1
|
Roth K, Støle M, Vadseth I, Samstad EO, Sandvik J, Hoff DAL. Long-term changes in lung function after Roux-en-Y gastric bypass in patients with severe obesity. Clin Obes 2024; 14:e12640. [PMID: 38239065 DOI: 10.1111/cob.12640] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/10/2023] [Accepted: 12/31/2023] [Indexed: 03/16/2024]
Abstract
Obesity can decrease the lung function. The proposed mechanisms of reduced lung function in persons with obesity have been altered mechanical properties in the lung and chest wall, airway narrowing and increased respiratory resistance. The aim of this current study was to analyse the long-term results after gastric bypass surgery in patients with reduced lung function. The bariatric surgery observation study invited patients to a follow up 10 years after gastric bypass surgery. We compared the spirometry results before surgery to the spirometry 10 years after surgery. Thirty percent of 198 participants had reduced lung function before surgery. There was no significant relation between body mass index before surgery and lung function. Seventy-three percent of the participants with reduced lung function had normal lung function 10 years after surgery. There was no significant relation between the degree of weight loss and the improvement in lung function. Most participants with reduced lung function had normal lung function 10 years after gastric bypass surgery. There was no significant correlation between weight loss and improvement in lung function.
Collapse
Affiliation(s)
- Kjetil Roth
- Department of Medicine, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maria Støle
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Vadseth
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eivind Ottersen Samstad
- Department of Medicine, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Jorunn Sandvik
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
- Department of surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Centre for Obesity Research, Clinic of Surgery, St. Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dag Arne Lihaug Hoff
- Department of Medicine, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| |
Collapse
|
2
|
Pawa R, Koutlas NJ, Russell G, Shen P, Pawa S. Endoscopic ultrasound-guided gastrojejunostomy versus robotic gastrojejunostomy for unresectable malignant gastric outlet obstruction. DEN Open 2024; 4:e248. [PMID: 37228709 PMCID: PMC10204173 DOI: 10.1002/deo2.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
Objectives Malignant gastric outlet obstruction (GOO) has traditionally been managed with enteral stenting and surgical gastrojejunostomy. Our study aimed to compare outcomes between endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) using a lumen-apposing metal stent and robotic GJ (R-GJ) for unresectable malignant GOO. Methods Patients undergoing EUS-GJ or R-GJ for unresectable malignant GOO were retrospectively analyzed. The primary outcome was clinical success defined by the ability to tolerate oral intake at the time of discharge. Secondary outcomes included technical success, procedure duration, adverse events, and post-procedure length of stay (LOS). Results A total of 44 patients met the inclusion criteria. Of the 44, 29 underwent EUS-GJ and 15 underwent R-GJ. Age, gender, malignant etiology, and presence of ascites were similar between the two groups. Patients treated with EUS-GJ had a higher mean Charlson comorbidity index (10.3 vs. 7.0; p ≤ 0.0001) and a lower preoperative body mass index (22.3 vs. 27.2; p = 0.007). Technical and clinical success was achieved in 100% of patients in both groups (p > 0.99). EUS-GJ was associated with shorter procedure duration (57.5 vs. 146.3 min; p < 0.0001), hospital LOS (4.3 vs. 8.2 days, p = 0.0009), and time to oral intake (1.0 vs. 5.8 days; p < 0.0001) when compared to R-GJ. Adverse events occurred in 5 of the R-GJ patients and none of the EUS-GJ patients (p = 0.003). Conclusions EUS-GJ has similar efficacy and superior clinical outcomes compared to R-GJ in the management of malignant GOO. Prospective studies with longer follow-up duration are needed to validate these findings.
Collapse
Affiliation(s)
- Rishi Pawa
- Department of MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Nicholas J Koutlas
- Department of MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Greg Russell
- Biostatistics and Data ScienceWake Forest School of MedicineWinston‐SalemUSA
| | - Perry Shen
- Department of SurgeryWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Swati Pawa
- Department of MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| |
Collapse
|
3
|
Miskelly MG, Berggren J, Svensson M, Koffert J, Honka H, Kauhanen S, Nuutila P, Hedenbro J, Lindqvist A, Melander O, Wierup N. The effects of Calorie restriction and Bariatric surgery on Circulating Proneurotensin levels. J Clin Endocrinol Metab 2024:dgae147. [PMID: 38477483 DOI: 10.1210/clinem/dgae147] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
CONTEXT Proneurotensin (pNT) is associated with obesity and T2D, but the effects of Roux-en-Y gastric bypass (RYGB) on postprandial pNT levels are not well studied. OBJECTIVE Assess effects of RYGB versus very low-energy diet (VLED) on pNT levels in response to mixed-meal tests (MMT), and long-term effects of RYGB on fasting pNT.Study participants: Cohort 1: Nine normoglycemic (NG) and ten T2D patients underwent MMT before and after VLED, immediately post-RYGB and six weeks post-RYGB. Cohort 2: Ten controls with normal weight and ten patients with obesity and T2D, who underwent RYGB or vertical sleeve gastrectomy (VSG), were subjected to MMTs and GIP infusions pre-surgery and three months post-surgery. GLP-1 infusions were performed in normal weight participants. Cohort 3: Fasting pNT was assessed pre-RYGB (n=161), two months post-RYGB (n=92) and 1-year post-RYGB (n=118) in NG and T2D patients. pNT levels were measured using ELISA. RESULTS Reduced fasting and postprandial pNT were evident after VLED and immediately following RYGB. Reintroduction of solid food post-RYGB increased fasting and postprandial pNT. Prior to RYGB, all patients lacked a meal response in pNT, but this was evident post-RYGB/VSG. GIP- or GLP-1 infusion had no effect on pNT levels. Fasting pNT were higher 1-year post-RYGB regardless of glycemic status. CONCLUSION RYGB causes a transient reduction in pNT as a consequence of caloric restriction. The RYGB/VSG-induced rise in postprandial pNT is independent of GIP and GLP-1 and higher fasting pNT are maintained one year post-surgically.
Collapse
Affiliation(s)
- Michael G Miskelly
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Johan Berggren
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Malin Svensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Jukka Koffert
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Gastroenterology, Turku University Hospital, Turku, Finland
| | - Henri Honka
- Turku PET Centre, University of Turku, Turku, Finland
| | - Saila Kauhanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Jan Hedenbro
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Andreas Lindqvist
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Nils Wierup
- Neuroendocrine Cell Biology, Lund University Diabetes Centre, Malmö, Sweden
| |
Collapse
|
4
|
Long LE, Alhayo ST, Talbot M. Iatrogenic eventration of the hemidiaphragm in a post-bariatric surgery patient. J Surg Case Rep 2024; 2024:rjae117. [PMID: 38487395 PMCID: PMC10937257 DOI: 10.1093/jscr/rjae117] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
The aim of this report is to describe the management of an iatrogenic diaphragmatic eventration following surgery to relieve neurogenic symptoms of thoracic outlet syndrome in a patient with a prior history of sleeve gastrectomy. We discuss the case of a 46-year-old woman with a 6-month history of gastro-oesophageal reflux and dyspnoea. Imaging demonstrated a left hemidiaphragm eventration and hiatus hernia. The patient underwent laparoscopic plication of the left hemidiaphragm, repair of the hiatus hernia, and an omega loop gastric bypass, with satisfactory resolution of her symptoms. This demonstrates that surgical diaphragmatic plication has good outcomes in cases where the abdominal anatomy is already altered as a result of previous bariatric surgery, and that concurrent hiatus hernia repair, plication of iatrogenic diaphragm eventration, and sleeve to gastric bypass conversion satisfactorily relieve reflux and dyspnoea in a morbidly obese patient.
Collapse
Affiliation(s)
- Leonora E Long
- Department of Surgery, St George Hospital, Grey St, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2217, Australia
| | - Sam Tharwat Alhayo
- Department of Surgery, St George Hospital, Grey St, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2217, Australia
| | - Michael Talbot
- Department of Surgery, St George Hospital, Grey St, Kogarah, NSW 2217, Australia
- St George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2217, Australia
| |
Collapse
|
5
|
Demaeyer N, Bruyneel M. Factors Associated with Persistent Obstructive Sleep Apnea After Bariatric Surgery: A Narrative Review. Nat Sci Sleep 2024; 16:111-123. [PMID: 38348054 PMCID: PMC10859698 DOI: 10.2147/nss.s448346] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/31/2024] [Indexed: 02/15/2024] Open
Abstract
The prevalence of obstructive sleep apnea (OSA) among the bariatric surgery population is estimated to be 45-70%. However, weight loss obtained by bariatric surgery is not always associated with full remission of OSA, suggesting that other confounding factors are present. This article aims to review the current literature, focusing on factors that could predict the persistence of OSA after bariatric surgery. For this purpose, relevant studies of more than 50 patients that assessed pre- and post-operative presence and severity of OSA detected by poly(somno)graphy (PG/PSG) in bariatric populations were collected. Six retrospective and prospective studies were evaluated that included 1302 OSA patients, with a BMI range of 42.6 to 56 kg/m2, age range of 44.8 to 50.7 years, and percentage of women ranging from 45% to 91%. The studies were very heterogeneous regarding type of bariatric surgery, diagnostic criteria for OSA and OSA remission, and delay of OSA reassessment. OSA remission was observed in 26% to 76% of patients at 11-12 months post-surgery. Loss to follow-up was high in all studies, leading to a potential underestimation of OSA remission. Based on this limited sample of bariatric patients, age, pre-operative OSA severity, proportion of weight loss, and type 2 diabetes (T2D) were identified as factors associated with OSA persistence but the results were inconsistent between studies regarding the impact of age and the magnitude of weight loss. Several other factors may potentially lead to OSA persistence in the bariatric surgery population, such as fat distribution, ethnicity, anatomical predisposition, pathophysiological traits, supine position, and REM-predominant hypopnea and apnea. Further well-conducted multicentric prospective studies are needed to document the importance of these factors to achieve a better understanding of OSA persistence after bariatric surgery in obese patients.
Collapse
Affiliation(s)
- Nathalie Demaeyer
- Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Bruyneel
- Department of Pneumology, CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pneumology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
6
|
Pinto SOSA, Pereira MA, Ribeiro Junior U, D'Albuquerque LAC, Ramos MFKP. PALLIATIVE GASTRECTOMY VERSUS GASTRIC BYPASS FOR SYMPTOMATIC CLINICAL STAGE IV GASTRIC CANCER: A PROPENSITY SCORE MATCHING ANALYSIS. Arq Bras Cir Dig 2024; 36:e1790. [PMID: 38324851 PMCID: PMC10841491 DOI: 10.1590/0102-672020230072e1790] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Patients with clinical stage IV gastric cancer may require palliative procedures to manage complications such as obstruction. However, there is no consensus on whether performing palliative gastrectomy compared to gastric bypass brings benefits in terms of survival. AIMS To compare the overall survival of patients with distal obstructive gastric cancer undergoing palliative surgical treatment, using propensity score matching analysis. METHODS Patients who underwent palliative bypass surgery (gastrojejunostomy or partitioning) and resection between the years 2009 and 2023 were retrospectively selected. Initial and postoperative clinicopathological variables were collected. RESULTS 150 patients were initially included. The derived group (n=91) presented more locally invasive disease (p<0.01), greater degree of obstruction (p<0.01), and worse clinical status (p<0.01), while the resected ones (n= 59) presented more distant metastasis (p<0.01). After matching, 35 patients remained in each group. There was no difference in the incidence of postoperative complications, but the derived group had higher 90-day mortality (p<0.01). Overall survival was 16.9 and 4.5 months for the resected and derived groups, respectively (p<0.01). After multivariate analysis, hypoalbuminemia (hazard ratio - HR=2.02, 95% confidence interval - 95%CI 1.17-3.48; p=0.01), absence of adjuvant chemotherapy (HR=5.97; 95%CI 3.03-11.7; p<0.01), and gastric bypass (HR=3,28; 95%CI 1.8-5.95; p<0.01) were associated with worse survival. CONCLUSIONS Palliative gastrectomy was associated with greater survival and lower postoperative morbidity compared to gastric bypass. This may be due to better local control of the disease, with lower risks of complications and better effectiveness of chemotherapy.
Collapse
Affiliation(s)
| | - Marina Alessandra Pereira
- Universidade de Sao Paulo, Faculty of Medicina, Cancer Institute, Hospital de Clinicas, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de Sao Paulo, Faculty of Medicina, Cancer Institute, Hospital de Clinicas, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Universidade de Sao Paulo, Faculty of Medicina, Cancer Institute, Hospital de Clinicas, Department of Gastroenterology - São Paulo (SP), Brazil
| | | |
Collapse
|
7
|
Monrabal Lezama M, Bras Harriott C, Herbella FAM, Schlottmann F. Gastroesophageal Reflux Disease After Roux-en-Y Gastric Bypass: Pathophysiology and Management. J Laparoendosc Adv Surg Tech A 2024; 34:167-172. [PMID: 38153398 DOI: 10.1089/lap.2023.0289] [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] [Indexed: 12/29/2023] Open
Abstract
Introduction: Patients with obesity are often affected by gastroesophageal reflux disease (GERD). Roux-en-Y gastric bypass (RYGB) is considered the ideal operation for patients with severe obesity and GERD. Although the majority of patients improve their reflux with the operation, some might persist symptomatic and others can even develop de novo GERD. The aim of this study was to determine pathophysiologic factors involved in the development of GERD after RYGB surgery and define potential treatments for this condition. Materials and Methods: Studies including patients with GERD before and after RYGB and/or analyzing possible GERD therapies were analyzed by the authors. Searches were conducted in PubMed, Cochrane Library, and Embase databases. Results: GERD can persist, worsen, or develop after RYGB. There are certain technical elements of the operation identified as potential risk factors for GERD. Medical therapy is effective in the majority of patients. Both endoscopic and surgical procedures can also help resolving GERD after RYGB. Conclusions: Although the majority of patients with GERD after RYGB can be effectively managed with medical therapy, some may require endoscopic or surgical treatment. Critical technical elements of RYGB should be considered to reduce the risk of postoperative GERD.
