1
|
Gutiérrez-Rey M, Castellar-Visbal L, Acevedo-Vergara K, Vargas-Manotas J, Rivera-Porras D, Londoño-Juliao G, Castillo-Guerrero B, Perdomo-Jiménez MC, Bermúdez V. The Weight of Bariatric Surgery: Wernicke-Korsakoff Syndrome after Vertical Sleeve Gastrectomy-A Case Series. J Pers Med 2024; 14:638. [PMID: 38929859 PMCID: PMC11204981 DOI: 10.3390/jpm14060638] [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: 04/18/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
In this case series, the simultaneous occurrence of Wernicke's encephalopathy (WE) and dry beriberi was reported in three patients who underwent vertical sleeve gastrectomy (VSG) between May 2021 and May 2023. All patients were obese women who underwent vertical sleeve gastrectomy (VSG) without immediate postoperative complications, but two weeks later, hyperemesis and subsequent encephalopathy with ocular movement abnormalities and weakness were observed over the following thirty days. Patients were referred to neurology, where due to the high suspicion of WE, thiamine replacement therapy was initiated; meanwhile, diagnostic neuroimaging and blood tests were conducted. Neurological and psychiatric evaluations and neuroconduction studies were performed to assess the clinical evolution and present sequelae. One year after diagnosis, all patients exhibited affective and behavioral sequelae, anterograde memory impairment, and executive functioning deficits. Two patients met the criteria for Korsakoff syndrome. Additionally, peripheral nervous system sequelae were observed, with all patients presenting with sensorimotor polyneuropathy. In conclusion, Wernicke's encephalopathy requires a high diagnostic suspicion for timely intervention and prevention of irreversible sequelae, which can be devastating. Therefore, raising awareness among medical professionals regarding the significance of this disease is essential.
Collapse
Affiliation(s)
- Melissa Gutiérrez-Rey
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| | - Lily Castellar-Visbal
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| | | | - José Vargas-Manotas
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| | - Diego Rivera-Porras
- Universidad Simón Bolívar, Facultad de Ciencias Jurídicas y Sociales, Centro de Investigación en Estudios Fronterizos, Cúcuta 540001, Colombia;
| | - Gloria Londoño-Juliao
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| | - Brenda Castillo-Guerrero
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| | - María-Camila Perdomo-Jiménez
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| | - Valmore Bermúdez
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla 080001, Colombia; (M.G.-R.); (L.C.-V.); (J.V.-M.); (G.L.-J.); (B.C.-G.); (M.-C.P.-J.)
| |
Collapse
|
2
|
Norris P, Gow J, Arthur T, Conway A, Fleming FJ, Ralph N. Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals. Int J Surg 2024; 110:541-553. [PMID: 37916943 PMCID: PMC10793842 DOI: 10.1097/js9.0000000000000834] [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: 06/07/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is characterised by the presence of at least three of the five following components: insulin resistance, obesity, chronic hypertension, elevated serum triglycerides, and decreased high-density lipoprotein cholesterol concentrations. It is estimated to affect 1 in 3 people around the globe and is reported to affect 46% of surgical patients. For people with MetS who undergo surgery, an emerging body of literature points to significantly poorer postoperative outcomes compared with nonaffected populations. The aim of this study is to review the current evidence on the risks of surgical complications in patients with MetS compared to those without MetS. METHODS Systematic review and meta-analysis using PRISMA and AMSTAR reporting guidelines. RESULTS The meta-analysis included 63 studies involving 1 919 347 patients with MetS and 11 248 114 patients without MetS. Compared to individuals without the condition, individuals with MetS were at an increased risk of mortality (OR 1.75 95% CI: 1.36-2.24; P <0.01); all surgical site infection types as well as dehiscence (OR 1.64 95% CI: 1.52-1.77; P <0.01); cardiovascular complications (OR 1.56 95% CI: 1.41-1.73; P <0.01) including myocardial infarction, stroke, cardiac arrest, cardiac arrythmias and deep vein thrombosis; increased length of hospital stay (MD 0.65 95% CI: 0.39-0.9; P <0.01); and hospital readmission (OR 1.55 95% CI: 1.41-1.71; P <0.01). CONCLUSION MetS is associated with a significantly increased risk of surgical complications including mortality, surgical site infection, cardiovascular complications, increased length of stay, and hospital readmission. Despite these risks and the high prevalence of MetS in surgical populations there is a lack of evidence on interventions for reducing surgical complications in patients with MetS. The authors suggest prioritising interventions across the surgical continuum that include (1) preoperative screening for MetS; (2) surgical prehabilitation; (3) intraoperative monitoring and management; and (4) postoperative rehabilitation and follow-up.
Collapse
Affiliation(s)
- Philip Norris
- School of Nursing and Midwifery, University of Southern Queensland, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia
- Senior Research Associate, School of Accounting, Economics and Finance, University of KwaZulu- Natal, Durban, South Africa
| | - Thomas Arthur
- Department of Surgery and Adjunct Professor, Toowoomba Hospital, Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Aaron Conway
- Peter Munk Cardiac Centre, University Health Network, Toronto, Canada, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | | |
Collapse
|
3
|
Chumakova-Orin M, Ingram JL, Que LG, Pagidipati N, Gordee A, Kuchibhatla M, Seymour KA. Short-term cardiovascular events after bariatric surgery in patients with metabolic syndrome. Surg Obes Relat Dis 2024; 20:18-28. [PMID: 37659898 PMCID: PMC10838346 DOI: 10.1016/j.soard.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/08/2023] [Accepted: 07/23/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Patients with metabolic syndrome (MetS) are at increased risk of developing cardiovascular disease along with other adverse events after bariatric surgery. OBJECTIVES The incidence of short-term major adverse cardiovascular events (MACE) in patients with MetS undergoing bariatric surgery is not well characterized. SETTING Accredited bariatric surgery centers in the United States and Canada. METHODS A total of 760,076 patients aged ≥18 years with body mass index ≥35 kg/m2 who underwent primary bariatric surgery between 2015 and 2018 were included. Patients with both diabetes and hypertension were described as the MetS cohort. Patient characteristics, operative technique, and 30-day outcomes were compared. The primary outcome was incidence of MACE, a composite of myocardial infarction, stroke, and all-cause mortality. Unadjusted and multivariable logistic regression analyses were performed and included an interaction between MetS and hyperlipidemia (HLD). RESULTS Of the 577,882 patients included, 111,128 (19.2%) exhibited MetS. Patients with MetS more frequently experienced MACE compared with patients without MetS (.3% versus .1%; P < .001). The odds of MACE were greater for patients with MetS versus Non-MetS (odds ratio [OR] 2.87; 95% CI, 2.49-3.32) in the unadjusted analysis. MetS without HLD, MetS with HLD, and Non-MetS with HLD are significantly associated with MACE when compared with those with non-MetS without HLD. CONCLUSIONS Patients with MetS have an increased frequency of cardiac events following bariatric surgery. Future studies should determine if optimization of 1 or more components of MetS or other related co-morbidities reduces the cardiovascular risk for patients.
Collapse
Affiliation(s)
| | - Jennifer L Ingram
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Loretta G Que
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Neha Pagidipati
- Department of Cardiology, Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Alexander Gordee
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina
| | - Keri A Seymour
- Department of Surgery, School of Medicine, Duke University, Durham, North Carolina.
| |
Collapse
|
4
|
Edwards MA, Hussain MWA, Spaulding AC. Gastric Bypass Mortality Trends in Racial Cohorts: Are We Improving? Obes Surg 2023; 33:1411-1421. [PMID: 36918474 DOI: 10.1007/s11695-023-06541-2] [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: 10/23/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) continues to be safely performed in racial cohorts. However, studies continue to report differences in complications, with non-Hispanic black (NHB) patients having a higher rate of adverse outcomes, including mortality. It is unclear how these disparate outcomes have evolved over time. Our objective was to determine RYGB procedure and mortality trends in racial cohorts. METHODS Using the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) database, we identified primary RYGB cases performed laparoscopically or robotically. Non-Hispanic white (NHW) and non-Hispanic black (NHB) patient cohorts were matched based on patient and surgical characteristics. Conditional logistic regression analysis was conducted on the matched pairs. Primary outcomes of interest included year-to-year all-cause and procedure-related mortality. Stata/MP 16.1 was utilized for analysis, and a p-value of < 0.05 and a 95% confidence interval that excluded 1 were considered significant. RESULTS A total of 148,829 RYGB cases in NHW (82.8%) and Black (17.2%) patients were analyzed. RYGB trends remain similar for NHB and NHW patients over 5 years. In matched cohorts, all-cause mortality (OR 2.23; 95% CI: 1.16-4.29), aggregate related readmission (OR 1.39; 95% CI: 1.27-1.51), related reintervention (OR 1.36; 95% CI: 1.19-1.56), and VTE (OR 1.86; 95% CI: 1.40-2.45) were more likely in NHB patients. During the study period, year-to-year mortality was higher in NHB patients compared to NHW patients. CONCLUSION Over a 5-year period, year-to-year mortality remains higher in NHB patients after RYGB. While bariatric outcomes continue to improve, outcome gaps between racial cohorts seem to persist.
