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1.
Deepali Jain Anne Sill Andrew Averbach 《Surgery for obesity and related diseases》2018,14(9):1304-1309
Background
As sleeve gastrectomy (SG) becomes the most common bariatric procedure, it remains unclear for which patients laparoscopic Roux-en-Y gastric bypass (LRYGB) may be advantageous. Some contend that patients with higher initial body mass index (BMI) achieve better weight loss with LRYGB.Objectives
This study evaluates weight loss in SG versus LRYGB patients based on preoperative BMI.Setting
Community teaching hospital, Baltimore, Maryland.Methods
A convenience cohort of 4935 individuals, undergoing bariatric surgery from 2001 to 2015, was studied to examine 5-year postsurgical trends in weight loss stratified by baseline BMI and procedure. Student t tests compared mean weight loss of baseline BMI groups (<45 versus ≥45; <50 versus ≥50; and <55 versus ≥55) and line graphs and plotted 95% confidence intervals of mean weight loss by year were examined to discern differences in percent excess weight loss (%EWL) by procedure type.Results
All patients were more likely to be female (79%) and Caucasian (62.5%). Nearly twice as many patients underwent LRYGB (N?=?3236) compared with SG (N?=?1699). In patients in the BMI <45, 50, and 55 kg/m2 categories, there was no significant difference in %EWL based on procedure. However, in those patients in the BMI ≥45 and 55 kg/m2 categories, there is significantly higher %EWL in the LRYGB group over SG.Conclusion
In conclusion, patients with lower baseline BMI had improved %EWL regardless of procedure, but those patients with higher baseline BMI who underwent LRYGB did have higher %EWL than those undergoing SG at 2 years follow-up. BMI is one of many key factors when selecting a procedure for an individual patient. 相似文献2.
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3.
4.
Mohamad A. Minhem Bassem Y. Safadi Robert H. Habib Etwal P. Bou Raad Ramzi S. Alami 《Surgery for obesity and related diseases》2018,14(10):1463-1470
Background
Laparoscopic sleeve gastrectomy (SG) has become the most popular bariatric operation over the last decade. Extreme obesity and increasing age have been generally associated with higher risks of complications after bariatric surgery. The postoperative risk for complications after SG has not been previously presented according to simultaneous grouping of body mass index (BMI) and age.Objective
We aim to explore the association of age and BMI in determining the postoperative risk of SG from a national perspective.Setting
The American College of Surgeons National Surgical Quality Improvement Program database.Methods
We analyzed patient characteristics and operative outcomes of the 2010 to 2013 SG cohort available in the American College of Surgeons National Surgical Quality Improvement Program (N?=?21,131). Patients were grouped based on age and BMI: young-obese (N?=?10,291; <50 yr, BMI <0 kg/m2; reference group), young-super-obese (N?=?3594; <50 yr and BMI ≥50 kg/m2), older-obese (N?=?5636; ≥50 yr, BMI <0 kg/m2), and older-super-obese (N?=?1610; ≥50 yr, BMI ≥50 kg/m2). Composite morbidity and/or mortality (M&M) was used as the primary outcome and risk-adjusted odds ratios (AOR[M&M]) were derived by logistic regression. M&M was a composite of surgical site, renal, neurologic, cardiac, thromboembolic, respiratory, septic and bleeding complications, unplanned readmissions, prolonged stay, and death.Results
Overall operative mortality was low (.1%) but significantly worse in older-super-obese patients (.37%; P?=?.005). M&M rates were lowest in young-obese (5.8%), similarly worse in young-super-obese (7.0%) and older-obese (7.0%), and highest for older-super-obese (10.1%; P < .001). After comprehensive covariate risk adjustment, the composite M&M outcome after SG was significantly increased (42%) only in older-super-obese patients (AOR?=?1.42 [1.16–1.73]), while older age alone (AOR?=?1.09 [.94–1.25]) and super obesity alone (AOR?=?1.09 [.93–1.28]) did not.Conclusions
Analysis of the American College of Surgeons National Surgical Quality Improvement Program showed that super obesity is associated with increased complications in older patients undergoing SG. Older-super-obese patients should be appropriately counseled about increased SG perioperative risks within the context of expected long-term benefits. 相似文献5.
