共查询到20条相似文献，搜索用时 15 毫秒
1.
Ponnie R. Dolo Libin Yao Chao Li Xiaocheng Zhu Linsen Shi Jason Widjaja 《Obesity surgery》2018,28(5):1313-1320
Background
Possible mechanisms underlying diabetes remission following Roux-en-Y gastric bypass (RYGB) include eradication of putative factor(s) with duodenal-jejunal bypass.Objective
The objective of this study is to observe the effects of duodenal-jejunal transit on glucose tolerance and diabetes remission in gastric bypass rat model.Method
In order to verify the effect of duodenal-jejunal transit on glucose tolerance and diabetes remission in gastric bypass, 22 type 2 diabetes Sprague-Dawley rat models established through high-fat diet and low-dose streptozotocin (STZ) administered intraperitoneally were assigned to one of three groups: gastric bypass with duodenal-jejunal transit (GB-DJT n = 8), gastric bypass without duodenal-jejunal transit (RYGB n = 8), and sham (n = 6). Body weight, food intake, blood glucose, as well as meal-stimulated insulin, and incretin hormone responses were assessed to ascertain the effect of surgery in all groups. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were conducted three and 7 weeks after surgery.Results
Comparing our GB-DJT to the RYGB group, we saw no differences in the mean decline in body weight, food intake, and blood glucose 8 weeks after surgery. GB-DJT group exhibited immediate and sustained glucose control throughout the study. Glucagon-like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP) levels were also significantly increased from preoperative level in the GB-DJT group (p < 0.05). Insulin and GLP-1 area under curve (AUC) as well as improved glycemic excursion on OGTT did not differ between GB-DJT and RYGB groups. Outcomes with sham operation did not differ from preoperative level.Conclusion
Preserving duodenal-jejunal transit does not impede glucose tolerance and diabetes remission after gastric bypass in type-2 diabetes Sprague-Dawley rat model.2.
Kaijing Wang Xiaogang Zhou Giang Quach Jiajun Lu Wei Gao Anan Xu Jiangfan Zhu 《Obesity surgery》2016,26(4):797-804
Background
Sleeve gastrectomy plus side-to-side jejunoileal anastomosis (JI-SG), a relatively new approach to bariatric surgeries, has shown promising results for treating obesity and metabolic comorbidities. This study investigated the feasibility and safety of JI-SG in weight loss and diabetes remission compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).Methods
Forty 10-week-old male Zucker diabetic fatty rats were randomly assigned to four groups: control, SG, JI-SG, and RYGB. Their body weights, food intake, and levels of gut hormones (ghrelin, insulin, and glucagon-like peptide-1 (GLP-1)) and lipids were measured.Results
Rats in the SG, JI-SG, and RYGB groups demonstrated lower food intake and more weight loss 2 weeks postoperatively compared with control rats. Furthermore, rats in the JI-SG group achieved more weight loss (mean 242.7?±?11.2 g) compared with those in the SG and RYGB groups (SG, 401.4?±?15.1 g and RYGB, 298?±?12 g, both P?<?0.01). All surgery groups demonstrated a decreased fasting insulin, serum glucose, lipid levels, and increased GLP-1 postoperatively. The JI-SG group had lower fasting ghrelin levels than the RYGB group (168?±?19.8 ng/L vs. 182?±?16.7 ng/L, P?<?0.01) and higher fasting GLP-1 levels than the SG group (1.99?±?0.11 pmol/L vs. 1.71?±?0.12 pmol/L, P?<?0.01) at 12 weeks postoperatively. Over the experimental period, the ghrelin levels slowly increased in all surgical groups but remained lower than the preoperative and control levels.Conclusions
JI-SG induced higher ghrelin and GLP-1 levels and improved glycemic control in Zucker diabetic fatty rats. Compared with SG and RYGB, JI-SG appeared to be a simple, relatively safe, and more effective procedure for treating type 2 diabetes and obesity in this animal model.3.
4.
