共查询到20条相似文献,搜索用时 31 毫秒
1.
Reza Nemati Jun Lu Michael Booth Lindsay D. Plank Rinki Murphy 《Obesity surgery》2018,28(9):2672-2686
Background
Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are both effective bariatric procedures to treat type 2 diabetes (T2DM) and obesity. The contribution of changes in bile acids (BAs) and fibroblast growth factor19 (FGF19) to such metabolic improvements is unclear.Methods
We examined associations between changes in BAs, FGF19 (fasting and prandial), with changes in body weight, glycemia, and other metabolic variables in 61 obese patients with T2DM before and 1 year after randomization to SG or RYGB.Results
Weight loss and diabetes remission (defined by HbA1c <?39 mmol/mol [<?5.7%] in the absence of glucose-lowering therapy) after RYGB and SG was similar (mean weight loss ??29 vs ??31 kg, p?=?0.50; diabetes remission proportion 37.5 vs 34%, p?=?1.0). Greater increments in fasting and prandial levels of total, secondary, and unconjugated BAs were seen after RYGB than SG. Fasting and prandial increases in total (r?=???0.3, p?=?0.01; r?=???0.2, p?=?0.04), secondary (r?=???0.3, p?=?0.01; r?=???0.4, p?=?0.01) and unconjugated BA (r?=???0.3, p?=?0.01; r?=?0.4, p?<?0.01) correlated with decreases in HbA1c, but not weight. Changes in 12α-OH/non 12α-OH were positively associated with prandial glucose increments (r?=?0.2, p?=?0.03), HbA1c (r?=?0.3, p?=?0.01), and negatively associated with changes in insulinogenc index (r?=???0.3, p?=?0.01). Only changes in prandial FGF19 were negatively associated with HbA1c (r?=???0.4, p?<?0.01) and visceral fat (r?=???0.3, p?=?0.04).Conclusions/interpretation
The association between increases in secondary, unconjugated BAs and improvements in HBA1c (but not weight) achieved after both RYGB and SG suggest manipulation of BA as a potential strategy for controlling T2DM through weight-independent means.2.
Mirko Otto Mohamad Elrefai Johannes Krammer Christel Weiß Peter Kienle Till Hasenberg 《Obesity surgery》2016,26(3):479-485
Background
Bariatric surgery is a safe and established treatment option of morbid obesity. Mere percentage of excess weight loss (%EWL) should not be the only goal of treatment.Methods
One hundred seventy-three obese patients were included in the study. They underwent either Roux-en-Y gastric bypass (RYGB; n?=?127, mean body mass index (BMI) 45.7?±?5.7 kg/m2) or sleeve gastrectomy (SG; n?=?46, mean BMI 55.9?±?7.8 kg/m2) for weight reduction. Body weight and body composition were assessed periodically by bioelectrical impedance analysis.Results
After 1 year of observation, %EWL was 62.9?±?18.0 % in RYGB and 52.3?±?15.0 % in SG (p?=?0.0024). Body fat was reduced in both procedures with a slight preference for SG, and lean body mass was better preserved in the RYGB group. Due to significant differences in the initial BMI between the two groups, an analysis of covariance was performed, which demonstrated no significant differences in the %EWL as well as in the other parameters of body composition 1 year after surgery. Using percentage of total weight loss to evaluate the outcomes between the two procedures, no significant difference was found (31.7?±?8.4 % in RYGB and 30.5?±?7.6 % in SG patients, p?>?0.4).Conclusions
Excess weight loss is highly influenced by the initial BMI. Total weight loss seems to be a better measurement tool abolishing initial weight differences. SG and RYGB do not differ in terms of body composition and weight loss 1 year after surgery.3.
