1
|
Tham KW, Ahmed A, Boonyavarakul A, Garcia MM, Guajardo M, Hanipah ZN, Nam TQ, Nicodemus NA, Pathan F, Romano JGU, Soegonda S, Tolentino EL, Unnikrishnan AGAG, Oldfield BJ. ACTION APAC: Understanding perceptions, attitudes and behaviours in obesity and its management across south and Southeast Asia. Clin Obes 2024; 14:e12644. [PMID: 38332544 DOI: 10.1111/cob.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 02/10/2024]
Abstract
To identify perceptions and attitudes among people with obesity (PwO) and healthcare professionals (HCPs) toward obesity and its management in nine Asia-Pacific (APAC) countries, a cross-sectional online survey was conducted among adult PwO with self-reported body mass index of ≥25 kg/m2 (≥27 kg/m2, Singapore), and HCPs involved in direct patient care. In total, 10 429 PwO and 1901 HCPs completed the survey. Most PwO (68%) and HCPs (84%) agreed that obesity is a disease; however, a significant proportion of PwO (63%) and HCPs (41%) believed weight loss was the complete responsibility of PwO and only 43% of PwO discussed weight with an HCP in the prior 5 years. Most respondents acknowledged that weight loss would be extremely beneficial to PwO's overall health (PwO 76%, HCPs 85%), although nearly half (45%) of PwO misperceived themselves as overweight or of normal weight. Obesity was perceived by PwO (58%) and HCPs (53%) to negatively impact PwO forming romantic relationships. HCPs cited PwOs' lack of interest (41%) and poor motivation (37%) to lose weight as top reasons for not discussing weight. Most PwO (65%) preferred lifestyle changes over medications to lose weight. PwO and HCPs agreed that lack of exercise and unhealthy eating habits were the major barriers to weight loss. Our data highlights a discordance between the understanding of obesity as a disease and the actual behaviour and preferred approaches to manage it among PwO and HCPs. The study addresses a need to align these gaps to deliver optimal care for PwO.
Collapse
Affiliation(s)
- Kwang Wei Tham
- Endocrinology Services, Department of Medicine, Woodlands Health, National Healthcare Group, Singapore, Singapore
| | - Asma Ahmed
- The Aga Khan University Hospital, Karachi, Pakistan
| | - Apussanee Boonyavarakul
- Division of Endocrinology, Department of Internal Medicine, Phramongkutklao Hospital, Thailand
| | | | | | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | | | - Faruque Pathan
- Department of Endocrinology Ibrahim Memorial Diabetes Center, Dhaka, Bangladesh
| | | | - Sidartawan Soegonda
- Indonesia Diabetes Institute, Diabetes Connection & Care, Eka Hospitals, Jakarta, Indonesia
| | - Edgardo L Tolentino
- Ateneo School of Medicine and Public Health, Pasig, Metro Manila, Philippines
| | | | - Brian J Oldfield
- Department of Physiology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Sim AXJ, Tsen PY, Ngali NM, Lim SY, Gee T, Hanipah ZN. Enhancing Clinical Success Through Intensive Dietary Support in Bariatric Patients: a Retrospective Study in Asian Population. Obes Surg 2024; 34:509-514. [PMID: 38150118 DOI: 10.1007/s11695-023-07001-7] [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: 09/27/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Weight loss surgery is an established intervention for obesity and related conditions, ensuring sustained weight reduction and improved comorbidities. Post-bariatric surgery, maintaining nutritional adequacy and weight loss necessitates ongoing, intensive dietary support. This research aims to discern the impact of standard care vs. intensive dietary support on outcomes following bariatric surgery within an Asian demographic. This study aims to research the part that intensive dietary support plays in contrast to standard care in altering weight loss and BMI change following bariatric surgery. METHODS A retrospective analysis of medical records from a Malaysian tertiary care hospital documented bariatric surgeries conducted from January 2020 to January 2022. Rigorous criteria selected 200 patients from 327, evenly split between standard care and intensive dietary support groups. The latter underwent six mandatory visits with a surgeon and a dietitian in the initial 3 months post-surgery. A dual-review mechanism was implemented for data interpretation, increasing robustness, and reducing biases in our findings. RESULTS At 6 and 12 months, the intensive dietary support group exhibited significantly greater weight loss and BMI reduction (p < 0.01). Postoperative complications did not significantly differ between groups. CONCLUSION In an Asian population, intensive dietary support enhances weight loss and BMI reduction compared to standard care after bariatric surgery.
Collapse
Affiliation(s)
- Alvina Xin Jie Sim
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia.
| | - Poh Yue Tsen
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Nurhanis Mohd Ngali
- Department of Nutrition and Dietetics, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Shu Yu Lim
- Department of General Surgery, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Tikfu Gee
- Department of General Surgery, iHEAL Medical Centre, 59200, Kuala Lumpur, Malaysia
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Science, University Putra Malaysia, 43400, Kuala Lumpur, Malaysia
| |
Collapse
|
3
|
Fazliana M, Nor Hanipah Z, Mohd Yusof BN, Zainal Abidin NA, Tan YZ, Mohkiar FH, Liyana AZ, Mohd Naeem MN, Mohmad Misnan N, Ahmad H, Draman MS, Tsen PY, Lim SY, Gee T. Molecular, Metabolic, and Nutritional Changes after Metabolic Surgery in Obese Diabetic Patients (MoMen): A Protocol for a Multicenter Prospective Cohort Study. Metabolites 2023; 13:metabo13030413. [PMID: 36984853 PMCID: PMC10059761 DOI: 10.3390/metabo13030413] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Metabolic surgery is an essential option in the treatment of obese patients with type 2 diabetes (T2D). Despite its known advantages, this surgery still needs to be introduced in Malaysia. In this prospective study, the pathophysiological mechanisms at the molecular level will be studied and the metabolomics pathways of diabetes remission will be explored. The present study aims to evaluate the changes in the anthropometric measurements, body composition, phase angle, diet intake, biochemistry parameters, adipokines, microRNA, and metabolomics, both pre- and post-surgery, among obese diabetic patients in Malaysia. This is a multicenter prospective cohort study that will involve obese patients (n = 102) with a body mass index (BMI) of ≥25 kg/m2 (Asian BMI categories: WHO/IASO/IOTF, 2000) who will undergo metabolic surgery. They will be categorized into three groups: non-diabetes, prediabetes, and diabetes. Their body composition will be measured using a bioimpedance analyzer (BIA). The phase angle (PhA) data will be analyzed. Venous blood will be collected from each patient for glycated hemoglobin (HbA1c), lipids, liver, renal profile, hormones, adipokines, and molecular and metabolomics analyses. The serum microRNA will be measured. A gene expression study of the adipose tissue of different groups will be conducted to compare the groups. The relationship between the 1HNMR-metabolic fingerprint and the patients’ lifestyles and dietary practices will be determined. The factors responsible for the excellent remission of T2D will be explored in this study.
