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Monteiro IA, de Sousa Barros A, Costa-Ferreira A. Postbariatric Abdominoplasty: A Comparative Study on Scarpa Fascia Preservation Versus Classical Technique. Aesthetic Plast Surg 2023; 47:2511-2524. [PMID: 37365309 DOI: 10.1007/s00266-023-03455-3] [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: 04/21/2023] [Accepted: 05/27/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Abdominoplasties performed with Scarpa Fascia preservation, improve recovery and reduce complications, particularly seroma. Bariatric patients who experience massive weight loss frequently seek body contouring procedures and represent a high-risk group. This study aimed to evaluate the effects of abdominoplasty with Scarpa Fascia preservation versus the classical technique in a bariatric population. METHODS A retrospective observational cohort study was performed between March 2015 and March 2021 in 65 postbariatric patients who underwent a classic full abdominoplasty (group A, N = 25) or a similar procedure except for the preservation of Scarpa fascia (group B, N = 40). Total and daily drain output, time until drain removal, long drainers (≥ 6 days), length of hospital stay, emergency department visit, readmission to the hospital, reoperation, local and systemic complications were the outcomes evaluated. RESULTS Group B had a 3-day reduction in time until drain removal (p < 0.001), a 62.6% reduction of total drain output (p < 0.001) and a 3-day reduction in the length of the hospital stay (p < 0.001). Long drainers (≥ 6 days) were highly reduced (from 56.0% in group A to 7.5% in group B) (p < 0.001). There was a lower incidence of liquid collections in group B, with a 66.7% reduction in seroma incidence. CONCLUSIONS Abdominoplasty with Scarpa Fascia preservation improves recovery by reducing drain output, allowing earlier drain removal and reducing long periods with suction drains. It also reduces hospital stay and seroma incidence. This technique modifies the high-risk postbariatric patient in such a major way that he behaves like a nonbariatric. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Inês Araújo Monteiro
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal.
| | - António de Sousa Barros
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal
- Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal
| | - António Costa-Ferreira
- Department of Surgery and Physiology, Faculty of Medicine, Porto University, Porto, Portugal
- Cardiovascular Research and Development Center (UnIC@RISE), Porto, Portugal
- Department of Plastic, Reconstructive and Aesthetic Surgery, São João University Hospital, Porto, Portugal
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Difference in 30-Day Readmission Rates After Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-En-Y Gastric Bypass: a Propensity Score Matched Study Using ACS NSQIP Data (2015-2019). Obes Surg 2023; 33:1040-1048. [PMID: 36708467 PMCID: PMC10079749 DOI: 10.1007/s11695-022-06446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE There are very few studies that have compared the short-term outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Among short-term outcomes, hospital readmission after these procedures is an area for quality enhancement and cost reduction. In this study, we compared 30-day readmission rates after LSG and LRYGB through analyzing a nationalized dataset. In addition, we identified the reasons of readmission. MATERIALS AND METHODS The current study was a retrospective analysis of data from National Surgical Quality Improvement Program (NSQIP) All adult patients, ≥ 18 years of age and who had LSG or LRYGB during 2014 to 2019 were included. Current Procedural Terminology (CPT) codes were used to identify the procedures. Multivariate logistic regressions were used to calculate propensity score adjusted odds ratios (ORs) for all cause 30-day re-admissions. RESULTS There were 109,900 patients who underwent laparoscopic bariatric surgeries (67.5% LSG and 32.5% LRYGB). Readmissions were reported in 4168 (3.8%) of the patients and were more common among RYGB recipients compared to LSG (5.6% versus 2.9%, P < 0.001). The odds of 30-day readmissions were significantly higher among LRYGB group compared to LSG group (AOR, 2.20; 95% CI; 1.83, 2.64). In addition, variables such as age, chronic obstructive pulmonary disease, hypertension, bleeding disorders, blood urea nitrogen, SGOT, alkaline phosphatase, hematocrit, and operation time were significantly predicting readmission rates. CONCLUSIONS Readmission rates were significantly higher among those receiving LRYGB, compared to LSG. Readmission was also affected by many patient factors. The factors could help patients and providers to make informed decisions for selecting appropriate procedures.
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Snoek KM, Steegers-Theunissen RPM, Klaassen RA, Laven JSE, Schoenmakers S. Impact of Bariatric surgery on EmbrYONic, fetal and placental Development (BEYOND): protocol for a prospective cohort study embedded in the Rotterdam periconceptional cohort. BMJ Open 2021; 11:e051110. [PMID: 34475184 PMCID: PMC8413945 DOI: 10.1136/bmjopen-2021-051110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/19/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The worldwide obesity epidemic has resulted in a rise of bariatric surgery in women of reproductive age, which can lead to 'iatrogenic undernutrition'. Long-lasting undernutrition can affect maternal health, pregnancy outcomes and offspring. We hypothesise that embryonic and placental growth are impaired in pregnancies after bariatric surgery due to the changed nutritional and microbiome dynamics. Therefore, our aim is to conduct the Bariatrics and EmbrYONic Development (BEYOND) study to investigate parameters of maternal nutritional and health status after bariatric surgery, both periconceptionally and during pregnancy, particularly concentrating on embryonic and fetal growth trajectories as well as placental development. METHODS AND ANALYSIS We designed a single-centre prospective, observational cohort, which investigates the iatrogenic nutritional and health status of women after bariatric surgery, periconceptionally and during pregnancy. The BEYOND study is embedded in the Rotterdam Periconceptional Cohort, a tertiary hospital-based birth cohort study. Eligible participants are women planning pregnancy or <12+0 weeks pregnant, ≥18 and ≤45 years of age, who have undergone bariatric surgery (cases) or without prior bariatric surgery (controls) and their male partners. Medical charts will be reviewed and questionnaires regarding general health, lifestyle and food intake will be collected. Moreover, we will perform serial three-dimensional ultrasounds to assess embryonic growth and placental development and two-dimensional ultrasounds for fetal growth assessment. The microbiome, including the virome, and blood samples will be sampled during the preconception period and in each trimester. Multivariable linear mixed model analyses will be used to assess the associations between bariatric surgery and pregnancy outcomes. ETHICS AND DISSEMINATION This proposal was approved by the Medical Ethics Committee from the Erasmus MC, Rotterdam, The Netherlands. Study results will be submitted for publication in high-impact journals, presented at scientific conferences, implemented into guidelines and communicated through the Erasmus MC and collaborating partners. TRIAL REGISTRATION NUMBER NL8217 (www.trialregister.nl).
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Affiliation(s)
- Katinka M Snoek
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - René A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Mizandari M, Keshavarz P, Azrumelashvili T, Yazdanpanah F, Lorzadeh E, Hosseinpour H, Bazyar A, Nejati SF, Ebrahimian Sadabad F. Left gastric artery embolization for obesity treatment: a systematic review and meta-analysis of human and animal studies. Abdom Radiol (NY) 2021; 46:4440-4451. [PMID: 33825928 DOI: 10.1007/s00261-021-03036-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/16/2023]
Abstract
PURPOSE The main purpose of this systematic review was to reflect on recent literature on bariatric LGA embolization for obesity treatment and to compare this new procedure in human and animal studies. METHODS A systematic search of Scopus, MEDLINE, Web of Science, Embase, and Google Scholar was performed to identify human and animal studies employing bariatric LGA embolization to treat obesity. As well, Cochrane's Q test and the I2 statistic were utilized to determine heterogeneity. RESULTS Nine human and four animal studies recruiting a total of 118 cases (n = 78 patients and n = 40 animals) were included in analysis. All assessments on body mass index (BMI), weight, and ghrelin levels had been fulfilled based on before-after (human studies) and intervention-control designs (animal studies) using bariatric LGA embolization. The findings suggested that bariatric LGA embolization had significantly decreased BMI (mean difference (MD): - 2.66, 95% confidence interval [CI] - 3.74, - 1.58, P < 0.001) and weight (MD: - 8.69, 95% CI - 10.48, - 6.89, P < 0.001) in humans. Although overall pooled estimate showed no significant changes in ghrelin levels following this procedure (Hedges' g statistic: - 0.91, 95% CI - 1.83, 0.01, P = 0.05) in humans, a significant reduction was observed in animal studies (MD: - 756.56, 95% CI - 1098.79, - 414.33, P < 0.001) along with a significant drop in weight (MD: - 7.64, 95% CI - 13.73, - 1.54, P < 0.001). CONCLUSION The present study concluded that ghrelin levels in humans had not been affected, although bariatric LGA embolization might significantly improve BMI and weight.
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Affiliation(s)
- Malkhaz Mizandari
- Department of Diagnostic & Interventional Radiology, New Hospitals LTD, 12 Krtsanisi., 0114, Tbilisi, Georgia.
