetivo: comparar o impacto das técnicas Bypass Gástrico em Y de Roux (BGYR) e Gastrectomia Vertical (GV) na redução do peso corporal ao longo de 1 e 5 anos após a cirurgia bariátrica em pacientes obesos no Estado do Paraná. Métodos: estudo longitudinal e retrospectivo, realizado entre janeiro de 2010 a dezembro de 2013, com 737 pacientes de ambos os sexos submetidos a BGYR ou GV e avaliados no pré-cirúrgico, 1 e 5 anos após Cirurgia Bariátrica (CB). Foram registrados idade, estatura, peso corporal, Índice de Massa Corpórea (IMC), parâmetros bioquímicos e pressóricos. Resultados: do total de pacientes, homens representavam menor frequência, eram ligeiramente mais velhos, com maior peso corporal, IMC e pior condição metabólica e pressórica que mulheres no pré-CB (p<0,05). Independente do sexo, BGYR e GV foram efetivas em promover redução do peso corporal e IMC em 1 e 5 anos pós-CB; tendo a técnica de BGYR maior impacto nestas variáveis em ambos os sexos (p<0,05). A maior porcentagem de peso perdido foi observada em mulheres submetidas a técnica da BGYR no primeiro ano após a CB. Cinco anos após a CB, a técnica de BGYR promoveu maior taxa de redução de peso corporal em homens e mulheres comparado a técnica da GV (p<0,05). Conclusão: independente do sexo a técnica de BGYR promove maior grau de redução do peso corporal e IMC ao longo do tempo em comparação com a GV; tendo seus maiores impactos no 1 ano pós-CB sobretudo em mulheres.
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Plamper A, Lingohr P, Nadal J, Trebicka J, Brol MJ, Woestemeier A, Schmitz SMT, Alizai PH, Neumann UP, Ulmer TF, Rheinwalt KP. A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg 2023; 27:47-55. [PMID: 36376721 PMCID: PMC9877051 DOI: 10.1007/s11605-022-05515-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) has become increasingly accepted in bariatric surgery and meanwhile represents the third most common procedure worldwide. While it shows promising weight loss results and comorbidity resolution, questions about issues such as reflux or nutritional deficiencies (ND) persist in the long term. On the other hand, the most frequently performed sleeve gastrectomy (SG) has to accept growing criticism regarding long-term results and reflux issues. There is a particular lack of long-term comparative data for both procedures. This study presents our long-term experience. METHODS We evaluated OAGB and SG patients retrospectively comparing for weight loss and resolution of comorbidities as well as perioperative and long-term complications in a follow-up period of 5 years. RESULTS Nine hundred eleven OAGB and 241 SG were included in the study. OAGB had a shorter operation time and hospital stay. Overall complication rate did not differ in both groups. Ulcers were more frequent in OAGB (7.7% vs. 1.7%, p = 0.001), whereas insufficient weight loss (IWL)/weight regain (WR) proved to be more prevalent in SG (25.7% vs. 6.4%, p < 0.001). The same held true for reflux (17.8% vs. 8.3%, p < .001). On the other hand, ND were more common in OAGB (20.0% vs. 12.0%, p = 0.005). Revisional surgery was more often indicated after SG. Analysis by linear mixed model showed that OAGB achieved a lower BMI/higher loss of BMI. Improvement of T2DM (94.6% vs. 85.2%, p = 0.008) and sleep apnea (88.8% vs. 78.8%, p = 0.01) was superior in OAGB. CONCLUSIONS OAGB had a superior effect on weight loss as well as improvement of T2DM and sleep apnea. Furthermore, long-term problems such as IWL/WR and reflux were more related to SG. On the other hand, a malabsorptive procedure such as OAGB showed a higher risk for ND. Our findings support the available data in the literature.
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Affiliation(s)
- Andreas Plamper
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Philipp Lingohr
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jennifer Nadal
- grid.15090.3d0000 0000 8786 803XInstitute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Jonel Trebicka
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Maximilian J. Brol
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Anna Woestemeier
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sophia M.-T. Schmitz
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick H. Alizai
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P. Neumann
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom F. Ulmer
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Karl P. Rheinwalt
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
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Aliyev SA, Mamedova SY, Aliyev ES. [Endoscopic intragastric injection of botulinum toxin in the treatment of patients with morbid obesity: opportunities and prospects]. Khirurgiia (Mosk) 2023:81-88. [PMID: 36583498 DOI: 10.17116/hirurgia202301181] [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: 12/31/2022]
Abstract
The authors consider modern epidemiological and demographic data on morbid obesity. Literature review is devoted to non-surgical treatment of patients with morbid obesity. The authors analyze the results of experimental and clinical studies on endoscopic intragastric injection of botulinum toxin and bariatric efficacy of this approach. The indications for endoscopic intragastric injection of botulinum toxin and advantages of this technique are clearly formulated. The authors identified the most significant criteria for objective assessment of clinical effectiveness of endoscopic intragastral injection of botulinum toxin, as well as scientific and methodological principles necessary for this technique. Clinical efficacy of intragastric injection of botulinum toxin including overweight loss, anorexigenic and gastroparetic effects indicates inconsistent results and certain unresolved problems. Thus, large-scale multiple-center randomized controlled trials and multivariate analysis are required to determine the role of endoscopic intragastric injection of botulinum toxin in complex treatment of patients with morbid obesity.
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Affiliation(s)
- S A Aliyev
- Azerbaijan Medical University, Baku, Azerbaijan
| | | | - E S Aliyev
- Azerbaijan Medical University, Baku, Azerbaijan
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12
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Restrepo-Castrillón J, Restrepo-Moreno M, Ramírez-Ceballos M, Román-González A, Toro-Vásquez JP. Baipás gástrico versus manga gástrica para el control de diabetes tipo 2 en pacientes obesos. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introducción. La diabetes mellitus tipo 2 y la obesidad son enfermedades con alta prevalencia, gran morbimortalidad y elevados costos en salud. La cirugía bariátrica ha demostrado efectividad para inducir pérdida de peso y un control adecuado de la glicemia.
Métodos. Estudio observacional analítico retrospectivo, realizado entre 2014 y 2019 en una institución de alta complejidad. Se incluyeron pacientes prediabéticos y diabéticos sometidos a cirugía bariátrica tipo baipás gástrico en Y-de-Roux o manga gástrica. Se analizaron la mejoría o resolución de la diabetes y la pérdida del exceso de peso a los 6, 12, 24 y 36 meses luego de la cirugía.
Resultados. Se incluyeron 103 pacientes en el estudio, 45 pacientes diabéticos y 58 pacientes prediabéticos. La única variable perioperatoria con diferencia estadísticamente significativa fue el tiempo quirúrgico mayor en el baipás (70 vs. 47,5 minutos; p<0,001). La pérdida de exceso de peso fue mayor en el baipás. Los pacientes diabéticos sometidos a baipás tuvieron un mayor porcentaje de resolución o control comparados con los sometidos a manga gástrica. En los pacientes prediabéticos hubo resolución en ambos grupos luego de 24 meses de seguimiento.
Conclusión. El baipás gástrico y la manga gástrica presentan excelentes resultados en cuanto a pérdida de peso y control metabólico en pacientes con diabetes mellitus tipo 2 y prediabetes, pero en nuestros pacientes se lograron resultados superiores en ambos aspectos con el baipás gástrico.
