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1.
Amit Surve Hinali Zaveri Daniel Cottam Austin Cottam Samuel Cottam LeGrand Belnap Walter Medlin Christina Richards 《Surgery for obesity and related diseases》2018,14(8):1139-1148
Background
Inadequate weight loss, weight recidivism, and device-related complications after an adjustable gastric banding (AGB) can be treated by a laparoscopic conversion to stomach intestinal pylorus-sparing surgery (SIPS).Objective
The aim of the study was to analyze the midterm outcomes of revision SIPS surgery after failed AGB.Setting
Private practice, United States.Methods
This is a retrospective review of our prospectively collected data of patients who underwent laparoscopic conversion from AGB to SIPS surgery from June 2013 and February 2017 by a single surgeon in a single institution.Results
Twenty-seven patients (1 stage: 22 and 2 stage: 5) underwent a laparoscopic revision of AGB to SIPS surgery. The mean ± standard deviation preoperative body mass index (BMI) before AGB was 47.5 ± 6.8 kg/m2, while the mean nadir BMI after AGB was 36 ± 7.7 kg/m2. The overall time to reoperation was 9.3 ± 8.7 and 5.6 ± 2.5 years in 1- and 2-stage conversion patients, respectively. The mean preoperative BMI before revision SIPS surgery was 46.7 ± 7 kg/m2. At 36 months, the patients had an average change in BMI of 20.9 units with 90% excess weight loss. A major complication occurred in 4 patients. Postoperatively, the fasting blood glucose, insulin, low-density lipoprotein, triglyceride, and most of the co-morbidities were resolved or improved.Conclusion
This study demonstrates that conversion of failed AGB to SIPS surgery is an effective approach to AGB failure. 相似文献2.
Rena C. Moon Vincent Kirkpatrick Lori Gaskins Andre F. Teixeira Muhammad A. Jawad 《Surgery for obesity and related diseases》2019,15(2):245-252
Background
Biliopancreatic diversion with duodenal switch (DS) is known to be superior in weight loss to other bariatric procedures, but with the disadvantage of increased complication rates. Single-anastomosis duodenal-ileal bypass (SADI-S) is reported to have similar weight loss with lower complication rates compared with traditional DS.Objectives
The aim of this study was to compare weight loss and complication rate between SADI-S and double-anastomosis DS at a single institution.Setting
Academic hospital, United States.Methods
A retrospective chart review was performed on 185 patients who underwent laparoscopic or robot-assisted laparoscopic DS between March 1, 2015 and December 10, 2017. A total of 111 patients had SADI-S, and 74 patients underwent double-anastomosis DS.Results
Baseline patient characteristics were comparable between the 2 groups. The mean preoperative body mass index was 56.3 kg/m2 and 54.4 kg/m2 in SADI-S and double-anastomosis DS patients, respectively. Thirteen (11.7%) and 4 (5.4%) patients were readmitted within 30 days after SADI-S and double-anastomosis DS, respectively (P?=?.16). Percentage of total weight loss was 22.0%, 38.5%, and 44.2% in the SADI-S group and 20.2%, 38.0%, and 48.4% in the double-anastomosis DS group at 6, 12, and 24 months, respectively. The majority of patients had vitamin A and E levels in the normal range. However, 40% to 60% of the patients had low levels of vitamin D after the procedure.Conclusions
SADI-S and double-anastomosis DS are comparable in terms of weight loss and complication rate. However, close nutritional follow-up is warranted for both procedures. 相似文献3.
