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Innovative Bariatric Procedures and Ethics in Bariatric Surgery: the IFSO Position Statement. Obes Surg 2022; 32:3217-3230. [PMID: 35922610 DOI: 10.1007/s11695-022-06220-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/17/2022] [Accepted: 07/24/2022] [Indexed: 02/06/2023]
Abstract
With the rise in obesity and bariatric procedures worldwide, there has been a surge in new and innovative procedures that has been increasingly offered to patients. In this position statement, IFSO highlights the importance of surgical ethics in innovation and when offering new procedures. Furthermore, the task force reviewed the current literature to describe which procedures can be offered as mainstream outside research protocols versus those that are still investigational and need further data.
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Taskin HE, Al M. Longitudinal Outcomes Through 4 Years After Sleeve Gastrectomy with Transit Bipartition. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2021.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Halit Eren Taskin
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Muzaffer Al
- Department of Surgery, Faculty of Medicine, Near East University Nicosia, Turkey
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Taskin HE, Al M. Testosterone Changes in Men With Obesity and Type 2 Diabetes 6 Months After Sleeve Gastrectomy With Transit Bipartition. Surg Laparosc Endosc Percutan Tech 2022; 32:188-196. [PMID: 35180734 DOI: 10.1097/sle.0000000000001039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Metabolic/bariatric surgery has been shown to increase testosterone in males with obesity. This study investigated the effect of the novel metabolic/bariatric surgery procedure, sleeve gastrectomy with transit bipartition (SG-TB), on serum total testosterone and metabolic variable changes in men with obesity and type 2 diabetes. METHODS In a prospective single-center cohort study, laboratory samples were analyzed preoperatively and at 6 months following SG-TB in patients with a body mass index (BMI) ≥30 kg/m2. Changes in metabolic parameters and testosterone were evaluated. RESULTS Between July 2018 and March 2019, 166 patients with a mean baseline BMI of 34.9±3.8 kg/m2 (mean age 51.5±9.3 y), glycosylated hemoglobin 9.5±1.3%, and testosterone 3.1±1.3 underwent SG-TB. At 6-month follow-up, mean excess BMI loss was 70.2±24.3%; glycosylated hemoglobin, 6.6±1.1% (P<0.001); and testosterone, 4.5±1.5 (P<0.001). CONCLUSION In the early term following SG-TB, more than any other factor assessed, BMI loss was found to be a significant driver of improvement in testosterone levels. Regardless of preoperative obesity classification, patients with initially low testosterone attained significantly increased testosterone levels at 6-month follow-up.
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Affiliation(s)
- Halit E Taskin
- Department of Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul
| | - Muzaffer Al
- Department of Surgery, Faculty of Medicine, Near East University, Nicosia, Turkey
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Calisir A, Ece I, Yilmaz H, Alptekin H, Acar F, Yormaz S, Colak B, Sahin M. The Mid-Term Effects of Transit Bipartition with Sleeve Gastrectomy on Glycemic Control, Weight Loss, and Nutritional Status in Patients with Type 2 Diabetes Mellitus: a Retrospective Analysis of a 3-Year Follow-up. Obes Surg 2021; 31:4724-4733. [PMID: 34195935 DOI: 10.1007/s11695-021-05536-1] [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: 12/28/2020] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Metabolic surgery is an effective treatment method for glycemic control and weight loss in obese patients with type 2 diabetes mellitus (T2DM). This study aimed to present the mid-term metabolic effects and weight loss results of the patients with T2DM who underwent transit bipartition with sleeve gastrectomy (TB-SG). METHODS A total of 32 obese patients with T2DM who underwent TB-SG were included in the study. The T2DM remission status after surgery was evaluated. The postoperative glycemic variables, weight loss, lipid profile, and nutritional profile were also compared with the baseline values. RESULTS At 36 months after surgery, T2DM remission occurred in 27 patients (84.3%) and the mean BMI decreased from 44.70 ± 9.34 to 29.75 ± 2.19 kg/m2. The percentage of total weight loss (TWL) and excess weight loss (EWL) was 33.84% and 77.19%, respectively. The mean LDL values significantly decreased compared to baseline; however, the mean HDL did not significantly differ. No significant difference was observed regarding the mean albumin, vitamin B12, and folic acid levels. CONCLUSION TB-SG procedure seems promising in terms of T2DM remission and weight loss with less malnutrition and vitamin deficiency in treating obese patients with T2DM.
