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Domènech E, Ciudin A, Balibrea JM, Espinet-Coll E, Cañete F, Flores L, Ferrer-Márquez M, Turró R, Hernández-Camba A, Zabana Y, Gutiérrez A. Recommendations on the management of severe obesity in patients with inflammatory bowel disease of the Spanish Group on Crohn's Disease and Ulcerative Colitis (GETECCU), Spanish Society of Obesity (SEEDO), Spanish Association of Surgery (AEC) and Spanish Society of Digestive Endoscopy (SEED). GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(23)00502-2. [PMID: 38290648 DOI: 10.1016/j.gastrohep.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
Obesity is a multifactorial, chronic, progressive and recurrent disease considered a public health issue worldwide and an important determinant of disability and death. In Spain, its current prevalence in the adult population is about 24% and an estimated prevalence in 2035 of 37%. Obesity increases the probability of several diseases linked to higher mortality such as diabetes, cardiovascular disease, hyperlipidemia, arterial hypertension, non-alcoholic fatty liver disease, several types of cancer, or obstructive sleep apnea. On the other hand, although the incidence of inflammatory bowel disease (IBD) is stabilizing in Western countries, its prevalence already exceeds 0.3%. Paralleling to general population, the current prevalence of obesity in adult patients with IBD is estimated at 15-40%. Obesity in patients with IBD could entail, in addition to its already known impact on disability and mortality, a worse evolution of the IBD itself and a worse response to treatments. The aim of this document, performed in collaboration by four scientific societies involved in the clinical care of severe obesity and IBD, is to establish clear and concise recommendations on the therapeutic possibilities of severe or typeIII obesity in patients with IBD. The document establishes general recommendations on dietary, pharmacological, endoscopic, and surgical treatment of severe obesity in patients with IBD, as well as pre- and post-treatment evaluation.
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Affiliation(s)
- Eugeni Domènech
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Andreea Ciudin
- Departament de Fisiologia i Immunologia, Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Endocrinología y Nutrición, Hospital Universitari Vall d'Hebron, Barcelona, España; Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
| | - José María Balibrea
- Servicio de Cirugía General y Digestiva, Hospital Universitari Germans Trias i Pujol; Departamento de Cirugía, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Eduard Espinet-Coll
- Unidad de Endoscopia Bariátrica, Hospital Universitario Dexeus y Clínica Diagonal, Barcelona, España
| | - Fiorella Cañete
- Servicio de Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)
| | - Lilliam Flores
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM); Unidad de Obesidad, Servicio de Endocrinología y Nutrición, Hospital Clínic, Barcelona, España
| | - Manuel Ferrer-Márquez
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, España
| | - Román Turró
- Unidad de Endoscopia Digestiva, Bariátrica y Metabólica, Servicio de Aparato Digestivo, Centro Médico Teknon y Hospital Quirón, Barcelona, España
| | - Alejandro Hernández-Camba
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - Yamile Zabana
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Servicio de Aparato Digestivo, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España
| | - Ana Gutiérrez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); Servicio de Aparato Digestivo, Hospital General Universitario Dr. Balmis, ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, España
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Neimark AE, Yashkov YI, Khatsiev BB, Samoilov VS, Zorin EA, Burikov MA, Anishchenko VV, Elagin IB, Khitaryan AG, Shulyakovskaya AS. [Results of the first All-Russian consensus conference on bariatric surgery]. Khirurgiia (Mosk) 2024:87-94. [PMID: 38477249 DOI: 10.17116/hirurgia202403187] [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: 03/14/2024]
Abstract
Until now, there has not been organized consensus for standardization in bariatric surgery In Russia. We present the results of the first Bariatric Surgery Consensus Conference conducted in Barnaul (March, 2023). A list of questions was proposed within 6 blocks: 1) general issues of bariatric surgery, 2) sleeve gastrectomy, 3) one-anastomosis gastric bypass («mini-gastric bypass»), 4) Roux-en-Y Gastric Bypass, 5) Single Anastomosis Duodenal Switch and other options for biliopancreatic bypass, 6) rare procedures. Consensus (>70% agreement) was reached for 51 out of 96 statements. Stratification by the level of expertise was carried out, and responses of the expert group were compared with responses of all participants.
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Affiliation(s)
- A E Neimark
- Almazov National Medical Research Center, St. Petersburg, Russia
| | - Yu I Yashkov
- JSC Center for Endosurgery and Lithotripsy, Moscow, Russia
| | - B B Khatsiev
- Stavropol State Medical University, Stavropol, Russia
| | - V S Samoilov
- Clinic «City of Health» (Center for Family Medicine «Olympus Health»), Voronezh, Russia
| | - E A Zorin
- Treatment and Rehabilitation Center, Moscow, Russia
| | - M A Burikov
- Rostov Regional Clinical Hospital, Rostov-on-Don, Russia
| | | | - I B Elagin
- Semashko Clinical Hospital "RZD-Medicine", Moscow, Russia
| | - A G Khitaryan
- Rostov-on-Don City Clinical Hospital «RZD-Medicine», Rostov-on-Don, Russia
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Martin-Fumadó C, Benet-Travé J, Vilallonga R, Barros M, Arimany-Manso J. Learning from error in bariatric surgery: analysis of malpractice closed claims in Spain. Surg Obes Relat Dis 2023; 19:76-77. [PMID: 36008278 DOI: 10.1016/j.soard.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Carles Martin-Fumadó
- Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain; Professional Liability and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Medicine Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Josep Benet-Travé
- Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain; Professional Liability and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramon Vilallonga
- Endocrine-Metabolic and Bariatric Unit, Robotic Surgery, Vall Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Barros
- General Surgery and Hepatobiliary and Liver Transplant Surgery Service, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Arimany-Manso