Hans J. Schmidt Edmund W. Lee Erica A. Amianda Themba L. Nyirenda Toghrul Talishinskiy Richard C. Novack Douglas R. Ewing 《Surgery for obesity and related diseases》2018,14(12):1869-1875
Background
The Roux-en-Y gastric bypass (RYGB) has long been considered the gold standard of weight loss procedures. However, there is limited evidence on revisional options with both minimal risk and long-term weight loss results.Objective
To examine percent excess weight loss, change in body mass index (BMI), and complications in patients who underwent laparoscopic adjustable gastric banding (LAGB) over prior RYGB.Setting
Academic hospital.Methods
Retrospective analysis of a single-center prospectively maintained database. Three thousand ninety-four LAGB placements were reviewed; 139 were placed in patients with prior RYGB.Results
At the time of LAGB, the median BMI was 41.3. After LAGB, we observed weight loss or stabilization in 135 patients (97%). The median maximal weight loss after LAGB was 37.7% excess weight loss and ?7.1 change in BMI (P < .0001). At last follow-up visit, the median weight loss was 27.5% excess weight loss and ?5.3 change in BMI (P < .0001). Median follow-up was 2.48 years (.01–11.48): 68 of 132 eligible (52%) with 3-year follow-up, 12 of 26 eligible (44%) with 6-year eligible follow-up, and 3 of 3 eligible (100%) with >10-year follow-up. Eleven bands required removal, 4 for erosion, 4 for dysphagia, and 3 for nonband-related issues.Conclusions
LAGB over prior RYGB is a safe operation, which reduces the surgical risks and nutritional deficiencies often seen in other accepted revisional operations. Complication rates were consistent with primary LAGB. Weight loss is both reliable and lasting, and it can be considered as the initial salvage procedure in patients with failed gastric bypass surgery. 相似文献4.
Collin Creange Megan Jenkins Matthew Pergamo George Fielding Christine Ren-Fielding Bradley Schwack 《Surgery for obesity and related diseases》2018,14(10):1531-1536
Background
Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss.Objective
To compare the weight loss results of these 2 surgeries.Setting
University hospital, United States.Methods
A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations.Results
The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB?=?32.93, LSG?=?38.34, P?=?.0004), percent excess BMI lost (RYGB?=?57.8%, LSG?=?29.3%, P < .0001), and percent weight loss (RYGB?=?23.4%, LSG?=?12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P?=?.0022), longer operating room time (RYGB?=?120.1 min versus LSG?=?115.5 min, P < .0001), and longer length of stay (RYGB?=?3.33 d versus LSG?=?2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P?=?.087).Conclusion
Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure. 相似文献5.
Shinban Liu Christine J. Ren-Fielding Bradley Schwack Marina Kurian George A. Fielding 《Surgery for obesity and related diseases》2018,14(10):1501-1506
Background
Studies reporting revisionary options for weight loss failure after Roux-en-Y gastric bypass (RYGB) have been underpowered and lacking long-term data. We have previously shown that short-term (12 mo) and midterm (24 mo) weight loss is achievable with laparoscopic adjustable gastric banding (LAGB) for failed RYGB. The present study represents the largest published series with longest postoperative follow-up of patients receiving salvage LAGB after RYGB failure.Objective
To investigate long-term results of salvage gastric banding.Setting
University Hospital, New York, United States.Methods
Data were prospectively collected with retrospective review. Baseline characteristics were evaluated and weights at multiple time intervals (before RYGB, before LAGB, each year of follow-up). Additional data included approach (open or laparoscopic), operative time, hospital length of stay, and postoperative complications.Results
A total of 168 patients underwent statistical analysis with 86 patients meeting inclusion for RYGB failure. The mean body mass index before RYGB was 48.9 kg/m2. Before LAGB, patients had an average body mass index of 43.7 kg/m2, with 10.4% total weight loss and 21.4% excess weight loss after RYGB. At 5-year follow-up, patients (n?=?20) had a mean body mass index of 33.6 kg/m2 with 22.5% total weight loss and 65.9% excess weight loss. The long-term reoperation rate for complications related to LAGB was 24%, and 8% of patients ultimately had their gastric bands removed.Conclusion
The results of our study have shown that LAGB had good long-term data as a revisionary procedure for weight loss failure after RYGB. 相似文献6.
