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Suvarnakar A, Hose BZ, Busog DN, McCloud S, Chao GF, Miller K, Pardo I, Alimi Y. Falling short in bariatric surgery: An exploration of key barriers and motivators of attrition. Am J Surg 2024; 236:115827. [PMID: 39029267 DOI: 10.1016/j.amjsurg.2024.115827] [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: 05/04/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND In the United States, obesity-related diseases pose significant healthcare challenges, with bariatric surgery offering a potential solution. However, bariatric surgery completion rates, particularly among Black and Hispanic populations, remain low. OBJECTIVE This study applied the Theoretical Domains Framework (TDF) to explore behavioral factors influencing bariatric surgery program attrition among a majority Black participant population to inform interventions for improving attrition. METHODS We conducted semi-structured interviews with 40 surgical and non-surgical participants and conducted deductive content analysis informed by six TDF constructs to explore factors influencing bariatric surgery program attrition. RESULTS Participants' decision-making regarding bariatric surgery is influenced by behavioral factors, including knowledge, skills, social roles, beliefs about capabilities, optimism, and beliefs about consequences. CONCLUSION Understanding multifaceted factors influencing bariatric surgery attrition will inform the development of tailored interventions that address knowledge gaps, enhance skills, and consider social role conflicts to improve patient engagement and decision-making in managing obesity, especially for Black populations.
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Affiliation(s)
| | - Bat-Zion Hose
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Deanna-Nicole Busog
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Summer McCloud
- Georgetown University School of Medicine, Washington, DC, USA
| | - Grace F Chao
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Kristen Miller
- Georgetown University School of Medicine, Washington, DC, USA; National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Ivanesa Pardo
- Georgetown University School of Medicine, Washington, DC, USA; Division of Minimally Invasive Surgery and Bariatric Surgery, Medstar Washington Hospital Center, Washington, DC, USA
| | - Yewande Alimi
- Georgetown University School of Medicine, Washington, DC, USA; Division of Minimally Invasive Surgery and Bariatric Surgery, Medstar Washington Hospital Center, Washington, DC, USA; Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
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Bombardieri A, Bufano A, Fralassi N, Ciuoli C, Benenati N, Dalmiglio C, Voglino C, Tirone A, Vuolo G, Castagna MG. Assessing the Prevalence of Male Obesity-Associated Gonadal Dysfunction in Severe Obesity: A Focus on the Impact of Bariatric Surgery and Surgical Approaches. Obes Surg 2024; 34:3434-3444. [PMID: 39085709 DOI: 10.1007/s11695-024-07426-8] [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: 02/15/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Obesity is an important risk factor for secondary hypogonadism in men. Several studies evaluated the impact of bariatric surgery on gonadal function in men, proving an improvement in testosterone levels, without yet a global consensus on the impact of different surgical approaches. Objectives of the study are: to estimate the prevalence of obesity-associated gonadal dysfunction among men with severe obesity; to evaluate the response to bariatric surgery in terms of resolution of this condition, distinguishing between restrictive and restrictive-malabsorptive surgery. METHODS We conducted a retrospective evaluation of 413 males with severe obesity (BMI 44.7 ± 8.3 kg/m2). A subgroup of them (61.7%) underwent bariatric surgery. Anthropometric assessment (weight, BMI, waist and hip circumference), metabolic (glyco-lipidic asset and urate) and hormonal (morning gonadotropin and total testosterone) assessments were carried out at baseline and 3-6 months post-surgery. RESULTS Using a TT threshold of 2.64 ng/ml, 256 out of 413 (62%) patients were categorized as having biochemical hypogonadism. At multivariate analysis, the only parameter significantly associated with biochemical hypogonadism, was BMI value (p = 0.001). At 3-6 months after surgery, during the acute weight loss phase, only 20.1% of patients still had biochemical hypogonadism. At multivariate analysis, which included age, presurgical BMI, pre-surgical TT, surgical approach and %EWL, presurgical TT levels (p = 0.0004), %EWL (p = 0.04), and mixed restrictive-malabsorptive surgery (p = 0.01), were independently associated with the recovery of gonadal function. CONCLUSIONS The results of this study underscore the potential reversibility of obesity-associated gonadal dysfunction through bariatric surgery, highlighting the importance of considering surgical approach.