Ricard Corcelles Mena Boules Dvir Froylich Amani Hag Christopher R. Daigle Ali Aminian Stacy A. Brethauer Barto Burguera Philip R. Schauer 《Obesity surgery》2016,26(8):1794-1798
Background
Currently, there is no agreement on the best method to describe weight loss (WL) after bariatric surgery. The aim of this study is to evaluate short-term outcomes using percent of total body weight loss (%TWL).Methods
A single-institution retrospective study of 2420 patients undergoing Roux-en-Y gastric bypass (RYGB) was performed. Suboptimal WL was defined as %TWL?<?20 % at 12 months.Results
Mean preoperative BMI was 46.8?±?7.8 kg/m2. One year after surgery, patients lost an average 14.1 kg/m2 units of body mass index (BMI), 30.0?±?8.5 %TWL, and 68.5?±?22.9 %EWL. At 6 and 12 months after RYGB, mean BMI and percent excess WL (%EWL) significantly improved for all baseline BMI groups (p?<?0.01, BMI; p?=?0.01, %EWL), whereas mean %TWL was not significantly different among baseline BMI groups (p?=?0.9). The regression analysis between each metric outcome and preoperative BMI demonstrated that preoperative BMI did not significantly correlate with %TWL at 1 year (r?=?0.04, p?=?0.3). On the contrary, preoperative BMI was strongly but negatively associated with the %EWL (r?=??0.52, p?<?0.01) and positively associated with the BMI units lost at 1 year (r?=?0.56, p?<?0.01). In total, 11.3 % of subjects achieved <20 %TWL at 12 months and were considered as suboptimal WL patients.Conclusion
The results of our study confirm that %TWL should be the metric of choice when reporting WL because it is less influenced by preoperative BMI. Eleven percent of patients failed to achieve successful WL during the in the first year after RYGB based on our definition.4.
Hinali Zaveri Ramsey M. Dallal Daniel Cottam Amit Surve Susan Kartiko Fernando Bonnani Austin Cottam Samuel Cottam 《Obesity surgery》2016,26(10):2285-2290
Background
Roux-en-Y gastric bypass (RYGB) is one of the best-known and most commonly performed bariatric procedures. However, this procedure carries infrequent but serious long-term complications, which may require revisional procedures. This study reports the indications and outcomes of gastric bypass reversal that have not been described well in the literature.Methods
A multicenter retrospective study of 50 patients who underwent reversal of RYGB conducted between 2006 and 2015 was reviewed to describe the usual indications and outcomes of gastric bypass reversal surgeries.Results
Of 50 patients, 7 (14 %) were males and 43 (86 %) were females. The mean age of the patient population was 40.4?±?11.6 years (range 19–66). Reasons for reversal included anastomotic ulcers (n?=?27), anastomotic complications (n?=?9), malnutrition (n?=?2), and functional disorder (n?=?12). The mean BMI before the reversal was 29?±?9.4 kg/m2 (range 16–60). The mean time between the primary procedure and reversal was 60?±?65.5 months (range 2–300). Fourteen of the reversals were done via laparotomy. Mean hospital stay was 8.4?±?7.3 days (range 3–34 days). There was no peri-operative death 30 days after reversal. Following gastric bypass reversal, 92.6 % (n?=?25) of the patient population had resolution from ulcers, 77.8 % (n?=?7) of the patient population had resolution from anatomic complications, 100 % (n?=?2) of the patient population had resolution from malnutrition, and 66.7 % (n?=?8) of the patient population had resolution from functional disorders.Conclusions
Gastric bypass reversal is a reasonable and safe treatment for complications arising from the GBP surgery. A laparoscopic approach is feasible in select patients.5.
Der-Ming Chang Wei-Jei Lee Jung-Chien Chen Kong-Han Ser Pei-Ling Tsai Yi-Chih Lee 《Obesity surgery》2018,28(10):2991-2997
Background
Laparoscopic sleeve gastrectomy (LSG) has been validated as a safe and effective treatment for morbid obesity. However, data of the long-term outcome remains lacking.Methods
A total of 1759 LSG was performed as primary bariatric procedure from 2005 to 2017 with mean age of 35.2?±?10.3 years old (14–71), female 69.7%, mean body mass index (BMI) 37.9?±?7.7 kg/m2, and mean waist width 113.7?±?17.9 cm. All patients were evaluated and managed under a strict multidisciplinary team approach. A retrospective analysis of a prospective bariatric database and telephone interview of patients who defaulted clinic follow-up at 10 years was conducted.Results
The mean operating time, intraoperative blood, and hospital stay of LSG were 121.5?±?36.5 min, 40.8?±?69.7 ml, and 2.8?±?2.7 days, respectively. The 30-day postoperative major complication occurred in 25 (1.4%) patients. The major complication rate was 15% at first year and 0% at the last year. The follow-up rate at 1, 5 and 10 years were 89.3%, 52.1 and 64.4%. At postoperative 1, 5, and 10 years, the mean percentage of total weight loss (%TWL) and excess weight loss (EWL%) of LSG patients were 33.4, 28.3, and 26.6% and 92.2, 80.1, and 70.5%, respectively. The mean BMI became 27, 26.2, and 27.1 kg/m2 at postoperative 1, 5, and 10 years. At follow-up, a total 69 patients needed surgical revision due to reflux disease (n?=?45), weight regain (n?=?19), persistent diabetes (n?=?2), and chronic fistula (n?=?3). The type of revision procedures were hiatal repair and gastropexy (n?=?29), Roux-en Y gastric bypass (RYGB) (n?=?23), and single anastomosis bypass (n?=?17) with median time to revision 33 months (range 3–62). At 10 years, the overall revision rate was 21.5% (14/65) and 11(16.9%) of 65 patients were converted to RYGB. The other 54 patients remained at LSG anatomy, but 45% of them required proton pump inhibitor for reflux symptoms.Conclusions
Our results showed that primary LSG is a durable primary bariatric procedure with sustained weight loss and a high resolution of comorbidities at 10 years, but about half the patients had de novo GERD. The need for conversion to RYGB was 16.9% at 10 years.6.
