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Johnson-Mann CN, Cupka JS, Ro A, Davidson AE, Armfield BA, Miralles F, Markal A, Fierman KE, Hough V, Newsom M, Verma I, Dozic AV, Bihorac A. A Systematic Review on Participant Diversity in Clinical Trials-Have We Made Progress for the Management of Obesity and Its Metabolic Sequelae in Diet, Drug, and Surgical Trials. J Racial Ethn Health Disparities 2023; 10:3140-3149. [PMID: 36536164 PMCID: PMC10645628 DOI: 10.1007/s40615-022-01487-0] [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: 09/06/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Individuals from Black and Hispanic backgrounds represent a minority of the overall US population, yet are the populations most affected by the disease of obesity and its comorbid conditions. Black and Hispanic individuals remain underrepresented among participants in obesity clinical trials, despite the mandate by the National Institutes of Health (NIH) Revitalization Act of 1993. This systematic review evaluates the racial, ethnic, and gender diversity of clinical trials focused on obesity at a national level. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of clinicaltrials.gov, PubMed, Cochrane Central, and Web of Science was undertaken to locate phase 3 and phase 4 clinical trials on the topic of obesity that met associated inclusion/exclusion criteria. Ultimately, 18 studies were included for review. RESULTS White non-Hispanic individuals represented the majority of clinical trial participants, as did females. No study classified participants by gender identity. Reporting of race/ethnicity was not uniform, with noted variability among racial/ethnic subgroups. CONCLUSIONS Our findings suggest that disparities remain in the diverse racial, ethnic, and gender representation of participants engaged in clinical trials on obesity relative to the prevalence of obesity in underrepresented populations. Commitment to inclusive and intentional recruiting practices is needed to increase the representation of underrepresented groups, thus increasing the generalizability of future research.
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Affiliation(s)
- Crystal N Johnson-Mann
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA.
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA.
| | - Julie S Cupka
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alexandra Ro
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Andrea E Davidson
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brooke A Armfield
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
| | - Frank Miralles
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Asena Markal
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kiara E Fierman
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Victoria Hough
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Mackenzie Newsom
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Isha Verma
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Abdul-Vehab Dozic
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Azra Bihorac
- Intelligent Critical Care Center, University of Florida, 1600 SW Archer Rd, PO Box 100109, Gainesville, FL, 32610-0109, USA
- Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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Phillips E, Ponce J, Bhoyrul S, Cunneen SA, Gomez E, Jacobs M, Kipnes M, Marema RT, Schwiers M, Waggoner JR, DeMarchi J. Safety and effectiveness of REALIZE adjustable gastric band: 5-year prospective study. Surg Obes Relat Dis 2021; 17:956-962. [PMID: 33674199 PMCID: PMC7826021 DOI: 10.1016/j.soard.2021.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/03/2021] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Background The long-term safety results of the REALIZE (Ethicon Endo-Surgery, Inc., Cincinnati, OH) adjustable gastric band collected in this prospective, multicenter study in patients with morbid obesity are presented. Objectives To determine the reoperation rate, including band revisions, replacements, and explants, resulting from a serious adverse device-related event through years 4 and 5. Various efficacy measures were also assessed as secondary objectives. Setting Nine academic and/or private institutions. Methods The participating institutions enrolled 303 patients, who were then assessed on an annual basis, with 231 patients completing 5 years of follow-up. The study parameters included reoperation rates, changes in percentage of excess weight loss (%EWL), and changes in body mass index (BMI), as well as parameters of diabetes and dyslipidemia. Quality of life was assessed using the Short Form (SF)-36 and the Impact of Weight on Quality of Life-Lite questionnaires. Results The reoperation rate due to a serious adverse event in this population at 5 years after implantation with the REALIZE gastric band was 8.9%. The most common serious adverse event was band slippage, which affected 6.9% of the study population. The mean %EWL was 35.6% ± 26.84%, and the decrease in mean BMI was −7.01 ± 5.45 kg/m2 at 5 years. Patients experienced improvements in mean glycated hemoglobin and serum lipid levels, in addition to improvements in the quality of life measures. Conclusion No new safety concerns were identified during the 5 years of follow-up. Although the results of this study did not meet the predefined safety criteria of 8% or less, the safety profile and long-term effectiveness observed in this study are consistent with those in the current literature.
