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Lee HC, Wu BG, Chen BC, Luk HN, Qu JZ. Structured Routine Use of Styletubation for Oro-Tracheal Intubation in Obese Patients Undergoing Bariatric Surgeries-A Case Series Report. Healthcare (Basel) 2024; 12:1404. [PMID: 39057547 PMCID: PMC11276324 DOI: 10.3390/healthcare12141404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this case series report is to provide a new topical view of styletubation (video intubating stylet technique) in obese patients undergoing bariatric surgeries. In contrast to various conventional direct laryngoscopes (DLs), videolaryngoscopes (VLs) have been applied in such obese populations with potentially difficult airway complications. The safety and effectiveness of VLs have been repeatedly studied, and the superiority of VLs has then been observed in and advocated for routine use. In this article, among our vast use experiences with styletubation (more than 54,998 patients since 2016) for first-line routine tracheal intubation, we present the unique experience to apply the styletubation technique in obese patients undergoing bariatric surgery. Consistent with the experiences applied in other patient populations, we found the styletubation technique itself to be swift (the time to intubate from 5 s to 24 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction). The learning curve is steep, but competency can be enhanced if technical pitfalls can be avoided. We, therefore, propose that the styletubation technique can be feasibly and routinely applied as a first-line airway modality in obese patients undergoing bariatric surgery.
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Affiliation(s)
- Hsiang-Chen Lee
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan;
| | - Bor-Gang Wu
- Department of Surgery, Hualien Tzu-Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu-Chi University, Hualien 97002, Taiwan;
| | - Bo-Cheng Chen
- Department of Otolaryngology, Hualien Tzu Chi Hospital, No. 707, Sec. 3, Chung-Yang Road, Hualien 97002, Taiwan;
| | - Hsiang-Ning Luk
- Department of Anesthesia, Hualien Tzuchi Hospital, Hualien 97002, Taiwan;
- Laboratory of Bio-Math, Department of Financial Engineering, Providence University, 200, Sec. 7, Taiwan Boulevard, Shalu Dist., Taichung City 43301, Taiwan
| | - Jason Zhensheng Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
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Yang N, Hua H, Liu S, Zhang S, Zhao X, Zhang P, Zhang P, Wang Y, Shen J, Lin S, Guan W, Liang H. The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study. Int J Surg 2024; 110:2577-2582. [PMID: 38265423 PMCID: PMC11093425 DOI: 10.1097/js9.0000000000001108] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Performing bariatric surgery on patients with a BMI of over 50 kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. MATERIALS AND METHODS A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. RESULTS Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44 702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50 kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. CONCLUSION Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.
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Affiliation(s)
- Ningli Yang
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Hongxia Hua
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Shaozhuang Liu
- Department of General Surgery, Division of Bariatric and Metabolic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Songhai Zhang
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, Zhenzhou, Henan
| | - Xiangwen Zhao
- Department of Metabolic and Bariatric Surgery, Xiaolan People’s Hospital of Zhongshan, Zhongshan, Guangdong
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People’s Hospital, Shanghai
| | - Yong Wang
- Department of weight loss and metabolism, the Fourth Clinical College Affiliated to China Medical University, ShenYang, Dongbei, China
| | - Jiajia Shen
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Shibo Lin
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Wei Guan
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Hui Liang
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
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Wong J, Li X, Arterburn DE, Li D, Messenger-Jones E, Wang R, Toh S. Using Claims Data to Predict Pre-Operative BMI Among Bariatric Surgery Patients: Development of the BMI Before Bariatric Surgery Scoring System (B3S3). Pragmat Obs Res 2024; 15:65-78. [PMID: 38559704 PMCID: PMC10981874 DOI: 10.2147/por.s450229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Lack of body mass index (BMI) measurements limits the utility of claims data for bariatric surgery research, but pre-operative BMI may be imputed due to existence of weight-related diagnosis codes and BMI-related reimbursement requirements. We used a machine learning pipeline to create a claims-based scoring system to predict pre-operative BMI, as documented in the electronic health record (EHR), among patients undergoing a new bariatric surgery. Methods Using the Optum Labs Data Warehouse, containing linked de-identified claims and EHR data for commercial or Medicare Advantage enrollees, we identified adults undergoing a new bariatric surgery between January 2011 and June 2018 with a BMI measurement in linked EHR data ≤30 days before the index surgery (n=3226). We constructed predictors from claims data and applied a machine learning pipeline to create a scoring system for pre-operative BMI, the B3S3. We evaluated the B3S3 and a simple linear regression model (benchmark) in test patients whose index surgery occurred concurrent (2011-2017) or prospective (2018) to the training data. Results The machine learning pipeline yielded a final scoring system that included weight-related diagnosis codes, age, and number of days hospitalized and distinct drugs dispensed in the past 6 months. In concurrent test data, the B3S3 had excellent performance (R2 0.862, 95% confidence interval [CI] 0.815-0.898) and calibration. The benchmark algorithm had good performance (R2 0.750, 95% CI 0.686-0.799) and calibration but both aspects were inferior to the B3S3. Findings in prospective test data were similar. Conclusion The B3S3 is an accessible tool that researchers can use with claims data to obtain granular and accurate predicted values of pre-operative BMI, which may enhance confounding control and investigation of effect modification by baseline obesity levels in bariatric surgery studies utilizing claims data.