Rebekah Forbes Danijela Gasevic Emily M. Watson Thomas R. Ziegler Edward Lin John R. Burgess Nana Gletsu-Miller 《Obesity surgery》2016,26(6):1237-1246
Background
Although patients experience hair loss and dry skin which may be attributable to deficiency in essential fatty acids (EFAs), the impact of bariatric surgeries on EFA status is unknown.Methods
This study aimed to assess plasma phospholipid fatty acid profiles following adjustable gastric banding (AGB), which restricts dietary fat intake, versus Roux-en-Y gastric bypass (RYGB), which also promotes fat malabsorption. Serial measures were obtained before and 1 and 6 months from women undergoing RYGB (N?=?13) and AGB (N?=?5). Measures included the composition of plasma fatty acids in phospholipids, dietary intake, and body fat mass. Friedman and Mann–Whitney tests were used to assess differences over time and between groups, respectively, p?<?0.05.Results
Dietary intake of fats decreased equally at 1 and 6 months following RYGB and AGB. By 6 months, the RYGB group lost more body fat. There were no remarkable changes in EFA in plasma phospholipids following AGB. However, following RYGB, a transient increase in 20:4N6 (+18 %) and a decrease in 20:3N6 at 1 (?47 %) and 6 months (?47 %) were observed. Similar changes were observed in N3 fatty acids following RYGB, including a transient increase in 22:6N3 (+11 %) and decreases in 20:5N3 (?79 and ?67 % at 1 and 6 months, respectively). EFA status improved following surgery in the RYGB group.Conclusions
We demonstrate alterations in plasma EFA following RYGB. The status of EFA improved, but the decrease in 20:5N3, the precursor for anti-inflammatory eicosanoids, may be a concern.5.
Background
Iron deficiency can occur in patients after Roux-en-y gastric bypass due to altered absorption. Pica, the compulsive craving and intake of non-nutritive substances, is a rare and poorly understood presentation of iron deficiency. To our knowledge, the rate of pica after RYGB has never been reported.Methods
The medical records of patients who underwent laparoscopic RYGB from 2001 to 2011 were reviewed. Patients with pica or other abnormal cravings were identified.Results
Pica was identified in 16/959 (1.7%) patients who underwent RYGB during the study period. The most common presenting sign was pagophagia. All patients with pica were female and had multiple risk factors for iron deficiency with 13/16 being premenopausal and 7/16 non-compliant with oral iron supplementation. Pica symptoms presented at a mean of 3.9 ± 1.9 years after RYGB. Iron deficiency was identified in all 16 patients, with a median ferritin level of 5.0 ng/mL (range 2–27). All 16 patients received intravenous iron and pica symptoms resolved.Conclusions
Pica is a rare phenomenon associated with iron deficiency and can occur despite oral iron supplementation. In our experience, intravenous iron can relieve symptoms. Patients considering bariatric surgery should be counseled on pica. Patients with unusual cravings should be evaluated for iron deficiency.6.
Ilenia Coluzzi Luigi Raparelli Laura Guarnacci Emanuela Paone Gianmattia Del Genio Carel W. le Roux Gianfranco Silecchia 《Obesity surgery》2016,26(9):2059-2067
Background
Laparoscopic sleeve gastrectomy (LSG) results in reduced calorie intake and weight loss. Whether patients consume the same types of food before and after surgery or whether they reduce the volume and calorie density of the foods they consume remains unknown.Objectives
The aim of this prospective study was to evaluate the changes in daily caloric and macronutrient intake after LSG and the relation between changes of taste and food tolerance over 2 years.Methods
Thirty morbidly obese patients with median body mass index (BMI) of 43.9 kg/m2 (39.5–57.3) were prospectively enrolled prior to LSG. Weight, BMI, %EWL, weight loss percentage (%WL), and daily intake were evaluated preoperatively at 1, 3, 6, 12, and 24 months after surgery along with a questionnaire evaluating food choices, quality of eating, tolerance of certain types of food, frequency of vomiting, and changes in taste.Results
The median %EWL and %WL at 12 and 24 months was 65 % (33.9–93.6 %), 27.3 % (14.2–45.5 %) and 71.5 % (39.6–101.1 %), 31 % (19.1–50.3 %) respectively. Six months after surgery, the daily caloric intake reduced by 68 % and the reduction was maintained until 24 months. The median score of the eating questionnaire was 18 (10–27) at 6 months, 22 (16–26) at 12 months, and 23 (10–27) at 24 months, suggesting that the quality of nutrition improved over time. At 6, 12, and 24 months, 75 % of the patients reported changes in taste with reduced interest in sweets, high fat food, and alcoholic drinks. However, at 24 months, 20 % of patients reported a heightened interest in sweets compared to 12 months previously.Conclusions
LSG reduced calorie intake both through volume of food and the calorie density of the food consumed. The mechanisms for the changes in food preferences may involve both unconditioned and conditioned effects. The influence of dietary counseling on learning which foods are consumed still requires further exploration.7.
