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Qanaq D, O'Keeffe M, Cremona S, Bernardo WM, McIntyre RD, Papada E, Benkalkar S, Rubino F. The Role of Dietary Intake in the Weight Loss Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy: A Systematic Review and Meta-analysis. Obes Surg 2024; 34:3021-3037. [PMID: 38907132 PMCID: PMC11289176 DOI: 10.1007/s11695-024-07183-8] [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: 05/13/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 06/23/2024]
Abstract
The relationship between postoperative dietary intake and weight loss after bariatric surgery remains unclear. We performed a systematic review and meta-analysis of studies published between January 2000 and May 2023, reporting weight loss outcomes, and dietary intake before and after Roux-en-Y gastric bypass and sleeve gastrectomy. A total of 42 studies were included. There was no detectable difference in dietary intake between the two procedures. Roux-en-Y gastric bypass induced an average decrease in energy intake of 886 kcal/day at 12-month post-surgery; however, there was no correlation between daily energy intake and weight loss. These findings show a substantial reduction of energy intake in the first year after bariatric surgery but do not support a link between lower energy intake and greater weight loss.
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Affiliation(s)
- Dalal Qanaq
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, 11481, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Centre, 11481, Riyadh, Kingdom of Saudi Arabia
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
| | - Majella O'Keeffe
- Department of Nutritional Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK
- School of Food and Nutritional Sciences, University College Cork, College Road, Cork, Ireland
| | - Simone Cremona
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- General and Digestive Surgery Department of Hospital Del Mar de, 08003, Barcelona, Spain
| | | | - Robert D McIntyre
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- School of Sport, Exercise and Applied Science, St Mary's University, Twickenham, London, TW1 4SX, UK
| | - Efstathia Papada
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
- Division of Medicine, University College London, London, WC1E 6JF, UK
| | - Saumit Benkalkar
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, James Black Centre, Denmark Hill Campus, 125 Coldharbour Road, London, SE5 9RJ, UK.
- Bariatric and Metabolic Surgery, King's College Hospital, London, SE5 9RS, UK.
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Sivakumar J, Chen Q, Chong L, Read M, Ward S, Winter N, Sutherland TR, Hii MW. Effect of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass on body composition. ANZ J Surg 2024. [PMID: 38994901 DOI: 10.1111/ans.19160] [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: 05/27/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND There is limited data with respect to body composition changes for laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB). The objective of this study was to analyse changes in body composition between these two procedures during the first year after bariatric surgery. METHODS A prospective study was performed in patients undergoing bariatric surgery at two tertiary hospitals between 2017 and 2023. Body composition was assessed with dual-energy x-ray absorptiometry immediately before surgery, and at 1-, 6-, 12-, 18- and 24-months post-operatively, with a subgroup analysis performed for patients who undertook a scan at 18- and 24-months. Total weight loss (TWL), body mass index (BMI), fat mass (FM), lean body mass (LBM) and bone mineral content (BMC) parameters were compared between SG and RYGB. RESULTS Forty-five patients were included in this series (SG n = 30, RYGB n = 15). There was a significant reduction in mean %TWL of 26.94 ± 8.86% and mean BMI of 11.12 ± 3.70 kg/m2 over 12-months. LBM accounted for 17.8% of TWL over 12-months, SG and RYGB did not differ in terms of loss of FM or LBM. For both procedures, the loss of LBM appeared to plateau at 6-months post-operatively. The only statistically significant finding between the two procedures was that RYGB resulted in an additional 0.06 kg loss compared with SG. CONCLUSION SG and RYGB have been shown to have comparable weight loss and body composition changes in the short-to-medium term following surgery. LBM reduction was most significant in the early post-operative period across the entire cohort.
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Affiliation(s)
- Jonathan Sivakumar
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Qianyu Chen
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Lynn Chong
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Salena Ward
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nicole Winter
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tom R Sutherland
- Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael W Hii
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Lodewijks Y, Luyer M, van Montfort G, de Zoete J, Smulders F, Nienhuijs S. Additional preparation program for bariatric surgery: Two-year results of a large cohort study. Obes Sci Pract 2023; 9:493-500. [PMID: 37810522 PMCID: PMC10551114 DOI: 10.1002/osp4.677] [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] [Received: 10/04/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 10/10/2023] Open
Abstract
Background Multidisciplinary screening of bariatric surgery candidates is recommended, and some centers provide an additional preparation program (APP) to optimize patients preoperatively. Objective To compare patients with APP to standard care 2 years after primary bariatric surgery regarding postoperative weight loss and resolution of obesity-related comorbidities. Methods A retrospective cohort study was conducted for patients undergoing primary Roux-en-Y gastric bypass and sleeve gastrectomy between September 2017 and March 2019. The first 12 months patients received an APP, after September 2018, the APP was no longer part of the weight loss trajectory. A multivariable linear regression model was built. Results Of the 384 patients receiving an APP advice, 50 were lost to follow up. In total, 192 (57%) received the APP and 142 (43%) received standard care. Percentage total weight loss after 2 years was significantly different, 28.8% for the APP group versus 32% for the standard group (p = 0.001). Postoperative weight loss after 2 years was increased in patients who had a gastric bypass, a higher baseline body mass index, and female gender in multivariable analysis. An APP was predictive for decreased postoperative weight. Diabetes mellitus was in remission significantly more often in the preparation group (84.1% of the cases) compared with the standard group (61.9%, p = 0.028). Conclusion A weight loss trajectory is at least as effective without additional preparation in terms of 2 years postoperative %TWL for primary gastric bypass and sleeve procedures. For comorbidities, diabetes mellitus was in remission more often in the APP group.
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Affiliation(s)
- Yentl Lodewijks
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
| | - Misha Luyer
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
| | | | | | - Frans Smulders
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
| | - Simon Nienhuijs
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
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4
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Pereira SS, Guimarães M, Monteiro MP. Towards precision medicine in bariatric surgery prescription. Rev Endocr Metab Disord 2023; 24:961-977. [PMID: 37129798 PMCID: PMC10492755 DOI: 10.1007/s11154-023-09801-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 05/03/2023]
Abstract
Obesity is a complex, multifactorial and chronic disease. Bariatric surgery is a safe and effective treatment intervention for obesity and obesity-related diseases. However, weight loss after surgery can be highly heterogeneous and is not entirely predictable, particularly in the long-term after intervention. In this review, we present and discuss the available data on patient-related and procedure-related factors that were previously appointed as putative predictors of bariatric surgery outcomes. In addition, we present a critical appraisal of the available evidence on which factors could be taken into account when recommending and deciding which bariatric procedure to perform. Several patient-related features were identified as having a potential impact on weight loss after bariatric surgery, including age, gender, anthropometrics, obesity co-morbidities, eating behavior, genetic background, circulating biomarkers (microRNAs, metabolites and hormones), psychological and socioeconomic factors. However, none of these factors are sufficiently robust to be used as predictive factors. Overall, there is no doubt that before we long for precision medicine, there is the unmet need for a better understanding of the socio-biological drivers of weight gain, weight loss failure and weight-regain after bariatric interventions. Machine learning models targeting preoperative factors and effectiveness measurements of specific bariatric surgery interventions, would enable a more precise identification of the causal links between determinants of weight gain and weight loss. Artificial intelligence algorithms to be used in clinical practice to predict the response to bariatric surgery interventions could then be created, which would ultimately allow to move forward into precision medicine in bariatric surgery prescription.
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Affiliation(s)
- Sofia S Pereira
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
| | - Marta Guimarães
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal
- Department of General Surgery, Hospital São Sebastião, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido Pinho, 4050-220, Santa Maia da Feira, Portugal
| | - Mariana P Monteiro
- UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge Viterbo Ferreira 228, 4050-313, Porto, Portugal.
- ITR - Laboratory of Integrative and Translocation Research in Population Health, Rua das Taipas 135, 4050-600, Porto, Portugal.
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5
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Sharma I, Nakanishi H, Hage K, Marrero K, Diwan TS, daSilva-deAbreu A, Davis SS, Clapp B, Ghanem OM. Bariatric surgery and left ventricular assist device in patients with heart failure: A systematic review and meta-analysis. Am J Surg 2023; 226:340-349. [PMID: 37355375 DOI: 10.1016/j.amjsurg.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/21/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The role of metabolic and bariatric surgery (MBS), in synergy with left ventricular assist device (LVAD) implantation, in the scope of end-stage heart failure management for patients with severe obesity is not well elucidated. METHODS We conducted a meta-analysis using Cochrane, Embase, PubMed, and Scopus databases to include articles from their inception to November 2022. RESULTS A total of 271 patients who underwent MBS during or after the LVAD implantation were included from eleven separate studies. After surgery, 67.4% of patients were listed on the heart transplant waitlist with 32.5% undergoing a successful transplant. We reported a mean listing time of 13.8 months. Finally, the pooled postoperative complication rate, 30-day readmission rate, and one-year mortality rate were 47.6%, 23.6% and 10.2% respectively. CONCLUSIONS MBS and LVAD is a safe and effective approach to bridge patients with severe obesity and end-stage heart failure for definitive heart transplantation.
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Affiliation(s)
- Ishna Sharma
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL, USA
| | - Tayyab S Diwan
- Division of Transplantation, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Scott S Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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O’Moore-Sullivan T, Paxton J, Cross M, Teppala S, Chikani V, Hopkins G, Wykes K, Scuffham PA. Health outcomes of patients with type 2 diabetes following bariatric surgery: Results from a publicly funded initiative. PLoS One 2023; 18:e0279923. [PMID: 36827391 PMCID: PMC9955585 DOI: 10.1371/journal.pone.0279923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/16/2022] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE Bariatric surgery is an effective treatment for type 2 diabetes and morbid obesity. This paper analyses the clinical and patient-reported outcomes of patients treated through the Bariatric Surgery Initiative, a health system collaboration providing bariatric surgery as a state-wide public service in Queensland, Australia. RESEARCH DESIGN AND METHODS A longitudinal prospective cohort study was undertaken. Eligible patients had type 2 diabetes and morbid obesity (BMI ≥ 35 kg/m2). Following referral by specialist outpatient clinics, 212 patients underwent Roux-en-Y gastric bypass or sleeve gastrectomy. Outcomes were tracked for a follow-up of 12-months and included body weight, BMI, HbA1c, comorbidities, health-related quality of life, eating behaviour, and patient satisfaction. RESULTS Following surgery, patients' average body weight decreased by 23.6%. Average HbA1c improved by 24.4% and 48.8% of patients were able to discontinue diabetes-related treatment. The incidence of hypertension, non-alcoholic steatohepatitis, and renal impairment decreased by 37.1%, 66.4%, and 62.3%, respectively. Patients' emotional eating scores, uncontrolled eating and cognitive restraint improved by 32.5%, 20.7%, and 6.9%, respectively. Quality of life increased by 18.8% and patients' overall satisfaction with the treatment remained above 97.5% throughout the recovery period. CONCLUSIONS This study confirmed previous work demonstrating the efficacy of publicly funded bariatric surgery in treating obesity, type 2 diabetes and related comorbidities, and improving patients' quality of life and eating behaviour. Despite the short follow-up period, the results bode well for future weight maintenance in this cohort.
