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1.
Background Obesity has recently been cited as the number one killer in the USA. This problem is both a national and regional epidemic.
The health care costs of obesity and obesity-related illnesses are ever increasing, and gastric bypass surgery is becoming
a popular treatment strategy. Recently, reports describe not only surgical outcomes, but also quality of life outcomes. The
bigger issue of obesity-related illness resolution is still evolving. Our institution has performed well over 500 gastric
bypasses since 2002. We evaluated over 100 patients prior to and 1 year after gastric bypass surgery.
Methods A prospective study was designed in order to systematically examine quality of life in gastric bypass patients and couple
the results with both objective and subjective assessment of bariatric surgery outcomes. One hundred nineteen patients undergoing
gastric bypass at our institution from January 2005 to December of 2005 were enrolled in the study. In addition to routine
preprocedural and postprocedural follow-up, completion of quality of life forms and anthropometric measurements were performed.
Using these data, we then correlated the change in quality of life scores with social factors, weight loss success, and status
of obesity-related conditions. We also examined the impact of alcohol intake and other demographic factors on both quality
of life and obesity related conditions.
Results A total of 119 patients were enrolled in the study during the calendar year 2005. Follow-up at approximately 1 year (average
12.86 months) postsurgery was obtained in 75 patients. A significant reduction in weight (144.4 ± 34.4 vs. 91.5 ± 28.8; p < 0.0001), body mass index (52.4 ± 12.2 vs. 32.3 ± 8.6; p < 0.0001), mean systolic blood pressure (140.4 ± 14.7 vs. 130.0 ± 21.7; p < 0.001), and lipids (194.3 ± 33.8 vs. 165.7 ± 32.1; p < 0.0001) was noted. Quality of life scores 1 year after gastric bypass surgery were also significantly improved (35.9 ± 19.5
vs. 82.2 ± 23.5; p < 0.0001). There was also a significant reduction in the reported usage of medications for obesity related conditions. Various
measures of success (change in BMI, change in quality of life scores, and follow up health ranking) were compared across demographic
and social factors and no significant associations were identified.
Conclusions Gastric bypass is associated with a reduction in weight, BMI, mean systolic blood pressure, cholesterol, and the usage of
medications for obesity-related conditions. A significant improvement in quality of life was also noted 1 year after surgery. 相似文献
2.
Iván Castilla Javier Mar Cristina Valcárcel-Nazco Arantzazu Arrospide Juan M. Ramos-Goñi 《Obesity surgery》2014,24(12):2061-2068
Background
To assess the cost–utility of gastric bypass versus usual care for patients with severe obesity in Spain.Methods
We have implemented a discrete-event simulation model with two branches: one branch involves gastric bypass, thereby reducing patients’ BMI, and another branch where patients do not undergo surgery. The model analyzes the emergence of comorbidities (stroke, coronary obstructive disease, diabetes, and breast cancer) associated with obesity during a lifetime horizon. The selected measure of effectiveness is health-related quality of life. Both costs and effects are discounted at 3 %. A probabilistic sensitivity analysis is also performed using second-order Monte Carlo simulation; acceptability curves for different time horizons were also calculated.Results
Patients with gastric bypass result in a lifetime increase of 5.63 quality-adjusted life years (QALYs) (18.18 vs. 12.55 QALYs). In addition, because of the reduced spending associated with the treatment of various obesity-related comorbidities, final savings stand at 13,994 €. The total cost of the intervention branch is close to half the cost of the non-intervention branch (17,431 vs. 31,425 €).Conclusions
Gastric bypass is an intervention that dominates over the option of not intervening when a lifetime horizon is considered. 相似文献3.
Susanne Otto A. M. Dizer M. E. Kreis J. Gröne 《Journal of gastrointestinal surgery》2018,22(4):731-736
Background
Resection rectopexy is performed to correct the anatomic defect associated with rectal prolapse. The aim of the study was to determine whether the change in the radiological prolapse grade has an influence on patients’ symptoms and quality of life.Methods
The study investigated 40 patients who underwent resection rectopexy for rectal prolapse. The following were determined before and after surgery: radiological prolapse grade, anorectal angle and pelvic floor position in defecography, clinical symptoms (Cleveland Clinic Incontinence and Constipation Scores, Kelly-Hohlschneider Score), quality of life.Results
Defecography revealed postoperative improvement in the prolapse grade and pelvic floor position (p < 0.05). The clinical symptoms and quality of life improved in both, the total population (n = 40) and in patients with improved radiological prolapse grade (n = 30): all clinical scores (p < 0.05), SF-36 (vitality, social role, mental health p < 0.05), and Fecal Incontinence Quality of Life Scale (lifestyle, coping, embarrassment p < 0.05). Patients without improved radiological findings showed no change in their symptoms or quality of life.Conclusion
Our study demonstrates that the radiological prolapse grade is improved by resection rectopexy. Correction of the anatomic defect was associated with improvement in symptoms and quality of life. Defecography may therefore be useful in the postoperative assessment of persistent symptoms or reduced quality of life.4.
