Bipolar Disorder Symptoms in Patients Seeking Bariatric Surgery

Background

Mood disorders are common among patients seeking bariatric surgery although little data exist regarding the prevalence of bipolar symptoms in this population and how they influence surgical outcomes. Our aim was to describe baseline rates of bipolar symptoms and their relationship to psychological factors and completing surgery in a sample of adults seeking bariatric surgery at an academic medical center.

Methods

We retrospectively reviewed the relationship of bipolar symptoms to demographic characteristics, baseline weight, psychological factors, and bariatric surgery completion.

Results

Nine hundred thirty-five patients completed the preoperative psychological evaluation. Six percent of the preoperative sample screened positive for symptoms of bipolar disorder. Patients with bipolar symptoms endorsed more robust psychopathology, trauma history, and problematic eating behaviors than patients without bipolar symptoms. Twenty-two percent of the patients with bipolar symptoms underwent bariatric surgery (n?=?12), yet only 13 % were denied bariatric surgery for psychiatric reasons, suggesting that other variables may influence the completion of bariatric surgery for these patients.

Conclusion

Prevalence rates of bipolar symptoms may be greater in patients seeking bariatric surgery compared with the general population, and few patients with bipolar symptoms actually undergo bariatric surgery. Psychological factors differentiate patients with bipolar symptoms who undergo bariatric surgery vs those who do not.     

The Impact of Temperament and Character Inventory Personality Traits on Long-Term Outcome of Roux-en-Y Gastric Bypass

Background

A significant proportion of patients who undergo bariatric surgery fail to achieve enduring weight loss. Previous studies suggest that psychosocial variables affect postoperative outcome, although this subject is still considered unclear. The purpose of this study is to further investigate the impact of psychosocial variables on Roux-en-Y gastric bypass (RYGB) outcomes over long-term follow-up.

Materials and Methods

Individuals eligible for bariatric surgery were evaluated using validated psychopathological scales and the Temperament and Character Inventory in a specialized clinic for bariatric treatment. Adult patients who had RYGB were selected for the study. Percent of excess weight loss (%EWL) was measured after surgery at 6 months, 1 year, 2 years, and on the last clinical observation.

Results

This study included 333 subjects who had RYGB. Before surgery, mean age was 35.4 years (±9.5) and mean BMI was 43.3 kg/m² (±4.8). Higher baseline age and BMI were associated with lower %EWL across endpoints, although this association diminished over time. Follow up at 2 years and on the last clinical observation demonstrated that lower scores on the persistence personality variable and lower body dissatisfaction before surgery predicted lower %EWL.

Conclusions

Psychosocial variables and personality traits assessed during preoperative evaluation significantly predicted weight loss after bariatric surgery. Greater impact was observed in long-term follow-up at 2 years. These findings provide guidance in identifying patients at risk for worse outcomes and designing interventions to improve long-term weight loss.     

Initial Experience with Laparoscopic Sleeve Gastrectomy by a Novice Bariatric Team in an Established Bariatric Center—A Review of Literature and Initial Results

Background

Laparoscopic sleeve gastrectomy (LSG) is a highly successful approach to morbid obesity with low incidence of complications. The literature suggests a learning curve of 50–100 cases for attaining proficiency and reducing the complication rates for laparoscopic bariatric surgery. The aims of this paper were to review the literature of initial cases by bariatric surgeons worldwide and to report the experience of initial 50 cases of LSG by a novice bariatric team in a single center. The objective was to evaluate the outcomes for laparoscopic bariatric surgery in the first 50 patients by a novice team of bariatric surgeons in an already established bariatric surgery program with short-term follow-up.

Methods

All surgeries were done by a new bariatric team who underwent laparoscopic fellowship training under a bariatric team with an experience of over 600 bariatric procedures. Fifty consecutive patients from March 2010 to January 2012 were offered LSG and followed up for a minimum of 6 months. Weight loss and comorbidity resolution were tabulated and assessed.