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Affiliation(s)
| | - Jody Paxton
- Healthcare Improvement Unit, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Megan Cross
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Srinivas Teppala
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Viral Chikani
- Department of Diabetes and Endocrinology, The Princess Alexandra Hospital, Brisbane & Senior Lecturer, University of Queensland, Brisbane, Queensland, Australia
| | - George Hopkins
- Royal Brisbane and Womens Hospital, Queensland Health, Brisbane, Queensland, Australia
| | - Katie Wykes
- Healthcare Improvement Unit, Clinical Excellence Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Paul A. Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- * E-mail:
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7
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Plamper A, Lingohr P, Nadal J, Trebicka J, Brol MJ, Woestemeier A, Schmitz SMT, Alizai PH, Neumann UP, Ulmer TF, Rheinwalt KP. A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg 2023; 27:47-55. [PMID: 36376721 PMCID: PMC9877051 DOI: 10.1007/s11605-022-05515-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) has become increasingly accepted in bariatric surgery and meanwhile represents the third most common procedure worldwide. While it shows promising weight loss results and comorbidity resolution, questions about issues such as reflux or nutritional deficiencies (ND) persist in the long term. On the other hand, the most frequently performed sleeve gastrectomy (SG) has to accept growing criticism regarding long-term results and reflux issues. There is a particular lack of long-term comparative data for both procedures. This study presents our long-term experience. METHODS We evaluated OAGB and SG patients retrospectively comparing for weight loss and resolution of comorbidities as well as perioperative and long-term complications in a follow-up period of 5 years. RESULTS Nine hundred eleven OAGB and 241 SG were included in the study. OAGB had a shorter operation time and hospital stay. Overall complication rate did not differ in both groups. Ulcers were more frequent in OAGB (7.7% vs. 1.7%, p = 0.001), whereas insufficient weight loss (IWL)/weight regain (WR) proved to be more prevalent in SG (25.7% vs. 6.4%, p < 0.001). The same held true for reflux (17.8% vs. 8.3%, p < .001). On the other hand, ND were more common in OAGB (20.0% vs. 12.0%, p = 0.005). Revisional surgery was more often indicated after SG. Analysis by linear mixed model showed that OAGB achieved a lower BMI/higher loss of BMI. Improvement of T2DM (94.6% vs. 85.2%, p = 0.008) and sleep apnea (88.8% vs. 78.8%, p = 0.01) was superior in OAGB. CONCLUSIONS OAGB had a superior effect on weight loss as well as improvement of T2DM and sleep apnea. Furthermore, long-term problems such as IWL/WR and reflux were more related to SG. On the other hand, a malabsorptive procedure such as OAGB showed a higher risk for ND. Our findings support the available data in the literature.
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Affiliation(s)
- Andreas Plamper
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Philipp Lingohr
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jennifer Nadal
- grid.15090.3d0000 0000 8786 803XInstitute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Jonel Trebicka
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Maximilian J. Brol
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Anna Woestemeier
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sophia M.-T. Schmitz
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick H. Alizai
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P. Neumann
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom F. Ulmer
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Karl P. Rheinwalt
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
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Holmberg D, Santoni G, Kauppila JH, Markar SR, Lagergren J. Long-term Survival After Sleeve Gastrectomy Versus Gastric Bypass in a Binational Cohort Study. Diabetes Care 2022; 45:1981-1986. [PMID: 35796573 DOI: 10.2337/dc22-0485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Bariatric surgery prolongs life expectancy in severely obese individuals, but it is uncertain which of the two dominating bariatric procedures, sleeve gastrectomy or gastric bypass, offers the best long-term survival. RESEARCH DESIGN AND METHODS This was a population-based cohort study of primary laparoscopic sleeve gastrectomy compared with gastric bypass for obesity in Sweden and Finland between 1 January 2007 and 31 December 2020. The risk of all-cause mortality was calculated using multivariable Cox regression, providing hazard ratios (HRs) with 95% CIs adjusted for age, sex, hypertension, diabetes, Charlson comorbidity index, country, and calendar year. RESULTS Among 61,503 patients (median age 42 years; 75.4% women), who contributed 415,712 person-years at risk (mean 6.8 person-years), 1,571 (2.6%) died during follow-up. Compared with patients who underwent gastric bypass (n = 51,891 [84.4%]), the sleeve gastrectomy group (n = 9,612 [15.6%]) had similar all-cause mortality during the entire study period (HR 0.98, 95% CI 0.81-1.20), but decreased all-cause mortality in more recent years (HR 0.72, 95% CI 0.54-0.97, from 2014 onward). Diabetes interacted statistically significantly with the type of bariatric surgery, with higher all-cause mortality after sleeve gastrectomy than after gastric bypass (HR 1.54, 95% CI 1.06-2.24). CONCLUSIONS The overall survival following sleeve gastrectomy seems to compare well with gastric bypass and may even be better during recent years. A tailored surgical approach in relation to patients' diabetes status may optimize survival in patients selected for bariatric surgery (i.e., sleeve gastrectomy for patients without diabetes and gastric bypass for patients with diabetes).
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Affiliation(s)
- Dag Holmberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Giola Santoni
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Joonas H Kauppila
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sheraz R Markar
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Nuffield Department of Surgery, University of Oxford, Oxford, U.K
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,School of Cancer and Pharmacological Sciences, King's College London, London, U.K
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9
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Lynch A, Kozak AT, Zalesin KC. “The stomach I have now has a brain connection:” changes in experiences of hunger and fullness following bariatric surgery. Appetite 2022; 179:106271. [DOI: 10.1016/j.appet.2022.106271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
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10
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Zhang C, Chen X, Liu S, Liu W, Zhu D, Li X, Qu S, Zhu Z, Zhang J, Zhou Z. Nutritional Status in Chinese Patients with Obesity Following Sleeve Gastrectomy/Roux-en-Y Gastric Bypass: A Retrospective Multicenter Cohort Study. Nutrients 2022; 14:1932. [PMID: 35565899 PMCID: PMC9101375 DOI: 10.3390/nu14091932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Metabolic surgery (MS) is one of the most effective therapies for treating obesity. Due to the lack of multicenter cohort research on nutritional evaluations after surgery in Chinese patients, we explored the changes in nutritional status following MS in Chinese patients. This was a retrospective study of patients (n = 903) who underwent sleeve gastrectomy (SG) (n = 640) or Roux-en-Y gastric bypass (RYGB) (n = 263) for obesity at five different hospitals in China between 17 February 2011, and 20 December 2019. Major nutrients were evaluated at baseline and 1, 3, 6, and 12 months postoperatively. Hb levels decreased, and anemia prevalence increased at 12 months after MS in the premenopausal female group. Moreover, patients with preoperative anemia had an increased risk of postoperative anemia. The ferritin levels (p < 0.001) decreased and iron deficiency increased (p < 0.001) at 12 months after MS among premenopausal females. No significant changes in folate deficiency and vitamin B12 deficiency were found throughout the study. The bone mineral density (BMD) of the femoral neck, lumbar spine, and total hip significantly decreased from baseline to 12 months after MS; however, no new patients developed osteopenia or osteoporosis after MS. Based on 12 months of follow-up, premenopausal females presented a high incidence of anemia after MS. Although we found no differences in osteopenia and osteoporosis prevalence after MS, the BMD did decrease significantly, which suggests that nutrient supplements and long-term follow-up are especially necessary postoperation.
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Affiliation(s)
- Chunlan Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (C.Z.); (X.C.); (S.L.)
| | - Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (C.Z.); (X.C.); (S.L.)
| | - Shiping Liu
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (C.Z.); (X.C.); (S.L.)
| | - Wei Liu
- Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China;
| | - Dalong Zhu
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210000, China;
| | - Xiaoying Li
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200000, China;
| | - Shen Qu
- Department of Endocrinology and Metabolism, School of Medicine, Shanghai Tenth People’s Hospital, Tongji University, Shanghai 200000, China;
| | - Zhiming Zhu
- Chongqing Hypertension Institute, Department of Hypertension and Endocrinology, Daping Hospital, The Third Military Medical University, Chongqing 400000, China;
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (C.Z.); (X.C.); (S.L.)
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, China; (C.Z.); (X.C.); (S.L.)
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11
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Or Koca A, Öztürk D, Koca HS, Dağdeviren M, Keskin M, Buluş H. The Effect of Sleeve Gastrectomy on the Function and Volume of the Thyroid Gland. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2019.0066] [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)
- Arzu Or Koca
- Department of Endocrinology and Metabolism, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Doğan Öztürk
- Department of General Surgery, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hüseyin Samet Koca
- Department of Otorhinolaryngology, Yüksek İhtisas University, Ankara, Turkey
| | - Murat Dağdeviren
- Department of Endocrinology and Metabolism, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Müge Keskin
- Department of Endocrinology and Metabolism, Ankara City Hospital, Ankara, Turkey
| | - Hakan Buluş
- Department of General Surgery, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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12
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Christopher AN, Morris MP, Patel V, Broach RB, Fischer JP. Abdominal Body Contouring: Does Body Mass Index Affect Clinical and Patient Reported Outcomes? J Surg Res 2021; 270:348-358. [PMID: 34731733 DOI: 10.1016/j.jss.2021.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/01/2021] [Accepted: 09/09/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obese individuals are thought to be higher risk for complications after excisional abdominal body contouring (EAC) due to co-morbidities and significant tissue resection. OBJECTIVES We comparatively analyzed EAC patients with Body Mass Index (BMI) ≥35 kg/m2 and BMI <35 kg/m2 to highlight key differences in clinical and patient-reported-outcomes (PROs). METHODS Patients ≥18 years-old undergoing EAC by a single surgeon from 01/2018-01/2020 were identified and separated into cohorts based on BMI (<35 and ≥35 kg/m2). Patients were excluded if they had a cosmetic abdominoplasty without history of bariatric surgery or massive weight loss, or if they had <1000 gs of tissue resected. Clinical outcomes and PROs using the BODY-Q were comparatively analyzed. RESULTS 70 total patients with median BMIs of 30[26-32] and 41[37-45] kg/m2 in each cohort, were identified. Patients with BMI ≥35 kg/m2 were more likely to have higher ASA (P<0.01) and use of incisional negative pressure wound devices (P = 0.042). Alternatively, they were less likely to have had concurrent liposuction (P = 0.05). There were no differences in development of an SSO, SSI or SSOpi (P>0.05) between cohorts. Multivariate logistic regression showed that BMI ≥35 kg/m2, iNPWD and liposuction were not associated with the development of complications. PROs demonstrated improvement in multiple domains despite BMI. CONCLUSION There was no association with BMI ≥35 kg/m2 and the development of complications within our cohort. We encourage preoperative weight loss when possible, however these procedures can be performed safely with acceptable outcomes even in individuals who are obese and/or require extensive tissue removal.