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Affiliation(s)
- Edward Phillips
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jaime Ponce
- Bariatric Surgery Program, Hamilton Medical Center, Dalton, Georgia
| | - Sunil Bhoyrul
- Bariatric Surgery, Scripps Memorial Hospital, La Jolla, California
| | - Scott A Cunneen
- Bariatric Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eddie Gomez
- General Surgery, Jackson South Hospital, Miami, Florida
| | - Moises Jacobs
- Gastric Sleeve Center, Jackson South Hospital, Miami, Florida
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McCarty TR, Sharma P, Lange A, Ngu JN, Davis A, Njei B. Safety of Bariatric Surgery in Morbidly Obese Patients with Human Immunodeficiency Virus: A Nationwide Inpatient Sample Analysis, 2004-2014. Bariatr Surg Pract Patient Care 2020; 15:116-123. [PMID: 32939330 DOI: 10.1089/bari.2019.0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Despite rising rates of obesity among human immunodeficiency virus (HIV)-positive individuals, the safety and tolerability of surgery in this population have not been established. The primary aim of this study was to examine the safety of bariatric surgery and rate of in-hospital postoperative complications in morbidly obese patients with HIV. Materials and Methods: The U.S. Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with codiagnoses of morbid obesity and bariatric surgery. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospitalization costs, and multiple categories of complications, including systemic complications, surgical complications, and nutritional and behavioral complications. Results: Among 267,082 patients with discharge diagnoses of morbid obesity and bariatric surgery, 346 (0.13%) were diagnosed with HIV. On multivariable analysis, HIV did not influence in-hospital mortality (p = 0.530). HIV was not associated with increased risk of renal failure (p = 0.274), thromboembolism (p = 0.713), myocardial infarction (p = 0.635), sepsis (p = 0.757), hemorrhage (p = 0.303), or wound infection (p = 0.229). Other measured surgical complications were not significantly different (p > 0.05). Notably, HIV-positive patients had an increased risk for postoperative pneumonia (p = 0.002), pancreatitis (p = 0.049), and thiamine deficiency (p = 0.016). Conclusion: Bariatric surgery among HIV-positive patients appears to be acceptably safe with the risk of postoperative complications comparable with non-HIV patients.
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Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Prabin Sharma
- Department of Gastroenterology and Hepatology, Yale New Haven Health-Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Andrew Lange
- Department of Gastroenterology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Julius N Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashley Davis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
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Wharton S, Kuk JL, Petrova L, Rye PI, Taylor VH, Christensen RAG. Effectiveness of a Community-Based Weight Management Program for Patients Taking Antidepressants and/or Antipsychotics. Obesity (Silver Spring) 2019; 27:1539-1544. [PMID: 31441235 DOI: 10.1002/oby.22567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to compare weight loss (WL) outcomes for patients taking antidepressants and/or antipsychotics with those not taking psychiatric medication. METHODS A total of 17,519 adults enrolled in a lifestyle WL intervention at the Wharton Medical Clinics in Ontario, Canada, were analyzed. Sex-stratified multivariable linear regression analysis was used to examine the association of taking antidepressants, antipsychotics, both, or neither with WL when adjusting for age, initial weight, and treatment time. RESULTS Twenty-three percent of patients were taking at least one psychiatric medication. Patients lost a significant amount of weight (P < 0.0001) regardless of psychiatric medication use. Women taking psychiatric medications lost a similar amount of weight as women who were not (P > 0.05). Conversely, men taking antidepressants lost only slightly less weight than men taking both classes or neither class of psychiatric medication (3.2 ± 0.3 kg vs. 5.6 ± 0.9 kg and 4.3 ± 0.1 kg; P < 0.05). However, taking psychiatric medications that cause weight gain was associated with similar significant decreases in weight as taking medications that are weight neutral or associated with WL for both sexes (P > 0.05). CONCLUSIONS Results of this study suggest that those who participate in a weight management program can lose significant amounts of weight regardless of psychiatric medication use.
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Affiliation(s)
- Sean Wharton
- Wharton Medical Clinic, Toronto, Ontario, Canada
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Jennifer L Kuk
- Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Lana Petrova
- Wharton Medical Clinic, Toronto, Ontario, Canada
| | - Peter I Rye
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie H Taylor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
The use of laparoscopic adjustable gastric banding (LAGB) is on the decline around the world despite the evidence base suggesting that it is a safe, effective and durable short-stay procedure which can be safely revised and is well tolerated by patients when they are appropriately supported. Currently, less than 1% of eligible obese persons are choosing to undergo bariatric surgery. If we are to improve uptake of bariatric surgery we need a raft of therapeutic options, including the LAGB, which sit between the relative impotence of medical therapies and the aggression of stapling procedures. This brief communication discusses what some of the drivers may be that are leading surgeons to abandon the band.
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Affiliation(s)
- Wendy A Brown
- Centre for Obesity Research and Education, Department of Surgery, Alfred Hospital, Monash University, Melbourne, 3004, Australia.
