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Jog A, Baldwin D, Wernsing D, Gershuni V, Hashimoto DA, Williams N, Dumon K, Altieri MS. Trends in bariatric surgery training: bariatric operations performed by Fellowship Council trainees from 2012 to 2019. Surg Obes Relat Dis 2024; 20:545-552. [PMID: 38413321 DOI: 10.1016/j.soard.2023.12.011] [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: 08/25/2023] [Revised: 11/28/2023] [Accepted: 12/17/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND The American Society for Metabolic and Bariatric Surgery (ASMBS) Fellowship Certificate was created to ensure satisfactory training and requires a minimum number of anastomotic cases. With laparoscopic sleeve gastrectomy becoming the most common bariatric procedure in the United States, this may present a challenge for fellows to obtain adequate numbers for ASMBS certification. OBJECTIVES To investigate bariatric fellowship trends from 2012 to 2019, the types, numbers, and approaches of surgical procedures performed by fellows were examined. SETTING Academic training centers in the United States. METHODS Data were obtained from Fellowship Council records of all cases performed by fellows in ASMBS-accredited bariatric surgery training programs between 2012 and 2019. A retrospective analysis using standard descriptive statistical methods was performed to investigate trends in total case volume and cases per fellow for common bariatric procedures. RESULTS From 2012 to 2019, sleeve gastrectomy cases performed by all Fellowship Council fellows nearly doubled from 6,514 to 12,398, compared with a slight increase for gastric bypass, from 8,486 to 9,204. Looking specifically at bariatric fellowships, the mean number of gastric bypass cases per fellow dropped over time, from 91.1 cases (SD = 46.8) in 2012-2013 to 52.6 (SD = 62.1) in 2018-2019. Mean sleeve gastrectomy cases per fellow increased from 54.7 (SD = 31.5) in 2012-2013 to a peak of 98.6 (SD = 64.3) in 2015-2016. Robotic gastric bypasses also increased from 4% of all cases performed in 2012-2013 to 13.3% in 2018-2019. CONCLUSIONS Bariatric fellowship training has seen a decrease in gastric bypasses, an increase in sleeve gastrectomies, and an increase in robotic surgery completed by each fellow from 2012 to 2019.
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Affiliation(s)
- Aditya Jog
- Department of Surgery, University of Pennsylvania, Philadelphia
| | - Dustin Baldwin
- Department of Surgery, Division of General and Bariatric Surgery, East Carolina University, Greenville, North Carolina
| | - David Wernsing
- Department of Surgery, University of Pennsylvania, Philadelphia
| | | | | | - Noel Williams
- Department of Surgery, University of Pennsylvania, Philadelphia
| | | | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia.
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Meira MD, Oliveira FDESC, Coutinho LR, Leão LHDEA, Vasconcelos GDEP, Siqueira LTDE, Ferraz ÁAB. Long-term evaluation of patients with BMI = 50kg/m2 who underwent Bariatric Surgery. Rev Col Bras Cir 2023; 50:e20233397. [PMID: 37162040 PMCID: PMC10508685 DOI: 10.1590/0100-6991e-20233397-en] [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: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 05/11/2023] Open
Abstract
PURPOSE to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. METHODS retrospective cohort that included a study group of 178 patients with SO and a control group of 181 patients with BMI 35-49.9Kg/m2. The groups were formed in a 1:1 nearest neighbor matching. The main variables were pre- and postoperative BMI and comorbidities, occurrence of severe postoperative complications, bowel obstruction, marginal ulcer, fistulae and 30-day death, besides the necessity of emergency room (ER) admission and abdominal computed tomography (CT) scans in the postoperative period due to acute abdomen. RESULTS the study group comprised 74.0% of women while the control group had 56.7%. The mean follow-up time was similar between both groups (5.48 x 6.09 years, p=0.216). There was no statistically significant difference on the prevalence of hypertension and T2D between the groups according to the surgical technique. All deaths occurred in the Study group (BMI = 50kg/m2) who underwent RYGB. There was no difference between the groups regarding the occurrence of severe complications. Data on ER admissions and the need for abdominal CT to investigate postoperative abdominal pain did not show statistically significant difference between the groups. CONCLUSION despite the high risk related to bariatric surgery in patients with SO, the benefits related to the remission of comorbidities are significant; although being lower than those found in patients with milder grades of obesity.
