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1.
Dhruvin H. Hirpara Michelle C. Cleghorn Josephine Kwong Fady Saleh Sanjeev Sockalingam Fayez A. Quereshy Allan Okrainec Timothy D. Jackson 《Obesity surgery》2016,26(8):1799-1805
Background
The objective of this study was to assess Canadian general surgeons’ knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients.Methods
A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012. The survey was also disseminated via membership association electronic newsletters in November and December 2012.Results
One hundred sixty-seven questionnaires were completed (104 practicing surgeons, 63 general surgery trainees). Twenty respondents were bariatric surgeons. Among 84 non-bariatric surgeons, 68.3 % referred a patient in the last year for bariatric surgery, 79 % agreed that bariatric surgery resulted in sustained weight loss, and 81.7 % would consider referring a family member. Knowledge gaps were identified in estimates of mortality and morbidity associated with bariatric procedures. The majority of surgeons surveyed have encountered patients with complications from bariatric surgery in the last year. Over 50 % of surgeons who do not perform bariatric procedures reported not feeling confident to manage complications, 35.4 % reported having adequate resources and equipment to manage morbidly obese patients, and few are able to transfer patients to a bariatric center. Of the respondents, 73.3 % reported residency training provided inadequate exposure to bariatric surgery, and 85.3 % felt that additional continuing medical education resources would be useful.Conclusions
There appears to be support for bariatric surgery among Canadian general surgeons participating in this survey. Knowledge gaps identified indicate the need for more education and resources to support general surgeons managing bariatric surgical patients.2.
Jan Peter Yska Sanneke Gertsen Gerbrich Flapper Marloes Emous Bob Wilffert Eric N. van Roon 《Obesity surgery》2016,26(12):2880-2885
Background
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used.Aim
To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery.Methods
A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients’ pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention.Results
Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS).Conclusions
Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).3.
Purpose
The aim of this study is to explore the role of attachment styles in obesity.Material and Methods
The present study explored differences in insecure attachment styles between an obese sample waiting for bariatric surgery (n = 195) and an age, sex and height matched normal weight control group (n = 195). It then explored the role of attachment styles in predicting change in BMI 1 year post bariatric surgery (n = 143).Results
The bariatric group reported significantly higher levels of anxious attachment and lower levels of avoidant attachment than the control non-obese group. Baseline attachment styles did not, however, predict change in BMI post surgery.Conclusion
Attachment style is different in those that are already obese from those who are not. Attachment was not related to weight loss post surgery.4.
Samir Johna 《World journal of surgery》2016,40(12):2904-2910
Background
Obesity and rapid weight loss after bariatric surgery are risk factors for gallstone disease.Objectives
The present study sought to evaluate the feasibility of selective concomitant cholecystectomy only in patients with symptomatic disease and study risk factors for the development of symptomatic gallstones after bariatric surgery.Methods
Between January 2010 and December 2012, 734 consecutive patients presenting to our institution underwent bariatric surgery. From these, 81 patients were excluded due to prior or concurrent cholecystectomy. The remaining 653 patients with in situ gallbladder were followed for 12 months and were clinically screened for symptomatic or complicated cholelithiasis. Clinical and demographic characteristics were compared at baseline and 12 months after surgery.Results
Of the 653 patients with in situ gallbladder, only 24 (3.3 %) developed symptomatic gallstones and only nine presented complicated disease. None of the patients with asymptomatic disease at the time of surgery progressed to symptomatic or complicated disease. Patients who developed symptomatic disease were not significantly different, although there was a trend toward longer obesity evolution, lower insulin levels, and lower hepatic enzymes level. A multivariate regression analysis revealed that patients with gastric sleeve were more likely to develop symptomatic gallstones.Conclusions
Although further studies are required, the management of gallstones in morbidly obese patients should not be different from normal-weight patients. Therefore, performing a laparoscopic cholecystectomy only in symptomatic patients is an effective approach and asymptomatic gallstones should not be treated at the time of bariatric surgery.5.
