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Destan C, Baratte C, Torcivia A, Brevart C, Malgras B, Clément K, Poitou C, Oppert JM, Aron-Wisnewsky J, Genser L. Revisional Roux-en-Y Gastric Bypass After Sleeve Gastrectomy for Gastro-esophageal Reflux Disease and or Insufficient Weight-Loss: a Comparative Study. Obes Surg 2023; 33:3077-3089. [PMID: 37594673 DOI: 10.1007/s11695-023-06784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is a popular surgical weight-loss procedure, but there are increasing reports of revisional Roux-Y-gastric-bypass (R-RYGB) to manage weight-loss failure (WLF) or proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) after SG, with little data available in these settings. METHODS This retrospective study included all consecutive patients undergoing R-RYGB for WLF or RGERD after SG in two bariatric care centers from 2012 to 2018. RESULTS Of 720 patients, 46 (3.6%) underwent R-RYGB (RGERD, n = 25; 54.4%; WLF, n = 21; 45.6%) within 44.8 ± 27.5 months post-SG. SG had enabled 27% ± 11.6 total weight loss (TWL) in the RGERD group vs. 7.2% ± 12.5% TWL in the WLF group (p < 0.001). At R-RYGB, WLF-group patients had a higher BMI (47.8 ± 8.4 vs. 34.7 ± 6.1 kg/m2; p < 0.001) and a higher number of comorbidities (2.4 ± 1.5 vs 1.5 ± 1.2; p < 0.02) compared to RGERD-group patients, while severe morbidity (Clavien-Dindo ≥ IIIb) was not significantly different between groups (6.5% vs 2.1%, p = 0.6). %TWL was still higher in the RGERD group at 12 months post-R-RYGB (35.6% ± 10.4 vs. 23.8% ± 9.2; p < 0.01) but not after 24 months post-R-RYGB. R-RYGB corrected reflux symptoms in 32 (94%) patients and reduced PPI use in 29 (97%) patients (p < 0.001), with no significant between-group difference. A history of adjustable gastric banding (AGB) (N = 8;17.4%) prior to SG was associated with a similar prevalence of GERD at R-RYGB and a lower %TWL (AGB:13.1 ± 10.2 vs. No AGB:31.6 ± 8.5; p < 0.05) at 3 years post-R-RYGB. CONCLUSION R-RYGB following SG provides remission of reflux symptoms in 94% of patients and extra weight loss in patients with WLF, except in patients with a history of AGB prior to SG.
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Affiliation(s)
- Clément Destan
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France
- Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Clément Baratte
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Adriana Torcivia
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Christophe Brevart
- Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France
- Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France
- Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Karine Clément
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France
| | - Christine Poitou
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France
| | - Jean-Michel Oppert
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Judith Aron-Wisnewsky
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France
| | - Laurent Genser
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France.
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McClelland PH, Kabata K, Gorecki W, Jano A, Zenilman ME, Gorecki P. Long-term weight loss after bariatric procedures for morbidly obese adolescents and youth: a single-institution analysis with up to 19-year follow-up. Surg Endosc 2023; 37:2224-2238. [PMID: 35879574 DOI: 10.1007/s00464-022-09434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/23/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity is a public health concern among adolescents and young adults. Bariatric surgery is the most effective treatment for morbid obesity and has been increasingly utilized in young patients. Long-term outcomes data for bariatric surgery in this age group are limited. METHODS This is a single-institution, prospective analysis of 167 patients aged 15-24 years who underwent one of three laparoscopic bariatric procedures between 2001 and 2019: Roux-en-Y gastric bypass (LRYGB, n = 71), adjustable gastric banding (LAGB, n = 22), and sleeve gastrectomy (LSG, n = 74). Longitudinal weight and body mass index (BMI) measurements were compared to evaluate patterns of weight loss. RESULTS All operations were completed laparoscopically using the same clinical pathways. Patients were predominantly female (82.6%), had a median age of 22.0 [Q1-Q3 20.0-23.0] years, and had a mean presurgical BMI of 48.5 ± 6.5 kg/m2 (range 38.4-68.1 kg/m2). All procedures produced significant weight loss by 1 year, peak weight loss by 2 years, and modest weight regain after 5 years. Mean percent weight/BMI losses at 5 years for LRYGB, LAGB, and LSG were - 36.7 ± 10.8%, - 14.5 ± 15.3%, and - 25.1 ± 13.4%, respectively (p < 0.001). LRYGB patients were most likely to achieve ≥ 25% weight loss at 1, 3, and 5 years and maintained significant average weight loss for more than 15 years after surgery. Reoperations were procedure-specific, with LAGB, LRYGB, and LSG having the highest, middle, and lowest reoperation rates, respectively (40.9% vs. 16.9% vs. 5.4%, p < 0.001). CONCLUSION All procedures provided significant and durable weight loss. LRYGB patients achieved the best and most sustained weight loss. LSG patients experienced second-best weight loss between 1 and 5 years, with lowest chance of reoperation. LAGB patients had the least weight loss and the highest reoperation rate. Compared to other factors, type of bariatric procedure was independently predictive of successful weight loss over time. More studies with long-term follow-up are needed.
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Affiliation(s)
- Paul H McClelland
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
| | - Krystyna Kabata
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Wojciech Gorecki
- Department of Pediatric Surgery, Jagiellonian University Medical College, University Children's Hospital of Krakow, Krakow, Poland
| | - Antalya Jano
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Michael E Zenilman
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
| | - Piotr Gorecki
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA
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Steygers A, De Moor V. Esophagectomy for Barrett's adenocarcinoma after multiple bariatric surgeries: A case report. Int J Surg Case Rep 2023; 102:107838. [PMID: 36527861 DOI: 10.1016/j.ijscr.2022.107838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Bariatric surgery diminishes the incidence of many kinds of neoplasms, but gastro-esophageal cancers may occur after bariatric procedures. Most esophageal neoplasms arise on Barrett's esophagus, which may be worsened by bariatric surgery, especially restrictive procedures. Endoscopic resections may cure cancer in its early stages, but surgery may be required in more advanced cases. PRESENTATION OF CASE A 62-year-old patient with history of adjustable gastric banding, sleeve gastrectomy then Roux-en-Y gastric bypass presented with an early Barrett's adenocarcinoma. Endoscopic treatment was first applied but the patient required surgery due to positive margins on the resected specimen. As the early tumor was located in the esophagus' lower third, a limited resection with eso-jejunal anastomosis was planned. However, as the previous bariatric did not allow a proper reconstruction, a total esophagectomy with colonic interposition had to be performed. DISCUSSION Eso-gastric malignancies remain rare after weight loss procedures, but more cases will arise due to the increasing incidence of bariatric surgery. Esophageal resection and reconstruction becomes increasingly challenging along with the number of bariatric procedures performed on the same patient. Endoscopic screening is of paramount importance before any obesity surgery or to assess any new onset of symptoms after a bariatric procedure, as endoscopic resections may cure cancer in its early stages. CONCLUSION Endoscopic screening and treatment remains of paramount importance, especially after multiple bariatric procedures as surgery and reconstruction gets increasingly challenging. Whenever surgery is required, a proper planning and individual approach is compulsory, as well as a back-up plan.