| | - Paul E O'Brien
- Centre for Obesity Research and Education, Department of Surgery, Alfred Hospital, Monash University, Melbourne, 3004, Australia
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Njei B, McCarty TR, Sharma P, Lange A, Najafian N, Ngu JN, Ngomba VE, Echouffo-Tcheugui JB. Bariatric Surgery and Hepatocellular Carcinoma: a Propensity Score-Matched Analysis. Obes Surg 2018; 28:3880-3889. [PMID: 30069863 PMCID: PMC6219901 DOI: 10.1007/s11695-018-3431-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The association between obesity and rising incidence of hepatocellular carcinoma (HCC) in the USA has been documented; however, the role of bariatric surgery remains less clear. AIM To evaluate the cross-sectional association of prior-bariatric surgery and HCC. METHODS The United States Nationwide Inpatient Sample (NIS) database was queried from 2004 to 2014 for discharges with a diagnosis of morbid obesity. Primary outcomes of interest were HCC and in-hospital mortality rate. Secondary outcomes were length of stay and cost. Baseline characteristics were balanced using propensity score matching (PSM). Using Poisson and logistic regressions, adjusted HCC prevalence ratio (PR) and mortality odds ratio (OR) were derived in patients with prior-bariatric surgery compared to those without bariatric surgery. RESULTS Of the 2,881,414 patients included in our study, 267,082 (9.3%) underwent bariatric surgery. From 2004 to 2014, there was a threefold increase in age-adjusted prevalence of HCC from 27 per 100,000 to 72 per 100,000 (PTrend < 0.001). After PSM, 230,956 patients with prior-bariatric surgery were matched with 230,956 patients without bariatric surgery. Prior-bariatric surgery was associated with lower prevalence of HCC (PR 0.11; 95% CI, 0.03-0.48; P < 0.001). In-hospital mortality was also lower for patients with surgery (OR 0.22; 95% CI, 0.20-0.26; P < 0.001). The occurrence of HCC added $18,840 extra cost, increased mean length of stay by 2 (95% CI; 1-3) days, and increased risk of death by 65% (aOR 1.65; 95% CI 1.18-2.29). CONCLUSION In this nationwide study of morbidly obese patients, prior-bariatric surgery was associated with a lower prevalence of HCC and lower in-patient mortality.
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Affiliation(s)
- Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.
| | - Thomas R McCarty
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Prabin Sharma
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Andrew Lange
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Nilofar Najafian
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius N Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Valmy E Ngomba
- Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY, USA
| | - Justin B Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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7
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Cronk DR, Martin MJ. Comment on: Roux-En-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study. Surg Obes Relat Dis 2018; 14:1667-1669. [PMID: 30245035 DOI: 10.1016/j.soard.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Daniel R Cronk
- Erlanger Bariatric and Metabolic Surgery Center, Chattanooga, Tennessee
| | - Matthew J Martin
- Metabolic and Bariatric Surgery Service, Department of Surgery, Madigan Army Medical Center, Tacoma, Washington
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8
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Sharma P, McCarty TR, Ngu JN, O’Donnell M, Njei B. Impact of bariatric surgery in patients with HIV infection: a nationwide inpatient sample analysis, 2004-2014. AIDS 2018; 32:1959-1965. [PMID: 30157083 PMCID: PMC6126912 DOI: 10.1097/qad.0000000000001915] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite rising rates of obesity among patients with HIV, the potential role for weight loss surgery in this population remains less clear. The primary aim of this study was to evaluate the role of bariatric surgery on relevant clinical outcomes among hospitalized obese patients with HIV. DESIGN Retrospective analysis using the United States Nationwide Inpatient Sample database from 2004 to 2014. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared with those without bariatric surgery. PATIENTS Patients with discharge co-diagnoses of morbid obesity and HIV. INTERVENTION Bariatric surgery. MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality. Secondary outcomes included renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, gastrointestinal strictures, micronutrient deficiency, length of stay, and hospitalization costs. RESULTS Among 7803 patients with discharge diagnoses of HIV and morbid obesity, 346 patients (4.4%) had bariatric surgery. The proportion of bariatric surgery in obese patients with HIV initially declined by -0.10% per year from 2004 to 2009 (Ptrend < 0.05), then increased at an annual rate of +0.33% from 2012 to 2014 (Ptrend < 0.05). On multivariable analysis, bariatric surgery did not influence mortality (P = 0.98). Bariatric surgery was associated with decreased risk for renal failure, respiratory failure, and sepsis (all P < 0.001). However, bariatric surgery increased the risk for postoperative strictures (IRR 2.5; 95% CI 1.5-4.5; P = 0.001). CONCLUSION Though initially underutilized, bariatric surgery in morbidly obese HIV patients is increasing and appears to be well tolerated and effective in significantly reducing life-threatening morbidity.
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Affiliation(s)
- Prabin Sharma
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Thomas R. McCarty
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Julius N. Ngu
- Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Michael O’Donnell
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Abstract
Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.
