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Viennet M, Rat P, Facy O. Robotic total esogastrectomy with thoracic esophago-jejunostomy (with video). J Visc Surg 2024; 161:221-223. [PMID: 38553374 DOI: 10.1016/j.jviscsurg.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Affiliation(s)
- Manon Viennet
- Dijon University Hospital, Department of Digestive Surgical Oncology, 21000 Dijon, France.
| | - Paul Rat
- Dijon University Hospital, Department of Digestive Surgical Oncology, 21000 Dijon, France
| | - Olivier Facy
- Dijon University Hospital, Department of Digestive Surgical Oncology, 21000 Dijon, France
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2
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Lind RP, Antunes J, Ghanem M, Jawad MA, Teixeira AF. Reflux After Sleeve Gastrectomy: Safety and Effectiveness of Laparoscopic Ligamentum Teres Cardiopexy, a Single-Center Experience. Obes Surg 2024; 34:1232-1237. [PMID: 38409622 DOI: 10.1007/s11695-024-07103-w] [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: 12/08/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Obesity is a well-known risk factor for gastroesophageal reflux disease (GERD). Even though symptoms may be mitigated or resolved with the weight loss caused by sleeve gastrectomy (SG), it may be associated with higher incidences of postoperative GERD. Ligamentum teres cardiopexy (LTC) is an alternative to Roux-en-Y gastric bypass, the gold standard treatment for GERD. METHODS This study was a retrospective single-center chart review, all patients in this cohort underwent LTC to treat refractory GERD at our institution. The option for LTC was presented after patients' refusal to undergo RYGB conversion. We collected baseline characteristics, standard demographics, pre-operative tests and imaging, and SG information, as well as intraoperative and perioperative data regarding LTC, and postoperative complications. RESULTS Our cohort included 29 patients; most were Caucasian (44.8%) females (86.2%). The mean weight and BMI before LTC were 216.5 ± 39.3 lb and 36.1 ± 5.4 kg/m2, respectively. Mean total body-weight loss (TBWL) at 12 and 24 months were 28.7% ± 9.5% and 28.4% ± 12.4%, respectively. The mean interval between the index bariatric surgery and LTC was 59.9 ± 34.9 months, mean operative time was 67 ± 18.2 min, and median length of stay (LOS) was 1 day (IQR = 1-2 days). Twelve patients (57.1%) were able to discontinue antisecretory medications, while 9 (42.9%) still required them to remain asymptomatic. Mortality and reoperation rates were 0% and the incidence of complication was 19.4% (n = 6). CONCLUSIONS LTC is a safe and effective surgical alternative to treat refractory GERD symptoms after SG.
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Affiliation(s)
- Romulo P Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
| | - Juliana Antunes
- Policlinica Itaipava, 12.235 Estarda Uniao e Industria, Petropolis, RJ, Brazil
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
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3
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Lind R, Hage K, Ghanem M, Shah M, Vierkant RA, Jawad M, Ghanem OM, Teixeira AF. Long-Term Outcomes of Sleeve Gastrectomy: Weight Recurrence and Surgical Non-responders. Obes Surg 2023; 33:3028-3034. [PMID: 37464052 DOI: 10.1007/s11695-023-06730-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an effective procedure with remarkable weight loss and low complication rates. However, up to 30% of cases require revisional surgery in non-responders or patients who experience weight recurrence. We aim to report the rate of weight recurrence/non-responders (WR/NR) in patients who underwent SG and had more than 5 years of follow-up. METHODS We performed a multicenter retrospective study of patients who underwent initial SG from 2008 to 2017. Patient demographics and weight loss outcomes up to 12 years after SG were collected. Surgical non-responders were defined as 20% weight regain compared to maximum weight loss. A chi-square test for categorical variables and a two-sample t-test for continuous variables were used. Data are summarized as mean ± standard deviation. RESULTS From a total of 1263 patients, we included 339 patients (78% female, age 47.3 ± 11.2 years; baseline weight 125.8 ± 27.6 kg) with at least 5 years of follow-up (mean follow-up of 7.1 ± 1.8 years) (Table 1). Surgical non-response was demonstrated in 15.9% of patients (n=54) and 64.0% (n=217) had weight recurrence after SG (Fig. 1). There was a statistically significant difference in history of hypertension (p=0.046) and diabetes (p=0.032) as well as %TBWL at 1 year (p=0.005) and at longest follow-up (p<0.001) between patients who experienced WR/NR and those who did not. CONCLUSIONS Only 20% of patients who underwent SG and followed up for more than 5 years were able to maintain appropriate weight loss.
