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1.
《Surgery for obesity and related diseases》2020,16(8):1011-1021
BackgroundLong-term changes in cardiovascular disease (CVD) risk after bariatric surgery are not well characterized.ObjectiveTo report sex-specific changes in CVD risk after Roux-en-Y gastric bypass surgery (RYGB).SettingObservational cohort study at ten hospitals throughout the United States.MethodsBetween 2006 and 2009, 1770 adults enrolled in a prospective cohort study underwent RYGB at 1 of 10 U.S. hospitals. Research assessments were conducted presurgery and annually postsurgery over 7 years. Sex specific–predicted 10-year and lifetime CVD risk were calculated using the Framingham10-year and lifetime risk scores, Framingham–body mass index, and atherosclerotic CVD scoring algorithms among participants with no history of CVD. Of 1566 eligible participants, 1234 (75.9%) with CVD risk determination pre- and postsurgery were included (1013 females, 221 males).ResultsBased on the Framingham10-year and lifetime risk scores, the percentage of females with predicted high (>20%) 10-year CVD risk declined from presurgery (6.5% [95% confidence interval: 6.7–7.5]) to 1 year postsurgery (1.0% [95% confidence interval: .8–1.2]; P < .001), then increased 1 to 7 years postsurgery (to 2.8% [95% confidence interval: 1.6–3.3]; P = .003), but was lower 7 years postsurgery versus presurgery (P < .001). Time trends for percentage of high-risk participants and mean CVD risk scores were similar for both sexes and other evaluated CVD risk scores. For example, among males mean lifetime atherosclerotic CVD score declined from presurgery to 1 year postsurgery, then increased 1 to 7 years postsurgery. However, there was a net decline from presurgery (P < .001).ConclusionAmong both females and males, predicted 10-year and lifetime CVD risk was substantially lower 7 years post RYGB than presurgery, suggesting RYGB surgery can lead to sustained improvements in short- and long-term CVD risk. 相似文献
2.
《Surgery for obesity and related diseases》2020,16(9):1236-1241
BackgroundMale sex has long been identified as a risk factor for adverse outcomes, including mortality, after Roux-en-Y gastric bypass (RYGB).ObjectivesThe objective of this study was to compare short-term outcomes of patients undergoing laparoscopic RYGB based on biologic sex.SettingGeisinger Medical Center, Danville, PA.MethodsPatients undergoing RYGB in the 2015, 2016, and 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were propensity matched 1:1 to compare 30-day outcomes between male and female sex.ResultsA total 47,906 patients were included (23,953 men/23,953 women). The overall complication rate was higher in female patients (11.5% versus 10.2%; P < .001) with no difference in mortality related to RYGB at 30 days. No significant differences were seen between sexes for organ space surgical site infection or septic shock. Women had significantly more superficial surgical site infections (P = .002), urinary tract infections (P < .001), readmissions (P < .001), and reinterventions (P < .001). Men had significantly more episodes of unplanned intubation (P = .008), extended ventilator use (P = .01), progressive renal insufficiency (P = .01), acute renal failure (P = .008), cardiac arrest (P = .005), intensive care unit admission (P < .001), all-cause 30-day mortality (P = .038), and inpatient mortality rate (P < .001).ConclusionsMale sex has been identified as a risk factor for adverse events and mortality after RYGB in several risk models. This study demonstrates an overall increased risk of both all-cause mortality and inpatient mortality. The study, however, did not demonstrate a difference in bariatric-related mortality. The prevalence of both major and minor complications was mixed between sexes, while women had a higher overall complication rate after RYGB. The abundance of data available within the MBSAQIP Participant Use Data File facilitates the creation of tools like risk models for bariatric surgery, such as the MBSAQIP Risk calculator. 相似文献
3.