Collapse
Affiliation(s)
- Mansor Fazliana
- Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
- Correspondence:
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Barakatun Nisak Mohd Yusof
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nur Azlin Zainal Abidin
- Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
| | - You Zhuan Tan
- Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
| | - Farah Huda Mohkiar
- Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
| | - Ahmad Zamri Liyana
- Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
| | - Mohd Nawi Mohd Naeem
- Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
| | - Norazlan Mohmad Misnan
- Herbal Medicine Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Selangor, Malaysia
| | - Haron Ahmad
- KPJ Damansara Specialist Hospital, 119, Jalan SS 20/10, Petaling Jaya 47400, Selangor, Malaysia
| | - Mohd Shazli Draman
- KPJ Damansara Specialist Hospital, 119, Jalan SS 20/10, Petaling Jaya 47400, Selangor, Malaysia
| | - Poh Yue Tsen
- Sunway Medical Centre, No. 5 Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia
- iHeal Medical Centre, Menara IGB, Mid Valley City, Lingkaran Syed Putra, Kuala Lumpur 59200, Malaysia
- Sunway Velocity Medical Centre, Lingkaran SV2, Sunway Velocity, Kuala Lumpur 55100, Malaysia
| | - Shu Yu Lim
- Sunway Medical Centre, No. 5 Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia
- iHeal Medical Centre, Menara IGB, Mid Valley City, Lingkaran Syed Putra, Kuala Lumpur 59200, Malaysia
- Sunway Velocity Medical Centre, Lingkaran SV2, Sunway Velocity, Kuala Lumpur 55100, Malaysia
| | - Tikfu Gee
- Sunway Medical Centre, No. 5 Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor, Malaysia
- iHeal Medical Centre, Menara IGB, Mid Valley City, Lingkaran Syed Putra, Kuala Lumpur 59200, Malaysia
- Sunway Velocity Medical Centre, Lingkaran SV2, Sunway Velocity, Kuala Lumpur 55100, Malaysia
| |
Collapse
|
4
|
Hanipah ZN, Rubino F, Schauer PR. Remission with an Intervention: Is Metabolic Surgery the Ultimate Solution? Endocrinol Metab Clin North Am 2023; 52:65-88. [PMID: 36754498 DOI: 10.1016/j.ecl.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Long-term remission of type 2 diabetes following lifestyle intervention or pharmacotherapy, even in patients with mild disease, is rare. Long-term remission following metabolic surgery however, is common and occurs in 23% to 98% depending on disease severity and type of surgery. Remission after surgery is associated with excellent glycemic control without reliance on pharmacotherapy, improvements in quality of life, and major reductions in microvascular and macrovascular complications. For patients with type 2 diabetes, early intervention with metabolic surgery, when beta cell function still remains intact, provides the greatest probability of long-term remission as high as 90% or more.
Collapse
Affiliation(s)
- Zubaidah Nor Hanipah
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Francesco Rubino
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London; Bariatric and Metabolic Surgery King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Philip R Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
| |
Collapse
|
5
|
Mohammad A, Falahi E, Mohd Yusof BN, Hanipah ZN, Sabran MR, Mohamad Yusof L, Gheitasvand M. The effects of the ginger supplements on inflammatory parameters in type 2 diabetes patients: A systematic review and meta-analysis of randomised controlled trials. Clin Nutr ESPEN 2021; 46:66-72. [PMID: 34857250 DOI: 10.1016/j.clnesp.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/28/2021] [Accepted: 10/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The effect of ginger supplements on inflammatory biomarkers and oxidative stress in patients with type 2 diabetes (T2DM) has been investigated, but findings are inconsistent. This systematic review and meta-analysis were conducted to determine the effects of ginger supplementation on inflammatory parameters (high-sensitivity C-reactive protein [hs-CRP], tumour necrosis factor-alpha [TNF-α], and interleukin-6 [IL-6]) in patients with T2DM. METHODS We performed a systematic search using PubMed, Scopus, Cochrane Library, Web of Science for randomised controlled trials (RCTs), published until March 17, 2021. The quality assessment was carried out using the Cochrane Collaboration risk of bias tool. The Q-test and I 2 tests were used for the determination of heterogeneity of the included studies. Data were pooled using a random-effects model, and weighted mean difference (WMD) was used for the overall effect size. RESULTS Pooled findings of the five RCTs demonstrated that ginger supplementations had significantly reduced hs-CRP (WMD -0.42 mg/L; 95% CI, -0.78, -0.05, P = 0.03), TNF-α (-2.13 pg/mL; 95% CI: -3.41, -0.86, P = 0.001), and IL-6 (WMD: -0.61 pg/mL; 95% CI: -0.92, -0.30, P = 0.001) levels in patients with T2DM. The quality assessment of the studies showed that all of the included studies were at high risk of bias. CONCLUSIONS The meta-analysis shows that ginger supplementations reduced inflammatory parameters in patients with T2DM. Nonetheless, the reduction is relatively small, and its meaningful clinical effects are unknown. Future high-quality RCTs are needed to confirm the beneficial effects of ginger supplementation in patients with T2DM.
Collapse
Affiliation(s)
- Abolfathi Mohammad
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
| | - Ebrahim Falahi
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Barakatun-Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia; Research Centre of Excellence for Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia; Institute of Social Sciences, Universiti Putra Malaysia, Malaysia.
