1
|
Quint E, Perry ZH, Elkrinawi N, Kukeev I, Czeiger D, Vakhrushev A, Sebbag G, Dukhno O. Banded One-Anastomosis Gastric Bypass (BOAGB) for Patients Living with Obesity and Extreme Obesity: A Single Institution's Experience. Obes Surg 2024; 34:1756-1763. [PMID: 38557949 DOI: 10.1007/s11695-024-07194-5] [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: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue. One such variation is adding a gastric band to limit the expansion of the newly created pouch. Limited data exist regarding the effectiveness of this procedure, called the banded one-anastomosis gastric bypass (BOAGB) procedure, compared to other bariatric procedures. METHOD In this retrospective study, we compared all patients who underwent the BOAGB procedure at the Bariatric Surgery Unit in our Medical Center with a postoperative follow-up of at least 1 year with patients who underwent a one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG) procedures. Data collected included demographics, comorbidities, surgical outcomes, complications, and postoperative quality-of-life assessments. RESULTS One hundred eleven patients were enlisted to our study during the relevant study period-24 patients underwent the BOAGB procedure, 43 underwent OAGB, and 44 underwent a SG. Lost to follow-up beyond 30 days was 9% (at 1-year post-surgery, we were able to establish contact with 101 patients). The pre-op BMI was significantly higher in the BOAGB group compared to the other procedures. Additionally, a higher prevalence of diabetes was observed in the BOAGB group. The duration of surgery was significantly longer for the BOAGB procedure. No significant differences were found in surgical complications. Overall, all procedures resulted in significant excess weight loss (EWL) or change in BMI, improvement in comorbidities, and improved quality of life postoperatively. CONCLUSIONS The BOAGB procedure, like OAGB and SG, demonstrated favorable weight loss outcomes and weight maintenance 1 year postoperatively without significant differences between the procedures. The BOAGB procedure is relatively new, with good bariatric outcomes and a favorable safety profile. Long-term study is needed to evaluate these various bariatric procedures' efficacy further.
Collapse
Affiliation(s)
- Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Zvi H Perry
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
- Department of General Surgery A, Soroka University Medical Center, Beer Sheba, Israel.
| | - Nur Elkrinawi
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Alex Vakhrushev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Oleg Dukhno
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| |
Collapse
|
2
|
Mouawad C, Aoun R, Dahboul H, Feghali EE, Kassar S, Alkassis M, Osseis M, Noun R, Chakhtoura G. Quality of life after laparoscopic sleeve gastrectomy: Pre-operative, 1-year and 5-year results. J Minim Access Surg 2023; 19:459-465. [PMID: 36629222 PMCID: PMC10695321 DOI: 10.4103/jmas.jmas_193_22] [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: 07/08/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The negative impact of obesity on the quality of life (QoL) and its association with multiple comorbidities is unquestionable. The primary objective of this study was to compare the QoL of patients before, 1 year and 5 years after laparoscopic sleeve gastrectomy (LSG). Secondary objectives were to evaluate the resolution of obesity-related comorbidities and weight loss success. Materials and Methods We included patients who underwent LSG for body mass index (BMI) ≥30 kg/m2 between August 2016 and April 2017 and completed the Moorehead-Ardelt QoL Questionnaire II (MA II). Statistical analysis was conducted using SPSS IBM Statistics for Windows version 21. Results In total, 64 patients participated with a female majority (73.44%) and a mean age of 36.09 with an average BMI at 40.47. Percentage of excess BMI loss and excess weight loss (% EWL) at one and 5 years after surgery went from 90.18% to 85.05% and 72.17% to 67.09%, respectively. The total MA II score before LSG was - 0.39 ± 0.94. Postoperatively, it increased to 1.73 ± 0.60 at 1 year and 1.95 ± 0.67 at 5 years. The positive impact of LSG on QoL was more significant in patients presenting ≥30% of weight loss and in females. At 5 years, a significant improvement in many comorbidities was noted except for arterial hypertension, coxalgia, gastro-oesophageal reflux disease and lower extremities' varices. Conclusion LSG maintains a long-term QoL improvement, a significant EWL and a resolution of the most common obesity-associated comorbidities such as diabetes, dyslipidaemia and symptoms related to sleep apnoea.
Collapse
Affiliation(s)
- Christian Mouawad
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Rany Aoun
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Elie El Feghali
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Marwan Alkassis
- Department of Urology, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Michael Osseis
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hotel Dieu De France Hospital, University Saint Joseph, Medical School, Beirut, Lebanon
| |
Collapse
|
3
|
Hatami M, Pazouki A, Hosseini-Baharanchi FS, Kabir A. Bariatric Surgeries, from Weight Loss to Weight Regain: A Retrospective Five-Years Cohort Study. Obes Facts 2023; 16:540-547. [PMID: 37598667 PMCID: PMC10697746 DOI: 10.1159/000533586] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Bariatric surgery may lead to unsatisfactory weight loss, weight loss plateau, and even weight regain after various types of surgery. Despite the numerous studies, the mid-term results of surgery, after repetitive weight fluctuations remain a major concern. The aim of the present study was to determine the key time points of weight changes after three types of bariatric procedures, as well as to determine 5-year weight loss outcome after surgery. METHODS This is a retrospective cohort study including patients with morbid obesity conducted in the Minimally Invasive Surgery Research Center. The patients underwent one of the three types of bariatric surgeries including laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB), who had been followed up for weight loss trend during 5 years postoperatively. RESULTS The mean excessive weight loss (%EWL) and total weight loss (%TWL) of 2,567 participants with obesity (mean age = 39.03, mean BMI = 45.67) in the first 6 months after surgery was independent of the type of surgery (p > 0.05). OAGB and RYGB showed significantly higher weight loss compared to LSG in ninth and 24th month after surgery, respectively (p < 0.05). The 5 years %WL could be comparable with %WL in 6, 9, and 12 months after LSG, RYGB, and OAGB, respectively. CONCLUSION OAGB provides the fastest and highest %EWL and %TWL, while LSG induced the earliest and largest weight plateau and weight regain during 5-years post-surgery. The pattern of early weight loss could predict the mid-term outcome of bariatric surgery. So, early identification of suboptimal weight loss could enhance long-term weight loss.
Collapse
Affiliation(s)
- Mahsa Hatami
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran
| | | | - Ali Kabir
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Vital R, Navez J, Gunes S, Tonneau C, Mehdi A, Moussaoui IE, Closset J. Long-Term Outcomes 10 Years after Laparoscopic Sleeve Gastrectomy: a Single Center Retrospective Analysis. Obes Surg 2023; 33:2356-2360. [PMID: 37382873 DOI: 10.1007/s11695-023-06709-w] [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: 03/24/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure in the world. The aim of the study was to evaluate outcomes after 10 years. METHODS Patients who underwent LSG between 2005 and 2010 in a single center were retrospectively assessed, focusing mainly on the percentage of excess weight loss (%EWL) after 10 years. Inadequate weight loss was defined as a %EWL < 50% or the need to perform a revisional bariatric surgery. RESULTS Overall, 149 patients underwent LSG, with a median preoperative body mass index of 42.0 ± 6.5 kg/m2. Ten patients (6.7%) underwent previous bariatric procedure. Patients eating behavior was described as volume eaters in 73 (49%), sweet eaters in 11 (7.4%) and both volume and sweet eaters in 65 (43.6%). Six patients died during follow-up and 25 patients were lost to follow-up, leaving 118 (79%) patients who completed full follow-up. Thirty-five patients (23.5%) needed a revisional bariatric surgery. For the 83 remaining patients, the mean %EWL was 35.9% at 10 years, only 23 of 83 patients (27.7%) had a %EWL ≥ 50%. Thus 80.5% patients (95/118) experienced inadequate weight loss 10 years after LSG. A lower %EWL after 1 year was predictive for inadequate weight loss after 10 years. CONCLUSION Ten years after LSG, the rate of inadequate weight loss was high, reaching 80% of patients. Thirty percent of patients required a revisional bariatric procedure. New studies must try to identify patients who are good candidates for LSG and strategies to improve long-term outcomes.
Collapse
Affiliation(s)
- Roxane Vital
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Seda Gunes
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Camille Tonneau
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Abdelilah Mehdi
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Imad El Moussaoui
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium.
| |
Collapse
|
5
|
Hany M, Zidan A, Sabry K, Ibrahim M, Agayby ASS, Aboelsoud MR, Torensma B. How Good is Stratification and Prediction Model Analysis Between Primary and Revisional Roux-en-Y Gastric Bypass Surgery? A Multi-center Study and Narrative Review. Obes Surg 2023; 33:1431-1448. [PMID: 36905504 PMCID: PMC10156787 DOI: 10.1007/s11695-023-06532-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTIONS Revision surgery because of weight recurrence is performed in 2.5-33% of primary vertical banded gastroplasty (VBG), laparoscopic sleeve gastrectomy (LSG), and gastric band (GB) cases. These cases qualify for revisional Roux-en-Y gastric bypass (RRYGB). METHODS This retrospective cohort study analyzed data from 2008 to 2019. A stratification analysis and multivariate logistic regression for prediction modeling compared the possibility of sufficient % excess weight loss (%EWL) ≥ 50 or insufficient %EWL < 50 between three different RRYGB procedures, with primary Roux-en-Y gastric bypass (PRYGB) as the control during 2 years of follow-up. A narrative review was conducted to test the presence of prediction models in the literature and their internal and external validity. RESULTS A total of 558 patients underwent PRYGB, and 338 underwent RRYGB after VBG, LSG, and GB, and completed 2 years of follow-up. Overall, 32.2% of patients after RRYGB had a sufficient %EWL ≥ 50 after 2 years, compared to 71.3% after PRYGB (p ≤ 0.001). The total %EWL after the revision surgeries for VBG, LSG, and GB was 68.5%, 74.2%, and 64.1%, respectively (p ≤ 0.001). After correcting for confounding factors, the baseline odds ratio (OR) or sufficient %EWL ≥ 50 after PRYGB, LSG, VBG, and GB was 2.4, 1.45, 0.29, and 0.32, respectively (p ≤ 0.001). Age was the only significant variable in the prediction model (p = 0.0016). It was impossible to develop a validated model after revision surgery because of the differences between stratification and the prediction model. The narrative review showed only 10.2% presence of validation in the prediction models, and 52.5% had external validation. CONCLUSION Overall, 32.2% of all patients after revisional surgery had a sufficient %EWL ≥ 50 after 2 years, compared to PRYGB. LSG had the best outcome in the revisional surgery group in the sufficient %EWL group and the best outcome in the insufficient %EWL group. The skewness between the prediction model and stratification resulted in a partially non-functional prediction model.