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Affiliation(s)
- Jenna Wong
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Optum Labs Visiting Fellow, Eden Prairie, MN, USA
| | - Xiaojuan Li
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Dongdong Li
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Rui Wang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
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Ponce de Leon-Ballesteros G, Pouwels S, Romero-Velez G, Aminian A, Angrisani L, Bhandari M, Brown W, Copaescu C, De Luca M, Fobi M, Ghanem OM, Hasenberg T, Herrera MF, Herrera-Kok JH, Himpens J, Kow L, Kroh M, Kurian M, Musella M, Narwaria M, Noel P, Pantoja JP, Ponce J, Prager G, Ramos A, Ribeiro R, Ruiz-Ucar E, Salminen P, Shikora S, Small P, Stier C, Taha S, Taskin EH, Torres A, Vaz C, Vilallonga R, Verboonen S, Zerrweck C, Zundel N, Parmar C. Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m 2): a Modified Delphi Study. Obes Surg 2024; 34:790-813. [PMID: 38238640 DOI: 10.1007/s11695-023-06990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. METHODS A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved. RESULTS A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. CONCLUSION This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.
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Affiliation(s)
- Guillermo Ponce de Leon-Ballesteros
- Department of Surgery, Hospital Angeles Morelia, Morelia, Postal: 331, Int. B-502, Av. Montaña Monarca, Montaña Monarca, 58350, Morelia, Michoacan, Mexico.
| | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Hospital, Oberhausen, NRW, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II" University of Naples, Naples, Italy
| | | | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Australia
| | - Catalin Copaescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | | | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Till Hasenberg
- Helios Obesity Center West, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Miguel F Herrera
- Clinic for Nutrition and Obesity, The American British Cowdray Medical Center Observatorio, Mexico City, Mexico
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Johnn H Herrera-Kok
- Department of General and Digestive Surgery, University Hospital of Leon, Leon, Spain
| | - Jacques Himpens
- Bariatric Surgery Unit, Delta CHIREC Hospital, Brussels, Belgium
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, Australia
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University of Naples, Naples, Italy
| | | | - Patrick Noel
- Clinique Bouchard, ELSAN, Marseille, France
- Emirates Specialty Hospital, DHCC, Dubai, UAE
| | - Juan P Pantoja
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jaime Ponce
- CHI Memorial Hospital Chattanooga, Chattanooga, TN, USA
| | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Rui Ribeiro
- Department of General Surgery, Hospital Lusiadas Amadora, Amadora, Portugal
| | - Elena Ruiz-Ucar
- Department of Bariatric and Endocrine Surgery, Fuenlabrada University Hospital, Madrid, Spain
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Small
- Directorate of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Christine Stier
- Department of Interdisciplinary Endoscopy and Visceral Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Safwan Taha
- Bariatric and Metabolic Surgery Center, Mediclinic Hospital Airport Road, Abu Dhabi, UAE
| | - Eren Halit Taskin
- Department of Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Antonio Torres
- General and Digestive Surgery Service, Department of Surgery, Hospital Clínico San Carlos, Complutense University Medical School, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - Carlos Vaz
- Obesity and Metabolic Surgery Unit, Hospital CUF Tejo, Lisbon, Portugal
| | - Ramon Vilallonga
- Department of Surgery, Enodcrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Carlos Zerrweck
- The American British Cowdray Medical Center Santa Fe, Mexico City, Mexico
| | - Natan Zundel
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Chetan Parmar
- Department of Surgery, The Whittington Hospital NHS Trust, London, UK
- Apollo Hospitals Educational and Research Foundation, Hyderabad, India
- University College London, London, UK