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
| | - Mohd Redzwan Sabran
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
| | - Loqman Mohamad Yusof
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Malaysia.
| | - Mohsen Gheitasvand
- Department of Pathology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| |
Collapse
|
6
|
Mohammad A, Falahi E, Barakatun-Nisak MY, Hanipah ZN, Redzwan SM, Yusof LM, Gheitasvand M, Rezaie F. Systematic review and meta-analyses of vitamin E (alpha-tocopherol) supplementation and blood lipid parameters in patients with diabetes mellitus. Diabetes Metab Syndr 2021; 15:102158. [PMID: 34186370 DOI: 10.1016/j.dsx.2021.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS The studies have shown that α-tocopherol supplementation could improve lipid profile in diabetes mellitus (DM) patients. Nonetheless, the result remains inconsistent. Therefore, this meta-analysis was performed to evaluate the efficacy of α-tocopherol supplement on lipid parameters in DM patients. METHODS We conducted an extensive search via Cochrane Library, PubMed, Scopus, and Web of Science databases to acquire the reported RCTs up to October 2020. RESULTS The results showed no effects of α-tocopherol supplementation on lipid profile in DM patients except when used ≥12 weeks. CONCLUSIONS α-tocopherol supplementation in DM patients had no significant effect on lipid profiles.
Collapse
Affiliation(s)
- Abolfathi Mohammad
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Ebrahim Falahi
- Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Mohd Yusof Barakatun-Nisak
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Research Centre of Excellence for NCD (Nutrition and Non-communicable Diseases), Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - S Mohd Redzwan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Loqman Mohamad Yusof
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
| | - Mohsen Gheitasvand
- Department of Pathology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Farahnaz Rezaie
- Department of Pathology, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.
| |
Collapse
|
7
|
Karas LA, Nor Hanipah Z, Cetin D, Schauer PR, Brethauer SA, Daigle CR, Aminian A. Assessment of empiric body mass index-based thromboprophylactic dosing of enoxaparin after bariatric surgery: evidence for dosage adjustment using anti-factor Xa in high-risk patients. Surg Obes Relat Dis 2020; 17:153-160. [PMID: 33046419 DOI: 10.1016/j.soard.2020.08.016] [Citation(s) in RCA: 4] [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: 05/30/2018] [Revised: 07/02/2020] [Accepted: 08/07/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite thromboprophylaxis, postoperative deep vein thrombosis and pulmonary embolism occur after bariatric surgery, perhaps because of failure to achieve optimal prophylactic levels in the obese population. OBJECTIVES The aim of this study was to evaluate the adequacy of prophylactic dosing of enoxaparin in patients with severe obesity by performing an antifactor Xa (AFXa) assay. SETTING An academic medical center METHODS: In this observational study, all bariatric surgery cases at an academic center between December 2016 and April 2017 who empirically received prophylactic enoxaparin (adjusted by body mass index [BMI] threshold of 50 kg/m2) were studied. The AFXa was measured 3-5 hours after the second dose of enoxaparin. RESULTS A total of 105 patients were included; 85% were female with a median age of 47 years. In total, 16 patients (15.2%) had AFXa levels outside the prophylactic range: 4 (3.8%) cases were in the subprophylactic and 12 (11.4%) cases were in the supraprophylactic range. Seventy patients had a BMI <50 kg/m2 and empirically received enoxaparin 40 mg every 12 hours; AFXa was subprophylactic in 4 (5.7%) and supraprophylactic in 6 (8.6%) of these patients. Of the 35 patients with a BMI ≥50 who empirically received enoxaparin 60 mg q12h, no AFXa was subprophylactic and 6 (17.1%) were supraprophylactic. Five patients (4.8%) had major bleeding complications. One patient developed pulmonary embolism on postoperative day 35. CONCLUSION BMI-based thromboprophylactic dosing of enoxaparin after bariatric surgery could be suboptimal in 15% of patients with obesity. Overdosing of prophylactic enoxaparin can occur more commonly than underdosing. AFXa testing can be a practical way to measure adequacy of pharmacologic thromboprophylaxis, especially in patients who are at higher risk for venous thromboembolism or bleeding.
Collapse
Affiliation(s)
- Linden A Karas
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Avita Health System, Galion, Ohio
| | - Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Derrick Cetin
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christopher R Daigle
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; The Bariatric Center, Cleveland Clinic Akron General, Akron, Ohio
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
8
|
Nor Hanipah Z, Punchai S, Antoine HJ, Brethauer SA, Schauer PR, Aminian A. Removal of Gastric Band Does Not Always Lead to Significant Weight Gain. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2018.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Suriya Punchai
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Heath J. Antoine
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stacy A. Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Philip R. Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
9
|
Aminian A, Vidal J, Salminen P, Still CD, Nor Hanipah Z, Sharma G, Tu C, Wood GC, Ibarzabal A, Jimenez A, Brethauer SA, Schauer PR, Mahawar K. Late Relapse of Diabetes After Bariatric Surgery: Not Rare, but Not a Failure. Diabetes Care 2020; 43:534-540. [PMID: 31974105 DOI: 10.2337/dc19-1057] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize the status of cardiometabolic risk factors after late relapse of type 2 diabetes mellitus (T2DM) and to identify factors predicting relapse after initial diabetes remission following bariatric surgery to construct prediction models for clinical practice. RESEARCH DESIGN AND METHODS Outcomes of 736 patients with T2DM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at an academic center (2004-2012) and had ≥5 years' glycemic follow-up were assessed. Of 736 patients, 425 (58%) experienced diabetes remission (HbA1c <6.5% [48 mmol/mol] with patients off medications) in the 1st year after surgery. These 425 patients were followed for a median of 8 years (range 5-14) to characterize late relapse of diabetes. RESULTS In 136 (32%) patients who experienced late relapse, a statistically significant improvement in glycemic control, number of diabetes medications including insulin use, blood pressure, and lipid profile was still observed at long-term. Independent baseline predictors of late relapse were preoperative number of diabetes medications, duration of T2DM before surgery, and SG versus RYGB. Furthermore, patients who relapsed lost less weight during the 1st year after surgery and regained more weight afterward. Prediction models were constructed and externally validated. CONCLUSIONS While late relapse of T2DM is a real phenomenon (one-third of our cohort), it should not be considered a failure, as the trajectory of the disease and its related cardiometabolic risk factors is changed favorably after bariatric surgery. Earlier surgical intervention, RYGB (compared with SG) and more weight loss (less late weight regain) are associated with less diabetes relapse in the long-term.