《Surgery for obesity and related diseases》2022,18(5):610-619
BackgroundMetabolic surgery is associated with improved cardiovascular risk profile. Randomized and observational studies exploring the impact of bariatric surgery on follow-up coronary revascularization (CR) as a primary endpoint are limited.ObjectivesTo identify the impact of metabolic surgery on the risk of follow-up CR, including percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG)SettingStony Brook Department of Surgery, Stony Brook University Hospital, New York, United States.MethodsA retrospective analysis was performed for patients with obesity between 2006 and September 2015. Patients were divided into those with history of metabolic surgery and those without. Patient were also stratified by bariatric surgery type. All study groups were followed till 2018 and for at least 3 years to monitor the development of the primary endpoint—any CR including PCI or CABG.ResultsThe study population with obesity was 515,307 patients; 95,901 with history of surgery versus 419,406 matched patients without. A total of 12,873 (13.4%) with surgery and 51,478 (12.27%) without were lost to follow-up by 2018. The group with history of surgery had a reduced risk of future CR (hazard ratio [HR], .46; 95% confidence interval [CI]: .42–.50; P < .0001), PCI (HR, .45; 95% CI: .41–.49; P < .0001) and CABG (HR, .49; 95% CI:.42–.56; P < .0001). In subgroup analysis, laparoscopic adjustable gastric banding compared with Roux-en-Y gastric bypass (RYGB) was associated with higher follow-up CR (HR, 1.34; 95% CI: 1.11–1.63; P < .01) and PCI (HR, 1.34; 95% CI: 1.07–1.68; P < .05).ConclusionBariatric surgery is associated with reduced risk of future CR, PCI, and CABG. Upon subgroup analysis, RYGB was associated with reduced risk of PCI and CR. 相似文献
4.
《Surgery for obesity and related diseases》2022,18(1):107-116
BackgroundPatients with obesity are prescribed more opioids than the general population.ObjectivesTo compare opioid consumption in patients with obesity who underwent Roux-en-Y bariatric surgery (RYGB) with population controls with and without obesity, not undergoing bariatric surgery, and to identify characteristics associated with opioid use.SettingThis study included all patients with a principal diagnosis of obesity, aged 18–72 years, with a RYGB surgical code in the Swedish Patient Register between 2007 and 2013.MethodsRYGB patients (n = 23,898) were age- and sex-matched with 1 control patient with obesity (n = 23,898) and 2 population controls without obesity (n = 46,064). Participants were classified as nonconsumers and consumers based on their opioid dispensations during the 12 months before baseline. Opioid consumption was assessed for 24 months.ResultsNonconsumers. Within 24 months, a significantly higher proportion of RYGB patients (16.6%) started using opioids compared with the controls with obesity (14.3%, P < .0001) and population controls (5.4%, P < .0001). RYGB patients and controls with obesity had higher median daily intake of opioid morphine equivalent (MEQ) (2.8 mg/d) than population controls (2.5 mg/d, P < .0001). Consumers. Within 24 months, the proportion of RYGB patients and controls with obesity that was using opioids were similar (53.1% and 53.4%), but higher compared to population controls (38.0%, P < .0001). The median daily opioid MEQ was higher among RYGB patients than in population controls (10.5 versus 7.8 mg/d, P < .0001). RYGB patients, overall, had higher incidence of bowel surgery and cholecystectomy compared with controls with obesity and population controls, leading to prolonged opioid use in this group. Opioid consumption in general was associated with chronic pain and psychiatric disorder, which were more common in patients with obesity than in the population controls.ConclusionRYGB surgery increased the risk of prolonged opioid use in patients with obesity who were nonconsumers before surgery but had no effect on overall opioid use among prior consumers. RYGB-associated complications requiring surgery influenced opioid use for both nonconsumers and consumers. Regular reassessments of pain mechanisms and specific treatment owing to type of pain could prevent unnecessary opioid use in this patient group. 相似文献
5.
Thomas C.C. Boerlage Floris Westerink Arnold W.J.M. van de Laar Barbara A. Hutten Desiderius P.M. Brandjes Victor E.A. Gerdes 《Surgery for obesity and related diseases》2019,15(6):871-877
BackgroundRoux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity, but many patients have increased gastrointestinal symptoms.ObjectivesTo evaluate gastrointestinal symptoms and food intolerance before and after RYGB over time in a large cohort of morbidly obese patients.SettingA high-volume bariatric center of excellence.MethodsA prospective cohort study was performed in patients who underwent RYGB between September 2014 and July 2015, with 2-year follow-up. Consecutive patients screened for bariatric surgery answered the Gastrointestinal Symptom Rating Scale (GSRS) and a food intolerance questionnaire before RYGB and 2 years after surgery. The prevalence of gastrointestinal symptoms before and after surgery and the association between patient characteristics and postoperative gastrointestinal symptoms were assessed.ResultsFollow-up was 86.2% (n = 168) for patients undergoing primary RYGB and 93.3% (n = 28) for revisional RYGB. The total mean GSRS score increased from 1.69 to 2.31 after surgery (P < .001), as did 13 of 16 of the individual scores. Preoperative GSRS score is associated with postoperative symptom severity (B = .343, P < .001). Food intolerance was present in 16.1% of patients before primary RYGB, increasing to 69.6% after surgery (P < .001). Patients who underwent revisional RYGB had a symptom severity and prevalence of food intolerance comparable with that among patients with primary RYGB, even though they had more symptoms before revisional surgery.ConclusionsTwo years after surgery, patients who underwent primary RYGB have increased gastrointestinal symptoms and food intolerance compared with the preoperative state. It is important that clinicians are aware of this and inform patients before surgery. 相似文献
6.
