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Mala T. Abdominal pain: A foe in the orchestra of improving symptoms after Roux-en-Y gastric bypass surgery. Clin Obes 2023; 13:e12582. [PMID: 36727223 DOI: 10.1111/cob.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/31/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Tom Mala
- Deparment of Pediatric and Gastrointestinal Surgery, Center for Morbid Obesity and Bariatric Surgery, Oslo University Hospital, The University of Oslo
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Chahal-Kummen M, Våge V, Kristinsson JA, Mala T. Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis 2023; 19:819-829. [PMID: 36870870 DOI: 10.1016/j.soard.2023.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic abdominal pain (CAP) after bariatric surgery is not extensively explored and may impact the postoperative outcomes. OBJECTIVE To compare the prevalence of patient-reported chronic abdominal pain (CAP) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Secondarily, we compared other abdominal and psychological symptoms and quality of life (QoL). Preoperative predictors of postoperative CAP were also explored. SETTING Tertiary referral centers for bariatric surgery in Norway. METHODS Analyses of 2 separate prospective longitudinal cohort studies evaluating CAP, abdominal and psychological symptoms and QoL before and 2 years after RYGB and SG. RESULTS Follow-ups were attended by 416 patients (85.8%), 300/416 (72.1%) were females and 209/416 (50.2%) were RYGB procedures. At follow-up, the mean age was 44.9 (10.0) years, BMI 29.5 (5.4) kg/m2, and total weight loss 31.6 (10.3) %. The prevalence of CAP was 28/236 (11.9%) before and 60/209 (28.7%) after RYGB (P < .001) and 32/223 (14.3%) before and 50/186 (26.9%) after SG (P < .001). Gastrointestinal symptom rating scale scores showed greater deterioration of diarrhea and indigestion after RYGB and reflux after SG. The improvement in depression symptoms was greater after SG, as well as several QoL scores improved more after SG. Patients with CAP after RYGB experienced deterioration in several QoL scores, while these scores improved in patients with CAP after SG. Preoperative hypertension, bothersome reflux symptoms, and CAP predicted postoperative CAP. CONCLUSIONS The prevalence of CAP increased comparably after RYGB and SG, with worsening of gastroesophageal reflux after SG and greater deterioration of diarrhea and indigestion after RYGB. In patients with CAP at follow-up, several QoL scores improved more after SG than RYGB.
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Affiliation(s)
- Monica Chahal-Kummen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jon A Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine and Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Blom-Høgestøl IK, Aasbrenn M, Kvalem IL, Eribe I, Kristinsson JA, Mala T. Pain sensitivity after Roux-en-Y gastric bypass - associations with chronic abdominal pain and psychosocial aspects. Scand J Pain 2023; 23:511-517. [PMID: 37306001 DOI: 10.1515/sjpain-2023-0005] [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: 01/03/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aims of this study were to investigate modifications in pain sensitivity after RYGB and to explore associations between pain sensitivity and weight loss, chronic abdominal pain, total body pain, anxiety, depression, and pain catastrophizing. METHODS In total, 163 patients with obesity were examined with a cold pressor test for pain sensitivity before and two years after RYGB. Two aspects of pain sensitivity were registered: Pain intensity (numeric rating scale, range 0-10) and pain tolerance (seconds). Associations between pain sensitivity and the explanatory variables were assessed with linear regression. RESULTS Two years after RYGB the pain intensity increased (mean ± SD 0.64 ± 1.9 score units, p<0.001). Pain tolerance decreased (7.2 ± 32.4 s, p=0.005). A larger reduction in body mass index was associated with increased pain intensity, β=-0.090 (95 % CI -0.15 to -0.031, p=0.003), and decreased pain tolerance β=1.1 (95 % CI 0.95 to 2.2, p=0.03). Before surgery, participants with chronic abdominal pain reported 1.2 ± 0.5 higher pain intensity (p=0.02) and had 19.2 ± 9.3 s lower pain tolerance (p=0.04) than those without abdominal pain. No differences in pain sensitivity were observed between participants who did or did not develop chronic abdominal pain after RYGB. Pain sensitivity was associated with symptoms of anxiety but not with pain catastrophizing, depression or bodily pain. CONCLUSIONS The pain sensitivity increased after RYGB and was associated with larger weight loss and anxiety symptoms. Changes in pain sensitivity were not associated with development of chronic abdominal pain after RYGB in our study.
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Affiliation(s)
- Ingvild K Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Martin Aasbrenn
- Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Inger Eribe
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Jon A Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Department of Gastrointestinal Surgery and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
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Hartman TJ, Nie JW, Zheng E, Oyetayo OO, MacGregor KR, Singh K. Poor mental health scores correlate with inferior outcomes following minimally invasive transforaminal lumbar interbody fusion. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05557-y. [PMID: 37071181 DOI: 10.1007/s00701-023-05557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/21/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Limited spine literature has studied the strength of association of mental health with other outcomes at time of survey collection. We aim to evaluate the degree to which mental health correlates with outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at several postoperative periods. METHODS Patients having undergone elective MIS-TLIF were searched within a retrospective single-surgeon database. Five hundred eighty-five patients were included. Patient-reported outcomes (PROs) including Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), 12-item Short Form Physical Component Score (SF-12 PCS) and Mental Component Score (SF-12 MCS), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) scores were collected preoperatively and at 6-week, 12-week, 6-month, 1-year, and 2-year periods. Pearson's correlation tests were used to evaluate the association between both SF-12 MCS and PHQ-9 scores to other PROs at each period. RESULTS SF-12 MCS correlated with PROMIS PF (|r|= 0.308-0.531), SF-12 PCS (|r|= 0.207-0.328), VAS back (|r|= 0.279-0.474), VAS leg (|r|= 0.178-0.395), and ODI (|r|= 0.450-0.538) at all time points (P ≤ 0.021, all) except for preoperative SF-12 PCS and 1-year VAS leg. PHQ-9 correlated with PROMIS PF (|r|= 0.366-0.701), SF-12 PCS (|r|= 0.305-0.568), VAS back (|r|= 0.362-0.714), VAS leg (|r|= 0.319-0.694), and ODI (|r|= 0.613-0.784) at all periods (P < 0.001, all). CONCLUSION Poor mental health scores were correlated with lower physical function, elevated pain scores, and higher disability. PHQ-9 scores demonstrated stronger correlation in all relationships compared to SF-12 MCS. Optimization of patient mental health may lead to improved patient perception regarding function, pain, and disability following MIS-TLIF.