Collapse
Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Josep Vidal
- Obesity Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland.,Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Satasairaala Central Hospital, Pori, Finland
| | | | - Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH.,Department of Surgery, University Putra Malaysia, Selangor, Malaysia
| | - Gautam Sharma
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - G Craig Wood
- Obesity Research Institute, Geisinger Clinic, Danville, PA
| | | | - Amanda Jimenez
- Obesity Unit, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH.,Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, U.K
| |
Collapse
|
10
|
Abstract
Metabolic surgery is increasingly becoming recognized as a more effective treatment for patients with type 2 diabetes (T2D) and obesity as compared to lifestyle modification and medical management alone. Both observational studies and clinical trials have shown metabolic surgery to result in sustained weight loss (20–30%), T2D remission rates ranging from 23% to 60%, and improvement in cardiovascular risk factors such as hypertension and dyslipidemia. Metabolic surgery is cost-effective and relatively safe, with perioperative risks and mortality comparable to low-risk procedures such as cholecystectomy, hysterectomy, and appendectomy. International diabetes and medical organizations have endorsed metabolic surgery as a standard treatment for T2D with obesity.
Collapse
Affiliation(s)
- Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor 43400, Malaysia
| | - Philip R. Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
| |
Collapse
|
11
|
Punchai S, Wilson RL, Meister KM, Nor Hanipah Z, Vangoitsenhoven R, Schauer PR, Steele SR, Hull TL, Aminian A. Does Colectomy Improve Type 2 Diabetes? Obes Surg 2020; 30:2429-2433. [PMID: 31898042 DOI: 10.1007/s11695-019-04346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gastrectomy and gastric bypass improve type 2 diabetes (T2DM), potentially through alterations in intestinal hormones and the microbiome. The aim of this study was to analyze whether colorectal resections result in improvement of T2DM. A total of 171 patients with T2DM who underwent colectomy for benign diseases were studied with a median postoperative follow-up of 3 years (interquartile range [IQR] 1-5). The median BMI and glycated hemoglobin (HbA1c) at baseline and post-colectomy were 30.3 kg/m2 (IQR 26.6-34.6) versus 30.4 kg/m2 (IQR 26.2-35) (p = 0.1), and 6.7% (IQR 6.2-7.5) versus 6.5% (IQR 6.5-7.1) (p = 0.5), respectively. The proportion of patients taking diabetes medications at baseline versus post-colectomy did not differ significantly. Changes in BMI, HbA1c, and status of diabetes medications were not statistically different between the subtypes of colorectal resection. Our experience suggests that colectomy for benign colorectal diseases is not associated with long-term changes in body weight or glycemic control.
Collapse
Affiliation(s)
- Suriya Punchai
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA.,Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Rickesha L Wilson
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA
| | - Katherine M Meister
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA.,Department of General Surgery, Good Samaritan Hospital, TriHealth, Cincinnati, OH, USA
| | - Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA.,Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Roman Vangoitsenhoven
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA.,Department of Endocrinology, UZ Leuven, Leuven, Belgium
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tracy L Hull
- Department of Colorectal Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA.
| |
Collapse
|
12
|
Abolfathi M, Mohd-Yusof BN, Hanipah ZN, Mohd Redzwan S, Yusof LM, Khosroshahi MZ. The effects of carnitine supplementation on clinical characteristics of patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2019; 48:102273. [PMID: 31987257 DOI: 10.1016/j.ctim.2019.102273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The beneficial effects of carnitine supplementation on nonalcoholic fatty liver disease are unclear. We conducted a systematic review and meta-analysis to evaluate the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance in patients with nonalcoholic fatty liver disease. METHODS A comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases were performed. Only randomized placebo-controlled human studies that examined the effects of carnitine supplementation on liver function, lipid profile, body mass index, body weight, and homeostasis model assessment of insulin resistance up to September 2019 were included. Fixed effects or random-effects models were applied to compute the pooled effect size. Heterogeneity assessments were performed using Cochran's Q test and I-squared statistics. The quality of the studies was assessed using the Jaded scale. RESULTS A total of 5 articles were selected, including 334 individuals (167 in control and 167 in intervention groups). The results demonstrated that carnitine supplementation significantly reduced homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: -0.91; 95 % CI: -1.11, -0.72; p < 0.001, I2 = 0.0 %) and the levels of aspartate aminotransferase (AST) (WMD: -16.62; 95 % CI: -28.11, -5.14; IU/l; p = 0.005, I2 = 93.5 %), alanine aminotransferase (ALT) (WMD: -33.39; 95 % CI: -45.13, -21.66; IU/l; p < 0.001, I2 = 93.4 %), and triglycerides (TG) (WMD: -22.13; 95 % CI: -38.91, -5.34; mg/dl; p = 0.01; I2 = 0.0 %). However, the results of the pooled effect size did not show any significant effect of carnitine supplementation on body mass index (BMI) (WMD: 0.07; 95 % CI: -0.15, 0.29; p = 0.55; I2 = 0.0 %), body weight (WMD: -0.28; 95 % CI: -2.23, 1.68; p = 0.78; I2 = 45.7 %), the levels of gamma-glutamyl transferase (γGT) (WMD: -11.31; 95 % CI: -24.35, 1.73; IU/l; p = 0.09, I2 = 61.1 %), cholesterol (WMD: -13.58; 95 % CI: -46.77, 19.60; mg/dl; p = 0.42; I2 = 94.9 %), high-density lipoprotein-cholesterol (HDL-C) (WMD: 1.36; 95 % CI: -0.96, 3.68; mg/dl; p = 0.25; I2 = 64.7 %), and low density lipoprotein-cholesterol (LDL-C) (WMD: -14.85; 95 % CI: -45.43, 15.73; mg/dl; p = 0.34; I2 = 96.4 %). CONCLUSIONS This analysis shows that carnitine supplementation for patients with nonalcoholic fatty liver disease demonstrates a reduction in AST, ALT, TG levels and HOMA-IR. However, no significant effect of carnitine supplementation was observed on BMI, body weight, the levels of γGT, TC, HDL-cholesterol and LDL-cholesterol.
