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Vinjamuri RG, Wu V, Eng A, Tan J, Lim E, Lee PC, Kovalik JP, Tan HC. The Impact of Bariatric Surgery on Nitrogen Balance at Six months Post-surgery. Obes Surg 2024; 34:2363-2368. [PMID: 38748346 DOI: 10.1007/s11695-024-07269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Obesity, defined as abnormal or excessive fat accumulation that presents a risk to health, rose from 8.6 to 10.5% in Singapore's residents. Bariatric surgery, the primary treatment for severe obesity, induces fat and muscle loss. Adequate protein intake is vital for preventing muscle loss. This study examines nitrogen balance in individuals with obesity pre- and post-surgery. MATERIALS AND METHODS Sixteen participants with severe obesity (BMI ≥ 32.5 kg/m2) undergoing bariatric surgery (14 sleeve gastrectomy, 2 Roux-en-Y gastric bypass) and 20 normal-weight controls (BMI < 25 kg/m2) were recruited. Nitrogen balance, calculated from dietary protein intake and urine nitrogen excretion, was assessed. Participants with obesity were re-evaluated 6 months post-surgery. Data were analyzed using parametric methods. RESULTS At baseline, controls had a BMI of 20.8 ± 2.1 kg/m2; those with obesity had 40.9 ± 7.3. Daily calorie and protein intake for participants with obesity were not statistically significantly different from controls (calorie intake at 1467 ± 430 vs. 1462 ± 391 kcal, p = 0.9701, protein intake 74.2 ± 28.7 vs. 64.6 ± 18.3 g, p = 0.2289). Post-surgery, BMI, fat-free mass, fat mass, total energy intake, carbohydrate, and protein intake decreased significantly (p < 0.01). Protein oxidation and urine nitrogen excretion did not change after bariatric surgery. However, nitrogen balance significantly reduced from 2.62 ± 5.07 to - 1.69 ± 5.07 g/day (p = 0.025). CONCLUSION Dietary protein intake is inadequate in individuals with obesity at 6 months post-bariatric surgery and contributes to a state of negative nitrogen balance.
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Affiliation(s)
| | - Vieon Wu
- Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore
| | - Alvin Eng
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, 169608, Singapore
| | - Jeremy Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, 169608, Singapore
| | - Eugene Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore, 169608, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore
| | | | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore.
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Iljin A, Antoszewski B, Szewczyk T, Sitek A. Selected factors affecting the rate of reduction of body weight components during the first six months after bariatric surgery: A cohort study. POLISH JOURNAL OF SURGERY 2023; 96:34-41. [PMID: 38353095 DOI: 10.5604/01.3001.0053.8609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
<b><br>Aim:</b> To determine whether the rate of slimming following bariatric surgery depends on the sex, type of bariatric surgery, time elapsed since surgery or body weight components.</br> <b><br>Materials and methods:</b> The material is comprised of the results of three series of anthropometric measurements in 91 obese patients (before bariatric surgery, about 3 months after bariatric surgery and about 6 months afterwards). The inclusion criteria were patients of Polish origin admitted to the hospital from July 1, 2017 to January 31, 2019 for surgical treatment of obesity and written consent for the surgery and participation in the study. The measurements included body weight components assessed by bioelectrical impedance analysis.</br> <b><br>Results:</b> The reduction of all features was greater after SG than GB (p<0.0001), greater in the first quartile than in the second quartile after surgery (p<0.0001), and higher for fat mass than for other body weight components (p<0.0001). The sex of the patients, type of bariatric surgery, time elapsed since the operation, and type of body weight component constituted interactive modifiers of the rate of reduction.</br> <b><br>Conclusion:</b> After bariatric surgery, the reduction of fat mass was quicker in men than in women. SG and RYGB lead to a greater reduction of fat mass than GB. Among all three analyzed procedures, only for SG did the rate of body weight component reduction not decrease in the second quartile after surgery. This finding should be taken into account when creating an algorithm for treating a patient after bariatric surgery</br>.