Juan Pujol Rafols Amr I. Al Abbas Stefanie Devriendt Anabela Guerra Miguel F. Herrera Jacques Himpens Eva Pardina Julia Peinado-Onsurbe Almino Ramos Rui José da Silva Ribeiro Bassem Safadi Hugo Sanchez-Aguilar Claire de Vries Bart Van Wagensveld 《Surgery for obesity and related diseases》2018,14(11):1659-1666
Background
To date, laparoscopic adjustable gastric banding remains the third most commonly performed surgical procedure for weight loss. Some patients fail to get acceptable outcomes and undergo revisional surgery at rates ranging from 7% to 60%. Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and sleeve gastrectomy (SG) are among the most common salvage options for failed laparoscopic adjustable gastric banding.Objective
To compare the outcomes of converting failed laparoscopic adjustable gastric banding to RYGB, OAGB, or SG.Methods
Data collected from 7 experienced bariatric centers around the world were retrospectively collected, reviewed, and analyzed. Final body mass index (BMI), change in BMI, percentage excess BMI loss, and major complications with particular attention to leaks, hemorrhage, and mortality were reported.Results
Of 1219 patients analyzed, 74% underwent RYGB, 16% underwent OAGB, and 10% underwent SG after banding failure. The mean age was 38 years (±10 yr), and 82% of patients were women. The mean follow-up was 33 months. The follow-up rate was 100%, 87%, and 52% at 1, 3, and 5 years, respectively. At the latest follow-up, percentage excess BMI loss >50% was achieved by 75% of RYGB, 85% of OAGB, and 67% of SG patients. Postoperative complications occurred in 13% of patients after RYGB, 5% after OAGB, and 15% after SG.Conclusion
Our data show that it is possible to achieve or maintain significant weight loss with an acceptable complication rate with all 3 surgical options. 相似文献6.
Tarek Debs Niccolo Petrucciani Radwan Kassir Eric Sejor Sami Karam Imed Ben Amor Jean Gugenheim 《Surgery for obesity and related diseases》2018,14(12):1804-1810
Background
Laparoscopic sleeve gastrectomy (SG) is gaining acceptance among bariatric surgeons as a viable option for treating morbidly obese patients. We describe the results of a single center's experience with SG, revealing a low complication rate.Objectives
The aim of the study was to analyze the short-term results of laparoscopic SG using exclusively black staples with staple-line reinforcement.Settings
University hospital, tertiary referral center for bariatric surgery.Methods
SG was performed in 434 consecutive patients from December 2014 to March 2017. A technique is described where all operations were performed with attention to avoiding strictures at the incisura angularis and not stapling near the esophagus at the angle of His. All the interventions were performed using black cartridges and staple-line reinforcement using bioabsorbable Seamguard. A prospective chart review was conducted to determine the occurrence of early complications.Results
Follow-up data were collected for all patients at 90 days postoperatively. A total complication rate of 4.4% was observed. No leaks occurred in any of the patients. One case of bleeding occurred that necessitated a surgical exploration, which found the origin of the bleeding to be a diaphragmatic vessel. The 90-day mortality rate was 0%.Conclusion
SG can be performed with a low complication rate. Selection of the appropriate staple height and reinforcement of the staple line could play a major role in optimizing the results of SG. 相似文献7.
