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Pajecki D, dos Anjos Pinheiro MC, Dantas ACB, Corsi GC, Dias MCG, Santo MA. Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass for Treating Obesity in Patients > 65 Years Old: 3-Year Outcomes of a Randomized Trial. J Gastrointest Surg 2023; 27:780-782. [PMID: 36717470 PMCID: PMC9886416 DOI: 10.1007/s11605-023-05608-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Denis Pajecki
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 9º Andar, Sao Paulo, SP 05403-000 Brazil
| | - Moisés Carmo dos Anjos Pinheiro
- Divisão de Nutrição E Dietética, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Anna Carolina Batista Dantas
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 9º Andar, Sao Paulo, SP 05403-000 Brazil
| | - Giovanna Cavanha Corsi
- Divisão de Nutrição E Dietética, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Maria Carolina Gonçalves Dias
- Divisão de Nutrição E Dietética, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
| | - Marco Aurelio Santo
- Unidade de Cirurgia Bariátrica E Metabólica, Disciplina de Cirurgia Do Aparelho Digestivo E Coloproctologia, Departamento de Gastroenterologia, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 9º Andar, Sao Paulo, SP 05403-000 Brazil
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Lima RCD, Rodrigues TMDS, Scheibe CL, Campelo GP, Pinto LEV, Valadão GJC, Carvalho GPCD, Machado Junior MRD, Valadão JA, Lima PCRD, Leal PDC, Oliveira CMBD, Moura ECR. Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment. Acta Cir Bras 2021; 36:e360203. [PMID: 33624720 PMCID: PMC7902054 DOI: 10.1590/acb360203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of
obese patients, adherence to clinical follow-up and the influence of factors
such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with
patients undergoing vertical gastrectomy, operated at Hospital São Domingos,
between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%)
and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was
56.18%. Among adherent patients (n = 117; 43.82%), most patients were female
(n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body
mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72
kg/m2. Both BMI and excess weight (EW) showed a statistically
significant difference between pre- and postoperative period. Percentage of
excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients.
Older patients had a statistically significant lower % EWL compared to the
other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with
significant weight loss.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Plinio da Cunha Leal
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
| | | | - Ed Carlos Rey Moura
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
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Geometry of Sleeve Gastrectomy Measured by 3D CT Versus Weight Loss: Preliminary Analysis. World J Surg 2020; 45:235-242. [PMID: 33037439 DOI: 10.1007/s00268-020-05807-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The size of the remnant stomach with respect to weight loss failure after laparoscopic sleeve gastrectomy (LSG) remains controversial. This study aimed to evaluate the impact of the actual size and volume of the remnant stomach, as measured by three-dimensional computed tomography (3D-CT) volumetry, on weight loss after LSG. METHODS The clinical outcomes of 52 patients who underwent LSG between October 2008 and February 2019 were assessed. Weight metrics were recorded at 1, 3, and 6 months and 1 year postoperatively. 3D-CT volumetry was performed 1 year postoperatively, and the total remnant stomach volume (TSV), proximal stomach volume (PSV), antral stomach volume (ASV), and the distance between the pylorus and the distal edge of staple line (DPS) were measured. The relationship between the weight metrics and aforementioned factors was analyzed. RESULTS Of the 52 patients who underwent LSG, 40 patients participated in this study. The average body mass index preoperatively was 38.3 ± 5.1 kg/m2, and the average percentage of total weight loss (%TWL) 1 year after LSG was 26.6 ± 9.3%. The average TSV, PSV, ASV, and DPS were 123.2 ± 60.3 ml, 73.4 ± 37.2 ml, 49.8 ± 30.3 ml, and 59.9 ± 18.5 mm, respectively. The DPS (r = - 0.394, p = 0.012) and ASV (r = - 0.356, p = 0.024) were correlated with %TWL 1 year postoperatively. CONCLUSIONS The actual DPS and ASV measured by 3D-CT affected weight loss after LSG. 3D-CT may be useful for the immediate identification of factors affecting insufficient weight loss in patients; this may, in turn, aid in the implementation of early intervention treatments.