Results

Mean preoperative and postoperative BMIs were 46.6 and 35.7 kg/m², respectively. There were no life threatening postoperative complications or mortality. The median percent excess weight loss was 50.3 % at the end of 6 months. Comorbidity resolution values were 96 % for obstructive sleep apnea, 89 % for diabetes mellitus, and 87 % for joint pains, among the most common comorbidities.

Conclusion

LSG is effective in achieving weight loss and in improving comorbidities with minimal complications even at the hands of novice bariatric surgeons with good laparoscopic skills and adequate bariatric training.     

Hematological variables and iron status in abdominoplasty after bariatric surgery

Background

Abdominoplasty, the treatment for abdominal wall deformity stemming from weight loss after bariatric surgery, can cause postoperative anemia. Moreover, bariatric surgery has been associated with iron deficiency, which by itself can compromise erythropoiesis. The objective of this research is to describe the development of anemia after postbariatric abdominoplasty.

Methods

The study group consisted of 32 adult women who had received bariatric surgery. Treatment group included 20 patients who were undergoing postbariatric abdominoplasty. Control group included 12 patients waiting for abdominoplasty. Values of hemoglobin, reticulocytes, iron, ferritin, and the transferrin saturation were obtained on the evening before abdominoplasty and during the first, fourth, and eighth postoperative weeks. Hemoglobin was measured at 48 h.

Results

Mean hemoglobin levels for treatment group decreased from 12.98 to 10.8 g/dL after 48 h, increased on day 7 to 11.53 g/dL, but did not increase further after day 7. The reticulocyte number increased in the first week. Serum iron and transferrin saturation index fell during the first week and remained low. Ferritin levels increased non-significantly from 29.77 to 37.24 ng/mL at week 1, then fell until they were decreased (16.44 ng/mL) by day 56.

Conclusions

As expected, hemoglobin fell after abdominoplasty. However, after a one-third recovery of hemoglobin concentrations by week 1 postoperative, they failed to return to preoperative levels by the eighth week. Additionally, by the eighth postoperative week, 45 % of abdominoplasty patients had developed an iron deficiency and hemoglobin deficit that was higher than that of patients who maintained normal iron stocks.     

The Results of a Surgical Complication Protection Program (BLIS, Inc.) for Private Pay Bariatric Patients in the U.S.: 2006–2011

Background

Bariatric surgery is the most effective treatment for morbid obesity and associated medical co morbidities. There is currently minimal surgical treatment penetration of this widespread disease. BLIS has been able to improve the access to bariatric surgery for cash-pay patients by alleviating concern about the costs of post-surgical complications. Recently, there has become an ability to attract payor groups by offering a “bundled” payment which includes BLIS complication protection.

Methods

A total of 5,364 self-pay patients underwent laparoscopic adjustable gastric banding, laparoscopic vertical sleeve gastrectomy, or laparoscopic Roux-en-Y gastric bypass with BLIS complication insurance.

Results

Of the overall 5,364 patients, the 30-day mortality rate was 0.04 % and 1-year mortality rate was 0.06 %. The frequency of complications was 5.4 % in the gastric banding group, 6.5 % in the sleeve gastrectomy group, and 9.7 % in the gastric bypass group.

Conclusions

The results for mortality and complications in the BLIS data set compares very well with other large data sets in bariatric surgery. BLIS complication insurance improves the access to bariatric surgery in patients who self-pay.     

Incidence of Venous Thromboembolism After Bariatric Surgery: A Population-Based Cohort Study

Background

The incidence of venous thromboembolism (VTE) after bariatric surgery is uncertain.