Collapse
Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Bariatric Surgery at Madina Women's Hospital (IFSO-Certified Bariatric Center), Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Karim Sabry
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Moustafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
| |
Collapse
|
6
|
Abu-Abeid A, Goren O, Abu-Abeid S, Dayan D. One Anastomosis Gastric Bypass for Revision of Restrictive Procedures: Mid-Term Outcomes and Analysis of Possible Outcome Predictors. Obes Surg 2022; 32:3264-3271. [PMID: 35953635 DOI: 10.1007/s11695-022-06235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/16/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors. MATERIALS AND METHODS Single-center retrospective comparative study of revisional OAGB outcomes (2015-2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed. RESULTS In all, 203 patients underwent revisional OAGB following LAGB (n = 125), SG (n = 64), and SRVG (n = 14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3 ± 6.6 and 42 ± 11.2 kg/m2 (p = 0.64), reduced to 31.3 ± 8.3 and 31.9 ± 8.3 (p = 0.64) at mid-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in ~ 50%, with EWL of 79.4 ± 20.4% (corresponding total weight loss 38.5 ± 10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p = 0.47 and p = 0.46), respectively. In univariable analysis, EWL > 50% was associated with male gender (p < 0.001), higher weight (p < 0.001), and BMI (p = 0.007) at primary surgery, and higher BMI at revisional OAGB (p < 0.001). In multivariable analysis, independent predictors for EWL > 50% were male gender (OR = 2.8, 95% CI 1.27-6.18; p = 0.01) and higher BMI at revisional OAGB (OR = 1.11, 95% CI 1.03-1.19; p = 0.006). CONCLUSION Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL > 50% following revisional OAGB. Identification of more predictors could aid judicious patient selection.
Collapse
Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel. .,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Or Goren
- Division of Anesthesiology, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Hatami M, Pazouki A, Kabir A. Excessive weight loss after bariatric surgery: a prediction model retrospective cohort study. Updates Surg 2022; 74:1399-1411. [PMID: 35779229 DOI: 10.1007/s13304-022-01319-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
Bariatric surgery has been recognized as the most effective long-term treatment for morbid obesity. Despite the considerable positive results, adverse consequence can develop. Excessive Weight Loss (EXWL), a rare consequence of bariatric surgery, can lead to a broad adverse consequence. The aim of this study was determining of prevalence and the predicting model of EXWL in patient underwent bariatric surgery until 24 months after surgery. Data have been extracted from the National Obesity Surgery Database in obesity clinic of Iran University of Medical Sciences. The subjects of this retrospective cohort study were morbid obese individuals who underwent three various types of bariatric surgery [One Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), or Sleeve Gastrectomy (SG)] in period of 24 months ago. EXWL has been defined as reaching to less than or equal to BMI 18.5 at any time until 24 months after surgery. SPSS was used in data analysis. Among 4214 subjects of this study, most excess weight loss after surgery has taken place in 18 months after surgery. 11.4% (n = 495) of patients experienced EXWL with highest percentage among OAGB patients (15.1%) at time of 24 months after surgery. The females (20.4% vs.9.9%) and younger persons (35.45 ± 10.25 vs. 39.06 ± 10.76) were more susceptible to EXWL. Patients with EXWL had significantly lower BMI (body mass index) (41.11 ± 4.51 vs. 46.73 ± 6.26) (Kg/m2), and were less probable to had emotional eating. Visceral fat level, fat percentage, and BMI were the best predictor of EXWL (P value for all < 0.05). So that per level increase in visceral fat, decreases the probability of EXWL as 47% and 61% in SG and OAGB. Moreover, each unit lower BMI leads to 25% higher susceptibility to experience EXWL. Surgery should be adjusted in younger females with a lower BMI and healthy metabolic status who are more prone to EXWL. In such a way that minimize weight loss speed/value. It may be possible by selection of other surgery procedures, rather than OAGB, tighter follow-ups, and consultations of patients after surgery is emphasized for more EXWL vulnerable patients.
Collapse
Affiliation(s)
- Mahsa Hatami
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.,Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.,Center of Excellence of International Federation for Surgery of Obesity, Hazrat E Rasool Hospital, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
8
|
Rodríguez F, Herrera A, Sepúlveda EM, Guilbert L, Hernández LA, Peñuñuri LF, Rodríguez FM, Zerrweck C. Weight loss before bariatric surgery and its impact on poor versus excellent outcomes at 2 years. Langenbecks Arch Surg 2022; 407:1047-1053. [PMID: 35013797 DOI: 10.1007/s00423-021-02399-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify preoperative factors that influence the outcomes of gastric bypass surgery, in terms of excess weight loss at 24 months. METHODS This retrospective study included two groups of patients who underwent laparoscopic gastric bypass surgery. Group A (poor outcomes) had ≤ 50%EWL or BMI ≥ 30 kg/m2; group B (excellent outcomes) had ≥ 80%EWL at 24 months. A comparative analysis of demography, anthropometry, comorbidities, and metabolic status was performed. A linear regression model was used to evaluate %EWL association; the number of preoperative and postoperative consultations were also compared. RESULTS A total of 202 patients completed follow-up; 71 (35.1%) and 78 (38%) had poor and excellent outcomes (%EWL 44.1 ± 9.4% vs. 92 ± 10.9%), respectively. Mean age was 40.4 ± 8.9 years. Patients with poor outcomes had higher weight and BMI, lesser preoperative %EWL, higher dyslipidemia and diabetes rates with longer periods of evolution, and increased HbA1c% levels. In the linear regression analysis, preoperative %EWL and initial and preoperative BMI were statistically significant determinants of %EWL at 24 months Diabetes remission was 46.2% (group A) vs. 66.6% (group B). Group A had higher non-attendance rates after surgery. CONCLUSION The factors independently associated with greater %EWL at 24 months between groups were higher preoperative %EWL, and lower initial and preoperative BMI.
Collapse
Affiliation(s)
- Fernando Rodríguez
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Antonio Herrera
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Lizbeth Guilbert
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Louis A Hernández
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Luis F Peñuñuri
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Fátima M Rodríguez
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico
| | - Carlos Zerrweck
- The Obesity Clinic at Hospital General Tláhuac, Avenida la Turba # 655, Col. Villa Centroamericana y del Caribe, Delegación Tláhuac, 13250, México City, Mexico.
| |
Collapse
|
9
|
Jacobs K, Vleeschouwers W, Debergh I, Haesen D, Dillemans B. Laparoscopic Adjustable Gastric Banding with the Adhesix® Bioring® for Weight Regain or Insufficient Weight Loss After a Roux-en-Y Gastric Bypass: Midterm Data from the Pronto Registry. Obes Surg 2021; 31:4295-4304. [PMID: 34275109 DOI: 10.1007/s11695-021-05537-0] [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: 01/13/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Although Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures, insufficient weight loss is described to be as high as 20-35%. To treat weight regain/inadequate weight loss, laparoscopic adjustable gastric banding (LAGB) could be a feasible revisional strategy. MATERIALS AND METHODS We report on a prospective study which included 35 patients who presented inadequate weight loss or significant weight regain after primary RYGB (percentage excess weight loss [%EWL] at revision < 50%). All patients underwent revisional LAGB with the placement of an Adhesix® Bioring® adjustable gastric band (Cousin Biotech, Wervicq-Sud, France). Patients' weight loss, complications, frequency of revisions and quality of life were evaluated. RESULTS Follow-up data at 24 months are available for 80% of the included patients. The mean BMI before RYGB was 43.6 ± 5.4 kg/m2 and before revisional LAGB was 38.8 ± 4.3kg/m2. The %EWL before revisional surgery was 23.3 ± 24.8%. The average time between both procedures was 6.7 (mean) ± 3.6 (SD) years. Twenty-four months after revisional LAGB, the average BMI calculated from the weight at RYGB dropped to 32.0 ± 4.5 kg/m2, with an additional %EWL of 49.9 ± 30.3% resulting in a total %EWL of 60.7 ± 28%. The reoperation rate for complications related to LAGB was 21.2%. No band erosions occurred, but two bands needed to be removed during the study. CONCLUSION Revisional LAGB may be considered a valid salvage procedure in patients with weight regain or inadequate weight loss after RYGB, though band- and port-related complications remain a notable concern.
Collapse
Affiliation(s)
- Karen Jacobs
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Bruges, Belgium.
| | - Wouter Vleeschouwers
- Department of General Surgery, AZ Sint-Elisabeth Zottegem, 9620 Zottegem, Godveerdegemstraat 69, Belgium
| | - Isabelle Debergh
- Department of general surgery, AZ Delta Hospital, 8820 Torhout, Sint-Rembertlaan 21, Belgium
| | - Dorien Haesen
- Archer Research CRO, Agoralaan Building A bis, 3590, Diepenbeek, Belgium
| | - Bruno Dillemans
- Department of Bariatric & Post-Bariatric Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Bruges, Belgium
| |
Collapse
|
10
|
Pañella C, Busto M, González A, Serra C, Goday A, Grande L, Pera M, Ramón JM. Correlation of Gastric Volume and Weight Loss 5 Years Following Sleeve Gastrectomy. Obes Surg 2021; 30:2199-2205. [PMID: 32065338 DOI: 10.1007/s11695-020-04445-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The volume of the gastric reservoir (VGR) after sleeve gastrectomy influences weight loss in the short-term, but long-term results are scarce. The aim was to analyze the correlation between the VGR and weight loss at 5 years of follow-up. METHODS It is a prospective observational study of 50 patients undergoing sleeve gastrectomy (SG) from February 2009 to December 2013. An upper gastrointestinal series was performed at 1 month and at 1 and 5 years after surgery. A composite formula was used for VGR estimation. Weight loss-related data included the following: body mass index (BMI), percentage of excess weight loss (%EWL), and percentage of excess BMI loss (%EBMIL) at 1 month and at 1 and 5 years. Uni- and multivariate analyses were carried out to determine other factors that might influence long-term weight loss results. RESULTS The %EWL at 1 year was 74.5(63.8-86) vs. 55.5(47-74.3) at 5 years (p < 0.001). The VGR 1 month after surgery was 114.9 (90.5-168.3) mL. The VGR increased from 216.7 (155.1-278.6) to 367.5 (273-560.3) mL (p < 0.001) at 1 and 5 years. Although a significant inverse correlation was observed between VGR and BMI, %EWL, and %EBMIL at 1 year, it disappeared at 5 years. In the multivariate analysis, the main factor to predict worse weight results at 5 years was a pre-surgical BMI ≥ 50 kg/m2. CONCLUSION The VGR increased progressively during the study period. Although an inverse relationship between VGR and weight was found at 1 year, this correlation did not remain at 5 years. A preoperative BMI ≥ 50 kg/m2 is the main predictive factor of poor weight outcomes.