《Surgery for obesity and related diseases》2020,16(9):1242-1248
BackgroundDiabetic nephropathy is the leading cause of chronic kidney disease. Observational studies suggest Roux-en-Y gastric bypass (RYGB) reduces progression of diabetic nephropathy.ObjectivesTo unravel the mechanisms by which RYGB is beneficial and protective for diabetic nephropathy.SettingAcademic laboratories.MethodsForty-eight Zucker diabetic fatty rats were randomized to RYGB, sham surgery (SHAM), or pair-fed (PF) groups. An oral glucose tolerance test was performed at 25 days post intervention and kidneys were harvested at 30 days. Primary outcome measures included expression of key genes and proteins in the glucose transport, oxidative stress, inflammation, and fibrosis pathways.ResultsThirty days post intervention, RYGB rats weighed 349 ± 8 g, which was lower than SHAM (436 ± 14 g, P < .001), but not PF (374 ± 18 g) rats. RYGB rats had lower fasting glucose than PF animals and improved homeostatic model assessment of insulin resistance compared with PF and SHAM groups. These enhanced metabolic outcomes were accompanied by reduced sodium-glucose co-transporter 1 (Sglt1) gene expression (−23% versus PF, P = .01) in the kidney of RYGB rats. Expression of Sglt2, Glut1, or Glut2 mRNA, or oxidative stress and inflammation markers did not differ significantly. However, RYGB surgery induced a 19% lower expression of transforming growth factor (Tgfβ) mRNA (P = .004) compared with SHAM treated animals. Notably, adenosine monophosphate-activated protein kinase phosphorylation was increased (P = .04) in kidneys of the RYGB surgery animals.ConclusionsImprovement of hyperglycemia after RYGB may reduce the glucose load on the kidney leading to a downregulation of specific glucose transporters. RYGB surgery may also attenuate kidney fibrosis through the adenosine monophosphate-activated protein kinase/TGFβ pathway. 相似文献
7.
《Surgery for obesity and related diseases》2022,18(2):241-252
BackgroundReadmission after bariatric surgery is not cost-effective and is a preventable quality metric within standardized practices. However, reasons for readmission among racial/ethnic bariatric cohorts are less explored and understood.ObjectiveOur study objective was designed to compare reasons for readmission among racial/ethnic cohorts of bariatric patients.SettingAcademic hospital.MethodsWe performed a retrospective analysis of the 2015–2018 MBSAQIP databases to identify Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) cases. Regression analyses determined predictors of all-cause and bariatric-related readmissions. Reasons for readmission were compared between racial/ethnic cohorts using propensity score matching.ResultsMore than 550 000 RYGB and SG cases were analyzed. The readmission rate was 3%–4%. Black race, RYGB, robot-assisted approach, and numerous co-morbidities were independently associated with readmission (P <.05). In RYGB cases, black (versus white) patients were at decreased odds of leak-related (P < .001) and cardiovascular-related (P < .001) readmissions but at increased odds of readmissions related to renal complications (P < .001). Hispanic (versus white) patients had a higher likelihood of venous thromboembolism–related readmissions (P < .001). In SG cases, black (versus white) patients had a similar lower likelihood of readmission related to leaks or cardiovascular complications but higher odds of readmission related to renal complications (P < .001). Hispanic (versus black) patients had a higher likelihood of leak-related readmissions (P < .001).ConclusionReadmission reasons after bariatric surgery vary by race/ethnicity. Perioperative pathways to mitigate complications, including readmissions, should consider these disparate findings. 相似文献
8.