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Affiliation(s)
- Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Lodz, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Lodz, Poland
| | | | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
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Circulating Lipoproteins in Subjects with Morbid Obesity Undergoing Bariatric Surgery with Gastric Bypass or Sleeve Gastrectomy. Nutrients 2022; 14:nu14122381. [PMID: 35745111 PMCID: PMC9228705 DOI: 10.3390/nu14122381] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/05/2022] [Indexed: 01/27/2023] Open
Abstract
The efficacy of various bariatric procedures on the mitigation of the obese dyslipidemia remains debated, and the impact of these measures on lipoprotein(a) (Lp(a)) levels is unknown. In this study we aimed to compare the two most commonly used procedures: gastric bypass (RYGB) and sleeve gastrectomy (SG). Adult patients with morbid obesity were assigned to receive either RYGB or SG. The levels of non-HDL cholesterol, LDL/HDL-ratio and Lp(a) at examinations conducted 6 and 12 months postoperatively were determined and compared to preoperative levels to estimate the efficacy of the two surgical methods. All results 6 and 12 months after surgery were used in the comparisons with the preoperative results. A linear mixed regression model for repeated analyses was used. The Lp(a) and the non-HDL cholesterol levels were considerably reduced in the RYGB group, in contrast to the minor changes in the SG group. In addition, the LDL/HDL ratio was significantly more reduced in the RYGB group when compared to the SG group. Conclusively, RYGB was found to be more efficient than SG for the mitigation of obese dyslipidemia, including preoperative high Lp(a)-levels. This might have important individual and societal implications, especially regarding the potential to reduce the risk of cardiovascular disease and the related societal costs.
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Zaki MKS, Al-Jefri OH, Kordi RE, Aljohani AH, Rizq MA, Kasem GH, Abuasidah SB. Correlation of Bariatric Surgery Effect on Lipid Profile Among Obese Patients. Cureus 2021; 13:e18118. [PMID: 34692329 PMCID: PMC8527874 DOI: 10.7759/cureus.18118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background A considerable subpopulation of patients with morbid obesity present with dyslipidemia. It is characterized by elevated total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and low high-density lipoprotein (HDL) concentrations. Sleeve gastrectomy (SG) is considered a method of treating morbid obesity and associated dyslipidemia. Objective To assess the effect of bariatric and metabolic surgery on lipid profile of morbidly obese patients. Methods We used a retrospective approach analyzing the lipid profiles of patients who underwent SG between January 2018 and July 2020. Patients were enrolled according to age (>17 years), pre-operative body mass index (BMI; >30 kg/m2), undergoing SG, and having complete follow-up records of lipid profiles. Baseline and post-operative lipid profiles, their variation, and the percentage of variation were compared. Results We analyzed data of 163 patients who underwent SG. The mean age was 36.75 ± 10.75 years, the mean BMI was 45.66 ±8.46, and the mean pre-operative TC, LDL, HDL, and TG were 4.67 ± 1.02, 2.55 ± 1.1, 1.14 ± 0.32, and 1.5 ± 1.11, respectively. There was a significant change in the mean level of TG as it was significantly higher pre-operatively compared to its mean level post-operatively. Furthermore, a significant change was observed in HDL. There was a non-significant change in levels of TC and LDL post-operatively. Conclusion SG showed to significantly reduce TG and elevate HDL in morbidly obese patients. On the contrary, TC and LDL were non-significantly affected. Further studies with longer follow-up are warranted to provide more reliable evidence.