Hairil Rizal Abdullah Tze Ping Tan Mercedeh Vaez Chameli Deb Naguib Farag Timothy D. Jackson David Tai Wong 《Obesity surgery》2016,26(7):1493-1499
Background
Obesity has been associated with increased risk of perioperative acute kidney injury (AKI). We aim to establish the incidence of AKI among patients undergoing laparoscopic bariatric surgery and identify potential risk factors.Methods
Records of 1230 patients who underwent laparoscopic bariatric surgery in a tertiary centre from 1 December 2009 to 31 January 2014 were retrospectively studied. AKI diagnosis was made by comparing the baseline and post-operative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analysis was subsequently done to determine independent predictors of AKI.Results
Thirty-five (2.9 %) patients developed AKI during the first 72 h post-surgery. Multivariate logistic regression analysis revealed impaired renal function (OR 10.429, 95 % CI 3.560 to 30.552), use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (OR 3.038, 95 % CI 1.352 to 6.824), and body mass index (OR 1.048, 95 % CI 1.005 to 1.093) as independent predictors of perioperative acute kidney injury in the obese patients who underwent laparoscopic bariatric surgery.Conclusions
We found that the incidence of perioperative AKI among patients who underwent laparoscopic bariatric surgery is at 2.9 %. Impaired renal function, use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers and raised body mass index were found to be independent predictors of AKI. Patients with these risk factors could be considered at risk for developing perioperative AKI, and extra perioperative vigilance should be undertaken.6.
G. Craig Wood Daniel Horwitz Christopher D. Still Tooraj Mirshahi Peter Benotti Manish Parikh Annemarie G. Hirsch 《Obesity surgery》2018,28(1):61-68
Objective
The objective of this study was to determine whether the DiaRem, a score that predicts type 2 diabetes (T2D) remission following roux-en-y gastric bariatric surgery (RYGB), also predicts remission following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in white and Hispanic patients.Background
While bariatric surgery is highly effective in reversing insulin resistance, there are patients for whom surgery will not lead to remission. To date, there is no score for predicting remission following LAGB or LSG surgery. Additionally, there is little known about how to predict whether Hispanic patients will experience remission.Methods
We conducted a retrospective cohort study of white and Hispanic patients with T2D who received bariatric surgery. There were 361 white and 130 Hispanic patients among whom 328 had RYGB surgery, 107 had LSG surgery, and 56 had LAGB surgery. We used age, diabetes treatment, and hemoglobin A1c to calculate DiaRem scores. Mann-Whitney U test was used to determine the association between DiaRem scores and remission. Area under the receiver operant curve (AUC) was used to assess the ability of the DiaRem to discriminate between patients who did and did not remit.Results
The DiaRem was associated with partial remission in all surgery types for white and Hispanic patients (Mann-Whitney, p < 0.001). The DiaRem had moderate to high discriminant ability (AUC > 0.70) for all surgical and racial/ethnic groups.Conclusions
The DiaRem distinguishes between patients likely and unlikely to experience remission, informing expectations of patients making T2D treatment decisions.7.
David B. Sarwer Thomas A. Wadden Jacqueline C. Spitzer James E. Mitchell Kathy Lancaster Anita Courcoulas William Gourash Raymond C. Rosen Nicholas J. Christian 《Obesity surgery》2018,28(4):892-899
Background
Initial weight loss after bariatric surgery has been associated with improvements in reproductive hormones and sexual functioning in women. Few studies have investigated the durability of these changes.Objectives
The objective of this paper is to investigate changes in sex hormones, sexual functioning, and relevant psychosocial constructs over 4 years in women who underwent bariatric surgery.Setting
The setting is a prospective cohort of 106 women from the Longitudinal Assessment of Bariatric Surgery consortium.Methods
Changes in sex hormones were assessed by blood assay. Sexual functioning, quality of life (QOL), body image, depressive symptoms, and marital adjustment were assessed by psychometric measures.Results
Women lost on average (95% confidence interval) 32.3% (30.4%, 34.3%) at postoperative year 3 and 30.6% (28.5%, 32.8%) at postoperative year 4. Compared to baseline, women experienced significant changes at 4 years in all hormones assessed, except estradiol. Women reported significant improvements in sexual functioning (i.e., arousal, desire, and satisfaction) through year 3, but these changes were not maintained through year 4. Changes in relationship quality followed a similar pattern. Improvements in physical aspects of QOL, body image, and depressive symptoms were maintained through 4 years.Conclusions
Improvements in reproductive hormones and physical aspects of QOL, body image, and depressive symptoms were maintained 4 years after bariatric surgery. Improvements in sexual functioning, relationship satisfaction, and mental components of QOL eroded over time.8.