Amit Surve Daniel Cottam Hinali Zaveri Austin Cottam LeGrand Belnap Christina Richards Walter Medlin Titus Duncan Karleena Tuggle Alberto Zorak Thomas Umbach Matthew Apel Peter Billing Josiah Billing Robert Landerholm Kurt Stewart Jedediah Kaufman Eric Harris Benjamin Horsley 《Surgery for obesity and related diseases》2018,14(10):1442-1447
Background
Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure that can be performed as an outpatient procedure.Objectives
The aim of the study was to determine whether same-day discharge LSG is safe when performed in an outpatient surgery center.Setting
Outpatient surgery centers.Methods
The medical records of 3162 patients who underwent primary LSG procedure by 21 surgeons at 9 outpatient surgery centers from January 2010 through February 2018 were retrospectively reviewed.Results
Three thousand one hundred sixty-two patients were managed with enhanced recovery after surgery protocol and were included in this analysis. The mean age and preoperative body mass index were 43.1 ± 10.8?years and 42.1 ± 7.1 kg/m2, respectively. Sleep apnea, type 2 diabetes, gastroesophageal reflux disease, hypertension, and hyperlipidemia were seen in 14.4%, 13.5%, 24.7%, 30.4%, and 17.6% patients, respectively. The mean total operative time was 56.4 ± 16.9 minutes (skin to skin). One intraoperative complication (.03%) occurred. The hospital transfer rate was .2%. The 30-day follow-up rate was 85%. The postoperative outcomes were analyzed based on the available data. The 30-day readmission, reoperation, reintervention, and emergency room visit rates were .6%, .6%, .2%, and .1%, respectively. The 30-day mortality rate was 0%. The total short-term complication rate was 2.5%.Conclusions
Same-day discharge seems to be safe when performed in an outpatient surgery center in selected patients. It would appear that outpatient surgery centers are a viable option for patients with minimal surgical risks. 相似文献7.
Tom P. Walsh Stephen J. Quinn Angela M. Evans Alison Yaxley Jacob A. Chisholm Lilian Kow E. Michael Shanahan 《Surgery for obesity and related diseases》2018,14(9):1389-1395
Background
Foot pain is a common manifestation of obesity.Objective
To determine if bariatric surgery is associated with a reduction in foot pain and if body mass index (BMI) or body composition predict a change in foot pain.Setting
University hospital.Methods
Participants with foot pain awaiting bariatric surgery were recruited for this prospective study. Multivariable linear regression was used to determine predictors of change in foot pain between baseline and 6-month follow-up using body composition (fat mass index and fat-free mass index) or BMI, adjusting for, depression, age, sex, and group (surgery versus control).Results
Forty-five participants (38 female), mean ± standard deviation age of 45.7 ± 9.4 years, were recruited for this study. Twenty-nine participants mean ± standard deviation BMI of 44.8 ± 7.0 kg underwent bariatric surgery, while 16 participants mean ± standard deviation BMI of 47.9 ± 5.2 kg were on the waiting list (control). One participant was lost to follow-up. The treatment group lost a mean of 24.3 kg (95% confidence interval [CI] 21.1–27.5), while the control group gained 1.2 kg (95% CI ?2.5 to 4.9), respectively. In multivariable analysis, bariatric surgery was significantly associated with reduced foot pain at 6-month follow-up ?32.6 points (95% CI ?43.8 to ?21.4, P < .001), while fat mass index was significantly associated with increased pain at follow-up 1.5 points (95% CI .2 to 2.8, P?=?.027), after controlling for fat-free mass index, age, sex, and depression.Conclusions
Bariatric surgery was significantly associated with reduced foot pain. Higher baseline fat mass index, but not fat-free mass index or BMI, was predictive of increased foot pain at follow-up. Foot pain may be mediated by metabolic, rather than mechanical, factors in bariatric surgery candidates. 相似文献8.