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Frankel A, Thomson I, Shah A, Chen C, Zahir SF, Barbour A, Holtmann G, Mark Smithers B. Laparoscopic fundoplication versus laparoscopic Roux-en-Y gastric bypass for gastro-oesophageal reflux disease in obese patients: protocol for a randomized clinical trial. BJS Open 2022; 6:6849402. [PMID: 36440813 PMCID: PMC9703586 DOI: 10.1093/bjsopen/zrac132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is the standard surgical procedure for the treatment of gastro-oesophageal reflux disease (GORD). Laparoscopic Roux-en-Y gastric bypass (LRYGB) is commonly performed to achieve weight loss in obese patients, but it also has anti-reflux properties. Hence, in the obese population suffering from GORD, LRYGB could be an alternative to LF. The aim of this trial will be to compare LF and LRYGB in an obese population presenting with GORD and being considered for surgery. METHODS This will be an investigator-initiated randomized clinical trial. The research population will be obese patients (BMI 30-34.9 with waist circumference more than 88 cm (women) or more than 102 cm (men), or BMI 35-40 with any waist circumference) referred to a public hospital for consideration of anti-reflux surgery. The primary aim of the study will be to determine the efficacy of LF compared with LRYGB on subjective and objective control of GORD. Secondary aims include determining early and late surgical morbidity and the side-effect profile of LF compared with LRYGB and to quantify any non-reflux benefits of LRYGB (including overall quality of life) compared with LF. CONCLUSION This trial will determine whether LRYGB is effective and acceptable as an alternative to LF for the surgical treatment of GORD in obese patients Registration number: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12622000636752p (https://www.anzctr.org.au/).
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Affiliation(s)
- Adam Frankel
- Correspondence to: Adam Frankel, Princess Alexandra Hospital, Upper GI Surgery, Ward 4D, 199 Ipswich Rd, Woolloongabba, Brisbane, Queensland, Australia 4102 (e-mail: )
| | - Iain Thomson
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Ayesha Shah
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Chen Chen
- School of Biomedical Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Syeda Farah Zahir
- Queensland Facility for Advanced Bioinformatics, Queensland Cyber Infrastructure Foundation, Queensland, Australia
| | - Andrew Barbour
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Gerald Holtmann
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - B Mark Smithers
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
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Dalkılıç MS, Erdem H, Gençtürk M, Yılmaz M, Sisik A. Acute Intrathoracic Migration With Incarceration of Laparoscopic Sleeve Gastrectomy Due to Incomplete Hiatal Hernia Repair. Cureus 2022; 14:e31362. [DOI: 10.7759/cureus.31362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
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15
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Baad VMA, Bezerra LR, de Holanda NCP, dos Santos ACO, da Silva AAM, Bandeira F, Cavalcante TCF. Body Composition, Sarcopenia and Physical Performance After Bariatric Surgery: Differences Between Sleeve Gastrectomy and Roux-En-Y Gastric Bypass. Obes Surg 2022; 32:3830-3838. [DOI: 10.1007/s11695-022-06335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022]
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Ozturk A, Celik Y. A Single-Center Experience: What is the Effect of Sleeve Gastrectomy in Patients With a BMI ≥ 50 kg/m²? Cureus 2022; 14:e27992. [PMID: 36120220 PMCID: PMC9469752 DOI: 10.7759/cureus.27992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Our research aimed to see how sleeve gastrectomy (SG) affects weight loss and comorbidities in patients with a body mass index (BMI) ≥ 50 kg/m². Materials and methods: Prospectively kept data of patients with a BMI ≥50 kg/m² who underwent SG between February 2016 and February 2020 were evaluated. Results: A total of 138 patients with a BMI ≥ 50 kg/m² were operated on. The average BMI was 56.36±7.661, the average age was 37.41±12.33. Forty-eight patients underwent concomitant cholecystectomy and/or hiatal hernia repair (HHR). The percentage of excess weight loss (EWL%) of patients at the 3rd, 6th, 12th, 18th, and 24th months were 36%, 54%, 67%, 72%, and 74%, respectively. Mean BMI values of the 0th, 3rd, 6th, 12th, 18th, and 24th months were 56, 45, 39, 35, 33, and 33, respectively. 0th, 3rd, 6th, 12th, 18th, and 24th months were significantly different for EWL%, total weight loss (TWL%), and BMI variables (p<0.001), but EWL% (p=0.527), TWL% (p=0.396) and BMI (p=0,657) were not found significantly different between the 18th and 24th months. When EWL% ≥ 50 was accepted, the success rate was 93% (n=93) and 92% (n=50) at the 18th and 24th months, respectively. While there was 82% remission in type 2 diabetes mellitus (DM) and 90% in hypertension (HT), the remission rate in patients with obstructive sleep apnea syndrome (OSAS) and gastroesophageal reflux disease (GERD) undergoing HHR was 100%. Conclusions: In patients with a BMI ≥ 50 kg/m², SG seems to be an effective and safe therapy option as the first line for weight loss and treatment of comorbid diseases. Further long-term studies are needed to confirm these results.
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Clinical Evaluation of the Medium-Term Efficacy of Laparoscopic Sleeve Gastrectomy against Obstructive Sleep Apnea-Hypopnea Syndrome in Obese Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7682706. [PMID: 35991129 PMCID: PMC9391148 DOI: 10.1155/2022/7682706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
Abstract
Objective This study was designed to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) for obstructive sleep apnea-hypopnea syndrome (OSAHS) in obese individuals and identify the related factors affecting its efficacy. Methods The clinical and follow-up data of 37 obese patients with OSAHS who underwent LSG in the Laparoscopic Surgery Department of Zibo Central Hospital from January 2017 to July 2018 were analyzed retrospectively. The effect of this operation on patients' weight and OSAHS was studied, and the factors affecting weight and OSAHS were examined through univariate and multivariate logistic regression analysis. Results Over 12 months of regular postoperative follow-up with the 37 patients, their body mass index (BMI) decreased, and the percentage of excess weight loss (EWL%) reached 73.2%. Additionally, the rate of successful OSAHS treatment reached 91.89%, and the apnea-hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO2) increased significantly. Univariate logistic regression analysis showed that gender, weight, EWL%, and smoking affected the efficacy of LSG against OSAHS (P < 0.05). EWL% and smoking were independent factors that helped determine the efficacy of LSG against morbid obesity (P < 0.05). Conclusion LSG can effectively help obese patients lose weight and show medium-term efficacy against OSAHS in obese people. Smoking and EWL% were found to be the factors determining the efficacy of LSG.
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Letter to the Editor regarding the article «Gerd symptoms after laparoscopic Roux-en-Y gastric bypass: an emerging scenario» by Antonella Santonicola, Luigi Ruggiero, Rossella Palma, Luigi Angrisani and Paola Iovino. International Journal of Obesity (2022) 46:1076-1078. Int J Obes (Lond) 2022; 46:1936-1937. [PMID: 35933446 DOI: 10.1038/s41366-022-01200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022]
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Abstract
Despite decades of obesity research and various public health initiatives, obesity remains a major public health concern. Our most drastic but most effective treatment of obesity is bariatric surgery with weight loss and improvements in co-morbidities, including resolution of type 2 diabetes (T2D). However, the mechanisms by which surgery elicits metabolic benefits are still not well understood. One proposed mechanism is through signals generated by the intestine (nutrients, neuronal, and/or endocrine) that communicate nutrient status to the brain. In this review, we discuss the contributions of gut-brain communication to the physiological regulation of body weight and its impact on the success of bariatric surgery. Advancing our understanding of the mechanisms that drive bariatric surgery-induced metabolic benefits will ultimately lead to the identification of novel, less invasive strategies to treat obesity.
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Affiliation(s)
- Maigen Bethea
- Department of Pediatrics, Nutrition Section, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave. Research Complex 1 South 7th Floor, Aurora, CO, 80045, USA
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave. Research Complex 1 South 7th Floor, Aurora, CO, 80045, USA
| | - Darleen A Sandoval
- Department of Pediatrics, Nutrition Section, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave. Research Complex 1 South 7th Floor, Aurora, CO, 80045, USA.
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave. Research Complex 1 South 7th Floor, Aurora, CO, 80045, USA.