Fernanda R. Azevedo Sergio Santoro Maria L. Correa-Giannella Marcos T. Toyoshima Daniel Giannella-Neto Daniela Calderaro Danielle M. Gualandro Pai C. Yu Bruno Caramelli 《Obesity surgery》2018,28(10):3012-3019
Purpose
To compare the effects of the sleeve gastrectomy with transit bipartition (SG?+?TB) procedure with standard medical therapy (SMT) in mildly obese patients with type II diabetes (T2D).Methods
This is a prospective, randomized, controlled trial. Twenty male adults, ≤?65 years old, with T2D, body mass index (BMI)?>?28 kg/m2 and <?35 kg/m2, and HbA1c level?>?8% were randomized to SG?+?TB or to SMT. Outcomes were the remission in the metabolic and cardiovascular risk variables up to 24 months.Results
At 24 months, SG?+?TB group showed a significant decrease in HbaA1c values (9.3?±?2.1 versus 5.5?±?1.1%, P?=?<?0.05) whereas SMT group maintained similar levels from baseline (8.0?±?1.5 versus 8.3?±?1.1%, P?=?NS). BMI values were lower in the SG?+?TB group (25.3?±?2.8 kg/m2 versus 30.9?±?2.5 kg/m2; P?=?<?0.001). At 24 months, none patient in SG?+?TB group needed medications for hyperlipidemia/hypertension. HDL-cholesterol levels increased in the SG?+?TB group (33?±?8 to 45?±?15 mg/dL, P?<?0.001). After 24 months, the area under the curve (AUC) of GLP1 increased and in the SG?+?TB group and the AUC of the GIP concentrations was lower in the SG?+?TB group than in the SMT. At 3 months, SG?+?TB group showed a marked increase in FGF19 levels (74.1?±?45.8 to 237.3?±?234 pg/mL; P?=?0.001).Conclusions
SG?+?TB is superior to SMT and was associated with a better metabolic and cardiovascular profile.7.
Ece A Kelekçi S Hekimoğlu A Kocamaz H Balik H Yolbaş I Erel O 《Pediatric nephrology (Berlin, Germany)》2007,22(8):1151-1157
The aim of this study was to investigate the role of neutrophil activation, protein oxidation and ceruloplasmin (CLP) in the pathogenesis of Henoch-Schönlein purpura (HSP), which has not been investigated previously. Serum activities of myeloperoxidase (MPO) and arylesterase (ARYL) and levels of free thiol groups, CLP and total oxidant status (TOS) were measured in 29 children with HSP at the onset of the disease and during remission in comparison with 30 healthy subjects. Patients at active stage had significantly higher MPO activity (391?±?277 vs. 155?±?154 U/l, P?0.001), higher CLP (832?±?120 vs. 682?±?114 mg/dl, P?0.001) and TOS values (20.7?±?11.8 vs. 7.5?±?2.8 μmol H2O2/l, P?0.001) than the controls, respectively. Patients had significantly lower ARYL activity (158?×?103?±?39?×?103 vs. 187?×?103?±?46?×?103 U/l, P?0.001) and lower free thiol levels (234?±?48 vs. 279?±?26 μmol/l, P?0.001) than the controls, respectively. Significantly positive correlations were found between TOS and MPO (r?=?0.437, P?=?0.018) and TOS and CLP (r?=?0.409, P?=?0.028) at disease onset, whereas a negative correlation was found between MPO and thiol (r?=??0.597, P?=?0.001) during remission. In conclusion, protein oxidation and neutrophil activation may play important roles in the pathogenesis of HSP. Further research is required to understand the potential linkage between oxidant stress and complications and to develop therapeutic strategies in HSP. 相似文献
8.