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Affiliation(s)
- Matheus Duarte Meira
- - Universidade Federal de Pernambuco (UFPE), Pós-graduação em Cirurgia - Recife - PE - Brasil
- - Hospital dos Servidores do Estado (HSE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | - Fernando DE Santa Cruz Oliveira
- - Universidade Federal de Pernambuco (UFPE), Pós-graduação em Cirurgia - Recife - PE - Brasil
- - Hospital dos Servidores do Estado (HSE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | | | | | - Géssica DE Paula Vasconcelos
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | - Luciana Teixeira DE Siqueira
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
- - Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia - Recife - PE - Brasil
| | - Álvaro Antônio Bandeira Ferraz
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
- - Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia - Recife - PE - Brasil
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Azhri AS, Almuqati A, Azzeh F, Alamro N, Azhar W, Qadhi A, Ghafouri K. Factors influencing body weight one year after bariatric surgery. Medicine (Baltimore) 2023; 102:e33111. [PMID: 36930099 PMCID: PMC10019114 DOI: 10.1097/md.0000000000033111] [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: 10/05/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023] Open
Abstract
The significant outcome of bariatric surgery (BS) is weight loss, which may be affected by many factors, such as initial body weight before surgery, sex, and dietary intake. Moreover, rapid weight loss is associated with an increased incidence of postsurgical cholelithiasis. To investigate the observed weight loss outcomes during the first year after BS, we investigated the factors that may influence weight loss and to detect the efficacy of prophylactic ursodeoxycholic acid against gallstone formation. This was a retrospective cohort study of all patients with morbid obesity who underwent BS in the hospital and completed a 1-year follow up. Patients with a previous BS or a history of cholecystectomy before BS were excluded. Data were extracted from the medical records at multiple postoperative intervals. There was significant weight loss in terms of percentage of excess weight loss and reduction in body mass index postoperative. A significant correlation was found between the percent of excess weight loss and age, initial body mass index, and initial weight, but there was no significant correlation with sex or type of surgery. The incidence of postoperative cholecystectomy is almost negligible. A significant association was found between age and weight loss after BS. ursodeoxycholic acid is an effective prophylaxis to decrease the incidence of cholecystectomy after BS.
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Affiliation(s)
- Afnan Sameer Azhri
- Department of Clinical Nutrition, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Asma Almuqati
- Department of Clinical Nutrition, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Firas Azzeh
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nuha Alamro
- Department of Clinical Nutrition, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Wedad Azhar
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alaa Qadhi
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khloud Ghafouri
- Department of Clinical Nutrition, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
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Mitsakos AT, Irish W, DeMaria EJ, Pories WJ, Altieri MS. Body mass index and risk of mortality in patients undergoing bariatric surgery. Surg Endosc 2023; 37:1213-1221. [PMID: 36156736 DOI: 10.1007/s00464-022-09651-7] [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: 02/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m2. METHODS A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m2) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. RESULTS A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m2; 1.5% of patients had BMI ≥ 70.0 kg/m2. On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m2, the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m2, although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB). CONCLUSIONS BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m2. In these patients, RYGB is associated with increased risk of mortality compared to SG.
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Affiliation(s)
- Anastasios T Mitsakos
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Department of Surgery, Vidant Medical Center, East Carolina University Brody School of Medicine, 2100 Stantonsburg Road, Greenville, NC, 27834, USA.
| | - William Irish
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Eric J DeMaria
- Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Walter J Pories
- Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Maria S Altieri
- Department of Surgery, Section of GI Surgery, Pennsylvania Hospital/University of Pennsylvania, Philadelphia, PA, USA
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Herrera-López S, Sepúlveda-Bastilla SM, Aguilar-Arango MC, Martínez-Rivera MS, Toro-Vásquez JP. Factores de riesgo asociados a la pérdida insuficiente o ganancia significativa de peso en pacientes sometidos a cirugía bariátrica. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introducción. La cirugía bariátrica es efectiva para inducir una rápida pérdida del exceso de peso, pero existen dudas sobre la duración de este efecto a largo plazo. Este estudio buscaba identificar la proporción de pacientes operados que presentaron una pérdida insuficiente o una ganancia significativa de peso y los posibles factores relacionados.
Métodos. Estudio de cohorte retrospectivo en pacientes adultos sometidos a cirugía bariátrica. Se describieron variables demográficas y clínicas. Se realizó un análisis multivariado para identificar factores relacionados con un peso fuera de metas posterior a la cirugía.
Resultados. Se incluyeron 187 pacientes, 117 con baipás gástrico y 70 con manga gástrica. La mediana de índice de masa corporal preoperatorio fue 41,3 kg/m2 y postoperatorio de 28,8 kg/m2. El 94,7 % de los pacientes en ambos grupos logró una adecuada pérdida del exceso de peso. La ganancia de peso mayor del 20 % se presentó en el 43,5 % de los pacientes, siendo mayor en el grupo de manga gástrica (p<0,004). Los factores independientes para ganancia de peso fueron el sexo masculino (OR 5,5), cirugía tipo manga gástrica (OR 3,4), síndrome de apnea del sueño (OR 2,9) y enfermedad mental medicada (OR 2,8).
Conclusión. La cirugía bariátrica produce una pérdida del exceso de peso suficiente en casi la totalidad de los pacientes, pero un buen número recuperan peso luego de 3 años. Los principales factores asociados a ganancia de peso son el sexo masculino y la cirugía tipo manga gástrica.
