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Cooiman MI, Aarts EO, Janssen IMC, Hazebroek EJ, Berends FJ. Weight Loss, Remission of Comorbidities, and Quality of Life After Bariatric Surgery in Young Adult Patients. Obes Surg 2020; 29:1851-1857. [PMID: 30790164 DOI: 10.1007/s11695-019-03781-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION One of the current criteria for bariatric surgery is to be of an age between 18 and 65 years. In all the available literature, there is a lack of studies focusing on the results of bariatric surgery in younger patient. This could be of great interest because the weight loss response can be altered by differences in metabolism or compliance rate. In recent years, a high amount of patients between 18 and 25 years of age have undergone bariatric surgery in our center, and it is our aim to evaluate the weight loss results in this youngest patient group. METHODS All preoperative and perioperative data from patients aged 18-25 and 35-55 years (control group) were collected retrospectively. Bariatric procedures took place between 2011 and 2014. Follow-up data were gathered prospectively by collecting (laboratory) measurements and questionnaires. RESULTS In total, 103 young adults (mean age 22.5) were matched to 103 adult control patients (mean age 42.6) on BMI and date of surgery. Of the young adults' group, 75 patients underwent a Roux-en-Y gastric bypass (RYGB) compared with 80 patients in the control group. Three years after RYGB, mean %total body weight loss (%TBWL) was 34 (± 9) and 30.3 (± 9) (p = 0.03), respectively. CONCLUSION Bariatric surgery is effective in young adults, and results after RYGB are even better compared with age groups in which bariatric surgery is most often performed. The high remission rate of comorbidities shows the importance of effective treatment options at a young age and preventing damaging effects in the long term.
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Affiliation(s)
- M I Cooiman
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands.
| | - E O Aarts
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| | - I M C Janssen
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| | - E J Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
| | - F J Berends
- Department of Bariatric Surgery, Rijnstate Hospital/Vitalys Clinics, Wagnerlaan, 55, 6815 AD, Arnhem, The Netherlands
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Boerboom AB, Berends FJ, Aarts EO. It Is the Width Not the Size of the Pouch That Matters. Obes Surg 2019; 30:1134-1135. [PMID: 31811622 DOI: 10.1007/s11695-019-04316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- A B Boerboom
- Department of Surgery, Rijnstate Hospital, Postal number 1190, 6800TA, Arnhem, Netherlands.
| | - F J Berends
- WeightWorks, The Surgical Weight Loss Clinic, Arnhem, Netherlands
| | - E O Aarts
- WeightWorks, The Surgical Weight Loss Clinic, Arnhem, Netherlands
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Betzel B, Cooiman MI, Aarts EO, Janssen IMC, Wahab PJ, Groenen MJM, Drenth JPH, Berends FJ. Clinical follow-up on weight loss, glycemic control, and safety aspects of 24 months of duodenal-jejunal bypass liner implantation. Surg Endosc 2019; 34:209-215. [PMID: 30877567 PMCID: PMC6946747 DOI: 10.1007/s00464-019-06752-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/06/2019] [Indexed: 01/30/2023]
Abstract
Background The duodenal-jejunal bypass liner (DJBL) is an endoscopic device designed to induce weight loss and improve glycemic control. The liner is licensed for a maximum implant duration of 12 months. It might be hypothesized that extension of the dwelling time results in added value. The goals of our study were to determine weight change, change in glycemic control, and safety in patients with an intended 24 months of DJBL dwelling time. Methods Patients were initially selected for a 12-month implantation period. When no physical complaints or adverse events (AEs) occurred, motivated patients who responded well were selected for extension of dwelling time to 24 months. Patients underwent a control endoscopy 12 months after implantation and visited the out-patient clinic every 3 months up to explantation. Patients agreed to remove the DJBL when complaints or AEs occurred that could not be treated conservatively. Results Implantation was extended in 44 patients, and 24 (55%) patients completed the full 24 months. Twenty patients required early removal due to AEs. During dwelling time, body weight decreased significantly (15.9 kg; TBWL 14.6%). HbA1c decreased non-significantly (4.9 mmol/mol). The number of insulin users and daily dose of insulin both decreased significantly. At 24 months after removal, glycemic control had worsened, while body weight was still significantly lower compared to baseline. In total, 68% of the patients experienced at least one AE. Two patients developed a hepatic abscess. Conclusions DJBL treatment results in significant weight loss and improves glycemic control during implantation. The largest beneficial effects occur during the first 9–12 months after implantation. Extension of dwelling time to 24 months results only in stabilization of body weight and glycemic control. After explantation, weight improvements are maintained, but glycemic control worsens. As the cumulative risk of AEs increases with time, a maximal dwelling time of 12 months is advisable. Electronic supplementary material The online version of this article (10.1007/s00464-019-06752-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- B Betzel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, Code 455, 6500 HB, Nijmegen, The Netherlands.