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Affiliation(s)
- Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA.
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Robert A Vierkant
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Muhammad Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr., 1st Floor, Orlando Health, Orlando, FL, USA
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4
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Mechanical Behavior of Subcutaneous and Visceral Abdominal Adipose Tissue in Patients with Obesity. Processes (Basel) 2022. [DOI: 10.3390/pr10091798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The mechanical characterization of adipose tissues is important for various medical purposes, including plastic surgery and biomechanical applications, such as computational human body models for the simulation of surgical procedures or injury prediction, for example, in the evaluation of vehicle crashworthiness. In this context, the measurement of human subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) mechanical properties in relation to subject characteristics may be really relevant. The aim of this work was to properly characterize the mechanical response of adipose tissues in patients with obesity. Then, the data were exploited to develop a reliable finite element model of the adipose tissues characterized by a constitutive material model that accounted for nonlinear elasticity and time dependence. Mechanical tests have been performed on both SAT and VAT specimens, which have been harvested from patients with severe obesity during standard laparoscopic sleeve gastrectomy intervention. The experimental campaign included indentation tests, which permitted us to obtain the initial/final indentation stiffnesses for each specimen. Statistical results revealed a higher statistical stiffness in SAT than in VAT, with an initial/final indentation stiffness of 1.65 (SD ± 0.29) N/30.30 (SD ± 20) N compared to 1.29 (SD ± 0.30) N/21.00 (SD ± 16) N. Moreover, the results showed that gender, BMI, and age did not significantly affect the stiffness. The experimental results were used in the identification of the constitutive parameters to be inserted in the constitutive material model. Such constitutive characterization of VAT and SAT mechanics can be the starting point for the future development of more accurate computational models of the human adipose tissue and, in general, of the human body for the optimization of numerous medical and biomechanical procedures and applications.
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5
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Impact of Laparoscopic Sleeve Gastrectomy on Thrombomodulin Concentration and Early Markers of Atherosclerosis. J Interv Cardiol 2022; 2022:6152571. [PMID: 35855391 PMCID: PMC9286949 DOI: 10.1155/2022/6152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Thrombomodulin, an integral membrane protein functioning as a cofactor in the anticoagulant pathways, has recently emerged as a marker of endothelial dysfunction. This study aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on thrombomodulin concentration and early markers of atherosclerosis. Methods Forty-four subjects undergoing LSG were prospectively examined. The change in thrombomodulin concentration from baseline (preoperative) to the sixth postoperative month following the LSG and the relationship between the change in thrombomodulin concentration and BMI, CIMT, ABI, and blood lipids were examined. Results The medical records were available for 44 patients (mean age: 37.2 ± 10.9 years, 65.9% male). LSG led to significant reductions in total body weight and body mass index (BMI) at postoperative six months (37.0 ± 5.6 kg/m2 vs. 47.1 ± 5.8 kg/m2, p < 0.001). Markers of early atherosclerotic events, including carotid intima-media thickness (CIMT) and ABI, improved. The change in thrombomodulin concentration (Δ TMD) was significantly correlated with the change in Δ BMI (r = 0.500, p=0.011), Δ LDL (r = 0.389, p=0.032), Δ systolic blood pressure (r = 0.384, p=0.012), and Δ CIMT (r = 0.327, p=0.012) and was negatively correlated with Δ HDL (r = −0.344, p=0.020) and Δ ABI (r = −0.357, p=0.020). Conclusion LSG leads to significant improvements in blood lipids, systolic and diastolic blood pressure, and in surrogate markers of atherosclerotic burden and endothelial function, including thrombomodulin, ABI, and CIMT, at postoperative six months. LSG might prevent or reduce atherogenesis in the early stages by stopping endothelial dysfunction.