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Khan S, Rock K, Baskara A, Qu W, Nazzal M, Ortiz J. Trends in bariatric surgery from 2008 to 2012. Am J Surg 2015; 211:1041-6. [PMID: 26762828 DOI: 10.1016/j.amjsurg.2015.10.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity is a global epidemic that has been increasing in prevalence. The only treatment method for durable weight loss is bariatric surgery. The aim of this study was to observe trends in usage and outcomes of bariatric operations used in the United States from 2008 to 2012. METHODS Analysis was performed on bariatric surgery admissions from 2008 to 2012 based off of the Nationwide Inpatient Sample database. Data were selected from using International Classification of Disease, 9th Revision codes correlating to bariatric procedures for the purpose of obesity. Annual estimates and trends were reviewed for patient demographics, procedure type, patient outcomes, and length of stay (LOS). RESULTS A total of 598,756 bariatric procedures were examined. Laparoscopic gastric bypass was the most commonly used surgical method in 2008 (58.2%). A decreasing trend in its use, and the use of laparoscopic gastric banding (LGB), was equipoised with increasing use of laparoscopic sleeve gastrectomy (LSG). Use of LSG accounted for 8.2% of procedures in 2011 and 39.6% in 2012. LGB and LSG had the lowest rates of complications, in-hospital morbidity and mortality, and the shortest LOS whereas open bypass and duodenal switch had the highest rates of complications, in-hospital morbidity and mortality, and longest LOSs. Overall rates of venous thromboembolism increased from .08% in 2008 to .215% in 2012. Respiratory complications decreased from 6.1% to 3.9%. There were no observed trends in rates of renal complications, visceral injury, bleeding, and infections. In-hospital morbidity decreased, whereas mortality rates were stable at .1%. CONCLUSIONS The utilization of bariatric procedures has reached a plateau in the United States. Changes in the composition of procedural types suggest that LSG has become a popular alternative to gastric bypass and LGB.
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Affiliation(s)
- Sohaib Khan
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Kathryn Rock
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Arunkumar Baskara
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Weikai Qu
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Munier Nazzal
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA
| | - Jorge Ortiz
- The University of Toledo Medical Centerm, 3000 Arlington Ave, Toledo, OH 43614, USA.
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Weight Loss After Laparoscopic Band-to-Bypass Revision Compared With Primary Gastric Bypass. Surg Laparosc Endosc Percutan Tech 2015; 25:258-61. [DOI: 10.1097/sle.0000000000000156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. Remission of type 2 diabetes: is bariatric surgery ready for prime time? Endocrine 2015; 48:417-21. [PMID: 25355307 DOI: 10.1007/s12020-014-0463-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/21/2014] [Indexed: 02/06/2023]
Abstract
There is mounting evidence that bariatric surgery leads to higher remission rates of type 2 diabetes than any conventional medical treatment, lifestyle intervention, or medically supervised weight loss program. Although remission rates of type 2 diabetes may be as high as 66.7 % after gastric bypass and 28.6 % after gastric band, very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Hence, trials that directly compare bariatric surgery procedures with medical and lifestyle intervention for patients with type 2 diabetes are the best candidate for assessing the role of bariatric surgery in diabetes remission. Three randomized controlled trials and one prospective study have so far been published comparing the effect of Roux-en-Y gastric bypass (RYGB) procedure against optimal medical therapy, with a follow-up ranging from 1 to 6 years: the percentage of diabetic patients in remission (hemoglobin A1C < 6-6.5 % without medications) ranged from 38 to 75 % at the end of follow-up. Intensive lifestyle intervention is also superior to conventional treatment for inducing remission of type 2 diabetes, with remission rates of type 2 diabetes between 10 and 15 % at 1 year of follow-up. Bariatric surgical procedures, especially RYGB, are more effective at inducing initial type 2 diabetes remission in obese patients, but more information is needed about the long-term durability of comorbidity control and complications after bariatric procedures. In the meantime, all efforts should be directed toward primary prevention of type 2 diabetes, given the encouraging results of lifestyle intervention studies.
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Affiliation(s)
- Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy,
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13
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Hopkins JC, Howes N, Chalmers K, Savovic J, Whale K, Coulman KD, Welbourn R, Whistance RN, Andrews RC, Byrne JP, Mahon D, Blazeby JM. Outcome reporting in bariatric surgery: an in-depth analysis to inform the development of a core outcome set, the BARIACT Study. Obes Rev 2015; 16:88-106. [PMID: 25442513 DOI: 10.1111/obr.12240] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 12/19/2022]
Abstract
Outcome reporting in bariatric surgery needs a core outcome set (COS), an agreed minimum set of outcomes reported in all studies of a particular condition. The aim of this study was to summarize outcome reporting in bariatric surgery to inform the development of a COS. Outcomes reported in randomized controlled trials (RCTs) and large non-randomized studies identified by a systematic review were listed verbatim and categorized into domains, scrutinizing the frequency of outcome reporting and uniformity of definitions. Ninety studies (39 RCTs) identified 1,088 separate outcomes, grouped into nine domains with most (n = 920, 85%) reported only once. The largest outcome domain was 'surgical complications', and overall, 42% of outcomes corresponded to a theme of 'adverse events'. Only a quarter of outcomes were defined, and where provided definitions, which were often contradictory. Percentage of excess weight loss was the main study outcome in 49 studies, but nearly 40% of weight loss outcomes were heterogeneous, thus not comparable. Outcomes of diverse bariatric operations focus largely on adverse events. Reporting is inconsistent and ill-defined, limiting interpretation and comparison of published studies. Thus, we propose and are developing a COS for the surgical treatment of severe and complex obesity.