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Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management - a 21-Year Experience. Obes Surg 2022; 32:3232-3238. [PMID: 35932414 PMCID: PMC9532327 DOI: 10.1007/s11695-022-06173-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
Purpose Morbidity and mortality associated with bariatric surgery are considered low. The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative bleeding (POB) after laparoscopic Roux-en-Y gastric by-pass (RYGB). Materials and Methods Retrospective analysis of prospectively collected data of consecutive patients who underwent RYGB in 2 expert bariatric centers between January 1999 and April 2020, with a common bariatric surgeon. Results A total of 2639 patients underwent RYGB and were included in the study. POB occurred in 72 patients (2.7%). Intraluminal bleeding (ILB) was present in 52 (72%) patients and extra-luminal bleeding (ELB) in 20 (28%) patients. POB took place within the first 3 postoperative days in 79% of patients. The most frequent symptom was tachycardia (63%). Abdominal pain was more regularly seen with ILB, compared to ELB (50% vs. 20%, respectively, p = 0.02). Male sex was an independent risk factor of POB on multivariate analysis (p < 0.01). LOS was significantly longer in patients who developed POB (8.3 vs. 3.8 days, p < 0.01). Management was conservative for most cases (68%). Eighteen patients with ILB (35%) and 5 patients with ELB (25%) required reoperation. One patient died from multiorgan failure after staple-line dehiscence of the excluded stomach (mortality 0.04%). Conclusion The incidence of POB is low, yet it is the most frequent postoperative complication after RYGB. Most POB can be managed conservatively while surgical treatment is required for patients with hemodynamic instability or signs of intestinal obstruction due to an intraluminal clot. Graphical abstract ![]()
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Taste-Driven Responsiveness to Fat and Sweet Stimuli in Mouse Models of Bariatric Surgery. Biomedicines 2022; 10:biomedicines10040741. [PMID: 35453491 PMCID: PMC9028277 DOI: 10.3390/biomedicines10040741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
A preferential consumption of healthier foods, low in fat and sugar, is often reported after bariatric surgery, suggesting a switch of taste-guided food choices. To further explore this hypothesis in well-standardized conditions, analysis of licking behavior in response to oily and sweet solutions has been realized in rats that have undergone a Roux-en-Y bypass (RYGB). Unfortunately, these studies have produced conflicting data mainly due to methodological differences. Paradoxically, whereas the vertical sleeve gastrectomy (VSG) becomes the most commonly performed bariatric surgery worldwide and is easier to perform and standardize in small animals, its putative impacts on the orosensory perception of energy-dense nutrients remains unknown. Using brief-access licking tests in VSG or RYGB mice, we found that (i) VSG induces a significant reduction in the fat mass in diet-induced obese (DIO) mice, (ii) VSG partially corrects the licking responses to lipid and sucrose stimuli which are degraded in sham-operated DIO mice, (iii) VSG improves the willingness to lick oily and sucrose solutions in DIO mice and (iv) RYGB leads to close outcomes. Altogether, these data strongly suggest that VSG, as RYGB, can counteract the deleterious effect of obesity on the orosensory perception of energy-dense nutrients in mice.
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Outcome of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass: a Prospective Observational 18-Month Study. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02958-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Hu Z, Sun J, Li R, Wang Z, Ding H, Zhu T, Wang G. A Comprehensive Comparison of LRYGB and LSG in Obese Patients Including the Effects on QoL, Comorbidities, Weight Loss, and Complications: a Systematic Review and Meta-Analysis. Obes Surg 2021; 30:819-827. [PMID: 31834563 PMCID: PMC7347514 DOI: 10.1007/s11695-019-04306-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To systematically and comprehensively evaluate the differences between laparoscopic Roux-en-Y gastric bypass (LRYGB) versus sleeve gastrectomy (LSG) in obese patients. Methods A systematic literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to December 2018. The meta-analysis was performed by the RevMan 5.3 software. Results Twenty-three articles with 7443 patients were included. In short term (< 3 years), LRYGB was superior to LSG in terms of improving comorbidities (T2D, odds ratio (OR) 1.93, 1.06–3.52, P < 0.05, hypertension, OR 1.59, 1.08–2.34, P < 0.05, dyslipidemia, OR 1.61, 1.05–2.46, P < 0.05), but there were no differences in the midterm and long term. Quality of life (QoL) after bariatric surgery was included, but no differences were observed in the QoL after LRYGB or LSG (gastrointestinal quality of life index (GIQLI) and Moorehead–Ardelt quality of life questionnaire (M-A-Q), P > 0.05). LRYGB achieved a higher EWL% than LSG (after 3 years, WMD 5.48, 0.13–10.84. P < 0.05; after 5 years, WMD 4.55, 1.04–8.05, P < 0.05) in long term, but no significant differences were found during 0.25- to 2.0-year follow-up. The rate of early and late complications was much higher in LRYGB than in LSG (early complications, OR = 2.11, 95% CI = 1.53–2.91, P < 0.001; late complications, OR = 2.60, 95% CI = 1.93–3.49, P < 0.001). Conclusions This meta-analysis showed that LRYGB was more effective than LSG in comorbidities’ resolution or improvement in short term. For weight loss, LRYGB had better long-term effects than LSG. In addition, no differences were observed in the quality of life after LRYGB or LSG. LRYGB was associated with more complications than LSG. Electronic supplementary material The online version of this article (10.1007/s11695-019-04306-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhihao Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Junfeng Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Ruixin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Zhuoyin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Hengxuan Ding
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Tianyu Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China
| | - Guojun Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, NO.1 Jianshe East Road, Zhengzhou, 450052, Henan, China.