Collapse
Affiliation(s)
| | | | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Francisco Schlottmann
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
| |
Collapse
|
8
|
McKinney GB, Rice RA, Fernandez AZ. Refractory Gastroparesis Following Duodenal Switch Treated With Laparoscopic Subtotal Gastrectomy With Roux-en-Y Reconstruction. Am Surg 2024; 90:309-311. [PMID: 37971245 DOI: 10.1177/00031348231216495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Gastroparesis following duodenal switch (DS) is a known but rare complication. Typically, patients are managed with prokinetic agents, with pyloromyotomy being the first-line surgical therapy. The literature is sparse regarding how to manage patients whose symptoms remain refractory to these first-line therapies. We present a patient who experienced gastroparesis following DS, who fell into this category. Her symptoms of prandial pain and regurgitation remained resistant to medical management and pyloromyotomy. She was successfully treated with subtotal gastrectomy with Roux-en-Y reconstruction with resolution of these symptoms. The literature suggests that bypassing or resecting the pylorus and removing overstretched aperistaltic gastric muscle could be the mechanism behind this treatment's effectiveness.
Collapse
Affiliation(s)
- Glen B McKinney
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rebecca A Rice
- Department of General Surgery, University of North Carolina Pardee, Hendersonville, NC, USA
| | - Adolfo Z Fernandez
- Department of General Surgery, Atrium Wake Forest Baptist, Winston-Salem, NC, USA
| |
Collapse
|
9
|
Sundbom M, Näslund I, Ottosson J, Stenberg E, Näslund E. Results from the Scandinavian Obesity Surgery Registry: A narrative review. Obes Rev 2024; 25:e13662. [PMID: 37962040 DOI: 10.1111/obr.13662] [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: 12/23/2022] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
In 2007, the Scandinavian Obesity Surgery Registry (SOReg) was started by the profession to monitor the results of bariatric surgery and to provide a high-quality database for research. In the end of August 2023, SOReg contains 88,379 patients (body mass index [BMI] 41.7 kg/m2 , 41.2 years, 77.1% females, gastric bypass 76.8%). In this narrative review, we demonstrate that preoperative weight loss is of value and that the laparoscopic double omega-loop technique is highly suitable for gastric bypass. Closing the mesenteric openings is, however, important. Swedish bariatric surgery has low mortality, and our results are comparative to those of other countries. Significant long-term improvements are found in common obesity-related diseases such as diabetes, hypertension, and sleep apnea. Furthermore, the risk for cardiac failure and major adverse cardiovascular events is significantly reduced. Pregnancy-related outcomes are also improved. Gastric bypass results in significant improvements in quality of life and seems to be cost saving. We have revealed that low socioeconomic status is associated with reduced chance of undergoing bariatric surgery and inferior outcomes. Of note, we have performed several randomized clinical trials within the registry database. In conclusion, high-quality national registry databases, such as SOReg, are important for maintaining high-quality care and present a platform for extensive research.
Collapse
Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ingmar Näslund
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Čierný M, Ucháľ J, Trávniček A. Gastric bypass - 10 years' results. Rozhl Chir 2024; 103:19-25. [PMID: 38503557 DOI: 10.33699/pis.2024.103.1.19-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Gastric bypass has not gained as much popularity in the Czech Republic as technically simpler restrictive bariatric procedures, frequently with a fading long-term effect. The aim of the presentation is to point out the long-term results after two types of gastric bypasses. METHOD Retrospective analysis of prospectively collected data in an initial set of patients after laparoscopic RYGB (Roux Y gastric bypass) and OAGB/MGB (one anastomosis/mini gastric bypass) performed at Breclav Hospital in 2010-2013. Evaluation based on the BAROS system, according to weight development, comorbidities, psychological aspects, complications and reoperations. RESULTS Data available for evaluation are from 32 patients out of a total of 60; the follow-up rate is 53%. The patients are lighter by 34 kg on average (0-64 kg); TBWL (total basic weight loss): 25.7%. The majority of operated diabetics are free of signs of diabetes, and all others have a reduced need for antidiabetic medication. Hypertension, sleep apnea and psychological assessment of life in 6 domains improved. Eight of the 32 followed patients underwent reoperation during 10 years; only 2 of these procedures were acute for complications (anastomotic ulceration), both in smokers; further elective reoperations included 2 conversions of OAGB/MGB to RYGB due to reflux, 2 corrective surgeries, and 2 procedures for a suspected internal hernia. There was no conversion from laparoscopic to open surgery, no peritonitis associated with a leak, and no mortality within 30 days. The BAROS score (5.56) indicates a "very good result" of the gastric bypasses after 10 years. CONCLUSION Gastric bypasses are safe and provide a high and lasting metabolic effect that meets the general expectations of an invasive intervention that can fundamentally improve the quality of treatment for otherwise incurable chronic diseases related to adiposity (so-called ABCD), especially type 2 diabetes.
Collapse
|
11
|
Tosta GA, de Almeida Leite RM, de Marchi DD, Ricciardi R, Zilberstein B. Efficacy and Safety of Sleeve Gastrectomy with Jejunoileal Bypass Compared with Roux-en-Y Gastric Bypass: Results from a Cohort Study. J Laparoendosc Adv Surg Tech A 2024; 34:1-6. [PMID: 37831926 DOI: 10.1089/lap.2023.0322] [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] [Indexed: 10/15/2023] Open
Abstract
Background: We previously described sleeve gastrectomy with jejunoileal bypass (SGJIB) as promising novel technique for the surgical treatment of obesity Methods: A retrospective analysis of a prospective database in a Private Practice of Alimentary Tract Surgery in São Paulo, Brazil. We analyzed 176 patients with 60 months of follow-up, 74 of whom underwent Vertical Sleeve Gastrectomy with Jejunoileal Bypass (VSG-JIB) (50 women and 24 men) with a mean age of 38 years and a mean body mass index (BMI) of 40 kg/m2, and 102 patients underwent Roux-en-Y gastric bypass (RYGB) (90 women and 12 men) with a mean age of 36.5 years and a mean BMI of 39.73 kg/m2. Results: There was no statistically significant difference in long-term weight loss between the two groups. The rate of postoperative complications immediately after surgery was similar, but there was a tendency toward less severe complications in the SGJIB cohort. Conclusion: Sleeve gastrectomy with jejunoileal bypass is a novel surgical procedure for weight loss with comparable efficacy and safety compared with laparoscopic RYGB.
Collapse
Affiliation(s)
- Gil Abdallah Tosta
- Sao Leopoldo Mandic School of Medicine, Campinas, Brazil
- Gastromed Zilberstein Institute, São Paulo, Brazil
- Beneficencia Portuguesa Hospital, São Paulo, Brazil
| | - Rodrigo Moises de Almeida Leite
- Gastromed Zilberstein Institute, São Paulo, Brazil
- Beneficencia Portuguesa Hospital, São Paulo, Brazil
- Gastrointestinal Surgery Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danilo Dallago de Marchi
- Sao Leopoldo Mandic School of Medicine, Campinas, Brazil
- Gastromed Zilberstein Institute, São Paulo, Brazil
- Beneficencia Portuguesa Hospital, São Paulo, Brazil
| | - Rocco Ricciardi
- Gastrointestinal Surgery Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Colon and Rectal Surgery Department, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Bruno Zilberstein
- Sao Leopoldo Mandic School of Medicine, Campinas, Brazil
- Gastromed Zilberstein Institute, São Paulo, Brazil
- Beneficencia Portuguesa Hospital, São Paulo, Brazil
| |
Collapse
|
12
|
Ragavan S, Elhelw O, Majeed W, Alkhaffaf B, Senapati S, Ammori BJ, Mudaliar RN, Syed AA. Weight Loss Following Bariatric Surgery in People with or without Metabolic Syndrome: A 5-Year Observational Comparative Study. J Clin Med 2024; 13:256. [PMID: 38202263 PMCID: PMC10779877 DOI: 10.3390/jcm13010256] [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: 10/14/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
AIM Whilst bariatric surgery is the most effective treatment for severe obesity, the aim of this study was to evaluate whether postoperative weight loss is similar in patients with or without metabolic syndrome. METHODS We performed a 5-year observational retrospective comparative cohort analysis of bariatric surgery in 333 patients (72% women) without (Group A, n = 133) or with (Group B, n = 200) metabolic syndrome at baseline. RESULTS Overall mean (SD) baseline body mass index was 51.7 (7.5) with no significant difference between groups. Overall mean percent total weight loss (%TWL) was 31.9% by 24 months after surgery. Although %TWL was greater in Group A (34.9%) than in Group B (30.2%, p = 0.006) at 24 months, there were no significant differences between groups subsequently up to 60 months of follow-up. Systolic and diastolic blood pressures and lipid profiles improved in both groups. In patients with metabolic syndrome at baseline, mean HbA1c reduced by 36.4% at 12 months and was sustained over the study period. CONCLUSIONS We report that bariatric surgery results in comparable long-term weight loss in patients with or without metabolic syndrome alongside expected improvements in metabolic comorbidities.
Collapse
Affiliation(s)
- Sharanniyan Ragavan
- School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK; (S.R.)
| | - Omar Elhelw
- School of Medical Sciences, The University of Manchester, Manchester M13 9PL, UK; (S.R.)
| | - Waseem Majeed
- Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Bilal Alkhaffaf
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Department of Oesophago-Gastric and Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK;
| | - Siba Senapati
- Department of Oesophago-Gastric and Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK;
- School of Health and Society, Allerton Concourse, Frederick Road Campus, University of Salford, Salford M6 6PU, UK
| | - Basil J. Ammori
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Department of Oesophago-Gastric and Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK;
- Department of Bariatric, General, Gastrointestinal and Hepatobiliary Surgery, Burjeel Hospital, Al Najdah Street, Abu Dhabi P.O. Box 7400, United Arab Emirates
| | - Rajshekhar N. Mudaliar
- Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Akheel A. Syed
- Department of Diabetes, Endocrinology and Obesity Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| |
Collapse
|
13
|
Xie Y, Wen J, Zhu H, Liu Y. The Effects of Reinforcement Techniques in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Protocol for a Web-Based Survey, Systematic Review, and Meta-Analysis. JMIR Res Protoc 2023; 12:e50677. [PMID: 38133924 PMCID: PMC10770791 DOI: 10.2196/50677] [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: 07/09/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The effects of reinforcement are still controversial in bariatric surgery, and variations may exist in using this technique. OBJECTIVE This protocol describes a study that aims to survey the views of bariatric surgeons on reinforcement techniques and evaluate the effects of applying reinforcement techniques in sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). METHODS This study is composed of 2 parts. Part 1 will investigate the differences of using reinforcement techniques among surgeons worldwide who perform SG or RYGB through a survey. The survey will be conducted by email and social media. Part 2 will evaluate the safety and effectiveness of using omentopexy or staple line reinforcement in SG and RYGB by systematic review and meta-analysis. In this part, literature searches will be performed in English databases, including CENTRAL, EMBASE CINAHL, Web of Science, and PubMed, and Chinese databases, including Wanfang, China National Knowledge Infrastructure, Database of Chinese Technical Periodicals, and Chinese Biological Medicine, from their establishment to November 2023. Randomized controlled trials and case-control studies will be included. The primary outcomes are rates of postoperative bleeding and gastric leakage. The secondary outcomes include anastomotic stenosis, surgical site infection, reoperation, estimated intraoperative blood loss, operative time (minutes), length of hospital stay (days), overall complications, and 30-day mortality. The meta-analysis will be conducted using RevMan 5.4 under the random-effects model, as well as through extensive subgroup and sensitivity analyses. P values <0.05 will be considered statistically significant. This study was registered with PROSPERO (Prospective Register of Systematic Reviews) in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols). RESULTS The results of this study will be published in a peer-reviewed journal. The web-based survey and initial title or abstract review of papers identified by the search strategy will be completed in November 2023. The second round of title or abstract review and downloading of the papers for full-text inclusion will be completed in January 2024. We aim to complete data extraction and meta-analysis by February 2024 and expect to publish the findings by the end of March 2024. CONCLUSIONS This study aims to investigate the impact of reinforcement techniques on reducing the incidence of postoperative complications in SG and RYGB procedures and provide assistance for standardizing the procedures of SG and RYGB operations for bariatric surgeons. TRIAL REGISTRATION PROSPERO CRD42022376438; https://tinyurl.com/2d53uf8n. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50677.