James Yoon Jingjing Sherman Alexandra Argiroff Edward Chin Daniel Herron William Inabnet Subhash Kini Scott Nguyen 《Obesity surgery》2016,26(11):2611-2615
Background
Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most common bariatric surgeries for treating morbid obesity. The purpose of this study is to determine differences in outcomes from RYGB or SG between patients ages?≥?60 years and?<?60 years.Methods
A retrospective review of patients who underwent RYGB and SG at our institution from 01/2008 to 05/2012 was conducted. Forty patients from each group (≥60 years and?<?60 years) were matched based on gender, body mass index (BMI), co-morbidities, and type of bariatric surgery performed, and their charts were reviewed up to 1 year post-operatively. Primary end points measured were mean length of stay, operative time, incidence of complications, and readmissions in the first post-operative year. A secondary end point measured was percent total weight loss (%TWL) and excess weight loss (%EWL).Results
There were no significant differences between group?<?60 and group?≥?60 in operative time (210 vs. 229 min; p?=?0.177), in-hospital post-operative complication rates (2.5 vs. 5 %; p?=?1.0), long-term complication rates (2.5 vs. 10 %; p?=?0.359), and 30-day readmission rates (2.5 vs. 12.5 %; p?=?0.2). Patients in group?<?60 had shorter lengths of stay (2.2 vs. 2.7 days; p?=?0.031), but this difference is not clinically significant. Both groups achieved similar %TWL (21.4 vs. 20.5 %; p?=?0.711) and %EWL (50.6 vs. 50.7 %; p?=?0.986).Conclusions
Advanced age (≥60 years) is not a significant predictor of a worse outcome for SG and RYGB.9.
Emilie Montastier Guillaume Becouarn Emilie Bérard Sophie Guyonnet Philippe Topart Patrick Ritz 《Obesity surgery》2016,26(8):1806-1813
Background
Roux-en-Y gastric bypass (RYGB) has recently been authorized for use in older patients. The objective of this single-center study was to evaluate 2-year weight loss in patients ≥60 years compared with younger matched patients undergoing RYGB. Secondary aims were to record complications and the resolution of comorbidities in a 2-year follow-up.Methods
Of 722 patients with at least 2 years follow-up data, 48 elderly patients were matched with 92 young (<40 years) and 96 middle-aged (40–59 year) patients, according to sex, baseline body mass index, and date of surgery. Weight loss, remission of comorbidities, death, and early (30-day) and 2-year complication rates were compared.Results
There were three deaths in the elderly group and none in the other groups. The early complication rate was not significantly different in the elderly group (17.8 %) compared with the young (11.5 %, p?=?0.637) and middle-aged (13.7 %, p?=?1.000) groups. The 2-year complication rates were not significantly different in the elderly group (9.3 %) compared with the young (23.5 %, p?=?0.107) and middle-aged (13.2 %, p?=?1.000) groups. The 2-year weight loss was lower in the elderly group (31.8?±?7.2 %; p?<?0.001) than in the young group (38.3?±?6.9 %) but was not significantly different from that in the middle-aged group (34.4?±?8.0 %; p?=?0.145). Remission rates for diabetes and obstructive sleep apnea were lower in the elderly than in the two younger groups.Conclusion
After bariatric surgery, major weight loss was observed in patients older than 60, but remission of metabolic comorbidities was less marked than in younger subjects.10.
E. Griffo M. Cotugno G. Nosso G. Saldalamacchia A. Mangione L. Angrisani A. A. Rivellese B. Capaldo 《Obesity surgery》2016,26(6):1247-1253
Background
Bariatric surgery (BS) is known to favorably impact fasting lipid profile. Fasting and postprandial lipids were evaluated before and 2 years after BS in obese type 2 diabetic (T2DM) patients.Methods
A prospective study was conducted in 19 obese T2DM patients: ten undergoing sleeve gastrectomy (SG) and nine undergoing Roux-en-Y gastric bypass (RYGB). Before and 2 years after BS, clinical parameters and the response of lipid and incretin hormones to a mixed meal (MM) were assessed.Results
The two groups had similar characteristics at baseline. After BS, weight loss was similar in the two groups (p?≤?0.01). Fasting glucose, insulin, and triglycerides decreased while HDL cholesterol increased in a similar way (p?<?0.05); in contrast, fasting LDL cholesterol decreased only after RYGB (p?<?0.05). Post-meal glucose concentrations decreased while early insulin response significantly improved after both procedures (p?<?0.001 for both). Postprandial triglycerides decreased after both procedures (p?<?0.05) while postprandial LDL cholesterol decreased only after RYGB (p?<?0.05). Meal-GLP-1 increased postoperatively in both groups although to a greater extent after RYGB (p?<?0.001 vs. SG). GIP decreased after both procedures, especially after RYGB (p?=?0.003). At multivariate analysis, GLP-1 peak was the best predictor of LDL reduction (β?=??0.552, p?=?0.039) while the improvement of HOMA-IR (β?=?0.574, p?=?0.014) and weight loss (β?=?0.418, p?=?0.036) predicted triglycerides reduction.Conclusions
Both surgical procedures markedly reduce fasting and postprandial triglycerides and increase HDL cholesterol levels. LDL cholesterol decreases only after RYGB through a mechanism likely mediated by the restoration of GLP-1.11.
