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De Luca M, Zese M, Silverii GA, Ragghianti B, Bandini G, Forestieri P, Zappa MA, Navarra G, Foschi D, Musella M, Sarro G, Pilone V, Facchiano E, Foletto M, Olmi S, Raffelli M, Bellini R, Gentileschi P, Cerbone MR, Grandone I, Berardi G, Di Lorenzo N, Lucchese M, Piazza L, Casella G, Manno E, Zaccaroni A, Balani A, Mannucci E, Monami M. Bariatric Surgery for Patients with Overweight/Obesity. A Comprehensive Grading Methodology and Network Metanalysis of Randomized Controlled Trials on Weight Loss Outcomes and Adverse Events. Obes Surg 2023; 33:4147-4158. [PMID: 37917391 DOI: 10.1007/s11695-023-06909-4] [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: 08/18/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
This study aims to compare different types of metabolic bariatric surgery (MBS) with lifestyle intervention/medical therapy (LSI/MT) for the treatment of overweight/obesity. The present and network meta-analysis (NMA) includes randomized trials. MBS was associated with a reduction of BMI, body weight, and percent weight loss, when compared to LSI/MT, and also with a significant reduction of HbA1c and a higher remission of diabetes. Meta-regression analyses revealed that BMI, a higher proportion of women, and a longer duration of trial were associated with greater effects of MBS. The NMA showed that all surgical procedures included (except greater curvature plication) were associated with a reduction of BMI. MBS is an effective option for the treatment of obesity. The choice of BMI thresholds for eligibility for surgery of patients with different complications should be performed making an evaluation of risks and benefits in each BMI category.
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Affiliation(s)
- Maurizio De Luca
- Dipartimento di Chirurgia Generale e Metabolica, Azienda ULSS5 Polesana, Ospedale di Rovigo, 45010, Rovigo, Italia
| | - Monica Zese
- Dipartimento di Chirurgia Generale e Metabolica, Azienda ULSS5 Polesana, Ospedale di Rovigo, 45010, Rovigo, Italia.
| | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi e Università di Firenze, 50134, Firenze, Italia
| | - Giulia Bandini
- Azienda Ospedaliero Universitaria Careggi e Università di Firenze, 50134, Firenze, Italia
| | - Pietro Forestieri
- Dipartimento di Scienze Biochimiche Avanzate, Università Degli Studi Di Napoli "Federico II", 80138, Napoli, Italia
| | | | - Giuseppe Navarra
- Policlinico Universitario "G. Martino" Messina, 98124, Messina, Italia
| | | | - Mario Musella
- Dipartimento di Scienze Biochimiche Avanzate, Università Degli Studi Di Napoli "Federico II", 80138, Napoli, Italia
| | - Giuliano Sarro
- UOC Chirurgia Generale e Bariatrica, Istituto Clinico Alta Specialità' San Gaudenzio - Novara, Gruppo Policlinico di Monza, 28100, Novara, Italia
| | - Vincenzo Pilone
- Università degli Studi di Salerno A.O.U. San Giovanni di Dio e Ruggi D'Aragona Ospedale G. Fucito, 84131, Salerno, Italia
| | | | - Mirto Foletto
- Policlinico Universitario di Padova, 35128, Padova, Italia
| | - Stefano Olmi
- Policlinico San Marco, Bergamo, 24046, Bergamo, Italia
| | - Marco Raffelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, 00168, Italia
| | - Rosario Bellini
- Azienda Ospedaliero-Universitaria Pisana, 56126, Pisa, Italia
| | - Paolo Gentileschi
- Dipartimento di Chirurgia Bariatrica e Metabolica-Ospedale San Carlo di Nancy, Università di Roma Tor Vergata, Roma e Maria Cecilia Hospital, Cotignola, 00165, (Ravenna), Italia
| | | | - Ilenia Grandone
- SC Diabetologia Dietologia e Nutrizione Clinica, Azienda Ospedaliera Santa Maria di Terni, 05100, Terni, Italia
| | - Giovanna Berardi
- Dipartimento di Scienze Biochimiche Avanzate, Università Degli Studi Di Napoli "Federico II", 80138, Napoli, Italia
| | | | - Marcello Lucchese
- Ospedale Santa Maria Nuova-Chirurgia Generale e Bariatrica - Azienda Sanitaria Toscana Centro, 50122, Firenze, Italia
| | - Luigi Piazza
- UOC Chirurgia Generale e d'Urgenza, Arnas Garibaldi, 95123, Catania, Italia
| | - Giovanni Casella
- Dipartimento di Chirurgia, Università La Sapienza, AOU Policlinico Umberto I, 00161, Roma, Italia
| | - Emilio Manno
- AORN A. Cardarelli Napoli, UO Chirurgia Bariatrica e Metabolica, 80131, Napoli, Italia
| | - Alberto Zaccaroni
- Chirurgia Endocrina e Metabolica, Ospedale G.B.Morgagni, 47121, Forlì, Italia
| | - Alessandro Balani
- Dipartimento Chirurgico del Presidio Ospedaliero Gorizia-Monfalcone, ASS2 Isontina, 34170, Gorizia, Italia
| | - Edoardo Mannucci
- Azienda Ospedaliero Universitaria Careggi e Università di Firenze, 50134, Firenze, Italia
| | - Matteo Monami
- Azienda Ospedaliero Universitaria Careggi e Università di Firenze, 50134, Firenze, Italia
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Boru CE, Marinari GM, Olmi S, Gentileschi P, Morino M, Anselmino M, Foletto M, Bernante P, Piazza L, Perrotta N, Morganti R, Silecchia G. Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study. Surg Obes Relat Dis 2023; 19:1270-1280. [PMID: 37391349 DOI: 10.1016/j.soard.2023.05.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently. OBJECTIVE Analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. SETTING Ten Italian high-volume BS centers (university hospitals and private centers). METHODS Prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients. RESULTS A total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers. CONCLUSIONS Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure.
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Affiliation(s)
- Cristian E Boru
- General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy.
| | - Giuseppe M Marinari
- Bariatric Unit, Humanitas Clinical and Research Hospital, IRCCS Rozzano, Milan, Italy
| | - Stefano Olmi
- General and Oncological Surgery Department, Center of Bariatric Surgery, Policlinico San Marco di Zingonia, Bergamo, Italy
| | - Paolo Gentileschi
- Bariatric and Metabolic Surgery Department, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Rome, Italy
| | - Mario Morino
- General Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedaliera of University of Padova, Padova, Italy
| | - Paolo Bernante
- Metabolic and Obesity Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for the Study and Research of Treatment for Morbid Obesity, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luigi Piazza
- General Surgery and Emergency Department, ARNAS Garibaldi Nesima Hospital, Catania, Italy
| | - Nicola Perrotta
- General Surgery Department, Villa d'Agri Hospital, Potenza, Italy
| | | | - Gianfranco Silecchia
- General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy
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Noel P, Olmi S, Gentileschi P, Caiazzo R, Marciniak C, Pintado DGM, Ungson G, Alarcon V, Carandina S, Manos T, Shamoun JM, Zundel N, Lutfi RE, Ponce J, Nedelcu M. Classification of Slippage Following Laparoscopic BariClip Gastroplasty. Obes Surg 2023; 33:3317-3322. [PMID: 37608121 DOI: 10.1007/s11695-023-06780-3] [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: 04/09/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a classification of this complication. METHODS A number of 381 patients who underwent LBCG in 8 different centers were analyzed concerning the risk of slippage. All cases with documented slippage were carefully reviewed in terms of patients' symptomatology (presence of satiety, vomiting), history of weight loss, radiological data, and management of their slippage. A new classification was proposed depending on the anatomy, the symptomatology, and the time of occurrence. RESULTS We have identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, and in the remaining 6 patients, the slippage was identified by radiological studies for insufficient weight loss, weight regain, or routine radiological follow-up. Depending on the interval time, the slippage was classified as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases. Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases. The management of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases, and conservative treatment in the remaining 5 cases. All patients with conservative treatment were recorded at the beginning of the experience. CONCLUSIONS Slippage is a possible complication after LBCG. This classification of the different types of slippage can benefit the surgeon in the management and treatment of this complication of LBCG.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, UAE
- ELSAN, Clinique Bouchard, Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Stefano Olmi
- Policlinico San Marco, Rio Isolo, Zingonia, Italy
| | | | - Robert Caiazzo
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | - Camille Marciniak
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | | | - John M Shamoun
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Natan Zundel
- University at Buffalo, NY, Jackson North Medical Center, Miami, USA
| | | | | | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Marseille, France.
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France.
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Gentileschi P, Sensi B, Siragusa L, Sorge R, Rispoli E, Angrisani L, Galfrascoli E, Bianciardi E, Giusti MP, De Luca M, Zappa MA, Balani A, Bellini R, Benavoli D, Berardi G, Casella G, Basso N, Cerbone MR, Di Lorenzo N, Facchiano E, Foletto M, Forestieri P, Foschi D, Grandone I, Lucchese M, Manno E, Musella M, Navarra G, Olmi S, Piazza L, PIlone V, Raffaelli M, Sarro G, Zaccaroni A. Evolution of Bariatric Surgery in Italy in the Last 11 Years: Data from the SICOB Yearly National Survey. Obes Surg 2023; 33:930-937. [PMID: 36690866 PMCID: PMC9871429 DOI: 10.1007/s11695-022-06435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is a relatively novel surgical field and is in continuous expansion and evolution. PURPOSE Aim of this study was to report changes in Italian surgical practice in the last decade. METHODS The Società Italiana di Chirurgia dell'Obesità (SICOB) conducted annual surveys to cense activity of SICOB centers between 2011 and 2021. Primary outcome was to detect differences in frequency of performance of adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), bilio-pancreatic diversion (BPD), and gastric plication (GP). Secondary outcome was to detect differences in performance of main non-malabsorptive procedures (AGB + SG) and overall bypass procedures (RYGB + OAGB). Geographical differences were also investigated. RESULTS Median response rate was 92%. AGB declined from 36% of procedures in 2011 to 5% in 2021 (p < 0.0001). SG increased from 30% in 2011 to 55% in 2021 (p < 0.0001). RYGB declined from 25 to 12% of procedures (p < 0.0001). OAGB rose from 0% of procedures in 2011 to 15% in 2021 (p < 0.0001). BPD underwent decrease from 6.2 to 0.2% in 2011 and 2021, respectively (p < 0.0001). Main non-malabsorptive procedures significantly decreased while overall bypass procedures remained stable. There were significant differences among regions in performance of SG, RYGB, and OAGB. CONCLUSIONS BS in Italy evolved significantly during the past 10 years. AGB underwent a decline, as did BPD and GP which are disappearing and RYGB which is giving way to OAGB. The latter is rising and is the second most-performed procedure after SG which has been confirmed as the preferred procedure by Italian bariatric surgeons.
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Affiliation(s)
- Paolo Gentileschi
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.,Bariatric and Metabolic Surgery Unit, San Carlo Di Nancy Hospital, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Leandro Siragusa
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Sorge
- Department of Biostatistics, Policlinico Tor Vergata University, Rome, Italy
| | | | - Luigi Angrisani
- Public Health Department "Federico II" University of Naples, Naples, Italy
| | - Elisa Galfrascoli
- Department of General Surgery, Fatebenefratelli Hospital, Milan, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Psychiatric Chair, University of Rome Tor Vergata, 00133, Rome, Italy
| | | | - Maurizio De Luca
- Chief Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy
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Arcudi C, Sensi B, Alicata F, Siragusa L, Procaccini C, Pavoncello D, Zobel LB, Bianciardi E, Gentileschi P. Surgical Technique for Robotic-Assisted Laparoscopic Vertical Clip Gastroplasty (LVCG). Obes Surg 2023; 33:1314-1316. [PMID: 36826679 DOI: 10.1007/s11695-023-06507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Claudio Arcudi
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Federica Alicata
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy.
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy.
| | - Leandro Siragusa
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Chiara Procaccini
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - David Pavoncello
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Lorenza Beomonte Zobel
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Psychiatric Chair, University of Rome Tor Vergata, 00133, Via Montpellier, 1, 81-0133, Rome, Italy
| | - Paolo Gentileschi
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
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Noel P, Nedelcu M, Olmi S, Gentileschi P, Caiazzo R, Pintado DGM, Garza MG, Roberto R, Abualsel A, Marchesini C, Boza C, Ungson G, Alarcon V, Carandina S, Zundel N, Ponce J, Lutfi RE. Evolving Technique of Laparoscopic Vertical Gastric Clip Placement. Obes Surg 2023; 33:1012-1016. [PMID: 36754925 DOI: 10.1007/s11695-023-06492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip. METHODS All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A). A control group (group B) was designed with patients who underwent previous LBCG technique between May 2017 and June 2019. This is a case-controlled group with patients matched by gender and BMI. We have analyzed the postoperative complications and more notably the slippage. RESULTS One hundred seventy-six patients (44 male and 132 female) with a mean age of 33 years (± 11) underwent evolving technique of LBCG. A control group of 67 patients who underwent previous technique of LBCG was included. All procedures were completed by laparoscopy with no intraoperative complication. For the study group, we have recorded a number of 5 slippages (2.8%). The diagnosis occurred during the first 6 months after the operation. The management consisted of repositioning-3 cases-and BariClip removal-2 cases. For the control group, we have recorded a number of 3 slippages (4.3%). All three patients underwent BariClip removal, with no repositioning. CONCLUSIONS We reported a new technique of placement of the BariClip with additional gastric plication anterior, posterior, and volume reduction in the antrum to potentially reduce the rate of slippage and improve weight loss outcomes.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, UAE.
- ELSAN, Clinique Bouchard, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France.