Collapse
Affiliation(s)
- Yunhui Xie
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Jun Wen
- College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Hongmei Zhu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| | - Yanjun Liu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, Chengdu, China
| |
Collapse
|
14
|
García-Honores L, Caballero-Alvarado J, Bustamante-Cabrejos A, Lozano-Peralta K, Zavaleta-Corvera C. LAPAROSCOPIC SLEEVE GASTRECTOMY VERSUS LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR WEIGHT LOSS IN OBESE PATIENTS: WHICH IS MORE EFFECTIVE? A SYSTEMATIC REVIEW AND META-ANALYSIS. Arq Bras Cir Dig 2023; 36:e1782. [PMID: 38088727 PMCID: PMC10712920 DOI: 10.1590/0102-672020230064e1782] [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] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS To determine if LSG is more effective than RYLGB for weight loss. METHODS A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
Collapse
Affiliation(s)
- Laura García-Honores
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
| | - Jose Caballero-Alvarado
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Regional Hospital of Trujillo, Department of surgery - Trujillo, La Libertad, Peru
| | - Alexander Bustamante-Cabrejos
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Alta Complejidad Virgen de la Puerta Hospital, Department of surgery - Trujillo, La Libertad, Peru
| | | | | |
Collapse
|
15
|
Hsu JL, Farrell TM. Updates in Bariatric Surgery. Am Surg 2023:31348231220576. [PMID: 38060198 DOI: 10.1177/00031348231220576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.
Collapse
Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
16
|
Onghena L, Van Nieuwenhove Y, Demeulenaere L, Devisscher L, Verhelst X, Degroote H, Raevens S, Van Vlierberghe H, Lefere S, Geerts A. Patients hospitalized with alcohol-related liver disease and prior bariatric surgery are more prone to develop acute-on-chronic liver failure. Liver Int 2023; 43:2743-2751. [PMID: 37718533 DOI: 10.1111/liv.15726] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND & AIMS Patients with a history of bariatric surgery (BS) are susceptible to developing alcohol use disorder. We and others have previously shown that these patients can develop severe alcohol-related liver disease (ARLD). Our aim was to describe the demographics, co-morbidities and mortality of a hospitalized population diagnosed with alcohol-related liver disease, in relation to BS. METHODS We included 299 patients hospitalized with ARLD at the Ghent University Hospital between 1 January 2018 and 31 December 2022. Clinical, biochemical and outcome data were retrospectively retrieved from the most recent hospitalization. Statistical analysis was performed using the t test, Mann-Whitney U and χ2 tests. RESULTS Thirteen per cent (39/299) of patients admitted with ARLD had a history of bariatric surgery, of whom 25 (64.1%) had undergone Roux-en-Y gastric bypass. Patients with a history of BS were predominantly female (76.9%), in contrast to the non-BS population (29.2%) (p < .0001), and despite being significantly younger (p < .0001) and had a similar survival (61.5% vs. 58.1%). Bariatric surgery and older age at diagnosis were both significantly associated with poorer transplant-free survival. The cause of death was acute-on-chronic liver failure in 73.3% of BS patients, compared to only 19.2% of those without a history of BS (p < .0001). The weekly amount of alcohol consumed (p = .012) and duration of use (p < .0001) were significantly lower/shorter in the BS population. CONCLUSIONS BS patients hospitalized with ARLD are predominantly younger women with a lower cumulative alcohol consumption compared to those without prior BS. BS impacted transplant-free survival, with ACLF as the predominant cause of death in these patients.
Collapse
Affiliation(s)
- Louis Onghena
- Department for Human Structure and Repair, Department of Gastrointestinal Surgery, Ghent University, Ghent, Belgium
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department for Human Structure and Repair, Department of Gastrointestinal Surgery, Ghent University, Ghent, Belgium
| | - Laurissa Demeulenaere
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Lindsey Devisscher
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Gut-Liver Immunopharmacology Unit, Ghent University, Ghent, Belgium
| | - Xavier Verhelst
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Helena Degroote
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Sarah Raevens
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Hans Van Vlierberghe
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Sander Lefere
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| | - Anja Geerts
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Hepatology Research Unit, Ghent University, Ghent, Belgium
| |
Collapse
|
17
|
De Hous N, Peeters J, Lockefeer F, Pauli S, Van Cleemput M, Bestman R. Metastatic melanoma causing small intestinal perforation at the jejunojejunostomy after Roux-en-Y gastric bypass: a case report. Acta Chir Belg 2023; 123:691-694. [PMID: 36069503 DOI: 10.1080/00015458.2022.2122315] [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: 06/02/2022] [Accepted: 09/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metastatic melanoma of the small intestine is relatively common, and among affected patients, the proportion with involvement of the small intestine ranges from 35% to 70%. Small intestinal perforation as a primary manifestation of metastatic melanoma is rare. We present the exceptional case of a perforation at the jejunojejunostomy after Roux-en-Y gastric bypass caused by metastatic melanoma. CASE PRESENTATION A 59-year-old woman with a history of a laparoscopic Roux-en-Y gastric bypass and toe amputation due to malignant melanoma (stadium IIIC) presented with an acute abdomen. The abdominal computed tomography scan showed a covered perforation at the jejunojejunostomy of the gastric bypass. The patient underwent an urgent surgical exploration revealing massive tumoral invasion of the anastomosis. The tumoral mass and anastomosis were resected and a new jejunojejunostomy was created. Histopathological examination identified the tumor as a malignant melanoma, so the current abdominal lesions were presumed to be metastases. The postoperative course was uneventful and adjuvant immunotherapy was started a week later. One year after surgery she was doing well with maintenance immunotherapy and there was no evidence of recurrent metastatic disease. CONCLUSION We report the first case of a perforation at the jejunojejunostomy after Roux-en-Y gastric bypass caused by metastatic melanoma. This exceptional case illustrates that a history of malignant melanoma in case of an acute abdomen should raise suspicion of possible metastatic disease.
Collapse
Affiliation(s)
- Nicolas De Hous
- Department of Abdominal Surgery, AZ Monica Hospital, Deurne, Belgium
| | - Jef Peeters
- Department of Radiology, AZ Monica Hospital, Deurne, Belgium
| | | | - Steven Pauli
- Department of Abdominal Surgery, AZ Monica Hospital, Deurne, Belgium
| | - Marc Van Cleemput
- Department of Abdominal Surgery, AZ Monica Hospital, Deurne, Belgium
| | - Raymond Bestman
- Department of Abdominal Surgery, AZ Monica Hospital, Deurne, Belgium
| |
Collapse
|
18
|
Davarpanah Jazi AH, Shahabi S, Sheikhbahaei E, Tolone S, Skalli ME, Kabir A, Valizadeh R, Kermansaravi M. A systematic review and meta-analysis on GERD after OAGB: rate, treatments, and success. Expert Rev Gastroenterol Hepatol 2023; 17:1321-1332. [PMID: 38148703 DOI: 10.1080/17474124.2023.2296992] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION This review aims to investigate the gastroesophageal reflux disease (GERD) as one of the important concerns for both surgeons and patients after one anastomosis gastric bypass (OAGB). METHOD PubMed, Scopus, Embase, Web of Science, and Cochrane were reviewed by the end of the 2021 with keywords relating to GERD, OAGB, and their equivalents. Data regarding OAGB, number of patients with GERD, treatment for GERD, endoscopy findings, the interval between GERD and OAGB were retrieved by two independent investigators. The primary effect/effect size measure was prevalence. RESULTS 40 studies examining 17,299 patients were included revealing that 2% of patients experience GERD following OAGB. Reflux after revisional OAGB is six times higher than primary OAGB. Despite being unclear, medical and surgical treatments for GERD after OAGB were used in 60% and 41% of patients with estimated success rate of 85% and 100%, respectively. CONCLUSION Based on how GERD was identified after OAGB, its rate ranged from 0 to 55%; the pooled rate of 2% is near to Roux-en-Y gastric bypass. GERD symptoms can be mild to be tolerated without medical treatment, moderate that respond to acid-reducing agents, or severe enough that are categorized as interactable and would need a surgical intervention.
Collapse
Affiliation(s)
- Amir Hossein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Shahabi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Salvatore Tolone
- Division of General and Bariatric Surgery, Department of Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mehdi El Skalli
- Centre Hospitalier Universitaire Montpellier, Université de Montpellier 1, Montpellier, France
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram University Hospital, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity (IFSO), Hazrat-E Rasool University Hospital, Tehran, Iran
| |
Collapse
|
19
|
Fuentes N, Reyes JA, Souferi B, Khan A, Kuo YH, Bates AT, Davis JM, Gadaleta D, Pechman DM. Effect of Smoking History on 30-Day Morbidity Following Bariatric Surgery. Am Surg 2023; 89:5436-5441. [PMID: 36786230 DOI: 10.1177/00031348231156766] [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] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Smoking and postoperative complications are well documented across surgical specialties. Preoperative smoking cessation is frequently recommended by surgeons. In this study, we assessed to what degree documented smoking history increased a patient's risk of postoperative complications. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for the years 2015-2018 was used. Patients were included if they underwent primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (LRYGB). Patients with a documented smoking history were assigned to the "SH" cohort and patients without smoking history were assigned to the "NSH" cohort. Patients without documentation regarding smoking history, missing variables, younger than 18, with prior surgery, or lost to follow-up were excluded. 30-day morbidity and mortality data were assessed. Multiple logistic regression analysis was made based on all available patient characteristics and perioperative factors, continuous variables were analyzed using Student's t-test and categorical variables were compared using the chi-square test. RESULTS After evaluation of 760,076 patients on the MBSAQIP database, 650,930 patients underwent non-revisional bariatric surgery, including 466,270 SG and 184,660 LRYGB. Of the total patients included in the study, 44,606 patients were assigned to the SH cohort and 479,601 were assigned to the NSH cohort. 4628 of patients did not have documented smoking status. Within 30 days SH patients had higher rates of readmission (4.2% vs 3.7%, P < .0001), reoperation (1.3% vs 1.1%, P < .0001), unplanned intubation (.2% vs .1%, P = .0212), and unplanned ICU admission (.7% vs .0.6%, P = .0022). CONCLUSION SH patients undergoing bariatric surgery were at significantly increased risk of readmission and reoperation within 30 days of procedure. In addition, SH patients were more likely to have unplanned intubation and unplanned ICU admission. Given the higher rates of complications in smoking patients, this study would suggest that preoperative smoking cessation in patients prior to primary bariatric surgery might be beneficial. Further study is warranted to compare short-term cessation vs long-term cessation preoperatively, which was not assessed in our study.
Collapse
Affiliation(s)
- Nicolas Fuentes
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - Jose A Reyes
- Department of Surgery, New York Medical College at Metropolitan Hospital Center, New York, NY, USA
| | - Benjamin Souferi
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - Ayda Khan
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - Yen-Hong Kuo
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - Andrew T Bates
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - John M Davis
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - Dominick Gadaleta
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| | - David M Pechman
- Department of Surgery, South Shore University Hospital-Northwell Health, Bay Shore, NY, USA
| |
Collapse
|
20
|
Salehi M, Peterson R, Tripathy D, Pezzica S, DeFronzo R, Gastaldelli A. Differential effect of gastric bypass versus sleeve gastrectomy on insulinotropic action of endogenous incretins. Obesity (Silver Spring) 2023; 31:2774-2785. [PMID: 37853989 PMCID: PMC10593483 DOI: 10.1002/oby.23872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Prandial hyperinsulinemia after Roux-en-Y gastric bypass surgery (GB), and to lesser degree after sleeve gastrectomy (SG), has been attributed to rapid glucose flux from the gut and increased insulinotropic gut hormones. However, β-cell sensitivity to exogenous incretin is reduced after GB. This study examines the effect of GB versus SG on prandial glycemia and β-cell response to increasing concentrations of endogenous incretins. METHODS Glucose kinetics, insulin secretion rate (ISR), and incretin responses to 50-g oral glucose ingestion were compared between ten nondiabetic participants with GB versus nine matched individuals with SG and seven nonoperated normal glucose tolerant control individuals (CN) with and without administration of 200 mg of sitagliptin. RESULTS Fasting glucose and hormonal levels were similar among three groups. Increasing plasma concentrations of endogenous incretins by two- to three-fold diminished prandial glycemia and increased β-cell secretion in all three groups (p < 0.05), but insulin secretion per insulin sensitivity (i.e., disposition index) was increased only in GB (p < 0.05 for interaction). However, plot of the slope of ISR (from premeal to peak values) versus plasma glucagon-like peptide-1 concentration was smaller after GB compared with SG and CN. CONCLUSIONS After GB, increasing incretin activity augments prandial β-cell response whereas the β-cell sensitivity to increasing plasma concentrations of endogenous incretin is diminished.