- Professional Liability Department, Barcelona's College of Physicians, Barcelona, Spain; Professional Liability and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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Recarte M, Corripio R, Palma S, Mata A, de-Cos AI. Improvement of Low-Grade Inflammation in Patients with Metabolically Healthy Severe Obesity After Primary Bariatric Surgery. Obes Surg 2023; 33:38-46. [PMID: 36348177 DOI: 10.1007/s11695-022-06345-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The inflammatory state that accompanies adiposity and the metabolic syndrome (MetS) is called "low-grade" inflammation. White blood cell count (WBC) has been proposed as an emerging biomarker for predicting future cardiovascular events, MetS and mortality. Bariatric surgery (BS) improves comorbidities associated with obesity and the MetS and the surgically induced weight loss is known to improve inflammatory status. OBJECTIVES To analyze the improvement of low-grade inflammation associated to obesity in patients with metabolically healthy severe obesity (MHSO) and patients with metabolically unhealthy obesity (MUSO) (severe obesity with MetS) after primary bariatric surgery as well as the protective effect of BS against the development of MetS in patients with MHSO by reducing the WBC. MATERIALS AND METHODS Retrospective analysis of prospectively collected data of patients undergoing laparoscopic primary BS (gastric by-pass or sleeve gastrectomy) from January 2004-December 2015. Outcomes included changing of low-grade inflammation in terms of leukocytes, neutrophils, lymphocytes, and platelets. RESULTS Twenty-one patients with MHSO and 167 patients with MUSO underwent laparoscopic primary BS. The preoperative values of leukocyte and platelet were statistically higher in the group of patients with MHSO. In both groups, there was significant postoperative decrease of inflammatory markers. The greatest drop in WBC occurred in the second postoperative year. No patient of the group of patients with MHSO developed MetS within five postoperative years. CONCLUSIONS Surgically induced weight loss plays an important role for improvement in chronic inflammation associated to obesity because of reduction of visceral fat mass. MHSO associates a low-grade chronic inflammatory status comparable to MUSO. The improvement or decrease of low-grade inflammation in patients with metabolically healthy severe obesity after bariatric surgery could have a protective effect against the development of MetS and medical conditions associated with severe obesity.
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Affiliation(s)
- María Recarte
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain.
| | - Ramón Corripio
- Bariatric and Metabolic Surgery Unit, Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Samara Palma
- Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Alberto Mata
- Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | - Ana I de-Cos
- Department of Endocrinology and Metabolism, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
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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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Physical Exercise to Improve Functional Capacity: Randomized Clinical Trial in Bariatric Surgery Population. J Clin Med 2022; 11:jcm11154621. [PMID: 35956235 PMCID: PMC9369494 DOI: 10.3390/jcm11154621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/31/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Bariatric surgery is a safe and effective method to lose weight over time. However, some patients fail to achieve healthy weight losses. We aimed to determine if a moderate-intensity physical exercise intervention in patients who underwent bariatric surgery increases their functional capacity thus improving bariatric surgery results. Methods: We conducted a parallel-group non-blinded randomized controlled trial at a surgery clinic in Talca, Chile. A total of 43 participants with obesity and scheduled bariatric surgery completed the six months follow-up. A physical exercise program was conducted in exercise group participants one month after bariatric surgery. Walked distance in the six-minute walk test, BMI, Borg scale of perceptive exertion results and cardiovascular variables were evaluated. Results: Patients’ weight significantly decreased after bariatric surgery but there was no difference between the groups of study. The exercise group progressed from a base value of 550 ± 75 m walked in the six-minute walk test to a sixth-month value of 649.6 ± 68.5 m (p < 0.05), whilst the control group yielded base values of 554.4 ± 35.1 and a sixth-month walked distance of 591.1 ± 75.34 (p > 0.05). Conclusions: Physical exercise in obese patients undergoing bariatric surgery increased functional capacity independently of weight losses resulting from bariatric surgery.
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Methodological appraisal of the evidence about efficacy of metabolic surgery in adults with non-morbid obesity and hypertension: An overview of systematic reviews. Int J Surg 2022; 104:106716. [PMID: 35732261 DOI: 10.1016/j.ijsu.2022.106716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nowadays, the high morbimortality of obesity is mainly related to diabetes, cancer, and hypertension. It is reported that obesity in patients with hypertension can lead to resistance to pressure reduction through pharmacological therapy and lifestyle changes, so bariatric surgery emerges as a proposed treatment for obesity. METHODS We performed an umbrella review that included systematic reviews of clinical trials that evaluated patients with hypertension and non-morbid obesity. The quality and certainty of the evidence was evaluated with the AMSTAR-II and GRADE tools. RESULTS 677 systematic reviews were identified, of which only three were included for analysis. We considered the outcomes addressed by the reviews on hypertension, identifying that 5 RCTs evaluated pressure reduction at 1 year of follow-up and 5 RCTs at more than 1 year, 5 RCTs evaluated hypertension rate, 6 RCTs analyzed changes in systolic pressure and 5 RCTs changes in diastolic pressure. Likewise, when assessing the methodological quality, it was concluded that the three reviews have critically low quality. CONCLUSIONS We found only three systematic reviews that evaluated the topic with critically low methodological quality. They reported results in favor of metabolic surgery, but with very low certainty of evidence.
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A Mediterranean-Style Diet Plan Is Associated with Greater Effectiveness and Sustainability in Weight Loss in Patients with Obesity after Endoscopic Bariatric Therapy. Medicina (B Aires) 2022; 58:medicina58020168. [PMID: 35208491 PMCID: PMC8875593 DOI: 10.3390/medicina58020168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to investigate the impact of a Mediterranean-style diet on weight loss effectiveness and sustainability in patients with obesity who underwent endoscopic bariatric therapies (EBT), relative to a protein diet plan. Thus, 132 patients with obesity (BMI 30–40 kg/m2) who underwent EBT, were asked to follow a Mediterranean-style diet plan (n = 52) or a protein diet plan (n = 26) for six months. General linear models were used to compare outcome variables between dietary intervention groups. Results showed that participants who followed a Mediterranean-style diet plan lost 14.2% more weight (95% CI: 3.0; 25.3), compared with those who followed a protein diet plan. Additionally, following a Mediterranean-style diet plan was associated with the sustainability of weight loss. Note that three months after the end of the dietary intervention, the patients who followed a Mediterranean-style diet plan were still losing weight (−1.2 ± 3.0 kg), while those with a protein diet plan gained, on average, 2.4 ± 3.3 kg (p < 0.001). Therefore, we conclude that combining EBT with a Mediterranean-style diet plan could represent an effective dietary intervention to improve the effectiveness and sustainability of weight loss after an EBT.