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Early effects of Roux-en-Y gastric bypass on dietary fatty acid absorption and metabolism in people with obesity and normal glucose tolerance. Int J Obes (Lond) 2022; 46:1359-1365. [PMID: 35459799 DOI: 10.1038/s41366-022-01123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) surgery markedly increases the rate of intestinal nutrient exposure after food intake, accelerates intestinal absorption of dietary glucose and protein, and alters the postprandial gut hormone response. However, our understanding of postprandial fat absorption and metabolism after RYGB is incomplete. METHODS Stable palmitate tracers were administered intravenously (K-[2,2-2H2]palmitate) and orally with a mixed meal ([U-13C16]palmitate) to study fatty acid absorption and metabolism before and 3 months after RYGB in 10 participants with obesity and normal glucose tolerance. RESULTS There was a tendency toward reduced fasting plasma nonesterified palmitate concentrations after RYGB, but neither fasting palmitate kinetics nor fasting triacylglycerol (TAG) concentrations changed compared with before surgery. Postprandial TAG concentrations were numerically, but nonsignificantly, reduced 3-4 h after meal intake after compared with before RYGB. However, the postprandial appearance of the oral palmitate tracer in the plasma TAG pool and overflow into the nonesterified palmitate pool were initially faster but overall reduced after RYGB by 50% (median, IQR: [47;64], P = 0.004) and 46% (median, IQR: [33;70], P = 0.041), respectively. The maximal postprandial suppression of plasma nonesterified palmitate concentrations was slightly greater but shorter lasting after RYGB ('time × visit' interaction: P < 0.001), without detectable effects of surgery on the rate of appearance and disappearance of plasma palmitate. CONCLUSION RYGB resulted in an initially accelerated but overall ~50% reduced 4-h postprandial systemic appearance of dietary palmitate in participants with obesity and normal glucose tolerance. This is likely a result of faster but incomplete intestinal fat absorption combined with enhanced chylomicron-TAG clearance, but it needs further investigation in studies specifically designed to investigate these mechanisms.
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Alotaibi AA, Almutairy AN, Alsaab AS. Post-Bariatric Surgery Patients: A Quality of Life Assessment in Saudi Arabia. Cureus 2022; 14:e24273. [PMID: 35602806 PMCID: PMC9119020 DOI: 10.7759/cureus.24273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
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Implications of Bariatric Surgery on the Pharmacokinetics of Antiretrovirals in People Living with HIV. Clin Pharmacokinet 2022; 61:619-635. [PMID: 35404470 PMCID: PMC9095546 DOI: 10.1007/s40262-022-01120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/06/2022]
Abstract
Bariatric surgery is increasingly applied among people living with HIV to reduce obesity and the associated morbidity and mortality. In people living with HIV, sufficient antiretroviral exposure and activity should always be maintained to prevent development of resistance and disease progression. However, bariatric surgery procedures bring various gastrointestinal modifications including changes in gastric volume, and acidity, gastrointestinal emptying time, enterohepatic circulation and delayed entry of bile acids. These alterations may affect many aspects of antiretroviral pharmacokinetics. Some drug characteristics may result in subtherapeutic exposure and the potential related risk of treatment failure and resistance. Antiretrovirals that require low pH, administration of fatty meals, longer intestinal exposure, and an enterohepatic recirculation for their absorption may be most impacted by bariatric surgery procedures. Additionally, some antiretrovirals can interact with the polyvalent cations in supplements or drugs inhibiting gastric acid, thereby preventing their use as these comedications are commonly prescribed post-bariatric surgery. Predicting pharmacokinetics on the basis of drug characteristics solely proved to be challenging, therefore pharmacokinetic studies remain crucial in this population. Here, we discuss general implications of bariatric surgery on antiretroviral outcomes in people living with HIV as well as drug properties that are relevant for the choice of antiretroviral treatment in this special patient population. Additionally, we summarise studies that evaluated the pharmacokinetics of antiretrovirals post-bariatric surgery. Finally, we performed a comprehensive analysis of theoretical considerations and published pharmacokinetic and pharmacodynamic data to provide recommendations on antiretrovirals for people living with HIV undergoing bariatric surgery.
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Torrent-Jansà L, Pérez-Xaus M, Casajoana A, Pera M. Pitfall in Bariatric Laporoscopic Surgery: Submucosal Tunneling in Gastric Bypass Anastomosis Intraoperative Detection and Repair. Obes Surg 2022; 32:1786-1787. [DOI: 10.1007/s11695-022-05988-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 02/19/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
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Uhe I, Douissard J, Podetta M, Chevallay M, Toso C, Jung MK, Meyer J. Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials. Obesity (Silver Spring) 2022; 30:614-627. [PMID: 35137548 PMCID: PMC9303972 DOI: 10.1002/oby.23338] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to determine which bariatric procedure allows patients to obtain the best weight-loss outcomes and a remission of type 2 diabetes. METHODS Databases were searched for randomized-controlled trials comparing Roux-en-Y gastric bypass (RYGB) with sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB). The mean difference (MD) or the relative risk was determined. RESULTS Twenty-five randomized-controlled trials were analyzed. Excess weight loss (EWL, percentage) was greater for RYGB patients at 3 years (MD: 11.93, p < 0.00001) and 5 years (MD: 13.11, p = 0.0004). Higher excess BMI loss (percentage) was found in RYGB at 1 year (MD: 11.66, p = 0.01). Total weight loss (percentage) was greater for RYGB patients after 3 months (MD: 2.41, p = 0.02), 6 months (MD: 3.83, p < 0.00001), 1 year (MD: 6.35, p < 0.00001), and 5 years (MD: 3.90, p = 0.005). No difference in terms of remission of type 2 diabetes was seen between RYGB and SG. EWL was significantly more important after OAGB than after RYGB after 1 year (MD: -10.82, p = 0.003). CONCLUSIONS RYGB is more efficient than SG in the midterm. OAGB offers greater EWL than RYGB after 1 year, but further evidence is needed to confirm this result.
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Affiliation(s)
- Isabelle Uhe
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
| | - Jonathan Douissard
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
| | - Michele Podetta
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
| | - Mickael Chevallay
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
| | - Christian Toso
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
| | - Minoa Karin Jung
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
| | - Jeremy Meyer
- Division of Digestive SurgeryUniversity Hospitals of GenevaGenève 14Switzerland
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Wojciechowska G, Szczerbinski L, Kretowski M, Niemira M, Hady HR, Kretowski A. Exploring microRNAs as predictive biomarkers for type 2 diabetes mellitus remission after sleeve gastrectomy: A pilot study. Obesity (Silver Spring) 2022; 30:435-446. [PMID: 35088558 PMCID: PMC9306824 DOI: 10.1002/oby.23342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to evaluate microRNAs (miRNAs) as predictive biomarkers for type 2 diabetes (T2D) remission 12 months after sleeve gastrectomy (SG). METHODS A total of 179 serum miRNAs were profiled, and 26 clinical variables were collected from 46 patients. Two patients were later excluded because of hemolysis, and six patients with unclear remission status were set aside to evaluate the prediction models. The remaining 38 patients were included for model building. Variable selection was done using different approaches, including Least Absolute Shrinkage and Selection Operator (LASSO). Prediction models were then developed using LASSO and assessed in the validation set. RESULTS A total of 26 out of 38 patients achieved T2D remission 12 months after SG. The prediction model with only clinical variables misclassified two patients, which were correctly classified using miRNAs. Two miRNA-only models achieved an accuracy of one but performed poorly for the validation set. The best miRNA model was a mixed model (accuracy: 0.974) containing four miRNAs (hsa-miR-32-5p, hsa-miR-382-5p, hsa-miR-1-3p, and hsa-miR-21-5p) and four clinical variables (T2D medication, sex, age, and fasting blood glucose). These miRNAs are involved in pathways related to obesity and insulin resistance. CONCLUSIONS This study suggests that four serum miRNAs might be predictive biomarkers for T2D remission 12 months after SG, but further validation studies are needed.