Bhumy A. Davé Camaleigh Jaber Alix Leader-Cramer Nicole Higgins Margaret Mueller Christina Lewicky-Gaupp Kimberly Kenton 《International urogynecology journal》2016,27(9):1327-1332
Introduction and hypothesis
There is no consensus on the most appropriate type of anesthesia for placement of a midurethral sling. Our objective was to compare intra- and perioperative outcomes for this procedure performed under general anesthesia versus monitored anesthesia care.Methods
Retrospective cohort analysis of women undergoing outpatient placement of synthetic retropubic midurethral sling under general anesthesia (n?=?141) or monitored anesthesia care (n?=?84). Patients undergoing concomitant procedures were excluded. Primary outcome was operating room time. Secondary outcomes included surgical and recovery times, cost, discharge home with a catheter, and postoperative pain and/or nausea.Results
In the general anesthesia group, both operating room time (mean?±?SD, 67.6?±?13.3 min vs 56.9?±?11.8 min, p?<?0.001) and recovery room time (240.0?±?69.8 min vs 190.1?±?78.3 min, p?<?0.001) were longer, whereas there was no difference in surgical time (30.0?±?8.9 min vs 29.0?±?9.7 min, p?=?0.43). Cost was significantly higher in the general anesthesia group ($4,095?±?715 vs $3,877?±?777, p?=?0.03). There was no difference in rates of bladder perforation (6.4 % vs 11.9 %, p?=?0.33). Patients who underwent general anesthesia had higher rates of discharge with a catheter (27.0 % vs 15.8 %, p?=?0.04).Conclusion
Monitored anesthesia care may offer significant benefits over general anesthesia in women undergoing retropubic midurethral sling, including shorter operating room and recovery times, lower costs, and less voiding dysfunction in the immediate postoperative period.12.
Meng Gu Chong Liu Yan-bo Chen Huan Xu Shi Fu Qi Chen Zhong Wang 《International urology and nephrology》2018,50(5):819-823
Purpose
This study aimed to estimate the validity and applicability of Vela laser enucleation of the prostate (VoLEP) in the management of benign prostatic hyperplasia (BPH).Methods
A retrospective chart review of 112 patients with BPH who underwent VoLEP (n?=?60) or holmium laser enucleation of the prostate (HoLEP) (n?=?56) was conducted at our institution from January 2015 to June 2015. The general and perioperative characteristics of the patients were collected. The 12-month follow-up data, including the lower urinary tract symptom (LUTS) indexes (International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]), as well as rates of perioperative and late complications, were analyzed.Results
No significant differences were observed in pre- and perioperative parameters, including operation time (58.05?±?10.14 vs. 60.14?±?12.30 min, P?=?0.44), serum sodium decrease (3.49?±?0.83 vs. 3.48?±?0.84 mmol/L, P?=?0.97), hemoglobin decrease (1.28?±?0.38 vs. 1.24?±?0.77 g/dL, P?=?0.71), catheterization time (3.63?±?1.10 vs. 3.89?±?1.11 days, P?=?0.21) and hospital stay (4.57?±?1.25 vs. 4.68?±?1.18 days, P?=?0.63) between the two groups of patients. Compared with the HoLEP group, the noise during operation was lower in VoLEP group (47.22?±?10.31 vs. 59.45?±?9.65 db, P?<?0.05). During 1, 6 and 12 months of follow-up visits, the LUTS indexes (I-PSS, QoL score and Qmax) were remarkably improved in both groups when comparing with the baseline values. Furthermore, LUTS indexes were comparable in both groups (P?>?0.05).Conclusion
Similarly as the holmium laser, the Vela laser is a potent, safe, efficient durable and surgical treatment option for minimally invasive surgery in patients with BPH-induced LUTS.13.