Collapse
Affiliation(s)
- Clara Pañella
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain. .,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - Marcos Busto
- Department of Radiology, Hospital del Mar, Barcelona, Spain
| | - Alba González
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain
| | - Carme Serra
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain
| | - Alberto Goday
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Endocrinology, Hospital del Mar, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,CiberOBN, Instituto de Salud Carlos III, Madrid, Spain
| | - Luís Grande
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Department of Surgery, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José M Ramón
- Bariatric and Metabolic Surgery Unit, Section of Gastrointestinal Surgery, Hospital del Mar, Barcelona, Spain.,Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| |
Collapse
|
11
|
Hussein AH, Khaled I, Faisal M. The role of the surgical resection distance from the pylorus after laparoscopic sleeve gastrectomy: a prospective cohort study from an academic medical center in Egypt. Patient Saf Surg 2020; 14:42. [PMID: 33292433 DOI: 10.1186/s13037-020-00270-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/09/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy was recently described as an effective approach for the operative treatment of obesity, but the ideal procedure remains controversial. One of the most debated issues is the resection distance from the pylorus. We conducted this study to elucidate any potential differences in the short-term outcomes between 2 and 6 cm distance from the pylorus in laparoscopic sleeve gastrectomy. METHODS A prospective observational cohort study in a selected cohort of 96 patients was conducted from January 2018 to March 2019 in morbidly obese patients who had laparoscopic sleeve gastrectomy performed at Suez Canal University Hospital. Outcome was expressed by excess weight loss percentage, resolution of comorbidities, improvement of quality of life, and incidence of complications after laparoscopic sleeve gastrectomy. The morbidly obese patients (body mass index [BMI] > 40 kg/m2 or > 35 kg/m2 with obesity-related comorbidities) in the study were divided into two equal groups: (1) Group 1 (48 patients) underwent laparoscopic sleeve gastrectomy with a 2 cm distance from the pylorus resection distance and (2) Group 2 (48 patients) underwent laparoscopic sleeve gastrectomy with a 6 cm distance from the pylorus resection distance. Body weight, BMI, bariatric quality of life, lipid profile, and comorbidities were evaluated pre- and post-operatively for a duration of 12 months. RESULTS Statistically, no significant differences between the two study groups regarding the excess weight loss percentage, comorbidity resolution throughout the postoperative follow-up, enhancement of the quality of life score throughout the postoperative follow-up, or incidence of complications (25% in Group 1 versus 25% in Group 2, p > 0.05) were found. CONCLUSION Laparoscopic sleeve gastrectomy was an effective and safe management for morbid obesity and obesity-related comorbidities with significant short-term weight loss; it also improved weight-related quality of life and had an acceptable complication rate. The distance from the pylorus resection distance did not affect the short-term effects of laparoscopic sleeve gastrectomy regarding excess weight loss percentage, resolution of comorbidities, change in quality of life, or occurrence of complications.
Collapse
|
12
|
Farraj M, Khoury T, Waksman I, Gedalia U, Bramnik Z, Sbeit W. The role of bariatric surgery in normalization of the coagulation profiles. Surg Obes Relat Dis 2020; 17:548-554. [PMID: 33317991 DOI: 10.1016/j.soard.2020.10.025] [Citation(s) in RCA: 1] [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: 06/21/2020] [Revised: 09/10/2020] [Accepted: 10/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Bariatric surgery achieves appropriate excess weight loss, controlling related co-morbidities, including coagulation abnormalities. OBJECTIVE We investigated the change in the coagulation profile after postoperative weight stabilization, correlating between EWL ratio and change in the coagulation profile. SETTING This study took place in our teaching institution (university setting). METHODS Between the years 2012 and 2014, 67 patients underwent surgery; 47 patients underwent laparoscopic sleeve gastrectomy (SG) and 20 patients underwent Roux-en-Y gastric bypass (RYGB). Average follow-up of postoperative thromboelastography (TEG) parameters was 30 ± 10.8 months (12-77). Average body mass index (BMI) before surgery was 41.7 ± 4.6kg/m2, average percentage of EWL at the time of data collection was 79%. Patients were divided into 3 groups, 6 patients had EWL < 50%, 13 had an EWL > 100%, and 48 had EWL between 50% and 100%. EXCLUSION CRITERIA use of anticoagulation, antiplatelet, or contraceptive medications; known thrombophilic, renal, hepatic, and hematologic diseases/disorders. Two follow-up groups: 1-2 years and over 2 years. Patients underwent pre and postoperative TEG coagulation studies, including maximal amplitude (MA), and clot strength (G). RESULTS Coagulation profile improved after bariatric surgery. Most prominent change seen in MA and G. There was a linear correlation between the EWL ratio and improvement of MA values starting at 50% EWL peaking at 60%-70%. There was no difference in the coagulation profile after surgery in the two surgery groups (SG and RYGB). CONCLUSIONS Achieving appropriate weight loss after bariatric surgery improves the coagulation profile as measured by TEG, probably decreasing thromboembolic risk in those patients. We recommend expanding the current indication for bariatric surgery to include patients with altered coagulation profile measured by TEG.
Collapse
Affiliation(s)
- Moaad Farraj
- General Surgery B, Galilee Medical Center, Nahariya, Israel.
| | - Tawfik Khoury
- General Surgery B, Galilee Medical Center, Nahariya, Israel
| | - Igor Waksman
- General Surgery B, Galilee Medical Center, Nahariya, Israel
| | - Uri Gedalia
- Memorial Hermann Hospital Medical Center, Houston, Texas
| | - Zakhar Bramnik
- General Surgery B, Galilee Medical Center, Nahariya, Israel
| | - Wisam Sbeit
- General Surgery B, Galilee Medical Center, Nahariya, Israel
| |
Collapse
|
13
|
Smelt HJM, Van Rijn S, Pouwels S, Aarts MPW, Smulders JF. The Influence of Different Alimentary and Biliopancreatic Limb Lengths in Gastric Bypass Patients. Obes Surg 2020; 31:481-489. [PMID: 33052551 DOI: 10.1007/s11695-020-05028-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to compare the effect of two different limb lengths after RYGB on weight loss, postoperative gastro-intestinal complications, and vitamin deficiencies. MATERIALS AND METHODS A retrospective analyses of 100 patients after RYGB with 2 different limb lengths were done. Group A (50 patients) had a biliopancreatic limb (BPL) of 75 cm and an alimentary limb (AL) of 150 cm. Group B (50 patients) had a BPL of 150 cm and an AL of 75 cm. The effect on weight loss, body mass index, excess weight loss (EWL), total weight loss (TWL), and postoperative complications was analyzed up to 2 years postoperatively. RESULTS Patients with a longer BPL achieved significantly more %EWL compared to a shorter BPL 2 years postoperatively (82.8 ± 31.2 versus 93.8 ± 15.1; p = 0.038). A significant difference was also seen in %TWL after 1 year (30.3 ± 10.1 versus 37.4 ± 6.9; p < 0.01) and 2 years (31.6 ± 7.5 versus 35.6 ± 8.6; p = 0.022), both in favor of group B. However, patients with a longer BPL (group B) showed significant more diarrhea and steatorrhea compared to group A (p < 0.01). CONCLUSION BPL of 150 cm is associated with more %EWL and %TWL 2 years after RYGB. However, it is accompanied by an increase of diarrhea and steatorrhea to disadvantage off group B. Future studies need to focus on further tailoring BPL and AL lengths to achieve the best possible outcomes for patients with morbid obesity.
Collapse
Affiliation(s)
- H J M Smelt
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands. .,Department of Surgery, Catharina Hospital, Michelangelolaan 2 P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands.
| | - S Van Rijn
- Department of Surgery, University Medical Center Maastrischt, Maastricht, The Netherlands
| | - S Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - M P W Aarts
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - J F Smulders
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands.,Department of Surgery, Catharina Hospital, Michelangelolaan 2 P.O. Box 1350, 5602, ZA, Eindhoven, The Netherlands
| |
Collapse
|
14
|
Yuksel A, Coskun M, Karaman K. The role of extended antral resection on weight loss and metabolic response after sleeve gastrectomy: A retrospective cohort study. Pak J Med Sci 2020; 36:1228-1233. [PMID: 32968385 PMCID: PMC7501036 DOI: 10.12669/pjms.36.6.2321] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The impact of extended antral resection (AR) after laparoscopic sleeve gastrectomy (LSG) on clinical results is still not clearly elucidated with conflicting results. Our study aimed to determine whether AR is superior to antral preservation (AP) regarding clinical results. Methods: Patients were divided into two groups according to the distance of gastric division as AR group (2cm from pylorus) and AP group (6cm from pylorus). Postoperative excess weight loss percentile (%EWL) and total body weight loss percentiles (%TBWL) at the end of first, 6th and 12 months were compared. Secondly, metabolic parameters and complications were compared. Results: The first 68 patients underwent AP, and the following 43 patients underwent AR. Although statistically not significant, AR achieve more %EWL and %TBWL at the end of the first year, (P>0.05). On the other hand, metabolic parameters were similar at the end of the first year, (P>0.05). Resolution of comorbidities were statistically not different, (P>0.05). Staple line leak occurred in two patients of the AR group (4.7%) and two patients of the AP group (2.9%), (P>0.05). Conclusion: Both AR and AP seem to be equally effective in resolution of metabolic response. Although statistically not significant- AR provided more %EWL and %TBWL at the end of 12 months.