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Affiliation(s)
- Adrienne N Christopher
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA; Department of Surgery. Thomas Jefferson University. Philadelphia, PA.
| | - Martin P Morris
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA
| | - Viren Patel
- Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania. Philadelphia, PA.
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13
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Development and validation of a scoring system for pre-surgical and early post-surgical prediction of bariatric surgery unsuccess at 2 years. Sci Rep 2021; 11:21067. [PMID: 34702864 PMCID: PMC8548411 DOI: 10.1038/s41598-021-00475-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
Bariatric surgery (BS) is an effective treatment for morbid obesity. However, a simple and easy-to-use tool for the prediction of BS unsuccess is still lacking. Baseline and follow-up data from 300 consecutive patients who underwent BS were retrospectively collected. Supervised regression and machine-learning techniques were used for model development, in which BS unsuccess at 2 years was defined as a percentage of excess-weight-loss (%EWL) < 50%. Model performances were also assessed considering the percentage of total-weight-loss (%TWL) as the reference parameter. Two scoring systems (NAG-score and ENAG-score) were developed. NAG-score, comprising only pre-surgical data, was structured on a 4.5-point-scale (2 points for neck circumference ≥ 44 cm, 1.5 for age ≥ 50 years, and 1 for fasting glucose ≥ 118 mg/dL). ENAG-score, including also early post-operative data, was structured on a 7-point-scale (3 points for %EWL at 6 months ≤ 45%, 1.5 for neck circumference ≥ 44 cm, 1 for age ≥ 50 years, and 1.5 for fasting glucose ≥ 118 mg/dL). A 3-class-clustering was proposed for clinical application. In conclusion, our study proposed two scoring systems for pre-surgical and early post-surgical prediction of 2-year BS weight-loss, which may be useful to guide the pre-operative assessment, the appropriate balance of patients' expectations, and the post-operative care.
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14
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A Comparative Analysis of Fleur-de-Lis and Traditional Panniculectomy after Bariatric Surgery. Aesthetic Plast Surg 2021; 45:2208-2219. [PMID: 33544187 DOI: 10.1007/s00266-021-02149-y] [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: 11/20/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Fleur-de-Lis panniculectomy (FdL) adds a vertical component to correct complex contour deformities after massive weight loss by addressing supra-umbilical horizontal skin excess which is not addressed with infra-umbilical transverse panniculectomy (TP). We aim to perform a head-to-head comparison of clinical outcomes and patient reported outcomes (PROs) between FdL and TP. METHODS A retrospective review of patients ≥18 with a history of bariatric surgery undergoing FdL or TP by a single plastic surgeon between 07/01/2015 and 05/31/2020 was conducted. Surgical site occurrences (SSOs) including surgical site infection (SSI), delayed healing, cellulitis, seroma, hematoma, surgical site occurrences requiring procedural intervention (SSOpi), and a composite of other postoperative outcomes were assessed. In addition, patient satisfaction was analyzed using the Body-Q questionnaire across 12 domains. RESULTS The analysis included 56 patients; 26 and 30 patients who were treated with FdL and TP, respectively. Cohorts were statistically similar in terms of age, gender, BMI, and co-morbid conditions. The overall complication rate was 50% (FdL n = 14 (53.9%), TP n = 14 (46.7%); p = 0.592). On multivariate analysis, pannus weight was associated with the development of SSO (p = 0.04). FdL incision, however, was not an independent risk factor for adverse outcomes. Absolute improvement in PROs was similar in both cohorts across multiple domains. CONCLUSION FdL showed a comparable safety and efficacy profile to TP when performed in post-bariatric surgery patients, with equivalent improvement in PROs across multiple domains. Preoperative weight loss should be encouraged in this population as pannus weight is an independent risk factor for complications. LEVEL OF EVIDENCE III 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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15
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Cosentino C, Marchetti C, Monami M, Mannucci E, Cresci B. Efficacy and effects of bariatric surgery in the treatment of obesity: Network meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2021; 31:2815-2824. [PMID: 34348877 DOI: 10.1016/j.numecd.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 02/08/2023]
Abstract
AIMS Bariatric surgery (BS) is recommended for subjects with a Body Mass Index (BMI) over of 40 kg/m2 or with a BMI between 35 and 40 kg/m2 with obesity-related comorbidities. Aim of the study was to compare different types of BS with medical therapy (MT) for the treatment of obesity. DATA SYNTHESIS We conducted a network-meta-analysis (NMA) including randomized clinical trials comparing different BS techniques versus MT in people with obesity, with a duration ≥24 weeks (PROSPERO, #CRD42020160359). Primary endpoint was BMI. Indirect comparisons of different types of surgery were performed by NMA. Types of BS included: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass, sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD); greater curvature plication (GCP); one-anastomosis gastric bypass (OAGB); Laparoscopic Vertical Banded Gastroplasty (LVBG) and duodenal switch (DS). 43 trials were retrieved in this metanalysis. BS was associated with a significant reduction in BMI, systolic blood pressure, triglyceride and fasting glucose, and with a significant increase of HDL cholesterol when compared to MT. In direct comparisons, RYGB was more effective than LAGB, LVBG, and GCP, but less effective than DS, whereas LAGB was less effective than LVBG and SG. In the NMA, DS and BPD appeared to be more effective than other procedures. CONCLUSIONS BS produces a greater weight loss than MT in morbidly obese patients, inducing a greater improvement of obesity-associated metabolic parameters. Available data are insufficient to assess the effect of BS on mortality. Different surgical procedures are heterogeneous for efficacy and safety.
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Climent E, Oliveras A, Pedro-Botet J, Goday A, Benaiges D. Bariatric Surgery and Hypertension. J Clin Med 2021; 10:jcm10184049. [PMID: 34575161 PMCID: PMC8467380 DOI: 10.3390/jcm10184049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022] Open
Abstract
A clear pathogenetic association exists between obesity and arterial hypertension, becoming even more evident in subjects with severe obesity. Bariatric surgery has proved to be the most effective treatment for severe obesity, with its benefits going beyond weight loss. The present review aimed to determine the effects of bariatric surgery on arterial hypertension evident in short- and long-term follow-ups. Moreover, the differences between surgical techniques regarding hypertension remission are described as well as the possible pathophysiologic mechanisms involved. In addition, the effects of bariatric surgery beyond blood pressure normalization are also analyzed, including those on target organs and cardiovascular morbidity and mortality.
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Affiliation(s)
- Elisenda Climent
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Anna Oliveras
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Nephrology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Area of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28029 Madrid, Spain
| | - Juan Pedro-Botet
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Albert Goday
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, 28029 Madrid, Spain
| | - David Benaiges
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Consorci Sanitari de l’Alt Penedès i Garraf, 08720 Vilafranca del Penedès, Spain
- Correspondence: ; Tel.: +34-93-248-3902; Fax: +34-93-248-3254
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Raby A, Beauvallet E, Kazma C, Ouazzani HE, Arnoux R, Albouy-Llaty M. Weight Gain After Bariatric Surgery; What Patients Need to Avoid: A Qualitative Study. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0076] [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)
- Axelle Raby
- Nouvelle Clinique Bordeaux Tondu, Floirac, France
| | | | - Carim Kazma
- Nouvelle Clinique Bordeaux Tondu, Floirac, France
| | - Houria El Ouazzani
- Patient Education Unit, Department of Public Health, BioSPharm Pole, University Hospital of Poitiers, Poitiers, France
- Clinical Investigation Center (CIC) 1402, INSERM, University Hospital of Poitiers, Poitiers, France
- Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers Cedex, France
| | | | - Marion Albouy-Llaty
- Patient Education Unit, Department of Public Health, BioSPharm Pole, University Hospital of Poitiers, Poitiers, France
- Clinical Investigation Center (CIC) 1402, INSERM, University Hospital of Poitiers, Poitiers, France
- Faculty of Medicine and Pharmacy, University of Poitiers, Poitiers Cedex, France
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Weight Loss Outcomes following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in an Ethnically Diverse Bariatric Population: Which Is More Effective? Minim Invasive Surg 2021; 2021:9702976. [PMID: 33953983 PMCID: PMC8064797 DOI: 10.1155/2021/9702976] [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: 06/25/2020] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. Objectives This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. Methods The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. Results Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively. In patients with a BMI of 45-50 kg/m2 who underwent LRYGB and LSG, the mean %TWL values were 69% and 56% after 1 year, 75% and 58% after 2 years, and 57% and 45% after 5 years, respectively. Meanwhile, the %TWL values of patients with BMI >50 kg/m2 who had LRYGB and LSG were 53% and 42% after 1 year, 53% and 45% after 2 years, and 49% and 36% after 5 years, respectively. All results were statistically significant (p < 0.0001) and remained valid after adjusting for cofactors. Conclusion Thus, LRYGB had consistent and sustained long-term weight loss outcomes compared with LSG in a predominantly ethnically diverse patient population with different BMI. Our study had several limitations in that it is retrospective in nature and some patients were lost to follow-up during the study period.