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Aldohayan A, Alshammari S, Binjaloud A, Bamehriz F, Narejo AS, Aqil M, Aldahian N, Aldabaeab A, Eldawlatly A. Pre-incisional Laparoscopic Preperitoneal Local Anesthetic Technique in Laparoscopic Sleeve Gastrectomy. JSLS 2022; 26:JSLS.2022.00049. [PMID: 36071990 PMCID: PMC9439284 DOI: 10.4293/jsls.2022.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: The increasing prevalence of obesity is a significant concern worldwide. Laparoscopic sleeve gastrectomy (LSG) is an effective and standard procedure for sustained weight loss. However, optimal pain control is essential for enhanced recovery after surgery. The aim of this randomized controlled study was to investigate the efficacy of a pre-incisional laparoscopic preperitoneal local anesthetic technique (PLPLAT) on recovery characteristics following LSG. Methods: A total of 120 obese patients scheduled to undergo LSG were randomized into the PLPLAT or placebo group (n = 60 patients in both groups). All patients received conventional intravenous or other analgesics postoperatively, as required. The primary outcome was the postoperative pain score. The secondary outcomes included morphine consumption, other analgesics, length of stay in the postanesthesia care unit (PACU), hemodynamic changes, postoperative nausea and vomiting (PONV), early mobilization, and length of hospital stay. Results: Pain scores in the PACU and at 12 hours after surgery in the ward were significantly lower in the PLPLAT group than in the placebo group (P < 0.05). The morphine consumption was significantly less in PLPLAT group with mean dosage of 2.95 mg (± 0.39) compared to 6.0 mg (± 0.4) in placebo group. PONV, mean arterial pressure, and PACU stay were significantly higher in the placebo group than in the PLPLAT group (P < 0.05). Conclusion: Intraoperative PLPLAT provide effective postoperative pain relief for patients undergoing LSG. The findings indicated the efficacy of PLPLAT in reducing postoperative pain, enhancing recovery, and facilitating early discharge.
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Affiliation(s)
- Abdullah Aldohayan
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman Alshammari
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Binjaloud
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Bamehriz
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Sattar Narejo
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mansoor Aqil
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Nahlah Aldahian
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia.,Pharmacology Department, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdulaziz Aldabaeab
- Department of Surgery, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdelazeem Eldawlatly
- Anesthesia Department, University Medical City, King Saud University, Riyadh, Saudi Arabia
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7
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Gülşen Atalay B, Parlak E. Laparoscopic Sleeve Gastrectomy: Do Lipid Profile and Cardiovascular Risk Predictor Improve in Moderately, Morbidly, and Super Obese Patients? Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Betül Gülşen Atalay
- Department of Health Management, Nutrition and Dietetics, Toros University, Mersin, Turkey
| | - Eda Parlak
- Department of Health Management, Nutrition and Dietetics, Toros University, Mersin, Turkey
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8
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Zhang K, Ma Y, Shi Q, Shen J, Wu J, Zhang X, Jiao P, Li GS, Tang X, Petersen RH, Ng CSH, Fiorelli A, Novoa NM, Bedetti B, Levi Sandri GB, Hochwald S, Lerut T, Sihoe ADL, Barchi LC, Gilbert S, Waseda R, Toker A, Gonzalez-Rivas D, Fruscio R, Scarci M, Davoli F, Piessen G, Qiu B, Wang SD, Chen Y, Gao S. Evidence on reporting guidelines for surgical technique in clinical disciplines: a scoping review protocol. Gland Surg 2021; 10:2325-2333. [PMID: 34422603 DOI: 10.21037/gs-21-311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
Background The reporting of surgical techniques is of mixed quality, with most at a very minimal level. Reporting guidelines that could be applied to guide surgical technique reporting vary in methodology for development, discipline coverage, dimension coverage and detail requested. However, a scoping review that could indicate the gaps and efforts needed in surgical technique reporting guidelines is lacking and warranted. This study aims to design a methodological rigour protocol to guide the development of a scoping review of surgical technique reporting guidelines. Methods This protocol is designed following the 2020 manual proposed by the Joanna Briggs Institute. To further ensure the soundness of the protocol, we also included multidisciplinary professionals (including methodologists, clinicians, and journal editors) to refine the protocol. Discussion Seven key steps for developing the scoping review are identified and presented in detail, including (I) identifying the research questions; (II) inclusion criteria; (III) search strategy; (IV) source of evidence selection; (V) data extraction; (VI) analysis of the evidence; and (VII) presentation of the results. Guided by this protocol, the subsequent scoping review will inform us the overview of surgical technique reporting guidelines and precisely guide our direction and next steps in improving surgical technique reporting guidelines. Trial registration This protocol is not registered as the PROSPERO database only accepts registration of systematic review protocols while does not accept registration of scoping review protocols.