Collapse
Affiliation(s)
- Adem Yuksel
- Adem Yuksel, Derince Teaching and Research Hospital, Department of Gastroenterological Surgery, Kocaeli, Turkey
| | - Murat Coskun
- Murat Coskun, Derince Teaching and Research Hospital, Department of General Surgery, Kocaeli, Turkey
| | - Kerem Karaman
- Kerem Karaman Sakarya University, Faculty of Medicine, Department of Gastroenterological Surgery, Sakarya, Turkey
| |
Collapse
|
15
|
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.
Collapse
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.
| |
Collapse
|
16
|
Abstract
BACKGROUND Some weight regain is expected after bariatric surgery; however, this concept is not well defined. A favorable weight loss response has commonly been defined as 50% excess weight loss (EWL). The medical literature uses %total weight loss (%TWL), which has recently been adopted in some surgical literature. OBJECTIVE To demonstrate variability in bariatric surgery outcomes based on the definition applied and propose a standardized definition. METHODS A retrospective review of patients who underwent bariatric surgery from 2001 to 2016 with ≥ 1 year follow-up was completed. Several previously proposed definitions of weight regain were analyzed. RESULTS One thousand five hundred seventy-four patients met inclusion criteria. Preoperative mean body mass index (BMI) was 47.6 ± 6.4 kg/m2. Increased preoperative BMI was associated with increased mean %TWL at 2 years postoperative (29.3 ± 9.1% for BMI < 40, vs. 37.5 ± 9.5% for BMI > 60; P < 0.001). Based on %EWL, 93% of patients experienced ≥ 50% EWL by 1-2 years, and 61.8% maintained ≥ 50% EWL through the 10-year follow-up period. Similarly, 97% experienced ≥ 20% TWL by 1-2 years and 70.3% maintained ≥ 20% TWL through the 10-year follow-up period. Over 50% of patients maintained their weight based on several proposed definitions through 5 years follow-up. CONCLUSIONS A high percentage (> 90%) of patients achieve ≥ 20% TWL and ≥ 50% EWL. Increased preoperative BMI was associated with increased %TWL and decreased %EWL at 2 years postoperative. The incidence of weight regain varies depending on the definition. We propose a standardized definition for identifying good responders following bariatric surgery to be ≥ 20% TWL, as this measure is least influenced by preoperative BMI.
Collapse
Affiliation(s)
- Brandon T Grover
- Department of General Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI, 54601, USA.
| | - Michael C Morell
- Minimally Invasive Bariatric Surgery and Advanced Laparoscopy Fellowship, Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Shanu N Kothari
- Department of General Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI, 54601, USA
| | - Andrew J Borgert
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA
| | - Matthew T Baker
- Department of General Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI, 54601, USA
| |
Collapse
|
17
|
Amor IB, Petrucciani N, Kassir R, Malyshev E, Mazoyer C, Korkmaz C, Debs T, Gugenheim J. Midterm Outcomes of Gastric Pouch Resizing for Weight Regain After Roux-en-Y Gastric Bypass. Obes Surg 2020; 30:2723-8. [PMID: 32356094 DOI: 10.1007/s11695-020-04560-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Resizing of the gastric pouch, with eventually resizing of the gastrojejunal anastomosis, has been proposed as revisional procedure to treat weight regain after Roux-en-Y gastric bypass (RYGB), in patients with large gastric pouch and/or large gastrojejunal (GJ) anastomosis. The aim of this study is to determine the midterm results and the safety of laparoscopic resizing of the gastric pouch after RYGB in cases where gastric pouch is > 200 ml and/or GJ anastomosis > 20 mm. MATERIALS AND METHODS All patients who underwent gastric pouch resizing between January 2009 and December 2016 were retrospectively reviewed from a prospective database. The gastric pouch was resized to a volume of 30-40 ml. RESULTS A total of 48 patients had gastric pouch resizing after RYGB. The mean initial BMI was 42.9 ± 4.8 kg/m2. Perioperative morbidity was 8.3% in this series. Mean follow-up was 5.4 years. The mean BMI was 30.0 ± 7.3 kg/m2 at 1 year, 30.0 ± 6.0 kg/m2 at 3 years, and 30.9 ± 5.7 kg/m2 at 5 years. Mean %EBMIL at 1-, 3-, and 5-year follow-up was 51.9%, 55.1%, and 39%, respectively, in 48% follow-up rate. The obesity-related comorbidities disappeared in 67.3% of cases at maximum follow-up. CONCLUSIONS In carefully selected patients with gastric pouch size > 200 ml and/or GJ anastomosis > 20 mm, and after extensive preoperative evaluation, gastric pouch resizing is a potentially effective option to treat weight regain due to anatomical factors after RYGB, with complication rate of 8%.
Collapse
|
18
|
Abstract
PURPOSE Conditions associated with surgical technique and postoperative lifestyle changes, as well as the characteristics of patients, may affect weight loss following laparoscopic sleeve gastrectomy. In this study, the effects of age, gender, BMI, and excess weight at the time of surgery on weight loss during follow-up were examined. MATERIALS AND METHODS Demographic data (age, gender), preoperative BMI, and weight values of the patients were recorded. TWL% and EWL% values of patients were recorded during follow-up at 1st, 3rd, 6th, 9th, 12th, and 18th months. Patients were grouped according to age (AGE1 < 30, AGE2 30-50, AGE3 ≥ 50 years), BMI at the time of surgery (BMI1 ≤ 50, BMI2 > 50 kg/m2), and EW at the time of surgery (EW1 ≤ 60, EW2 > 60 kg). EWL% values obtained in the follow-up visits were compared among the gender, age, BMI, and EW groups. RESULTS A total of 456 patients (371 females, 85 males) were operated. Mean EWL% was lower in AGE3 group (p < 0.001). Patients in AGE1 group had the highest mean EWL%, while those in BMI2 and EW2 groups had lower mean EWL% values throughout the follow-up period (p < 0.001). Regression analysis showed that age and BMI were associated with EWL% at all follow-up visits (p < 0.05). CONCLUSION Patients with less than 60 kg of excess weight, those with BMI ≤ 50 kg/m2 and younger patients may lose weight more effectively following LSG.
Collapse
Affiliation(s)
- Abdullah Sisik
- Umraniye Education and Research Hospital, General Surgery Department, University of Health Sciences, Elmalikent Mah. Adem Yavuz Cad. No: 1 Umraniye, Istanbul, Turkey.
| | - Fatih Basak
- Umraniye Education and Research Hospital, General Surgery Department, University of Health Sciences, Elmalikent Mah. Adem Yavuz Cad. No: 1 Umraniye, Istanbul, Turkey
| |
Collapse
|
19
|
Vallois A, Menahem B, Le Roux Y, Bion AL, Meunier H, Gautier T, Contival N, Mulliri A, Lubrano J, Parienti JJ, Alves A. Revisional Roux-en-Y Gastric Bypass: a Safe Surgical Opportunity? Results of a Case-Matched Study. Obes Surg 2019; 29:903-10. [PMID: 30467707 DOI: 10.1007/s11695-018-3606-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of revisional Roux-en-Y gastric bypass (RYGB) after adjustable gastric banding (AGB) or sleeve gastrectomy (SG) compared with primary RYGB, in regard to early and late morbidity, weight, and resolution of obesity-related comorbidities. METHODS The group of patients undergoing revisional RYGB was matched in a 1:1 ratio with control patient who underwent a primary RYGB, based on age, gender, American Society of Anesthesiologist (ASA) score, preoperative body mass index (BMI), and diabetes mellitus. Demographics, anthropometrics, preoperative work-up, and perioperative data were retrieved. RESULTS One hundred fifteen patients (16 males and 99 females) with a mean age of 45.5 ± 1.5 years underwent revisional RYGB following either LAGB in 82 patients (71.3%) or laparoscopic sleeve gastrectomy (LSG) in 33 patients (28.7%). There was no conversion and no mortality in either group. Revisional RYGB was associated with similar early (16.5 vs 15.6%, ns) and late (42.6% vs 32.2%, ns) morbidity rates with a mean follow-up of 25.3 ± 16.6 months compared to primary laparoscopic Roux-en-Y gastric bypass. The revisional RYGB group had significantly less weight loss (mean %EWL 67.4 ± 20.7 vs 72.7 ± 22.9, p = 0.023 and mean %EBMI 68.1 ± 22 vs 78.3 ± 25.7, p = 0.01) at the time of 1 year. Improvement of comorbidities including hypertension (62.5 vs 70.5%; p > 0.05), diabetes (73.7 vs 79%; p > 0.05), and obstructive sleep apnea syndrome (100 vs 97%; p > 0.05) was similar. CONCLUSION This large case-matched study suggests that conversion of SG or AGB to RYGB is feasible with early and late comparable morbidity in an accredited center; even weight results might be inferior.
Collapse
|
20
|
Tadokoro R, Iida T, Mikura K, Imai H, Murai N, Kaji M, Hashizume M, Kigawa Y, Endo K, Iizaka T, Otsuka F, Iso Y, Sanbe T, Nagasaka S. Factors involved in body weight loss and its maintenance in morbidly obese inpatients. Diabetol Int 2020; 11:41-8. [PMID: 31950003 DOI: 10.1007/s13340-019-00403-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/15/2018] [Accepted: 06/29/2019] [Indexed: 01/07/2023]
Abstract
Background Body weight loss in patients with obesity improves abnormal glucose tolerance, dyslipidemia and hypertension; however, it is difficult to maintain this loss of body weight. The objective of this study was to examine factors involved in body weight loss and its maintenance in morbidly obese inpatients. Method The subjects were 31 patients (11 males and 20 females) who were admitted to hospital for obesity management. Factors involved in body weight changes during hospitalization and after discharge were examined retrospectively. The mean age was 58.1 ± 13.6 years and body mass index (BMI) was 40.2 ± 10.2 kg/m2. Twenty-four patients were complicated with type 2 diabetes mellitus. Diet therapy was 23.8 ± 3.9 kcal/kg ideal body weight/day. Results Excess weight loss (EWL) during hospitalization varied from 4.2 to 61.7%. Since EWL was affected by duration of hospital stay, the subjects were divided by the median of EWL per day. The subjects with greater EWL per day had lower body weight, BMI and fat mass on admission in the entire (n = 31), diabetic (n = 24), and non-diabetic subjects (n = 7), respectively. EWL per day was not different between diabetic and non-diabetic subjects. Follow-up data revealed that BMI remained unchanged 3 months after discharge but modestly increased 1 year after discharge, irrespective of EWL per day during hospitalization. In diabetic subjects followed up 1 year after discharge (n = 15), the increase in body weight was smaller than that in non-diabetic subjects (n = 3). Conclusion These results suggest that EWL in morbidly obese inpatients is greater than those with lower baseline BMI and fat mass. The presence of diabetes had no effects on EWL during hospitalization. EWL during hospitalization was not correlated with its maintenance after discharge. Diabetic patients displayed lesser degree of body weight gain after discharge, possibly due to the effects of anti-diabetic medications.