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Sisik A, Basak F. Presurgical Predictive Factors of Excess Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:2905-2912. [PMID: 32307671 DOI: 10.1007/s11695-020-04624-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Conditions associated with surgical technique and postoperative lifestyle changes, as well as the characteristics of patients, may affect weight loss following laparoscopic sleeve gastrectomy. In this study, the effects of age, gender, BMI, and excess weight at the time of surgery on weight loss during follow-up were examined. MATERIALS AND METHODS Demographic data (age, gender), preoperative BMI, and weight values of the patients were recorded. TWL% and EWL% values of patients were recorded during follow-up at 1st, 3rd, 6th, 9th, 12th, and 18th months. Patients were grouped according to age (AGE1 < 30, AGE2 30-50, AGE3 ≥ 50 years), BMI at the time of surgery (BMI1 ≤ 50, BMI2 > 50 kg/m2), and EW at the time of surgery (EW1 ≤ 60, EW2 > 60 kg). EWL% values obtained in the follow-up visits were compared among the gender, age, BMI, and EW groups. RESULTS A total of 456 patients (371 females, 85 males) were operated. Mean EWL% was lower in AGE3 group (p < 0.001). Patients in AGE1 group had the highest mean EWL%, while those in BMI2 and EW2 groups had lower mean EWL% values throughout the follow-up period (p < 0.001). Regression analysis showed that age and BMI were associated with EWL% at all follow-up visits (p < 0.05). CONCLUSION Patients with less than 60 kg of excess weight, those with BMI ≤ 50 kg/m2 and younger patients may lose weight more effectively following LSG.
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Affiliation(s)
- Abdullah Sisik
- Umraniye Education and Research Hospital, General Surgery Department, University of Health Sciences, Elmalikent Mah. Adem Yavuz Cad. No: 1 Umraniye, Istanbul, Turkey.
| | - Fatih Basak
- Umraniye Education and Research Hospital, General Surgery Department, University of Health Sciences, Elmalikent Mah. Adem Yavuz Cad. No: 1 Umraniye, Istanbul, Turkey
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Dowgiałło-Wnukiewicz N, Janik MR, Lech P, Major P, Pędziwiatr M, Kowalewski PK, Walędziak M, Wysocki M, Michalik M. Outcomes of sleeve gastrectomy in patients older than 60 years: a multicenter matched case-control study. Wideochir Inne Tech Maloinwazyjne 2020; 15:123-128. [PMID: 32117495 PMCID: PMC7020714 DOI: 10.5114/wiitm.2019.81450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The prevalence of obesity is increasing according to the World Health Organization. Furthermore, global aging is increasing, especially in developed countries in Europe. Whether bariatric surgery should be performed in elderly people is still controversial. AIM To determine the clinical outcomes of sleeve gastrectomies (SG) in older central European patients. We compared the safety and efficacy of SG in patients older than 60 years with younger patients. MATERIAL AND METHODS Eighty-nine patients older than 60 years, who underwent SG, were included in the study. Eighty-nine younger patients (aged 18-40 years) were matched according to body mass index (BMI) and comorbidities. The analyzed data included age, sex, total body weight, BMI, length of hospital stay, 30-day complications and improvement in comorbidities. RESULTS There was no significant difference in the complication rate between the 2 age groups (p = 0.59). An improvement in hypertension was observed in 73.1% of older patients and in 69.2% of younger patients (p = 0.67). There was improvement in diabetes mellitus in 40% of older patients and in 31.1% of younger patients (p = 0.25). The ΔBMI after 12, 24 and 36 months was significantly lower in older patients than in younger patients (p = 0.002, p = 0.001; p = 0.043, respectively). Percent excess BMI loss (%EBMIL) after 12, 24, and 60 months was significantly lower in older than in younger patients (p = 0.001, p = 0.001, p = 0.028, respectively). CONCLUSIONS Better weight loss is achieved in younger than in older patients, while maintaining a similar effect on the risk of complications and improvement in comorbidities. Therefore, SG is safe and effective in older people.