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Luesma MJ, Fernando J, Cantarero I, Lucea P, Santander S. Surgical Treatment of Obesity. Special Mention to Roux-en-Y Gastric Bypass and Vertical Gastrectomy. Front Endocrinol (Lausanne) 2022; 13:867838. [PMID: 35432187 PMCID: PMC9010401 DOI: 10.3389/fendo.2022.867838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The prevalence of obesity has increased exponentially in recent decades, being one of the diseases that most affects global health. It is a chronic disease associated with multiple comorbidities, which lead to a decrease in life expectancy and quality of life. It requires a multidisciplinary approach by a specialized medical team. Obesity can be treated with conservative or with surgical treatments that will depend on the characteristics of the patient. OBJECTIVE/METHODOLOGY The referenced surgery can be performed using different surgical techniques that are analyzed in the present work through an exhaustive narrative bibliographic review in the PubMed and Cochrane databases, as well as in UpToDate. RESULTS Currently, those most used are restrictive techniques, specifically vertical gastrectomy and mixed techniques, with gastric bypass being the "gold standard". CONCLUSIONS In order to choose one technique or another, the characteristics of each patient and the experience of the surgical team must be taken into account.
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Affiliation(s)
- María José Luesma
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
| | - José Fernando
- General Surgery and Digestive System Service, Royo Villanova Hospital, Zaragoza, Spain
| | - Irene Cantarero
- Department of Morphological and Social Health Sciences, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Pilar Lucea
- Department of Human Anatomy and Histology, School of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Sonia Santander
- Department of Pharmacology and Physiology, School of Medicine, University of Zaragoza, Zaragoza, Spain
- *Correspondence: Sonia Santander, ; María José Luesma,
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Evaluación de la calidad de vida, pérdida de peso y evolución de comorbilidades a los 6 años de la cirugía bariátrica. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Junquera Bañares S, Ramírez Real L, Camuñas Segovia J, Martín García-Almenta M, Llanos Egüez K, Álvarez Hernández J. Evaluation of quality of life, weight loss and evolution of comorbidities at 6 years after bariatric surgery. ENDOCRINOL DIAB NUTR 2021; 68:501-508. [PMID: 34863415 DOI: 10.1016/j.endien.2021.11.010] [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: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Morbid obesity is a disease with multiple comorbidities and considerably limits the quality of life and life expectancy. Bariatric surgery is an effective therapeutic alternative in these patients; it acts on the decrease and / or absorption of nutrients, achieving a significant weight loss which is maintained over time. The objective of the study is to determine the long-term results, in terms of efficacy, regarding weight loss, the resolution of comorbidities and improvement in the quality of life of our patients. MATERIAL AND METHODS This was a retrospective study that comprised all patients consecutively undergoing laparoscopic bariatric surgery at our center over a 10 year period. In all patients, the anthropometric and clinical data were collected prior to surgery and in subsequent protocolized visits after surgery. At the end of the follow-up, a BAROS questionnaire was used that recorded weight loss, the resolution of comorbidities, complications and the quality of life test completed by the patients. RESULTS 353 patients (303 GBPRY and 50 GV), 105 men and 248 women, with a mean age of 42.14 ± 10.16 years, BMI 48.63 kg / m2 and 68.5% had some comorbidity. The mean follow-up was 5.7 ± 2.6 years for 96.7% of the total number operated on. At the end of the follow-up the %EWL was 59.00 ± 19.50, %EBMIL 68.15 ± 22.94, the final BMI 32.65 ± 5.98 and 31.3% of the patients had %EWL ≤ 50. The resolution of comorbidities was as follows: 48.7% hypertension, 70.3% Type 2 Diabetes, 82.6% DLP and 71.6% SAHS. The result of the quality of life test was 1.51 ± 0.93, with 67.2% of patients reporting good or very good quality, with the highest score being for self-esteem, followed by physical condition, work and social activity, and the lowest being for sexual quality of life in that only 40.3% reported an improvement. The BAROS score was 4.35 ± 2.06 with 84.7% of the patients in the good to excellent range, while 91.2% of all patients would undergo surgery again. CONCLUSIONS Bariatric surgery is an effective technique for reducing weight, resolving comorbidities and improving the quality of life of patients with morbid obesity, mainly in its physical aspect. In our series, the percentage of follow-up and average time was within the range of established quality standards.
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Affiliation(s)
- Sonia Junquera Bañares
- Servicio de Endocrinología y Nutrición, Hospital Central de la Cruz Roja, Madrid, Spain.