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Affiliation(s)
- Kaiping Zhang
- Editorial Office, AME Publishing Company, Hong Kong, China.,School of Public Health, Imperial College London, London, UK
| | - Yanfang Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Jinlin Wu
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Xianzhuo Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Panpan Jiao
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Grace S Li
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - Xueqin Tang
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Calvin S H Ng
- The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nuria M Novoa
- Thoracic Surgery Service, University Hospital of Salamanca, Salamanca, Spain
| | - Benedetta Bedetti
- Department of Thoracic Surgery, Helios Clinic Bonn/Rhein Sieg, Bonn, Germany
| | | | - Steven Hochwald
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | | | - Leandro Cardoso Barchi
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Sebastien Gilbert
- Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Ryuichi Waseda
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain.,Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, S. Gerardo Hospital, Monza, Italy
| | - Fabio Davoli
- Department of Thoracic Surgery, AUSL Romagna, S. Maria delle Croci Teaching Hospital, Ravenna, Italy
| | - Guillaume Piessen
- University of Lille, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Bin Qiu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Stephen D Wang
- Editorial Office, AME Publishing Company, Hong Kong, China
| | - Yaolong Chen
- World Health Organization (WHO) Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.,Lanzhou University Institute of Health Data Science, Lanzhou, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Salmaso C, Toniolo I, Fontanella CG, Da Roit P, Albanese A, Polese L, Stefanini C, Foletto M, Carniel EL. Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery. Ann Biomed Eng 2020; 48:2466-2483. [PMID: 32472365 DOI: 10.1007/s10439-020-02542-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/27/2020] [Indexed: 01/10/2023]
Abstract
Obesity is one of the main health concerns worldwide. Bariatric Surgery (BS) is the gold standard treatment for severe obesity. Nevertheless, unsatisfactory weight loss and complications can occur. The efficacy of BS is mainly defined on experiential bases; therefore, a more rational approach is required. The here reported activities aim to show the strength of experimental and computational biomechanics in evaluating stomach functionality depending on bariatric procedure. The experimental activities consisted in insufflation tests on samples of swine stomach to assess the pressure-volume behaviour both in pre- and post-surgical configurations. The investigation pertained to two main bariatric procedures: adjustable gastric banding (AGB) and laparoscopic sleeve gastrectomy (LSG). Subsequently, a computational model of the stomach was exploited to validate and to integrate results from experimental activities, as well as to broad the investigation to a wider scenario of surgical procedures and techniques. Furthermore, the computational approach allowed analysing stress and strain fields within stomach tissues because of food ingestion. Such fields elicit mechanical stimulation of gastric receptors, contributing to release satiety signals. Pressure-volume curves assessed stomach capacity and stiffness according to the surgical procedure. Both AGB and LSG proved to reduce stomach capacity and to increase stiffness, with markedly greater effect for LSG. At an internal pressure of 5 kPa, outcomes showed that in pre-surgical configuration the inflated volume was about 1000 mL, after AGB the inflated volume was slightly lower, while after LSG it fell significantly, reaching 100 mL. Computational modelling techniques showed the influence of bariatric intervention on mechanical stimulation of gastric receptors due to food ingestion. AGB markedly enhanced the mechanical stimulation within the fundus region, while LSG significantly reduced stress and strain intensities. Further computational investigations revealed the potentialities of hybrid endoscopic procedures to induce both reduction of stomach capacity and enhancement of gastric receptors mechanical stimulation. In conclusion, biomechanics proved to be useful for the investigation of BS effects. Future exploitations of the biomechanical methods may largely improve BS reliability, efficacy and penetration rate.
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Affiliation(s)
- C Salmaso
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - I Toniolo
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy.