Background
The aim of the study was to compare the changes in health-related quality of life (QOL) after lung surgery between young and old patients. 相似文献5.
Hyun Jin Song Jin Won Kwon Yong Jin Kim Sung-Hee Oh Yoonseok Heo Sang-Moon Han 《Obesity surgery》2013,23(12):2058-2067
Background
In South Korea, the number of severely obese patients has increased. An economic study comparing bariatric surgery with nonsurgical interventions has not been published for Asia.Objectives
This study was conducted to evaluate the cost effectiveness of bariatric surgery as compared to nonsurgical interventions for severe obese Korean people.Methods
We used the Markov model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and nonsurgical interventions from Korean Healthcare system perspectives. Our target cohort consisted of severe obese people defined as having a body mass index of 30–<40 kg/m2 in South Korea. The starting age of the cohort was 30 years old, and the cycle length was 1 year. Nonsurgical interventions included a physician visit, exercise, diet, and pharmacotherapy. A discount of 5 % was applied in cost and QALY. The incremental cost-effectiveness ratio (ICER) of bariatric surgery compared to nonsurgery interventions was calculated.Results
The cost-utility analysis study indicated that bariatric surgery had US$1,522 incremental costs and 0.86 incremental QALYs as compared to nonsurgical interventions. Through the base case analysis, ICER was US$1,771/QALY. The sensitivity analyses were performed using a variety of assumptions, and the robustness of the study results was also demonstrated.Conclusion
The study indicated that bariatric surgery was a cost-effective alternative to nonsurgical interventions over a lifetime, providing substantial lifetime benefits for severely obese Korean people. 相似文献6.
7.
Busetto L Pisent C Rinaldi D Longhin PL Segato G De Marchi F Foletto M Favretti F Lise M Enzi G 《Obesity surgery》2000,10(6):569-577
Background: A moderate weight loss is known to improve the lipid levels in simple obesity.The extent of weight loss needed
to achieve a clinically meaningful effect on lipid abnormalities in morbid obesity is little understood.We analyzed the effects
of different levels of body weight loss on the lipid levels of morbidly obese patients operated with the LAPBAND? System.
Methods: 225 morbidly obese patients (172 F and 53 M) in which a complete lipid profile has been collected both before and
12-18 months after surgery were studied. The changes of the lipid profile were analyzed according to different levels of percent
weight loss (%WL: <10%, 10-20%, 20-30%, >30%). Results: Mean weight loss was 30.7±15.2 kg, corresponding to a 23.1±9.7% reduction
of body weight. A large variability in the weight loss was observed. A significant difference in the change of the lipid parameters
between the group with <10%WL and the group with 10-20%WL was observed for total-cholesterol (+10.0±17.2% vs-0.7±14.7%; p<0.05),
for the LDL (+18.7±26.3% vs +3.1±22.9%; p<0.05), and for the triglycerides (+7.7±26.3% vs -21.9±25.4%; p<0.05). No further
significant differences were found between the two groups with greater weight loss (20-30%WL and >30%WL) and the group with
10-20%WL, the only exception being the percent change in triglycerides levels, i.e. higher in the group with %WL >30 (-33.6±31.5%
vs -21.9±25.4%; p<0.05). Conclusion: A moderate weight loss of 10-20% of initial body weight produced the maximal effects
on the lipid levels in morbid obesity. 相似文献
8.
9.