Collapse
|
21
|
Abstract
BACKGROUND One anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) is considered an alternative option in metabolic and bariatric surgery. The aim of this study was to evaluate the safety, efficacy and postoperative challenges of OAGB/MGB as a new procedure. METHODS We performed 519 primary MGBs and 8 additional second-stage MGBs during 2014-2018. The data were collected from patients' notes as well as the surgeons' prospective data sheets. Two senior surgeons performed the operations. The ultimate primary measures were assessment of the safety and management of the complications. The secondary outcomes were excess weight loss and resolution of the comorbidities. RESULTS The type 2 diabetes mellitus (T2DM) remission rate was 83% and 70% over 1 and 3 years, respectively (HBA1C < 6.5%). Weight loss was 28-152 kg (SD 23.11). Excess weight loss ranged from 41 to 125%. Hypertension resolution was 61%, 58% and 58% in the first, second and third years, respectively. Ninety-nine per cent of sleep apnoea patients improved symptomatically and went off the continuous positive airway pressure (CPAP) machine. Two (0.37%) patients developed diarrhoea, cured by shortening the afferent biliopancreatic limb (BPL). Eight (1.5%) stomal ulcers were reported. Two patients (0.37%) developed deranged liver function, revised by shortening the BPL in one patient and a reversal in the second patient. The mean follow-up was 2.5 years. Mortality was zero. CONCLUSIONS This is the largest UK OAGB/MGB study to date showing safety and acceptable results for metabolic syndrome and obesity problems. OAGB/MGB revisional options are rectifying the morbidity and no mortality.
Collapse
Affiliation(s)
- A Hussain
- Doncaster Royal Infirmary, Doncaster and Bassetlaw Teaching Hospitals, Doncaster, DN2 5LT, UK.
| | | |
Collapse
|
22
|
Mauriello C, Chouillard E, d'alessandro A, Marte G, Papadimitriou A, Chahine E, Kassir R. Retrospective Comparison of Single-Port Sleeve Gastrectomy Versus Three-Port Laparoscopic Sleeve Gastrectomy: a Propensity Score Adjustment Analysis. Obes Surg 2019; 28:2105-2112. [PMID: 29663249 DOI: 10.1007/s11695-018-3244-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/19/2022]
Abstract
PURPOSE Evaluate the efficacy of single-port sleeve gastrectomy (SPSG) and then compare it to a less-invasive sleeve approach (three-port) (3PSG) according to a propensity score (PS) matching analysis. MATERIALS AND METHODS We analyzed all patients who underwent SG through a three-port or a single-port laparoscopic approach. RESULTS After 2 years, the follow-up was completed in 84% patients treated with 3PSG and 95% patients of the SPSG group. Excess weight loss (EWL) was comparable for the first year of follow-up within the two groups except for the controls at 3 months in which the SPSG group showed a higher EWL (p = 0.0243). CONCLUSION We demonstrated the efficacy of SPSG in bariatric surgery even compared to another, less invasive, laparoscopic SG approach (three-port).
Collapse
Affiliation(s)
- Claudio Mauriello
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Elie Chouillard
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Antonio d'alessandro
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Gianpaolo Marte
- Department of Surgery, Regional Center for HPB Surgery, Regional Hospital of Treviso, 31100, Treviso, Italy
| | - Argyri Papadimitriou
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Elias Chahine
- Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, La réunion, Saint Denis, France. .,Department of Bariatric Surgery, CHU Felix-Guyon, La réunion, Saint Denis, France.
| |
Collapse
|
23
|
Sherf-Dagan S, Zelber-Sagi S, Buch A, Bar N, Webb M, Sakran N, Raziel A, Goitein D, Keidar A, Shibolet O. Prospective Longitudinal Trends in Body Composition and Clinical Outcomes 3 Years Following Sleeve Gastrectomy. Obes Surg 2019; 29:3833-3841. [PMID: 31301031 DOI: 10.1007/s11695-019-04057-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Longitudinal assessment of body composition following bariatric surgery allows monitoring of health status. Our aim was to elucidate trends of anthropometric and clinical outcomes 3 years following sleeve gastrectomy (SG). METHODS A prospective cohort study of 60 patients who underwent SG. Anthropometrics including body composition analysis measured by multi-frequency bioelectrical impedance analysis, blood tests, liver fat content measured by abdominal ultrasound and habitual physical activity were evaluated at baseline and at 6 (M6), 12 (M12), and 36 (M36) months post-surgery. RESULTS Sixty patients (55% women, age 44.7 ± 8.7 years) who completed the entire follow-up were included. Fat mass (FM) was reduced significantly 1 year post-surgery (55.8 ± 11.3 to 26.7 ± 8.3 kg; P < 0.001) and then increased between 1 and 3 years post-operatively, but remained below baseline level (26.7 ± 8.3 to 33.1 ± 11.1 kg; P < 0.001). Fat free mass (FFM) decreased significantly during the first 6 months (64.7 ± 14.3 to 56.9 ± 11.8 kg; P < 0.001), slightly decreased between M6 and M12 and then reached a plateau through M36. Weight loss "failure" (< 50% excess weight loss) was noticed in 5.0% and 28.3% of patients at M12 and M36, respectively. Markers of lipid and glucose metabolism changed thereafter in parallel to the changes observed in FM, with the exception of HDL-C, which increased continuingly from M6 throughout the whole period analyzed (45.0 ± 10.2 to 59.5 ± 15.4 mg/dl; P < 0.001) and HbA1c which continued to decrease between M12 and M36 (5.5 ± 0.4 to 5.3 ± 0.4%; P < 0.001). There were marked within-person variations in trends of anthropometric and clinical parameters during the 3-year follow-up. CONCLUSIONS Weight regain primarily attributed to FM with no further decrease in FFM occurs between 1 and 3 years post-SG. FM increase at mid-term may underlie the recurrence of metabolic risk factors and can govern clinical interventions.
Collapse
Affiliation(s)
- Shiri Sherf-Dagan
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel. .,Department of Nutrition, Assuta Medical Center, 20 Habarzel St., 69710, Tel Aviv, Israel.
| | - Shira Zelber-Sagi
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel.,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Assaf Buch
- Institute of Endocrinology, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,School of Nutritional Sciences, The Hebrew University of Jerusalem, Rehovot, Israel
| | - Nir Bar
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Muriel Webb
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Nasser Sakran
- Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.,Department of Surgery A, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Asnat Raziel
- Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - David Goitein
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Israeli Center for Bariatric Surgery (ICBS), Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel.,Department of Surgery C, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Andrei Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, The Ben-Gurion University, Be'er Sheva, Israel
| | - Oren Shibolet
- Department Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
24
|
Hussain A, Van den Bossche M, Kerrigan DD, Alhamdani A, Parmar C, Javed S, Harper C, Darrien J, Singhal R, Yeluri S, Vasas P, Balchandra S, El-Hasani S. Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group. Int J Surg 2019; 69:13-18. [PMID: 31299430 DOI: 10.1016/j.ijsu.2019.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 03/06/2019] [Revised: 06/23/2019] [Accepted: 07/04/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Mini-One Anastomosis Gastric Bypass is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of MGB-OAGB procedures. The aim of this study is to report the causes and management of these revisions. METHODS From 2010 to 2018, 925 MGB-OAGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was the identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years. RESULTS Twenty-two patients [2.3%] required revisional surgery after MGB-OAGB. Five patients [0.5%] developed severe diarrhoea managed by shortening the bilio-pancreatic limb to 150 cm. Four patients [0.4%] developed afferent loop syndrome and bile reflux was reported in another 3 [0.3%] cases; all were managed by either conversion to Roux en Y Gastric Bypass or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients [0.3%]. Liver decompensation that was reported in 2 patients [0.2%] was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis [0.2%], one perforated ulcer [0.1%], one patient [0.1%] with excessive weight loss and one case [0.1%] of protein malnutrition. None of the 22 patients undergoing revisional surgery after MGB-OAGB died. Lost to follow up rate was 0.2%. CONCLUSION Complications requiring revisional surgery after MGB-OAGB are uncommon [2.3%] and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea.
Collapse
Affiliation(s)
- A Hussain
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom.
| | | | | | - A Alhamdani
- Whittington Hospital, London, United Kingdom
| | - C Parmar
- Whittington Hospital, London, United Kingdom
| | - S Javed
- Phoenix Health, Chester, United Kingdom
| | - C Harper
- Phoenix Health, Chester, United Kingdom
| | - J Darrien
- Phoenix Health, Chester, United Kingdom
| | - R Singhal
- Heart of England Hospital, Birmingham, United Kingdom
| | - S Yeluri
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - P Vasas
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - S Balchandra
- Doncaster and Bassetlaw Teaching Hospitals, Doncaster, United Kingdom
| | - S El-Hasani
- King's College Hospitals, London, United Kingdom; Chelsfield Park Hospital, United Kingdom
| |
Collapse
|
25
|
Nickel F, de la Garza JR, Werthmann FS, Benner L, Tapking C, Karadza E, Wekerle AL, Billeter AT, Kenngott HG, Fischer L, Müller-Stich BP. Predictors of Risk and Success of Obesity Surgery. Obes Facts 2019; 12:427-439. [PMID: 31416073 PMCID: PMC6758709 DOI: 10.1159/000496939] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 10/05/2018] [Accepted: 01/14/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Obesity surgery has proven successful for weight loss and the resolution of comorbidities. There is, however, little evidence on its success and the risk of complications when considering age of onset of obesity (AOO), years of obesity (YOO), preoperative body mass index (BMI), Edmonton obesity staging system (EOSS) score, and age as possible predictors of weight loss, the resolution of comorbidities, and the risk of complications. METHODS Patients who underwent Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) from a prospective database were analyzed. Multiple regression analyses were used to predict comorbidities and their resolution, percentage excess weight loss (%EWL) and total weight loss (%TWL) 12 months after surgery, and the risk of complications using the predictors AOO, YOO, age, EOSS, and BMI. RESULTS 180 patients aged 46.8 ± 11.1 years with a preoperative BMI 49.5 ± 7.5 were included. The number of preoperative comorbidities was higher with older age (β = 0.054; p = 0.023) and a greater BMI (β = 0.040; p = 0.036) but was not related to AOO and YOO. Patients with AOO as a child or adolescent were more likely to have an EOSS score of ≥2. Greater preoperative BMI was negatively associated with %EWL (β = -1.236; p < 0.001) and older age was negatively associated with %TWL (β = -0.344; p = 0.020). Postoperative complications were positively associated with EOSS score (odds ratio [OR] 1.147; p = 0.042) and BMI (OR 1.010; p = 0.020), but not with age. AOO and YOO were not related to postoperative outcome. CONCLUSION Greater BMI was associated with a lower %EWL and age was associated with a low %TWL. YOO and AOO did not influence outcome. Age, BMI, and EOSS score were the most important predictors for risk and success after obesity surgery. Surgery should be performed early enough for optimal outcomes.