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Thaher O, Driouch J, Hukauf M, Stroh C. One-Stage Versus Two-Stage Gastric Bypass as Redo Surgery After Failed Adjustable Gastric Banding-Observation Comparative Multicenter Study. J Gastrointest Surg 2022; 26:1596-606. [PMID: 35610533 DOI: 10.1007/s11605-022-05358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study investigates the outcome of one-stage and two-stage Roux-Y gastric bypass (RYGB) as a revision procedure after failed adjustable gastric banding (AGB). MATERIAL AND METHODS Data of patients who underwent a one-stage RYGB (OS-RYGB) or a two-stage RYGB (TS-RYGB) revision procedure after failing AGB between 2005 and 2019 were analyzed. Outcome criteria were perioperative complications, operating time, change in weight and BMI, and remission of comorbidities at 1-year follow-up. RESULTS Data from 230 patients after OS-RYGB and 197 after TS-RYGB were analyzed. The total perioperative complication rates were not significantly different between the two groups (overall p > 5%). In the category of other complications, there was a significant difference between the two groups, with a lower rate in TS-RYGB than in OS-RYGB (p = 0.020). Wound infections occurred more frequently after TS-RYGB than after OS-RYGB (p = 0.015). Mean operating time differed significantly between the two groups (OS-RYGB (149.9 min) and TS-RYGB 191 min; p < 0.001). The change in hypertension was significantly higher in OS-RYGB (37.9 vs. 21.1%; p = 0.007). Other comorbidities showed no significant change within 1 year after surgery. Regarding the change in BMI, %TWL, and %EWL, there were no significant benefits for either group (p = 0.574, 0.762, and 0.378, respectively). CONCLUSION Removing a failed AGB using the OS- or TS-RYGB is safe and feasible. The decision between OS- and TS-RYGB is still individual and depends on the patient's general condition, the desired goal of the procedure, and the personal competence of the surgeon. Further studies are needed to clarify long-term outcome and effect of both procedures.
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Petrucciani N, Martini F, Benois M, Kassir R, Boudrie H, Van Haverbeke O, Hamid C, Juglard G, Costa G, Debs T, Liagre A. Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches. Obes Surg 2021; 31:5330-5341. [PMID: 34609712 PMCID: PMC8595146 DOI: 10.1007/s11695-021-05728-9] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) was a common procedure worldwide but associated with a high rate of long-term failure. This study aims to evaluate the safety and effectiveness of conversion to one anastomosis gastric bypass (OAGB) after failed LAGB. MATERIALS AND METHODS We undertook a retrospective analysis of a prospectively maintained database in a tertiary referral center for bariatric surgery. All cases of revisional OAGB with a biliopancreatic limb (BPL) of 150 cm after failed LAGB performed between 2010 and 2016 were analyzed. RESULTS Overall, 215 patients underwent conversion from LAGB to OAGB. Indication for surgery was primary weight loss (WL) failure in 30.7% of cases and long-term complications in the remaining patients, with or without associated weight regain. At the time of OAGB, the mean age was 43.2 ± 10.5 years and the mean BMI was 42 ± 6.9. Overall postoperative morbidity was 13.5%. The postoperative abscess ± leak rate was 5.9% in the overall population. Two years after OAGB, 9.7% of patients were lost to follow-up, % excess weight loss (EWL) was 88.2 ± 23.9, and % total weight loss (TWL) was 38.7 ± 9.3. At 5 years, 16.6% of patients were lost to follow-up, %EWL was 82.4 ± 25, and %TWL was 36.1 ± 10. There was no statistical difference in complication rates or WL results between the one-stage and two-stage approaches. CONCLUSION OAGB with a 150-cm BPL represents a safe and effective option after failed LAGB. Both synchronous OAGB and two-step revisional OAGB guarantee satisfying results in terms of postoperative morbidity and WL outcomes.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, via di Grottarossa 1035-9, 00189, Rome, Italy.
| | - Francesco Martini
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Marine Benois
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Hubert Boudrie
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Celine Hamid
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Gildas Juglard
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Gianluca Costa
- Division of General Surgery, Campus Bio-Medico Hospital, Rome, Italy
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Arnaud Liagre
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
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Pereira A, Pinho AC, Sousa HS, da Costa EL, Rodrigues S, Barbosa E, Preto J. How Far Can Our Expectations Go on Revisional Bariatric Surgery After Failed Adjustable Gastric Banding? Obes Surg 2021; 31:1603-1611. [PMID: 33438161 DOI: 10.1007/s11695-020-05167-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/29/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Bariatric surgery has proven its effectiveness in the treatment of obesity and related comorbidities. However, several procedures may be required to treat this chronic disease and/or complications after bariatric surgery. The most frequent revisional surgeries performed after failed laparoscopic adjustable gastric banding (AGB) have been Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). The aim of this study is to compare medium-term outcomes of primary and revisional bariatric procedures. MATERIAL AND METHODS Single institution, matched case-control study of obese patients submitted to bariatric surgery, divided into four groups of 50 patients: (A) primary RYGB; (B) primary SG; (C) revisional Roux-en-Y gastric bypass (rRYGB) after failed laparoscopic AGB; (D) revisional sleeve gastrectomy (rSG) after failed laparoscopic AGB. Demographic variables, surgical procedures characteristics and complications, weight loss outcomes and resolution of comorbidities were compared. RESULTS Mortality and morbidity were comparable between primary and revisional procedures. Weight loss outcomes were inferior in patients submitted to rRYGB when compared to those submitted to RYGB, with no significant differences found when comparing the other groups. Regarding comorbidities' outcomes, only patients submitted to rSG had lower odds of comorbidities' improvement. Patients submitted to rRYGB had an odd 7 times higher of comorbidities' improvement than those submitted to rSG, independent of weight loss outcomes. CONCLUSION Revisional surgeries are safe procedures with adequate weight loss outcomes in this difficult set of patients. The choice of revisional procedure may not influence weight loss outcomes, but rRYGB seems to be a better option regarding comorbidities' resolution.
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Affiliation(s)
- André Pereira
- General Surgery Department, São João University Medical Center, Porto, Portugal. .,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.
| | - André Costa Pinho
- Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Hugo Santos Sousa
- Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Eduardo Lima da Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
| | - Sara Rodrigues
- General Surgery Department, São João University Medical Center, Porto, Portugal.,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal
| | - Elisabete Barbosa
- General Surgery Department, São João University Medical Center, Porto, Portugal.,Faculty of Medicine of University of Porto, São João University Medical Center, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Porto, Portugal
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Bonouvrie DS, de Boer H, Aarts EO. Three-year follow-up of bone status in male patients after bariatric surgery-a prospective single-center cohort study. Surg Obes Relat Dis 2020; 17:771-779. [PMID: 33436310 DOI: 10.1016/j.soard.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/03/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In women, bariatric surgery (BS) leads to a decline in bone mineral density (BMD) and may ultimately lead to premature osteoporosis. The impact in men is largely unknown. OBJECTIVE To assess the effect of BS on bone metabolism in males. SETTING Single-center prospective cohort study. METHODS Twenty-four male BS candidates were prospectively enrolled. Anthropometric characteristics, serum gonadal hormones, markers of bone metabolism, and BMD were measured at baseline, 6-, 12- and 36-months postoperatively. RESULTS Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) were performed in 15 and 9 patients, respectively. Nineteen patients completed the 3-year follow-up. At 3 years, BMD of the right and left femur had decreased by 9.1 ± 7.2% and 9.4 ± 5.8% for RYGB and by 6.7 ± 3.9% and 4.5 ± 2.8% for AGB. Radius BMD had decreased by 14.0 ± 5.6% for RYGB and 5.9 ± 4.1% for AGB, i.e., significantly stronger for RYGB (P = .006). Serum parathyroid hormone increased in both groups and 13 of 19 patients developed Vitamin D deficiency. A significant increase of the bone resorption marker was seen only during the first year despite continuation of bone loss. Four patients developed de novo osteopenia or osteoporosis. No fractures were observed. CONCLUSION There are strong indications that male bone metabolism response after BS differs from female metabolism. The most affected site is the radius. In males, the cause of this BMD loss seems multifactorial, including mechanical unloading, hyperparathyroidism, and hypogonadism. However, clinical relevance remains unknown and therefore studies with longer-term follow-up are necessary.