Collapse
Affiliation(s)
- Mohammad Abolfathi
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Barakatun-Nisak Mohd-Yusof
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Research Centre of Excellence for NCD (Nutrition and Non-Communicable Diseases), Universiti Putra Malaysia, 43400, UPM Serdang, Selangor, Malaysia.
| | - Zubaidah Nor Hanipah
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - S Mohd Redzwan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Loqman Mohamad Yusof
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
| | | |
Collapse
|
13
|
Nor Hanipah Z, Punchai S, Karas LA, Szomstein S, Rosenthal RJ, Brethauer SA, Aminian A, Schauer PR. The Outcome of Bariatric Surgery in Patients Aged 75 years and Older. Obes Surg 2019; 28:1498-1503. [PMID: 29290011 DOI: 10.1007/s11695-017-3020-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Bariatric surgery has been shown to be safe and effective in patients aged 60-75 years; however, outcomes in patients aged 75 or older are undocumented. METHODS Patients aged 75 years and older who underwent bariatric procedures in two academic centers between 2006 and 2015 were studied. RESULTS A total of 19 patients aged 75 years and above were identified. Eleven (58%) were male, the median age was 76 years old (range 75-81), and the median preoperative body mass index (BMI) was 41.4 kg/m2 (range 35.8-57.5). All of the bariatric procedures were primary procedures and performed laparoscopically: sleeve gastrectomy (SG) (n = 11, 58%), adjustable gastric band (AGB) (n = 4, 21%), Roux-en-Y gastric bypass (RYGB) (n = 2, 11%), banded gastric plication (n = 1, 5%), and gastric plication (n = 1, 5%). The median operative time was 120 min (range 75-240), and the median length of stay was 2 days (range 1-7). Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss (%TWL) was 18.4% (range 7.4-22.0). The 1-year %TWL varied among the bariatric procedures performed: SG (21%), RYGB (22%), AGB (7%), and gastric plication (8%). There were no 30-day readmissions, reoperations, or mortalities. CONCLUSION Our experience suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk. Age alone should not be the limiting factor for selecting patients for bariatric surgery.
Collapse
Affiliation(s)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Suriya Punchai
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Linden A Karas
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel Szomstein
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Weston, FL, USA
| | - Rahul J Rosenthal
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Weston, FL, USA
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
14
|
Abstract
BACKGROUND Perioperative management of chronically anti-coagulated patients undergoing bariatric surgery requires a balance of managing hemorrhagic and thromboembolic risks. The aim of this study is to evaluate the incidence of hemorrhagic complications and their management in chronically anticoagulated (CAT) patients undergoing bariatric surgery. METHODS A retrospective review of CAT patients undergoing bariatric surgery at an academic center from 2008 to 2015 was studied. RESULTS A total of 153 patients on CAT underwent surgery [Roux-en-Y gastric bypass (n = 79), sleeve gastrectomy (n = 63), and adjustable gastric banding (n = 11)] during the study period: 85 patients (55%) were females; median age was 56 years (interquartile range [IQR] 49-64), and median BMI was 49 kg/m2 (IQR 43-56). The most common indications for CAT were venous thromboembolism (n = 87) and atrial fibrillation (n = 83). Median duration of procedure and estimated intraoperative blood loss was 150 min (IQR 118-177) and 50 ml (IQR 25-75), respectively. Thirty-day postoperative complications were reported in 33 patients (21.6%) including postoperative bleeding (n = 19), anastomotic leak (n = 3), and pulmonary embolism (n = 1). Nineteen patients (12%) with early postoperative bleeding were further categorized to intra-abdominal (n = 10), intraluminal (n = 6), and at the port site or abdominal wall (n = 3). All-cause readmissions within 30 days of surgery occurred in 19 patients (12%). There was no 30-day mortality. CONCLUSION In our experience, patients who require chronic anticoagulation medication are higher than average risk for postoperative complications and all-cause readmission rates. Careful surgical technique and close attention to postoperative anticoagulation protocols are essential to decrease perioperative risk in this high-risk cohort.
Collapse
Affiliation(s)
- Gautam Sharma
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA.,Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Suriya Punchai
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA.,Department of Surgery, Faculty of Medicine, KhonKaen University, KhonKaen, Thailand
| | - Emre Bucak
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Desk M61, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| |
Collapse
|
15
|
Nor Hanipah Z, Hsin MC, Liu CC, Huang CK. Laparoscopic loop duodenaljejunal bypass with sleeve gastrectomy in type 2 diabetic patients. Surg Obes Relat Dis 2019; 15:696-702. [PMID: 30935839 DOI: 10.1016/j.soard.2019.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/12/2019] [Accepted: 01/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Laparoscopic loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a new metabolic procedure. Our initial data on type 2 diabetes (T2D) remission after LDJB-SG were promising. OBJECTIVES The aim of this study was to look at our intermediate outcomes after LDJB-SG. SETTING An academic medical center. METHODS A prospective analysis of T2D patients who underwent LDJB-SG between October 2011 and October 2014 was performed. Data collected included baseline demographic, body mass index, fasting blood glucose, glycosylated hemoglobin, C-peptide, resolution of co-morbidities, and postoperative complications. RESULTS A total of 163 patients with minimum of follow-up >1 year were enrolled in this study (57 men and 106 women). The mean age and body mass index were 47.7 (±10.7) years and a 30.2 (±5.1) kg/m2, respectively. There were 119 patients on oral hypoglycemic agents only, 29 patients were on oral hypoglycemic agents and insulin, 3 patients were on insulin only, and the other 12 patients were not on diabetic medication. Mean operation time and length of hospital stay were 144.7 (± 45.1) minutes and 2.4 (± 1.0) days, respectively. Seven patients (3.6%) needed reoperation due to bleeding (n = 1), anastomotic leak (n = 2), sleeve strictures (n = 2), and incisional hernia (n = 2). At 2 years of follow-up, there were 56 patients. None of the patients were on insulin and only 20% of patients were on oral hypoglycemic agents. Mean body mass index significantly dropped to 22.9 (±5.6) kg/m2 at 2 years. The mean preoperative fasting blood glucose, glycosylated hemoglobin, and C-peptide levels were 174.7 mg/dL (± 61.0), 8.8% (±1.8), and 2.6 (±1.7) ng/mL, respectively. The mean fasting blood glucose, glycosylated hemoglobin, and C-peptide at 2 years were 112.5 (±60.7) mg/dL, 6.4% (±2.0), and 1.5 (±0.6) ng/mL, respectively. No patient needed revisional surgery because of dumping syndrome, marginal ulcer, or gastroesophageal reflux disease at the last follow up period. CONCLUSION At 2 years, LDJB-SG is a relatively safe and effective metabolic surgery with significant weight loss and resolution of co-morbidities.