Methods

Using the resources of the Rochester Epidemiology Project and the Mayo Bariatric Surgery Registry, we identified all residents of Olmsted County, Minnesota, with incident VTE after undergoing bariatric surgery from 1987 through 2005. Using the dates of bariatric surgery and VTE events, we determined the cumulative incidence of VTE after bariatric surgery by using the Kaplan–Meier estimator. Cox proportional hazards modeling was used to assess patient age, sex, weight, and body mass index as potential predictors of VTE after bariatric surgery.

Results

We identified 396 residents who underwent 402 bariatric operations. The most common operation was an open Roux-en-Y gastric bypass (n?=?228). Eight patients had VTE that developed within 6 months (7 within 1 month) after surgery; five events occurred after hospital discharge but within 1 month after bariatric surgery. The cumulative incidence of VTE at 7, 30, 90, and 180 days was 0.3, 1.9, 2.1, and 2.1 %, respectively (180-day 95 % confidence interval (CI), 0.7–3.6 %). Patient age was a predictor of postoperative VTE (hazard ratio, 1.89 per 10-year increase in age; 95 % CI, 1.01–3.55; P?=?0.05).

Conclusions

In our population-based study, bariatric surgery had a high risk of VTE, especially for older patients. Because most VTE events occurred after hospital discharge, a randomized controlled trial of extended outpatient thromboprophylaxis is warranted in patients undergoing open Roux-en-Y gastric bypass for medically complicated obesity.     

The Impact of Surgical Complications as a Main Risk Factor for Venous Thromboembolism: A Multicenter Study

Background

Studies suggest that postoperative complications are a risk factor for venous thromboembolism (VTE) after bariatric surgery. Knowledge of factors associated with a higher risk of VTE after bariatric surgery may be essential to select patients who may benefit from either prolonged or intensified thrombosis prophylaxis. The aim of this study is to determine the relationship between postoperative complications and VTE after bariatric surgery and other classical risk factors.

Methods

A retrospective multicenter case-control study was performed in patients who had bariatric surgery between January 2008 and September 2011. VTE until 6 months after surgery was registered, and patients were contacted to ascertain the results. For every case of VTE after surgery, 6 control patients were selected who were matched for gender, age, participating center and type of surgery. Risk factors for VTE before and after surgery and postoperative complications were registered.

Results

A total of 2,064 surgeries were included. In 12 patients, VTE occurred within 6 months after bariatric surgery (incidence 0.58 %, 95 % confidence interval (CI)?=?0.25–0.93). There was a strong association of complications after surgery (cases 91.7 %, controls 15.3 %, odds ratio (OR) 61.0; 95 % CI?=?7.1–521.3) or intensive care admission (cases 50.0 %, controls 11.1 %, OR?=?8.0; 95 % CI?=?2.1–30.8) with VTE. The majority of postoperative complications were anastomotic leak, abdominal abscess, and infection. We could not detect an association between classical thrombosis risk factors and postoperative VTE.

Conclusions

The incidence of VTE is low after bariatric surgery using thrombosis prophylaxis. However, there is a strong association between postoperative complications and VTE. These patients may benefit from more intensive thrombosis prophylaxis.     

Experience of Excess Skin and Desire for Body Contouring Surgery in Post-bariatric Patients

Background

This study was done to analyze the problems of post-bariatric patients with excess skin and to determine their interest in body contouring surgery. The self-administered Sahlgrenska Excess Skin Questionnaire (SESQ) was used together with a study-specific questionnaire.

Methods

The patients who were operated with bariatric surgery at Sahlgrenska University Hospital between 1999 and 2008 were identified and sent the SESQ and a study-specific questionnaire.

Results

The response rate was 65 % (23 % men). The most common problem in both men and women was the feeling of having an unattractive body (91 and 67 %, respectively). The most frequently reported sites of excess skin were the upper arms in women (91 %) and the abdomen in men (78 %). In both women and men, excess skin on the abdomen was reported to cause the most discomfort (median 7 and 3, respectively, on a scale from 0 to 10). Women reported significantly more problems, discomfort, and amount of excess skin (p?<?0.05) than men. There was a strong correlation between the amount of excess skin and the degree of discomfort for all body parts. Seventeen percent of the responders had been operated with body contouring surgery of one body part and 5 % of two or more. Fourteen percent desired body contouring surgery of one body part and 61 % of two or more.