S. A. Saboor Aftab L. Halder M. K. Piya N. Reddy I. Fraser V. Menon S. Bridgwater D. Kendrick S. Kumar T. M. Barber 《Obesity surgery》2014,24(6):885-890
Background
There is uncertainty regarding preoperative predictors of a successful outcome for bariatric surgery (BarSurg), on which to determine appropriateness for such a procedure. Our aims were to identify preoperative clinical and psychosocial predictors of success following BarSurg and to explore the influence of body mass index (BMI) on these parameters.Methods
Preoperative data, including Impact of Weight on Quality of Life—Lite (IWQOL-Lite) scores transformed to Health-Related Quality of Life (HRQOL) scores, were accrued from 76 morbidly obese adults awaiting BarSurg. Pre- and postoperative data were also accrued for 26 patients who had completed 1-year follow-up post-bariatric surgery (laparoscopic adjustable gastric banding—LAGB). Statistical analysis was performed to assess the relationships between preoperative HRQOL scores, preoperative BMI and excess weight loss 1 year following BarSurg (EWL-1 year).Results
Preoperative BMI showed a significant independent, negative linear correlation with the public distress domain of preoperative quality of life (QOL) (r?=??0.368, p?=?0.001; β?=??0.245, p?=?0.009). Preoperative BMI had a significant, positive and independent association with EWL-1 year (r?=?0.499, p?=?0.009; β?=?0.679, p?=?0.015). Preoperative QOL scores had no association with EWL-1 year.Conclusions
Preoperative BMI appears to predict EWL-1 year following restrictive bariatric surgery (LAGB). Preoperatively, patients with higher BMI appear to manifest greater public distress. Preoperative QOL scores, however, do not appear to have any predictive value for EWL-1 year post-LAGB. Preoperative BMI should therefore be employed as a predictor of EWL-1 year post-LAGB. Other measures of successful outcomes of bariatric surgeries (such as effects on QOL scores at 1 year) should be explored in future, larger and longer term studies. 相似文献10.
Gustavo L. Carvalho Cesar Borges Barros Carlos Eduardo Moraes Masaichi Okazaki Moacir de Novaes Lima Ferreira José Sérgio N. Silva Pedro Paulo C. de Albuquerque Raphael de Macedo Cavalcanti Coelho 《Obesity surgery》2011,21(7):924-927
Background
In this study, a new safer and faster intragastric balloon procedure was also employed to treat pre-obese patients (body mass index (BMI) < 30). 相似文献11.
Muhammad Qutayba Almerie Vittal Sree Rama Rao Mark Bernard Peter Peter Sedman Prashant Jain 《Obesity surgery》2018,28(12):3890-3894
Background
With population ageing, more older patients would benefit from the reduced comorbidities associated with laparoscopic Roux-en-Y gastric bypass (LRYGB). However, health care providers are still reluctant to offer bariatric surgery to older obese patients due to the perceived increased risk and possible reduced benefit. Here, we report the outcomes of first UK series of LRYGB in patients (>?60 years) with emphasis on quality of life (QoL).Setting
University hospital.Methods
Data was collected prospectively on all patients aged >?60 years undergoing LRYGB between 2006 and 2011. Patients had a minimum 1-year follow-up. Data related to weight loss, peri-operative complications and obesity-related morbidity (ORM) was collected. Patients’ QoL was assessed by postal questionnaire.Results
Forty-six patients with a median age of 63 (60–71) underwent LRYGB with a median follow-up of 23 (12–55) months. There was a significant drop in patients’ BMI [mean (SD) 47.5 (6.2) to 31.2 (4.4) kg/m2]. Patients had an average 69% (SD 17%) excess weight loss and 34% (SD 10%) total body weight loss.The median hospital stay was 3 (1–16) with 13% peri-operative morbidity and no mortality. There was a 25% (30/123) resolution and 54% (66/123) ‘improvement’ in ORM. The QoL score increased significantly in several domains particularly physical performance (2.8 to 8.0, p?<?0.001), self-esteem (3.6 to 8.3, p?<?0.001) and mobility (2.9 to 7.5, p?<?0.001).Conclusion
LRYGB in patients aged >?60 years can be performed safely and with weight loss comparable to younger patients. There is associated benefit in reducing ORM and substantial improvement in QoL.12.
Jonathan B. Yuval Abed Khalaileh Mahmoud Abu-Gazala Yair Shachar Andrei Keidar Yoav Mintz Aviram Nissan Ram Elazary 《Obesity surgery》2014,24(12):2134-2137
Background
Gastrointestinal stromal tumor (GIST) is a rare neoplasm of the alimentary tract. Previous reports described an incidence of 1 per 100,000. Laparoscopic sleeve gastrectomy (LSG) provides pathological specimens of the majority of the stomach. We examined the pathology from LSG and the incidence and location of GIST. The aim of this study was to study the incidence of asymptomatic GISTs found during LSG at our institution.Methods
A search was conducted in a prospectively maintained bariatric registry. Data collected included the following: gender, age, body mass index (BMI), and concomitant hypertension or diabetes mellitus. Histopathology reports were reviewed for incidental GIST. We compared the patients with incidental GIST to the rest of the cohort.Results
Pathology reports of 827 patients that underwent LSG between 2007 and 2014 were reviewed. Five patients had GIST in the resected stomach, an incidence of 0.6 %. The group of patients with GIST had lower BMI and older age compared to the remaining 822 patients. All tumors were located close to the lesser curvature.Conclusions
The incidence of GIST found in this cohort is significantly higher than previously reported. This may be due to an association between these tumors and obesity or because asymptomatic GISTs are underdiagnosed in the general population. These tumors are particularly common in older patients and special attention must be given when performing LSG on this subpopulation. The stomach should be inspected thoroughly before resection. A tumor on the lesser curvature may necessitate changing the surgical plan or aborting the procedure. 相似文献13.