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Affiliation(s)
| | - Lukasz Szczerbinski
- Clinical Research CentreMedical University of BiałystokBiałystokPoland
- Department of Endocrinology, Diabetology and Internal MedicineMedical University of BiałystokBiałystokPoland
| | - Marek Kretowski
- Faculty of Computer ScienceBiałystok University of TechnologyBiałystokPoland
| | - Magdalena Niemira
- Clinical Research CentreMedical University of BiałystokBiałystokPoland
| | - Hady Razak Hady
- 1st Clinical Department of General and Endocrine SurgeryMedical University of BiałystokBiałystokPoland
| | - Adam Kretowski
- Clinical Research CentreMedical University of BiałystokBiałystokPoland
- Department of Endocrinology, Diabetology and Internal MedicineMedical University of BiałystokBiałystokPoland
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First fully endoscopic metabolic procedure with NOTES gastrojejunostomy, controlled bypass length and duodenal exclusion: a 9-month porcine study. Sci Rep 2022; 12:21. [PMID: 34996894 PMCID: PMC8741923 DOI: 10.1038/s41598-021-02921-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/18/2021] [Indexed: 01/14/2023] Open
Abstract
We conducted a pilot study of a potential endoscopic alternative to bariatric surgery. We developed a Natural Orifice Transluminal Endoscopic Surgery (NOTES) gastric bypass with controlled bypass limb length using four new devices including a dedicated lumen-apposing metal stent (GJ-LAMS) and pyloric duodenal exclusion device (DED). We evaluated procedural technical success, weight change from baseline, and adverse events in growing Landrace/Large-White pigs through 38 weeks after GJ-LAMS placement. Six pigs (age 2.5 months, mean baseline weight 26.1 ± 2.7 kg) had initial GJ-LAMS placement with controlled bypass limb length, followed by DED placement at 2 weeks. Technical success was 100%. GJ-LAMS migrated in 3 of 6, and DED migrated in 3 of 5 surviving pigs after mucosal abrasion. One pig died by Day 94. At 38 weeks, necropsy showed 100–240 cm limb length except for one at 760 cm. Weight gain was significantly lower in the pigs that underwent endoscopic bypass procedures compared to expected weight for age. This first survival study of a fully endoscopic controlled bypass length gastrojejunostomy with duodenal exclusion in a growing porcine model showed high technical success but significant adverse events. Future studies will include procedural and device optimizations and comparison to a control group.
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Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in Egyptian patients with morbid obesity. Ann Med Surg (Lond) 2022; 73:103235. [PMID: 35079369 PMCID: PMC8767301 DOI: 10.1016/j.amsu.2021.103235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
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Koenis MMG, Papasavas PK, Janssen RJ, Tishler DS, Pearlson GD. Brain responses to anticipatory cues and milkshake taste in obesity, and their relationship to bariatric surgery outcome. Neuroimage 2021; 245:118623. [PMID: 34627978 PMCID: PMC10947342 DOI: 10.1016/j.neuroimage.2021.118623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
There is substantial variability in percent total weight loss (%TWL) following bariatric surgery. Functional brain imaging may explain more variance in post-surgical weight loss than psychological or metabolic information. Here we examined the neuronal responses during anticipatory cues and receipt of drops of milkshake in 52 pre-bariatric surgery men and women with severe obesity (OW, BMI = 35-60 kg/m2) (23 sleeve gastrectomy (SG), 24 Roux-en-Y gastric bypass (RYGB), 3 laparoscopic adjustable gastric banding (LAGB), 2 did not undergo surgery) and 21 healthy-weight (HW) controls (BMI = 19-27 kg/m2). One-year post-surgery weight loss ranged from 3.1 to 44.0 TWL%. Compared to HW, OW had a stronger response to milkshake cues (compared to water) in frontal and motor, somatosensory, occipital, and cerebellar regions. Responses to milkshake taste receipt (compared to water) differed from HW in frontal, motor, and supramarginal regions where OW showed more similar response to water. One year post-surgery, responses to high-fat milkshake cues normalized in frontal, motor, and somatosensory regions. This change in brain response was related to scores on a composite health index. We found no correlation between baseline response to milkshake cues or tastes and%TWL at 1-yr post-surgery. In RYGB participants only, a stronger response to low-fat milkshake and water cues (compared to high-fat) in supramarginal and cuneal regions respectively was associated with more weight loss. A stronger cerebellar response to high-fat vs low-fat milkshake receipt was also associated with more weight loss. We confirm differential responses to anticipatory milkshake cues in participants with severe obesity and HW in the largest adult cohort to date. Our brain wide results emphasizes the need to look beyond reward and cognitive control regions. Despite the lack of a correlation with post-surgical weight loss in the entire surgical group, participants who underwent RYGB showed predictive power in several regions and contrasts. Our findings may help in understanding the neuronal mechanisms associated with obesity.
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Affiliation(s)
- Marinka M G Koenis
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06102, United States.
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, United States
| | - Ronald J Janssen
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06102, United States
| | - Darren S Tishler
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, United States
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living at Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06102, United States; Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States
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29
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Jans A, Szabo E, Näslund I, Ottosson J, Näslund E, Stenberg E. Factors affecting relapse of type 2 diabetes after bariatric surgery in Sweden 2007-2015: a registry-based cohort study. Surg Obes Relat Dis 2021; 18:305-312. [PMID: 34974997 DOI: 10.1016/j.soard.2021.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/06/2021] [Accepted: 12/01/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse. OBJECTIVES To identify possible risk factors for T2D relapse in patients who initially experienced remission. SETTING Nationwide, registry-based study. METHODS We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m2 who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication. RESULTS In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates. CONCLUSION Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.
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Affiliation(s)
- Anders Jans
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Lorentzen J, Medhus AW, Hofsø D, Svanevik M, Seip B, Hjelmesæth J. Sleeve Gastrectomy Confers Higher Risk of Gastroesophageal Reflux Disease Than Gastric Bypass: A Randomized Controlled Trial From the Oseberg Reflux Working Group. Gastroenterology 2021; 161:2044-2046.e4. [PMID: 34419459 DOI: 10.1053/j.gastro.2021.08.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Jolanta Lorentzen
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Asle W Medhus
- Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Dag Hofsø
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marius Svanevik
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway; Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Birgitte Seip
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Altieri MS, DeMaria E, Lensing C, Derecho J, Fallorina R, Mehrotra S, Pories W, Irish WD. Retrospective comparative study of the effectiveness of bariatric surgery on 3-year outcomes in the real-world clinical setting. Surg Obes Relat Dis 2021; 18:196-204. [PMID: 34922843 DOI: 10.1016/j.soard.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery has shown an improvement in obesity and obesity-related disease in many clinical trials and single center studies. However, real-world data, including data from non-centers of excellence, is sparse. OBJECTIVES To provide clinical outcomes of patients who underwent bariatric surgery in real-world clinical setting. SETTING Academic Institution. METHODS Adults with obesity undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and a control group (CG) between 2007 and 2019 were identified. The CG represented patients with a previous visit to a bariatric surgeon without a subsequent surgery. Cohorts were matched on age, gender, ethnicity, baseline body mass index (BMI), and presence of diabetes and hypertension. Groups were compared in terms of co-morbidities, weight loss, and chronic conditions for three years. RESULTS A total of 61 313 patients were identified. From these, 14 916 RYGB and 20 867 SG patients were matched to the CG (n = 16 562). The median BMI loss three years after surgery was 28.7% (interquartile range [IQR] 20.8%-36.2%) and 20.5% (IQR 13.5%-28.6%) for RYGB and SG groups, respectively. The CG had a median BMI loss of 6.7% with IQR of 20.4% decrease to 1.78% gain. At three years postoperatively, HbA1C decreased by 13% for RYGB and 5.9% for the SG group. The probabilities of remission from diabetes, hypertension, and low high-density lipoprotein cholesterol were significantly higher among patients who had surgery compared to the CG. For both RYGB and SG, the estimated probabilities of remission were similar. CONCLUSION This study shows that bariatric surgery performed in the real-world clinical setting is an effective therapy for various expressions of the metabolic syndrome with results that are comparable to randomized control trials.