Yaron Rudnicki Moran Slavin Andrei Keidar Ilan Kent Liron Berkovich Vitaly Tiomkin Roye Inbar Shmuel Avital 《Surgery for obesity and related diseases》2018,14(9):1297-1303
Background
Hypothyroidism is prevalent in morbidly obese patients and may improve after a weight reduction surgery.Objectives
Laboratory and clinical changes in hypothyroid patients undergoing laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) were compared and evaluated.Settings
Data were retrieved from a prospectively collected database of 2 public bariatric units.Methods
Patients with hypothyroidism prior to bariatric procedure were evaluated for changes in thyroid stimulating hormone (TSH) and changes or cessation of hormone replacement therapy after surgery. Correlation between changes in TSH levels and percentage of excess weight loss and comparison between effects of LSG and LRYGB were evaluated.Results
Ninety patients were included. Mean follow-up was 11 ± 9 .73 months. Mean body mass index decreased from 43.8 to 33.2 kg/m2. Forty patients had deranged elevated TSH levels prior to surgery that decreased significantly after surgery (mean 6.6 ± 1.9 to 2.9 ± 1.5 mU/L, P < .01). Of patients receiving hormone replacement therapy prior to surgery, 42% required lower doses, with a 61% mean decrease in doses, while 10% stopped hormone replacement therapy completely. No correlation was found between the improvement in TSH and percentage of excess weight loss. A significant advantage to one of the bariatric procedures (LSG [61] and LRYGB [29]) could not be established.Conclusions
LSG and LRYGB both proved to improve thyroid function in hypothyroid obese patients. No procedure was found to be superior. No correlation was found between percentage of excess weight loss and TSH reduction. This implies that the effect of bariatric surgery on the improvement of thyroid functions is mediated by mechanisms other than weight loss, probably hormonal. 相似文献9.
10.
Lidia Castagneto Gissey James R. Casella Mariolo Alfredo Genco Alfonso Troisi Nicola Basso Giovanni Casella 《Surgery for obesity and related diseases》2018,14(10):1480-1487
Background
Sleeve gastrectomy (SG) has grown into the most popular bariatric operation. Nevertheless, a scarcity of long-term outcomes are available.Objectives
This study aims at evaluating the long-term percent weight loss (%WL), excess weight loss (%EWL), weight regain (WR), and co-morbidity resolution rates in a single-center cohort undergoing SG as a primary procedure, with a minimum 10-year follow-up.Setting
University hospital, Italy.Methods
One hundred eighty-two morbidly obese patients with body mass index (BMI) 46.6 ± 7.3 kg/m2 underwent SG. Obesity-related co-morbidities (type 2 diabetes, hypertension, sleep apnea, gastroesophageal reflux disease) were investigated. Predictors of dichotomous dependent-variable diabetes remission were computed using a binomial logistic regression.Results
Patient retention rate was 77%. Mean %WL was 30.9, %EWL was 52.5%, and WR (≥25% maximum WL) occurred in 10.4%. Baseline BMI significantly (P?=?.001) and linearly predicted %EWL (10 yr %EWL?=?18.951?+?initial BMI × .74); the super-obese subgroup generated substantially greater WL compared with those with BMI <50 kg/m2 (%EWL 48.0 ± 18.5 versus 61.5 ± 23.2; P < .001). Type 2 diabetes remission occurred in 64.7%; 42.9% patients developed de novo gastroesophageal reflux disease symptoms postoperatively (P < .0001).Conclusions
SG generates sustained WL and co-morbidity resolution up to 10 years postoperatively. Although a notable portion of patients experience WR, mean %WL persists to exceed 30%, translating in adequate WL also in the long term. Additionally, WR does not seem to impact negatively on co-morbidity resolution. SG represents a safe and effective bariatric operation, which easily grants the possibility to proceed to revisional bariatric surgery in patients with WR or failure to WL. 相似文献11.
Vasileios Charalampakis Charalampos Seretis Markos Daskalakis Christos Fokoloros Ahmed Karim John Melissas 《Surgery for obesity and related diseases》2018,14(11):1652-1658
Background
Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up.Objectives
To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome.Setting
Bariatric Unit, University Hospital of Heraklion, Greece.Methods
Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded.Results
A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m2 completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from ?.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study.Conclusions
Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome. 相似文献12.
