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Mou D, Smith SR, Patel A, Stetler J, Srinivasan J, Oyefule O, Lin E, Davis S, Hechenbleikner EM. How does sleeve gastrectomy impact long-term eating-related symptoms, distress, and behavior? A cross-sectional study using the BODY-Q patient-reported outcome measures. Surg Endosc 2024:10.1007/s00464-024-10984-8. [PMID: 38886234 DOI: 10.1007/s00464-024-10984-8] [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: 04/16/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Patients undergoing sleeve gastrectomy (SG) experience transformative changes in eating-related experiences that include eating-related symptoms, emotions, and habits. Long-term assessment of these endpoints with rigorous patient-reported outcome measures (PROMs) is limited. We assessed patients undergoing SG with the Body-Q Eating Module PROMs. METHODS All patients evaluated at the Emory Bariatric Center were given the Body-Q Eating Modules questionnaire at preoperative/postoperative clinic visits. Rasch scores and prevalence of relevant endpoints were assessed across six time-points of interest: preoperatively, post-operative months 0-6, 7-12, 12-24, 24-36, and over 36. Student's t-test and Chi-square test were used for analysis. RESULTS Overall, 1,352 questionnaires were completed pre-operatively and 493 postoperatively. Survey compliance was 81%. Compared to the pre-operative group, the post-operative group had lower BMI (39.7 vs. 46.4, p < 0.001) and higher age (46.3 vs. 44.9, p = 0.019). Beginning one year after SG, patients experience more frequent eating-related pain, nausea and constipation compared to pre-operative baseline (p < 0.05). They also more frequently experience eating-related regurgitation and dumping syndrome-related symptoms beginning post-operative year two (p < 0.05). In the first year after SG, patients more rarely feel eating-related embarrassment, guilt, and disappointment compared to pre-operative baseline (p < 0.05). These improvements disappear one year after SG, after which patients more frequently experience feeling out of control, unhappy, like a failure, disappointed, and guilty (p < 0.05). In the first year after SG, patients experience an increased frequency in positive eating behaviors (ate healthy foods, showed self-control, stopped before full; (p < 0.05). Only two eating-related behavior improvements persist long-term: feeling in control and eating the right amount (p < 0.05). CONCLUSIONS Patients undergoing SG may experience more frequent eating-related symptoms, distress, and behavior in the long-term. These findings can enhance the pre-operative informed consent and guide development of a more tailored approach to postoperative clinical management such as more frequent visits with the dietician.
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Affiliation(s)
- Danny Mou
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA.
| | - Savannah R Smith
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
| | - Ankit Patel
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
| | - Jamil Stetler
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
| | - Jahnavi Srinivasan
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
| | - Omobolanle Oyefule
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
| | - Edward Lin
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
| | - Scott Davis
- Department of Surgery, Emory University, 1364 Clifton Road, NE, Atlanta, GA, USA
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Elsaigh M, Awan B, Shabana A, Sohail A, Asqalan A, Saleh O, Szul J, Khalil R, Elgohary H, Marzouk M, Alasmar M. Comparing Safety and Efficacy Outcomes of Gastric Bypass and Sleeve Gastrectomy in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52796. [PMID: 38389648 PMCID: PMC10883263 DOI: 10.7759/cureus.52796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Sleeve Gastrectomy (SG) could be done by the removal of a big portion of the stomach, leading to reduced amounts of food taken as a result of the smaller stomach size. In contrast, Roux-en-Y Gastric Bypass (RYGB) can be done by creating a small stomach pouch and rerouting a part of the small intestine, employing combined mechanisms of restriction and malabsorption to limit food intake and modify nutrient absorption. Our aim is to identify the most effective and safest surgical intervention for individuals with both Type 2 Diabetes Mellitus (T2DM) and obesity, considering both short and long-term outcomes. We will assess participants undergoing either SG or RYGB to determine the optimal surgical approach. We made a thorough search of PubMed, Cochrane Library, Scopus, and Web of Science databases up to November 2023. Our focus was on randomized controlled trials (RCTs) comparing the safety and efficacy of RYGB and SG in T2DM regarding any extractable data. We excluded studies of other designs, such as cohorts, case reports, case series, reviews, in vitro studies, postmortem analyses, and conference abstracts. Utilizing Review Manager 5.4, we performed a meta-analysis, combining risk ratios (RR) with a 95% confidence interval (CI) conducted for binary outcomes, while mean with SD and 95% CI are pooled for the