Kamyar Hariri Daniela Guevara Matthew Dong Subhash U. Kini Daniel M. Herron Gustavo Fernandez-Ranvier 《Surgery for obesity and related diseases》2018,14(9):1261-1268
Background
Type 2 diabetes (T2D), obstructive sleep apnea (OSA), hypertension (HTN), and hyperlipidemia (HLD) are common co-morbidities that are strongly associated with obesity.Objective
The purpose of this study was to compare the rate of obesity-related co-morbidity remission and percent total body weight loss of super-obese patients with a body mass index (BMI) ≥50 kg/m2 with bariatric patients who have a BMI of 30 to 49.9 kg/m2.Setting
Academic hospital, United States.Methods
A retrospective analysis of outcomes of a prospectively maintained database was done on obese patients with a diagnosis of ≥1 co-morbidity (T2D, OSA, HTN, or HLD) who at the time of initial visit had undergone either a sleeve gastrectomy or a Roux-en-Y gastric bypass at our hospital between 2011 and 2015. The patients were stratified based on their preoperative BMI class, BMI of 30 to 49.9 kg/m2 versus BMI ≥50 kg/m2.Results
Of the 930 patients, 732 underwent sleeve gastrectomy and 198 underwent Roux-en-Y gastric bypass. The 6-month follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m2 (n?=?759) versus super-obese patients (n?=?171) were 46.0% and 36.7% (P?=?.348) for T2D; 75.0% and 73.2% (P?=?.772) for OSA; 35.0% and 22.0% (P?=?.142) for HTN; and 37.0% and 21.0% (P?=?.081) for HLD, respectively. The 1-year follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m2 versus super-obese patients were 54.2% and 45.5% (P?=?.460) for T2D; 87.0% and 89.7% (P?=?.649) for OSA; 37.4% and 23.9% (P?=?.081) for HTN; and 43.2% and 34.6% (P?=?.422) for HLD, respectively. Furthermore, there was no difference in the mean percent total weight loss for patients with a preoperative BMI of 30 to 49.9 kg/m2 versus the super-obese at the 6-month (21.4%, 20.9%, P?=?.612) and 1-year (28.0%, 30.7%, P?=?.107) follow-ups.Conclusion
In our study, preoperative BMI did not have an impact on postoperative co-morbidity remission rates or percent total body weight loss. Future studies should investigate the effect of other factors, such as disease severity and duration. 相似文献8.
Dino Kröll Philipp C. Nett Yves Michael Borbély Sabine Schädelin Debora Bertaggia Calderara Lorenzo Alberio Guido Stirnimann 《Surgery for obesity and related diseases》2018,14(12):1890-1896
Background
Thromboembolic disease is a potentially serious complication in bariatric surgery patients. Direct oral anticoagulants (DOAC) have been investigated in orthopedic surgery patients. DOAC data after bariatric surgery are still limited to the early postsurgical period. Whether postsurgical midterm adaptations due to anatomic and physiologic alterations influence drug pharmacology is currently not known.Objective
The aim of this study was to investigate the influence of weight loss and type of bariatric surgery on midterm postsurgical pharmacokinetic and pharmacodynamic parameters of rivaroxaban.Setting
University hospital.Methods
In this monocentric study, bariatric patients received a single oral dose of rivaroxaban (10 mg) 6 to 8 months after sleeve gastrectomy (SG) or Roux-en-Y-gastric bypass (RYGB). Pharmacokinetic and pharmacodynamic parameters were assessed and compared with prebariatric surgery results.Results
We included 6 RYGB and 6 SG patients. Percent excess weight loss was 71.4% (interquartile range 56.4, 87.9) in the SG group and 76.6% (64.5, 85.7) in the RYGB group. Rivaroxaban mean areas under the curve 6 to 8 months after the bariatric procedure (922.4 µg?×?h/L, coefficient of variation 43.2) were comparable to those measured preoperatively (952.6 µg?×?h/L, 16.8). There was no relevant difference between the 2 surgical procedure groups. Rivaroxaban led to a decrease of prothrombin fragments F1+2 over 12 hours after oral intake confirming in vivo efficacy.Conclusions
Significant weight loss and altered anatomy after RYGB and SG procedures do not appear to affect the pharmacokinetics and pharmacodynamics of prophylactic rivaroxaban. A single dose of Rivaroxaban was well tolerated and considered safe in this trial. 相似文献9.
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10.