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Affiliation(s)
| | - Michal R. Janik
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Pawel Lech
- Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury, Olsztyn, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr K. Kowalewski
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Michał Wysocki
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Maciej Michalik
- Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury, Olsztyn, Poland
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Giordano S, Salminen P. Laparoscopic Sleeve Gastrectomy Is Safe for Patients Over 60 Years of Age: A Meta-Analysis of Comparative Studies. J Laparoendosc Adv Surg Tech A 2020; 30:12-19. [DOI: 10.1089/lap.2019.0463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Salvatore Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Department of Surgery, Satasairaala Central Hospital, Pori, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
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Effectiveness and Safety of Roux-en-Y Gastric Bypass in Elderly Patients-Systematic Review and Meta-analysis. Obes Surg 2019; 29:361-368. [PMID: 30353247 DOI: 10.1007/s11695-018-3546-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION As the population ages, there is more interest in bariatric surgery for older patients. There are controversies regarding the safety and effectiveness of surgical weight loss in this population. AIM The aim of this study was to compare the safety and efficacy of Roux-en-Y gastric bypass in patients over the age of 60 years with younger patients. METHODS The available literature was searched for eligible studies up to February 2018. Inclusion criteria were reports on mortality, morbidity, percentage excess weight loss (%EWL), remission of diabetes, remission of hypertension, and remission of obstructive sleep apnea. Random effects meta-analyses were performed. RESULTS The initial search yielded 2000 references. The final meta-analysis involved nine studies and revealed significant differences in mortality (odds ratio 4.38, 95% confidence interval [1.25, 15.31], p = 0.02), morbidity (OR 1.88, CI [1.07, 3.30], p = 0.03), %EWL (mean difference - 5.86, 95% CI [- 9.15, - 2.56], p < 0.001), and remission of comorbidities. CONCLUSION Higher mortality and morbidity were found in the group of older patients. The analysis suggested lower effectiveness of Roux-en-Y gastric bypass for weight loss and improvement in comorbidity in older patients when compared with younger patients.
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Nevo N, Eldar SM, Lessing Y, Sabo E, Nachmany I, Hazzan D. Sleeve Gastrectomy in the Elderly. Obes Facts 2019; 12:502-508. [PMID: 31610540 PMCID: PMC6876611 DOI: 10.1159/000502697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/12/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Even though risks are higher and long-term results may be less favorable, the elderly obese can still benefit from bariatric surgery. Whether the higher surgical risk is worth the benefits is yet to be determined. MATERIALS AND METHODS We reviewed our database and identified all patients aged 65 or older who underwent sleeve gastrectomy between May 2010 and November 2015. We documented patient demographics, obesity-related comorbidities, body mass index (BMI) before and after the procedure, percent excess weight loss, comorbidity improvement or resolution, length of follow-up, postoperative complications, re-operations, and length of hospital stay. We compared our study group to a control group of sleeve gastrectomy patients under the age of 65. RESULTS Sixty-six patients (mean age 67.6 ± 2.6 years) underwent laparoscopic sleeve gastrectomy. Patients achieved an average of 53.5% excess BMI loss (EBMIL) after 21 months of follow-up. EBMIL was inferior to that achieved by the control group (EBMIL 77.3%, p < 0.0001). Elderly patients showed significant improvement or resolution in all obesity-related comorbidities. Complication and re-operation rates were similar between the 2 groups. CONCLUSION In an elderly population, laparoscopic sleeve gastrectomy is safe and effective, yet weight loss outcomes are more modest when compared to a younger surgical population. Carefully selected elderly patients can benefit from bariatric surgery.