continuous ones. The total number of participants in our study is 4,148 patients. Our analysis indicates superior outcomes in the group undergoing RYGB surgery compared to the SG group (RR = 0.76, 95% (CI) (0.66 to 0.88), P = 0.0002). The pooled data exhibited homogeneity (P = 0.51, I2 = 0%) after employing the leave-one-out method. For the 1-3 year period, six studies involving 332 patients with T2DM yielded non-significant results (RR = 0.83, 95% CI (0.66 to 1.06), P = 0.14) with homogeneity (P = 0.24, I2 = 28%). Conversely, the 5-10 year period, with six studies comprising 728 DM patients, demonstrated significant results (RR = 0.69, 95% CI (0.56 to 0.85), P = 0.14) and homogeneity (P = 0.84, I2 = 0%). In terms of total body weight loss, our findings indicate significantly higher weight loss with RYGB (mean difference (MD) = -6.13, 95% CI (-8.65 to -3.6), P > 0.00001). However, pooled data exhibited considerable heterogeneity (P > 0.00001, I2 = 93%). Subgroup analyses for the 1-3 year period (five studies, 364 DM patients) and 5-10 year period (six studies, 985 DM patients) also revealed significant differences favoring RYGB, with heterogeneity observed in both periods (1-3 years: P > 0.00001, I2 = 95%; 5-10 years: P = 0.001, I2 = 75%). RYGB demonstrated significant long-term improvement in diabetes remission and superior total body weight loss compared to SG. While no notable differences were observed in other efficacy outcomes, safety parameters require further investigation. no significant distinctions were found in any of the safety outcomes: hypertension (HTN), high-density lipoprotein (HDL), hyperlipidemia, fasting blood glucose, vomiting, low-density lipoprotein (LDL), and total cholesterol. Further research is essential to comprehensively assess safety outcomes for both surgical approaches.
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Affiliation(s)
- Mohamed Elsaigh
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Bakhtawar Awan
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Ahmed Shabana
- Bariatric and General Surgery, Shifa Hospital, Cairo, EGY
| | - Azka Sohail
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Ahmad Asqalan
- Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, GBR
| | - Omnia Saleh
- Surgery, Brigham and Women's Hospital, Boston, USA
| | - Justyna Szul
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Rana Khalil
- General and Emergency Surgery, Newcastle University Hospitals and Kasralainy Medical School, Cairo University, Cairo, EGY
| | - Hatem Elgohary
- General and Emergency Surgery, Helwan University, Cairo, EGY
| | - Mohamed Marzouk
- General and Emergency Surgery, Northwick Park Hospital, London North West University, London, GBR
| | - Mohamed Alasmar
- General and Emergency Surgery, Salford Royal Hospital, University of Manchester, Manchester, GBR
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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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Dan AG. Comment on: 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; 19:829-830. [PMID: 37142471 DOI: 10.1016/j.soard.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Adrian G Dan
- Weight Management Institute, Northeast Ohio Medical University, Summa Health System, Akron, Ohio
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Svanevik M, Lorentzen J, Borgeraas H, Sandbu R, Seip B, Medhus AW, Hertel JK, Kolotkin RL, Småstuen MC, Hofsø D, Hjelmesæth J. Patient-reported outcomes, weight loss, and remission of type 2 diabetes 3 years after gastric bypass and sleeve gastrectomy (Oseberg); a single-centre, randomised controlled trial. Lancet Diabetes Endocrinol 2023:S2213-8587(23)00127-4. [PMID: 37414071 DOI: 10.1016/s2213-8587(23)00127-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Little is known about the comparative effects of various bariatric procedures on patient-reported outcomes. We aimed to compare 3-year effects of gastric bypass and sleeve gastrectomy on patient-reported outcome measures in patients with obesity and type 2 diabetes. METHODS The Oseberg trial was a single-centre, parallel-group, randomised trial at Vestfold Hospital Trust, a public tertiary obesity centre in Tønsberg, Norway. Eligible patients were aged 18 years or older with previously verified BMI 35·0 kg/m2 or greater. Diabetes was diagnosed if glycated haemoglobin was at least 6·5% (48 mmol/mol) or by their use of anti-diabetic medications with glycated haemoglobin at least 6·1% (43 mmol/mol). Eligible patients were randomly assigned (1:1) to gastric bypass or sleeve gastrectomy. All patients received identical preoperative and postoperative treatment. Randomisation was done with a computerised random number generator and a block size of ten. Study personnel, patients, and the primary outcome assessor were blinded to allocations for 1 year. The prespecified secondary outcomes reported here were 3-year changes in several clinically important patient-reported outcomes, weight loss, and diabetes remission. Analyses were done in the intention to treat population. This trial is ongoing, closed to recruitment and is registered with ClinicalTrials.gov, NCT01778738. FINDINGS Between Oct 15, 2012 and Sept 1, 2017, 319 consecutive patients with type 2 diabetes scheduled for bariatric surgery were assessed for eligibility. 