Kara J. Kallies Luis D. Ramirez Brandon T. Grover Shanu N. Kothari 《Surgery for obesity and related diseases》2018,14(12):1843-1849
Background
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted.Objective
To evaluate preferences for RYGB versus SG.Setting
Survey of U.S. adults.Methods
An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information.Results
Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n?=?922) and 28.7 ± 8.0 kg/m2 (n?=?915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information?+?SG image versus SG information?+?RYGB image (44%).Conclusions
Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference. 相似文献11.
Maria S. Altieri Aurora Pryor Andrew Bates Salvatore Docimo Mark Talamini Konstantinos Spaniolas 《Surgery for obesity and related diseases》2018,14(9):1368-1372
Background
With the rise of obesity in adolescents, there is an exponential increase in bariatric procedures in this patient population.Objectives
The purpose of our study was to examine perioperative outcomes after bariatric surgery in this cohort.Setting
University hospital, involving a large database in New York State.Methods
The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file was queried to identify all adolescent patients (age <19 years) undergoing primary laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2015. We assessed 30-day postoperative complications.Results
We identified 1072 patients who underwent Roux-en-Y gastric bypass (n?=?279) or SG (n?=?793). The majority were Caucasian (n?=?790) and female (n?=?857) with mean body mass index and age of 47.9 ± 8.1 kg/m2 and 18.2 ± 1 years, respectively, preoperative hypertension, type 2 diabetes, and obstructive sleep apnea were present in 90 (8.4%), 139 (13%), and 165 (15.4%) of patients, respectively. There was significant difference in preoperative gastroesophageal reflux disease (18.6% versus 13.4%, P?=?.033), obstructive sleep apnea (19.7% versus 13.9%, P?=?.02), and body mass index (48.6 ± 7.9 versus 47.6 ± 8.2 kg/m2, P?=?.03) between patients undergoing Roux-en-Y gastric bypass and SG, respectively. Thirty-day reoperation, readmission, and reintervention were reported in 1.5%, 3.3%, and 1.6% of the adolescent cohort, respectively. Four patients (.4%) developed a staple line/anastomotic leak, and 1 patient (.09%) died within 30 days; 93.9% of all adolescent patients experienced an uneventful 30-day recovery. Uneventful recovery was significantly more likely for patients undergoing SG (95.3% versus 90%, P?=?.001; adjusted odds ratio 2.2, 95% confidence interval 1.31–3.69).Conclusion
Perioperative safety of bariatric surgery in adolescents in accredited centers is safer than previously reported with low rate of 30-day events. SG is a safer procedure in this patient population. 相似文献12.
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13.
Deanna M. Arble Simon S. Evers Nadejda Bozadjieva Henriette Frikke-Schmidt Andriy Myronovych Alfor Lewis Mouhamadoul Habib Toure Randy J. Seeley 《Surgery for obesity and related diseases》2018,14(12):1857-1867
Background
One-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal switch (SADS) have become increasingly popular weight loss strategies. However, data directly comparing the effectiveness of these procedures with Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (SG) are limited.Objectives
To examine the metabolic outcomes of OAGB, SADS, RYGB, and SG in a controlled rodent model.Setting
Academic research laboratory, United States.Methods
Surgeries were performed in diet-induced obese Long-Evans rats, and metabolic outcomes were monitored before and for 15 weeks after surgery.Results
All bariatric procedures induced weight loss compared with sham that lasted throughout the course of the study. The highest percent fat loss occurred after OAGB and RYGB. All bariatric procedures had improved glucose dynamics associated with an increase in insulin (notably OAGB and SADS) and/or glucagon-like protein-1 secretion. Circulating cholesterol was reduced in OAGB, SG, and RYGB. OAGB and SG additionally decreased circulating triglycerides. Liver triglycerides were most profoundly reduced after OAGB and RYGB. Circulating iron levels were decreased in all surgical groups, associated with a decreased hematocrit value and increased reticulocyte count. The fecal microbiome communities of OAGB, SADS, and RYGB were significantly altered; however, SG exhibited no change in microbiome diversity or composition.Conclusions
These data support the use of the rat for modeling bariatric surgical procedures and highlight the ability of the OAGB to meet or exceed the metabolic improvements of RYGB. These data point to the likelihood that each surgery accomplishes metabolic improvements through both overlapping and distinct mechanisms and warrants further research. 相似文献14.