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia.
| | - Pedram Keshavarz
- Department of Diagnostic & Interventional Radiology, New Hospitals LTD, 12 Krtsanisi., 0114, Tbilisi, Georgia
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tamta Azrumelashvili
- Department of Diagnostic & Interventional Radiology, New Hospitals LTD, 12 Krtsanisi., 0114, Tbilisi, Georgia
- Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia
| | - Fereshteh Yazdanpanah
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tabriz, Iran
| | - Elnaz Lorzadeh
- Department of Nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamidreza Hosseinpour
- Department of Surgery, Shiraz Laparoscopic Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Bazyar
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Faraz Nejati
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faranak Ebrahimian Sadabad
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kheirvari M, Akbarzadeh I, Eshghjoo S, Yazdannasab M, Alaniz RC, Hosseini S, Anbara T. Diagnostic Value of Erythrocyte Sedimentation Rate Levels as a Predictor of Staple-Line Leakage in Bariatric Surgery. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Milad Kheirvari
- Microbiology Research Centre, Pasteur Institute of Iran, Tehran, Iran
| | - Isa Akbarzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Eshghjoo
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M University, Health Science Center, Bryan, Texas, USA
| | | | - Robert C. Alaniz
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M University, Health Science Center, Bryan, Texas, USA
| | - Sara Hosseini
- Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
| | - Taha Anbara
- Department of Surgery, Erfan Niayesh Hospital, Tehran, Iran
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Kankaya B, Buyukasik S, Alis H. Review of Metabolic Efficiency of Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2020.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Burak Kankaya
- Departmant of General Surgery, İstanbul Aydin University Faculty of Medicine, İstanbul, Turkey
| | - Suleyman Buyukasik
- Departmant of General Surgery, İstanbul Aydin University Faculty of Medicine, İstanbul, Turkey
| | - Halil Alis
- Departmant of General Surgery, İstanbul Aydin University Faculty of Medicine, İstanbul, Turkey
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[Effects of gastric bypass on cardiovascular risk and resolution of comorbidities: results at 5 years]. NUTR HOSP 2020; 37:750-756. [PMID: 32686438 DOI: 10.20960/nh.02993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.
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Bariatric Surgery Population at Significantly Increased Risk of Spinal Disorders and Surgical Intervention Compared With Morbidly Obese Patients. Clin Spine Surg 2020; 33:E158-E161. [PMID: 32168118 DOI: 10.1097/bsd.0000000000000960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Obesity is associated with acceleration of musculoskeletal degenerative diseases and functional impairment secondary to spinal disorders. Bariatric surgery (BS) is an increasingly common treatment for severe obesity but can affect bone and mineral metabolism. The effect of BS on degenerative spinal disorders is yet to be fully described. The aim of our study was to analyze changes in bariatric patients' risk for spinal degenerative diseases and spinal surgery. METHODS Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years (2004-2013) using patient linkage codes. The incidence of degenerative spinal diagnoses and spinal surgery was queried using International Classification of Diseases, Ninth Revision (ICD)-9 codes for morbidly obese patients (ICD-9 278.01) with and without a history of BS. The incidence of degenerative spinal diagnoses and spinal surgery was determined using χ tests for independence. Logistic testing controlled for age, sex, and comorbidity burden. RESULTS A total of 18,176 patients were identified in the NYSID database with a history of BS and 146,252 patients were identified as morbidly obese without a history of BS. BS patients have a significantly higher rate of spinal diagnoses than morbidly obese patients without BS (19.3% vs. 8.1%, P<0.001). Bariatric patients were more likely to have spinal diagnoses and procedures than nonbariatric obese patients (P<0.001). This was mostly observed in lumbar spinal stenosis (5.0%), cervical disk herniation (3.3%), lumbar disk degeneration (3.4%), lumbar spondylolisthesis (2.9%), lumbar spondylosis (1.9%), and cervical spondylosis with myelopathy (2.0%). Spine procedure rates are higher for bariatric patients than nonbariatric overall (25.6% vs. 2.3, P<0.001) and for fusions and decompressions (P<0.001). When controlling for age, sex, and comorbidities (and diagnosis rate with regards to procedure rates), these results persist, with BS patients having a higher likelihood of spinal diagnoses and procedures. In addition, bariatric patients had a lower comorbidity burden than morbidly obese patients without a history of BS. CONCLUSIONS Morbidly obese BS patients have a dramatically higher incidence of spinal diagnoses and procedures, relative to morbidly obese patients without BS. Further study is necessary to determine if there is a pathophysiological mechanism underlying this higher risk of spinal disease and intervention in bariatric patients, and the effect of BS on these rates following treatment. LEVEL OF EVIDENCE Level III.
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Losco L, Roxo AC, Roxo CW, Lo Torto F, Bolletta A, de Sire A, Aksoyler D, Ribuffo D, Cigna E, Roxo CP. Lower Body Lift After Bariatric Surgery: 323 Consecutive Cases Over 10-Year Experience. Aesthetic Plast Surg 2020; 44:421-432. [PMID: 31748908 DOI: 10.1007/s00266-019-01543-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lower body lift is a widespread procedure for massive weight loss patients aimed to improve the contour of the lower trunk, gluteal region and proximal lower extremity. The data about complications are confusing, and there is a lack of uniform studies for massive weight loss patients. A simple formula to carry out a reliable procedure in a short time with a low complication rate should be advocated. METHODS This retrospective study analyzed data of 323 patients undergoing lower body lift after bariatric surgery over a 10-year period. Selection criteria, careful preoperative marking, reliable intra- and postoperative care and a few surgical tips are discussed. All the complications (both major and minor) and the aesthetic satisfaction were evaluated. Risk factors assessed were patient age, tobacco consumption, current BMI, operative time and combined surgery. RESULTS The overall complication rate was 42%. We recorded a lower rate of major complications and skin dehiscence; no infection and no skin necrosis were observed. The most frequent complication was seroma (35%). A complication development was straight related to age (p = 0.0177) and tobacco use (p = 0.0336). Patients' satisfaction about overall aesthetic was high. CONCLUSIONS We present our case load and describe an easy recipe to perform a safe surgery without undermining and liposuction in short operative times. The reasonable overall complication rate and the surprisingly lower rate of dehiscence and skin necrosis combined with a pleasant aesthetic result make the lower body lift an easy and safe procedure, when applied to the appropriate patient population. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Luigi Losco
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56125, Pisa, Italy.
| | - Ana Claudia Roxo
- Plastic Surgery Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - Carlos W Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Alberto Bolletta
- Plastic Surgery Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro de Sire
- Physical and Rehabilitation Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Dicle Aksoyler
- Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Diego Ribuffo
- Plastic Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Emanuele Cigna
- Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 67, 56125, Pisa, Italy
| | - Carlos P Roxo
- Plastic Surgery Unit, Andaraì Federal Hospital, Rio de Janeiro, Brazil
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Major P, Wysocki M, Dworak J, Pędziwiatr M, Pisarska M, Wierdak M, Zub-Pokrowiecka A, Natkaniec M, Małczak P, Nowakowski M, Budzyński A. Analysis of Laparoscopic Sleeve Gastrectomy Learning Curve and Its Influence on Procedure Safety and Perioperative Complications. Obes Surg 2019; 28:1672-1680. [PMID: 29275495 PMCID: PMC5973999 DOI: 10.1007/s11695-017-3075-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) has become an attractive bariatric procedure with promising treatment effects yet amount of data regarding institutional learning process is limited. MATERIALS AND METHODS Retrospective study included patients submitted to LSG at academic teaching hospital. Patients were divided into groups every 100 consecutive patients. LSG introduction was structured along with Enhanced Recovery after Surgery (ERAS) treatment protocol. Primary endpoint was determining the LSG learning curve's stabilization point, using operative time, intraoperative difficulties, intraoperative adverse events (IAE), and number of stapler firings. Secondary endpoints: influence on perioperative complications and reoperations. Five hundred patients were included (330 females, median age of 40 (33-49) years). RESULTS Operative time in G1-G2 differed significantly from G3-G5. Stabilization point was the 200th procedure using operative time. Intraoperative difficulties of G1 differed significantly from G2-G5, with stabilization after the 100th procedure. IAE and number of stapler firings could not be used as predictor. Based on perioperative morbidity, the learning curve was stabilized at the 100th procedure. The morbidity rates in the groups were G1, 13%; G2, 4%; G3, 5%; G4, 5%; and G5, 2%. The reoperation rate in G1 was 3%; G2, 2%; G3, 2%; G4, 1%; and G5, 0%. CONCLUSION The institutional learning process stabilization point for LSG in a newly established bariatric center is between the 100th and 200th operation. Initially, the morbidity rate is high, which should concern surgeons who are willing to perform bariatric surgery.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Jadwiga Dworak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Anna Zub-Pokrowiecka
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Michał Natkaniec
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Nowakowski
- Department of Medical Education, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St, 31-501 Krakow, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Turkeltaub JA, Edmundowicz SA. Endoscopic Bariatric Therapies: Intragastric Balloons, Tissue Apposition, and Aspiration Therapy. ACTA ACUST UNITED AC 2019; 17:187-201. [PMID: 30963378 DOI: 10.1007/s11938-019-00232-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Endoscopic bariatric therapies (EBTs) have been identified as a group of procedures that can bridge the treatment gap between bariatric surgical procedures and non-procedural treatments such as pharmacotherapy and lifestyle therapy. We will review the recent progress that has been made in this important area in the past several years. RECENT FINDINGS Traditional intragastric balloons (IGB) that are both placed and removed endoscopically have been the fixture of IGB therapy. They have been shown to be safe and effective, when kept in place for 6 months. Newer IGBs, both currently FDA approved and those in clinical trials, have unique features. The Obalon gastric balloon system is gas filled and does not require endoscopy for placement. The Elipse balloon system that is in clinical trials neither requires endoscopy for placement nor removal. The Spatz3 balloon is in clinical trials and can be adjusted endoscopically by adding or subtracting volume to titrate balloon volume to symptoms and weight loss. In addition to IGBs, several other promising therapies have continued to evolve. Endoscopic sleeve gastroplasty (ESG) is a promising gastric restriction technique that has efficacy and durability. POSE is a gastric plication technique that is available in Europe and in clinical trials in the USA. Aspiration therapy is a novel approach to weight loss that requires patient compliance but can be very effective and used long term. EBTs are an evolving effective and safe approach for patients who do not qualify for or do not want bariatric surgery. There are multiple EBTs currently FDA approved as well as prospective endoscopic therapies in clinical trials that appear promising.