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Affiliation(s)
- Nadav Nevo
- General Surgery Division, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty, Tel-Aviv-Yafo, Israel,
| | - Shai Meron Eldar
- General Surgery Division, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty, Tel-Aviv-Yafo, Israel
- Bariatric Surgery Unit, The Tel-Aviv Sourasky Medical Center of Medicine, Tel Aviv University, Tel-Aviv-Yafo, Israel
| | - Yonatan Lessing
- General Surgery Division, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty, Tel-Aviv-Yafo, Israel
| | - Edmond Sabo
- Department of Pathology, Technion, Haifa, Israel
| | - Ido Nachmany
- General Surgery Division, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty, Tel-Aviv-Yafo, Israel
| | - David Hazzan
- General Surgery Department C, Sheba Medical Center, Ramat Gan, Israel
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Khidir N, El-Matbouly M, Al Kuwari M, Gagner M, Bashah M. Incidence, Indications, and Predictive Factors for ICU Admission in Elderly, High-Risk Patients Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2019; 28:2603-2608. [PMID: 29616465 DOI: 10.1007/s11695-018-3221-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Obesity affects the elderly, leading to increased prevalence of age- and obesity-associated comorbidities. There are no guidelines for indications and risk assessment for the elderly undergoing bariatric surgery. OBJECTIVES To determine the incidence, indications, and outcomes of planned ICU admission in elderly, high-risk patients after laparoscopic sleeve gastrectomy (LSG) and to assess if preoperative risk factors for planned postoperative ICU admission in elderly patients undergoing LSG could be predicted preoperatively. METHODS Retrospective review of prospectively collected data for all patients aged ≥ 60 years who underwent LSG (2011-2016) at Hamad General Hospital in Qatar. RESULTS We followed up 58 patients aged 60-75 years for 28 ± 17 months. About 77.6% of patients were in the intermediate-risk group of the Obesity Surgery Mortality Risk Score (OS-MRS). Fourteen patients (24%) required ICU admission for 2 ± 1.2 days; all patients belonged to the American Society of Anesthesiologists (ASA) III class and intermediate to high risk on OS-MRS. There were no reported mortalities. The mean body mass index (BMI) decreased from 49 ± 10.6 to 37.6 ± 10.1 kg/m2. The number of patient comorbidities (OR, 1.43; 95% CI, 1.03-1.99) and the diagnosis of obstructive sleep apnea (OSA; OR, 7.8; 95% CI, 1.92-31.68) were associated with planned ICU admission. CONCLUSION Elderly patients undergoing LSG usually have excellent postoperative course despite the associated high risk and the required ICU admission. The number of comorbidities, diagnosis of OSA, and ASA score are possible clinically significant predictive factors for the need of post-LSG ICU admission.
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Affiliation(s)
- Nesreen Khidir
- Department of Bariatric Surgery, Hamad General Hospital, Doha, Qatar. .,HMC, P.O. Box: 3050, Doha, Qatar.
| | | | | | - Michel Gagner
- Department of Surgery, Hopital du Sacre Coeur, Montreal, Canada
| | - Moataz Bashah
- Department of Bariatric Surgery, Hamad General Hospital, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar
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Martín AS, Sepúlveda M, Guzman F, Guzmán H, Patiño F, Preiss Y. Surgical Morbidity in the Elderly Bariatric Patient: Does Age Matter? Obes Surg 2019; 29:2548-2552. [PMID: 30993573 DOI: 10.1007/s11695-019-03876-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Obesity is a global health problem that also affects older adults. In Chile, as in most of the developing countries, more than half of older adults are overweight or obese, and bariatric surgery may be riskier for this group. The aim of this study is to compare our experience in patients over 60 years of age with a control group to determine associated surgical morbidity and mortality. METHODS Case-control study of bariatric surgeries performed between 2006 and 2017 in our institution. Patients aged ≥ 60 years for the case group versus control group for patients ≤ 50 years selected randomly, matched by body mass index, type 2 diabetes, hypertension, dyslipidemia, surgical technique, and gender (ratio 1:2). Primary endpoint was surgical morbidity, 30-day readmission, and mortality. RESULTS Seventy-two patients in case group were matched with 144 patients in control group. Surgical complications rate was the same for both groups. No differences were observed in the conversion to open surgery rate or 30-day readmission rate. There was no mortality in this series. CONCLUSION In this case-control study, being elderly does not increase the risk of morbidity and mortality associated with bariatric surgery.
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Affiliation(s)
- Andrés San Martín
- Escuela de Medicina, Universidad Diego Portales, Av. Ejército Libertador, 141, Santiago, Chile
| | - Matías Sepúlveda
- Escuela de Medicina, Universidad Diego Portales, Av. Ejército Libertador, 141, Santiago, Chile. .,Bariatric and Metabolic Surgery Center, DIPRECA Hospital, Vital Apoquindo 1200, Las Condes, Santiago, Chile.