Collapse
Affiliation(s)
- Marzieh Salehi
- Division of Diabetes, University of Texas at San Antonio, San Antonio, TX, United States
- STVHCS, Audie Murphy Hospital, San Antonio, TX, United States
| | - Richard Peterson
- Department of Surgery, University of Texas at San Antonio, San Antonio, TX, United States
| | - Devjit Tripathy
- Division of Diabetes, University of Texas at San Antonio, San Antonio, TX, United States
| | - Samantha Pezzica
- Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| | - Ralph DeFronzo
- Division of Diabetes, University of Texas at San Antonio, San Antonio, TX, United States
| | - Amalia Gastaldelli
- Division of Diabetes, University of Texas at San Antonio, San Antonio, TX, United States
- Cardiometabolic Risk Unit, CNR Institute of Clinical Physiology, Pisa, Italy
| |
Collapse
|
21
|
Al‐Alsheikh AS, Alabdulkader S, Miras AD, Goldstone AP. Effects of bariatric surgery and dietary interventions for obesity on brain neurotransmitter systems and metabolism: A systematic review of positron emission tomography (PET) and single-photon emission computed tomography (SPECT) studies. Obes Rev 2023; 24:e13620. [PMID: 37699864 PMCID: PMC10909448 DOI: 10.1111/obr.13620] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/05/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023]
Abstract
This systematic review collates studies of dietary or bariatric surgery interventions for obesity using positron emission tomography and single-photon emission computed tomography. Of 604 publications identified, 22 met inclusion criteria. Twelve studies assessed bariatric surgery (seven gastric bypass, five gastric bypass/sleeve gastrectomy), and ten dietary interventions (six low-calorie diet, three very low-calorie diet, one prolonged fasting). Thirteen studies examined neurotransmitter systems (six used tracers for dopamine DRD2/3 receptors: two each for 11 C-raclopride, 18 F-fallypride, 123 I-IBZM; one for dopamine transporter, 123 I-FP-CIT; one used tracer for serotonin 5-HT2A receptor, 18 F-altanserin; two used tracers for serotonin transporter, 11 C-DASB or 123 I-FP-CIT; two used tracer for μ-opioid receptor, 11 C-carfentanil; one used tracer for noradrenaline transporter, 11 C-MRB); seven studies assessed glucose uptake using 18 F-fluorodeoxyglucose; four studies assessed regional cerebral blood flow using 15 O-H2 O (one study also used arterial spin labeling); and two studies measured fatty acid uptake using 18 F-FTHA and one using 11 C-palmitate. The review summarizes findings and correlations with clinical outcomes, eating behavior, and mechanistic mediators. The small number of studies using each tracer and intervention, lack of dietary intervention control groups in any surgical studies, heterogeneity in time since intervention and degree of weight loss, and small sample sizes hindered the drawing of robust conclusions across studies.
Collapse
Affiliation(s)
- Alhanouf S. Al‐Alsheikh
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonHammersmith HospitalLondonUK
- Department of Community Health Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Shahd Alabdulkader
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonHammersmith HospitalLondonUK
- Department of Health Sciences, College of Health and Rehabilitation SciencesPrincess Nourah Bint Abdulrahman UniversityRiyadhSaudi Arabia
| | - Alexander D. Miras
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonHammersmith HospitalLondonUK
- School of Medicine, Faculty of Life and Health SciencesUlster UniversityLondonderryUK
| | - Anthony P. Goldstone
- PsychoNeuroEndocrinology Research Group, Division of Psychiatry, Department of Brain Sciences, Imperial College LondonHammersmith HospitalLondonUK
| |
Collapse
|
22
|
Iwamoto N, Oikawa M, Kukimoto T, Ito J, Murakami K, Kaiho Y. Renal pelvis cancer with initial symptoms of malignant gastric outlet obstruction. IJU Case Rep 2023; 6:475-478. [PMID: 37928298 PMCID: PMC10622218 DOI: 10.1002/iju5.12652] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Gastric outlet obstruction caused by upper tract urothelial carcinoma is rare. Case presentation A 78-year-old man presented to the hospital with nausea and vomiting. No hematuria was observed. Computed tomography revealed a tumor in the right renal pelvis and duodenal stenosis. Gastrojejunostomy was performed to treat the symptoms of the gastric outlet obstruction so that the patient could resume oral intake and outpatient chemotherapy. Chemotherapy was unsuccessful, and the patient died 9 months after the gastrojejunostomy. Histological assessment of an autopsy specimen revealed plasmacytoid urothelial carcinoma with direct infiltration of the duodenal wall, which caused the stenosis. Conclusion Autopsy revealed a right renal pelvis cancer causing gastric outlet obstruction. Early gastrojejunostomy enabled oral intake and outpatient visits.
Collapse
Affiliation(s)
- Nao Iwamoto
- Division of Urology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Masaaki Oikawa
- Division of Urology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Takashi Kukimoto
- Division of Urology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Jun Ito
- Division of Urology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Kazuhiro Murakami
- Division of Pathology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| | - Yasuhiro Kaiho
- Division of Urology, Faculty of MedicineTohoku Medical and Pharmaceutical UniversitySendaiJapan
| |
Collapse
|
23
|
Reyes F, Pecora N, Weiss ZF. Duped by dumping syndrome: non-endemic Vibrio cholerae bacteremia in an immunocompetent host with gastric bypass surgery, a case report. Access Microbiol 2023; 5:000517.v3. [PMID: 37970081 PMCID: PMC10634482 DOI: 10.1099/acmi.0.000517.v3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/13/2023] [Indexed: 11/17/2023] Open
Abstract
Extra-intestinal infection with non-O1/non-O139 strains of Vibrio cholerae (NOVC) is rare, though bacteremia and hepatobiliary manifestations have been reported. Reduced stomach acid, or hypochlorhydria, can increase risk of V. cholerae infection. We describe a 42-year-old woman with hypochlorhydria due to untreated Helicobacter pylori infection, gastric-bypass surgery, and chronic proton pump inhibitors (PPI) exposure, who developed acute diarrhoea following raw oyster consumption. Her symptoms were attributed to rapid gastric emptying (dumping syndrome) after a negative limited stool work-up. She had persistent diarrhoea, weight loss, and after 5 months was admitted with acute cholecystitis and NOVC bacteremia, requiring cholecystectomy. This is the first reported case of NOVC bacteremia and cholecystitis in a patient with gastric bypass. This case highlights the potential for NOVC biliary carriage, the role of hypochlorhydria as a risk factor for Vibrio infection, and the importance of excluding infectious diarrhoea in patients with new onset of symptoms compatible with dumping syndrome and a relevant travel history.
Collapse
Affiliation(s)
- Fabiola Reyes
- Brigham and Women’s Hospital, Division of Infectious Diseases, 75 Francis St, Boston, MA, 02115, USA
- Tufts Medical Center, Department of Pathology, 800 Washington St. Boston, MA, 02111, USA
| | - Nicole Pecora
- Brigham and Women’s Hospital, Department of Pathology, 75 Francis St, Boston, MA, 02115, USA
| | - Zoe Freeman Weiss
- Brigham and Women’s Hospital, Division of Infectious Diseases, 75 Francis St, Boston, MA, 02115, USA
- Tufts Medical Center, Department of Pathology, 800 Washington St. Boston, MA, 02111, USA
- Brigham and Women’s Hospital, Department of Pathology, 75 Francis St, Boston, MA, 02115, USA
- Tufts Medical Center, Division of Geographic Medicine and Infectious Diseases, 800 Washington St. Boston, MA, 02111, USA
| |
Collapse
|
24
|
Lira LLF, Cavalcante KC, Freire TT, Takagi IM, de Oliveira CMB, Moura ECR, Leal PDC. Intraoperative, sociodemographic, and postoperative parameters in individuals undergoing bariatric surgery. Rev Assoc Med Bras (1992) 2023; 69:e20230535. [PMID: 37909617 PMCID: PMC10610775 DOI: 10.1590/1806-9282.20230535] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study aimed to comparatively analyze sociodemographic data and postoperative parameters of patients undergoing bypass and sleeve surgeries in a private hospital in São Luís, MA. METHODS The study was descriptive, prospective, observational, and comparative, with a quantitative approach between August 2020 and July 2021. We analyzed 74 participants of both genders, aged between 18 and 70 years, with 31 undergoing Roux-en-Y gastric bypass surgery and 43 undergoing sleeve gastrectomy surgery. In the postoperative period, sociodemographic characteristics, surgery and anesthesia duration, pain levels, adverse effects, weight loss, and complications from the surgical procedure were analyzed. RESULTS Males predominated in Roux-en-Y gastric bypass and females in sleeve gastrectomy surgery. Clinical characteristics regarding self-declared ethnicity, age and place of birth, education, and marital status were similar between the studied groups. Roux-en-Y gastric bypass had an average surgery time of 112.14±10.06 min and sleeve gastrectomy 91.11±23.69 min, with a significant difference (p<0.001). Regarding anesthesia time, gastric bypass averaged 160.36±13.99 min and sleeve gastrectomy 154.88±29.10 min, with no statistical difference between groups (p=0.335). Nausea, vomiting, and drowsiness were more common in Sleeve gastrectomy, with no significant difference (p=0.562). Roux-en-Y gastric bypass showed a higher rate of weight loss from 1 month after surgery (14.2±4.15) and more variation in body mass index within 3 months after surgery (32.17±4.76). Complications occurred in a small number of patients. CONCLUSION The two surgical techniques proved effective in delivering the best results for patients, with the group undergoing bypass showing statistically significant weight loss from 1 month after the surgical procedure.
Collapse
Affiliation(s)
- Lyrian Lorena Freire Lira
- Universidade Federal do Maranhão, Postgraduate Program in Physical Education – São Luís (MA), Brazil
| | | | | | | | | | - Ed Carlos Rey Moura
- Universidade Federal do Maranhão, Postgraduate Program in Adult Health – São Luís (MA), Brazil
| | - Plinio da Cunha Leal
- Universidade Federal do Maranhão, Postgraduate Program in Adult Health – São Luís (MA), Brazil
| |
Collapse
|
25
|
Workneh HT, Mehta B, Grover A. Sugar Swing After Surgery: Hyperinsulinemic Hypoglycemia With Possible Nesidioblastosis After Roux-en-Y Gastric Bypass Surgery. Cureus 2023; 15:e47349. [PMID: 38021505 PMCID: PMC10657272 DOI: 10.7759/cureus.47349] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Bariatric surgery is a procedure performed to achieve weight loss and manage obesity. However, it can result in various complications including post-surgical hypoglycemia. Nesidioblastosis is a rare hypoglycemic syndrome marked by diffuse hyperplasia of pancreatic β cells with distinct histologic features. Recent case reports have indicated an association of nesidioblastosis with certain bariatric procedures, often specifically linked to Roux-en-Y gastric bypass (RYGB) surgery. In this case report, we describe a 78-year-old male with a complex medical history who presented with altered mental status and severe hypoglycemia (13 mg/dL), despite having no history of diabetes or use of hypoglycemic medications. The patient's clinical condition improved after receiving a 50% intravenous dextrose injection and subsequently placed on a 10% dextrose infusion. Adrenal insufficiency was ruled out with normal cortisol level, and tests for β-hydroxybutyrate, dehydroepiandrosterone (DHEA) sulfate, and hypoglycemia panels were all negative. However, further investigations were significant for elevated serum insulin, C-peptide, and proinsulin levels. The patient then underwent an abdominal computed tomography (CT) scan, which revealed a grossly normal liver, spleen, pancreas, and adrenal glands, along with evidence of prior gastric bypass surgery. Further evaluation confirmed a history of Roux-en-Y gastric bypass surgery, which was performed to address morbid obesity and obstructive sleep apnea. Following the procedure, the patient began experiencing hypoglycemic episodes. Subsequently, the patient was diagnosed with hyperinsulinemic hypoglycemia with possible nesidioblastosis. This diagnosis was made based on severe recurrent postprandial hypoglycemia, accompanied by elevated endogenous insulin production, and a pancreas that appeared grossly normal on imaging. The patient was treated with acarbose to prevent carbohydrate-driven blood sugar and insulin spikes, octreotide to inhibit insulin secretion, and dietary guidance to avoid high glycemic index foods. This case emphasizes the potential link between bariatric surgeries and metabolic disturbances, underscoring the importance of identifying uncommon hypoglycemic syndromes.
Collapse
Affiliation(s)
- Hiwot T Workneh
- Internal Medicine, Hackensack Meridian Mountainside Medical Center, Montclair, USA
| | - Bijal Mehta
- Internal Medicine, Hackensack Meridian Mountainside Medical Center, Montclair, USA
| | - Anjali Grover
- Endocrinology, Diabetes and Metabolism, Hackensack Meridian Mountainside Medical Center, Montclair, USA
| |
Collapse
|
26
|
Abstract
OBJECTIVE In a large multisite cohort of Veterans who underwent Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy, we compared the 5-year suicidal ideation and attempt rates with matched nonsurgical controls. BACKGROUND Bariatric surgery has significant health benefits but has also been associated with adverse mental health outcomes. METHODS Five-year rates of suicidal ideation and suicide attempts of Veterans who underwent Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from the fiscal year 2000-2016 to matched nonsurgical controls using sequential stratification using cumulative incidence functions (ideation cohort: n=38,199; attempt cohort: n=38,661 after excluding patients with past-year outcome events). Adjusted differences in suicidal ideation and suicide attempts were estimated using a Cox regression with a robust sandwich variance estimator. RESULTS In the matched cohorts for suicidal ideation analyses, the mean age was 53.47 years and the majority were males (78.7%) and White (77.7%). Over 40% were treated for depression (41.8%), had a nonrecent depression diagnosis (40.9%), and 4.1% had past suicidal ideation or suicide attempts >1 year before index. Characteristics of the suicide attempt cohort were similar. Regression results found that risk of suicidal ideation was significantly higher for surgical patients (adjusted hazard ratio=1.21, 95% CI: 1.03-1.41), as was risk of suicide attempt (adjusted hazard ratio=1.62, 95% CI: 1.22-2.15). CONCLUSIONS Bariatric surgery appears to be associated with a greater risk of suicidal ideation and attempts than nonsurgical treatment of patients with severe obesity, suggesting that patients need careful monitoring for suicidal ideation and additional psychological support after bariatric surgery.