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Singla V, Gupta A, Gupta A, Monga S, Kumar A, Chekuri R, Gupta M, Kashyap L, Shalimar, Aggarwal S. Outcomes of Laparoscopic Sleeve Gastrectomy (LSG) vs One-Anastomosis Gastric Bypass (OAGB) in Patients with Super-Super Obesity (BMI ≥ 60 kg/m 2). Obes Surg 2024; 34:43-50. [PMID: 37996770 DOI: 10.1007/s11695-023-06960-1] [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: 07/31/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The data comparing laparoscopic sleeve gastrectomy (LSG) and one-anastomosis gastric bypass (OAGB) in patients with BMI ≥ 60 kg/m2 is scarce. METHODS Prospectively collected data of patients with BMI ≥ 60 kg/m2 undergoing LSG or OAGB from January 2008 until June 2022 was analyzed retrospectively. Weight loss outcomes, impact on comorbidities, and complications were compared in both groups. RESULTS Fifty-six patients underwent LSG and 13 patients underwent OAGB. The median age and BMI were 37 (34-44) years and 63 (61.3-64.6) kg/m2 respectively. Both the groups had similar baseline demographic parameters. The percentage excess BMI loss (%EBMIL) was statistically similar in LSG and OAGB groups at 1 year (46.2% vs 46.1%), 3 years (52.9% vs 56.7%), and 5 years (51.1% vs 62.3%). The percentage excess BMI regain was lower (although statistically similar) following OAGB at 3 years (5.3% vs 0.1%) and 5 years (12.9% vs 4.4%). OAGB was found to correlate positively with weight loss and negatively with weight regain (p > 0.05). There was one 30-day mortality due to postoperative lower respiratory infection in the LSG group. CONCLUSION OAGB has a trend towards better weight loss outcomes as compared to LSG in patients with a BMI ≥ 60 kg/m2 with lesser complication rates and might be a preferred option. LSG also has acceptable weight loss and should be considered a standalone procedure if OAGB is not feasible technically.
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Affiliation(s)
- Vitish Singla
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Aishwary Gupta
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Aishwary Gupta
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Sukhda Monga
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Arun Kumar
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Ritvik Chekuri
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Mehul Gupta
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India
| | - Lokesh Kashyap
- Department of Anesthesiology, India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, India Institute of Medical Sciences, Room No. 5034, New Delhi, India.
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Kauffels A, Reichert M, Sauerbier L, Hauenschild A, Hecker A, Strowitzki MJ, Sprenger T. Outcomes of totally robotic Roux-en-Y gastric bypass in patients with BMI ≥ 50 kg/m 2: can the robot level out "traditional" risk factors? J Robot Surg 2023; 17:2881-2888. [PMID: 37816994 PMCID: PMC10678766 DOI: 10.1007/s11701-023-01729-1] [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: 07/24/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) in patients with body mass index (BMI) ≥ 50 kg/m2 is a challenging procedure and BMI ≥ 50 kg/m2 has been identified as independent risk factor for postoperative complications and increased morbidity in previous studies. The objective of the present study was to assess whether a BMI ≥ 50 kg/m2 and various established risk factors maintain their significance in patients undergoing fully robotic RYGB (rRYGB). A single-center analysis of prospectively collected data of 113 consecutive patients undergoing standardized rRYGB with robotic stapling technique and hand-sewn gastrojejunostomy using the daVinci Xi system. Surgical outcomes were analyzed considering a number of individual perioperative risk factors including BMI ≥ 50 kg/m2. The mean BMI of the total cohort was 50.6 ± 5.5 kg/m2 and 63.7% of patients had a BMI ≥ 50 kg/m2. There were no major surgical and perioperative complications in patients with BMI ≥ 50 kg/m2 as well as in those with BMI < 50 kg/m2 after rRYGB. We identified female sex and surgeon experience but neither body weight, BMI, metabolic disorders, ASA nor EOSS scores as independent factors for shorter operation times (OT) in multivariate analyses. Complication rates and length of hospital stay (LOS) did not significantly differ between patients with potential risk factors and those without. rRYGB is a safe procedure in both, patients with BMI ≥ 50 kg/m2 and with BMI < 50 kg/m2. Higher body weight and BMI did affect neither OT nor LOS. A fully robotic approach for RYGB might help to overcome "traditional" risk factors identified in conventional laparoscopic bariatric surgery. However, larger and prospective studies are necessary to confirm these results.