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Affiliation(s)
- Joshua A Turkeltaub
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, MSB-158, Aurora, CO, 80045, USA.
| | - Steven A Edmundowicz
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, MSB-158, Aurora, CO, 80045, USA.
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Zhong BY, Abiola G, Weiss CR. Bariatric Arterial Embolization for Obesity: A Review of Early Clinical Evidence. Cardiovasc Intervent Radiol 2018; 41:1639-1647. [PMID: 29872893 PMCID: PMC6281784 DOI: 10.1007/s00270-018-1996-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/20/2018] [Indexed: 02/07/2023]
Abstract
Obesity is a worldwide public health epidemic that leads to increased morbidity, mortality, and cost burden to health care. Although bariatric surgery has been recognized as a standard invasive treatment for obesity, it is accompanied by relatively high morbidity and cost burden, as well as limited treatment outcome. Therefore, alternative treatments with lower morbidity and cost for surgery that target patients who are obese, but not morbidly obese, are needed. A minimally invasive trans-catheter procedure, named bariatric arterial embolization or bariatric embolization (BAE), has been identified as a potential solution, based on its safety and preliminary efficacy profiles. The purpose of this review is to introduce up-to-date clinical data and discuss future directions for BAE for the treatment of obesity.
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Affiliation(s)
- Bin-Yan Zhong
- Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
- Division of Interventional Radiology, Department of Radiology and Radiologic Science, Johns Hopkins School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA
| | | | - Clifford R Weiss
- Division of Interventional Radiology, Department of Radiology and Radiologic Science, Johns Hopkins School of Medicine, Sheikh Zayed Tower, Suite 7203, 1800 Orleans St, Baltimore, MD, USA.
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Sarkis R, Khazzaka A, Kassir R. Pilot Study of a New Model of Bariatric Surgery: Laparoscopic Intestinal Bipartition-Safety and Efficacy Against Metabolic Disorders. Obes Surg 2018; 28:3717-3723. [PMID: 30182334 DOI: 10.1007/s11695-018-3483-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the availability of many gastric surgery techniques to reduce obesity and its associated comorbidities, most of these procedures can result in life-threatening conditions including lifetime chronic illnesses and death. Vertical sleeve gastrectomy and Roux-en-Y gastric bypass have been reported to improve obesity-related comorbidities such as T2DM, but the long-term efficacy of these two procedures is unknown, and their significant impact on long-term weight loss was diminished by complications as reported in previous studies. Recently, laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) was developed to achieve sustained weight loss (Buchwald et al. Am J Med. 122:248-56, 2009; Sjöström et al. N Engl J Med. 351:2683-93, 2004) as well as an improvement in comorbid conditions, such as T2DM and hypertension (Buchwald et al. in Am J Med. 122:248-56, 2009; Dorman et al. Surgery. 152:758-65, 2012). The malabsorptive strategy of bypassing portions of the small intestine and delivering nutrients directly to the ileum may promote weight loss by enhanced activation of a negative feedback mechanism known as the "ileal brake" (Näslund et al. J Gastrointest Surg. 5:556-67, 2001). The purpose of this pilot study was to evaluate the safety, reproducibility, and efficiency of a new surgical bariatric model of laparoscopic intestinal bipartition (LIB) in patients with a BMI between 35 and 40 kg/m2. The setting was in university hospitals. METHODS Between January 2011 and September 2012, seven patients were enrolled in the study and underwent the LIB procedure. One patient was operated by LIB for morbid obesity with comorbidities, especially T2DM, without any previous bariatric or gastric surgery. Six patients underwent the surgery after a sleeve gastrectomy for ≥ 4 years with a recurrence of obesity and diabetes. RESULTS The comorbidity factors decreased to the normal values in all patients at 6 months, 1 year, and 5 years postoperatively. The percentage of total weight loss was 21.1% at 6 months, 22.6% at 1 year, and 15.6% at 5 years. Weight excess was significantly lower at 6-month, 1-year, and 5-year postoperatively compared with baseline (p < 0.001). Comparison of comorbidity values at 6 months, 1 year, and 5 years did not show any significant differences. CONCLUSION Laparoscopic intestinal bipartition produced a total recovery from obesity-related comorbidities, especially T2DM and EWL without any signs of nutritional deficiency, although the 5-year follow-up is ongoing in order to demonstrate the efficacy and long-term durability of this procedure.
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Affiliation(s)
- Riad Sarkis
- Department of General Surgery, Hotel Dieu de France University Hospital, Beirut, Lebanon.,Department of Digestive Surgery, Bellevue Medical Center University Hospital, Mansourieh, Lebanon.,Surgical Research Laboratory, Saint Joseph University, Beirut, Lebanon
| | - Aline Khazzaka
- Surgical Research Laboratory, Saint Joseph University, Beirut, Lebanon
| | - Radwan Kassir
- Department of General Surgery, CHU Félix Guyon, La Réunion, Saint Denis, France. .,Department of Bariatric Surgery, CHU Felix-Guyon, La Réunion, St-Denis, France.
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Lyn-Sue JR, Doble JA, Juza RM, Alli VV. Optimizing Hospital Resource Utilization in Bariatric Readmission. JSLS 2018; 22:JSLS.2017.00096. [PMID: 29950798 PMCID: PMC6002251 DOI: 10.4293/jsls.2017.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives The prevalence of patients with a history of bariatric surgery is climbing. Medical and surgical questions arising in this patient population may prompt them to present to the nearest emergency department (ED), irrespective of that facility's experience with bariatric surgery. The emergency physician is the first to evaluate patients with a history of bariatric surgery who present with abdominal symptoms. As a quality improvement project aimed at reducing resource utilization, we sought to determine which patients presenting to the ED could be treated in an outpatient setting in lieu of hospital admission. Methods We conducted a retrospective review of bariatric patients admitted from our ED with abdominal symptoms, including abdominal pain, nausea, vomiting, dysphagia, obstruction, and hematemesis. We collected the following variables: type of bariatric operation, admission and discharge diagnoses, and all interventions performed during admission. Results One hundred sixty-nine patients (76.1%) had a history of laparoscopic Roux-en-Y gastric bypass. The time from bariatric operation to presentation averaged 42 ± 4.63 (SD) months. The most common symptom was abdominal pain (80.2%). Ninety-four percent of patients underwent invasive management via upper endoscopy, laparoscopy, or laparotomy. The most common postprocedural diagnoses were stricture, bowel obstruction, inflammatory findings, and cholecystitis. Conclusion Most patient encounters resulted in invasive management (204/282; 72.3%). The subset of these patients requiring endoscopic evaluation or therapy (37.7%) may be suitable for outpatient management if appropriate measures are available for rapid follow-up and procedural scheduling.
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Affiliation(s)
- Jerome R Lyn-Sue
- Department of Surgery, The Pennsylvania State University, College of Medicine. Hershey, Pennsylvania, USA
| | - Justin A Doble
- Department of Surgery, The Pennsylvania State University, College of Medicine. Hershey, Pennsylvania, USA
| | - Ryan M Juza
- Department of Surgery, The Pennsylvania State University, College of Medicine. Hershey, Pennsylvania, USA
| | - Vamsi V Alli
- Department of Surgery, The Pennsylvania State University, College of Medicine. Hershey, Pennsylvania, USA
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Zacharoulis D, Bakalis V, Zachari E, Sioka E, Tsimpida D, Magouliotis D, Tasiopoulou V, Chatedaki C, Tzovaras G. Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly. Asian J Endosc Surg 2018; 11:138-145. [PMID: 29105338 DOI: 10.1111/ases.12436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The purpose of this study was to assess doctors' knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery. METHODS A self-administered survey was administered to 500 doctors with varying medical specialties in public and private practice. RESULTS The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity-related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non-referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients' postoperative follow-ups. CONCLUSION The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity-related comorbidities. A great effort should be made to inform health-care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.