Background
Postoperative nausea and vomiting (PONV) is problematic in bariatric surgery patients and has negative impacts on perioperative outcome. Antiemetic prophylaxis may reduce PONV. Perioperative antiemetic prophylaxis or therapy is crucial and may enhance fast-track bariatric surgery. This study examined the impact of intraoperative multimodal antiemetic prophylaxis on fast-track bariatric surgery.Methods
This prospective observational clinical study explored the perioperative data of 400 consecutive laparoscopic bariatric surgery patients, over a 6-year period. Perioperative outcomes and variables were analyzed and compared between different intraoperative antiemetic modes.Results
The mean BMI was 49, mean age was 42, and male:female ratio was 1:4. About 70% of patients received intraoperative multimodal antiemetic, comprising combinations of prochlorperazine, dexamethasone, ondansetron, or cyclizine. PONV occurred in 19.5% of patients. Intraoperative multimodal antiemetic was associated with significantly less PONV, shorter post-anesthesia care unit duration, earlier postoperative drinking, and shorter hospital stay (p = 0.001). Compared to other multimodal antiemetic modes, dexamethasone + cyclizine + prochlorperazine provided the best prophylaxis and outcome: p = 0.002.Conclusion
PONV is a common and peculiar problem in bariatric surgery patients. However, intraoperative multimodal antiemetic prophylaxis effectively minimizes PONV. Intraoperative multimodal antiemetic enhances fast-track bariatric surgical care, patient satisfaction, and perioperative outcomes.9.
Wendy A. Brown Paul R. Burton Kalai Shaw Brittany Smith Shelley Maffescioni Bernadette Comitti Michael A. Cowley Cheryl Laurie Andrew Way Peter Nottle 《Obesity surgery》2016,26(9):2074-2081
Background
We designed an assessment and education program which was delivered to patients prior to first outpatient appointment for bariatric surgery. We hypothesised that this program would streamline care and would lead to improved weight loss following bariatric surgery.Methods
The program incorporates a structured general practitioners (GP) review, a patient information evening and an on-line learning package. It was introduced in September 2012. Patient flow through the program was recorded. Outcomes of the new program were compared with contemporaneously treated patients who did not undertake the pre-hospital program.Results
All 636 patients on the waiting list for first appointment at the Alfred Health bariatric surgery clinic were invited to participate. There were 400 patients ultimately removed from the waiting list for first appointment. Of the remaining 236 patients, 229 consented to participate in the new program. The mean BMI was 47.8?±?9.2. The fail to attend first appointment rate dropped from 12 to 2.1 %. At 12 months post-bariatric surgery, patients who undertook the new program (n?=?82) had a mean excess weight loss (EWL) of 41.1?±?20.3 % where as those treated on the standard pathway (n?=?61) had a mean EWL 32?±?18.0 % (p?=?0.012).Conclusions
The introduction of a pre-hospital education program has led to an improvement in attendance rates and early weight loss post-bariatric surgery.10.
Dietric L. Hennings Maria Baimas-George Zaid Al-Quarayshi Rachel Moore Emad Kandil Christopher G. DuCoin 《Obesity surgery》2018,28(1):44-51
Objective
Bariatric surgery has been shown to be the most effective method of achieving weight loss and alleviating obesity-related comorbidities. Yet, it is not being used equitably. This study seeks to identify if there is a disparity in payer status of patients undergoing bariatric surgery and what factors are associated with this disparity.Methods
We performed a case-control analysis of National Inpatient Sample. We identified adults with body mass index (BMI) greater than or equal to 25 kg/m2 who underwent bariatric surgery and matched them with overweight inpatient adult controls not undergoing surgery. The sample was analyzed using multivariate logistic regression.Results
We identified 132,342 cases, in which the majority had private insurance (72.8%). Bariatric patients were significantly more likely to be privately insured than any other payer status; Medicare- and Medicaid-covered patients accounted for a low percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29–0.37, p < 0.001; Medicaid 8.7%, OR 0.21, 95% CI 0.18–0.25, p < 0.001). Medicare (OR 1.54, 95% CI 1.33–1.78, p < 0.001) and Medicaid (OR 1.31, 95% CI 1.08–1.60, p = 0.007) patients undergoing bariatric surgery had an increased risk of complications compared to privately insured patients.Conclusions
Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.11.
Background
While LAGB has become uncommon in the bariatric surgery practice, band removal with or without revision surgery is still common. Retained postoperative foreign body, of which surgical sponges are the most common, is a rare condition. We report a rare case of retained gastric band port and the attached tube.Case presentation
A 31-year-old Caucasian female presented to the outpatient clinic, 5?years after her last surgery, complaining of a left upper quadrant abdominal mass over the last 2?years. She had a history of 2 weight loss operations. She had no significant family history nor smoking. CT of the abdomen and pelvis revealed a retained foreign body. On exploration, the port with 10?cm of the connected tube was found and removed through a small incision without laparotomy. The patient made an uneventful recovery.Conclusion
A bariatric surgeon should be involved in the evaluation of any patient who complains of abdominal pain and/or palpable mass if she/he has a previous weight loss procedure because the bariatric surgeon is fully aware of the possible complications of the bariatric surgeries.12.