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Stefano Olmi
- Policlinico San Marco Zingonia, Vita E Salute San Raffaele University Milan, Milan, Italy
| | - Paolo Gentileschi
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Robert Caiazzo
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | | | | | | | | | | | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Natan Zundel
- University at Buffalo, Buffalo, NY, USA
- Jackson North Medical Center, Miami, USA
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7
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Guglielmi V, Campanelli M, Bianciardi E, Benavoli D, Colangeli L, D'Adamo M, Sbraccia P, Gentileschi P. Bariatric surgery for metabolic unhealthy obesity (MUO) during the COVID era: short-term results of a high-volume center. Eat Weight Disord 2022; 27:3119-3124. [PMID: 35852766 PMCID: PMC9294774 DOI: 10.1007/s40519-022-01438-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE During the coronavirus disease 19 (COVID-19) outbreak, most public hospitals worldwide have been forced to postpone a major part of bariatric surgery (BS) operations with unfavorable consequences for weight and obesity complications. The aim of this study was to evaluate the effectiveness and safety of laparoscopic BS on subjects with metabolically unhealthy obesity (MUO) during COVID-19 pandemic in a high-volume Italian center. METHODS Between March 2020 and January 2021, all patients with MUO submitted to laparoscopic BS (sleeve gastrectomy [SG], one anastomosis gastric bypass [OAGB] and Roux-en-Y gastric bypass [RYGB]) were enrolled according to the ATP III Guidelines, with a minimum follow-up of 3 months. RESULTS In the study period, 210 patients with MUO underwent laparoscopic BS (77 RYGB, 85 SG and 48 OAGB) in our obesity referral center. Postoperative major complications occurred in 4 patients (1.9%) with zero mortality. At 9-month follow-up, a total weight loss (TWL) of 28.2 ± 18.4, 26.1 ± 23.1 and 24.5 ± 11.3% (p = 0.042) was observed in RYGB, OAGB and SG groups, respectively. The rate of comorbidity resolution was very similar for all type of surgeries (p = 0.871). Only two cases of postoperative SARS-CoV-2 infection were registered (0.9%) and both cases resolved with medical therapy and observation. CONCLUSION Among the patients studied, all surgical techniques were safe and effective for MUO during the COVID era. This group of patients is at high risk for general and SARS-CoV-2-related mortality and therefore should be prioritized for BS. LEVEL OF EVIDENCE Level III, single-center retrospective cohort study.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy. .,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy.
| | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Domenico Benavoli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.,Internal Medicine Unit and Obesity Center, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
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8
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Lisi G, Gentileschi P, Spoletini D, Passaro U, Orlandi S, Campanelli M. Sclerotherapy for III- and IV-degree hemorrhoids: Results of a prospective study. Front Surg 2022; 9:978574. [PMID: 36117836 PMCID: PMC9474687 DOI: 10.3389/fsurg.2022.978574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/08/2022] [Indexed: 01/11/2023] Open
Abstract
BackgroundIn the last 2 years, anorectal surgery has been strongly affected and even surgery for urgent cases cannot be scheduled; also, patients with III- and IV-degree bleeding hemorrhoids should be treated conservatively. The aim was to evaluate the effectiveness of sclerotherapy in patients who had to postpone surgery.MethodsWe included all patients with III- and IV-degree bleeding hemorrhoids who underwent outpatient sclerotherapy. The visual analog scale and the hemorrhoid severity score were used at the baseline and at 4 weeks after the procedure with a telephone interview, and all patients were outpatient-evaluated 1 week, 1 month, and 1 year after the treatment. All pre- and postoperative data were recorded.ResultsFrom October 2020 to November 2021, 19 patients with III- (12 patients; 63%) and IV-degree (7 patients; 37%) bleeding hemorrhoids were enrolled. The mean operative time was 4.5 min, and no intraoperative complications occurred. One case of tenesmus and three failures were detected. Six months after the procedure, the overall success rate was 84%, although all of the patients enrolled reported persistent bleeding at the end of the study period. Of these, 5 patients (26%) were scheduled for surgery and 11 patients (58%) refused surgery and asked to undergo a re-do sclerotherapy.ConclusionSclerotherapy with 3% polidocanol foam is a safe and effective procedure also in III- and IV-degree bleeding hemorrhoids. The long-term data on the length of the foam remain to be evaluated in additional studies.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant’Eugenio Hospital, Rome, Italy
- Correspondence: Giorgio Lisi
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, University of Tor Vergata, San Carlo of Nancy Hospital, Rome, Italy
| | | | | | - Simone Orlandi
- Department of Gastroenterology and Digestive Endoscopy, IRCSS Sacro Cuore don Calabria, Negrar di Valpolicella, Italy
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9
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Colangeli L, Gentileschi P, Sbraccia P, Guglielmi V. Ketogenic Diet for Preoperative Weight Reduction in Bariatric Surgery: A Narrative Review. Nutrients 2022; 14:nu14173610. [PMID: 36079867 PMCID: PMC9460892 DOI: 10.3390/nu14173610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Bariatric surgery (BS) is the most effective treatment in reducing weight and the burden of comorbidities in patients with severe obesity. Despite the overall low mortality rate, intra- and post-operative complications remains quite common. Weight loss before BS reduces surgical risk, but studies are inconclusive regarding which is the best approach to apply. In this review, we summarize the current evidence on the effect of a ketogenic diet (KD) before BS. All studies agree that KD leads to considerable weight loss and important improvements in terms of surgical risk, but populations, interventions and outcomes are very heterogeneous. KD appears to be a safe and effective approach to induce weight loss before BS. However, randomized controlled trials with better-defined dietary protocols and homogeneous outcomes are necessary in order to draw firm conclusions.
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Affiliation(s)
- Luca Colangeli
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Obesity Medical Center, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Obesity Medical Center, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Valeria Guglielmi
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Obesity Medical Center, Policlinico Tor Vergata, 00133 Rome, Italy
- Correspondence:
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10
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Lisi G, Campanelli M, Benavoli D, Bianciardi E, Spoletini D, Gentileschi P. Benign Anorectal Disorders and Pelvic Floor Disease After Bariatric Surgery. J Clin Med Res 2022; 14:260-263. [PMID: 35974804 PMCID: PMC9365667 DOI: 10.14740/jocmr4713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
The correlations between morbid obesity, bariatric surgery and gastrointestinal disorders are well known and reported. Symptoms like abdominal pain, constipation, bloating, heartburn and gastroesophageal reflux disease are known to be significantly more prevalent in overweight patients and body mass index is associated positively with abdominal pain and diarrhea. In spite of these conditions, less is known about the lower gastrointestinal tract. Of these, anorectal disorders and pelvic floor disease are both believed to be more frequent in obese patients compared to the general population. Weight loss related to bariatric surgery seems to improve quality of life and weight-related symptoms, although some of these conditions may get worse. All these conditions are rarely studied in patients undergoing bariatric surgery for morbid obesity. This concise review aimed to focus on these conditions in patients undergoing bariatric surgery for morbid obesity in order to improve patient selection and post-operative management.
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Affiliation(s)
- Giorgio Lisi
- Department of Surgery, Sant’Eugenio Hospital, Piazzale dell’Umanesimo 10, 00144 Rome, Italy
- Corresponding Author: Giorgio Lisi, Department of Surgery, Sant’Eugenio Hospital, Piazzale dell’Umanesimo 10, 00144 Rome, Italy.
| | - Michela Campanelli
- Emergency Surgery Unit, University Hospital of Tor Vergata, viale Oxford 81, 00133 Rome, Italy
- Department of Bariatric and Metabolic Surgery, University of Tor Vergata, San Carlo of Nancy Hospital, via Aurelia 275, 00165 Rome, Italy
| | - Domenico Benavoli
- Department of Bariatric and Metabolic Surgery, University of Tor Vergata, San Carlo of Nancy Hospital, via Aurelia 275, 00165 Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Chair of Psychiatry, University Hospital of Tor Vergata, viale Oxford 81, 00133 Rome, Italy
| | - Domenico Spoletini
- Department of Surgery, Sant’Eugenio Hospital, Piazzale dell’Umanesimo 10, 00144 Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, University of Tor Vergata, San Carlo of Nancy Hospital, via Aurelia 275, 00165 Rome, Italy
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11
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Sensi B, Beomonte Zobel L, Forte V, Alicata F, Procaccini C, Pavoncello D, Arcudi C, Bianciardi E, Gentileschi P. Internal herniation of small bowel through the minimizer ring after banded one anastomosis gastric bypass: Case report with diagnosis and management of a rare complication. Obes Res Clin Pract 2022; 16:349-352. [DOI: 10.1016/j.orcp.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
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12
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Menghini R, Hoyles L, Cardellini M, Casagrande V, Marino A, Gentileschi P, Davato F, Mavilio M, Arisi I, Mauriello A, Montanaro M, Scimeca M, Barton RH, Rappa F, Cappello F, Vinciguerra M, Moreno-Navarrete JM, Ricart W, Porzio O, Fernández-Real JM, Burcelin R, Dumas ME, Federici M. ITCH E3 Ubiquitin Ligase downregulation compromises hepatic degradation of branched-chain amino acids. Mol Metab 2022; 59:101454. [PMID: 35150905 PMCID: PMC8886057 DOI: 10.1016/j.molmet.2022.101454] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Metabolic syndrome, obesity, and steatosis are characterized by a range of dysregulations including defects in ubiquitin ligase tagging proteins for degradation. The identification of novel hepatic genes associated with fatty liver disease and metabolic dysregulation may be relevant to unravelling new mechanisms involved in liver disease progression Methods Through integrative analysis of liver transcriptomic and metabolomic obtained from obese subjects with steatosis, we identified itchy E ubiquitin protein ligase (ITCH) as a gene downregulated in human hepatic tissue in relation to steatosis grade. Wild-type or ITCH knockout mouse models of non-alcoholic fatty liver disease (NAFLD) and obesity-related hepatocellular carcinoma were analyzed to dissect the causal role of ITCH in steatosis Results We show that ITCH regulation of branched-chain amino acids (BCAAs) degradation enzymes is impaired in obese women with grade 3 compared with grade 0 steatosis, and that ITCH acts as a gatekeeper whose loss results in elevation of circulating BCAAs associated with hepatic steatosis. When ITCH expression was specifically restored in the liver of ITCH knockout mice, ACADSB mRNA and protein are restored, and BCAA levels are normalized both in liver and plasma Conclusions Our data support a novel functional role for ITCH in the hepatic regulation of BCAA metabolism and suggest that targeting ITCH in a liver-specific manner might help delay the progression of metabolic hepatic diseases and insulin resistance. ITCH expression is reduced in liver during NAFLD. Transcriptomics analysis of liver in obese women highlighted the interplay between ITCH and genes involved in BCAA degradation. Modulation of ITCH in models of metabolic hepatic diseases supported the association between ITCH and BCAA metabolism. Targeting ITCH in a liver specific manner might help to delay the progression of metabolic hepatic diseases and insulin resistance.
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Affiliation(s)
- Rossella Menghini
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Lesley Hoyles
- Department of Biosciences, Nottingham Trent University, Nottingham NG11 8NS, United Kingdom
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Viviana Casagrande
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Arianna Marino
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Paolo Gentileschi
- Department of Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Francesca Davato
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Maria Mavilio
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Ivan Arisi
- European Brain Research Institute (EBRI) "Rita Levi-Montalcini", Viale Regina Elena, 295, 00161, Rome, Italy; CNR, Institute of Translational Pharmacology (IFT), Via del Fosso del Cavaliere 100, 00131, Rome, Italy
| | - Alessandro Mauriello
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Manuela Montanaro
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Manuel Scimeca
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Richard H Barton
- Imperial College London, Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom
| | - Francesca Rappa
- Section of Human Anatomy, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy; Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Francesco Cappello
- Section of Human Anatomy, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy; Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Manlio Vinciguerra
- International Clinical Research Center (FNUSA-ICRC), St Anne University Hospital, Brno, Czech Republic; Institute of Liver and Digestive Health, Division of Medicine, University College London (UCL), London, United Kingdom
| | - José Maria Moreno-Navarrete
- Department of Diabetes, Endocrinology and Nutrition, University Hospital of Girona 'Dr Josep Trueta' Institut d'Investigacio Biomedica de Girona IdibGi; and CIBER Fisiopatologia de la Obesidad y Nutricion, Girona, Spain
| | - Wifredo Ricart
- Department of Diabetes, Endocrinology and Nutrition, University Hospital of Girona 'Dr Josep Trueta' Institut d'Investigacio Biomedica de Girona IdibGi; and CIBER Fisiopatologia de la Obesidad y Nutricion, Girona, Spain
| | - Ottavia Porzio
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - José-Manuel Fernández-Real
- Department of Diabetes, Endocrinology and Nutrition, University Hospital of Girona 'Dr Josep Trueta' Institut d'Investigacio Biomedica de Girona IdibGi; and CIBER Fisiopatologia de la Obesidad y Nutricion, Girona, Spain; Department of Medical Sciences. School of Medicine, University of Girona, Spain
| | - Rémy Burcelin
- INSERM and University Paul Sabatier: Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U1048 F-31432 Toulouse, France and Université Paul Sabatier, F-31432, Toulouse, France
| | - Marc-Emmanuel Dumas
- Imperial College London, Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, United Kingdom; Section of Genomic and Environmental Medicine, Respiratory Division, National Heart and Lung Institute, Imperial College London, Dovehouse St, London, SW3 6LY, United Kingdom; European Genomic Institute for Diabetes, CNRS UMR 8199, INSERM UMR 1283, Institut Pasteur de Lille, Lille University Hospital, University of Lille, 59045, Lille, France; McGill University and Genome Quebec Innovation Centre, 740 Doctor Penfield Avenue, Montréal, QC, H3A 0G1, Canada.
| | - Massimo Federici
- Department of Systems Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; Center for Atherosclerosis, University Hospital "Policlinico Tor Vergata", Italy.