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Affiliation(s)
| | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | - Edo O Aarts
- WeighWorks Clinics, Obesity Treatment, Oosterbeek, Netherlands; Obesity Treatment, Allurion Clinic, Hilversum, Netherlands
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Nandrino JL, Grynberg D, Gandolphe MC, Willem C, Benaisa K, Van de Maele J, Taccoen A, Verkindt H, Pattou F. Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding. Appetite 2020; 149:104620. [PMID: 32070712 DOI: 10.1016/j.appet.2020.104620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 01/03/2023]
Abstract
While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.
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Affiliation(s)
- Jean-Louis Nandrino
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France; Fondation Santé des étudiants de France, Clinique des 4 Cantons, Villeneuve d'Ascq, France.
| | - Delphine Grynberg
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Marie-Charlotte Gandolphe
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Clémence Willem
- UMR CNRS 9193, SCALab, Laboratoire de Sciences Cognitives et Affectives, Université de Lille, France.
| | - Karima Benaisa
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Justine Van de Maele
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Aurore Taccoen
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - Hélène Verkindt
- Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
| | - François Pattou
- UMR INSERM 1190, Recherche Translationnelle sur le Diabète, Université de Lille, France; Department of Endocrine Surgery, Centre Hospitalier Universitaire, Lille, France.
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Tsouristakis AI, Febres G, McMahon DJ, Tchang B, Conwell IM, Tsang AJ, Ahmed L, Bessler M, Korner J. Long-Term Modulation of Appetitive Hormones and Sweet Cravings After Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. Obes Surg 2020; 29:3698-3705. [PMID: 31376135 DOI: 10.1007/s11695-019-04111-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/25/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) produces greater weight loss compared with a purely restrictive procedure such as laparoscopic adjustable gastric banding (LAGB). OBJECTIVE The objective of this study was to quantify changes in hormones that regulate energy homeostasis and appetitive sensations before and after LAGB (n = 18) and RYGB (n = 38) in order to better understand the mechanisms underlying the greater weight loss after RYGB. METHODS A standardized test meal was administered prior to surgery, at 6 months, and annually thereafter to year 2 after LAGB and year 4 after RYGB. Blood samples were obtained in the fasted state and 30, 60, 90, and 120 min post-meal. RESULTS Progressive increases in fasting PYY were observed after RYGB together with increases in postprandial area under the curve (AUC) levels that were unchanged after LAGB. GLP-1 AUC increased only after RYGB. There was a weight loss-related increase in fasting ghrelin levels after LAGB that was unchanged 1 year after RYGB despite greater percentage weight loss; ghrelin subsequently increased at years 2-4 post-RYGB. HOMA-IR decreased after both procedures but correlated with weight loss only after LAGB, whereas leptin correlated with weight loss in both groups. Sweet cravings decreased after RYGB. CONCLUSION A number of weight loss-independent changes in the gut hormonal milieu likely act in concert to promote a decrease in insulin resistance and greater weight loss efficacy after RYGB. A progressive change in hormone levels over time may reflect gut enteroplasticity after RYGB. A decrease in sweet cravings specific to RYGB may further promote superior weight loss outcomes.
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Affiliation(s)
- Alina I Tsouristakis
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA
| | - Gerardo Febres
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA
| | - Donald J McMahon
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA
| | - Beverly Tchang
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA
| | - Irene M Conwell
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA
| | - Amanda J Tsang
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA
| | - Leaque Ahmed
- Department of Surgery, Wyckoff Heights Hospital, Brooklyn, NY, USA
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - Judith Korner
- Department of Medicine, Columbia University College of Physicians & Surgeons, 650 West 168th St., BB 20-08, New York, NY, 10032, USA.
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10
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Barreto SG, Chisholm J, Mehdorn AS, Collins J, Schloithe A, Kow L. Eroded Gastric Band: Where to Next? An Analysis of the Largest Contemporary Series. Obes Surg 2020; 30:2469-74. [PMID: 32318993 DOI: 10.1007/s11695-020-04610-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Erosion of a laparoscopic adjustable gastric band (LAGB) is a devastating problem. There is no clear evidence in literature to guide the choice of revisional procedure following an eroded LAGB. The purpose of this study is to analyse the largest series of erosions following LAGB published to-date with an aim to share our experience with this rare complication and how we managed this cohort of patients following explantation of their LAGB. MATERIALS AND METHODS This is a retrospective cohort study. Patient data is maintained prospectively in a surgical database. The study period was from January 1996 to January 2019. The outcomes of patients who underwent an erosion of LAGB were studied. RESULTS Gastric band erosion was encountered in 4.7% of patients. Sixty patients opted for a revisional procedure which included 37 repeat LAGBs, 6 laparoscopic sleeve gastrectomies (LSG), 7 Roux-en-Y gastric bypasses (RYGB), 1 intragastric balloon, and 9 failed revisional procedures. Re-erosions were noted in 27% of patients who underwent a repeat gastric banding. Median %TWL at a 1-year follow-up was significantly higher in LSG and RYGB groups compared with that in LAGB (P < 0.008 and P < 0.000, respectively). There was no significant difference between the LSG and RYGB groups. CONCLUSION The risk of re-erosion is increased in patients who undergo repeat AGB following a previous episode of erosion. Repeat LAGB should not be offered after a previous erosion. LSG and RYGB should be considered as appropriate revisional procedures in a patient who experience weight regain following explantation of an eroded LAGB.
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11
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Shoar S, Naderan M, Shoar N, Modukuru VR, Mahmoodzadeh H. Alteration Pattern of Taste Perception After Bariatric Surgery: a Systematic Review of Four Taste Domains. Obes Surg 2020; 29:1542-1550. [PMID: 30712168 DOI: 10.1007/s11695-019-03730-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 12/26/2022]
Abstract
BACKGROUND Efforts continue to understand the underlying mechanism of weight loss after bariatric surgery. Taste perception has shown to be a contributing factor. However, the alteration pattern in different taste domains and among bariatric procedures has not been sufficiently investigated. OBJECTIVES To study the alteration pattern in the perception of four taste domains after different bariatric procedures. SETTINGS Private Research Institute, USA. METHODS A systematic review was conducted to pool available data in the literature on post-operative changes in the perception of sensitivity to four taste domains after Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and adjustable gastric banding (AGB). RESULTS Our study showed that bariatric surgery is associated with significant change in sensitivity to all four taste domains especially salt taste, sweetness, and sourness. LSG patients showed an increased sensitivity to all four taste domains. However, RYGB patients had a variable alteration pattern of taste perception but more commonly a decreased sensitivity to sweetness and an increased sensitivity to salt taste and sourness. Additionally, AGB patients had a decreased sensitivity to sweetness, salt taste, and sourness. CONCLUSION Bariatric surgery is associated with taste change in a way which results in less preference for high-calorie food and possibly reduced calorie intake. This may explain one of the mechanisms by which bariatric surgery produces weight loss. However, data are heterogeneous, the potential effect dilutes over time, and the alteration varies significantly between different procedures.