| | - M I Cooiman
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - E O Aarts
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - I M C Janssen
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - P J Wahab
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - M J M Groenen
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - J P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, P.O. Box 9101, Code 455, 6500 HB, Nijmegen, The Netherlands
| | - F J Berends
- Vitalys Clinic, Velp, The Netherlands
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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Koehestanie P, Betzel B, Aarts EO, Janssen IMC, Wahab P, Berends FJ. Is reimplantation of the duodenal-jejunal bypass liner feasible? Surg Obes Relat Dis 2015; 11:1099-104. [PMID: 25979208 DOI: 10.1016/j.soard.2015.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/18/2015] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND The endoscopic ally implanted DJBL is a 60-cm impermeable fluoropolymer device, which prevents food from making contact with the proximal intestine. It was designed to induce weight loss and treat type 2 diabetes mellitus (T2DM). OBJECTIVES To evaluate the feasibility, safety, and effectiveness of duodenal-jejunal bypass liner (DJBL) reimplantation. SETTING Prospective, observational study was conducted at the department of surgery and gastroenterology of the Rijnstate hospital, Arnhem, the Netherlands, between 2009 and 2011. METHODS Five obese patients with T2DM with body mass index (BMI) = Mass (kg) / height (m(2)), ranging from 30-35 kg/m(2) who completed the follow-up after their first implant and underwent removal of the DJBL after 6 months, were selected for reimplantation after an additional 18 months of follow-up. Weight loss, BMI, and HbA1 c were analyzed before and twelve months after reimplantation. RESULTS In all 5 patients, the DJBL was implanted and explanted without any complications. Also the reimplantation and reexplantation occurred without any complications. Median weight decreased significantly from 105 kg to 95 kg, and BMI decreased from 33 to 29. The glycated hemoglobin (HbA1 c) level decreased from 8.4% to 7.3% by the first implantation but it wasn't significant. CONCLUSIONS Reimplantation of DJBL is feasible, deemed safe, and showed additional weight loss.
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Affiliation(s)
- P Koehestanie
- Department of Surgery, Rijnstate Hospital, the Netherlands.
| | - B Betzel
- Department of Surgery, Rijnstate Hospital, the Netherlands
| | - E O Aarts
- Department of Surgery, Rijnstate Hospital, the Netherlands
| | - I M C Janssen
- Department of Surgery, Rijnstate Hospital, the Netherlands
| | - P Wahab
- Department of Gastroenterology, Rijnstate Hospital, the Netherlands
| | - F J Berends
- Department of Surgery, Rijnstate Hospital, the Netherlands
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Dogan K, Betzel B, Homan J, Aarts EO, Ploeger N, de Boer H, Aufenacker TJ, van Laarhoven CJHM, Janssen IMC, Berends FJ. Long-Term Effects of Laparoscopic Roux-en-Y Gastric Bypass on Diabetes Mellitus, Hypertension and Dyslipidaemia in Morbidly Obese Patients. Obes Surg 2014; 24:1835-42. [PMID: 25027982 DOI: 10.1007/s11695-014-1310-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- K Dogan
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA, Arnhem, The Netherlands,