Collapse
Affiliation(s)
- Michael A Edwards
- Advanced GI and Bariatrics Division, Department of Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA. .,Department of Surgery, Mayo Clinic Alix School of Medicine, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
| | - Md Walid Akram Hussain
- Advanced GI and Bariatrics Division, Department of Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Aaron C Spaulding
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center, Mayo Clinic, Jacksonville, FL, 32224, USA
| |
Collapse
|
5
|
DEVABALAN Y, DURAND-HILL M, RAJAGOPAL S, GE Y, RAMAR S. Factors affecting length of stay in bariatric surgery in a UK institution. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
|
6
|
Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
| |
Collapse
|
7
|
Kapralou AN, Chrousos GP. Metabolic effects of truncal vagotomy when combined with bariatric-metabolic surgery. Metabolism 2022; 135:155263. [PMID: 35835160 DOI: 10.1016/j.metabol.2022.155263] [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: 01/07/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022]
Abstract
Bariatric-metabolic surgery (BMS) in patients with obesity frequently leads to remission of concurrent type 2 diabetes mellitus (T2DM), even before body weight loss takes place. This is probably based on the correction of a dysmetabolic cycle in the gastrointestinal physiology of T2DM that includes increased vagus-dependent exocrine pancreatic secretion (EPS) and, hence, amplified digestion and nutrient absorption. The resultant chronic exposure of tissues to high plasma levels of glucose, fatty acids and amino acids causes tissue resistance to the actions of insulin and, at a later stage, β-cell dysfunction and reduction of insulin release. We hypothesize that the addition of a surgical truncal vagotomy (TV) may improve and solidify the beneficial results of BMS on T2DM by stably decreasing EPS, - hence reducing the digestion and absorption of nutrients -, and increasing incretin secretion as a result of increased delivery of unabsorbed nutrients to the distal intestine. This hypothesis is supported by surgical data from gastrointestinal malignancies and peptic ulcer operations that include TV, as well as by vagal blockade studies. We suggest that TV may result in a stable reduction of EPS, and that its combination with the appropriate type of BΜS, may enhance and sustain the salutary effects of the latter on T2DM.
Collapse
Affiliation(s)
| | - George P Chrousos
- University Research Institute of Maternal and Child Health and Precision Medicine, UNESCO Chair on Adolescent Health Care, National and Kapodistrian University of Athens Medical School, Athens, Greece
| |
Collapse
|
8
|
Sarna MJ, Giorgi M, Luhrs AR. Metabolic syndrome as a predictor of perioperative outcomes in primary bariatric surgery, a MBSAQIP survey. Surg Endosc 2022; 36:6122-6128. [PMID: 35118531 DOI: 10.1007/s00464-021-08954-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Among bariatric surgery patients, body mass index (BMI) does not fully capture the severity of obesity and it may be complicated to stratify patients at higher risk of peri-operative complications. In our study, we surveyed the MBSAQIP database to determine whether bariatric patients with metabolic syndrome (MetS) are at higher risk for peri-operative complications. METHODS MBSAQIP database was used to investigate the correlation between MetS and perioperative outcomes. All patients between 2015 and 2018, ≥ 18 years old, who underwent primary bariatric surgery were included. Patients were excluded if they underwent natural orifice transluminal endoscopic surgery or had surgery performed by gastroenterologist or interventional radiologist. We modified the International Diabetes Federation definition of MetS for our study to select patients with BMI > 30 in addition to two or more of the following comorbidities: hypertension, hyperlipidemia, or diabetes. The primary outcome was perioperative mortality. Secondary outcomes included post-operative surgical site infections (SSI), perioperative MI, stroke, acute renal failure, transfusion requirement, readmission, conversion to open and reoperation. RESULTS Between 2015 and 2018, 760,076 bariatric operations were performed. 670,935 met criteria for analysis. 190,239 patients were identified to have MetS. Patients with MetS were found to have higher odds of death (OR 2.32; 95% CI 1.97-2.72), SSI (OR 1.39; 95% CI 1.31-1.48), perioperative MI (OR 4.70; 95% CI 3.42-6.45), stroke (OR 3.30; 95% CI 2.08-5.24), acute renal failure (OR 3.04; 95% CI 2.48-3.72), and transfusion requirement (OR 1.30; 95% CI 1.33-1.39). CONCLUSION Patients with metabolic syndrome are at increased odds of peri-operative complications after bariatric surgery.
Collapse
Affiliation(s)
- Matthew J Sarna
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Surgery, Brown University/Rhode Island Hospital, APC 4, 593 Eddy Street, Providence, RI, 02903, USA.
| | - Marcoandrea Giorgi
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew R Luhrs
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
9
|
Kermansaravi M, Davarpanah Jazi AH, Talebian P, Rokhgireh S, Kabir A, Pazouki A. Bariatric surgery in transplant recipients: A narrative review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:44. [PMID: 34484376 PMCID: PMC8384002 DOI: 10.4103/jrms.jrms_631_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/20/2020] [Accepted: 02/09/2021] [Indexed: 11/11/2022]
Abstract
Morbidity and mortality rates are increased due to obesity after organ transplantation; in this regards, bariatric surgery (BS) is believed to be an effective treatment for posttransplant obese patients. Nevertheless, some studies are doubtful in terms of the effectiveness of BS, the most suitable bariatric procedure, and management of immunosuppressant drugs in some kinds of organ transplants. We evaluated nonsurgical therapies, weight reduction, adjustment of immunosuppressants, comorbidities, and the recommended surgical procedures for posttransplant BS for different types of organ transplantations.
Collapse
Affiliation(s)
- Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e-Rasool Hospital, Tehran, Iran
| | - Amir Hossein Davarpanah Jazi
- Department of Surgery, Minimally Invasive Surgery Research Center, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of General Surgery, Shariati Hospital, Isfahan, Iran
| | - Pedram Talebian
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Rokhgireh
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e-Rasool Hospital, Tehran, Iran
| |
Collapse
|
10
|
Guzel K. The Efficacy of Mini-Gastric Bypass Surgery in Diabetic and Prediabetic Obese Patients. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kerim Guzel
- Department of General Surgery, Faculty of Medicine, Biruni University, İstanbul, Turkey
| |
Collapse
|
11
|
van Olst N, van Rijswijk AS, Mikdad S, Schoonmade LJ, van de Laar AW, Acherman YIZ, Bruin SC, van der Peet DL, de Brauw LM. Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2021; 31:2380-2390. [PMID: 33813682 PMCID: PMC8113200 DOI: 10.1007/s11695-021-05286-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. MATERIALS AND METHODS A systematic search in PubMed, Scopus, Embase.com , Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. RESULTS Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. CONCLUSION Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.
Collapse
Affiliation(s)
- N van Olst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - A S van Rijswijk
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S Mikdad
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A W van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Y I Z Acherman
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S C Bruin
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - D L van der Peet
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L M de Brauw
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| |
Collapse
|
12
|
Calcaterra V, Cena H, Pelizzo G, Porri D, Regalbuto C, Vinci F, Destro F, Vestri E, Verduci E, Bosetti A, Zuccotti G, Stanford FC. Bariatric Surgery in Adolescents: To Do or Not to Do? CHILDREN (BASEL, SWITZERLAND) 2021; 8:453. [PMID: 34072065 PMCID: PMC8204230 DOI: 10.3390/children8060453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 01/19/2023]
Abstract
Pediatric obesity is a multifaceted disease that can impact physical and mental health. It is a complex condition that interweaves biological, developmental, environmental, behavioral, and genetic factors. In most cases lifestyle and behavioral modification as well as medical treatment led to poor short-term weight reduction and long-term failure. Thus, bariatric surgery should be considered in adolescents with moderate to severe obesity who have previously participated in lifestyle interventions with unsuccessful outcomes. In particular, laparoscopic sleeve gastrectomy is considered the most commonly performed bariatric surgery worldwide. The procedure is safe and feasible. The efficacy of this weight loss surgical procedure has been demonstrated in pediatric age. Nevertheless, there are barriers at the patient, provider, and health system levels, to be removed. First and foremost, more efforts must be made to prevent decline in nutritional status that is frequent after bariatric surgery, and to avoid inadequate weight loss and weight regain, ensuring successful long-term treatment and allowing healthy growth. In this narrative review, we considered the rationale behind surgical treatment options, outcomes, and clinical indications in adolescents with severe obesity, focusing on LSG, nutritional management, and resolution of metabolic comorbidities.
Collapse
Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
| | - Hellas Cena
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy; (H.C.); (D.P.)
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Debora Porri
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy; (H.C.); (D.P.)
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Corrado Regalbuto
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Federica Vinci
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Francesca Destro
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Elettra Vestri
- Pediatric Surgery Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (F.D.); (E.V.)
| | - Elvira Verduci
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
- Department of Health Sciences, University of Milan, 20146 Milan, Italy
| | - Alessandra Bosetti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milan, Italy; (E.V.); (A.B.); (G.Z.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20146 Milan, Italy
| | - Fatima Cody Stanford
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA;
| |
Collapse
|
13
|
Zetu C, Popa S, Golli AL, Condurache A, Munteanu R. Long-term improvement of dyslipidaemia, hyperuricemia and metabolic syndrome in patients undergoing laparoscopic sleeve gastrectomy. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:704-709. [PMID: 34033279 PMCID: PMC10528615 DOI: 10.20945/2359-3997000000273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to assess the long-term impact of laparoscopic sleeve gastrectomy (LSG) on lipid profile, uric acid level and metabolic syndrome. METHODS A prospective study was performed between 2009-2014, evaluating long-term percentage of excesso body mass index loss (%EBMIL), lipid profile, uric acid level and metabolic syndrome. RESULTS Overall sixty subjects were followed-up. %EBMIL increased significantly, reaching a maximum (86,9 ± 6,3%) at 5 years post-LSG. Therapeutic success rate (%EBMIL ≥ 60%) was 80% at 5 years. The triglyceride level decreased significantly (148 ± 72.1 mg/dL baseline vs 130.7 ± 57.5 mg/dL at 1 month vs 110.7 ± 42.6 mg/dL at 3 months vs 92.5 ± 35.2 mg/dL at 1 year vs 84.2 ± 32.3 mg/dL at 5 years; p < 0.05 for all). HDL-cholesterol increased and uric acid decreased significantly in the first year postoperatively, remaining stable afterwards (46.9 ± 12.3 mg/dL baseline vs 47.4 ± 10 mg/dL at 1 month vs 49.8 ± 9.3 mg/dL at 3 months vs 55.4 ± 10.2 mg/dL at 1 year; p < 0.05 for all for HDL-cholesterol and 6.4 ± 2 mg/dL baseline vs 6 ± 1.7 mg/dL at 1 month vs 5.2 ± 1.3 mg/dL at 3 months vs 4.8 ± 1 mg/dL at 1 year; p < 0.05 for all for uric acid). The prevalence of metabolic syndrome decreased from 66.7% baseline to 8.3% at 5 years postoperatively (p < 0.01). CONCLUSION LSG was effective in terms of %EBMIL and metabolic traits improvement for Romanian patients.