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Affiliation(s)
- Saeed Shoar
- Department of ScientificWriting, Division of Surgical Research, Shoar Research Institute, Houston, TX, USA. .,Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran.
| | - Mohammad Naderan
- Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran
| | - Nasrin Shoar
- Department of ScientificWriting, Division of Surgical Research, Shoar Research Institute, Houston, TX, USA.,Faculty of Medicine, Kashan University of Medical Science, Kashan, Iran
| | - Venkat R Modukuru
- Department of ScientificWriting, Division of Surgical Research, Shoar Research Institute, Houston, TX, USA.,Faculty Surgeon, Department of Surgery, NYMC at Metropolitan Hospital Program, New York City, NY, USA
| | - Habibollah Mahmoodzadeh
- Cancer Institute, Imam Khomeini Hospital Complex, Division of Surgical Oncology, Department of Surgery, Tehran University of Medical Science, Tehran, Iran
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12
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Abstract
Bariatric surgery is currently the most effective weight loss treatment of severe obesity and its associated comorbidities and is being increasingly used to treat children and adolescents with severe obesity, including those with Type 2 Diabetes (T2D). This review focuses on the conventional management of T2D in children and adolescents, comparison of various types of bariatric surgeries, effect of bariatric surgery on gastrointestinal physiology and metabolism, current literature on the use of bariatric surgery to treat youth with severe obesity and T2D, and the potential complications of bariatric surgery in this population.
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Affiliation(s)
- Anna Zenno
- Division of Endocrinology, Children's National Health System, Washington, DC, USA.
| | - Evan P Nadler
- Division of Pediatric Surgery, Children's National Health System, Washington, DC, USA.,The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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13
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Dardamanis D, Navez J, Coubeau L, Navez B. A Retrospective Comparative Study of Primary Versus Revisional Roux-en-Y Gastric Bypass: Long-Term Results. Obes Surg 2018; 28:2457-64. [PMID: 29524183 DOI: 10.1007/s11695-018-3186-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS To compare the perioperative parameters and excess weight loss between patients operated by laporoscopic Roux-en-Y gastric bypass (LRYGB), as a primary operation or a revisional, for insufficient weight loss after vertical banded gastroplasty (VBG) or adjustable gastric banding (AGB). METHODS A retrospective analysis of all patients who underwent a LRYGB was performed for the period 2004-2011. Demographics, preoperative body mass index (BMI), co-morbidities, operation time, conversion rate, perioperative complications, hospitalization period, and % of excess BMI loss (%EBMIL) were investigated and compared between groups. RESULTS Three hundred forty-two laparoscopic gastric bypass operations were performed, 245 were primary, and 97 revisional. Median follow-up was 30 months (range 0-108 months). Mean BMI (kg/m2) before bypass was 45.2 for primary laparoscopic Roux-en-Y gastric bypass (pLRYGB) and 41.1 for revisional laparoscopic Roux-en-Y gastric bypass (rLRYGB). Median operative time and length of stay were longer for rLRYGB 157.5 versus 235 min (p < 0.001) and 6 versus 6.5 days (p = 0.05). Conversion to laparotomy was performed in eight patients, 0.4% of primary and 7.2% of revisional. Morbidity rate was 6.5% in pLRYGB versus 10% in rLRYGB (NS). There was one death in the primary group. Percentage of EBMIL was significantly lower in the revisional group at 12, 18, and 24 months of follow-up. CONCLUSIONS Revisional and primary gastric bypass have no statistical differences in terms of morbidity. The % of excess BMI loss is lower after revisional gastric bypass during the first 2 years of follow-up. The trend of weight loss or weight regain was similar in both groups.
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14
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Bailly L, Schiavo L, Sebastianelli L, Fabre R, Pradier C, Iannelli A. Anemia and Bariatric Surgery: Results of a National French Survey on Administrative Data of 306,298 Consecutive Patients Between 2008 and 2016. Obes Surg 2019. [PMID: 29516395 DOI: 10.1007/s11695-018-3143-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery (BS) has grown exponentially in France, and long-term anemia due to micronutrient deficiencies has become common. OBJECTIVES The objective of this study was to assess the long-term risk of anemia after BS and to investigate the factors associated with the occurrence of this complication. MATERIALS AND METHODS Data from the French National Health Service database on patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB), between 2008 and 2016 were extracted. Only patients with a primary intervention were considered. RESULTS Data from 306,298 patients (143.733 SG, 79.188 GB, and 36.413 AGB) were analyzed. Overall, 12.930 of them (5.0%) had a diagnosis of anemia due to micronutrient deficiencies as main diagnosis or related diagnosis at time of a hospital stay between 2008 and 2016. In multivariate analysis, GB surgery, female gender, age younger than 52 years, and 25-OH vitamin D deficiency were positively associated with the occurrence of anemia whereas hospital procedural volume was negatively associated. The risk to be diagnosed with anemia after BS was 13.0% after a GB, 5.6% after a SG and 4.0% after an AGB (Log-rank p < 0.0001). The hazard ratio for anemia after GB compared to SG was 2.0 (95% CI 1.9-2.1), adjusted for age and gender. CONCLUSION In France, between 2008 and 2016, 5% of patients had anemia after BS. The risk to develop anemia was 2-fold higher after a GB than after a SG. Young women should be particularly aware of this long-term risk.
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Affiliation(s)
- Laurent Bailly
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - 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
| | - Lionel Sebastianelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France
| | - Roxane Fabre
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
- EA CoBTek, University of Nice Sophia-Antipolis, Nice, France
| | - Christian Pradier
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity", 06204, Nice, France.
- University of Nice Sophia Antipolis, 06107, Nice, France.
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15
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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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16
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Pontiroli AE, Zakaria AS, Micheletto G, Osio C, Saibene A, Folli F. A 9 years comparison of weight loss, disappearance of obesity, and resolution of diabetes mellitus with biliointestinal bypass and with adjustable gastric banding: experience of a collaborative network. Acta Diabetol 2019; 56:163-169. [PMID: 30411157 DOI: 10.1007/s00592-018-1221-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/29/2018] [Indexed: 01/06/2023]
Abstract
AIMS Long-term comparisons between bariatric surgical techniques have been performed for gastric bypass (RYGB), sleeve gastrectomy (LSG), and biliopancreatic diversion (BPD) vs gastric banding (LAGB), but short-term studies (6 months-4 years) have only compared biliointestinal bypass (BIBP) and LAGB. The participating institutions regularly perform both BIBP and LAGB with a common protocol, and the aim of this retrospective study was to compare long-term effects of the two procedures on body weight, on clinical and metabolic variables, and on resolution of obesity and of diabetes. METHODS All procedures performed between 01/01/1998 and 31/12/2005 were considered; 73 out of 91 patients undergoing BIBP, and 154 out of 249 patients undergoing LAGB were evaluable up to 9 years. RESULTS BIBP was significantly more effective than LAGB in terms of weight loss and of resolution of obesity (BMI < 30 kg/m2), in terms of decrease of systolic blood pressure and of serum cholesterol, and similar in terms of resolution of diabetes. In addition, the effect of BIBP was stable, while the effect of LAGB decreased with time. CONCLUSIONS Both BIBP and LAGB exert long-term effects on body weight, on blood pressure, and on resolution of diabetes mellitus; the effect of BIBP is significantly greater than the effect of LAGB in terms of weight loss, resolution of obesity, of control of systolic blood pressure and of serum cholesterol, but not in terms of resolution of diabetes.