Collapse
Affiliation(s)
- Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
| | - Theodore S. Z. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC
| | - David E. Arterburn
- Department of Medicine, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - James E. Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, ND Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Katharine A. Bradley
- Department of Medicine, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Services, University of Washington, Seattle, WA
| | - Nathan A. Kimbrel
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
| |
Collapse
|
27
|
Abdelsamee KS. Short-term outcomes of double omentopexy in one anastomosis gastric bypass surgery: A controlled clinical trial. Niger J Clin Pract 2023; 26:1483-1490. [PMID: 37929524 DOI: 10.4103/njcp.njcp_26_23] [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] [Indexed: 11/07/2023]
Abstract
Purpose This study aims to assess the efficacy of implementing a novel technique of reinforcement of gastric pouch and remnant stomach staple line with Double Omentopexy (DO) in patients undergoing One-Anastomosis Gastric Bypass (OAGB) surgery and evaluate its impact in reducing the early postoperative complications. Materials and Methods The 123 patients were allocated into two groups: 61 in the standard OAGB group and 62 in OAGB with DO group. The primary outcomes are postoperative complications (including early postoperative bleeding, leakage, gastric twist, reflux, etc.) and hospital stay. The secondary outcome is excess body weight loss. Follow-up visits were planned after discharge: at two weeks, two months, and three months postoperatively. Results Postoperative complications were significantly lower, 3 (4.84%) in OAGB with DO compared with 10 (16.39%) in standard OAGB (P =0.037). There was no statistically significant difference in the incidence of early postoperative bleeding, deep vein thrombosis, biliary reflux, and gall bladder stone (P >.05). No patient had leakage in either group. The mean operative time was significantly longer (68.66 ± 6.68 min) in OAGB with the DO group when compared with the standard OAGB group (62.16 ± 7.54 min) (P <.001). Conclusion Applying the DO technique may be a good measure to be added during OAGB to decrease the incidence of potential postoperative complications, especially the rate and severity of bleeding.
Collapse
Affiliation(s)
- K S Abdelsamee
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
28
|
Franken RJ, Franken J, Sluiter NR, de Vries R, Euser S, Gerdes VEA, de Brauw M. Efficacy and safety of revisional treatments for weight regain or insufficient weight loss after Roux-en-Y gastric bypass: A systematic review and meta-analysis. Obes Rev 2023; 24:e13607. [PMID: 37515352 DOI: 10.1111/obr.13607] [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: 10/07/2022] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
Weight regain or inadequate weight loss following Roux-en-Y gastric bypass poses a significant clinical challenge. Our objective was to evaluate various revisional techniques for addressing weight regain and insufficient weight loss after Roux-en-Y gastric bypass through a systematic review and meta-analysis. We performed a literature search (in PubMed and Embase) on revisional interventions in collaboration with a medical information specialist. Measured outcomes included body mass index at intervention, total weight loss during follow-up, and complications. Random effects models were used to determine pooled effect size and corresponding 95% confidence intervals. Thirty-nine studies were included: four studies reported on argon plasma coagulation, four studies on transoral outlet reduction, nine studies on transoral outlet reduction + argon plasma coagulation, four studies on pouch/gastrojejunal anastomosis revision, five on laparoscopic gastric banding, two studies on laparoscopic gastric banding + pouch resizing, 10 on distalization-RYGB, and one on duodenal switch. All techniques resulted in short-term clinically relevant weight loss. Endoscopic procedures had a short follow-up and resulted in modest and temporary weight loss. Surgical revision techniques were successful for weight loss in longer term follow-up, at the expense of high complication rates.
Collapse
Affiliation(s)
- Rutger J Franken
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | - Josephine Franken
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | - Nina R Sluiter
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| | | | - Sjoerd Euser
- Department of Epidemiology, Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Victor E A Gerdes
- Department of Internal Medicine, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
- Department of Vascular Medicine, AUMC, Amsterdam, the Netherlands
| | - Maurits de Brauw
- Department of Surgery, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
| |
Collapse
|
29
|
Hussan H, McLaughlin E, Chiang C, Marsano JG, Lieberman D. The Risk of Colorectal Polyps after Weight Loss Therapy Versus Obesity: A Propensity-Matched Nationwide Cohort Study. Cancers (Basel) 2023; 15:4820. [PMID: 37835515 PMCID: PMC10571780 DOI: 10.3390/cancers15194820] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND A fundamental understanding of the impact of bariatric surgery (BRS) on mechanisms of colorectal carcinogenesis is limited. For instance, studies report a reduced risk of colorectal cancer in females but not in males after BRS. We examined whether this sex-specific difference existed at the earlier polyp development stage. METHODS This retrospective cohort study included 281,417 adults from the 2012-2020 MarketScan database. We compared polyps rates on colonoscopy in four groups: post- vs. pre-BRS (treatment) to post- vs. pre-severe obesity (SO) diagnosis (control). We focused our main analysis on a propensity-matched sample that yielded a balanced distribution of covariates in our four groups (n = 9680 adults, 21.9% males). We also adjusted for important covariates. RESULTS Metabolic syndrome parameters improved after bariatric surgery and worsened after severe obesity diagnosis (p < 0.05). The rate of polyps was 46.7% at a median of 0.5 years pre-BRS and 47.9% at a median of 0.6 years pre-SO diagnosis. The polyps rate was 45.4% at a median (range) of 3.2 (1.0-8.5) years post-BRS. Conversely, 53.8% of adults had polyps at 3.0 (1.0-8.6) years post-SO. There was no change in the risk of colorectal polyps in males or females post- vs. pre-BRS. However, the risk of polyps was higher in males (OR = 1.32, 95% CI: 1.02-1.70) and females (OR = 1.29, 95% CI: 1.13-1.47) post- vs. pre-SO. When compared to the control group (SO), the odds ratios for colorectal polyps were lower for males and females after bariatric surgery (OR = 0.63, 95% CI: 0.44-0.90, and OR = 0.79, 95% CI: 0.66-0.96, respectively). CONCLUSIONS Obesity is associated with an increased risk of colorectal polyps, an effect that is ameliorated after bariatric surgery. These data are relevant for studies investigating colorectal carcinogenesis mechanisms.
Collapse
Affiliation(s)
- Hisham Hussan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95616, USA
| | - Eric McLaughlin
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Chienwei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Joseph G. Marsano
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of California Davis, Sacramento, CA 95616, USA
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
| |
Collapse
|
30
|
Arishi AA, Gosadi IM, Hakami IA, Darraj H, Abusageah F, Hakami KM, Zaalah SA, Awaf M, Maghrabi R, Alamer AA, Hamdi S, Jareebi MA, Masmali AM, Hakami GH, Najmi WA. Bariatric Surgery Reduces Weight Loss, Comorbidities Prevalence, and Improves Quality of Life in the Southern Region of Saudi Arabia. Medicina (Kaunas) 2023; 59:1695. [PMID: 37893415 PMCID: PMC10608156 DOI: 10.3390/medicina59101695] [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] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Bariatric surgery has been proposed as a treatment option for type 2 diabetes, but there is limited research on its efficacy and the use of standardized outcome measures. Therefore, this study aimed to evaluate the efficacy of bariatric surgery in managing type 2 diabetes and to assess the BAROS protocol postoperatively. Material and Methods: This cross-sectional study was conducted in southern Saudi Arabia, involving 346 bariatric surgery patients aged 18-60. This study collected data through an electronic questionnaire distributed via a Telegram group and Twitter hashtag. Anthropometric data, postoperative complications, and the evolution of obesity-related comorbidities were collected. The quality of life was evaluated using the Moorehead-Ardelt questionnaire of the BAROS protocol. The total BAROS score was classified as "Insufficient", "Moderate", "Good", "Very good", or "Excellent", considering the presence of comorbidities. The data were analyzed using SPSS software ver.23. Results: The mean age of the participants was 30.97 ± 8.49 years, and 70.81% were female. Sleeve Vertical Gastrectomy was the most common surgical technique used (n = 336). The excess weight loss percentage (EWL%) was 70.55 ± 22.57%, and 27.75% of participants achieved complete remission of type 2 diabetes. The total BAROS score was "Excellent" for 40.17% of participants and "Moderate" for 27.16%. The presence of comorbidities was negatively correlated with the BAROS score (r = -0.651, p < 0.001). Conclusions: Bariatric surgery effectively manages type 2 diabetes with a high rate of EWL% and complete remission. The BAROS protocol is a valuable tool for assessing the quality of life postoperatively, with most participants achieving a "Moderate" to "Excellent" score. Comorbidities negatively impact the BAROS score, highlighting the importance of managing these conditions postoperatively.
Collapse
Affiliation(s)
- Abdulaziz A. Arishi
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ibrahim Metaan Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (I.M.G.)
| | - Ibrahim Ali Hakami
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Hussam Darraj
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Faisal Abusageah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Khalid M. Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Shaden A. Zaalah
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Mohammed Awaf
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Rawan Maghrabi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Afnan A. Alamer
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Sulaiman Hamdi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Mohammad Abdu Jareebi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia; (I.M.G.)
| | - Amro M. Masmali
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Ghalia H. Hakami
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| | - Weaam A. Najmi
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia (K.M.H.)
| |
Collapse
|
31
|
Valezi AC, Campos ACL, Bahten LCV. BRAZILIAN MULTI-SOCIETY POSITION STATEMENT ON EMERGING BARIATRIC AND METABOLIC SURGICAL PROCEDURES. Arq Bras Cir Dig 2023; 36:e1759. [PMID: 37729276 PMCID: PMC10510373 DOI: 10.1590/0102-672020230041e1759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 09/22/2023]
Abstract
This Brazilian multi-society position statement on emerging bariatric and metabolic surgical procedures was issued by the Brazilian Society of Bariatric and Metabolic Surgery (SBCBM), the Brazilian College of Digestive Surgery (CBCD), and the Brazilian College of Surgeons (CBC). This document is the result of a Brazilian Emerging Surgeries Forum aimed at evaluating the results of surgeries that are not yet listed in the Federal Council of Medicine (CFM), the regulatory agency that oversees and regulates medical practice in Brazil. The Forum integrated more than 400 specialists and academics with extensive knowledge about bariatric and metabolic surgery, representing the three surgical societies: SBCBM, CBC, and CBCD. International speakers participated online and presented their experiences with the techniques under discussion, emphasizing the regulatory policies in their countries. The indications for surgery and the subsequent procedures were carefully reviewed, including one anastomosis gastric bypass (OAGB), single anastomosis duodeno-ileal with sleeve gastrectomy (SADI-S or OADS), sleeve gastrectomy with transit bipartition (SGTB), and sleeve gastrectomy with ileal interposition (SGII). The recommendations of this document are based on an extensive literature review and discussions among bariatric surgery specialists from the three surgical societies. We concluded that patients with a body mass index over 30 kg/m2 may be candidates for metabolic surgery in the presence of comorbidities (arterial hypertension and type 2 diabetes) with no response to clinical treatment of obesity or in the control of other associated diseases. Regarding the surgical procedures, we concluded that OAGB, OADS, and SGTB are associated with low morbidity rates, satisfactory weight loss, and resolution of obesity-related comorbidities such as diabetes and arterial hypertension. SGII was considered a good and viable promising surgical alternative technique. The recommendations of this statement aim to synchronize our societies with the sentiments and understandings of most of our members and also serve as a guide for future decisions regarding bariatric surgical procedures in our country and worldwide.
Collapse
|
32
|
Hage K, Barajas-Gamboa JS, Romero-Velez G, Allemang M, Navarrete S, Corcelles R, Rodriguez J, Ghanem OM, Kroh M, Dang JT. Revisional Procedures after Sleeve Gastrectomy for Weight Recurrence or Inadequate Weight Loss: An Analysis of the MBSAQIP Database. J Clin Med 2023; 12:5975. [PMID: 37762916 PMCID: PMC10531699 DOI: 10.3390/jcm12185975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION The safety of conversional bariatric procedures after sleeve gastrectomy (SG) for weight recurrence (WR) or inadequate weight loss (IWL) is debated due to limited evidence. Conversion options include Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass (SADI), and biliopancreatic diversion with duodenal switch (BPD-DS). We aimed to compare serious complications and mortality rates between these procedures within 30 days. METHODS Using the 2020 and 2021 MBSAQIP databases, we identified patients who underwent a conversion from SG to RYGB, SADI, or BPD-DS. We performed a multivariable logistic regression to assess predictors of 30-day complications and mortality. RESULTS Among 7388 patients (77.6% RYGB, 8.7% SADI, 13.7% BPD-DS), those undergoing SADI and BPD-DS had higher preoperative body mass index. Conversion reasons included WR (63.0%) and IWL (37.0%). SADI and BPD-DS patients had longer operative times (p < 0.001) and higher leak rates (p = 0.001). Serious complications, reoperations, readmissions, and 30-day mortality were similar across groups. Conversion procedure type was not an independent predictor of complications. CONCLUSION RYGB was the most performed conversional procedure after SG. The study indicated a similar safety profile for revisional RYGB, SADI, and BPD-DS, with comparable 30-day complications and mortality rates. However, SADI and BPD-DS patients had longer operative time and higher leak rates.