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13
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Anselmo A, Siragusa L, Sensi B, Bacchiocchi G, Pellicciaro M, Manzia TM, Gentileschi P, Tisone G. High-priority liver transplantation and simultaneous sleeve gastrectomy in MELD 32 end-stage liver disease: a case report with long-term follow-up. Obes Res Clin Pract 2022; 16:91-94. [PMID: 35016856 DOI: 10.1016/j.orcp.2022.01.001] [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: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Morbid obesity is a worldwide epidemic closely linked to Non-Alcoholic Fatty Liver Disease (NAFLD), an ever more relevant indication for Liver Transplantation (LT). Obesity affects an increasing number of LT recipients, but the ideal management of these patients remain unclear. Bariatric surgery (BS) in LT setting is challenging but feasible, although the debate is still open about the best timing of bariatric surgery. Herein we report a case of high-priority LT and simultaneous sleeve gastrectomy (SG) in an obese young adult. CASE REPORT A 45 years old man with morbid obesity (BMI 46 kg/m2) and severe NAFLD-related end-stage liver disease (ESLD) underwent simultaneous LT and sleeve gastrectomy (SG) in an emergency setting, due to a MELD score of 32. He had substantial weight loss during long-term follow-up and enjoyed resolution of diabetes and hypertension. At 4 years follow-up, he has normal allograft function with appropriate immunosuppressant blood levels and no ultrasound evidence of steatosis. CONCLUSION In selected patients, combined LT and SG present several advantages in terms of transplant outcomes, weight loss and resolution of obesity-related comorbidities. In addition, it can be performed in the high-priority setting in case of severe ESLD with good results in the short- and long-term.
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Affiliation(s)
| | - Leandro Siragusa
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
| | - Bruno Sensi
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | - Giuseppe Tisone
- Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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14
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Campanelli M, Bianciardi E, Benavoli D, Bagaglini G, Lisi G, Gentileschi P. Laparoscopic Banded One Anastomosis Gastric Bypass: A Single-Center Series. J Obes 2022; 2022:4942052. [PMID: 35132363 PMCID: PMC8817855 DOI: 10.1155/2022/4942052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Laparoscopic one anastomosis gastric bypass (LOAGB) is a relatively new procedure for the treatment of morbid obesity and related comorbidities. On average, this procedure results in good postoperative weight loss with a low complication rate. Recent publications suggest that dumping syndrome and weight regain might be reduced by placing a silicone ring over the gastric pouch during the procedure, so called laparoscopic banded one anastomosis gastric bypass (LBOAGB). METHODS 86 patients undergoing LBOAGB between 2018 and 2020 were enrolled in this retrospective study. Hospital records were used to assess weight loss, comorbidity resolution, and any complications either in the short or medium term. RESULTS 54 Female and 32 male patients were included with a mean age of 43 years (25-64), preoperative body mass index of 42 kg/m2 (35-49), and preoperative weight of 114 kg (86-162). Thirty-four patients presented with type 2 diabetes (39.5%), 42 patients (49%) diagnosed with hypertension, 24 presented with OSAS (28%), and 21 (24%) hypercholesterolaemia patients were included. In total, 36 patients were diagnosed with multiple comorbidities. The operative data showed an average operative time of 48 minutes with 3.4% of patients suffering from early (minor) complications and 2.3% with a late (minor) complication. One patient required reoperation due to intra-abdominal bleeding. The median length of hospital stay was 2.5 days. Median follow-up was 18 months (5-36). In that period, no patient required ring removal or conversion to Roux-en-Y gastric bypass surgery. Food intolerance/vomiting was present in 1 patient (1.1%), bile reflux was present in 1 patient (1.1%), and no stomal ulcers were observed. Mean % excess weight loss at 12 and 24 months was 72% and 80%, respectively. Fifty-two out of 86 patients (60%) had a complete resolution of comorbidities. A CONUT score >2 (mild malnutrition) was found in 40% of patients, while a CONUT score 0-1 was found in 60% of patients. CONCLUSION LBOAGB shows promising results in terms of safety and efficacy in the short term. Further prospective studies will be required to evaluate the consistency of the results in the long term.
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Affiliation(s)
- Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
| | - Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Domenico Benavoli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
| | - Giulia Bagaglini
- General Surgery Residency School, University of Rome “Tor Vergata”, Rome, Italy
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome 00144, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
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Bianciardi E, Gentileschi P, Niolu C, Innamorati M, Fabbricatore M, Contini LM, Procenesi L, Siracusano A, Imperatori C. Assessing psychopathology in bariatric surgery candidates: discriminant validity of the SCL-90-R and SCL-K-9 in a large sample of patients. Eat Weight Disord 2021; 26:2211-2218. [PMID: 33226607 PMCID: PMC8437842 DOI: 10.1007/s40519-020-01068-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Pre-surgical psychosocial evaluation of bariatric surgery (BS) patients should identify psychiatric issues that could worsen after surgery and those requiring additional ongoing intervention. In this view, the use of reliable, appropriate and concise evaluating instruments is of critical importance. The aim of the present study was to investigate the clinical utility of both the Symptom Checklist 90-Revised (SCL-90-R) and its brief unidimensional version, the so-called Symptom-Checklist-K-9 (SCL-K-9) in detecting the presence of psychiatric disorders among bariatric surgery (BS) candidates. METHODS Seven-hundred-and-ninety-eight BS candidates (563 women and 235 men; mean age: 44.15 ± 11.45) were enrolled in the present study. All participants underwent a full psychiatric interview and were administered the SCL-90-R. RESULTS Three-hundred-and-sixty-two patients (45.4%) met the criteria for a diagnosis of at least one psychiatric disorder and ninety-nine patients (12.4%) had psychiatric comorbidities. In the current sample, 219 patients (27.4%) met the criteria for binge eating disorders (BED), 158 (19.8%) met the criteria for major depressive disorder (MDD), and 67 (8.4%) met both criteria. A receiver operating characteristic (ROC) curves procedure showed that both the SCL-90-R and the SCL-K-9 satisfactorily categorize patients with any psychiatric disorder, both BED and MDD (area under the ROC curve ≥ 0.70, p < 0.001). CONCLUSION Our results suggest that the SCL-90-R and the SCL-K-9 may represent first-level screening tests identifying at-risk patients, eligible for a more expensive or time-consuming clinical assessment. LEVEL OF EVIDENCE Level V, cross-sectional, descriptive study.
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Affiliation(s)
- Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome "Tor Vergata", Via Cracovia, 50, 00133, Rome, Italy.
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata", Rome, Italy
| | - Cinzia Niolu
- Psychiatric Chair, Department of Systems Medicine, University of Rome "Tor Vergata", Via Cracovia, 50, 00133, Rome, Italy
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Lorenzo Maria Contini
- Psychiatric Chair, Department of Systems Medicine, University of Rome "Tor Vergata", Via Cracovia, 50, 00133, Rome, Italy
| | - Leonardo Procenesi
- Psychiatric Chair, Department of Systems Medicine, University of Rome "Tor Vergata", Via Cracovia, 50, 00133, Rome, Italy
| | - Alberto Siracusano
- Psychiatric Chair, Department of Systems Medicine, University of Rome "Tor Vergata", Via Cracovia, 50, 00133, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
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Abstract
Bariatric operations have been documented in clinical trials to promote remission or dramatic improvement of Type II Diabetes Mellitus and related comorbidities. Herein we review randomized trials and meta-analyses published during the last 20 years on the results of bariatric/metabolic surgery in obese patients with type 2 diabetes with the aim of highlighting the scientific evidence available. Several studies and RCTs in the last 20 years have showed outstanding results of bariatric/metabolic surgery on Type II diabetes and comorbidities in patients with either BMI > 35 kg/m2 or BMI < 35 kg/m2. They have established that bariatric procedures are superior to non-surgical interventions for inducing weight loss and amelioration of type 2 diabetes, even in patients with a BMI between 30 and 35 kg/m2. The physiopatologic changes that improve glucose homeostasis after bariatric surgery remain unclear but glycemic control is improved after sleeve gastrectomy, duodenal-jejunal bypass, Roux-en-Y gastric bypass, gastric banding, One Anastomosis Gastric Bypass, and biliopancreatic diversion. Nevertheless, it is suggested that the various gastrointestinal procedures may have different effects and mechanisms of action. Metabolic surgery will help integrate knowledge and multidisciplinary expertise to provide a combination of conservative and surgical treatments for Type II diabetes. These treatments must be considered as complementary options and not alternative strategies, with the same goal of controlling diabetes and achieving cure.
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Affiliation(s)
- Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | | | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy.
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17
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Valente M, Campanelli M, Benavoli D, Arcudi C, Riccó M, Bianciardi E, Gentileschi P. Safety and Outcomes of Laparoscopic Sleeve Gastrectomy in a General Surgery Residency Program. JSLS 2021; 25:JSLS.2020.00063. [PMID: 33879991 PMCID: PMC8035819 DOI: 10.4293/jsls.2020.00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: With the escalation of surgical treatment of morbid obesity, there is a growing interest in the training of bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) gained popularity both as a first-stage approach and as a stand-alone procedure. Objectives: The aim of this study was to assess detectable differences in LSG with intra-operative resident involvement. Methods: We reviewed obese patients, who had undergone LSG between January 1, 2017 and January 31, 2020. Collected data reported demographic factors, operative time, postoperative complications, and outcomes. Results: Among 313 patients who met the inclusion criteria, 94 were men and 219 were women. The procedures were performed either by an expert bariatric surgeon (group 1), or a general surgery resident (group 2), respectively in 228 and 85 cases. Mean operative time of the first group was 65.3 ± 18.8 minutes, while it was 74.3 ± 17.2 among trainees (p < 0.001). Perioperative complications were diagnosed in 13 patients (10 in group 1 and 3 in group 2). Mean excess body weight loss after 12 months was 87.7 ± 28.2% in the first group and 81.1 ± 31.6% in the residents group. Between the two groups, we found no differences in the incidence of perioperative complications and in surgical outcomes. Trainee involvement was associated with increased operative time, with no correlation with a worse postoperative course. Conclusions: Residents can safely perform LSG in referral centers under the supervision of an expert bariatric surgeon. Trainee involvement is not related to increased leak rate, nor to suboptimal short-term outcome.
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Affiliation(s)
- Marina Valente
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Domenico Benavoli
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Claudio Arcudi
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | | | | | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
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Silecchia G, Boru CE, M Marinari G, Gentileschi P, Morino M, Olmi S, Foletto M, Bernante P, Morganti R, Tascini C, Anselmino M, Bianciardi E, Campanelli M, Fiorello L, Mancini R, Oldani A, Rottoli M, Salzano A, Trotta M. Laparoscopic bariatric surgery is safe during phase 2-3 of COVID-19 pandemic in Italy: A multicenter, prospective, observational study. Diabetes Res Clin Pract 2021; 177:108919. [PMID: 34133962 PMCID: PMC8200253 DOI: 10.1016/j.diabres.2021.108919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sars-Cov-2 epidemic in Italy caused one of the greatest 2020 European outbreaks, with suspension of elective bariatric/metabolic surgery (BMS). From May 2020 a significant decline of the epidemic has been observed (phase 2); National Health Service protocols permitted elective BMS' resumption. A new, more severe COVID-19 surge, the "second wave", started on October 2020 (phase 3). AIM The primary end point was to analyze the outcomes of any Sars-Cov-2 infection and related morbidity/mortality within 30 POD after laparoscopic BMS during phase 2-3; secondary end points were readmission and reoperation rates. METHODS Study design prospective, multicenter, observational. SETTING Eight Italian high-volume bariatric centers. All patients undergoing BMS from July 2020 through January 2021 were enrolled according to the following criteria: no Sars-Cov-2 infection; primary procedures; no concomitant procedure; age > 18 < 60 years; compensated comorbidities; informed consent including COVID-19 addendum; adherence to specific admission, in-hospital and follow-up protocols. Data were collected in a prospective database. Patients undergone BMS during July-December 2019 were considered a control group. RESULTS 1258 patients were enrolled and compared with 1451 operated on in 2019, with no differences for demographics, complications, readmission, and reintervention rates. Eight patients (0·6%) tested positive for Sars-Cov-2 infection after discharge, as well as and 15 healthcare professionals, with no related complications or mortality. CONCLUSIONS Introduction of strict COVID-19 protocols concerning the protection of patients and health-care professionals guaranteed a safe resumption of elective BMS in Italy. The safety profile was, also, maintained during the second wave of outbreak, thus allowing access to a cure for the obese population.
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Affiliation(s)
- Gianfranco Silecchia
- Division of General Surgery and Bariatric Center of Excellence IFSO-EC, Department of Medico-Surgical Sciences and Biotechnologies, University "La Sapienza" of Rome, Via Corso della Repubblica 79, Latina, LT 04100, Italy.
| | - Cristian E Boru
- Division of General Surgery and Bariatric Center of Excellence IFSO-EC, Department of Medico-Surgical Sciences and Biotechnologies, University "La Sapienza" of Rome, Via Corso della Repubblica 79, Latina, LT 04100, Italy.
| | - Giuseppe M Marinari
- Bariatric Unit, Humanitas Clinical and Research Hospital, IRCCS Rozzano, Milan Via A. Manzoni 56, Rozzano, MI 20089, Italy.
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Via Aurelia 275, Roma, RM 00165, Italy.
| | - Mario Morino
- General Surgery, Department of Surgical Sciences, University of Turin, Via Corso Bramante 88, Turin, TO 10126, Italy.
| | - Stefano Olmi
- Department of General and Oncological Surgery, Center of Bariatric Surgery, Policlinico San Marco di Zingonia, Bergamo Corso Europa 7, Zingonia, BG 24040, Italy.
| | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedaliera of University of Padova, Via Nicolò Giustiniani 2, Padova, PD 35128, Italy.
| | - Paolo Bernante
- Metabolic and Obesity Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for the Study and Research of Treatment for Morbid Obesity, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Giuseppe Massarenti 9, Bologna, BO 40138, Italy.
