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Mezzapesa F, Di Costanzo S, Coadă CA, Bernante P, Balsamo F, Garelli S, Genovesi L, Pasquini P, Lambertini A, Caramelli F, De Iaco P, Perrone AM. Combined robotic surgery for concomitant treatment of endometrial cancer and obesity. Surg Endosc 2024; 38:6691-6699. [PMID: 39320546 DOI: 10.1007/s00464-024-11274-z] [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: 07/13/2024] [Accepted: 09/11/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Endometrial Cancer (EC) is strongly linked to obesity. Bariatric surgery is recognized as a long-term solution for weight loss in severely obese patients. This pilot study investigates the feasibility, intraoperative and 30-day morbidity outcomes of integrating gynecological surgical staging and bariatric robotic surgery in class II and III obese patients affected by early EC or Endometrial Intraepithelial Neoplasia (EIN). METHODS Patients aged over 18 years old with early EC or EIN and class II and III obesity (Body mass index (BMI) ≥ 35 kg/m2) who are surgical and anesthesiologic candidates. Standard robotic surgery for early EC staging performed alone (THBSO group) or in conjunction with sleeve gastrectomy (THBSO + SG group) for obesity management was proposed. RESULTS Of the 13 patients who met the inclusion criteria, 5 (38.46%) opted for combined surgery. The groups showed a significant difference in preoperative BMI (49.68 kg/m2 vs. 40.24 kg/m2 p = 0.017 with and without SG), preoperative weight (143.92 kg vs. 105.62 kg p = 0.004 with and without SG), preoperative (p = 0.01) and postoperative (p = 0.005) aspartate transaminase (AST). The THBSO + SG group had higher anesthesia induction end-tidal carbon dioxide (ETCO2) (p = 0.05), final Partial pressure of carbon dioxide (PaCO2) (p = 0.044), anesthesia induction lactate (p = 0.001) and final lactate (p = 0.011) without a significant difference in final pH (p = 0.31). Operative time was longer in the THBSO + SG group (p < 0.001), but this did not result in longer ICU (p = 0.351), total hospital stays (p = 0.208), nor increased blood loss and transfusion. The simultaneous combined approach had an 80% success rate. At 6 months, the THBSO + SG group achieved significantly greater weight loss than the THBSO group (ΔBMI - 11.81 kg/m2 vs - 1.72 kg/m2, p = 0.003, with and without SG). CONCLUSION Integrating robotic EC staging with SG in obese women with early EC increased the operative time without increasing intraoperative risks, early and 30 days post-surgery complication and offering a promising approach to simultaneously treating both conditions.
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Affiliation(s)
- Francesco Mezzapesa
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Stella Di Costanzo
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Camelia Alexandra Coadă
- Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Paolo Bernante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Division of Metabolic and Bariatric Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesca Balsamo
- Division of Metabolic and Bariatric Surgery, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Silvia Garelli
- Endocrinology and Diabetes Prevention and Care Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Lucia Genovesi
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Pasquini
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Agnese Lambertini
- Anesthesiology and General and Pediatric Resuscitation Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Fabio Caramelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Anesthesiology and General and Pediatric Resuscitation Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Pierandrea De Iaco
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Anna Myriam Perrone
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [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: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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Abu-Zeid EED, Atias S, Netz U, Golani G, Avital I, Perry ZH. Gender Comparisons of Surgical Outcomes in Patients Undergoing One Anastomosis Gastric Bypass (OAGB): a Historical Cohort Study. Obes Surg 2024; 34:98-105. [PMID: 38010452 DOI: 10.1007/s11695-023-06954-z] [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: 08/05/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION AND PURPOSE Clinical trials in the field of bariatrics have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results in one anastomosis gastric bypass (OAGB), and specifically quality of life (QOL) parameters, have not been addressed sufficiently. A better understanding of gender's effect on OAGB outcomes can play an important role in selecting the appropriate bariatric surgery for patients. Our study was aimed at examining mid-term gender-associated outcome of OAGB, including the effect on QOL. MATERIALS AND METHODS A retrospective cohort study of patients who underwent OAGB at surgical ward A, SUMC, Israel, between 2015 and 2020. Demographics, body mass index (BMI), and comorbidities were extracted from the national medical records system. Follow-up quality of life (QOL) and weight parameters were supplemented via telephone questionnaires, using the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS A total of 152 patients were included; of these, 51 (33.6%) were males, with an average follow-up period of 4.1 (± 1.3) years post-surgery. Basic demographics showed no significant pre- or post-surgery differences between males and females, except for pre-op weight (which as expected was higher for males). Males had a higher overall BAROS score than females (3.8 ± 2.1 vs. 2.6 ± 2.1, p < 0.001). CONCLUSIONS OAGB surgery results in better outcomes for male than for female patients as measured by the BAROS, despite a similar BMI reduction, and with no difference in complications. Gender-specific outcomes are one of the variables that one should be aware of in optimizing patient selection and pre-operative patient counseling.