Takayuki Tsuji Kazuhisa Ohishi Asumi Takeda Daiki Goto Taichi Sato Naro Ohashi Yoshihide Fujigaki Akihiko Kato Hideo Yasuda 《Clinical and experimental nephrology》2018,22(6):1300-1308
Background
Febuxostat is tolerable in chronic kidney disease (CKD) patients with hyperuricemia. However, the long-term effect of lowering uric acid with febuxostat on renal function and blood pressure has not been elucidated.Methods
This was a 2 years retrospective observational study. 86 CKD patients with hyperuricemia who continued with allopurinol (allopurinol group, n?=?30), switched from allopurinol to febuxostat (switched group, n?=?25), or were newly prescribed febuxostat (febuxostat group, n?=?31) were included in this study. Serum uric acid, estimated glomerular filtration rate (eGFR), blood pressure, and urinary protein were analyzed. Moreover, the impact of serum uric acid reduction on renal function and blood pressure was assessed.Results
Serum uric acid in the switched and febuxostat groups was significantly reduced at 6 months (switched group; 8.49?±?1.32–7.19?±?1.14 mg/dL, p?<?0.0001, febuxostat group; 9.43?±?1.63–6.31?±?0.90 mg/dL, p?<?0.0001). In the allopurinol group, serum uric acid was increased (6.86?±?0.87–7.10?±?0.85 mg/dL, p?=?0.0213). eGFR was significantly increased (35.2?±?12.8–37.3?±?13.9 mL/min/1.73 m2, p?=?0.0232), while mean arterial pressure (93.1?±?10.8–88.2?±?9.5 mmHg, p?=?0.0039) was significantly decreased at 6 months in the febuxostat group, resulting in the retention of eGFR for 2 years.Conclusions
The impact of serum uric acid reduction might have beneficial effects on CKD progression and blood pressure. However, a large prospective study is needed to determine the long-term efficacy of febuxostat therapy in CKD patients with hyperuricemia.14.
Daniela Lopes Gomes Dyanara de Almeida Oliveira Eliane Said Dutra Nathalia Pizato Kênia Mara Baiocchi de Carvalho 《Obesity surgery》2016,26(7):1443-1447
Background
Weight regain 24 months after Roux-en-Y gastric bypass (RYGB) and low protein intake in patients without protein supplementation can favor fat-free mass loss and reduce resting energy expenditure (REE). We aimed to assess REE and its association with the body composition of women with weight regain and no protein supplementation in the late postoperative period of RYGB.Methods
We determined the body mass index (BMI), REE by indirect calorimetry, body composition by tetrapolar bioelectrical impedance analysis, and energy intake by two 24-h recalls of 34 patients with at least 5 % of weight regain and no protein supplementation. The software SPSS v.17 analyzed the data calculating measures of central tendency and dispersion and using Pearson’s correlation to test the association between the variables and the multivariate linear regression model at a p?<?0.05 significance level.Results
Postoperative period was positively associated with weight regain (r?=?0.39; p?=?0.023). The mean percentages of fat and fat-free masses were 45.1?±?8.3 % and 54.3?±?8.1 %, respectively. The mean REE was 1424.7?±?187.2 kcal (14 kcal/kg of the current weight), mean energy intake was 1258.6?±?454.3 kcal, and mean protein intake was 0.9 g/kg of the ideal weight?±?0.3. Fat-free mass was positively associated with REE regardless of protein intake and postoperative period.Conclusions
Female bariatric patients with weight regain and no protein supplementation lose fat-free mass, lowering their REE. Health practices that promote maintenance of BMI and body composition may lead to improved outcomes of bariatric surgery.15.