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Affiliation(s)
| | | | - Reem E Kordi
- College of Medicine, Taibah University, Madinah, SAU
| | | | - Maha A Rizq
- Collage of Medicine, Taibah University, Madianh, SAU
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Choi SI. Is the Sleeve Gastrectomy Sufficient or Does it Require Additional Surgical Procedures? JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2021; 10:9-13. [PMID: 36687753 PMCID: PMC9847646 DOI: 10.17476/jmbs.2021.10.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 06/17/2023]
Abstract
Laparoscopic sleeve gastrectomy is a relatively simple procedure and has become the most well-known bariatric surgical procedure in Korea and Western countries. However, this procedure has several disadvantages in terms of long-term weight loss and metabolic disease control. Laparoscopic sleeve gastrectomy and additional bypass (sleeve plus) procedures were recently introduced into bariatric surgery in order to combine the physiologic advantages of pyloric-saving reconstruction and the bypass effect. A sleeve gastrectomy was performed first, followed by a bypass procedure. This review describes sleeve plus procedures reported in the literature and compares their outcomes with the most frequently performed techniques.
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Affiliation(s)
- Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Safety and feasibility of laparoscopic sleeve gastrectomy with loop duodenojejunal bypass for obesity. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:10-17. [PMID: 35601283 PMCID: PMC8965984 DOI: 10.7602/jmis.2021.24.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
Purpose Laparoscopic sleeve gastrectomy (SG) with loop duodenojejunal bypass (LDJB) is a combination of SG and one anastomosis gastric bypass surgeries. This study was intended to evaluate the safety and feasibility of SG-LDJB surgery. Methods This was a retrospective study analyzing SG-LDJB surgery using 250-cm length biliopancreatic limbs that was performed between May 2013 and December 2017 in 113 Indians with obesity. All demographic, clinical, operative, and follow-up data were analyzed for weight loss and diabetes remission efficacy. Weight-loss success was defined as percentage of total weight loss (%TWL) ≥ 25%. Diabetes remission was defined as hemoglobin A1c < 6% without the need for antidiabetic medications. Safety and feasibility were analyzed in terms of intraoperative and postoperative complications and serum albumin, iron, and calcium levels. Results The %TWL was 35.0% and 31.0% at the 1-year and 3-year follow-ups, respectively. The weight-loss success rate was 91.3% and 78.1% at the 1-year and 3-year follow-ups, respectively. Sixty-six out of 113 patients had type 2 diabetes. Diabetes remission was 80.0% and 75.4% at the 1-year and 3-year follow-ups, respectively. Major perioperative complications occurred in 0.9% of the patients. The 30-day mortality rate was zero. None of the patients had serum albumin levels of <3 g/dL at the 1-year and 3-year follow-ups or symptoms of hypoproteinemia. Conclusion SG-LDJB surgery using a 250-cm biliopancreatic limb is a safe and effective procedure to treat obesity. It is technically complex but has the advantages of endoscopic access to the stomach and negligible postoperative complications or hypoproteinemia.
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Jo YG, Yuem JH, Kim JM, Choi SI. Short-Term Outcomes of Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass for Morbid Obesity. JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2020; 9:61-67. [PMID: 36688118 PMCID: PMC9847660 DOI: 10.17476/jmbs.2020.9.2.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/25/2023]
Abstract
Purpose This study aimed to evaluate the safety and feasibility of laparoscopic sleeve gastrectomy with duodenojejunal bypass (SDJB) surgery in Korean patients. Materials and Methods This was a retrospective study analyzing SDJB surgery with a 200-cm biliopancreatic limb; the surgery was performed between January 2019 and August 2020 in 56 Koreans with morbid obesity. All demographic, clinical, operative, and follow-up data were documented and analyzed for weight loss and diabetes remission efficacy. Safety and feasibility were analyzed in terms of perioperative and postoperative complications. A decrease in the HbA1c value and discontinuation or reduction of anti-diabetics were considered as indicators of improvement in diabetes. Results he median operation time was 180.0 min (105-210 min), and the median postoperative hospital stay was 5.0 days (3-35 days). Postoperative complications occurred in two patients who were managed by conversion to Roux-en-Y gastric bypass surgery. Meaningful weight loss was 3.5%, 27.7%, and 54.9% at the 1-month, 3-month, and 6-month follow-ups, respectively. Of the 56 patients, 46 had type 2 diabetes. Among those patients, at the 1-month follow-up, 4/31 patients (12%), at the 3-month follow-up, 22/41 patients (53.6%), and at the 6-month follow-up, 31/42 patients (73.8%) were found to show improvement. Of the patients who received anti-diabetics or insulin therapy, only three (9%) patients continued to receive reduced treatment of diabetes, and the other thirty (91%) discontinued the anti-diabetics. Conclusion SDJB surgery with a 200-cm biliopancreatic limb was a safe and effective procedure to treat morbid obesity and diabetes.