| | - Felipe Guzman
- Escuela de Medicina, Universidad de Santiago, Av Libertador Bernardo O'Higgins, 3363, Santiago, Chile
| | - Hernán Guzmán
- Bariatric and Metabolic Surgery Center, DIPRECA Hospital, Vital Apoquindo 1200, Las Condes, Santiago, Chile
| | - Felipe Patiño
- Bariatric and Metabolic Surgery Center, DIPRECA Hospital, Vital Apoquindo 1200, Las Condes, Santiago, Chile
| | - Yudith Preiss
- Bariatric and Metabolic Surgery Center, DIPRECA Hospital, Vital Apoquindo 1200, Las Condes, Santiago, Chile
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Bioelectrical Impedance Analysis Results for Estimating Body Composition Are Associated with Glucose Metabolism Following Laparoscopic Sleeve Gastrectomy in Obese Japanese Patients. Nutrients 2018; 10:nu10101456. [PMID: 30297607 PMCID: PMC6213007 DOI: 10.3390/nu10101456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 12/18/2022] Open
Abstract
We investigated the association between body composition and changes in glucose metabolism following laparoscopic sleeve gastrectomy (LSG) in obese Japanese patients. Thirty-two Class III obese patients were assessed before LSG and 3, 6, and 12 months postoperatively. Variables including fat mass (FM), % body fat (%FM), total and skeletal muscle mass (MM), the ratio of lower extremity MM to body weight (BW) (L/W), and the ratio of upper extremity MM to BW (U/W) were measured while using bioelectrical impedance analysis (BIA). LSG significantly decreased BW, FM, and %FM in all time periods observed after surgery with concomitant improvements in metabolic markers. MM was decreased at three months but maintained from 3⁻12 months post-surgery. Importantly, %MM, U/W, and the L/W ratio increased after LSG. Furthermore, change in FM was positively correlated with change in BW 12 months after LSG, whereas changes in %MM were negatively correlated with fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c). Finally, multivariable stepwise regression analyses showed that changes in % total MM was an independent determinant of FPG and change in % skeletal MM was a significant independent determinant of HbA1c in Class III obese Japanese patients after LSG.
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Bianco P, Rizzuto A, Velotti N, Bocchetti A, Manzolillo D, Maietta P, Milone M, Amato M, Conzo G, Buonomo O, Petrella G, Musella M. Results following laparoscopic sleeve gastrectomy in elderly obese patients: a single center experience with follow-up at three years. MINERVA CHIR 2018; 75:77-82. [PMID: 29963791 DOI: 10.23736/s0026-4733.18.07757-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) represents the most performed bariatric surgical procedure worldwide. Morbid Overweight in elderly patients is becoming a significant health problem even in Italy. As well as in younger age groups, bariatric surgery could be indicated even in this subset of patients. However the advantages and results of LSG in patients over 60 years old have received minimal attention. METHODS The records of 375 patients underwent LSG between 2008 and 2016 were reviewed. In the entire series 18 patients were aged 60 years or older at the time of surgery. Since a 3 years follow-up was available for 12 patients out of the 18 aged over 60 we included in the study only these. General epidemiologic data, clinical findings, BMI and comorbidities surgical treatment and follow-up data were collected; postoperative measurements such as operative time, intraoperative complications, mortality rate, length of stay, incidence of early and late complications, Body mass Index (BMI), excess weight loss rate (EWL%) and comorbidities resolution were also recorded. RESULTS LSG was successfully performed for all geriatric patients. Global complications rate was 16.6% At 3 years mean BMI was 34.4±3.8 with a mean EWL% 66.1±31.9. Postoperative resolution of obesity comorbidities was observed; Hypertension (71.4%), type 2 Diabetes Mellitus (T2DM) (50.0%), obstructive sleep apnea syndrome (OSAS) (66.6%) respectively. No intraoperative complications or mortality were recorded. CONCLUSIONS LSG offered cure in geriatric patients affected by morbid obesity for weight loss and comorbidities resolution. Larger studies are necessary to analyze and minimize the incidence of postoperative complications associated to this surgical procedure in elderly patients.
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Affiliation(s)
- Paolo Bianco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Alessio Bocchetti
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Domenico Manzolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Paola Maietta
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Marco Milone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Amato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Giovanni Conzo
- Department of Cardiothoracic and Respiratory Sciences, Luigi Vanvitelli University, Naples, Italy
| | - Oreste Buonomo
- Department of Surgery, Tor Vergata University, Rome, Italy
| | | | - Mario Musella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy -
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