Conclusions

Most post-bariatric patients, but women in particular, experience significant problems of excess skin and request body contouring surgery.     

Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery

Background

Obesity is associated with respiratory symptoms and impaired pulmonary function, which could increase the risk of complications after bariatric surgery. The purpose of this study is to assess the relationship between pulmonary function parameters before, and the risk of complications after, laparoscopic bariatric surgery.

Methods

This prospective study included patients (age 18–60, BMI >35 kg/m²), who were eligible for bariatric surgery. Spirometry was performed in all patients. Complications up to 30 days after bariatric surgery were recorded.

Results

Four hundred eighty-five patients were included (304 laparoscopic sleeve gastrectomy, 181 laparoscopic gastric bypass). There were 53 complications (8 pulmonary, 27 surgical, 14 infectious, 4 other) in 50 patients (10 %). There were 35 re-admissions (7.2 %), and 17 re-laparoscopies (3.5 %). Subjects with and without complications did not differ significantly with respect to demographics, weight, BMI, abdominal circumference or fat percentage. Subjects with complications had a significantly lower mean FEV₁ (mean 86.9 % predicted) and FVC (95.6 % predicted) compared to patients without complications (95.9 % predicted, p?=?0.005, and 100.1 % predicted, p?=?0.045, respectively). After adjustment for age, gender, BMI, and smoking, abnormal spirometry value remained the single predictive covariable of postoperative complications: FEV₁/FVC <70 % adjusted OR 3.1 (95%CI 1.4–6.8, p?=?0.006) and ΔFEV₁ ≥12 % adjusted OR 2.9 (95 %CI 1.3–6.6, p?=?0.010).

Conclusions

The risk of pulmonary complications after laparoscopic bariatric surgery is low. However, subjects with abnormal spirometry test results have a threefold risk of complications after laparoscopic bariatric surgery. Preoperative pulmonary function testing might be useful to predict the risk of complications of laparoscopic bariatric surgery.     

Fracture risk following bariatric surgery: a population-based study

Summary

The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics.

Introduction

Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture.

Methods

We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985–2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model.

Results

The mean (±SD) body mass index at bariatric surgery was 49.0?±?8.4 kg/m², with an average age of 44?±?10 years and 82 % (212) females. Gastric bypass surgery was performed in 94 % of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95 % confidence interval (CI), 1.8–2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95 % CI, 1.1–2.9), as well as for a first fracture at any other site (SIR, 2.5; 95 % CI, 2.0–3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95 % CI, 0.2–0.8) while prior fracture history was not associated with postoperative fracture risk.

Conclusions

Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.     

Warfarin Users Prone to Coagulopathy in First 30 Days After Hospital Discharge from Gastric Bypass

Background

Lehigh Valley Health Network (LVHN), a nonprofit tertiary care facility in Allentown, Pennsylvania, is an accredited American College of Surgeons Bariatric Surgery Center Network (ACSBSCN) Level 1 site performing 400+ bariatric procedures annually. Bariatric data submission began in April 2008. Complication review revealed that approximately 17 % of patients on chronic anticoagulation (warfarin) therapy preoperatively were readmitted with supratherapeutic international normalized ratios (INRs), postsurgical bleeding, anastomotic ulcer, or other intraluminal hemorrhage. Opinion level recommendations have been published regarding the adjustment of warfarin dosages post-bariatric procedures with no widespread consensus. Case series have been published detailing perioperative hemorrhage risk for bariatric patients on preoperative anticoagulation. Little data of post-discharge hemorrhage rates have been published. With increasing numbers of bariatric surgical procedures performed annually, there is a potential for developing serious coagulopathic complications in those patients who resume their anticoagulation therapy postoperatively.