Recep Aktimur Cuneyt Kirkil Kadir Yildirim Nizamettin Kutluer 《Surgery for obesity and related diseases》2018,14(12):1850-1856
Background
One-anastomosis gastric bypass (OAGB) is considered new from the bariatric standpoint.Objectives
To assess the effectiveness and safety of the enhanced recovery after surgery protocol compared with the conventional approach in perioperative care of OAGB patients.Setting
Turkey.Methods
The prospectively collected data of 92 patients managed with standard care (group 1) were compared with 216 patients managed by the enhanced recovery after surgery pathway (group 2). All patients underwent OAGB by the same surgeon. The groups were compared in terms of mean postoperative length of stay; costs for surgery and recovery; and rates of complications, emergency room visits, and readmissions.Results
Length of stay was always 5 days in group 1 and had a mean of 1.2 ± 1.3 days in group 2 (P < .001). The mean total cost for surgery and recovery was 858.6 ± 33.1 USD in group 1 and 625.2 ± 289.1 USD in group 2 (P < .001). Specific complications (Clavien-Dindo IIIa) occurred in 1 patient (1.1%) in group 1 and in 3 patients (1.4 %) in group 2 (P?=?1.000). Fifty-seven patients (61.9%) in group 1 and 45 (20.9%) in group 2 visited the emergency room within 1 month of being discharged (P < .001). Two patients (.9%) in group 2 needed hospital readmission; there was no need for rehospitalization in group 1 (P < .001).Conclusion
The enhanced recovery after surgery pathway significantly reduces length of stay and cost after OAGB, with no significant difference in terms of surgical outcomes. It also reduces postdischarge resource utilization. 相似文献13.
Rafael Alvarez Elika Ridelman Natalie Rizk Morgan S. White Chuan Zhou Heang-Ping Chan Oliver A. Varban Mark A. Helvie Randy J. Seeley 《Surgery for obesity and related diseases》2018,14(11):1643-1651
Background
Mammographic breast density (BD) is an independent risk factor for breast cancer. The effects of bariatric surgery on BD are unknown.Objectives
To investigate BD changes after sleeve gastrectomy (SG).Setting
University hospital, United States.Methods
Fifty women with mammograms before and after SG performed from 2009 to 2015 were identified after excluding patients with a history of breast cancer, hormone replacement, and/or breast surgery. Patient age, menopausal status, co-morbidities, hemoglobin A1C, and body mass index were collected. Craniocaudal mammographic views before and after SG were interpreted by a blinded radiologist and analyzed by software to obtain breast imaging reporting and data system density categories, breast area, BD, and absolute dense breast area (ADA). Analyses were performed using χ2, McNemar's test, t test, and linear regressions.Results
Radiologist interpretation revealed a significant increase in breast imaging reporting and data system B+C category (68% versus 54%; P?=?.0095) and BD (9.8 ± 7.4% versus 8.3 ± 6.4%; P?=?.0006) after SG. Software analyses showed a postoperative decrease in breast area (75,398.9 ± 22,941.2 versus 90,655.9 ± 25,621.0 pixels; P < .0001) and ADA (7287.1 ± 3951.3 versus 8204.6 ± 4769.9 pixels; P?=?.0314) with no significant change in BD. Reduction in ADA was accentuated in postmenopausal patients. Declining breast area was directly correlated with body mass index reduction (R2?=?.4495; P < 0.0001). Changes in breast rather than whole body adiposity better explained ADA reduction. Neither diabetes status nor changes in hemoglobin A1C correlated with changes in ADA.Conclusions
ADA decreases after SG, particularly in postmenopausal patients. Software-generated ADA may be more accurate than radiologist-estimated BD or breast imaging reporting and data system for capturing changes in dense breast tissue after SG. 相似文献14.
