Single incision laparoscopic adjustable gastric band: technique,feasibility, safety and learning curve

Introduction

Single incision laparoscopic surgery (SILS) is established in many procedures but not in bariatric surgery. One explanation may be that SILS is technically demanding in morbidly obese patients. This report describes our technique and experience with single incision laparoscopic adjustable gastric banding (SILAGB).

Methods

Prospective data collection was performed on consecutive obese patients who underwent SILAGB between November 2009 and February 2011. A single 3cm transverse incision in the right upper quadrant was used for a Covidien SILS^™ multichannel access port. The technique is described with a standard pars flaccida approach and the ‘tips and tricks’ needed for a wide range of candidates using standard laparoscopic equipment.

Results

A total of 29 patients (27 female) with a median body mass index of 41kg/m² (range: 35–52kg/m²) and median age of 44 years (range: 22–57 years) underwent SILAGB. There were no ‘conversions’ to a standard laparoscopic technique. Two cases required the addition of one single 5mm port. The only complications were two postoperative wound infections (one with a port site infection requiring replacement of the port) and one faulty band requiring replacement. There were therefore two returns to theatre and no 30-day deaths. All patients were discharged on the first postoperative day. In this series, operative times reduced significantly to be comparable with the conventional laparoscopic approach.

Conclusions

SILAGB is safe and feasible in the morbidly obese. Proficiency in this technique using conventional laparoscopic equipment can be achieved with a short learning curve.     

Obesity and Prostate Cancer: Weighing the Evidence

Context

Obesity and prostate cancer (PCa) affect substantial proportions of Western society. Mounting evidence, both epidemiologic and mechanistic, for an association between the two is of public health interest. An improved understanding of the role of this modifiable risk factor in PCa etiology is imperative to optimize screening, treatment, and prevention.

Objective

To consolidate and evaluate the evidence for an epidemiologic link between obesity and PCa, in addition to examining the proposed underlying molecular mechanisms.

Evidence acquisition

A PubMed search for relevant articles published between 1991 and July 2012 was performed by combining the following terms: obesity, BMI, body mass index and prostate cancer risk, prostate cancer incidence, prostate cancer mortality, radical prostatectomy, androgen-deprivation therapy, external-beam radiation, brachytherapy, prostate cancer and quality of life, prostate cancer and active surveillance, in addition to obesity, BMI, body mass index and prostate cancer and insulin, insulin-like growth factor, androgen, estradiol, leptin, adiponectin, and IL-6. Articles were selected based on content, date of publication, and relevancy, and their references were also searched for relevant articles.

Evidence synthesis

Increasing evidence suggests obesity is associated with elevated incidence of aggressive PCa, increased risk of biochemical failure following radical prostatectomy and external-beam radiotherapy, higher frequency of complications following androgen-deprivation therapy, and increased PCa-specific mortality, although perhaps a lower overall PCa incidence. These results may in part relate to difficulties in detecting and treating obese men. However, multiple molecular mechanisms could explain these associations as well. Weight loss slows PCa in animal models but has yet to be fully tested in human trials.

Conclusions

Obesity appears to be linked with aggressive PCa. We suggest clinical tips to better diagnose and treat obese men with PCa. Whether reversing obesity slows PCa growth is currently unknown, although it is an active area of research.     

成年人体重指数、脂肪分布、脂肪含量的监测及分析

目的调查成人超重、肥胖的发生率，探讨体重指数（BMI）、体脂百分比（PBF）、腰臀比（WHR）与超重、肥胖之间的关系。方法对111名成人用InBody3．0人体成分分析仪随机进行人体成分测试，分析他们体重指数、体脂分布、体脂百分比情况。结果男女超重率63．06％，肥胖率19．82％。男女腰臀比及体脂肪比率超标分别占70．27％、72．07％。不同BMI和不同年龄的男性和女性腰臀比都有显著性差异（P〈0．01）。不同BMI男性体脂百分比有显著差异（P〈0．05），女性有显著性差异（P〈0．01）。不同年龄男性和女性体脂百分比有差异（P〈0．05）。结论体重指数的增加主要是脂肪增加造成的，而体内的脂肪又主要堆积在腹部。超重、肥胖情况较严重、体脂分布不合理、体内脂肪含量过高需引起重视，应采取各种措施以减少由超重带来的一系列问题。     