Methods

Retrospective review of LVHN data from the ACSBSCN database was analyzed for 30-day readmissions due to documented extra- or intraluminal hemorrhage with INR and coagulopathy. Follow-up INR and warfarin doses were collected up to 6 months postoperatively.

Results

Over a 3-year period, 38 patients undergoing bariatric procedures were identified as being on preoperative warfarin therapy. Six of 38 developed hemorrhage within 30 days. Two patients presented beyond 30 days with bleeding. Supratherapeutic INR was present in five of six readmitted patients. Mean INR was 5.8. Warfarin sensitivity was present in a statistically significant higher number of patients within 30 days of surgery. After 30 days, a resistance to warfarin was demonstrated.

Conclusions

Bariatric surgery patients taking warfarin are prone to coagulopathy in the early post-op period requiring vigilant monitoring to prevent supratherapeutic INR and corresponding risk of hemorrhage.     

Bariatric Surgery for the Treatment of Severely Obese Patients in South Korea—Is it Cost Effective?

Background

In South Korea, the number of severely obese patients has increased. An economic study comparing bariatric surgery with nonsurgical interventions has not been published for Asia.

Objectives

This study was conducted to evaluate the cost effectiveness of bariatric surgery as compared to nonsurgical interventions for severe obese Korean people.

Methods

We used the Markov model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and nonsurgical interventions from Korean Healthcare system perspectives. Our target cohort consisted of severe obese people defined as having a body mass index of 30–<40 kg/m² in South Korea. The starting age of the cohort was 30 years old, and the cycle length was 1 year. Nonsurgical interventions included a physician visit, exercise, diet, and pharmacotherapy. A discount of 5 % was applied in cost and QALY. The incremental cost-effectiveness ratio (ICER) of bariatric surgery compared to nonsurgery interventions was calculated.

Results

The cost-utility analysis study indicated that bariatric surgery had US$1,522 incremental costs and 0.86 incremental QALYs as compared to nonsurgical interventions. Through the base case analysis, ICER was US$1,771/QALY. The sensitivity analyses were performed using a variety of assumptions, and the robustness of the study results was also demonstrated.

Conclusion

The study indicated that bariatric surgery was a cost-effective alternative to nonsurgical interventions over a lifetime, providing substantial lifetime benefits for severely obese Korean people.     

Antibiotic Prophylaxis in Bariatric Surgery with Continuous Infusion of Cefazolin: Determination of Concentration in Adipose Tissue

Background

The aim of this study was to evaluate the concentration of cefazolin in adipose tissue of patients undergoing bariatric surgery.

Methods

Eighteen patients undergoing bariatric surgery were evaluated during the period from October 2011 to May 2012. All patients had a dosage schedule of antibiotic prophylaxis with cefazolin administered as follows: first, 2 g in anesthetic induction, followed by continuous infusion of 1 g diluted in 250 ml of saline solution. Adipose samples, collected soon after the incision (initial) and before the skin synthesis (final), were analyzed using reverse phase high-pressure liquid chromatography. The level of significance adopted was 5 %.

Results

The cefazolin concentration in the adipose tissue samples at the beginning of surgery was an average of 6.66?±?2.56 ug/ml. The mean concentration before the skin synthesis was 7.93?±?2.54 ug/ml. Patients with BMI?2 had higher initial and final sample concentrations of cefazolin than patients with BMI?≥?40 kg/m². There was no surgical site infection (SSI) in any of the patients.

Conclusions

In bariatric surgeries, addition of a 1 g increase of cefazolin, administered through continuous intravenous infusion, to the currently recommended dose of 2 g administered in anesthetic induction provided a concentration in the adipose tissue above the minimum inhibitory concentration (MIC) of the main causal agents of SSI. An inverse correlation between BMI and concentration of cefazolin in adipose tissue was observed.     