Collapse
Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Javier R de la Garza
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Fabian S Werthmann
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Laura Benner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Christian Tapking
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Emir Karadza
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Anna-Laura Wekerle
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany,
| |
Collapse
|
26
|
Talebpour M, Sadid D, Talebpour A, Sharifi A, Davari FV. Comparison of Short-Term Effectiveness and Postoperative Complications: Laparoscopic Gastric Plication vs Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:996-1001. [PMID: 29043548 DOI: 10.1007/s11695-017-2951-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Bariatric surgeries are the only effective long-term treatment in obese patients. The innovation of laparoscopic gastric plication (LGP) raised some questions about its effectiveness compared to traditionally used techniques such as laparoscopic sleeve gastrectomy (LSG). We tried to answer some of these questions. MATERIALS AND METHODS We investigated 70 patients in a randomized clinical trial (IRCT2013123012294N5) from 2012 to 2015. Thirty-five patients were randomly assigned to each LSG or LGP group, using sealed envelope method. The body mass index (BMI) reduction and the percentage of excess weight loss (%EWL) along with %total body weight loss (%TWL) were primary endpoint and were assessed at follow-up periods. We recorded postoperative complications, as well. RESULTS Two-year follow-up rate was 100%. There were no statistically significant differences between the two groups in means of preoperative BMI. Also, postoperative follow-ups were not suggestive for a significant difference in BMI (all p values > 0.05). The mean %EWL at follow-ups showed no significant difference at any point, except for 3 and 6 months after surgery (p value = 0.002 and 0.017, respectively). This finding was confirmed by %TWL trend in 12 months after surgery. LSG patients were readmitted more than LGP patients (seven cases vs one case, p value = 0.024). Postoperative complications such as nausea and vomiting, hair loss, iron deficiency, vitamin D deficiency, and cholelithiasis were not different between the two groups. There was one death in the LGP group due to pulmonary thromboembolism. CONCLUSIONS LGP showed to be efficient regarding %EWL and %TWL reduction in short-term follow-ups with comparable postoperative complications to LSG.
Collapse
|
27
|
Abstract
BACKGROUND Knowledge regarding the feasibility and safety of sleeve gastrectomy (SG) in obese liver transplant recipients is scarce. We report our experience of sleeve gastrectomy following liver transplantation (LT). METHODS All patients who had undergone LT and subsequently underwent SG at our institution were retrospectively reviewed. Surgical outcomes, liver and kidney function tests, outcomes of obesity-related comorbidities, and excess weight loss were analyzed. RESULTS Between May 2008 and February 2015, six consecutive patients underwent SG after LT. Three procedures (50%) were performed totally by laparoscopy, and three by upfront laparotomy for concomitant incisional hernia complex repair. Within the first 30 days, one complication occurred: early gastric fistula that required multiple endoscopic procedures and re-intervention, followed by death 19 months after SG due to multi-organ failure. Another patient had one late complication: chronic infection on a parietal mesh successfully controlled by mesh removal. Excess weight loss averaged 76% at 2 years with a median BMI of 28 (21-39) kg/m2. Median follow-up was 37.2 months (range 13-101 months). Median length of stay was 9 days (range: 6-81 days). CONCLUSIONS SG is technically feasible after LT and resulted in weight loss without adversely affecting graft function and immunosuppression. However, morbidity and mortality are high.
Collapse
Affiliation(s)
- Michael Osseis
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France
| | - Andrea Lazzati
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Chady Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France
| | - Concepcion Gomez Gavara
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France
| | - Philippe Compagnon
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France
- UNITE INSERM 955, Creteil, France
| | - Cyrille Feray
- UNITE INSERM 955, Creteil, France
- Department of Hepatology, Henri Mondor Hospital, Creteil, France
| | - Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France
| | - Daniel Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France.
- Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Creteil, France.
- UNITE INSERM 955, Creteil, France.
| |
Collapse
|
28
|
Abstract
BACKGROUND Bariatric surgery is well established as an effective method for treating obesity and its related comorbidities. The laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to a Roux-en-Y gastric bypass (RYGBP). The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports long-term results from a cohort of patients undergoing a SR-MGBP in a single centre. METHODS Long-term outcomes (up to 11 years) in a cohort of 156 patients undergoing surgery between August 2005 and January 2008 were analysed. A combination of follow-up questionnaires and electronic hospital records were used to assess weight loss, comorbidity resolution and complications. RESULTS A total of 156 patients (mean body mass index 46 kg/m2) underwent surgery. Ninety-two patients responded to the follow-up questionnaires. Computer-based hospital information was available on a total of 139 patients. Mean percent excess weight loss (%EWL) at 11 years was 84.3%. Comorbidity resolution, determined by medication use, showed a reduction in diabetes (21.8% to 7.1%), hypertension (37.2% to 21.4%) and hypercholesterolaemia (40.4% to 13.4%). Five of 139 patients (3.6%) had SR problems needing removal. Two other patients had the SR changed to a bigger size and a further two had endoscopic removal of the SR for erosion. Of the 139 patients, 9.4% required conversion to a Roux-en-Y gastric bypass (RYGBP). The number of patients on anti-reflux medications increased from 5.1% to 44.6% at 11 years. There were two deaths unrelated to surgery. CONCLUSIONS SR-MGBP appears to be a safe and effective operation for the morbidly obese. It is durable, with good weight loss at up to 11 years post-surgery. The SR can easily be removed or exchanged for another size and is reasonable to consider when performing a MGBP. Concerns about bile reflux appear to be well founded, and some patients who are poorly controlled medically will require revision.
Collapse
|
29
|
Navez B, Thomopoulos T, Stefanescu I, Coubeau L. Common Limb Length Does Not Influence Weight Loss After Standard Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2016; 26:1705-9. [PMID: 26660489 DOI: 10.1007/s11695-015-1992-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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 Although Roux-en-Y gastric bypass (RYGBP) has proven its reliability over time in terms of weight loss and resolution of comorbidities, there continues to be a significant controversy in terms of used limb lengths. In the classical RYGBP, most surgeons have reported an alimentary limb length (ALL) of 100 to 150 cm and a bilio-pancreatic limb length (BPLL) of 50 to 75 cm. On the other hand, the common limb length (CLL) remains unknown in all the patients. As it is theoretically related to the level of malabsorption, CLL could influence weight loss after RYGBP. MATERIALS AND METHODS We performed a laparoscopic RYGBP in 90 patients with a mean preoperative body mass index (BMI) of 44.8. ALL and BPLL were respectively fixed at 150 and 75 cm. A systematic intraoperative measurement of CLL was performed. RESULTS As expected, we found a great variation of the jejuno-ileal length and also of the CLL. We created three subgroups of patients: one with the entire population, one excluding the super-obese patients (BMI > 50) and the third one excluding the revisions. There was no statistically significant correlation between CLL and excess BMI loss (EBMIL) at 1, 3, 6 and 12 months of follow-up in each group. We also found a linear correlation between the jejuno-ileal length and the height of individuals. CONCLUSION With a fixed 150-cm ALL and a 75-cm BPLL, there is no evidence that the anatomical variations of CLL could influence weight loss after classical RYGBP.
Collapse
|
30
|
Kraljević M, Delko T, Köstler T, Osto E, Lutz T, Thommen S, Droeser RA, Rothwell L, Oertli D, Zingg U. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic mini gastric bypass in the treatment of obesity: study protocol for a randomized controlled trial. Trials 2017; 18:226. [PMID: 28532499 PMCID: PMC5441098 DOI: 10.1186/s13063-017-1957-9] [Citation(s) in RCA: 7] [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: 11/09/2016] [Accepted: 04/27/2017] [Indexed: 12/12/2022] Open
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard in bariatric surgery, achieving durable long-term weight loss with improvement of obesity-related comorbidities. Lately, the laparoscopic mini gastric bypass (LMGB) has gained worldwide popularity with similar results to LRYGB in terms of weight loss and comorbidity resolution. However, there is a lack of randomized controlled trials (RCT) comparing LMGB and LRYGB. This article describes the design and protocol of a randomized controlled trial comparing the outcomes of these two bariatric procedures. Methods/Design The trial is designed as a single center, randomized, patient and observer blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that LMGB is not inferior to LRYGB in terms of excess weight loss (EWL) the study is conducted as a non-inferiority trial with the sample-size calculations performed accordingly. EWL 12 months after surgery is the primary endpoint, whereas 3-year EWL, morbidity, mortality, remission of obesity related comorbidities, quality of life (QOL) and hormonal and lipid profile changes are secondary endpoints. Eighty patients, 18 years or older and with a body mass index (BMI) between 35 and 50 kg/m2 who meet the Swiss guidelines for the surgical treatment of morbid obesity will be randomized. The endpoints and baseline measurements will be assessed pre-surgery, peri-surgery and post-surgery (fixed follow up measurements are at discharge and at the time points 6 weeks and 12 and 36 months postoperatively). Discussion With its 3-year follow up time, this RCT will provide important data on the impact of LMGB and LRYGB on EWL, remission of comorbidities, QOL and hormonal and lipid profile changes. Trial registration ClinicalTrials.gov, NCT02601092. Registered on 28 September 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1957-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Marko Kraljević
- Department of General Surgery, University Hospital Basel, 4031, Basel, Switzerland.