Christine Stroh C. Groh R. Weiner K. Ludwig S. Wolff M. Kabelitz T. Manger 《Obesity surgery》2013,23(11):1783-1789
Background
Since 1 January 2005, the situation of bariatric surgery has been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg.Methods
Data collection on the results of gastric banding procedures was started in 2005, and the data are registered in an online database. Follow-up data were collected once a year. Participation in the quality assurance study is voluntary.Results
Since 2005, 3,453 gastric banding procedures have been performed at 88 hospitals. The mean age of patients was 40.7 years, and the mean body mass index (BMI) was 45.2 kg/m2. BMI and comorbidities are significantly higher in male patients. Regarding gender-specific aspects, there are no significant differences in the perioperative complication rates. The amelioration rate of comorbidities in male patients is lower than in female patients.Conclusion
Gastric banding in Germany is generally performed in patients with a BMI below 45 kg/m2. The perioperative complication rate is low. Data from the nationwide survey of the German Bariatric Surgery Registry show significant differences in preoperative comorbidities and their amelioration between male and female patients. There is a need for further evaluation of gender-specific aspects of gastric banding procedures to optimize patient selection, reduce specific postoperative complications, and achieve long-term effects on weight loss and remission of comorbidities. 相似文献14.
15.
Christine Stroh D. Benedix R. Weiner F. Benedix S. Wolff C. Knoll T. Manger 《Obesity surgery》2014,24(1):9-14
Background
Since 1 January 2005, the outcomes of bariatric surgeries have been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.Methods
Data are collected in an online data bank. Data collection began in 2005 for the results of gastric banding (GB) and in 2006 for sleeve gastrectomies (SGs). In addition to primary bariatric operations, data regarding the complications of revision procedures and redo operations have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany.Results
SGs are a popular redo operation after failed gastric banding. Using the German Bariatric Surgery Registry, we analyzed data from 137 SGs that were used in a one-step approach after GB and 37 SGs that were used in a two-step approach. Leakage rates for primary SGs dropped to 1.9 %. The incidence of leakage after a one-step SG after GB is significantly higher (4.4 %) than for a two-step approach (0 %).Conclusion
SGs are popular procedures after failed GB in Germany, but the complication rates for one-step band removal are higher than for a two-step approach. After examining the data, we suggest performing band removal and SG as a two-step procedure. Further analysis is necessary to evaluate the optimal time period between band removal and SG. Follow-up investigations must be performed to determine if SG is an effective and safe option after GB. 相似文献16.
The laparoscopic Roux Y gastric bypass (LRYGB) and the laparoscopic gastric sleeve resection are frequently used methods for
the treatment of morbid obesity. Quality of life, weight loss and improvement of the co-morbidities were examined. Match pair
analysis of the prospectively collected database of the 47 gastric bypass and 47 gastric sleeve resection patients operated
on in our hospital was performed. The quality of life parameters were measured with two standard questionnaires (SF 36 and
Moorehead–Ardelt II). The mean preoperative and postoperative BMI was in gastric bypass group 46.1 and 28.1 kg/m2 (mean follow-up: 15.7 months) and in gastric sleeve group 50.3 and 33.5 kg/m2 (mean follow-up: 38.3 months). The SF 36 questionnaire yielded a mean total score of 671 for the bypass and 611 for the sleeve
resection patients (p = 0.06). The Moorehead–Ardelt II test signed a total score of 2.09 for gastric bypass versus 1.70 for gastric sleeve patients
(p = 0.13). Ninety percent of the diabetes was resolved in the bypass and 55% in the sleeve resection group. Seventy-three percent
of the hypertension patients needed no more antihypertensive treatment after gastric bypass and 30% after sleeve resection.
Ninety-two percent of the gastro-oesophageal reflux were resolved in the bypass group and 25% in the sleeve (with 33% progression)
group. Ninety-four percent of the patients were satisfied with the result after gastric bypass and 90% after sleeve resection.