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Ali M, Khan SA, Mushtaq M, Haider SA. Comparison of Laparoscopic Sleeve Gastrectomy (LSG) with Laparoscopic Gastric Bypass (LRYGB) in Bariatric Surgery. Cureus 2021; 13:e14022. [PMID: 33889462 PMCID: PMC8057121 DOI: 10.7759/cureus.14022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction The objective of our study was to compare the 30-day post-operative outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Materials and Methods This randomized controlled study contained patients who underwent bariatric surgery from June 13, 2018 to October 12, 2019. A total of 116 patients having body mass index (BMI) > 35 kg/m2 (morbidly obese), age 18 to 65 years and with failure of conservative treatment were included. Group I patients underwent bariatric surgery using LRYGB technique while group II patients underwent bariatric surgery using the LSG technique. All patients were followed 30 days after surgery to determine early post-operative outcomes. Results The demographic profile, such as age and BMI, was similar between the groups. The mean operating time was 72 ±12 minutes in the LSG group and 156 ± 18 min in the LRYGB group (p-value 0.0001). Major complications were seen in five (8.62%) patients in LSG patients and in four (6.89%) patients in LRYGB group (p-value 0.12). Minor complications were seen in 21 (36.2%) patients in LSG group and in 19 (32.75%) patients in LRYGB group (p-value 0.15). The length of stay in the hospital in LSG group was 6.2±4.2 versus 9.4± 4.6 (p-value 0.0002). Conclusion Both LRYGB and LSG are effective and safe bariatric procedures with a similar incidence of major complications. However, LSG is associated with shorter operative time and hospital stay. Long-term follow-up studies are required to compare the effectiveness of these procedures.
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Affiliation(s)
- Manzar Ali
- General and Colorectal Surgery, Ibn-e-Siena Hospital and Research Institute, Multan, PAK
| | - Safdar Ali Khan
- General Surgery, Ibn-e-Siena Hospital and Research Institute, Multan, PAK
| | - Muhammad Mushtaq
- General Surgery, Ibn-e-Siena Hospital and Research Institute, Multan, PAK
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Does the Length of the Common Channel as Part of the Total Alimentary Tract Matter? One Year Results from the Multicenter Dutch Common Channel Trial (DUCATI) Comparing Standard Versus Distal Roux-en-Y Gastric Bypass with Similar Biliopancreatic Bowel Limb Lengths. Obes Surg 2020; 30:4732-4740. [PMID: 32955672 DOI: 10.1007/s11695-020-04982-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Although the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold-standard bariatric procedure, it remains uncertain what the optimal bowel limb lengths are to accomplish maximal weight loss while minimizing nutritional deficiencies and related gastro-intestinal complaints. The aim of this randomized controlled multicenter trial is to investigate the effect of significant lengthening of the length of the Roux limb (RL) at the cost of the length of the common channel (CC) while keeping the biliopancreatic limb (BPL) lengths the same on both study arms. METHODS Four hundred forty-four patients were randomized to receive either a Very Long Roux Limb LRYGB (VLRL-LRYGB) (variable RL length, BPL 60 cm, and CC 100 cm) or a Standard LRYGB (S-LRYGB) (RL 150 cm, BPL 60 cm, and a variable CC length). Results at 1-year follow-up for weight loss, effect on obesity-related comorbid conditions, complications, re-operation rate, malnutrition rate, and re-admission rate were investigated. RESULTS Weight loss at 1-year showed no significant differences for %EWL (84.3% versus 85.3%, p = 0.72) and %TWL (34.2% versus 33.6%, p = 0.359) comparing VLRL-LRYGB versus S-LRYGB. Malabsorption requiring surgical bowel length adjustment was observed in 1.4% in VLRL-LRYGB group versus 0.9% in S-LRYGB group (p = 0.316). CONCLUSION Significant lengthening of the RL at the cost of the common channel seems to have no effect on the weight loss at 1-year follow-up, which supports the theory that absorption of nutrients also occurs in the RL. Nevertheless, long-term results of the VLRL-LRYGB have to be awaited to draw final conclusions as part of the discussion towards optimal limb length in LRYGB surgery.
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Yan Y, Wang F, Chen H, Zhao X, Yin D, Hui Y, Ma N, Yang C, Zheng Z, Zhang T, Xu N, Wang G. Efficacy of laparoscopic gastric bypass vs laparoscopic sleeve gastrectomy in treating obesity combined with type-2 diabetes. Br J Biomed Sci 2020; 78:35-40. [PMID: 32698681 DOI: 10.1080/09674845.2020.1798578] [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] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This prospective study compared the efficacy and safety of laparoscopic gastric bypass and laparoscopic sleeve gastrectomy in treating overweight and obese patients with BMI>28 kg/m2 and type-2 diabetes. METHODS Patients were randomized into a gastric bypass group (n = 77) or a gastrectomy group (n = 80). The surgery time, intraoperative blood loss, recovery time, and hospitalization time were collected. BMI, waistline, hipline, C-peptide level, insulin resistance index (HOMA-IR), and their blood and lipid profile were also measured. RESULTS Surgery time and blood loss were significantly higher in the gastrectomy group, when compared to the gastric bypass group (P < 0.05). In both groups, the levels of BMI, waist circumference and hip circumference (but not their ratio) gradually and significantly decreased after surgery compared with baseline (P < 0.05), and no significant difference was found between these two groups. The C-peptide level, HOMA-IR, fasting blood glucose, 2-hour postprandial blood glucose and glycosylated haemoglobin gradually and significantly decreased after surgery compared with the values before treatment (P < 0.05). The levels of total cholesterol, triglyceride, LDL, and monocyte chemoattractant protein-1 were also lower after surgery in both groups, while HDL and glucagon-like peptide-1 were significantly higher after surgery compared with the values before treatment (P < 0.05). However, no significant difference was found between these two groups of patients. CONCLUSION Both laparoscopic gastric bypass and laparoscopic sleeve gastrectomy improved the BMI and diabetic conditions of overweight/obese diabetics, while laparoscopic sleeve gastrectomy had a shorter surgical time and less blood loss.