Zachary M. Helmen Melissa C. Helm Joseph H. Helm Alexander Nielsen Tammy Kindel Rana Higgins Jon C. Gould 《Obesity surgery》2018,28(7):1950-1954
Background
In bariatric surgery patients, urinary tract infections (UTIs) are one of the most common postoperative infections. In this study, we sought to determine if preoperative patient factors and perioperative processes contribute to an increased risk of UTI.Methods
A retrospective analysis was performed of patients who underwent bariatric surgery at a single institution between March 2012 and May 2016. Standard protocol was antibiotic prophylaxis with cefazolin. Patients with a penicillin allergy received clindamycin. Urinary catheters were placed selectively. A univariate and multivariate analyses were performed to determine risk factors for patients who developed a UTI within 30 days postoperatively.Results
Six hundred ninety-four patients (82.7% female) underwent bariatric surgery in the study interval. UTIs were more common in females (4.9 vs. 1.7%, p?=?0.12). On univariate analysis age, operative time, length of stay, urinary catheter placement, clindamycin prophylaxis, and revisional surgery were significantly correlated with UTI. A multivariate logistic regression model revealed the risk of UTI increased 5.38-fold [95% confidence interval (CI) 2.41–12.05] with clindamycin use, 6.37-fold [95% CI 2.22–18.18] with revision surgery, and 1.25-fold [95% CI 1.05–1.49] for every 5 years gained in age.Conclusions
Older age, clindamycin prophylaxis, and revisional procedures are significantly associated with an increased rate of UTI following bariatric surgery. Several identified variables are modifiable risk factors and targets for a quality improvement initiative to decrease the rate of UTI in bariatric surgery patients.13.
Saskia L Boerboom Ann de Haes Lianne vd Wetering Edo O Aarts Ignace M.C. Janssen Jose W Geurts Ed T Kamphuis 《Obesity surgery》2018,28(10):3102-3110
Introduction
A multimodal pain treatment including local anesthetics is advised for perioperative analgesia in bariatric surgery. Due to obesity, bariatric surgery patients are at risk of respiratory complications. Opioid consumption is an important risk factor for hypoventilation. Furthermore, acute postoperative pain is an important risk factor for chronic postsurgical pain. In this study, we aimed to evaluate whether preperitoneal anesthesia with bupivacaine would reduce pain and opioid consumption after bariatric surgery.Methods
One hundred adults undergoing laparoscopic bariatric surgery were randomized to receive either preperitoneal bupivacaine 0.5% or normal saline before incision. Postoperative opioid consumption, postoperative pain, and postoperative recovery parameters were assessed for the first 24 h after surgery. One year after surgery, chronic postsurgical pain and influence of pain on daily living were evaluated.Results
Postoperative opioid consumption during the first hour after surgery was 2.8?±?3.0 mg in the bupivacaine group, whereas in the control group, it was 4.4?±?3.4 mg (p =?0.01). Pain scores were significantly reduced in this first hour at rest and at 6 h during mobilization on the ward. One year after surgery, the incidence of chronic postsurgical pain was 13% in the bupivacaine group versus 40% in the placebo group.Conclusion
This study shows that preperitoneal local anesthesia with bupivacaine results in a reduction in opioid consumption and postoperative pain and seems to lower the incidence rate of chronic postsurgical pain after laparoscopic bariatric surgery.14.