Jorunn Sandvik Torstein Hole Christian A. Klöckner Bård E. Kulseng Arne Wibe 《Obesity surgery》2018,28(9):2609-2616
Introduction
Acute, intermittent, and chronic abdominal pain is a common complaint after Roux-en-Y gastric bypass (RYGB).Objectives
The aim of the study was to evaluate the use of medical imaging and the need for surgery treating abdominal pain after RYGB in a cohort with long-term follow-up.Methods
Data from 569 patients who underwent RYGB as the primary bariatric procedure at a public hospital in Norway between April 2004 and June 2011 were prospectively registered in a local quality registry for bariatric surgery. All abdominal imaging and abdominal surgical procedures were registered until August 2017.Results
Mean follow-up was 100 months (61–159). During the observation period, 22% had one CT, 9% had two CTs, 4% had three CTs, and 5% had four or more CTs for abdominal pain. Twenty-two percent underwent abdominal surgery, as 16% had one and 6% had two or more operations and gynecological procedures excluded. The purpose of operation was postoperative complications (1.4%), suspected internal herniation (9.3%), cholecystectomy (9.3%), appendectomy (2.3%), hernias (3.2%), and perforated ulcer in the gastrojejunal anastomosis (0.7%). Mean time interval was 42?±?27 months from RYGB to cholecystectomy and 51?±?26 months for suspected IH.Conclusion
With a mean follow-up period of more than 8 years after RYGB, 40% of the patients suffered from abdominal pain, needing one or more CT scans. The need for surgery treating suspected internal hernia and cholecystectomy was equal, at 9.3% for both procedures, but the mean time from RYGB to operation was shorter for cholecystectomies.8.
Corey J. Lager Nazanene H. Esfandiari Yingying Luo Angela R. Subauste Andrew T. Kraftson Morton B. Brown Oliver A. Varban Rasimcan Meral Ruth B. Cassidy Catherine K. Nay Amy L. Lockwood Darlene Bellers Colleen M. Buda Elif A. Oral 《Obesity surgery》2018,28(11):3415-3423
Background
Sleeve gastrectomy (LSG) is now the predominant bariatric surgery performed, yet there is limited long-term data comparing important outcomes between LSG and Roux-en-Y gastric bypass (RYGB). This study compares weight loss and impact on comorbidities of the two procedures.Methods
We retrospectively evaluated weight, blood pressure, hemoglobin A1c, cholesterol, and medication use for hypertension, diabetes, and hyperlipidemia at 1–4 years post-operatively in 380 patients who underwent RYGB and 334 patients who underwent LSG at the University of Michigan from January 2008 to November 2013. Follow-up rates from 714 patients initially were 657 (92%), 556 (78%), 507 (71%), and 498 (70%) at 1–4 years post-operatively.Results
Baseline characteristics were similar except for higher weight and BMI in LSG. There was greater weight loss with RYGB vs. LSG at all points. Hemoglobin A1c and total cholesterol improved more in RYGB vs. LSG at 4 years. There was greater remission of hypertension and discontinuation of all medications for hypertension and diabetes with RYGB at 4 years.Conclusions
Weight loss, reduction in medications for hypertension and diabetes, improvements in markers of diabetes and hyperlipidemia, and remission rates of hypertension were superior with RYGB vs. LSG 4 years post-operatively. Choice of bariatric procedures should be tailored to surgical risk, comorbidities, and weight loss goals.9.
