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1.
Elisenda Climent David Benaiges Juana A. Flores-Le Roux Jose M. Ramón Juan Pedro-Botet Albert Goday 《Surgery for obesity and related diseases》2018,14(8):1099-1105
Background
Few studies have compared mid-term results of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG), and none have focused on lipid profile.Objectives
To compare LRYGB versus LSG with respect to lipid disturbance evolution and remission at mid-term after bariatric surgery (BS) and to assess associated factors with the remission of lipid disturbances at 5 years.Setting
Hospital del Mar, Barcelona, from January 2005 to January 2012.Methods
A retrospective analysis of a nonrandomized, prospective cohort was conducted on patients undergoing BS at Hospital del Mar, Barcelona, from January 2005 to January 2012 with ≥5 years’ follow-up.Results
Of 259 patients, 151 (58.3%) completed the 5-year follow-up. The proportion of patients who achieved normal low-density lipoprotein cholesterol levels at 5 years post-LRYGB was greater than after LSG (30/49 [61.2%] versus 6/23 [26.1%]; P?=?.005), being male sex, absence of statins treatment, and type of BS technique (LRYGB) the associated factors with remission. Hypertriglyceridemia remission was also higher after LRYGB (23/25 [92.0%] versus 10/15 [66.7%]; P?=?.041), although type of surgery was not an associated factor. No differences were found in remission rates of low high-density lipoprotein cholesterol between groups. Absence of fibrates treatment and 5-year percentage of excess weight loss were independently associated with hypertriglyceridemia remission, and only the latter was independently associated with low high-density lipoprotein cholesterol remission 5 years after surgery.Conclusions
Five-year outcome data showed that, among patients with severe obesity undergoing BS, LRYGB was associated with a higher total and low-density lipoprotein cholesterol reduction and remission in comparison to LSG, with no differences in hypertriglyceridemia and high-density lipoprotein cholesterol normalization. 相似文献2.
Xiao Du Xiang-hui Fu Bo-qiang Peng Rong Luo Jian-kun Hu Zhong Cheng 《Surgery for obesity and related diseases》2018,14(9):1348-1356
Background
The effects of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on metabolic syndrome (MS) in morbidly obese patients have not been well studied.Objective
To compare the effectiveness of LSG and LRYGB in Chinese morbidly obese patients with MS.Setting
University Hospital, China.Methods
Patients who underwent LRYGB or LSG surgery and had completed at least 1 year of follow-up were retrospectively reviewed. Bariatric and metabolic outcomes in the 2 groups were compared. Univariate and multivariate analyses were performed to identify the predictors of MS remission.Results
Of the 176 patients enrolled in this study, 79 underwent LSG and 97 underwent LRYGB. Eighty-three met 3 of the International Diabetes Federation criteria for diagnosis of MS, 69 met 4 of the criteria, and 24 met 5 of the criteria. At 1 year after bariatric surgery, 79% of patients achieved remission of MS. In both LSG and LRYGB groups, the number of MS criteria met by patients decreased significantly after surgery. The MS remission rate was not significantly different between the 2 groups (74.7% in LSG versus 82.5% in LGB; P?=?.21). In LSG patients, there was no significant decrease in blood pressure or increase in the high-density lipoprotein cholesterol at 1 year. On logistic regression analysis, younger age, lower body mass index, and lower homeostatic model of assessment-insulin resistance were independently associated with MS remission at 1 year after surgery. Both groups showed satisfactory and comparable weight loss (percentage of excess weight loss: 71.7% in LSG versus 74.4% in LRYGB). No surgery-related mortality occurred.Conclusions
Both LSG and LRYGB are feasible, safe, and effective in Chinese obese patients with MS. LSG seems to be inferior to LRYGB with regard to control of hypertension and high-density lipoprotein cholesterol. 相似文献3.
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4.