Background
Sarcopenic obesity is the combination of low muscle mass and strength with increased fat mass. This condition is associated with negative health outcomes. We hypothesized that sarcopenia could be a pejorative factor on surgical weight loss.Objective
The objectives of the study are to determine the influence of sarcopenic obesity on gastric bypass and sleeve gastrectomy results regarding weight loss and comorbidities resolution at 3, 6, and 12 months.Setting
The study was conducted at the University Hospital.Methods
Sixty-nine obese patients who benefited from bariatric surgery were included. Skeletal muscle mass was determined by the Janssen’s equation. Physical performance and muscle strength were determined using the 6-min walk test and the wall sit test. Obese subjects from the lowest tertile of the Skeletal Muscle mass Index (SMI) of Baumgartner were set as sarcopenic.Results
Weight loss outcomes and rate of weight loss failure were not influenced by sarcopenia. At 1 year, mean EBMIL% was 75.4 %?±?5 in sarcopenic subjects vs 67.8 % ±4 in the non-sarcopenic subjects (p?=?0.242). Improvement rates of co-morbidities were similar between groups. Skeletal muscle mass was no more different between groups at 1 year after surgery. There was no patient lost to follow-up.Conclusions
Bariatric surgery remains effective in achieving weight loss target in sarcopenic patients, with similar remission rates of main comorbidities and similar safety profile than in the non-sarcopenic group. Whether bariatric surgery could result in improvement or deterioration of daily living activities disabilities and functional autonomy in sarcopenic obese patients still have to be evaluated.15.
Enoch Wu Andrea Luk Simon K. H. Wong Wing-Yee So Alice Kong Francis Chow Yuying Zhang Candice Lam Enders K. W. Ng 《Obesity surgery》2016,26(3):538-545
Background
To evaluate health-related quality of life (HRQOL) following bariatric surgery and its correlation with different glycaemic status in Hong Kong Chinese adults.Materials and Methods
In 2002–2008, obese Chinese adults were recruited for bariatric surgery, undergoing laparoscopic adjustable gastric banding or laparoscopic sleeve gastrectomy. Patients were invited to complete the Chinese Hong Kong Medical Outcomes Study Short-Form Health Survey (SF-36) at baseline and at 1-year post operation.Results
Sixty patients (60 % female) completed baseline and 1-year follow-up HRQOL assessments. Mean age was 38 years and mean BMI was 41.6 kg/m2. At baseline, 30.0 % of patients had diabetes and 31.7 % prediabetes. Mean absolute weight reduction 1 year after bariatric surgery was 19.8 kg. Statistically significant improvements in SF-36 scores were demonstrated in all physical domains and in three of the four psychological domains. Greater body weight reduction was associated with greater improvements in certain physical domains postoperatively. After adjusting for co-variables, abnormal glucose tolerance was associated with greater improvements in five of the eight HRQOL domains.Conclusions
Bariatric surgery resulted in significant gains in HRQOL as well as significant reductions in body weight in obese Chinese adults. This study suggests that bariatric surgery offers greater HRQOL improvements in patients with prediabetes and diabetes compared with normoglycaemic individuals.16.
Nadav Nevo Subhi Abu-Abeid Guy Lahat Joseph Klausner Shai M. Eldar 《Obesity surgery》2018,28(2):364-368
Background
Sleeve gastrectomy (SG) is gaining popularity and has become the procedure of choice for many bariatric surgeons. Long-term weight loss failure is not uncommon. The preferred revisional procedure for these patients is still under debate.Objective
The objective of this study was to assess the safety and efficacy of laparoscopic gastric bypass as a revisional surgery for sleeve gastrectomy patients with weight loss failure.Setting
The study was done at a bariatric surgery center in a university hospital.Methods
We reviewed our prospectively collected database and identified all patients who underwent conversion of a sleeve gastrectomy to a gastric bypass for weight loss failure. Data on patient demographics, baseline characteristics, and outcomes of bariatric surgery were retrieved.Results
Twenty-three patients with a mean body mass index (BMI) of 41.6 kg/m2 (range 34.1–50.1 kg/m2) underwent conversion to a gastric bypass. Four patients underwent a gastric band prior to the sleeve gastrectomy, and two patients underwent a re-sleeve gastrectomy prior to conversion to a gastric bypass.At a mean follow-up of 24 months (range 9–46 months), the average body mass index (BMI) decreased to 33.8 kg/m2 and the excess body mass index loss (EBMIL) was 42.6%. Diabetes, hypertension, dyslipidemia, and obstructive sleep apnea resolved or improved in 44.4, 45.5, 50, and 50% of the patients, respectively. Three patients developed early postop complications (13%), while late complications occurred in four patients (17%).Conclusion
Converting a sleeve gastrectomy to a gastric bypass for weight loss failure is safe, yet weight loss benefit is limited.17.