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Affiliation(s)
- Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey.
| | - Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Husnu Alptekin
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Fahrettin Acar
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Bayram Colak
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, 42075, Konya, Turkey
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Santoro S, Aquino CGG, Mota FC. Exclusions May Be Dismissed if the Ileum Is Early and Potently Stimulated. Obes Surg 2021; 31:5049-5050. [PMID: 34184186 DOI: 10.1007/s11695-021-05526-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/17/2021] [Accepted: 06/08/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Sergio Santoro
- Surgery Department, Hospital Israelita Albert Einstein, Av Albert Einstein, 627 Bloco A1, Room 223, 05652-900, Sao Paulo, Brazil.
| | - Caio Gustavo Gaspar Aquino
- Surgery Department, Hospital Israelita Albert Einstein, Av Albert Einstein, 627 Bloco A1, Room 223, 05652-900, Sao Paulo, Brazil
| | - Filippe Camarotto Mota
- Surgery Department, Hospital Israelita Albert Einstein, Av Albert Einstein, 627 Bloco A1, Room 223, 05652-900, Sao Paulo, Brazil
- Surgery Department, Hospital Israelita Albert Einstein and Hospital das Clinicas - FMUSP, Sao Paulo, Brazil
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Lee WJ, Almuhanna M. Paired Editorial: Effects of Sleeve Gastrectomy with Transit Bipartition on Glycemic Variables, Lipid Profile, Liver Enzymes and Nutritional Status in Type 2 Diabetes Mellitus Patients: a 1-Year Follow-up Study. Obes Surg 2021; 30:1128-1129. [PMID: 31834564 DOI: 10.1007/s11695-019-04327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, People's Republic of China.
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Comparing the Anti-diabetic Effect of Sleeve Gastrectomy with Transit Bipartition Against Sleeve Gastrectomy and Roux-en-Y Gastric Bypass Using a Diabetic Rodent Model. Obes Surg 2021; 31:2203-2210. [PMID: 33507518 DOI: 10.1007/s11695-021-05256-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) has superior long-term diabetes remission outcomes to sleeve gastrectomy (SG). However, in regions with a high prevalence of gastric cancer, RYGB may not be the best option. This study aimed to investigate the anti-diabetic effect of SG with transit bipartition (SG-TB) compared with SG and RYGB. MATERIALS AND METHODS A total of 32 diabetic Sprague-Dawley rat models were assigned to one of four groups: SG (n = 8), RYGB (n = 8), SG-TB (n = 8), and SHAM (n = 8). Body weight, food intake, blood glucose, and hormonal changes (glucagon-like peptide-1 (GLP-1), insulin, and glucagon) were measured to investigate the effect of surgery in all groups. Oral glucose tolerance test and insulin tolerance test were performed before and 8 weeks after surgery. RESULTS There were no significant differences in the postoperative changes in body weight and food intake among the SG, RYGB, and SG-TB groups. Postoperatively, the RYGB and SG-TB groups had significantly higher GLP-1 levels and lower insulin levels than the SG group. Further, RYGB and SG-TB had significantly better glucose control improvements than SG. There were no significant differences in GLP-1, insulin, glucagon, and homeostasis model assessment of insulin resistance levels between RYGB and SG-TB. The preoperative and postoperative values of all variables in the SHAM group did not show significant differences. CONCLUSION In this study using a diabetes-induced rodent model, we found that the anti-diabetic effect of SG-TB is superior to that of SG and non-inferior to that of RYGB.