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Affiliation(s)
- Antonio E Pontiroli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
| | | | - Giancarlo Micheletto
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
- UOC Chirurgia Generale e INCO Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | | | - Franco Folli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- Ospedale San Paolo, Milan, Italy
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17
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Pontiroli AE, Zakaria AS, Fanchini M, Osio C, Tagliabue E, Micheletto G, Saibene A, Folli F. A 23-year study of mortality and development of co-morbidities in patients with obesity undergoing bariatric surgery (laparoscopic gastric banding) in comparison with medical treatment of obesity. Cardiovasc Diabetol 2018; 17:161. [PMID: 30594184 PMCID: PMC6311074 DOI: 10.1186/s12933-018-0801-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background and aim Several studies have shown that bariatric surgery reduces long term mortality compared to medical weight loss therapy. In a previous study we have demonstrated that gastric banding (LAGB) is associated with reduced mortality in patients with and without diabetes, and with reduced incidence of obesity co-morbidities (cardiovascular disease, diabetes, and cancer) at a 17 year follow-up. The aim of this study was to verify at a longer time interval (23 years) mortality and incidence of co-morbidities in patients undergoing LAGB or medical weight loss therapy. Patients and methods As reported in the previous shorter-time study, medical records of obese patients [body mass index (BMI) > 35 kg/m2 undergoing LAGB (n = 385; 52 with diabetes) or medical treatment (controls, n = 681; 127 with diabetes), during the period 1995–2001 (visit 1)] were collected. Patients were matched for age, sex, BMI, and blood pressure. Identification codes of patients were entered in the Italian National Health System Lumbardy database, that contains life status, causes of death, as well as exemptions, prescriptions, and hospital admissions (proxies of diseases) from visit 1 to June 2018. Survival was compared across LAGB patients and matched controls using Kaplan–Meier plots adjusted Cox regression analyses. Results Final observation period was 19.5 ± 1.87 years (13.4–23.5). Compared to controls, LAGB was associated with reduced mortality [HR = 0.52, 95% CI 0.33–0.80, p = 0.003], significant in patients with diabetes [HR = 0.46, 95% CI 0.22–0.94, p = 0.034], borderline significant in patients without diabetes [HR = 0.61, 95% CI = 0.35–1.05, p = 0.076]. LAGB was associated with lower incidence of diabetes (15 vs 75 cases, p = 0.001), of CV diseases (61 vs 226 cases, p = 0.009), of cancer (10 vs 35, p = 0.01), and of renal diseases (0 vs 35, p = 0.001), and of hospital admissions (92 vs 377, p = 0.001). Conclusion The preventive effect of LAGB on mortality is maintained up to 23 years, even with a decreased efficacy compared with the shorter-time study, while the preventive effect of LAGB on co-morbidities and on hospital admissions increases with time. Electronic supplementary material The online version of this article (10.1186/s12933-018-0801-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Giancarlo Micheletto
- Università degli Studi di Milano, Milan, Italy.,INCO-Istituto Clinico Sant'Ambrogio, Milan, Italy
| | | | - Franco Folli
- Università degli Studi di Milano, Milan, Italy.,ASST Santi Paolo e Carlo, Milan, Italy
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18
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Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is associated with approximately 25 % weight loss failure, resulting in insufficient weight loss or weight regain. Strategies of revisional surgery focus on alteration of limb length, pouch or stoma size. Altering pouch size and outlet by adding laparoscopic adjustable gastric band (LAGB) might initiate further weight loss. The goal of this study is to review the safety and efficacy of LAGB after failed RYGB in a retrospective cohort of patients in our institute. METHODS Patients with secondary LAGB (n = 44) were studied between May 2012 and January 2015. Demographics, effects on weight loss and complications were analysed. RESULTS Mean age and body mass index (BMI) at time of LAGB was 45.8 ± 8.2 years and 37.2 ± 5.4 kg/m2, respectively. Mean interval between RYGB and LAGB was 2.6 ± 1.3 years. Mean follow-up was 14 ± 7.9 months, with 25 % loss to follow-up at 12 months. Due to LAGB, patients lost an additional 17.6 % ± 28.3 % excess weight. Patients with weight regain after initial weight loss success showed more excess weight loss (EWL) compared to patients whom never reached 50% EWL after RYGB. Overall complication and reoperation rates were 30 and 21 %, respectively, with 16 % band removal. One fatality due to septic shock following band erosion was observed. CONCLUSION In this largest published cohort, secondary banding of failed RYGB provides only limited additional weight loss. Furthermore, this technique is associated with high morbidity and reoperation rates. A significant difference in effect was found between patients with weight loss failure and weight regain. Larger prospective series are necessary to evaluate if the modest benefits are worth the risks of secondary LAGB.
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Affiliation(s)
- Martine Uittenbogaart
- Obesity Center Máxima, Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
| | - Wouter Kg Leclercq
- Obesity Center Máxima, Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Arijan Apm Luijten
- Obesity Center Máxima, Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Francois Mh van Dielen
- Obesity Center Máxima, Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
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19
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Doble B, Wordsworth S, Rogers CA, Welbourn R, Byrne J, Blazeby JM. What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses. Obes Surg 2017; 27:2179-2192. [PMID: 28550438 PMCID: PMC5509820 DOI: 10.1007/s11695-017-2749-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven ‘important’ cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended ‘important’ cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.
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Affiliation(s)
- Brett Doble
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, BS2 8HW, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - James Byrne
- Southampton University Hospitals NHS Trust, Southampton, SO16 6YD, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
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20
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Spivak H, Sakran N, Dicker D, Rubin M, Raz I, Shohat T, Blumenfeld O. Different effects of bariatric surgical procedures on dyslipidemia: a registry-based analysis. Surg Obes Relat Dis 2017; 13:1189-1194. [PMID: 28456511 DOI: 10.1016/j.soard.2017.03.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 12/10/2016] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND The scale and variables linked to bariatric surgery's effect on dyslipidemia have not been conclusive. OBJECTIVE To compare the effect of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (LAGB) on dyslipidemia SETTING: National bariatric surgery registry. METHODS Plasma lipids and associated variables were compared at baseline and 1 year (12±4 mo) after surgery for registry patients with dyslipidemia enrolled from June 2013 to August 2014. RESULTS The greatest mean total-cholesterol (TC) reduction was observed post-RYGB, 226.7±26.4 to 181.3±30.9 mg/dL (19.9%, n = 208), followed by post-SG, 227.9±24.4 to 206.7±34.2 mg/dL (8.9%, n = 1515; P<.001). Normal TC levels of below 200 mg/dL were achieved by 76% post-RYGB patients compared with 43.5% post-SG patients (odds ratio [OR] = 6.24, 95% confidence interval [CI]: 3.69-10.53) and 25.6% post-LABG patients (OR = 9.66, 95% CI: 4.11-22.67; P<.01). Although equivalent patterns were observed for low-density-lipoprotein cholesterol (LDL), the levels of high-density-lipoprotein cholesterol (HDL) were most improved post-SG, reaching normal levels in 58.1% of SG male patients versus 39.5% of RYGB male patients (OR = 1.56, 95% CI: 1.04-2.35), (P = .02). The lowering of triglyceride levels by approximately 75% was comparable after SG and RYGB procedures. The type of surgery was the strongest independent predictor for all lipid level improvements or remissions. Male sex was an independent predictor for LDL normalization only (OR = 1.88, 95% CI: 1.24-2.85). Excess weight loss offered no meaningful prediction for lipid improvement (OR = 1.01-1.03). CONCLUSION Particular types of bariatric surgeries had different effects on dyslipidemia, independent of weight loss. Overall, the RYGB achieved the biggest reduction in plasma lipids (TC and LDL), although SG did affect HDL. Our results could aid in the decision-making process regarding the most appropriate procedure for patients with dyslipidemia.