Collapse
Affiliation(s)
- Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Juan S. Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi P.O. Box 112412, United Arab Emirates
| | | | - Matthew Allemang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Ricard Corcelles
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - John Rodriguez
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi P.O. Box 112412, United Arab Emirates
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jerry T. Dang
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
33
|
Barros FD, Fonseca ABM, Kiss ASB, Braga CF, DA-Silva FR, Regonati YH. ROBOTIC VERSUS LAPAROSCOPIC ROUX-EN-Y- GASTRIC BYPASS: A RETROSPECTIVE STUDY IN A SINGLE CENTER. Arq Bras Cir Dig 2023; 36:e1756. [PMID: 37729282 PMCID: PMC10510099 DOI: 10.1590/0102-672020230038e1756] [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] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/07/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Bariatric surgery is the best treatment option for patients with obesity. As a result of the advancement of technology, the robotic gastric bypass presents promising results, despite its still high costs. AIMS The aim of this study was to compare patients submitted to a robotic versus a laparoscopic gastric bypass at a single center by a single surgeon. METHODS This retrospective study collected data from the medical records of 221 patients (121 laparoscopic procedures versus 100 with daVinci platform). The variables analyzed were sex, age, body mass index, comorbidities, surgical time, length of stay, and complications. RESULTS The mean surgical time for patients in the robotic group was shorter (102.41±39.44 min versus 113.86±39.03 min, p=0.018). The length of hospital stay in robotic patients was shorter (34.12±20.59 h versus 34.93±11.74 h, p=0.007). There were no serious complications. CONCLUSIONS The group submitted to the robotic method had a shorter surgical time and a shorter hospital stay. No difference was found regarding strictures, bleeding, or leakage.
Collapse
Affiliation(s)
- Fernando de Barros
- Universidade Federal Fluminense, Department of General and Specialized Surgery - Niterói (RJ), Brazil
- DASA, Robotic Surgery - Rio de Janeiro (RJ), Brazil
| | | | | | - Camilla Ferreira Braga
- Universidade Federal Fluminense, Department of General and Specialized Surgery - Niterói (RJ), Brazil
| | | | - Yumi Honda Regonati
- Universidade Federal Fluminense, Department of General and Specialized Surgery - Niterói (RJ), Brazil
| |
Collapse
|
34
|
Bulisani BM, Rodrigues MR, Gomes LGL, de Oliveira Leite MA, Rossi FMB, Rostey N, Waisberg J. Internal post-bariatric hernia due to hepatic adhesion: a case report. Einstein (Sao Paulo) 2023; 21:eRC0478. [PMID: 37729312 PMCID: PMC10501762 DOI: 10.31744/einstein_journal/2023rc0478] [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: 02/16/2023] [Accepted: 04/23/2023] [Indexed: 09/22/2023] Open
Abstract
Roux-en-Y gastric bypass, a procedure proven effective for treating morbid obesity and metabolic disorders, carries the risk of complications such as the formation of internal hernias. These hernias are often difficult to diagnose and can be potentially fatal because they can cause structural obstruction. Most internal hernias occur in the jejunojejunostomy mesentery space, followed by Petersen's space hernias, although herniation at other locations can also occur. Our case report presents an example of a rare internal hernia after laparoscopic Roux-en-Y gastric bypass. A 36-year-old woman presented with an uncommon internal hernia located between the liver and alimentary loop, resulting in the formation of a new space and consequently incarcerating the entire biliopancreatic loop. This type of internal hernia is rare and has not been reported in the literature, indicating that this is the first report of such a case. In this case, we realized that the diagnosis was challenging and imaging examinations could not help determine the etiology of the pain and obstruction. Therefore, videolaparoscopy revealed an uncommon hernia formed by firm adhesion between the hepatic segment III and the alimentary loop mesentery. Our case is an example of an internal hernia that was not detected with a normal computed tomography scan of the abdomen and pelvis. Only diagnostic laparoscopy revealed herniation, effectively preventing further complications for the patient.
Collapse
Affiliation(s)
- Bruno Mirandola Bulisani
- RR Médicos CirurgiõesSão Bernardo do CampoSPBrazilRR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil.
- Centro Universitário FMABCSanto AndréSPBrazilCentro Universitário FMABC, Santo André, SP, Brazil.
| | - Murilo Rocha Rodrigues
- RR Médicos CirurgiõesSão Bernardo do CampoSPBrazilRR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil.
| | - Luiz Guilherme Lisboa Gomes
- RR Médicos CirurgiõesSão Bernardo do CampoSPBrazilRR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil.
- Centro Universitário FMABCSanto AndréSPBrazilCentro Universitário FMABC, Santo André, SP, Brazil.
| | | | - Felipe Martin Bianco Rossi
- RR Médicos CirurgiõesSão Bernardo do CampoSPBrazilRR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil.
| | - Nathan Rostey
- RR Médicos CirurgiõesSão Bernardo do CampoSPBrazilRR Médicos Cirurgiões, São Bernardo do Campo, SP, Brazil.
| | - Jaques Waisberg
- Centro Universitário FMABCSanto AndréSPBrazilCentro Universitário FMABC, Santo André, SP, Brazil.
| |
Collapse
|
35
|
Kayastha A, Wasselle J, Wilensky A, Sujka JA, Mhaskar R, DuCoin CG. Feasibility of Anti-reflux Gastric Bypass for Massive Paraesophageal Hernia in Obese Patients With Gastroesophageal Reflux Disease. Cureus 2023; 15:e45616. [PMID: 37868460 PMCID: PMC10588764 DOI: 10.7759/cureus.45616] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Background The objective of this study is to demonstrate the safety and feasibility of anti-reflux gastric bypass (ARGB) as a treatment for symptomatic massive paraesophageal hernias (PEH) in the obese population. Both gastroesophageal reflux disease (GERD) and PEH are particularly prevalent in the obese patient population, and obesity adversely affects the long-term outcomes of all anti-reflux procedures. Methods This is a single-center, retrospective review of 17 obese adults who underwent ARGB for the treatment of massive PEH between September 2019 and December 2021. Massive PEH was defined as >5 cm in a singular direction, and obesity as BMI ≥30 kg/m2. Patients without preoperative diagnostic testing were excluded. We reviewed and analyzed patient demographic data, postoperative symptom resolution, weight loss, and complications using descriptive statistics, change from baseline, and comparison of proportions. Results Sixteen of the 17 subjects were female. The median age was 48, and the median BMI was 39.10 kg/m2 (30.0-49.3 kg/m2). The average PEH size on imaging was 6.48 (H) x 6.25 (W) cm. The resolution of heartburn was 93.8% (p<0.001), and the resolution of nausea and vomiting was 80.0%. The mean postoperative length of follow-up was 9.12 months. Median excess body weight loss percentages at one, three, six, and 12 months were 16.43% (p<0.001), 35.92% (p<0.001), 40.64% (p=0.001), and 58.58% (p<0.01), respectively. Five patients experienced adverse events requiring additional intervention or hospitalization. There were no symptomatic hernia recurrences or mortality. Conclusion This study demonstrates that ARGB is feasible and potentially effective in treating symptomatic massive paraesophageal hernias in the obese patient population. Further investigation is needed to determine efficacy and long-term outcomes compared to standard surgical repair.
Collapse
Affiliation(s)
- Ahan Kayastha
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Joseph Wasselle
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Adam Wilensky
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Joseph A Sujka
- Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Rahul Mhaskar
- Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | | |
Collapse
|
36
|
Alkhaled L, Al-Kurd A, Butsch WS, Kashyap SR, Aminian A. Diagnosis and management of post-bariatric surgery hypoglycemia. Expert Rev Endocrinol Metab 2023; 18:459-468. [PMID: 37850227 DOI: 10.1080/17446651.2023.2267136] [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: 07/01/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION While bariatric surgery remains the most effective treatment for obesity that allows substantial weight loss with improvement and possibly remission of obesity-associated comorbidities, some postoperative complications may occur. Managing physicians need to be familiar with the common problems to ensure timely and effective management. Of these complications, postoperative hypoglycemia is an increasingly recognized complication of bariatric surgery that remains underreported and underdiagnosed. AREA COVERED This article highlights the importance of identifying hypoglycemia in patients with a history of bariatric surgery, reviews pathophysiology and addresses available nutritional, pharmacological and surgical management options. Systemic evaluation including careful history taking, confirmation of hypoglycemia and biochemical assessment is essential to establish accurate diagnosis. Understanding the weight-dependent and weight-independent mechanisms of improved postoperative glycemic control can provide better insight into the causes of the exaggerated responses that lead to postoperative hypoglycemia. EXPERT OPINION Management of post-operative hypoglycemia can be challenging and requires a multidisciplinary approach. While dietary modification is the mainstay of treatment for most patients, some patients may benefit from pharmacotherapy (e.g. GLP-1 receptor antagonist); Surgery (e.g. reversal of gastric bypass) is reserved for unresponsive severe cases. Additional research is needed to understand the underlying pathophysiology with a primary aim in optimizing diagnostics and treatment options.
Collapse
Affiliation(s)
- Lina Alkhaled
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH USA
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH USA
| | - Abbas Al-Kurd
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH USA
- Department of General Surgery, Henry Ford Hospital, Detroit, MI USA
| | - W Scott Butsch
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH USA
| | - Sangeeta R Kashyap
- Division of Endocrinology, Diabetes and Metabolism, Weill Cornell Medicine, New York, NY USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH USA
| |
Collapse
|
37
|
Kowalka AM, Alexiadou K, Cuenco J, Clarke RE, Minnion J, Williams EL, Bech P, Purkayastha S, Ahmed AR, Takats Z, Whitwell HJ, Romero MG, Bloom SR, Camuzeaux S, Lewis MR, Khoo B, Tan TM. The postprandial secretion of peptide YY 1-36 and 3-36 in obesity is differentially increased after gastric bypass versus sleeve gastrectomy. Clin Endocrinol (Oxf) 2023; 99:272-284. [PMID: 36345253 PMCID: PMC10952770 DOI: 10.1111/cen.14846] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Peptide tyrosine tyrosine (PYY) exists as two species, PYY1-36 and PYY3-36 , with distinct effects on insulin secretion and appetite regulation. The detailed effects of bariatric surgery on PYY1-36 and PYY3-36 secretion are not known as previous studies have used nonspecific immunoassays to measure total PYY. Our objective was to characterize the effect of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) on fasting and postprandial PYY1-36 and PYY3-36 secretion using a newly developed liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. DESIGN AND SUBJECTS Observational study in 10 healthy nonobese volunteers and 30 participants with obesity who underwent RYGB (n = 24) or SG (n = 6) at the Imperial Weight Centre [NCT01945840]. Participants were studied using a standardized mixed meal test (MMT) before and 1 year after surgery. The outcome measures were PYY1-36 and PYY3-36 concentrations. RESULTS Presurgery, the fasting and postprandial levels of PYY1-36 and PYY3-36 were low, with minimal responses to the MMT, and these did not differ from healthy nonobese volunteers. The postprandial secretion of both PYY1-36 and PYY3-36 at 1 year was amplified after RYGB, but not SG, with the response being significantly higher in RYGB compared with SG. CONCLUSIONS There appears to be no difference in PYY secretion between nonobese and obese volunteers at baseline. At 1 year after surgery, RYGB, but not SG, is associated with increased postprandial secretion of PYY1-36 and PYY3-36 , which may account for long-term differences in efficacy and adverse effects between the two types of surgery.
Collapse
Affiliation(s)
- Anna M. Kowalka
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Kleopatra Alexiadou
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Joyceline Cuenco
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | | | - James Minnion
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Emma L. Williams
- Department of Clinical Biochemistry, North West London PathologyCharing Cross HospitalLondonUK
| | - Paul Bech
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Sanjay Purkayastha
- Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Ahmed R. Ahmed
- Department of Surgery and CancerImperial College Healthcare NHS TrustLondonUK
| | - Zoltan Takats
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Harry J. Whitwell
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Maria Gomez Romero
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Stephen R. Bloom
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| | - Stephane Camuzeaux
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Matthew R. Lewis
- Section of Bioanalytical Chemistry, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
- National Phenome CentreImperial College LondonLondonUK
| | - Bernard Khoo
- Endocrinology, Division of MedicineUniversity College LondonLondonUK
| | - Tricia M.‐M. Tan
- Section of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and ReproductionImperial College LondonLondonUK
| |
Collapse
|
38
|
Nicanor-Carreón JG, Seyedsadjadi N, Rowitz B, Pepino MY. Weight Regain and Ingestive Behavior in Women after Metabolic Surgery. Nutrients 2023; 15:3670. [PMID: 37686704 PMCID: PMC10490188 DOI: 10.3390/nu15173670] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated associations between maladaptive ingestive behaviors and weight regain in women who underwent metabolic surgery 2-10 years ago. Using a web-based survey, we assessed emotional, external, and restrained eating (Dutch Eating Behavior Questionnaire-DEBQ), food cravings (Food-Craving Inventory-FCI), and other behaviors (e.g., Eating Disorder Examination Questionnaire-EDE-Q; Alcohol Use Disorder Identification Test-Concise-AUDIT-C) in 36 women (42.9 ± 9.5 years old) post-surgery. We found that weight regain was specifically associated with increased frequency of cravings for sweets (r = 0.43), higher global scores in the EDE-Q (r = 0.38), and time elapsed since surgery (r = 0.35; all p's < 0.04). Multiple regression analysis revealed that the association between weight regain and sweet cravings interacted with time after surgery (p = 0.04), with the strongest association observed in women assessed closer to the surgery (i.e., 2.0-2.8 years). The combination of time after surgery and its interaction with sweet cravings accounted for 31% of the individual variations in weight regain (p = 0.005). Notably, among participants who reported alcohol consumption (31 of 36), 55% had an AUDIT-C score indicating hazardous drinking. These findings highlight the relevance of attending to patients' reports of frequent sweet cravings and screening for alcohol use to enhance strategies tailored to prevent weight regain and alcohol-related health problems post-surgery.