《Surgery for obesity and related diseases》2022,18(5):666-673
BackgroundDiabetes remission after bariatric surgery was reported to be characterized by increased risk of hypoglycemia.ObjectivesThis study aimed to examine the contribution of glycemic variability (GV) to the risk of hypoglycemia, and the suitability of time in range (TIR), an emerging glycemic marker, to define diabetes remission after Roux-en-Y gastric bypass (RYGB).SettingA single referral center in China.MethodsThis retrospective study included 175 individuals with type 2 diabetes and obesity who underwent RYGB. Subjects were classified as remission/nonremission according to the current standard. Each participant underwent continuous glucose monitoring both before and 1 year after RYGB. GV was measured by glucose coefficient of variation (CV), and hypoglycemia was assessed by time below range (TBR).ResultsComplete remission was achieved in 88 of the 175 participants following RYGB. In the remission group, significant correlations between postoperative CV and TBRs (r = .353–.442, both P ≤ .001) were found. Excess hypoglycemia (TBR<54 , ≥1%, TBR<70, ≥4%) increased with ascending CV quintiles (both P for trend <.05) and was significantly more frequent in subjects with glucose CV >32.2% (both P <.05). Compared with glycated hemoglobin A1C, TIR showed stronger correlation with glucose CV and risk of hypoglycemia.ConclusionIncreased glycemic variability was linked to excess risk of hypoglycemia after RYGB. Furthermore, TIR may serve as a new metric, in addition to HbA1C, for defining diabetes remission. 相似文献
9.
《Surgery for obesity and related diseases》2020,16(4):536-544
BackgroundRoux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most common bariatric surgeries performed worldwide, increase the risk to develop an alcohol use disorder. This might be due, in part, to surgery-related changes in alcohol pharmacokinetics. Another risk factor, unexplored within this population, is having a reduced subjective response to alcohol’s sedative effects.ObjectivesTo assess whether the alcohol sensitivity questionnaire (ASQ), a simple self-report measure, could pinpoint reduced alcohol sensitivity in the bariatric population.SettingUniversity medical centers in Missouri and Illinois.MethodsWomen who had RYGB (n = 16), SG (n = 28), or laparoscopic adjustable gastric banding surgery (n = 11) within the last 5 years completed the ASQ for both pre- and postsurgical timeframes, and 45 of them participated in oral alcohol challenge testing postsurgery. Blood alcohol concentration (BAC) and subjective stimulation and sedation were measured before and for 3.5 hours after drinking.ResultsIn line with faster and higher peak BACs after RYGB and SG than laparoscopic adjustable gastric banding surgery (P < .001), postsurgery ASQ scores were more reduced from presurgery scores after RYGB/SG than after laparoscopic adjustable gastric banding surgery (−2.3 ± .3 versus −1.2 ± .2; P < .05). However, despite the dramatic changes in BAC observed when ingesting alcohol after RYGB/SG surgeries, which resulted in peak BAC that were approximately 50% above the legal driving limit, a third of these women felt almost no alcohol-related sedative effects.ConclusionsAlthough RYGB/SG dramatically increased sensitivity to alcohol in all participants, meaningful interindividual differences remained. The ASQ might help identify patients at increased risk to develop an alcohol use disorder after surgery. 相似文献
10.
Zhamak Khorgami Theresa N. Jackson Ali Aminian James M. Sahawneh Guido M. Sclabas Geoffrey S. Chow 《Surgery for obesity and related diseases》2019,15(7):1132-1137
BackgroundMajor adverse cardiac events (MACE) can be a cause of postoperative mortality. This is specifically important in bariatric surgery due to obesity-related cardiovascular risk factors.ObjectiveTo assess postoperative cardiac adverse events after bariatric surgery and its independent predictors.SettingA retrospective analysis of 2011–2015 Healthcare Cost and Utilization Project-National Inpatient Sample.MethodsData on patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were retrieved. MACE was identified as a composite variable including myocardial infarction, acute ischemic heart disease without myocardial infarction, and acute heart failure. Dysrhythmia (excluding premature beats) was identified as a separate outcome. Multivariate regression analysis for MACE was performed using demographic factors, co-morbidities, and type of surgery.ResultsThe analysis included 108,432 patients (SG: 54.6%, RYGB: 45.4%). MACE was found in 116 patients (.1%), and dysrhythmia occurred in 3670 patients (3.4%). Median length of stay in patients with MACE was 4.5 versus 2 days in others (P < .001). There were 43 deaths overall, and 31 were in patients with MACE or dysrhythmia (P < .001). Age ≥ 50 years, male sex, congestive heart failure, chronic pulmonary disease, ischemic heart disease, history of pulmonary emboli, and fluid or electrolyte disorders were independent predictors of MACE based on multivariate analysis. Type of surgery (SG versus RYGB) was not an independent predictor for MACE (odds ratio 1.41, 95% confidence interval: .77–2.55).ConclusionsWhile cardiac complications are rare after bariatric surgery, their occurrence is associated with increased length of stay, hospital charges, and mortality. Older age, male sex, cardiopulmonary co-morbidities, and fluid or electrolyte disorders are predictive of MACE. RYGB does not increase the risk of MACE compared with SG. 相似文献
11.