Revisional Bariatric Surgery for Unsuccessful Weight Loss and Complications

Background

There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery.

Methods

We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes.

Results

From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3 %) of these cases were coded as revisional procedures. The mean age at revision was 49.1?±?11.3 and the mean BMI was 44.0?±?13.7 kg/m². Revisional surgery was performed laparoscopically in 121 patients (78.6 %). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n?=?106) and patients with complications of their primary procedures (group B, n?=?48). In group A, 74.5 % of the patients were revised to a bypass procedure and 25.5 % to a restrictive procedure. Mean excess weight loss was 53.7?±?29.3 % after revision of primary restrictive procedures and 37.6?±?35.1 % after revision of bypass procedures at >1-year follow-up (p?<?0.05). In group B, the complications prompting revision were effectively treated by revisional surgery.

Conclusions

Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.     

Understanding Disposition After Referral for Bariatric Surgery: When and Why Patients Referred Do Not Undergo Surgery

Background

Bariatric surgery is an effective long-term solution for weight loss in the severely obese. Prevalence of bariatric surgery has increased over the recent years; however, the attrition rate of those referred who actually undergo surgery is high. The purpose of this study was to examine patients' attrition rates after referral for bariatric surgery at an academic tertiary care institution. When and why patients who were referred for bariatric surgery did not ultimately undergo surgical treatment was examined.

Methods

Charts of 1,237 patients referred to the Toronto Western Hospital Bariatric Program from program inception to February 2011 were retrospectively reviewed. Patient demographics, appointment dates, no shows and cancellations, and when and why patients did not undergo surgery were summarized.

Results

Patients' mean age was 47. Most patients were female, and the mean body mass index was 47. Half (50.6 %) of the total persons referred left the program prior to being seen by a health-care professional, and only 36.2 % underwent surgical treatment. Only 2.75 % of persons were ineligible for surgery. A total of 60.6 % of persons self-removed from our program. Reasons for self-removal varied, with the most common reason for leaving the program recorded as “unknown.”

Conclusions

Our multidisciplinary program with in-hospital psychosocial resources resulted in very few persons being excluded from receiving surgical treatment. However, less than half of those referred underwent surgery as most persons self-removed from our program for unknown reasons. Further investigation is required to determine which patient, administrative, and system factors play a role in the patients' decision to not undergo bariatric surgical treatment.     

Pulmonary Embolism and Deep Venous Thrombosis Following Bariatric Surgery

Background

The contribution of obesity to the thromboembolic risks of surgery suggests that patients undergoing bariatric surgery would have a particularly high risk of postoperative pulmonary embolism (PE) and/or deep venous thrombosis (DVT). This study aimed to assess the prevalence of in-hospital PE, DVT, and venous thromboembolism (VTE) following bariatric surgery in the USA from 2007 to 2009.

Methods

We used the database of the Nationwide Inpatient Sample.

Results

The prevalence of PE was 4,500 of 508,230 (0.9 %). The prevalence of DVT not accompanied by PE was 6,480 of 508,230 (1.3 %) and VTE (either PE or DVT) occurred in 10,980 of 508,230 (2.2 %). In-hospital death among patients with PE was 130 of 508,231 (0.03 %). Vena cava filters were inserted in 1,515 of 508,230 (0.3 %) patients who underwent bariatric surgery. Among patients who had VTE, filters were inserted in 1,150 of 10,980 (10.5 %). Among patients who had neither PE nor DVT, prophylactic vena cava filters were inserted in 365 of 497,250 (0.07 %). Among patients with PE, in-hospital mortality was 25 of 635 (3.9 %) with a filter compared with 105 of 3,865 (2.7 %) (NS) without a filter. However, among patients with DVT alone, in-hospital mortality was 0 of 510 (0 %) with a filter compared with 80 of 5,970 (1.3 %) (P?=?0.009) without a filter.