Daniel Berglind Mikaela Willmer Per Tynelius Ata Ghaderi Erik Näslund Finn Rasmussen 《Obesity surgery》2016,26(7):1463-1470
Background
Roux-en-Y gastric bypass (RYGB) patients report significant pre- to post-surgery increases in physical activity (PA). Conversely, objectively assessed PA does not increase after RYGB. The aim of the study was to compare self-reported and accelerometer-measured changes in moderate-to-vigorous PA (MVPA) and exercise from pre- to post-surgery, in women undergoing RYGB.Methods
Forty-three women with an average pre-surgery body mass index of 39.2 kg/m2 (SD 3.1) were recruited at Swedish hospitals. PA was measured by the Actigraph GT3X+ and by a previously validated short PA questionnaire, at home visits 3 months before and 9 months after surgery, thus limiting seasonal effects.Results
Self-reported time spent in exercise increased with 75 % and time spent in MVPA increased with 51 %, whereas accelerometer-assessed time spent in exercise increased with 0.9 % and time spent in MVPA increased with 2.1 %, from before to after surgery. Correlations comparing accelerometers with the questionnaire were 0.35 (P?=?0.02) for MVPA and 0.13 (P?=?0.4) for exercise before RYGB and 0.52 (P?≤?0.001) for MVPA and 0.12 (P?=?0.4) for exercise after RYGB.Conclusions
Pre- to post-RYGB surgery increases in self-reported PA were not confirmed by accelerometer-measured PA. Thus, health care workers should use objective measures of PA in patients undergoing RYGB, in order to assess whether patients achieve sufficient levels of PA.10.
Pichamol Jirapinyo David X. Jin Taha Qazi Nitin Mishra Christopher C. Thompson 《Obesity surgery》2018,28(3):615-626
Background
Roux-en-Y gastric bypass (RYGB) is an effective treatment for diabetes. Glucagon-like peptide-1 (GLP-1) is a gut hormone that is important to glucose homeostasis.Objective
This study aimed to assess GLP-1 level and its predictors after RYGB.Methods
The study design was a meta-analysis. The data sources were MEDLINE, EMBASE, Web of Science, and the Cochrane Databases. The study selection composed of studies with pre- and post-RYGB levels. The main outcomes were as follows: Primary outcome was the change in postprandial GLP-1 levels after RYGB. Secondary outcomes included the changes in fasting glucose, fasting insulin, and fasting GLP-1 levels after RYGB. Meta-regression to determine predictors of changes in GLP-1 levels was performed. Outcomes were reported using Hedge’s g.Results
Twenty-four studies with 368 patients were included. Postprandial GLP-1 levels increased after RYGB (Hedge’s g = 1.29, p < 0.0001), while fasting GLP-1 did not change (p = 0.23). Peak postprandial GLP-1 levels gave the most consistent results (I 2 = 9.11). Fasting glucose and insulin levels decreased after RYGB (p < 0.0001).Roux limb length was a significant predictor for amount of GLP-1 increase (β = ? 0.01, p = 0.02). Diabetes status, amount of weight loss, length of biliopancreatic limb, and time of measurement were not significant predictors (p > 0.05).Conclusion
Postprandial GLP-1 levels increase after RYGB, while fasting levels remain unchanged. Shorter Roux limb length is associated with greater increase in postprandial GLP-1, which may lead to better glycemic control in this population.11.
Daniela Lopes Gomes Dyanara de Almeida Oliveira Eliane Said Dutra Nathalia Pizato Kênia Mara Baiocchi de Carvalho 《Obesity surgery》2016,26(7):1443-1447
Background
Weight regain 24 months after Roux-en-Y gastric bypass (RYGB) and low protein intake in patients without protein supplementation can favor fat-free mass loss and reduce resting energy expenditure (REE). We aimed to assess REE and its association with the body composition of women with weight regain and no protein supplementation in the late postoperative period of RYGB.Methods
We determined the body mass index (BMI), REE by indirect calorimetry, body composition by tetrapolar bioelectrical impedance analysis, and energy intake by two 24-h recalls of 34 patients with at least 5 % of weight regain and no protein supplementation. The software SPSS v.17 analyzed the data calculating measures of central tendency and dispersion and using Pearson’s correlation to test the association between the variables and the multivariate linear regression model at a p?<?0.05 significance level.Results
Postoperative period was positively associated with weight regain (r?=?0.39; p?=?0.023). The mean percentages of fat and fat-free masses were 45.1?±?8.3 % and 54.3?±?8.1 %, respectively. The mean REE was 1424.7?±?187.2 kcal (14 kcal/kg of the current weight), mean energy intake was 1258.6?±?454.3 kcal, and mean protein intake was 0.9 g/kg of the ideal weight?±?0.3. Fat-free mass was positively associated with REE regardless of protein intake and postoperative period.Conclusions
Female bariatric patients with weight regain and no protein supplementation lose fat-free mass, lowering their REE. Health practices that promote maintenance of BMI and body composition may lead to improved outcomes of bariatric surgery.12.