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Affiliation(s)
- Y Yan
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , JiangSu, China
| | - F Wang
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , JiangSu, China
| | - H Chen
- Department of Gastrointestinal Surgery, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , JiangSu, China
| | - X Zhao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Soochow University; the First Affiliated Hospital of Kangda College, Nanjing Medical University , Nanjing, China
| | - D Yin
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - Y Hui
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - N Ma
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - C Yang
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - Z Zheng
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - T Zhang
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - N Xu
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
| | - G Wang
- Department of Endocrinology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, the First People's Hospital of Lianyungang; Lianyungang Clinical College of Nanjing Medical University, the First People's Hospital of Lianyungang , Jiangsu, China
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13
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Dittrich L, Schwenninger MV, Dittrich K, Pratschke J, Aigner F, Raakow J. Marginal ulcers after laparoscopic Roux-en-Y gastric bypass: analysis of the amount of daily and lifetime smoking on postoperative risk. Surg Obes Relat Dis 2020; 16:389-396. [DOI: 10.1016/j.soard.2019.11.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/25/2019] [Accepted: 11/24/2019] [Indexed: 01/16/2023]
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14
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Gu L, Huang X, Li S, Mao D, Shen Z, Khadaroo PA, Ng DM, Chen P. A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. BMC Surg 2020; 20:30. [PMID: 32050953 PMCID: PMC7014764 DOI: 10.1186/s12893-020-00695-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are two representative bariatric surgeries. This study aimed to compare the effects of the LSG and LRYGB based on high-quality analysis and massive amount of data. Methods For this study databases of PubMed, Web of Science, EBSCO, Medline, and Cochrane Library were searched for articles published until January 2019 comparing the outcomes of LSG and LRYGB. Results This study included 28 articles. Overall, 9038 patients (4597, LSG group; 4441, LRYGB group) were included. The remission rate of type 2 diabetes mellitus (T2DM) in the LRYGB group was superior to that in the LSG group at the 3-years follow-up. Five-year follow-up results showed that LRYGB had an advantage over LSG for the percentage of excess weight loss and remission of T2DM, hypertension, dyslipidemia, and abnormally low-density lipoprotein. Conclusions In terms of the long-term effects of bariatric surgery, the effect of LRYGB was better than of LSG.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China
| | - Xiaojing Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shengnan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zefeng Shen
- Department of General Surgery, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | | | - Derry Minyao Ng
- Medical College of Ningbo University, Hangzhou, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China.
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15
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Calvo B, Gracia JA, Bielsa MA, Martínez M. Metabolic effects and outcomes of sleeve gastrectomy and gastric bypass: a cohort study. Surg Endosc 2020; 34:5550-5557. [PMID: 31932931 DOI: 10.1007/s00464-019-07355-z] [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: 06/27/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The outcomes of bariatric surgery should not be evaluated only for weight loss purposes but from a wider point of view that is closer to the reality of morbidly obese patients. The study of the influence of bariatric surgery over obesity-related diseases in bariatric patients is worthwhile. METHODS We present a cohort study of 329 patients who underwent either laparoscopic sleeve gastrectomy (LSG: 165 patients) or laparoscopic gastric bypass (LRYGBP: 164). We analyzed complication rate, comorbidities and weight loss evolution. RESULTS Both groups were comparable in demographic characteristics at baseline. Significant statistical differences were found in length of hospital stay and operative time (both were lower in the LSG group). Bleeding and wound infection were higher in the LRYGBP group, as it happened with intestinal occlusion as a late complication (p < 0.05). After a 5-year follow-up, the percentage of excess weight loss (%EWL) was higher in gastric bypass than sleeve gastrectomy (p = 0.01) but there was no statistical difference in percentage of total weight loss (%TWL) (p = 0.2). The resolution of comorbidities was similar in both groups except for dyslipidemia, which resolution was significantly higher in the gastric bypass group (p = 0.005). Metabolic syndrome (MeTS) resolution was similar in both groups. CONCLUSIONS Sleeve gastrectomy and gastric bypass achieve similar outcomes in hypertension, type 2 diabetes, obstructive sleep apnea and MeTS resolution even when there is weight regain. Although gastric bypass achieves higher weight loss in morbid obese patients, complication rates are also higher compared to those of sleeve gastrectomy. Thus, the appropriate procedure should be tailored based on patient factors and comorbidities, but also on surgeon comfort level and experience.
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Affiliation(s)
- B Calvo
- Department of Surgery, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009, Zaragoza, Spain.