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, Via Roma, 67, Pisa, PI 56126, Italy.
| | - Carlo Tascini
- Infectious Diseases Clinic, DAME, University of Udine, P.le S. Maria della Misericordia, 15, Udine, UD 33100, Italy.
| | - Marco Anselmino
- Bariatric and Metabolic Surgery Unit, Azienda Ospedaliera at University of Pisa, Via Roma, 67, Pisa, PI 56126, Italy.
| | - Emanuela Bianciardi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Via Aurelia 275, Roma, RM 00165, Italy
| | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Via Aurelia 275, Roma, RM 00165, Italy
| | - Luigi Fiorello
- Bariatric Surgery Unit, Azienda Ospedaliera of University of Padova, Via Nicolò Giustiniani 2, Padova, PD 35128, Italy
| | - Rudj Mancini
- Bariatric and Metabolic Surgery Unit, Azienda Ospedaliera at University of Pisa, Via Roma, 67, Pisa, PI 56126, Italy
| | - Alberto Oldani
- Department of General and Oncological Surgery, Center of Bariatric Surgery, Policlinico San Marco di Zingonia, Bergamo Corso Europa 7, Zingonia, BG 24040, Italy
| | - Matteo Rottoli
- Metabolic and Obesity Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for the Study and Research of Treatment for Morbid Obesity, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Via Giuseppe Massarenti 9, Bologna, BO 40138, Italy
| | - Antonio Salzano
- General Surgery, Department of Surgical Sciences, University of Turin, Via Corso Bramante 88, Turin, TO 10126, Italy
| | - Manuela Trotta
- Bariatric Unit, Humanitas Clinical and Research Hospital, IRCCS Rozzano, Milan Via A. Manzoni 56, Rozzano, MI 20089, Italy
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Mayneris-Perxachs J, Cardellini M, Hoyles L, Latorre J, Davato F, Moreno-Navarrete JM, Arnoriaga-Rodríguez M, Serino M, Abbott J, Barton RH, Puig J, Fernández-Real X, Ricart W, Tomlinson C, Woodbridge M, Gentileschi P, Butcher SA, Holmes E, Nicholson JK, Pérez-Brocal V, Moya A, Clain DM, Burcelin R, Dumas ME, Federici M, Fernández-Real JM. Iron status influences non-alcoholic fatty liver disease in obesity through the gut microbiome. Microbiome 2021; 9:104. [PMID: 33962692 PMCID: PMC8106161 DOI: 10.1186/s40168-021-01052-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/18/2021] [Indexed: 05/30/2023]
Abstract
BACKGROUND The gut microbiome and iron status are known to play a role in the pathophysiology of non-alcoholic fatty liver disease (NAFLD), although their complex interaction remains unclear. RESULTS Here, we applied an integrative systems medicine approach (faecal metagenomics, plasma and urine metabolomics, hepatic transcriptomics) in 2 well-characterised human cohorts of subjects with obesity (discovery n = 49 and validation n = 628) and an independent cohort formed by both individuals with and without obesity (n = 130), combined with in vitro and animal models. Serum ferritin levels, as a markers of liver iron stores, were positively associated with liver fat accumulation in parallel with lower gut microbial gene richness, composition and functionality. Specifically, ferritin had strong negative associations with the Pasteurellaceae, Leuconostocaceae and Micrococcaea families. It also had consistent negative associations with several Veillonella, Bifidobacterium and Lactobacillus species, but positive associations with Bacteroides and Prevotella spp. Notably, the ferritin-associated bacterial families had a strong correlation with iron-related liver genes. In addition, several bacterial functions related to iron metabolism (transport, chelation, heme and siderophore biosynthesis) and NAFLD (fatty acid and glutathione biosynthesis) were also associated with the host serum ferritin levels. This iron-related microbiome signature was linked to a transcriptomic and metabolomic signature associated to the degree of liver fat accumulation through hepatic glucose metabolism. In particular, we found a consistent association among serum ferritin, Pasteurellaceae and Micrococcacea families, bacterial functions involved in histidine transport, the host circulating histidine levels and the liver expression of GYS2 and SEC24B. Serum ferritin was also related to bacterial glycine transporters, the host glycine serum levels and the liver expression of glycine transporters. The transcriptomic findings were replicated in human primary hepatocytes, where iron supplementation also led to triglycerides accumulation and induced the expression of lipid and iron metabolism genes in synergy with palmitic acid. We further explored the direct impact of the microbiome on iron metabolism and liver fact accumulation through transplantation of faecal microbiota into recipient's mice. In line with the results in humans, transplantation from 'high ferritin donors' resulted in alterations in several genes related to iron metabolism and fatty acid accumulation in recipient's mice. CONCLUSIONS Altogether, a significant interplay among the gut microbiome, iron status and liver fat accumulation is revealed, with potential significance for target therapies. Video abstract.
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Affiliation(s)
- Jordi Mayneris-Perxachs
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain
| | - Marina Cardellini
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Lesley Hoyles
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
- Department of Bioscience, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Jèssica Latorre
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain
| | - Francesca Davato
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - José Maria Moreno-Navarrete
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain
| | - María Arnoriaga-Rodríguez
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain
| | - Matteo Serino
- Institut National de la Santé et de la Recherche Médicale (INSERM), Toulouse, France
- Université Paul Sabatier (UPS), Unité Mixte de Recherche (UMR) 1048, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Team 2: 'Intestinal Risk Factors, Diabetes, Dyslipidemia, and Heart Failure', 31432, Toulouse Cedex 4, France
| | - James Abbott
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Richard H Barton
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Josep Puig
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain
| | | | - Wifredo Ricart
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain
| | - Christopher Tomlinson
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Mark Woodbridge
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | | | - Sarah A Butcher
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Elaine Holmes
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Jeremy K Nicholson
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Vicente Pérez-Brocal
- Unidad Mixta de Investigación en Genómica y Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) and Instituto de Biología Integrativa de Sistemas, Universitat de València and Consejo Superior de Investigaciones Científicas (CSIC), València, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andrés Moya
- Unidad Mixta de Investigación en Genómica y Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO) and Instituto de Biología Integrativa de Sistemas, Universitat de València and Consejo Superior de Investigaciones Científicas (CSIC), València, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Donald Mc Clain
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, 27157, USA
- The W. G. Hefner Veterans Affairs Medical Center, Salisbury, NC, 28144, USA
| | - Rémy Burcelin
- Institut National de la Santé et de la Recherche Médicale (INSERM), Toulouse, France
- Université Paul Sabatier (UPS), Unité Mixte de Recherche (UMR) 1048, Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Team 2: 'Intestinal Risk Factors, Diabetes, Dyslipidemia, and Heart Failure', 31432, Toulouse Cedex 4, France
| | - Marc-Emmanuel Dumas
- Section of Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
- Section of Genomic and Environmental Medicine, National Heart & Lung Institute, Imperial College London, Dovehouse Street, London, SW3 6LY, UK
- European Genomic Institute for Diabetes, CNRS UMR 8199, INSERM UMR 1283, Institut Pasteur de Lille, Lille University Hospital, University of Lille, 59045, Lille, France
- McGill University and Genome Quebec Innovation Centre, 740 Doctor Penfield Avenue, Montréal, QC, H3A 0G1, Canada
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - José-Manuel Fernández-Real
- Department of Endocrinology, Diabetes and Nutrition, Hospital of Girona "Dr Josep Trueta", Girona, Spain.
- Departament de Ciències Mèdiques, University of Girona, Girona and Biomedical Research Institute of Girona (IdibGi), Girona, Spain.
- CIBERobn Pathophysiology of Obesity and Nutrition, Instituto de Salud Carlos III, Girona, Spain.
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20
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Termine P, Boru CE, Iossa A, Ciccioriccio MC, Campanelli M, Bianciardi E, Gentileschi P, Silecchia G. Transhiatal Migration After Laparoscopic Sleeve Gastrectomy: Myth or Reality? A Multicenter, Retrospective Study on the Incidence and Clinical Impact. Obes Surg 2021; 31:3419-3426. [PMID: 33834373 DOI: 10.1007/s11695-021-05340-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Only anecdotally reported, intrathoracic migration (ITM) represents an unacknowledged complication after sleeve gastrectomy (LSG) contributing to gastroesophageal reflux disease (GERD) development, both recurrent and de novo. The primary endpoint of this study was to evaluate the incidence of postoperative ITM ≥ 2 cm; the secondary endpoint was to determine the relationships between ITM, GERD, endoscopic findings, and percentage of patients requiring surgical revision. MATERIALS AND METHODS A retrospective, multicenter study on prospective databases was conducted, analyzing LSGs performed between 2013 and 2018. Inclusion criteria consisted of primary operation; BMI ranging 35-60 kg/m2; age 18-65 years; minimum follow-up 24 months; and postoperative UGIE, excluding concomitant hiatal hernia repair. Esophageal manometry and 24-h pH-metry were indicated, based on postoperative questionnaires and UGIE; patients with GERD due to ITM, and non-responders to medical therapy, were converted to R-en-Y gastric bypass (RYGB). RESULTS An ITM ≥ 2cm was postoperatively diagnosed in 94 patients (7% of 1337 LSGs), after mean 24.16 ± 13.6 months. Postoperative esophagitis was found in 29 patients vs. 15 initially (p=0.001), while GERD was demonstrated in 75 (vs. 20 preoperatively, p< 0.001). Fifteen patients (16%) underwent revision to RYGB with posterior cruroplasty. Seventeen patients with severe GERD presented improvement of endoscopic findings and clinical symptoms as a result of conservative therapy. CONCLUSIONS ITM after LSG is not a negligible complication and represents an important pathogenic factor in the development or worsening of GERD. Postoperative UGIE plays a fundamental role in the diagnosis of esophageal mucosal lesions.
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Affiliation(s)
- Pietro Termine
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Cristian Eugeniu Boru
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy.
| | - Angelo Iossa
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Maria Chiara Ciccioriccio
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
| | - Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, and "Tor Vergata" University of Rome, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, and "Tor Vergata" University of Rome, Rome, Italy
| | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence-IFSO EC, Department of Medico- Surgical Sciences and Biotechnologies, "La Sapienza" University of Rome, Rome, Italy
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21
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Gentileschi P, Benavoli D, Arcudi C, Campanelli M, Valente M, Petagna L, Bianciardi E. Laparoscopic Banded Sleeve Gastrectomy: Single-Center Experience with a Four-Year Follow-Up. J Laparoendosc Adv Surg Tech A 2021; 31:1269-1273. [PMID: 33449836 DOI: 10.1089/lap.2020.0726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Introduction: Laparoscopic sleeve gastrectomy (LSG) is now the most common bariatric procedure to treat morbidly obese patients. The main concern of LSG lies in the long-term weight regain, which is reported to happen in up to 75.6% of patients after 6 years. In this study, we report our overall experience with Laparoscopic Banded Sleeve Gastrectomy (LBSG) using the MiniMizer® over a 6-year period. Materials and Methods: We performed a retrospective review of data from a prospectively collected database. All patients submitted to primary LBSG were examined. Patients were submitted to LBSG between February 2014 and January 2020. Collected data included demographic factors, preoperative body mass index (BMI), operative time, surgical complications, and clinical outcomes. Results: Two hundred nine patients were submitted to primary LBSG in the study period. They were 136 females (65%) and 73 males (35%) with a median age of 43.0 years (range, 18-65 years). Median preoperative BMI was 48.4 kg/m2 (range, 36.2-65.5 kg/m2). Median operative time was 72.0 minutes (range, 40-142 minutes). Median time for ring placement was 8.0 minutes. Median postoperative hospital stay was 2.8 days. Seven major complications occurred in the postoperative period (3.3%): five gastric leaks (2.3%) and two major bleedings (0.9%). There was no postoperative mortality in the 209 patients. Long-term major complications occurred in 2 patients (0.9%). Median follow-up was 49.2 months (range, 2-72 months). Median postoperative BMI was 29.6 kg/m2 (range, 22-42 kg/m2). Median %excess weight loss (%EWL) at 1 year after surgery was 52.0%. Median %EWL at last follow-up visit was 64.0%. Conclusion: LBSG is as safe as standard LSG with excellent results in terms of postoperative morbidity and weight loss outcomes. Whether this procedure may result superior to standard LSG in the long-term period needs to be evaluated in randomized trials. Clinical Study Registration Number: NCT04354532.
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Affiliation(s)
- Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Domenico Benavoli
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Claudio Arcudi
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Marina Valente
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Lorenzo Petagna
- Obesity Unit, Department of Surgery, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, University of Rome "Tor Vergata," Rome, Italy
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22
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Bianciardi E, Raimondi G, Samela T, Innamorati M, Contini LM, Procenesi L, Fabbricatore M, Imperatori C, Gentileschi P. Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study. Front Endocrinol (Lausanne) 2021; 12:662252. [PMID: 34025579 PMCID: PMC8131828 DOI: 10.3389/fendo.2021.662252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven's Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.