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Affiliation(s)
- Maria S Altieri
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina.
| | - Eric DeMaria
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Cody Lensing
- OptumLabs at UnitedHealth Group, Minnetonka, Minnesota
| | | | | | | | - Walter Pories
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - William D Irish
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
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32
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Abellán Garay L, Navarro García MI, González-Costea Martínez R, Torregrosa Pérez NM, Vázquez Rojas JL. Medium/long term evaluation of lipid profile after bariatric surgery (gastric bypass versus sleeve gastrectomy). ENDOCRINOL DIAB NUTR 2021; 68:372-380. [PMID: 34742470 DOI: 10.1016/j.endien.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/22/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bariatric surgery aims to reduce weight and resolve the comorbidities associated with obesity. Few studies have assessed mid/long-term changes in lipid profile with sleeve gastrectomy versus gastric bypass. This study was conducted to assess and compare changes in lipid profile with each procedure after 60 months. METHODS This was an observational, retrospective study of analytical cohorts enrolling 100 patients distributed into two groups: 50 had undergone gastric bypass (GBP) surgery and 50 sleeve gastrectomy (SG) surgery. Total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) levels were measured before surgery and at 1, 6, 12, 24, 36, 48, and 60 months. Weight loss and the resolution of dyslipidemia with each of the procedures were also assessed. RESULTS Ninety-five of the 100 patients completed follow-up. At 60 months, TC and LDL levels had significantly decreased in the BPG group (167.42 ± 31.22 mg/dl and 88.06 ± 31.37 mg/dl, respectively), while there were no differences in the SG group. Increased HDL levels were seen with both procedures (BPG: 62.69 ± 16.3 mg/dl vs. SG: 60.64 ± 18.73 mg/dl), with no difference between the procedures. TG levels decreased in both groups (BPG: 86.06 ± 56.57 mg/dl vs. SG: 111.09 ± 53.08 mg/dl), but values were higher in the BPG group (P < .05). The percentage of overweight lost (PSP) was higher in the BPG group: 75.65 ± 22.98 mg/dl vs. the GV group: 57.83 ± 27.95 mg/dl. CONCLUSION Gastric bypass achieved better mid/long-term results in terms of weight reduction and the resolution of hypercholesterolemia as compared to sleeve gastrectomy. While gastric bypass improved all lipid profile parameters, sleeve gastrectomy only improved HDL and triglyceride levels.
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Affiliation(s)
- Laura Abellán Garay
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain.
| | | | | | - Nuria María Torregrosa Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - José Luis Vázquez Rojas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
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33
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Bonouvrie DS, Taverne SB, Janssen L, Luijten AA, van Dielen FM, Leclercq WK. Pregnancy and Bariatric Surgery: Significant Variation in Bariatric Surgeons' Practices and Preferences: A National Survey. Bariatr Surg Pract Patient Care 2021; 17:103-110. [PMID: 35765306 PMCID: PMC9233520 DOI: 10.1089/bari.2021.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Bariatric complications may occur during pregnancy, potentially causing serious maternal and fetal problems. The aim of this study was to determine the current practice and preferences of bariatric surgeons regarding the pregnancy care of fertile women before and after bariatric surgery. Methods: A 26-question anonymous online survey was designed and sent to all bariatric surgeons of the Dutch Society of Metabolic and Bariatric Surgery. Results: At least one bariatric surgeon from each bariatric center (n = 18) completed the survey. In case of a future child, wish sleeve gastrectomy became more popular than Roux-en-Y gastric bypass. All surgeons provided preoperative education regarding bariatric complications during pregnancy. Nine centers without neonatal intensive care would not refer pregnant women with acute complications. Half of the centers had a standard operating procedure. Seven per 18 bariatric centers had seen at least one postbariatric pregnant patient with severe maternal morbidity. One case of perinatal mortality was reported. Conclusion: There is an inconsistent and often below guideline standard daily practice regarding pregnancy before and after bariatric surgery. There is limited experience with pregnant women with acute bariatric complications. Referral to tertiary centers is inadequate. Better information provision for both professionals and patients regarding possible complications is needed.
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Affiliation(s)
- Daniëlle S. Bonouvrie
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Address correspondence to: Daniëlle S. Bonouvrie, MD, Obesity Center Máxima, Máxima Medical Center, Mailbox 90052, Eindhoven 5600 PD, The Netherlands
| | - Sophie B.M. Taverne
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Loes Janssen
- Department of Surgery, Maxima Medical Center, Eindhoven/Veldhoven, The Netherlands
| | | | | | - Wouter K.G. Leclercq
- Obesity Center Máxima, Máxima Medical Center, Eindhoven/Veldhoven, The Netherlands
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34
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Turgut E, Okut G, Kaplan K, Bağ YM, Sumer F, Kayaalp C. Is Sleeve Gastrectomy or Roux-en-Y Gastric Bypass Better in Terms of Quality of Life? Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Emre Turgut
- Department of Gastrointestinal Surgery, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Gokalp Okut
- Department of Gastrointestinal Surgery, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Kuntay Kaplan
- Department of Gastrointestinal Surgery, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Yusuf Murat Bağ
- Department of Gastrointestinal Surgery, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Fatih Sumer
- Department of Gastrointestinal Surgery, Faculty of Medicine, University of Inonu, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Faculty of Medicine, University of Inonu, Malatya, Turkey
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35
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Tandon A, Akbari K, Dempster N, Child E, Gillies R, Sgromo B. Meta-Analysis of Gastrointestinal Quality of Life After Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ashutosh Tandon
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
| | - Khalid Akbari
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
| | - Niall Dempster
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Emma Child
- Knowledge & Evidence Services, Warrington and Halton Hospitals, Warrington, United Kingdom
| | - Richard Gillies
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
| | - Bruno Sgromo
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
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36
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Kindel TL, Ganga RR, Baker JW, Noria SF, Jones DB, Omotosho P, Volckmann ET, Williams NN, Telem DA, Petrick AT, Gould JC. American Society for Metabolic and Bariatric Surgery: Preoperative Care Pathway for Laparoscopic Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2021; 17:1529-1540. [PMID: 34148848 DOI: 10.1016/j.soard.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Rama Rao Ganga
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - John Wilder Baker
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sabrena F Noria
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Philip Omotosho
- Department of Surgery, Rush Medical College, Chicago, Illinois
| | - Erick T Volckmann
- Department of Surgery, University of Utah and Affiliated Hospitals, Salt Lake City, Utah
| | - Noel N Williams
- Department of Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Anthony T Petrick
- Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania
| | - Jon C Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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37
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Wölnerhanssen BK, Peterli R, Hurme S, Bueter M, Helmiö M, Juuti A, Meyer-Gerspach AC, Slawik M, Peromaa-Haavisto P, Nuutila P, Salminen P. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: 5-year outcomes of merged data from two randomized clinical trials (SLEEVEPASS and SM-BOSS). Br J Surg 2021; 108:49-57. [PMID: 33640917 DOI: 10.1093/bjs/znaa011] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/03/2020] [Accepted: 09/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are both effective surgical procedures to achieve weight reduction in patients with obesity. The trial objective was to merge individual-patient data from two RCTs to compare outcomes after LSG and LRYGB. METHODS Five-year outcomes of the Finnish SLEEVEPASS and Swiss SM-BOSS RCTs comparing LSG with LRYGB were analysed. Both original trials were designed to evaluate weight loss. Additional patient-level data on type 2 diabetes (T2DM), obstructive sleep apnoea, and complications were retrieved. The primary outcome was percentage excess BMI loss (%EBMIL). Secondary predefined outcomes in both trials included total weight loss, remission of co-morbidities, improvement in quality of life (QoL), and overall morbidity. RESULTS At baseline, 228 LSG and 229 LRYGB procedures were performed. Five-year follow-up was available for 199 of 228 patients (87.3 per cent) after LSG and 199 of 229 (87.1 per cent) after LRYGB. Model-based mean estimate of %EBMIL was 7.0 (95 per cent c.i. 3.5 to 10.5) percentage points better after LRYGB than after LSG (62.7 versus 55.5 per cent respectively; P < 0.001). There was no difference in remission of T2DM, obstructive sleep apnoea or QoL improvement; remission for hypertension was better after LRYGB compared with LSG (60.3 versus 44.9 per cent; P = 0.049). The complication rate was higher after LRYGB than LSG (37.2 versus 22.5 per cent; P = 0.001), but there was no difference in mean Comprehensive Complication Index value (30.6 versus 31.0 points; P = 0.859). CONCLUSION Although LRYGB induced greater weight loss and better amelioration of hypertension than LSG, there was no difference in remission of T2DM, obstructive sleep apnoea, or QoL at 5 years. There were more complications after LRYGB, but the individual burden for patients with complications was similar after both operations.