| | - J A Gracia
- Department of Surgery, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009, Zaragoza, Spain
| | - M A Bielsa
- Department of Surgery, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009, Zaragoza, Spain
| | - M Martínez
- Department of Surgery, Hospital Clínico Universitario, Avda. San Juan Bosco 15, 50009, Zaragoza, Spain
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16
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Lewis KH, Arterburn DE, Callaway K, Zhang F, Argetsinger S, Wallace J, Fernandez A, Ross-Degnan D, Wharam JF. Risk of Operative and Nonoperative Interventions Up to 4 Years After Roux-en-Y Gastric Bypass vs Vertical Sleeve Gastrectomy in a Nationwide US Commercial Insurance Claims Database. JAMA Netw Open 2019; 2:e1917603. [PMID: 31851344 PMCID: PMC6991222 DOI: 10.1001/jamanetworkopen.2019.17603] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
IMPORTANCE There are few nationwide studies comparing the risk of reintervention after contemporary bariatric procedures. OBJECTIVE To compare the risk of intervention after Roux-en-Y gastric bypass (RYGB) vs vertical sleeve gastrectomy (VSG). DESIGN, SETTING, AND PARTICIPANTS This cohort study used a nationwide US commercial insurance claims database. Adults aged 18 to 64 years who underwent a first RYGB or VSG procedure between January 1, 2010, and June 30, 2017, were matched on US region, year of surgery, most recent presurgery body mass index (BMI) category (based on diagnosis codes), and baseline type 2 diabetes. The prematch pool included 4496 patients undergoing RYGB and 8627 patients undergoing VSG, and the final weighted matched sample included 4476 patients undergoing RYGB and 8551 patients undergoing VSG. EXPOSURES Bariatric surgery procedure type (RYGB vs VSG). MAIN OUTCOMES AND MEASURES The primary outcome was any abdominal operative intervention after the index procedure. Secondary outcomes included the following subtypes of operative intervention: biliary procedures, abdominal wall hernia repair, bariatric conversion or revision, and other abdominal operations. Nonoperative outcomes included endoscopy and enteral access. Time to first event was compared using multivariable Cox proportional hazards regression modeling. RESULTS Among 13 027 patients, the mean (SD) age was 44.4 (10.3) years, and 74.1% were female; 13.7% had a preoperative BMI between 30 and 39.9, 45.8% had a preoperative BMI between 40 and 49.9, and 24.2% had a preoperative BMI of at least 50. Patients were followed up for up to 4 years after surgery (median, 1.6 years; interquartile range, 0.7-3.2 years), with 41.9% having at least 2 years of follow-up and 16.3% having at least 4 years of follow-up. Patients undergoing VSG were less likely to have any subsequent operative intervention than matched patients undergoing RYGB (adjusted hazard ratio [aHR], 0.80; 95% CI, 0.72-0.89) and similarly were less likely to undergo biliary procedures (aHR, 0.77; 95% CI, 0.67-0.90), abdominal wall hernia repair (aHR, 0.60; 95% CI, 0.47-0.75), other abdominal operations (aHR, 0.71; 95% CI, 0.61-0.82), and endoscopy (aHR, 0.54; 95% CI, 0.49-0.59) or have enteral access placed (aHR, 0.58; 95% CI, 0.39-0.86). Patients undergoing VSG were more likely to undergo bariatric conversion or revision (aHR, 1.83; 95% CI, 1.19-2.80). CONCLUSIONS AND RELEVANCE In this nationwide study, patients undergoing VSG appeared to be less likely than matched patients undergoing RYGB to experience subsequent abdominal operative interventions, except for bariatric conversion or revision procedures. Patients considering bariatric surgery should be aware of the increased risk of subsequent procedures associated with RYGB vs VSG as part of shared decision-making around procedure choice.
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Affiliation(s)
- Kristina H. Lewis
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Katherine Callaway
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Stephanie Argetsinger
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Jamie Wallace
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - Adolfo Fernandez
- Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Dennis Ross-Degnan
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
| | - James F. Wharam
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Harvard Medical School, Boston, Massachusetts
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Preoperative liking and wanting for sweet beverages as predictors of body weight loss after Roux-en-Y gastric bypass and sleeve gastrectomy. Int J Obes (Lond) 2019; 44:1350-1359. [PMID: 31641214 PMCID: PMC7174088 DOI: 10.1038/s41366-019-0474-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
Background/objectives: Patients who receive Roux-en-Y gastric bypass (RYGB) lose more weight than those who receive vertical sleeve gastrectomy (VSG). RYGB and VSG alter hedonic responses to sweet flavor, but whether baseline differences in hedonic responses modulate weight loss after RYGB or VSG remains untested. Participants/methods: Male and female candidates (n=66) for RYGB or VSG were recruited and tested for their subjective liking and wanting ratings of sucrose solutions and flavored beverages sweetened with aspartame. Participants were classified by unsupervised hierarchical clustering for their liking and wanting ratings of sucrose and aspartame. Participant liking ratings were also used in a supervised classification using pre-established categories of liking ratings (liker, disliker, and inverted u-shape). Effects of categories obtained from unsupervised or supervised classification on body weight loss and their interaction with surgery type were analyzed separately at 3 and 12 months after surgery using linear models corrected for sex and age. Results: RYGB participants lost more body weight compared to VSG participants at 3 and 12 months after surgery (P < 0.001 for both time points). Unsupervised clustering analysis identified clusters corresponding to high and low wanting or liking ratings for sucrose or aspartame. RYGB participants in high-wanting clusters based on sucrose, but not aspartame, lost more weight than VSG at both 3 (P = 0.01) and 12 months (P = 0.03), yielding a significant cluster by surgery interaction. Categories based on supervised classification using liking ratings for sucrose or aspartame showed no significant effects on body weight loss between RYGB and VSG participants. Conclusions: Classification of patients into high/low wanting ratings for sucrose before surgery can predict differential body weight loss after RYGB or VSG in adults and could be used to advise on surgery type.