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy.
| | - C G Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - P Da Roit
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
| | - A Albanese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - L Polese
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - C Stefanini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - M Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - E L Carniel
- Centre for Mechanics of Biological Materials, University of Padova, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Venezia, 1, 35131, Padua, Italy
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10
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Carniel EL, Albanese A, Fontanella CG, Pavan PG, Prevedello L, Salmaso C, Todros S, Toniolo I, Foletto M. Biomechanics of stomach tissues and structure in patients with obesity. J Mech Behav Biomed Mater 2020; 110:103883. [PMID: 32957190 DOI: 10.1016/j.jmbbm.2020.103883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 05/14/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
Even though bariatric surgery is one of the most effective treatment option of obesity, post-surgical weight loss is not always ensured, especially in the long term, when many patients experience weight regain. Bariatric procedures are largely based on surgeon's expertise and intra-operative decisions, while an integrated in-silico approach could support surgical activity. The effects of bariatric surgery on gastric distension, which activates the neural circuitry promoting satiety, can be considered one of the main factors in the operation success. This aspect can be investigated trough computational modelling based on the mechanical properties of stomach tissues and structure. Mechanical tests on gastric tissues and structure from people with obesity are carried out, as basis for the development of a computational model. The samples are obtained from stomach residuals explanted during laparoscopic sleeve gastrectomy interventions. Uniaxial tensile and stress relaxation tests are performed in different directions and inflation tests are carried out on the entire stomach residual. Experimental results show anisotropic, non-linear elastic and time-dependent behavior. In addition, the mechanical properties demonstrate to be dependent on the sample location within the stomach. Inflation tests confirm the characteristics of time-dependence and non-linear elasticity of the stomach wall. Experimental activities developed provide a unique set of data about the mechanical behavior of the stomach of patients with obesity, considering both tissues and structure. This data set can be adopted for the development of computational models of the stomach, as support to the rational investigation of biomechanical aspects of bariatric surgery.
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Affiliation(s)
- Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy.
| | - Alice Albanese
- IFSO Bariatric Center of Excellence, Policlinico Universitario, University of Padova, Italy
| | - Chiara Giulia Fontanella
- Centre for Mechanics of Biological Materials, University of Padova, Italy; Department of Civil, Environmental and Architectural Engineering, University of Padova, Italy
| | - Piero Giovanni Pavan
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| | - Luca Prevedello
- IFSO Bariatric Center of Excellence, Policlinico Universitario, University of Padova, Italy
| | - Claudia Salmaso
- Department of Industrial Engineering, University of Padova, Italy
| | - Silvia Todros
- Department of Industrial Engineering, University of Padova, Italy; Centre for Mechanics of Biological Materials, University of Padova, Italy
| | - Ilaria Toniolo
- Department of Industrial Engineering, University of Padova, Italy
| | - Mirto Foletto
- Centre for Mechanics of Biological Materials, University of Padova, Italy; IFSO Bariatric Center of Excellence, Policlinico Universitario, University of Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
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11
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Kaya BC, Elkan H. Impact of Weight Loss with Laparoscopic Sleeve Gastrectomy on Left Ventricular Diastolic Function: a Prospective Study. Obes Surg 2020; 30:3280-3286. [DOI: 10.1007/s11695-020-04573-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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Pilone V, Tramontano S, Renzulli M, Romano M, Monda A, Albanese A, Foletto M. Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study. BMC Surg 2019; 19:56. [PMID: 31690312 PMCID: PMC6829794 DOI: 10.1186/s12893-019-0507-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/09/2019] [Indexed: 01/12/2023] Open
Abstract
Background Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Methods Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study. Results Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2. Conclusion Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime. Trial registration Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).
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Affiliation(s)
- Vincenzo Pilone
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Salvatore Tramontano
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy.