Collapse
Affiliation(s)
- Zubaidah Nor Hanipah
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC); Department of General Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Ming-Che Hsin
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC)
| | - Chia-Chia Liu
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC)
| | - Chih-Kun Huang
- Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital, Taichung City, Taiwan (ROC).
| |
Collapse
|
16
|
Aminian A, Hanipah ZN, Sharma G, Tu C, Brethauer SA, Schauer PR. Late Relapse of Diabetes after Bariatric Surgery Should not be Considered as a Failure. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.049] [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: 10/27/2022]
|
17
|
Ardila-Gatas J, Sharma G, Nor Hanipah Z, Tu C, Brethauer SA, Aminian A, Tolle L, Schauer PR. Bariatric surgery in patients with interstitial lung disease. Surg Endosc 2018; 33:1952-1958. [PMID: 30367295 DOI: 10.1007/s00464-018-6475-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/20/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Perioperative pulmonary complications are frequent in patients with interstitial lung diseases (ILD). Limited literature exists regarding the safety of bariatric procedures in patients with ILD. This study aims to assess the safety, feasibility, and outcomes of patients with ILD who underwent bariatric surgery at our institution. METHODS After IRB approval, all patients with preoperative diagnosis of ILD who had bariatric surgery at an academic center between 2004 and 2014 were retrospectively reviewed. RESULTS A total of 25 patients with ILD underwent bariatric surgery: Roux-en-Y gastric bypass (n = 17, 68%), sleeve gastrectomy (n = 7, 28%), and adjustable gastric banding (n = 1, 4%). Twenty-one patients (84%) were females. The median age and preoperative body mass index (BMI) were 53 (IQR 42-58) years and 39 (IQR 37-44) kg/m2, respectively. The median operative time and length of stay was 137 (IQR 110-187) min and 3 (IQR 2-5) days, respectively. The 30-day complications were reported in four patients (16%) but there was no pulmonary complication or unplanned admission to the intensive care unit. At 1-year follow-up (85%), the median BMI and excess weight loss were 30 (IQR 25-36) kg/m2 and 67% (IQR 45-100), respectively. Compared to preoperative values, there was significant improvement in the pulmonary function test (PFT) variables at 1 year with respect to forced vital capacity (62% vs 74%; n = 13, p = 0.003), and diffusing capacity of the lungs for carbon monoxide (53% vs 66%; n = 10, p = 0.003). Six out of the seven potential lung transplant candidates became eligible for transplantation after weight loss, and one of them had successful lung transplant at 88 months after bariatric surgery. CONCLUSION In our experience, bariatric patients with ILD achieved significant weight loss and improvement in PFT. Bariatric surgery in these higher risk ILD patients appears relatively safe with acceptable perioperative morbidity and improved candidacy for lung transplantation.
Collapse
Affiliation(s)
- Jessica Ardila-Gatas
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA
| | - Gautam Sharma
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA
| | - Zubaidah Nor Hanipah
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA.,Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stacy A Brethauer
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA
| | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA
| | - Leslie Tolle
- Department of Pulmonary Medicine and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Philip R Schauer
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Ave/A100, Cleveland, OH, 44195, USA.
| |
Collapse
|
18
|
Young L, Nor Hanipah Z, Brethauer SA, Schauer PR, Aminian A. Long-term impact of bariatric surgery in diabetic nephropathy. Surg Endosc 2018; 33:1654-1660. [DOI: 10.1007/s00464-018-6458-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022]
|
19
|
Schauer PR, Nor Hanipah Z, Rubino F. Metabolic surgery for treating type 2 diabetes mellitus: Now supported by the world's leading diabetes organizations. Cleve Clin J Med 2018; 84:S47-S56. [PMID: 28708482 DOI: 10.3949/ccjm.84.s1.06] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The term metabolic surgery describes bariatric surgical procedures used primarily to treat type 2 diabetes and related metabolic conditions. Originally, bariatric surgery was used as an alternative weight-loss therapy for patients with severe obesity, but clinical data revealed its metabolic benefits in patients with type 2 diabetes. Metabolic surgery is more effective than lifestyle or medical management in achieving glycemic control, sustained weight loss, and reducing diabetes comorbidities. Perioperative adverse events are similar to other gastrointestinal surgeries. New guidelines for type 2 diabetes expand use of metabolic surgery to patients with a lower body mass index.