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Affiliation(s)
- Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vissarion Bakalis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Zachari
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dialecthi Tsimpida
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Dimitrios Magouliotis
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Vasiliki Tasiopoulou
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Christina Chatedaki
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Ahmed HO. Pattern of changes in quality of life of obese patients after sleeve gastrectomy in Sulaimani provence -Kurdistan-Iraq, based on 4 years experience in two bariatric centers. Ann Med Surg (Lond) 2018; 26:9-14. [PMID: 29904608 PMCID: PMC5904781 DOI: 10.1016/j.amsu.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity influences all aspects of the life of obese patients physically, psychologically, socially and monetarily, it is not only a disease but rather a beginning point of a group of ailments and inabilities, which gradually impacts and changes all aspects of their life. OBJECTIVES The changes in the Quality of life in respect to the amount of access weight lost after sleeve gastrectomy. PATIENTS MATERIALS AND METHODS A prospective longitudinal study evaluating 40 female patients who underwent laparoscopic sleeve gastrectomy within 4 years, starting from July 4th, 2012 up to July 5th, 2016. RESULTS More than three-quarter of the patients were not satisfied with their body before their operation, but six to twelve months after their weight loss; (N = 36, 90%) of them were satisfied with their new body image. Half of the patients were unhappy before their operation, but twelve months later (N = 31, 77.5%) of them became much happier. Regarding satisfaction with the body image, noticeable improvement occurred since (N = 36, 90%) of them were satisfied with their new body image. While, most of them have had low self-esteem and (N 27, 67.5%) of the patients had no self-esteem at all, 12 months after the operation (N = 35, 87.5%) felt great improvement in their self-esteem (p-value = .040). A significant decrease in appetite was noticed in (N = 39, 97.5%) of the patients after 12 months. CONCLUSION Significant changes in the parallel pattern to the extent of EWL were noticed in the quality of life of morbidly obese patients after laparoscopic sleeve gastrectomy.
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[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]. Chirurg 2017; 89:4-16. [PMID: 29209749 DOI: 10.1007/s00104-017-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.
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Sanchez-Santos R, Padin EM, Adam D, Borisenko O, Fernandez SE, Dacosta EC, Fernández SG, Vazquez JT, de Adana JCR, de la Cruz Vigo F. Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2017; 18:305-314. [PMID: 29188745 DOI: 10.1080/14737167.2018.1407649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We assessed the cost-effectiveness of bariatric surgery (BS) versus conservative management (CM) for treating morbid obesity in Spain. METHODS We developed a probabilistic Markov model to estimate health outcomes, quality-adjusted life years (QALY), life years gained (LYG), and costs over lifetime and 10-year horizons. Combined common BS procedures were compared with CM. Clinical and utility inputs were obtained from the literature and resource use and costs from local sources (€2017). RESULTS Over the 10-year horizon, BS led to a cost increment of €9,386 and 1.6 additional QALY (€5,966/QALY). Leading to 0.6 LYG and 4.4 QALY gains and €300/patient average cost savings over lifetime, BS could potentially significantly reduce diabetes and cardiovascular disease risk over the considered horizons. Despite short-term cost reductions, surgery delay may lead to significant clinical benefits loss. CONCLUSIONS Compared to CM, BS is a more effective and less costly alternative for treating morbid obesity in Spain.
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Affiliation(s)
- Raquel Sanchez-Santos
- a General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra, Instituto de Investigación Galicia Sur , Pontevedra , Spain
| | - Esther Mariño Padin
- b General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra , Pontevedra , Spain
| | - Daniel Adam
- c Health Economics Department , Synergus AB , Danderyd , Sweden
| | - Oleg Borisenko
- c Health Economics Department , Synergus AB , Danderyd , Sweden
| | - Sergio Estevez Fernandez
- d General and Digestive Surgery Department , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Ester Carrera Dacosta
- d General and Digestive Surgery Department , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Sonia González Fernández
- b General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra , Pontevedra , Spain
| | - Juan Turnes Vazquez
- e Digestive System Department , Instituo de investigación Galicia Sur , Pontevedra , Spain
| | | | - Felipe de la Cruz Vigo
- g General and Digestive Surgery Department , Hospital Universitario 12 de Octubre , Madrid , Spain
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Jung FUCE, Luck-Sikorski C, König HH, Riedel-Heller SG. Stigma and Knowledge as Determinants of Recommendation and Referral Behavior of General Practitioners and Internists. Obes Surg 2017; 26:2393-401. [PMID: 26886930 DOI: 10.1007/s11695-016-2104-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite reported effectiveness, weight loss surgery (WLS) still remains one of the least preferred options for outpatient providers, especially in Germany. The aim of this study was to examine the effect of stigma and knowledge on recommendation of WLS and referral to a surgeon by general practitioners (GPs) and internists. METHOD The sample consists of 201 GPs and internists from Germany. The questionnaire included questions on the perceived effectiveness of WLS, the frequency of recommendations of WLS, and the frequency of referral to WLS. Stigma, as well as knowledge was also assessed in this context. Linear and logistic regression models were conducted. A mediation analysis was carried out within post hoc analysis. RESULTS Knowledge (b = 0.258, p < 0.001) and stigma towards surgery (b = -0.129, p = 0.013) were related to the frequency of recommendation of WLS. Additionally, respondents, who were more likely to express negative attitudes towards WLS, were less likely to recommend WLS and thus refer patients to WLS (b = -0.107, p < 0.05). Furthermore, respondents with more expertise on WLS were more likely to recommend and thus refer patients to WLS (b = 0.026, p < 0.05). CONCLUSION This study showed that stigma plays a role when it comes to defining treatment pathways for patients with obesity. The question remains how this might influence the patients and their decision regarding their treatment selection. Interventions are required to make treatment decisions by physicians or patients independent of social pressure due to stigma.
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Affiliation(s)
- Franziska U C E Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany. .,IFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany. .,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Leipzig, Germany.
| | - Claudia Luck-Sikorski
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.,IFB Adiposity Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany
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Weiss CR, Kathait AS. Bariatric embolization: a new and effective option for the obese patient? Expert Rev Gastroenterol Hepatol 2017; 11:293-302. [PMID: 28276817 DOI: 10.1080/17474124.2017.1294060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is a public health epidemic in the United States, which results in significant morbidity, mortality, and cost to the healthcare system. Despite advancements in traditional therapeutic options for the obese patients, there is a treatment gap for patients in whom lifestyle modifications alone have not been successful, but for whom bariatric surgery is not a suitable option. Areas covered: This treatment gap needs to be addressed and thus, complimentary or alternative treatments to lifestyle changes and surgery are urgently needed. Recent evidence suggests that embolization of the gastric fundus ('Bariatric Embolization'), which is predominantly supplied by the left gastric artery, may affect energy homeostasis by decreasing ghrelin production. The purpose of this special report is to discuss the background, rationale and latest data on this topic, as well as provide the latest data from the ongoing BEAT Obesity clinical trial. Expert commentary: A multipronged approach is essential in the treatment of obesity. Bariatric embolization looks to treat the hormonal imbalances which contribute to obesity. If proven successful in the long-term, bariatric embolization represents a potential minimally invasive approach to treat obesity offered by interventional radiologists.
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Affiliation(s)
- Clifford R Weiss
- a Russell H. Morgan Department of Radiology and Radiologic Science , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Anjaneya S Kathait
- a Russell H. Morgan Department of Radiology and Radiologic Science , The Johns Hopkins University School of Medicine , Baltimore , MD , USA
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Abstract
BACKGROUND Obesity treatment options are of great interest worldwide with major developments in the past 20 years. From general surgery to natural orifice transluminal endoscopic surgery intervention nowadays, obesity surgical therapies have surely developed and are now offering a variety of possibilities. AREAS OF UNCERTAINTY Although surgery is the only proven approach for weight loss, a joint decision between the physician and patient is required before proceeding to such a procedure. With a lot of options available, the treatment should be individualized because the benefits of surgical intervention must be weighed against the surgical risks. DATA SOURCES Medline search to locate full-text articles and abstracts with obvious conclusions by using the keywords: obesity, surgical endoscopy, gastric bypass, bariatric surgery, and endoscopic surgery, alone and in various combinations. Additional relevant publications were also searched using the reference lists of the identified articles as a starting point. RESULTS Laparoscopic Roux-en-Y gastric bypass still is the most effective, less invasive, bariatric surgical intervention, although there are various complications encountered, such as postoperative hemorrhage (1.9%-4.4%), internal hernias, anastomotic strictures (2.9%-23%), marginal ulcerations (1%-16%), fistulas (1.5%-6%), weight gain, and nutritional deficiencies. However, the absence of parietal incisions, less pain, decreased risk of infection, and short hospital stay make room for endoscopic surgery as a possible valid option for obesity for both the doctors' and the patients' perspective. CONCLUSIONS The current tendency is to promote surgical treatment of obesity to a status of less invasive scars therefore promoting minimally invasive surgical techniques.