Muriel Coupaye Hélène Legardeur Ouidad Sami Daniela Calabrese Laurent Mandelbrot Séverine Ledoux 《Surgery for obesity and related diseases》2018,14(10):1488-1494
Background
There is a lack of evidence on whether sleeve gastrectomy (SG), which induces fewer nutritional deficiencies than Roux-en-Y gastric bypass (RYGB), also affects fetal growth (FG).Objectives
To compare neonatal outcomes after RYGB and SG and to assess the impact of maternal nutritional alterations on FG after both procedures.Setting
University Hospital, France.Methods
Women with singleton pregnancies who had at least 1 nutritional evaluation in our institution between 2004 and 2017 were included. FG was assessed with birth weight (BW) and BW-Z score (adjusted for sex and term), and maternal nutritional deficiencies were defined according to standard and pregnancy-specific norms.Results
During the study period 123 pregnancies were included, 77 after RYGB and 46 after SG. Weight loss was higher after RYGB than after SG (45.6 ± 12.4 versus 39.5 ± 13.7 kg, P?=?.02), but mean weight before pregnancy and weight gain during pregnancy were similar. Mean BW (3026 ± 677 versus 3162 ± 712 g), mean BW Z-score and incidence of small for gestational age (24% versus 19%) were not significantly different after RYGB and SG. Mean number of nutritional deficiencies during the second trimester was similar (2.2 ± 1.5 versus 2.1 ± 1.2 with specific norms), but the affected parameters differed between procedures. Urinary urea (R?=?.285, P?=?.04) was positively correlated to BW Z-score after both procedures. In contrast, serum iron parameters were negatively associated to BW Z-score.Conclusion
FG restriction occurs after both SG and RYGB. FG after bariatric surgery is positively associated with protein supply and negatively correlated with maternal iron status. 相似文献15.
Thomas H. Inge R. Yates Coley Lydia A. Bazzano Stavra A. Xanthakos Kathleen McTigue David Arterburn Neely Williams Rob Wellman Karen J. Coleman Anita Courcoulas Nirav K. Desai Jane Anau Roy Pardee Sengwee Toh Cheri Janning Andrea Cook Jessica Sturtevant Casie Horgan Marc Michalsky 《Surgery for obesity and related diseases》2018,14(9):1374-1386
Background
Bariatric surgery has been used for treatment of severe obesity in adolescents but most studies have been small and limited in follow-up.Objectives
We hypothesized that electronic health record data could be used to compare effectiveness of bariatric procedures in adolescents.Setting
Data were obtained from clinical research networks using a common data model to extract data from each site.Methods
Adolescents who underwent a primary bariatric procedure from 2005 through 2015 were identified. The percent change in body mass index (BMI) at 1, 3, and 5 years was estimated using random effects linear regression for patients undergoing all operations. Propensity score adjusted estimates and 95% confidence intervals were estimated for procedures with >25 patients at each time period.Results
This cohort of 544 adolescents was predominantly female (79%) and White (66%), with mean (±standard deviation) age of 17.3 (±1.6) years and mean BMI of 49.8 (± 7.8) kg/m2. Procedures included Roux-en-Y gastric bypass (RYGB; n?=?177), sleeve gastrectomy (SG; n?=?306), and laparoscopic adjustable gastric banding (n?=?61). For those undergoing RYGB, SG, and laparoscopic adjustable gastric banding, mean (95% confidence interval) BMI changes of ?31% (?30% to ?33%), ?28% (?27% to ?29%), and ?10% (?8% to ?12%), were estimated at 1 year. For RYGB and SG, BMI changes of ?29% (?26% to ?33%) and ?25% (?22% to ?28%) were estimated at 3 years.Conclusions
Adolescents undergoing SG and RYGB experienced greater declines in BMI at 1- and 3-year follow-up time points, while laparoscopic adjustable gastric banding was significantly less effective for BMI reduction. 相似文献16.