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Affiliation(s)
- Ez El Din Abu-Zeid
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shahar Atias
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Uri Netz
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Guy Golani
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itzhak Avital
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Norton Cancer Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zvi H Perry
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Chaouch MA, Yang W, Gouader A, Krimi B, Carneiro da Costa A, Pourcher G, Oweira H. Banded versus non-banded sleeve gastrectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32982. [PMID: 37058050 PMCID: PMC10101294 DOI: 10.1097/md.0000000000032982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/25/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Laparoscopic banded sleeve gastrectomy (LBSG) has been compared to laparoscopic sleeve gastrectomy (LSG) in terms of anthropometric results and postoperative complications, which are controversial. This systematic review and meta-analysis aimed to compare the safety and efficacy of LBSG and LSG. METHODS We performed a systematic review with meta-analysis according to preferred reporting items for systematic review and meta-analysis 2020 and assessing the methodological quality of systematic review 2 guidelines. We included studies that systematically searched electronic databases and compared LBSG with LSG conducted until August 10, 2021. RESULTS The literature search yielded 8 comparative studies. Seven hundred forty-three patients were included: 352 in the LBSG group and 391 in the LSG group. LBSG group allowed greater anthropometric parameters (body mass index [BMI] after 1 year (mean difference [MD] = -3.18; 95% CI [-5.45, -0.92], P = .006), %EWL after 1 year (MD = 8.02; 95% CI [1.22, 14.81], P = .02), and %EWL after 3 years (MD = 10.60; 95% CI [5.60, 15.69], P < .001) and similar results with LSG group in terms of operative time (MD = 1.23; 95% CI [-4.71, 7.17], P = .69), food intolerance (OR = 1.72; 95% CI [0.84, 3.49], P = .14), postoperative vomiting (OR = 2.10; 95% CI [0.69, 6.35], P = .19), and De novo GERD (OR = 0.65; 95% CI [0.34, 1.26], P = .2). Nevertheless, major postoperative complications did not differ between the 2 groups. CONCLUSIONS This systematic review and meta-analysis comparing LBSG and LSG concluded that banding sleeve gastrectomy (SG) may ensure a lower BMI and %EWL after 1 year of follow-up, and a significant reduction in %EWL after 3 years of follow-up. There is no evidence to support LBSG in vomiting, de novo GERD, food intolerance, or operative time.
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Affiliation(s)
- Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Fattouma Bourguiba Hospital, University of Monastir, Monastir, Tunisia
- Department of Digestive, Metabolic, and Oncologic Surgery, Institut Mutualiste of Montsouris, Paris, France
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Amine Gouader
- Department of Visceral and Obesity Surgery, Perpignan Hospital Center, Perpignan, France
| | - Bassem Krimi
- Department of Visceral and Obesity Surgery, Perpignan Hospital Center, Perpignan, France
| | - Adriano Carneiro da Costa
- Department of Digestive, Metabolic, and Oncologic Surgery, Institut Mutualiste of Montsouris, Paris, France
| | - Guillaume Pourcher
- Department of Digestive, Metabolic, and Oncologic Surgery, Institut Mutualiste of Montsouris, Paris, France
| | - Hani Oweira
- Department of Surgery, Universitäts medizin Mannheim, Heidelberg University, Mannheim, Germany
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Qin ZH, Yang X, Zheng YQ, An LY, Yang T, Du YL, Wang X, Zhao SH, Li HH, Sun CK, Sun DL, Lin YY. Quality evaluation of metabolic and bariatric surgical guidelines. Front Endocrinol (Lausanne) 2023; 14:1118564. [PMID: 36967766 PMCID: PMC10035593 DOI: 10.3389/fendo.2023.1118564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE To evaluate the quality of surgical guidelines on bariatric/metabolic surgery. METHODS Four independent reviewers used the AGREE II (The Appraisal of Guidelines for Research and Evaluation II) tool to assess the methodological quality of the included guidelines and conducted a comparative analysis of the main recommendations for surgical methods of these guidelines. RESULTS Nine surgical guidelines were included in this study. Five articles with AGREE II scores over 60% are worthy of clinical recommendation. The field of rigor of development was relatively low, with an average score of 50.82%. Among 15 key recommendations and the corresponding best evidence in the guidelines, only 4 key recommendations were grade A recommendations. CONCLUSIONS The quality of metabolic and bariatric guidelines is uneven, and there is much room for improvement.