| | - Luis Ramírez Real
- Servicio de Endocrinología y Nutrición, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Juan Camuñas Segovia
- Servicio Cirugía General y Aparato Digestivo, Hospital Central de la Cruz Roja, Madrid, Spain
| | | | - Katiuska Llanos Egüez
- Servicio Cirugía General y Aparato Digestivo, Hospital Central de la Cruz Roja, Madrid, Spain
| | - Julia Álvarez Hernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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Granero-Molina J, Torrente-Sánchez MJ, Ferrer-Márquez M, Hernández-Padilla JM, Sánchez-Navarro M, Ruiz-Muelle A, Ruiz-Fernández MD, Fernández-Sola C. Sexuality amongst heterosexual women with morbid obesity in a bariatric surgery programme: A qualitative study. J Adv Nurs 2021; 77:4537-4548. [PMID: 34252209 DOI: 10.1111/jan.14972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/20/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS The objective of this study is to describe and understand the experiences of sexuality amongst heterosexual women with morbid obesity (MO) who are in a bariatric surgery program. BACKGROUND Morbid obesity is a chronic, metabolic disease that affects women's physical, psychological and sexual health. MO is associated with anxiety, depression and body image disorders. Bariatric surgery is a reliable method for weight loss in people with MO. DESIGN A qualitative descriptive study research design was adopted. METHODS Twenty-one heterosexual women with MO in a bariatric surgery program were recruited through purposive sampling. Data collection included individual semi-structured interviews conducted between November 2018 and May 2019. Interviews were audio recorded, transcribed verbatim and analysed using a computer-assisted qualitative data. FINDINGS Three main themes emerged from the analysis: (1) trapped in a body that limits my sexuality; (2) between neglect and hope and (3) the partner as a source of support for sexuality in women with MO. CONCLUSION Women hide a body that they do not accept and ignore their own sexuality, focusing on that of their partner. Although the women have doubts about their partners' desire for them, they share the decision-making process with them whilst waiting for bariatric surgery, on which they place all of their hopes for improved sexuality and quality of life. IMPACT The findings highlight the importance of exploring the experiences and sexual issues faced by heterosexual women with MO in a bariatric surgery program. Bariatric nurses have a privileged position to assess these women's sexuality, recommend alternatives to sexual intercourse or refer them to sexologists. As part of the multidisciplinary team, nurses can contribute to managing the expectations of women with MO and their partners in relation to the improvement of their sex lives following bariatric surgery.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | - Manuel Ferrer-Márquez
- Bariatric Surgery Unit, Hospital HLA Mediterráneo, Almería, Spain.,Bariatric Surgery Unit, Hospital Universitario Torrecárdenas, Almería, Spain
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Adult, Child and Midwifery Department, School of Health and Education, Middlesex University, London, UK
| | | | - Alicia Ruiz-Muelle
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
| | | | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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Piquer-Garcia I, Cereijo R, Corral-Pérez J, Pellitero S, Martínez E, Taxerås SD, Tarascó J, Moreno P, Balibrea J, Puig-Domingo M, Serra D, Herrero L, Jiménez-Pavón D, Lerin C, Villarroya F, Sánchez-Infantes D. Use of Infrared Thermography to Estimate Brown Fat Activation After a Cooling Protocol in Patients with Severe Obesity That Underwent Bariatric Surgery. Obes Surg 2021; 30:2375-2381. [PMID: 32133589 DOI: 10.1007/s11695-020-04502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND In contrast to the energy-storing role of white adipose tissue (WAT), brown adipose tissue (BAT) acts as the main site of non-shivering thermogenesis in mammals and has been reported to play a role in protection against obesity and associated metabolic alterations in rodents. Infrared thermography (IRT) has been proposed as a novel non-invasive, safe, and quick method to estimate BAT thermogenic activation in humans. The aim of this study is to determine whether the IRT could be a potential new tool to estimate BAT thermogenic activation in patients with severe obesity in response to bariatric surgery. METHODS Supraclavicular BAT thermogenic activation was evaluated using IRT in a cohort of 31 patients (50 ± 10 years old, BMI = 44.5 ± 7.8; 15 undergoing laparoscopy sleeve gastrectomy and 16 Roux-en-Y gastric bypass) at baseline and 6 months after a bariatric surgery. Clinical parameters were determined at these same time points. RESULTS Supraclavicular BAT-related activity was detected in our patients by IRT after a cooling stimulus. The BAT thermogenic activation was higher at 6 months after laparoscopy sleeve gastrectomy (0.06 ± 0.1 vs 0.32 ± 0.1), while patients undergoing to a roux-en-Y gastric bypass did not change their thermogenic response using the same cooling stimulus (0.09 ± 0.1 vs 0.08 ± 0.1). CONCLUSIONS Our study postulates the IRT as a potential tool to evaluate BAT thermogenic activation in patients with obesity before and after a bariatric surgery. Further studies are needed to evaluate differences between LSG technique and RYGB on BAT activation.
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Affiliation(s)
| | - Rubén Cereijo
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Juan Corral-Pérez
- MOVE-IT Research Group and Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cádiz (INiBICA), University of Cádiz, Cadiz, Spain
| | - Silvia Pellitero
- Germans Trias i Pujol Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Fisiopatología de la Diabetes y enfermedades metabólicas (CIBERDEM), ISCIII, Madrid, Spain
| | - Eva Martínez
- Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Siri D Taxerås
- Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Jordi Tarascó
- Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Pau Moreno
- Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - José Balibrea
- Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manel Puig-Domingo
- Germans Trias i Pujol Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Fisiopatología de la Diabetes y enfermedades metabólicas (CIBERDEM), ISCIII, Madrid, Spain
| | - Dolors Serra
- Centro de Investigación Biomédica de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Department of Biochemistry and Physiology, School of Pharmacy, Institut de Biomedicina de la Universitat de Barcelona (IBUB),, Universitat de Barcelona, 08028, Barcelona, Spain
| | - Laura Herrero
- Centro de Investigación Biomédica de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain.,Department of Biochemistry and Physiology, School of Pharmacy, Institut de Biomedicina de la Universitat de Barcelona (IBUB),, Universitat de Barcelona, 08028, Barcelona, Spain
| | - David Jiménez-Pavón
- MOVE-IT Research Group and Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cádiz (INiBICA), University of Cádiz, Cadiz, Spain
| | - Carles Lerin
- Endocrinology department, Institut de Recerca Sant Joan de Déu, 08950, Barcelona, Spain
| | - Francesc Villarroya
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - David Sánchez-Infantes
- Germans Trias i Pujol Research Institute, Barcelona, Spain. .,Centro de Investigación Biomédica de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain. .,Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain.