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Affiliation(s)
- Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- *Correspondence: Emanuela Bianciardi,
| | - Giulia Raimondi
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Tonia Samela
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Lorenzo Maria Contini
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Leonardo Procenesi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
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23
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Bianciardi E, Imperatori C, Niolu C, Campanelli M, Franceschilli M, Petagna L, Zerbin F, Siracusano A, Gentileschi P. Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of Waiting List Candidates. Front Public Health 2020; 8:582699. [PMID: 33313038 PMCID: PMC7706656 DOI: 10.3389/fpubh.2020.582699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background: From the beginning of March 2020, lockdown regimens prevented patients with obesity from receiving bariatric surgery. Surgical emergencies and oncological procedures were the only operations allowed in public hospitals. Consequently, patients with morbid obesity were put in a standby situation. With the aim at exploring the viewpoint of our future bariatric surgery patients, we built a questionnaire concerning obesity and COVID-19. Method: A total of 116 bariatric surgery candidates were approached using a telephonic interview during the Italian lockdown. Results: Of the total sample, 73.8% were favorable to regular bariatric surgery execution. Forty percent were concerned about their own health status due to the COVID-19 emergency, and 61.1% were troubled by the temporary closure of the bariatric unit. The majority of the sample were eating more. Forty-five percent and the 27.5% of patients reported a worsening of the emotional state and physical health, respectively. Most of the patients (52.2%) considered themselves more vulnerable to COVID-19, especially individuals with class III obesity. Patients who reported an increased consumption of food were younger (43.44 ± 12.16 vs. 49.18 ± 12.66; F = 4.28, p = 0.042). No gender difference emerged. Conclusion: The lockdown had a negative result on Italian patients' psychological well-being and eating habits. The majority of patients would have proceeded with the surgery even during the COVID-19 emergency. Effective management and bariatric surgery should be restarted as soon as possible.
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Affiliation(s)
- Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Marzia Franceschilli
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Lorenzo Petagna
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Zerbin
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
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Marinari GM, Anselmino M, Tascini C, Bernante P, Foletto M, Gentileschi P, Morino M, Olmi S, Toppino M, Silecchia G. Bariatric and metabolic surgery during COVID-19 outbreak phase 2 in Italy: why, when and how to restart. Surg Obes Relat Dis 2020; 16:1614-1618. [PMID: 32739265 PMCID: PMC7313526 DOI: 10.1016/j.soard.2020.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 01/21/2023]
Abstract
In Italy elective bariatric and metabolic surgery was cancelled on February 21,2020 at the beginning of the so-called phase 1 of the SARS-CoV-2 outbreak. Gradually it was restarted on May 4,2020 at the beginning of the so-called phase 2, when epidemiological data showed containment of the infection. Before the outbreak in eight high-volume bariatric centers 840 patients were surgically treated developing a Covid-19 infection, during phase 1, in only 5 cases (0.6%) without mortality. The post-operative complication rate was similar when compared to the 836 subjects submitted to bariatric surgery the year before. Since the high prevalence of infection in subjects with BMI > 30, it was argued that early intervention on obesity during phase 2 could help to minimize the effects of the disease in the event of a possible reversion to a SARS-CoV-2 outbreak phase 1. At the same time a prospective observational study from July 1 till the WHO declaration of the end of the pandemic has started in the eight high volume centers to monitor the post-operative outcome and its effect on SARS-CoV-2 infection.
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Affiliation(s)
| | - Marco Anselmino
- Bariatric & Metabolic Surgery Unit, Department of General Surgery, Pisa, Italy
| | - Carlo Tascini
- SOC Malattie infettive, Azienda Sanitaria Integrata, University of Udine Udine, Italy
| | - Paolo Bernante
- Bariatric & Metabolic Surgery Unit, Department of medical and surgical sciences, Azienda Ospedaliera Universitaria Policlinico di Sant'Orsola Bologna, Bologna, Italy
| | - Mirto Foletto
- Week Surgery - Bariatric Unit, Padova University Hospital, University of Padova, Padova, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, Tor Vergata University, Roma, Italy
| | - Mario Morino
- General Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Stefano Olmi
- General and Oncological Surgery, Center of Advanced Laparoscopy, Center of Bariatric and Metabolic Surgery, Zingonia, Italy
| | - Mauro Toppino
- General Surgery, Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Gianfranco Silecchia
- Division of General Surgery & Bariatric Center of Excellence IFSO EC, Department of Medico-Surgical Sciences and Biothecnologies, Sapienza University of Rome, Latina, Italy.
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25
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Navarra G, Komaei I, Currò G, Angrisani L, Bellini R, Cerbone MR, Di Lorenzo N, De Luca M, Foletto M, Gentileschi P, Musella M, Nannipieri M, Piazza L, Olmi S, Pilone V, Raffaelli M, Sarro G, Vitiello A, Zappa MA, Foschi D. Bariatric surgery and the COVID-19 pandemic: SICOB recommendations on how to perform surgery during the outbreak and when to resume the activities in phase 2 of lockdown. Updates Surg 2020; 72:259-268. [PMID: 32514743 PMCID: PMC7278242 DOI: 10.1007/s13304-020-00821-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its related disease, coronavirus disease 2019 (COVID-19), has been rapidly spreading all over the world and is responsible for the current pandemic. The current pandemic has found the Italian national health system unprepared to provide an appropriate and prompt response, heavily affecting surgical activities. Based on the limited data available in the literature and personal experiences, the Società Italiana di Chirurgia dell’OBesità e Malattie Metaboliche (SICOB) provides recommendations regarding the triage of bariatric surgical procedures during the COVID-19 pandemic defining a dedicated path for surgery in morbidly obese patients with known or suspected COVID-19 who may require emergency operations. Finally, the current paper delineates a strategy to resume outpatient visits and elective bariatric surgery once the acute phase of the pandemic is over. Models developed during the COVID-19 crisis should be integrated into hospital practices for future use in similar scenarios. Surgeons are presented with a golden opportunity to embrace systemic change and to drive their professional future.
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Affiliation(s)
- Giuseppe Navarra
- Department of General Surgery, University Hospital of Messina "G. Martino", Messina, Italy
| | - Iman Komaei
- Department of General Surgery, University Hospital of Messina "G. Martino", Messina, Italy.
| | - Giuseppe Currò
- Department of General Surgery, University Hospital of Messina "G. Martino", Messina, Italy
| | - Luigi Angrisani
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | | | | | - Nicola Di Lorenzo
- Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy
| | - Maurizio De Luca
- Division of General Surgery, San Valentino Hospital, Montebelluna, Italy
| | | | | | - Mario Musella
- Advanced Biomedical Sciences Department, University of Naples "Federico II", Naples, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Luigi Piazza
- Department of General and Emergency Surgery, ARNAS "G. Garibaldi", Catania, Italy
| | - Stefano Olmi
- Centre of Bariatric Surgery, San Marco Hospital, Zingonia, Italy
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Marco Raffaelli
- Endocrine and Metabolic Surgery Unit, A., Gemelli University Hospital IRCCS, Rome, Italy
| | | | - Antonio Vitiello
- Department of Surgery, University Hospital of Naples "Federico II", Naples, Italy
| | | | - Diego Foschi
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Imperatori C, Bianciardi E, Niolu C, Fabbricatore M, Gentileschi P, Di Lorenzo G, Siracusano A, Innamorati M. The Symptom-Checklist-K-9 (SCL-K-9) Discriminates between Overweight/Obese Patients with and without Significant Binge Eating Pathology: Psychometric Properties of an Italian Version. Nutrients 2020; 12:nu12030674. [PMID: 32121618 PMCID: PMC7146623 DOI: 10.3390/nu12030674] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
A general personality and psychopathology evaluation is considered to be crucial part of the multidisciplinary assessment for weight-related problems. The Symptom Checklist-90-Revised (SCL-90-R) is commonly used to assess general psychopathology in both overweight and obese patients seeking weight-loss treatment. The main purpose of the present research was to investigate the psychometric properties of the brief form of the SCL-90-R (i.e., the SCL-K-9) in a clinical sample (N = 397) of patients seeking weight-loss treatment (i.e., bariatric surgery and a nutritional weight-loss program). The results of the confirmatory factor analysis supported a one-factor solution of the SCL-K-9, with all nine items loading significantly on the common latent factor (lambdas ≥ 0.587). The ordinal α (= 0.91), the inter-item mean indices of correlation (rii = 0.53), and the convergent validity were also satisfactory. A receiver operating characteristic curves procedure showed that both SCL-90-R and SCL-K-9 were able to classify patients with and without significant binge eating pathology according to the Binge Eating Scale (BES) total score. Overall, our results suggest that the SCL-K-9 has adequate psychometric properties and can be applied as a short screening tool to assess general psychopathology in overweight/obese individuals seeking weight-loss treatment and at follow-up interviews when time restraints preclude the use of the full-length form.
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Affiliation(s)
- Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
- Correspondence: ; Tel.: +06-66-54-38-73
| | - Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Cinzia Niolu
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy;
| | - Giorgio Di Lorenzo
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy
| | - Alberto Siracusano
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
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Bianciardi E, Fabbricatore M, Di Lorenzo G, Innamorati M, Tomassini L, Gentileschi P, Niolu C, Siracusano A, Imperatori C. Prevalence of Food Addiction and Binge Eating in an Italian sample of bariatric surgery candidates and overweight/obese patients seeking low-energy-diet therapy. Riv Psichiatr 2020; 54:127-130. [PMID: 31282493 DOI: 10.1708/3181.31602] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM The main aim of the present study was to investigate the prevalence of Food Addiction (FA) and clinical level of Binge Eating in an Italian sample of overweight/obese patients attending low energy-diet therapy, and in an Italian sample of obese bariatric surgery candidates. METHODS Participants were: i) 122 overweight/obese patients (86 women) referred to a medical center in Rome (Italy), specialized in nutritional treatment of obesity (i.e., non-surgery patients group), and ii) 281 surgery candidates (207 women) referred to the center for Bariatric Surgery at the University of Rome Tor Vergata (i.e., surgery candidates group). All patients were administered self-report measures investigating FA, binge eating, and psychopathology. RESULTS Non-surgery patients and surgery candidates did not differ in the prevalence of FA (31.1% vs 26.3%), moderate level of binge eating (32.0% vs 31.8%), and severe level of binge eating (11.05% vs 13.6%). Compared to non-surgery patients, surgery candidates reported higher prevalence in two FA symptoms: i) food consumed more than planned (13.9% vs 25.3%; p=0.011) and ii) persistent desire or repeated unsuccessful attempts (89.3% vs 96.8; p=0.002). DISCUSSION AND CONCLUSION Our results confirm that both FA and clinical level of binge eating are common problems in both overweight/obese patients seeking low-energy-diet therapy and in obese bariatric surgery candidates, justifying the clinical utility of assessing these dysfunctional eating patterns.
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Affiliation(s)
- Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Lorenzo Tomassini
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Gentileschi P, Bianciardi E, Siragusa L, Tognoni V, Benavoli D, D'Ugo S. Banded Sleeve Gastrectomy Improves Weight Loss Compared to Nonbanded Sleeve: Midterm Results from a Prospective Randomized Study. J Obes 2020; 2020:9792518. [PMID: 32566276 PMCID: PMC7285409 DOI: 10.1155/2020/9792518] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Weight regain after laparoscopic sleeve gastrectomy (LSG) is nowadays a growing concern. Sleeve dilatation and loss of food restriction is considered the main mechanism. The placement of a silicon ring around the gastric tube seems to give benefits in the short term. We report the results of a randomized study comparing LSG and laparoscopic banded sleeve gastrectomy (LBSG) over a 4-year follow-up. OBJECTIVES To evaluate the efficacy of banded sleeve gastrectomy compared to standard sleeve in the midterm. METHODS Between 01/2014 and 01/2015, we randomly assigned 50 patients to receive one of the two procedures. Patients' management was exactly the same, apart from the band placement. We analyzed differences in weight loss, operative time, complication rate, and mortality, with a median follow-up of 4 years. RESULTS Twenty five patients were assigned to receive LSG (Group A) and 25 LBSG (Group B). The mean preoperative BMI (body mass index) was 47.3 ± 6.58 kg/m2 and 45.95 ± 5.85 kg/m2, respectively. There was no significant difference in the operative time. No intraoperative or postoperative complications occurred. At 12-month follow-up, the mean BMI was 29.72 ± 4.40 kg/m2 in Group A and 27.42 ± 4.47 kg/m2 in Group B (p=0.186). After a median follow-up of 4 years, the mean BMI in Group B was significantly lower than Group A (24.10 ± 4.52 kg/m2 vs 28.80 ± 4.62 kg/m2; p=0.00199). CONCLUSIONS LBSG is a safe procedure, with no impact on postoperative complications. The banded sleeve showed a significant greater weight loss in the midterm follow-up. Considering the issue of weight regain observed after LSG, the placement of a perigastric ring during the first procedure may be a strategy to improve the results. This trial is registered with NCT04228185.
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Affiliation(s)
- Paolo Gentileschi
- Department of Surgery, Obesity Unit, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Leandro Siragusa
- Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Valeria Tognoni
- Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Domenico Benavoli
- Department of Surgery, Tor Vergata University Hospital, Viale Oxford 81–00133, Rome, Italy
| | - Stefano D'Ugo
- Department of General Surgery, “Vito Fazzi” Hospital, Piazza Muratore 1–73100, Lecce, Italy
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Bianciardi E, Di Lorenzo G, Niolu C, Betrò S, Zerbin F, Gentileschi P, Siracusano A. Body image dissatisfaction in individuals with obesity seeking bariatric surgery: exploring the burden of new mediating factors. Riv Psichiatr 2019; 54:8-17. [PMID: 30760932 DOI: 10.1708/3104.30935] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION For bariatric surgery candidates body image dissatisfaction (BID) may influence both psychological well-being and motivation to obtain surgery. This study aims to examine possible psychiatric predictors of BID. In particular, we explored the burden of new associated factors such as early trauma and attachment style (AS), which have not been assessed in previous literature. METHODS In this study, 536 patients with extreme obesity (mean Body Mass Index, BMI=43 kg/m2, SD=6.62) undergoing presurgical psychiatric evaluations as part of a mandatory workup before surgery were chosen as participants. A semi-structured clinical interview was performed to assess psychiatric diagnosis and patients' history of early trauma. BID was assessed using the Body Shape Questionnaire (BSQ). Depression, binge eating, and AS were assessed using self-report instruments. RESULTS Binge eating behavior (p<0.0001), depression severity (p<0.0001), female gender (p<0.0001), and the "need for approval" dimension of insecure AS (p<0.0001) were found to be independent and significant predictors of BSQ score. However, early trauma and BMI were not included in the significant regression model (F4,442=90.784, p<0.0001, adjR2=0.446). DISCUSSION Our results increased the understanding of BID among individuals with extreme obesity. Similar to previous studies, we reported that binge-eating, depressive symptoms, and gender influenced BID. Neither early trauma nor BMI were associated with BID. Our novel finding was the significance of insecure AS. Implications for multidisciplinary approaches to obesity treatment are discussed. Identifying critical features of BID to be targeted in pre- and post-operative behavioral interventions may open new possibilities for providing effective support for individuals over the course of their therapy. CONCLUSIONS For some individuals living with obesity, developmental and relational processes such as insecure AS may play a substantial role in the development of BID.