Michał R. Janik Rami R. Mustafa Tomasz G. Rogula Adel Alhaj Saleh Mujjahid Abbas Leena Khaitan 《Surgery for obesity and related diseases》2018,14(9):1276-1282
Background
An increase in the prevalence of obesity and longer life expectancy has resulted in an increased number of candidates over the age of 60 who are pursuing a bariatric procedure.Objective
The aim of this study was to assess the safety of laparoscopic Roux-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG) in patients aged 60 years or older.Setting
University Hospital, United StatesMethods
Preoperative characteristics and 30-day outcomes from the MBSAQIP 2015 were selected for all patients aged 60 years or older who underwent a LSG or LRYGB. LRYGB cases were closely matched (1:1) with LSG patients by age (±1 year), BMI (±1 kg/m2), gender, preoperative steroid or immunosuppressant use, preoperative functional health status and comorbidities including: diabetes, gastroesophageal reflux disease, hypertension, hyperlipidemia, venous stasis, sleep apnea and history of severe chronic obstructive pulmonary disease.Results
A 3371 matched pairs were included in the study. The mean operative time in LRYGB was significantly longer in comparison to LSG patients (122 vs 84 min., P<0.001). Patients after LRYGB had a significantly increased anastomotic leakage rate (1.01% vs 0.47 %, p = 0.011), 30-day readmission rate (6.08% vs 3.74%, p < 0.001) and 30-day reoperation rate (2.49% vs 0.89%, p < 0.001) The length of hospital stay was longer in LRYGB. Mortality and bleed rate was comparable.Conclusions
LRYGB and LSG in patients aged 60 years or older are relatively safe in the short term with an acceptable complication rate and low mortality. However, LRYGB is more challenging and is associated with significantly increased rates of leakage events, 30-day reoperation, 30-day readmission, longer operative time and longer hospital stay. 相似文献5.
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6.
Ahmad Assalia Anat Ilivitzki Amos Ofer Alain Suissa Elias Manassa Iyad Khamaysi Ahmad Mahajna 《Surgery for obesity and related diseases》2018,14(8):1093-1098
Background
Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality.Objectives
To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG.Setting
University hospital, Israel.Methods
Twenty-four morbidly obese patients (mean age?=?42.2 yr, mean body mass index?=?42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage.Results
There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20–46).Conclusions
Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG. 相似文献7.
Colette S. Inaba Christina Y. Koh Sarath Sujatha-Bhaskar Marija Pejcinovska Ninh T. Nguyen 《Surgery for obesity and related diseases》2018,14(10):1448-1453
Background
Laparoscopic sleeve gastrectomy (LSG) is associated with low morbidity and mortality and a short length of stay. Studies on the safety of same-day discharge after LSG are limited.Objective
To compare outcomes between same-day versus first-postoperative-day (POD1) discharge after LSG.Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database.Methods
The 2015 to 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was analyzed for elective LSG cases with same-day or POD1 discharge. Open, revisional, and converted cases were excluded. Multivariate analysis was performed to compare adjusted 30-day mortality, morbidity, readmission, and reoperation for same-day versus POD1 discharge.Results
We examined 85,321 LSG cases, including 4728 same-day discharges and 80,593 POD1 discharges. Compared with POD1 discharges, same-day discharges were associated with higher overall morbidity (1.31% versus .84%, respectively; adjusted odds ratio [AOR] 1.72; P?=?.0002), a higher readmission rate (2.14% versus 1.64%, respectively; AOR 1.40; P?=?0.0034), and a higher reoperation rate (.61% versus .27%, respectively; AOR 2.35; P < .0001). There was no difference in mortality (.08% versus .04%, respectively; AOR 2.62; P?=?.0923).Conclusion
Same-day discharge after LSG is associated with increased complications, readmissions, and reoperations compared with POD1 discharge. Further studies are needed to examine objective criteria for safe same-day discharge after LSG. 相似文献8.
Merel van den Broek Loek J.M. de Heide Marloes Emous Ragnhild B. Wijma Nic J.G.M. Veeger Albert Wolthuis Anke J. Laskewitz M. Rebecca Heiner-Fokkema Anneke C. Muller Kobold Bruce H.R. Wolffenbuttel André P. van Beek 《Surgery for obesity and related diseases》2018,14(8):1106-1117
Background
Circulating amino acids have been associated with both appetite and the secretion of anorexigenic hormones in healthy and obese populations. This effect has not been investigated in subjects having undergone Roux-en-Y gastric bypass surgery (RYGB).Objective
To investigate the association between postprandial plasma concentrations of amino acids and the anorexigenic hormones glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY), the orexigenic hormone ghrelin, and satiety and hunger in post-RYGB subjects.Setting
A Dutch surgical department.Methods
Participants after primary RYGB were studied during a Mixed Meal Tolerance Test (MMTT). Satiety and hunger were assessed every 30 minutes on visual analogue scales. Blood samples were collected at baseline, every 10 minutes during the first half hour and every 30 minutes until 210 minutes after the start. The samples were assessed for 24 amino acids and 3 gastrointestinal hormones. Incremental areas under the curve (iAUCs) were calculated. Exploratory analyses were performed in which subjects were divided into high and low responders depending on the median iAUC.Results
42 subjects, aged 48 ± 11 (mean ± SD) years, 31 to 76 months post-RYGB and with total weight loss of 30 ± 9% completed the MMTT. Subjects with high satiety scores had more than a 25% higher net iAUC of PYY and GLP-1 and at least a 10% higher net iAUC of 10 amino acids compared to subjects with low scores (P < 0.05). The net iAUC of five of these amino acids (i.e. arginine, asparagine, histidine, serine and threonine) was more than 10% higher in subjects with high responses on GLP-1 and/or PYY (P < 0.05).Conclusions
Certain postprandial amino acids were associated with satiety and anorexigenic hormones and could therefore play a role in appetite regulation after RYGB; either by a direct effect on satiety, indirectly through gastrointestinal hormones, or both. 相似文献9.