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Ramada Faria GF, Nunes Santos JM, Simonson DC. Quality of life after gastric sleeve and gastric bypass for morbid obesity. Porto Biomed J 2017; 2:40-46. [PMID: 32258584 DOI: 10.1016/j.pbj.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/21/2016] [Indexed: 01/20/2023] Open
Abstract
Highlights Quality-of-life measures improve as early as 3 months after bariatric surgery.There is wide variability in reporting that renders direct comparisons difficult.The available comparisons between RYGB and sleeve gastrectomy could not detect any difference.Improvement in PRO measures might be related to weight loss.Larger and better designed studies are required to achieve discrimination in PRO measures. Background Obesity is associated with reduced quality-of-life (QoL), which generally improves after bariatric surgery. The differential effect of each type of surgery (gastric sleeve [SG] and gastric bypass [RYGB]) on QoL is not yet fully understood. Objectives To understand which of these surgeries offers greatest improvement in QoL and patient satisfaction. Methods Systematic literature search on Pubmed in July 2014. Relevant articles were selected in a step-wise approach. The 2482 titles were scanned for relevance and 191 were selected for abstract reviewing; and 88 papers were selected for full text analysis. Results Only 5 papers compared the 2 techniques and only 17 more had retrievable data either on SG or RYGB. The reports were very heterogeneous, preventing a direct comparison of patient reported outcomes (PRO) among studies.Improved results have been reported as early has 3 months and SF-36 scores were improved in all domains in medium to long-term. The question remains whether the improvement in QoL is related to the weight loss and which factors are associated with improved patients' perceptions. Conclusions There is wide heterogeneity in the reporting of PRO measures after bariatric surgery, but data is consistent with a significant improvement after both surgeries.Larger and better-designed studies are required to understand if there are significant differences in the quality of life after SG or RYGB.
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Affiliation(s)
- Gil Filipe Ramada Faria
- Department of Surgery, Unidade de Investigação em Cirurgia Digestiva e Metabólica, Centro Hospitalar do Porto, Hospital de Sto António, Portugal.,Center for Health Technology and Services Research (CINTESIS), Instituto de Ciências Biomédicas de Abel Salazar, Portugal
| | - Jorge Manuel Nunes Santos
- Department of Surgery, Unidade de Investigação em Cirurgia Digestiva e Metabólica, Centro Hospitalar do Porto, Hospital de Sto António, Portugal.,Instituto de Ciências Biomédicas de Abel Salazar, Portugal
| | - Donald C Simonson
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, United States
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Sullivan S, Edmundowicz S. Early Experience With Endoscopic Sleeve Gastroplasty and Hints at Mechanisms of Action. Clin Gastroenterol Hepatol 2017; 15:44-45. [PMID: 27693522 DOI: 10.1016/j.cgh.2016.09.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 02/07/2023]
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Risk factors for complications of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Int J Surg 2016; 37:71-78. [PMID: 27956112 DOI: 10.1016/j.ijsu.2016.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/12/2016] [Accepted: 12/07/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although bariatric procedures are considered safe, yet still they involve a risk of possible perioperative complications. Identification of risk factors for complications would allow for appropriate preoperative optimization of the patient, as well as reasonable postoperative care and early diagnosis and treatment of possible complications. The aim of this study was to determine the risk factors for perioperative complications after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIAL AND METHODS A retrospective analysis of prospectively collected data of patients operated for morbid obesity. Regarding postoperative complications defined as adverse events occurring within 30 days of the procedure. Factors associated with patient characteristics and those related to the surgical procedure were determined. 408 patients met inclusion criteria and were submitted to surgical treatment. LSG and LRYGB were performed in 233 and 175 patients, respectively. RESULTS Complications were observed in 30 (7.3%) patients. The maximum preoperative body weight and BMI, as well as body weight and BMI on the day of surgery were associated with increased complication rate. The type of the procedure did not influence perioperative complications (LRYGB vs. LSG; OR: 1.14; CI: 0.53-2.44; p = 0.74). Although operative time statistically significantly increased the risk of complications, it did not seem clinically relevant (OR: 1.01; CI: 1.00-1.02; p = 0.003). An increase in the number of stapler firings used significantly increased complication rate only in LSG group. CONCLUSION Longer duration of LSG and the increase in the number of stapler firings used during LSG should alert a surgeon to an increased risk of postoperative complications. In patients submitted to LRYGB the risk of possible complications increases with BMI.
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Neylan CJ, Kannan U, Dempsey DT, Williams NN, Dumon KR. The Surgical Management of Obesity. Gastroenterol Clin North Am 2016; 45:689-703. [PMID: 27837782 DOI: 10.1016/j.gtc.2016.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the United States, more than one-third of the population is obese. Currently, bariatric surgery is the best known treatment for obesity, and multiple meta-analyses have shown bariatric surgery to be more effective for treating obesity than diet and exercise or pharmacologic treatment. The modern era of bariatric surgery began in 2005, which is defined by a drastic increase in the use of laparoscopy. Bariatric surgery has the potential to improve obesity-related comorbidities, such as type 2 diabetes, cardiovascular disease, and sleep apnea. The effect of bariatric surgery on weight loss and comorbidities varies by the type of procedure.
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Affiliation(s)
- Christopher J Neylan
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Umashankkar Kannan
- Department of Surgery, Bronx-Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, USA
| | - Daniel T Dempsey
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Risk Stratification Models: How Well do They Predict Adverse Outcomes in a Large Dutch Bariatric Cohort? Obes Surg 2016; 25:2290-301. [PMID: 25937046 DOI: 10.1007/s11695-015-1699-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Risk prediction models are useful tools for informing patients undergoing bariatric surgery about their risk for complications and correcting outcome reports. The aim of this study is to externally validate risk models assessing complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. METHODS All 740 patients who underwent a primary LRYGB between December 2007 and July 2012 were included in the validation cohort. PubMed was systematically searched for risk prediction models. Eight risk models were selected for validation. We classified our complications according to the Clavien-Dindo classification. Predefined criteria of a good model were a non-significant Hosmer and Lemeshow test, Nagelkerke R (2) ≥ 0.10, and c-statistic ≥0.7. RESULTS There were 85 (7.8 %) grade 1, 54 (7.3 %) grade 2, 5 (0.7 %) grade 3a, 14 (1.9 %) grade 3b, and 14 (1.9 %) grade 4a complications in our validation cohort. Only one model predicted adverse events satisfactorily. This model consisted of one patient-related factor (age) and four surgeon- or center related factors (conversion to open surgery, intraoperative events, the need for additional procedures during LRYGB and the learning curve of the center). CONCLUSIONS The overall majority of the included risk models are unsuitable for risk prediction. Only one model with an emphasis on surgeon- and center-related factors instead of patient-related factors predicted adverse outcome correctly in our external validation cohort. These findings support the establishment of specialty centers and warn benchmark data institutions not to correct bariatric outcome data by any other patient-related factor than age.
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Javanainen MH, Scheinin T, Mustonen H, Leivonen M. Do Changes in Perioperative and Postoperative Treatment Protocol Influence the Frequency of Pulmonary Complications? A Retrospective Analysis of Four Different Bariatric Groups. Obes Surg 2016; 27:64-69. [PMID: 27220851 DOI: 10.1007/s11695-016-2236-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current understanding of prophylaxis of pulmonary complications in bariatric surgery is weak. PURPOSE The aim of this study was to observe how changes in perioperative and postoperative treatments affect the incidence of pulmonary complications in bariatric patients. MATERIALS This is a retrospective clinical study of 400 consecutive bariatric patients. The patients, who either underwent a sleeve gastrectomy or a Roux-en-Y gastric bypass, were divided consecutively into four subgroups with different approaches to perioperative treatment. METHODS The first group (patients 0-100) was recovered in the intensive care unit with minimal mobilization (ICU). They had a urinary catheter and a drain. The second group (patients 101-200) was similar to the first group, but the patients used a continuous positive airway pressure (CPAP) device intermittently (ICU-CPAP). The third group (patients 201-300) was recovered on a normal ward without a urinary catheter or a drain and used a CPAP device (ward-slow). The fourth group (patients 301-400) walked to the operating theater and was mobilized in the recovery room during the first 2 h after the operation (ward-fast). CPAP was also used. Primary endpoints were pulmonary complications, pneumonia, and infection, non-ultra descriptus (NUD). RESULTS The number of pulmonary complications among the groups was significantly different. A long operation time increased the risk for infection (p < 0.001 95 % CI from 2.02 to 6.59 %). CONCLUSIONS Operation time increases the risk for pulmonary complications. Changes in perioperative care toward the ERAS protocol may have a positive effect on the number of pulmonary complications.