超重或肥胖2型糖尿病患者空腹血浆胰岛素及游离脂肪酸水平变化分析

目的 探讨超重或肥胖的2型糖尿病(T2DM)患者空腹血浆胰岛素(FINS)及游离脂肪酸(FFA)水平变化.方法选取263例T2DM患者,按体质指数分为正常体重组(108例)、超重和肥胖组(155例),并与72例正常对照组比较.采用化学发光法测定FINS水平,FFA水平采用比色法测定.结果T2DM组较正常对照组FINS水平明显升高[(6.18±1.86)mIU/L与(4.60±2.58)mIU/L,P<0.01];FFA水平明显升高[(0.58±0.25)mmol/L与(0.35±0.14)mmol/L,P<0.01].超重或肥胖组血FINS水平[(7.20±1.99)mIU/L]与正常体重组[(5.31±1.21)mIU/L]、正常对照组[(4.60±2.58)mIU/L]比较,差异有统计学意义(P<0.01).T2DM组FINS水平与病程(r=0.334,P<0.01)、体质指数(r=0.532,P<0.01)及舒张压(r=0.342,P<0.01)呈正相关.结论超重或肥胖T2DM患者FINS水平显著高于正常体重T2DM患者,T2DM患者血FFA水平显著高于正常对照组,二者参与了胰岛素抵抗及T2DM的发生发展.     

Obesity is associated with aortic enlargement and increased stiffness: an echocardiographic study

Background Obesity may be associated with early vascular changes. The current study was designed to assess the relationship between obesity and aortic stiffness in two populations, one aged 18–40 years and one aged 41–64 years. Methods The study complied 121 subjects, all of them underwent a physical examination, transthoracic echocardiography and blood pressure measurement. Aortic stiffness index (β) was evaluated from aortic diameter and blood pressure data. Results β was higher in obese subjects both in the young (4.26 ± 1.57 vs. 6.88 ± 5.96, P < 0.05) and old patient populations (7.13 ± 4.99 vs. 14.89 ± 14.64, P < 0.05). Systolic (SD) aortic diameters (in mm) were enlarged in obese young patients (25.7 ± 2.8 vs. 27.1 ± 2.5, P < 0.05) and obese old subjects (28.0 ± 3.0 vs. 30.3 ± 3.3, P < 0.05). Diastolic (DD) aortic diameter (in mm) showed similar tendency in youngs (22.8 ± 2.9 vs. 24.9 ± 2.5, P < 0.05) and old subjects (25.9 ± 2.7 vs. 28.0 ± 3.1, P < 0.05). Conclusions Aortic stiffness is higher in young obese patients and similar to older subjects without obesity. Both SD and DD are increasing with age, but subjects within similar age group have larger SD and DD suggesting early vascular remodelling in obesity.     

Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees?

Miller M, Wong WK, Wu J, Cavenett S, Daniels L, Crotty M. Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees?

Objective

To evaluate the utility of body mass index (BMI) and corrected-arm-muscle area (CAMA) as measures of nutritional health for lower-limb amputees attending prosthetics clinics.

Design

Cross-sectional study.

Setting

Prosthetics clinic in Australia.

Participants

Unilateral lower-extremity amputees (N=58; age range, 21-91y; 37 transtibial, 21 transfemoral) attending a regional prosthetics clinic between May and November 2003.

Interventions

Not applicable.

Main Outcome Measures

Weight (without prosthesis), corrected and uncorrected for the amputated limb was used with height estimated from knee height to calculate corrected BMI (cBMI) and uncorrected BMI (uBMI). CAMA was calculated using the mean of triplicate mid-upper-arm circumference (MUAC) and triceps skinfold thickness (TST) measurements. The Mini Nutritional Assessment (MNA) and Assessment of Quality of Life were administered according to recommended protocols. The Pearson correlation was used to determine the strength and significance of associations between variables, and bivariate regression analyses were performed to determine whether an association existed between the nutritional variables (BMI, CAMA, MNA) and quality of life (QOL).