Collapse
Affiliation(s)
- Cornelia Zetu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Simona Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy Craiova, Craiova, Romania,
| | - Andreea-Loredana Golli
- Department of Public Health and Healthcare Management, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Ancuta Condurache
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Rubin Munteanu
- Department of Surgery, Euroclinic - Regina Maria Hospital Bucharest, Bucharest, Romania
| |
Collapse
|
14
|
Halpern B, Mancini MC. Type 2 diabetes and metabolic surgery guidelines and recommendations should urgently be unified. Acta Diabetol 2021; 58:531-536. [PMID: 32930887 PMCID: PMC7491361 DOI: 10.1007/s00592-020-01603-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 10/26/2022]
Abstract
Metabolic surgery has been studied in the last decades as an effective and safe treatment for type 2 diabetes (T2D), and randomized controlled trials generally found surgery superior when compared with medical treatment. In 2016, the DSS-II Joint Statement recognized the importance of metabolic surgery in the treatment of T2D and urged clinicians to discuss, recommend, or at least consider this procedure for their patients. Diabetes societies also cogitate metabolic surgery as an option for T2D patients in their guidelines. However, there are some differences in recommendations that could lead a careful reader to some confusion. This was potentialized in a recent document published by the same DSS-II group concerning prioritization for surgery after the COVID-19 pandemic, in which the criteria suggested for an expedited recommendation that is not exactly evidence-based, and collided substantially with several clinical guidelines worldwide, especially with regard to secondary prevention of cardiovascular disease. A more harmonious discussion and unified guidelines between clinicians and surgeons are needed in order to provide the same message for those who read different articles.
Collapse
Affiliation(s)
- Bruno Halpern
- Obesity Group, Department of Endocrinology, Hospital das Clinicas Universidade de São Paulo, São Paulo, Brazil.
- Department of Epidemiology and Prevention, Brazilian Association for the Study of Obesity (ABESO), São Paulo, Brazil.
| | - Marcio C Mancini
- Obesity Group, Department of Endocrinology, Hospital das Clinicas Universidade de São Paulo, São Paulo, Brazil
- Brazilian Society of Endocrinology and Metabolism (SBEM), Rio de Janeiro, Brazil
| |
Collapse
|
15
|
Madadi F, Jawad R, Mousati I, Plaeke P, Hubens G. Remission of Type 2 Diabetes and Sleeve Gastrectomy in Morbid Obesity: a Comparative Systematic Review and Meta-analysis. Obes Surg 2020; 29:4066-4076. [PMID: 31655953 DOI: 10.1007/s11695-019-04199-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The sleeve gastrectomy (SG) has gained popularity which has resulted in a rising number of patients with T2DM to undergo this procedure. This systematic review and meta-analysis aimed to compare the long-term effects of SG on T2DM remission with remission seen after Roux-en-Y gastric bypass (RYGB) or gastric banding (GB). METHODS A literature search was performed in PubMed and Cochrane Library using the following search terms: 'sleeve gastrectomy', 'diabetes', 'gastric bypass' and 'gastric banding'. Studies published between January 2000 and April 2018, and with following inclusion criteria were selected for this review: BMI ≥ 35 kg/m2, age ≥ 18 years, follow-up ≥ 1 year, T2DM. Data was statistically analysed using a random-effects model and results were expressed as odds ratio with 95% confidence interval. RESULTS After exclusion, 35 out of an initial 748 studies, consisting of 18 138 T2DM patients, remained for inclusion. Of these patients, 2480 underwent a SG. The remaining patients underwent a RYGB (n = 10,597) or GB (n = 5061). One year postoperatively, SG patients reached significantly (OR 0.71, p = 0.003) less T2DM remission than RYGB. After stratifying for different criteria for remission, RYGB still tended to result in higher remission rates, but the difference was not statistically significant. Beyond 1 year of follow-up, the difference between RYGB and SG in terms of T2DM remission decreased. SG was superior to the GB (OR 2.17, p = 0.001) after 1 year of follow-up. CONCLUSION This review demonstrates important remission of T2DM following SG. Nevertheless, as remission was significantly more often observed following RYGB surgery, the latter procedure remains the gold standard for reaching T2DM remission in patients with concurrent obesity.
Collapse
Affiliation(s)
- Ferdous Madadi
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium. .,Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Rami Jawad
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Ismail Mousati
- Faculty of Medicine and Health Care, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Philip Plaeke
- Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Guy Hubens
- Department of Abdominal Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| |
Collapse
|
16
|
Does Metabolic Syndrome Increase the Risk of Postoperative Complications in Patients Undergoing Colorectal Cancer Surgery? Dis Colon Rectum 2019; 62:849-858. [PMID: 31188186 DOI: 10.1097/dcr.0000000000001334] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metabolic syndrome is associated with poorer postoperative outcomes after various abdominal operations. However, the impact of metabolic syndrome on outcomes after colorectal cancer surgery remains poorly described. OBJECTIVE The purpose of this study was to determine the association between metabolic syndrome and short-term postoperative outcomes in patients undergoing elective colorectal cancer surgery. DESIGN This was a retrospective cohort study. SETTINGS This study used a national multicenter database. PATIENTS Adult patients who underwent elective colectomy for colorectal cancer from 2010 to 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. MAIN OUTCOME MEASURES Thirty-day postoperative mortality and morbidity, unplanned reoperation, unplanned readmission, operative time, and length of stay were measured. RESULTS A total of 91,566 patients were analyzed; 7603 (8.3%) had metabolic syndrome. On unadjusted analysis, metabolic syndrome was associated with an increased risk of 30-day overall morbidity, pulmonary complications, renal complications, septic complications, cardiac complications, wound complications, blood transfusion, longer length of stay, and unplanned readmissions. On multivariable analysis, metabolic syndrome remained significantly associated with renal complications (OR = 1.44 (95% CI, 1.29-1.60)), superficial surgical site infection (OR = 1.46 (95% CI, 1.32-1.60)), deep surgical site infection (OR = 1.40 (95% CI, 1.15-1.70)), wound dehiscence (OR = 1.47 (95% CI, 1.20-1.80)), and unplanned readmissions (HR = 1.24 (95% CI, 1.15-1.34)). The risks of overall morbidity, cardiac and septic complications, and prolonged length of stay for laparoscopic procedures were significantly associated with diabetes mellitus rather than metabolic syndrome as a composite entity. LIMITATIONS This study was limited by its retrospective design and inability to analyze outcomes beyond 30 days. CONCLUSIONS Patients with metabolic syndrome undergoing elective surgery for colorectal cancer have an increased risk of 30-day postoperative renal complications, wound complications, and unplanned hospital readmissions. A multidisciplinary approach involving lifestyle modifications and pharmacologic interventions to improve the components of metabolic syndrome should be implemented preoperatively for these patients. See Video Abstract at http://links.lww.com/DCR/A909.
Collapse
|
17
|
Halpern B, Mancini MC. Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m 2 : Why caution is still needed. Obes Rev 2019; 20:633-647. [PMID: 30821085 DOI: 10.1111/obr.12837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022]
Abstract
Bariatric surgery has shifted from being a risky procedure to an evidence-based one, with proven benefits on all-cause mortality, cardiovascular disease, cancer, and diabetes control. The procedure has an overall positive result on type 2 diabetes mellitus (T2DM), with a substantial number of patients achieving disease remission. This has resulted in several studies assessing possible weight-independent effects of bariatric surgery on glycemic improvement, in addition to recommendation of the procedure to patients with class 1 obesity and T2DM, for whom the procedure was classically not indicated, and adoption of a new term, "metabolic surgery," to highlight the overall metabolic benefit of the procedure beyond weight loss. Recently, the Diabetes Surgery Summit (DSS) has included metabolic surgery in its T2DM treatment algorithm. Although the discussion brought by this consensus is highly relevant, the recommendation of metabolic surgery for patients with uncontrolled T2DM and a body mass index of 30 to 35 kg/m2 still lacks enough evidence. This article provides an overall view of the metabolic benefits of bariatric/metabolic surgery in patients with class 1 obesity, compares the procedure against clinical treatment, and presents our rationale for defending caution on recommending the procedure to less obese individuals.