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Affiliation(s)
- Hadar Spivak
- Department of Surgery, Chaim Sheba Medical Center, Rama-Gan, Israel; Department of Surgery, Herzliya Medical Center, Herzliya, Israel.
| | - Nasser Sakran
- Department of Surgery A, Emek Medical Center, Afula, Israel; affiliated with the Technion - Israel Institute of Technology, Haifa, Israel
| | - Dror Dicker
- Department of Medicine, Hasharon Hospital-Rabin Medical Center, Petach-Tikva, Israel; affiliated with Sackler School of Medicine Tel Aviv University, Israel
| | - Moshe Rubin
- Department of Surgery, Chaim Sheba Medical Center, Rama-Gan, Israel; Department of Surgery, Herzliya Medical Center, Herzliya, Israel
| | - Itamar Raz
- Diabetes Unit, Hadassah University Hospital, Jerusalem, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
| | - Orit Blumenfeld
- Israel Center for Disease Control, Israel Ministry of Health, Ramat Gan, Israel
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Cunha FM, Oliveira J, Preto J, Saavedra A, Costa MM, Magalhães D, Lau E, Bettencourt-Silva R, Freitas P, Varela A, Carvalho D. The Effect of Bariatric Surgery Type on Lipid Profile: An Age, Sex, Body Mass Index and Excess Weight Loss Matched Study. Obes Surg 2016; 26:1041-7. [PMID: 26220239 DOI: 10.1007/s11695-015-1825-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery improves lipid profile. A still unanswered question is whether this improvement is merely weight-dependent or also results from factors inherent to specificities of the bariatric procedure. We aimed to study lipid profile 1 year after bariatric surgery and compare its changes between the different procedures in patients matched for initial weight and weight loss. METHODS We retrospectively analysed patients submitted to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB) or sleeve gastrectomy (SG) between 2010 and 2013. Patients were matched for age (±5 years), sex, pre-surgery body mass index (BMI) (±2 Kg/m(2)) and excess weight loss (EWL) (±5%). Baseline and 1-year lipid profile, its variation and percentage of variation was compared between surgeries. RESULTS We analysed 229 patients: 72 pairs RYGB-AGB, 47 pairs RYGB-SG and 33 pairs AGB-SG. The median age was 41 (35-52) years and 11.8% were male. Pre-operative BMI was 44.0 ± 4.6 and 32.1 ± 4.4 Kg/m(2) at 1 year. EWL at 1 year was 64.2 ± 18.9%. There were no differences in baseline lipid profile between patients submitted to different types of bariatric surgery. At 1 year, high-density lipoprotein cholesterol (HDL) and triglycerides (TG) improved similarly with all surgeries. Total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) at 1 year decreased significantly more in patients submitted to RYGB than in weight-matched patients undergoing AGB or SG. CONCLUSIONS RYGB is the only bariatric surgery that reduces TC and LDL in age-, sex-, BMI- and EWL-matched patients. All three procedures improved TG and HDL similarly when the confounding effect of weight loss is eliminated.
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22
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Jahansouz C, Serrot FJ, Frohnert BI, Foncea RE, Dorman RB, Slusarek B, Leslie DB, Bernlohr DA, Ikramuddin S. Roux-en-Y Gastric Bypass Acutely Decreases Protein Carbonylation and Increases Expression of Mitochondrial Biogenesis Genes in Subcutaneous Adipose Tissue. Obes Surg 2016; 25:2376-85. [PMID: 25975200 DOI: 10.1007/s11695-015-1708-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 01/06/2023]
Abstract
BACKGROUND Mitochondrial dysfunction in adipose tissue has been implicated as a pathogenic step in the development of type 2 diabetes mellitus (T2DM). In adipose tissue, chronic nutrient overload results in mitochondria driven increased reactive oxygen species (ROS) leading to carbonylation of proteins that impair mitochondrial function and downregulation of key genes linked to mitochondrial biogenesis. In patients with T2DM, Roux-en-Y gastric bypass (RYGB) surgery leads to improvements in glycemic profile prior to significant weight loss. Consequently, we hypothesized that improved glycemia early after RYGB would be paralleled by decreased protein carbonylation and increased expression of genes related to mitochondrial biogenesis in adipose tissue. METHODS To evaluate this hypothesis, 16 obese individuals were studied before and 7-8 days following RYGB and adjustable gastric banding (AGB). Subcutaneous adipose tissue was obtained pre- and post-bariatric surgery as well as from eight healthy, non-obese individual controls. RESULTS Prior to surgery, adipose tissue expression of PGC1α, NRF1, Cyt C, and eNOS (but not Tfam) showed significantly lower expression in the obese bariatric surgery group when compared to lean controls (p < 0.05). Following RYGB, but not after AGB, patients showed significant decrease in HOMA-IR, reduction in adipose protein carbonylation, and increased expression of genes linked to mitochondrial biogenesis. CONCLUSIONS These results suggest that rapid reduction in protein carbonylation and increased mitochondrial biogenesis may explain postoperative metabolic improvements following RYGB.
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Affiliation(s)
- Cyrus Jahansouz
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Federico J Serrot
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Brigitte I Frohnert
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Rocio E Foncea
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Robert B Dorman
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Bridget Slusarek
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Daniel B Leslie
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - David A Bernlohr
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, 420 Delaware St. SE, MMC 195, Minneapolis, MN, 55455, USA.
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23
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Savir S, Kalchiem-Dekel O, Naggan L, Maimon N. Respiratory deterioration following laparoscopic adjustable gastric banding: A three-year follow-up of over 3,000 subjects. Respir Med 2016; 115:66-71. [PMID: 27215506 DOI: 10.1016/j.rmed.2016.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 04/08/2016] [Accepted: 04/24/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obesity is considered a global epidemic. Until recently, laparoscopic adjustable gastric binding (LAGB) was routinely offered as a means of weight reduction for selected patient populations. Previous case series have documented several pulmonary complications following LAGB. In the current study, we explored the rate of long-term respiratory deterioration associated with LAGB. METHODS The study is a historical cohort study of medical records of subjects who underwent LAGB at Soroka University Medical Center in Israel between January 1997 and July 2008. After the exclusion of short-term respiratory events, respiratory morbidity during the three years following the operation was compared with that three years prior to the operation. Subjects whose respiratory status worsened following surgery were further compared with those whose status either remained unchanged or improved. RESULTS The final analysis included 3084 subjects, of whom 709 (22.9%) had documented respiratory morbidity following surgery. Compared to pre-operative respiratory status, respiratory deterioration following LAGB was found in 590 subjects (19.1%). Risk factors associated with the worsening of respiratory status were age ≤28 or ≥46 years (odds ratio [OR] = 1.32, 95% confidence interval [CI]: 1.02-1.71 and OR = 1.42, 95% CI: 1.09-1.85, respectively), female gender (OR = 1.31, 95% CI: 1.06-1.63), and pre-operative documentation of respiratory morbidity. CONCLUSIONS The rate of deterioration in the respiratory status observed among subjects who underwent LAGB was high. Consequently, physicians should be aware of the possible link, even years after the surgery, between respiratory symptoms and a history of LAGB.
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Debs T, Petrucciani N, Kassir R, Iannelli A, Amor IB, Gugenheim J. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005-2014. Surg Obes Relat Dis 2016; 12:1602-1609. [PMID: 27516221 DOI: 10.1016/j.soard.2016.05.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND During the past decade, the field of bariatric surgery has changed dramatically. OBJECTIVES The study aims to summarize and perform a periodic assessment of the current trends in the use of bariatric surgery in France and review findings on the long-term progression of bariatric surgery. The data were extracted from the national registry Programme de Médicalisation des Systèmes d׳Information from 2005 to 2014. SETTING National health system and private practice in France. METHODS We identified all hospitalizations during which a bariatric procedure was performed for the treatment of morbid obesity from 2005 to 2014 in France. Data were reviewed for patient characteristics and the number and types of bariatric procedures. We also analyzed the setting and the characteristics of the centers and the difference of the activity between the public and private sector. RESULTS Between 2005 and 2014, the number of bariatric operations increased fourfold. Sleeve gastrectomy became the most performed bariatric intervention, representing 60.7% of bariatric activity in 2014. There was a concomitant steep increase in sleeve gastrectomy, with Roux-en-Y gastric bypass increasing slightly overall and a substantial decrease in adjustable gastric banding. In 2014, 481 centers performed bariatric surgery. Among them, one third performed<30 operations/yr. We observed an overall in-hospital mortality ranging from .038% to .05% during the last 3 years. CONCLUSION Bariatric surgery is increasing in France, with a fourfold augmentation of interventions in the last 10 years. The number of sleeve gastrectomies has increased considerably. This activity is performed in numerous centers, one third of them performing<30 interventions/yr.