Ponnie Robertlee Dolo Chao Li Xiaocheng Zhu Libin Yao Song Meng Jian Hong 《Surgery for obesity and related diseases》2018,14(10):1552-1560
Background
An increase in glucagon-like peptide-1 (GLP-1) mediating early diabetes remission after Roux-en-Y gastric bypass (RYGB) is believed to be associated with distal-ileal stimulation.Objective
To observe the effect of distal-ileal exclusion on glucose tolerance and GLP-1 response after RYGB.Setting
Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.Methods
A type 2 diabetes model was created in 40 Sprague-Dawley rats that were randomly assigned to a RYGB group (n?=?32) and a sham group (n?=?8). Four weeks after surgery, the RYGB group was further divided into the RYGB control group (n?=?8) and the distal-ileal exclusion group (RYGB-IEx, n?=?24). Rats in the RYGB-IEx group underwent laparotomy, and the last 20 cm of ileum was excluded. An oral glucose tolerance test, insulin tolerance test, and mixed-meal tolerance test conducted preoperatively were repeated in all groups at 4 and 8 weeks postoperatively.Results
Compared with preoperative level, GLP-1 was significantly increased after RYGB. GLP-1 area under the curve recorded after oral gavage at week 4 postoperatively was significantly higher than the preoperative level (P < .05). GLP-1, insulin area under the curve, and improved glucose-excursion on oral glucose tolerance test 4 weeks after gastric bypass were not reversed at week 8 after distal-ileal exclusion in the RYGB-IEx group. Food intake increased significantly after distal-ileal exclusion in the RYGB-IEx group.Conclusion
These findings suggest that distal-ileal stimulation might not be required for incretin response and diabetes remission after gastric bypass in the type 2 diabetes Sprague-Dawley rat model. 相似文献10.
Amihai Rottenstreich Gabriel Levin Geffen Kleinstern Misgav Rottenstreich Uriel Elchalal Ram Elazary 《Surgery for obesity and related diseases》2018,14(12):1795-1803
Background
The optimal timing of pregnancy after bariatric surgery has not been established, with data limited regarding laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric operation performed.Objectives
We explored associations of the surgery-to-conception interval with pregnancy outcomes after LSG.Setting
A university hospital.Methods
We assessed pregnancy outcomes in relation to the surgery-to-conception interval for all women who underwent LSG and delivered during 2006 to 2018.Results
Of 154 patients, 67 (43.5%) conceived within the first 18 months postoperatively (early-pregnancy group), whereas 87 (56.5%) conceived later (late-pregnancy group). The median surgery-to-conception interval was 390 (interquartile range 247–459) days in the early-pregnancy group and 1104 (8527–1548) days in the late-pregnancy group. Compared with the early-pregnancy group, the late-pregnancy group had higher gestational weight gain (median 11 versus 8 kg, P < .001) and lower hemoglobin levels in early pregnancy (12.3 versus 12.6 g/dL, P?=?.03) and after delivery (10.0 versus 10.4 g/dL, P?=?.02). Other maternal and perinatal outcomes were similar between the groups, including the proportion of small-for-gestational-age infants (11.9% versus 14.9%, P?=?.64) for those who conceived within or later than 18 months after surgery. Similar rates of small-for-gestational-age infants were found between those who conceived within or ≥12 months after surgery (P?=?1.0).Conclusions
Timing of pregnancy after LSG was found not to be associated with pregnancy outcomes. Together with documentations of a similar safety profile of pregnancy occurring earlier or later in the postoperative course, these data should reassure women who do not wish to delay conception after surgery. 相似文献11.