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Affiliation(s)
- J C Hopkins
- University Surgery Unit, University Hospitals Southampton, Southampton, UK
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Puzziferri N, Roshek TB, Mayo HG, Gallagher R, Belle SH, Livingston EH. Long-term follow-up after bariatric surgery: a systematic review. JAMA 2014; 312:934-42. [PMID: 25182102 PMCID: PMC4409000 DOI: 10.1001/jama.2014.10706] [Citation(s) in RCA: 559] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults. EVIDENCE REVIEW MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size-weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size-weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass ( n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections.
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Affiliation(s)
- Nancy Puzziferri
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas
| | - Thomas B Roshek
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Helen G Mayo
- University of Texas Southwestern Medical Center Library, Dallas
| | - Ryan Gallagher
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Steven H Belle
- Departments of Epidemiology and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward H Livingston
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas2Department of Surgery, North Texas Veterans Administration Healthcare System, Dallas5Department of Biomedical Engineering, University of Texas-Arlington, Arlington6Deputy Edito
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Obeid NR, Deese-Laurent S, Schwack BF, Youn H, Kurian MS, Ren-Fielding C, Fielding GA. Location and number of sutures placed for hiatal hernia repair during laparoscopic adjustable gastric banding: does it matter? Surg Endosc 2013; 28:58-64. [PMID: 24061619 DOI: 10.1007/s00464-013-3161-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/31/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been demonstrated that hiatal hernia repair (HHR) during laparoscopic adjustable gastric banding (LAGB) decreases the rate of reoperation. However, the technical aspects (location and number of sutures) are not standardized. It is unknown whether such technical details are associated with differing rates of reoperation for band-related problems. METHODS A retrospective analysis was performed from a single institution, including 2,301 patients undergoing LAGB with HHR from July 1, 2007 to December 31, 2011. Independent variables were number and location of sutures. Data collected included demographics, operating room (OR) time, length of stay (LOS), follow-up time, postoperative BMI/%EWL, and rates of readmission/reoperation. Statistical analyses included ANOVA and Chi squared tests. Kaplan-Meier, log-rank, and Cox regression tests were used for follow-up data and reoperation rates, in order to account for differential length of follow-up and confounding variables. RESULTS There was no difference in length of follow-up among all groups. The majority of patients had one suture (range 1-6; 55 %). Patients with fewer sutures had shorter OR time (1 suture 45 min vs. 4+ sutures 56 min, p < 0.0001). LOS, 30-day readmission, band-related reoperation, and postop BMI/%EWL were not statistically significant. Anterior suture placement (vs. posterior vs. both) was most common (61 %). OR time was shorter in those with anterior suture (41 min vs. posterior 56 min vs. both 59 min, p < 0.0001). Patients with posterior suture had a longer LOS (84 % 1 day vs. anterior 74 % 1 day vs. both 74 % 1 day, p < 0.0001). There was no difference in 30-day readmission, band-related reoperation, and postoperative BMI/%EWL. CONCLUSIONS Patients with fewer or anterior sutures have shorter OR times. However, 30-day readmission, band-related reoperation, and postoperative weight loss were unaffected by number or location of suture. The technical aspects of HHR did not appear to be associated with readmission or reoperation, and therefore a standardized approach may not be necessary.
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Affiliation(s)
- Nabeel R Obeid
- Department of Surgery, New York University Medical Center, 530 First Ave., Suite 10S, New York, NY, 10016, USA,
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Keogh JB, Brancatisano A, Taylor SF, McDonald F, Brancatisano R, Hamdorf JM, Chisholm J, Kow L, Wahlroos S, Ryan B, Toouli J. Evaluation of the Swedish adjustable gastric band VC (SAGB-VC) in an Australian population: early results. Can J Surg 2013. [PMID: 23187036 DOI: 10.1503/cjs.011511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The Swedish adjustable gastric band VC (SAGB-VC) has been in use in Australia since 2007. We evaluated its efficacy and safety. METHODS We retrospectively analyzed the prospective clinical data of patients who received the implant between November 2007 and June 2009 at 3 Australian bariatric centres. RESULTS In all, 1176 patients (mean age 45.9 [standard deviation (SD) 12.3] yr, mean body mass index 43.4 [SD 7.6]) received the SAGB-VC. At a mean follow-up of 11 (SD 3) months, weight reduced by a mean of 18.4 (SD 11.1) kg with an excess weight loss of 37.8% (SD 19.9%). Body mass index decreased (from mean 43.4 [SD 7.7] to mean 36.7 [SD 6.5], p < 0.001). Type 2 diabetes (T2DM) was reported in 167 patients and hypertension in 373. Improvement occurred in 73.5% of patients with T2DM and 31% with hypertension, with patient-reported reduction or cessation of medication. Metabolic syndrome indices improved during follow-up: high-density lipoprotein cholesterol (mean 1.3 [SD 0.3] v. mean 1.4 [SD 0.3] mmol/L, p < 0.001), triglycerides (mean 1.6 [SD 0.8] v. mean 1.3 [SD 0.7] mmol/L, p < 0.001), waist circumference (men 141 [SD 103] to 121 [SD 15] cm, women 117 [SD 14] to 105 [SD 14] cm, both p < 0.001), C-reactive protein (90.5 [SD 75.2] v. 53.3 [SD 61.9] nmol/L, p < 0.001). The complication rate was 4.2%. CONCLUSION The SAGB-VC is safe and effective for treating obesity and its comorbidities. The results are reproducible in separate Australian centres and consistent with published literature.