| | - Michele Renzulli
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Mafalda Romano
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Angela Monda
- General, Bariatric and Emergency Surgery Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Alice Albanese
- Week Surgery Unit, University Hospital of Padova, Padova, Italy
| | - Mirto Foletto
- Week Surgery Unit, University Hospital of Padova, Padova, Italy
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13
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Pilone V, Tramontano S, Renzulli M, Monda A, Cutolo C, Romano M, Schiavo L. Evaluation of anti-Müller hormone AMH levels in obese women after sleeve gastrectomy. Gynecol Endocrinol 2019; 35:548-551. [PMID: 30668195 DOI: 10.1080/09513590.2018.1559285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION The link between obesity epidemic in fertile age and fertility reduction, in relation with BMI increase, has been demonstrated. An inverse proportionality between BMI and anti-Müller hormone (AMH) has been investigated. This hormone is strictly related to ovarian function. It has been demonstrated that it is significantly decreased in obese women. SCOPE The aim of this study was evaluation of AMH levels in 53 obesity women with BMI >35, at 3 and 6 months after laparoscopic sleeve gastrectomy (LSG). Specific evaluation of comorbidities and of gynecological effects of weight loss was also evaluated. RESULTS Cohort of 53 women was considered, treated with LSG. A progressive increase of AMH levels after LSG was confirmed, with statistically significant results at followup of 6 months. In these patients, we also observed an improvement in the menstrual cycle and resolution of dysmenorrhea. All considered comorbidities were ameliorated at both followup. CONCLUSION LSG determined a significant increase of AMH level in women, at early followup, with a comprehensive amelioration of gynecological status. Larger cohorts and a better evaluation of ovarian function after LSG will lead to more powerful results of the effect of weight loss on women.
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Affiliation(s)
- Vincenzo Pilone
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Salvatore Tramontano
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Michele Renzulli
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Angela Monda
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Carmen Cutolo
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Mafalda Romano
- a Department of Medicine, Surgery, and Dentistry , University of Salerno , Salerno , Italy
- b General, Bariatric and Emergency Surgical Unit of Fucito Hospital , University Hospital of Salerno , Salerno , Italy
| | - Luigi Schiavo
- c Department of Cardio-Thoracic and Respiratory Science , University of Campania "Luigi Vanvitelli ," Naples , Italy
- d IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology , Naples University Polyclinic , Naples , Italy
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14
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Boules M, Batayyah E, Froylich D, Zelisko A, O'Rourke C, Brethauer S, El-Hayek K, Boike A, Strong AT, Kroh M. Effect of Surgical Weight Loss on Plantar Fasciitis and Health-Care Use. J Am Podiatr Med Assoc 2018; 108:442-448. [PMID: 29617149 DOI: 10.7547/15-169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND: Plantar fasciitis (PF) is one of the most common causes of heel pain. Obesity is recognized as a major factor in PF development, possibly due to increased mechanical loading of the foot due to excess weight. The benefit of bariatric surgery is documented for other comorbidities but not for PF. METHODS: A retrospective medical record review was performed for patients with PF identified from a prospectively maintained database of the Cleveland Clinic Bariatric and Metabolic Institute. Age, sex, surgery, excess weight loss, body mass index (BMI), and health-care use related to PF treatment were abstracted. Comparative analyses were stratified by surgery type. RESULTS: Two hundred twenty-eight of 10,305 patients (2.2%) had a documented diagnosis of PF, of whom 163 underwent bariatric surgery and were included in the analysis. Eighty-five percent of patients were women, mean ± SD age was 52.2 ± 9.9 years, and mean ± SD preintervention BMI was 45 ± 7.7. Postoperatively, mean ± SD BMI and excess weight loss were 34.8 ± 7.8 and 51.0% ± 20.4%, respectively. One hundred forty-six patients (90%) achieved resolution of PF and related symptoms. The mean ± SD number of treatment modalities used for PF per patient preoperatively was 1.9 ± 1.0 ( P = .25). After surgery, the mean ± SD number of treatment modalities used per patient was reduced to 0.3 ± 0.1 ( P = .01). CONCLUSIONS: We present new evidence suggesting that reductions in BMI after bariatric surgery may be associated with decreasing the number of visits for PF and may contribute to symptomatic improvement.
