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Gala K, Ghusn W, Abu Dayyeh BK. Gut motility and hormone changes after bariatric procedures. Curr Opin Endocrinol Diabetes Obes 2024; 31:131-137. [PMID: 38533785 DOI: 10.1097/med.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/28/2024]
Abstract
PURPOSE OF REVIEW Metabolic and bariatric surgery (MBS) and endoscopic bariatric therapies (EBT) are being increasingly utilized for the management of obesity. They work through multiple mechanisms, including restriction, malabsorption, and changes in the gastrointestinal hormonal and motility. RECENT FINDINGS Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) cause decrease in leptin, increase in GLP-1 and PYY, and variable changes in ghrelin (generally thought to decrease). RYGB and LSG lead to rapid gastric emptying, increase in small bowel motility, and possible decrease in colonic motility. Endoscopic sleeve gastroplasty (ESG) causes decrease in leptin and increase in GLP-1, ghrelin, and PYY; and delayed gastric motility. SUMMARY Understanding mechanisms of action for MBS and EBT is critical for optimal care of patients and will help in further refinement of these interventions.
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Affiliation(s)
- Khushboo Gala
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Wissam Ghusn
- Department of Internal Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Bharani T, Tavakkoli A, Tsai TC, Robinson MK, Sheu EG. Safety of Same-Day Discharge after Bariatric Surgery: Retrospective 6-Year North American Analysis. J Am Coll Surg 2024; 238:1023-1034. [PMID: 38376072 DOI: 10.1097/xcs.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND With increasing implementation of Enhanced Recovery After Surgery protocols and rising demand for inpatient hospital beds accentuated by COVID-19, there has been interest in same-day discharge (SDD) for bariatric surgery. The aim of this study was to determine the national trends, safety profile, and risk factors for complications of SDD for minimally invasive bariatric surgery. STUDY DESIGN We analyzed the MBSAQIP database from 2016 to 2021 to characterize trends in SDD for minimally invasive bariatric operation. Multivariate logistic regression was performed on preoperative patient characteristics predictive of increased complications associated with SDD. A comparative analysis of postoperative outcomes within 30 days was performed for SDD and admission after 1:1 nearest neighbor propensity score matching for patient demographics and preoperative comorbidities. RESULTS SDD increased from 2.4% in 2016 to 7.4% in 2021. Major preoperative factors associated with increased complications for SDD included Black race, history of MI, renal insufficiency, deep vein thrombosis, and smoking. SDD for Roux-en-Y gastric bypass had 72% increased risk of postoperative complications compared with sleeve gastrectomy. The overall major complications were lower in SDD cohort vs admission cohort (odds ratio [OR] 0.62, p < 0.01). However, there was a significant increase in deaths within 30 days (OR 2.11, p = 0.01), cardiac arrest (OR 2.73; p < 0.01), and dehydration requiring treatment (OR 1.33; p < 0.01) in SDD cohort compared with admission cohort. CONCLUSIONS Nationally, there has been a rise in SDD for bariatric operation from 2016 to 2021. Matched analysis demonstrates that SDD is associated with a significantly higher mortality rate. Additionally, the risk of complications with SDD is higher for RYGB compared with sleeve gastrectomy. Therefore, further studies are required to appropriately select patients for whom bariatric surgery can be safely performed as an outpatient.
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Affiliation(s)
- Tina Bharani
- From the Department of Surgery, Brigham and Women's Hospital, Boston, MA
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Medhati P, Saleh OS, Nimeri A, Apovian C, Thompson C, Jirapinyo P, Sheu EG, Tavakkoli A. Outcomes and Management of Re-Establishing Bariatric Patients. J Am Coll Surg 2024; 238:1035-1043. [PMID: 38421026 DOI: 10.1097/xcs.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Lifelong follow-up after metabolic and bariatric surgery (MBS) is necessary to monitor for patient outcomes and nutritional status. However, many patients do not routinely follow-up with their MBS team. We studied what prompted MBS patients to seek bariatric care after being lost to follow-up and the subsequent treatments they received. STUDY DESIGN A retrospective cohort study of patients after MBS who had discontinued regular MBS follow-up but represented to the MBS clinic between July 2018 and December 2022 to re-establish care. Patients with a history of a sleeve gastrectomy (SG), Roux-En-Y gastric bypass (RYGB), and adjustable gastric banding (AGB) were included. RESULTS We identified 400 patients (83.5% women, mean age 50.3 ± 12.2 years at the time of re-establishment of bariatric care), of whom 177 (44.3%) had RYGB, 154 (38.5%) had SG, and 69 (17.2%) had AGB. Overall, recurrent weight gain was the most common reason for presentation for all three procedures (81.2% in SG, 62.7% in RYGB, and 65.2% in AGB; p < 0.001). Patients who underwent SG were more likely to undergo a revision MBS compared with patients who underwent RYGB (16.9% vs 5.8%, p < 0.001), whereas patients who underwent RYGB were more likely to undergo an endoscopic intervention than patients who underwent SG (17.5% vs 7.8%, p < 0.001). The response to antiobesity medication agents, specifically glucagon-like peptide-1 receptor agonists drugs, was better in patients who underwent RYGB, than that in patients who underwent SG. CONCLUSIONS This study highlights recurrent weight gain as the most common reason for patients after MBS seeking to re-establish care with the MBS team. SG had a higher rate of revision MBS than RYGB, whereas endoscopic interventions were performed more frequently in the RYGB group. Antiobesity medication agents, especially glucagon-like peptide-1 receptor agonists drugs, were more effective in patients who underwent RYGB.
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Affiliation(s)
- Pourya Medhati
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Omnia S Saleh
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Abdelrahman Nimeri
- From the Division of General and GI Surgery (Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Caroline Apovian
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Christopher Thompson
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Pichamol Jirapinyo
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Eric G Sheu
- From the Division of General and GI Surgery (Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
| | - Ali Tavakkoli
- From the Division of General and GI Surgery (Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Center for Weight Management and Wellness (Nimeri, Apovian, Thompson, Jirapinyo, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
- Laboratory for Surgical and Metabolic Research, Brigham and Women's Hospital (Medhati, Saleh, Nimeri, Sheu, Tavakkoli), Brigham and Women's Hospital, Boston, MA
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Saleh OS, Farag YMK, Medhati P, Tavakkoli A. Impact of Preoperative Weight Loss on 30-Day Complication Rate after Bariatric Surgery. J Am Coll Surg 2024; 238:993-999. [PMID: 38345226 DOI: 10.1097/xcs.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND The aim of this study is to evaluate the impact of preoperative weight loss on surgical outcomes and operating room (OR) times after primary bariatric procedures, including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (RYGB). STUDY DESIGN A retrospective cohort study uses the 2021 MBSAQIP dataset. Preoperative total weight loss (TWL)% was calculated. Patients were then divided in to 4 groups: those with no weight loss, lost <0 to <5%, lost ≥5% to <10%, or lost ≥10% TWL preoperatively. These groups were then stratified into those with BMI less than 50 kg/m 2 and those with BMI 50 kg/m 2 or more and 30-day outcomes and OR times were compared. RESULTS Analysis included 171,010 patients. For BMI less than 50 kg/m 2 , preoperative weight loss led to no consistent improvement in surgical outcomes. Although >0% to <5% TWL led to a decrease in intra- and postoperative occurrences after RYGB and a decrease in reoperation rates after LSG, these observations were not seen in those with higher degree of weight loss. In patients with BMI 50 kg/m 2 or more, preoperative weight loss showed a consistent improvement in reintervention rates after LSG, and readmission rates after RYGB. There was no improvement in other outcomes, however, irrespective of degree of preoperative weight loss. CONCLUSIONS In patients undergoing primary bariatric surgery, preoperative weight loss does not lead to a consistent improvement in outcomes or OR times. In those with BMI 50 kg/m 2 or more, there may be improvement in select outcomes that is procedure-specific. Overall, these data do not support a uniform policy of preoperative weight loss, although selective use in some high-risk patients may be appropriate.
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Affiliation(s)
- Omnia S Saleh
- From the Department of Surgery, Laboratory for Surgical and Metabolic Research (Saleh, Medhati, Tavakkoli), Harvard Medical School, Boston, MA
| | - Youssef M K Farag
- Brigham and Women's Hospital, Postgraduate Medical Education (Farag), Harvard Medical School, Boston, MA
- Bayer US LLC, Cambridge, MA (Farag)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Farag)
| | - Pourya Medhati
- From the Department of Surgery, Laboratory for Surgical and Metabolic Research (Saleh, Medhati, Tavakkoli), Harvard Medical School, Boston, MA
| | - Ali Tavakkoli
- From the Department of Surgery, Laboratory for Surgical and Metabolic Research (Saleh, Medhati, Tavakkoli), Harvard Medical School, Boston, MA
- Division of General and GI Surgery (Tavakkoli), Harvard Medical School, Boston, MA
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Zhang Z, Wang L, Wei Z, Zhang Z, Cui L, Jiang T. Analysis of the 1-year efficacy of four different surgical methods for treating Chinese super obese (BMI ≥ 50 kg/m 2) patients. Sci Rep 2024; 14:10451. [PMID: 38714716 PMCID: PMC11076457 DOI: 10.1038/s41598-024-60983-x] [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: 12/19/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024] Open
Abstract
This study aimed to retrospectively analyze the perioperative and postoperative follow-up data of patients with super obesity who had undergone RYGB, SG, BPD/DS, and SADI-S. A retrospective observational study was conducted to analyze the perioperative and postoperative follow-up data of 60 patients with super obesity who had undergone bariatric surgery. A total of 34 men and 26 women were included in this study. The participants had an average preoperative BMI of 53.81 ± 3.25 kg/m2. The body weight and BMI of all four patient groups decreased significantly at 3, 6, and 12 months postoperatively compared with the preoperative values. Additionally, the TWL (%) and EWL (%) of all four groups increased gradually over the same period. Compared with the preoperative values, the systolic and diastolic blood pressure, glycosylated hemoglobin, uric acid, triglycerides, and total cholesterol decreased to varying degrees in the four groups 1 year postoperatively. RYGB, SG, BPD/DS, and SADI-S are all safe and effective in treating super obese patients and improving their metabolic diseases to a certain extent.
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Affiliation(s)
- Zheng Zhang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, No. 126 Xiantai Avenue, Changchun, 130033, Jilin, China
| | - Lun Wang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, No. 126 Xiantai Avenue, Changchun, 130033, Jilin, China
| | - Zhiqiang Wei
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, No. 126 Xiantai Avenue, Changchun, 130033, Jilin, China
| | - Zhenhua Zhang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, No. 126 Xiantai Avenue, Changchun, 130033, Jilin, China
| | - Liang Cui
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, No. 126 Xiantai Avenue, Changchun, 130033, Jilin, China
| | - Tao Jiang
- Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, No. 126 Xiantai Avenue, Changchun, 130033, Jilin, China.
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Cadière GB, Poras M, Maréchal MT, Pau L, Muteganya R, Gossum MV, Cadière B, Sante NV, Gagner M. Sleeve gastrectomy with duodenoileal bipartition using linear magnets: feasibility and safety at 1-year follow-up. J Gastrointest Surg 2024; 28:640-650. [PMID: 38704201 DOI: 10.1016/j.gassur.2024.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Single-anastomosis metabolic/bariatric surgery procedures may lessen the incidence of anastomotic complications. This study aimed to evaluate the feasibility and safety of performing side-to-side duodenoileal (DI) bipartition using magnetic compression anastomosis (MCA). In addition, preliminary efficacy, quality of life (QoL), and distribution of food through the DI bipartition were evaluated. METHODS Patients with a body mass index (BMI) of ≥35.0 to 50.0 kg/m2 underwent side-to-side DI bipartition with the magnet anastomosis system (MS) with sleeve gastrectomy (SG). By endoscopic positioning, a distal magnet (250 cm proximal to the ileocecal valve) and a proximal magnet (first part of the duodenum) were aligned with laparoscopic assistance to inaugurate MCA. An isotopic study assessed transit through the bipartition. RESULTS Between March 14, 2022 to June 1, 2022, 10 patients (BMI of 44.2 ± 1.3 kg/m2) underwent side-to-side MS DI. In 9 of 10 patients, an SG was performed concurrently. The median operative time was 161.0 minutes (IQR, 108.0-236.0), and the median hospital stay was 3 days (IQR, 2-40). Paired magnets were expelled at a median of 43 days (IQR, 21-87). There was no device-related serious advanced event within 1 year. All anastomoses were patent with satisfactory diameters after magnet expulsion and at 1 year. Respective BMI, BMI reduction, and total weight loss were 28.9 ± 1.8 kg/m2, 15.2 ± 1.8 kg/m2, and 34.2% ± 4.1%, respectively. Of note, 70.0% of patients reported that they were very satisfied. The isotopic study found a median of 19.0% of the meal transited through the ileal loop. CONCLUSION Side-to-side MCA DI bipartition with SG in adults with class II to III obesity was feasible, safe, and efficient with good QoL at 1-year follow-up. Moreover, 19% of ingested food passed directly into the ileum.