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Affiliation(s)
- Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France.
| | - Niccolo Petrucciani
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Radwan Kassir
- Department of General Surgery, CHU Hospital, Jean Monnet University, Saint Étienne, France
| | - Antonio Iannelli
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Imed Ben Amor
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Hôpital Archet 2, Nice, France
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25
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Obeid NR, Malick W, Baxter A, Molina B, Schwack BF, Kurian MS, Ren-Fielding CJ, Fielding GA. Weight loss outcomes among patients referred after primary bariatric procedure. Am J Surg 2015; 212:69-75. [PMID: 26307420 DOI: 10.1016/j.amjsurg.2015.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/06/2015] [Revised: 04/04/2015] [Accepted: 04/17/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Bariatric patients may not always obtain long-term care by their primary surgeon. Our aim was to evaluate weight loss outcomes in patients who had surgery elsewhere. METHODS We conducted a retrospective analysis. Postreferral management included nonsurgical, revision, or conversion. Primary outcomes were percent excess weight loss (%EWL) overall, according to original operation, and based on postreferral management. RESULTS Between 2001 and 2013, there were 569 patients. Mean follow-up was 3.1 years. Management was 42% nonsurgical, 41% revision, and 17% conversion. Overall, mean %EWL was 45.3%. Based on original surgery type, %EWL was 41.2% for adjustable gastric banding vs 58.3% for Roux-en-Y gastric bypass (P ≤ .0001). Management affected %EWL (41.2% nonsurgical vs 45.3% revision vs 55.1% conversion, P ≤ .0001). CONCLUSIONS Patients referred after bariatric surgery can achieve satisfactory weight loss. This differs based on surgery type and management strategy.
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Affiliation(s)
- Nabeel R Obeid
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA.
| | - Waqas Malick
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA
| | - Andrew Baxter
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA
| | - Bianca Molina
- Department of Surgery, Mount Sinai Beth Israel, New York, NY, USA
| | - Bradley F Schwack
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA
| | - Marina S Kurian
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA
| | - Christine J Ren-Fielding
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA
| | - George A Fielding
- Department of Surgery, New York University School of Medicine, 530 First Avenue, Suite #10S, New York, NY 10016, USA
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Handgraaf HJM, Ashton D, Favretti F, Segato G, van Ramshorst B, Meesters B, Greve JWM. The Gastric Band That Is Not to Be : Efficacy, Safety and Performance of the Easyband™: a Multicenter Experience. Obes Surg 2015; 25:2239-44. [PMID: 25956149 DOI: 10.1007/s11695-015-1704-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Access port problems after laparoscopic adjustable gastric banding can be significant complications. The Easyband™ is an innovative type of gastric band, whose internal diameter can be adjusted by a telemetrically activated motor. The aim of this study was to evaluate safety, efficacy and performance of the Easyband™. METHODS A total of 110 morbidly obese patients were prospectively enrolled. The Easyband™ was implanted laparoscopically by experienced bariatric surgeons in six different hospital locations. Patient characteristics, surgery details, postoperative weight loss, and complications were recorded. Follow-up lasted 2 years. RESULTS Follow-up was completed by 78.2 % of the patients. Surgeons rated 71 % of each aspect of Easyband™ implantation as "easy" or "very easy". Adjustments were successful in 91 % of the attempts. One or more adverse events occurred in 79.1 % of the patients. Thirty-six serious adverse events were reported, of which 50 % was device-related. One or more functional tests failed in 20.9 % of the devices, 8.2 % passed after a repeated test. A reintervention was necessary in 15.5 % of the patients. Mean weight loss after 2 years was 24.2 ± 14.0 kg, mean excess weight loss was 46.1 ± 24 %. CONCLUSION Excess weight loss with the Easyband™ was comparable with other gastric banding devices. Adjustment of the device was simple, non-invasive and more acceptable to patients than with a standard access port. However, a high incidence of device-related problems requiring surgical explantation occurred. The Easyband™ represents a major advance in gastric band design, but significant technical problems need to be resolved before further implants can be recommended.
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Affiliation(s)
- Henricus J M Handgraaf
- Department of Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - David Ashton
- Healthier Weight Centres, 22 Upper Wimpole Street, London, W1G 6NB, UK.
| | - Franco Favretti
- Department of Surgery, San Bortolo Regional Hospital, Viale Ferdinando Rodolfi, 37, Vicenza, 36100, Italy.
| | - Gianni Segato
- Department of Surgery, San Bortolo Regional Hospital, Viale Ferdinando Rodolfi, 37, Vicenza, 36100, Italy.
| | - Bert van Ramshorst
- Department of Surgery, St. Antonius Hospital, P.O. Box 2500, Nieuwegein, 3430EM, The Netherlands.
| | - Berry Meesters
- Department of Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
| | - Jan Willem M Greve
- Department of Surgery, Atrium Medical Center Parkstad, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
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27
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Ritz P, Topart P, Benchetrit S, Tuyeras G, Lepage B, Mouiel J, Becouarn G, Pattou F, Chevallier JM. Benefits and risks of bariatric surgery in patients aged more than 60 years. Surg Obes Relat Dis 2014:S1550-7289(14)00004-5. [PMID: 24708912 DOI: 10.1016/j.soard.2013.12.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 07/12/2013] [Revised: 10/30/2013] [Accepted: 12/10/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefits and risks of bariatric surgery are debated in older patients. The objective of this study was to compare the weight changes and adverse outcomes in patients>60 years and in younger ones. METHODS The French SOFFCO registry was screened for gastric bypass (RYGB), gastric banding (LAGB), or sleeve gastrectomy (SG) performed between 2007 and 2010. Adverse outcomes and weight changes (%) over 12 months were compared between patients<40 years (N = 1379), between 40-59 years (N = 1065), and>60 years (N = 164). RESULTS After a RYGB surgical (12.3 versus 3.8%; P = .03) and nonsurgical (7.0% versus .8%; P = .01) complications were more prevalent in patients above 60 years than in those below 40. No increased prevalence of surgical and nonsurgical complications was seen after a LAGB or a SG. Weight loss (% of initial weight) was lower after a LAGB than after a RYGB or a SG. After LAGB weight loss (%) did not differ between patients above 60 years and those aged<40 (difference 1.7±1.5%, P = .26). After a RYGB weight loss (%) was lower in patients aged>60 years (-5.6±1.7%, P = .001) than in those aged<40 years. After a SG, weight loss (%) was lower in patients aged>60 years (-7.0±2.6%, P = .01) than in those aged<40 years. CONCLUSION Bariatric surgery can be a short-term effective and safe therapeutic option in elderly patients. LAGB or SG appears to be an alternative strategy to RYGB, with lower adverse outcome rate.