Manuel Macías-González Gracia María Martín-Núñez Lourdes Garrido-Sánchez Eduardo García-Fuentes Francisco José Tinahones Sonsoles Morcillo 《Surgery for obesity and related diseases》2018,14(9):1327-1334
Background
Obesity is characterized by a chronic, low-grade inflammation, and bariatric surgery is proposed as an effective treatment for reducing the obesity-related co-morbidities. Epigenetic modifications could be involved in the metabolic improvement after surgery.Objective
The main aim of this study was to evaluate whether DNA methylation pattern from genes related to inflammation and insulin response is associated with the metabolic improvement after bariatric surgery in morbidly obese patients and if these changes depend on the surgical procedure.Setting
University hospital, Spain.Methods
We studied 60 severely obese patients; 31 underwent Roux-en-Y gastric bypass and 29 underwent laparoscopic sleeve gastrectomy. All patients were examined before and at 6 months after bariatric surgery. DNA methylation profile of genes related to the inflammatory response and insulin sensitivity was measured by pyrosequencing.Results
The promoter methylation levels of the NFKB1 gene were increased significantly after surgery (2.16 ± .9 versus 2.8 ± 1.03). The decrease in blood pressure, both systolic and diastolic, after surgery was significantly associated with the changes in the promoter methylation levels of the NFKB1 gene (β?=??.513, P?=?.003 and β?=??.543, P?=?.004, respectively). A decrease in inflammation status, measured by high sensitivity C-reactive protein values, was associated with changes in SLC19A1 methylation levels.Conclusion
Our study shows for the first time an association between NFKB1 methylation levels and blood pressure after bariatric surgery, highlighting the possible function of this gene in the regulation of arterial pressure. Regarding SLC19A1, this gene could position as a potential target linking inflammation and insulin resistance. 相似文献17.
Jad Khoraki Guilherme S. Mazzini Amar S. Shah Paul A.R. Del Prado Luke G. Wolfe Guilherme M. Campos 《Surgery for obesity and related diseases》2018,14(8):1118-1125
Background
Early small bowel obstruction (ESBO; within 30 d of surgery) after laparoscopic gastric bypass (LRYGB) is reported in .5% to 5.2% of primary cases, but it is associated with significant morbidity, and the treatment is not standardized.Objectives
To review prevalence, causes, management, and outcomes of patients treated for ESBO after LRYGB.Setting
Tertiary academic medical center.Methods
Retrospective review to identify consecutive patients who underwent primary LRYGB and those who developed ESBO from January 2000 through June 2017. Data included demographic characteristics, co-morbidities, LRYGB technical details, and ESBO clinical presentation, location, causes, treatment, and outcomes.Results
One thousand seven hundred seventeen patients (84.2% females) had LRYGB. Mean age and body mass index was 42.4 ± 11.1 years and 48.2 ± 7.3 kg/m2, respectively. Twenty-nine patients (1.7%) had ESBO. All patients presented with symptoms, most commonly nausea and vomiting (n?=?17), on average 4.1 ± 5.9 days postoperatively; most required reoperation (n?=?23, 79.3%) and 5 required >1 reoperation. Location of the obstruction and treatment used were the following: (1) jejuno-jejunostomy (n?=?17, 58.6%; narrowing or clot), treated with reoperation in 11; and (2) other than at the jejuno-jejunostomy (n?=?12, 41.4%; trocar site, incisional or internal hernia, adhesions, mesenteric ischemia), treated with reoperation in all. All ESBO patients had additional complications, 6 (20.1%) developed an anastomotic leak, and 2 (6.9%) died.Conclusion
ESBO infrequently occurs after LRYGB; many causes are technique related and possibly preventable. However, it is associated with significant morbidity and mortality. A high index of clinical suspicion, rapid and appropriate imaging, and prompt operative intervention are recommended. 相似文献18.