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Affiliation(s)
- Guy-Bernard Cadière
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Mathilde Poras
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
| | - Marie-Thérèse Maréchal
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Luca Pau
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Raoul Muteganya
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Marc van Gossum
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Benjamin Cadière
- Division of Digestive Surgery, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - Michel Gagner
- Department of Surgery, Westmount Square Surgical Center, Westmount, Quebec, Canada
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Kitaghenda FK, Hidig SM. Improvement in Pulmonary Hypertension Following Metabolic and Bariatric Surgery: a Brief Review and Meta-analysis. Obes Surg 2024; 34:1866-1873. [PMID: 38478193 DOI: 10.1007/s11695-024-07162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
We reviewed the available evidence on the outcome of metabolic and bariatric surgery (MBS) in patients with pulmonary hypertension (PH). Five studies examining 174 patients were included; the mean age was 54.5 ± 9.27 years; the mean BMI before surgery and at the end of follow-up were 47.2 ± 5.95 kg/m2 and 37.4 ± 2.51 kg/m2, respectively. Furthermore, the results showed a significant decrease in the right ventricle systolic pressure (RVSP) after MBS with a mean difference of 10.11% (CI 95%: 3.52, 16.70, I2 = 85.37%, p = < 0.001), at 16.5 ± 3.8 month follow-up with a morbidity rate of 26% and 0 mortality. Thirty-day postoperative complications included respiratory failure, pulmonary embolism, pulmonary edema, and anastomotic leak. There appears to be a significant improvement in PH with a decrease in medication requirements after MBS.
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Affiliation(s)
- Fidele Kakule Kitaghenda
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, People's Republic of China.
| | - Sakarie Mustafe Hidig
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People's Republic of China
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Abstract
Bariatric surgery is currently the most effective long-term treatment for morbid obesity as well as type-2 diabetes mellitus. The field of metabolic and bariatric surgery has seen tremendous growth over the past decade with dramatically reduced risks. This article aims to provide an update on bariatric surgery, highlighting the latest outcomes, improvements, and challenges in the field. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) released a major update to the indications for bariatric surgery at BMI ≥35 kg/m2 regardless of co-morbidities and 30-34.9 kg/m2 with obesity-related comorbidities. Sleeve gastrectomy has emerged as the most popular bariatric procedure in the last 10 years with its remarkable efficacy and safety profile. The implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and Enhanced Recovery After Surgery (ERAS) protocols have significantly improved the quality of care for all bariatric patients. The recent introduction and FDA approval of Glucagon-Like Peptide-1 (GLP-1) agonists for chronic obesity has garnered significant media coverage and popularity, but no guidelines exist regarding its use in relation to bariatric surgery. This update underscores the need for tailored approaches, ongoing research, and the integration of evidence-based medicine and innovations to enhance patient care.
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Affiliation(s)
- Justin L Hsu
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Brown WA, Liem R, Al-Sabah S, Anvari M, Boza C, Cohen RV, Ghaferi A, Våge V, Himpens J, Kow L, Morton J, Musella M, Pattou F, Sakran N, Clapp B, Prager G, Shikora S. Metabolic Bariatric Surgery Across the IFSO Chapters: Key Insights on the Baseline Patient Demographics, Procedure Types, and Mortality from the Eighth IFSO Global Registry Report. Obes Surg 2024; 34:1764-1777. [PMID: 38592648 PMCID: PMC11031475 DOI: 10.1007/s11695-024-07196-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION The International Federation for Surgery for Obesity and Metabolic Disorders (IFSO) Global Registry aims to provide descriptive data about the caseload and penetrance of surgery for metabolic disease and obesity in member countries. The data presented in this report represent the key findings of the eighth report of the IFSO Global Registry. METHODS All existing Metabolic and Bariatric Surgery (MBS) registries known to IFSO were invited to contribute to the eighth report. Aggregated data was provided by each MBS registry to the team at the Australia and New Zealand Bariatric Surgery Registry (ANZBSR) and was securely stored on a Redcap™ database housed at Monash University, Melbourne, Australia. Data was checked for completeness and analyzed by the IFSO Global Registry Committee. Prior to the finalization of the report, all graphs were circulated to contributors and to the global registry committee of IFSO to ensure data accuracy. RESULTS Data was received from 24 national and 2 regional registries, providing information on 502,150 procedures. The most performed primary MBS procedure was sleeve gastrectomy, whereas the most performed revisional MBS procedure was Roux-en-Y gastric bypass. Asian countries reported people with lower BMI undergoing MBS along with higher rates of diabetes. Mortality was a rare event. CONCLUSION Registries enable meaningful comparisons between countries on the demographics, characteristics, operation types and approaches, and trends in MBS procedures. Reported outcomes can be seen as flags of potential issues or relationships that could be studied in more detail in specific research studies.
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Affiliation(s)
- Wendy A Brown
- Department of Surgery, Australia and New Zealand Bariatric Surgery Registry, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
| | - Ronald Liem
- Dutch Audit for the Treatment of Obesity, Heerlen, Netherlands
| | - Salman Al-Sabah
- Department of Surgery, Kuwait University (Kuwait Bariatric Surgery Registry), Kuwait, Kuwait
| | | | - Camilo Boza
- Bariatric Surgery Center, Clinica MEDS (Chilean Bariatric Surgery Registry), Santiago, Chile
| | - Ricardo V Cohen
- The Center for the treatment of Obesity and Diabetes - COD Hospital Oswaldo Cruz (Brazilian Registry), Sao Paulo, Brazil
| | - Amir Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Villy Våge
- Scandinavian Obesity Surgery Registry Norway (SOReg-N), Helse Bergen Health Trust, Bergen, Norway
| | | | - Lilian Kow
- Department GI Surgery, Flinders University South Australia (Australian and New Zealand Bariatric Surgery Registry), Adelaide, Australia
| | - John Morton
- Yale School of Medicine (MBSAQIP- Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project), New Haven, CT, USA
| | - Mario Musella
- Advanced Biomedical Sciences Department (Italian Registry), Naples "Federico II" University, Naples, Italy
| | - Francois Pattou
- University of Lille, Integrated Center for Obesity, CHU Lille, Inserm,, Institut Pasteur Lille (SOFFCO-MM Registry), Lille, France
| | - Nasser Sakran
- Department of General Surgery, Holy Family Hospital, Nazareth, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University (Israelian Registry), Ramat Gan, Israel
| | - Benjamin Clapp
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, 79902, USA
| | - Gerhard Prager
- Universitätsklinik Für Allgemeinchirurgie, Vienna, Austria
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Harvard Medical School (MBSAQIP), Boston, MA, USA
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Cohen RV, Friedman AN. Comment on: Changes in renal blood flow after surgically induced weight loss: can bariatric surgery halt the progression of chronic kidney disease? Surg Obes Relat Dis 2024; 20:444-445. [PMID: 38311539 DOI: 10.1016/j.soard.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/27/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Allon N Friedman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
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Funes DR, Blanco DG, Lo Menzo E, Szomstein S, Rosenthal RJ. Changes in renal blood flow after surgically induced weight loss: can bariatric surgery halt the progression of chronic kidney disease? Surg Obes Relat Dis 2024; 20:439-444. [PMID: 38158311 DOI: 10.1016/j.soard.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND We previously demonstrated how kidney injury in patients with morbid obesity can be reversed by bariatric surgery (BaS). OBJECTIVE(S) Based on previous experience, we hypothesize patients' potentially reversible kidney injury might be secondary to reduction in renal blood flow (RBF), which improves following BaS. SETTING Academic Hospital. METHODS We conducted a retrospective analysis of patients who underwent BaS at our institution from 2002 to 2019. We identified patients with chronic kidney disease (CKD) using the estimated glomerular filtration rate (eGFR) from the CKD Epidemiology Collaboration Study (CKD-EPI) classification system. We used the BUN/Creatinine (Cr) ratio pre- and postoperatively to determine a prerenal (decreased RBF) versus intrinsic component as the responsible cause of CKD in this patient population. Decreased RBF was defined as BUN/Cr > 20 preoperatively. RESULTS Our analysis included n = 2924 patients, of which 11% (n = 325) presented decreased RBF. From our original sample, only n = 228 patients had the complete data necessary to assess both eGFR and RBF (BUN/Cr). Patients with baseline CKD stage 2 demonstrated preoperative BUN/Cr 20.85 ± 10.23 decreasing to 14.99 ± 9.10 at 12-month follow-up (P < .01). Patients with baseline CKD stage 3 presented with preoperative BUN/Cr 23.88 ± 8.75; after 12-month follow-up, BUN/Cr ratio decreased to 16.38 ± 9.27 (P < .01). Patients with CKD stage 4 and ESRD (eGFR < 30) did not demonstrate a difference for pre- and postoperative BUN/Cr 21.71 ± 9.28 and 19.21 ± 14.58, respectively. CONCLUSION(S) According to our findings, patients with CKD stages 1-3 present improvement of their kidney function after BaS. This amelioration could be secondary to improvement of the RBF, an unstudied reversible mechanism of kidney injury in the bariatric population.
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Affiliation(s)
- David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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12
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Danys D, Marcinkeviciute K, Cereska V, Miknevicius P, Poskus T, Osorio J. Telementoring Experience for Complex Bariatric Operation-Laparoscopic Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S). Obes Surg 2024; 34:1983-1986. [PMID: 38530550 DOI: 10.1007/s11695-024-07200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
In a groundbreaking surgical collaboration, a team of surgeons in Lithuania successfully performed the first single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) operation under the remote telemonitoring guidance of a highly experienced surgeon from Spain.The Lithuanian surgical team, comprising skilled bariatric surgeons, meticulously prepared for the SADI-S operation under the remote guidance of their Spanish proctor. Utilizing video conferencing and real-time communication, the mentor provided step-by-step instructions, shared insights, and addressed any concerns during the procedure. The mentor's extensive experience and guidance ensured a safe and successful surgical outcome.This innovative approach not only demonstrates the potential of telemedicine in the field of complex bariatric surgeries but also highlights the power of international cooperation in advancing surgical techniques and patient care by using modern methods of telemedicine and proctorship.
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Affiliation(s)
- Donatas Danys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania.
| | | | - Vaidas Cereska
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Povilas Miknevicius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, 03101, Vilnius, Lithuania
| | - Javier Osorio
- Department of General and Digestive Surgery, Bariatric and Metabolic Surgery Unit, Bellvitge University Hospital, University of Barcelona, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
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13
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Pozzi M, Marcaccini G, Giardino FR, El Araby MM, Nisi G, Grimaldi L, Cuomo R. Flowchart in Post-Bariatric Surgery: A Research for the Appropriate Type and Timing of Plasties Reshaping the Body. Aesthetic Plast Surg 2024; 48:1790-1796. [PMID: 38110738 DOI: 10.1007/s00266-023-03763-8] [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: 07/15/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Obesity is a chronic disease with significant health implications. Bariatric surgery is an effective treatment for obesity-related conditions. However, the timing of post-bariatric body contouring surgery remains uncertain. MATERIALS AND METHODS We conducted a retrospective study of 1336 patients who underwent bariatric surgery. We analyzed weight trends and variations after different types of bariatric procedures. The Pittsburgh Index was used to evaluate body contouring outcomes. RESULTS The majority of patients were women, and sleeve gastrectomy was the most common procedure. Weight loss varied depending on the surgery type, with different outcomes for male and female patients. The Pittsburgh Index remained stable in most cases. CONCLUSION Our findings suggest that the timing of body contouring surgery should be tailored to the type of bariatric procedure performed. Abdominoplasty is recommended as a last procedure for sleeve gastrectomy patients, while gastric bypass patients are suitable candidates for early abdominoplasty. Biliopancreatic diversion patients should stabilize their weight before abdominoplasty. The Pittsburgh Index is a valuable tool for assessing the timing of post-bariatric plastic surgery. Further research is needed to optimize surgical planning and outcomes. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mirco Pozzi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Gianluca Marcaccini
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy.
| | - Francesco Ruben Giardino
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mohamed Marzouk El Araby
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Nisi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Grimaldi
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Roberto Cuomo
- Unit of Plastic and Reconstructive Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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14
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Mokhlesi SS, Vasilevski V, Sweet L. Breastfeeding and pre-pregnancy bariatric surgery: A scoping review. Women Birth 2024; 37:101600. [PMID: 38513305 DOI: 10.1016/j.wombi.2024.101600] [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: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Bariatric surgery is a procedure for people with class II and III obesity who are unable to lose weight using traditional methods. The incidence rate of bariatric surgery in reproductive-age women is increasing rapidly, so the number of women who become pregnant after bariatric surgery is rising. AIM To collate and synthesise available literature regarding breastfeeding following bariatric surgery. METHODS This review was reported by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-Scr). The review included peer-reviewed research studies and research-based conference abstracts on breastfeeding outcomes in mothers who have undergone bariatric surgery before pregnancy. Health databases were searched from 1990 to December 2023. Included studies were analysed using a narrative synthesis. FINDINGS From 1506 abstracts, 16 papers were identified. Three themes emerged from the analysis: challenges in exclusive breastfeeding, nutritional composition in breast milk, and breastfeeding experience. There was a tendency for lower breastfeeding rates and shorter durations in mothers who had bariatric surgery. Most studies focussed on the nutritional composition of breast milk however these results were mixed. Only three articles were qualitative, and their findings showed that women wanted more information and support about breastfeeding following bariatric surgery. DISCUSSION Our review indicates breastfeeding challenges in post-bariatric surgery mothers and reduced breastfeeding rates. It is unclear whether bariatric surgery impacts the nutritional quality of breast milk due to inconsistent study outcomes. CONCLUSION Future research is essential, specifically on understanding the breastfeeding concerns and experiences of women who have undergone bariatric surgery.