Chih Kun Huang Chi-Ming Tai Po-Chih Chang Kirubakaran Malapan Ching-Chung Tsai Kamthorn Yolsuriyanwong 《Obesity surgery》2016,26(10):2291-2301
Background
Roux-en-Y gastric bypass (RYGB) has shown good diabetes remission in obese patients with type 2 diabetes mellitus (T2DM), but long-term complications were observed. We developed loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) to achieve diabetes remission and avoid the drawbacks of RYGB. We compare 1-year results between LDJB-SG and RYGB with body mass index (BMI) <35 kg/m2 of T2DM patients.Methods
We conducted a case-matched study of BMI?<?35 kg/m2 T2DM patients who underwent RYGB and LDJB-SG matching on age, BMI, and duration of diabetes. The 1-year surgical results were compared.Results
Sixty patients were included from March 2010 to August 2012. Thirty patients underwent RYGB and 30 underwent LDJB-SG. The operative time (mean?±?SD) and length of stay (median [IQR]) were significantly longer in the LDJB-SG group than in the RYGB group (127.0?±?40.2 vs. 105.0?±?64.7 min and 3[3, 4] vs. 3[2, 3] days, respectively). There were no statistical differences between the groups in the mean BMI, fasting plasma glucose, and %HbA1c either at baseline or at 1 year. However, these parameters dropped significantly from the preoperative values (p?<?0.01). The level of HOMA-%B at 1 year was significantly higher in the LDJB-SG group than in the RYGB group (p?=?0.004). The resolution of comorbidities was similar. Late complications seemed higher in the RYGB group (12 vs. 5, p?=?0.08). There were no deaths, but two patients in each group required reoperation.Conclusions
LDJB-SG was comparable to RYGB in terms of weight loss, glycemic control, and comorbidity resolution in BMI <35 kg/m2 T2DM patients in the short-term.16.
Kaijing Wang Xiaogang Zhou Giang Quach Jiajun Lu Wei Gao Anan Xu Jiangfan Zhu 《Obesity surgery》2016,26(4):797-804
Background
Sleeve gastrectomy plus side-to-side jejunoileal anastomosis (JI-SG), a relatively new approach to bariatric surgeries, has shown promising results for treating obesity and metabolic comorbidities. This study investigated the feasibility and safety of JI-SG in weight loss and diabetes remission compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).Methods
Forty 10-week-old male Zucker diabetic fatty rats were randomly assigned to four groups: control, SG, JI-SG, and RYGB. Their body weights, food intake, and levels of gut hormones (ghrelin, insulin, and glucagon-like peptide-1 (GLP-1)) and lipids were measured.Results
Rats in the SG, JI-SG, and RYGB groups demonstrated lower food intake and more weight loss 2 weeks postoperatively compared with control rats. Furthermore, rats in the JI-SG group achieved more weight loss (mean 242.7?±?11.2 g) compared with those in the SG and RYGB groups (SG, 401.4?±?15.1 g and RYGB, 298?±?12 g, both P?<?0.01). All surgery groups demonstrated a decreased fasting insulin, serum glucose, lipid levels, and increased GLP-1 postoperatively. The JI-SG group had lower fasting ghrelin levels than the RYGB group (168?±?19.8 ng/L vs. 182?±?16.7 ng/L, P?<?0.01) and higher fasting GLP-1 levels than the SG group (1.99?±?0.11 pmol/L vs. 1.71?±?0.12 pmol/L, P?<?0.01) at 12 weeks postoperatively. Over the experimental period, the ghrelin levels slowly increased in all surgical groups but remained lower than the preoperative and control levels.Conclusions
JI-SG induced higher ghrelin and GLP-1 levels and improved glycemic control in Zucker diabetic fatty rats. Compared with SG and RYGB, JI-SG appeared to be a simple, relatively safe, and more effective procedure for treating type 2 diabetes and obesity in this animal model.17.
Rena C. Moon Juan C. Gutierrez Nelson A. Royall Andre F. Teixeira Muhammad A. Jawad 《Obesity surgery》2016,26(5):1016-1020
Background
Along with the development of technology, robotic approach is being performed for laparoscopic Roux-en-Y gastric bypass (LRYGB). Some literatures reported same or better peri-operative outcomes with the robotic procedure. The aim of this study is to compare our experience in robot-assisted LRYGB (RA-LRYGB) with LRYGB in terms of peri-operative outcomes.Methods
From January 1, 2012 to April 30, 2014, a total of 270 patients underwent LRYGB by one surgeon at a single institution. Of these, 64 cases were done robotically. A retrospective review was performed for these patients, noting the outcomes and complications of the procedure.Results
The 64 RA-LRYGB patients had a mean age of 45.9?±?10.0 years (range, 23–67) and a mean preoperative body mass index (BMI) of 48.4?±?7.9 kg/m2 (range, 33.8–76.4). The 207 LRYGB patients had a mean age of 45.0?±?10.7 years (range, 21–67) and a mean preoperative BMI of 48.4?±?8.1 kg/m2 (range, 34.0–80.4). These two groups were clinically comparable. Mean length of hospital stay was 3.0?±?4.1 days (range, 1–19) in RA-LRYGB patients, significantly longer than 1.6?±?1.7 days (range, 1–17) in LRYGB patients (p?<?0.01). Thirty-day readmission rate was 9.3 % (n?=?6) in the RA-LRYGB group and 6.8 % (n?=?14) in the LRYGB group. Higher leak rate was noticed in RA-LRYGB patients at 7.8 % (n?=?5), compared to 0.5 % (n?=?1) in LRYGB patients (p?<?0.01). All the leaks occurred at the pouch level in the RA-LRYGB group, while one leak from the LRYGB group occurred at the gastrojejunal anastomosis site.Conclusions
Robot-assisted Roux-en-Y gastric bypass may result in higher leak rate at the pouch level, when compared to that of laparoscopic procedures.18.