Michelle R. Lent Yirui Hu Peter N. Benotti Anthony T. Petrick G. Craig Wood Christopher D. Still H. Lester Kirchner 《Surgery for obesity and related diseases》2018,14(11):1680-1685
Background
Weight change trajectories after weight-loss surgery may vary significantly.Objectives
This study evaluated the weight trajectories of Roux-en-Y gastric bypass (RYGB) patients and identified the distinct clinical, behavioral, and demographic features of patients by trajectory.Setting
Data from 2918 RYGB patients from a comprehensive medical center between January 2004 and November 2016 were included.Methods
This retrospective, observational study used data for RYGB patients up to year 7 postsurgery. Group-based trajectory models were fitted for percentage weight change. Variables evaluated by trajectory included age, sex, diagnoses, medications, smoking, presurgical body mass index, preoperative weight loss, and early postoperative weight loss.Results
Of 3215 possible patients, 2918 (90.8%) were included (mean age?=?46.2 ± 11.2 yr, body mass index?=?46.9 ± 7.9 kg/m2 at the time of surgery). Three weight change trajectories were identified (above average, average, and below average). Mean percentage weight change at the nadir for the above average group was ?42.85% ± 5.7% compared with ?31.57% ± 5.0% in the average group and ?22.74% ± 5.7% in the below average group. Compared with the above average group, the below average group was more likely to be male (odds ratio [OR]?=?2.40, P < .0001) and have diabetes (noninsulin users, OR?=?2.08, P < .0001), but less likely to have a smoking history (OR?=?.62, P?=?.0007) or take sleep medications (OR?=?.50, P?=?.005). Below average group patients had a lower BMI at the time of surgery (OR?=?.91, P < .0001). Lower initial weight loss postsurgery was associated with a greater chance of a poorer weight outcomes (OR?=?1.64, P < .0001).Conclusion
Select clinical, demographic, and behavioral factors may increase or decrease the chance for better weight loss after RYGB. 相似文献19.
Daniel Antonio de Luis Susana García Calvo David Pacheco Hilda Fernandez Ovalle Rocio Aller 《Surgery for obesity and related diseases》2018,14(9):1402-1408
Background
ADIPOQ rs266729 have been associated with body mass index and metabolic parameters.Objectives
Our aim was to assess the contribution of this genetic variant on lipid profile and serum adiponectin levels after biliopancreatic diversion surgery in morbidly obese patients in a 3-year prospective study.Setting
Tertiary Hospital.Methods
A prospective cohort study (sample) of 149 patients with morbid obesity was evaluated. Biochemical and anthropometric parameters were studied at baseline and every year for a 3-year-follow-up period.Results
Percentage of excess weight loss (65.9% versus 66.0%:ns), body mass index, weight, waist circumference, fat mass, blood pressure, fasting glucose, low-density lipoprotein cholesterol, total cholesterol, insulin, homeostasis model assessment of insulin resistance, and triglyceride levels improved in both genotype groups. A decrease in fasting insulin levels, homeostasis model assessment of insulin resistance, total cholesterol, low-density lipoprotein cholesterol, and triglycerides was higher in non-G-allele carriers than G-allele carriers. The increase of adiponectin levels (at 1 yr) found after 1 (delta: 16.2 ± 3.1 ng/mL versus 2.1 ± 1.0 ng/mL; P?=?.02), 2 (delta: 24.2 ± 3.1 ng/mL versus 3.1 ± 1.1 ng/mL; P?=?.02), and 3 years (delta: 33.2 ± 3.9 ng/mL versus 4.7 ± 1.8 ng/mL; P?=?.01) was higher in non-G-allele carriers than G carriers. At all times, adiponectin levels were higher in patients with genotype CC.Conclusions
Non-G allele of ADIPOQ gene variant (rs266729) is associated with increases in adiponectin levels and better improvement of low-density lipoprotein cholesterol, triglycerides, insulin, and homeostasis model assessment of insulin resistance after biliopancreatic diversion massive weight loss than G-allele carriers. 相似文献20.
Roux-en-Y gastric bypass surgery in youth with severe obesity: 1-year longitudinal changes in spexin
Seema Kumar MD Jobayer Hossain Thomas Inge P Babu Balagopal 《Surgery for obesity and related diseases》2018,14(10):1537-1543