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Affiliation(s)
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Center for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Center for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
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15
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Mills DW, Woolley DM, Ammori BJ, Chinoy H, Syed AA. Changes in Serum Urate Levels after Bariatric Surgery in Patients with Obesity: An Observational Study. Obes Surg 2024; 34:1737-1741. [PMID: 38528214 PMCID: PMC11031430 DOI: 10.1007/s11695-024-07191-8] [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: 02/01/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Obesity is a risk factor for hyperuricemia and gout, while weight reduction can reduce urate levels. The aim of this study was to examine the effect of bariatric surgery on longitudinal serum urate levels. METHODS We performed a retrospective observational study of 283 patients who had undergone bariatric surgery [237 (83.7%) gastric bypass, 34 (12.0%) sleeve gastrectomy and 12 (4.2%) gastric banding] and were followed up for 2 years. The results shown represent mean (standard deviation). RESULTS Bariatric surgery was associated with significant reduction in serum urate from baseline level of 0.343 (0.086) mmol/L to 0.296 (0.076) mmol/L (p < 0.001) at 12 months and 0.286 (0.073) mmol/L (p < 0.001) at 24 months, including in men and women, and in patients with or without diabetes. Patients with elevated urate levels at baseline, who comprised 27.2% of the total cohort, achieved reduction in levels by 4 months. CONCLUSION Bariatric surgery leads to significant reduction in serum urate levels at 12 and 24 months. This could reduce incidence of gout and need for prophylactic medication(s).
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Affiliation(s)
- Daniel W Mills
- General (Internal) Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Dylan M Woolley
- General (Internal) Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Basil J Ammori
- Metabolic and Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Metabolic and Bariatric Surgery, Burjeel Hospital, Burjeel Holdings, Abu Dhabi, UAE
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Akheel A Syed
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Diabetes, Endocrinology and Obesity Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
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16
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Friedman AN. Improving Kidney Transplant Rates in Obese CKD Patients by Sleeve Gastrectomy. Mayo Clin Proc 2024; 99:688-690. [PMID: 38702119 DOI: 10.1016/j.mayocp.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Allon N Friedman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN.
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17
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Corrêa EL, Cotian LFP, Lourenço JW, Lopes CM, Carvalho DR, Strobel R, Junior OC, Strobel KM, Schaefer JL, Nara EOB. Overview of the Last 71 Years of Metabolic and Bariatric Surgery: Content Analysis and Meta-analysis to Investigate the Topic and Scientific Evolution. Obes Surg 2024; 34:1885-1908. [PMID: 38485892 DOI: 10.1007/s11695-024-07165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
Obesity is a worldwide epidemic, and bariatric surgery has become increasingly popular due to its effectiveness in treating it. Therefore, understanding this area is of paramount importance. This article aims to provide an understanding of the development of the topic related to procedures, content, data, and status. To achieve this objective, a literature review and a bibliometric analysis were conducted. The methods provided insight into the current state and relevant topics over time. In conclusion, the article provided the identification of the transformation of the research field, initially focused only on physical aspects, to a more complex approach, which also incorporates psychological and social aspects and the correlation between obesity, bariatric surgery, and quality of life.
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Affiliation(s)
- Erica L Corrêa
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Luís F P Cotian
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Jordam W Lourenço
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Caroline M Lopes
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Deborah R Carvalho
- Department of Applied Social Sciences, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Rodrigo Strobel
- Gastrovida: Bariatric and Metabolic Surgical Center, Curitiba, 433, Brazil
| | - Osiris C Junior
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Kamyla M Strobel
- Gastrovida: Bariatric and Metabolic Surgical Center, Curitiba, 433, Brazil
| | - Jones L Schaefer
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil
| | - Elpídio O B Nara
- Department of Production and Systems Engineering, Pontifical Catholic University of Paraná, Curitiba, 1155, Brazil.
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18
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Katz-Summercorn AC, Arhi C, Agyemang-Yeboah D, Cirocchi N, Musendeki D, Fitt I, McGrandles R, Zalin A, Foldi I, Rashid F, Adil MT, Jain V, Mamidanna R, Jambulingam P, Munasinghe A, Whitelaw DE, Al-Taan O. Patient and operative factors influence delayed discharge following bariatric surgery in an enhanced recovery setting. Surg Obes Relat Dis 2024; 20:446-452. [PMID: 38218689 DOI: 10.1016/j.soard.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/29/2023] [Accepted: 11/04/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) programs have been widely adopted in bariatric surgery. However, not all patients are successfully managed in the ERAS setting and there is currently little way of predicting the patients who will deviate from the program. Early identification of these patients could allow for more tailored protocols to be implemented preoperatively to address the issues, thereby improving patient outcomes. OBJECTIVES The aim of this study was to elucidate the factors which preclude discharge by comparing patients who were successfully discharged by the end of the first postoperative day (POD 0/1) to those who stayed longer, including revisional surgery in this analysis. SETTING A tertiary, high-volume Bariatric Centre, United Kingdom. METHODS A retrospective analysis was performed of all patients undergoing bariatric surgery in a single centre in 1 year. Multivariate analyses compared patient and operative variables between patients who were discharged on POD 0/1 and those who stayed longer. RESULTS A total of 288 bariatric operations were performed: 78% of operations performed were laparoscopic Roux-en-Y gastric bypass; 22% laparoscopic sleeve gastrectomy. Of these cases, 13% were revisional operations. Four patients returned to theatre on the index admission. 81% of patients were discharged by POD 0/1. A re-presentation within 30 days was seen in 6% of patients. There was no significant difference in length of stay for the type of operation performed (P = .86). Patients who had a revisional procedure were not more likely to stay longer. Length of stay was also independent of age, BMI, and comorbidities. Caucasian patients were more likely to be discharged on POD 0/1 than those of other ethnicities (90% versus 78%; P = .02). Operations performed by trainee surgeons, under consultant supervision, were significantly more likely to be discharged on POD 0/1 (P = .03). However, a logistic regression analysis was unable to predict patients who had a prolonged stay. CONCLUSIONS Patient length of stay is independent of BMI, operation, and comorbidities and these factors do not need special consideration in ERAS pathways. Patients undergoing revisional procedures can be managed in the same way as those having primary procedures, with a routine POD 0/1 discharge. However, the impact of individual patient factors, and their interaction, is complex and cannot predict overstay.
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Affiliation(s)
- Annalise C Katz-Summercorn
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Chanpreet Arhi
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - David Agyemang-Yeboah
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Nicholas Cirocchi
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Debbie Musendeki
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Irene Fitt
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Rosie McGrandles
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Anjali Zalin
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Istvan Foldi
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Farhan Rashid
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Md Tanveer Adil
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Vigyan Jain
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Ravikrishna Mamidanna
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Periyathambi Jambulingam
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Aruna Munasinghe
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Douglas E Whitelaw
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Omer Al-Taan
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom.
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19
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Rahimi AO, Soliman D, Hsu CH, Ghaderi I. The impact of gender, race, and ethnicity on bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:454-461. [PMID: 38326184 DOI: 10.1016/j.soard.2023.12.020] [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: 09/17/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The rates of postoperative complications can vary among specific patient populations. OBJECTIVES The aim of this study is to examine how gender, race, and ethnicity can affect short-term postoperative complications in bariatric surgery patients. SETTING United States. METHODS Patients who underwent bariatric surgery between the years 2016 and 2021 were included and stratified based on gender, race/ethnicity, and procedure type. The 30-day outcomes were assessed using Clavien-Dindo (CD) classification of III-V. Wilcoxon rank-sum test was performed to compare continuous variables among groups and Chi-squared test for categorical variables. Logistic regression was performed to examine the effects of gender, race/ethnicity on CD classification ≥ III complications by the procedure type. RESULTS A total of 975,642 bariatric surgery patients were included. Descriptive univariate analysis showed that CD ≥ III complications were higher among non-Hispanic blacks (NHB) and lowest in Hispanic patients, regardless of their gender, except in the duodenal switch DS group, where non-Hispanic whites (NHW) had the lowest complication rate. There was no difference between male and female patients with regards to postoperative complications, except in the sleeve gastrectomy (SG) group, where NHW males had more complications than NHW females. Sleeve gastrectomy showed the lowest complication rates followed by gastric bypass and DS in all groups. In multivariate logistic regression model, for both females and males NHBs had higher odds of postoperative complications compared to NHWs in sleeve gastrectomy (Female aOR:1.31, 95% CI: [1.23-1.40]; Male aOR:1.24, 95% CI: [1.08-1.43], P < .001) and gastric bypass (Female aOR:1.24, 95% CI: [1.16-1.33]; Male aOR:1.25, 95% CI: [1.06-1.48], P < .01). CONCLUSIONS Non-Hispanic Black patients are at a higher rate of developing CD ≥ III complications compared to non-Hispanic Whites after bariatric surgery. The male gender was not a significant risk factor for serious postoperative complications. Among the different types of bariatric procedures, sleeve gastrectomy has the lowest rates of severe complications, followed by gastric bypass and duodenal switch. These results highlight the significance of considering gender, race, ethnicity, and procedure type during preoperative evaluation, surgical planning, and postoperative care.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, Arizona
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.
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20
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Clapp B, Ponce J, Corbett J, Ghanem OM, Kurian M, Rogers AM, Peterson RM, LaMasters T, English WJ. American Society for Metabolic and Bariatric Surgery 2022 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis 2024; 20:425-431. [PMID: 38448343 DOI: 10.1016/j.soard.2024.01.012] [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: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS), despite being the most effective durable treatment for obesity, remains underused as approximately 1% of all qualified patients undergo surgery. The American Society for Metabolic and Bariatric Surgery established a Numbers Taskforce to specify the annual rate of obesity treatment interventions utilization and to determine if patients in need are receiving appropriate treatment. OBJECTIVE To provide the best estimated number of metabolic and bariatric procedures being performed in the United States in 2022. SETTING United States. METHODS We reviewed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and National Surgical Quality Improvement Program. In addition, data from industry and state databases were used to estimate activity at non-accredited centers. Data from 2022 were compared mainly with data from the previous 2 years. RESULTS Compared with 2021, the total number of MBS performed in 2022 increased from approximately 262,893 to 280,000. The sleeve gastrectomy (SG) continues to be the most commonly performed procedure. The gastric bypass procedure trend remained relatively stable. The percentage of revision procedures and biliopancreatic diversion with duodenal switch procedures increased slightly. Intragastric balloon placement increased from the previous year. Endoscopic sleeve gastroplasty increased in numbers. CONCLUSIONS There was a 6.5% increase in MBS volume from 2021 to 2022 and a 41% increase from 2020, which demonstrates a recovery from the COVID-19 pandemic. SG continues to be the most dominant MBS procedure.
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Affiliation(s)
- Benjamin Clapp
- Texas Tech Paul Foster School of Medicine, El Paso, Texas.