Iliya Goldberg Jie Yang Lizhou Nie Andrew T. Bates Salvatore Docimo Aurora D. Pryor Tyler Cohn Konstantinos Spaniolas 《Surgery for obesity and related diseases》2019,15(8):1380-1387
BackgroundThe increase in life expectancy along with the obesity epidemic has led to an increase in the number of older patients undergoing bariatric surgery. There is conflicting evidence regarding the safety of performing bariatric procedures on older patients.ObjectiveThe purpose of this study was to compare the safety of laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for older patients (>65 yr).SettingNationwide analysis of accredited centers.MethodsThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2017 database was used to identify nonrevisional laparoscopic RYGB and SG procedures. Comparisons were made based on patient age. Clinical outcomes included postoperative events and mortality.ResultsThere was a total 13,422 and 5395 matched pairs for SG and RYGB in comparing patients aged 18 years to those aged 65 and >65 years, respectively, and 5395 matched RYGB and SG procedures performed in patients >65 years. The complication rate was higher in older patients undergoing RYGB compared with SG (risk difference = 2.39%, 95% confidence interval: 1.57%–3.21%, P < .0001). When comparing older to younger patients, the older group had a higher complication rate for SG but not for RYGB (SG: risk difference = 1.01%, 95% confidence interval: .59%–1.43%, P < .0001, RYGB: risk difference = .59%, 95% confidence interval: ?.29% to 1.47%, P = .2003).ConclusionsOverall complication rates of bariatric surgery are low in patients >65 years. SG appears to have a favorable safety profile in this patient population compared with RYGB. The overall complication rate for RYGB is not significantly different between the older and younger groups. 相似文献
12.
《Surgery for obesity and related diseases》2022,18(2):190-195
BackgroundResearch shows that surgery patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk for an alcohol use disorder (AUD). However, the mechanisms through which this increased risk is incurred are poorly understood. A host of variables have been proposed as potentially causal in developing AUDs, but empirical examination of many of these variables in human samples is lacking.ObjectivesOur objective was to examine the extent to which alcohol pharmacokinetics (PK), the rewarding effects of alcohol, and the relationship between these variables change from before to after weight loss surgery.SettingLarge healthcare facility in the Midwest United StatesMethodsThirty-four participants completed assessments before and 1 year after RYGB. They completed laboratory sessions and provided data on the PK of alcohol and the extent to which alcohol was reinforcing to them at each timepoint.ResultsFindings show that the PK effects of alcohol (P < .01) and how rewarding alcohol was reported to be (P < .01) changed from before to 1 year after weight loss surgery. Further, statistically significant increases in the association between these variables were witnessed from before to 1 year after surgery (P < .01).ConclusionThese results implicate changes (from before surgery to one year after) in the reinforcing and PK effects of alcohol as possible mechanisms for increased risk of alcohol use disorder following Roux-en-Y gastric bypass surgery. 相似文献
13.
《Surgery for obesity and related diseases》2014,10(4):576-582
BackgroundRoux-en-Y gastric bypass (RYGB) surgery has been shown to have favorable effects on components of metabolic syndrome. However, the long-term effect of RYGB on predicted risk of end-organ complications is less clear. The objective of this study was to examine long-term changes in predicted risk of metabolic syndrome-related complications after RYGB.MethodsThe predicted risk of metabolic syndrome-related complications in a cohort of 131 diabetic patients was compared between baseline and last follow-up points after RYGB using validated risk assessment tools.ResultsAfter a median postsurgical follow-up time of 6 years (range, 5–9), a mean percent excess weight loss of 60.7±25.1% was associated with a diabetes remission rate of 61%. At long-term follow-up, the levels of glycated hemoglobin, low-density lipoprotein, and blood pressure were within the recommended American Diabetes Association’s goals in 85%, 73%, and 63% of patients, respectively (P<.001). RYGB was associated with a relative risk reduction of 27% for 10-year overall risk of coronary heart disease (CHD), stroke, and peripheral vascular disease; 20% for 10-year risk of CHD; 40% for 10-year risk of myocardial infarction; 42% for 10-year risk of stroke; 47% for 4-year risk of intermittent claudication; 45% for 5-year risk of moderate-severe kidney disease; and 18% for 5-year risk of cardiovascular mortality. Four-year risk of diabetic retinopathy was also significantly decreased.ConclusionRYGB in diabetic patients results in remarkable control of diabetes, dyslipidemia, and hypertension, and is associated with a significant reduction in predicted risk of major complications including nephropathy, retinopathy, and cardiovascular disease and mortality in the range of 18–47% at long-term follow-up. 相似文献
14.