Andrew Demeusy Anne Sill Andrew Averbach 《Surgery for obesity and related diseases》2018,14(10):1454-1461
Background
Laparoscopic sleeve gastrectomy (LSG) has become a dominant bariatric procedure. In the past, significant leak rates prompted the search for staple line reinforcement (SLR) techniques. Previous analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all LSG suggested a detrimental influence of SLR on leak rates and overall morbidity.Objective
To investigate the relationship between various SLR techniques and bougie size with 30-day outcomes.Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program–accredited bariatric surgery hospitals.Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2016 Participant Use File data, primary LSG cases were divided into study groups based on surgical techniques. All variables were reported in the Participant Use File except leak rate and overall morbidity, which had to be derived. Multiple bivariate analyses were used to analyze the 30-day outcomes.Results
A total of 198,339 primary LSG operations were included and grouped into No SLR (23.0%), SLR (54.2%), oversewn staple line (9.5%), and a combination of SLR?+?oversewn staple line (13.3%). There were no statistical differences between study groups in mortality, overall morbidity, or leak rate. Bleeding and reoperation rates were statistically higher in the No SLR group. Bougie size was not associated with change in leak rates.Conclusion
Primary LSG is a safe procedure with low morbidity and mortality rates. SLR is associated with decreased rates of bleeding and reoperations but does not affect leak rates. The selection of SLR technique should be left to the surgeon's discretion with an understanding of the associated risks, benefits, and costs. 相似文献12.
Peter W. Lundberg Samantha Wolfe Jacqueline Seaone Jill Stoltzfus Leonardo Claros Maher El Chaar 《Surgery for obesity and related diseases》2018,14(9):1240-1245
Background
The use of robotic platforms in performing laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing, though their safety compared with the conventional laparoscopic approach remains unclear.Objective
The objective of this study was to evaluate perioperative data and 30-day outcomes of conventional and robot-assisted LRYGB using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.Setting
University health network, United States.Methods
We reviewed all conventional and robot-assisted LRYGB cases entered between January 1 and December 31, 2016 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Demographic characteristics and 30-day outcomes were analyzed based on separate Mann-Whitney rank sums tests, χ2, or Fisher's exact tests as appropriate, with P ≤ .05 denoting statistical significance with no adjustment for multiple testing.Results
Of the 39,425 patients who underwent LRYGB, 2822 were robot-assisted. The robot-assisted approach required significantly more time (138 versus 108 min, P < .0001). Rates of organ space infection, bleeding, and other significant adverse events after the conventional and robot-assisted approaches were .3% versus .5% (P?=?.13), 1.1% versus .8% (P?=?.11), and 2.3% versus 2.3% (P?=?.96), respectively. There were also no significant differences in the rates of mortality, length of stay, reoperation, or readmission between the 2 groups.Conclusions
Robot-assisted LRYGB is an increasingly popular alternative to the conventional laparoscopic approach. According to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, the early safety of these 2 techniques is equal, although the robotic approach requires more operative time. 相似文献13.
Eman Al-Shawaf Ebaa Al-Ozairi Fahad Al-Asfar Shaima Al-Beloushi Surbhi Kumari Jaakko Tuomilehto Hossein Arefanian 《Surgery for obesity and related diseases》2018,14(9):1284-1294
Background
Angiopoietin-like 8 (ANGPTL8) a hepatic protein, is implicated by several studies with a role in promoting pancreatic β-cell proliferation and improving glucose tolerance. Although a matter of controversy, a growing number of reports support ANGPTL8’s potential, yet unclear, role in type 2 diabetes (T2D).Objectives
To examine changes in fasting ANGPTL8 level in people with morbid obesity, with or without diabetes after laparoscopic sleeve gastrectomy (LSG) in a 1-year prospective study.Setting
Dasman Diabetes Institute, government, and private hospitals, Kuwait.Methods
Fasting serum ANGPTL8 was measured by enzyme-linked immunosorbent assay at baseline in participants with morbid obesity, 17 with diabetes and 23 without diabetes, and in healthy weight participants, 19 with and 15 without diabetes, during 1 year post-LSG in participants with morbid obesity.Results
At baseline, people with T2D had higher ANGPTL8 level, (morbid obese, mean ± standard error of the mean; 1415 ± 196.4 pg/mL, and healthy weight, 2231 ± 328.1 pg/mL), compared with individuals without T2D (morbid obese, 876 ± 155.0 pg/mL, and healthy weight controls 868.9 ± 218.7 pg/mL). In participants with diabetes and morbid obesity, T2D remission occurred 15 days post-LSG, defined by a sustained reduced fasting blood glucose levels <6.9 mmol/L. In this group, the 1-year post-LSG measurement of ANGPTL8 showed unique biphasic changes, first a prominent elevation (day 60, 3336 ± 916.5 pg/mL, P < .01), followed by a gradual decrease to reach almost the baseline level (day 360, 1184 ± 119.3 pg/mL).Conclusion
Elevated baseline ANGPTL8 in participants with diabetes at baseline reflected a link to T2D. Interestingly, the unique biphasic pattern of change in fasting ANGPTL8 post-LSG, occurred only in people with diabetes, suggesting ANGPTL8’s potential role in T2D remission. 相似文献14.