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14
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Gimeno-Moro AM, Errando CL, Escrig-Sos VJ, Laguna-Sastre JM. Analysis of the 'Evaluation Indicators' of an Enhanced Recovery After Bariatric Surgery Pathway in the First Six Months After Implementation. Obes Surg 2021; 31:2551-2566. [PMID: 33840012 DOI: 10.1007/s11695-021-05274-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 12/19/2022]
Abstract
The implementation of a clinical pathway in bariatric surgery (BS) might facilitate systemic care. Focusing on enhanced recovery after surgery (ERAS) programs may also improve surgical outcomes depending on the degree of adherence achieved. We hypothesized that the implementation of an ERAS clinical pathway in BS (ERABS) improves clinical outcomes compared to traditional treatment in a tertiary care hospital. The main objective was to assess the degree of adherence to the ERABS program. Secondary objectives were to evaluate compliance with the quality indicators of the Spanish Society for Obesity Surgery (SECO) and overall patients' satisfaction. A retrospective observational study was designed. Data from patients who underwent BS into an ERABS context were reviewed and compared with traditionally treated patients. Process and outcomes indicators adapted from RICA (Recuperación Intensificada en Cirugía Abdominal) pathway, degree of compliance with SECO quality indicators and patients' satisfaction were analyzed. Forty-three patients were included per group. Indicators' compliance rate per patient was 83.23%. Differences were found in postoperative bleeding, immediate morbidity and overall morbidity, but not in severity of complications. No patient felt dissatisfied or unsatisfied. Average compliance with indicators of process and outcome was 90.45%. Overall morbidity in ERABS group did not differ from that recommended by SECO, but traditional group did show significant increase. Adherence was 83.63% and overall incidence of complications was 7%. Our study shows improved clinical outcomes in ERABS group with a high degree of adherence. Quality indicators were met, improving overall morbidity with no difference in the severity of complications.
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Affiliation(s)
- Ana M Gimeno-Moro
- Service of Anesthesiology, Hospital General Universitario de Castellón, Av. Benicassim, 128, 12004, Castellón, Spain.
| | - Carlos L Errando
- Service of Anesthesiology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Vicente J Escrig-Sos
- Service of General Surgery, Hospital General Universitario de Castellón, Castellón, Spain
- Jaume I University, Castellón, Spain
| | - José M Laguna-Sastre
- Jaume I University, Castellón, Spain
- Service of General Surgery, Hospital General Universitario de Castellón, Castellón, Spain
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15
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Ferrer-Márquez M, Ibáñez VM, Gil FR, Salmerón MJS, Sánchez MJT, Martínez Amo-Gámez A, Ferrer-Ayza M. Missing Jejunal Perforation During Small Bowel Measurement in Patient Operated by Laparoscopic One-Anastomosis Gastric Bypass. Obes Surg 2021; 31:2841-2842. [PMID: 33825151 DOI: 10.1007/s11695-021-05365-2] [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: 02/02/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity surgery is justified as it produces sustained weight loss, increases life expectancy, and reduces the complications of obesity. For this reason, increasing numbers of patients are undergoing this surgery [1]. Complications following surgical treatment of severe obesity vary based upon the procedure performed and, although it is currently below 7% in more experienced centers, it may increase in more complex surgeries (such as revision surgery) and can be as high as 40% [2, 3]. Patients with early postoperative complications may be managed in specialist centers by the bariatric surgeon during the hospital stay [4]. Missing bowel injury may occur primarily during insertion of a Veress needle and trocar, use of electrosurgery and laser beams, suturing, and adhesiolysis [5]. Less frequently, the bowel perforation is due to the measurement of the loop and goes unnoticed. Perforation of the intestines due to any reason is a severe condition that can clinically present with free intraabdominal air, purulent or even fecal peritonitis, and abdominal compartment syndrome [6]. High clinical suspicion is crucial for early diagnosis. Early recognition of bowel injury and early intervention is crucial to reduce its morbidity and mortality [5]. METHODS We present a case of a 50-year-old male patient with a BMI of 36.1 kg/m2, hypertension, and dyslipidemia who was proposed for bariatric surgery. A laparoscopic one-anastomosis gastric bypass (OAGB) was performed with no intraoperative incidents. Few hours after the surgery, the patient manifests intense abdominal pain and tachycardia (120 bpm) so we decided to order an abdominal CT scan that showed signs of jejunal perforation (pneumoperitoneum, oral contrast extravasation, and small air bubbles next to the jejunum wall). RESULTS Emergency laparoscopy was done and showed generalized peritonitis caused by a 4-mm perforation in the mesenteric border of the jejunum with everted mucosa that was located 150 cm from the loop of Treitz. We decided to place three infraumbilical trocars to help us with washing, viewing, and surgical repair. We performed a 2-0 barbed simple suture of the perforation and extensive washing of the entire cavity with 10 L of serum. We left three drains. The patient made an uneventful recovery and was discharged 72 h after surgery with an established oral diet. CONCLUSIONS Missing intestinal perforation is an uncommon injury during bariatric surgery, but its early diagnosis is important to avoid endangering the patient's life. Simple postoperative tachycardia in obese patients should be taken seriously as it is a warning signal. Laparoscopic reoperation in these early diagnosed cases is safe and effective, since it allows visualization and washing of the entire cavity. Bowel injuries, which may occur as a result of the insertion of an insufflation needle or trocar, are a rare complication of laparoscopy. In the case we present, the perforation occurred during the small bowel measurement so we insist on the extreme caution that surgeons must take during every detail of the surgical technique. The use of atraumatic forceps, handling of the bowel strictly at the antimesenteric side, and the infusion of sufficient methylene blue in the anastomosis testing are gestures that can help reduce the risk.
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Affiliation(s)
- Manuel Ferrer-Márquez
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain.
| | - Vanesa Maturana Ibáñez
- Department of Bariatric Surgery, General Surgery, Hospital Vistahermosa, Alicante, Spain
| | - Francisco Rubio Gil
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain
| | - María José Solvas Salmerón
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain
| | | | | | - Manuel Ferrer-Ayza
- Department of Bariatric Surgery (ObesidadAlmería), General Surgery, Hospital Mediterráneo, Almería, Spain
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16
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Sánchez Santos R, Garcia Ruiz de Gordejuela A, Breton Lesmes I, Lecube Torelló A, Moizé Arcone V, Arroyo Martin JJ, Fernandez Alsina E, Martín Antona E, Rubio Herrera MÁ, Sabench Pereferrer F, Sánchez Pernaute A, Vilallonga Puy R. Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. Cir Esp 2021; 99:4-10. [PMID: 32921419 PMCID: PMC7301111 DOI: 10.1016/j.ciresp.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Abstract
The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.