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Affiliation(s)
- Jennifer B Keogh
- The Australian Institute of Weight Control, Adelaide, Australia.
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Cunneen SA, Brathwaite CEM, Joyce C, Gersin K, Kim K, Schram JL, Wilson EB, Schwiers M, Gutierrez M. Clinical outcomes of the Realize Adjustable Gastric Band-C at 2 years in a United States population. Surg Obes Relat Dis 2013; 9:885-93. [PMID: 23642493 DOI: 10.1016/j.soard.2013.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/21/2013] [Accepted: 02/26/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2008, the Realize Band (RB) adopted a precurved design (RB-C). We present 2-year outcomes data from the first multiinstitutional study of RB-C. The objective of this study was to analyze weight loss and safety data from bariatric practices in the United States, including academic, nonacademic, public, and private. METHODS The study included adult RB-C patients with a preoperative body mass index (BMI)≥40 kg/m(2) or >35 kg/m(2) with co-morbidity. Exclusions included RB-C's label contraindications for use. Outcomes parameters were percent excess weight loss (%EWL), BMI change, number and volume of band adjustments, and adverse events. RESULTS A total of 231 patients met inclusion/exclusion criteria. Of these, 161 had 24-month data available. Mean %EWL was 44.4%±26.9% (P<.0001). BMI decreased from 44.1±5.7 kg/m(2) to 35.3±6.9 kg/m(2) (P<.0001). Percent EWL varied by preoperative BMI (P = .0002), bariatric practice (P<.0001), aftercare frequency (P = .0004), and band fill frequency (P = .0271), but %EWL was not influenced by gender, race, or age (P>.20 each). Adverse events were dysphagia (21.2%), gastroesophageal reflux (21.6%), and vomiting (30.7%). Incidence of pouch dilation, esophageal dilation, and slippage was ≤1%. Revisions (2.2%) were for unbuckled band, tube kinking, slippage, and suspected band leak (1 each). No erosions, explants, or mortality were reported. CONCLUSION RB-C appears to be as well tolerated and effective as the first generation RB for weight loss. The near 45% EWL at 2 years is consistent with other high-quality publications on the RB. Preoperative BMI and frequency of postoperative care, including frequency of band fills, influence %EWL. Significant weight loss is achievable with RB-C despite variable postoperative management practices. The low morbidity and the absence of mortality at 24 months reflect positively on the RB-C characteristics.
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Affiliation(s)
- Scott A Cunneen
- Cedars-Sinai Medical Center, Weight Loss Center, Los Angeles, California
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18
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Ribaric G, Buchwald JN, d'Orsay G, Daoud F. 3-year real-world outcomes with the Swedish adjustable gastric band™ in France. Obes Surg 2013; 23:184-96. [PMID: 23054572 PMCID: PMC3560940 DOI: 10.1007/s11695-012-0765-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The study objective was to ascertain outcomes with the Swedish adjustable gastric band (SAGB) on an intention-to-treat basis in multiple centers across the French social health insurance system. SAGB results at 3-year follow-up are reported. The noncomparative, observational, prospective, consecutive cohort study design sought a 500-patient minimum recruitment geographically representative of continental France. Safety (adverse events [AEs], device-related morbidity, and mortality) and effectiveness (change in body mass index [BMI, kilograms per square meter], percentage excess weight loss, comorbidities, quality of life [QoL]) were assessed. Adjustable gastric band survival was calculated. Thirty-one surgeons in 28 multidisciplinary teams/sites enrolled patients between September 2, 2007 and April 30, 2008. SAGB was successfully implanted in 517 patients: 88.0 % female; mean age, 37.5 years; obesity duration, 15.3 years (baseline: mean BMI, 41.0; comorbidities, 773 in 74.3 % of patients; Bariatric Analysis and Reporting Outcome System (BAROS), 1.4; EuroQoL 5-Dimensions (EQ-5D), 0.61; EuroQoL-visual analog scale (EQ-VAS), 52.3). At 3 years: BMI, 32.2 (mean change, -9.0; p < 0.0001); excess weight loss, 47.4 %; comorbidities, 161 in 27.2 %; BAROS, 3.6 (+2.2, p < 0.0001); EQ-5D, 0.84 (+0.22, p < 0.0001); EQ-VAS, 73.4 (+21.4, p < 0.0001). SAGB-induced weight loss was associated with substantially improved QoL. One death occurred and was unrelated to the treatment. No AE was reported in 68.3 % of patients, and no confirmed device-related AE in 77.0 %. Overall AE rate was 0.19 per patient year. Device retention was 87.0 %. Analysis of patients lost to follow-up showed a nonsignificant effect on overall study results. In a prospective, consecutive cohort, "real-world", nationwide study, the Swedish Adjustable Gastric Band was found safe and effective at 3-year follow-up.