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Affiliation(s)
- Young Gil Jo
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jeong Hyun Yuem
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jong Min Kim
- Department of Surgery, Min General Surgery Hospital, Seoul, Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Vennapusa A, Panchangam RB, Kesara C, Chivukula T. Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity. J Obes Metab Syndr 2020; 29:208-214. [PMID: 32908024 PMCID: PMC7539344 DOI: 10.7570/jomes20044] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) is a loop modification of biliopancreatic diversion with duodenal switch. The aim of this study was to analyze weight loss response and factors predicting weight loss outcomes after SG LDJB. Methods This was a retrospective study analyzing SG LDJB surgeries performed between May 2013 and December 2017 in 126 Indians suffering from obesity. The collected data was analyzed to understand weight loss efficacy and the factors predicting weight loss. Surgery was considered successful when percentage excess weight loss (%EWL) was ≥50% or percentage total weight loss (%TWL) was ≥25%. Results %EWL was 95.77% and 83.84% and %TWL was 34.64% and 30.32% at the 1-year and 3-year follow-up, respectively. %EWL ≥50% was 99.04% and 96.47% and %TWL ≥25% was 91.35% and 75.29% at the 1-year and 3-year follow-up, respectively. Patient age and sex did not independently predict %EWL or %TWL. Preoperative body mass index (BMI), weight, and excess weight negatively predicted %EWL and positively predicted %TWL at the 1-year and 3-year follow-up. Multiple regression analysis showed that these parameters were independent predictors of %EWL and %TWL at 1 year, while preoperative weight and excess weight also independently predicted %EWL at the 3-year follow-up. In diabetic patients, %EWL was significantly lower at the 3-year follow-up and %TWL was significantly lower at the 1-year and 3-year follow-up. Conclusion SG LDJB was an effective bariatric surgery to treat obesity. Preoperative BMI, weight, excess weight, and the presence of diabetes were the significant factors associated with the weight loss outcomes.
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Affiliation(s)
- Amar Vennapusa
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | | | - Charita Kesara
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
| | - Tejaswi Chivukula
- Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, India
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Głuszek S, Bociek A, Suliga E, Matykiewicz J, Kołomańska M, Bryk P, Znamirowski P, Nawacki Ł, Głuszek-Osuch M, Wawrzycka I, Kozieł D. The Effect of Bariatric Surgery on Weight Loss and Metabolic Changes in Adults with Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155342. [PMID: 32722225 PMCID: PMC7432000 DOI: 10.3390/ijerph17155342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Methods of treating obesity, such as changes in lifestyle, physical activity, restrictive diets, and psychotherapy, are not sufficient. Currently, it is considered that in the case of patients who meet the eligibility criteria for surgery, the treatment of choice should be bariatric surgery. The aim of this study was to assess the weight loss and metabolic changes in a group of adults with obesity undergoing bariatric surgery. The study involved 163 patients whose body mass index (BMI) exceeded 40 or 35 kg/m2, concurrent with at least one metabolic sequelae. In 120 of the cases (74%), sleeve gastrectomy was used; in 35 (21%), gastric banding was used; and in 8 (5%), laparoscopic Roux-en-Y gastric bypass was used. Metabolic parameters such as total cholesterol, LDL-cholesterol (low-density lipoprotein cholesterol), HDL-cholesterol (high-density lipoprotein cholesterol), triglycerides, and glucose were measured preoperatively and postoperatively, as well as the creatinine, creatine kinase (CK-MB), and leptin activity. In patients undergoing bariatric surgery, a significant decrease in excess weight (p < 0.001) was observed at all the analyzed time points, compared to the pre-surgery value. Weight loss after surgery was associated with a significant improvement in glycemia (109.6 ± 48.0 vs. 86.6 ± 7.9 mg/dL >24 months after surgery; p = 0.003), triglycerides (156.9 ± 79.6 vs. 112.7 ± 44.3 mg/dL >24 months after surgery; p = 0.043) and leptin (197.50 ± 257.3 vs. 75.98 ± 117.7 pg/mL 12 months after surgery; p = 0.0116) concentration. The results of the research confirm the thesis on the effectiveness of bariatric surgery in reducing excess body weight and improving metabolic parameters in patients with extreme obesity.