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Ece I, Yilmaz H, Yormaz S, Çolak B, Calisir A, Sahin M. The Short-Term Effects of Transit Bipartition with Sleeve Gastrectomy and Distal-Roux-en-Y Gastric Bypass on Glycemic Control, Weight Loss, and Nutritional Status in Morbidly Obese and Type 2 Diabetes Mellitus Patients. Obes Surg 2021; 31:2062-2071. [PMID: 33409969 DOI: 10.1007/s11695-020-05212-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study was to compare the postoperative metabolic and nutritional outcomes after transit bipartition with sleeve gastrectomy (TB-SG) and distal-Roux-en-Y gastric bypass (D-RYGB). MATERIALS AND METHODS A retrospective evaluation was made of 109 morbidly obese patients who underwent TB-SG or D-RYGB. Primary outcomes included metabolic variables such as glycemic control and serum lipid levels, and secondary outcomes consisted of nutritional deficiencies and weight loss after surgical procedures. RESULTS During the study period, 83 and 26 patients underwent D-RYGB and TB-SG, respectively. The preoperative characteristics and nutritional status of the groups were similar. D-RYGB resulted in significantly higher weight loss rates in the first 3 months, but the percentage of excess weight loss (EWL %) was not different in the 12-month follow-up period. Although D-RYGB provided faster glycemic control due to early weight loss, there was no difference between the two groups. At the end of the follow-up period, the TB-SG was associated with significantly less deficiency of vitamin D, vitamin B12, iron, and folic acid. Anastomosis leakage was more common in the D-RYGB technique. The overall complication rates of the groups were similar. CONCLUSION TB-SG is a safe and effective alternative to D-RYGB for the treatment of obesity-related metabolic disorders with fewer nutritional deficiencies.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey.
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Bayram Çolak
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Akin Calisir
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
| | - Mustafa Sahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Selcuklu, 42075, Konya, Turkey
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Santoro S. The bipartition may be better, and not just for super obesity. Surg Obes Relat Dis 2020; 16:e49-e50. [PMID: 32418768 DOI: 10.1016/j.soard.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sérgio Santoro
- Hospital Israelita Albert Einstein of Surgery, Sao Paulo, Brazil
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Is transit bipartition a better alternative to biliopancreatic diversion with duodenal switch for superobesity? Comparison of the early results of both procedures. Surg Obes Relat Dis 2020; 16:497-502. [DOI: 10.1016/j.soard.2019.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/10/2019] [Accepted: 12/16/2019] [Indexed: 01/23/2023]
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Santoro S, Mota FC, Aquino CG. Treating Severe GERD and Obesity with a Sleeve Gastrectomy with Cardioplication and a Transit Bipartition. Obes Surg 2019; 29:1439-1441. [PMID: 30737760 DOI: 10.1007/s11695-019-03752-4] [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: 11/30/2022]
Abstract
INTRODUCTION Epidemiological data have demonstrated that obesity is an important risk factor for the development of gastroesophageal reflux disease (GERD). The proportion of subjects with GERD symptoms can be as high as 50% for BMI > 30. Although still controversial in the literature, there are several studies associating sleeve gastrectomy (SG) with an increase in GERD prevalence. The current video shows the technique of a SG with cardioplication associated with transit bipartition (TB) for the treatment of an obese patient with severe GERD. CASE REPORT AND MANAGEMENT A 46-year-old male presented with obesity and GERD symptoms for several years. His BMI was 37.8 kg/m2 with mainly central obesity and several obesity-related comorbidities, including hypertension, dyslipidemia, severe insulin resistance, and obstructive sleep apnea. After a diagnostic evaluation, the patient was submitted to a sleeve gastrectomy with a transit bipartition. He presented satisfactory weight loss, reaching a BMI of 26 and remission of all comorbidities and complete remission of GERD symptoms. The current follow-up period is 2.5 years and the patient did not present any weight regain or return of the GERD symptoms. CONCLUSION We presented a surgical alternative that is effective in both weight loss and remission of GERD. SG + TB is a potent intervention for metabolic syndrome and obesity. Furthermore, this alternative is capable of treating both obesity and GERD, in a simple way, avoiding mechanical restriction and the significant malabsorption related to excluded segments.
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Affiliation(s)
- Sergio Santoro
- Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil
| | - Filippe Camarotto Mota
- Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil.
| | - Caio Gustavo Aquino
- Gastroenterology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627. Morumbi, São Paulo, SP, 050652-900, Brazil
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