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Affiliation(s)
- G Ribaric
- Ethicon Endo-Surgery (Europe), European Surgical Institute, Hamburg, Germany.
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Yin DP, Boyd KL, Williams PE, Abumrad NN, Wasserman DH. Mouse Models of Bariatric Surgery. CURRENT PROTOCOLS IN MOUSE BIOLOGY 2012; 2012:mo120087. [PMID: 25364628 PMCID: PMC4214370 DOI: 10.1002/9780470942390.mo120087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Morbid obesity is linked to increased incidences of glucose intolerance, Type 2 diabetes mellitus, cardiovascular diseases, various forms of liver disease, and specific forms of cancer. Treatment of obesity by lifestyle modifications (i.e. changes in diet and exercise) and drug therapy is generally ineffective. Bariatric surgery is currently the most effective means of treating obesity and related disorders. We as well as others have developed surgical procedures for application to genetic mouse models that mimic an array of human bariatric surgical procedures used in the treatment of obesity. The application of bariatric surgery to genetic mouse models will broaden our understanding of the role of the gut in metabolic disease. Models that have been developed include gastric banding, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) with a complete exclusion of the stomach, duodenal-jejunal bypass (DJB) and biliopancreatic diversion (BPD). The detailed methods of these procedures are provided.
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Affiliation(s)
- Deng Ping Yin
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Mouse Metabolic Phenotyping Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kelli L. Boyd
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Mouse Metabolic Phenotyping Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Phillip E. Williams
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Diabetes Research Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Naji N. Abumrad
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Diabetes Research Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David H. Wasserman
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Mouse Metabolic Phenotyping Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Diabetes Research Training Center, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Cywes R, Bhoyrul S, Billy H, Ponce J, Okerson T, Oefelein MG. Interim results at 48 weeks of LAP-BAND AP experience (APEX) study: prospective, multicenter, open-label longitudinal patient observational study. Surg Obes Relat Dis 2012; 8:741-6. [DOI: 10.1016/j.soard.2011.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/18/2011] [Accepted: 09/07/2011] [Indexed: 02/05/2023]
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Valle E, Luu MB, Autajay K, Francescatti AB, Fogg LF, Myers JA. Frequency of Adjustments and Weight Loss after Laparoscopic Adjustable Gastric Banding. Obes Surg 2012; 22:1880-3. [DOI: 10.1007/s11695-012-0748-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Cunneen SA, Brathwaite CE, Joyce C, Gersin K, Kim K, Schram JL, Wilson EB, Rodriguez CE, Gutierrez M. Clinical outcomes of the REALIZE adjustable gastric band-C at one year in a U.S. population. Surg Obes Relat Dis 2012; 8:288-95. [DOI: 10.1016/j.soard.2011.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/07/2011] [Accepted: 03/11/2011] [Indexed: 11/29/2022]
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Assessment of different bariatric surgeries in the treatment of obesity and insulin resistance in mice. Ann Surg 2011; 254:73-82. [PMID: 21522012 DOI: 10.1097/sla.0b013e3182197035] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the effects of different bariatric surgical procedures on the treatment of obesity and insulin resistance in high fat diet-induced obese (DIO) mice. BACKGROUND Bariatric surgery is currently considered the most effective treatment for morbid obesity and its comorbidities; however, a systematic study of their mechanisms is still lacking. METHODS We developed bariatric surgery models, including gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), modified RYGB (mRYGB) and biliopancreatic diversion (BPD), in DIO mice. Body weight, body fat and lean mass, liver steatosis, glucose tolerance and pancreatic beta cell function were examined. RESULTS All bariatric surgeries resulted in significant weight loss, reduced body fat and improved glucose tolerance in the short term (4 weeks), compared with mice with sham surgery. Of the bariatric surgery models, sleeve gastrectomy and mRYGB had higher success rates and lower mortalities and represent reliable restrictive and gastrointestinal (GI) bypass mouse bariatric surgery models, respectively. In the long term, the GI bypass procedure produced more profound weight loss, significant improvement of glucose tolerance and liver steatosis than the restrictive procedure. DIO mice had increased insulin promoter activity, suggesting overactivation of pancreatic beta cells, which was regulated by the mRYGB procedure. Compared with the restrictive procedure, the GI bypass procedure showed more severe symptoms of malnutrition following bariatric surgery. DISCUSSIONS Both restrictive and GI bypass procedures provide positive effects on weight loss, fat composition, liver steatosis and glucose tolerance; however, in the long term, the GI bypass shows better results than restrictive procedures.