Ramen Goel Madhu Goel Amrit Manik Nasta Sharmila Vyas Shefali Dharia Shireen Hamrapurkar 《Obesity surgery》2018,28(12):3738-3743
Introduction
Bariatric surgery leads to significant weight loss but the results vary. Application of dietary principles like portion-controlled eating leads to greater weight loss and fewer complications.Aims
To evaluate the improvement in weight loss outcomes by incorporating portion-controlled eating behavior in postbariatric patients.Methods
All patients who underwent bariatric surgery from January 2012 to December 2013 were included in the study. Portion-controlled eating behavior was incorporated in the post-bariatric nutritional protocol. Their demographic, preoperative, and postoperative data were prospectively maintained on Microsoft Office Excel and analyzed statistically.Results
Three hundred and seventy-two (89.6%) underwent laparoscopic sleeve gastrectomy (LSG), while 43 (10.4%) underwent laparoscopic Roux-en-Y gastric bypass (RYGB). In the LSG group, lowest (nadir) BMI was 28.99?±?5.6 kg/m2 and % Excess weight loss (EWL) was 87.3?±?27.2%, achieved between 1 and 2 years. In the RYGB group, lowest (nadir) BMI was 27.5?±?12.09 kg/m and % EWL was 94.32?±?33.12%. Surgical failure (less than 50% EWL) were 10 (3.27%) in the LSG group and 1 (3%) in the RYGB group. There were no leaks reported in our study.Conclusion
Our study highlights the importance of postoperative nutritional interventions like portion-controlled eating for successful bariatric outcome.13.
Background
Objectively measured levels of physical activity (PA) in patients undergoing Roux-en-Y Gastric Bypass (RYGB) surgery remain essentially unchanged from before to one year after surgery. Effects from RYGB on objectively measured levels of PA among women undergoing RYGB and appurtenant children beyond one year post-surgery are unknown.The aim of the present study was to objectively assess longitudinal changes in PA and sedentary time (ST), among women undergoing RYGB and appurtenant children, from three months before to nine and 48 months after maternal surgery.Methods
Thirty women undergoing RYGB and 40 children provided anthropometric measures during home visits and valid accelerometer assessed (Actigraph GT3X+) PA data, three months before and nine and 48 months after maternal RYGB surgery.Results
Women undergoing RYGB decreased time spent in moderate to vigorous PA (MVPA) with 2.0 min/day (p?=?0.65) and increased ST with 14.4 min/day (p?=?0.35), whereas their children decreased time spent in MVPA with 13.2 min/day (p?=?0.04) and increased ST with 110.5 min/day (p?<?0.001), from three months before to 48 months after maternal surgery. Twenty, 27 and 33% of women, and 60, 68 and 35% of children reached current PA guidelines three months before and nine and 48 months after maternal RYGB, respectively.Conclusions
Objectively measured PA in women remains unchanged, while appurtenant children decrease time spent in MVPA and increase ST, from three months before through nine and 48 months after maternal RYGB. The majority of both women undergoing RYGB and children are insufficiently active 48 months after maternal RYGB.14.
Blandine Tramunt Charlotte Vaurs Jocelyne Lijeron Eric Guillaume Patrick Ritz Chloé Diméglio Hélène Hanaire 《Obesity surgery》2016,26(7):1487-1492
Background
Abnormal glucose profiles have been described after Roux-en-Y gastric bypass (RYGB) with intense postprandial hyperglycemic peaks in some but not all the patients. The underlying mechanisms of these anomalies are not totally understood.Objective
The aim of this study is to determine whether or not the composition of the meal impacts the existence and maximum interstitial glucose (IG) concentration, measured under real-life conditions.Design
Retrospective cohort.Setting
Referral bariatric surgery left.Methods
Continuous glucose monitoring (CGM) and meal composition were recorded for at least 3 days on an outpatient basis in 56 patients after RYGB. The presence of postprandial peaks defined by IG above 140 mg/dl, the maximum postprandial IG, the carbohydrate content, and the glycemic load of the meals were analyzed.Results
Thirty-two patients had a hyperglycemic peak (PEAK), and 24 did not (NO PEAK). The average max IG was 159.6?±?33.0 mg/dl in PEAK individuals and 111.8?±?13.0 mg/dl in NO PEAK. Age was significantly higher in PEAK, but no other parameter was different between the two groups, including meal composition. In the PEAK patients, in multivariate analyses, carbohydrate content in model one and glucose load in model two explained respectively 50 and 26 % of maximum IG variance. For each gram of ingested carbohydrates, interstitial glucose increased by 1.68 mg/dl.Conclusions
Following a gastric bypass, under real-life conditions, irrespective of the carbohydrate content of the meal, some patients develop postprandial hyperglycemic peaks, whereas others do not. In patients with postprandial hyperglycemic peaks, the maximum IG depends on the carbohydrate content of the meal.15.