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Affiliation(s)
- Alessio Bombardieri
- Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy
| | - Annalisa Bufano
- Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy
| | - Noemi Fralassi
- Department of Biochemical, Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Cristina Ciuoli
- Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy
| | - Nicoletta Benenati
- Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy
| | - Cristina Dalmiglio
- Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy
| | - Costantino Voglino
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Siena, Italy
| | - Andrea Tirone
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Siena, Italy
| | - Giuseppe Vuolo
- Department of General and Specialized Surgery, Unit of Bariatric Surgery, University of Siena, Siena, Italy
| | - Maria Grazia Castagna
- Department of Medicine, Surgery and Neuroscience, UOC Endocrinology, University of Siena, Siena, Italy.
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Jog A, Mosquera Zavaleta J, Rodriguez Piedra L, Singh A, Fan D, Grbach V, Lvovsky D. Characteristics of Patients Undergoing Bariatric Surgery in an Inner-City Minority Population: A Pre and Postoperative Comparison Between Patients With and Without Obstructive Sleep Apnea. Cureus 2024; 16:e66440. [PMID: 39246910 PMCID: PMC11380468 DOI: 10.7759/cureus.66440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Background Obese patients are at an increased risk of obstructive sleep apnea (OSA). Bariatric surgery or weight loss surgery is an important therapeutic measure in obese patients for the management of weight and comorbidities. Data are scarce in inner-city Hispanic and Black patients who undergo bariatric surgery, which eventually leads to health disparity in this minority population. Differences between patients with and without OSA have not been assessed in this population. This study aims to answer these questions. Methodology The study was conducted in a high-volume hospital in the Bronx, New York. Before bariatric surgery, patients underwent a preoperative evaluation that included a variety of blood tests, a sleep study, esophagogastroduodenoscopy, and echocardiography. They also underwent basic anthropometric measurements, such as weight, height, and body mass index (BMI), before surgery and 6 months and 12 months postoperatively. Additional calculations were made using these anthropometric measures, namely, total weight loss, excess weight loss, and delta BMI. Results Most patients were Hispanic (85.2%), with a mean age of 41.9 ± 10.8 years. We found that of the 108 patients included in the study, 69.4% (70/108) had OSA. Preoperative BMI in the study was 43.9 ± 13 kg/m2. Postoperatively, the mean decrease in BMI was 12.3 ± 14.5 kg/m2. Total weight loss and excess weight loss were 30.2 ± 14.3 and 52.6 ± 16.6, respectively. Conclusions In this study, no significant difference was noted in patients with or without OSA in either the laboratory or anthropometric parameters.
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Affiliation(s)
- Abhishrut Jog
- Pulmonary Medicine, BronxCare Health System, Bronx, USA
| | | | | | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, USA
| | - David Fan
- General Surgery, BronxCare Health System, Bronx, USA
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Yakout A, Elli EF, Kumbhari V, Bakheet N. Endoscopic therapies for bariatric surgery complications. Curr Opin Gastroenterol 2024:00001574-990000000-00153. [PMID: 38900492 DOI: 10.1097/mog.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of endoscopic therapies for bariatric surgery complications. RECENT FINDINGS The field of interventional endoscopy now presents a range of minimally invasive procedures for addressing postbariatric complications. Lumen-opposing metal stents have emerged as a reliable solution for managing gastrojejunal strictures following Roux-en-Y gastric bypass, whether with or without associated leaks. Additionally, they serve as a conduit for performing endoscopic retrograde cholangiopancreatography (ERCP) post-RYGB via EUS-directed ERCP (EDGE). Gastric peroral endoscopic myotomy, originally designed for gastroparesis, has demonstrated effectiveness in treating postgastric sleeve stenosis, particularly the challenging helical stenosis cases. Furthermore, innovative endoscopic antireflux techniques are showing encouraging outcomes in addressing gastroesophageal reflux disease (GERD) following sleeve gastrectomy. Additionally, several modifications have been proposed to enhance the efficacy of transoral outlet reduction (TORe), originally developed to treat weight regain due to gastrojejunal anastomotic issues post-RYGB. SUMMARY Endoscopic management of bariatric surgery complications is continuously evolving. The development of new techniques and devices allows endoscopists to provide novel, minimally invasive alternatives that were not possible in the near past. Many techniques, however, are limited to expert centers because they are technically demanding, and specialized training in bariatric endoscopy is still required.