Collapse
Affiliation(s)
- Bruno Halpern
- Obesity Group, Department of Endocrinology and Metabolism, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcio Correa Mancini
- Obesity Group, Department of Endocrinology and Metabolism, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
18
|
Lak KL, Helm MC, Kindel TL, Gould JC. Metabolic Syndrome Is a Significant Predictor of Postoperative Morbidity and Mortality Following Bariatric Surgery. J Gastrointest Surg 2019; 23:739-744. [PMID: 30430431 DOI: 10.1007/s11605-018-4035-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/23/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION/PURPOSE Metabolic syndrome is commonly demonstrated in patients with morbid obesity undergoing bariatric surgery. The purpose of this study was to determine the effect of metabolic syndrome on morbidity and mortality following bariatric surgery. MATERIALS AND METHODS The National Surgical Quality Improvement Program (NSQIP) dataset was queried for patients who underwent bariatric surgical procedures between 2012 and 2014. Patient demographics, comorbid conditions, bariatric procedure type, and postoperative complications were analyzed. Metabolic syndrome was defined as having a body mass index > 30 kg/m2 in the presence of the comorbid conditions of hypertension and diabetes. Regression analysis was used to determine the relationship between metabolic syndrome and postoperative morbidity and mortality. RESULTS During the study interval, 59,404 patients underwent bariatric surgery (Roux-en-Y gastric bypass = 28,263, sleeve gastrectomy = 30,239, revision = 422, and biliopancreatic diversion = 480). The mean body mass index was 45.9 kg/m2, and the mean age was 45 years. Of the cohort, 30,104 (50.6%) patients had a diagnosis of hypertension, 16,558 (27.8%) had diabetes mellitus, and 12,803 (21.5%) met the criteria for metabolic syndrome. Patients with metabolic syndrome were more likely to have Roux-en-Y gastric bypass procedure, a history of congestive heart failure, severe COPD, renal failure, and diminished functional status (p < 0.0001). Morbidity was greater for patients with metabolic syndrome (7.5% vs. 5%; p < 0.0001), and patients in this subset also had a 3.2-fold increased risk of mortality (p < 0.0001). DISCUSSION Metabolic syndrome is prevalent in patients who undergo bariatric surgery. We have demonstrated that patients with the constellation of comorbid conditions defining metabolic syndrome are at an increased risk of morbidity and mortality following bariatric surgery. Patients and surgeons should be informed of the potential increased risk in this patient population.
Collapse
Affiliation(s)
- Kathleen L Lak
- Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA. .,Division of General Surgery, HUB Building, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Melissa C Helm
- Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Tammy L Kindel
- Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Jon C Gould
- Department of Surgery, Division of General Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA
| |
Collapse
|
19
|
Kabir A, Mousavi S, Pazouki A. The Complications of Bariatric Surgery Patients with Type 2 Diabetes in the World: A Systematic Review and Meta-Analysis. Curr Diabetes Rev 2019; 15:49-61. [PMID: 29623848 DOI: 10.2174/1573399814666180403164529] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/09/2018] [Accepted: 03/25/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND In this Meta-analysis, we aimed to quantify the incidence of complications of different methods of bariatric surgery on diabetic patients. INTRODUCTION Type 2 Diabetes Mellitus (T2DM) is increasing worldwide specifically in obese cases. Additionally, obesity worsens T2DM. Complications of each bariatric surgery method were assessed separately; but, a meta-analysis of these complications and comparison between procedures in T2DM patients have not been investigated previously. The result of this study will help surgeons to choose the most appropriate surgical technique, considering individual conditions for a diabetic patient. METHODS We searched PubMed, Scopus, and ISI for original papers including bariatric surgical procedures for diabetic population and the reported consequences. Data analyses were done using Stata software. RESULTS Mortality percentage between diabetic and non-diabetic patients was statistically nonsignificant (P = 0.987). Early and late complications were higher in diabetic group in comparison with non-diabetic (6.0% vs. 1.8%, P = 0.024 and 0.6% vs. 0.3%, P = 0.04, respectively). Most prevalent findings in malabsorptive (7.8%, P < 0.001) and restrictive procedures (80%, P < 0.001) were major complications and hypoglycemic episodes, respectively. CONCLUSION As our study showed, most of the complications are not necessarily higher in diabetic population but dependent on the method of surgery.
Collapse
Affiliation(s)
- Ali Kabir
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
| | - Sara Mousavi
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
| |
Collapse
|
20
|
Wei JH, Lee WJ, Lin SJ, Huang PH. Reply letter to the editor metabolic surgery ameliorates cardiovascular risk in obese diabetic patients: influence of different surgical procedures. Surg Obes Relat Dis 2018; 15:353-354. [PMID: 30638793 DOI: 10.1016/j.soard.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Jih-Hua Wei
- Cardiovascular Division, Internal Medicine Department, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China; Department of Nutrition and Health Sciences, School of Healthcare Management, Kai-Nan University, Taoyuan, Taiwan, Republic of China; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, Republic of China
| | - Shing-Jong Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Division of Cardiology, Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China; Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Po-Hsun Huang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China; Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China; Division of Cardiology, Department of Internal Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China
| |
Collapse
|
21
|
Magro DO, Cazzo E, Kotze PG, Vasques ACJ, Martinez CAR, Chaim EA, Geloneze B, Pareja JC, Coy CSR. Glucose Metabolism Parameters and Post-Prandial GLP-1 and GLP-2 Release Largely Vary in Several Distinct Situations: a Controlled Comparison Among Individuals with Crohn's Disease and Individuals with Obesity Before and After Bariatric Surgery. Obes Surg 2018; 28:378-388. [PMID: 28776152 DOI: 10.1007/s11695-017-2851-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aims to compare the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 among individuals with Crohn's disease (CD), obese individuals before and after bariatric surgery, and healthy controls. METHODS This an exploratory cross-sectional study that involved five groups of patients (two groups of individuals with CD-active and inactive), bariatric patients (pre- and post-surgery, who were their own controls), and a distinct separated control group of healthy volunteers. C-reactive protein (CRP) levels and the post-prandial curves of glucose, insulin, GLP-1, and GLP-2 curves were assessed and compared. RESULTS The pre-RYGB group presented significantly higher levels of CRP than the post-RYGB (p = 0.001) and the control group (p = 0.001). The inactive CD group presented a higher post-prandial GLP-1 area under the curve (AUC) than the pre-RYGB group (p = 0.009). The post-RYGB group presented significantly higher AUCs of GLP-2 than the pre-RYGB group (p < 0.0001), both inactive and active CD groups (p < 0.0001 in both situations), and the control group (p = 0.002). The pre-RYGB group presented a significantly higher AUC of glucose than the post-RYGB (p = 0.02) and both active and inactive CD groups (p = 0.019 and p = 0.046, respectively). The pre-RYGB group presented a significantly higher AUC of insulin than the control (p = 0.005) and both CD groups (p < 0.0001). CONCLUSIONS Obesity is associated with an inflammatory state comparable to the one observed in CD; inflammation may also be enrolled in the blockade of GLP-2. CD individuals present a more incretin-driven pattern of glucose metabolism, as a way to prevent hypoglycemia and compensate the carbohydrate malabsorption and GLP-2 blockade.
Collapse
Affiliation(s)
- Daniéla Oliveira Magro
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil.
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, Paraná, Brazil
| | - Ana Carolina Junqueira Vasques
- Research Laboratory of Metabolism and Diabetes (LIMED), Gastrocentro, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carlos Augusto Real Martinez
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Elinton Adami Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Bruno Geloneze
- Research Laboratory of Metabolism and Diabetes (LIMED), Gastrocentro, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - José Carlos Pareja
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| | - Cláudio Saddy Rodrigues Coy
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), R. Alexander Fleming, s/n, 13083-887, Campinas, São Paulo, Brazil
| |
Collapse
|
22
|
Lim R, Beekley A, Johnson DC, Davis KA. Early and late complications of bariatric operation. Trauma Surg Acute Care Open 2018; 3:e000219. [PMID: 30402562 PMCID: PMC6203132 DOI: 10.1136/tsaco-2018-000219] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 01/02/2023] Open
Abstract
Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient’s anatomy, which can lead to complications at any time during the course of a patient’s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen—acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease—for these are still among the most common etiologies of abdominal pathology in these patients.
Collapse
Affiliation(s)
- Robert Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, Hawaii, USA
| | - Alec Beekley
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dirk C Johnson
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
23
|
Billeter AT, de la Garza Herrera JR, Scheurlen KM, Nickel F, Billmann F, Müller-Stich BP. MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass. Eur J Endocrinol 2018; 179:R77-R93. [PMID: 29764908 DOI: 10.1530/eje-18-0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022]
Abstract
Obesity and its associated comorbidities have become one of the largest challenges for health care in the near future. Conservative therapy for obesity and related comorbidities has a very high failure rate and poor long-term results. Similarly, the conservative and medical management of the majority of metabolic diseases such as type 2 diabetes mellitus are only able to slow down disease progression but have no causal effect on the disease process. Obesity surgery has evolved as a highly effective therapy for severe obesity achieving long-lasting weight loss. Furthermore, several studies have demonstrated the beneficial effects of obesity surgery on reduction of overall mortality, reduction of cardiovascular events and superior control of obesity-related diseases such as type 2 diabetes mellitus, dyslipidemia and also the non-alcoholic steatohepatitis compared to medical therapy. Based on these findings, the term 'metabolic surgery' with the focus on treating metabolic diseases independent of body weight has been coined. Of great interest are recent studies that show that even existing complications of metabolic diseases such as diabetic nephropathy or the non-alcoholic steatohepatitis can be reversed by metabolic surgery. Although metabolic surgery has proven to be a safe and effective treatment for obesity, resolution of comorbidities and enhancing quality of life, it is still uncertain and unclear, which surgical procedure is the most effective to achieve these metabolic effects. The aim of this review is to compare the effects of the two currently most widely used metabolic operations, the Roux-en-Y gastric bypass and the sleeve gastrectomy in the treatment of obesity and its related comorbidities.