M. S. Morseth S. E. Hanvold Ø. Rø H. Risstad T. Mala J. Šaltytė Benth M. Engström T. Olbers S. Henjum 《Obesity surgery》2016,26(3):588-594
Background
This study assessed eating disorder pathology in persons with obesity before and after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (DS), in a 5-year follow-up study.Methods
Sixty participants with BMI 50–60 kg/m2 were randomly assigned to RYGB (n?=?31) or DS (n?=?29). The participants completed the Eating Disorder Examination-Questionnaire (EDE-Q) before and 6 months, 1 year, 2 years, and 5 years after surgery.Results
Before surgery, the prevalence of objective bulimic episodes was 29 % in the RYGB group and 32 % in the DS group. The prevalence improved during the first 12 months after surgery in both groups. After 5 years, the prevalence of objective bulimic episodes was 22 % in the RYGB group and 7 % in the DS group. The difference between groups throughout follow-up was non-significant (logistic regression model). A linear mixed model showed that global EDE-Q score was not a significant predictor for weight loss after surgery, but participants reporting objective bulimic episodes before surgery had significantly lower BMI than those with no episodes after 2 years (p?=?0.042) and 5 years (p?=?0.013). Global EDE-Q score was significantly lower in the DS group after 5 years (p?=?0.009) (linear mixed model).Conclusions
Objective bulimic episodes but not global EDE-Q score before surgery predicted greater weight loss after RYGB and DS. The DS group had a significantly lower global EDE-Q score than the RYGB group 5 years after surgery.16.
Background
The epidemic of obesity is engulfing developed as well as developing countries like India. We present our 7-year experience with laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and mini-gastric bypass (MGB) to determine an effective and safe bariatric and metabolic procedure.Methods
The study is an analysis of a prospectively collected bariatric database of 473 MGBs, 339 LSGs, and 295 RYGBs.Results
Mortality rate was 2.1 % in LSG, 0.3 % in RYGB, and 0 % in MGB. Leaks were highest in LSG (1.5 %), followed by RYGB (0.3 %), and zero in MGB. Bile reflux was seen in <1 % in the MGB series. Persistent vomiting was seen only in LSG. Weight regain was 14.2 % in LSG, 8.5 % in RYGB, but 0 % in MGB. Hypoalbuminemia was minimal in LSG, 2.0 % in RYGB, and 13.1 % in MGB (in earlier patients where bypass was >250 cm). The following resolution of comorbidities: dyslipidemia, type 2 diabetes (T2D), hypertension, and percent excess weight loss (%EWL) was maximum in MGB. GERD was maximum in LSG (9.8 %), followed by RYGB (1.7 %), and minimal in MGB (0.6 %).Conclusions
RYGB and MGB act on the principle of restriction and malabsorption, but MGB superseded RYGB in its technical ease, efficacy, revisibility, and reversibility. Mortality was zero in MGB. %EWL and resolution of comorbidities were highly significant in MGB. Based on this audit, we suggest that MGB is the effective and safe procedure for patients who are compliant in taking their supplements. LSG may be done in non-compliant patients and those ready to accept weight regain.17.