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Affiliation(s)
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Department of Medicine
| | - Nader Bakheet
- Division of Gastroenterology and Hepatology, Department of Medicine
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Jain M, Tantia O, Goyal G, Chaudhuri T, Khanna S, Majumdar K, Gupta S. LSG vs OAGB: 7-Year Follow-up Data of a Randomised Control Trial and Comparative Outcome Based on BAROS Score. Obes Surg 2024; 34:1295-1305. [PMID: 38427149 DOI: 10.1007/s11695-024-07114-7] [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: 07/20/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study aims to evaluate and compare long-term results of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) based on bariatric analysis reporting and outcome system (BAROS) score. MATERIALS AND METHODS Patients operated for morbid obesity between 2013 and 2015 were randomised to LSG and OAGB groups. Based on inclusion and exclusion criteria, 201 patients (100 LSG and 101 OAGB) were analysed for changes in total body weight (TBW), body mass index (BMI), percent excess weight loss (%EWL), percent total weight loss (%TWL), QoL (quality of life) scores, comorbidity resolution and outcome based on BAROS at 7 years. RESULTS Sixty-six LSG and 64 OAGB patients were followed up at 7 years. Mean pre-operative TBW and BMI were 119 ± 28.2 and 44.87 ± 7.71 for LSG group and 113.25 ± 23.74 and 44.71 ± 8.75 for OAGB group respectively. At 7 years after surgery, there was significant drop in mean TBW and BMI in both groups. Mean %EWL for LSG and OAGB patients was 50.78 ± 28.48 and 59.99 ± 23.32 and mean %TWL for LSG and OAGB patients was 23.22 ± 12.66 and 27.71 ± 12.27 respectively. Mean QoL scores at 7 years were significantly higher than the pre-operative scores and most of the patients in both groups had remission or improvement in their comorbidities. 68.76% OAGB patients had very good or excellent outcome on BAROS score while only 36.37% LSG patients had similar outcome. CONCLUSIONS LSG and OAGB are successful bariatric procedures over the long term. OAGB outperforms LSG and has significantly higher %EWL and %TWL over the long term.
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Affiliation(s)
- Mayank Jain
- Department of Minimal Access & Bariatric Surgery, Synergyplus Hospital, NH2, Near Guru Ka Taal, Agra, 282007, Uttar Pradesh, India
| | - Om Tantia
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India.
| | - Ghanshyam Goyal
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Tamonas Chaudhuri
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Shashi Khanna
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Kajari Majumdar
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
| | - Sonam Gupta
- Department of Minimal Access & Bariatric Surgery, ILS Hospitals, DD-6, Sector 1, Salt Lake City, Kolkata, 700064, West Bengal, India
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Farinella E, Koliakos N, Papakonstantinou D, Breuer N, Pau L, Poras M, Maréchal MT, Briganti G. The Utilisation of Digital Applications for Measuring Patient Outcomes Following Bariatric Surgery: a Systematic Review and Meta-analysis of Comparative Studies. Obes Surg 2024; 34:635-642. [PMID: 38183593 DOI: 10.1007/s11695-023-07000-8] [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: 09/09/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
In the context of escalating obesity rates, bariatric surgery holds a crucial role in managing severely obese patients. With a demonstrated effectiveness in weight loss and with the advent of ambulatory surgery, bariatric surgery allows for a streamlined care pathway, ideally suited for postoperative surveillance using digital health applications. The aim of this systematic review and meta-analysis is to evaluate the effect of eHealth-delivered health services or support for adults undergoing bariatric surgery. Five studies, encompassing 2210 patients, were analysed. The intervention group showed a 10% increase in total weight reduction and a 22% reduction in excess weight loss. ED visitation rates also trended towards reduction. Despite the absence of clear statistical superiority for DHA, the findings suggest potential benefits of DHA in postoperative monitoring.
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Affiliation(s)
- Eleonora Farinella
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium.
- Artificial Intelligence and Digital Medicine, Faculty of Medicine, University of Mons, Mons, Belgium.
| | - Nikolaos Koliakos
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Dimitrios Papakonstantinou
- Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nicolas Breuer
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Luca Pau
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Mathilde Poras
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Marie-Therese Maréchal
- Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, 1000, Brussels, Belgium
| | - Giovanni Briganti
- Artificial Intelligence and Digital Medicine, Faculty of Medicine, University of Mons, Mons, Belgium
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