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18
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Ozmen MM, Gundogdu E, Guldogan CE. First 30 Robotic Versus Last 30 Laparoscopic Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Mehmet Mahir Ozmen
- Department of Surgery, School of Medicine, Istinye University (ISU), Istanbul, Turkey
| | - Emre Gundogdu
- Department of Surgery, School of Medicine, Istinye University (ISU), Istanbul, Turkey
| | - Cem Emir Guldogan
- Department of Surgery, School of Medicine, Istinye University (ISU), Istanbul, Turkey
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19
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Early cardiac complications after bariatric surgery: does the type of procedure matter? Surg Obes Relat Dis 2019; 15:1132-1137. [DOI: 10.1016/j.soard.2019.03.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/17/2019] [Indexed: 12/21/2022]
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20
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Zafar SN, Miller K, Felton J, Wise ES, Kligman M. Postoperative bleeding after laparoscopic Roux en Y gastric bypass: predictors and consequences. Surg Endosc 2019; 33:272-280. [PMID: 30232617 DOI: 10.1007/s00464-018-6365-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/20/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common, safe and effective bariatric procedure. Bleeding is a significant source of postoperative morbidity. We aimed to determine the incidence, outcomes, and predictors of postoperative bleeding after LRYGB. METHODS LRYGB patients included in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset were identified. Preoperative and intraoperative factors were tested for associations with bleeding using univariable and multivariable logistic regression analysis. Outcomes of length of stay, in-hospital mortality, 30-day mortality, discharge disposition, and 30-day complications among patients with and without clinically significant postoperative bleeding were compared using multivariable regression. RESULTS In the 43,280 LRYGB patients included in this analysis, postoperative bleeding occurred in 652 (1.51%) patients. Of these, 165 (25.3%) underwent a re-operation and 97 (14.9%) underwent an unplanned endoscopy for 'bleeding'. Postoperative bleeding was associated with a longer median postoperative length of stay (4 vs. 2 days), higher in-hospital mortality (1.23 vs. 0.04%), higher 30-day mortality (1.38 vs. 0.15%), discharge to an extended-care facility (3.88 vs. 0.6%), and higher rates of major complications (all P < 0.05). Independent predictors of postoperative bleeding included; a history of renal insufficiency (OR 2.55, 95% CI 1.43-4.52), preoperative therapeutic anticoagulation (OR 2.44, 95% CI 1.69-3.53), and revisional surgery (OR 1.45, 95% CI 1.06-1.97). Intraoperative associated factors included conversions (OR 3.37, 95% CI 1.42-7.97), and drain placement (OR 1.40, 95% CI 1.18-1.67). Robotic approaches resulted in independently lower postoperative bleeding rates (OR 0.50, 95% CI 0.32-0.77). CONCLUSIONS Postoperative bleeding occurs in 1.5% of patients undergoing a LRYGB and is associated with significantly increased morbidity and mortality. We have identified patient and operative factors that are independently associated with postoperative bleeding.
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Affiliation(s)
- Syed Nabeel Zafar
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Kaylie Miller
- School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Jessica Felton
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Eric S Wise
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Mark Kligman
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA. .,Center for Weight Management & Wellness, University of Maryland Medical Center, 29 South Greene Street, Suite 105, Baltimore, MD, 21201, USA.
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21
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Major P, Stefura T, Małczak P, Wysocki M, Witowski J, Kulawik J, Wierdak M, Pisarska M, Pędziwiatr M, Budzyński A. Postoperative Care and Functional Recovery After Laparoscopic Sleeve Gastrectomy vs. Laparoscopic Roux-en-Y Gastric Bypass Among Patients Under ERAS Protocol. Obes Surg 2018; 28:1031-1039. [PMID: 29058236 PMCID: PMC5880856 DOI: 10.1007/s11695-017-2964-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The most commonly performed bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are major differences between LSG and LRYGB during postoperative period. Optimization of the postoperative care may be achieved by using enhanced recovery after surgery (ERAS) protocol, which allows earlier functional recovery. Purpose The aim was to assess differences in the course of postoperative care conducted in accordance with ERAS protocol among patients after LSG and LRYGB. Material and Methods Data concerning patients treated for morbid obesity were prospectively gathered in one academic center. Patients were divided into two groups: LSG (n = 364, 63.41%) and LRYGB (n = 210, 36.59%). Multiple factors were used as endpoints to determine the influence of the type of bariatric procedure on postoperative course. Results The rate of postoperative nausea and vomiting and incidence of intravenous fluid administration during the operation was higher in LSG group. LRYGB patients were able to tolerate higher oral fluid intake volumes during the first and the second postoperative day. Mean diuresis during the second and the third postoperative day was significantly higher in LRYGB group. Administration of diuretics and painkillers was comparable between groups, while the risk of fever after the operation was higher in LRYGB group. Mean length of stay was higher in LSG group (LRYGB vs. LSG, 3.46 days ± 1.58 vs. 3.64 days ± 4.41, p = 0.039). Conclusions In our opinion, postoperative treatment after LSG requires more supervision and longer time until functional recovery is achieved.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Tomasz Stefura
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland.