| | - Tarik Delko
- Department of General Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Thomas Köstler
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| | - Elena Osto
- IFNH Laboratory of Translational Nutrition Biology, ETH Zurich, 8603, Schwerzenbach, Switzerland
| | - Thomas Lutz
- Institute of Veterinary Physiology, Vetsuisse Faculty and Centre of Integrative Human Physiology, University of Zurich, 8057, Zurich, Switzerland
| | - Sarah Thommen
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, 4031, Basel, Switzerland
| | - Raoul A Droeser
- Department of General Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Lincoln Rothwell
- Department of General Surgery, Ipswich General Hospital, Ipswich, Queensland, 4305, Australia
| | - Daniel Oertli
- Department of General Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Urs Zingg
- Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
| |
Collapse
|
31
|
Abstract
INTRODUCTION The aim of this study was to determine the impact of hypovitaminosis D on Gastric Bypass outcomes. METHODS We retrospectively reviewed all patients who underwent primary intention Gastric Bypass in our center between January 2012 and December 2013. Postoperative complications, 1 and 2-year excess weight loss were compared between patients with and without hypovitaminosis D. RESULTS Among 258 patients who met inclusion criteria, 56 (21.7%) presented with vitamin D deficiency. Mean age was 41.73 ± 12.95 years. Mean BMI was 40.90 kg/m2 (34-58 kg/m2). No statistically significant difference in postoperative complication rate was found between patients with and without hypovitaminosis D. Mean 1-year excess weight loss was 75.24%. In patients with vitamin D deficiency mean 1-year excess weight loss was 71.90 versus 76.15% in patients with optimal serum vitamin D level (p = 0.17). No significant difference was found after a 2-year follow-up. In patients presenting with vitamin D insufficiency, 1-year excess weight loss was 75.64 versus 79.34% in patients with optimal serum vitamin D level (p = 0.53). After a 2-year follow-up, there was a significant difference between patients presenting with and without vitamin D insufficiency (79.45 versus 91.71%; p = 0.01) and between patients presenting with and without hypovitaminosis D (80.50 versus 91.71%; p = 0.01). CONCLUSION In our study, hypovitaminosis D seemed to have a negative impact on long term excess weight loss, but not on short-term outcome or postoperative complications. The role of systematic supplementation before bariatric surgery has to be explored in prospective studies.
Collapse
Affiliation(s)
- Caroline Schaaf
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia Antipolis, Nice, France.
| | - Jean Gugenheim
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia Antipolis, Nice, France
| |
Collapse
|
32
|
de Raaff CAL, Coblijn UK, de Vries N, Heymans MW, van den Berg BTJ, van Tets WF, van Wagensveld BA. Predictive Factors for Insufficient Weight Loss After Bariatric Surgery: Does Obstructive Sleep Apnea Influence Weight Loss? Obes Surg 2016. [PMID: 26220241 DOI: 10.1007/s11695-015-1830-4] [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: 12/31/2022]
Abstract
BACKGROUND Important endpoints of bariatric surgery are weight loss and improvement of comorbidities, of which obstructive sleep apnea (OSA) is the highest accompanying comorbidity (70%). This study aimed to evaluate the influence of OSA on weight loss after bariatric surgery and to provide predictive factors for insufficient weight loss (defined as ≤50% excess weight loss (EWL)) at 1 year follow-up. METHODS All consecutive patients, who underwent primary laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between 2006 and 2014 were retrospectively reviewed. Patients with data on preoperative apnea-hypopnea index (AHI) and pre- and postoperative body mass index (BMI) were included. After surgery, the percentage excess weight loss (%EWL) and BMI changes were compared between preoperatively diagnosed OSA-, subdivided in mild, moderate, and severe OSA, and non-OSA patients. Multivariable logistic regression analysis evaluated predictive factors for ≤50% EWL. RESULTS A total of 816 patients, 522 (64%) with and 294 (36%) without OSA, were included. After 1 year, OSA patients achieved less %EWL than non-OSA patients (65.5 SD 20.7 versus 70.3 SD 21.0; p < 0.01). The lowest %EWL was seen in severe OSA patients (61.7 SD 20.2). However, when adjusted for waist circumference, BMI, and age, no effect of OSA was seen on %EWL or changes in BMI. Although AHI, gender, age, BMI, type of surgery, and type II diabetes were predictive factors for ≤50% EWL (area under the curve 0.778), the AHI as variable was of little importance. CONCLUSIONS The presence of OSA does not individually impair weight loss after bariatric surgery.
Collapse
Affiliation(s)
| | - Usha K Coblijn
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Nico de Vries
- Department of Otolaryngology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.,Department of Otolaryngology, University of Antwerp, Antwerp, Belgium
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands.,Department of Methodology and Applied Biostatistics, Faculty of Health and Life Sciences, VU Amsterdam, Amsterdam, The Netherlands
| | - Bob T J van den Berg
- Department of Pulmonology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Willem F van Tets
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | | |
Collapse
|
33
|
Abstract
OBJECTIVE The objective of this study was to investigate the effects of adherence to postoperative recommended psychiatric follow-up on weight loss in morbid obesity patients with psychiatric disorders 1 year after gastric bypass. METHODS Three hundred eighteen morbidly obese patients were retrospectively reviewed. They were divided into four groups according to preoperative psychiatric evaluations and adherence to psychiatric follow-up 1 year after their bypass surgery. The first group included patients who did not meet the referral criteria (NMRC). The second group consisted of patients who did not meet the psychiatric diagnostic criteria (NMDC). The third group was patients who met criteria for a psychiatric disorder and were nonadherent (NA) to psychiatric follow-up. The fourth group consisted of patients who met criteria for a psychiatric disorder and were adherent (A) to psychiatric follow-up. RESULTS The A group exhibited higher % change in BMI than the NA and NMRC groups at 1 year after bypass surgery. Regression analyses to examine the effects of the grouping variable on % change in BMI were performed by controlling the effects of age, gender, educational level, and preoperative BMI. The regression coefficient for the grouping variable was 0.175 (p = .003) at the 6-month and 0.133 (p = .027) at the 1-year % change in BMI. CONCLUSION Our preliminary data suggest that adherence to postoperative psychiatric follow-up is associated with greater postoperative weight loss. However, evidence from studies with a longer follow-up is required to justify this therapeutic approach.
Collapse
|
34
|
Shanti H, Obeidat F. The impact of family members on weight loss after sleeve gastrectomy. Surg Obes Relat Dis 2016; 12:1499-1503. [PMID: 27288261 DOI: 10.1016/j.soard.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/19/2016] [Accepted: 04/01/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight loss after laparoscopic sleeve gastrectomy (LSG) is multifactorial. Postoperative compliance with appropriate dietary guidance may be affected by psychosocial factors and may influence the success of surgery. OBJECTIVE To evaluate the effect of LSG in siblings compared to case-matched controls. SETTING University hospital. METHODS Siblings who had undergone LSG were compared with controls case-matched by age, sex, and body mass index. The percentage excess weight loss (%EWL) was calculated at 3, 6, and 12 months postoperatively. RESULTS We had 32 siblings, of which 4 were lost to follow-up. Thus, 28 (87.5%) siblings completed 1 year of follow-up and were included in the study. In the family group, the %EWL was 72.7±15.0% at 1 year while in the control group the mean %EWL was 62.1±21.4%. Patients in the family group had significantly greater weight loss. Within the family group, the outcomes of family order had no statistically significant difference in weight loss between the first family member who had undergone LSG and subsequent family members. In addition, family members who had resided together in the same home had no advantage over those who resided separately. CONCLUSION Genetic and environmental factors may have great influence on outcomes after bariatric surgery.
Collapse
Affiliation(s)
- Hiba Shanti
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | | |
Collapse
|
35
|
Vuolo G, Voglino C, Tirone A, Colasanto G, Gaggelli I, Ciuoli C, Ferrara F, Marrelli D. Is sleeve gastrectomy a therapeutic procedure for all obese patients? Int J Surg 2016; 30:48-55. [PMID: 27109203 DOI: 10.1016/j.ijsu.2016.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/14/2015] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a worldwide surgical procedure for morbid obesity. However patients selection is still anecdotal. The aim of this study is to analyse clinical and anthropometric parameters correlated with LSG and to check the validity of this procedure for different categories of obese patients. METHODS Two-hundred one consecutive patients were submitted to LSG as a primary bariatric procedure between 2008 and 2014. One year follow-up was completed in 159 patients. Smaller groups of patients completed 2 and 3 years follow-up (78, 46 patients respectively). Median preoperative body mass index (BMI) was 45.4 kg/m2 (range: 34.8-73.8); 135 patients (80%) had one or more comorbidities. Potential correlations between age, gender, preoperative BMI, preoperative excess weight, early excess weight loss (EWL) and 1 and 3 year-EWL were investigated. RESULTS All procedures were regularly completed with laparoscopic approach without conversion to laparotomy. Postoperative complications occurred in six patients (3.7%); no postoperative mortality was observed. Median one-year BMI and EWL were 32.8 kg/m2 and 55.34%, respectively. Three year-EWL was significantly influenced by age, and early EWL. A complete normalization of glycemic levels after the three-year follow-up was also observed in high percentage of diabetic patients. In patients with preoperative BMI>50 kg/m2 we observed most failure cases in terms of EWL and the worst metabolic results. CONCLUSIONS Our experience indicates that LSG is a safe procedure with satisfactory three-year late weight loss in patients with preoperative BMI <50 kg/m2. Promising results, in terms of improvements of comorbidities, were also observed. These results make LSG one of the most attractive first stage surgical procedure for morbid obesity.