Collapse
Affiliation(s)
- Adrian T Billeter
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Katharina M Scheurlen
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Franck Billmann
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
24
|
Perioperative Course, Weight Loss and Resolution of Comorbidities After Primary Sleeve Gastrectomy for Morbid Obesity: Are There Differences Between Adolescents and Adults? Obes Surg 2018; 27:2388-2397. [PMID: 28293902 DOI: 10.1007/s11695-017-2640-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Morbid obesity in both adolescents and adults has risen in an alarming rate. Bariatric surgery is playing an increasing role in pediatric surgery. However, current evidence is limited regarding its safety and outcome. METHODS Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered. For the current analysis, all adolescent and adult subjects that had undergone laparoscopic sleeve gastrectomy (LSG) from 2005 to 2014 were considered. RESULTS LSG represents the most common bariatric procedure in Germany with a proportion of 48.1% in adolescent and 48.7% in adult obese in 2014. LSG was performed in 362 adolescent and 15,428 adult subjects. Pre-operative BMI was comparable between the two populations. However, adult obese had more frequently coexisting comorbidities (p < 0.01). Complication rates and mortality (0 vs. 0.2%) did not differ significantly. Adolescents achieved a BMI reduction of 16.8 and 18.0 kg/m2 at 12 and 24 months compared with 15.4 and 16.6 kg/m2 in the adult group. There was a significantly higher BMI reduction in late adolescents (19-21 years) compared with patients ≤18 years at 24 months (19.8 vs. 13.6 kg/m2). Resolution rate of hypertension was significantly higher in adolescents. CONCLUSION LSG is a safe therapeutic option that can be performed in adolescents without mortality. Late adolescents experienced the highest weight loss; resolution rate of comorbidities was lower in adults. All future efforts should now be focused on the evaluation of the long-term outcomes of LSG in the pediatric population.
Collapse
|
25
|
Menguer RK, Weston AC, Schmid H. Evaluation of Metabolic Syndrome in morbidly Obese Patients Submitted to Laparoscopic Bariatric Surgery: Comparison of the Results between Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg 2018; 27:1719-1723. [PMID: 28176218 DOI: 10.1007/s11695-017-2547-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Morbid obesity is a state of insulin resistance combined with excess of visceral fat, which contributes to the development of metabolic syndrome (MetS). Nonsurgical treatment of obesity usually improves MetS, but there is no ultimate resolution and weight regain is common. Surgical options like Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) result in a significant and sustained weight loss accompanied by improvement of MetS. The aim of this study was to compare the weight loss and improvement of MetS parameters between degree II and III obese patients with MetS undergoing RYGB or SG in a period of 12 months. METHODS Analysis of medical records of 102 patients diagnosed with MetS (63 undergoing RYGB and 39 undergoing SG) in a reference center (CTO ISCMPA) between 2010 and 2013. RESULTS After 1-year follow-up, an excess weight loss (EWL) of 77.2 ± 22.5% and of 63.4 ± 20.1% (p = 0.033) was observed in the RYGB and SG groups, respectively. The rate of MetS resolution was very similar (87.3 and 84.6%, respectively; p = 0.971). The percentage of patients with type 2 diabetes was 3.3% for RYGB and 15.4% for SG (p = 0.025). Fasting blood glucose levels followed the same trend with mean values reaching 87.6 ± 16.9 mg/dl in the RYGB group and 97.7 ± 35.5 mg/dl in the group undergoing SG (p = 0.023). CONCLUSIONS Among the patients studied, both surgical techniques were safe and effective for MetS resolution in 12 months. However, RYGB was more effective for EWL and improvement of some parameters related to glucose metabolism.
Collapse
Affiliation(s)
- Rodrigo Koprovski Menguer
- Diabetes and Obesity Education and Research Center and Obesity Treatment Center of Hospital Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Av. Independência, 78/701, Centro. 90020-160, Porto Alegre, RS, Brazil.
| | - Antônio Carlos Weston
- Obesity Treatment Center, Hospital Santa Casa de Misericórdia de Porto Alegre, Av. Independência, 78/701, Centro. 90020-160, Porto Alegre, Rio Grande do Sul, Brazil
| | - Helena Schmid
- Diabetes and Obesity Education and Research Center and Obesity Treatment Center of Hospital Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Av. Independência, 78/701, Centro. 90020-160, Porto Alegre, RS, Brazil
| |
Collapse
|
26
|
Metabolic syndrome is associated with increased postoperative complications and use of hospital resources in patients undergoing laparoscopic adrenalectomy. Surgery 2018; 163:167-175. [DOI: 10.1016/j.surg.2017.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/21/2017] [Accepted: 06/13/2017] [Indexed: 01/08/2023]
|
27
|
[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]. Chirurg 2017; 89:4-16. [PMID: 29209749 DOI: 10.1007/s00104-017-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.
Collapse
|
28
|
Clinical evaluation of C-reactive protein and procalcitonin for the early detection of postoperative complications after laparoscopic sleeve gastrectomy. Wideochir Inne Tech Maloinwazyjne 2017; 12:160-165. [PMID: 28694902 PMCID: PMC5502341 DOI: 10.5114/wiitm.2017.67678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 04/18/2017] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications. AIM To develop and implement certain standards for early detection of complications. MATERIAL AND METHODS The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1st and 2nd postoperative day (POD). RESULTS Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1st and 2nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2nd POD compared to the remainder. CONCLUSIONS The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.
Collapse
|
29
|
Kanoski SE, Grill HJ. Hippocampus Contributions to Food Intake Control: Mnemonic, Neuroanatomical, and Endocrine Mechanisms. Biol Psychiatry 2017; 81:748-756. [PMID: 26555354 PMCID: PMC4809793 DOI: 10.1016/j.biopsych.2015.09.011] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/22/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
Food intake is a complex behavior that can occur or cease to occur for a multitude of reasons. Decisions about where, when, what, and how much to eat are not merely reflexive responses to food-relevant stimuli or to changes in energy status. Rather, feeding behavior is modulated by various contextual factors and by previous experiences. The data reviewed here support the perspective that neurons in multiple hippocampal subregions constitute an important neural substrate linking the external context, the internal context, and mnemonic and cognitive information to control both appetitive and ingestive behavior. Feeding behavior is heavily influenced by hippocampal-dependent mnemonic functions, including episodic meal-related memories and conditional learned associations between food-related stimuli and postingestive consequences. These mnemonic processes are undoubtedly influenced by both external and internal factors relating to food availability, location, and physiological energy status. The afferent and efferent neuroanatomical connectivity of the subregions of the hippocampus is reviewed with regard to the integration of visuospatial and olfactory sensory information (the external context) with endocrine and gastrointestinal interoceptive stimuli (the internal context). Also discussed are recent findings demonstrating that peripherally derived endocrine signals act on receptors in hippocampal neurons to reduce (leptin, glucagon-like peptide-1) or increase (ghrelin) food intake and learned food reward-driven responding, thereby highlighting endocrine and neuropeptidergic signaling in hippocampal neurons as a novel substrate of importance in the higher-order regulation of feeding behavior.
Collapse
Affiliation(s)
- Scott E. Kanoski
- Department of Biological Sciences, University of Southern California
| | | |
Collapse
|
30
|
Laou E, Milionis H, Petrou A, Arnaoutoglou E, Glantzounis G, Bairaktari E, Mavridis D, Mikhailidis DP, Papadopoulos G, Tzimas P. The impact of metabolic syndrome and its components on perioperative outcomes after elective laparotomy - A prospective observational study. Am J Surg 2017; 214:831-837. [PMID: 28330739 DOI: 10.1016/j.amjsurg.2017.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/01/2017] [Accepted: 02/25/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Metabolic syndrome (MetS) represents a constellation of risk factors, including central obesity, elevated fasting blood glucose, high blood pressure and atherogenic dyslipidemia. This prospective observational study aimed to assess the impact of MetS on perioperative outcomes of patients undergoing elective abdominal surgery with laparotomy. METHODS We included 105 consecutive non-diabetic patients undergoing elective abdominal surgery with laparotomy. Patients were divided into two groups based on MetS diagnosis. Perioperative adverse events were recorded according to the definitions of the European Perioperative Clinical Outcome guidelines. RESULTS The prevalence of MetS was 57.1%. The presence of MetS was associated with a 2.64 higher odds (95% CI 1.18-5.95, P = 0.019) for respiratory events and a 3.42 higher odds (95% CI 1.05-11.13, P = 0.041) for superficial surgical site infections. Furthermore, regarding MetS patients, all individual components of MetS were associated with worse outcomes in an independent manner. CONCLUSIONS MetS as an entity along with its individual components are associated with an increased risk of perioperative events in patients undergoing elective abdominal surgery with laparotomy.