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Burgerhart JS, Aarts EO, van de Meeberg PC, Berends FJ, Siersema PD, Smout AJPM. Esophageal motor responses to increasing adjustment of an implanted gastric band. Neurogastroenterol Motil 2013; 25:587-e461. [PMID: 23534401 DOI: 10.1111/nmo.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND The adjustable gastric band is an effective surgical treatment to induce weight loss in patients with morbid obesity. We aimed to assess the effects of band placement and stepwise adjustment on esophageal motility, using high-resolution manometry (HRM). METHODS Patients underwent esophageal HRM before and 6 weeks after gastric band placement. During postoperative assessment, HRM was combined with intraband pressure measurement at increasing filling volumes. KEY RESULTS In total, 15 patients were studied. Mean DCI (±SD) decreased from 1085.3 ± 1064.1 mmHg s(-1) cm(-1) before to 507 ± 347.2 mmHg s(-1) cm(-1) (P = 0.015) after band placement, mean IBP from 10.7 ± 1.7 mmHg to 7.7 ± 1.6 mmHg (P = 0.01). Stepwise band adjustment from 1 to 8 mL had an immediate and profound effect on swallow-induced esophageal contractions: DCI increased from 766 ± 590.4 to 7231 ± 6298.1 mmHg s(-1) cm(-1) , IBP from 4.3 mmHg to 31.1 ± 17.3 mmHg, and intraband pressure increased from -109.1 ± 60.6 mmHg to 150.2 ± 65 mmHg. During band filling with volumes >5 mL, upward displacement of the LES was observed, indicative of shortening of the esophagus; the distance between the UES and LES decreased from 23.5 ± 1.3 cm at 0 mL to 19.9 ± 2 cm at 8 mL. CONCLUSIONS & INFERENCES Stepwise gastric band adjustment leads to immediate enforcement of esophageal peristalsis associated with an increase in intrabolus pressure and with pronounced esophageal shortening. Subjects who lack these responses to outflow obstruction may be more prone to dysphagia after band placement.
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Affiliation(s)
- J S Burgerhart
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. J.S.
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Aarts EO, Janssen J, Janssen IMC, Berends FJ, Telting D, de Boer H. Preoperative Fasting Plasma C-Peptide Level May Help to Predict Diabetes Outcome After Gastric Bypass Surgery. Obes Surg 2013; 23:867-73. [DOI: 10.1007/s11695-013-0872-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Aarts EO, van Wageningen B, Janssen IMC, Berends FJ. Prevalence of Anemia and Related Deficiencies in the First Year following Laparoscopic Gastric Bypass for Morbid Obesity. J Obes 2012; 2012:193705. [PMID: 22523660 PMCID: PMC3317129 DOI: 10.1155/2012/193705] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 12/19/2011] [Indexed: 02/08/2023] Open
Abstract
Background. Anemia associated with deficiencies in iron, folic acid, and vitamin B12 are very common after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) surgery for morbid obesity. This study was conducted to evaluate the prevalence of anemia after LRYGB. Patients and Methods. A total of 377 morbid obese patients were included in our study. All patients underwent a LRYGB. Hematologic parameters were obtained prior to and after surgery on standardized time intervals. Results. Anemia was present in 21 (P = 0.02) patients after surgery. Iron, folic acid, and vitamin B12 deficiencies were diagnosed in 66%, 15%, and 50% of patients, respectively. In 86% of patients, anemia was accompanied by one of these deficiencies. Conclusion. These results show that anemia and deficiencies for iron, folic acid deficiency, and vitamin B12 are very common within the first year after LRYGB. We advise a minimal daily intake of 65 mg of iron in male and 100 mg in female patients, 350 μg of vitamin B12, and 400 μg of folic acid. Patients undergoing LRYGB must be closely monitored for deficiencies pre- and postoperative and supplemented when deficiencies occur.