Collapse
Affiliation(s)
- Giuseppe Vuolo
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Costantino Voglino
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Andrea Tirone
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Giuseppina Colasanto
- Department of Medicine, Surgery and Neurosciences, Unit of Bariatric Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Ilaria Gaggelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Cristina Ciuoli
- Department of Medicine, Surgery and Neurosciences, Unit of Endocrinology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| | - Francesco Ferrara
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Viale Bracci, Policlinico "Le Scotte", 53100, Siena, Italy
| |
Collapse
|
36
|
Serrano OK, Tannebaum JE, Cumella L, Choi J, Vemulapalli P, Scott Melvin W, Camacho DR. Weight loss outcomes and complications from bariatric surgery in the super super obese. Surg Endosc 2016; 30:2505-11. [PMID: 26304105 DOI: 10.1007/s00464-015-4509-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bariatric surgery has been established as the most effective long-term treatment for morbid obesity. METHODS We performed a retrospective review of SSO patients treated at our institute between 2008 and 2013 who underwent a laparoscopic gastric bypass (LGBP) or sleeve gastrectomy (LSG). The primary end point for this study was excess weight loss (EWL) at 1, 3, 6, and 12 months. Secondary end points included procedure length (PL), length of stay (LOS), diabetes management and postoperative complications. RESULTS We identified 135 SSO patients who underwent bariatric surgery (93 LGBP, 42 LSG) at our institute from 2008 to 2013 with a median follow-up of 49 months. The incidence of EWL > 30 % for patients in the LGBP group was 3.9, 29.0, 72.2 and 94.6 % at 1, 3, 6 and 12 months, respectively, while the incidence of EWL > 30 % in patients in the LSG group was 4.2, 25.0, 59.1 and 100 % at 1, 3, 6 and 12 months, respectively. PL was 124 ± 49 min for the LGBP group and 98 + 51 min for the LSG group (p < 0.005). LOS was on average 3.0 days (range 1-21) for the LGBP group and 3.4 days (range 1-13) for the LSG group (p = 0.41). Patients experienced a decrease in their hemoglobin A1C level by 10 % for the LGBP group and 9 % for the LSG group at 1 year (p = 0.89). Postoperative complications were seen in 15.1 % of LGBP patients and 4.8 % of LSG patients. CONCLUSIONS Bariatric surgery is feasible in the SSO patients with comparable EWL outcomes and postoperative complications to historical non-SSO patients.
Collapse
|
37
|
Martini F, Anty R, Schneck AS, Casanova V, Iannelli A, Gugenheim J. Predictors of metabolic syndrome persistence 1 year after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2015; 11:1054-60. [PMID: 25868838 DOI: 10.1016/j.soard.2015.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 10/19/2014] [Revised: 01/30/2015] [Accepted: 02/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic Roux-en-Y gastric bypass (LRYGB) is effective in reversing the metabolic syndrome (MS) in up to 90% of patients. OBJECTIVES The aim of this study was to determine predictors of MS persistence 1 year after LRYGB. SETTING University Hospital, France. METHODS Ninety-one patients with a mean age of 44.4 years and a mean body mass index (BMI) of 43.1 kg/m² meeting the criteria for MS were enrolled in this prospective study. Anthropometric, metabolic, and inflammatory biological parameters were assessed before and 1 year after LRYGB. Patients were divided into 2 groups according to the persistence (MS nonresponders) or resolution of MS (MS responders) 1 year after LRYGB and a comparison was performed at baseline and 1 year after surgery. RESULTS Sixty-nine patients (75.8%) underwent remission, while 22 (24.2%) showed persistence of MS 1 year after LRYGB. At baseline the MS nonresponders group presented significantly higher values of fasting plasma glucose (7.8 versus 5.3 mmol/L, P = .004), glycosylated hemoglobin (HbA1c, 7.3% versus 5.9%, P = .0004), triglycerides (TG, 2.37 versus 1.33 mmol/L, P = .006), and homeostasis model assessment of insulin resistance (HOMA-IR, 442.5 versus 256, P = .006). The rate of diabetes was significantly higher in this group (68.2% versus 36.8%, P = .0086), as well as the number of MS components per patient. One year after LRYGB, the MS nonresponders showed a significantly lower excess BMI lost (EBMIL) (56.1% versus 82.4%, P = .00008). On multivariate analysis, baseline levels of TG, glucose metabolism markers and EBMIL were associated with the persistence of MS. CONCLUSION Baseline levels of TG, plasma fasting glucose, and HbA1c, as well as history of type 2 diabetes and EBMIL, represent predictors of MS persistence 1 year after LRYGB.
Collapse
Affiliation(s)
- Francesco Martini
- University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France.
| | - Rodolphe Anty
- University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France
| | - Anne-Sophie Schneck
- University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France
| | - Vincent Casanova
- University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France
| | - Antonio Iannelli
- University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France
| | - Jean Gugenheim
- University Hospital of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France
| |
Collapse
|
38
|
Alexandrou A, Athanasiou A, Michalinos A, Felekouras E, Tsigris C, Diamantis T. Laparoscopic sleeve gastrectomy for morbid obesity: 5-year results. Am J Surg 2014; 209:230-4. [PMID: 25034410 DOI: 10.1016/j.amjsurg.2014.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 11/11/2013] [Revised: 04/07/2014] [Accepted: 04/18/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Data concerning the long-term efficacy of laparoscopic sleeve gastrectomy in the treatment of morbid obesity remain scarce. In this retrospective, the authors present 5-year follow-up of 30 patients having undergone laparoscopic sleeve gastrectomy. METHODS Since 2004, 30 patients underwent laparoscopic sleeve gastrectomy and completed 5 years of follow-up. Five patients were subsequently subjected to laparoscopic Roux-en-Y gastric bypass and were excluded from further analysis. The remaining 25 patients comprised the study population. RESULTS Mean excess weight loss was 65.2 ± 6.1%, 64.7 ± 5.6%, 62 ± 4.9%, 58.2 ± 5.5%, and 56.4 ± 5.8% for the first 5 years, respectively. There were no deaths, nor any major morbidity. Remission of comorbidities was observed in 40% to 80.9% of cases. CONCLUSIONS Laparoscopic sleeve gastrectomy is a safe and effective means of treatment of morbid obesity both in the short and in the long term. More research is needed to better predict which patient will benefit most from this operation.
Collapse
Affiliation(s)
- Andreas Alexandrou
- 1st Department of Surgery, Laikon University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece.
| | - Antonios Athanasiou
- 1st Department of Surgery, Laikon University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece
| | - Adamantios Michalinos
- 1st Department of Surgery, Laikon University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece
| | - Christos Tsigris
- 1st Department of Surgery, Laikon University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece
| | - Theodoros Diamantis
- 1st Department of Surgery, Laikon University Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17, Athens, Greece
| |
Collapse
|
39
|
Victorzon M, Tolonen P. Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Relat Dis 2013; 9:753-7. [PMID: 24079901 DOI: 10.1016/j.soard.2013.05.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 03/07/2012] [Revised: 04/08/2013] [Accepted: 05/12/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many studies of short-term to mid-term outcomes after laparoscopic adjustable gastric banding (LAGB) have been published, but reliable long-term outcome reports with a minimum follow up ≥ 10 years in a sufficient number of included patients are still scarce. The objective of this study was to evaluate the long-term results after LAGB. METHODS Sixty consecutive patients (44 women, 16 men) were treated for morbid obesity by LAGB between 1996 and 1999. Median age of the patients at the time of operation was 45 years (range 21-64). Median preoperative body mass index (BMI, kg/m(2)) was 45 (range 35-55). All patients were asked to adhere to a strict follow-up program. Patients' BMI and percentage excess weight loss (%EWL) were calculated in the hospital's database for bariatric patients, and excess weight was taken as the weight in kilograms above the weight at BMI of 25 kg/m(2). RESULTS Complete data on all 60 patients could be assessed; thus, the overall rate of follow-up was 100%. After a median (range) follow-up of 14.1 years (13.2-16.8 years), the mean BMI (SD) dropped from 45 (5) to 36 (6) kg/m(2), with a mean (SD) EWL of 49% (29). At 15 years of follow-up, 29 (48%) bands have been removed, and 38 (63%) reoperations have been performed in 29 (48%) patients. Almost 70% received further treatment for their morbid obesity after band removal. Of those patients with the band still in place at 14 years, 40% had more than 50% EWL and 20% had less than 25% EWL. There was no mortality related to the primary or revisional operations, but 2 patients died of unrelated causes. CONCLUSIONS Mean %EWL after LAGB after more than 14 years was fairly good-49%. However, a reoperation rate of more than 60% in 48% of the patients and a band removal rate of almost 50% may indicate that LAGB cannot be recommended as a primary procedure to the general morbidly obese population.
Collapse
Affiliation(s)
- Mikael Victorzon
- Department of Abdominal and Minimally Invasive Surgery, Vaasa Central Hospital, Vaasa Hospital District, Finland; University of Turku, Vaasa Central Hospital, Turku, Finland.
| | | |
Collapse
|
40
|
Al Khalifa K, Violato C, Al Ansari A. Reduction in weight and BMI and changes in Co-morbidities following laparoscopic adjustable gastric banding procedure for morbidly obese patients in Bahrain: a five year longitudinal study. Springerplus 2013; 2:19. [PMID: 23450466 PMCID: PMC3581763 DOI: 10.1186/2193-1801-2-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/17/2013] [Indexed: 11/10/2022]
Abstract
Background Obesity and its related illnesses are pan-endemic health problems which require intervention. Laparoscopic Adjustable Gastric Banding (LAGB) is seen as a safe surgical procedure with satisfactory results on weight reduction and improvement in obesity related illness. Methods Data were collected in a repeated-measures longitudinal five year study for 143 morbidly obese patients who underwent laparoscopic adjustable gastric banding (LAGB). Follow up was continued from 3 to 60 months post operatively. Patients were assessed for diabetes, hypertension and dyslipidemia. Results Repeated measures ANOVAs revealed that both men and women lose weight and reduce their BMIs at a consistent rate. At 3, 6 and 9 months post-operative there are no differences in percent weight loss between men and women with mean weight loss at 8.9%, 13.1% and 16.0% respectively of pre-operative weight. At 12, 24 and 60 months post-operatively, however, men significantly increase the percentage of weight loss as well as improve their BMI compared to women (p < .05). At 24 months post-operative, men and women have BMIs of 36.03 and 32.85, both still in the obese range. By 60 months men have achieved a BMI that is slightly under the obese range into the overweight range (30.76) while women (BMI = 36.61) were still in the obese range. At 60 months, men have lost a total of 33.75% of their pre-operative body weight while women have lost a total of 21.50. Diabetes, hypertension and dyslipidemia were significantly reduced in the sample post-operatively (p < .01). Conclusion LAGB is a safe and effective surgical procedure for morbidly obese patients resulting in weight loss, BMI decrease and reduction in co-morbid illnesses.
Collapse
Affiliation(s)
- Khalid Al Khalifa
- FRCSI, Department of General Surgery, Bahrain Defense Force Hospital, West Riffa, Bahrain
| | | | | |
Collapse
|