Results

There were no statistically significant differences in the measures of nutritional health according to site (transtibial, transfemoral) of amputation. MUAC, TST, and CAMA all showed moderate to high positive correlations (r range, .541−.782) with both cBMI and uBMI. The strength of the relationship between the MNA and cBMI/uBMI was weaker (r=.383, r=.380, respectively) but remained positive and statistically significant (P=.003). QOL was not associated with cBMI or uBMI but was related to CAMA (β=−.132; P=.030) and MNA (β=−.561; P=.017).

Conclusions

For persons with unilateral lower-extremity amputation, measurement of upper-arm anthropometry may be a more useful indicator of nutritional health and its consequences than BMI.     

Obesity Is Associated with Increased Prostate Growth and Attenuated Prostate Volume Reduction by Dutasteride

Background

Although obesity has been associated with larger prostate volumes (PV), few studies have actually investigated whether obesity enhances PV growth, especially among men using 5α-reductase inhibitors.

Objective

To examine whether obesity is associated with enhanced PV growth measured by serial transrectal ultrasound (TRUS) measurements.

Design, setting, and participants

We conducted a secondary analysis of the REduction by DUtasteride of prostate Cancer Events (REDUCE) trial, which was originally aimed at cancer risk reduction among high-risk men with a single negative prestudy biopsy.

Intervention

Per-protocol randomization to placebo or dutasteride and mandatory TRUS-guided biopsies at 2 yr and 4 yr.

Outcome measurements and statistical analysis

Percentage change in PV at 2 yr and 4 yr from baseline. We tested its association with baseline body mass index (BMI) groups of <25, 25–29.9, and ≥30 kg/m² using multivariable linear regression. Secondarily, we tested whether BMI was associated with the likelihood of having no PV reduction among men randomized to dutasteride using multivariable logistic regression.

Results and limitations

Of 8122 participants, we analyzed 71.8% and 54.5% with complete 2-yr and 4-yr PV data, respectively. In multivariable analysis, men on placebo with BMI ≥30 versus <25 kg/m² had enhanced PV growth from baseline (at 2 yr: 17.0% vs 10.7%, p < 0.001; at 4 yr: 29.4% vs 20.1%; p = 0.001). Men on dutasteride with BMI ≥30 versus <25 kg/m² had attenuated PV reduction from baseline (at 2 yr: −14.3% vs −18.5%; p = 0.002; at 4 yr: −13.2% vs −19.3%; p = 0.001) and higher likelihood of having no PV reduction (at 2 yr: odds ratio [OR]: 1.44; 95% confidence interval [CI], 1.08–1.93; p = 0.014; at 4 yr: OR: 1.62; 95% CI, 1.18–2.22; p = 0.003). We found no significant interactions between BMI and dutasteride on PV change at 2 yr and 4 yr (p interaction ≥0.36). No clinical outcomes or effects of weight change were assessed.

Conclusions

Obesity enhanced PV growth and attenuated PV reduction by dutasteride. The null interaction between obesity and dutasteride for PV change implies that the effect of obesity on dutasteride-treated men is likely a combination of dutasteride-driven PV reduction with obesity-driven PV growth rather than decreased dutasteride efficacy.

ClinicalTrials.gov identifier

NCT00056407.     

腹部电运动并耳穴贴压治疗肥胖症152例

目的：通过腹部减肥，防治心血管疾病，提高生命质量。方法：采用电脑控制的多步程序，各种不同调制方式的低频调制中频电流，对腹部肥胖１５２例进行电运动刺激，并用耳穴贴压减肥治疗。结果：显效６３例，有效８３例，无效６例。平均治疗１２．８次，总有效率９６％。结论：该法安全、无痛苦、不改变正常饮食，是一种疗效较好的科学减肥法。