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15.
Arnold W. van de Laar Simon W. Nienhuijs Jan A. Apers Anne-Sophie van Rijswijk Jean-Paul de Zoete Ralph P. Gadiot 《Surgery for obesity and related diseases》2019,15(2):200-210
Background
Current methods for weight loss assessment after bariatric surgery do not meet the high standards required to accurately judge patient outcome in a fair and evidence-based way.Objectives
To build an evidence-based, versatile tool to assess weight loss and weight regain and identify poor responders up to 7 years after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), for any preoperative body mass index (BMI).Setting
Multicenter, observational study.Methods
Bariatric weight loss charts were built with standard deviation (SD) percentile (p) curves p+2SD/p+1SD/p50(median)/p?1SD/p?2SD, based on all last measured weight results after primary LRYGB and LSG, performed in 3 large bariatric centers, expressed with percentage total weight loss (%TWL) and percentage-alterable weight loss (%AWL), a special BMI-independent metric. The p?1SD %AWL curves were compared with popular bariatric criteria 50% excess weight loss and 20%TWL. The p50 %TWL curves were compared with %TWL outcome in literature (external validation).Results
In total, 9393 patients (5516 LRYGB, 3877 LSG, baseline BMI 43.7 (±SD 5.3) kg/m2, age 43 (±SD 10.9) years, 20% male, 21% type 2 diabetes) had mean follow-up 26 (range, 0–109) months, with .09% 30-day mortality. Independent outcome is presented in percentile charts for %AWL and %TWL. Percentile curves p+2SD/p+1SD/p50/p?1SD/p?2SD showed for LRYGB 72%/62%/50%/38%/28%AWL at nadir, 66%/55%/43%/30%/17%AWL at 4 years, 64%/52%/38%/25%/11%AWL at 7 years, and for LSG 69%/58%/46%/34%/22%AWL, 65%/53%/38%/23%/12%AWL, and 63%/51%/35%/22%/9%AWL, respectively. Bariatric criteria 50% excess weight loss and 20%TWL matched with most insufficient results for LSG, but not for LRYGB (low specificities). Both p50 %TWL curves are comparable with long-term weight loss in bariatric literature.Conclusions
Just as well-known growth charts are essential for pediatrics, weight loss charts should become the tools of choice for bariatrics. These multicenter charts are baseline BMI independent, superior to current bariatric criteria, and quite intuitive to use. They allow to readily detect poor responders in any postoperative phase, monitor the effect of extra counseling, judge weight regain, and manage patient expectations. 相似文献16.
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17.