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Cornejo-Pareja I, Molina-Vega M, Gómez-Pérez AM, Damas-Fuentes M, Tinahones FJ. Factors Related to Weight Loss Maintenance in the Medium-Long Term after Bariatric Surgery: A Review. J Clin Med 2021; 10:jcm10081739. [PMID: 33923789 PMCID: PMC8073104 DOI: 10.3390/jcm10081739] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 12/15/2022] Open
Abstract
Despite bariatric surgery being the most effective treatment for obesity, some individuals do not respond adequately, especially in the long term. Identifying the predictors of correct weight maintenance in the medium (from 1 to 3 years after surgery) and long term (from 3 years and above) is of vital importance to reduce failure after bariatric surgery; therefore, we summarize the evidence about certain factors, among which we highlight surgical technique, psychological factors, physical activity, adherence to diet, gastrointestinal hormones or neurological factors related to appetite control. We conducted a search in PubMed focused on the last five years (2015–2021). Main findings are as follows: despite Roux-en-Y gastric bypass being more effective in the long term, sleeve gastrectomy shows a more beneficial effectiveness–complications balance; pre-surgical psychological and behavioral evaluation along with post-surgical treatment improve long-term surgical outcomes; physical activity programs after bariatric surgery, in addition to continuous and comprehensive care interventions regarding diet habits, improve weight loss maintenance, but it is necessary to improve adherence; the impact of bariatric surgery on the gut–brain axis seems to influence weight maintenance. In conclusion, although interesting findings exist, the evidence is contradictory in some places, and long-term clinical trials are necessary to draw more robust conclusions.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (I.C.-P.); (M.D.-F.); (F.J.T.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Molina-Vega
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (I.C.-P.); (M.D.-F.); (F.J.T.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Correspondence: (M.M.-V.); (A.M.G.-P.); Tel.: +34-95-1034-044 (M.M.-V. & A.M.G.-P.)
| | - Ana María Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (I.C.-P.); (M.D.-F.); (F.J.T.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Correspondence: (M.M.-V.); (A.M.G.-P.); Tel.: +34-95-1034-044 (M.M.-V. & A.M.G.-P.)
| | - Miguel Damas-Fuentes
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (I.C.-P.); (M.D.-F.); (F.J.T.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Málaga, Spain; (I.C.-P.); (M.D.-F.); (F.J.T.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Short-Term Changes on Body Composition and Bone Mass After One-Anastomosis Gastric Bypass: a Prospective Observational Study. Obes Surg 2021; 30:3514-3521. [PMID: 32314255 DOI: 10.1007/s11695-020-04603-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB). METHODS A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery. RESULTS A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB. CONCLUSIONS OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.
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21
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Hansen D, Decroix L, Devos Y, Nocca D, Cornelissen V, Dillemans B, Lannoo M. Towards Optimized Care After Bariatric Surgery by Physical Activity and Exercise Intervention: a Review. Obes Surg 2021; 30:1118-1125. [PMID: 31912467 DOI: 10.1007/s11695-020-04390-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Although there is growing evidence on the importance of physical activity and exercise intervention after bariatric surgery, it remains to be clarified as to why and how post-operative exercise intervention should be implemented. In this narrative and practically oriented review, it is explained why exercise interventions and physical activity are important after bariatric surgery, how to prescribe exercise and monitor physical activity and how and when physical fitness, muscle strength, fat (-free) mass and bone mineral density could be assessed during follow-up. It is suggested that the inclusion of physical activity and exercise training in the clinical follow-up trajectory could be of great benefit to bariatric surgery patients, since it leads to greater improvements in body composition, bone mineral density, muscle strength and physical fitness.
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Affiliation(s)
- Dominique Hansen
- Faculty of Rehabilitation Sciences, REVAL - Rehabilitation Research Center, Hasselt University, Agoralaan, Building A, Diepenbeek, 3590, Hasselt, Belgium. .,Hasselt University, BIOMED, Hasselt, Belgium. .,Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.
| | - Lieselot Decroix
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Devos
- Fitness als Medicijn®-Medisch Fitness Centrum, Ternat, Belgium
| | - David Nocca
- Department of Surgery, Université de Montpellier, Montpellier, France
| | | | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Brugge, Belgium
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Luker J, Tajran J, Marquette L, Tepper D, Carlin A, Darian V, Siddiqui A. Long-Term Weight Loss with Body Contour Surgery After Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:3159-3164. [PMID: 33851305 DOI: 10.1007/s11695-021-05405-x] [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: 11/30/2020] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery is accepted as an evidence-based treatment for morbid obesity. Many patients seek out body contour surgery afterwards to correct acquired deformities. This study seeks to better define the impact of body contour surgery on long-term weight loss. METHODS This study is a single-center retrospective review of 78 patients who underwent body contouring surgery post-Roux-en-Y gastric bypass compared with 221 matched control patients who underwent Roux-en-Y gastric bypass only. Data was collected for patients at least 7 years post-Roux-en-Y gastric bypass. RESULTS Patients who underwent both bariatric surgery and body contour surgery maintained mean long-term weight loss of 58 kg. The matched control group mean weight loss over the same time interval was 42 kg. The difference was statistically and clinically significant (p = 0.005). Change in body mass index, percent total weight loss, and percent excess body mass index loss were all statistically significant between the 2 groups. CONCLUSION Patients who underwent body contour surgery better maintained long-term weight reduction in comparison to those who only had gastric bypass. Further understanding of the etiology of this association is important for patients contemplating body contouring surgery.
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Affiliation(s)
- Jenna Luker
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA
| | - Jahan Tajran
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Lauren Marquette
- Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Donna Tepper
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA
| | - Arthur Carlin
- Division of Bariatric Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Vigen Darian
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA
| | - Aamir Siddiqui
- Division of Plastic Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Suite k-16, Detroit, MI, 48202, USA.
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Masrur M, Bustos R, Sanchez-Johnsen L, Gonzalez-Ciccarelli L, Mangano A, Gonzalez-Heredia R, Patel R, Danielson KK, Gangemi A, Elli EF. Factors Associated with Weight Loss After Metabolic Surgery in a Multiethnic Sample of 1012 Patients. Obes Surg 2021; 30:975-981. [PMID: 31848986 DOI: 10.1007/s11695-019-04338-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Metabolic surgery is the most effective method for weight loss in the long-term treatment of morbid obesity and its comorbidities. The primary aim of this study was to examine factors associated with percent total weight loss (%TWL) after metabolic surgery among an ethnically diverse sample of patients. METHODS A retrospective review was performed on 1012 patients who underwent either a sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at our institution between January 2008 and June 2015. RESULTS African Americans had a lower %TWL than non-Hispanic/Latino Whites at 6, 9, 12, 18, and 48 months. At all timeframes, there was a negative association between pre-surgery TWL and %TWL after surgery. Female sex was negatively associated with %TWL at 3 months only. Higher initial BMI was also associated with greater post-operative %TWL at 18, 24 and 36 months. Older patients had lower %TWL at 6, 9, 12 and 24 months post-surgery. Patients who received RYGB had greater %TWL than those who received SG at 3, 6, 9, 12, 24 and 36 months. CONCLUSIONS African Americans had a lower %TWL than non-Hispanic/Latino Whites at most time points; there were no other significant race/ethnicity or sex differences. BMI (greater initial BMI), age (lower) and RYGB were associated with a greater post-operative %TWL at certain post-surgery follow-up time points. A limitation of this study is that there was missing data at a number of time points due to lack of attendance at certain follow-up visits.
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Affiliation(s)
- Mario Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.
| | - Lisa Sanchez-Johnsen
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.,Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Luis Gonzalez-Ciccarelli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | | | - Ronak Patel
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Kirstie K Danielson
- Division of Endocrinology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Antonio Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Enrique Fernando Elli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.,Department of Surgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA
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Senol K, Ferhatoglu MF, Kocaeli AA, Dundar HZ, Kaya E. Clinical Features and Short-Term Outcomes of Bariatric Surgery in Morbidly Obese Patients: Institutional Experience at a Rural Hospital. Bariatr Surg Pract Patient Care 2021; 16:61-67. [PMID: 33763312 PMCID: PMC7984649 DOI: 10.1089/bari.2020.0110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective: To prospectively evaluate the postoperative morbidity, mortality, and weight loss evolution of patients who underwent a bariatric procedure during 1 year of follow-up. Methods: Since July 2016, a total of 101 patients' data have been prospectively registered in a database. Comorbidities, operating time, hospital stay, early and late complications rate, and weight loss evolution after 1 year of follow-up were recorded. Results: The mean age was 38.41 ± 11.05 years with a mean body mass index (BMI) of 49.02 ± 5.89 kg/m2 (range 38-67). Laparoscopic sleeve gastrectomy (LSG) was performed in 93 patients (92.07%) and Roux-en-Y gastric bypass (RNYGB) in 8 patients (7.92%). Thirty-day morbidity rate was 7.92% (8/101). Within a mean 9.32 ± 2.25 (range 1-19) months follow-up time, mean percent of the excess of weight loss of 1st, 6th, and 12th months were 22.7 ± 6.1, 67.2 ± 11.2, and 81.4 ± 10.5, respectively. Diabetes (n = 38, 37.6%), hypertension (n = 13, 12.9%), and obstructive sleep apnea (n = 5, 4.9%) were resolved in 76%, 68.4%, and 100% of the patients, respectively (p < 0.001). Conclusions: LSG and RNYGB are safe and highly effective, particularly in patients with a BMI >50 kg/m2. Both techniques have been presented with better clinical outcomes regarding significant comorbidity resolution in the early evolution of weight loss.
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Affiliation(s)
- Kazim Senol
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | | | | | - Halit Ziya Dundar
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ekrem Kaya
- Department of General Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
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Spann RA, Welch BA, Grayson BE. Ghrelin signalling is dysregulated in male but not female offspring in a rat model of maternal vertical sleeve gastrectomy. J Neuroendocrinol 2021; 33:e12913. [PMID: 33169872 PMCID: PMC7831688 DOI: 10.1111/jne.12913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022]
Abstract
Bariatric surgery is the most effective and durable means of treating obesity and its comorbidities. Women make up 80% of those receiving weight loss surgery and they experience improvements in fertility. Unfortunately, bariatric surgery in the context of pregnancy is associated with complications, including growth restriction and small-for-gestational age offspring (SGA). SGA offspring have a greater risk for obesity in adulthood, although the mechanism for this SGA-induced obesity is unknown. In a rat model of vertical sleeve gastrectomy (VSG), we previously identified reductions during pregnancy in ghrelin, a stomach-derived hormone that increases appetite and induces growth hormone secretion. Here, we hypothesise that VSG offspring will have altered ghrelin signalling compared to offspring of Sham dams as a result of reduced in utero ghrelin. At postnatal day (PND)21, male and female offspring of dams that have previously received VSG have an increase in mRNA expression for the ghrelin receptor in the hypothalamus compared to Sham offspring, and the expression of GOAT is lower in females compared to males. Liver expression of endogenous ghrelin antagonist, LEAP2, is elevated at PND60 in VSG offspring. Expression of other genes in the growth hormone system (growth hormone-releasing hormone and growth hormone) were not altered. Plasma levels of total ghrelin at PND21 are also not different between VSG and Sham pups. In adult pups, 1-hour chow intake of male but not female VSG offspring given is less than Sham offspring when given 50 µg kg-1 of exogenous ghrelin by i.p. injection. These results indicate that maternal VSG surgery has an impact on ghrelin signalling in offspring and that, as adults, male VSG offspring may be functionally less responsive to ghrelin than controls.