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17
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Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2021. [PMCID: PMC7836702 DOI: 10.1016/j.cireng.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The SARS-CoV-2 pandemic has a great impact worldwide, being Spain one of the most affected countries. The delay in bariatric surgery can have fatal consequences since up to 50% of the patients who are on the waiting list develop a new comorbidity during the time they remain on it and 1.5% of patients die while waiting for the intervention. That is why bariatric surgery should not be delayed, if the occupation of the hospital by COVID-19+ patients decreases significantly, and sufficient resources and safety are available to restart surgery in patients with benign pathology. This document contains the main recommendations for the bariatric surgery programs in our country from the point of view of safety, bariatric patient preparation and follow up during the SARS-CoV-2 pandemia.
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18
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Laparoscopic sleeve gastrectomy: Correlation of gastric emptying and weight loss. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.823768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Cereijo R, Taxerås SD, Piquer-Garcia I, Pellitero S, Martínez E, Tarascó J, Moreno P, Balibrea J, Puig-Domingo M, Jiménez-Pavón D, Lerin C, Villarroya F, Sánchez-Infantes D. Elevated Levels of Circulating miR-92a Are Associated with Impaired Glucose Homeostasis in Patients with Obesity and Correlate with Metabolic Status After Bariatric Surgery. Obes Surg 2020; 30:174-179. [PMID: 31346930 DOI: 10.1007/s11695-019-04104-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION miRNAs are small non-coding RNAs, some of which are expressed in adipose tissues, are present in the circulation, and are regulated in obesity. Bariatric surgery (BS) has been proposed to lead to activation of brown adipose tissue, an effect that may be related to beneficial effects of BS on systemic metabolism. Here, we evaluated circulating levels of miR-92a and miR-99b, two miRNAs proposed as biomarkers of brown fat activity, in a cohort of patients with severe obesity before and after BS, and studied their potential relationship with BS-associated improvements in metabolic parameters. METHODS Circulating levels of miR-92a and miR-99b were quantified in a cohort of 26 patients (age, 48 ± 10 years; BMI, 45 ± 7 kg/m2) before and 6 months after BS. Clinical parameters were determined at different time points and correlations among them were studied. RESULTS Basal levels of miR-92a were significantly increased in patients with obesity relative to lean controls. Serum miR-92a levels were strongly reduced at 6 months after BS, reaching levels similar to those in controls. Serum miR-99b levels were unchanged in relation to both the obese condition and BS. Elevated levels of miR-92a were directly correlated with worsened glucose homeostasis parameters and poor BS outcome. CONCLUSIONS Our findings show that miR-92a is elevated in conditions of obesity, and its reduction after BS correlates with metabolic improvement. Further studies would be necessary to establish miR-92a as serum biomarker and potential predictor of the BS success in improving the metabolic status of patients with obesity.
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Affiliation(s)
- Rubén Cereijo
- Department of Biochemistry and Molecular Biomedicine, Institute of Biomedicine, University of Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain
| | - Siri D Taxerås
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain
| | - Irene Piquer-Garcia
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain
| | - Silvia Pellitero
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain.,Biomedical Research Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIII, Madrid, Spain
| | - Eva Martínez
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain
| | - Jordi Tarascó
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain
| | - Pau Moreno
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain
| | - José Balibrea
- Metabolic and Bariatric Surgery Unit, EAC-BS Center of Excellence, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manel Puig-Domingo
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain.,Biomedical Research Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIII, Madrid, Spain
| | - David Jiménez-Pavón
- MOVE-IT Research group and Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cádiz (INiBICA), University of Cádiz, Cádiz, Spain
| | - Carles Lerin
- Institut de Recerca Sant Joan de Déu, Barcelona, Catalonia, Spain
| | - Francesc Villarroya
- Department of Biochemistry and Molecular Biomedicine, Institute of Biomedicine, University of Barcelona, Barcelona, Catalonia, Spain. .,Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Catalonia, Spain. .,Institut de Recerca Sant Joan de Déu, Barcelona, Catalonia, Spain.
| | - David Sánchez-Infantes
- Germans Trias i Pujol Research Institute, Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n, Badalona, 08916, Barcelona, Spain.
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20
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Bellver Oliver M, Escrig-Sos J, Rotellar Sastre F, Moya-Herráiz Á, Sabater-Ortí L. Outcome quality standards for surgery of colorectal liver metastasis. Langenbecks Arch Surg 2020; 405:745-756. [PMID: 32577822 DOI: 10.1007/s00423-020-01908-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Liver metastases are the most common malignant solid liver lesions, approximately 40% of which stem from colorectal tumors. Liver resection is currently the only curative treatment for colorectal cancer liver metastases (CRLM). However, there is a lack of consensus criteria to assess the results of this treatment. In order to evaluate the quality of surgical outcomes, it is necessary to identify quality indicators (QIs) and their corresponding quality standards (QS). We propose a simple method to determine QI and QS in CRLM surgery (CRLMS) and establish acceptable quality limits (AQL) for each QI. MATERIAL AND METHODS A systematic review of CRLMS results published from 2006 to 2016. Clinical guidelines, consensus conferences, and publications related to the CRLMS were reviewed to identify and select QIs. Once selected, a new review of the papers including the results of at least one of the QIs was performed. Statistical process control (SPC) method was applied to calculate the QS and AQL of each QI. The limits of variability were established from mean and confidence intervals at 95% and 99.8%. RESULTS The most relevant QIs and its AQLs were postoperative mortality (2%, < 4.5%), overall postoperative morbidity (33%, < 41%), liver failure (5%, < 8%), postoperative hemorrhage (1%, < 3%), biliary fistula (6%, < 10%), reoperation (3%, < 6%), R1 resection margins (18%, < 25%), and overall survival at 12 and 60 months (84%, > 77%; and 34%, > 25%, respectively). CONCLUSIONS Despite its limitations, the present study constitutes the most extensive scientific evidence to date on QI and AQL in CRLMS and may constitute a reference in future studies.