Samantha H. Mohun Mary B. Spitznagel John Gunstad Amber Rochette Leslie J. Heinberg 《Obesity surgery》2018,28(9):2700-2704
Background
Bariatric surgery candidates exhibit cognitive impairment on neuropsychological testing and these deficits are associated with reduced post-operative weight loss. However, less is known about the prevalence of cognitive function in older adults that pursue surgery, despite being at higher risk for cognitive dysfunction.Objective
To examine the prevalence and profile of cognitive impairment using the Montreal Cognitive Assessment (MoCA) in elderly bariatric patients. We hypothesized that increased body mass index (BMI) and higher number of medications would be linked to lower MoCA score, and that men would evidence poorer MoCA scores than women given past work showing that men presenting for bariatric surgery have more medical comorbidities.Methods
Data was retrospectively extracted from electronic medical records. Patients 65 and older who completed pre-surgical MoCA assessment and bariatric surgery were included in the study (n?=?55).Results
Twenty-two percent of patients scored below cutoff for impairment on the MoCA. MoCA total score was negatively correlated with BMI and number of medications pre-surgery. There was a significant effect for gender, with men outperforming women.Conclusions
The current findings suggest that cognitive impairment is common in older adults presenting for bariatric surgery. Future studies are needed to determine the most appropriate methods for detecting cognitive dysfunction in this high-risk population.18.
Anna Duprée Alexander Tarek El Gammal Stefan Wolter Silvana Urbanek Nina Sauer Oliver Mann Philipp Busch 《Obesity surgery》2018,28(7):1895-1901
Background
Prevalence of obesity is increasing with a pandemic magnitude worldwide. Incidence of super-super-obesity (>?60 kg/m2) is expanding by the same means. While bariatric surgery is the only approach with proven long-term results, surgical outcome in super-super-obesity is still discussed controversially.Objective
This retrospective study examined bariatric surgery patients’ short-term outcome in relation to their degree of obesity.Setting
Data collection was performed in a German university medical center between March 2010 and November 2013.Methods
This study analyzes a cohort of 715 patients in a single institution. Patients were subdivided into three groups, obese (≤?49.9 kg/m2), super-obese (≥?50 kg/m2), and super-super-obese (≥?60 kg/m2), and evaluated regarding perioperative outcome.Results
Three hundred eighty-one patients were included into obese (O); 225 patients, into super-obese (SO); and 109 patients, into super-super-obese (SSO) cohort. There were no significant differences regarding patient characteristics including quantity of comorbidities and perioperative outcome. BMI was significantly lower in patients with complications, compared to patients without complications (p?<?0.05), whereas patients’ age was significantly higher (p?<?0.05) in complication cohort. One SSO patient died of a septic multiorgan failure. Thus, the 30-day overall mortality was 0.14%. The BMI showed an inverse correlation to the patients’ age at surgery (p?<?0.05).Conclusion
Super-super-obesity should not be considered as a limiting factor for bariatric surgery outcome; however, the patients’ age, surgeries prior to the bariatric procedure, and comorbidities must be considered prior to bariatric surgical treatment.19.
Allison A. Holgerson Matthew M. Clark Gretchen E. Ames Maria L. Collazo-Clavell Todd A. Kellogg Karen M. Graszer Sarah A. Kalsy Karen Grothe 《Obesity surgery》2018,28(11):3386-3392
Introduction/Purpose
Adverse childhood experiences (ACEs) are known risk factors for obesity and poor outcomes following weight loss interventions. ACEs are also associated with addictive behaviors and, potentially, food addiction (FA). This study examined the relationship between ACEs and FA, and their association to undergoing bariatric surgery and post-surgical weight loss outcomes.Materials and Methods
Between June 2013 and January 2016, 1586 bariatric-surgery-seeking patients completed a psychological evaluation. During their evaluation, the patients were administered measures including the ACE questionnaire and the Yale Food Addiction Scale.Results
19.2% of those seeking bariatric surgery reported being the victim of childhood sexual abuse, and 22.1% reported being the victim of childhood physical abuse. An elevated ACE score corresponded to increased likelihood of screening positive for FA and more severe FA. When the type of ACE was analyzed separately, ACE was not associated with bariatric surgery completion or percent total weight loss (%TWL). Screening positive for FA corresponded to less %TWL 1 year post-surgery as the total number of ACEs increased, yet there was no association with %TWL 2 years post-surgery. The participants were classified into two groups, those positive for an ACE or FA versus those negative for both. Those who screened positive were significantly less likely to undergo bariatric surgery.Conclusion
Screening positive for experiencing ACEs was related to severity of FA, and screening positive for being the victim of either childhood abuse or FA reduced the likelihood of completing bariatric surgery. More research is needed to determine how these psychosocial factors might influence bariatric surgery outcomes.20.
Masanari Takami Amr Elwany Jean Destandau 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2016,26(3):253-258