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Affiliation(s)
- E. O. Aarts
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
- Department of Bariatric Surgery, Rijnstate Hospital and Vitalys Clinic, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - B. van Wageningen
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - I. M. C. Janssen
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
| | - F. J. Berends
- Department of Surgery, Rijnstate Hospital, Postal number 1190, P.O. Box 9555, 6800 TA Arnhem, The Netherlands
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Abstract
Access-port (AP) complications after laparoscopic adjustable gastric banding (LAGB) are often seen but seldom reported in literature. AP complications requiring additional surgery is reported in 3.6% to 24% of LAGB patients (Susmallian et al. Obes. Surg, 4:128–131, 2003; Peterli et al. Obes. Surg., 12(6):851–856, 2002; Busetto et al. Obes. Surg., 12:83–92, 2002; Mittermair et al. Obes. Surg., 19:446–450, 2009; Holeczy et al. Obes. Surg., 9:453–455, 1999; Bueter et al. Arch. Surg., 393:199–205, 2008; Launay-Savary et al. Obes Surg, 18:1406–1410, 2008; Balsiger et al. J. Gastrointest. Surg., 11:1470–1477, 2007; Szold and Abu-Abeid Surg. Endosc., 16:230–233, 2002). We evaluated the effect of fixing the AP on the pectoral fascia using the Velocity™ Injection Port on complication and re-operation rate. From January 2005 till October 2007, 619 LAGB procedures were performed using the SAGB QuickClose™. All procedures were performed by three dedicated surgeons using the pars flaccida technique. APs were placed on the fascia of the pectoral muscle using an infra-mammary incision. The AP device was fixed on the fascia using the Velocity™ Injection Port and Applier. Data was obtained retrospectively and records of 619 consecutive patients were reviewed for access-port complications. Sixty-eight AP complications were observed. Complications could be divided in four categories. Discomfort was reported in 30 patients, seven needing additional surgery. Infection contributed to 11 patients needing surgical removal of the device. Fourteen Patients with superficial infection were treated conservatively. Nine patients had inaccessible APs. Ultrasound-guided access was required in three patients. The remainder needed surgical relocation of the AP. Leakage of the tube was observed in four patients all of which needed revisional surgery. Our experience shows that fixation of the AP on the left pectoral fascia using the Velocity™ leads to a readily accessible AP with good anaesthetic and aesthetic results. In our series, 68 (11%) complications were recorded, of which 28 (4.5%) needed additional surgery.
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Affiliation(s)
- Bas van Wageningen
- Department of Surgery, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
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Aarts EO, Berends FJ, Janssen IMC, Schweitzer DH. Semiquantitative assessment of bowel habits and its relation with calcium metabolism after gastric bypass surgery: a retrospective study. J Obes 2011; 2011:156164. [PMID: 21253537 PMCID: PMC3021851 DOI: 10.1155/2011/156164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 11/02/2010] [Indexed: 11/17/2022] Open
Abstract
Background. Calcium malabsorption after bariatric surgery may be harmful to skeletal health and demands for optimal skeletal management. Methods. 103 Patients were evaluated retrospectively at 12 months after surgery. The evaluation included a questionnaire about stool frequency and consistency and laboratory assessments. Results. 103 Patients, 27 males and 76 females, were included in the study. 83 Patients had an alimentary limb of 100 cm and 20 patients one of 150 cm. At 12 months after surgery, 77.7% reported changes of bowel habits, albumin adjusted calcium levels were normal in all but 2 patients, and PTH levels were increased in 35%. Correlations between semiquantified bowel scores (fecal scores) and data from the laboratory demonstrated increasing PTH values along with more frequent and softer/watery stools (RR 30.5, CI 6.2-149.2, P < .001). There was a trend for higher PTH levels in patients with an alimentary limb of 150 cm. Normal PTH levels were more frequently found in case of calcium and vitamin D3 use (RR 14.3, CI 3.6-56.5, P < .001). Conclusion. This study demonstrates interrelationships between semi-quantified fecal scores, PTH levels, and the compliance of taking calcium/vitamin D3 suppletion. However, prospective randomized studies are necessary to show causal relationships.
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Affiliation(s)
- E. O. Aarts
- Department of Bariatric Surgery, Rijnstate Hospital, Alysis Zorggroep, P.O. box 9555, 6800 TA Arnhem, The Netherlands
- *E. O. Aarts:
| | - F. J. Berends
- Department of Bariatric Surgery, Rijnstate Hospital, Alysis Zorggroep, P.O. box 9555, 6800 TA Arnhem, The Netherlands
| | - I. M. C. Janssen
- Department of Bariatric Surgery, Rijnstate Hospital, Alysis Zorggroep, P.O. box 9555, 6800 TA Arnhem, The Netherlands
| | - D. H. Schweitzer
- Department of Internal Medicine and Endocrinology, Reinier de Graaf Group of Hospitals, 2625 AD Delft, The Netherlands
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