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15.
16.
Athar S.M. Elward Mohamed H.A. Fahmy Ashraf M. Abu-Seida 《Surgery for obesity and related diseases》2018,14(12):1814-1820
Background
Laparoscopic sleeve gastrectomy (LSG) has serious complications, such as leaks, reflux, stenosis, and kinks, which are also consequences of shortcomings in the LSG technique.Objectives
We evaluated the feasibility and weight loss of a novel bariatric procedure, using the greater curvature as the gastric pouch for sleeve gastrectomy (SG) in dogs.Setting
Animal house in Faculty of Medicine, Cairo University.Methods
Five 20- to 25-kg stray mongrel male dogs were subjected to open SG using the greater curve as the gastric pouch (GCSG group). The weight was monitored at day of surgery and at postoperative weeks 2, 4, 6, and 8; weight progression was compared with a sham and a standard SG group. By the end of the follow-up period autopsy was done.Results
The mean operative time in GCSG group was 39.6 ± 3.97 minutes. At the end of the study, dogs in the sham group had gained 8% of their preoperative weight, while the GCSG and standard SG groups lost 24.7% and 25% of their preoperative weight, respectively. At autopsy, the gastric sleeve in the GCSG group showed excellent healing with no stenotic areas, kinks, or mucosal ulcerations.Conclusion
Greater curvature SG is technically feasible in a canine model. Larger studies with longer follow-up period will be needed to assess weight progression and resolution of the metabolic co-morbidities. 相似文献17.
Daniel Gärtner Christine Stroh Martin Hukauf Frank Benedix Thomas Manger 《Surgery for obesity and related diseases》2019,15(2):187-193
Background
Recently, sleeve gastrectomy (SG) has become one of the most important procedures in bariatric surgery. Short-term results show that SG is a feasible, safe, and effective operation treating obesity and its related co-morbidities. Now, the main focus is on long-term data after SG.Objectives
The aim of this study was to analyze perioperative and long-term results after SG in the German Bariatric Surgery Registry.Setting
National database, Germany.Methods
Perioperative data of primary SG (n?=?21525) and follow-up data for 5 years ± 6 months (n?=?435, 18.3% of 2375 SG performed between 2005 and 2011) were analyzed. After a review of the literature long-term results were compared with international data.Results
Mean baseline body mass index (BMI) was 51.1 kg/m2. Two hundred ninety-eight (68.5%) patients were female and 137 (31.5%) were male. Of patients, 90% had ≥1 co-morbidities. Mean operation time was 86 minutes. General postoperative complications occurred in 4.1% and special complications in 4.6% (staple-line leaks 1.6%). Mean maximum BMI loss was 18.0 ± 6.8 kg/m2 and BMI loss after 5 years was 14.3 ± 7.4 kg/m2 (P < .001). Co-morbidities, such as type 2 diabetes, hypertension, and sleep apnea, were significantly improved (P < .001). Gastroesophageal reflux was significantly impaired (P < .001).Conclusions
The current results showed that SG is a safe and effective procedure in bariatric surgery. BMI loss was significant 5 years after SG. Most co-morbidities were significantly improved, but gastroesophageal reflux has often worsened. The follow-up rate was very low, which is a persistent problem in German bariatric surgery. 相似文献18.