The patients have scored a high level of satisfaction in both study groups. The gastric bypass is associated with a trend
toward a better quality of life without reaching statistical significance, pronounced loss of weight and more remarkable positive
effects on the co-morbidities comparing with the gastric sleeve resection. 相似文献
17.
Brunault P Jacobi D Léger J Bourbao-Tournois C Huten N Camus V Ballon N Couet C 《Obesity surgery》2011,21(8):1225-1231
Background
Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) are coexisting first-choice restrictive procedures for bariatric surgery candidates, it is possible, given their different modes of action, that these procedures have different effects on quality of life (QOL). We hypothesized that improvement of QOL and comfort with food could be better with LSG compared to LAGB. 相似文献18.
Laparoscopic adjustable gastric banding (LAGB) has become a standard restrictive procedure in the USA for the treatment of
severe obesity (body mass index, BMI > 35 kg/m2). Mildly obese individuals (BMI < 35 kg/m2) are also at increased risk from obesity-related conditions. Recently, an FDA panel supported its use in this subgroup. We
compared the perioperative outcomes of LAGB in mildly and severely obese. Thirty consecutive patients (mildly obese n = 10; severely obese n = 20) that underwent preoperative medical weight loss followed by LAGB procedures were prospectively evaluated. Outcome variables
included: operative room (OR) time, intraoperative estimated blood loss (EBL), length of hospital (LOS), and intensive care
unit (ICU) stay, reoperations, readmissions, 30-day morbidity and mortality. Demographic data was comparable between groups.
BMI was significantly higher in the severely obese compared to mildly obese (44.0 ± 5 vs. 33.6 ± 1 kg/m2). OR time, EBL, LOS, and ICU admissions were similar between BMI groups. There were no reoperations or 30-day mortality in
either group. Minor morbidity was only observed in the severely obese group. BMI correlated with OR time and EBL. In mildly
obese, LAGB is as safe as in the severely obese with no perioperative morbidity. The perioperative outcomes and hospital resource
utilization are comparable between BMI groups. Lower BMI is associated with lower operative times and blood loss. 相似文献
19.
Carneiro JR da Silveira VG Vasconcelos AC de Souza LL Xerez D da Cruz GG Quaresma JC Macedo RG de Oliveira JE 《Obesity surgery》2007,17(2):255-257
A young woman with achondroplasia and morbid obesity (two disabling conditions) is presented. She underwent open Roux-en-Y
gastric bypass (RYGBP). We emphasize preoperative preparation by a multidisciplinary team and the use of the 6-minute walk
test to follow and assess mobility and quality of life. 相似文献
20.
Wyler SF Ruszat R Straumann U Forster TH Provenzano M Sulser T Gasser TC Bachmann A 《European urology》2007,51(4):1004-12; discussion 1012-4
OBJECTIVES: To evaluate quality of life (QoL) after laparoscopic radical prostatectomy (LRP) and investigate whether the learning curve of laparoscopic novices has a negative influence on patients' QoL. METHODS: Evaluation of QoL with the EORTC QLQ C-30 and the PR25 preoperatively (t0) as well as postoperatively after 1-3 mo (t1), 4-6 mo (t2), 7-12 mo (t3), 13-24 mo (t4), and yearly thereafter (t5-t7). Surgeons were grouped according to their prior experience in laparoscopy into experienced and novices. RESULTS: LRP was performed in 343 patients; 268 (78%) participated in the study. The mean patient age was 63.3+/-6.3 yr; mean PSA, 10.0+/-9.2 ng/ml; mean follow-up, 26 mo. Global health was impaired for t1 (p<0.001) and then returned to baseline. Emotional functioning improved (p<0.001) for t2-t7 versus baseline. Physical functioning remained impaired for t1-t2, and role and social functioning for t1-t6. Only sexual functioning did not return to baseline for t1-t7. Urinary symptoms were worse at t1 and then improved gradually (p<0.001). No significant difference in any QoL domain could be identified for experienced surgeons versus novices except for financial difficulties at t2-t3, which related to social differences. Thirty-one (9%) patients with adjuvant therapy had significantly worse global health, bowel symptoms, urinary symptoms, fatigue, and sexual functioning. CONCLUSIONS: The learning curve of laparoscopic novices does not have a negative impact on patients' QoL. For intermediate- to long-term follow-up, patients reach their baseline or score even better in all domains except for sexual functioning but are significantly impaired if adjuvant treatment is performed. 相似文献