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Affiliation(s)
- Anne Kauffels
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Martin Reichert
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Lisa Sauerbier
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Annette Hauenschild
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Andreas Hecker
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Moritz J Strowitzki
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany
| | - Thilo Sprenger
- Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf- Buchheim-Str. 7, 35392, Giessen, Germany.
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Wu BG, Luk HN, Qu JZ, Shikani A. Styletubation in Bariatric Surgery: A Case Report. Healthcare (Basel) 2023; 11:2256. [PMID: 37628454 PMCID: PMC10454672 DOI: 10.3390/healthcare11162256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/27/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Direct laryngoscopes and videolaryngoscopes are the dominant endotracheal intubation tools. The styletubation technique (using a video-assisted intubating stylet) has shown its advantages in terms of short intubation time, high success rate, less required stimulation, and operator satisfaction. The learning curve can be steep but is easily overcome if technical pitfalls are avoided. Conditions that make styletubation challenging include secretions/blood, short/stiff neck, restricted mouth opening and cervical spine mobility, anatomical abnormalities over head and neck regions, obesity, etc. In this clinical report, we present the effectiveness and efficiency of the routine use of the styletubation for tracheal intubation in a super-super-obese patient (BMI 103 kg/m2) undergoing bariatric surgery with laparoscopic sleeve gastrectomy.
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Affiliation(s)
- Bor-Gang Wu
- Department of Surgery, Hualien Tzu-Chi Hospital, Buddhist Tzu Chi Medical Foundation and School of Medicine, Tzu-Chi University, Hualien 970, Taiwan;
| | - Hsiang-Ning Luk
- Department of Anesthesia, Hualien Tzu-Chi Hospital, Hualien 970, Taiwan
- Bio-Math Laboratory, Department of Financial Engineering, Providence University, Taichung 433719, Taiwan
| | - Jason Zhensheng Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Alan Shikani
- Division of Otolaryngology—Head and Neck Surgery, LifeBridge Sinai Hospital, Baltimore, MD 21040, USA;
- Division of Otolaryngology—Head and Neck Surgery, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
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8
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Yu X, Huang YH, Feng YZ, Cheng ZY, Wang CC, Cai XR. Association of body composition with postoperative complications after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Eur J Radiol 2023; 162:110768. [PMID: 36913816 DOI: 10.1016/j.ejrad.2023.110768] [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: 08/01/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate predictive values of body composition parameters measured from preoperative CT/MRIs for postoperative complications after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) in patients with obesity. METHODS In this retrospective case-control study, patients performing abdominal CT/MRIs within one month before and developing 30-day complications after bariatric procedures were matched for age, sex, and type of surgery with patients without complications (1/3 ratio, respectively). Complications were determined by documentation in the medical record. Two readers blindly segmented the total abdominal muscle area (TAMA) and visceral fat area (VFA) using predetermined thresholds for the Hounsfield unit (HU) on unenhanced CT and the signal intensity (SI) on T1-weighted MRI at the L3 vertebral level. Visceral obesity (VO) was defined as VFA > 136 cm2 in males and > 95 cm2 in females. These measures, along with perioperative variables, were compared. Multivariate logistic regression analyses were performed. RESULTS Of 145 included patients, 36 had postoperative complications. No significant differences between LSG and LRYGB were present regarding complications and VO. Hypertension (p = 0.022), impaired lung function (p = 0.018), American Society of Anesthesiologists (ASA) grade (p = 0.046), VO (p = 0.021), and VFA/TAMA ratio (p < 0.0001) were associated with postoperative complications in the univariate logistic analysis; the VFA/TAMA ratio was the only independent predictor in multivariate analyses (OR 2.01, 95% CI 1.37-2.93, p < 0.001). CONCLUSION The VFA/TAMA ratio provides important perioperative information in predicting patients who are likely to develop postoperative complications undergoing bariatric surgery.
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Affiliation(s)
- Xin Yu
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yan-Hao Huang
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - You-Zhen Feng
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Zhong-Yuan Cheng
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Cun-Chuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Xiang-Ran Cai
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, New South Wales, Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
- Division of Pediatric Surgery, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis 2022; 18:1345-1356. [PMID: 36280539 DOI: 10.1016/j.soard.2022.08.013] [Citation(s) in RCA: 191] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/06/2022]
Abstract
Major updates to 1991 National Institutes of Health guidelines for bariatric surgery.