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Affiliation(s)
- Stanisław Głuszek
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Arkadiusz Bociek
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Correspondence: ; Tel.: +48-41-349-69-11
| | - Edyta Suliga
- The Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (E.S.); (M.G.-O.); (D.K.)
| | - Jarosław Matykiewicz
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of Oncological Surgery of the Swiętokrzyskie Center of Oncology in Kielce, 25-734 Kielce, Poland
| | - Magdalena Kołomańska
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Piotr Bryk
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Przemysław Znamirowski
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Łukasz Nawacki
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Martyna Głuszek-Osuch
- The Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (E.S.); (M.G.-O.); (D.K.)
| | - Iwona Wawrzycka
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Dorota Kozieł
- The Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (E.S.); (M.G.-O.); (D.K.)
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Schwenger KJP, Alghamdi MM, Ghorbani Y, Jackson TD, Okrainec A, Allard JP. Hyposalivation is prevalent in bariatric patients but improves after surgery. Surg Obes Relat Dis 2020; 16:1407-1413. [PMID: 32690458 DOI: 10.1016/j.soard.2020.06.005] [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: 01/06/2020] [Revised: 05/13/2020] [Accepted: 06/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Obesity and type 2 diabetes can be associated with poor oral health. This can be because of hyposalivation leading to chronic oral inflammation (OI) and periodontal disease. OBJECTIVE To assess the prevalence of hyposalivation and OI in individuals undergoing Roux-en-Y gastric bypass (RYGB) and determine the relationship with metabolic and anthropometric parameters before and after RYGB. SETTING University hospital in Canada. METHODS This was a cross-sectional and prospective cohort study of 59 patients undergoing RYGB from September 2015 to December 2019. Anthropometric, biochemical, and oral measurements were taken before surgery and 1 and 6 months post RYGB. Oral parameters included salivary flow rate and neutrophil count as marker of OI. RESULTS Fifty-nine patients were enrolled with 29 completing this study. At baseline, the median age was 47 years and body mass index was 46.5 kg/m2, 52 (88.1%) were female and 14 individuals (23.7%) had type 2 diabetes; 54.2% (n = 32) of patients had hyposalivation and 13.6% (n = 8) had high neutrophil count. Patients with hyposalivation had significantly higher fasting glucose (5.7 mmol/L) compared with those without hyposalivation (5.2 mmol/L) but no difference was found between high versus low neutrophil count. At 6 months post RYGB, all variables except oral neutrophil count significantly improved. Hyposalivation persisted in 7 (24%) individuals. CONCLUSIONS In our bariatric patients, more than half the patients had hyposalivation before RYGB and this was associated with higher fasting glucose. Hyposalivation improved post RYGB in parallel with improvements in metabolic parameters but there was no change in OI. Increased salivation may reduce the risk of periodontal disease.