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Affiliation(s)
- B K Wölnerhanssen
- St Clara Research Ltd, St Clara Hospital, Basle, Switzerland.,University of Basle, Basle, Switzerland
| | - R Peterli
- University of Basle, Basle, Switzerland.,Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital Basle, Basle, Switzerland
| | - S Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - M Bueter
- Department of Visceral and Transplantation Surgery, University Hospital, Zürich, Switzerland
| | - M Helmiö
- Department of Digestive Surgery, Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - A Juuti
- Department of Abdominal Surgery, Abdominal Centre, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - A C Meyer-Gerspach
- St Clara Research Ltd, St Clara Hospital, Basle, Switzerland.,University of Basle, Basle, Switzerland
| | - M Slawik
- Department of Internal Medicine and Endocrinology, St. Clara Hospital, Basle, Switzerland
| | - P Peromaa-Haavisto
- Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.,Department of Surgery, Hatanpää City Hospital, Tampere, Finland
| | - P Nuutila
- Department of Endocrinology, Turku University Hospital, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - P Salminen
- Department of Digestive Surgery, Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Department of Surgery, Satasairaala Central Hospital, Pori, Finland
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38
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Weight Loss Outcomes following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in an Ethnically Diverse Bariatric Population: Which Is More Effective? Minim Invasive Surg 2021; 2021:9702976. [PMID: 33953983 PMCID: PMC8064797 DOI: 10.1155/2021/9702976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. Objectives This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. Methods The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. Results Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively. In patients with a BMI of 45-50 kg/m2 who underwent LRYGB and LSG, the mean %TWL values were 69% and 56% after 1 year, 75% and 58% after 2 years, and 57% and 45% after 5 years, respectively. Meanwhile, the %TWL values of patients with BMI >50 kg/m2 who had LRYGB and LSG were 53% and 42% after 1 year, 53% and 45% after 2 years, and 49% and 36% after 5 years, respectively. All results were statistically significant (p < 0.0001) and remained valid after adjusting for cofactors. Conclusion Thus, LRYGB had consistent and sustained long-term weight loss outcomes compared with LSG in a predominantly ethnically diverse patient population with different BMI. Our study had several limitations in that it is retrospective in nature and some patients were lost to follow-up during the study period.
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Mikler R, Pinzón FE, Metke R. Cirugía bariátrica secundaria en el Hospital Universitario San Ignacio. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La Organización Mundial de la Salud define la obesidad como un incremento en el porcentaje de grasa corporal, generalmente acompañado de aumento en el peso, cuya cantidad y distribución condicionan la salud del individuo. Se caracteriza por ser una enfermedad crónica y de muy difícil manejo. La cirugía bariátrica es un procedimiento cada vez más frecuente, que ha demostrado ser la mejor opción terapéutica para el manejo de la obesidad moderada y severa, enfermedad que ha ido ganado terreno en el mundo. Según la Encuesta Nacional de la Situación Nutricional en Colombia 2015, la incidencia de sobrepeso fue del 37,8 % y de obesidad del 18,7 %. Con el incremento de la cirugía bariátrica primaria, también se ha incrementado la frecuencia de la cirugía bariátrica de revisión, conversión y reversión, siendo la de conversión la más frecuente.
Métodos. Estudio observacional retrospectivo en el que se analizaron los pacientes llevados a cirugía bariátrica de conversión en el Hospital Universitario San Ignacio entre 2014 y 2019.
Resultados. En nuestra institución la cirugía de conversión corresponde al 8,8 %, y coincide con la estadística mundial para este procedimiento. La causa más frecuente, a diferencia de la literatura, es el reflujo gastroesofágico, seguido de la reganancia de peso.
Discusión. Los resultados obtenidos en el Hospital Universitario San Ignacio se asemejan a las cifras mundiales de procedimientos de conversión. Se obtiene la resolución de los síntomas de reflujo gastroesofágico y el manejo adecuado de la reganancia de peso en un alto porcentaje de pacientes, con muy pocas complicaciones.
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Hu Z, Sun J, Li R, Wang Z, Ding H, Zhu T, Wang G. A Comprehensive Comparison of LRYGB and LSG in Obese Patients Including the Effects on QoL, Comorbidities, Weight Loss, and Complications: a Systematic Review and Meta-Analysis. Obes Surg 2021; 30:819-827. [PMID: 31834563 PMCID: PMC7347514 DOI: 10.1007/s11695-019-04306-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To systematically and comprehensively evaluate the differences between laparoscopic Roux-en-Y gastric bypass (LRYGB) versus sleeve gastrectomy (LSG) in obese patients. Methods A systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018. The meta-analysis was performed by the RevMan 5.3 software. Results Twenty-three articles with 7443 patients were included. In short term (< 3 years), LRYGB was superior to LSG in terms of improving comorbidities (T2D, odds ratio (OR) 1.93, 1.06–3.52, P < 0.05, hypertension, OR 1.59, 1.08–2.34, P < 0.05, dyslipidemia, OR 1.61, 1.05–2.46, P < 0.05), but there were no differences in the midterm and long term. Quality of life (QoL) after bariatric surgery was included, but no differences were observed in the QoL after LRYGB or LSG (gastrointestinal quality of life index (GIQLI) and Moorehead–Ardelt quality of life questionnaire (M-A-Q), P > 0.05). LRYGB achieved a higher EWL% than LSG (after 3 years, WMD 5.48, 0.13–10.84. P < 0.05; after 5 years, WMD 4.55, 1.04–8.05, P < 0.05) in long term, but no significant differences were found during 0.25- to 2.0-year follow-up. The rate of early and late complications was much higher in LRYGB than in LSG (early complications, OR = 2.11, 95% CI = 1.53–2.91, P < 0.001; late complications, OR = 2.60, 95% CI = 1.93–3.49, P < 0.001). Conclusions This meta-analysis showed that LRYGB was more effective than LSG in comorbidities’ resolution or improvement in short term. For weight loss, LRYGB had better long-term effects than LSG. In addition, no differences were observed in the quality of life after LRYGB or LSG. LRYGB was associated with more complications than LSG. Electronic supplementary material The online version of this article (10.1007/s11695-019-04306-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhihao Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Junfeng Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Ruixin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Zhuoyin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Hengxuan Ding
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Tianyu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Guojun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
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Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2021; 30:664-672. [PMID: 31724116 DOI: 10.1007/s11695-019-04235-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures. OBJECTIVES We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG. METHODS Medline, Embase, The Cochrane Library, and NHS Evidence were searched for English language RCTs comparing RYGB with SG and assessed weight loss and/or comorbidity resolution at 5 years. RESULTS Five studies were included in the final analysis. Meta-analysis demonstrates a significantly greater percentage excess weight loss in patients undergoing RYGB compared with SG (65.7% vs 57.3%, p < 0.0001). Resolution of diabetes was seen in 37.4% and 27.5% after RYGB and SG respectively. There was no significant difference between RYGB and SG in rates of resolution or improvement of diabetes. Similarly, HbA1C levels were not significantly different between the two procedures. Resolution of dyslipidaemia was more common after RYGB (68.6% vs 55.2%, p = 0.0443). Remission of gastro-oesophageal reflux occurred in 60.4% in the RYGB group in contrast to 25.0% in the SG group (p = 0.002). CONCLUSIONS Both RYGB and SG result in sustained weight loss and comorbidity control at 5 years. RYGB resulted in greater %EWL, improved dyslipidaemia outcomes and a lower incidence of postoperative gastro-oesophageal reflux disease (GORD).