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, Tennessee
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Teresa LaMasters
- UnityPoint Clinic Weight Loss Specialists, West Des Moines, Iowa
| | - Wayne J English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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21
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Nedelcut S, Axer S, Olbers T. The risk and benefit of revisional vs. primary metabolic- bariatric surgery and drug therapy - A narrative review. Metabolism 2024; 154:155799. [PMID: 38281557 DOI: 10.1016/j.metabol.2024.155799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/10/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/30/2024]
Abstract
Metabolic and bariatric surgery (MBS) leads to long-term weight loss, reduced risk of cardiovascular events and cancer, and reduced mortality. Sleeve gastrectomy and Roux-en-Y gastric bypass are currently the most common surgical techniques. Weight loss after MBS was previously believed to work through restriction and malabsorption, however, mechanistic studies show that MBS techniques with long term efficacy instead alter physiological signaling between the gut and the brain. In revisional MBS, the initial surgical technique is corrected, modified, or converted to a new one. The indication for revisional MBS can be to achieve further weight loss or improvement in obesity comorbidity, but it may be necessary due to complications (e.g., gastroesophageal reflux or obstruction). Revisional MBS is associated with an increased risk of surgical complications and often less weight loss compared to the results following primary surgery. This narrative review summarizes data from revisional MBS where information is often presented with inconsistent definitions for indications and outcomes, making comparison between strategies difficult. In summary, we suggest careful weighing of potential benefits and risks with revisional MBS, bearing in mind the option of add-on therapy with new anti-obesity drugs.
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Affiliation(s)
| | - Stephan Axer
- Faculty of Health and Medicine, Örebro University, Campus USÖ, 701 82 Örebro, Sweden; Department of General Surgery, Torsby Hospital, Box 502, 685 29 Torsby, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences, Department of Surgery, Linköping University, Norrköping, Sweden
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22
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Kukla A, Sahi SS, Navratil P, Benzo RP, Smith BH, Duffy D, Park WD, Shah M, Shah P, Clark MM, Fipps DC, Denic A, Schinstock CA, Dean PG, Stegall MD, Kudva YC, Diwan TS. Weight Loss Surgery Increases Kidney Transplant Rates in Patients With Renal Failure and Obesity. Mayo Clin Proc 2024; 99:705-715. [PMID: 38702124 DOI: 10.1016/j.mayocp.2024.01.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To describe the outcomes of kidney transplant (KT) candidates with obesity undergoing sleeve gastrectomy (SG) to meet the criteria for KT. METHODS Retrospective analysis was conducted of electronic medical records of KT candidates with obesity (body mass index >35 kg/m2) who underwent SG in our institution. Weight loss, adverse health events, and the listing and transplant rates were abstracted and compared with the nonsurgical cohort. RESULTS The SG was performed in 54 patients; 50 patients did not have surgery. Baseline demographic characteristics were comparable at the time of evaluation. Mean body mass index ± SD of the SG group was 41.7±3.6 kg/m2 at baseline (vs 41.5±4.3 kg/m2 for nonsurgical controls); at 2 and 12 months after SG, it was 36.4±4.1 kg/m2 and 32.6±4.0 kg/m2 (P<.01 for both). In the median follow-up time of 15.5 months (interquartile range, 6.4 to 23.9 months), SG was followed by active listing (37/54 people), and 20 of 54 received KT during a median follow-up time of 20.9 months (interquartile range, 14.7 to 28.3 months) after SG. In contrast, 14 of 50 patients in the nonsurgical cohort were listed, and 5 received a KT (P<.01). Three patients (5.6%) experienced surgical complications. There was no difference in overall hospitalization rates and adverse health outcomes, but the SG cohort experienced a higher risk of clinically significant functional decline. CONCLUSION In KT candidates with obesity, SG appears to be effective, with 37% of patients undergoing KT during the next 18 months (P<.01). Further research is needed to confirm and to improve the safety and efficacy of SG for patients with obesity seeking a KT.
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Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
| | - Sukhdeep S Sahi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Pavel Navratil
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Roberto P Benzo
- Department of Pulmonary Medicine, Mayo Clinic, Rochester, MN
| | - Byron H Smith
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dustin Duffy
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Walter D Park
- Department of Cardiovascular Surgery Research, Mayo Clinic, Rochester, MN
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Pankaj Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Matthew M Clark
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - David C Fipps
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie A Schinstock
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN; Von Liebig Transplant Center, Mayo Clinic, Rochester, MN
| | - Patrick G Dean
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | - Mark D Stegall
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | - Yogish C Kudva
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Tayyab S Diwan
- Von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
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Mingrone G, Rajagopalan H. Bariatrics and endoscopic therapies for the treatment of metabolic disease: Past, present, and future. Diabetes Res Clin Pract 2024; 211:111651. [PMID: 38580037 DOI: 10.1016/j.diabres.2024.111651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
The burden of chronic metabolic diseases such as obesity, type 2 diabetes mellitus (T2DM), and metabolic dysfunction-associated steatotic liver disease (MASLD) and the urgency of the epidemiological situation necessitate the development of therapies that enhance metabolic health and alter the trajectory of metabolic disease in society. Certain bariatric-metabolic surgeries have proven to be effective approaches for treating metabolic dysfunction, showing remission or significant improvements in obesity, T2DM, and MASLD-related outcomes, suggesting that these interventions might be able to "reset" a pathologically calibrated metabolic setpoint. However, considering the challenges and invasiveness of surgery, endoscopic bariatric metabolic therapies (EBMTs) have emerged with a primary focus to reconstruct or mimic anatomical and/or functional changes observed with bariatric surgery in a more broadly accessible manner. These innovative approaches offer a potentially promising solution to address significant unmet medical need in the large segment of society, which remains at risk for the consequences of metabolic diseases. In this review, we discuss therapeutic options within the EBMT space in the context of the metabolic setpoint intellectual model and provide a brief overview of current knowledge surrounding their mechanisms of action and impact on metabolic health. Finally, we explore future perspectives and directions in this exciting field.
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Affiliation(s)
- Geltrude Mingrone
- Division of Obesity and Metabolic Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Division of Diabetes & Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King's College London, London, United Kingdom.
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24
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Nottelmann K, Menzen A, Röding T, Grünewald M, Kehl F. [Anesthesia in bariatric surgery-Results of a web-based survey]. Anaesthesiologie 2024; 73:348-351. [PMID: 38607385 DOI: 10.1007/s00101-024-01401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/13/2024]
Affiliation(s)
- Klaus Nottelmann
- Anästhesiologie, Intensiv- und Schmerzmedizin, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland.
| | - Angelika Menzen
- Anästhesiologie und Intensivmedizin, St. Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - Thomas Röding
- Adipositaszentrum der Klinik Ernst von Bergmann, Bad Belzig und Adipositaszentrum im Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Matthias Grünewald
- Klinik für Anästhesiologie und Intensivmedizin, Ev. Amalie Sieveking Krankenhaus, Hamburg, Deutschland
| | - Franz Kehl
- Städtisches Klinikum Karlsruhe, Klinik für Anästhesie und Intensivmedizin, Karlsruhe, Deutschland
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25
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McKechnie T, Saddik M, Doumouras A, Eskicioglu C, Parpia S, Bhandari M. PREscribing preoperative weight loss prior to major non-bariatric abdominal surgery for patients with Elevated weight: Patient and Provider Survey Protocols (PREPARE surveys). PLoS One 2024; 19:e0302482. [PMID: 38687754 PMCID: PMC11060585 DOI: 10.1371/journal.pone.0302482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Preoperative very low energy diet (VLED) interventions are used routinely in patients undergoing bariatric surgery, a surgical subspecialty that deals almost exclusively with patients with obesity. Yet, their use and study has been limited in non-bariatric abdominal surgery. To investigate the use of VLEDs in non-bariatric surgery, we plan on conducting a randomized controlled trial (RCT). Prior to proceeding, however, we have designed two surveys as important pre-emptive studies aimed at elucidating patient and provider perspectives regarding these interventions. METHODS The patient survey is a cross-sectional, single-center survey aimed at assessing the safety, adherence, barriers to adherence, and willingness to participate in preoperative optimization protocols with VLEDs prior to undergoing elective non-bariatric intra-abdominal surgery (S1 File). The population of interest is all adult patients with obesity undergoing elective non-bariatric intra-abdominal surgery at St. Joseph's Healthcare Hamilton who were prescribed a course of preoperative VLED. The primary outcomes will be safety and adherence. The target sample size is 35 survey responses. The provider survey is a cross-sectional national survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery aimed assessing the willingness and ability to prescribe preoperative weight loss interventions amongst practicing Canadian surgeons who perform major non-bariatric abdominal surgery (S2 File). The population of interest is independent practicing surgeons in Canada who perform major non-bariatric abdominal surgery. The primary outcome will be willingness to prescribe preoperative VLED to patients with obesity undergoing major non-bariatric abdominal surgery for both benign and malignant indications. The target sample size is 61 survey responses. Descriptive statistics will be used to characterize the sample populations. To determine variables associated with primary outcomes in the surveys, regression analyses will be performed. DISCUSSION These survey data will ultimately inform the design of an RCT evaluating the efficacy of preoperative VLEDs for patients with obesity undergoing major abdominal surgery.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maisa Saddik
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Visaggi P, Ghisa M, Barberio B, Chiu PW, Ishihara R, Kohn GP, Morozov S, Thompson SK, Wong I, Hassan C, Savarino EV. Gastro-esophageal diagnostic workup before bariatric surgery or endoscopic treatment for obesity: position statement of the International Society of Diseases of the Esophagus. Dis Esophagus 2024; 37:doae006. [PMID: 38281990 DOI: 10.1093/dote/doae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
Obesity is a chronic and multifactorial condition characterized by abnormal weight gain due to excessive adipose tissue accumulation that represents a growing worldwide challenge for public health. In addition, obese patients have an increased risk of hiatal hernia, esophageal, and gastric dysfunction, as well as gastroesophageal reflux disease, which has a prevalence over 40% in those seeking endoscopic or surgical intervention. Surgery has been demonstrated to be the most effective treatment for severe obesity in terms of long-term weight loss, comorbidities, and quality of life improvements and overall mortality decrease. The recent emergence of bariatric endoscopic techniques promises less invasive, more cost-effective, and reproducible approaches to the treatment of obesity. With the endorsement of the International Society for Diseases of the Esophagus, we started a Delphi process to develop consensus statements on the most appropriate diagnostic workup to preoperatively assess gastroesophageal function before bariatric surgical or endoscopic interventions. The Consensus Working Group comprised 11 international experts from five countries. The group consisted of gastroenterologists and surgeons with a large expertise with regard to gastroesophageal reflux disease, bariatric surgery and endoscopy, and physiology. Ten statements were selected, on the basis of the agreement level and clinical relevance, which represent an evidence and experience-based consensus of the International Society for Diseases of the Esophagus.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Digestive Endoscopy Unit, Pisa University Hospital, Pisa, Italy
| | - Matteo Ghisa
- Digestive Endoscopy Unit, Department of Gastroenterology, Padua University Hospital, Padua, Italy
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Philip W Chiu
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Geoffrey P Kohn
- Department of Surgery, Monash University Eastern Health Clinical School, Melbourne, Australia
- Melbourne Upper GI Surgical Group, c/o Cabrini Hospital, Malvern, Australia
| | - Sergey Morozov
- Department of Gastroenterology, Hepatology and Nutrition, Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - Sarah K Thompson
- College of Medicine & Public Health, Flinders University, Bedford Park, Australia
| | - Ian Wong
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Biomedical Sciences, Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Milan, Italy
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università of Padua, Padua, Italy
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27
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Pipek LZ, Moraes WAF, Nobetani RM, Cortez VS, Condi AS, Taba JV, Nascimento RFV, Suzuki MO, do Nascimento FS, de Mattos VC, Iuamoto LR, Hsing WT, Carneiro-D'Albuquerque LA, Meyer A, Andraus W. Surgery is associated with better long-term outcomes than pharmacological treatment for obesity: a systematic review and meta-analysis. Sci Rep 2024; 14:9521. [PMID: 38664450 PMCID: PMC11045962 DOI: 10.1038/s41598-024-57724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Obesity is a highly prevalent disease with numerous complications. Both intensive medical treatment with the use of pharmacological drugs and bariatric surgery are current options. The objective of this meta-analysis was to compare, in the long-term, intensive medical treatment and surgery based on twelve parameters related to weight loss, cardiovascular and endocrine changes. A review of the literature was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42021265637). The literature screening was done from inception to October 2023 through PubMed, EMBASE and Web of Science databases. We included randomized clinical trials that had separate groups for medical treatment and bariatric surgery as an intervention for obesity. The risk of bias was assessed through RoB2. A meta-analysis was performed with measures of heterogeneity and publication bias. Subgroup analysis for each surgery type was performed. Data is presented as forest-plots. Reviewers independently identified 6719 articles and 6 papers with a total 427 patients were included. All studies were randomized controlled trials, three had a follow up of 5 years and two had a follow up of 10 years. Both groups demonstrated statistical significance for most parameters studied. Surgery was superior for weight loss (- 22.05 kg [- 28.86; - 15.23), total cholesterol (- 0.88 [- 1.59; - 0.17]), triglycerides (- 0.70 [- 0.82; - 0.59]), HDL (0.12 [0.02; 0.23]), systolic pressure (- 4.49 [- 7.65; - 1.33]), diastolic pressure (- 2.28 [- 4.25; - 0.31]), Hb glycated (- 0.97 [- 1.31; - 0.62]), HOMA IR (- 2.94; [- 3.52; - 2.35]) and cardiovascular risk (- 0.08; [- 0.10; - 0.05]). Patient in the surgical treatment group had better long term outcomes when compared to the non-surgical group for most clinical parameters.