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Affiliation(s)
- Katherine J P Schwenger
- Institute of Medical Science, University of Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Canada
| | - Maryam M Alghamdi
- Toronto General Hospital, University Health Network, Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Yasaman Ghorbani
- Institute of Medical Science, University of Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Canada
| | - Timothy D Jackson
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Johane P Allard
- Institute of Medical Science, University of Toronto, Ontario, Canada; Toronto General Hospital, University Health Network, Toronto, Canada; Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
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Kheirvari M, Dadkhah Nikroo N, Jaafarinejad H, Farsimadan M, Eshghjoo S, Hosseini S, Anbara T. The advantages and disadvantages of sleeve gastrectomy; clinical laboratory to bedside review. Heliyon 2020; 6:e03496. [PMID: 32154399 PMCID: PMC7052082 DOI: 10.1016/j.heliyon.2020.e03496] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 12/01/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
Sleeve gastrectomy is a surgical technique and a leading method in metabolic surgery. Sleeve gastrectomy gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery and has proved to be a successful method in achieving considerable weight loss in a short time. There are some disparate effects that patients may experience after sleeve gastrectomy including a reduction in BMI, weight, blood pressure, stroke, and cancer and also a significant remission in obesity-related diseases including type 2 diabetes (T2D), Non-alcoholic fatty liver (NAFLD), cardiovascular disease, obstructive sleep apnea, and craniopharyngioma-related hypothalamic obesity as well as non-obesity-related diseases such as gout, musculoskeletal problems, ovarian disorders and urinary incontinence. The most common complications of sleeve gastrectomy are bleeding, nutrient deficiencies, and leakage. There are several studies on the impact of gender and ethnic disparities on post-operative complications. This study collects state of the art of reports on sleeve gastrectomy. The aim of this study was to analyze recent studies and review the advantages and disadvantages of sleeve gastrectomy.
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Affiliation(s)
- Milad Kheirvari
- Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran
| | | | - Habib Jaafarinejad
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Marziye Farsimadan
- Department of Biology, Faculty of Sciences, University of Guilan, Rasht Iran
| | - Sahar Eshghjoo
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M University, Health Science Center, Bryan, TX, USA
| | - Sara Hosseini
- Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
| | - Taha Anbara
- Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
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Rocha de Almeida R, Cândido de Souza MF, Gama de Matos D, Monteiro Costa Pereira L, Batista Oliveira V, Menezes Oliveira JL, Soares Barreto-Filho JA, Almeida-Santos MA, de Souza RF, de Freitas Zanona A, Machado Reis V, Aidar FJ, Sobral Sousa AC. A Retrospective Study about the Differences in Cardiometabolic Risk Indicators and Level of Physical Activity in Bariatric Surgery Patients from Private vs. Public Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234751. [PMID: 31783626 PMCID: PMC6926728 DOI: 10.3390/ijerph16234751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Abstract
Background: Obesity is a pathology with a growing incidence in developing countries. Objective: To evaluate the evolution of cardiometabolic, anthropometrics, and physical activity parameters in individuals undergoing bariatric surgery (BS) in the public healthcare system (PUS) and private healthcare system (PHS). Methods: A longitudinal, observational, and retrospective study was conducted with 111 bariatric patients on two different health systems, with 60 patients from the PUS and 51 from the PHS. Cardiometabolic risk (CR) was analyzed by the assessment of obesity-related comorbidities (AORC) on admission and 3, 6, and 12 months after BS, and the International Physical Activity Questionnaire (IPAQ) was surveyed before and 12 months after BS. In addition, cardiometabolic risk was also assessed by biochemical (fasting glucose and complete lipidogram) and anthropometric (weight, weight loss, waist circumference, and waist-to-height ratio) parameters. Results: On admission, the parameters of severe obesity, systemic arterial hypertension (SAH), Diabetes mellitus (DM), and waiting time to BS were higher in the PUS. Additionally, in the PUS, AORC was reduced only in the SAH parameter. However, in the post-surgery moment, AORC reduced, and there was no difference between the two groups after BS. Regarding physical activity, the IPAQ showed a higher level of activity in the PHS before and one year after BS. Conclusion: At the PUS, BS is performed in patients with a higher degree of comorbidities, but BS improved the reduction of the CR at a similar level to those observed in the PHS.