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Affiliation(s)
- Redin A. Spann
- Department of Neurobiology and Anatomical Sciences University of Mississippi Medical Center, Jackson, MS 39216
| | - Bradley A. Welch
- Department of Neurobiology and Anatomical Sciences University of Mississippi Medical Center, Jackson, MS 39216
| | - Bernadette E. Grayson
- Department of Neurobiology and Anatomical Sciences University of Mississippi Medical Center, Jackson, MS 39216
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Phillips J, Randall JA, Kerns JC, Abel N, Papademetriou M, Brody F. Outcomes of Sleeve Gastrectomy at a Veterans Affairs Medical Center. J Laparoendosc Adv Surg Tech A 2020; 31:765-771. [PMID: 33155863 DOI: 10.1089/lap.2020.0639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Bariatric surgery is the most effective treatment for obesity while improving comorbid conditions and decreasing mortality rates. The purpose of this analysis was to identify the predictive factors associated with the short-term outcomes of laparoscopic sleeve gastrectomy (LSG) at a single Veterans Affairs Medical Center (VAMC). Methods: This is a retrospective analysis of LSG performed at a VAMC from 2013 to 2019. Veterans were followed for 12 months postoperatively. The primary outcomes of interest were excess weight loss (EWL) and total weight loss (TWL) at 3, 6, 9, and 12 months along with resolution of comorbidities. Independent predictors included: demographics, pre- and postoperative findings, geographic distance from VAMC, and per-capita salary of the veteran's residence. Results: A total of 128 patients, including 50 males, completed 12 months' follow-up after LSG. There were no mortalities, transfusions, or conversions to open surgery. The mean length of stay was 2.3 days. At 3, 6, 9, and 12 months, EWL was 27.2%, 33.7%, 35.9%, and 36.6%, respectively; TWL was 12.3%, 15.3%, 16.3%, and 16.7%, respectively. Postoperative hemoglobin A1c and oral hyperglycemic medication usage significantly decreased. High-density lipoprotein levels significantly increased. At 6 months' follow-up, preoperative body mass index (BMI; odds ratio [OR] = 0.7 [95% confidence interval, CI 0.6-0.9]) and age (OR = 0.9 [95% CI 0.8-1.0]) were significant predictors of 50% EWL and EWL broadly (P = .002). Conclusion: Similar to the private sector, LSG is a safe and effective tool for morbid obesity with clinical and serological improvements. For Veterans, increasing BMI and age may portend less weight loss but does not affect resolution of some comorbidities.
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Affiliation(s)
- Joshua Phillips
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - James A Randall
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Jennifer C Kerns
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Nicole Abel
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | | | - Fredrick Brody
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, USA
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Weight Loss After Sleeve Gastrectomy: Does Type 2 Diabetes Status Impact Weight and Body Composition Trajectories? Obes Surg 2020; 31:1046-1054. [PMID: 33146869 DOI: 10.1007/s11695-020-05075-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION/ PURPOSE Sleeve gastrectomy (SG), the most frequently performed bariatric procedure, induces marked weight-loss, but with high inter-individual variability. Since type 2 diabetes (T2D) negatively impacts weight-loss outcomes after Roux-en-Y gastric bypass (RYGB), we herein aimed to evaluate whether and how T2D status may influence weight-loss and body composition changes in individuals with or without T2D after SG. MATERIAL AND METHODS We retrospectively included individuals with obesity operated from SG and prospectively followed at our center: 373 patients including 152 with T2D (40%). All subjects' clinical characteristics were collected before and during 4 years of follow-up post-SG. Linear mixed models were applied to analyze weight-loss trajectories post-surgery. RESULTS Compared to individuals with obesity but no T2D, those with T2D before SG displayed lower weight-loss at 1 year (21 vs. 27% from baseline, p < 10-3). This difference was accentuated in patients with poorer glucose control (HbA1c > 7%) at baseline. Furthermore, patients with T2D underwent less favorable body composition changes at 1-year post-SG compared to individuals without T2D (% fat mass reduction: 28 vs. 37%, p < 10-3 respectively). CONCLUSION When undergoing SG, subjects with obesity and T2D who have poor pre-operative glycemic control display reduced weight-loss and less improvement in body composition compared to patients with obesity but without T2D. This result suggests that glycemic control prior to surgery is important to take into account for the outcome of bariatric surgery.
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Variables Associated with Short-Term Weight Loss in a Cohort of Patients with Morbid Obesity According to Age and Three Types of Bariatric Surgery. J Clin Med 2020; 9:jcm9113537. [PMID: 33147793 PMCID: PMC7692348 DOI: 10.3390/jcm9113537] [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] [Received: 10/21/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background The percentage of excess weight lost (%EWL) after bariatric surgery (BS) shows great discrepancies from one individual to another. Objective To evaluate the %EWL one year after BS and to determine the existence of baseline biomarkers associated with weight loss. Methods We studied 329 patients with morbid obesity undergoing three types of BS (biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG)), depending on the %EWL one year after surgery: good responders (GR) (%EWL ≥ 50%) and non-responders (NR) (%EWL < 50%). Results The GR presented a higher percentage of change in anthropometric and biochemical variables compared to the NR group, even within each type of BS. There was a greater percentage of GR among those who underwent RYGB. The patients who underwent SG showed the lowest decrease in biochemical variables, both in GR and NR. Within the GR group, those with a lower age showed greater improvement compared to the other age groups. A %EWL ≥50% was negatively associated with the age and atherogenic index of plasma (AIP), and positively with the type of BS (RYGB). Conclusions The GR group was associated with lower age and AIP and undergoing RYGB. Additionally, those patients who underwent SG showed a lower metabolic improvement.
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Moffett RC, Docherty NG, le Roux CW. The altered enteroendocrine reportoire following roux-en-Y-gastric bypass as an effector of weight loss and improved glycaemic control. Appetite 2020; 156:104807. [PMID: 32871202 DOI: 10.1016/j.appet.2020.104807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 02/08/2023]
Abstract
The alarming rise in obesity and relative lack of pharmacotherapies to treat, what is becoming a global epidemic, has necessitated that an increasing number of bariatric procedures be performed. Several surgical techniques have been developed during the last 50 years and the advent of laparoscopic surgery has increased the safety and efficacy of these procedures. Bariatric surgery is by a substantial margin, the most efficacious means of achieving sustained weight loss maintenance in patients with obesity. Roux-en-Y gastric bypass surgery (RYGB) elicits the most favourable metabolic outcomes with attendant benefits for type 2 diabetes and, cardiovascular disease as well as endocrine disorders and cancers in females. RYGB is the most extensively studied bariatric procedure regarding mechanism of action. In this review we catalogue the multiple alterations in secretion of gut hormones (ghrelin, obestatin, cholecystokinin, GLP-1, PYY, GIP, oxyntomodulin, glicentin and GLP-2) occurring after RYGB and summarise evidence indicating that these changes play a role in the reduction of food intake and improvements in glucose homeostasis.
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Affiliation(s)
- R Charlotte Moffett
- SAAD Centre for Pharmacy and Diabetes, School of Biomedical Sciences, University of Ulster, Coleraine, UK.
| | - Neil G Docherty
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Ireland; Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Ireland; Investigative Science, Imperial College London, UK
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Surgical resident training program to perform laparoscopic bariatric procedures: Are safety and postoperative outcomes compromised? Cir Esp 2020; 99:200-207. [PMID: 32693919 DOI: 10.1016/j.ciresp.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/23/2020] [Accepted: 05/30/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Laparoscopic bariatric procedures such as laparoscopic Roux-en-Y gastric bypass (LRYGB) are technically demanding and require a long learning curve. Little is known about whether surgical resident (SR) training programs to perform these procedures are safe and feasible. This study aims to evaluate the results of our SR training program to perform LRYGB. METHODS We designed a retrospective study including patients with LRYGB between January 2014 and December 2018, comparing SR results to experienced bariatric surgeons (EBS). In our country, SR have a five-year surgical formative period, and in the fourth year they are trained for 6 months in our bariatric surgery unit, from January to June. In the beginning, they perform different steps of this procedure, to finally complete an LRYGB. We collected demographic data, comorbidities, intraoperative outcomes, and postoperative complications and outcomes after a one-year follow-up. RESULTS Two hundred and eight patients were eligible for inclusion: 67 in group I (SR), and 141 in group II (EBS). Both groups were comparable. There was no statistically significant difference in operating time (166.45min in group I vs. 156.69min in group II; P=0.156). Conversion to open surgery, hospital stay, postoperative complications, and short-term outcomes had no significant differences between the two groups. There was no mortality registered during this period. CONCLUSION Implementation of LRYGB stepwise learning as part of an SR training program is safe, and results are comparable to EBS, without loss of efficiency. Therefore, it is feasible to train SR in bariatric surgery under EBS supervision.
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Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Surg Laparosc Endosc Percutan Tech 2020; 30:542-553. [PMID: 32658120 DOI: 10.1097/sle.0000000000000834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the 5-year outcomes of comparing LVSG and LRYGB. We undertook a systematic review and meta-analysis to compare 5-year weight loss outcomes of randomized controlled trials comparing LVSG to LRYGB. MATERIALS AND METHODS Searches of electronic databases (PubMed, Embase, CINAHL, Cochrane) were undertaken for randomized controlled trials describing weight loss outcomes in adults at 5 years postoperatively. Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman estimation method for random effects model was utilized. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS Five studies met the inclusion criteria totaling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies. Statistically significant body mass index loss ranged from -11.37 kg/m (range: -6.3 to -15.7 kg/m) in the LVSG group and -12.6 kg/m (range: -9.5 to -15.4 kg/m) for LRYGB at 5 years (P<0.001). Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess body mass index loss than LVSG: this was not corroborated in the meta-analysis. CONCLUSIONS Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at 5 years postoperatively, however, differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol analysis of the 2 largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.