Elias Chahine Radwan Kassir Mazen Dirani Saadeddine Joumaa Tarek Debs Elie Chouillard 《Obesity surgery》2018,28(4):939-944
Background
Gastrogastric fistula (GGF) occurs in 1–6% of patients who undergo Roux-en-Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer.Objectives
The purposes of the study are to describe the principles of management and to review the literature of this uncommon complication.Setting
The setting of this study is University Hospital, France.Materials and Methods
We conducted a retrospective review of all patients’ records with a diagnosis of GGF after RYGB between January 2004 and November 2014.Results
During the study period, 1273 patients had RYGB for morbid obesity. Fifteen patients presented with a symptomatic GGF (1.18%). The average interval from surgery to presentation was 28 months (22–62). A history of marginal ulcer or anastomotic leak was present in nine patients (60%). The most common presentation was weight regain (80%), followed by pain (73.3%). Two types of fistulas were identified, an exclusively GGF (high) and a gastro-jejuno-gastric fistula (low). High GGF, frequently associated with dilatation of the gastric pouch, was treated by a sleeve of the pouch and sleeve resection of the remnant stomach (nine patients). Low GGF was treated with gastric resection coupled with a revision of the gastrojejunal anastomosis (six patients). All patients were treated laparoscopically with no conversion to laparotomy. The average length of postoperative hospital stay was 5.2 days (range 3–10).Conclusion
GGF after RYGB is a rare complication. Its pathophysiology remains unclear. Surgical management is the definitive treatment.18.
Salvador Navarrete José Luis Leyba Salvador Navarrete Ll Guillermo Borjas José León Tapia Ruben Alcázar 《Obesity surgery》2018,28(9):2597-2602
Introduction
Obesity has experienced worldwide increase and surgery has become the treatment that has achieved the best results. Several techniques have been described; the most popular are vertical gastrectomy (GV) and the Roux-en-Y gastric bypass (RYGB). However, mini-gastric bypass/one anastomosis gastric bypass (MGB/OAGB) has gained popularity due to its simplicity and good results.Objective
To comparatively evaluate the results of MGB/OAGB with those of RYGB with 1-year follow-up.Methods
The paper presents a comparative case and control study of 100 patients that underwent MGB/OAGB surgery and another 100 with RYGB surgery, operated between 2008 and 2016. Patients were not submitted to revision surgery and had the following pre-operative variables: age 40.46?±?12.4 vs. 39.43?±?10.33 years; sex 64 and 54 women, 36 and 46 men; BMI 44.8?±?12.06 and 45.29?±?8.82 kg/m2; 50 and 54 cases with comorbidities, respectively, these being non-significant differences.Results
The surgical time was 69.01?±?4.62 (OAGB) vs. 88.98?±?3.44 min; the time of hospitalization was 2 days, reaching a BMI of 27.7?±?7.85 and 29?±?4.52 kg/m2, with an excess weight loss 1 year after surgery of 89.4 vs. 85.9%, respectively. The morbidity rates are 9% for OAGB and 11% for the RYGB. There was a comorbidity resolution of 84.4 and 83.7% respectively, without mortality.Conclusions
The results show the benefits of both techniques, OAGB being the easiest to perform and with less surgical time.19.
Sorena Afshar Fiona Malcomson Seamus B. Kelly Keith Seymour Sean Woodcock John C. Mathers 《Obesity surgery》2018,28(4):945-954
Purpose
The impact of weight loss on obesity-related colorectal cancer (CRC) risk is not well defined. Previous studies have suggested that Roux-en-Y gastric bypass (RYGB) surgery may have an unexpected adverse impact on CRC risk. This study aimed to investigate the impact of RYGB on biomarkers of CRC risk.Materials and methods
Rectal mucosal biopsies and blood were obtained from patients undergoing RYGB (n = 22) and non-obese control participants (n = 20) at baseline and at a median of 6.5 months after surgery. Markers of systemic inflammation and glucose homeostasis were measured. Expression of pro-inflammatory genes and proto-oncogenes in the rectal mucosa was quantified using qPCR. Crypt cell proliferation state of the rectal mucosa was assessed by counting mitotic figures in whole micro-dissected crypts.Results
At 6.5 months post-surgery, participants had lost 29 kg body mass and showed improvements in markers of glucose homeostasis and in systemic inflammation. Expression of pro-inflammatory genes in the rectal mucosa did not increase and COX-1 expression fell significantly (P = 0.019). The mean number of mitoses per crypt decreased from 6.5 to 4.3 (P = 0.028) after RYGB.Conclusion
RYGB in obese adults led to lower rectal crypt cell proliferation, reduced systemic and mucosal markers of inflammation and improvements in glucose regulation. These consistent findings of reduced markers of tumourigenic potential suggest that surgically induced weight loss may lower CRC risk.20.
Renee A. Mischler Seth M. Armah Bruce A. Craig Arthur D. Rosen Ambar Banerjee Don J. Selzer Jennifer N. Choi Nana Gletsu-Miller 《Obesity surgery》2018,28(2):369-377