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Affiliation(s)
- Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Woods R, Moga AM, Ribeiro PAB, Stojanovic J, Lavoie KL, Bacon SL. Evolution of depressive symptoms from before to 24 months after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2023; 24:e13557. [PMID: 36823768 DOI: 10.1111/obr.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/16/2022] [Accepted: 01/22/2023] [Indexed: 02/25/2023]
Abstract
AIMS Depression after bariatric surgery can lead to suboptimal health outcomes. However, it is unclear how depressive symptoms evolve over the 24 months after surgery. We determined the extent depressive symptoms changed up to 24 months after bariatric surgery and how this was impacted by measurement tool and surgical procedure. METHODS We conducted a systematic review and meta-analysis, searching five databases from database inception to June 2021 for studies that prospectively measured depressive symptoms before and up to 24 months after bariatric surgery. Change scores were converted to Hedge's g, and analyses were performed using mixed-effects models. Subgroup analyses examined differences across time of follow-up, measurement tool, and surgical procedure. FINDINGS Forty-six studies met inclusion criteria (32,342 patients). Meta-analysis indicated a postsurgical reduction in depressive symptom scores that were significant (large effect, g = 0.804; 95% CI: 0.73-0.88, I2 = 95.7%). Subgroup analyses found that symptom reductions did not differ between the timing of follow-up periods, measurement tool, and surgical procedure. CONCLUSIONS Depressive symptom scores reduced substantially following surgery; comparable decreases occurred 6 through 24 months after surgery. These findings can help inform practitioners of the typical evolution of depressive symptoms following surgery and where deviations from this may require additional intervention.
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Affiliation(s)
- Robbie Woods
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Ana M Moga
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, McGill University Health Center-Research Institute, Montreal, Quebec, Canada
| | - Paula A B Ribeiro
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jovana Stojanovic
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, University of Quebec at Montréal, Montreal, Quebec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Quebec, Canada
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Lundin Kvalem I, Gabrielsen L, Eribe I, Kristinsson JA, Mala T. Predicting satisfaction with outcome and follow-up care 5 years after bariatric surgery: A prospective evaluation. Obes Sci Pract 2022; 8:595-602. [PMID: 36238221 PMCID: PMC9535663 DOI: 10.1002/osp4.594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Patient satisfaction is viewed as essential for a successful outcome of bariatric surgery. Few studies have explored long-term satisfaction prospectively. This study aimed to examine pre- and post-surgery predictors for satisfaction with follow-up care, and change in outcome satisfaction from one to 5 years after bariatric surgery. Methods A sample of 210 participants was recruited from a single treatment center. Self-reported and medical record data regarding mental and somatic health, body image, follow-up attendance, and weight loss were obtained before, 1 year, and 5 years after surgery. Results Over 90% of the participants were satisfied with the results and treatment 1 year after surgery, while 69% had their outcome expectations fulfilled and 62% were satisfied with the follow-up 5 years after surgery. A shift from initial satisfaction to unfulfillment of expectations was predicted by baseline body dissatisfaction, greater percentage of weight regain after initial weight loss, and more discomfort from somatic symptoms 5 years after surgery. In addition to symptom discomfort, worry about surgery predicted satisfaction with follow-up care. Conclusion At 5 years, one-fifth of those initially satisfied reported that bariatric surgery had failed to meet their expectations. This suggests that outcome expectations related to weight loss, somatic symptoms, and body image need to be addressed both before and after bariatric surgery.
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Affiliation(s)
| | | | - Inger Eribe
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
| | - Jon A. Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Department of Gastrointestinal and Paediatric SurgeryUniversity of OsloOsloNorway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Department of Gastrointestinal and Paediatric SurgeryUniversity of OsloOsloNorway
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What Is Weight Loss After Bariatric Surgery Expressed in Percentage Total Weight Loss (%TWL)? A Systematic Review. Obes Surg 2021; 31:3833-3847. [PMID: 34002289 DOI: 10.1007/s11695-021-05394-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 12/15/2022]
Abstract
Percentage total weight loss (%TWL) might be better than percentage excess weight loss to express weight loss in bariatric surgery. In this systematic review, performed according to the PRISMA statement, results of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are assessed in %TWL. A total of 13,426 studies were screened and 49 included, reporting data of 24,760 patients. The results show that, despite limiting data, LRYGB is favorable over LSG in terms of weight loss in short-term follow-up. Although recent guidelines recommend to use %TWL when reporting outcome in bariatric surgery, this study shows that there is still insufficient quality data in %TWL, especially on LSG. The use of %TWL as the primary outcome measure in bariatric surgery should be encouraged.
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Gribsholt SB. Comment on: Associations between perceived somatic symptoms and mental health after Roux-en-Y gastric bypass: a 3-year prospective cohort study. Surg Obes Relat Dis 2020; 16:632-633. [PMID: 32122818 DOI: 10.1016/j.soard.2020.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Sigrid Bjerge Gribsholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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