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Affiliation(s)
- Manuel Bellver Oliver
- Department of Surgery, HPB Unit, Hospital General Universitario Castellón, Jaume I University, Castellón de la Plana, Spain.
| | - Javier Escrig-Sos
- Department of Surgery, HPB Unit, Hospital General Universitario Castellón, Jaume I University, Castellón de la Plana, Spain
| | - Fernando Rotellar Sastre
- HPB and Liver Transplant Unit, General and Digestive Surgery, University Clinic of Navarra, University of Navarra, Pamplona, Spain
| | - Ángel Moya-Herráiz
- Department of Surgery, HPB Unit, Hospital General Universitario Castellón, Jaume I University, Castellón de la Plana, Spain
| | - Luis Sabater-Ortí
- Department of Surgery, Biomedical Research Institute INCLIVA, Hospital Clínico, University of Valencia, Valencia, Spain
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21
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Piquer-Garcia I, Campderros L, Taxerås SD, Gavaldà-Navarro A, Pardo R, Vila M, Pellitero S, Martínez E, Tarascó J, Moreno P, Villarroya J, Cereijo R, González L, Reyes M, Rodriguez-Fernández S, Vives-Pi M, Lerin C, Elks CM, Stephens JM, Puig-Domingo M, Villarroya F, Villena JA, Sánchez-Infantes D. A Role for Oncostatin M in the Impairment of Glucose Homeostasis in Obesity. J Clin Endocrinol Metab 2020; 105:5586710. [PMID: 31606738 PMCID: PMC7112982 DOI: 10.1210/clinem/dgz090] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/02/2019] [Indexed: 12/19/2022]
Abstract
CONTEXT Oncostatin M (OSM) plays a key role in inflammation, but its regulation and function during obesity is not fully understood. OBJECTIVE The aim of this study was to evaluate the relationship of OSM with the inflammatory state that leads to impaired glucose homeostasis in obesity. We also assessed whether OSM immunoneutralization could revert metabolic disturbances caused by a high-fat diet (HFD) in mice. DESIGN 28 patients with severe obesity were included and stratified into two groups: (1) glucose levels <100 mg/dL and (2) glucose levels >100 mg/dL. White adipose tissue was obtained to examine OSM gene expression. Human adipocytes were used to evaluate the effect of OSM in the inflammatory response, and HFD-fed C57BL/6J mice were injected with anti-OSM antibody to evaluate its effects. RESULTS OSM expression was elevated in subcutaneous and visceral fat from patients with obesity and hyperglycemia, and correlated with Glut4 mRNA levels, serum insulin, homeostatic model assessment of insulin resistance, and inflammatory markers. OSM inhibited adipogenesis and induced inflammation in human adipocytes. Finally, OSM receptor knockout mice had increased Glut4 mRNA levels in adipose tissue, and OSM immunoneutralization resulted in a reduction of glucose levels and Ccl2 expression in adipose tissue from HFD-fed mice. CONCLUSIONS OSM contributes to the inflammatory state during obesity and may be involved in the development of insulin resistance.
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Affiliation(s)
- Irene Piquer-Garcia
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Laura Campderros
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIII, Madrid, Spain
| | - Siri D Taxerås
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Aleix Gavaldà-Navarro
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIII, Madrid, Spain
| | - Rosario Pardo
- Laboratory of Metabolism and Obesity, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Vila
- Laboratory of Metabolism and Obesity, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Pellitero
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIII, Madrid, Spain
| | - Eva Martínez
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Jordi Tarascó
- Department of Surgery, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Pau Moreno
- Department of Surgery, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Joan Villarroya
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Cereijo
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIII, Madrid, Spain
| | - Lorena González
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Marjorie Reyes
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | | | - Marta Vives-Pi
- BiomedicalResearch Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIII, Madrid, Spain
- Immunology Section, Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Carles Lerin
- Endocrinology, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Carrie M Elks
- Matrix Biology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Jacqueline M Stephens
- Adipocyte Biology Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIII, Madrid, Spain
| | - Francesc Villarroya
- Department of Biochemistry and Molecular Biomedicine, and Institute of Biomedicine, University of Barcelona, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIII, Madrid, Spain
| | - Josep A Villena
- Laboratory of Metabolism and Obesity, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIII, Madrid, Spain
| | - David Sánchez-Infantes
- Department of Endocrinology and Nutrition, Germans Trias i Pujol Research Institute, Barcelona, Spain
- BiomedicalResearch Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIII, Madrid, Spain
- Correspondence and Reprint Requests: David Sánchez-Infantes, PhD, Obesity and Type 2 Diabetes: Adipose Tissue Biology Group Leader, Germans Trias i Pujol Research Institute (IGTP), Campus Can Ruti, Carretera de Can Ruti, Camí de les Escoles s/n 08916 Badalona, Barcelona, Spain. E-mail:
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Análisis de la pérdida ponderal a medio plazo después del bypass gastroyeyunal en Y de Roux y de la gastrectomía vertical: propuesta de gráficos de percentiles del porcentaje de peso total perdido para su uso en la práctica clínica diaria. Cir Esp 2020; 98:72-78. [DOI: 10.1016/j.ciresp.2019.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/14/2019] [Accepted: 09/24/2019] [Indexed: 12/21/2022]
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Taxerås SD, Galán M, Campderros L, Piquer‐Garcia I, Pellitero S, Martínez E, Puig R, Lucena I, Tarascó J, Moreno P, Balibrea J, Bel J, Murillo M, Martínez M, Ramon‐Krauel M, Puig‐Domingo M, Villarroya F, Lerin C, Sánchez‐Infantes D. Differential association between S100A4 levels and insulin resistance in prepubertal children and adult subjects with clinically severe obesity. Obes Sci Pract 2020; 6:99-106. [PMID: 32128247 PMCID: PMC7042100 DOI: 10.1002/osp4.381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/09/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES S100A4 has been recently identified as an adipokine associated with insulin resistance (IR) in adult subjects with obesity. However, no data about its levels in children with obesity and only a few approaches regarding its potential mechanism of action have been reported. To obtain a deeper understanding of the role of S100A4 in obesity, (a) S100A4 levels were measured in prepubertal children and adult subjects with and without obesity and studied the relationship with IR and (b) the effects of S100A4 in cultured human adipocytes and vascular smooth muscle cells (VSMCs) were determined. METHODS Sixty-five children (50 with obesity, age 9.0 ±1.1 years and 15 normal weight, age 8.4 ±0.8 years) and fifty-nine adults (43 with severe obesity, age 46 ±11 years and 16 normal weight, age 45 ±9 years) were included. Blood from children and adults and adipose tissue samples from adults were obtained and analysed. Human adipocytes and VSMC were incubated with S100A4 to evaluate their response to this adipokine. RESULTS Circulating S100A4 levels were increased in both children (P = .002) and adults (P < .001) with obesity compared with their normal-weight controls. In subjects with obesity, S100A4 levels were associated with homeostatic model assessment-insulin resistance (HOMA-IR) in adults (βstd = .42, P = .008) but not in children (βstd = .12, P = .356). Human adipocytes were not sensitive to S100A4, while incubation with this adipokine significantly reduced inflammatory markers in VSMC. CONCLUSIONS Our human data demonstrate that higher S100A4 levels are a marker of IR in adults with obesity but not in prepubertal children. Furthermore, the in vitro results suggest that S100A4 might exert an anti-inflammatory effect. Further studies will be necessary to determine whether S100A4 can be a therapeutic target for obesity.