Collapse
Affiliation(s)
- Eleni Laou
- Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Haralampos Milionis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Anastasios Petrou
- Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Eleni Arnaoutoglou
- Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Georgios Glantzounis
- Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Eleni Bairaktari
- Laboratory of Clinical Chemistry, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Dimitrios Mavridis
- Department of Hygiene and Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG, UK.
| | - Georgios Papadopoulos
- Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| | - Petros Tzimas
- Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina University Campus, Stavros Niarchos Ave., Ioannina 45110, Greece.
| |
Collapse
|
31
|
Comparison of the Effect of Gastric Bypass and Sleeve Gastrectomy on Metabolic Syndrome and its Components in a Cohort: Tehran Obesity Treatment Study (TOTS). Obes Surg 2017; 27:1697-1704. [DOI: 10.1007/s11695-016-2526-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
32
|
Hubal MJ, Nadler EP, Ferrante SC, Barberio MD, Suh JH, Wang J, Dohm GL, Pories WJ, Mietus-Snyder M, Freishtat RJ. Circulating adipocyte-derived exosomal MicroRNAs associated with decreased insulin resistance after gastric bypass. Obesity (Silver Spring) 2017; 25:102-110. [PMID: 27883272 PMCID: PMC5182153 DOI: 10.1002/oby.21709] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/18/2016] [Accepted: 09/13/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Exosomes from obese adipose contain dysregulated microRNAs linked to insulin signaling, as compared with lean controls, providing a direct connection between adiposity and insulin resistance. This study tested the hypotheses that gastric bypass surgery and its subsequent weight loss would normalize adipocyte-derived exosomal microRNAs associated with insulin signaling and the associated metabolome related to glucose homeostasis. METHODS African American female subjects with obesity (N = 6; age: 38.5 ± 6.8 years; BMI: 51.2 ± 8.8 kg/m2 ) were tested before and 1 year after surgery. Insulin resistance (HOMA), serum metabolomics, and global microRNA profiles of circulating adipocyte-derived exosomes were evaluated via ANCOVA and correlational analyses. RESULTS One year postsurgery, patients showed decreased BMI (-18.6 ± 5.1 kg/m2 ; P < 0.001), ameliorated insulin resistance (HOMA: 1.94 ± 0.6 presurgery, 0.49 ± 0.1 postsurgery; P < 0.001), and altered metabolites including branched chain amino acids (BCAA). Biological pathway analysis of predicted mRNA targets of 168 surgery-responsive microRNAs (P < 0.05) identified the insulin signaling pathway (P = 1.27E-10; 52/138 elements), among others, in the data set. The insulin signaling pathway was also a target of 10 microRNAs correlated to changes in HOMA (P < 0.05; r > 0.4), and 48 microRNAs correlated to changes in BCAA levels. CONCLUSIONS These data indicate that circulating adipocyte-derived exosomes are modified following gastric bypass surgery and correlate to improved postsurgery insulin resistance.
Collapse
Affiliation(s)
- Monica J Hubal
- Department of Integrative Systems Biology, George Washington University, Washington, DC
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC
| | - Evan P Nadler
- Department of Integrative Systems Biology, George Washington University, Washington, DC
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC
- Division of Pediatric Surgery, Children’s National Medical Center, Washington, DC
| | - Sarah C Ferrante
- Department of Integrative Systems Biology, George Washington University, Washington, DC
| | - Matthew D. Barberio
- Department of Integrative Systems Biology, George Washington University, Washington, DC
| | - Jung-Hyuk Suh
- Center for Nutrition and Metabolism, Children's Hospital Oakland Research Institute, Oakland, CA
| | - Justin Wang
- Department of Integrative Systems Biology, George Washington University, Washington, DC
| | - G. Lynis Dohm
- Department of Physiology, East Carolina University, Greenville, NC
| | | | | | - Robert J Freishtat
- Department of Integrative Systems Biology, George Washington University, Washington, DC
- Department of Pediatrics, Children’s National Medical Center, Washington, DC
- Division of Emergency Medicine, Children’s National Medical Center, Washington, DC
| |
Collapse
|
33
|
|
34
|
Abstract
Insufficient hepatic O2 in animal and human studies has been shown to elicit a hepatorenal reflex in response to increased hepatic adenosine, resulting in the stimulation of renal as well as muscle sympathetic nerve activity and activating the renin angiotensin system. Low hepatic ATP, hyperuricemia, and hepatic lipid accumulation reported in metabolic syndrome (MetS) patients may reflect insufficient hepatic O2 delivery, potentially accounting for the sympathetic overdrive associated with MetS. This theoretical concept is supported by experimental results in animals fed a high fructose diet to induce MetS. Hepatic fructose metabolism rapidly consumes ATP resulting in increased adenosine production and hyperuricemia as well as elevated renin release and sympathetic activity. This review makes the case for the hepatorenal reflex causing sympathetic overdrive and metabolic syndrome in response to exaggerated splanchnic oxygen consumption from excessive eating. This is strongly reinforced by the fact that MetS is cured in a matter of days in a significant percentage of patients by diet, bariatric surgery, or endoluminal sleeve, all of which would decrease splanchnic oxygen demand by limiting nutrient contact with the mucosa and reducing the nutrient load due to loss of appetite or dietary restriction.
Collapse
Affiliation(s)
- Michael D Wider
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
35
|
Abstract
Insufficient hepatic O2 in animal and human studies has been shown to elicit a hepatorenal reflex in response to increased hepatic adenosine, resulting in stimulation of renal as well as muscle sympathetic nerve activity and activating the renin angiotensin system. Low hepatic ATP, hyperuricemia, and hepatic lipid accumulation reported in metabolic syndrome (MetS) patients may reflect insufficient hepatic O2 delivery, potentially accounting for the sympathetic overdrive associated with MetS. This theoretical concept is supported by experimental results in animals fed a high fructose diet to induce MetS. Hepatic fructose metabolism rapidly consumes ATP resulting in increased adenosine production and hyperuricemia as well as elevated renin release and sympathetic activity. This review makes the case for the hepatorenal reflex causing sympathetic overdrive and metabolic syndrome in response to exaggerated splanchnic oxygen consumption from excessive eating. This is strongly reinforced by the fact that MetS is cured in a matter of days in a significant percentage of patients by diet, bariatric surgery, or endoluminal sleeve, all of which would decrease splanchnic oxygen demand by limiting nutrient contact with the mucosa and reducing the nutrient load due to the loss of appetite or dietary restriction.
Collapse
Affiliation(s)
- Michael D Wider
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
36
|
Hopkins J, Welbourn R. The importance of national registries/databases in metabolic surgery: the UK experience. Surg Obes Relat Dis 2016; 12:1178-85. [DOI: 10.1016/j.soard.2016.02.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
|
37
|
Batterham RL, Cummings DE. Mechanisms of Diabetes Improvement Following Bariatric/Metabolic Surgery. Diabetes Care 2016; 39:893-901. [PMID: 27222547 PMCID: PMC5864134 DOI: 10.2337/dc16-0145] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/21/2016] [Indexed: 02/03/2023]
Abstract
More than 20 years ago, Pories et al. published a seminal article, "Who Would Have Thought It? An Operation Proves to Be the Most Effective Therapy for Adult-Onset Diabetes Mellitus." This was based on their observation that bariatric surgery rapidly normalized blood glucose levels in obese people with type 2 diabetes mellitus (T2DM), and 10 years later, almost 90% remained diabetes free. Pories et al. suggested that caloric restriction played a key role and that the relative contributions of proximal intestinal nutrient exclusion, rapid distal gut nutrient delivery, and the role of gut hormones required further investigation. These findings of T2DM improvement/remission after bariatric surgery have been widely replicated, together with the observation that bariatric surgery prevents or delays incident T2DM. Over the ensuing two decades, important glucoregulatory roles of the gastrointestinal (GI) tract have been firmly established. However, the physiological and molecular mechanisms underlying the beneficial glycemic effects of bariatric surgery remain incompletely understood. In addition to the mechanisms proposed by Pories et al., changes in bile acid metabolism, GI tract nutrient sensing and glucose utilization, incretins, possible anti-incretin(s), and the intestinal microbiome are implicated. These changes, acting through peripheral and/or central pathways, lead to reduced hepatic glucose production, increased tissue glucose uptake, improved insulin sensitivity, and enhanced β-cell function. A constellation of factors, rather than a single overarching mechanism, likely mediate postoperative glycemic improvement, with the contributing factors varying according to the surgical procedure. Thus, different bariatric/metabolic procedures provide us with experimental tools to probe GI tract physiology. Embracing this approach through the application of detailed phenotyping, genomics, metabolomics, and gut microbiome studies will enhance our understanding of metabolic regulation and help identify novel therapeutic targets.
Collapse
Affiliation(s)
- Rachel L Batterham
- Centre for Obesity Research, Department of Medicine, University College London, London, U.K. Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London, U.K. National Institute for Health Research, Biomedical Research Centre, University College London Hospital, London, U.K.
| | - David E Cummings
- VA Puget Sound Health Care System and Diabetes and Obesity Center of Excellence, University of Washington, Seattle, WA
| |
Collapse
|
38
|
|
39
|
Kanoski SE, Hayes MR, Skibicka KP. GLP-1 and weight loss: unraveling the diverse neural circuitry. Am J Physiol Regul Integr Comp Physiol 2016; 310:R885-95. [PMID: 27030669 DOI: 10.1152/ajpregu.00520.2015] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/26/2016] [Indexed: 02/07/2023]
Abstract
Glucagon-like peptide-1 (GLP-1) is currently one of the most promising biological systems for the development of effective obesity pharmacotherapies. Long-acting GLP-1 analogs potently reduce food intake and body weight, and recent discoveries reveal that peripheral administration of these drugs reduces food intake largely through humoral pathways involving direct action on brain GLP-1 receptors (GLP-1R). Thus, it is of critical importance to understand the neural systems through which GLP-1 and long-acting GLP-1 analogs reduce food intake and body weight. In this review, we discuss several neural, physiological, cellular and molecular, as well as behavioral mechanisms through which peripheral and central GLP-1R signaling reduces feeding. Particular attention is devoted to discussion regarding the numerous neural substrates through which GLP-1 and GLP-1 analogs act to reduce food intake and body weight, including various hypothalamic nuclei (arcuate nucleus of the hypothalamus, periventricular hypothalamus, lateral hypothalamic area), hindbrain nuclei (parabrachial nucleus, medial nucleus tractus solitarius), hippocampus (ventral subregion; vHP), and nuclei embedded within the mesolimbic reward circuitry [ventral tegmental area (VTA) and nucleus accumbens (NAc)]. In some of these nuclei [VTA, NAc, and vHP], GLP-1R activation reduces food intake and body weight without concomitant nausea responses, suggesting that targeting these specific pathways may be of particular interest for future obesity pharmacotherapy. The widely distributed neural systems through which GLP-1 and GLP-1 analogs act to reduce body weight highlight the complexity of the neural systems regulating energy balance, as well as the challenges for developing effective obesity pharmacotherapies that reduce feeding without producing parallel negative side effects.