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Affiliation(s)
- Leonardo Zumerkorn Pipek
- Department of Neurology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - João Victor Taba
- Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Leandro Ryuchi Iuamoto
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | - Wu Tu Hsing
- Center of Acupuncture, Department of Orthopaedics and Traumatology, University of São Paulo, São Paulo, Brazil
| | | | - Alberto Meyer
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, Avenida Doutor Arnaldo, 455, São Paulo, Brazil.
| | - Wellington Andraus
- Department of Gastroenterology, Hospital das Clínicas, HCFMUSP, Avenida Doutor Arnaldo, 455, São Paulo, Brazil
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28
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Retnakaran R, Kashyap SR, Gerstein HC, Aroda VR. Contemporary Clinical Perspectives on Targeting Remission of Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:1179-1188. [PMID: 38108415 DOI: 10.1210/clinem/dgad746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 12/19/2023]
Abstract
It has long been known that some patients with type 2 diabetes (T2DM) can experience sustained metabolic improvement to near-normal levels of glycemia either spontaneously or after medical intervention. Now recognized as remission of diabetes, this intriguing state is currently more feasible than ever before due to profound advances in metabolic surgery, pharmacologic therapy, and regimens of lifestyle modification. This enhanced capacity to induce remission has revealed new pathophysiologic insights, including the presence of a reversible component of the pancreatic beta-cell dysfunction that otherwise drives the chronic progressive nature of T2DM. In doing so, it has changed the therapeutic landscape by offering new potential management objectives and considerations for patients and providers. However, the excitement around these developments must also be tempered by the sobering realities of our current understanding of remission, including the recognition that this condition may not be permanent (resulting in glycemic relapse over time) and that beta-cell function may not be normalized in the setting of remission. These limitations highlight both the many gaps in our current understanding of remission and the caution with which clinical discussions must be handled for clear patient-directed communication of the pros and cons of targeting this outcome in practice. In this mini-review, we consider this rapidly growing literature, including its implications and its limitations, and thereby seek to provide objective balanced perspectives on targeting remission of T2DM in current clinical care.
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Affiliation(s)
- Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON M5S 3H2, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
| | - Sangeeta R Kashyap
- Division of Endocrinology, Diabetes, and Metabolism, New York Presbyterian-Weill Cornell Medicine, New York, NY 10021, USA
| | - Hertzel C Gerstein
- Division of Endocrinology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Vanita R Aroda
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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29
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Huluță I, Apostol LM, Botezatu R, Panaitescu AM, Gică C, Sima RM, Gică N, Nedelea FM. Beyond Weight Loss: A Comprehensive Review of Pregnancy Management following Bariatric Procedures. Medicina (Kaunas) 2024; 60:635. [PMID: 38674281 PMCID: PMC11052297 DOI: 10.3390/medicina60040635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
The increasing prevalence of bariatric surgery among women of childbearing age raises critical questions about the correct management of pregnancy following these procedures. This literature review delves into the multifaceted considerations surrounding pregnancy after bariatric surgery, with a particular focus on the importance of preconception counselling, appropriate nutrition assessment, and the necessity of correct folic acid supplementation. Key areas of investigation include nutrient absorption challenges, weight gain during pregnancy, and potential micronutrient deficiencies. Examining the relationship between bariatric surgery and birth defects, particularly heart and musculoskeletal issues, uncovers a twofold increase in risk for women who underwent surgery before pregnancy, with the risk emphasized before folic acid fortification. In contrast, a nationwide study suggests that infants born to mothers with bariatric surgery exhibit a reduced risk of major birth defects, potentially associated with improved glucose metabolism. In addition, this review outlines strategies for managing gestational diabetes and other pregnancy-related complications in individuals with a history of bariatric surgery. By synthesizing existing literature, this paper aims to provide healthcare providers with a comprehensive framework for the correct management of pregnancy in this unique patient population, promoting the health and well-being of both mother and child.
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Affiliation(s)
- Iulia Huluță
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Livia-Mihaela Apostol
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
| | - Radu Botezatu
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Maria Panaitescu
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Corina Gică
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Romina-Marina Sima
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
| | - Nicolae Gică
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
- Obstetrics and Gynecology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florina Mihaela Nedelea
- Clinical Hospital of Obstetrics and Gynaecology Filantropia, 011132 Bucharest, Romania; (I.H.); (L.-M.A.); (R.B.); (A.M.P.); (C.G.); (R.-M.S.)
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30
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Dowgiałło-Gornowicz N, Lech P, Katkowski B, Walędziak M, Proczko-Stepaniak M, Szymański M, Karpińska I, Major P. Risk factors for bariatric surgery in patients over 65 years of age-a multicenter retrospective cohort study. Langenbecks Arch Surg 2024; 409:115. [PMID: 38589572 PMCID: PMC11001652 DOI: 10.1007/s00423-024-03304-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Societies are aging, life expectancy is increasing, and as a result, the percentage of elderly people in the population is constantly increasing. When qualifying patients over 65 years of age for bariatric surgery, the benefits and risks should be carefully assessed. Weighing risk factors against each other to improve the quality of life and better control of obesity-related diseases. The study aimed to determine risk factors for bariatric surgery among patients over 65 years of age. METHODS A multicenter, retrospective analysis of patients undergoing laparoscopic bariatric procedures from 2008 to 2022. The patients were divided into two groups: complicated (C) and uncomplicated (UC). Uni- and multivariate logistic regression analysis was performed to obtain significant, independent risk factors. RESULTS There were 20 (7.0%) patients in C group and 264 (93.0%) patients in UC group. The most common complication was intraperitoneal bleeding (8, 2.8). There was no postoperative mortality. The mean follow-up was 47.5 months. In a multivariate logistic regression analysis, length of stay and %EWL significantly corresponded to general complications (OR 1.173, OR 1.020). A higher weight loss before surgery lowered the risk for hemorrhagic events after surgery (OR 0.889). A longer length of stay corresponded to leak after surgery (OR 1.175). CONCLUSIONS Bariatric and metabolic surgery appears to be a safe method of obesity treatment in patients over 65 years of age. The most common complication was intraperitoneal bleeding. A prolonged hospital stay may increase the risk of leakage, while a higher weight loss before the surgery may lower the risk of bleeding.
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Affiliation(s)
- Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, 10-045, Olsztyn, Poland.
| | - Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, 10-045, Olsztyn, Poland
| | - Bartosz Katkowski
- Department of General and Vascular Surgery, Specialist Medical Center, 57-320, Polanica Zdrój, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 04-141, Warsaw, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-214, Gdańsk, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-214, Gdańsk, Poland
| | - Izabela Karpińska
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688, Cracow, Poland
- Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 30-688, Cracow, Poland
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Wang ZY, Qu YF, Yu TM, Liu ZL, Cheng YG, Zhong MW, Hu SY. Novel subtype of obesity influencing the outcomes of sleeve gastrectomy: Familial aggregation of obesity. World J Gastroenterol 2024; 30:1887-1898. [PMID: 38659480 PMCID: PMC11036498 DOI: 10.3748/wjg.v30.i13.1887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/07/2024] [Accepted: 03/14/2024] [Indexed: 04/03/2024] Open
Abstract
BACKGROUND Differences in the preoperative characteristics and weight loss outcomes after sleeve gastrectomy (SG) between patients with familial aggregation of obesity (FAO) and patients with sporadic obesity (SO) have not been elucidated. AIM To explore the impact of SG on weight loss and the alleviation of obesity-related comorbidities in individuals with FAO. METHODS A total of 193 patients with obesity who underwent SG were selected. Patients with FAO/SO were matched 1:1 by propensity score matching and were categorized into 4 groups based on the number of first-degree relatives with obesity (1SO vs 1FAO, 2SO vs 2FAO). The baseline characteristics, weight loss outcomes, prevalence of obesity-related comorbidities and incidence of major surgery-related complications were compared between groups. RESULTS We defined FAO as the presence of two or more first-degree relatives with obesity. Patients with FAO did not initially show significant differences in baseline data, short-term postoperative weight loss, or obesity-related comorbidities when compared to patients with SO preoperatively. However, distinctions between the two groups became evident at the two-year mark, with statistically significant differences in both percentage of total weight loss (P = 0.006) and percentage of excess weight loss (P < 0.001). The FAO group exhibited weaker remission of type 2 diabetes mellitus (T2DM) (P = 0.031), hyperlipidemia (P = 0.012), and non-alcoholic fatty liver disease (NAFLD) (P = 0.003) as well as a lower incidence of acid reflux (P = 0.038). CONCLUSION FAO patients is associated with decreased mid-to-long-term weight loss outcomes; the alleviation of T2DM, hyperlipidemia and NAFLD; and decreased incidence of acid reflux postoperatively.
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Affiliation(s)
- Ze-Yu Wang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250000, Shandong Province, China
- Department of Postgraduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250000, Shandong Province, China
| | - Yun-Fei Qu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250000, Shandong Province, China
- Department of Postgraduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250000, Shandong Province, China
| | - Tian-Ming Yu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine Shandong University, Jinan 250000, Shandong Province, China
| | - Zeng-Lin Liu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250000, Shandong Province, China
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine Shandong University, Jinan 250000, Shandong Province, China
| | - Yu-Gang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250000, Shandong Province, China
| | - Ming-Wei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250000, Shandong Province, China
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Lunan Pharmaceutical Group Co. Ltd., Linyi 276005, Shandong Province, China
| | - San-Yuan Hu
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan 250000, Shandong Province, China
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Pais ML, Crisóstomo J, Abrunhosa A, Castelo-Branco M. Portuguese observational cross-sectional clinical imaging study protocol to investigate central dopaminergic mechanisms of successful weight loss through bariatric surgery. BMJ Open 2024; 14:e080702. [PMID: 38569700 PMCID: PMC10989096 DOI: 10.1136/bmjopen-2023-080702] [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: 10/08/2023] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Bariatric surgery (BS) is the treatment of choice for refractory obesity. Although weight loss (WL) reduces the prevalence of obesity-related comorbidities, not all patients maintain it. It has been suggested that central mechanisms involving dopamine receptors may play a role in successful WL. This protocol describes an observational cross-sectional study to test if the binding of central dopamine receptors is similar in individuals who responded successfully to BS and age- and gender-matched normal-weight healthy individuals (controls). As secondary goals, the protocol will investigate if this binding correlates with key parameters such as age, hormonal status, anthropometric metrics and neurobehavioural scores. Finally, as exploratory goals, we will include a cohort of individuals with obesity before and after BS to explore whether obesity and type of BS (sleeve gastrectomy and Roux-en-Y gastric bypass) yield distinct binding values and track central dopaminergic changes resulting from BS. METHODS AND ANALYSIS To address the major research question of this observational study, positron emission tomography (PET) with [11C]raclopride will be used to map brain dopamine type 2 and 3 receptors (D2/3R) non-displaceable binding potential (BPND) of individuals who have successfully responded to BS. Mean regional D2/3R BPND values will be compared with control individuals by two one-sided test approaches. The sample size (23 per group) was estimated to demonstrate the equivalence between two independent group means. In addition, these binding values will be correlated with key parameters to address secondary goals. Finally, for exploratory analysis, these values will be compared within the same individuals (before and after BS) and between individuals with obesity and controls and types of BS. ETHICS AND DISSEMINATION The project and informed consent received ethical approval from the Faculty of Medicine and the Coimbra University Hospital ethics committees. Results will be disseminated in international peer-reviewed journals and conferences.