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Affiliation(s)
- Patrick Ritz
- Centre Intégré Obésité, Endocrinology Metabolism and Nutrition Department, CHU Toulouse, France; USMR 1027 Inserm Université Paul Sabatier, CHU Toulouse, France.
| | - Philippe Topart
- Bariatric Surgery Department, Clinique de l'Anjou, Angers, France
| | | | - Géraud Tuyeras
- Centre Intégré Obésité, Endocrinology Metabolism and Nutrition Department, CHU Toulouse, France; USMR 1027 Inserm Université Paul Sabatier, CHU Toulouse, France
| | - Benoit Lepage
- USMR 1027 Inserm Université Paul Sabatier, CHU Toulouse, France
| | - Jean Mouiel
- Obesity Center, Clinique St George, Nice, France
| | | | - François Pattou
- General and Endocrine Surgery, CHRU Lille, INSERM UMR 859, Université de Lille-Nord de France, Lille, France
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28
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Ayloo SM, Fernandes E, Masrur MA, Giulianotti PC. Adjustable gastric banding: a comparison of models. Surg Obes Relat Dis 2013; 10:1097-103. [PMID: 24342037 DOI: 10.1016/j.soard.2013.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 12/20/2012] [Revised: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are several models of adjustable gastric banding in use with little evidence for choosing a particular model. The objective of this study was to evaluate factors for selecting a particular type of band in terms of weight loss, complications, and co-morbidities. METHODS From July 2006 to May 2012, 222 patients underwent laparoscopic adjustable gastric banding (LAGB) by a single surgeon. Patient demographic characteristics, weight loss, body mass index (BMI), percentage of weight loss (%EWL), complications, and co-morbidities were retrospectively reviewed. Patients were grouped according to the band model into 6 categories: 27 LAP-BAND Adjustable Gastric Banding System VG, 25 Allergan-LAGB, 20 LAP-BAND AP(M) Standard, 18 LAP-BAND AP(M) Large, 34 Realize Band, and 98 Realize-C band. RESULTS At 60 months follow up, in the LAP-BAND VG Group, the mean %EWL was 41%, percentage of co-morbidity improvement was 66%, and percentage of complications was 14.3%; the same percentages in the Allergan-LAGB Group were 41%, 0%, and 52%, respectively; in the LAP-BAND AP Standard Group were 42%, 20%, and 40%, respectively; in the LAP-BAND AP Large group were 38% , 12.5%, and 27.8%, respectively (at 48 months); in the Realize Band Group were 37%, 60%, and 0%, respectively (at 48 months); and in the Realize-C Band Group were 48%,12.5%, and 12.2%, respectively (at 36 months). CONCLUSIONS In terms of weight loss and co-morbidities, no differences were found supporting the choice of one model over the others. Short-term and long-term band-related complications occurred without any clear predilection. The port-related complications were significantly lower in the Realize bands.
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Affiliation(s)
- Subhashini M Ayloo
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
| | - Eduardo Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mario A Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Pallati PK, Shaligram A, Shostrom VK, Oleynikov D, McBride CL, Goede MR. Improvement in gastroesophageal reflux disease symptoms after various bariatric procedures: review of the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis 2013; 10:502-7. [PMID: 24238733 DOI: 10.1016/j.soard.2013.07.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [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: 05/14/2013] [Revised: 07/22/2013] [Accepted: 07/23/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of gastroesophageal reflux disease (GERD) in the morbidly obese population is as high as 45%. The objective of this study was to compare the efficacy of various bariatric procedures in the improvement of GERD. METHODS The Bariatric Outcomes Longitudinal Database is a prospective database of patients who undergo bariatric surgery by a participant in the American Society of Metabolic and Bariatric Surgery Center of Excellence program. GERD is graded on a 6-point scale, from 0 (no history of GERD) to 5 (prior surgery for GERD). Patients with GERD severe enough to require medications (grades 2, 3, and 4) from June 2007 to December 2009 are identified; the resolution of GERD is noted based on 6-month follow-up. RESULTS Of a total of 116,136 patients, 36,938 patients had evidence of GERD preoperatively. After excluding patients undergoing concomitant hiatal hernia repair or fundoplication, there were 22,870 patients with 6-month follow-up. Mean age was 47.6±11.1 years, with an 82% female population. Mean BMI was 46.3±8.0 kg/m(2). Mean preoperative GERD score for patients with Roux-en-Y gastric bypass (RYGB) was 2.80±.56, and mean postoperative score was 1.33±1.41 (P<.0001). Similarly, adjustable gastric banding (AGB, 2.77±.57 to 1.63±1.37, P<.0001) and sleeve gastrectomy (SG, 2.82±.57 to 1.85±1.40, P<.0001) had significant improvement in GERD score. GERD score improvement was best in RYGB patients (56.5%; 7955 of 14,078) followed by AGB (46%; 3773 of 8207) and SG patients (41%; 240 of 585). CONCLUSION All common bariatric procedures improve GERD. Roux-en-Y gastric bypass is superior to adjustable gastric banding and sleeve gastrectomy in improving GERD. Also, the greater the loss in excess weight, the greater the improvement in GERD score.
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Affiliation(s)
- Pradeep K Pallati
- Department of Surgery, Creighton University Medical Center, Omaha, Nebraska
| | - Abhijit Shaligram
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Valerie K Shostrom
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Dmitry Oleynikov
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Corrigan L McBride
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew R Goede
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.
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30
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Lazzati A, Guy-Lachuer R, Delaunay V, Szwarcensztein K, Azoulay D. Bariatric surgery trends in France: 2005-2011. Surg Obes Relat Dis. 2014;10:328-334. [PMID: 24209875 DOI: 10.1016/j.soard.2013.07.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/11/2013] [Accepted: 06/11/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bariatric surgery underwent a dramatic change in the past decade in France. The objective of this study was to examine elective bariatric surgical procedures from 2005 to 2011 in France and to determine trends in the use of the procedure. METHODS Data were extracted from the National Hospital Database. All admissions involving a bariatric surgery procedure were included. Procedures authorized by the Public Health Authority for the treatment of morbid obesity, including the adjustable gastric banding (AGB), vertical banded gastroplasty (VBG), gastric bypass (GB), sleeve gastrectomy (SG), and biliopancreatic diversion (BPD), either by laparotomic or laparoscopic approach, were retrieved. Revisional procedures, such as band removal or repositioning, band changing, and access device revisions, were also evaluated. RESULTS We observed a 2.5-fold increase in bariatric procedures, from 12,800 in 2005 to 31,000 in 2011. Sleeve gastrectomy and gastric bypass became the most common bariatric procedures in France in 2011, whereas adjustable gastric banding has been decreasing since 2007. During the analysis period, about 50,000 revisional procedures were performed. The number of hospitals (private or public) providing bariatric surgery has considerably increased. However, most of the activity remains confined to a small number of centers, as 50% of all bariatric surgeries are carried out in 12% of hospitals. Bariatric procedures are predominantly performed in private hospitals. CONCLUSIONS In France the number of bariatric procedures increased considerably between 2005 and 2011. The type of procedures changed, with a constant decrease of AGB and an important increase of SG and GB. Most bariatric procedures are still performed in low volume activity hospitals and in private hospitals.
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Spanou M, Tziomalos K. Bariatric surgery as a treatment option in patients with type 2 diabetes mellitus. World J Diabetes 2013; 4:14-18. [PMID: 23593531 PMCID: PMC3627414 DOI: 10.4239/wjd.v4.i2.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/10/2013] [Accepted: 03/07/2013] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a leading cause of blindness, non-traumatic amputation and end-stage renal disease as well as a major cardiovascular risk factor. Tight glycemic control reduces the incidence of microvascular complications of T2DM whereas its effects on macrovascular complication are more controversial. However, glycemic targets are achieved by a minority of diabetic patients despite the availability of several antidiabetic agents. In the present commentary, we discuss the findings of two recent randomized studies that compared bariatric surgery with medical treatment in patients with uncontrolled T2DM. Both studies showed that bariatric surgery results in remission of T2DM in the majority of patients. However, both studies were limited to relatively young patients without comorbidities, had relatively short follow-up and did not assess the effects of surgery on T2DM complications. Moreover, the perioperative complications of bariatric surgery and its limited availability in some areas are additional barriers to the wider implementation of this therapeutic approach. On the other hand, the elucidation of the mechanisms underpinning the resolution of T2DM following bariatric surgery might result in the development of novel, more effective pharmacotherapies for this common disease.
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