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Affiliation(s)
- Mena Boules
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Esam Batayyah
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Dvir Froylich
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Andrea Zelisko
- Department of General Surgery, Carolinas Medical Center, Charlotte, NC
| | - Colin O'Rourke
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, WA
| | - Stacy Brethauer
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Kevin El-Hayek
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Allan Boike
- Kent State University College of Podiatric Medicine, Independence, OH
| | - Andrew T. Strong
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew Kroh
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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15
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Guida B, Cataldi M, Busetto L, Aiello ML, Musella M, Capone D, Parolisi S, Policastro V, Ragozini G, Belfiore A. Predictors of fat-free mass loss 1 year after laparoscopic sleeve gastrectomy. J Endocrinol Invest 2018; 41:1307-1315. [PMID: 29574529 DOI: 10.1007/s40618-018-0868-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/09/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed bariatric surgery interventions because of its safety and efficacy. Nevertheless, concerns have been raised on its detrimental effect on patient nutritional state that can ultimately lead to the loss of fat-free mass (FFM). There is interest in identifying predictors for the early identification of patients at risk of this highly unwanted adverse because they could benefit of nutritional preventive interventions. Therefore, we investigated whether anthropometric parameters, body composition or resting energy expenditure (REE) measured before surgery could predict FFM loss 1 year after LSG. METHODS Study design was retrospective observational. We retrieved data on body weight, BMI, body composition and REE before and 1 year after LSG from the medical files of 36 patients operated on by LSG at our institutions. Simple regression, the Oldham's method and multilevel analysis were used to identify predictors of FFM loss. RESULTS Averaged percentage FFM loss 1 year after LSG was 17.0 ± 7.7% with significant differences between sexes (20.8 ± 6.6 in males and 12.2 ± 6.1% in females, p < 0.001). FFM loss was strongly predicted by pre-surgery FFM and this effect persisted also after correcting for the contribution of sex. CONCLUSIONS High FFM values before surgery predict a more severe FFM loss after LSG. This factor could also account for the higher FFM loss in men than in women. Our finding could help in the early identification of patient requiring a nutritional support after LSG.
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Affiliation(s)
- B Guida
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy.
- Federico II University Hospital, Naples, Italy.
| | - M Cataldi
- Federico II University Hospital, Naples, Italy
- Division of Pharmacology, Department of Neuroscience, Reproductive Sciences and Dentistry, Federico II University of Naples, Naples, Italy
| | - L Busetto
- Department of Medicine, University of Padova, Padua, Italy
| | - M L Aiello
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy
| | - M Musella
- Federico II University Hospital, Naples, Italy
- Division of Surgery, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - D Capone
- Federico II University Hospital, Naples, Italy
| | - S Parolisi
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy
| | - V Policastro
- Division of Statistics, Department of Political Science, Federico II University of Naples, Naples, Italy
| | - G Ragozini
- Division of Statistics, Department of Political Science, Federico II University of Naples, Naples, Italy
| | - A Belfiore
- Division of Physiology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Pansini n°5, 80131, Naples, Italy
- Federico II University Hospital, Naples, Italy
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Cazzo E, Gestic MA, Utrini MP, Chaim FDM, Geloneze B, Pareja JC, Chaim EA, Magro DO. GLP-2: A POORLY UNDERSTOOD MEDIATOR ENROLLED IN VARIOUS BARIATRIC/METABOLIC SURGERY-RELATED PATHOPHYSIOLOGIC MECHANISMS. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 29:272-275. [PMID: 28076485 PMCID: PMC5225870 DOI: 10.1590/0102-6720201600040014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/02/2016] [Indexed: 12/31/2022]
Abstract
Introduction: Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone whose effects are predominantly trophic on the intestinal mucosa. Aim: Critically evaluate the current literature on the influence of bariatric/metabolic surgery on the levels of GLP-2 and its potential clinical implications. Method s: Narrative review through online research on the databases Medline and Lilacs. There were six prospective human studies, two cross-sectional human studies, and three experimental animal studies selected. Results: There is evidence demonstrating significant increase in the levels of GLP-2 following gastric bypass, Scopinaro operation, and sleeve gastrectomy. There are no differences between gastric bypass and sleeve gastrectomy in regards to the increase in the GLP-2 levels. There is no correlation between the postoperative levels of GLP-2 and the occurrence of adequate or insufficient postoperative weight loss. Conclusion: GLP-2 plays significant roles on the regulation of nutrient absorption, permeability of gut mucosa, control of bone resorption, and regulation of satiety. The overall impact of these effects potentially exerts a significant adaptive or compensatory effect within the context of varied bariatric surgical techniques.
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Affiliation(s)
| | | | | | | | - Bruno Geloneze
- Research Laboratory in Metabology and Diabetes (Limed), State University of Campinas - Unicamp, Campinas, SP, Brazil
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