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Abellán Garay L, Navarro García MI, González-Costea Martínez R, Torregrosa Pérez NM, Vázquez Rojas JL. Medium/long term evaluation of lipid profile after bariatric surgery (gastric bypass versus sleeve gastrectomy). ACTA ACUST UNITED AC 2021. [PMID: 33812906 DOI: 10.1016/j.endinu.2020.10.018] [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: 11/29/2022]
Abstract
INTRODUCTION Bariatric surgery aims to reduce weight and resolve the comorbidities associated with obesity. Few studies have assessed mid/long-term changes in lipid profile with sleeve gastrectomy versus gastric bypass. This study was conducted to assess and compare changes in lipid profile with each procedure after 60 months. METHODS This was an observational, retrospective study of analytical cohorts enrolling 100 patients distributed into two groups: 50 had undergone gastric bypass (GBP) surgery and 50 sleeve gastrectomy (SG) surgery. Total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) levels were measured before surgery and at 1, 6, 12, 24, 36, 48 and 60 months. Weight loss and the resolution of dyslipidemia with each of the procedures were also assessed. RESULTS Ninety-five of the 100 patients completed follow-up. At 60 months, TC and LDL levels had significantly decreased in the GBP group (167.42±31.22mg/dl and 88.06±31.37mg/dl, respectively), while there were no differences in the SG group. Increased HDL levels were seen with both procedures (GBP: 62.69±16.3mg/dl vs. SG: 60.64±18.73mg/dl), with no difference between the procedures. TG levels decreased in both groups (GBP: 86.06±56.57mg/dl vs. SG: 111.09±53.08mg/dl), but values were higher in the GBP group (p<0.05). The percentage of overweight lost (PSP) was higher in the GBP group: 75.65±22.98mg/dl vs. the GV group: 57.83±27.95mg/dl. CONCLUSION Gastric bypass achieved better mid/long-term results in terms of weight reduction and the resolution of hypercholesterolemia as compared to sleeve gastrectomy. While gastric bypass improved all lipid profile parameters, sleeve gastrectomy only improved HDL and triglyceride levels.
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Affiliation(s)
- Laura Abellán Garay
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España.
| | | | | | - Nuria María Torregrosa Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
| | - José Luis Vázquez Rojas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Santa Lucía, Cartagena, Murcia, España
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Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass in the Elderly: 1-Year Preliminary Outcomes in a Randomized Trial (BASE Trial). Obes Surg 2021; 31:2359-2363. [PMID: 33683573 DOI: 10.1007/s11695-021-05316-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes. OBJECTIVES This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older. METHODS Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions. RESULTS The median age (67 × 67 years; p=0.67) and initial body mass index (BMI) (46.3 × 51.3 kg/m2; p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 × 47.6 kg/m2; p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 × 68%; p=0.04; 24.9 × 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 × -0.5%; p<0.01) as well as LDL control (-27.5 × +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality. CONCLUSION Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.
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Akpinar EO, Liem RSL, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Metabolic effects of bariatric surgery on patients with type 2 diabetes: a population-based study. Surg Obes Relat Dis 2021; 17:1349-1358. [PMID: 33762128 DOI: 10.1016/j.soard.2021.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/11/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery among patients with obesity and type 2 diabetes (T2D) can induce complete remission. However, it remains unclear whether sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) has better T2D remission within a population-based daily practice. OBJECTIVES To compare patients undergoing RYGB and SG on the extent of T2D remission at the 1-year follow-up. SETTING Nationwide, population-based study including all 18 hospitals in the Netherlands providing metabolic and bariatric surgery. METHODS Patients undergoing RYGB and SG between October 2015 and October 2018 with 1 year of complete follow-up data were selected from the mandatory nationwide Dutch Audit for Treatment of Obesity (DATO). The primary outcome is T2D remission within 1 year. Secondary outcomes include ≥20% total weight loss (TWL), obesity-related co-morbidity reduction, and postoperative complications with a Clavien-Dindo (CD) grade ≥III within 30 days. We compared T2D remission between RYGB and SG groups using propensity score matching to adjust for confounding by indication. RESULTS A total of 5015 patients were identified from the DATO, and 4132 (82.4%) had completed a 1-year follow-up visit. There were 3350 (66.8%) patients with a valid T2D status who were included in the analysis (RYGB = 2623; SG = 727). RYGB patients had a lower body mass index than SG patients, but were more often female, with higher gastroesophageal reflux disease and dyslipidemia rates. After adjusting for these confounders, RYGB patients had increased odds of achieving T2D remission (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.14-2.1; P < .01). Groups were balanced after matching 695 patients in each group. After matching, RYGB patients still had better odds of T2D remission (OR, 1.91; 95% CI, 1.27-2.88; P < .01). Also, significantly more RYGB patients had ≥20%TWL (OR, 2.71; 95% CI, 1.96-3.75; P < .01) and RYGB patients had higher dyslipidemia remission rates (OR, 1.96; 95% CI, 1.39-2.76; P < .01). There were no significant differences in CD ≥III complications. CONCLUSION Using population-based data from the Netherlands, this study shows that RYGB leads to better T2D remission rates at the 1-year follow-up and better metabolic outcomes for patients with obesity and T2D undergoing bariatric surgery in daily practice.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, Netherlands.
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, Netherlands; Dutch Obesity Clinic, The Hague, Netherlands
| | | | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, Netherlands; Dutch Obesity Clinic South, Heerlen, Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, Netherlands
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Ningombam SS, Kumar R, Tanwar P. Mutant strains of SARS-CoV-2 are more prone to infect obese patient: a review. Wien Klin Wochenschr 2021; 133:383-392. [PMID: 33595720 PMCID: PMC7887545 DOI: 10.1007/s00508-021-01819-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/16/2021] [Indexed: 01/08/2023]
Abstract
The current review critically analyzes obesity as an important risk factor for increased predisposition towards coronavirus disease 2019 (COVID-19), its severity and causal death in current pandemic. Countries with higher prevalence of exposed obese individuals experienced the highest number of mortalities. The analysis also proved that individuals having more adipose tissue in body have a higher level of angiotensin-converting enzyme 2 (ACE2), which is identified as functional receptor for COVID-19. Therefore, obese individuals are worse in condition because of a higher presence of adiposity increases the number of ACE2 expressing cells. Furthermore, in silico interactions of ACE2 and different variants of coronavirus 2 (CoV-2) spike S1 protein suggest that mutant strains are more infectious than wildtype as they bind to host ACE2 protein with high binding affinities. Certain specific cancers including cervical cancer, pancreatic and rectal adenocarcinomas have more expression of such receptors and pose additional risk to already immunocompromised cancer patients. This review emphasizes obesity, as the covert risk factor of COVID-19 infection and sensitizes about of calorie restrictions, immunity building and preventive measures.
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Affiliation(s)
- Somorjit Singh Ningombam
- Laboratory Oncology Unit, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Rakesh Kumar
- Laboratory Oncology Unit, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Pranay Tanwar
- Laboratory Oncology Unit, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, 110029, New Delhi, India.