《Surgery for obesity and related diseases》2023,19(6):555-561
BackgroundHypoalbuminemia (HA) is a risk factor for serious complications after elective bariatric surgery. Patients undergoing revisional/conversional bariatric surgery may represent a higher-risk group who often have underlying co-morbid medical illnesses and more complex surgery.ObjectivesThis study investigated the postoperative complications in patients with HA undergoing revisional/conversional bariatric surgery.SettingMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), years 2015–2019.MethodsThe MBSAQIP database was used to evaluate patients undergoing non-banding revisional/conversional bariatric surgery between 2015 and 2019. Patients were categorized by serum albumin (≤3.5 g/dL). Variables were assessed via bivariate analysis and multivariable regression. Propensity score matching was conducted to compare gastric bypass (RYGB) to sleeve gastrectomy (VSG).ResultsOne hundred forty-seven thousand four hundred thirty patients underwent revisional/conversional procedures. After applied exclusions, 58,777 patients were available for analysis. The HA group had a significantly (P < .05) higher prevalence of being black (22.95% versus 17.76%), renal insufficiency (1.08% versus .36%), smoking history (9.47% versus 6.91%), chronic obstructive pulmonary disease (COPD) (2.54% versus 1.33%), and history of deep vein thrombosis (DVT) (4.03% versus 2.3%). Postoperative complications associated with HA included perioperative blood transfusion (3.1% versus 1.27%; P < .001), 30day readmission (10.87 versus 6.77%; P < .001), 30day reoperation (4.9% versus 3.18%; P < .001), and 30day mortality (.40% versus .14%; P < .0001). HA was a significant predictor of 30day readmission in the RYGB versus VSG matched cohort (odds ratio [OR], 1.30; 95% confidence interval [CI], [1.14, 1.48]; P < .001).ConclusionsHA is a risk factor requiring attention for patients undergoing revisional/conversional bariatric surgery and optimization of nutritional status or medical comorbidities associated with HA prior to bariatric surgery may help avoid postoperative complications. 相似文献
15.
Shashank S. Shah Jayashree S. Todkar Poonam S. Shah David E. Cummings 《Surgery for obesity and related diseases》2010,6(4):332-338
BackgroundRoux-en-Y gastric bypass (RYGB) benefits patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) >35 kg/m2; however, its effectiveness in patients with T2DM and a BMI <35 kg/m2 is unclear. Asian Indians have a high risk of T2DM and cardiovascular disease at relatively low BMI levels. We examined the safety and efficacy of RYGB in Asian Indian patients with T2DM and a BMI of 22–35 kg/m2 in a tertiary care medical center.MethodsA total of 15 consecutive patients with T2DM and a BMI of 22–35 kg/m2 underwent RYGB. The data were prospectively collected before surgery and at 1, 3, 6, and 9 months postoperatively.ResultsOf the 15 patients, 8 were men and 7 were women (age 45.6 ± 12 years). Their preoperative characteristics were BMI 28.9 ± 4.0 kg/m2, body weight 78.7 ± 12.5 kg, waist circumference 100.2 ± 6.8 cm, and duration of T2DM 8.7 ± 5.3 years. At baseline, 80% of subjects required insulin, and 20% controlled their T2DM with oral hypoglycemic medication. The BMI decreased postoperatively by 20%, from 28.9 ± 4.0 kg/m2 to 23.0 ± 3.6 kg/m2 (P <.001). All antidiabetic medications were discontinued by 1 month after surgery in 80% of the subjects. At 3 months and thereafter, 100% were euglycemic and no longer required diabetes medication. The fasting blood glucose level decreased from 233 ± 87 mg/dL to 89 ± 12 mg/dL (P <.001), and the hemoglobin A1c decreased from 10.1% ± 2.0% to 6.1% ± 0.6% (P <.001). Their waist circumference, presence of dyslipidemia, and hypertension improved significantly. The predicted 10-year cardiovascular disease risk (calculated using the United Kingdom Prospective Diabetes Study equations) decreased substantially for fatal and nonfatal coronary heart disease and stroke. No mortality, major surgical morbidity, or excessive weight loss occurred.ConclusionRYGB safely and effectively eliminated T2DM in Asian Indians with a BMI <35 kg/m2. Larger, longer term studies are needed to confirm this benefit. 相似文献
16.