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Major P, Stefura T, Dziurowicz B, Radwan J, Wysocki M, Małczak P, Pędziwiatr M. Quality of Life 10 Years After Bariatric Surgery. Obes Surg 2020; 30:3675-3684. [PMID: 32535784 PMCID: PMC7467960 DOI: 10.1007/s11695-020-04726-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Improvement of the quality of life after bariatric surgery is an important outcome of the treatment. Assessing the long-term QoL results provides better insights into the effectiveness of bariatric surgery. MATERIALS AND METHODS This is a cohort study including patients who underwent bariatric surgery between June 2009 and May 2010 in one academic center. Patients underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Overall, 34 patients underwent LSG (52.3%) and 31 patients underwent LRYGB (47.7%). Preoperatively, and after 1 and 10 years, QoL was assessed using two standardized questionnaires: SF-36 and MA-QoLII. After 10 years, 72% of patients filled out these questionnaires. RESULTS The global QoL score before surgery was 48.3 ± 20.6. At the 1-year follow-up, the global total QoL score was 79.7 ± 9.8. At the 10-year follow-up, the global total QoL score was 65.1 ± 21.4. There was a significant increase in total QoL between measurements before the operation and 10 years after surgery in the whole study group (p = 0.001) and for patients who underwent LSG (p = 0.001). There was no significant difference between total QoL prior to surgery and 10 years after for patients who underwent LRYGB (p = 0.450). CONCLUSION LSG led to significant improvement in QoL.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Tomasz Stefura
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.
| | - Błażej Dziurowicz
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Radwan
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
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Aasbrenn M, Schnurr TM, Have CT, Svendstrup M, Hansen DL, Worm D, Balslev-Harder M, Hollensted M, Grarup N, Burgdorf KS, Vestergaard H, Pedersen O, Sørensen TIA, Fenger M, Madsbad S, Hansen T. Genetic Determinants of Weight Loss After Bariatric Surgery. Obes Surg 2020; 29:2554-2561. [PMID: 31001758 DOI: 10.1007/s11695-019-03878-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The weight loss after bariatric surgery shows considerable individual variation. Twin studies of response to dietary interventions and studies of bariatric surgery patients suggest that genetic differences may play a role. This study aimed to examine the effect of three genetic risk scores on the inter-individual variation in excess body mass index loss (EBMIL) after Roux-en-Y gastric bypass. Furthermore, we searched among known adiposity-related single nucleotide polymorphisms (SNPs) for genetic determinants of the inter-individual variation in EBMIL. METHODS Patients with morbid obesity underwent Roux-en-Y gastric bypass and were genotyped (n = 577). Two genetic risk scores for weight loss after bariatric surgery and a genetic risk score for body mass index were calculated. Associations between the genetic risk scores and EBMIL were evaluated. Lasso regression was performed on 126 SNPs known to be associated with adiposity. RESULTS The average EBMIL was 76.9% (range 21.7-149.2%). EBMIL was 81.1% (SD 20.6) and 73.9% (SD 21.7) in the high and low tertile groups of a genetic risk score for weight loss. Patients with a low genetic risk score for body mass index (in the lowest 5% percentile) had an EBMIL of 68.8% (SD 20.6, p = 0.018). Thirteen adiposity-related SNPs were identified to associate with EBMIL through lasso regression. DISCUSSION A genetic risk score was associated with EBMIL after bariatric surgery, but may not yet be applicable to clinical practice. Patients genetically predisposed to low body mass index had lower weight loss after bariatric surgery.
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Affiliation(s)
- Martin Aasbrenn
- Department of Surgery, Innlandet Hospital Trust, Gjøvik, Norway. .,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark.
| | - Theresia Maria Schnurr
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
| | - Christian Theil Have
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
| | - Mathilde Svendstrup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | | | - Dorte Worm
- Department of Medicine, Amager Hospital, København, Denmark
| | - Marie Balslev-Harder
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
| | - Mette Hollensted
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
| | | | - Henrik Vestergaard
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
| | - Thorkild I A Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Fenger
- Department of Clinical Biochemistry, Hvidovre University Hospital, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen N, Denmark
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Sisik A, Basak F. Presurgical Predictive Factors of Excess Weight Loss After Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 30:2905-2912. [PMID: 32307671 DOI: 10.1007/s11695-020-04624-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Conditions associated with surgical technique and postoperative lifestyle changes, as well as the characteristics of patients, may affect weight loss following laparoscopic sleeve gastrectomy. In this study, the effects of age, gender, BMI, and excess weight at the time of surgery on weight loss during follow-up were examined. MATERIALS AND METHODS Demographic data (age, gender), preoperative BMI, and weight values of the patients were recorded. TWL% and EWL% values of patients were recorded during follow-up at 1st, 3rd, 6th, 9th, 12th, and 18th months. Patients were grouped according to age (AGE1 < 30, AGE2 30-50, AGE3 ≥ 50 years), BMI at the time of surgery (BMI1 ≤ 50, BMI2 > 50 kg/m2), and EW at the time of surgery (EW1 ≤ 60, EW2 > 60 kg). EWL% values obtained in the follow-up visits were compared among the gender, age, BMI, and EW groups. RESULTS A total of 456 patients (371 females, 85 males) were operated. Mean EWL% was lower in AGE3 group (p < 0.001). Patients in AGE1 group had the highest mean EWL%, while those in BMI2 and EW2 groups had lower mean EWL% values throughout the follow-up period (p < 0.001). Regression analysis showed that age and BMI were associated with EWL% at all follow-up visits (p < 0.05). CONCLUSION Patients with less than 60 kg of excess weight, those with BMI ≤ 50 kg/m2 and younger patients may lose weight more effectively following LSG.
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Affiliation(s)
- Abdullah Sisik
- Umraniye Education and Research Hospital, General Surgery Department, University of Health Sciences, Elmalikent Mah. Adem Yavuz Cad. No: 1 Umraniye, Istanbul, Turkey.
| | - Fatih Basak
- Umraniye Education and Research Hospital, General Surgery Department, University of Health Sciences, Elmalikent Mah. Adem Yavuz Cad. No: 1 Umraniye, Istanbul, Turkey
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Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for 5-year hypertension remission in obese patients: a systematic review and meta-analysis. J Hypertens 2020; 38:185-195. [DOI: 10.1097/hjh.0000000000002255] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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36
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Shariq OA, McKenzie TJ. Obesity-related hypertension: a review of pathophysiology, management, and the role of metabolic surgery. Gland Surg 2020; 9:80-93. [PMID: 32206601 DOI: 10.21037/gs.2019.12.03] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Obesity is a significant public health challenge worldwide and is inextricably linked to adverse cardiovascular outcomes. The relationship between excess adiposity and increased blood pressure is well established, and it is estimated that obesity accounts for 65-78% of cases of primary hypertension. The mechanisms through which obesity causes hypertension are complex and include sympathetic nervous system overactivation, stimulation of the renin-angiotensin-aldosterone system, alterations in adipose-derived cytokines, insulin resistance, and structural and functional renal changes. Weight loss is the primary goal of treatment for obesity-related hypertension, although few individuals achieve success with nonpharmacological management alone. Specific considerations apply when selecting the most appropriate pharmacological therapy for obese hypertensive patients. Metabolic surgery has proved to be the most effective means of ensuring substantial and sustained weight loss and has also been shown to confer beneficial effects in type 2 diabetes mellitus. Increasing evidence suggests that metabolic surgery may also be an effective treatment for obesity-related hypertension, although prospective data on long-term blood pressure outcomes are awaited. This review will discuss the pathophysiological mechanisms that link obesity with hypertension and will provide an overview of treatment strategies, with a focus on metabolic surgery.
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Climent E, Benaiges D, Goday A, Villatoro M, Julià H, Ramón JM, Flores JA, Pedro-Botet J. Morbid obesity and dyslipidaemia: The impact of bariatric surgery. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 32:79-86. [PMID: 31973950 DOI: 10.1016/j.arteri.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
Obesity prevalence has presented an exponential increase in the last decades, becoming a first order public health issue. Dyslipidemia of obesity, characterized by low levels of high density lipoprotein (HDL) cholesterol, hypertriglyceridemia and small and dense low-density lipoprotein (LDL) particles, is partly responsible for the high residual cardiovascular risk of this clinical situation. On the other hand, bariatric surgery (BS) is the most effective treatment for obesity, obtaining a greater weight loss than achieved with conventional medical therapy and favoring the improvement or remission of associated comorbidities. The most commonly used BS techniques nowadays are laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Both of these procedures have obtained similar results in terms of weight loss and comorbidity remission such as type2 diabetes mellitus or hypertension. A differential feature between both techniques could be the different impact on the lipoprotein profile. In this respect, previous studies with short and mid-term follow-up have proved LRYGB to be superior to LSG in total and LDL cholesterol reduction. Results regarding triglycerides and HDL cholesterol are contradictory. Therefore, we consider of interest to review the effects of BS at short and mid-term follow-up on lipoprotein profile, as well as the remission rates of the different lipid abnormalities and the possible related factors.
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Affiliation(s)
- Elisenda Climent
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, España
| | - David Benaiges
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - Albert Goday
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | | | - Helena Julià
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España
| | - Jose M Ramón
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Servicio de Cirugía General, Hospital del Mar, Barcelona, España
| | - Juana A Flores
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - Juan Pedro-Botet
- Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
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Sultan S, Patel AG, El-Hassani S, Whitelaw B, Leca BM, Vincent RP, le Roux CW, Rubino F, Aywlin SJB, Dimitriadis GK. Male Obesity Associated Gonadal Dysfunction and the Role of Bariatric Surgery. Front Endocrinol (Lausanne) 2020; 11:408. [PMID: 32636807 PMCID: PMC7318874 DOI: 10.3389/fendo.2020.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/20/2020] [Indexed: 01/01/2023] Open
Abstract
Obesity is an ever growing pandemic and a prevalent problem among men of reproductive age that can both cause and exacerbate male-factor infertility by means of endocrine abnormalities, associated comorbidities, and direct effects on the precision and throughput of spermatogenesis. Robust epidemiologic, clinical, genetic, epigenetic, and preclinical data support these findings. Clinical studies on the impact of medically induced weight loss on serum testosterone concentrations and spermatogenesis is promising but may show differential and unsustainable results. In contrast, literature has demonstrated that weight loss after bariatric surgery is correlated with an increase in serum testosterone concentrations that is superior than that obtained with only lifestyle modifications, supporting a further metabolic benefit from surgery that may be specific to the male reproductive system. The data on sperm and semen parameters is controversial to date. Emerging evidence in the burgeoning field of genetics and epigenetics has demonstrated that paternal obesity can affect offspring metabolic and reproductive phenotypes by means of epigenetic reprogramming of spermatogonial stem cells. Understanding the impact of this reprogramming is critical to a comprehensive view of the impact of obesity on subsequent generations. Furthermore, conveying the potential impact of these lifestyle changes on future progeny can serve as a powerful tool for obese men to modify their behavior. Healthcare professionals treating male infertility and obesity need to adapt their practice to assimilate these new findings to better counsel men about the importance of paternal preconception health and the impact of novel non-medical therapeutic interventions. Herein, we summarize the pathophysiology of obesity on the male reproductive system and emerging evidence regarding the potential role of bariatric surgery as treatment of male obesity-associated gonadal dysfunction.