Rena C. Moon Flavio Kreimer Andre F. Teixeira Josemberg M. Campos Alvaro Ferraz Muhammad A. Jawad 《Obesity surgery》2016,26(4):730-736
Background
As life expectancy increases, more elderly patients fit into the criteria for bariatric procedures. The aim of our study is to evaluate and compare the safety and efficacy of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB) in patients older than 60.Material and Methods
Between January 2005 and December 2013, 68 LAGB, 73 LSG, and 212 RYGB patients were 60 years or older at the time of primary procedure. A retrospective review was performed in these patients.Results
Mean age and body mass index (BMI) was 62.7?±?2.2, 64.1?±?2.9, and 62.6?±?2.3 years and 42.7?±?5.6, 44.0?±?7.0, and 45.2?±?6.7 kg/m2 for LAGB, LSG, and RYGB at the time of procedure, respectively.Seven (10.3 %) patients from the LAGB, 3 (4.1 %) from the LSG, and 29 (13.8 %) from the RYGB group required readmissions. Reoperation rate was 10.3, 1.4, and 9.5 % in LAGB, LSG, and RYGB, respectively. The difference in reoperation rates was statistically significant (p?<?0.03) while that in readmission rates was not (p?>?0.58). Procedure-related mortality rate was 1.4 % in the RYGB group, while no mortality was observed in LSG and LAGB groups. At 6, 12, and 18 months postoperatively, mean percentage of excess weight loss were highest in the RYGB group, followed by LSG and LAGB group (p?<?0.01). Mean number of comorbidities at the last follow-up significantly decreased in LSG and RYGB patients.Conclusions
LSG showed the lowest readmission and reoperation rate, and RYGB patients had the highest mortality rate. Weight loss and comorbidity resolution were effectively achieved in RYGB and LSG patients.19.
Jinqian Liang Jianhua Hu Chong Chen Hao Yin Fangliang Dong 《Journal of orthopaedic surgery and research》2017,12(1):196
Background
Although measures to reduce and treat the postoperative surgical drain output are discussed, along with the increased interest in causative factors related to the prevention and treatment reported by many studies, these are still controversial.Methods
A retrospective study was conducted on a consecutive series of 217 patients who had underwent ACCF between January 2016 and March 2017. Patients were categorized based on normal or increased total drain output. These two groups were compared for demographic distribution and clinical data to investigate the predictive factors of increased drain output by multivariate analysis.Results
The overall incidence rate of increased drain output after ACCF was 16.6%. There are no significant differences in sex, BMI, history of taking aspirin, and ASA classification between the two groups (P?>?0.05). Of the patients with increased drain output, a significantly higher proportion of patients have OPLL in the surgical level, 18 (50.0%) versus 33 (18.2%) (P?=?0.000). The mean age was 60.67?±?8.18 years versus 54.41?±?10.05 years (P?=?0.001). Number of discs involved was 2.42?±?0.50 versus 2.02?±?0.65 (P?=?0.001). Operation time was 112.22?±?16.49 min versus 105.21?±?17.89 min (P?=?0.031). Intraoperative blood loss was 109.86?±?62.02 mL versus 87.83?±?56.40 mL (P?=?0.036). Logistic regression analysis showed that age (OR, 1.075; p?=?0.003), history of smoking (OR, 2.792; p?=?0.021), OPLL in surgical level (OR, 2.107; p?=?0.001), and number of discs involved (OR, 2.764; p?=?0.003) maintained its significance in predicting likelihood of increased surgical drain output.Conclusions
The occurrence of increased drain output after ACCF is most likely multifactorial and is related to age, history of smoking, OPLL in surgical level, and number of discs involved.20.
Aurélie?Baillot Warner?M.?Mampuya Isabelle?J.?Dionne Emilie?Comeau Anne?Méziat-Burdin Marie-France?Langlois