Collapse
Affiliation(s)
- Philip R Schauer
- Director, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Francesco Rubino
- Department of Metabolic and Bariatric Surgery, Diabetes and Nutrition Science Division, King's College London, UK
| |
Collapse
|
20
|
Nor Hanipah Z, Punchai S, Birriel TJ, Lansang MC, Kashyap SR, Brethauer SA, Schauer PR, Aminian A. Clinical features of symptomatic hypoglycemia observed after bariatric surgery. Surg Obes Relat Dis 2018; 14:1335-1339. [DOI: 10.1016/j.soard.2018.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 01/10/2023]
|
21
|
Hanipah ZN, Punchai S, McCullough A, Dasarathy S, Brethauer SA, Aminian A, Schauer PR. Bariatric Surgery in Patients with Cirrhosis and Portal Hypertension. Obes Surg 2018; 28:3431-3438. [DOI: 10.1007/s11695-018-3372-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
22
|
Affiliation(s)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
23
|
Strong AT, Sharma G, Nor Hanipah Z, Tu C, Brethauer SA, Schauer PR, Cetin D, Aminian A. Adjustments to warfarin dosing after gastric bypass and sleeve gastrectomy. Surg Obes Relat Dis 2018; 14:700-706. [DOI: 10.1016/j.soard.2017.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 12/16/2022]
|
24
|
Takahashi H, Allemang MT, Strong AT, Boules M, Nor Hanipah Z, Guerron AD, El-Hayek K, Rodriguez JH, Kroh MD. Completion Gastrectomy with Esophagojejunostomy for Management of Complications of Benign Foregut Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:983-989. [PMID: 29493349 DOI: 10.1089/lap.2017.0540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With the worldwide epidemic of obesity, an increasing number of bariatric operations and antireflux fundoplications are being performed. Despite low morbidity of the primary foregut surgery, completion gastrectomy may be necessary as a definitive procedure for complications of prior foregut surgery; however, the literature evaluating outcomes after completion gastrectomy with esophagojejunostomy (EJ) for benign diseases is limited. We present our experience of completion gastrectomy with Roux-en-Y EJ in the setting of benign disease at a single tertiary center. METHODS AND PROCEDURES All patients who underwent total, proximal, or completion gastrectomy with EJ for complications of benign foregut surgery from January 2006 to December 2015 were retrospectively identified. All cancer operations were excluded. RESULTS There were 23 patients who underwent gastrectomy with EJ (13 laparoscopic EJ [LEJ] and 10 open EJ). The index operations included 12 antireflux, 9 bariatric, and 2 peptic ulcer disease surgeries. Seventy-eight percent of patients had surgical or endoscopic interventions before EJ, with a median of one prior intervention and a median interval from the index operation to EJ of 25 months (interquartile range 9-87). The 30-day perioperative complication rate was 30% with 17% classified being major (Clavien-Dindo ≥ III) and no 30-day perioperative mortality. Comparing laparoscopic and open approaches showed similar operative times, estimated blood loss, and overall complication rate. LEJ was associated with a shorter length of stay (LOS) (P < .001), fewer postoperative ICU days (P = .002), fewer 6-month complication rates (P < .007), and decreased readmission rate (P = .024). CONCLUSION Our series demonstrates that EJ is a reasonable option for reoperative foregut surgery. The laparoscopic approach appears to be associated with decreased LOS and readmissions.
Collapse
Affiliation(s)
- Hideo Takahashi
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - Matthew T Allemang
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - Andrew T Strong
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio.,2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, Ohio
| | - Mena Boules
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - Zubaidah Nor Hanipah
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio
| | - Alfredo D Guerron
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio.,3 Department of General Surgery, Duke University Health System , Durham, North Carolina
| | - Kevin El-Hayek
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio.,2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, Ohio
| | - John H Rodriguez
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio.,2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, Ohio
| | - Matthew D Kroh
- 1 Bariatric and Metabolic Institute, Digestive Disease and Surgery Institute , Cleveland Clinic, Cleveland, Ohio.,2 Cleveland Clinic Lerner College of Medicine of Case Western Reserve University , Cleveland, Ohio.,4 Digestive Disease Institute , Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| |
Collapse
|
25
|
Haskins IN, Chang J, Nor Hanipah Z, Singh T, Mehta N, McCullough AJ, Brethauer SA, Schauer PR, Aminian A. Patients with clinically metabolically healthy obesity are not necessarily healthy subclinically: further support for bariatric surgery in patients without metabolic disease? Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2017.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
26
|
Abstract
INTRODUCTION The aim of this study was to assess the incidence, clinical presentation, and outcomes of neurologic disorders secondary to vitamin B deficiencies following bariatric surgery. METHODS Patients at a single academic institution who underwent bariatric surgery and developed neurologic complications secondary to low levels of vitamins B1, B2, B6, and B12 between the years 2004 and 2015 were studied. RESULTS In total, 47 (0.7%) bariatric surgical patients (Roux-en-Y gastric bypass n = 36, sleeve gastrectomy n = 9, and duodenal switch n = 2) developed neurologic manifestations secondary to vitamin B deficiencies. Eleven (23%) patients developed postoperative anatomical complications contributed to poor oral intake. Median duration to onset of neurologic manifestation following surgery was 12 months (IQR, 5-32). Vitamin deficiencies reported in the cohort included B1 (n = 30), B2 (n = 1), B6 (n = 12), and B12 (n = 12) deficiency. The most common manifestations were paresthesia (n = 31), muscle weakness (n = 15), abnormal gait (n = 11), and polyneuropathy (n = 7). Four patients were diagnosed with Wernicke-Korsakoff syndrome (WKS) which was developed after gastric bypass (n = 3) and sleeve gastrectomy (n = 1). Seven patients required readmission for management of severe vitamin B deficiencies. Overall, resolution of neurologic symptoms with nutritional interventions and pharmacotherapy was noted in 40 patients (85%). The WKS was not reversible, and all four patients had residual mild ataxia and nystagmus at the last follow-up time. CONCLUSIONS Nutritional neurologic disorders secondary to vitamin B deficiency are relatively uncommon after bariatric surgery. While neurologic disorders are reversible in most patients (85%) with vitamin replacements, persistent residual neurologic symptoms are common in patients with WKS.
Collapse
Affiliation(s)
- Suriya Punchai
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
- Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Katherine M Meister
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, M61, Cleveland, OH, 44195, USA.