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.,Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Jan Witowski
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.,Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Jan Kulawik
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Kraków, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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22
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Laparoscopic Sleeve Gastrectomy has a Lower Risk of Postoperative Bleeding Than Laparoscopic Roux-en-Y Gastric Bypass. Surg Laparosc Endosc Percutan Tech 2018; 29:53-57. [PMID: 30499889 DOI: 10.1097/sle.0000000000000598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Measures to reduce postoperative bleeding (POB) after bariatric surgery is skewed toward laparoscopic sleeve gastrectomy (LSG). We use 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterize the differences in bleeding rates between LSG and laparoscopic Roux-en-Y gastric bypasses (LRYGB). Propensity score matching and multivariable logistic regressions tested for independent differences in POB rates. A total of 168,093 patients from 742 centers were identified in the data set. After selection 36,925 patients with LRYGB and 20,020 patients with LSG were included in the analysis. A total of 710 (1.25%) patient suffered a POB. The independent odds of POB were 38% lower for patients having LSG compared with those having LRYGB (odds ratio, 0.62; 95% confidence interval=0.51-0.76). This difference is more pronounced with intraoperative securing of the staple line. Appropriate measures to reduce POB after each type of bariatric procedure is warranted.
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23
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Inaba CS, Koh CY, Sujatha-Bhaskar S, Pejcinovska M, Nguyen NT. How safe is same-day discharge after laparoscopic sleeve gastrectomy? Surg Obes Relat Dis 2018; 14:1448-1453. [DOI: 10.1016/j.soard.2018.07.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022]
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24
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Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program. Obes Surg 2018; 28:2844-2851. [PMID: 29696572 DOI: 10.1007/s11695-018-3259-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Chronic liver disease is prevalent in obese patients presenting for bariatric surgery and is associated with increased postoperative morbidity and mortality (M&M). There are no comparative studies on the safety of different types of bariatric operations in this subset of patients. OBJECTIVE The aim of this study is to compare the 30-day postoperative M&M between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-Y-gastric bypass (LRYGB) in the subset of patients with a model of end-stage liver disease (MELD) score ≥ 8. METHODS Data for LSG and LRYGB were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from years 2012 and 2013. MELD score was calculated using serum creatinine, bilirubin, INR, and sodium. Postoperative M&M were assessed in patients with a score ≥ 8 and compared for the type of operation. This was followed by analysis for MELD subcategories. Multiple logistic regression was performed to adjust for confounders. RESULTS Out of 34,169, 9.8% of cases had MELD ≥ 8 and were included. Primary endpoint, 30-day M&M, was significantly lower post-LSG (9.5%) compared to LRYGB (14.7%); [AOR = 0.66(0.53, 0.83)]. Superficial wound infection, prolonged hospital stay, and unplanned readmission were more common in LRYGB. M&M post-LRYGB (30.6%) was significantly higher than LSG (15.7%) among MELD15-19 subgroup analysis. CONCLUSION LRYGB is associated with a higher postoperative risk than LSG in patients with MELD ≥ 8. The difference in postoperative complications between procedures was magnified with higher MELD. This suggests that LSG might be a safer option in morbidly obese patients with higher MELD scores, especially above 15.
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25
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Lynch AI, Reznar MM, Zalesin KC, Bohn D. To Keep Myself on Track: The Impact of Dietary and Weight Monitoring Behaviors on Weight Loss After Bariatric Surgery. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amanda I. Lynch
- Department of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, Michigan
| | - Melissa M. Reznar
- Department of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, Michigan
| | - Kerstyn C. Zalesin
- Weight Control Center, Beaumont Health and Wellness Center, William Beaumont Hospital, Royal Oak, Michigan
| | - Danielle Bohn
- Department of Wellness and Health Promotion, School of Health Sciences, Oakland University, Rochester, Michigan
- Health Behavior and Health Education, Michigan School of Public Health, University of Michigan, Ann Arbor, Michigan
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Nance K, Eagon JC, Klein S, Pepino MY. Effects of Sleeve Gastrectomy vs. Roux-en-Y Gastric Bypass on Eating Behavior and Sweet Taste Perception in Subjects with Obesity. Nutrients 2017; 10:nu10010018. [PMID: 29295558 PMCID: PMC5793246 DOI: 10.3390/nu10010018] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023] Open
Abstract
The goal of this study was to test the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB) has greater effects on taste perception and eating behavior than comparable weight loss induced by sleeve gastrectomy (SG). We evaluated the following outcomes in 31 subjects both before and after ~20% weight loss induced by RYGB (n = 23) or SG (n = 8): (1) sweet, savory, and salty taste sensitivity; (2) the most preferred concentrations of sucrose and monosodium glutamate; (3) sweetness palatability, by using validated sensory testing techniques; and (4) eating behavior, by using the Food Craving Inventory and the Dutch Eating Behavior Questionnaire. We found that neither RYGB nor SG affected sweetness or saltiness sensitivity. However, weight loss induced by either RYGB or SG caused the same decrease in: (1) frequency of cravings for foods; (2) influence of emotions and external food cues on eating behavior; and (3) shifted sweetness palatability from pleasant to unpleasant when repetitively tasting sucrose (all p-values ≤ 0.01). Therefore, when matched on weight loss, SG and RYGB cause the same beneficial effects on key factors involved in the regulation of eating behavior and hedonic component of taste perception.
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Affiliation(s)
- Katie Nance
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois, Urbana-Champaign, Champaign, IL 61801, USA.
| | - J Christopher Eagon
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Samuel Klein
- Center for Human Nutrition, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Marta Yanina Pepino
- Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois, Urbana-Champaign, Champaign, IL 61801, USA.
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