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Affiliation(s)
- Sana Sultan
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ameet G. Patel
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Shamsi El-Hassani
- Minimal Access and Bariatric Unit, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Orpington, United Kingdom
| | - Benjamin Whitelaw
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bianca M. Leca
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Royce P. Vincent
- Department of Clinical Biochemistry, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Carel W. le Roux
- Diabetes Complication Research Centre, School of Medicine and Medical Science, UCD Conway Institute, University College Dublin, Belfield, Ireland
| | - Francesco Rubino
- Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Simon J. B. Aywlin
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology and Metabolic Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Georgios K. Dimitriadis
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Preoperative liking and wanting for sweet beverages as predictors of body weight loss after Roux-en-Y gastric bypass and sleeve gastrectomy. Int J Obes (Lond) 2019; 44:1350-1359. [PMID: 31641214 PMCID: PMC7174088 DOI: 10.1038/s41366-019-0474-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/18/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022]
Abstract
Background/objectives: Patients who receive Roux-en-Y gastric bypass (RYGB) lose more weight than those who receive vertical sleeve gastrectomy (VSG). RYGB and VSG alter hedonic responses to sweet flavor, but whether baseline differences in hedonic responses modulate weight loss after RYGB or VSG remains untested. Participants/methods: Male and female candidates (n=66) for RYGB or VSG were recruited and tested for their subjective liking and wanting ratings of sucrose solutions and flavored beverages sweetened with aspartame. Participants were classified by unsupervised hierarchical clustering for their liking and wanting ratings of sucrose and aspartame. Participant liking ratings were also used in a supervised classification using pre-established categories of liking ratings (liker, disliker, and inverted u-shape). Effects of categories obtained from unsupervised or supervised classification on body weight loss and their interaction with surgery type were analyzed separately at 3 and 12 months after surgery using linear models corrected for sex and age. Results: RYGB participants lost more body weight compared to VSG participants at 3 and 12 months after surgery (P < 0.001 for both time points). Unsupervised clustering analysis identified clusters corresponding to high and low wanting or liking ratings for sucrose or aspartame. RYGB participants in high-wanting clusters based on sucrose, but not aspartame, lost more weight than VSG at both 3 (P = 0.01) and 12 months (P = 0.03), yielding a significant cluster by surgery interaction. Categories based on supervised classification using liking ratings for sucrose or aspartame showed no significant effects on body weight loss between RYGB and VSG participants. Conclusions: Classification of patients into high/low wanting ratings for sucrose before surgery can predict differential body weight loss after RYGB or VSG in adults and could be used to advise on surgery type.
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40
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Abstract
PURPOSE OF REVIEW In this review, we summarize what is currently described in terms of gut microbiota (GM) dysbiosis modification post-bariatric surgery (BS) and their link with BS-induced clinical improvement. We also discuss how the major inter-individual variability in terms of GM changes could impact the clinical improvements seen in patients. RECENT FINDINGS The persisting increase in severe obesity prevalence has led to the subsequent burst in BS number. Indeed, it is to date the best treatment option to induce major and sustainable weight loss and metabolic improvement in these patients. During obesity, the gut microbiota displays distinctive features such as low microbial gene richness and compositional and functional alterations (termed dysbiosis) which have been associated with low-grade inflammation, increased body weight and fat mass, as well as type-2 diabetes. Interestingly, GM changes post-BS is currently being proposed as one the many mechanism explaining BS beneficial clinical outcomes. BS enables partial rescue of GM dysbiosis observed during obesity. Some of the GM characteristics modified post-BS (composition in terms of bacteria and functions) are linked to BS beneficial outcomes such as weight loss or metabolic improvements. Nevertheless, the changes in GM post-BS display major variability from one patient to the other. As such, further large sample size studies associated with GM transfer studies in animals are still needed to completely decipher the role of GM in the clinical improvements observed post-surgery.
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Affiliation(s)
- Jean Debédat
- INSERM, NutriOmics Research Unit, Sorbonne Université, Paris, France
| | - Karine Clément
- INSERM, NutriOmics Research Unit, Sorbonne Université, Paris, France.
- Assistance Publique Hôpitaux de Paris, Nutrition Departement, Pitié-Salpêtrière Hospital, Sorbonne Université, 47-83 bd de l'Hôpital, 75013, Paris, France.
| | - Judith Aron-Wisnewsky
- INSERM, NutriOmics Research Unit, Sorbonne Université, Paris, France.
- Assistance Publique Hôpitaux de Paris, Nutrition Departement, Pitié-Salpêtrière Hospital, Sorbonne Université, 47-83 bd de l'Hôpital, 75013, Paris, France.
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41
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Al-Rubaye H, McGlone ER, Farzaneh B, Mustafa L, Johnson M, Kayal A, English CL, Kaur V, Kalendran M, Reddy M, Khan OA. Roux-en-Y gastric bypass or sleeve gastrectomy for obstructive sleep apnea: A systematic review and meta-analysis. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2019. [DOI: 10.1016/j.lers.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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42
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Nasta AM, Vyas S, Goel M, Goel R. Is sleeve gastrectomy overcriticized? A single-center Indian experience with 5-year follow-up results. Surg Obes Relat Dis 2019; 15:1883-1887. [PMID: 31564636 DOI: 10.1016/j.soard.2019.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bariatric surgery has seen a sharp rise in numbers worldwide in the last decade. Being a popular procedure, sleeve gastrectomy (SG) has been widely studied over the years for its efficacy, potential for weight regain, metabolic impact, and de novo gastroesophageal reflux disease (GERD). OBJECTIVES To evaluate clinical outcomes of laparoscopic SG after 5 years of follow-up in terms of weight loss, co-morbidity resolution, and GERD. SETTING The study was performed in a center of excellence in bariatric surgery in India. METHODS All patients who underwent laparoscopic SG from January 2012 to April 2013 were included in the study. Their demographic, preoperative, and postoperative data were prospectively maintained in Microsoft Excel and analyzed statistically. RESULTS Two hundred eighteen patients underwent SG in 2012-2013. Patients had a preoperative body mass index of 45.8 ± 9.5 kg/m2 (mean ± standard deviation) and excess weight of 54.1 ± 25.6 kg. Percent excess weight loss was 87.6% ± 28.9% at 1 year, 77.2% ± 29.3% at 3 years, and 69.1% ± 27.8% at 5 years. Percent total weight loss at 1 year was 35.5% ± 7.6%, 31.4% ± 9.1% at 3 years, and 29.2% ± 9.8% at 5 years. At 5 years, 11 of 25 (44%) showed complete diabetic remission and 5 of 25 (20%) showed partial remission. De novo GERD was seen in 24 of 153 (15.7%) patients. CONCLUSION Our study reflects good outcomes after SG in terms of weight loss and diabetes resolution at 5-year follow-up, though GERD remains a matter of concern.
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Affiliation(s)
| | | | - Madhu Goel
- Wockhardt Hospitals, Mumbai Central, Mumbai, India
| | - Ramen Goel
- Wockhardt Hospitals, Mumbai Central, Mumbai, India
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43
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Debédat J, Amouyal C, Aron-Wisnewsky J, Clément K. Impact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome? Semin Immunopathol 2019; 41:461-475. [DOI: 10.1007/s00281-019-00738-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/15/2019] [Indexed: 02/06/2023]
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44
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Abstract
Weight loss surgery is the most effective intervention for addressing obesity and related metabolic disorders such as diabetes. We describe common surgical procedures as well as emerging and investigational procedures in terms of their capacity to induce weight reduction and their risk profiles. We then discuss the impact of weight loss surgery on important obesity related disorders including diabetes, cardiovascular disease, and non-alcoholic fatty liver disease. The question of operative choice is discussed with respect to benefits and risks of common procedures. Reoperative weight loss surgery, an increasingly common element of weight loss surgical practice, is reviewed. We briefly discuss the metabolic mechanism of action of weight loss surgery. Lack of access to and under-utilization of weight loss surgery represent important challenges to adequate obesity treatment, and we review these topics as well.
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Affiliation(s)
- Jacob Nudel
- Department of Surgery, Boston University School of Medicine, Boston, MA, United States of America; Institute for Health System Innovation and Policy, Boston University, Boston, MA, United States of America
| | - Vivian M Sanchez
- Department of Surgery, Boston University School of Medicine, Boston, MA, United States of America; Department of Surgery, VA Boston Healthcare System, Boston, MA, United States of America.
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45
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Pucci A, Batterham RL. Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest 2019; 42:117-128. [PMID: 29730732 PMCID: PMC6394763 DOI: 10.1007/s40618-018-0892-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 12/12/2022]
Abstract
The worldwide obesity epidemic continues unabated, adversely impacting upon global health and economies. People with severe obesity suffer the greatest adverse health consequences with reduced life expectancy. Currently, bariatric surgery is the most effective treatment for people with severe obesity, resulting in marked sustained weight loss, improved obesity-associated comorbidities and reduced mortality. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), the most common bariatric procedures undertaken globally, engender weight loss and metabolic improvements by mechanisms other than restriction and malabsorption. It is now clear that a plethora of gastrointestinal (GI) tract-derived signals plays a critical role in energy and glucose regulation. SG and RYGB, which alter GI anatomy and nutrient flow, impact upon these GI signals ultimately leading to weight loss and metabolic improvements. However, whilst highly effective overall, at individual level, post-operative outcomes are highly variable, with a proportion of patients experiencing poor long-term weight loss outcome and gaining little health benefit. RYGB and SG are markedly different anatomically and thus differentially impact upon GI signalling and bodyweight regulation. Here, we review the mechanisms proposed to cause weight loss following RYGB and SG. We highlight similarities and differences between these two procedures with a focus on gut hormones, bile acids and gut microbiota. A greater understanding of these procedure-related mechanisms will allow surgical procedure choice to be tailored to the individual to maximise post-surgery health outcomes and will facilitate the discovery of non-surgical treatments for people with obesity.
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Affiliation(s)
- A Pucci
- Centre for Obesity Research, Rayne Institute, University College London, London, UK
- Centre for Weight Management and Metabolic Surgery, University College London Hospital Bariatric, London, UK
| | - R L Batterham
- Centre for Obesity Research, Rayne Institute, University College London, London, UK.
- Centre for Weight Management and Metabolic Surgery, University College London Hospital Bariatric, London, UK.
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK.