101 patients were not eligible (29 did not have type 2 diabetes according to inclusion criteria and 72 other exclusion criteria) and 93 declined to participate. 109 patients were enrolled and randomly assigned to sleeve gastrectomy (n=55) or gastric bypass (n=54). 72 (66%) of 109 patients were female and 37 (34%) were male. 104 (95%) of patients were White. 16 patients were lost to follow up and 93 (85%) patients completed the 3-year follow-up. Three additional patients were contacted by phone for registration of comorbidities Compared with sleeve gastrectomy, gastric bypass was associated with a greater improvement in weight-related quality of life (between group difference 9·4, 95% CI 3·3 to 15·5), less reflux symptoms (0·54, 0·17 to -0·90), greater total bodyweight loss (8% difference, 25% vs 17%), and a higher probability of diabetes remission (67% vs 33%, risk ratio 2·00; 95% CI 1·27 to 3·14). Five patients reported postprandial hypoglycaemia in the third year after gastric bypass versus none after sleeve-gastrectomy (p=0·059). Symptoms of abdominal pain, indigestion, diarrhoea, dumping syndrome, depression, binge eating, and appetitive drive did not differ between groups. INTERPRETATION At 3 years, gastric bypass was superior to sleeve gastrectomy in patients with type 2 diabetes and obesity regarding weight related quality of life, reflux symptoms, weight loss, and remission of diabetes, while symptoms of abdominal pain, indigestion, diarrhoea, dumping, depression and binge eating did not differ between groups. This new patient-reported knowledge can be used in the shared decision-making process to inform patients about similarities and differences between expected outcomes after the two surgical procedures. FUNDING Morbid Obesity Centre, Vestfold Hospital Trust. TRANSLATION For the Norwegian translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marius Svanevik
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Jolanta Lorentzen
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Heidi Borgeraas
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - Rune Sandbu
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Birgitte Seip
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Asle W Medhus
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Jens K Hertel
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ronette L Kolotkin
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Quality of Life Consulting, Durham, NC, USA; Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA; Førde Hospital Trust, Førde, Norway
| | - Milada C Småstuen
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Department of Nutrition and Management, Oslo Metropolitan University, Oslo, Norway
| | - Dag Hofsø
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Department of Endocrinology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hu FY, Ariagno M, Tavakkoli A, Ghushe N. BODY-Q eating-related symptoms following sleeve gastrectomy. Surg Endosc 2023; 37:2189-2193. [PMID: 35737137 DOI: 10.1007/s00464-022-09389-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent data describing gastrointestinal (GI) symptoms experienced by patients after bariatric surgery is lacking, and previous studies in sleeve gastrectomy patients have been limited in scope of follow-up time or extent of GI symptoms examined. We sought to characterize the prevalence and time course of patient-reported eating-related symptoms in sleeve gastrectomy patients. METHODS From July 2020 to July 2021, sleeve gastrectomy patients seen at three Boston area hospitals received electronic surveys and prospectively reported GI symptoms using the BODY-Q eating-related symptoms scale. Descriptive analyses were performed for patient demographics and symptom prevalence. Chi-square tests were used to compare prevalence of eating-related symptoms between follow-up time intervals. RESULTS 491 sleeve gastrectomy patients completed postoperative surveys with mean follow-up time of 1.9 years. Mean age was 46.6 years, and 81.3% were female. The most reported GI symptoms overall included constipation (56.6%), bloating (54.0%), heartburn when standing (41.5%), and heartburn when lying down (39.9%) while the least commonly reported symptoms were palpitations (16.3%), low blood sugar (15.7%), and emesis (15.1%). At greater than 12 months, the most reported symptoms similarly included bloating (60.3%), constipation (53.2%), and heartburn while standing (46.0%). When comparing prevalence of eating-related symptoms across follow-up time intervals from < 1 to > 12 months, patients reported a significant decrease in constipation, abdominal pain, and nausea over time (p = 0.012, p < .0001, p = 0.03, respectively). CONCLUSION Patients experience both upper and lower GI symptoms following sleeve gastrectomy, and symptoms, including bloating, constipation, and heartburn may persist through long-term follow-up. These patient-centered measures add value by guiding preoperative counseling, informing postoperative expectations, and providing real-time clinical feedback for bariatric surgery patients.