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Sullivan S, Kumar N, Edmundowicz SA, Abu Dayyeh BK, Jonnalagadda SS, Larsen M, Thompson CC. ASGE position statement on endoscopic bariatric therapies in clinical practice. Gastrointest Endosc 2015; 82:767-72. [PMID: 26282949 DOI: 10.1016/j.gie.2015.06.038] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 12/13/2022]
Affiliation(s)
| | - Shelby Sullivan
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nitin Kumar
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Steven A Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Barham K Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael Larsen
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
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Echaverry-Navarrete DJ, Maldonado-Vázquez A, Cortes-Romano P, Cabrera-Jardines R, Mondragón-Pinzón EE, Castillo-González FA. [Gastric band erosion: Alternative management]. CIR CIR 2015; 83:418-23. [PMID: 26164136 DOI: 10.1016/j.circir.2015.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 09/04/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity is a public health problem, for which the prevalence has increased worldwide at an alarming rate, affecting 1.7 billion people in the world. OBJECTIVE To describe the technique employed in incomplete penetration of gastric band where endoscopic management and/or primary closure is not feasible. MATERIAL AND METHODS Laparoscopic removal of gastric band was performed in five patients with incomplete penetrance using Foley catheterization in the perforation site that could lead to the development of a gastro-cutaneous fistula. CLINICAL CASES The cases presented include a leak that required surgical lavage with satisfactory outcome, and one patient developed stenosis 3 years after surgical management, which was resolved endoscopically. In all cases, the penetration site closed spontaneously. DISCUSSION Gastric band erosion has been reported in 3.4% of cases. The reason for inserting a catheter is to create a controlled gastro-cutaneous fistula, allowing spontaneous closure. CONCLUSIONS Various techniques have been described: the totally endoscopic, hybrid techniques (endoscopic/laparoscopic) and completely laparoscopic. A technique is described here that is useful and successful in cases where the above-described treatments are not viable.
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Affiliation(s)
| | | | - Pablo Cortes-Romano
- Instituto de Obesidad y Síndrome Metabólico, Hospital Ángeles del Pedregal, México, D.F., México
| | - Ricardo Cabrera-Jardines
- Instituto de Obesidad y Síndrome Metabólico, Hospital Ángeles del Pedregal, México, D.F., México
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Chand B, Prathanvanich P. Critical Care Management of Bariatric Surgery Complications. J Intensive Care Med 2015; 31:511-28. [PMID: 26115959 DOI: 10.1177/0885066615593067] [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: 02/26/2015] [Accepted: 06/01/2015] [Indexed: 12/23/2022]
Abstract
Obesity remains a major medical disease that often requires surgical intervention in morbidly obese patients. Surgical procedures have evolved and are performed routinely in most major medical centers. Outcomes are often dependent on patient characteristics, type of procedure, and preoperative planning. Risk stratification often depends on screening and optimizing known comorbidities often encountered in this patient population. A thorough understanding of the physiologic changes seen in obese patient and the commonly performed operations will allow the physician to perform optimal treatment strategies.
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Affiliation(s)
- Bipan Chand
- Department of Surgery, Loyola University, Maywood, IL, USA
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Advances in the Endoscopic Management of Obesity. Gastroenterol Res Pract 2015; 2015:757821. [PMID: 26106413 PMCID: PMC4461770 DOI: 10.1155/2015/757821] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/25/2015] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a worldwide epidemic with significant impact on quality of life, morbidity, and mortality rates. Over the past two decades, bariatric surgery has established itself as the most effective and durable treatment for patients with obesity and its associated comorbidities. However, despite the use of minimally invasive techniques, bariatric surgery is associated with complications in approximately 15% of patients, has a substantial cost, and is used by only 1% of patients who are eligible. Therefore, there is a need for effective minimally invasive therapies, which will be utilized by the large proportion of obese patients who are in desperate need of treatment but are not receiving any. Endoscopic approaches to the management of obesity have been developed, with the aim of delivering more effective, durable, and safer methods of weight reduction. In this paper, we review currently available and future endoscopic therapies that will likely join the armamentarium used in the management of obesity.
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Glenn JA, Turaga KK, Gamblin TC, Hohmann SF, Johnston FM. Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc 2015; 29:3768-75. [PMID: 25791064 DOI: 10.1007/s00464-015-4152-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internationally, the utilization of minimally invasive techniques for gastric cancer resection has been increasing since first introduced in 1994. In the USA, the feasibility and safety of these techniques for cancer have not yet been demonstrated. METHODS The University HealthSystem Consortium database was queried for gastrectomies performed between 2008 and 2013. Any adult patient with an abdominal visceral malignancy that necessitated gastric resection was included in the cohort. Clinicopathological and in-hospital outcome metrics were collected for open, laparoscopic, and robotic procedures. RESULTS Open gastrectomies comprised 89.5% of the total study group, while 8.2% of procedures were performed laparoscopically, and 2.3% were performed with robotic assistance. When accounting for disparities in patient severity of illness and risk of mortality subclass designations, there were no significant differences in mean length of stay, 30-day readmission, and in-hospital mortality between the three groups; however, mean total cost was highest in the robotic-assisted group (P = 0.017). Overall, complication rates were also similar; however, there was a higher incidence of superficial infection in the laparoscopic group (P = 0.013) and a higher incidence of venous thromboembolism in the robotic group (P = 0.038). CONCLUSION Despite widespread adoption for benign indications, minimally invasive gastrectomy for cancer remains underutilized in the USA. In these patients, laparoscopic and robot-assisted gastrectomies appear to be comparable to open resection with respect to overall complications, length of stay, 30-day readmission, and in-hospital mortality. However, when employing minimally invasive techniques, infection and thromboembolism risk reduction strategies should be emphasized in the operative and postoperative periods.
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Affiliation(s)
- Jason A Glenn
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Samuel F Hohmann
- University HealthSystem Consortium, 155 N Upper Wacker Dr, Chicago, IL, 60606, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
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Weiss CR, Gunn AJ, Kim CY, Paxton BE, Kraitchman DL, Arepally A. Bariatric embolization of the gastric arteries for the treatment of obesity. J Vasc Interv Radiol 2015; 26:613-24. [PMID: 25777177 DOI: 10.1016/j.jvir.2015.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 12/31/2022] Open
Abstract
Obesity is a public health epidemic in the United States that results in significant morbidity, mortality, and cost to the health care system. Despite advancements in therapeutic options for patients receiving bariatric procedures, the number of overweight and obese individuals continues to increase. Therefore, complementary or alternative treatments to lifestyle changes and surgery are urgently needed. Embolization of the left gastric artery, or bariatric arterial embolization (BAE), has been shown to modulate body weight in animal models and early clinical studies. If successful, BAE represents a potential minimally invasive approach offered by interventional radiologists to treat obesity. The purpose of the present review is to introduce the interventional radiologist to BAE by presenting its physiologic and anatomic bases, reviewing the preclinical and clinical data, and discussing current and future investigations.
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Affiliation(s)
- Clifford R Weiss
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, Maryland.
| | - Andrew J Gunn
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, Maryland
| | - Charles Y Kim
- Department of Vascular and Interventional Radiology, Duke University Medical Center, Durham, North Carolina
| | - Ben E Paxton
- Department of Interventional Radiology, Yavapai Regional Medical Center, Prescott, Arizona
| | - Dara L Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, Maryland; Department of Molecular and Comparative Pathobiology, The Johns Hopkins University, Baltimore, Maryland
| | - Aravind Arepally
- Division of Interventional Radiology, Piedmont Radiology, Atlanta, Georgia
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Bowel obstruction rates in antecolic/antegastric versus retrocolic/retrogastric Roux limb gastric bypass: a meta-analysis. Surg Obes Relat Dis 2015; 12:194-8. [PMID: 26003892 DOI: 10.1016/j.soard.2015.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous literature is varied with regard to rates of bowel obstruction after laparoscopic Roux-en-Y gastric bypass (LRYGB). Internal herniation through mesenteric defects is a common cause of bowel obstructions. There are advantages and disadvantages to routing the Roux limb via a retrocolic/retrogastric (RC/RG) versus an antecolic/antegastric (AC/AG) position. OBJECTIVE To review the literature comparing obstruction rates in RYGB using the antecolic versus retrocolic approach. SETTING Community-based integrated multispecialty health system with a teaching hospital serving 19 counties over a 3-state region. METHODS A literature search for articles published from 1994-2013 was completed. Articles were included if they reported an n>25, Roux limb route, obstruction rate by route, and follow-up duration. Statistical analysis included χ(2) test by patient number. RESULTS The initial search identified 241 articles; 8 met inclusion criteria. There were 4805 patients in the AC/AG group, and 2238 in the RC/RG group. Follow-up ranged from 0 to 68 months. A linear stapled technique was reported in 4231 (88%) patients in the AC/AG group and 1541 (69%) of RC/RG group. Handsewn closure of mesenteric defects was reported in 2152 (45%) patients in the AC/AG group and 1012 (45%) patients in the RC/RG group. Bowel obstructions occurred in 68 (1.4%) patients in the AC/AG group and 117 (5.2%) patients in the RC/RG group (P<.001). Internal hernias were reported in 65 (1.3%) patients in the AC/AG group and 52 (2.3%) patients in the RC/RG group (P<.001). Two mortalities were reported in the AC/AG group. CONCLUSIONS Increased rates of bowel obstruction and internal hernia were observed in the RC/RG group compared with the AC/AG group. A prospective, randomized trial would be necessary to definitively determine the impact of Roux limb position and routine closure of mesenteric defects on bowel obstruction rates after gastric bypass.