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Affiliation(s)
- Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sophia Betrò
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Zerbin
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Psychiatric Chair, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Hoyles L, Fernández-Real JM, Federici M, Serino M, Abbott J, Charpentier J, Heymes C, Luque JL, Anthony E, Barton RH, Chilloux J, Myridakis A, Martinez-Gili L, Moreno-Navarrete JM, Benhamed F, Azalbert V, Blasco-Baque V, Puig J, Xifra G, Ricart W, Tomlinson C, Woodbridge M, Cardellini M, Davato F, Cardolini I, Porzio O, Gentileschi P, Lopez F, Foufelle F, Butcher SA, Holmes E, Nicholson JK, Postic C, Burcelin R, Dumas ME. Publisher Correction: Molecular phenomics and metagenomics of hepatic steatosis in non-diabetic obese women. Nat Med 2018; 24:1628. [DOI: 10.1038/s41591-018-0169-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Guglielmi V, Bellia A, Gentileschi P, Lombardo M, D'Adamo M, Lauro D, Sbraccia P. Parathyroid hormone in surgery-induced weight loss: no glucometabolic effects but potential adaptive response to skeletal loading. Endocrine 2018; 59:288-295. [PMID: 29168114 DOI: 10.1007/s12020-017-1477-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 10/04/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Increased parathyroid hormone (PTH) is commonly associated with obesity, and its role in the pathogenesis of obesity-related glucometabolic abnormalities is uncertain. We aimed to explore the relationships of PTH with glucose/insulin homeostasis parameters before and after bariatric surgery-induced weight loss, and whether they depend or not on 25-hydroxyvitamin D (25OHD) status. METHODS We included 42 subjects (27 women, aged 40 ± 5 years, BMI 48.5 ± 7.3 kg/m2) without diabetes, chronic kidney disease, or hyperparathyroidism undergoing sleeve gastrectomy. The following parameters were evaluated before and 6 months after surgery: circulating levels of PTH, calcium, phosphorus, 25OHD, leptin, insulin growth factor (IGF)-1; 75-g oral glucose tolerance test to derive measures of insulin sensitivity (ISI) and secretion (Stumvoll index); dual-energy X-ray absorptiometry to assess fat distribution and bone mineral density. RESULTS Weight loss was accompanied by significant reduction of PTH levels (77.9 ± 19.1 vs. 60.5 ± 13.4 pg/ml; p = 0.005), without concomitant modification of 25OHD status. Both baseline PTH and its postoperative percent change resulted associated, with baseline fat mass (β = 0.615, p = 0.003) and its concurrent postoperative reduction (r = 0.419; p = 0.006), but neither with glucose homeostasis parameters nor their respective variations after weight loss. Interestingly, leptin reduction after weight loss was independently related to PTH change (β = 0.396, p = 0.015) and IGF-1 levels (β = 0.176, p = 0.059). CONCLUSIONS Circulating PTH decreases with fat mass reduction independent of 25OHD status, but it is not associated with improvement of insulin resistance and related metabolic parameters. Leptin and PTH may mediate the cross-talk between adipose tissue and parathyroid glands, which possibly contributes to bone adaptation to excess body weight.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Paolo Gentileschi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
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Guglielmi V, D'Adamo M, Menghini R, Cardellini M, Gentileschi P, Federici M, Sbraccia P. MicroRNA 21 is up-regulated in adipose tissue of obese diabetic subjects. ACTA ACUST UNITED AC 2017; 4:141-145. [PMID: 28447068 PMCID: PMC5389040 DOI: 10.3233/nha-160020] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We investigated miR21 expression in omental (OAT) and subcutaneous adipose tissue (SAT) from 16 obese subjects undergoing bariatric surgery. Patients were divided into two age- and BMI-matched groups according to the presence of type 2 diabetes (T2D). miR21 was not differently expressed in OAT and SAT. However, miR21 expression was two folds greater in adipose tissue in patients with T2D. Accordingly, in primary cultures of adipocytes from non diabetic overweight subjects, miR21 expression increased after 24-h exposure to high glucose and insulin. In conclusion, miR21 appears linked to insulin-resistance deterioration within its pathophysiologic progression from obesity to T2D.
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Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy.,Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy.,Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Rossella Menghini
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marina Cardellini
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy.,Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
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Perrone F, Bianciardi E, Ippoliti S, Nardella J, Fabi F, Gentileschi P. Long-term effects of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for the treatment of morbid obesity: a monocentric prospective study with minimum follow-up of 5 years. Updates Surg 2017; 69:101-107. [PMID: 28266000 DOI: 10.1007/s13304-017-0426-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 05/30/2016] [Accepted: 02/21/2017] [Indexed: 02/07/2023]
Abstract
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most widely used bariatric procedures nowadays. The aim of this study was to compare long-term results on weight loss and comorbidities improvement for both procedures. A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 underwent LSG and 142 underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range 60-96). LSG showed greater effectiveness in percentage of excess weight loss (%EWL) at 180 days and at 1 year of follow-up. Instead, at 5th year follow-up LRYGB and LSG showed similar %EWL values (72.34 versus 70.26). LSG group showed a lack of weight loss in patients from 3 to 5 years after surgery, whereas LRYGB group patients maintained an effective weight loss during the entire follow-up period. In LSG group both length of stay and operative time were found to be shorter. LRYGB showed better effectiveness in type 2 diabetes mellitus (T2DM) resolution rate. None of the two techniques has proven to be clearly better than the other on a long-term follow-up analysis, except for the LRYGB better results in T2DM healing. According to our findings, in LSG Group after 3 years the weight remains stable.
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Affiliation(s)
- Federico Perrone
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy.
| | - Emanuela Bianciardi
- Psychiatric Unit, Department of System Medicine, University of Rome, Tor Vergata, Rome, Italy
| | | | | | | | - Paolo Gentileschi
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy.,Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Rome, Italy
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Montuori M, Benavoli D, D'Ugo S, Di Benedetto L, Bianciardi E, Gaspari AL, Gentileschi P. Integrated Approaches for the Management of Staple Line Leaks following Sleeve Gastrectomy. J Obes 2017; 2017:4703236. [PMID: 28261497 PMCID: PMC5312046 DOI: 10.1155/2017/4703236] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/05/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction. Aim of the study was trying to draw a final flow chart for the management of gastric leaks after laparoscopic sleeve gastrectomy, based on the review of our cases over 10 years' experience. Material and Methods. We retrospectively reviewed all patients who underwent LSG as a primary operation at the Bariatric Unit of Tor Vergata University Hospital in Rome from 2007 to 2015. Results. Patients included in the study were 418. There were 6 staple line leaks (1.44%). All patients with diagnosis of a leak were initially discharged home in good clinical conditions and then returned to A&E because of the complication. The mean interval between surgery and readmission for leak was 13,4 days (range 6-34 days, SD ± 11.85). We recorded one death (16.67%) due to sepsis. The remaining five cases were successfully treated with a mean healing time of the gastric leak of 55,5 days (range 26-83 days; SD ± 25.44). Conclusion. Choosing the proper treatment depends on clinical stability and on the presence or not of collected abscess. Our treatment protocol showed being associated with low complication rate and minor discomfort to the patients, reducing the need for more invasive procedures.
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Affiliation(s)
- Mauro Montuori
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
- *Mauro Montuori:
| | - Domenico Benavoli
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Stefano D'Ugo
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Luca Di Benedetto
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Emanuela Bianciardi
- Psychiatry Unit, Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Achille L. Gaspari
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, 00133 Rome, Italy
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Tariciotti L, D'Ugo S, Manzia TM, Tognoni V, Sica G, Gentileschi P, Tisone G. Combined liver transplantation and sleeve gastrectomy for end-stage liver disease in a bariatric patient: First European case-report. Int J Surg Case Rep 2016; 28:38-41. [PMID: 27677115 PMCID: PMC5037123 DOI: 10.1016/j.ijscr.2016.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 02/08/2023] Open
Abstract
Non-alcoholic Steatohepatitis is the 3rd indication for liver transplantation. Obese transplanted patients have higher morbidity and mortality rates. Bariatric surgery decreases morbidity and mortality in obese patients. Combined liver transplant and sleeve gastrectomy can be safely performed.
Introduction Obesity is a contributor to the global burden of chronic diseases, including non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH). NASH cirrhosis is becoming a leading indication for liver transplant (LT). Obese transplanted patients have higher morbidity and mortality rates. One strategy, to improve the outcomes in these patients, includes bariatric surgery at the time of LT. Herein we report the first European combined LT and sleeve gastrectomy (SG). Case presentation A 53 years old woman with Hepatocellular carcinoma and Hepatitis C virus related cirrhosis, was referred to our unit. She also presented with severe morbid obesity (BMI 40 kg/m2) and insulin-dependent diabetes. Once listed for LT, she was assessed by the bariatric surgery team to undergo a combined LT/SG. At the time of transplantation the patient had a model for end-stage liver disease calculated score of 14 and a BMI of 38 kg/m2. The LT was performed using a deceased donor. An experienced bariatric surgeon, following completion of the LT, performed the SG. Operation time was 8 h and 50 min. The patient had an uneventful recovery and is currently alive, 5 months after the combined procedure, with normal allograft function, significant weight loss (BMI = 29 kg/m2), and diabetes resolution. Conclusion Despite the ideal approach to the management of the obese LT patients remains unknown, we strongly support the combined procedure during LT in selected patients, offering advantages in terms of allograft and patient survival, maintenance of weigh loss that will ultimately reduce obese related co-morbidities.
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Affiliation(s)
- Laura Tariciotti
- Liver and Kidney Transplant Centre, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy.
| | - Stefano D'Ugo
- General Surgery and Bariatric Surgery Unit, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Tommaso Maria Manzia
- Liver and Kidney Transplant Centre, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Valeria Tognoni
- General Surgery and Bariatric Surgery Unit, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Sica
- General Surgery and Bariatric Surgery Unit, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Paolo Gentileschi
- General Surgery and Bariatric Surgery Unit, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Tisone
- Liver and Kidney Transplant Centre, Fondazione Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
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Perrone F, Bianciardi E, Benavoli D, Tognoni V, Niolu C, Siracusano A, Gaspari AL, Gentileschi P. Gender Influence on Long-Term Weight Loss and Comorbidities After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: a Prospective Study With a 5-Year Follow-up. Obes Surg 2016; 26:276-81. [PMID: 26033435 DOI: 10.1007/s11695-015-1746-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gender might be important in predicting outcomes after bariatric surgery. The aim of the study was to investigate the influence of gender on long-term weight loss and comorbidity improvement after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS A cohort of 304 consecutive patients underwent surgery in 2006-2009: 162 (98 women, 64 men) underwent LSG and 142 (112 women, 30 men) underwent LRYGB. The mean follow-up time was 75.8 ± 8.4 months (range, 60-96 months). RESULTS Overall mean (95% CI) reduction in BMI was 23.5 (24.3-22.7) kg/m(2) after 5 years, with no statistical difference between LSG and LRYGB groups (P = 0.94). The overall means ± standard deviations of %EBMIL after 5 years were 78.8 ± 23.5 and 81.6 ± 21.4 in the LSG and LRYGB groups, respectively. Only for LSG group %EBMIL after 24-36 and 60 months differed significantly between male and female patients (P = 0.003 versus P = 0.06 in LRYGB), and 89 versus 90% of patients showed improvements in comorbidities in the LSG and LRYGB groups, respectively. Only two patients (women) were lost to follow-up: 1/162 (0.6%) for LSG at the 4th year and 1/142 (0.7%) for LRYGB to the 5th year. CONCLUSIONS LSG was more effective in obese male than in female patients in terms of %EBMIL, with no difference in comorbidities. LRYGB elicited similar results in both genders in terms of %EBMIL and comorbidities.
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Affiliation(s)
- Federico Perrone
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Italy.
| | - Emanuela Bianciardi
- Psychiatric Unit, Department of System Medicine, University of Rome, Tor Vergata, Italy.
| | - Domenico Benavoli
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Italy.
| | - Valeria Tognoni
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Italy.
| | - Cinzia Niolu
- Psychiatric Unit, Department of System Medicine, University of Rome, Tor Vergata, Italy.
| | - Alberto Siracusano
- Psychiatric Unit, Department of System Medicine, University of Rome, Tor Vergata, Italy.
| | - Achille L Gaspari
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Italy.
| | - Paolo Gentileschi
- General Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Italy. .,Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome, Tor Vergata, Italy.