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11
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Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m2. Surg Laparosc Endosc Percutan Tech 2022; 32:466-471. [PMID: 35583523 DOI: 10.1097/sle.0000000000001063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients undergoing bariatric surgery with body mass index (BMI) >50 kg/m2 are at a higher risk of surgical morbidity when compared with less obese patients, however, there is limited data correlating surgical risk and efficacy with increasing BMI in patients with severe obesity. We hypothesize that regardless of the degree above 50 kg/m2 their BMI, patients with severe obesity respond similarly to bariatric surgery. MATERIALS AND METHODS We performed a retrospective analysis of patients with BMI >50 kg/m2 who underwent biliopancreatic diversion with duodenal switch, Roux-en-Y gastric bypass, or sleeve gastrectomy at a single institution. Outcomes were compared in patients with a BMI between 50 and 60 kg/m2 to patients with a BMI >60 kg/m2 and included percent total weight loss as well as early and late complications. Statistical analyses were performed using logistic regression, univariate, and multivariate models. RESULTS There were 571 patients with BMI >50 kg/m2 who underwent bariatric surgery at our center, 170 (29.8%) had a BMI >60 kg/m2. Percent total weight loss was statistically significant between the BMI 50 and 60 kg/m2 and BMI >60 kg/m2 groups at 24 months (P=0.047) but not at 60 months (P=0.54). No significant difference was found in the incidence of early complications in a univariate (P=0.46) or a multivariate (P=0.06) analysis. The BMI >60 subgroup was associated with a higher rate of late complications in univariate analysis (heart rate=2.37; 1.03-5.47, P=0.04), but not in multivariate analysis (P=0.78). CONCLUSIONS Efficacy and complication rates of bariatric surgeries are similar in patients with BMI 50 to 60 kg/m2 and >60 kg/m2, providing evidence supporting similar management of patients despite specific subgroups.
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Impact of Intragastric Balloon Placement on the Stomach Wall: A Prospective Cohort Study. Obes Surg 2022; 32:2426-2432. [DOI: 10.1007/s11695-022-06101-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
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Singhal R, Omar I, Madhok B, Ludwig C, Tahrani AA, Mahawar K. Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study. Obes Res Clin Pract 2022; 16:249-253. [PMID: 35718696 PMCID: PMC9174153 DOI: 10.1016/j.orcp.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 06/04/2022] [Indexed: 11/17/2022]
Abstract
Background It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI<50 kg/m2), Group II (BMI 50–60 kg/m2), and Group III (BMI>60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 ± 24.4 Kgs and 43.03 ± 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively. The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = <0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.
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Affiliation(s)
- Rishi Singhal
- Upper GI unit, University Hospital Birmingham NHS Foundation Trust, UK.
| | - Islam Omar
- General Surgery Department, Wirral University Teaching Hospital NHS Foundation Trust, UK
| | - Brijesh Madhok
- Upper GI unit, University Hospital of Derby and Burton NHS Foundation Trust, UK
| | - Christian Ludwig
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
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Thaher O, Tallak W, Hukauf M, Stroh C. Outcome of Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass for Patients with Super Obesity (Body Mass Index > 50 kg/m 2). Obes Surg 2022; 32:1546-1555. [PMID: 35175541 DOI: 10.1007/s11695-022-05965-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE With increasing BMI, the complexity of treating patients with obesity rises. The focus of this study is to investigate the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on perioperative morbidity and remission of comorbidities at 3 years in patients with a BMI > 50 kg/m2. MATERIALS AND METHODS A retrospective multicenter analysis of a prospectively maintained database was performed to enroll patients with a 3-year follow-up after SG or RYGB between 2005 and 2019 and a BMI of > 50 kg/m2 preoperatively. Patients' BMI and comorbidity status were recorded preoperatively. RESULTS We analyzed data from 2939 patients who had at least a preoperative BMI > 50 kg/m2. A total of 1278 patients underwent RYGB surgery, and 1661 underwent SG. The distribution of sex, BMI, hypertension, reflux, and sleep apnea was significant between the two groups. Three years after surgery, the percent excess weight loss (%EWL) was 62.21% in RYGB and 55.87% in SG (p < 0.001). The change in hypertension (p < 0.001) and reflux (p < 0.001) was significantly in favor of RYGB. The change in diabetes mellitus was not significant between the two groups (p > 5%). There was a minimal difference in sleep apnea in favor of SG (p < 0.001). Mortality and overall complication rates were not significant in either group. CONCLUSION Both procedures positively affected comorbidities, BMI, and %EWL in patients with super obesity 3 years after surgery. In some categories, RYGB was better than SG. Nevertheless, the decision between the two methods remains a matter of the surgeon's experience and the patient's general condition.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Wael Tallak
- Department of Neurosurgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research mbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Christine Stroh
- Department of Obesity and Metabolic Surgery, SRH Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany.