《Surgery for obesity and related diseases》2022,18(12):1399-1406
BackgroundRoux-en-Y gastric bypass (RYGB) surgery is an established, effective treatment for severe adolescent obesity. Long-term dietary intake and the relationship to eating-related problems are scarcely evaluated in this population.ObjectivesAssess changes in dietary intake in adolescents after RYGB and explore associations between dietary intake and eating-related problems.Setting: Multicenter study in Swedish university hospitals.MethodDiet history, binge eating scale (BES), and Three-Factor Eating Questionnaire were assessed preoperatively and 1, 2, and 5 years after RYGB in 85 adolescents (67% female) aged 16.5 ± 1.2 years with a body mass index (BMI) of 45.5 ± 6.0 kg/m2 and compared with control individuals at 5 years.ResultsFive-year BMI change was –28.6% ± 12.7% versus +9.9% ± 18.9% in RYGB patients versus control individuals (P < .001). Through 5 years, RYGB adolescents reported reduced energy intake, portion size of cooked meals at dinner, and milk/yoghurt consumption (P < .01). The BES scores were 9.3 ± 8.3 versus 13.4 ± 10.5 in RYGB patients versus control individuals (P = .04). Association between BES score and energy intake was stronger in control individuals (r = .27 versus r = .62 in RYGB patients versus control individuals, P < .001). At 5 years, lower energy intake was associated with greater BMI loss in all adolescents (r = .33, P < .001). Higher scores in BES and uncontrolled and emotional eating were associated with higher energy intake, cooked meals, candies/chocolates, cakes/cookies, desserts, and sugary drinks (r > .23, P < .04) and lower intake of fruits/berries (r = –.32, P = .044). A higher score in cognitive restraint was associated with a higher intake of cereals and fruits/berries (r > .22, P < .05) and a lower intake of sugary drinks (r = –.24, P < .03).ConclusionTo support optimization of long-term outcomes in adolescent RYGB patients, it is important to provide management strategies to reduce energy intake. Monitoring eating-related problems could identify potential individuals at risk of poor weight loss and to initiate treatment interventions. 相似文献
17.
Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system
《Surgery for obesity and related diseases》2014,10(3):396-403
BackgroundA registry was created for patients having procedures for weight loss from 2004 to the present time at a large integrated healthcare system. The objective of this study was to compare findings to the literature and national quality monitoring databases and present 3-year weight loss outcomes.MethodsPatients are passively enrolled in the registry with the following characteristics: a bariatric procedure for weight loss after January 1, 2004 and actively enrolled in the health plan at the time of surgery.ResultsCompared to national surgical quality databases, the registry (n = 20,296) has a similar proportion of Roux-en-Y gastric bypass (RYGB; 58%), more vertical sleeve gastrectomy (SG; 40%), fewer banding (2%) procedures, more Hispanic patients (35%), and higher rates of 1 year follow-up (78%). RYGB patients lost more weight at every time point up to 3 years after surgery compared with SG patients (P<.001). Non-Hispanic white RYGB patients had a higher percent excess weight loss than non-Hispanic black (P<.001) and Hispanic (P<.001) RYGB patients. There were no differences between SG racial/ethnic groups in percent excess weight loss throughout the 3-year follow-up period.ConclusionWe are one of the first groups to publish comparison weight outcomes for RYGB and SG in a diverse patient population, showing that the responses to RYGB and not SG vary by race/ethnicity. 相似文献
18.
《Surgery for obesity and related diseases》2022,18(7):902-910
BackgroundLong-term change in CRP is not well characterized in the context of RYGB.ObjectiveTo report C-reactive protein (CRP) after Roux-en-Y gastric bypass surgery (RYGB).SettingBetween 2006 and 2009 1770 adults enrolled in a prospective cohort study underwent Roux-en-Y gastric bypass (RYGB) at 1 of 10 U.S. hospitals.MethodsResearch assessments were conducted before surgery and annually postoperatively for up to 7 years. This study included those with high-sensitivity CRP assessed before surgery and 1 or more follow-up assessments (n = 1180).ResultsBefore surgery, participants’ median age was 46 years, and the median body mass index (BMI) was 46 kg/m2; 80% were female. Before surgery, mean (95% confidence interval [CI]) CRP was the highest of all time points (1.01 [.95–1.08] mg/L); it then decreased to a nadir of .18 (.15–.22) mg/L at 2 years postoperatively (P < .001). CRP was higher at 7 years (.26 [.22, .29] mg/L) than at 2 years postoperatively (P < .001) but remained lower at 7 years than preoperatively (P < .001). Additionally, only 3.2% (95% CI: 1.6%–4.8%) of participants had elevated CRP (>1 mg/dL) 7 years postoperatively versus 32.9% (95% CI: 30.2%–35.3%) preoperatively (P < .001). Several preoperative factors were associated with following a less favorable CRP trajectory over time, including higher preoperative CRP level, higher BMI, current smoking, and diabetes.ConclusionThe vast majority of adults who underwent RYGB experienced a sustained improvement in CRP throughout 7 years of follow-up with nonelevated values. However, those with higher preoperative CRP and BMI levels and diabetes and who smoke may benefit from additional testing and monitoring to ensure nonelevated inflammation after surgery. 相似文献
19.