| |
Collapse
|
27
|
Karas L, Hanipah ZN, Meister K, Antoine H, Javier Birriel T, Schauer P, Brethauer S, Aminian A. BMI-based thromboprophylactic dosing of enoxaparin after bariatric surgery could be sub-optimal: Evidence for dosage adjustment by anti-Factor Xa in high-risk patients. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.121] [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: 10/18/2022]
|
28
|
Aminian A, Punchai S, Hanipah ZN, Schauer P, Brethauer S. Bariatric Surgery as a First Line Treatment of Type 2 Diabetes in Patients with Obesity Class I and II: 89% Diabetes Remission in Long-term Follow-up. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.292] [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: 11/28/2022]
|
29
|
Hanipah ZN, Punchai S, Augustin T, Brethauer S, Schauer P, Aminian A. Impact of early post-bariatric surgery acute kidney injury on long-term renal function. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.385] [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: 10/18/2022]
|
30
|
Hanipah ZN, Punchai S, Brethauer S, Schauer P, Aminian A. Development of De Novo Diabetes in Long-term Follow-up after Bariatric Surgery. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.026] [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: 10/18/2022]
|
31
|
Aminian A, Hanipah ZN, Punchai S, Mackey J, Brethauer S, Schauer P. Long-Term Effects of Bariatric Surgery in Patients with Insulin-Treated Type 2 Diabetes: 44% at Glycemic Target without Insulin use. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
32
|
Heinberg LJ, Marek R, Haskins IN, Bucak E, Nor Hanipah Z, Brethauer S. 30-day readmission following weight loss surgery: can psychological factors predict nonspecific indications for readmission? Surg Obes Relat Dis 2017; 13:1376-1381. [DOI: 10.1016/j.soard.2017.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 01/13/2023]
|
33
|
Abstract
Sleeve gastrectomy, gastric bypass, gastric banding, and duodenal switch are the most common bariatric procedures performed worldwide. Ninety-five percent of bariatric operations are performed with minimally invasive laparoscopic technique. Perioperative morbidities and mortalities average around 5% and 0.2%, respectively. Long-term weight loss averages around 15% to 25% or about 80 to 100 lbs (40-50 kg). Comorbidities, including type 2 diabetes, hypertension, dyslipidemia, sleep apnea, arthritis, gastroesophageal reflux disease, and nonalcoholic fatty liver disease, improve or resolve after bariatric surgery.
Collapse
Affiliation(s)
- Zubaidah Nor Hanipah
- Bariatric and Metabolic Institute, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44022, USA; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, UPM-Serdang, 43400 Serdang, Selangor, Malaysia
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Digestive Disease and Surgical Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44022, USA.
| |
Collapse
|
34
|
Abstract
Peritoneal dialysate leakage is a well-known complication of continuous ambulatory peritoneal dialysis (CAPD). In late leakage, it is usually managed conservatively and subsequently converted to hemodialysis. We hereby report a case of peritoneal dialysate leakage secondary to necrotic peritoneum, which was managed by laparoscopic excision of the affected peritoneum. Regeneration of new peritoneum was documented and the patient could resume CAPD successfully.
Collapse
Affiliation(s)
- Chih-Kun Huang
- 1 Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital , Taichung City, Taiwan (ROC)
| | - Hsi-Hao Wang
- 2 Division of Nephrology, Department of Internal Medicine, E-Da Hospital/I-Shou University , Kaohsiung, Taiwan (ROC)
| | - Zubaidah Nor Hanipah
- 1 Body Science & Metabolic Disorders International (BMI) Medical Center, China Medical University Hospital , Taichung City, Taiwan (ROC).,3 Department of General Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia , Serdang, Malaysia
| |
Collapse
|
35
|
bucak E, Sharma G, Hanipah ZN, Punchai S, Froylich D, Aminian A, Brethauer S, Schauer P. Outcomes of RYGB in Patients with Pulmonary Fibrosis and GERD. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.139] [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: 10/20/2022]
|
36
|
Heinberg L, bucak E, Marek R, Hanipah ZN, Ashton K, Lavery M, Punchai S, Sharma G, Haskins I, Froylich D, Chang J, Tammy F, Schauer P, Brethauer S. 30 Day Readmission Following Weight Loss Surgery: Can Psychological Factors Predict Non-Specific Indications for Readmission? Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.167] [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: 10/20/2022]
|
37
|
Hanipah ZN, bucak E, Punchai S, Gautam S, Kroh M, Aminian A, Brethauer S, Schauer P. Early Experience with Distal Bypass for Weight Regain after Roux-en-Y Gastric Bypass. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.325] [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: 11/28/2022]
|
38
|
Punchai S, Sharma G, Nor Hanipah Z, bucak E, Mulcahy M, Aminian A, Steckner K, Brethauer S, Cywinski J, Schauer P, Young J. Feasibility of Laparoscopic Sleeve Gastrectomy in patients with Left Ventricular Assist Device. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.387] [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: 10/20/2022]
|
39
|
Punchai S, Hanipah ZN, Sharma G, bucak E, Kroh M, Aminian A, Schauer P. Early Experience with Duodenal Switch as a Primary or Revisional Operation. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.294] [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: 11/15/2022]
|
40
|
Punchai S, Nor Hanipah Z, Sharma G, bucak E, Froylich D, Sullivan L, Heinberg L, Schauer P, Brethauer S, Aminian A. Neurologic Manifestations of Vitamin B Deficiency after Bariatric Surgery. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.163] [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: 11/26/2022]
|
41
|
Mulcahy M, Hanipah ZN, Bucak E, Sharma G, Punchai S, Steckner K, Schauer P, Brethauer S, Dweik R. Baratric Surgery in Patients with Pulmonary Hypertension. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.483] [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: 10/20/2022]
|
42
|
Sharma G, Hanipah ZN, Puchai S, bucak E, Boules M, Alsulaimy M, Aminian A, Schauer P, Brethauer S. Outcomes of Bariatric Surgery in Patients on Chronic Anti-coagulation Medication. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.071] [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: 10/20/2022]
|
43
|
bucak E, Nasr E, Nor Hanipah Z, Sharma G, Punchai S, Burguera B, Aminian A, Schauer P, Brethauer S, Cetin D. Impact of adjuvant pharmacotherapy on weight loss outcomes after bariatric surgery. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.223] [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: 11/29/2022]
|
44
|
Abstract
Buerger's disease or thromboangiitis obliterans causes pain, ulceration, or gangrene in the lower or upper extremity. It is associated with chronic cigarette smoking and is believed to be an immune mediated vasculitis. The pathogenesis is still unknown but recent postulate of its association with odontal bacteria has generated much renewed interest. Despite its recognition more than a century ago, little progress has been made in its treatment. Until the pathogenesis is elucidated, abstinence from cigarette is the only effective therapy.
Collapse
Affiliation(s)
| | - Limi Lee
- Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | | - Tikfu Gee
- Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | | |
Collapse
|