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Affiliation(s)
- Marta Lapo Pais
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Science and Technology, University of Coimbra, Coimbra, Portugal
| | - Joana Crisóstomo
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal
| | - Antero Abrunhosa
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Chierici A, Bulsei J, De Fatico S, Alromayan M, Alamri A, Pavone G, Liddo G, Fontas E, Iannelli A. Effects of bariatric surgery on severe suppurative hidradenitis: Results of a nationwide administrative data study in France. J Eur Acad Dermatol Venereol 2024; 38:e359-e361. [PMID: 38041567 DOI: 10.1111/jdv.19649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Andrea Chierici
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Julie Bulsei
- Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Serena De Fatico
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Mohamed Alromayan
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
- Security Forces Medical City, Riyadh, Saudi Arabia
| | - Abdelrahmane Alamri
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
- Department of Surgery, Medical College, Najran University, Najran, Saudi Arabia
| | - Giovanna Pavone
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Guido Liddo
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Eric Fontas
- Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
- Université Côte d'Azur, Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France
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Surve A, Cottam D, Pryor A, Cottam S, Michaelson R, Umbach T, Williams M, Bagshahi H, July L, Bueno R, Chock D, Apel M, Hart C, Johnson W, Curtis B, Rosenbluth A, Spaniolas K, Medlin W, Wright W, Lee C, Lee C, Trujeque R, Rinker D. A Prospective Multicenter Standard of Care Study of Outpatient Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1122-1130. [PMID: 38366263 PMCID: PMC11026234 DOI: 10.1007/s11695-024-07094-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
A global shift is occurring as hospital procedures move to ambulatory surgical settings. Surgeons have performed outpatient sleeve gastrectomy (SG) in bariatric surgery since 2010. However, prospective trials are needed to ensure its safety before widespread adoption. PURPOSE The study aimed to present a comprehensive report on the prospective data collection of 30-day outcomes of outpatient primary laparoscopic SG (LSG). This trial seeks to assess whether outpatient LSG is non-inferior to hospital-based surgery in selected patients who meet the outpatient surgery criteria set by the American Society for Metabolic and Bariatric Surgery. MATERIALS AND METHODS This study is funded by the Society of American Gastrointestinal and Endoscopic Surgeons and has been approved by the Advarra Institutional Review Board (Pro00055990). Cognizant of the necessity for a prospective approach, data collection commenced after patients underwent primary LSG procedures, spanning from August 2021 to September 2022, at six medical centers across the USA. Data centralization was facilitated through ArborMetrix. Each center has its own enhanced recovery protocols, and no attempt was made to standardize the protocols. RESULTS The analysis included 365 patients with a mean preoperative BMI of 43.7 ± 5.7 kg/m2. Rates for 30-day complications, reoperations, readmissions, emergency department visits, and urgent care visits were low: 1.6%, .5%, .2%, .2%, and 0%, respectively. Two patients (0.5%) experienced grade IIIb complications. There were no mortalities or leaks reported. CONCLUSION The prospective cohort study suggests that same-day discharge following LSG seems safe in highly selected patients at experienced US centers.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA.
| | - Aurora Pryor
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Robert Michaelson
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Thomas Umbach
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Michael Williams
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Laura July
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Racquel Bueno
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Devorah Chock
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Matthew Apel
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Christopher Hart
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - William Johnson
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Brendon Curtis
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Amy Rosenbluth
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | | | - Walter Medlin
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Whitney Wright
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Ciara Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Christy Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Deborah Rinker
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
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Scott J, Blackhurst D, Hodgens BD, Carbonell AM, Cobb WS, Richardson ES, Dahlgren NJ, Kothari SN. Use of Preoperative Endoscopic Capsule-Based pH Testing Before Bariatric Surgery. J Am Coll Surg 2024; 238:551-558. [PMID: 38230854 DOI: 10.1097/xcs.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Vertical sleeve gastrectomy is the most performed bariatric operation in the US; however, a significant number of patients suffer from persistent or new-onset reflux. No consensus for objective preoperative evaluation in these patients exists. We compared capsule-based pH testing vs GERD symptom scoring to determine extent of preoperative GERD to aid in procedure selection for bariatric surgery. STUDY DESIGN An IRB-approved retrospective review of consecutive patients at a single institution was performed from April 2021 to December 2022. During initial consultation for bariatric surgery, a validated GERD symptom subjective survey was administered. All patients demonstrating interest in sleeve gastrectomy or had a history of reflux underwent upper endoscopy with capsule-based pH testing. RESULTS Sixty-two patients underwent preoperative endoscopy with capsule-based pH testing and completed GERD symptom assessment survey(s). Median BMI was 43.4 kg/m 2 and 66.1% of patients were not taking a proton-pump inhibitor before performance of pH testing. There was negligible linear association between the objective DeMeester score obtained by capsule-based pH probe and GERD symptom survey scores. Median GERD symptom survey scores did not differ between patients with and without a diagnosis of GERD based on pH testing (all p values >0.11). CONCLUSIONS An objective method for identifying severe GERD in the preoperative assessment may aid in the decision tree for procedure selection and informed consent process. Patients with significant preoperative GERD may be at higher risk for future GERD-related sleeve complications. Capsule-based pH testing may prove to be superior to subjective symptom scoring systems in this patient population.
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Affiliation(s)
- John Scott
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Dawn Blackhurst
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Brian D Hodgens
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Alfredo M Carbonell
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - William S Cobb
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Emily S Richardson
- University of South Carolina School of Medicine Greenville, Greenville, SC (Richardson)
| | - Nicholas Jp Dahlgren
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
| | - Shanu N Kothari
- From the Department of Surgery, Prisma Health, Greenville, SC (Scott, Blackhurst, Hodgens, Carbonell, Cobb, Dahlgren, Kothari)
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O'Brien C, Murad V, Renton M. Up-to-date review into the evolving world of bariatric interventions: a guide for radiologists. Abdom Radiol (NY) 2024; 49:1007-1019. [PMID: 38329482 DOI: 10.1007/s00261-023-04137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 02/09/2024]
Abstract
Obesity is a worldwide health concern leading to several chronic health problems and comorbidities. Its treatment requires a multidisciplinary approach where lifestyle changes are fundamental. Additionally, in the past decade, the use of different surgical procedures of various levels of complexity has grown, with the objective of reducing the gastric capacity, creating diversions, or a combination of both. The aim of this article is to review and illustrate the major types of bariatric surgical techniques, their normal post-surgical anatomy, and the possible associated complications, to aid the radiologist in their assessment and timely diagnosis.
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Affiliation(s)
- Ciara O'Brien
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. ciara.o'
| | - Vanessa Murad
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Mary Renton
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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Angrisani L, Santonicola A, Iovino P, Palma R, Kow L, Prager G, Ramos A, Shikora S. IFSO Worldwide Survey 2020-2021: Current Trends for Bariatric and Metabolic Procedures. Obes Surg 2024; 34:1075-1085. [PMID: 38438667 PMCID: PMC11026210 DOI: 10.1007/s11695-024-07118-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE This IFSO survey aims to describe the current trends of metabolic and bariatric surgery (MBS) reporting on the number and types of surgical and endoluminal procedures performed in 2020 and 2021, in the world and within each IFSO chapter. METHODS All national societies belonging to IFSO were asked to complete the survey form. The number and types of procedures performed (surgical and endoluminal interventions) from 2020 to 2021 were documented. A special section focused on the impact of COVID-19, the existence of national protocols for MBS, the use of telemedicine, and any mortality related to MBS. A trend analysis of the data, both worldwide and within each IFSO chapter, was also performed for the period between 2018 and 2021. RESULTS Fifty-seven of the 74 (77%) IFSO national societies submitted the survey. Twenty-four of the 57 (42.1%) reported data from their national registries. The total number of surgical and endoluminal procedures performed in 2020 was 507,806 and in 2021 was 598,834. Sleeve gastrectomy (SG) remained the most performed bariatric procedure. Thirty national societies (52%) had regional protocols for MBS during COVID-19, 61.4% supported the use of telemedicine, and only 47.3% collected data on mortality after MBS in 2020. These percentages did not significantly change in 2021 (p > 0.05). CONCLUSIONS The number of MBS markedly decreased worldwide during 2020. Although there was a positive trend in 2021, it did not reach the values obtained before the COVID-19 pandemic. SG continued to be the most performed operation. Adjustable gastric banding (AGB) continues to decrease worldwide.
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Affiliation(s)
- Luigi Angrisani
- Public Health Department - School of Medicine, "Federico II" University of Naples, Naples, Italy.
| | - Antonella Santonicola
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Paola Iovino
- Gastrointestinal Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Rossella Palma
- Department of Surgical Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Lilian Kow
- Flinders University, Adelaide, South Australia
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Almino Ramos
- Gastro-Obeso-Center Institute, Sao Paulo, Brazil
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Dijkhorst PJ, Nijland LMG, van Veen RN, de Castro SMM. Factors associated with decision regret after bariatric surgery. Clin Obes 2024; 14:e12633. [PMID: 38124342 DOI: 10.1111/cob.12633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/01/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
It is assumed that the individuals who undergo bariatric surgery will experience significant improvements in their health and overall well-being. However, it is yet to be examined whether these individuals may also experience subsequent decision regret. The level of regret regarding the choice to undergo bariatric surgery was assessed 1 year after bariatric surgery using the Decision Regret Scale (DRS). Associations of regret with patient characteristics, complications, weight loss and quality of life (BODY-Q) were investigated using linear regression analyses. In total, 115 patients completed the DRS (92% underwent Roux-en-Y gastric bypass Roux-en-Y gastric bypass and 8% underwent sleeve gastrectomy (SG)). Two out of 115 patients indicated absolute regret about their decision to undergo bariatric surgery because of insufficient weight loss and complications. The median decision regret score was zero (range 0-80). Most patients experienced no decision regret (50.4%), followed by mild regret (34.8%) and moderate to strong regret (14.8%). Higher levels of regret were associated with having osteo-articular disorders, gastro-oesophageal reflux disease or a history of psychiatric disorders at baseline. Patients with mild regret demonstrated significantly more weight loss and better psychological function. Major surgical complications were not associated with increased decision regret. Only two out of 115 patients (1.7%) indicated absolute regret about their decision to undergo bariatric surgery, and 15% reported moderate-to-strong regret according to the results of the DRS. These findings should be considered when providing pre-operative counselling and could assist patients in their decision-making process.
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Affiliation(s)
- Phillip J Dijkhorst
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
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Pino JMV, Silva VF, Campos RMS, Mônico-Neto M, de Araujo KA, Seva DC, Kato MY, Galvão TD, Bitterncourt LRA, Tufik S, Lee KS. Impact of Bariatric Surgery on Circulating Metabolites and Cognitive Performance. Obes Surg 2024; 34:1102-1112. [PMID: 38363496 DOI: 10.1007/s11695-024-07096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Bariatric surgery is an effective intervention to reduce obesity and improve associated comorbidities. However, its effects on cognitive function are still the subject of debate. Given that the bioavailability of circulating metabolites can influence brain metabolism and cognitive performance, we aimed to assess the effects of bariatric surgery on plasma metabolic profiles and cognitive performance. METHODS We recruited 26 women undergoing gastric bypass surgery. We conducted anthropometric assessments and collected plasma samples for metabolomic analysis. A set of 4 cognitive tests were used to evaluate cognitive performance. Participants were reevaluated 1 year post-surgery. RESULTS After surgery, attention capacity and executive function were improved, while immediate memory had deteriorated. Regarding metabolic profile, reduction of beta-tocopherol and increase of serine, glutamic acid, butanoic acid, and glycolic acid were observed. To better understand the relationship between cognitive function and metabolites, a cluster analysis was conducted to identify more homogeneous subgroups based on the cognitive performance. We identified cluster 1, which did not show changes in cognitive performance after surgery, and cluster 2, which showed improved attention and executive function, but reduced performance in the immediate memory test. Thus, cluster 2 was more homogeneous group that replicated the results of non-clustered subjects. Analysis of the metabolic profile of cluster 2 confirmed serine, glutamic acid, and glycolic acid as potential metabolites associated with cognitive performance. CONCLUSIONS Metabolites identified in this study have potential for biomarkers and alternative therapeutic target to prevent obesity-related cognitive decline. KEY POINTS • Attention capacity and executive function were improved 12 months post bariatric surgery. • Immediate memory was worsened 12 months post bariatric surgery. • Serine, glutamic acid, and glycolic acid are potential metabolites linked to the alteration of cognitive performance.
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Affiliation(s)
- Jessica M V Pino
- Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, Edifício de Pesquisa II, Rua Pedro de Toledo, 669, 8º Andar, CEP, São Paulo, 04039-032, Brazil
| | - Vitória F Silva
- Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, Edifício de Pesquisa II, Rua Pedro de Toledo, 669, 8º Andar, CEP, São Paulo, 04039-032, Brazil
| | - Raquel M S Campos
- Post Graduated Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Santos, Brazil
| | - Marcos Mônico-Neto
- Post Graduated Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Santos, Brazil
- BariMais Clinic-Integrated Medicine, São Paulo, Brazil
| | - Kaique A de Araujo
- Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, Edifício de Pesquisa II, Rua Pedro de Toledo, 669, 8º Andar, CEP, São Paulo, 04039-032, Brazil
| | - Danielle C Seva
- Post Graduated Program of Interdisciplinary Health Sciences, Universidade Federal de São Paulo, Santos, Brazil
| | - Melissa Y Kato
- Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, Edifício de Pesquisa II, Rua Pedro de Toledo, 669, 8º Andar, CEP, São Paulo, 04039-032, Brazil
| | | | - Lia R A Bitterncourt
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Department of Psychobiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kil S Lee
- Department of Biochemistry, Escola Paulista de Medicina, Universidade Federal de São Paulo, Edifício de Pesquisa II, Rua Pedro de Toledo, 669, 8º Andar, CEP, São Paulo, 04039-032, Brazil.