Collapse
Affiliation(s)
- Scott E Kanoski
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, California;
| | - Matthew R Hayes
- Translational Neuroscience Program, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania; and
| | - Karolina P Skibicka
- Department of Physiology/Metabolic Physiology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
40
|
Abstract
In ancient Greek medicine the concept of a distinct syndrome (going together) was used to label 'a group of signs and symptoms' that occur together and 'characterize a particular abnormality and condition'. The (dys)metabolic syndrome is a common cluster of five pre-morbid metabolic-vascular risk factors or diseases associated with increased cardiovascular morbidity, fatty liver disease and risk of cancer. The risk for major complications such as cardiovascular diseases, NASH and some cancers develops along a continuum of risk factors into clinical diseases. Therefore we still include hyperglycemia, visceral obesity, dyslipidemia and hypertension as diagnostic traits in the definition according to the term 'deadly quartet'. From the beginning elevated blood pressure and hyperglycemia were core traits of the metabolic syndrome associated with endothelial dysfunction and increased risk of cardiovascular disease. Thus metabolic and vascular abnormalities are in extricable linked. Therefore it seems reasonable to extend the term to metabolic-vascular syndrome (MVS) to signal the clinical relevance and related risk of multimorbidity. This has important implications for integrated diagnostics and therapeutic approach. According to the definition of a syndrome the rapid global rise in the prevalence of all traits and comorbidities of the MVS is mainly caused by rapid changes in life-style and sociocultural transition resp. with over- and malnutrition, low physical activity and social stress as a common soil.
Collapse
Affiliation(s)
- Markolf Hanefeld
- GWT-TU Dresden GmbH, Fiedlerstr. 34, 01307, Dresden, Germany
- Medizinische Klinik 3, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Frank Pistrosch
- GWT-TU Dresden GmbH, Fiedlerstr. 34, 01307, Dresden, Germany
- Medizinische Klinik 3, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
| | - Stefan R Bornstein
- Medizinische Klinik 3, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany
- Section of Diabetes and Nutritional Sciences, Rayne Institute, Denmark Hill Campus, King's College London, London, UK
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Andreas L Birkenfeld
- GWT-TU Dresden GmbH, Fiedlerstr. 34, 01307, Dresden, Germany.
- Medizinische Klinik 3, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Germany.
- Section of Diabetes and Nutritional Sciences, Rayne Institute, Denmark Hill Campus, King's College London, London, UK.
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, TU Dresden, Dresden, Germany.
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| |
Collapse
|
41
|
Ceccarini G, Ciccarone AM, Santini F, Del Prato S. Integrating medical and surgical therapies to optimize the outcomes of type 2 diabetes. Surg Obes Relat Dis 2016; 12:1186-91. [PMID: 27178605 DOI: 10.1016/j.soard.2016.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/13/2016] [Accepted: 01/29/2016] [Indexed: 01/03/2023]
Abstract
Modern treatment of type 2 diabetes must rely on therapy individualization. Morbid obesity confers an independent excess of risk to diabetes. In these individuals metabolic surgery is an opportunity the physician should consider, especially at the time of the diabetes diagnosis, because of its efficacy and long-term effects. In addition to the possible remission of diabetes, bariatric surgery is also associated with reduced risk of micro- and macrovascular complications. A multidisciplinary team approach is necessary to maximize the beneficial effects and minimize the adverse events of metabolic surgery and to ensure proper follow-up based on the residual possibility of developing complications. In this regard, a consensus on definition of remission must be reached to define the residual risk after antidiabetic drug withdrawal. Finally, randomized clinical trials are deemed necessary to establish the risk-to-benefit profile of glucose-lowering agents for those patients who have remained diabetic or experience a disease relapse.
Collapse
Affiliation(s)
- Giovanni Ceccarini
- Endocrine Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anna Maria Ciccarone
- Diabetes Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ferruccio Santini
- Endocrine Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Diabetes Section, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| |
Collapse
|
42
|
Corcelles R, Daigle CR, Schauer PR. MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery. Eur J Endocrinol 2016; 174:R19-28. [PMID: 26340972 DOI: 10.1530/eje-15-0533] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022]
Abstract
Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality.
Collapse
Affiliation(s)
- Ricard Corcelles
- Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Christopher R Daigle
- Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Philip R Schauer
- Bariatric and Metabolic InstituteCleveland Clinic, 9500 Euclid Avenue, M61 Cleveland, OH 44195, USADepartment of Gastrointestinal SurgeryInstitute of Digestive and Metabolic Diseases, Fundació Clínic per a la Recerca Biomèdica, Hospital Clinic de Barcelona, Barcelona, Spain
| |
Collapse
|
43
|
Rodríguez-Ortiz D, Reyes-Pérez A, León P, Sánchez H, Mosti M, Aguilar-Salinas CA, Velázquez-Fernández D, Herrera MF. Assessment of two different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of metabolic syndrome remission in a longitudinal cohort of patients undergoing Roux-en-Y gastric bypass. Surgery 2015; 159:1121-8. [PMID: 26747228 DOI: 10.1016/j.surg.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/28/2015] [Accepted: 11/21/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery has proven to provide durable weight loss and control of comorbid conditions, including the metabolic syndrome (MS). Existing definitions of MS have caused substantial confusion regarding their concordance for identifying the same individuals. The aim of this study was to assess the value of 2 different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of remission of MS after Roux-en-Y gastric bypass (RYGB). PATIENTS AND METHODS A cohort of 381 patients who underwent a primary RYGB, satisfied the criteria for MS, and had at least o1 postoperative visit were selected. Weight loss and MS remission were analyzed 6 and 12 months after surgery by ATP III and IDF criteria. RESULTS Before surgery, 381 (48.9%) and 354 (45.4%) patients fulfilled the criteria for MS according to the ATP III and IDF, respectively. According to the ATP III definition, remission of MS after bariatric surgery occurred in 209 of 239 (87.4%) and 98/102 (96.1%) patients at 6 and 12 months, respectively. According to the IDF definition, this occurred in 180 of 232 (77.6%) and 54 of 64 (84.4%) at the same time periods. On the basis of different percentage of excess body weight loss cut-off values, the area under the curve in receiver operating characteristic analysis at 12 months was slightly better for ATP III (0.77) than IDF criteria (0.68) for remission of MS. CONCLUSIONS With the use of the IDF definition, the remission rate of MS was 10% more rigorous than with use of the ATP-III criteria. This feature is attributable to a greater discrimination of patients with high blood pressure, glycemia, and dyslipidemia. The IDF criteria seem more accurate to evaluate MS remission.
Collapse
Affiliation(s)
- Donají Rodríguez-Ortiz
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México
| | - Azucena Reyes-Pérez
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México
| | - Pablo León
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México
| | - Hugo Sánchez
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México
| | - Maureen Mosti
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de la Nutrición, Salvador Zubirán, México D.F., México
| | - David Velázquez-Fernández
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México
| | - Miguel F Herrera
- Center for Nutrition, Obesity and Metabolic Disorders, The American British Cowdray Medical Center, México D.F., México.
| |
Collapse
|
44
|
Bariatric versus diabetes surgery after five years of follow up. Asian J Surg 2015; 39:96-102. [PMID: 26235458 DOI: 10.1016/j.asjsur.2015.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/16/2015] [Accepted: 04/28/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Bariatric surgery (BS) is totally different from diabetes surgery (DS) in the patient characters, goals of surgery, and management although similar in surgical procedure. Comparison of BS and DS with long-term data is lacking. MATERIALS AND METHODS A retrospective review of patients who received BS and patients who received DS at Min-Sheng General Hospital from 2007 to 2013 was designed. All inpatient and outpatient follow-up data were analyzed. Patients undergoing BS for the treatment of morbid obesity were compared with patients undergoing metabolic surgery for the treatment of type 2 diabetes mellitus (T2DM). Patients who received revision surgeries were excluded. The main outcome measures were: (1) operation risk; (2) weight loss; and (3) diabetes remission. RESULTS Between 2007 and 2013, 2073 patients who received BS and 741 patients who received DS were recruited from both centers. DS patients were older (41.1 ± 10.9 years vs. 33.1 ± 9.3 years, p < 0.05) and were more likely to be male (40.2% vs. 28.2%, p < 0.05) and to have diabetes (100% vs. 6.0%, p < 0.05), however, they had similar body mass index (BMI) (37.9 ± 8.0 vs. 38.5 ± 9.7, p = 0.78) compared to the BS patients. Surgical procedures are significantly different between the two groups (73.3% of the DS surgeries were gastric bypass procedure, whereas this procedure made up only 47.1% of BS surgeries). Although the major complication rates were similar (2.0% vs. 2.4%), the DS program had a significant higher mortality rate than the BS program (0.54% vs. 0.1%; p < 0.05). At the 5-year follow-up time point, 58.0% of the BS patients had achieved successful results (weight loss > 30%) and 80% of the DS patients had complete remission of their diabetes [hemoglobin A1c (HbA1c) < 6.0%]. Both the DS and the BS group had good results in up to 85% of the patients at the 5-year follow-up time point. CONCLUSION The clinical profiles were very different between the BS and the DS programs. Both programs achieved the desired outcomes equally well, however, the DS program had a higher risk than the BS program.