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Sleeve Gastrectomy Compared With Roux-en-Y Gastric Bypass in Individuals Living With HIV. J Acquir Immune Defic Syndr 2021; 84:e28-e31. [PMID: 32433253 DOI: 10.1097/qai.0000000000002392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: A Systematic Review and Meta-analysis of Weight Loss, Comorbidities, and Biochemical Outcomes From Randomized Controlled Trials. Ann Surg 2021; 273:66-74. [PMID: 31693504 DOI: 10.1097/sla.0000000000003671] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare weight loss, obesity-related comorbidities, and biochemical outcomes of LSG versus LRYGB through a meta-analysis of randomized controlled trials (RCTs). SUMMARY OF BACKGROUND DATA LSG and LRYGB are the 2 most commonly performed bariatric surgeries for the treatment of obesity. The comparative outcomes of the 2 surgeries is a topic of ongoing debate and medium-term outcomes remain uncertain. METHODS A search for RCTs comparing LRYGB versus LSG was conducted. Pooled outcomes between 2 procedures were compared using pairwise random-effects meta-analysis at 1, 3, and 5-year follow-up time points. Grading of recommendations, assessment, development, and evaluation was used to assess certainty of evidence. RESULTS Thirty-three studies involving 2475 patients were included. LRYGB resulted in greater loss of body mass index compared to LSG at 1 year [mean difference -1.25 kg/m2, 95% confidence interval (CI) -2.01 to -0.49, P = 0.001; moderate certainty of evidence] which persisted at 3 years, but there was insufficient evidence at 5 years. Resolution of dyslipidemia was higher for LRYGB than LSG at 1 year (risk ratio 0.58, 95% CI 0.46-0.73, P < 0.001; moderate certainty of evidence) and 5 years (risk ratio 0.68, 95%CI 0.46-0.99, P = 0.04; low certainty of evidence). There was no difference between LRYGB and LSG for remission of type 2 diabetes, hypertension, and hemoglobin A1c, fasting insulin, homeostatic model assessment of insulin resistance, high-density lipoprotein, and the rate of 30-day major and minor complications. CONCLUSIONS There are insufficient data from RCTs to draw any conclusions regarding the long-term comparative effectiveness beyond 3 years between LRYGB and LSG.
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Comparative Safety of Sleeve Gastrectomy and Gastric Bypass: An Instrumental Variables Approach. Ann Surg 2020; 275:539-545. [PMID: 33201113 DOI: 10.1097/sla.0000000000004297] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the safety of sleeve gastrectomy and gastric bypass in a large cohort of commercially insured bariatric surgery patients from the IBM MarketScan claims database, while accounting for measurable and unmeasurable sources of selection bias in who is chosen for each operation. SUMMARY OF BACKGROUND DATA Sleeve gastrectomy has rapidly become the most common bariatric operation performed in the United States, but its longer-term safety is poorly described, and the risk of worsening gastroesophageal reflux requiring revision may be higher than previously thought. Prior studies comparing sleeve gastrectomy to gastric bypass are limited by low sample size (in randomized trials) and selection bias (in observational studies). METHODS Instrumental variables analysis of commercially insured patients in the IBM MarketScan claims database from 2011 to 2018. We studied patients undergoing bariatric surgery from 2012 to 2016. We identified re-interventions and complications at 30 days and 2 years from surgery using Comprehensive Procedural Terminology and International Classification of Disease (ICD)-9/10 codes. To overcome unmeasured confounding, we use the prior year's sleeve gastrectomy utilization within each state as an instrumental variable-exploiting variation in the timing of payers' decisions to cover sleeve gastrectomy as a natural experiment. RESULTS Among 38,153 patients who underwent bariatric surgery between 2012 and 2016, the share of sleeve gastrectomy rose from 52.6% (2012) to 75% (2016). At 2 years from surgery, patients undergoing sleeve gastrectomy had fewer re-interventions (sleeve 9.9%, bypass 15.6%, P < 0.001) and complications (sleeve 6.6%, bypass 9.6%, P = 0.001), and lower overall healthcare spending ($47,891 vs $55,213, P = 0.003), than patients undergoing gastric bypass. However, at the 2-year mark, revisions were slightly more common in sleeve gastrectomy than in gastric bypass (sleeve 0.6%, bypass 0.4%, P = 0.009). CONCLUSIONS AND RELEVANCE In a large cohort of commercially insured patients, sleeve gastrectomy had a superior safety profile to gastric bypass up to 2 years from surgery, even when accounting for selection bias. However, the higher risk of revisions in sleeve gastrectomy merits further exploration.
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Lymphovenous Anastomosis for Morbidly Obese Patients with Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2860. [PMID: 33133910 PMCID: PMC7572113 DOI: 10.1097/gox.0000000000002860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/25/2020] [Indexed: 11/27/2022]
Abstract
Although patients with obesity-induced lymphedema can be treated by weight loss therapy, they find it difficult to lose the required amount of weight. The aims of this study were to clarify the characteristics of the lymphatic vessels in patients with obesity-induced lymphedema and to determine the feasibility and efficacy of lymphovenous anastomosis (LVA) in these patients. Methods Twenty-two patients (44 edematous lower limbs) with a body mass index (BMI) >35 kg/m2 (obese group) and 91 patients with lymphedema (141 edematous lower limbs) and BMI <25 kg/m2 were enrolled as a control group (nonobese group) and underwent LVA. The diameter and depth of lymphatics and the effect of LVA were compared. Results Lymphatics were detectable within 10-mm depth in the nonobese group and the obese group (3.0 ± 1.4 mm versus 3.5 ± 2.1 mm; P < 0.01). The lymphatic diameter was significantly greater in the obese group than in the nonobese group (0.79 ± 0.30 mm versus 0.54 ± 0.22 mm; P < 0.01). There was no significant difference in the rate of improvement in lymphedema after LVA between the nonobese group (9.1% ± 9.2%) and the obese group (8.9% ± 7.3%; P = 0.84). There was no correlation between the improvement rate of lymphedema and that of BMI in the obese group (P = 0.57). Conclusions LVA is a feasible procedure even in morbidly obese patients. Considering that substantial weight loss is a difficult and time-consuming task for patients, LVA combined with not gaining weight is a good option for these patients.
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Factors influencing the choice between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc 2020; 35:4691-4699. [PMID: 32909206 DOI: 10.1007/s00464-020-07933-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND While laparoscopic sleeve gastrectomy (LSG) continues to be the most commonly performed bariatric operation, several variables influence surgeons' practice patterns and patients' decision-making in the type of bariatric procedure to perform. The aim of this study was to evaluate patient factors that influence the decision between laparoscopic Roux-en-Y gastric bypass (LRYGB) versus LSG. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried for patients undergoing LSG and LRYGB between 2015 and 2017. Univariate analysis and multivariate logistic regression were used to evaluate factors associated with performing LRYGB compared to LSG. RESULTS A total of 252,117 (72.3%) LSG and 96,677 (27.7%) LRYGB cases were identified. Patients undergoing LSG were younger (44.3 ± 12.0 vs 45.2 ± 11.8 years; p < 0.01) and had a lower body mass index (BMI; 45.1 ± 7.8 vs 46.2 ± 8.1 kg/m2; p < 0.01). Most of the patients were females (79.4%), white (73.0%), with an American Society of Anesthesiology (ASA) class ≤ 3 (96.4%). The factors associated with undergoing LRYGB compared to LSG were diabetes mellitus, gastroesophageal reflux disease, BMI ≥ 50 kg/m2, ASA class > 3, obstructive sleep apnea, hypertension, and hyperlipidemia. However, patients with kidney disease, black race, chronic steroid use, age ≥ 60 years, recent smoking history, chronic obstructive pulmonary disease, and coronary artery disease were more likely to undergo LSG. CONCLUSIONS The decision to perform LRYGB is primarily driven by obesity-associated comorbidities and higher BMI, whereas LSG is more likely to be performed in higher risk patients.
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