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Zellmer JD, Mathiason MA, Kallies KJ, Kothari SN. Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis. Am J Surg 2014; 208:903-10; discussion 909-10. [DOI: 10.1016/j.amjsurg.2014.08.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/05/2014] [Accepted: 08/11/2014] [Indexed: 02/07/2023]
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Sanni A, Perez S, Medbery R, Urrego HD, McCready C, Toro JP, Patel AD, Lin E, Sweeney JF, Davis SS. Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data. Surg Endosc 2014; 28:3302-9. [PMID: 25115863 DOI: 10.1007/s00464-014-3606-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/03/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery results in long-term weight loss and significant morbidity reduction. Morbidity and mortality following bariatric surgery remain low and acceptable. This study looks to define the trend of morbidity and mortality as it relates to increasing age and body mass index (BMI) in patients undergoing bariatric surgery. METHODS We queried the ACS/NSQIP 2010-2011 Public Use File for patients who underwent elective laparoscopic adjustable banding (LAGB), sleeve gastrectomy (LSG) and gastric bypass (LGBP). Total morbidity and 30-day mortality were evaluated. Logistic regression models were created to estimate the effect of increasing age and BMI on morbidity for these bariatric procedures. RESULTS A total of 20,308 laparoscopic bariatric procedures were reviewed (11617 LGBP, 3069 LSG and 5622 LAGB). Overall mortality and morbidity rates were 0.11 and 3.84%, respectively. The odds of postoperative complications increased by 2% with each additional year of age (OR 1.02, 95% CI 1.02-1.03) and every point increase in BMI (OR 1.02, 95% CI 1.01-1.03). Multiple logistic regression identified COPD, Diabetes, Hypertension, and Dyspnea as major risk factors for postoperative morbidity. Postoperative complications were three times more likely after LGBP (OR 2.87, 95% CI 2.31-3.57) and two times more likely after LSG (OR 2.06, 95% CI 1.57-2.72) when compared to patients undergoing LAGB. CONCLUSION Morbidity and mortality increase on a predictable trend with increasing age and BMI. There is increased risk of morbidity for stapling procedures when compared to gastric banding, but this must be considered in context of surgical efficacy when choosing a bariatric procedure. These data can be used in preoperative counseling and evaluation of surgical candidacy of bariatric surgical patients.
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Affiliation(s)
- Aliu Sanni
- Emory Endosurgery/Bariatrics Unit, Department of Surgery, Emory University, 1365 Clifton Road. Building A Suite 5040, Atlanta, GA, 30322, USA,
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Weight loss expectations of laparoscopic sleeve gastrectomy candidates compared to clinically expected weight loss outcomes 1-year post-surgery. Obes Surg 2014; 23:1987-93. [PMID: 23794118 DOI: 10.1007/s11695-013-1007-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) results in significant, sustainable weight loss in obese individuals (body mass index (BMI) ≥ 40 kg/m(2) or BMI 35.0-39.9 kg/m(2) with major comorbidity). Average clinically expected % excess weight loss (%EWL) has been reported to be 56.1 % 1 year after LSG. Unrealistic weight loss expectations are purported to negatively impact treatment adherence and weight loss outcomes. This study examined the weight loss expectations of LSG candidates in Newfoundland and Labrador, Canada. METHODS The Goals and Relative Weights Questionnaire was administered before the start of a bariatric surgery education session to 84 consecutive LSG candidates. Patients reported postoperative weight loss expectations in four categories: "dream", "happy", "acceptable", and "disappointed". RESULTS Participants included 69 women and 15 men with an average age and weight of 43.7 years and 136.7 kg. The patients reported average postoperative "dream" and "happy" weights as 71.1 and 80.0 kg, respectively. Patients reported a weight of 86.2 kg as "acceptable" but would be "disappointed" with a weight of 105.6 kg. To achieve the desired amount of weight loss for each category, patients would have to achieve %EWLs of 88.7, 76.4, 68.2, and 40.6 %, respectively. CONCLUSIONS Patients have higher weight loss expectations than those that are clinically expected within 1 year after LSG.
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JOURNAL CLUB: Gastric Band Slippage: A Case-Controlled Study Comparing New and Old Radiographic Signs of This Important Surgical Complication. AJR Am J Roentgenol 2014; 203:10-6. [DOI: 10.2214/ajr.13.11650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Urrego H, Sanni A, Toro JP, Lytle N, McCready C, Davis SS, Sweeney JF, Lin E, Patel AD. Out by 3:30—A Study in Robotic Bariatric Surgery Efficiency. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hernan Urrego
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Aliu Sanni
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Juan P. Toro
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
- Department of Surgery, SOMA Clinic, Medellin, Antioquia, Colombia
| | - Nathaniel Lytle
- Department of General Surgery, Kaiser Permanente, Atlanta, Georgia
| | - Craig McCready
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - S. Scott Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - John F. Sweeney
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward Lin
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ankit D. Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Toro JP, Lin E, Patel AD, Davis SS, Sanni A, Urrego HD, Sweeney JF, Srinivasan JK, Small W, Mittal P, Sekhar A, Moreno CC. Association of radiographic morphology with early gastroesophageal reflux disease and satiety control after sleeve gastrectomy. J Am Coll Surg 2014; 219:430-8. [PMID: 25026879 DOI: 10.1016/j.jamcollsurg.2014.02.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/26/2014] [Accepted: 02/26/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Variable gastric morphology has been identified on routine upper gastrointestinal series after laparoscopic sleeve gastrectomy. This test might give us useful information beyond the presence of leak and obstruction. The aim of this study is to standardize a morphologic classification of gastric sleeve based on water-soluble contrast upper gastrointestinal series, and to determine possible clinical implications. STUDY DESIGN One hundred morbidly obese patients underwent laparoscopic sleeve gastrectomy and had routine upper gastrointestinal on postoperative day 1 or 2. Images were reviewed by 4 radiologists who were blinded to outcomes, and sleeve shape was classified as upper pouch, lower pouch, tubular, or dumbbell. Inter-observer agreement was calculated. Clinical outcomes including weight loss, satiety control, and reflux symptoms were recorded. Comparisons were determined by 1-way ANOVA and t-test. RESULTS Mean age was 46 ± 12 years and mean BMI was 45.1 ± 6 kg/m(2). Overall inter-observer agreement level for the sleeve shape classification was 76.3%. Sleeve shapes were tubular in 37%, dumbbell in 32%, lower pouch in 22%, and upper pouch in 8%. Mean excess body weight loss at 1, 3, and 6 months was 16.8%, 29.9%, and 39.1%, respectively. Excess body weight loss was not associated with sleeve shape. Mean hunger score was 213 ± 97, and patients with dumbbell shape had higher hunger scores (p = 0.003). Mean reflux score was 5.7 ± 8. Upper pouch shape was associated with greater severity of reflux symptoms (p = 0.02). CONCLUSIONS This study suggests a standardized radiographic classification of gastric sleeve morphology. Although sleeve shape is not correlated with weight loss, gastric sleeves with retained fundus result in lower satiety control and higher severity of reflux symptoms. An adequate resection of the gastric fundus might avoid this potential complication.
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Affiliation(s)
- Juan P Toro
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - Edward Lin
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA.
| | - Ankit D Patel
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - S Scott Davis
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - Aliu Sanni
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - Hernan D Urrego
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - John F Sweeney
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - Jahnavi K Srinivasan
- Emory Endosurgery Unit, Emory Bariatric Center, Emory University School of Medicine, Atlanta, GA
| | - William Small
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Pardeep Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Aarti Sekhar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
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De Cesare A, Cangemi B, Fiori E, Bononi M, Cangemi R, Basso L. Early and long-term clinical outcomes of bilio-intestinal diversion in morbidly obese patients. Surg Today 2014; 44:1424-33. [PMID: 24519396 DOI: 10.1007/s00595-014-0856-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/18/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients. METHODS Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Policlinico "Umberto I°", Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists. RESULTS There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12-24 months after surgery, while the mean percentage excess weight loss at 3-5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients. CONCLUSIONS Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy.