Pia Henfridsson Anna Laurenius Ola Wallengren Andrew J. Beamish Jovanna Dahlgren Carl-Erik Flodmark Claude Marcus Torsten Olbers Eva Gronowitz Lars Ellegard 《Surgery for obesity and related diseases》2019,15(9):1494-1502
BackgroundRoux-en-Y gastric bypass (RYGB) is an effective obesity treatment in adults and has become established in adolescents. Lower adherence to supplementation in adolescents confers a risk for long-term nutritional deficiencies.ObjectivesTo assess adherence to supplementation, micronutrient intake, and biochemistry in adolescents through 5 years after RYGB.SettingUniversity hospitals, multicenter study, Sweden.MethodsMicronutrient intake and adherence to supplementation were assessed by diet history interviews and biochemistry preoperatively, 1, 2, and 5 years after RYGB in 85 adolescents (67% females), aged 16.5 years (± 1.2) with a body mass index of 45.5 kg/m2 (± 6.0). Adherence was defined as taking prescribed supplements ≥3 times a week. Micronutrient intake and biochemistry were compared with matched controls at 5 years.ResultsOver 75% completed the dietary assessments across 5 years after RYGB. Adherence ranged between 44–61% through 5 years. At 5 years, ferritin and hemoglobin decreased (P < .04) and 61% had iron deficiency (P ≤ .001). Among females with iron deficiency, most did not adhere to supplementation (P = .005), and 59% of these had anemia (P < .001). Vitamin D insufficiency continued after surgery and 80% of participants who did not adhere to supplementation had insufficiency (P = .002). Adolescents not adhering had lower levels of vitamin D, B12, and ferritin (females) compared with both adhering adolescents and the control group (all P < .04).ConclusionsHalf of adolescents after RYGB reported sufficient long-term adherence to supplementation. Adhering to supplements and reporting a higher micronutrient intake were associated with more favorable biochemistry. Results support the recommendations for monitoring micronutrient intake and biochemistry in all patients who have undergone RYGB surgery, and the recommendation of higher preventive supplementation of vitamin D and iron in both sexes. As hypothesized, adolescents not adhering had a higher prevalence of long-term micronutrient deficiencies. 相似文献
20.
《Surgery for obesity and related diseases》2022,18(9):1151-1159
BackgroundMechanical problems at the level of the jejunojejunostomy (JJ) have been identified as a cause of small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (RYGB).ObjectivesThe objective of the study was to investigate associations between specific surgical techniques used to construct the JJ and the subsequent risk of SBO.SettingNationwide Registry, Sweden.MethodsThe risk of SBO after primary RYGB surgery during 2012–2019 was assessed using data from the Scandinavian Obesity Surgery Registry and the Swedish National Patient Register. The impact of unidirectional or bidirectional stapling and length of the mesenteric division (0, 1–4, or ≥5 cm) at the JJ was analyzed with adjustments for known covariates.ResultsWe analyzed outcomes from 23,448 patients (mean follow-up = 4.3 ± 2.2 yr). In multivariate analysis, bidirectional stapling of the JJ was associated with a reduced 30-day risk of SBO (hazard ratio [HR] = .52, 95% confidence interval [CI] = .29–.95, P < .05), whereas limited mesenteric division (1–4 cm) increased the risk of SBO (HR = 1.66, 95% CI = 1.14–2.42, P < .01). The long-term incidence of SBO was increased by bidirectional stapling but unaffected by mesenteric division. However, mesenteric division decreased the long-term risk of SBO in patients with a bidirectionally stapled JJ (1–4 cm, HR = .59, 95% CI = .38–.90, P < .05; ≥5 cm, HR = .30, 95% CI = .14–.65, P < .005).ConclusionsThe surgical technique for construction of the JJ may affect the incidence of SBO after RYGB surgery. 相似文献