Conclusions

This investigation establishes a baseline for the incidence of venous thromboembolic complications following bariatric surgery in recent years. Determination of the present in-hospital rate of PE and DVT may contribute to antithrombotic prophylactic considerations.     

Serum SPARC and Matrix Metalloproteinase-2 and Metalloproteinase-9 Concentrations after Bariatric Surgery in Obese Adults

Background

Remodeling of the extracellular matrix (ECM) of adipose tissue is regarded as part of the pathophysiology of obesity. Secreted protein acidic and rich in cysteine (SPARC) was the first ECM protein described in adipose tissue. Matrix metalloproteinases (MMPs) also play a role in ECM remodeling, and MMP-2 and MMP-9 may be associated with abnormal ECM metabolism. Here, we investigated changes in serum SPARC, MMP-2, and MMP-9 concentrations after bariatric surgery in obese adults.

Methods

We recruited 34 obese patients who were scheduled to undergo bariatric surgery for weight loss. We analyzed changes in serum SPARC, MMP-2, and MMP-9 concentrations before and 9 months after bariatric surgery and any associations between changes in SPARC, MMP-2, and MMP-9 concentrations and obesity-related parameters.

Results

Serum leptin levels significantly decreased, and the serum adiponectin level significantly increased after bariatric surgery. The serum SPARC concentration decreased significantly from 165.0?±?18.2 to 68.7?±?6.7 ng/mL (p?<?0.001), and the MMP-2 concentration also decreased significantly from 262.2?±?15.2 to 235.9?±?10.5 ng/mL (p?<?0.001). Changes in the serum SPARC concentration were significantly correlated with HOMA-IR changes, and changes in the serum MMP-9 concentration were found to inversely correlate with serum adiponectin changes.

Conclusion

These findings show that significant decreases in serum SPARC and MMP-2 concentrations occur after bariatric surgery. Our results thus suggest that weight loss via bariatric surgery could alter the ECM environment, and that these changes are related to certain metabolic changes.     

Entwicklung der Adipositaschirurgie am Krankenhaus der Maximalversorgung

Background

Bariatric surgery has been performed since 1983 at the Bad Cannstatt Hospital near Stuttgart, Germany. The aim of this study was to investigate the development of bariatric surgery during the past 25 years.

Methods

Data were collected retrospectively. The parameters were number of surgical procedures, hospital stay, and postoperative complications.

Results

In the 25-year period 1,041 primary bariatric operations were performed. Open horizontal bypass and open vertical banded gastroplasty were performed initially. Starting in 2003 there was a change to laparoscopic procedures (gastric banding and Roux-en-Y bypass). The mean hospital stays were 14.7±5.1 days for open procedures and 6.7±4.2 days for laparoscopic methods, with 30-day mortalities of 0.8% and 0.0% and short-term complications at 16.9% and 7.8%, respectively.

Conclusions

Perioperative complications and hospital stay were reduced by performing laparoscopic bariatric surgery. Our study emphasizes the advantages of the laparoscopic procedures which are standard at our hospital and fit in with the remaining operations in a department of visceral surgery.     

Correlation between Postoperative Weight Loss and Diabetes Mellitus Remission: A Meta-Analysis

Objective

This meta-analysis was conducted to determine the effect of percent excess weight loss (%EWL) after bariatric surgery on diabetes remission.

Methods

The Cochrane Library, PubMed, MEDLINE, Embase, and CINAHL were searched. All reports on %EWL involving humans and published in English between 1 January 1992 and 1 September 2013 were included in the analysis.

Results

Eight studies involving 1,247 patients who underwent bariatric surgery were selected. %EWL was positively associated with remission rate (WMD?=?11.15, 95 % CI: 6.73–15.56, p?Conclusions Patients with extensive weight loss were more likely to achieve T2DM remission after bariatric surgery. Further randomized controlled trials (RCTs) with uniform remission criterion should be performed to provide more reliable evidence.