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Affiliation(s)
- Alessandro De Cesare
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Faculty of Medicine and Dentistry, viale del Policlinico 155, 00161, Rome, Italy
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Sullivan S, Stein R, Jonnalagadda S, Mullady D, Edmundowicz S. Aspiration therapy leads to weight loss in obese subjects: a pilot study. Gastroenterology 2013; 145:1245-52.e1-5. [PMID: 24012983 PMCID: PMC4025911 DOI: 10.1053/j.gastro.2013.08.056] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/05/2013] [Accepted: 08/29/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Obese patients rarely achieve long-term weight loss with only lifestyle interventions. We evaluated the use of endoscopic aspiration therapy for obesity. Aspiration therapy involves endoscopic placement of a gastrostomy tube (A-Tube) and the AspireAssist siphon assembly (Aspire Bariatrics, King of Prussia, PA) to aspirate gastric contents 20 minutes after meal consumption. METHODS We performed a pilot study of 18 obese subjects who were randomly assigned (2:1) to groups that underwent aspiration therapy for 1 year plus lifestyle therapy (n = 11; mean body mass index, 42.6 ± 1.4 kg/m(2)) or lifestyle therapy only (n = 7; mean body mass index, 43.4 ± 2.0 kg/m(2)). Lifestyle intervention comprised a 15-session diet and behavioral education program. RESULTS Ten of the 11 subjects who underwent aspiration therapy and 4 of the 7 subjects who underwent lifestyle therapy completed the first year of the study. After 1 year, subjects in the aspiration therapy group lost 18.6% ± 2.3% of their body weight (49.0% ± 7.7% of excess weight loss [EWL]) and those in the lifestyle therapy group lost 5.9% ± 5.0% (14.9% ± 12.2% of EWL) (P < .04). Seven of the 10 subjects in the aspiration therapy group completed an additional year of therapy and maintained a 20.1% ± 3.5% body weight loss (54.6% ± 12.0% of EWL). There were no adverse effects of aspiration therapy on eating behavior and no evidence of compensation for aspirated calories with increased food intake. No episodes of binge eating in the aspiration therapy group or serious adverse were reported. CONCLUSIONS In a pilot study, aspiration therapy appears to be a safe and effective long-term weight loss therapy for obesity.
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Affiliation(s)
- Shelby Sullivan
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri.
| | - Richard Stein
- Divisions of Geriatrics and Nutritional Science, Washington University School of Medicine, St Louis, Missouri
| | | | - Daniel Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Steven Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
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Ties JS, Zlabek JA, Kallies KJ, Al-Hamadini M, Kothari SN. The Effect of Laparoscopic Gastric Bypass on Dyslipidemia in Severely Obese Patients: a 5-Year Follow-up Analysis. Obes Surg 2013; 24:549-53. [DOI: 10.1007/s11695-013-1120-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
BACKGROUND Prevalence rates of obesity are still rising. Weight loss surgery (WLS) is the most invasive but also most effective treatment option when behavioral modification has failed. Research indicates that health care professionals hold ambivalent views on bariatric surgery, while views of the general public have not yet been investigated. METHODS In a German representative sample of n = 3,003 respondents in a computer-assisted telephone interview, n = 1,008 persons were interviewed on their views of the effectiveness of bariatric surgery and other interventions for obesity. Also, willingness to recommend a treatment was assessed. RESULTS Lifestyle-based interventions were viewed as most effective in terms of weight loss. About 50 % of the population stated that WLS is "very effective" while still a quarter of respondents did not ascribe effectiveness to WLS. Higher age was associated with lower expectations of effectiveness while higher stigmatizing attitudes and genetic attributes for obesity were associated with higher expectations of effectiveness. Seventy-two percent would not recommend WLS or undergo it, if applicable, themselves. Higher educated respondents and those that viewed WLS as effective were more likely to recommend WLS. CONCLUSIONS The German general public seems to be rather cautious regarding bariatric surgery. It may be assumed that false beliefs on the effectiveness and risk patterns of bariatric surgery are still very common, despite rising surgery numbers. Our results further emphasize the need for providing evidence-based information on bariatric surgery to the general public.
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Apovian CM, Huskey KW, Chiodi S, Hess DT, Schneider BE, Blackburn GL, Jones DB, Wee CC. Patient factors associated with undergoing laparoscopic adjustable gastric banding vs Roux-en-Y gastric bypass for weight loss. J Am Coll Surg 2013; 217:1118-25. [PMID: 24083911 DOI: 10.1016/j.jamcollsurg.2013.08.004] [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: 02/28/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are 2 commonly performed bariatric procedures in the US with different profiles for risk and effectiveness. Little is known about factors that might lead patients to proceed with one procedure over the other. STUDY DESIGN We recruited and interviewed patients seeking bariatric surgery from 2 academic centers in Boston (response rate 70%). We conducted multivariable analyses to identify patient perceptions and clinical and behavioral characteristics that correlated with undergoing gastric banding (n = 239) vs gastric bypass (n = 297). RESULTS After adjustment for socio-demographic and clinical factors, we found that older patients (odds ratio [OR] 1.03; 95% CI 1.00 to 1.05) and those with higher quality of life scores and higher levels of uncontrolled eating were more likely to undergo gastric banding as opposed to gastric bypass. In contrast, patients with type 2 diabetes (OR 0.46; 95% CI 0.28 to 0.77), those who desired greater weight loss, and those who were willing to assume higher mortality risk to achieve their ideal weight were less likely to proceed with gastric banding. After initial adjustment, male sex and lower body mass index were associated with a likelihood of undergoing gastric banding; however, these factors were no longer significant after adjustment for other significant correlates such as patients' perceived ideal weight, predilection to assume risk to lose weight, and eating behavior. CONCLUSIONS Patients' diabetes status, quality of life, eating behavior, ideal weight loss, and willingness to assume mortality risk to lose weight were associated with whether patients proceeded with gastric banding as opposed to gastric bypass. Other clinical factors were less important.
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Affiliation(s)
- Caroline M Apovian
- Evans Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center and Boston University School of Medicine, Boston, MA
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[Is the morbid obesity surgery profitable in times of crisis? A cost-benefit analysis of bariatric surgery]. Cir Esp 2013; 91:476-84. [PMID: 23628503 DOI: 10.1016/j.ciresp.2013.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/03/2013] [Accepted: 02/05/2013] [Indexed: 12/21/2022]
Abstract
Morbid obesity is a serious health problem whose prevalence is increasing. Expensive co-morbidities are associated to these patients, as well as a reduction in the survival. Bariatric surgery resolves the co-morbidities (type 2 diabetes mellitus, 86.6%; cardiovascular risk, 79.0%; obstructive sleep apnea syndrome, 83.6%; hypertension, 61.7%), reduces the mortality rate (among 31-40%), and increases the morbid obese patients survival over a 10-years period. It provides significant savings for the National Health System. The obese patients consume a 20% plus of health resources and 68% plus of drugs than general population. Bariatric surgery requires an initial investment (diagnosis-related group cost: 7,468 €), but it is recovered in a cost-effectiveness ratio of 2.5 years. Significant savings are obtained from the third year. To the direct economic benefits associated with reduced health expenditures it should be added an increase in tax collection (sick leave and unemployment reduction is estimated in 18%, with a productivity increase of 57% for self-employed people). Bariatric surgery is one of the most cost-effective procedures in the healthcare system.
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Acute complications after laparoscopic bariatric procedures: update for the general surgeon. Langenbecks Arch Surg 2013; 398:669-86. [DOI: 10.1007/s00423-013-1077-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 03/05/2013] [Indexed: 12/24/2022]
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Abstract
Bariatric surgery is gaining in popularity in the United States and around the world as a treatment for morbid obesity. Patients seek surgery in order to lose weight and limit the long-term effects of insulin-resistant diabetes, heart disease and lung disease, including risk of sudden death. While gastric bypass in patients with morbid obesity can reduce the risk of diabetes and myocardial infarction to population levels, the risk of death remains increased. These patients may die suddenly and unexpectedly as a direct result of surgery, as an indirect result of surgery, or of end-organ damage wrought by years of obesity, completely unrelated to the surgery. Proper forensic pathologic assessment of these patients requires an understanding of the anatomic changes caused by bariatric surgery, the complications and the metabolic consequences of the different procedures. In order to better understand this subgroup of patients, a search of the peer-reviewed medical literature at the National Library of Medicine was conducted for articles using the keywords bariatric, surgery, gastric bypass, autopsy, review, toxicology, alcohol, drug, ethanol, absorption, elimination, litigation, forensic, and death. This review outlines the most common laparoscopic and open surgical procedures; the common immediate post-surgical complications that lead to morbidity and mortality; forensic toxicological considerations in bariatric patients; and the long-term complications and other causes that could lead to unexpected death in these patients.
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Affiliation(s)
- Judy Melinek
- Office of the Chief Medical Examiner in San Francisco
- University of California at San Francisco
| | - Nikolas P. Lemos
- Forensic Laboratory Division, Office of the Chief Medical Examiner, City and County of San Francisco
- Department of Laboratory Medicine, School of Medicine, University of California, San Francisco
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Is body mass index an adequate measure for individualized clinical decision making? Surg Obes Relat Dis 2013; 9:428. [PMID: 23434276 DOI: 10.1016/j.soard.2013.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/23/2022]
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