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Zhang L, Cheng X, Xia L, Liu N, Liu L, Liu S, Wang S, Yin J. Analysis of 16s rRNA Gene Sequencing in Feces: The Impact of Bariatric Surgery on the Gut Microbiota in Patients with Obesity. Obes Surg 2024; 34:1185-1195. [PMID: 38388967 DOI: 10.1007/s11695-024-07087-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Obesity is a risk factor for many chronic diseases. This study aimed to investigate the effect of bariatric surgery on the gut microbiota from patients with obesity. MATERIALS AND METHODS The microbiota composition from stool samples before and after bariatric surgery were identified using bacterial 16S rRNA gene sequencing. Based on the speed of weight loss, patients were classified as the slow-loss group and fast-loss group. The ɑ- and β-diversity analysis was done to compare the species richness, evenness, and overall structure of the microbiota between different groups. Next, linear discriminant analysis effect size (LEfSe) and receiver operating characteristic (ROC) analysis were implemented to identify high-dimensional biomarkers and significantly different species of microbial taxa between different groups. Finally, the pathway analysis was inferred using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) to predict the functional profiling of microbial communities. RESULTS β-diversity analysis suggested that species diversity of preoperative samples of slow-loss group was significantly higher than the fast-loss group. High levels of Oscillospira and Abiotrophia in the preoperative gut microbiota may lead to poor postoperative weight loss. For patients with poor postoperative weight loss due to changes in gut microbiota, the gut microbiota is mainly composed of Lactobacillus. For patients with good postoperative results, the gut microbiota is mainly composed of Escherichia, Robinsonella, and Dialister. In addition, multiple metabolic-related pathways were significantly different between the four groups. CONCLUSION This comparative study revealed biomarker species based on microfloral composition in patients with obesity before and after bariatric surgery.
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Affiliation(s)
- Lijun Zhang
- Department of General Surgery, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China
| | - Xiaolei Cheng
- Department of Endocrinology, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China
| | - Lianli Xia
- Department of Endocrinology, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China
| | - Na Liu
- Department of Endocrinology, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China
| | - Liyin Liu
- Department of General Surgery, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China
| | - Shujuan Liu
- Department of General Surgery, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China
| | - Shaojia Wang
- Department of Gynecology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China.
| | - Jianhui Yin
- Department of General Surgery, The First Hospital of Kunming, 504 Qingnian Road, Kunming, 650118, China.
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Wilson NC, Dilsaver DB, Walters RW, Nandipati KC. Bariatric Surgery Outcomes in Patients with Inflammatory Bowel Disease in the United States: An Analysis of the Nationwide Readmissions Database. Obes Surg 2024; 34:1279-1285. [PMID: 38413497 PMCID: PMC11026179 DOI: 10.1007/s11695-024-07111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/12/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Bariatric surgery has been reported to produce durable weight loss in the management of obesity; sleeve gastrectomy (SG) is the most common bariatric procedure. Obesity is a common comorbidity of inflammatory bowel disease (IBD), and the impact of IBD on short-term SG outcomes has not been widely reported. This study assessed whether IBD was associated with adverse post-SG outcomes. MATERIALS AND METHODS Hospitalizations of patients undergoing SG in the United States were identified using the 2010-2020 Nationwide Readmissions Database (NRD) and stratified by IBD diagnosis. The SG cohort was propensity-matched based on age, biological sex, body mass index (BMI), comorbid diabetes, hypertension, depression, chronic obstructive pulmonary disease, and discharge in quarter four. Primary aims were to compare in-hospital mortality, post-operative complications, and all-cause 90-day readmission between patients with and without IBD. Secondary outcomes were length of stay (LOS) and total hospital cost. RESULTS A total of 2030 hospitalizations were matched. The odds of complication were 48% higher for hospitalizations of patients with IBD (11.1% vs. 7.8%; aOR 1.48, aOR 95% CI 1.10-2.00, p = .009). The most common complication was nausea (4.9% vs. 3.7%, p = .187). No statistically significant difference was observed for all-cause 90-day readmissions, LOS, or hospital cost. CONCLUSION Hospitalizations of patients with IBD who underwent SG experienced significantly higher post-operative complication rates. However, the similar lengths of stay and readmission rates compared to propensity-matched SG hospitalizations without IBD suggest many complications were minor. SG remains a safe weight loss procedure for patients suffering from IBD and obesity.
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Affiliation(s)
- Noah C Wilson
- School of Medicine, Creighton University, 2500 California Plaza, Omaha, NE, 68178, USA
| | - Danielle B Dilsaver
- Department of Clinical Research and Public Health, School of Medicine, Creighton University, 7710 Mercy Road, Education Building, Suite 502, Omaha, NE, 68124, USA
| | - Ryan W Walters
- Department of Clinical Research and Public Health, School of Medicine, Creighton University, 7710 Mercy Road, Education Building, Suite 502, Omaha, NE, 68124, USA
| | - Kalyana C Nandipati
- Department of Surgery, School of Medicine, Creighton University, 7710 Mercy Road, Education Building, Suite 501, Omaha, NE, 68124, USA.
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Bacha F, Gupta R, Jenkins TM, Brandt ML, Inge TH, Kleiner DE, Xanthakos SA. Prognostic factors in resolution of nonalcoholic fatty liver disease post bariatric surgery in adolescents. Surg Obes Relat Dis 2024; 20:367-375. [PMID: 38155077 DOI: 10.1016/j.soard.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/31/2023] [Accepted: 11/12/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The long-term effect of bariatric surgery on adolescent non-alcoholic fatty liver disease is not clear. OBJECTIVES To evaluate longitudinal change in serum alanine aminotransferase (ALT) levels and to determine the factors independently associated with this change over 2 years after bariatric surgery in adolescents with severe obesity. SETTING An observational prospective cohort from the Teen-LABS Consortium. METHODS We examined the relationship of longitudinal change in serum ALT (% change and normalization) to change in body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides (TG), high- (HDL) and low-density lipoprotein cholesterol, A1C and fasting glucose, accounting for age, sex, race-ethnicity, blood pressure, and baseline BMI in 219 adolescents during the first 2 years post-surgery. RESULTS Mean BMI declined from a baseline of 52.6 to 37.2 kg/m2 at 2 years (P < .01). Alanine aminotransferase decreased significantly from baseline (36.5 [95% CI: 31.4, 41.7]) to 6 months (30.5 [95% CI: 25.4, 35.6]), and remained stable at 12 and 24 months, all P < .01 versus baseline. After adjustment, improvement in BMI, fasting glucose, HOMA-IR, triglycerides, TG/HDL ratio, and HDL were independently associated with reduced ALT at 6 months. These remained significantly associated with a decline in ALT after adjusting for BMI change. The %participants with elevated ALT decreased from 71% at baseline to 42% and 36% at 1 and 2 years post-surgery. CONCLUSIONS Bariatric surgery resulted in significant and sustained improvement in ALT levels over 2 years. Although associated with weight loss, this decline was also associated with improved metabolic indices, independent of weight loss.
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Affiliation(s)
- Fida Bacha
- Children's Nutrition Research Center and Division of Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Resmi Gupta
- Department of Internal Medicine, Division of Clinical and Translational Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Todd M Jenkins
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary L Brandt
- Department of Surgery, Tulane University School of Medicine and Children's Hospital New Orleans, New Orleans, Louisiana
| | - Thomas H Inge
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - David E Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stavra A Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Alkhamees NH, Ali OI, Abdelraouf OR, Ibrahim ZM, Mohamed AA. Assessment of Isokinetic Trunk Muscle Strength and Fatigue Rate in Individuals after Bariatric Surgery. Medicina (Kaunas) 2024; 60:534. [PMID: 38674180 PMCID: PMC11052368 DOI: 10.3390/medicina60040534] [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] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Lean body mass loss after bariatric surgery (BS) is remarkable, despite an effective long-term mass reduction and significant declines in comorbidities. A person's functional capacity is adversely affected when their skeletal muscle strength declines by up to 30%. This study aimed to assess the isokinetic trunk muscle strength and fatigue rate in individuals after BS. Materials and Methods: This study included fifty-eight patients, both male and female, ranging in age from 19 to 45. Twenty-seven individuals had BS and twenty-seven healthy people served as the control group. The primary outcomes were the measurement of the concentric and eccentric isokinetic muscle strength of the trunk flexor and extensor muscles. An isokinetic dynamometer (Biodex Rehabilitation and Testing System 3) was used for the assessment of the isokinetic muscle strength. Noraxon EMG was used to determine a secondary outcome, which was the median frequency slop (MF/time) and root mean square slop (RMS/time) of the lumbar erector spinea muscle at 50% of the Maximum Voluntary Isometric Contraction (MVIC). Outcome measures were assessed for both groups. Results: Compared to the control group, the bariatric group showed a lower mean value of both concentric and eccentric isokinetic muscle strength for the flexor and extensor trunk muscles (p < 0.05). In terms of the EMG fatigue rate, the RMS slope increased significantly more than that of the control group, while the MF slope decreased (p > 0.05). Conclusions: The current study found that, in comparison to the healthy subjects, the BS group showed reduced levels of fatigue and isokinetic strength in the trunk muscles. Based on these results, it is recommended that individuals who underwent BS take part in tailored rehabilitation programs to avoid potential musculoskeletal issues in the future.
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Affiliation(s)
- Nouf H. Alkhamees
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh 11671, Saudi Arabia;
| | - Olfat Ibrahim Ali
- Physical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (O.I.A.); (O.R.A.)
| | - Osama R. Abdelraouf
- Physical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia; (O.I.A.); (O.R.A.)
| | - Zizi M. Ibrahim
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University (PNU), Riyadh 11671, Saudi Arabia;
| | - Aya Abdelhamied Mohamed
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
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Sapino G, Soldini C, Schiraldi L, Di Summa P. [Treatment of abdominal lipocutaneous excess in massive weight loss patients]. Rev Med Suisse 2024; 20:584-589. [PMID: 38506459 DOI: 10.53738/revmed.2024.20.866.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
In massive weight loss patients, abdominal lipocutaneous excess is a frequently encountered complication with major psychological, medical and functional consequences. A wide variety of corrective techniques exists, each with its advantages and side effects, and the choice of the technique must be made in conjunction with the patient, taking into account his unique anatomy, his wishes and his risk factors, in order to obtain the best aesthetic result while minimising the per- and post-operative complications. Liposuction, if prudently executed with the correct technique, permits a further harmonisation of the body contour in zones not reached by the surgical correction, representing a very useful and efficient additional tool.
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Affiliation(s)
- Gianluca Sapino
- Service de chirurgie plastique et reconstructive, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Cecilia Soldini
- Service de chirurgie cardiaque, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Luigi Schiraldi
- Service de chirurgie plastique et reconstructive, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Pietro Di Summa
- Service de chirurgie plastique et reconstructive, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Granero-Molina J, Jiménez-Lasserrotte MDM, Arias Hoyos C, Sánchez MJT, Fernández-Sola C, Ruiz-Fernández MD. Sexuality and self-concept of morbidly obese women who are sexually attracted to men after bariatric surgery: a phenomenological study. BMC Womens Health 2024; 24:174. [PMID: 38481251 PMCID: PMC10936016 DOI: 10.1186/s12905-024-03014-1] [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: 12/29/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Morbid Obesity (MO) is a public health problem that affects a person's physical, psychological and sexual well-being. Women with MO are affected by their body image and self-concept, and obesity stigma may affect women in social and sexual relationships. OBJECTIVE To describe and understand the experiences of morbidly obese heterosexual women (who are sexually attracted to men) in relation to their body image and sexuality after bariatric surgery. METHODOLOGY Qualitative study using Merleau-Ponty's hermeneutic phenomenology as a philosophical framework. Data collection took place between 2020 and 2021 in a southern Spanish province. A total of 22 in-depth interviews were conducted using open-ended questions until data saturation was reached. RESULTS Two main themes were identified: (1) "Escaping from a cruel environment": weight loss to increase self-esteem; with the sub-themes: 'I love myself now', and 'Body image and social relationships; a vicious circle; (2) "Now, I am truly me": accepting my body to reclaim my sexuality, with the sub-themes: 'The body as the focal point of sexuality', and 'When regaining your sex drive reignites your sex life and relationship'. CONCLUSION Weight loss and body acceptance radically change morbidly obese women's sex lives after bariatric surgery. They rediscover their bodies, have increased self-esteem, and see improvements in their social relationships and sexuality. These women feel seen, loved and desired, and now value their body image and femininity. As they go through continuous improvements following bariatric surgery, they gradually regain self-esteem, acceptance of their bodies and control over their sex life. Even though the women's partners benefit from these improvements, they seem to be afraid of being left.