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Affiliation(s)
- Rebeca Rocha de Almeida
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Estácio Sergipe University Center, Aracaju, Sergipe 49020-490, Brazil
| | - Márcia Ferreira Cândido de Souza
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
| | - Dihogo Gama de Matos
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil; (D.G.d.M.); (R.F.d.S.)
- Institute of Parasitology, McGill University, Montreal, QC H3A 0E6, Canada
| | - Larissa Monteiro Costa Pereira
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Estácio Sergipe University Center, Aracaju, Sergipe 49020-490, Brazil
| | - Victor Batista Oliveira
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
| | - Joselina Luzia Menezes Oliveira
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Cardiovascular System Unit Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Clinic and Hospital São Lucas—Rede D’Or São Luiz, Aracaju, Sergipe 49015-400, Brazil
| | - José Augusto Soares Barreto-Filho
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Cardiovascular System Unit Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Clinic and Hospital São Lucas—Rede D’Or São Luiz, Aracaju, Sergipe 49015-400, Brazil
| | | | - Raphael Fabrício de Souza
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil; (D.G.d.M.); (R.F.d.S.)
- Department of Physical Education, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49060-108, Brazil
| | - Aristela de Freitas Zanona
- Department of Occupational Therapy, Federal University of Sergipe—UFS, Lagarto, Sergipe 49170-000, Brazil;
| | - Victor Machado Reis
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5000-801 Vila Real, Portugal;
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil; (D.G.d.M.); (R.F.d.S.)
- Department of Physical Education, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49060-108, Brazil
- Graduate Program in Physiological Sciences, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil
- Correspondence: ; Tel.: +55-79-3194-6600
| | - Antônio Carlos Sobral Sousa
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Cardiovascular System Unit Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Clinic and Hospital São Lucas—Rede D’Or São Luiz, Aracaju, Sergipe 49015-400, Brazil
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Husain F, Jeong IH, Spight D, Wolfe B, Mattar SG. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res 2018; 95:100-110. [PMID: 30079327 PMCID: PMC6073041 DOI: 10.4174/astr.2018.95.2.100] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose Vertical sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are currently the most common bariatric procedures. Although the safety of these operations has markedly improved, there continues to be a certain rate of complications. Such adverse events can have a significant deleterious effect on the outcome of these procedures and represent a costly burden on patients and society at large. A better understanding of these complications and their predictive factors may help ameliorate and optimize outcomes. Methods Seven hundred seventy-two consecutive patients who underwent SG or RYGB for morbid obesity between January 2011 and October 2015, in the Division of Bariatric Surgery at a tertiary institution, were included through retrospective review of the medical database. The complications were categorized and evaluated according to severity using the Clavien-Dindo classification system. Significant risk factors were evaluated by binary logistic regression to identify independent predictors and analyzed to identify their relationship with the type of complication. Results Independent predictors of severe complication after these procedures included male gender, open and revisional surgery, hypertension, and hypoalbuminemia. Hypoalbuminemia had significant associations with occurrence of deep surgical site infection and leak. Open surgery had significant associations with occurrence of superficial and deep surgical site infection and respiratory complications. Independent predictors of severe complication after laparoscopic primary RYGB included previous abdominal surgery. Previous abdominal surgery had significant associations with deep surgical site infection and leak. Conclusion Recognition and optimization of these risk factors would be valuable in operative risk prediction before bariatric surgery.
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Affiliation(s)
- Farah Husain
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - In Ho Jeong
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA.,Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Donn Spight
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Bruce Wolfe
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Samer G Mattar
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
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