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Kermansaravi M, Lainas P, Shahmiri SS, Yang W, Jazi AD, Vilallonga R, Antozzi L, Parmar C, Kassir R, Chiappetta S, Zubiaga L, Vitiello A, Mahawar K, Carbajo M, Musella M, Shikora S. The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons. Surg Endosc 2022; 36:6170-6180. [PMID: 35064321 PMCID: PMC9283149 DOI: 10.1007/s00464-021-08979-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08979-w.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
- Metropolitan Hospital of Athens, HEAL Academy, Athens, Greece
| | - Shahab Shahabi Shahmiri
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Toulon, France
| | | | - Chetan Parmar
- Department of Surgery, The Whittington Health NHS Trust, London, UK
- University College London Medical School, London, UK
| | - Radwan Kassir
- Department of Digestive Surgery, Centre Hospitalier Universitaire Félix Guyon, St Denis de la Réunion, France
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Lorea Zubiaga
- Miguel Hernandez of Elche University, Alicante, Spain
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Clinical outcomes after one anastomosis gastric bypass versus sleeve gastrectomy in super-super-obese patients. Surg Endosc 2022; 36:4401-4407. [PMID: 34704152 PMCID: PMC9085670 DOI: 10.1007/s00464-021-08790-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/17/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Bariatric surgery in super-super-obese (SSO) patients remains a continuous challenge due to intraabdominal fat masses, higher liver volume and existing comorbidities. A convenient procedure in SSO patients is one anastomosis gastric bypass (OAGB). The aim of this study was to compare the outcome of SSO patients undergoing OAGB in comparison to laparoscopic sleeve gastrectomy (LSG). METHODS We retrospectively reviewed data from SSO patients who underwent OAGB and LSG in our institution between 2008 and 2020. Primary endpoints included percentage total body weight loss and percentage BMI loss at 12, 24, and 36 months after the operation. Secondary endpoints were perioperative complications, procedure length, length of hospital stay and outcome of comorbidities. RESULTS 243 patients were included in this study. 93 patients underwent LSG and 150 underwent OAGB. At any of the time points evaluated, weight loss in patients after OAGB was greater than in LSG patients, while procedure length was significantly shorter for OAGB than LSG (81.4 vs. 92.1 min, p-value < 0.001). Additionally, mean length of hospital stay was shorter in the OAGB group (3.4 vs. 4.5 days, p-value < 0.001). There were more severe complications (Clavien-Dindo ≥ 3a) in the LSG group (11.8% vs 2.7%, p-value = 0.005). CONCLUSION In this retrospective analysis, OAGB was superior to LSG in terms of weight loss in SSO patients. Procedure length and hospital stay were shorter after OAGB in comparison to LSG and there were fewer severe complications. OAGB can therefore be regarded a safe and effective treatment modality for SSO patients.
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Albaugh VL. Comment on: Outcomes of bariatric surgery in extreme obesity: results from the United Kingdom National Bariatric Surgery Registry for patients with body mass index over 70 kg/m 2. Surg Obes Relat Dis 2021; 17:1738-1739. [PMID: 34266777 DOI: 10.1016/j.soard.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Vance L Albaugh
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
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Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB. Obes Surg 2021; 31:3391-3399. [PMID: 33993423 DOI: 10.1007/s11695-021-05464-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m2) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients. METHODS Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted. RESULTS The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m2. Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%). CONCLUSION SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG.
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Skogar ML, Sundbom M. Early complications, long-term adverse events, and quality of life after duodenal switch and gastric bypass in a matched national cohort. Surg Obes Relat Dis 2020; 16:614-619. [DOI: 10.1016/j.soard.2020.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/04/2020] [Accepted: 02/04/2020] [Indexed: 01/12/2023]
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