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Affiliation(s)
- Zi-Han Qin
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Yang
- Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Ya-Qi Zheng
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li-Ya An
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting Yang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yu-Lu Du
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiao Wang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Shu-Han Zhao
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hao-Han Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Cheng-Kai Sun
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Da-Li Sun, ; Yue-Ying Lin,
| | - Yue-Ying Lin
- The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- *Correspondence: Da-Li Sun, ; Yue-Ying Lin,
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Cantay H, Binnetoglu K, Erdogdu UE, Firat YD, Cayci HM. Comparison of short- and long-term outcomes of bariatric surgery methods: A retrospective study. Medicine (Baltimore) 2022; 101:e30679. [PMID: 36197162 PMCID: PMC9509144 DOI: 10.1097/md.0000000000030679] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The present study is intended to retrospectively compare the short- and long-term outcomes of 3 different treatment methods in patients undergoing bariatric surgery and the variances in weight and nutritional parameters during the preoperative and postoperative periods. In this study, 534 patients who underwent laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-En-Y gastric bypass (LRYGB), and laparoscopic one anastomosis gastric bypass (LOAGB) between 2014 and 2021 were included. The sociodemographic and biodemographic characteristics of these patients, their weight losses and nutritional changes in the preoperative and postoperative periods, operative times, hospital stays, complications, and morbidity and mortality rates were retrospectively compared. There was a statistically significant difference between the surgical methods in the percentages of excess weight loss and total weight loss in the 1st and 3rd months. There were significant differences in the homeostasis model assessment of insulin resistance, folic acid, vitamin D, iron, ferritin, and parathyroid hormone levels (P < .05). All 3 techniques were found to be successful in facilitating weight loss at the end of the first year. LRYGB and LOAGB were found to be superior to LSG in terms of remission from diabetes during the first 6 months, whereas LSG was superior to the other methods in terms of nutritional deficiencies. Despite being more advantageous in terms of operative time, LSG and LOAGB were disadvantageous compared with the LRYGB technique because of the higher rates of leakage and mortality in the LSG technique and the higher rate of bile reflux in the LOAGB technique.
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Affiliation(s)
- Hasan Cantay
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
- *Correspondence: Hasan Cantay, Department of General Surgery, Kafkas University Faculty of Medicine, 36000 Kars, Turkey (e-mail: )
| | - Kenan Binnetoglu
- Department of General Surgery, Kafkas University Faculty of Medicine, Kars, Turkey
| | - Umut Eren Erdogdu
- Department of General Surgery, The University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Yurdakul Deniz Firat
- Department of General Surgery, The University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
| | - Haci Murat Cayci
- Department of General Surgery, The University of Health Sciences, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey
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Ponce de Leon-Ballesteros G, Romero-Velez G, Martinez-Portilla RJ, Pereira X, Roy-Garcia I, Fobi MAL, Herrera MF. Comparison of Outcomes Between Banded and Non-banded Sleeve Gastrectomy: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:1-12. [PMID: 35451804 DOI: 10.1007/s11695-022-06043-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. It accounts for more than 50% of primary bariatric surgeries performed each year. Recent long-term data has shown an alarming trend of weight recidivism. Some authors have proposed the concurrent use of a non-adjustable gastric band to decrease long-term sleeve failure. OBJECTIVE To compare the outcomes (weight loss) and safety (rate of complication and presence of upper GI symptoms) between SG and BSG. METHODS A systematic search with no language or time restrictions was performed to identify relevant observational studies and randomized controlled trials (RCT) evaluating people with morbid obesity undergoing SG or SGB for weight loss. An inverse-of-the-variance meta-analysis was performed by random effects model. Heterogeneity was assessed using Cochrane X2 and I2 analysis. RESULTS A total of 7 observational studies and 3 RCT were included in the final analysis. There were 911 participants pooled from observational studies and 194 from RCT. BSG showed a significant higher excess of weight loss (% EWL). The difference among groups was clinically relevant after the third year where the weighted mean difference (SMD) was 16.8 (CI 95% 12.45, 21.15, p < 0.0001), while at 5 years, a SMD of 25.59 (16.31, 34.87, p < 0.0001) was noticed. No differences related to overall complications were noticed. Upper GI symptoms were up to three times more frequent in the BSG group (OR 3.26. CI 95% 1.96, 5.42, p < 0.0001). CONCLUSIONS According to the results, BSG is superior to SG in weight loss at 5 years but is associated with a higher incidence of upper GI symptoms. However, these conclusions are based mainly on data obtained from observational studies. Further RCT are needed to evaluate the effect and safety of BSG.
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Affiliation(s)
| | | | - Raigam Jafet Martinez-Portilla
- Clinical Research Division, National Institute of Perinatology, Mexico City, Mexico
- Fetal Surgery Clinic, ABC Medical Center, Mexico City, Mexico
| | - Xavier Pereira
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Ivonne Roy-Garcia
- Center for Training and Clinical Research, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Miguel F Herrera
- Clinic for Nutrition and Obesity, ABC Medical Center, 116, Sur 136, Las Américas, Álvaro Obregón, 01120, Mexico City, Mexico.
- Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubiran, Mexico City, Mexico.
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