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Arterburn D, Wellman R, Emiliano A, Smith SR, Odegaard AO, Murali S, Williams N, Coleman KJ, Courcoulas A, Coley RY, Anau J, Pardee R, Toh S, Janning C, Cook A, Sturtevant J, Horgan C, McTigue KM. Comparative Effectiveness and Safety of Bariatric Procedures for Weight Loss: A PCORnet Cohort Study. Ann Intern Med 2018; 169:741-750. [PMID: 30383139 PMCID: PMC6652193 DOI: 10.7326/m17-2786] [Citation(s) in RCA: 192] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There has been a dramatic shift in use of bariatric procedures, but little is known about their long-term comparative effectiveness. OBJECTIVE To compare weight loss and safety among bariatric procedures. DESIGN Retrospective observational cohort study, January 2005 to September 2015. (ClinicalTrials.gov: NCT02741674). SETTING 41 health systems in the National Patient-Centered Clinical Research Network. PARTICIPANTS 65 093 patients aged 20 to 79 years with body mass index (BMI) of 35 kg/m2 or greater who had bariatric procedures. INTERVENTION 32 208 Roux-en-Y gastric bypass (RYGB), 29 693 sleeve gastrectomy (SG), and 3192 adjustable gastric banding (AGB) procedures. MEASUREMENTS Estimated percent total weight loss (TWL) at 1, 3, and 5 years; 30-day rates of major adverse events. RESULTS Total numbers of eligible patients with weight measures at 1, 3, and 5 years were 44 978 (84%), 20 783 (68%), and 7159 (69%), respectively. Thirty-day rates of major adverse events were 5.0% for RYGB, 2.6% for SG, and 2.9% for AGB. One-year mean TWLs were 31.2% (95% CI, 31.1% to 31.3%) for RYGB, 25.2% (CI, 25.1% to 25.4%) for SG, and 13.7% (CI, 13.3% to 14.0%) for AGB. At 1 year, RYGB patients lost 5.9 (CI, 5.8 to 6.1) percentage points more weight than SG patients and 17.7 (CI, 17.3 to 18.1) percentage points more than AGB patients, and SG patients lost 12.0 (CI, 11.6 to 12.5) percentage points more than AGB patients. Five-year mean TWLs were 25.5% (CI, 25.1% to 25.9%) for RYGB, 18.8% (CI, 18.0% to 19.6%) for SG, and 11.7% (CI, 10.2% to 13.1%) for AGB. Patients with diabetes, those with BMI less than 50 kg/m2, those aged 65 years or older, African American patients, and Hispanic patients lost less weight than patients without those characteristics. LIMITATION Potential unobserved confounding due to nonrandomized design; electronic health record databases had missing outcome data. CONCLUSION Adults lost more weight with RYGB than with SG or AGB at 1, 3, and 5 years; however, RYGB had the highest 30-day rate of major adverse events. Small subgroup differences in weight loss outcomes were observed. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Ana Emiliano
- Rockefeller University, New York, New York (A.E.)
| | - Steven R Smith
- The Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida (S.R.S.)
| | - Andrew O Odegaard
- University of California, Irvine, School of Medicine, Irvine, California (A.O.O.)
| | - Sameer Murali
- Kaiser Permanente Southern California, Pasadena, California (S.M., K.J.C.)
| | - Neely Williams
- Community Partners' Network, Nashville, Tennessee (N.W.)
| | - Karen J Coleman
- Kaiser Permanente Southern California, Pasadena, California (S.M., K.J.C.)
| | - Anita Courcoulas
- University of Pittsburgh, Pittsburgh, Pennsylvania (A.C., K.M.M.)
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Roy Pardee
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Sengwee Toh
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.)
| | - Cheri Janning
- Duke Clinical & Translational Science Institute, Durham, North Carolina (C.J.)
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.A., R.W., R.Y.C., J.A., R.P., A.C.)
| | - Jessica Sturtevant
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.)
| | - Casie Horgan
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (S.T., J.S., C.H.)
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Dilday J, Derickson M, Kuckelman J, Reitz C, Ahnfeldt E, Martin M, Paul Sanders J. Sleeve Gastrectomy for Obesity in Polycystic Ovarian Syndrome: a Pilot Study Evaluating Weight Loss and Fertility Outcomes. Obes Surg 2018; 29:93-98. [DOI: 10.1007/s11695-018-3473-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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48
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Goel R, Goel M, Nasta AM, Vyas S, Dharia S, Hamrapurkar S. Portion Control Eating-a Determinant of Bariatric Outcomes. Obes Surg 2018; 28:3738-3743. [PMID: 30074144 DOI: 10.1007/s11695-018-3436-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Bariatric surgery leads to significant weight loss but the results vary. Application of dietary principles like portion-controlled eating leads to greater weight loss and fewer complications. AIMS To evaluate the improvement in weight loss outcomes by incorporating portion-controlled eating behavior in postbariatric patients. METHODS All patients who underwent bariatric surgery from January 2012 to December 2013 were included in the study. Portion-controlled eating behavior was incorporated in the post-bariatric nutritional protocol. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically. RESULTS Three hundred and seventy-two (89.6%) underwent laparoscopic sleeve gastrectomy (LSG), while 43 (10.4%) underwent laparoscopic Roux-en-Y gastric bypass (RYGB). In the LSG group, lowest (nadir) BMI was 28.99 ± 5.6 kg/m2 and % Excess weight loss (EWL) was 87.3 ± 27.2%, achieved between 1 and 2 years. In the RYGB group, lowest (nadir) BMI was 27.5 ± 12.09 kg/m and % EWL was 94.32 ± 33.12%. Surgical failure (less than 50% EWL) were 10 (3.27%) in the LSG group and 1 (3%) in the RYGB group. There were no leaks reported in our study. CONCLUSION Our study highlights the importance of postoperative nutritional interventions like portion-controlled eating for successful bariatric outcome.
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Affiliation(s)
- Ramen Goel
- Wockhardt Hospitals, Mumbai Central, Mumbai, India
| | - Madhu Goel
- Wockhardt Hospitals, Mumbai Central, Mumbai, India
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Skancke M, Schoolfield C, Grossman R, Kerns JC, Abel N, Brody F. Laparoscopic Sleeve Gastrectomy for Morbid Obesity at a Veterans Affairs Medical Center. J Laparoendosc Adv Surg Tech A 2018; 28:650-655. [PMID: 29589988 DOI: 10.1089/lap.2018.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Class III obesity is a global health emergency associated with an increase in the incidence of many other diseases such as type 2 diabetes mellitus, hypertension, hyperlipidemia, cancer, obstructive sleep apnea, nonalcoholic fatty liver disease, osteoarthritis, infertility, and mental health disorders. Minimal work has been published regarding the efficacy of laparoscopic sleeve gastrectomy (LSG) in the veteran population to surgically manage morbid obesity. DESIGN Retrospective analysis of LSG performed at a Veterans Affairs Medical Center (VAMC) between 2010 and 2017. Veterans were followed from their enrollment in the bariatric program until twelve months following LSG. The primary outcome of interest was excess and total weight loss with resolution of associated comorbidities. RESULTS Excess weight loss at nine and 12 months was 43.5% and 40.7% and total weight loss was 20.1% and 19.0%, respectively. LSG performed at a VAMC resulted in 86.9% improvement in type 2 diabetes mellitus and a 66.1% improvement in hypertension and 74.3% improvement in hyperlipidemia. Approximately 10.0% of diabetics obtained partial and 9.0% obtained complete resolution of their disease. Similarly, 22.0% of Veterans obtained partial and 13.0% obtained complete resolution from hypertension. Complete resolution from hyperlipidemia was achieved in 8.8% of Veterans. There were no postoperative complications or staple line leaks. CONCLUSION LSG is a safe and effective tool for morbid obesity with clinical and serological improvements for individuals who are unable to lose weight with medical management alone.
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Affiliation(s)
- Matthew Skancke
- Department of Bariatric Surgery, Veterans Administration Medical Center , Washington, District of Columbia
| | - Clint Schoolfield
- Department of Bariatric Surgery, Veterans Administration Medical Center , Washington, District of Columbia
| | - Robert Grossman
- Department of Bariatric Surgery, Veterans Administration Medical Center , Washington, District of Columbia
| | - Jennifer C Kerns
- Department of Bariatric Surgery, Veterans Administration Medical Center , Washington, District of Columbia
| | - Nicole Abel
- Department of Bariatric Surgery, Veterans Administration Medical Center , Washington, District of Columbia
| | - Fredrick Brody
- Department of Bariatric Surgery, Veterans Administration Medical Center , Washington, District of Columbia
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Pilone V, Tramontano S, Renzulli M, Romano M, Cobellis L, Berselli T, Schiavo L. Metabolic effects, safety, and acceptability of very low-calorie ketogenic dietetic scheme on candidates for bariatric surgery. Surg Obes Relat Dis 2018; 14:1013-1019. [PMID: 29785940 DOI: 10.1016/j.soard.2018.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies have demonstrated significant advantages from a preoperative dietetic regimen for candidates to bariatric procedure. OBJECTIVES Evaluation of safety, efficacy, and acceptability of a very low-calorie ketogenic diet in patients before bariatric surgery. SETTING University Hospital. METHODS A standardized 30-day sequential preoperative diet regimen has been analyzed, optimizing metabolic response with gradual carbohydrate reintroduction. Patients were given a dedicated KetoStationkit, for use during the first 10 days of the scheme, followed by a hypocaloric scheme for 20 days. The study group underwent routine laboratory tests and anthropometric measurements (percent weight loss, body mass index, waist circumference) at enrollment (T0), after 10 days (T1), and after 30 days (T2). Ketone body levels were measured in the plasma and urine. RESULTS Between January 2015 and September 2015, 119 patients were included in the study. Mean body mass index was 41.5 ± 7.6 kg/m2. Weight, body mass index, and waist circumference at T0 and T1, T0 and T2, and T1 and T2 decreased significantly (P<.05). A bioelectrical impedance assay determined a significant reduction in visceral fat at T1 and T2. We observed a significant (P<.05) improvement in several clinical parameters, including glycemic and lipid profile parameters. We also observed a mean 30% reduction in liver volume. The majority of patients declared satisfied or very satisfied. The adverse effects were mild, of short duration, and not clinically relevant. CONCLUSION Our results confirm the acceptability, safety, and significant advantage of a very low-calorie ketogenic diet for reducing weight and liver volume of patients in preparation for bariatric surgery.
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Affiliation(s)
- Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy; General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Salvatore Tramontano
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy.
| | - Michele Renzulli
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Mafalda Romano
- General, Bariatric and Emergency Surgical Unit of Fucito Hospital, University Hospital of Salerno, Salerno, Italy
| | - Luigi Cobellis
- Surgical Unit Cobellis Clinical Hospital, Vallo della Lucania, Italy
| | | | - Luigi Schiavo
- Department of Cardio-Thoracic and Respiratory Science, University of Campania "Luigi Vanvitelli," Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy
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