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Lombardo M, Bellia A, Mattiuzzo F, Franchi A, Ferri C, Elvira P, Guglielmi V, D'Adamo M, Giuseppe A, Gentileschi P, Iellamo F, Lauro D, Federici M, Sbraccia P. Frequent Follow-Up Visits Reduce Weight Regain in Long-Term Management After Bariatric Surgery. Bariatr Surg Pract Patient Care 2015. [DOI: 10.1089/bari.2015.0021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Mauro Lombardo
- Human Nutrition, San Raffaele Open University, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | | | | | - Carola Ferri
- Human Nutrition, San Raffaele Open University, Rome, Italy
| | - Padua Elvira
- Human Nutrition, San Raffaele Open University, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Valeria Guglielmi
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Annino Giuseppe
- School of Human Movement Science, University of Rome “Tor Vergata,” Rome, Italy
| | - Paolo Gentileschi
- Bariatric Surgery Unit—Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata,” Rome, Italy
| | - Ferdinando Iellamo
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
- School of Human Movement Science, University of Rome “Tor Vergata,” Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
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Guglielmi V, Cardellini M, Cinti F, Corgosinho F, Cardolini I, D'Adamo M, Zingaretti MC, Bellia A, Lauro D, Gentileschi P, Federici M, Cinti S, Sbraccia P. Omental adipose tissue fibrosis and insulin resistance in severe obesity. Nutr Diabetes 2015; 5:e175. [PMID: 26258766 PMCID: PMC4558556 DOI: 10.1038/nutd.2015.22] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/13/2015] [Accepted: 05/31/2015] [Indexed: 02/06/2023] Open
Abstract
Background/Objectives: The unresolved chronic inflammation of white adipose tissue (WAT) in obesity leads to interstitial deposition of fibrogenic proteins as reparative process. The contribution of omental adipose tissue (oWAT) fibrosis to obesity-related complications remains controversial. The aim of our study was to investigate whether oWAT fibrosis may be related to insulin resistance in severely obese population. Subjects/Methods: Forty obese subjects were studied by glucose clamp before undergoing bariatric surgery and thus stratified according to insulin resistance severity (M-value). From the first (Group B: n=13; M=1.9±0.7 mg kg−1 min−1) and the highest (Group A: n=14; M=4.5±1.4 mg kg−1 min−1) M-value tertiles, which were age-, waist- and body mass index-matched, oWAT samples were then obtained. Gene expression of collagen type I, III and VI, interleukin-6, profibrotic mediators (transforming growth factor (TGF)-β1, activin A, connective tissue growth factor), hypoxia inducible factor-1α (HIF-1α) and macrophage (CD68, monocyte chemotactic protein (MCP)-1, CD86, CD206, CD150) markers were analyzed by quantitative reverse transcription PCR. Adipocyte size and total fibrosis were assessed by histomorphometry techniques. Results: Fibrosis at morphological level resulted significantly greater in Group B compared with Group A, although collagens gene expression did not differ. Notably, collagen VI messenger RNA significantly correlated with collagen I, collagen III, HIF-1α, TGF-β1, CD68, MCP-1 and CD86 transcription levels, supporting their relation with fibrosis development. Conclusions: In conclusion, we show for the first time that human oWAT fibrosis in severe obesity is consistent with a higher degree of insulin resistance measured by glucose clamp. Therefore, collagen deposition could represent a maladaptive mechanism contributing to obesity-related metabolic complications.
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Affiliation(s)
- V Guglielmi
- 1] Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy [2] Obesity Center (EASO accredited COM), Policlinico Tor Vergata, Rome, Italy
| | - M Cardellini
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - F Cinti
- 1] Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy [2] Department of Experimental and Clinical Medicine, Obesity Center, University of Ancona (Politecnica delle Marche), Ancona, Italy
| | - F Corgosinho
- 1] Department of Experimental and Clinical Medicine, Obesity Center, University of Ancona (Politecnica delle Marche), Ancona, Italy [2] CAPES Foundation, Ministry of Education of Brazil, Brasília, DF, Brazil
| | - I Cardolini
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - M D'Adamo
- 1] Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy [2] Obesity Center (EASO accredited COM), Policlinico Tor Vergata, Rome, Italy
| | - M C Zingaretti
- Department of Experimental and Clinical Medicine, Obesity Center, University of Ancona (Politecnica delle Marche), Ancona, Italy
| | - A Bellia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - D Lauro
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - P Gentileschi
- Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - M Federici
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - S Cinti
- Department of Experimental and Clinical Medicine, Obesity Center, University of Ancona (Politecnica delle Marche), Ancona, Italy
| | - P Sbraccia
- 1] Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome 'Tor Vergata', Rome, Italy [2] Obesity Center (EASO accredited COM), Policlinico Tor Vergata, Rome, Italy
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D'Ugo S, Gentileschi P, Benavoli D, Cerci M, Gaspari A, Berta RD, Moretto C, Bellini R, Basso N, Casella G, Soricelli E, Cutolo P, Formisano G, Angrisani L, Anselmino M. Comparative use of different techniques for leak and bleeding prevention during laparoscopic sleeve gastrectomy: a multicenter study. Surg Obes Relat Dis 2013; 10:450-4. [PMID: 24448100 DOI: 10.1016/j.soard.2013.10.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [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: 06/20/2013] [Revised: 10/17/2013] [Accepted: 10/18/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is an approved primary procedure for morbid obesity, but it is associated with serious complications, such as staple line leaks and bleeding. The objective of this study was to assess the effectiveness of staple line reinforcement (SLR) in reducing leaks and bleeding after LSG. METHODS A total of 1162 patients underwent LSG (305 males, 857 females). The mean age was 43.7 years and the mean body mass index was 48 kg/m(2). The patients were divided into 6 groups based on the type of SLR, including a no-SLR control group, with evaluation of leaking and bleeding risk and correlation of patients' characteristics with complications. RESULTS A total of 189 patients underwent LSG without reinforcement. The SLR method was oversewing in 476 patients, bovine pericardium in 312, synthetic polyester in 76, glycolide/trimethylene copolymer in 63, and thrombin matrix in 46. The overall leak frequency was 2.8%; higher with synthetic polyester (7.8%), 4.8% with no reinforcement, and lower with bovine pericardium strips (.3%; P<.01). Postoperative hemorrhage occurred in 35 patients (3%), with a higher frequency being observed without SLR (13.7%; P = .02). Only diabetes was a risk-factor for a leak (P< .01). CONCLUSION SLR with bovine pericardium strips significantly reduced the leak risk. Postoperative bleeding was significantly lower with all SLR-methods, although there was no significant difference among the various techniques. Patients with type II diabetes had a higher risk of staple line leak after LSG. Further randomized, controlled studies are needed to improve our understanding of the efficacy of SLR during LSG.
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Affiliation(s)
- Stefano D'Ugo
- Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
| | - Paolo Gentileschi
- Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Domenico Benavoli
- Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Michela Cerci
- Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Achille Gaspari
- Bariatric Surgery Unit - Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Rossana Daniela Berta
- Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Carlo Moretto
- Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Rosario Bellini
- Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
| | - Nicola Basso
- VII Department of Surgery - La Sapienza University, Rome, Italy
| | | | | | - Pierpaolo Cutolo
- Department of General Surgery - S. Giovanni Bosco Hospital, Naples, Italy
| | | | - Luigi Angrisani
- Department of General Surgery - S. Giovanni Bosco Hospital, Naples, Italy
| | - Marco Anselmino
- Bariatric and Metabolic Surgery Unit - Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy
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Dhimolea S, Rulli F, Bellini M, Gentileschi P, Carrano F, Gaspari A. Incidental thyroid carcinoma in benign thyroid diseases. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bellia A, Garcovich C, D'Adamo M, Lombardo M, Tesauro M, Donadel G, Gentileschi P, Lauro D, Federici M, Lauro R, Sbraccia P. Serum 25-hydroxyvitamin D levels are inversely associated with systemic inflammation in severe obese subjects. Intern Emerg Med 2013; 8:33-40. [PMID: 21437585 DOI: 10.1007/s11739-011-0559-x] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 03/06/2011] [Indexed: 12/15/2022]
Abstract
Obesity is frequently characterized by a reduced vitamin D bioavailability, as well as insulin-resistance and a chronic inflammatory response. We tested the hypothesis of an independent relationship between serum concentrations of 25-hydroxyvitamin D (25[OH]D) and several circulating inflammatory markers in a cohort of severely obese individuals. Cross-sectional study was carried out among obese patients undergoing a clinical evaluation before bariatric surgery in our University Hospital. Serum 25(OH)D, fasting and post load glucose and insulin, high-sensitive C-reactive protein (hs CRP), fibrinogen, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), leptin, adiponectin and lipid profile were collected. Insulin-resistance was assessed by insulin sensitivity index (ISI). Total body fat (FAT kg), total percent body fat (FAT%) and truncal fat mass (TrFAT) were assessed with dual-energy X-ray absorptiometry. A total of 147 obese subjects (89 women, 37.8 ± 7.1 years) with mean body mass index (BMI) of 43.6 ± 4.3 kg/m(2) were enrolled. Patients in the lowest tertile of 25(OH)D were significantly more obese with a higher amount of TrFAT, more insulin-resistant, and had higher levels of fasting and post-challenge glucose (p < 0.05 for all). In a multivariate regression analysis, serum 25(OH)D was inversely related to significant levels of hs CRP, IL-6 and TNF-α after accounting for age, gender, season of recruitment, BMI, FAT kg and TrFAT (p < 0.01 for all). In extremely obese subjects, 25(OH)D serum concentrations are inversely associated with several biomarkers of systemic inflammation, regardless of the total quantity of fat mass.
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Affiliation(s)
- Alfonso Bellia
- Department of Internal Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
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Bellia A, Marinoni G, D'Adamo M, Guglielmi V, Lombardo M, Donadel G, Gentileschi P, Lauro D, Federici M, Lauro R, Sbraccia P. Parathyroid hormone and insulin resistance in distinct phenotypes of severe obesity: a cross-sectional analysis in middle-aged men and premenopausal women. J Clin Endocrinol Metab 2012; 97:4724-32. [PMID: 23027922 DOI: 10.1210/jc.2012-2513] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT High levels of PTH are reported in obese individuals and related to increased cardiometabolic risk. OBJECTIVE Our objective was to evaluate whether the relationship between PTH, insulin resistance, and related metabolic parameters differ between metabolically healthy obese (MHO) and insulin-resistant obese (IRO) subjects. DESIGN AND SETTING We conducted a cross-sectional study among patients evaluated for bariatric surgery in our University Hospital. PATIENTS Patients initially included were 174 severely obese subjects (114 women, aged 40 ± 5 yr, body mass index of 45 ± 6 kg/m(2)) without diabetes, chronic kidney disease, or hyperparathyroidism. MHO (n = 43) and IRO (n = 86) subjects were identified according to quartiles of insulin resistance. MAIN OUTCOME MEASURES Fasting and postload glucose, insulin, total and high-density lipoprotein cholesterol, triglycerides, creatinine, calcium, phosphorus, PTH, 25-hydroxyvitamin D (25OHD), fibrinogen, and high-sensitivity C-reactive protein were assessed. Insulin sensitivity index was derived from a 75-g oral glucose tolerance test. Fat distribution and bone mineral density were assessed with dual-energy x-ray absorptiometry. RESULTS Although 25OHD levels were higher in MHO than in IRO subjects [72.23 (59.41-80.36) vs. 52.36 (41.98-62.57) nmol/liter, P = 0.002], PTH levels were comparable between groups (74.4 ± 13.2 vs. 72.1 ± 15.1 ng/liter, P = 0.34). No differences in serum calcium, phosphorus, bone mineral density, and renal function were detected. An independent inverse association between 25OHD and insulin resistance was seen in both groups. In contrast to IRO subjects, after adjusting for covariates, PTH levels were unrelated to insulin sensitivity index, fasting and postload glucose, insulin, and high-sensitivity C-reactive protein in MHO subjects. CONCLUSIONS MHO and IRO subjects show comparably high levels of circulating PTH, which are not associated with insulin resistance and related metabolic parameters in MHO subjects. Most of the associations observed in IRO subjects appear to be mediated by greater truncal fat mass.
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Affiliation(s)
- Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, I-00133 Rome, Italy
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Schinzari F, Tesauro M, Rovella V, Di Daniele N, Gentileschi P, Mores N, Campia U, Cardillo C. Rho-kinase inhibition improves vasodilator responsiveness during hyperinsulinemia in the metabolic syndrome. Am J Physiol Endocrinol Metab 2012; 303:E806-11. [PMID: 22829585 PMCID: PMC3468433 DOI: 10.1152/ajpendo.00206.2012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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] [Indexed: 02/07/2023]
Abstract
In patients with the metabolic syndrome (MetS), the facilitatory effect of insulin on forearm vasodilator responsiveness to different stimuli is impaired. Whether the RhoA/Rho kinase (ROCK) pathway is involved in this abnormality is unknown. We tested the hypotheses that, in MetS patients, ROCK inhibition with fasudil restores insulin-stimulated vasodilator reactivity and that oxidative stress plays a role in this mechanism. Endothelium-dependent and -independent forearm blood flow responses to acetylcholine (ACh) and sodium nitroprusside (SNP), respectively, were assessed in MetS patients (n = 8) and healthy controls (n = 5) before and after the addition of fasudil (200 μg/min) to an intra-arterial infusion of insulin (0.1 mU/kg/min). In MetS patients (n = 5), fasudil was also infused without hyperinsulinemia. The possible involvement of oxidative stress in the effect of fasudil during hyperinsulinemia was investigated in MetS patients (n = 5) by infusing vitamin C (25 mg/min). In MetS patients, compared with saline, fasudil enhanced endothelium-dependent and -independent vasodilator responses during insulin infusion (P < 0.001 and P = 0.008, respectively), but not in the absence of hyperinsulinemia (P = 0.25 and P = 0.13, respectively). By contrast, fasudil did not affect vasoreactivity to ACh and SNP during hyperinsulinemia in controls (P = 0.11 and P = 0.56, respectively). In MetS patients, fasudil added to insulin and vitamin C did not further enhance vasodilation to ACh and SNP (P = 0.15 and P = 0.43, respectively). In the forearm circulation of patients with the MetS, ROCK inhibition by fasudil improves endothelium-dependent and -independent vasodilator responsiveness during hyperinsulinemia; increased oxidative stress seems to be involved in the pathophysiology of this phenomenon.