Hutan Ashrafian Maren Monnich Thomas Stephen Braby James Smellie Gianluca Bonanomi Evangelos Efthimiou 《Surgery for obesity and related diseases》2018,14(11):1691-1699
Background
Intragastric balloons represent an endoscopic therapy aimed at achieving weight loss by mechanical induction of satiety. Their exact role within the bariatric armamentarium remains uncertain.Objective
Our study aimed to evaluate the use of intragastric balloon therapy alone and before definitive bariatric surgery over a 16-year period.Setting
A large city academic bariatric center for super-obese patients.Methods
Between January 2000 and February 2016, 207 patients underwent ORBERA intragastric balloon placement at esophagogastroduodenoscopy. Four surgeons performed the procedures, and data were entered prospectively into a dedicated bariatric database. Patients’ weight loss data were measured through body mass index (BMI) and excess weight loss and recorded at each clinic review for up to 5 years (60 mo). Treatment arms included intragastric balloon alone with lifestyle therapy or intragastric balloon and definitive bariatric surgery: gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass. An additional treatment arm of analysis included the overall results from intragastric balloon followed by stapled procedure.Results
One hundred twenty-nine female and 78 male patients had a mean age of 44.5 (±11.3) years and a mean BMI of 57.3 (±9.7) kg/m2. Fifty-eight percent of patients suffered from type 2 diabetes. Time from initial or first balloon insertion to definitive surgical therapy ranged between 9 and 13 months. Seventy-six patients had intragastric balloon alone, and 131 had intragastric balloon followed by definitive procedure. At 60 months postoperatively the intragastric balloon alone with lifestyle changes demonstrated an excess weight loss of 9.04% and BMI drop of 3.8; intragastric balloon with gastric banding demonstrated an excess weight loss of 32.9% and BMI drop of 8.9. Intragastric balloon and definitive stapled procedure demonstrated a BMI drop of 17.6 and an excess weight loss of 52.8%. Overall, there were 3 deaths (1.4%), 2 within 10 days due to acute gastric perforation secondary to vomiting and 1 cardiac arrest at 4 weeks postoperatively.Conclusion
Intragastric balloons can offer effective weight loss in selected super-obese patients within a dedicated bariatric center offering multidisciplinary support. Balloon insertion alone offers only short-term weight loss; however, when combined with definitive bariatric surgical approaches, durable weight loss outcomes can be achieved. A strategy of early and continual vigilance for side effects and a low threshold for removal should be implemented. Surgeon and unit experience with intragastric balloons can contribute to “kick starting” successful weight loss as a bridge to definitive therapy in an established bariatric surgical pathway. 相似文献19.
Yung Lee Michał Pędziwiatr Piotr Major Karanbir Brar Aristithes G. Doumouras Dennis Hong 《Surgery for obesity and related diseases》2018,14(11):1766-1782
Background
Excess visceral adipose tissue has been identified as an important risk factor for obesity-related co-morbidities. Conflicting information exists on whether omentectomy added to bariatric surgery is beneficial to metabolic variables.Objective
To evaluate the impact of omentectomy added to bariatric surgery on metabolic outcomesSetting
University Hospital, Canada.Methods
MEDLINE, EMBASE, and PubMed were searched up to May 2018. Studies were eligible for inclusion if they were randomized controlled trials comparing omentectomy added to bariatric surgery with bariatric surgery alone. Primary outcome measures were absolute change in metabolic variables (body mass index, insulin, glucose, cholesterol, lipoproteins, and triglycerides); secondary outcomes were changes in adipocytokines. Pooled mean differences (mean deviation; MD) were calculated using random effects meta-analyses, and heterogeneity was quantified using the I2 statistic.Results
Ten trials involving a total of 366 patients met the inclusion criteria with a median follow-up time of 1 year after surgery. Adding omentectomy to bariatric surgery demonstrated a minimal but statistically significant decrease in body mass index compared with bariatric surgery alone (MD 1.29, 95% confidence interval .35–2.23, P?=?.007, I2?=?0%, 10 trials). Conversely, patients who underwent bariatric surgery alone had significant increases in high-density lipoprotein (MD ?2.12, 95% confidence interval ?4.13 to ?.11, P?=?.04, I2?=?0%, 6 trials). Other metabolic outcomes and adipocytokines showed no significant difference between procedures.Conclusion
The addition of omentectomy to bariatric surgery results in minimal reduction of body mass index. Considering no overall improvement in metabolic outcomes and the time and effort required, the therapeutic use of omentectomy added to bariatric surgery is not warranted. 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