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Affiliation(s)
- Frances Y Hu
- Department of Surgery, Brigham and Woman's Hospital, c/o Surgery Education Office, 75 Francis Street, Boston, MA, 02120, USA.
| | - Meghan Ariagno
- Department of Surgery, Brigham and Woman's Hospital, c/o Surgery Education Office, 75 Francis Street, Boston, MA, 02120, USA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Woman's Hospital, c/o Surgery Education Office, 75 Francis Street, Boston, MA, 02120, USA
| | - Neil Ghushe
- Department of Surgery, Brigham and Woman's Hospital, c/o Surgery Education Office, 75 Francis Street, Boston, MA, 02120, USA.,Department of Surgery, South Shore Hospital, Weymouth, MA, USA
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Vogelaerts R, Van Pachtenbeke L, Raudsepp M, Morlion B. Chronic abdominal pain after bariatric surgery: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2022. [DOI: 10.56126/73.4.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objective: This paper reviews the prevalence, etiology, risk factors, diagnosis and prevention of chronic abdominal pain after bariatric surgery.
Introduction: Chronic pain is a very common and complex problem that has serious consequences on individuals and society. It frequently presents as a result of a disease or an injury. Obesity and obesity-related comorbidities are a major health problem and are dramatically increasing year after year. Dieting and physical exercise show disappointing results in the treatment of obesity. Therefore, bariatric surgery is increasingly widely offered as a weight reducing strategy. In our pain clinic we see a lot of patients who suffer from chronic abdominal pain after bariatric surgery. This review aims to explore the link between chronic abdominal pain and bariatric surgery in this specific type of patients.
Method: The review is based on searches in PubMed, Embase and Cochrane databases. Keywords are used in different combinations. We did a cross-reference of the articles included.
Results: Chronic abdominal pain after bariatric surgery is very common. Around 30% of the bariatric patients experience persistent abdominal pain. An explanation for the abdominal pain is found in 2/3 of these patients.
There is a wide variety of causes including behavioral and nutritional disorders, functional motility disorders, biliary disorders, marginal ulceration and internal hernia. Another, frequently overlooked, cause is abdominal wall pain. Unexplained abdominal pain after bariatric surgery is present in 1/3 of the patients with persistent abdominal pain. More studies are needed on the risk factors and prevention of unexplained abdominal pain in bariatric patients.
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Yu Y, Ma Q, Groth SW. Risk factors for preterm birth in pregnancies following bariatric surgery: an analysis of the Longitudinal Assessment of Bariatric Surgery-2. Surg Obes Relat Dis 2022; 18:1304-1312. [PMID: 35995663 PMCID: PMC9617754 DOI: 10.1016/j.soard.2022.07.013] [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: 03/28/2022] [Revised: 06/15/2022] [Accepted: 07/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to increase the risk for preterm birth in a subsequent pregnancy. Determining factors that contribute to this heightened risk will inform the development of targeted interventions to improve birth outcomes postbariatric surgery. OBJECTIVES This study aimed to identify risk factors of preterm birth in pregnancies following bariatric surgery. Factors being considered were preoperative medical conditions and behaviors (e.g., obesity-associated co-morbidities, gastrointestinal symptoms, substance use), antenatal factors (e.g., prepregnancy body mass index, gestational weight gain), and surgery-specific factors (e.g., surgery type, surgery-to-conception interval). SETTING Bariatric surgery centers in the United States. METHODS This is a retrospective analysis of the Longitudinal Assessment of Bariatric Surgery-2. Participants were women who reported at least 1 singleton live birth during the 7-year postoperative period. Logistic regressions were used to identify risk factors of preterm birth, adjusting for covariates such as maternal age, race, and ethnicity. RESULTS Participants (n = 97) were mostly White (84.5%) and non-Hispanic (88.7%). At the time of surgery, the mean age was 29.4 ± 4.6 years, and the mean body mass index was 47.6 ± 6.3 kg/m2. The prevalence of preterm birth was 13.4%. Preoperative gastrointestinal symptoms significantly increased (odds ratio: 1.12; 95% confidence interval: 1.00-1.26), while unexpectedly, excessive versus adequate gestational weight gain (odds ratio: .12; 95% confidence interval: .02-1.00) decreased the odds of preterm birth following bariatric surgery. CONCLUSIONS This analysis identified potential risk and protective factors of preterm birth among pregnancies postbariatric surgery. However, given the small sample size, findings should be regarded as hypothesis-generating and merit further study.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | - Qianheng Ma
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
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Comment on: Surgical Technique in Constructing the Jejuno-jejunostomy and the Risk of Small Bowel Obstruction after Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2022; 18:1159-1160. [DOI: 10.1016/j.soard.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/23/2022]
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