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Affiliation(s)
- José Granero-Molina
- Physiotheraphy and Medicine Department, University of Almería, Almería, Spain
- Faculty of Health Sciences, Universidad Autónoma de Chile, Chile, Santiago, 7500000, Spain
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Giannopoulos S, Li WS, Kalantar Motamedi SM, Embry M, Stefanidis D. Outcome comparison between primary and revisional bariatric surgery: A propensity-matched analysis. Surgery 2024; 175:592-598. [PMID: 37730514 DOI: 10.1016/j.surg.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/08/2023] [Revised: 06/09/2023] [Accepted: 07/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Revisional bariatric procedures for weight recurrence are rising but are considered higher risk and less effective than primary bariatric procedures. This study aimed to compare clinical outcomes between primary and revisional bariatric surgery for weight recurrence. METHODS Prospectively collected data from adult patients who underwent revisional or primary bariatric surgery from 2016 to 2020 in an academic institution were reviewed. Roux-en-Y gastric bypass and sleeve gastrectomy were performed primarily or as conversion procedures after laparoscopic adjustable gastric band, vertical banded gastroplasty, and sleeve gastrectomy. 1:1 propensity score matching was performed between revisional bariatric surgery and primary bariatric surgery, and logistic regression analysis was used to compare up to 2-year weight loss and comorbidity resolution outcomes. RESULTS A total of172 cases (86 revisional bariatric surgery versus 86 primary bariatric surgery) were included. Groups were matched for age, sex, preoperative body mass index, bariatric procedure, diabetes, hypertension, and obstructive sleep apnea. Procedure duration (203 ± 78 vs 154 ± 69 minutes; P < .001) and length of stay (2.3 ± 2.1 vs 1.7 ± 1 days; P = .02) were longer for revisional bariatric surgery versus primary bariatric surgery, respectively. Total weight loss was less in revisional bariatric surgery compared with primary bariatric surgery at 1 year (23 ± 10% vs 32 ± 9%; P < .001) and 2 years (21 ± 12.% vs 32 ± 10%; P < .001) of follow-up; however, no differences were detected in postoperative occurrences, emergency department visits, readmissions, reintervention and reoperation rates, and comorbidity resolution. CONCLUSION Although revisional bariatric surgery was associated with longer operation times, prolonged hospitalization, and lower weight loss than primary bariatric surgery, it was accomplished safely and led to substantial weight loss and comorbidity resolution. This information can guide patient counseling before revisional surgery for weight recurrence.
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Affiliation(s)
- Spyridon Giannopoulos
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/sgianno_MD
| | - Wendy S Li
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN. https://twitter.com/md_wendyli
| | | | - Marisa Embry
- Section of Bariatric Surgery, Indiana University Health North Hospital, Carmel, Indianapolis, IN
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Huang J, Liao C, Zhou W, Li H. Incidence rate and implications of splenic ischemia during sleeve gastrectomy and its related procedure. Medicine (Baltimore) 2024; 103:e37276. [PMID: 38428862 PMCID: PMC10906596 DOI: 10.1097/md.0000000000037276] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024] Open
Abstract
Splenic ischemia (SI) is a common finding during sleeve gastrectomy (SG) procedures; however, reports are still lacking. In this study, we retrospectively analyzed our SG patients to understand better the incidence rate and implications of SI. Patients' data from the beginning of the year 2021 until December 2022 that underwent bariatric surgery at our university hospital were retrospectively analyzed. Patient surgery video was reviewed by all the authors to investigate the incidence of SI. Thereafter, the corresponding patient age, height, weight, BMI, and their postoperative day 1 (POD1) temperature and blood routine test results (patients were routinely discharged at POD2) were collected and analyzed. 204 patients were included in this study. The mean age and preoperative BMI were 31.7 ± 7.4 years old and 38.8 ± 5.6 kg/m2, respectively. SI was observed in 18 cases (8.8%). 30-day readmission rate was seen in 3 patients (1.5%, all without SI during the primary surgery). There was no statistical difference with regard to the POD1 temperature and blood test results between the patients with and without SI. The incidence of SI during sleeve gastrectomy-related procedures is a common finding in our study. We did not observe significant differences postoperatively between the patients with and without SI before discharge. Further study is needed to understand the mechanism for the incidence of SI during SG.
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Affiliation(s)
- Jinrong Huang
- Department of Gastrointestinal Surgery, the Ningde Municipal Hospital of Ningde Normal University, Ningde Fujian, P. R. China
| | - Chenglong Liao
- Department of Gastrointestinal Surgery, the Ningde Municipal Hospital of Ningde Normal University, Ningde Fujian, P. R. China
| | - Weiwei Zhou
- Department of Gastrointestinal Surgery, the Ningde Municipal Hospital of Ningde Normal University, Ningde Fujian, P. R. China
| | - Hancheng Li
- Department of Gastrointestinal Surgery, the Ningde Municipal Hospital of Ningde Normal University, Ningde Fujian, P. R. China
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Ponce de Leon-Ballesteros G, Pouwels S, Romero-Velez G, Aminian A, Angrisani L, Bhandari M, Brown W, Copaescu C, De Luca M, Fobi M, Ghanem OM, Hasenberg T, Herrera MF, Herrera-Kok JH, Himpens J, Kow L, Kroh M, Kurian M, Musella M, Narwaria M, Noel P, Pantoja JP, Ponce J, Prager G, Ramos A, Ribeiro R, Ruiz-Ucar E, Salminen P, Shikora S, Small P, Stier C, Taha S, Taskin EH, Torres A, Vaz C, Vilallonga R, Verboonen S, Zerrweck C, Zundel N, Parmar C. Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m 2): a Modified Delphi Study. Obes Surg 2024; 34:790-813. [PMID: 38238640 DOI: 10.1007/s11695-023-06990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. METHODS A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved. RESULTS A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. CONCLUSION This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.
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Affiliation(s)
- Guillermo Ponce de Leon-Ballesteros
- Department of Surgery, Hospital Angeles Morelia, Morelia, Postal: 331, Int. B-502, Av. Montaña Monarca, Montaña Monarca, 58350, Morelia, Michoacan, Mexico.
| | - Sjaak Pouwels
- Department of General, Abdominal Surgery and Coloproctology, Helios St. Elisabeth Hospital, Oberhausen, NRW, Germany
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Ali Aminian
- Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, Federico II" University of Naples, Naples, Italy
| | | | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Australia
| | - Catalin Copaescu
- Department of Surgery, Ponderas Academic Hospital, Bucharest, Romania
| | | | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Till Hasenberg
- Helios Obesity Center West, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Miguel F Herrera
- Clinic for Nutrition and Obesity, The American British Cowdray Medical Center Observatorio, Mexico City, Mexico
- Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Johnn H Herrera-Kok
- Department of General and Digestive Surgery, University Hospital of Leon, Leon, Spain
| | - Jacques Himpens
- Bariatric Surgery Unit, Delta CHIREC Hospital, Brussels, Belgium
| | - Lilian Kow
- Flinders Medical Centre, Adelaide, Australia
| | - Matthew Kroh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Mario Musella
- Advanced Biomedical Sciences Department, "Federico II" University of Naples, Naples, Italy
| | | | - Patrick Noel
- Clinique Bouchard, ELSAN, Marseille, France
- Emirates Specialty Hospital, DHCC, Dubai, UAE
| | - Juan P Pantoja
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Jaime Ponce
- CHI Memorial Hospital Chattanooga, Chattanooga, TN, USA
| | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Rui Ribeiro
- Department of General Surgery, Hospital Lusiadas Amadora, Amadora, Portugal
| | - Elena Ruiz-Ucar
- Department of Bariatric and Endocrine Surgery, Fuenlabrada University Hospital, Madrid, Spain
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Scott Shikora
- Department of Surgery, Division of Gastrointestinal and General Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter Small
- Directorate of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Christine Stier
- Department of Interdisciplinary Endoscopy and Visceral Surgery, University Hospital Mannheim, Mannheim, Germany
| | - Safwan Taha
- Bariatric and Metabolic Surgery Center, Mediclinic Hospital Airport Road, Abu Dhabi, UAE
| | - Eren Halit Taskin
- Department of Surgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Antonio Torres
- General and Digestive Surgery Service, Department of Surgery, Hospital Clínico San Carlos, Complutense University Medical School, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - Carlos Vaz
- Obesity and Metabolic Surgery Unit, Hospital CUF Tejo, Lisbon, Portugal
| | - Ramon Vilallonga
- Department of Surgery, Enodcrine-Metabolic and Bariatric Surgery Unit, Vall Hebron Barcelona Hospital Campus, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Carlos Zerrweck
- The American British Cowdray Medical Center Santa Fe, Mexico City, Mexico
| | - Natan Zundel
- Department of Surgery, University of Buffalo, Buffalo, NY, USA
| | - Chetan Parmar
- Department of Surgery, The Whittington Hospital NHS Trust, London, UK
- Apollo Hospitals Educational and Research Foundation, Hyderabad, India
- University College London, London, UK
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Lodewijks Y, van Ede L, Scheerhoorn J, Bouwman A, Nienhuijs S. Patient's Preference for Same-Day Discharge or Hospitalization After Bariatric Surgery. Obes Surg 2024; 34:716-722. [PMID: 38278982 DOI: 10.1007/s11695-024-07068-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE Enhanced Recovery After Bariatric Surgery protocols have proven to be effective in reducing complication rates and length of stay. Guidelines do not include a recommendation on the length of hospital stay whereas same-day discharge is currently widely investigated on safety and feasibility. However, none of these studies takes patient preferences into account. The study aimed to reveal the patient's preference for outpatient surgery (OS) in patients who underwent primary bariatric surgery. MATERIALS AND METHODS A single-center preference-based randomized trial was performed between March and December of 2021. Adult patients planned for primary bariatric surgery were able to choose their care pathway, either OS with remote heart and respiratory rate monitoring by a wearable data logger or standard care with at least one-night hospitalization. RESULTS Out of the 202 patients, nearly everyone (98.5%) had a preference. Of 199 patients, 99 (49.7%) chose inpatient surgery. Of the 100 with a preference for OS, 23 stayed in the hospital due to medical reasons and 12 patients changed their preference. Based on both initial preference and changed preference, there were no differences between sex, age, body mass index, and co-morbidities such as diabetes mellitus, hypertension, and atrial fibrillation, nor in the use of anticoagulants or type of surgery. CONCLUSION Patients seemed to have a strong preference for their stay after a bariatric procedure. The preference is equally divided between outpatient and inpatient surgery and is not influenced by any patient characteristics.
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Affiliation(s)
- Yentl Lodewijks
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Lisa van Ede
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Jai Scheerhoorn
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- Department of Electrical Engineering, Signal Processing Systems, Eindhoven Technical University, De Zaale, Eindhoven, The Netherlands
| | - Simon Nienhuijs
- Department of Obesity Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Bezerra A, Boppre G, Freitas L, Battista F, Duregon F, Faggian S, Busetto L, Ermolao A, Fonseca H. Body Composition Changes in Adolescents Who Underwent Bariatric Surgery: A Systematic Review and Meta-analysis. Curr Obes Rep 2024; 13:107-120. [PMID: 38172484 PMCID: PMC10933211 DOI: 10.1007/s13679-023-00549-6] [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] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review and meta-analysis is to characterize the changes in body composition of children and adolescents who underwent bariatric surgery and identify possible negative effects of performing this procedure during pediatric ages. RECENT FINDINGS Bariatric surgery in children and adolescents is an emerging strategy to promote higher and faster body weight and fat mass losses. However, possible negative effects usually observed in surgical patients' muscle-skeletal system raise a major concern perform this intervention during growth. Despite these possible issues, most experimental studies and reviews analyze bariatric surgery's effectiveness only by assessing anthropometric outcomes such as body weight and BMI, disregarding the short- and long-term impact of bariatric surgery on all body composition outcomes. Bariatric surgery is effective to reduce fat mass in adolescents, as well as body weight, waist circumference, and BMI. Significant reduction in lean mass and fat-free mass is also observed. Bone mass seems not to be impaired. All outcomes reduction were observed only in the first 12 months after surgery. Sensitivity analysis suggests possible sex and type of surgery-related differences, favoring a higher fat mass, body weight, and BMI losses in boys and in patients who underwent RYGB.
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Affiliation(s)
- Andréa Bezerra
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Human Motricity Research Center, University Adventista, Chillean, Chile
| | - Laura Freitas
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Sara Faggian
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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