Collapse
Affiliation(s)
- Jessica G. Nicanor-Carreón
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
| | - Neda Seyedsadjadi
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Blair Rowitz
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
- Department of Surgery, Carle Foundation Hospital, Urbana, IL 61801, USA
| | - Marta Yanina Pepino
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
| |
Collapse
|
39
|
Meyers MH, Swei EC, Tarter W, Schoen J, Rothchild K, Pratap A, Sullivan SA. Factors Associated with Weight Loss After Endoscopic Transoral Outlet Reduction (TORe). J Gastrointest Surg 2023; 27:1587-1593. [PMID: 37237090 PMCID: PMC10215034 DOI: 10.1007/s11605-023-05695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 04/01/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Endoscopic transoral outlet reduction (TORe) has emerged as a safe and effective treatment option for weight regain after Roux-en-Y Gastric Bypass (RYGB). Factors that predict successful weight loss after TORe are incompletely understood. The aims of this study were to evaluate procedural factors and patient factors that may affect percent total body weight loss (%TBWL) after TORe. METHODS A retrospective cohort study was performed on patients after TORe. The primary outcomes were %TBWL at 6 and 12 months based on four procedural factors: purse-string (PS) vs. non-purse-string (NPS) suture pattern, gastric pouch sutures (N), change in the diameter of the gastrojejunal anastomosis, and change in the length of the gastric pouch. Secondary outcomes included patient factors that affected weight loss. RESULTS Fifty-one patients underwent TORe. Weight loss for completers was 11.3 ± 7.6% and 12.2 ± 9.2% at 6 and 12 months. There was a correlation between %TBWL and change in pouch length at 6 and 12 months and number of sutures in the pouch at 6 months. The difference in %TBWL between PS and NPS groups at 6 months (PS, n=21, 12.3 ± 8.5% and NPS, n=8, 8.7 ± 3.7%) and 12 months (PS, n=21, 13.5 ± 9.2% and NPS, n=5, 7.0 ± 7.9%) did not reach statistical significance. For secondary outcomes, depression was associated with %TBWL. CONCLUSION Change in pouch length and number of sutures in the pouch correlated positively while depression correlated negatively with weight loss after TORe. Further studies are needed to understand these effects.
Collapse
Affiliation(s)
- Matthew H Meyers
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Eric C Swei
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Wyatt Tarter
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Jonathan Schoen
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Kevin Rothchild
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Akshay Pratap
- Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Shelby A Sullivan
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| |
Collapse
|
40
|
Verras GI, Mulita F, Pouwels S, Parmar C, Drakos N, Bouchagier K, Kaplanis C, Skroubis G. Outcomes at 10-Year Follow-Up after Roux-en-Y Gastric Bypass, Biliopancreatic Diversion, and Sleeve Gastrectomy. J Clin Med 2023; 12:4973. [PMID: 37568375 PMCID: PMC10419540 DOI: 10.3390/jcm12154973] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Morbid obesity is a well-defined chronic disease, the incidence of which is constantly rising. Surgical treatment of morbid obesity has produced superior outcomes compared to conventional weight loss measures. Currently, there is a gap in the literature regarding long-term outcomes. Our single-institution, retrospective cohort study aims to evaluate weight loss outcomes, comorbidity reduction, and adverse effects at 10 years following Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Sleeve Gastrectomy (SG). MATERIALS AND METHODS We included all consecutive patients with 10-year follow-up records operated on within our institution. The comparison was carried out on the average percentage of weight and BMI loss. Nausea and vomiting were evaluated through self-reporting Likert scales. Diabetes resolution and nutritional deficiencies were also evaluated. RESULTS A total of 490 patients from 1995 up to 2011 were included in our study. Of these, 322 underwent RYGB, 58 underwent long-limb BPD, 34 underwent laparoscopic RYGB with fundus excision, 47 underwent laparoscopic SG, and 29 underwent laparoscopic RYGB as a revision of prior SG. RYGB and BPD were significantly associated with higher percentages of weight loss (37.6% and 37.5%), but were not found to be independent predictors of weight loss. Nausea and vomiting were associated with SG and laparoscopic RYGB with fundus excision, more so than the other operations. No differences were observed regarding diabetes resolution and nutritional deficiencies. CONCLUSIONS Longer follow-up reports are important for the comparison of outcomes between different types of bariatric operations. BPD and RYGB resulted in superior weight loss, with no observed differences in diabetes resolution and adverse outcomes.
Collapse
Affiliation(s)
- Georgios-Ioannis Verras
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Sjaak Pouwels
- Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, 47805 Krefeld, Germany;
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, 5022 Tiburg, The Netherlands
| | - Chetan Parmar
- The Wittington Hospital NHS Trust, London N19 5NF, UK;
| | - Nikolas Drakos
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Konstantinos Bouchagier
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - Charalampos Kaplanis
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| | - George Skroubis
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece; (N.D.); (K.B.); (C.K.) (G.S.)
| |
Collapse
|
41
|
Sayadishahraki M, Salehi A. The Association of Demographic Characteristics with the Rate of Weight Loss and Changes in Nutritional Factors (Albumin, Vitamin D3, Ferritin) One Year after One Anastomosis Gastric Bypass. Adv Biomed Res 2023; 12:192. [PMID: 37694235 PMCID: PMC10492623 DOI: 10.4103/abr.abr_442_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: 12/28/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background The effect of bariatric surgery on weight loss (WL) of patients with severe obesity is an established finding. However, some studies have shown that other factors such as demographic characteristics can also be involved in the extent of success and relapse of obesity. Thus, this study was performed to determine the association of demographic characteristics with the rate of weight loss and changes in nutritional factors one year after one anastomosis gastric bypass (OAGB). Materials and Methods In this cross-sectional study, 121 patients undergoing OAGB were investigated. Patients' body mass index (BMI), nutritional factors (including levels of albumin, vitamin D3, and serum ferritin), and demographic characteristics were measured one year after the surgery. Results The BMI one year after surgery was significantly lower than before surgery (47.12 ± 5.08 kg/m2 vs. 29.42 ± 3.86 kg/m2; P value <0.001). WL was 37.37 ± 6.70%. In addition, the serum level of vitamin D3 one year after surgery with the mean of 44.54 ± 17.25 was significantly higher than its level before surgery with the mean of 38.13 ± 14.42 (P value <0.001). WL in less than 50 years old and married patients was significantly higher than WL in over 50 years old and single patients (P value <0.05). Moreover, the decrease in serum ferritin level with the mean of 1.90 ± 0.56 ng/ml in women was significantly higher than its decrease with the mean of 3.02 ± 0.94 ng/ml in men (P value = 0.003). Conclusion Some demographic characteristics such as age, gender, and marital status seem to affect the rate of weight loss or ferritin level one year after OAGB.
Collapse
Affiliation(s)
- Masoud Sayadishahraki
- Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atefe Salehi
- General Physician, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
42
|
Abstract
Background Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce. Methods A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction. Results Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake. Conclusion Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.
Collapse
Affiliation(s)
- A D'hoedt
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - T Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium. Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta) KULeuven, Leuven, Belgium
| |
Collapse
|
43
|
Ramos-Levi AM, Rubio-Herrera MA, Matía-Martín P, Pérez-Ferre N, Marcuello C, Sánchez-Pernaute A, Torres-García AJ, Calle-Pascual AL. Mixed Meal Tolerance Test Versus Continuous Glucose Monitoring for an Effective Diagnosis of Persistent Post-Bariatric Hypoglycemia. J Clin Med 2023; 12:4295. [PMID: 37445330 DOI: 10.3390/jcm12134295] [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: 04/30/2023] [Revised: 05/31/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Gastric bypass determines an increase in incretin secretion and glucose excursions throughout the day and may sometimes entail the development of severe post-bariatric hypoglycemia (PBH). However, there is no consensus on the gold standard method for its diagnosis. In this study, we evaluated the usefulness of a mixed meal tolerance test (MMTT) and continuous glucose monitoring (CGM) for the diagnosis of PBH, defined as glucose levels <54 mg/dL (3.0 mmol/L). We found that hypoglycemia occurred in 60% of patients after the MMTT and in 75% during CGM, and it was predominantly asymptomatic. The MMTT confirmed the diagnosis of PBH in 88.9%of patients in whom surgery had been performed more than three years ago, in comparison to 36.4% in cases with a shorter postsurgical duration. CGM diagnosed nocturnal asymptomatic hypoglycemia in 70% of patients, and daytime postprandial hypoglycemia in 25% of cases. The mean duration of asymptomatic hypoglycemia was more than 30 min a day. Patients with ≥2% of their CGM readings with hypoglycemia exhibited a higher degree of glucose variability than those with <1% of the time in hypoglycemia. Our results show that the MMTT may be a useful dynamic test to confirm the occurrence of hypoglycemia in a large number of patients with persistent and recurrent PBH during long-term follow-up after gastric bypass. CGM, on its part, helps identify hypoglycemia in the real-world setting, especially nocturnal asymptomatic hypoglycemia, bringing to light that PBH is not always postprandial.
Collapse
Affiliation(s)
- Ana M Ramos-Levi
- Departament of Endocrinology and Nutrition, Hospital La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Miguel A Rubio-Herrera
- Departament of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
- Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Pilar Matía-Martín
- Departament of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
- Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Natalia Pérez-Ferre
- Departament of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
- Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Clara Marcuello
- Departament of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
| | - Andrés Sánchez-Pernaute
- Department of Surgery, Hospital Clínico San Carlos, IdISSC, Faculty of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Antonio J Torres-García
- Department of Surgery, Hospital Clínico San Carlos, IdISSC, Faculty of Medicine, Universidad Complutense, 28040 Madrid, Spain
| | - Alfonso L Calle-Pascual
- Departament of Endocrinology and Nutrition, Hospital Clínico San Carlos, IdISSC, 28040 Madrid, Spain
- Faculty of Medicine, Department of Medicine, Universidad Complutense, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28040 Madrid, Spain
| |
Collapse
|
44
|
Tran M, Ait Said K, Menahem B, Morello R, Tillou X. Urinary Lithiasis Risk Assessment after Bariatric Surgery. J Clin Med 2023; 12:4040. [PMID: 37373733 DOI: 10.3390/jcm12124040] [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: 04/16/2023] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Malabsorption is a consequence of gastric bypass (GB). GB increases the risk of kidney stone formation. This study aimed to evaluate the accuracy of a screening questionnaire for assessing the risk of lithiasis in this population. We performed a monocentric retrospective study to evaluate a screening questionnaire administered to patients who underwent gastric bypass surgery between 2014 and 2015. Patients were asked to answer a questionnaire that included 22 questions divided into four parts: medical history, episodes of renal colic before and after bypass surgery, and eating habits. A total of 143 patients were included in the study, and the mean age of the patients was 49.1 ± 10.8 years. The time between gastric bypass surgery and the completion of the questionnaire was 50.75 ± 4.95 months. The prevalence of kidney stones in the study population was 19.6%. We found that with a score of ≥6, the sensitivity and specificity were 92.9% and 76.5%, respectively. Positive and negative predictive values were 49.1% and 97.8%, respectively. The ROC curve showed an Area Under the Curve (AUC) of 0.932 ± 0.029 (p < 0.001). We developed a reliable and short questionnaire to identify patients at a high risk of kidney stones after gastric bypass. When the results of the questionnaire were equal to or greater than six, the patient was at a high risk of kidney stone formation. With a good predictive negative value, it could be used in daily practice to screen patients who have undergone gastric bypass and are at a high risk of renal lithiasis.
Collapse
Affiliation(s)
- Marie Tran
- Urology Department, CHU de Caen, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Khelifa Ait Said
- Urology Department, CHU de Caen, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Benjamin Menahem
- Abdominal Surgery Department, CHU de Caen, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Rémy Morello
- Biostatistic and Clinical Research Department, CHU de Caen, Avenue de la Côte de Nacre, 14000 Caen, France
| | - Xavier Tillou
- Urology Department, CHU de Caen, Avenue de la Côte de Nacre, 14000 Caen, France
| |
Collapse
|
45
|
Nedelcu M, Laclau-Lacrouts M, Najah H, Carandina S, Monsaingeon M, Pupier E, Collet D, Gatta-Cherifi B, Gronnier C. Long-Term Results After Bariatric Surgery in Super-Super-Obese Patients. J Laparoendosc Adv Surg Tech A 2023. [PMID: 37273194 DOI: 10.1089/lap.2021.0847] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Introduction: Despite addressing to high risk population, we can propose laparoscopic bariatric surgery to super-super-obese (SSO) patients (body mass index [BMI] ≥60 kg/m2). The aim of this study was to report our experience in terms of weight loss and improvement of medical comorbidities after a follow-up of 5 years in the SSO population who underwent different bariatric procedures. Methods: This retrospective study includes all SSO patients who underwent bariatric surgery (sleeve gastrectomy [SG] and/or gastric bypass) between 2006 and 2017. The population was divided in three groups (SG alone; Roux-en-Y gastric bypass [RYGB] alone and SG+RYGB). The rate of complication and the weight-loss results were analyzed. Results: Among 43 patients who underwent surgery, the mean age was 42[31-54]. There were more women (72%) with the mean preoperative BMI of 64.9 kg/m2 [59.6-70.1]. There were 9 SGs, 26 RYGB, and 8 SG revised to gastric bypass (SG+RYGB) after a median delay of 23.5 months [16.5-32]. The perioperative complication rate was 25%, and there was 1 postoperative death. The median follow-up was 69 months [1-128]. The mean percentage of excess weight loss (%EWL) was 39.2% [18.2-60.3] after 5 years. For the SG group, the %EWL was inferior -27.1 [-3.6 to 57.8], but with no significant difference. An improvement of comorbidities' rate was recorded in all groups of patients. Conclusion: Bariatric surgery in SSO patients leads to an improvement of comorbidities even if the weight-loss results, especially in the SG group, are less favorable. The two steps approach should be re-evaluated by shortening the interval between. Other surgical strategies than RYGB are needed to be evaluated to improve long-term weight loss.