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Affiliation(s)
- Siri D. Taxerås
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - María Galán
- Institut de Recerca del Hospital de la Santa Creu i Sant Pau‐Programa ICCCBarcelonaSpain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), ISCIIIMadridSpain
| | - Laura Campderros
- Department of Biochemistry and Molecular Biology, Institute of BiomedicineUniversity of BarcelonaBarcelonaSpain
- Biomedical Research Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIIIMadridSpain
| | - Irene Piquer‐Garcia
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Silvia Pellitero
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
- Biomedical Research Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIIIMadridSpain
| | - Eva Martínez
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Rocío Puig
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Icíar Lucena
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Jordi Tarascó
- Department of SurgeryGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Pau Moreno
- Department of SurgeryGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - José Balibrea
- Metabolic and Bariatric Surgery Unit, EAC‐BS Center of ExcellenceVall d'Hebron University HospitalBarcelonaSpain
| | - Joan Bel
- Department of PediatricGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Marta Murillo
- Department of PediatricGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - María Martínez
- Department of PediatricGermans Trias i Pujol Research InstituteBarcelonaSpain
| | - Marta Ramon‐Krauel
- Endocrinology DepartmentInstitut de Recerca Sant Joan de DéuBarcelonaSpain
- Hospital Sant Joan de DéuBarcelonaSpain
| | - Manel Puig‐Domingo
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
- Biomedical Research Center (Red Fisiopatología de la Diabetes y enfermedades metabólicas) (CIBERDEM), ISCIIIMadridSpain
| | - Francesc Villarroya
- Department of Biochemistry and Molecular Biology, Institute of BiomedicineUniversity of BarcelonaBarcelonaSpain
- Biomedical Research Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIIIMadridSpain
| | - Carles Lerin
- Endocrinology DepartmentInstitut de Recerca Sant Joan de DéuBarcelonaSpain
- Hospital Sant Joan de DéuBarcelonaSpain
| | - David Sánchez‐Infantes
- Department of Endocrinology and NutritionGermans Trias i Pujol Research InstituteBarcelonaSpain
- Biomedical Research Center (Red Fisiopatología de la Obesidad y Nutrición) (CIBEROBN), ISCIIIMadridSpain
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Mora Oliver I, Cassinello Fernández N, Alfonso Ballester R, Cuenca Ramírez MD, Ortega Serrano J. Cirugía bariátrica de conversión por fallo de la técnica inicial: 25 años de experiencia en una Unidad especializada de Cirugía de la Obesidad en España. Cir Esp 2019; 97:568-574. [DOI: 10.1016/j.ciresp.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/28/2019] [Accepted: 07/25/2019] [Indexed: 10/25/2022]
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Gil-Rojas Y, Garzón A, Lasalvia P, Hernández F, Castañeda-Cardona C, Rosselli D. Cost-Effectiveness of Bariatric Surgery Compared With Nonsurgical Treatment in People With Obesity and Comorbidity in Colombia. Value Health Reg Issues 2019; 20:79-85. [PMID: 31082638 DOI: 10.1016/j.vhri.2019.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The increase in obesity prevalence and its relationship with multiple cardiovascular complications have raised the burden of obesity in the general population. Bariatric surgery has shown to be more effective in reducing weight than the traditional pharmacologic and nonpharmacologic treatments. OBJECTIVE To evaluate the cost-effectiveness of this alternative compared with standard treatment in the Colombian context. METHODS A Markov single cohort model was used to simulate the incremental cost per quality-adjusted life-year (QALY) gained every year over a base-case 5-year time horizon. The model considers 5 health states: comorbidity, remission, acute myocardial infarction, stroke, and death. Four comorbidity conditions were evaluated separately: diabetes, hypertension, dyslipidemia, and sleep apnea. The model was evaluated from a third-payer perspective. All costs were expressed in 2016 Colombian pesos ($1.00 = 3051 COP). A 5% annual discount rate was applied to both costs and outcomes. RESULTS In baseline analysis, bariatric surgery was a cost-effective alternative compared with nonsurgical treatment in the diabetes and hypertension cohort with an incremental cost-effectiveness ratio of $6 194 899 and $43 689 527 per QALY gained, respectively. In the sleep apnea cohort, surgery has greater effectiveness and lower costs, which is why it is a dominant strategy. In the dyslipidemia cohort, bariatric surgery is dominated by the nonsurgical approach. CONCLUSION The current study provides evidence that bariatric surgery is a cost-effective alternative among some cohorts in the Colombian setting. For obese patients with sleep apnea or diabetes, bariatric surgery is a recommendable alternative (dominant and cost-effective, respectively) for the Colombian healthcare system.
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Affiliation(s)
| | - Andrés Garzón
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | | | | | - Diego Rosselli
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia.
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