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Ponce J, Lindsey B, Pritchett S, Bleech M, Marlowe K. New adjustable gastric bands available in the United States: a comparative study. Surg Obes Relat Dis 2011; 7:74-9. [DOI: 10.1016/j.soard.2010.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 06/18/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022]
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Adjustable gastric banding outcomes with and without gastrogastric imbrication sutures: a randomized controlled trial. Surg Obes Relat Dis 2011; 7:23-31. [DOI: 10.1016/j.soard.2010.09.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 07/29/2010] [Accepted: 09/25/2010] [Indexed: 02/05/2023]
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The “O” Sign, a Simple and Helpful Tool in the Diagnosis of Laparoscopic Adjustable Gastric Band Slippage. AJR Am J Roentgenol 2010; 195:137-41. [DOI: 10.2214/ajr.09.3933] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fried M, Ghosh SK, Gutierrez M, Dolezalova K, Widenhouse T, Gayoso G. The Relationship Between Esophageal Peristalsis and In Vivo Intraband Pressure Measurements in Gastric Banding Patients. Obes Surg 2010; 20:1102-9. [DOI: 10.1007/s11695-010-0182-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Leslie DB, Kellogg TA, Ikramuddin S. The surgical approach to management of pediatric obesity: when to refer and what to expect. Rev Endocr Metab Disord 2009; 10:215-29. [PMID: 19728099 DOI: 10.1007/s11154-009-9112-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Weight loss surgery is recommended for adult patients with morbid obesity and has been used on a case by case basis in the pediatric population. Surgery, however,is just a tool added to the two mainstays of therapy for obesity: 1.) controlled dietary intake and 2.) increases inactivity and exercise behaviors. For the pediatric population,the health consequences of obesity are profound with increased cardiovascular risk during adolescence and increased mortality in adulthood. Currently accepted guidelines for weight loss surgery referral use BMI cut points that are the same as for adults: BMI > or = 35 kg/m(2) and serious comorbidities of obesity or BMI > or = 40 kg/m(2) with minor comorbidities of obesity. A multidisciplinary approach to weight management must be utilized, and a lifetime of follow-up must be addressed. The most commonly performed operations for obesity are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). LAGB is safer and does not permanently alter gastrointestinal continuity; however, LAGB is not currently approved for implantation in adolescent patients. LRYGB involves a complex, permanent altering of the gastrointestinal anatomy and is associated with more complications around the time of surgery and is not subject to FDA approval because there is no associated implant. In each operation, appetite is suppressed by construction of a virtual (LAGB) or real(LRYGB) pouch. The dynamics and speed of appetite suppression and, consequently, weight loss are typically different for each operation though longer-term outcomes may be similar. Short- and long-term risks of surgery must be carefully weighed against the benefits of the associated weight loss for each patient. The patient must be empowered to understand the importance of lifestyle and behavior in achieving long-term health.
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Affiliation(s)
- Daniel B Leslie
- Department of Surgery, University of Minnesota Medical School, 420 Delaware Street SE, MMC 290, Minneapolis, MN 55455, USA.
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Toouli J, Kow L, Ramos AC, Aigner F, Pattyn P, Galvão-Neto MP, Miller KA, Romano S, Gutierrez M, Jokinen J. International multicenter study of safety and effectiveness of Swedish Adjustable Gastric Band in 1-, 3-, and 5-year follow-up cohorts. Surg Obes Relat Dis 2009; 5:598-609. [PMID: 19656740 DOI: 10.1016/j.soard.2009.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/11/2009] [Accepted: 04/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND No long-term, international, multicenter studies of the effectiveness and safety of the SAGB in morbid obesity have been previously published. The objective of this study was to assess the effectiveness and safety of the Swedish Adjustable Gastric Band (SAGB) at 6 bariatric centers in Australia, Europe, and Brazil, with < or =5 years of follow-up; the effect on patient covariates; and changes in co-morbidity. METHODS A 2-phase study design was used, involving both retrospective and prospective data. SAGB was implanted by way of the pars flaccida 1, 3, and 5 years previously. The retrospective phase entailed a review of the records. The prospective phase included a subset of eligible patients who agreed to undergo additional clinical assessments. The percentage of excess weight loss (%EWL), patient level predictors, change in co-morbidities, and complications were analyzed. RESULTS A total of 481 patients in 3 mutually exclusive follow-up cohorts (1 yr, n = 200; 3 yr, n = 184; 5 yr, n = 97) participated in the present study. Of these 481 patients, 339 (1 yr, n = 139; 3 yr, n = 131; 5 yr, n = 69) underwent prospective evaluations. The mean %EWL was 43.5% + or - 21.8%, 57.7% + or - 25.9%, and 49.8% + or - 27.6% and the mean change in body mass index was -7.64, -10.75, and -9.52 in the 1-, 3-, and 5-year cohorts, respectively (P <.001). Gender and age did not predict the %EWL; however, a greater preoperative body mass index was inversely related to the %EWL. Longer postimplantation times were associated with greater improvement in co-morbidities and with greater frequencies of reoperation. Fewer than 15% of the patients in the 5-year cohort had undergone band removal and 10% required band revisions. No fatal or life-threatening complications occurred. CONCLUSION SAGB is safe and effective in inducing weight loss and improvement of co-morbidities in morbidly obese patients at international bariatric centers at 1, 3, and 5 years postoperatively.
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Affiliation(s)
- James Toouli
- Department of Surgery, Flinders University of South Australia, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia
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