Collapse
Affiliation(s)
- Marius Nedelcu
- ELSAN, Clinique Saint Michel, Toulon, France
- ELSAN, Clinique Bouchard, Marseille, France
| | - Marie Laclau-Lacrouts
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Haythem Najah
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
| | | | - Maud Monsaingeon
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France
| | - Emilie Pupier
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France
| | - Denis Collet
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
- Bordeaux Medicine University, Bordeaux, France
| | - Blandine Gatta-Cherifi
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France
| | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
- Bordeaux Medicine University, Bordeaux, France
| |
Collapse
|
46
|
Yaqub S, Tholfsen T, Waage A, Kleive D, Labori KJ. Pancreatoduodenectomy after Roux-en-Y gastric bypass surgery: Single-center experience and literature review. Scand J Surg 2023; 112:98-104. [PMID: 36803183 DOI: 10.1177/14574969231156350] [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] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Bariatric surgery with Roux-en-Y gastric bypass (RYGB) is widely used to treat morbid obesity and present diagnostic and therapeutic challenges in patients with pancreatic and periampullary tumors. The aim of this study was to describe diagnostic tools and challenges in performing pancreatoduodenectomy (PD) on patients with altered anatomy after RYGB. METHODS Patients undergoing PD after RYGB from April 2015 to June 2022 at a tertiary referral center were identified. Preoperative workup, operative techniques, and outcomes were reviewed. A literature search was performed to identify articles reporting PD in post-RYGB patients. RESULTS Of a total of 788 PDs, six patients had previous RYGB. The majority were women (n = 5), and median age was 59 years. The patients most commonly presented with pain (50%) and jaundice (50%) with a median of 5.5 years after RYGB. The gastric remnant was resected in all cases, and reconstruction of the pancreatobiliary drainage was achieved using the distal part of the pre-existing pancreatobiliary limb in all patients. Median follow-up was 60 months. The Clavien-Dindo grade ⩾3 complications occurred in two patients (33.3%), and 90 days mortality occurred in one patient (16.6%). The literature search revealed 9 articles reporting a total of 122 cases, specifically addressing PD after RYGB. CONCLUSIONS Reconstruction after PD in post-RYGB patients may be challenging. Resection of the gastric remnant and use of the pre-existing biliopancreatic limb may be a safe strategy, but surgeons should be prepared for other reconstruction options for creation of a new pancreatobiliary limb.
Collapse
Affiliation(s)
- Sheraz Yaqub
- Department of Hepato-Pancreato-Biliary SurgeryOslo University HospitalSognsvannsveien 20N-0372 OsloNorwayInstitute of Clinical MedicineUniversity of OsloOsloNorway
| | - Tore Tholfsen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Dyre Kleive
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Knut Jørgen Labori
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, NorwayInstitute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
47
|
Wildisen A, Peterli R, Werder G, Mueller B, Schuetz P, Kaegi-Braun N, Kutz A. Rate of Cardiovascular Events and Safety Outcomes Seven Years Following Gastric Bypass Versus Sleeve Gastrectomy. Ann Surg Open 2023; 4:e286. [PMID: 37601481 PMCID: PMC10431536 DOI: 10.1097/as9.0000000000000286] [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: 10/17/2022] [Accepted: 04/13/2023] [Indexed: 08/22/2023] Open
Abstract
Objective The study aimed to assess major adverse cardiovascular events (MACEs), complications requiring revision surgery, and bariatric conversion surgery 7 years after gastric bypass (GB) and sleeve gastrectomy (SG) using real-world data. Background GB and SG both result in weight loss and improved cardiometabolic health. Whether the long-term rate of MACE differs between the 2 bariatric procedures is unclear. Methods In this population-based retrospective cohort study, we used inhospital National Health Registry data from January 2012 to December 2018. Patients undergoing GB were 1:1 propensity score-matched with patients who had SG. The primary outcome was the incidence of MACE, defined as acute myocardial infarction, ischemic stroke, cardiac arrest, or hospitalization for heart failure. Secondary outcomes encompassed individual MACE components, postoperative complications, and the need for bariatric conversion surgery. Results Among 5240 propensity score-matched pairs, the incidence rate per 1000 person-years of MACE was 2.8 among patients undergoing GB and 3.2 among those undergoing SG (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.62-1.37). Single components of MACE were not different between both groups. Patients after GB had a higher risk of long-term postoperative complications requiring a revision surgery compared with those after SG (HR, 3.53 [95% CI, 2.78-4.49]). Bariatric conversion surgery was less frequently performed among patients undergoing GB compared with patients undergoing SG (HR, 0.09 [95% CI, 0.06-0.13]). Conclusions In this study, the performance of GB versus SG was associated with a similar risk of MACE. While postoperative complications were more frequent among patients undergoing GB, patients following SG had a higher probability of bariatric conversion surgery.
Collapse
Affiliation(s)
- Alessia Wildisen
- Division of Endocrinology, Diabetes and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gabriela Werder
- Department of Visceral Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nina Kaegi-Braun
- Division of Endocrinology, Diabetes and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
48
|
Huang TH, Chen CJ, Lin HCA, Chen CH, Fang JY. Self-Nanoemulsifying Drug Delivery System-Containing the Poorly Absorbed Drug - Valsartan in Post-Bariatric Surgery. Int J Nanomedicine 2023; 18:2647-2658. [PMID: 37220630 PMCID: PMC10200115 DOI: 10.2147/ijn.s394624] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Morbid obesity and its related metabolic syndrome are an important health issue. Recently, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) have accounted for the most popular bariatric surgeries. Valsartan (VST) is a common hypertension drug, and nano-carriers can increase its solubility and bioavailability. This study aims to explore the nano-VST formula in bariatric surgery subjects. Methods High-fat fed animals were used as obese models. Operations were performed according to a standardized protocol. The drug was administrated by gavage, and blood samples were taken by serial tail vein sampling. Caco-2 cells were used for examining cell viability and drug uptake. A self-nano-emusifying drug delivery system (SNEDDS) formula was composed of sefsol-218, RH-40 and propylene glycol by a specified ratio, while high-performance liquid chromatography (HPLC) was used for determining drug concentrations. Results Post-operatively, subjects that underwent RYGB lost more body weight compared to the SG group. The SNEDDS did not exhibit cytotoxicity after adequate dilution, and the cytotoxicity was not related to VST dose. A better cellular uptake of SNEDDS was observed in vitro. The SNEDDS formula achieved a diameter of 84 nm in distilled water and 140 nm in simulated gastric fluid. In obese animals, the maximum serum concentration (Cmax) of VST was increased 1.68-folds by SNEDDS. In RYGB with SUS, the Cmax was reduced to less than 50% of the obese group. SNEDDS increased the Cmax to 3.5 folds higher than SUS and resulted in 3.28-folds higher AUC0-24 in the RYGB group. Fluorescence imaging also confirmed a stronger signal of SNEDDS in the gastrointestinal mucosa. SNEDDS accumulated a higher drug concentration than suspension alone in the liver of the obese group. Conclusion SNEDDS could reverse the VST malabsorption in RYGB. Further studies are mandatory to clarify post-SG change of drug absorption.
Collapse
Affiliation(s)
- Tzu-Hao Huang
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Jung Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Hsin-Chia Angela Lin
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Han Chen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jia-You Fang
- Graduate Institute of Natural Products, Chang Gung University, Kweishan, Taoyuan, Taiwan
- Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, and Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan
| |
Collapse
|
49
|
Sherf-Dagan S, Biton R, Ribeiro R, Kessler Y, Ben-Porat T, Raziel A, Rossoni C, Kais H, Bragança R, Santos Z, Goitein D, Viveiros O, Graham Y, Mahawar K, Sakran N. Gastrointestinal reported outcomes following One Anastomosis Gastric Bypass based on a multicenter study. Expert Rev Gastroenterol Hepatol 2023:1-9. [PMID: 37165861 DOI: 10.1080/17474124.2023.2211766] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To describe gastrointestinal-related side-effects reported following One Anastomosis Gastric Bypass (OAGB). METHODS A multicenter study among OAGB patients across Israel (n=277) and Portugal (n=111) who were recruited to the study based on time elapsed since surgery was performed. An online survey with information on demographics, anthropometrics, medical conditions, and gastrointestinal outcomes was administered in both countries simultaneously. RESULTS Respondents from Israel (pre-surgery age of 41.6±11.0 years, 75.8% females) and Portugal (pre-surgery age of 45.6±12.3 years, 79.3% females) presented mean excess weight loss of 51.0±19.9 and 62.4±26.5%, 89.0±22.0 and 86.2±21.4%, and 89.9±23.6 and 98.2±20.9% (P<0.001 for both countries), at 1-6 months, 6-12 months, and 1-5 years post-surgery, respectively. Median Gastrointestinal Symptom Rating Scale score was similar between time elapsed since surgery groups among respondents from Israel and Portugal (≤1.97 and ≤2.12). A notable proportion of respondents from Israel and Portugal at all time points reported 1-3 bowel movements per day (≤62.8 and ≤87.6%), Bristol stool scale categories which represent diarrhea-like stools (≤51.9 and ≤56.3%), having discomfort due to flatulence (≤79.4 and ≤90.2%), and mild to severe dyspepsia symptoms (≤50.5 and ≤73.0%). CONCLUSIONS A notable proportion of OAGB patients might experience certain gastrointestinal symptoms postoperatively, including flatulence, dyspepsia, and diarrhea-like stools.
Collapse
Affiliation(s)
- Shiri Sherf-Dagan
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Reut Biton
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rui Ribeiro
- Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
- General Surgery Department Coordinator - Hospital Lusíadas Amadora, Amadora, Portugal
| | - Yafit Kessler
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Tair Ben-Porat
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montréal, Canada
- Montreal Behavioural Medicine Centre (MBMC), Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Montréal, Canada
| | - Asnat Raziel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
| | - Carina Rossoni
- Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
- Institute of Environmental Health, Faculty Medicine, University of Lisbon, Lisbon, Portugal
| | - Hasan Kais
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of surgery, Shamir Medical Center, Zerifin, Israel
| | - Rossela Bragança
- Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
| | - Zélia Santos
- Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
- H&TRC-Health & Technology Research Center (ESTeSL)-Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal
| | - David Goitein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery C, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Octávio Viveiros
- Multidisciplinary Center for Obesity Treatment - Hospital Lusíadas Amadora, Amadora, Portugal
| | - Yitka Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Surgical Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Surgical Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Nasser Sakran
- Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel
- Department of Surgery, Holy Family Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, Ramat Gan, Israel
| |
Collapse
|
50
|
Raza MM, Njideaka-Kevin T, Polo J, Azimuddin K. Long-Term Outcomes of Bariatric Surgery: A Systematic Review. Cureus 2023; 15:e39638. [PMID: 37388618 PMCID: PMC10305785 DOI: 10.7759/cureus.39638] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
Roux-en-Y gastric bypass (RYGB) is a minimally invasive procedure that usually takes two hours. It is commonly performed in refractory cases to help morbidly obese patients (BMI ≥ 40 kg/m2) lose weight. It is well known that morbid obesity accompanies other comorbid conditions such as atherosclerotic diseases, strokes, cancers, and mental health issues such as anxiety and depression. It is crucial to treat this category of patients to improve their quality of life and minimize the chance of mortality in these patients. Given the importance of treating this group, we explored the long-term outcomes of patients who underwent bariatric surgery for cardiovascular diseases, cancer, and depression compared to those who did not. This systematic review utilized articles identified through PubMed using the following search terms: (morbidly obese OR obesity OR obese) AND (bariatric surgery OR metabolic surgery OR gastric bypass OR gastrectomy) AND (chronic disease OR chronic diseases OR cardiovascular diseases OR heart diseases OR cancer OR neoplasms OR stroke OR depressive disorder OR depression). The filter used was observational studies, which yielded 217 studies. Out of these results, eight citations were included in an observational study that met our eligibility criteria. From our search, the articles showed a clinically significant decrease in the incidence of cardiovascular disease, cancer, and depressive disorders after treatment with bariatric surgery. Furthermore, there was also a correlation between bariatric surgery and remission of type 2 diabetes. The surgery has an apparent protective effect on the development and progression of comorbid conditions accompanying morbid obesity. Overall, the quality of life has improved in patients who have undergone the procedure compared to those who have not. Bariatric surgery must be recommended as a beneficial option in managing morbidly obese patients (BMI ≥ 40 kg/m2) who have responded poorly to first-line management plans.
Collapse
Affiliation(s)
- Murtajiz M Raza
- Department of Research, Avalon University School of Medicine, Willemstad, CUW
| | | | - Jordan Polo
- Department of Research, Avalon University School of Medicine, Willemstad, CUW
| | - Khawaja Azimuddin
- Department of Surgery, Houston Methodist Willowbrook Hospital, Houston, USA
| |
Collapse
|