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Affiliation(s)
- Francesca Schinzari
- Department of Internal Medicine, Catholic University Medical School, Rome, Italy
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Gentileschi P, D'Ugo S, Benavoli D, Gaspari AL. Staple-Line Reinforcement with a Thrombin Matrix During Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Case Series. J Laparoendosc Adv Surg Tech A 2012; 22:249-53. [DOI: 10.1089/lap.2011.0372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Paolo Gentileschi
- Department of Surgical Sciences, University of Rome “Tor Vergata,” Rome, Italy
| | - Stefano D'Ugo
- Department of Surgical Sciences, University of Rome “Tor Vergata,” Rome, Italy
| | - Domenico Benavoli
- Department of Surgical Sciences, University of Rome “Tor Vergata,” Rome, Italy
| | - Achille L. Gaspari
- Department of Surgical Sciences, University of Rome “Tor Vergata,” Rome, Italy
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Gentileschi P, Camperchioli I, D'Ugo S, Benavoli D, Gaspari AL. Staple-line reinforcement during laparoscopic sleeve gastrectomy using three different techniques: a randomized trial. Surg Endosc 2012; 26:2623-9. [PMID: 22441975 DOI: 10.1007/s00464-012-2243-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/01/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The main drawback of laparoscopic sleeve gastrectomy (LSG) is the severity of postoperative complications. Staple line reinforcement (SLR) is strongly advocated. The purpose of this study was to compare prospectively and randomly three different techniques of SLR during LSG. METHODS From April 2010 to April 2011, patients submitted to LSG were randomly selected for the following three different techniques of SLR: oversewing (group A); buttressed transection with a polyglycolide acid and trimethylene carbonate (group B); and staple-line roofing with a gelatin fibrin matrix (group C). Primary endpoints were reinforcement operative time, incidence of postoperative staple-line bleeding, and leaks. Operative time was calculated as follows: oversewing time in group A; positioning of polyglycolide acid and trimethylene carbonate over the stapler in group B; and roofing of the entire staple line in group C. RESULTS A total of 120 patients were enrolled in the study (82 women and 38 men). Mean age was 44.6 ± 9.2 (range, 28-64) years. Mean preoperative body mass index was 47.2 ± 6.6 (range, 40-66) kg/m². Mean time for SLR was longer in group A (14.2 ± 4.2 (range, 8-18) minutes) compared with group B (2.4 ± 1.8 (range, 1-4) minutes) and group C (4.4 ± 1.6 (range, 3-6) minutes; P < 0.01). Four major complications were observed (3.3 %): one leak and one bleeding in group A; one bleeding in group B; and one leak in group C, with no significant differences between the groups. No mortality was observed. CONCLUSIONS SLR with either polyglycolide acid with trimethylene carbonate or gelatin fibrin matrix is faster compared with oversewing. No significant differences were observed regarding postoperative staple-line complications.
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Affiliation(s)
- Paolo Gentileschi
- Bariatric Surgery Unit-Department of Surgery, University of Rome Tor Vergata, Rome, Italy
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Menghini R, Casagrande V, Menini S, Marino A, Marzano V, Hribal ML, Gentileschi P, Lauro D, Schillaci O, Pugliese G, Sbraccia P, Urbani A, Lauro R, Federici M. TIMP3 overexpression in macrophages protects from insulin resistance, adipose inflammation, and nonalcoholic fatty liver disease in mice. Diabetes 2012; 61:454-62. [PMID: 22228717 PMCID: PMC3266402 DOI: 10.2337/db11-0613] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The tissue inhibitor of metalloproteinase (TIMP)3, a stromal protein that restrains the activity of proteases and receptors, is reduced in inflammatory metabolic disorders such as type 2 diabetes mellitus (T2DM) and atherosclerosis. We overexpressed Timp3 in mouse macrophages (MacT3) to analyze its potential antidiabetic and antiatherosclerotic effects. Transgenic mice with myeloid cells targeting overexpression of TIMP3 were generated and fed a high-fat diet for 20 weeks. Physical and metabolic phenotypes were determined. Inflammatory markers, lipid accumulation, and insulin sensitivity were measured in white adipose tissue (WAT), liver, and skeletal muscle. In a model of insulin resistance, MacT3 mice were more glucose tolerant and insulin sensitive than wild-type mice in both in vitro and in vivo tests. Molecular and biochemical analyses revealed that increased expression of TIMP3 restrained metabolic inflammation and stress-related pathways, including Jun NH2-terminal kinase and p38 kinase activation, in WAT and liver. TIMP3 overexpression in macrophages resulted in reduced activation of oxidative stress signals related to lipid peroxidation, protein carbonylation, and nitration in WAT and liver. Our data show that macrophage-specific overexpression of TIMP3 protects from metabolic inflammation and related metabolic disorders such as insulin resistance, glucose intolerance, and nonalcoholic steatohepatitis.
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Affiliation(s)
- Rossella Menghini
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Viviana Casagrande
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Stefano Menini
- Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy
| | - Arianna Marino
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Valeria Marzano
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
- Laboratory of Proteomics, EBRI/Santa Lucia Foundation, Rome, Italy
| | - Marta L. Hribal
- Department of Medical and Surgical Sciences, University of Magna Graecia, Catanzaro, Italy
| | - Paolo Gentileschi
- Department of Surgery, University of Rome “Tor Vergata,” Rome, Italy
| | - Davide Lauro
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Orazio Schillaci
- Department of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico Neuromed, Pozzilli, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy
| | - Paolo Sbraccia
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Andrea Urbani
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
- Laboratory of Proteomics, EBRI/Santa Lucia Foundation, Rome, Italy
| | - Renato Lauro
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Massimo Federici
- Department of Internal Medicine, University of Rome “Tor Vergata,” Rome, Italy
- Corresponding author: Massimo Federici,
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Casagrande V, Menghini R, Menini S, Marino A, Marchetti V, Cavalera M, Fabrizi M, Hribal ML, Pugliese G, Gentileschi P, Schillaci O, Porzio O, Lauro D, Sbraccia P, Lauro R, Federici M. Overexpression of Tissue Inhibitor of Metalloproteinase 3 in Macrophages Reduces Atherosclerosis in Low-Density Lipoprotein Receptor Knockout Mice. Arterioscler Thromb Vasc Biol 2012; 32:74-81. [DOI: 10.1161/atvbaha.111.238402] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Viviana Casagrande
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Rossella Menghini
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Stefano Menini
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Arianna Marino
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Valentina Marchetti
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Michele Cavalera
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Marta Fabrizi
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Marta L. Hribal
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Giuseppe Pugliese
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Paolo Gentileschi
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Orazio Schillaci
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Ottavia Porzio
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Davide Lauro
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Paolo Sbraccia
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Renato Lauro
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
| | - Massimo Federici
- From the Departments of Internal Medicine (V.C., R.M., A.M., V.M., M.C., M. Fabrizi, O.P., D.L., P.S., R.L., M. Federici), Surgery (P.G.), Diagnostic Imaging (O.S.), University of Rome “Tor Vergata,” Rome, Italy; Department of Clinical and Molecular Medicine, “Sapienza” University, Rome, Italy (S.M., G.P.); University of Magna Graecia, Catanzaro, Italy (M.L.H.)
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Sileri P, Franceschilli L, Cadeddu F, De Luca E, D'Ugo S, Tognoni V, Camperchioli I, Benavoli D, Di Lorenzo N, Gaspari AL, Gentileschi P. Prevalence of defaecatory disorders in morbidly obese patients before and after bariatric surgery. J Gastrointest Surg 2012; 16:62-6; discussion 66-7. [PMID: 21948149 DOI: 10.1007/s11605-011-1705-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 09/14/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide and has lately reached epidemic proportions in western countries. Several epidemiological studies have consistently shown that both overweight and obesity are important risk factors for the development of various functional defaecatory disorders (DDs), including faecal incontinence and constipation. However, data on their prevalence as well as effectiveness of bariatric surgery on their correction are scant. The primary objective of this study was to estimate the effect of morbid obesity on DDs in a cohort of patients listed for bariatric surgery. We also evaluated preliminary results of the effects of sleeve gastrectomy on these disorders. PATIENTS AND METHODS A questionnaire-based study was proposed to morbidly obese patients having bariatric surgery. Data included demographics, past medical, surgical and obstetrics histories, as well as obesity related co-morbidities. Wexner Constipation Score (WCS) and the Faecal Incontinence Severity Index (FISI) questionnaires were used to evaluate constipation and incontinence. For the purpose of this study, we considered clinically relevant a WCS ≥5 and a FISI score ≥10. The same questionnaires were completed at 3 and 6 months follow-up after surgery. RESULTS A total of 139 patients accepted the study and 68 underwent sleeve gastrectomy and fully satisfied our inclusion criteria with a minimum follow-up of 6 months. Overall, mean body mass index (BMI) at listing was 47 ± 7 kg/m(2) (range 35-67 kg/m(2)). Mean WCS was 4.1 ± 4 (range 0-17), while mean FISI score (expressed as mean±standard deviation) was 9.5 ± 9 (range 0-38). Overall, 58.9% of the patients reported DDs according to the above-mentioned scores. Twenty-eight patients (20%) had WCS ≥5. Thirty-five patients (25%) had a FISI ≥10 while 19 patients (13.7%) reported combined abnormal scores. Overall, DDs were more evident with the increase of obesity grade: Mean BMI decreased significantly from 47 ± 7 to 36 ± 6 and to 29 ± 4 kg/m(2) respectively at 3 and 6 months after surgery (p < 0.0001). According to the BMI decrease, the mean WCS decreased from 3.7 ± 3 to 3.1 ± 4 and to 1.6 ± 3 respectively at 3 and 6 months (p = 0.02). Similarly, the FISI score decreased from 10 ± 8 to 3 ± 4 and to 1 ± 2 respectively at 3 and 6 months (p = 0.0001). CONCLUSIONS Defaecatory disorders are common in morbidly obese patients. The risk of DDs increases with BMI. Bariatric surgery reduces DDs, mainly faecal incontinence, and these findings correlated with BMI reduction.
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Affiliation(s)
- Pierpaolo Sileri
- Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy.
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Cardellini M, Menghini R, Luzi A, Davato F, Cardolini I, D'Alfonso R, Gentileschi P, Rizza S, Marini MA, Porzio O, Lauro D, Sbraccia P, Lauro R, Federici M. Decreased IRS2 and TIMP3 expression in monocytes from offspring of type 2 diabetic patients is correlated with insulin resistance and increased intima-media thickness. Diabetes 2011; 60:3265-70. [PMID: 21984580 PMCID: PMC3219931 DOI: 10.2337/db11-0162] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In humans, it is unclear if insulin resistance at the monocyte level is associated with atherosclerosis in vivo. Here we have studied first-degree relatives of patients with type 2 diabetes to investigate whether a reduction in components of the insulin signal transduction pathways, such as the insulin receptor (InsR) or InsR substrate 1 or 2 (IRS1 or IRS2), or a reduction in genetic modifiers of insulin action, such as the TIMP3/ADAM17 (tissue inhibitor of metalloproteinase 3/A disintegrin and metalloprotease domain 17) pathway, is associated with evidence of atherosclerosis. RESEARCH DESIGN AND METHODS Insulin sensitivity was analyzed through euglycemic-hyperinsulinemic clamp, and subclinical atherosclerosis was analyzed through intimal medial thickness. Monocytes were isolated through magnetic cell sorting, and mRNA and proteins were extracted and analyzed by quantitative PCR and pathscan enzyme-linked immunosorbent assays, respectively. RESULTS In monocyte cells from human subjects with increased risk for diabetes and atherosclerosis, we found that gene expression, protein levels, and tyrosine phosphorylation of IRS2, but not InsR or IRS1, were decreased. TIMP3 was also reduced, along with insulin resistance, resulting in increased ectodomain shedding activity of the metalloprotease ADAM17. CONCLUSIONS Systemic insulin resistance and subclinical atherosclerosis are associated with decreased IRS2 and TIMP3 expression in circulating monocytes.
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Affiliation(s)
- Marina Cardellini
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rossella Menghini
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alessio Luzi
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Davato
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Iris Cardolini
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rossella D'Alfonso
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Rizza
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Ottavia Porzio
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Renato Lauro
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Federici
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
- Corresponding author: Massimo Federici,
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Sica GS, Iaculli E, Biancone L, Carlo SD, Scaramuzzo R, Fiorani C, Gentileschi P, Gaspari AL. Comparative study of laparoscopic vs open gastrectomy in gastric cancer management. World J Gastroenterol 2011; 17:4602-6. [PMID: 22147966 PMCID: PMC3226983 DOI: 10.3748/wjg.v17.i41.4602] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/05/2011] [Accepted: 01/12/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare long-term results of gastric cancer patients undergoing laparoscopic and open gastrectomy in a single unit.
METHODS: From February 2000 to September 2004, all patients with adenocarcinoma of the stomach were assessed to entry in this longitudinal prospective non-randomized trial. Primary endpoint was cancer-related survival and secondary endpoints were overall survival, evaluation of surgical complications and mortality.
RESULTS: Fifty-eight patients were enrolled. Forty-seven patients were followed-up (range 11-103, median 38 mo). Four patients were lost at follow up. Twenty-two patients underwent a laparoscopic gastric surgery (LGS) and 25 had a standard open procedure (OGS). No statistical difference was found between the two groups in terms of 5 years cancer-related mortality rate (50% vs 52%, P = 1), and 5 years overall mortality rate (54.5% vs 56%, P = 1). Accordingly, cancer-related and overall survival probability by Kaplan-Meier method showed comparable results (P = 0.81 and P = 0.83, respectively). We found no differences in surgical complications in the 2 groups. There was no conversion to open surgery in this series.
CONCLUSION: LGS is as effective as OGS in the management of advanced gastric cancer. However LGS cannot be recommended routinely over OGS for the treatment of advanced gastric cancer.
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