Ville Wallenius Eveline Dirinck Lars Fändriks Almantas Maleckas Carel W le Roux Anders Thorell 《Obesity surgery》2018,28(6):1461-1472
Background
Roux-en-Y gastric bypass (LRYGB) has weight-independent effects on glycemia in obese type 2 diabetic patients, whereas sleeve gastrectomy (LSG) is less well characterized. This study aims to compare early weight-independent and later weight-dependent glycemic effects of LRYGB and LSG.Methods
Eighteen LRYGB and 15 LSG patients were included in the study. Glucose, insulin, GLP-1, and GIP levels were monitored during a modified 30 g oral glucose tolerance test before surgery and 2 days, 3 weeks, and 12 months after surgery. Patients self-monitored glucose levels 2 weeks before and after surgery.Results
Postoperative fasting blood glucose decreased similarly in both groups (LRYGB vs. SG; baseline—8.1?±?0.6 vs. 8.2?±?0.4 mmol/l, 2 days—7.8?±?0.5 vs. 7.4?±?0.3 mmol/l, 3 weeks—6.6?±?0.4 vs. 6.6?±?0.3 mmol/l, respectively, P <?0.01 vs. baseline for both groups; 12 months—6.6?±?0.4 vs. 5.9?±?0.4, respectively, P <?0.05 for LRYGB and P <?0.001 for LSG vs. baseline, P =?ns between the groups at all times). LSG, but not LRYGB, showed increased peak insulin levels 2 days postoperatively (mean?±?SEM; LSG +?58?±?14%, P <?0.01; LRYGB ??8?±?17%, P =?ns). GLP-1 levels increased similarly at 2 days, but were higher in LRYGB at 3 weeks (AUC; 7525?±?1258 vs. 4779?±?712 pmol?×?min, respectively, P <?0.05). GIP levels did not differ. Body mass index (BMI) decreased more after LRYGB than LSG (??10.1?±?0.9 vs. ??7.9?±?0.5 kg/m2, respectively, P <?0.05).Conclusion
LRYGB and LSG show very similar effects on glycemic control, despite lower GLP-1 levels and inferior BMI decrease after LSG.18.
Amihai Rottenstreich Jaber Shufanieh Geffen Kleinstern Ariela Goldenshluger Uriel Elchalal Ram Elazary 《Surgery for obesity and related diseases》2018,14(10):1594-1599
Background
Pregnancy outcomes after bariatric surgery have been addressed extensively; however, the impact of pregnancy on long-term outcomes after bariatric surgery has only been sparsely studied.Objectives
We explored the effects of pregnancy on weight loss outcomes after laparoscopic sleeve gastrectomy (LSG).Setting
University hospital.Methods
A cross-sectional case-control study. Eighty women who became pregnant after LSG were matched by preoperative body mass index, age, and follow-up duration to 80 post-LSG patients who did not conceive after surgery (control group).Results
The median follow-up duration was 5.2 years for the study group and 5.3 years for the control group (P?=?.73). For the study group, the median time from surgery to conception was 508 (interquartile range 372–954) days and the median gestational weight gain was 9 (6–12) kg. Comparing the study with the control group, median percentage total weight loss was similar, 31% versus 30% (P?=?.77); as was percentage excess weight loss (EWL%) 72% versus 71% (P?=?.77). For the study group, a multivariable analysis showed EWL% at the end of follow-up to be directly correlated with the lowest EWL% achieved before pregnancy (β?=?.78, P < .0001), and inversely correlated with time lapsed from surgery (β?=??.26, P < .0001); yet EWL% was not found to be associated with surgery-to-conception time interval, gestational weight gain, breastfeeding, co-morbidities, smoking, occupational status, physical activity, and dietary habits.Conclusions
Pregnancy after LSG does not affect long-term weight results. Coupled with the positive reports of improved pregnancy outcomes after bariatric surgery, these data should reassure women who wish to conceive after surgery. 相似文献19.
Russell B. Hawkins Kristina Go Steven L. Raymond Alexander Ayzengart Jeffrey Friedman 《Surgery for obesity and related diseases》2018,14(9):1269-1273
Background
Obesity is an epidemic that is closely associated with heart failure. The ultimate treatment for end-stage heart failure is cardiac transplantation. Patients with morbid obesity are often excluded from receiving donor organs. Many transplant centers use body mass index (BMI) >35 kg/m2 as a contraindication to listing for heart transplant. Left ventricular assist devices (LVADs) were developed as a bridge to transplant for many heart failure patients, but bariatric surgery for LVAD patients has not been well described.Objectives
The purpose of our study was to evaluate the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in LVAD patients and the impact on heart failure recovery as a bridge to cardiac transplantation.Setting
University hospital.Methods
A retrospective study was conducted to evaluate the outcomes of patients with morbid obesity and LVADs who underwent LSG at a large academic medical center between 2013 and 2017. Age, BMI, percent excess weight loss, cardiac ejection fraction, listing status for transplantation, and success of transplant were reviewed.Results
Eleven patients were identified with morbid obesity and heart failure with LVAD support who underwent LSG. There were no perioperative deaths. Four patients (37%) achieved BMI <35 and were successfully listed for and received cardiac transplantation. An additional 3 patients (27%) achieved BMI <35 kg/m2 and are listed for cardiac transplantation.Conclusions
LSG can be safely used in patients with morbid obesity and end-stage heart failure requiring LVAD support to lower their BMI and become eligible for cardiac transplantation. 相似文献20.
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