Collapse
|
45
|
Cazzo E, Gestic MA, Utrini MP, Machado RR, Jimenez LS, da Silva APC, Baracat J, Callejas-Neto F, Pareja JC, Chaim EA. Influence of Insulin Resistance Status on the Development of Gallstones Following Roux-En-Y Gastric Bypass: a Prospective Cohort Study. Obes Surg 2015. [DOI: 10.1007/s11695-015-1815-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
46
|
Khorgami Z, Zhang C, Messiah SE, de la Cruz-Muñoz N. Predictors of Postoperative Aftercare Attrition among Gastric Bypass Patients. Bariatr Surg Pract Patient Care 2015; 10:79-83. [PMID: 26155436 PMCID: PMC4491160 DOI: 10.1089/bari.2014.0053] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Poor adherence to post-bariatric surgery aftercare continues to challenge surgical practices. The objective of this study was to identify factors that predict poor aftercare attendance among patients who underwent Roux-en-Y Gastric Bypass (RYGB) surgery. Method: A retrospective medical chart review of patients who underwent RYGB from 2002 to 2011 was conducted. Patients with four visits or more in the first 2 years (>50%) were categorized as "acceptable follow-up" and with ≤50% as "poor follow-up." Demographics, presurgical body mass index (BMI), and comorbidities were compared using multivariate analysis. Results: Out of 2,658 patients, 1,092 (41.1%) had acceptable follow-up. Preoperative factors that predicted acceptable follow-up included female gender (odds ratio [OR] 1.41 [95% confidence interval (CI) 1.15-1.72]), older age (OR 1.03 [95% CI 1.03-1.04]), higher BMI at surgery (OR 1.02 [95% CI 1.01-1.03]), and Hispanic ethnicity (OR 1.40 [95% CI 1.15-1.72]). Conversely, presence of diabetes mellitus (OR 0.58 [95% CI 0.39-0.88]), hypertension (OR 0.53 [95% CI 0.39-0.72]), and obstructive sleep apnea (OR 0.39 [95% CI 0.26-0.57]) predicted less adherence to RYGB aftercare. Conclusion: These findings suggest RYGB patients' age, gender, ethnicity, preoperative BMI, and certain comorbidities should be considered to maximize postoperative aftercare attendance.
Collapse
Affiliation(s)
- Zhamak Khorgami
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Chi Zhang
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Sarah E Messiah
- Division of Pediatric Clinical Research, Department of Pediatrics, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Nestor de la Cruz-Muñoz
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| |
Collapse
|
47
|
Stey AM, Russell MM, Ko CY, Sacks GD, Dawes AJ, Gibbons MM. Clinical registries and quality measurement in surgery: a systematic review. Surgery 2015; 157:381-95. [PMID: 25616951 DOI: 10.1016/j.surg.2014.08.097] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/11/2014] [Accepted: 08/26/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Surgical clinical registries provide clinical information with the intent of measuring and improving quality. This study aimed to describe how surgical clinical registries have been used to measure surgical quality, the reported findings, and the limitations of registry measurements. METHODS Medline, CINAHL, and Cochrane were queried for English articles with the terms: "registry AND surgery AND quality." Eligibility criteria were studies explicitly assessing quality measurement with registries as the primary data source. Studies were abstracted to identify registries, define registry structure, uses for quality measurement, and limitations of the measurements used. RESULTS A total of 111 studies of 18 registries were identified for data abstraction. Two registries were financed privately, and 5 registries were financed by a governmental organization. Across registries, the most common uses of process measures were for monitoring providers and as platforms for quality improvement initiatives. The most common uses of outcome measures were to improve quality modeling and to identify preoperative risk factors for poor outcomes. Eight studies noted improvements in risk-adjusted mortality with registry participation; one found no change. A major limitation is bias from context and means of data collection threatening internal validity of registry quality measurement. Conversely, the other major limitation is the cost of participation, which threatens the external validity of registry quality measurement. CONCLUSION Clinical registries have advanced surgical quality definition, measurement, and modeling as well as having served as platforms for local initiatives for quality improvement. The implication of this finding is that subsidizing registry participation may improve data validity as well as engage providers in quality improvement.
Collapse
Affiliation(s)
- Anne M Stey
- Icahn School of Medicine, Mount Sinai Medical Center, New York, NY; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
| | - Marcia M Russell
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Clifford Y Ko
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; American College of Surgeons, Chicago, IL
| | - Greg D Sacks
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Aaron J Dawes
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Melinda M Gibbons
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
48
|
Lee WJ, Almulaifi A. Recent advances in bariatric/metabolic surgery: appraisal of clinical evidence. J Biomed Res 2015; 29:98-104. [PMID: 25859263 PMCID: PMC4389121 DOI: 10.7555/jbr.28.20140120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 09/16/2014] [Accepted: 11/05/2014] [Indexed: 12/17/2022] Open
Abstract
Obesity and associated type 2 diabetes mellitus (T2DM) are becoming a serious medical issue worldwide. Bariatric surgery has been shown to be the most effective and durable therapy for the treatment of morbid obese patients. Increasing data indicates bariatric surgery as metabolic surgery is an effective and novel therapy for not well controlled obese T2DM patients. The review of recent developments in bariatric/metabolic surgery covers 4 major fields. 1) Improvement of safety: recent advances in laparoscopic/metabolic surgery has made this minimal invasive surgery more than ten times safer than a decade ago. The safety profile of laparoscopic/metabolic surgery is compatible with that of laparoscopic cholecystectomy now. 2) New bariatric/metabolic surgery: laparoscopic sleeve gastrectomy (LSG) is becoming the leading bariatric surgery because of its simplicity and efficacy. Other new procedures, such as gastric plication, banded plication, single anastomosis (mini) gastric bypass and Duodeno-jejunal bypass with sleeve gastrectomy have all been accepted as treatment modalities for bariatric/metabolic surgery. 3) Mechanism of bariatric/metabolic surgery: Restriction is the most important mechanism for bariatric surgery. Weight regain after bariatric surgery is usually associated with loss of restriction. Recent studies demonstrated that gut hormone, microbiota and bile acid changes after bariatric surgery may play an important role in durable weight loss as well as in T2DM remission. However, weight loss is still the cornerstone of T2DM remission after metabolic surgery. 4) PATIENT SELECTION: patients who may benefit most from bariatric surgery was found to be patients with insulin resistance. For Asian T2DM patients, the indication of metabolic surgery has been set to those with not well controlled (HbA1c > 7.5%) disease and with their BMI > 27.5 Kg/m(2). A novel diabetes surgical score, ABCD score, is a simple system for predicting the success of surgical therapy for T2DM.
Collapse
Affiliation(s)
- Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taoyuan, Taiwan, China.
| | | |
Collapse
|
49
|
Ardestani A, Rhoads D, Tavakkoli A. Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes. Diabetes Care 2015; 38:659-64. [PMID: 25573879 DOI: 10.2337/dc14-1751] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The impact of bariatric surgeries on insulin-treated type 2 diabetes (I-T2D) in the general population is largely undocumented. We assessed changes in insulin treatment after bariatric surgery in a large cohort of I-T2D patients, comparing Roux-en-Y gastric bypass surgery (RYGB) with laparoscopic adjustable gastric banding (LAGB), controlling for differences in weight loss between procedures. RESEARCH DESIGN AND METHODS Of 113,638 adult surgical patients in the Bariatric Outcomes Longitudinal Database (BOLD), 10% had I-T2D. Analysis was restricted to 5,225 patients with I-T2D and at least 1 year of postoperative follow-up. Regression models were used to identify factors that predict cessation of insulin therapy. To control for differences in weight loss patterns between RYGB and LAGB, a case-matched analysis was also performed. RESULTS Of I-T2D patients who underwent RYGB (n = 3,318), 62% were off insulin at 12 months compared with 34% (n = 1,907) after LAGB (P < 0.001). Regression analysis indicated that RYGB strongly predicted insulin cessation at both 1 and 12 months postoperatively. In the case-matched analysis at 3 months, the proportion of insulin cessation was significantly higher in the RYGB group than in the LAGB group (P = 0.03), and the diabetes remission rate was higher at all time points after this surgery. RYGB was a weight-independent predictor of insulin therapy cessation early after surgery, whereas insulin cessation after LAGB was linked to weight loss. CONCLUSIONS I-T2D patients have a greater probability of stopping insulin after RYGB than after LAGB (62% vs. 34%, respectively, at 1 year), with weight-independent effects in the early months after surgery. These findings support RYGB as the procedure of choice for reversing I-T2D.
Collapse
Affiliation(s)
- Ali Ardestani
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Rhoads
- Pediatric Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Center for Weight Management and Metabolic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
50
|
Shuai X, Tao K, Mori M, Kanda T. Bariatric surgery for metabolic syndrome in obesity. Metab Syndr Relat Disord 2015; 13:149-60. [PMID: 25715110 DOI: 10.1089/met.2014.0115] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Metabolic syndrome is closely associated with morbid obesity and leads to increased risk of cardiovascular diseases and related mortality. Bariatric surgery is considered an effective option for the management of this condition. We searched MEDLINE, Current Contents, and the Cochrane Library for papers published on bariatric surgery outcomes in English from January 1, 1990, to April 20, 2014. Bariatric surgery can significantly reduce body weight, resolve or cure many of the symptoms of metabolic syndrome, including type 2 diabetes, hypertension, hyperlipidemia, and improve long-term survival. Surgery, in addition to existing therapy, could therefore be considered as an optimal treatment for patients with metabolic syndrome and morbid obesity.
Collapse
Affiliation(s)
- Xiaoming Shuai
- 1 Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei Province, People's Republic of China
| | | | | | | |
Collapse
|